Objective: To assess the extent of cognitive impairment in a group of female alcoholics and to examine if any relationship was present between the degree of cognitive impairment, and the duration of alcohol dependence, impairment of liver function or associated prescribed medication abuse. Method: The subjects were thirty consecutive women in a residential alcoholism treatment programme who were assessed two weeks after detoxification. The visual reproduction subtest of the Wechsler Memory Scale was used, together with four subtests of the Wechsler Adult Intelligence Scale: vocabulary, similarities, block design and object assembly. We examined the effect on these scales of prolonged alcohol abuse (>5 years), abnormal liver function tests and prescribed medication abuse. Results: The group showed a significant impairment on the subtests, similarities, block design and object assembly when compared with the general population mean for the WAIS-R. Analysis of sub-groups showed little statistically significantly greater impairment on cognitive testing then the remainder of the group. Conclusions: The pattern of cognitive dysfunction for the group indicated subjects had deficits in abstraction, visual spatial and visual motor reasoning similar to previous studies involving male alcoholics. The usefulness of the sub-group comparisons was limited by the small numbers involved and larger studies would help clarify the role of contributory factors in the development of cognitive dysfunction in alcoholic subjects.

Objective: The aim of this study was to examine the provision of psychiatric care to inpatients in two Irish general hospitals without psychiatric units and to comment on (a) how this service model compares with previous Irish studies, (b) whether it meets the goals of liaison psychiatry, and (c) the implications for future service planning. Method: Demographic and clinical details relating to all the psychiatric consultations to inpatients (i.e. there was no emergency service to the casualty department) in two general hospitals were collected over a six month period. Results: Although the service was provided on a nonemergency basis the referral rate [1.6% of total admissions], patient characteristics, reasons for referral, diagnoses, and suggested management strategies were very similar to previous Irish studies. Assessment of deliberate self-harm cases was the most common reason for referral [37.9% of 145 referrals]. Notably, there was a high level of diagnostic accuracy from non-psychiatric colleagues in this liaison model. Conclusions: This study, of a service model characterised by an emphasis on liaison, points to efforts on the part of the psychiatrist to improve communication with medical and surgical colleagues as being of primary importance in the development of general hospital psychiatry services.

Different authors have used markedly different definitions of bingeing. Probably the most widely used of the current definitions is the DSM III R definition which states that a large amount of food must be consumed over a short period of time. Three case histories and a case vignette are used to illustrate the different clinical syndromes which may include bingeing, when bingeing is defined in this way. The authors argue that cognitive constructs are a more precise way of defining bingeing within the context of eating disorders.

We present a case of possible olanzapine-induced rhabdomyolysis in the absence of other features of neuroleptic malignant syndrome (NMS). There is evidence to suggest that there are different underlying pathophysiological mechanisms for rhabdomyolysis occurring alone, in contrast to when it presents as part of NMS. This has possible implications for drug rechallenge which is discussed.

Objective: Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women. Method: Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements. Results: Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted. Conclusions: Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.

Objective: The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge.

Method: Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated.

Results: Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study.

Conclusion: Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.

We present a descriptive study discussing the reasons why patients remained as in-patients within the psychiatric unit over the Christmas period. In over 50% of cases continuation of in-patient stay was necessitated by the severity of mental illness. However, a significant minority of patients were unable to leave because of either poor family support or reduced input from the community mental health services. There was some evidence of Christmas good will influencing admission policy with a significantly greater number of patients admitted with alcohol problems over the week before Christmas all of whom were lonely and expressed a preference to be in hospital.

A more long term problem was also evident as an important minority of patients' hospital stay was unnecessarily prolonged because of unavailability of suitable community placements.

A 35-year-old South Asian Muslim male was admitted for acute psychotic episode to an urban acute psychiatric unit. In the context of ongoing religious delusions, and on his request to fast during the Islamic month of Ramadan we made alterations to his medication dosing schedule. We discuss the clinical implications of such practice.

Levels of immunoglobulins were measured in 32 schizophrenic patients with tardive dyskinesia and 34 schizophrenic patients without tardive dyskinesia. The duration of neuroleptic treatment in years was similar in the two groups. The serum immunoglobulin concentrations (mg%) were found to be significantly different in the two groups; IGA and IGM levels were higher in patients with tardive dyskinesia. The present results may be explained on the basis of dysfunction of the immunological system in tardive dyskinesia.

Koro is characterised as a perception that one's genital organs are shrinking and will eventually recede into the abdomen. It was initially described in South East Asia as a culture bound syndrome but this syndrome has recently been recognised in a non-culture bound context A case is described of a depressed Eastern European asylum seeker with koro like symptoms. All symptoms resolved completely with fluoxetine treatment The relevant literature to the case is reviewed, in relation to onset, symptoms and treatment of this rare syndrome. In addition comparison is made with previous reports of the non-culture bound variant.

The treatment of psychosis in patients with Parkinson's disease (PD) is one of the most difficult problems in clinical psychiatry. Clozapine's low propensity to induce extrapyramidal side effects makes it an attractive treatment for psychotic patients with PD. A number of published uncontrolled studies suggest that low-dose clozapine is effective in these patients. However, the dose range, side effect profiles and length of treatment have varied in these reports. In this article, the authors review the literature and report on the effects of clozapine in a patient with Parkinson's disease and psychosis. Clozapine (50mg per day) resulted in a complete resolution of psychosis, improvement of motor function, reduction of “off” time and a major improvement in levodopa-induced dystonic dyskinesias. The only adverse effect was mild sedation during the first two weeks of clozapine treatment. The lack of acute blockade of striatal D2 receptors by clozapine and the failure of chronic clozapine treatment to suppress striatal dopamine release may account for its beneficial effect in Parkinson's disease. Additionally, an ameliorating effect of clozapine on parkinsonism might be due to its action on serotonergic systems leading to release of striatal dopamine.

The publication of the new guidelines is a welcome step, bringing more lucidity to the subject and providing useful guidance to clinicians. However, the guidelines pose new and unique responsibilities on mental health services with resulting training needs, resource issues and ethical issues. We propose a collaborative model based on the development of regional specialised teams to perform this task. This may prove to be a more suitable and cost effective option in the long run.

This is a personal account of the transition from the child to the adult mental health services. The title references Janus, the Roman god of transitions. As such, the narrative looks to the past and the future in youth mental health. The discussion begins with a brief examination of the phenomenon of personal accounts in the broader context of evidence-based knowledge. There are a number of themes discussed throughout this perspective including access to education and loss of vocational capacity as a result of illness and service involvement. The discussion emphasises the importance of ‘Time’ in the delivery of services and provides justification for improved access to vocational and/or therapeutic options for young people with mental health difficulties. Time is also used as a structural device in order to communicate lived experience of mental illness, treatment and recovery.