Objectives: The changing family and social patterns in modern society are likely to influence the availability of informal support for older people. The aims of this study were to determine the support network distribution of a community dwelling elderly population in Dublin, and of those with mental disorders (dementia, depression and anxiety).

Methods: Interviews with 1,001 community dwelling older people using GMS-AGECAT. In addition, a support network assessment instrument was administered, which identifies five different support network types. The local integrated and wider community focused networks are characterised by extensive community involvement, family dependent networks by close family support, and the local self contained and private restricted networks by low levels of family and community involvement.

Results: Of the elderly population, 83% had support networks characterised by close community and/or family involvement. Subjects with cognitive impairment had lower levels of informal support from the community, as indicated by a lower proportion of local integrated (44% v 63%) and a higher proportion of private restricted (6% v 12%) networks. Late life depression was also associated with decreased levels of community integration.

Conclusions: The elderly in Dublin appear to have high levels of informal support. The extensive support may be a factor in the lower rates of depression found in Dublin than in London and New York. While the overall level of informal support available to older people with mental disorders in the community remains high, a proportion have low levels of family and community involvement and consequently their mental health problems may go unrecognised.

Objectives: Despite their potential importance in affecting interactions between doctors and patients, there have been few attempts to measure attitudes to doctors and medicine. One scale, developed by Marteau, had shown a promising factor structure in a UK antenatal setting. The present study assessed its characteristics in Dublin general practice attenders.

Method: Patients aged over 16 waiting for a self-initiated consultation were recruited. The Attitudes to Doctors and Medicine Scale was administered by interview. Item analysis and factor analysis were used to examine its psychometric properties.

Results: Of 200 respondents, with a median age of 31, 144 were women. Item analysis showed lower reliabilities for the subscales of Marteau's scale than the original UK study, especially the subscales measuring negative attitudes to doctors and to medicine. Factor analysis failed to confirm a clear-cut distinction between attitudes to doctors and attitudes to medicine, and between positive and negative attitudes. Furthermore, factors which loaded in opposite directions in the original UK study loaded in the same direction in the Irish sample.

Conclusions: The differences found may reflect the differences either in culture or setting between the two studies. They strongly suggest that the Attitudes to Doctors and Medicine Scale does not have desirable psychometric properties. They also underline the need for a reliable and valid measure of attitudes to doctors and medicine, and for a more serious research interest in the area.

Objectives: To investigate the nature and pattern of teenage admissions (13-18yrs) to the 14 adult psychiatric units in Northern Ireland (NI) between 1989 and 1995.

Method: An analysis of routine hospital data, a review of case-notes at one hospital and in-depth interviews with young people previously admitted to adult inpatient care.

Results: Sixteen per cent of all under 25s admitted during the six-year period (443/2823) were under 18. There was an increasing trend over time in admissions and re-admissions to hospital. More than half of the teenagers were female and the most common diagnoses included emotional/conduct disorders, ‘stress’ and neurotic illnesses. Self-harm, substance abuse and exposure to violent/abusive environments or behaviour were the most commonly recorded factors preceding admission. All but one of the small number of people interviewed had attempted suicide prior to admission to hospital.

Conclusions: The increase in the use of adult inpatient care by young teenagers is of considerable concern but may be unavoidable in the absence of suitable alternatives especially for adolescents at risk of self-harm or suicide. Further research is required to determine the most appropriat e and effective service response for this vulnerable group . The findings have important implications for the future development of adolescent mental health services.

Objectives: This study was designed to explore the social correlates of the country suicide rate in Ireland.

Method: Suicide rates for Irish counties were calculated for the period 1978-1984, a seven year period centred around the 1981 Census.

Results: The county suicide rates were positively associated with death rates and the percentage of elderly population and negatively with change in population, the birth rate and the percentage of the population under the age of 15.

Conclusions: There is good evidence to suggest that the official suicide rate in Ireland has been underestimated in the past. This underestimation may not have been uniform across all of the counties.

Major advances have been made in ADHD over the years, both in terms of diagnostic validity, different subtypes, comorbidities and treatment options. A comprehensive assessment needs to include medical, developmental and educational history using multiple sources of information and across different settings. In certain cases, additional investigations and neuropsychological testing may need to complement basic physical and neurological examination. The focus of treatment must include not only the core ADHD symptoms but also additional comorbid problems, family and peer relationships, and academic achievement. Treatment should therefore be multi-modal with simultaneous medication, behavioural and educational management. Both diagnosis and treatment response needs to be reviewed regularly to ensure optimal response with minimal adverse side effects.

The increased awareness of ADHD by both clinicians and other professionals has resulted in a huge increase of referrals for assessment, diagnosis and treatment. In particular, families are becoming increasingly knowledgeable about the disorder and are rightly requesting adequate assessment and treatment of their children. It is therefore essential that all clinicians are equally knowledgeable about the advances in this area and offer a service to families which represents good clinical practice. This article reviews what constitutes good clinical practice in ADHD.

Doctor Maurice O'Connor Drury worked for most of his life in Saint Patrick's Hospital, Dublin. While going about his routine clinical work at that hospital, Doctor Drury quietly maintained a close, lifelong friendship with the man regarded as perhaps the greatest philosopher of the 20th century, Ludwig Wittgenstein.

Few realised that before studying medicine at Trinity College, Dublin, ‘Con’ Drury had read philosophy at Cambridge, where he came into close contact with some of the great minds of philosophy this century; Bertrand Russell, George Moore and Gilbert Ryle.

Con Drury is importan t not just because of his own philosophical work but because, through his enduring friendship with the deeply troubled philosopher, he challenged the portraye d image of Wittgenstein as a ‘cantankerous, arrogant and tormented genius’.

A patient presenting with co-existent Capgras and deClerambault's syndromes, with a history of morbid jealousy is described. This combination of syndromes has not previously been described. The relevant literature to this case is reviewed, in relation to the onset of these syndromes, aetiology and treatment. Abnormalities in pathways involving recognition of familiar faces have been implicated in a number of similar cases.

A case of suicidal behaviour precipitated by sleep paralysis is described. The condition and related phenomena are briefly considered.