Objective: Physiological and psychological distortions associated with eating are recognised within the syndrome of anorexia nervosa. The purpose of this study was to compare subgroups of restricting and bulimic anorexic patients (AN-R and AN-B) with control subjects, and with themselves after six weeks of refeeding and weight gain, on a series of indices before and after a standard meal. Method: Nineteen consecutively admitted female AN patients completed visual analogue ratings of hunger, satiety, depression, urge to binge, urge to vomit and food craving during the first week and sixth week of hospitalisation. A female control group of seven subjects completed similar ratings for one week. The patient ratings were compared to those of the control subjects at baseline before and after a meal. Further comparisons between the two patient groups were also carried out six weeks after treatment. Results: As expected, AN patients reported significantly higher ratings of depression, urges to vomit, urges to binge and higher satiety levels when compared to controls. Comparisons between the patient subgroups revealed that at baseline AN-B patients had significantly higher urges to vomit that AN-R patients after meals, and reported significantly less satiety both before and after eating. Also, an increase in depression after the meal, at baseline, was reported by both groups although after six weeks higher levels of depression were recorded before rather than after the meal. There was also a significant decrease in food cravings after six weeks compared to baseline for both patient groups.

Conclusions: The findings in this study provide further evidence that clinically significant differences exist between subtypes of patients suffering from anorexia nervosa, and highlight the differential, change in various symptoms during intense hospital treatment.

Objective: To evaluate the clinical usefulness of carbohydrate deficient transferrin (CDT) as an indicator of alcohol dependence (DSM 111R). Method: Subjects included 18 patients with alcohol dependence and 36 controls (15 recovering alcohol dependents and 21 blood donors). Blood samples from the subjects were analysed for CDT, mean corpuscular volume (MCV) and γ Glutamyltransferase (γGT). These indicators were compared for their sensitivities and specificities to detect excessive alcohol use. Results: Amongst patients with alcohol dependence, CDT was detected in all (100%), γGT was raised in 8 (44%) and MCV was raised in 4 (22%). CDT was detected in five of the 36 controls. Conclusion: CDT was the most sensitive indicator of alcohol dependence. However, CDT showed a much higher false positive rate compared to previous studies. More research is required to elicit at what level of alcohol consumption CDT becomes positive. CDT could prove to be a clinically useful indicator of excessive alcohol use in future.

Objective: Northern Ireland has suffered from civil unrest since 1969. During this time both the nature of violence and the nature of psychiatric services have changed. Considerable variation in incidence figures for psychological consequence of civil unrest exists in the international literature (1). The purpose of our study was to ascertain the workload for a new community mental health team which had accrued solely as a result of civil unrest and the possible implication for the local service. Method: The new patient referrals to a Community Mental Health Team November 1990-91 which were solely and directly consequent on civil disorder were identified. The litigant population was excluded from study. We checked how many still remained in treatment in November 1992 and used Fisher's Exact Test to identify factors associated with still being in treatment at two years. Results: We found that 8.2% of the new referrals satisfied the criteria and 30% remained in treatment at two years. Satisfying criteria for post traumatic stress disorder was not significantly associated with still being in treatment. Remaining in treatment at two years was associated with having received or not received stress management advice in those satisfying post traumatic stress disorder criteria. Conclusion: Civil unrest substantially increased the Community Mental Health Team workload in the first year of existence.

Objective: The study was undertaken to determine the current demographic and clinical features of cases of deliberate self-poisoning (DSP) presenting to an acute general hospital and to compare the findings with previous work in Ireland and elsewhere. Method: Four hundred and sixty seven consecutive admissions for DSP presenting to a Dublin hospital between 1986 and 1990 inclusive were identified retrospectively and the case notes reviewed. Data was collected on age, sex, marital status, past history, date of DSP, drugs used, motivating factors and outcome. Results: The peak age of DSP was 15-24 years. The female:male ratio was 1.5:1. There was an increased incidence of DSP in women in July and August. In 32% there was a previous history of DSP. Benzodiazepines, antidepressants and analgesics/anti-inflammatories were the commonest drugs taken. There was a significant medical complication in 10.5% of cases, but no fatalities. Twenty-five percent of patients were subsequently admitted to psychiatric inpatient care. Conclusions: DSP is an ongoing problem. The summer peak in females may be related to the parenting burden during the summer recess. The high rate of repetition suggests a significant reduction could be achieved with successful strategies for secondary prevention. The high rate of psychiatric in-patient referral may be related to a low threshold for admissions to Irish psychiatric hospitals.

Objective: To estimate the prevalence of alcohol dependence syndrome in a rural General Hospital. Method: The entire inpatient population of 107 patients was administered the CAGE questionnaire to detect alcohol dependency. Patients scoring two or more (maximum score 4) were diagnosed alcohol dependent. Results: Sixteen patients were unable to complete the questionnaire due to severity of illness or dementia. Of the 91 patients who completed the CAGE questionnaire, 20 scored one or more, and 12 scored two or more, giving a prevalence of probable alcohol dependency in this population of 13%. There were significantly more male alcohol dependent patients than female, 30% vs 2% (p<0.001). Fifty percent of the patients who scored on the CAGE as alcohol dependent were not recognised by medical staff as being problem drinkers. All of the alcohol dependent patients came from the medical and surgical units including Ear, Nose and Throat surgical unit (ENT). Conclusion: Administration of the CAGE questionnaire to all medical and surgical admissions seems to be one of the most economical way of detecting alcohol dependency and engaging patients in treatment as early as possible.

Objective: To investigate the relationship between disappointment in a community and deliberate self poisoning. Method: The Accident and Emergency department records of Nottingham's University Hospital were scrutinised for cases of deliberate self poisoning presenting during the weekend of Nottingham Forest's F.A. Cup Final defeat in 1991 and the weekend of their subsequent failure at the quarter-final stage in 1992. Rates of deliberate self poisoning during these periods of intense expectation and disappointment in Nottingham were compared to the weekends either side of these important football matches. Results: Nottingham Forest's defeat in the F.A. Cup Final in 1991 and in the quarterfinals a year later was associated with a short-term excess of cases of deliberate self poisoning in Nottingham. This was statistically significant following the cup final (p<0.01) but not so after only reaching the last eight (p=0.057). Conclusion: The repeatability of these findings supports the hypothesis that a sudden disappointment experienced through an entire community may prove one stress too many for some vulnerable members of that community.

We report the case of a 48 year old woman who presents with a 25 year history of somatisation disorder. She has ten volumes of notes from four hospitals in one city which together weigh almost 10kg. She has been under the care of ten hospital specialities, had eleven operations, with 77 admissions and a total of 856 days in hospital over a period of twenty-five years. No physical diagnoses can satisfactorily explain her presentations which have been accurately costed to a total of over £250,000 as a conservative estimate.

Somatisation disorder is a chronic illness with financial, medical and personal costs. We report in detail recurrent dangers and pitfalls which arose during her hospital contact. By undertaking a case note review, contacting all the physicians involved and writing a “Key” summary letter outlining the contribution of psychological factors to her problems, her annual health care costs were reduced from a total of over £10,000 a year to a little over £2,000 after psychiatric intervention and the appointment of one physician to take overall charge of her case. Implications for service provision are discussed.

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.

14 patients are described sharing a remarkably similar presentation with chronic perineal and lower abdominal dysaethesias. The abnormal sensations of movements are described. Investigations revealed evidence of central nervous system damage, in particular multi-infarct disease.

Objective: To examine the evidence concerning the psychological consequences of abortion, the risk of suicide in pregnancy and the psychological consequences for the mother and the child in cases of refused abortion. Method: An extensive literature search was undertaken and key relevant papers were examined and analysed. Results: Legal abortion has become more widely available throughout the western world and the actual reported incidence of cases of refused abortion is low. The majority of studies indicate that the psychological consequences of abortion itself are in the main mild and transient but there is evidence that women who have strong religious or cultural attitudes negative to abortion do experience high levels of psychological stress following abortion. The risk of suicide is low in pregnancy and suicide is a rare outcome of refused abortion. There is evidence of psychological and social difficulties experienced by mothers of unwanted pregnancies forced to proceed to term and by many offspring of such unwanted pregnancies. Conclusions: Definitive conclusions are difficult to draw from the published studies of refused abortion and many studies are over thirty years old.

Reports from the United States have linked fluoxetine with suicidality. As a result, litigation is pending, and the matter has recieved much media attention. There is no acceptable evidence to support the hypothesis that fluoxetine promotes suicide.