Objectives: To establish the prevalence of psychological problems in older adolescents.

Method: The Youth Self Report was completed by teenagers in a class group. Percentages scoring above clinical threshold were calculated. Gender differences and variances between school type were examined.

Results: Seven hundred and seventy-nine students participated in the study, 373 males and 406 females. Of the girls 23% reported problems in the clinical range on total problem score compared with 19% of boys. Significant gender differences were noted on total problem and internalising scores but not on externalising scores. The levels of psychological problems did not appear to be influenced by school type. Of the total group 6.4% reported thinking of suicide frequently (almost twice as many girls as boys) and this rose to 25% of girls who scored in the clinical range of total problem score and 15% of boys.

Conclusions: Twenty-one per cent of adolescents had problems in the clinical range. Girls reported more problems than boys. It was surprising to find that there was no gender difference in reported levels of externalising problems. The high expression of suicidal and thoughts of self-harm in those with externalising and internalising problems is of concern. This highlights the vulnerability of older adolescents as they tend to fall between the current child and adolescent services. Service provision for this population should be a priority in rural areas and on a national basis.

Objectives: Some patients with mental illness have said that religion (whether institutional or private) provides them with resources to cope with their illness. The aim of the study was to examine the spiritual well-being and religious practices, beliefs and psychological morbidity of psychiatric patients (n = 41) compared to control groups of patients with chronic medical conditions (n = 40) and community controls attending their GP (n = 39).

Method: The study was a cross sectional survey. The study group were identified in psychiatric rehabilitation and day unit settings, the medical controls from a physical rehabilitation hospital and rheumatology outpatient department and the community controls from a GPs surgery. General Health Questionnaire-28 (GHQ-28), the Spiritual Well-Being Scale (consisting of religious and existential well-being subscales) and an open-ended Religious Survey Questionnaire were personally administered to the groups and information supplemented by casenote data.

Results: Although there were no differences between the groups on the measure of overall Spiritual Weil-Being or on the subscale of Religious Well-Being, the psychiatric group scored lower on the Existential Well-Being subscale (p < 0.001) and had higher scores on the GHQ-28 (p < 0.001). The psychiatric group had increased frequency of private religious behaviour (p < 0.05) (praying and reading the Bible) which were thought to be coping strategies. Existential Well-Being of the whole sample was positively correlated to religious beliefs (feeling close to God (F = 6,337, p < 0.001); believing everything is according to God's plan (F = 2,709, p < 0.05) and having a mission in life (F = 3,563, p < 0.05)) and to religious practice (attending church) (F = 3,489, p < 0.05). Regression analysis of the whole sample showed that 49.5% of the variance in Existential Well-Being could be predicted by the severe depression subscale of the GHQ, but an additional 9.6% of the variance in Existential Well-Being could be predicted by religious beliefs.

Conclusions: The psychiatric group expressed lower life satisfaction and purpose, and were more likely to be single and unemployed. Religious belief does impact on life satisfaction and could be considered as an adjunct in the management of some psychiatric patients.

Objectives: This small exploratory study aims to investigate the characteristics of those convicted of rape or serious sexual assault against an elderly person (aged 65 years or over) who were referred to the Irish Forensic Psychiatry Service for assessment.

Method: A retrospective examination of the case histories of such individuals both at the Central Mental Hospital, Dundrum, Dublin and at Arbour Hill Prison, Dublin between 1989 and 1995.

Results: Ten such cases were found. The most frequent diagnoses were those of schizophrenia and alcohol dependence syndrome. A dual diagnosis of both schizophrenia and alcohol dependence was common. A high percentage of the schizophrenia cases had been previously charged with sexual offences and most were non-compliant with prescribed psychotropic medication at the time of the offence.

Conclusions: A very small number of people with mental illness may be at increased risk of committing a sexual offence against an elderly person. Further study of such offenders is merited.

Objectives: The manner in which psychiatrists dress and how they address their patients and in turn are addressed, may impact upon the therapeutic relationship. We undertook a survey to assess patients' preferences regarding doctors' dress and forms of address.

Method: Patients attending four psychiatric clinics were asked to complete a questionnaire asking them to rate photographs of doctors dressed in varying levels of formality, presented in random order.

Results: One hundred and forty-five patients agreed to take part. Patients had a strong preference for their consultants to wear suits but were more ambivalent about NCHDs' attire. When asked to rate the photographs in terms of competence and ease in forming a trusting relationship, suits scored the highest ratings. When asked to rate for friendliness, smart attire scored slightly higher than suits. Of the patients 50% said that they wished to be called by their first name and 50% said that they did not have a preference. Very few patients preferred to be addressed by title but 95% said that they tended to call their doctor by title. Of the respondents 70% preferred to be called patients rather than clients or service users.

Conclusions: The patients in this survey preferred their doctors to dress formally and were comfortable with an asymmetrical form of address.

Objectives: Psychological coronary-proncncss is most probably one of the first recognised risk factors for coronary heart disease (CHD). The mechanisms by which psychological risk factors might exert their influence on the cardiovascular system arc less clear than those for the more standard biological risk factors. The aim of this review was to classify all possible mechanisms of potentiation of CHD by psychological factors.

Method: A MEDLINE search was conducted by selecting literature on both standard biological risk factors (eg. dyslipidaemia, hypertension, smoking) and psychological risk factors (eg. personality traits, behavioural characteristics, coping with stress) for CHD.

Results: It was suggested that six biological mechanisms could mediate psychological influences specifically for CHD, of course, together with the seventh mechanism of general alterations in health-related behaviours. These are: increased oxygen demand of the heart muscle, decreased blood supply to the heart muscle, increased concentration of blood, enhanced blood clotting, increase in cholesterol and other plasma lipids, disturbances of blood sugar level, and alterations in health-related behaviours.

Conclusions: If more studies of CHD were conducted with both physical and psychological risk factors simultaneously, it would be possible to investigate which of the above suggested mechanisms are important, which could in turn substantially improve both primary and secondary preventive measures.

Stammering (or stuttering) may be defined as an impairment of continuous utterance. Developmental stammering, regardless of country or language, affects one per cent of adult populations. Exacerbation by the stress of adult conversation or public speaking contrasts sharply with normal flow during singing, acting or conversation with children. Alterations in regional cerebral blood flow suggest that there are underlying differences in sensorimotor function in developmental stammerers whose symptoms commonly appear during the period of intensive language acquisition around the third and fourth year. Emotional tensions may exacerbate the disturbance, but equally psychological growth is adversely affected by the handicap. Abnormal motor control is confirmed by the exaggerated activity in the right hemisphere. The normal sequence of articulatory programming and motor preparation for single word reading is reversed. Absence of activation over the left auditory cortex supports the notion of impaired or diminished auditory feedback in the self-monitoring of speech seen in normal brains. Subcortical abnormalities are a feature of both developmental and acquired stammering.