Objectives: To assess social and educational status, trauma experienced, diagnosis and treatment of asylum seekers, who presented to psychiatrists in St James's hospital Dublin over a two-year period.

Method: All files of asylum seekers assessed by psychiatrists in St James's hospital over a two-year period were scrutinised. Using a pro-forma, data was obtained about social and educational status, language skills, trauma suffered, diagnosis, treatment and follow-up. Demographic data was obtained from the Department of Justice, the Irish refugee centre and various social welfare offices.

Results: Over a two-year period 31 asylum seekers were in contact with this service. Most originated from Africa. Overall subjects were well educated but socially isolated with poor language skills. Many had been imprisoned or tortured, or had relatives or friends tortured or killed prior to migration. Almost one third met criteria for PTSD and greater than a third met criteria for major depression. The majority of subjects received pharmacological treatment, but few were offered psychological treatments. Most had no prior psychiatric diagnosis and dropped out of treatment at an early stage.

Conclusions: Large numbers of asylum seekers are currently residing in Dublin and may need specialised psychological support and treatment. They have been exposed to significant levels of pre-migratory trauma, often have poor language skills and drop out of treatment quickly which may indicate dissatisfaction with existing treatment approaches. There is an urgent need for increased funding for the psychological needs of this vulnerable group, for the provision of trained interpreters, specialised psychotherapy and assessment of their needs.

Infanticide and child murders have been known to all civilisations throughout time. This study looks at the problem from an Irish perspective, particularly with regard to the forensic psychiatry service. The case notes and legal files of 64 women admitted to the Central Mental Hospital (CMH), Dublin, between May 1850 and 2000 were examined. This group represents a complete sample of female inpatients charged with these offenses over the 150 year history of the institution. Sociodemographic and clinical data were analysed to provide psychiatric and social backgrounds to the cases. There has been a considerable decrease in the number of women admitted to the CMH on charges or conviction for infanticide and child murder in recent years. It appears that the attitude of the judiciary to these women has altered. The cases are discussed in the context of the prevailing attitudes of the era.

Objectives: To identify excessive drinking in a Hampshire general practice and evaluate the usefulness of the screening tools employed. Although excessive alcohol consumption is common, only one in 10 heavy drinkers is known to their general practitioner. Early identification of such patients increases the likelihood that successful intervention will decrease their alcohol intake. Screening helps recognise excessive drinkers.

Method: Three hundred and one patients consulting their general practitioner for any reason were interviewed using a questionnaire comprising a drinking history, CAGE, and brief MAST (Michigan Alcohol Screening Test). The medical records of patients identified as drinking excessively were reviewed.

Results: Forty-eight (15.9%) patients were identified as drinking to excess. Only nine of them were known to the general practitioner. The most useful tests were the drinking history and CAGE, detecting 21 and 20 of the excessive drinkers respectively. No single test used in isolation performed adequately, but the combination of a drinking history, including enquiry about binge drinking, and the CAGE was the most productive.

Conclusion: Screening for excessive drinking by taking a simple drinking history and using the CAGE is cheap and easy to administer. Only about one in five of the patients identified in this study had information concerning excessive alcohol intake in their GP records.

Objective: Significant controversy continues to exist in the empirical literature regarding the diagnosis and treatment of mitral valve prolapse (MVP). In addition, there is also inconsistency in the correlation of anxiety disorders as co-existing with MVP, as well as cause and effect issues in terms of the role of the autonomic nervous system, MVP and panic attacks. Recent studies suggest that the co-morbidity of an anxiety disorder and clinical depression appears to increase the likelihood of MVP in predisposed patients. The objective of this review was to examine, clarify, and further define the medical and psychiatric aspects of MVP.

Methods: A literature review was conducted on empirical studies and reviews examining MVP.

Results: It was found that although MVP is highly correlated with psychiatric disorders, the lack of adequate control groups and clear criteria for a diagnosis of MVP in most empirical studies examining these associations make it difficult to determine the relationship between MVP and psychiatric disorders.

Conclusions: Suggestions for further research in the areas of depression and personality characteristics are offered. It is also suggested that the use of control groups from populations with cardiac disorders and a better definition of MVP will clarify many of the problems in empirical studies aiming to determine the relationship between MVP and psychiatric disorders.

This overview of mental illness services in Ireland, North and South, over recent decades, is a descriptive account. It refers to policies, development and operation of the services, with certain figures relating to hospital admissions, human resources and costs in Northern Ireland and the Republic of Ireland. The paper points to the need for more detailed comparisons, which would require more rigorous, systematic health services research.

It is perhaps surprising that mental illness has such a limited role in the various works of James Joyce. When one considers the volume of material in his books relating to Dublin, topographical and biographical, there appears to be a studious avoidance of psychiatric institutions. The then huge Grangegorman complex (now St Brendan's Hospital) must have had an ominous presence in the city: the size of its population (between 1,500 and 2,000 patients) indicating that few families of whatever class could have escaped contact with it. Indeed, as an institution it probably had economic power comparable to Guinness's brewery or the British Army, which had five barracks in the city, each about the same size as Grange-gorman.

We describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.

We describe a lady with a history of recurrent psychotic depression, together with a persistent delusion of immortality, which appears to be independent of the depressive illness. It is of interest that this woman is a patient of the hospital founded by Dean Jonathan Swift, who described a people stricken with a similar dilemma of unhappy immortality over 200 years ago.