Objectives: To describe the psychosocial and clinical characteristics of children referred to a community-based child and adolescent mental health service, whose mothers reported that they took opiates during the pregnancy.

Methods: In a retrospective study, the case notes of all children whose mothers reported that they had been exposed to opiates in utero, and who were referred to the Department of Child and Family Psychiatry, Mater Hospital, between 2001–2003, were identified by maternal reports. Information was obtained on age, gender, referral source, socio-economic group, family type, number of siblings, involvement of community care services, nature of presenting problems, diagnosis, interventions offered, and treatment difficulties. Information was recorded anonymously.

Results: 15 children were identified, of whom nine were male. Most were found to be living with their mother alone or with their mother and a partner, and to be socially and financially disadvantaged. Their presenting complaints usually involved combinations of aggressive, hyperactive, and oppositional behaviour. Diagnoses included ADHD, a speech and language disorder, and an axis II disorder. Interventions were frequently unsuccessful because of parents' difficulties with attending appointments, and because of instability in the families' living arrangements.

Conclusions: These children, due to a complex interplay of biological and psychosocial adversity, are at serious risk of ongoing psychiatric disorders in childhood and adolescence, and for adverse outcomes in adult life. A prospective cohort study of all children born to opiatedependent mothers is necessary to quantify the level of risk and identify resilience factors.

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.

Objectives: To estimate the psychiatric service requirements for the remand population.

Method: We interviewed 232 (42.6%) men, a representative sample of men on remand, using the SADS-L, SODQ and a structured demographic interview.

Results: We found high rates of psychiatric morbidity in our sample. The six month prevalence of psychosis was 7.6%, almost twice the rate in a recent international meta-analysis. Major depressive disorder was present in 10.1% (six month prevalence). Substance misuse problems were also common but there was no significant difference between rates of substance misuse in psychotic and nonpsychotic prisoners. A total of 31.2% had a lifetime history of any mental illness (excluding substance misuse, adjustment disorder and personality disorder).

Conclusions: The high levels of psychiatric morbidity detected in our sample indicate a substantial unmet need for mental health services and addiction treatment services for the mentally ill in Irish prisons.

Objectives: This study was carried out to determine the prescribing of psychotropic medication of non-consultant hospital doctors in the management of delirium and to compare this with best practice guidelines.

Method: A structured questionnaire was forwarded to all non-consultant hospital doctors (n = 95) working at St Vincent's University Hospital and data was collected over a six month period. The questionnaire addressed type, dose and route of psychotropic medication use in delirium as well as adjunctive measures used to manage delirium.

Results: There was a 55% response rate (n = 52). Haloperidol and lorazepam were the two most frequently prescribed psychotropic agents used and over one third of respondents (n = 20) reported the use of risperidone. There was wide variation in doses used and a substantial proportion of NCHDs used higher than recommended starting doses for elderly patients with delirium. In addition, the intramuscular route was reported as the commonest route of administration with a majority of respondents reporting infrequent intravenous route of administration.

Conclusions: The drug choice reported by respondents followed best practice guidelines. However, the wide variation in drug doses used and frequency of parenteral route of administration (particularly intramuscular) indicate the need for increasing awareness of best practice international guidelines. Guidance and clarification regarding the use of atypical antipsychotic medication is required following concerns about their use in dementia.

Autistic spectrum disorders (ASD), are a group of disorders characterised by qualitative abnormalities in social and emotional behaviour and are associated with restricted, stereotyped and repetitive interests and activities. There has been considerable understanding of ASD in recent years. This educational review paper focuses on four areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists (MRCPsych): (a) diagnosing ASD; (b) epidemiology of ASD; (c) aetiology, including genetic, cognitive and neurochemical/neuropathological theories in ASD; and (d) treatment of ASD. Relevant papers are discussed and recommendations for further reading are provided.

Body dysmorphic disorder (BDD, previously called dysmorphophobia) is an excessive preoccupation with trivial or non-existent physical abnormalities, perceived to be deformities. BDD causes significant distress or functional impairment and is both time-consuming and difficult to control. Feelings of low self-esteem, shame, embarrassment and unworthiness are common, as is fear of rejection. This report presents a case of BDD in a young male who sought surgery abroad in an effort to ameliorate his perceived deformity. His suicidal ideation, low mood and anxiety symptoms responded well to venlafaxine, olanzapine and cognitive behavioural therapy; however his overvalued ideas with regard to his physical appearance were slow to improve.

Clozapine is associated with a risk of myocarditis and cardiomyopathy. The exact mechanisms still remains unclear although there have been a range of proposals ranging from hypersensitivity reactions, toxic effects of the drug to vitamin deficiency. We present three cases where there were minor deviations of heart function or structure prior to the onset of clozapine treatment. One case developed a mild rise in troponin-1 levels within one month of clozapine treatment. We also review the current literature on the link between clozapine, myocarditis and cardiomyopathy and suggest clinical guidelines for monitoring patients for cardiac symptoms prior to commencing and while on clozapine treatment.

London born James Henry Pullen (1836–1915) was admitted to Essex Hall in Colchester, an institution catering for learning disability, at the age of 13. Here his artistic talent was spotted before he moved two years later to Earlswood Asylum for Idiots, where he was apprenticed to woodworking. Such was his manual skill he was eventually employed making furniture for the asylum. His artistic propensity was similarly encouraged and although he never mastered coherent speech he has left a pictorial autobiography of some distinction. At observation he underwent detailed examination by Frederich Sano (1871–1946), particular attention being paid to tokens of arrested development. The clinical and pathological evidence of a pervasive developmental disorder points to a retrospective diagnosis of autism.