Objectives: Drivers with certain mental illnesses are obliged by the Driver & Vehicle Licensing Authority (DVLA) to stop driving and to report their condition. This study aims to quantify the number of psychiatric patients failing to meet the DVLA standards of ‘fitness to drive’ and to record how frequently psychiatrists failed to advise patients of these standards.

Method: In this prospective descriptive study, 10 psychiatrists reported by questionnaire the diagnosis and driving status of all patients encountered over a four week period. They recorded their advice given to patients failing to meet the DVLA criteria of ‘fitness to drive’ and advice given when prescribing psychotropic medication.

Results: Of 297 patients, 123 (41%) were drivers. 19/123 (13%) of drivers failed to meet the DVLA standards of ‘fitness to drive’. In 9/19 of these cases the psychiatrist did not advise the patient in line with the DVLA guidelines. This was especially the case for alcohol related disorders. Of drivers 49% were prescribed psychotropic medication with potential adverse effects on driving.

Conclusions: Driving amongst mentally ill patients appears commonplace. In this study, 13% of drivers were considered by the authorities to be unfit to drive. Psychiatrists frequently used their own judgement when advising patients regarding driving. This arguably contravenes doctors' responsibilities to patients and has potential legal implications for both the patient and psychiatrist.

Objectives: 1) To ascertain the stability of a diagnosis of compulsive water drinking (CWD) among psychiatric rehabilitation inpatients after a period of four years. 2) To ascertain the discharge status of CWD inpatients in comparison with matched control inpatients after a period of four years.

Method: A follow-up study was performed. Urine specific gravity testing was used to determine CWD status among psychiatric rehabilitation inpatients. Originally, 21 CWD subjects were identified, and 21 age and sex matched control subjects were selected from the non-CWD rehabilitation inpatients. Four years later those CWD and control subjects successfully traced (18 and 15 respectively) were retested for CWD. In addition each subject's living situation (inpatient or community resident) was recorded. Chi-square, Odds Ratio, and Fisher's Exact Test were used as tests of statistical significance.

Results: While the original CWD status was associated with the follow-up CWD status using Chi-square (p < 0.05), there was no statistical association using Odds Ratio (95% CI was 0.95 to 71.6). Half of the 18 original CWD subjects retested negative for CWD. Two of the 15 control subjects retested positive for CWD. Original CWD status was not associated with subsequent living situation, however all seven community dwelling subjects (four original CWD, three original controls) that were successfully traced were negative for CWD.

Conclusions: CWD status may not be as stable as implied in the literature.

Objectives: This study investigates the problem of assaults on psychiatrists by their patients.

Method: A postal questionnaire was circulated to 178 psychiatrists and trainees working in the Dublin area enquiring about assaults experienced in the previous three years.

Results: Of those 147 (82%) who responded 57 (39%) had been assaulted. There were few discriminating factors between those assaulted and those not but those in child psychiatry were less likely and those in general adult psychiatry were more likely to have been the victim of an assault. Only 10% of respondents had received any formal training in violence management. Assailants tended to be male (63%) and known to the doctor involved (71%). Personality disorder (37%), schizophrenia (29%) and substance abuse (26%) were common assailant diagnoses. Management responses to the assaults were generally internal with administrative staff involvement in only four cases.

Conclusions: Factors which potentially protect or expose clinicians to a greater risk of assault are not well defined and need to be further explored. Simple clinician or patient variables are not especially predictive of violence risk. Clinicians need to acquaint themselves better with the basic practices of violence prevention and management. External measures (such as involving administration) could be used more frequently to combat this common problem.

Objectives: The object of this paper is to evaluate the evidence suggesting an association between the use of the anti-acne agent isotretinoin and the subsequent development of depression.

Method: Three case histories of individuals who had received treatment with isotretinoin and subsequently developed depression are reviewed.

Results: All three individuals were noted to have a depressive illness which was notable by the prominence of symptoms of irritability, agitation and aggression.

Conclusions: The indications from the three cases described suggest that there appears to be an association between depression and the recent use of isotretinoin. This may relate to the ability of isotretinoin to simulate hypovitaminosis A, with aggression, irritability and depression as a direct result of this effect. Young males may be particularly prone to developing this response.

Sixteen general practices completed an audit of the care of their patients with schizophrenia. This resulted in improved levels of recording of six different aspects of patient care; family care, Mental State Examination, quality of life, preventive physical care, co-ordinated care and details of medication.

The false memory syndrome has been the subject of recent intense debate. Can false memories of child sexual abuse be engendered in the minds of susceptible individuals by well meaning therapists? This paper examines the evidence for false memories. Memory in childhood and adults is discussed, and the different processes involved in traumatic memory are emphasised. Evidence for amnesia following sexual abuse with subsequent recall is presented.

It is important to weigh carefullythe evidence both for and against the false memory syndrome. Good evidence for false memories exists, but conversely amnesia and subsequent recall of sexual abuse undoubtedly occur. The principle of primum non nocere is particularly important in guiding therapeutic endeavours.

Coprophagia is a disturbing behaviour sometimes associated with mental disorder in humans which is poorly described and understood. We describe a case of hypothyroidism and depressive psychosis, associated with coprophagia which resolved with treatment. Further examination of this phenomenon and its relationship with underlying endocrine and psychotic disorder is required.

This case report is of a young male with learning disability, who presented with long-term polydipsia and hyperphagia. The patient's polydipsia and hyperphagia showed a correlation with long-term use of neuroleptics for behavioural problems. Withdrawal of all neuroleptic medication resulted in an immediate improvement in both the polydipsia and hyperphagia leading to a complete resolution of both symptoms. While neuroleptics are a recognised cause of polydipsia, hyperphagia is less frequently described and we believe this to be the first report in which a patient is observed to have polydipsia and hyperphagia induced by neuroleptics. We discuss the possible aetiological mechanisms for both polydipsia and hyperphagia and conclude that the basic pathophysiology in our case appears to be a neuroleptic induced malfunction of the satiety centre due to blockage of dopamine receptors in the ventromedial hypothalamus.