Objective: The identification of personality disorder among psychiatric in-patients is important because of the effect on the course and outcome of illness. The introduction of a multiaxial approach to diagnosis, has resulted in a higher than previously reported rate of occurrence of personality disorder in a variety of psychiatric settings. A prevalence of personality disorder of 4.9% is reported in the official statistics for Irish psychiatric hospitals. The aim of this study is to determine the true prevalence of personality disorders in two Irish psychiatric hospitals, one public and one private, using a multiaxial approach to diagnosis.

Methods: The Standardised Assessment of Personality (SAP) is a validated, semistructured, informant based instrument that reliably generates diagnoses of personality disorder irrespective of current mental state. Over a four month period, 78 consecutive, first ever admissions to two hospitals were examined using the SAP.

Results: The prevalence of personality disorder in this population was 26%. There was no significant difference in the rate of personality disorder between the public and private institutions.

Conclusions: The prevalence of personality disorder amongst in-patients in both public and private psychiatric hospitals in Ireland is far higher than previously reported. This highlights the importance of a multiaxial approach to diagnosis in order to establish the true extent of psychiatric morbidity.

Objective: The trends in suicide in Northern Ireland over a 70 year period were examined with respect to sex, age and method used, and then compared with rates of unemployment and homicide.

Method: The records in the office of the registrar general in Belfast were examined to obtain data. Unemployment figures were obtained from the Department of Economic Development.

Results: Suicide is increasing in Northern Ireland and particularly in young men (aged 34 and under). There is a relation to unemployment although it is not felt to be directly causal. Men prefer more violent methods although vehicle exhaust gas is popular. A large number of women still choose drowning.

Conclusions: Despite all initiatives, the suicide rate is increasing in Northern Ireland, in common with many European countries. It represents a major health care issue. Measures of a social or political nature may have more effect than health care advances in reducing the rate of suicide.

Objective: This report describes an open prospective study of the effects of clozapine on positive and negative symptomatology in treatment resistant schizophrenic patients.

Method: In this prospective study, 15 DSM-III-R schizophrenic patients, who had failed to respond to various neuroleptics were followed up for a period of 21 months (median: 9; 25th and 75th percentiles: 4-10). When clozapine treatment was initiated, the mean duration of the illness was 16 +/-9 years. Brief Psychiatric Rating Scale (BPRS) scores, BPRS ‘positive symptoms’ and BPRS ‘anergia factor’ scores were all rated at days 0 and 15, months one, two and three and every three months thereafter.

Results: Significant improvements in total BPRS scores, BPRS positive symptoms and anergia factor were recorded and resulted in two distinct patterns of outcome. The improvements in BPRS scores translated into marked changes in health care utilisation and in sheltered employment. Of the side effects noted, dry mouth was more common in the first month after wash-out (three patients), while hypersalivation was more frequent after this period (eight patients). There was no agranulocytosis in this cohort. Two cases of eosinophilla occurred during the first month. Weight gain affected six patients.

Conclusions: We found that clozapine offers particular benefits for some treatment-resistant schizophrenic patients despite the increased hematologic risk. Our study also indicates that the beneficial effects of clozapine are delayed in relation to negative symptoms as compared with positive symptoms.

Objective: The relationship between early adverse experience and psychological illness has been studied in younger adults, but not in the elderly. This study investigated early adverse experience in elderly women with a history of severe depression by using a semi-structured interview.

Method: Women admitted with a history of severe depression were identified and interviewed using the Brief Parenting Interview (BPI)(n=14).

Results: The majority of elderly women (71%) with a history of severe depression had suffered significant childhood trauma. Eight (57%) women reported parental loss, six (49%) reported tension or discord in the family home and one woman reported severe child sexual abuse. The majority of the women (87%) did not find the questionnaire distressing and all found it acceptable.

Conclusions: Considering the high prevalence of childhood trauma in this group and the problems treating severe depressive illness in the elderly, this area deserves further study. The BPI is well tolerated in elderly women with a history of depression.

A 54 year old woman presenting to the psychiatric services with persecutory delusions, complex visual hallucinations and fluctuating levels of consciousness was discovered to have a meningioma occupying the cerebellopontine angle. The psychiatric symptomatology of cerebellopontine angle lesions is reviewed and the pathogenic mechanisms are explored in the light of the symptomatology observed.

A case is described of an elderly man with secondary mania caused by neurosyphilis. This is thought to be the first such case in an elderly person. The implications for routine sero-testing are discussed.

We report on a patient with neurosyphilis with psychiatric manifestations. A point to notice in this case is the time elapsed (one year) between the first psychiatric contact and the final diagnosis. The case reported here suggests that neurosyphilis may have become a ‘forgotten disease’.

Objective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.

Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.

Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.

Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.

Objectives: General practitioners were surveyed by questionnaire for their opinions on their needs and usage of a new child psychiatric service in the Midwestern Health Board.

Methods: The questionnaire was returned by 72% of GPs. Their practices included inner city, new towns, country town, and rural communities.

Results: It was found that 160 children were awaiting referral to the new service of which the most prominent presenting problems were hyperactivity, learning difficulties, enuresis, poor parenting skills, dysfunctional families, anorexia/eating disorders and psychosomatic problems. Primary school children required more frequent referral than secondary school children. GPs appreciated telephone access to the psychiatrist and for the service to be available for emergencies. A few GPs requested discussion meetings following referral. Most GPs were satisfied with any member of the multi-disciplinary child psychiatric team assessing the children.

Conclusions: This study was a useful method of assessing the numbers and nature of problems which might present to a new child psychiatric service in order that staff and treatment programmes could be organised. Results suggest that further research is necessary.

Objective: To quantify the perceived discrepancies between the medication that GPs believed their patients were taking and that which was recorded on admission to acute psychiatric wards.

Methods: A prospective survey of 107 consecutive admissions to a Swansea psychiatric hospital was carried out.

Results: In 62% of patients studied, there was at least one discrepancy each and in 33%, the discrepancies were considered potentially clinically significant.

Conclusions: The study showed a significant number of potentially serious discrepancies in medication at the GP-Hospital interface and highlighted the need for improved communication between GPs and their psychiatric colleagues. The possible reasons for the discrepancies and the implications for communication between primary and secondary care for psychiatric patients are explored.

This paper summarises the work of Michael Balint, offers a revisionist view of his work, and argues that the new term heartsink is an indication that the problems Balint addressed need to be re-examined.

The richness of Michael Balint's life was documented by Hopkins. The variety of his professional experiences meant that he was able to create a fertile atmosphere in which GPs felt free to express feelings about themselves and their patients. The Balint movement was based upon the talents of an exceptional man.