Objective: Psychiatric illness and the use of psychotropic medication are recognised as factors that may impair driving ability. Clinicians in the UK have a legal duty to advise patients on the effects of illness and prescribed medication on driving ability. Although clinicians in Ireland have no equivalent legal obligations, good medical practice suggests that doctors should be aware of whether patients are active drivers, and issue appropriate advice, supported by adequate documentation in clinical notes.

Method: The initial phase of the study analysed 44 outpatient records and 48 discharge records to ascertain the level of documentation regarding driving status, and advice given to patients regarding the effect of illness or medication on driving ability. The second phase involved distribution of an anonymous questionnaire to 18 psychiatrists employed in the acute psychiatric unit setting.

Results: Although there was minimal documentation regarding the potential effect of illness on driving ability, more than 50% of case notes revealed documented advice to patients regarding side-effects of medication and driving ability. Over 50% of case notes contained advice about medication compliance, but none contained cautionary advice about operating machinery. All psychiatrists admitted not being aware of the driving status of every patient they reviewed. Over 50% admitted to advising patients of the effect of illness or medication on driving ability, but fewer reported documenting this advice on every occasion. All psychiatrists reported that they would benefit from training in this area.

Conclusion: This study suggests that there is underdocumentation of advice given to patients regarding the effect of their symptoms or medication on driving ability. Clinicians need to improve their awareness of patients' driving status, in addition to receiving training on what their responsibilities are in this regard.

A case of schizophrenia with vampiric delusions is described. The relevant classical and contemporary literature is reviewed, both in relation to clinical vampirism and the relationship between vampirism and schizophrenia. In patients with vampiric delusions, the possibility of future vampiric behaviour should be considered, and appropriate treatment initiated.

Childhood behavioural problems and social competence in children of mothers attending a Dublin general practice were studied; they were found to have a prevalence of 30%, and to be associated with maternal depression, and marital disharmony. This relationship is explored, and the possible implications for management in a general practice discussed.

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.

Objective: To explore the nature of the relationship between the Greysteel massacre and the low number of admissions with overdose to the area general hospital in the following week.

Method: Ward records over a ten year period were examined for seasonal and yearly trends for admission with overdose.

Results: In the two year period surrounding the week following the Greysteel massacre there were no similar periods of low admission with overdose.

Conclusion: A direct relationship between the Greysteel massacre and the ensuing dearth of admissions with overdose seems likely.

This lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.

Knowledge about attention-deficit hyperactivity disorder (ADHD) is rapidly accumulating. Recent advances in diagnosis, genetics, neuroimaging, drug and non-drug treatments are considered, and the results are related to the critical attack on the ADHD diagnosis, which argues it a medicalising social construct, unhelpfully sustaining power relationships. The advances reviewed suggest that, while this attack can be conclusively dismissed as wrong and misleading, the phenomenological definition of ADHD is no longer sufficient for construct validity, though continues to be valuable as a guide for clinicians. The humanising and individualising concerns underlying the attack on the diagnosis could usefully be redirected to improving effective measurement of patient outcomes.

A variety of demographic, psychosocial, intrapersonal and behavioural factors have been shown to influence behavioural change in response to AIDS education. The study investigated perceived risk of HIV acquisition amongst 50 male heterosexual STD clinic attenders and its relationship to knowledge regarding the nature and prevention of transmission of HIV, current sexual practices, relationship difficulties, sexual dysfunction, alcohol abuse and psychiatric morbidity.

The sample demonstrated a good general knowledge about AIDS but there was little evidence of the practice of ‘safer sex’. The overall incidence of psychiatric morbidity was 38%, of problem drinking 52%, of sexual dysfunction 32% and marital/relationship dysfunction 42%. Only 22% felt that their life-style put them at risk of HIV acquisition. It was felt that a narrow emphasis on information in AIDS prevention programmes ignores the powerful effect other factors may have on an individual's motivation to change his behaviour. Evaluation of the cognitions of this at risk group with particular reference to the role of cognitive distortions in perception of risk could provide a means of enhancing the efficacy of future health education campaigns.

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.

Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.

Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.

Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.

Objectives: Following disruption from students, particularly boys, during the administration of item 10, the ‘feel like crying’ question, of the Children's Depression Inventory (CDI), this study sought to explore the issue of non-response to this question. It was decided that particular attention should be given to gender differences in responses and non-responses, based on the experiences of researchers administering this measure.

Method: Chi-square analysis of non-responses was conducted on CDI items collected from a total sample of 2,297 second year and pre-leaving certificate students from 23 randomly selected schools in the Mid-West region of Ireland.

Results: Analysis identified item 10 as being significantly less likely to be completed than any other item. Further analysis revealed that boys were significantly less likely to respond to this question than girls.

Conclusion: A modification of the wording to item 10 is suggested to ameliorate this difficulty.

The concerns expressed by Dr. Trigwell and his colleagues are not new. They have been expressed by many critics of psychoanalysis and psychodynamic psychotherapy including within the past decade Frederick Crews and Robert Wilcocks. What gives them a particular relevance and urgency is the fact that they have been articulated by young psychiatrists in training, individuals exposed to the actual practical application of psychoanalytic theory as distinct from theoretical explorations of it. The depressing thing is the reaction of one of the course supervisors. It may well serve only to reinforce their critical view.

The criticisms can be summarised as follows. First, the theories of Freud and his successors were taught on this course at any rate as scientifically established facts rather than as theories or constructs concerning human behaviour, helpful insights in certain instances but not always relevant. These theories and related interpretations were formulated in a way that made it impossible to refute them. They tended to be used in a way that suggested that they explain everything from the most trivial and reflex of thoughts and responses to the most complex and profound.

These criticisms, it might be said, relate to the actual content of psychoanalysis and psychodynamic psychotherapy, to what is being taught. Raymond Tallis has put the same general criticism with somewhat more force, observing that the manner in which psychoanalytic conclusions are drawn from clinical case histories “is reminiscent of how a first year medical student or a hypochondriac, using a few observations to light a gunpowder trail of inference primed with his own preconceptions, might arrive at a wrong diagnosis”.