This is a personal account of the transition from the child to the adult mental health services. The title references Janus, the Roman god of transitions. As such, the narrative looks to the past and the future in youth mental health. The discussion begins with a brief examination of the phenomenon of personal accounts in the broader context of evidence-based knowledge. There are a number of themes discussed throughout this perspective including access to education and loss of vocational capacity as a result of illness and service involvement. The discussion emphasises the importance of ‘Time’ in the delivery of services and provides justification for improved access to vocational and/or therapeutic options for young people with mental health difficulties. Time is also used as a structural device in order to communicate lived experience of mental illness, treatment and recovery.

Objectives: The aim of this study was to determine the profile of attenders at psychiatric outpatient clinics in community health centres in Dublin.

Method: A chart review was undertaken retrospectively on attenders at two clinics in different socioeconomic areas. Demographic data and information on services was recorded. Psychiatric outpatient clinic functioning in a community setting was observed during the period of the study.

Results: The findings of this study suggest that attenders at psychiatric OPD clinics are more likely to be long-term, in the 40-50 year age group, female, unemployed and eligible for free medical care within the General Medical Services (GMS). Mood (affective) disorders was the largest diagnostic category. There were financial barriers to patient discharge to primary care and shared care with general practitioners.

Conclusions: Opportunitie s have been identified to improve communication and optimise patient flow through the psychiatric OPD system. Such improvements in clinic function would be likely to lead to enhanced health gain for attenders.

Koro is characterised as a perception that one's genital organs are shrinking and will eventually recede into the abdomen. It was initially described in South East Asia as a culture bound syndrome but this syndrome has recently been recognised in a non-culture bound context A case is described of a depressed Eastern European asylum seeker with koro like symptoms. All symptoms resolved completely with fluoxetine treatment The relevant literature to the case is reviewed, in relation to onset, symptoms and treatment of this rare syndrome. In addition comparison is made with previous reports of the non-culture bound variant.

We present a case of possible olanzapine-induced rhabdomyolysis in the absence of other features of neuroleptic malignant syndrome (NMS). There is evidence to suggest that there are different underlying pathophysiological mechanisms for rhabdomyolysis occurring alone, in contrast to when it presents as part of NMS. This has possible implications for drug rechallenge which is discussed.

Different authors have used markedly different definitions of bingeing. Probably the most widely used of the current definitions is the DSM III R definition which states that a large amount of food must be consumed over a short period of time. Three case histories and a case vignette are used to illustrate the different clinical syndromes which may include bingeing, when bingeing is defined in this way. The authors argue that cognitive constructs are a more precise way of defining bingeing within the context of eating disorders.

Objectives: We sought to determine the frequency of learning disability (IQ > 70) among referrals over a period of six years to a community child psychiatric service in a socially disadvantaged area of Dublin.

Methods: We investigated the gender and age characteristics, as well as the frequency of speech and language, emotional, and behavioural problems in this group. We tried to determine what educational help each child was receiving at the time of referral.

Results: Sixty-five of 942 patients referred to the clinic had a mild (60) or moderate (five) learning disability. Forty-eight patients were male and 17 were female. The mean age at referral was 10.5 years, and there was no gender difference. All were referred because of educational problems. Behavioural disorders were present in 31, emotional disorders in 13 and speech and language disorders in 37. Six had suffered some form of abuse, mostly emotional. Five had problems with concentration or markedly impulsive behaviour. At the time of referral, 10 were in special schools, seven were in special classes in normal schools, and nine had a special resource teacher. Adequate educational support was not being adequately provided for 33 at the time of psychiatric referral.

Conclusions: Learning disability occurs in 7% of children referred to the child psychiatry clinic of a disadvantaged urban community and, while this may reflect the late onset of psycho-social and educational problems in such children, these findings give cause for concern that delayed referral may exacerbate their and their families' problems. The educational needs of most of the children were not being addressed. Reasons for these findings are discussed.

The publication of the new guidelines is a welcome step, bringing more lucidity to the subject and providing useful guidance to clinicians. However, the guidelines pose new and unique responsibilities on mental health services with resulting training needs, resource issues and ethical issues. We propose a collaborative model based on the development of regional specialised teams to perform this task. This may prove to be a more suitable and cost effective option in the long run.

We present a case showing inducement of acute dystonia by clomipramine therapy and discuss the possible explanations. We could find no previous reports of this phenomenon.

In the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.

Levels of immunoglobulins were measured in 32 schizophrenic patients with tardive dyskinesia and 34 schizophrenic patients without tardive dyskinesia. The duration of neuroleptic treatment in years was similar in the two groups. The serum immunoglobulin concentrations (mg%) were found to be significantly different in the two groups; IGA and IGM levels were higher in patients with tardive dyskinesia. The present results may be explained on the basis of dysfunction of the immunological system in tardive dyskinesia.

Studies in general medicine and general practice have shown that psychological disorder is frequently undetected and that it may exacerbate the morbidity of physical conditions. The aim of this study was to detect possible psychological disorder in patients with soft tissue neck injury (STNI) attending a 660 bed teaching hospital in Dublin. Using the General Health Questionnaire-30, 100 STNI patients were compared with 100 consecutive other attenders at the Accident and Emergency Department. There was a significantly greater prevalence in the frequency and severity of psychological disorder in the STNI group, who also were more likely to have a history of depression.

Death faces us all. Preoccupation with it however is commonly regarded as morbid. As a way of dying, suicide is seen as being abnormal. This is certainly so in a statistical sense. In 1993, there were 31,896 deaths in the Republic of Ireland of which officially 357 were suicides. This means that approximately one in a hundred deaths today are self-inflicted. The proportion of suicide deaths to other deaths varies across age groups, however. Generally speaking among the young, suicide is a more common cause of death because other types of death are less common. In the past the official Irish suicide figures may have under-estimated the true picture. Recent research however has shown that the official Irish suicide statistics are likely not to underestimate the true rate and are also more likely to be reliable than are the equivalent statistics from England and Wales.

The word ‘abnormal’, however, in medicine is also used in a nonstatistical sense to imply deviation from the ideal or desirable. If we say someone is abnormal, we imply that he is either mentally ill or suffering from a defect or blemish of personality. Most people assume that those who intentionally end their lives are abnormal in this latter medical sense, immediately prior to death. The opposite holds in murder. Society assumes the perpetrator is not mentally ill unless evidence is brought forward to the contrary. Not all believe this, however, and some actively canvass the viewpoint that suicide, in certain circumstances, is to be encouraged.

Objective: The aim of this study was to determine the prevalence of metabolic syndrome and obesity as defined by Body Mass Index (BMI) in a long-stay psychiatric unit where all care is provided by the psychiatric team.

Method: All residents in this long-stay unit were screened. Their BMI was calculated. Waist circumference and blood investigations were done. Ward records were used to determine those who had been previously diagnosed with hypertension and diabetes. The ATP 111 criteria were used to determine the prevalence of metabolic syndrome.

Results: We found a prevalence of 33% for BMI obesity and a prevalence of 66% for metabolic syndrome. These are higher than those of the general Irish middle aged population and the accepted estimate of a general psychiatric population. It is also higher than that of a previous published study on an Irish long-stay psychiatric ward population.

Conclusion: There is high prevalence of BMI obesity and metabolic syndrome in long-stay psychiatric residents. This has the potential to impact significantly on physical morbidity and mortality. People with severe and enduring mental illness should have access to primary care and other health services on the same basis as any other citizen.

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.