A case of post traumatic rapid cycling unipolar mania is described in an individual with no apparent genetic predisposition to an affective disorder. A head injury is proposed as being causative. It is suggested that head injury should be included as a cause of rapid cycling affective disorder.

A non-alcoholic patient is reported who as a result of self-induced starvation was found to have nystagmus, gait ataxia and severe deficits in recent and remote memory and new learning, with intact immediate recall, abstraction and judgement capabilities. This pattern of cognitive deficit with nystagmus and ataxia suggests the diagnosis of Wernicke-Korsakoff syndrome.

A 21 year-old woman with Prader-Willi syndrome (PWS) and a delusional disorder (paranoid psychosis) is described. Other reports of psychoses associated with PWS are reviewed. Reasons for the co-existence of the two disorders are considered, with discussion of the possible role of auditory information processing deficits in the genesis of psychotic symptoms. Such symptoms must be differentiated from maladaptive behaviours not arising from psychosis, the latter being relatively common in PWS. Treatment with a small dose of flupenthixol greatly reduced the impact of the patient's psychotic symptoms, with a corresponding improvement in her quality of life.

There are few reports in the literature of schizophrenia in individuals with Down's syndrome, but a suggestion that such individuals may be protected from schizophrenia. We report six cases of schizophrenia fulfilling ICD-10 guidelines, occurring in people with Down's syndrome. In one case, hypothyroidism was associated. Response to neuroleptic treatment was good. Reasons for the paucity of previous reports on this association are discussed.

A case of secondary mania subsequent to cerebral hypoxia is presented. The relevant literature is briefly reviewed. The authors suggest that cerebral hypoxia be added to the list of causes of secondary mania.

Objective: Case notes on 116 patients aged 65 or more admitted to a general psychiatry hospital over a three month period were examined to assess the current use of haematological screening tests.

Method: Retrospective justification for tests performed, rate of abnormal results, and consequences for patient management were assessed by case note review.

Results: A total of 200 screening tests, 105 of which appeared justified, were performed; 66 patients were screened, of whom 85% had at least one abnormal result. Those who were older were less likely to be screened. There was no relationship between diagnosis and being screened. Of the 90 abnormal results received, less then one third affected clinical management.

Conclusions: The financial and other costs of screening tests are discussed. The current use of haematological screening tests in this population appears erratic and often adds little to patient management.

A patient was admitted with an acute paranoid psychosis. Prior to her illness, she had been using Nicobate patches while still smoking. The relationship between the two are discussed.

Objective: Review of literature on non-compliance with medication in psychiatric patients.

Method: Computer and manual search of English language literature on non-compliance with drugs, psychiatric disorder, and phenomena which may be related, such as readmission and discharge against medical advice.

Results: The literature is discussed and a tentative checklist of risk factors for non-compliance is offered, as is advice on ways in which the problem may be minimised. It is noted that there is an emphasis on major mental disorders in the published literature.

Conclusion: There is no stereotypical defaulter. A high index of suspicion is essential. As far as possible, the patient should be educated to share in the responsibility for treatment, and concerned relatives and others can often play a pivotal role. More research is required on compliance problems in the minor psychiatric disorders. Close liaison with the general practitioner is vital.

Objective: In recent years a number of articles have highlighted deficiencies in drinking histories taken by junior doctors. This study examines whether standards have improved as a result. It also examines for the first time: 1. the quality of drinking histories taken from patients following parasuicide; and 2. the quality of illicit drug usage histories.

Method: An audit of case notes was undertaken of 114 patients admitted to a district hospital's acute psychiatric wards or assessed following overdose. Two periods were considered; one preceding many of the articles, and the second four years later.

Results: There was an overall improvement from 58% of histories in 1988 having no mention of alcohol usage to 25% in 1992. (X2MH=10.57, p<0.01). There was, however, insufficient improvement of quantitative histories to reach statistical significance. Histories taken as part of an overdose assessment were not significantly different from those taken for inpatient admission. In 1992, 27% of patients had any illicit drug usage history recorded which represented a statistically significant improvement (X2MH=5.91, p<0.02) compared with four years earlier.

Conclusions: Although improvements have been noted, alcohol and drug histories remain inadequate.

At the instigation of William Tuke the York Retreat was built in 1794 by the Society of Friends. From its opening in 1796 until 1845 its management was in the hands of lay administrators, and the moral treatment of insanity which was the creation of George Jepson between 1797 and 1823 became a model of its kind. The great tradition thus established was continued by William's grandson, Samuel Tuke, and Samuel's son Daniel Hack Tuke. Daniel's older brother James is better known to Irish history for his philanthropy during Black '47 which is still warmly embedded in folk memory in the West of Ireland.