This article reviews the current knowledge regarding the hepatic cytochrome P450 system, with particular reference to its effect on psychotherapeutic medication. The metabolic processes – by which drugs are broken down in the liver by cytochrome P450 enzymes – are affected by genetic variation between individuals, inhibition and induction of these enzymes by other drugs, disease and age. Genetic influences and enzyme inhibition/induction are discussed in particular detail in this article.

Objectives: The aims of the study were to examine: i) whether sex offending in elderly people is a serious problem, ii) whether mental disorder or alcohol abuse occur in association with such behaviour, iii) how such behaviour is managed by the psychiatric service and iv) the outcome of such management.

Method: Referrals of people with sexually offensive behaviour to the North Dublin Psychiatry of Old Age Service from its inception in 1989 to date (1997) were examined. Information collected included: i) mode and reason for referral, ii) demographic, social and medical information, iii) psychiatric diagnosis, iv) management and v) outcome.

Results: Thirteen cases were identified in the eight year period. The sexually offensive behaviours included indecent assault, masturbation in public and lewd remarks. Diagnoses included vascular dementia, frontal lobe dysfunction, Alzheimer's disease, chronic schizophrenia, depression with alcohol abuse and ‘no psychiatric diagnosis’. Two patients had positive syphilis serology detected on dementia screening. Alcohol abuse featured in almost half of the cases. Regarding treatment, five were treated with oral cyproterone acetate and one with benperidol, and all of these had a good response. Three were treated with neuroleptics and also settled. Specific treatment was not indicated in three cases and forensic services were involved in a further three cases.

Conclusions: It is noted that most subjects had an underlying psychiatric diagnosis particularly organic brain damage. Management alleviated the problem in all cases with psychiatric disorder. Cyproterone acetate is clearly useful in management. This review highlights the importance of thorough assessment, diagnosis and management of sexually offensive behaviour in old age.

Objective: To explore the relationship between social skills and depressive symptoms in a normal young adolescent population.

Method: An all male group of 85 schoolchildren, in the first year of secondary school, completed self-report instruments to measure the constructs of depression and of social skills. The Depression Self-Rating Scale (DSRS) and the Matson Evaluation of Social Skills with Youngsters (MESSY) were the instruments used.

Result. Regression analysis of the factor scores on the MESSY and the total score on the DSRS revealed a significant, negative relationship. This was particularly so for the jealousy/withdrawal factor (Factor V) on the MESSY (f = 27.323; p < 0.001)

Conclusion: The data provide support for the social skills deficit model of depression and indicate the possible role of fostering pro-social behaviours and promoting social skills enhancement in the vulnerable young adolescent.

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.

Objectives: The aim of this study was to provide the first Irish prevalence data on mental illness in an elderly, rural, community dwelling population.

Method: Subjects were identified from four general practitioners' lists. This included GMS patients, private patients and nursing home residents. Six hundred and fifty people aged 65 years or over were interviewed in their own homes using GMS-AGECAT, a standardised diagnostic instrument.

Results: The overall prevalence of mental illness was 14.6%. The prevalence of depression was 9.4%. There was a significantly higher rate among women (13.2%) than men (4.3%). Depression in women was not age related. Of the total sample, 3.7% were classified as organic cases. Of the remaining cases, anxiety disorders occurred most frequently and represented 0.9% of all cases.

Conclusions: Elderly people in rural areas experience similar levels of psychiatric morbidity as those in urban centres.

Objective: To examine the phenomenology of erotomania and to discuss the relevance of its classification into primary and secondary forms.

Method: Two case reports are presented. Both were female, non-Irish nationals who travelled to Ireland expressly to pursue their objects, who were both members of an internationally famous rock band. Case 1 and Case 2 are presented as primary and secondary erotomania, respectfully.

Result: The difficulty in distinguishing primary from secondary erotomania is discussed; the modern literature is referred to, which appears to be divided about the status of the primary form of this disorder as a distinct entity.

Conclusion: Until further advances are made in elucidating mental disorders, diagnosis will remain symptom-based, leaving diagnostic formulations somewhat over-crowded with syndromes of undetermined aetiology. Such is the case with erotomania.

Objectives: The aims of the audit were to monitor the activities of the liaison clinic over a 12 month period, to establish the number of attenders and non-attenders and to evaluate whether the service was meeting the needs of patients with perinatal disorders.

Method: The Coombe Women's Hospital is one of three maternity hospitals in Dublin and had 6,452 deliveries and 5,273 inpatient gynaecological procedures performed in 1994. The charts of all the patients who were given an appointment for the psychiatric clinic between January 1 and December 31, 1994 were reviewed.

Results: Fifty-six patients attended the clinic over the 12 month period, 38(68%) of whom were new referrals to the service. Twenty-two patients were antenatal, 20 were postnatal and 14 patients were attending the gynaecology department. Seventeen patients (30%) who were referred to the clinic failed to attend for their first appointment. Forty-one (73%) patients had sufficient symptomatology to make an ICD-10 diagnosis. Medication was prescribed for 58% of those who attended. Four patients were referred to their catchment area service for inpatient care: six patients were referred to their catchment area service for further outpatient care as they had psychiatric illnesses which predated their pregnancies.

Conclusions: The number of patients referred to the liaison service with postnatal depression is remarkably less than that anticipated and there is a high rate of defaulting among first attenders. Various recommendations are made to improve the effectiveness of the service.

A period of psychiatric training in New Zealand is relatively easy to organise and provides opportunities not available locally. This article illustrates some of the similarities and differences between Irish and New Zealand psychiatry and provides advice on how to arrange a placement.

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.

The social, personal, occupational and domestic deficits of schizophrenia are well known. Perhaps it has not been emphasised sufficiently that people suffering from schizophrenia also have an increased mortality. It is important to recognise that suicide is the commonest form of death among both male and female schizophrenics and occurs in 10%-15% of cases.

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.

A case of self-inflicted eye injury is described in a setting of alcohol intoxication and severe personality disturbance. The case is believed to be the only one of its type described this century. The relevant classical and contemporary literature is reviewed and psychopathological explanations discussed. Possible indicators of impending self-violence are reviewed.

Interest in the psychiatric aspects of old age predated the institution of geriatrics as a clinical discipline, but the systematic study of the ageing brain only began in the second half of this century when an ageing population presented a global numerical challenge to society. In the senescent cerebral cortex, though the number of neurons is not reduced, cell shrinkage results in synaptic impoverishment with consequent cognitive impairment. Recent advances in imaging techniques, combined with burgeoning knowledge of neurobiological structure and function, have increased our understanding of the ageing processes in the human brain and permit an optimistic approach in the application of the newer insights into neuropsychology and geriatric psychiatry.

Psychiatrists throughout Ireland lost a valued and respected colleague when Michael Kelleher died on the 9th August 1998. It is unusual for a doctor and certainly for a psychiatrist to receive widespread tributes in the national as well as the professional press, and these have borne eloquent witness to Michael's qualities as a man and to his achievements as a psychiatrist.

Dr Kelleher's major achievements have been well recorded: they particularly concern his research in Cork on suicide in the latter decades of the 20th century. This interest arose from his work with a post-graduate student, Dr Maura Daly, in the early 1980s. They identified the rising suicide rate, especially amongst the young, and set about understanding the phenomena they carefully observed. Having provided evidence that improved official reporting of suicide was not a sufficient cause of the rising rate, Dr Kelleher moved on to focus on unemployment, the availability of medicines, substance abuse and the rapid changes in Irish society in seeking to explain these disturbing trends. His writing was careful and considered and he maintained a consistently high standard of scholarship. This is clearly evident in his editorial “Youth suicide trends in the Republic of Ireland” for the British Journal of Psychiatry, published posthumously in September 1998. In latter years his voice became familiar in the media when he was always lucid and cautionary, while strongly advocating measures to improve Ireland's mental health.

Clozapine has become a widely used drug in therapyresistant schizophrenia and, increasingly, in the levodopa-induced dyskinesias and the psychoses of chronic Parkinson's disease. We report the case of a 43 year old male patient who developed a reversible encephalopathy associated with clozapine therapy.

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.