Objective: The objective of this audit to examine the effect of risperidone therapy in controlling some behavioural disturbances in people with learning disability.

Method: Retrospective analysis of various behavioural disturbances before and after beginning risperidone therapy (during the month before risperidone was started in each case, and during September 1994 in all cases).

Results: Risperidone was found to be effective in controlling various behaviour problems in 12 of 17 patients.

Conclusion: Risperidone may selectively influence behaviour problems secondary to possible underlying mental illness but not others. There was also some evidence that it was more effective in an average dose of 6-8mg/day, but was not beneficial in doses smaller or larger than this dose range.

Our objective in writing this paper was to present a case of Diogenes' syndrome and to examine the evolution of thinking about the phenomenon. To do this we looked at original case material and then carried out a literature review, the results of this showed the syndrome has been reported most often in the elderly and in higher socio-economic groups. It represents a non-specific final common pathway for many interacting variables.

In our conclusion we found that a detailed multidisciplinary assessment is indicated in all cases. Further work is required to estimate the role of personality disorder and organic frontal lobe dysfunction in the aetiology of this syndrome. A multiaxial approach to diagnosis should be employed. Intervention should be based on objective findings and risk-assessment, rather than on ideological grounds. Irish law does not allow a large variety of options to the helping professions.

A case of folie a famille is described. The presenting symptom bearer was a child thus necessitating psychiatric contact with his family. This prevented the folie a famille from remaining covert as may have occurred had an adult presented in a similar manner. The possibility is raised that folie a plusieurs has a higher incidence than previously believed. Criticism is made of the tendency of adult psychiatry and its diagnostic systems to focus purely upon the individual. The investigation, formulation and management of the case using the family is outlined.

A 48 year old housewife, admitted with a diagnosis of major depressive episode suddenly developed Ganser syndrome during the course of her illness. This resulted in spontaneous resolution of symptoms of depression. The resolution of intrapsychic conflict as a result of development of Ganser syndrome which led to sudden remission of major depressive episode is discussed.

We report the case of a patient with schizophrenia who demonstrated increased serum clozapine and norclozapine levels in association with hypertension, when treated with fluoxetine and clozapine in combination.

We report the case of a patient with schizophrenia who has suffered severe side effects with many different antipsychotics. She is poorly compliant with treatment probably because of her experiences with medication. We determined her genotype at the CYP2D6 gene that codes for an enzyme principally involved in the metabolism of many antipsychotics. She was homozygous for the ‘B’ mutation, the most frequent of several known mutations. She therefore has no functioning CYP2D6 enzyme in common with 5%-10% of the population. This may explain why she is sensitive to quite moderate doses of antipsychotic medication, and more rational prescribing may lead to fewer side effects and increased compliance.

Single photon emission tomography (SPECT) is the prototypical tool for measuring cerebral blood flow (CBF) in discrete areas of the brain. Compared with when a male ‘crack’ cocaine user received placebo, oral cocaine (1mg/kg) ingestion was associated with non-uniformity of overall CBF with hypoperfusion of discrete brain regions, particularly of the frontal, temporo-parietal, basal ganglia, and thalamic areas. While these results should be viewed as preliminary, they do suggest that oral cocaine use may be associated with CBF abnormalities in ‘crack’ users.

Patients with Parkinson's disease are frequently treated by psychiatrists. We report on the exacerbation of parkinsonian symptoms in tw o patients prescribed paroxetine, an SSRI antidepressant. We discuss the possible mechanism for such an interaction.

A case is described in which a man with asthma and a history of alcohol dependence presented with a paranoid psychosis refractory to standard neuroleptic treatment. Symptomatic improvement was achieved when abuse of salbutamol (Ventolin®) metered dose inhaler was discovered and an alternative β2-agonist delivery system prescribed. A contribution by salbutamol to the psychosis is proposed. It is suggested that increased awareness regarding psychiatric morbidity is needed when metered dose salbutamol inhalers are prescribed.