Objective: To evaluate the clinical usefulness of carbohydrate deficient transferrin (CDT) as an indicator of alcohol dependence (DSM 111R). Method: Subjects included 18 patients with alcohol dependence and 36 controls (15 recovering alcohol dependents and 21 blood donors). Blood samples from the subjects were analysed for CDT, mean corpuscular volume (MCV) and γ Glutamyltransferase (γGT). These indicators were compared for their sensitivities and specificities to detect excessive alcohol use. Results: Amongst patients with alcohol dependence, CDT was detected in all (100%), γGT was raised in 8 (44%) and MCV was raised in 4 (22%). CDT was detected in five of the 36 controls. Conclusion: CDT was the most sensitive indicator of alcohol dependence. However, CDT showed a much higher false positive rate compared to previous studies. More research is required to elicit at what level of alcohol consumption CDT becomes positive. CDT could prove to be a clinically useful indicator of excessive alcohol use in future.

Objective: An audit was carried out to evaluate the performance of a telephone consultancy service in adolescent psychiatry. Its objective was to answer the following questions: What does a telephone consultancy service actually do? Is it worth having? If so, how can we improve it? Method: Proforma data sheets on 69 consecutive calls to the Telephone Consultancy Service over a 16-month period were analysed. Results: Seventy-seven percent of enquirers used the service to request a referral or to ask about the appropriateness of referral but only 46% of enquiries were responded to in this way. Twenty-two percent of enquiries were given counselling or advice on how to proceed with the cases themselves. Almost 50% of calls came from the social work department and they enquired principally about conduct problems (27% of their calls) and sexual abuse victims (18% of their calls). General practitioners infrequently used the service (7 calls over a 16-month period). Conclusions: These findings appear to indicate that a telephone consultancy service can provide a counselling service and highlight community resources that may be overlooked by other agencies. However, infrequent use of the service by general practitioners suggests that there has been poor dissemination of information about the service – therefore it is important to bolster awareness of the service itself on a periodic basis amongst potential users.

Objective: To determine the characteristics of compulsory admissions by the police and to compare them with compulsory admissions by other means. Method: A retrospective review over one year of the case records of 48 consecutive compulsory admissions after referral by the police was compared with 96 other randomly chosen compulsory referrals over the same period. Results: In both groups a majority had a chronic history of mental illness with frequent prior compulsory hospitalisation. Significant differences were found between the two groups with the police group more often younger, single, unemployed, males. They were also significantly more likely to suffer from schizophrenia and to have had their admission precipitated by behaviour of an assaultive nature, or by property offences, and on admission to spend a shorter period in hospital. Conclusions: It is suggested that at-risk case registers and the use of alternative emergency procedures will serve to lessen the need for police intervention with the mentally ill.

Therapeutic doses of lofepramine and fluvoxamine were associated with the development of first degree and second degree heart block, respectively, in an 83 year old man with a normal ECG prior to treatment and with no history of cardiovascular disease. Caution is recommended in treating patients with newer generation antidepressants, even in cases where cardiac status appears normal prior to treatment.

Self-injurious behaviour (SIB) is one of the challenging behaviours that is exhibited by people with severe learning disabilities. Various current aetiological theories of SIB have failed to provide a feasible model of care for this complex clinical problem. Recent advances in the understanding of serotonin neurotransmitter function may provide a way forward in the management of SIB. Case histories of two people whose SIB responded to antidepressant medication are described. Possible implication of serotonin neurotransmitter function in the causation of SIB is explored and relevant recent literature is reviewed.

A case of Monosymptomatic hypochondriacal psychosis responding to paroxetine is described. Conventional treatments had failed.

Objective: Northern Ireland has suffered from civil unrest since 1969. During this time both the nature of violence and the nature of psychiatric services have changed. Considerable variation in incidence figures for psychological consequence of civil unrest exists in the international literature (1). The purpose of our study was to ascertain the workload for a new community mental health team which had accrued solely as a result of civil unrest and the possible implication for the local service. Method: The new patient referrals to a Community Mental Health Team November 1990-91 which were solely and directly consequent on civil disorder were identified. The litigant population was excluded from study. We checked how many still remained in treatment in November 1992 and used Fisher's Exact Test to identify factors associated with still being in treatment at two years. Results: We found that 8.2% of the new referrals satisfied the criteria and 30% remained in treatment at two years. Satisfying criteria for post traumatic stress disorder was not significantly associated with still being in treatment. Remaining in treatment at two years was associated with having received or not received stress management advice in those satisfying post traumatic stress disorder criteria. Conclusion: Civil unrest substantially increased the Community Mental Health Team workload in the first year of existence.

Objective: To discover whether patients who had formerly been prescribed triazolam continued to take psychotropic medication after its withdrawal. Method: 11 general practitioners provided details of the psychotropic medication of their patients who had previously been prescribed triazolam, 12 month after its withdrawal from Britain. Results: 70 of 91 patients (77%) were still taking regular hypnotics twelve months after the drug was withdrawn. Success at withdrawal was linked to lower doses of triazolam but did not depend upon age or sex. Conclusions: The withdrawal of triazolam resulted in a proportion of patients stopping hypnotics that is comparable with other interventions to reduce psychotropic consumption in general practice. Most patients continued to take hypnotics, which suggests that the withdrawal of a drug will usually lead to the substitution of a similar one when one is available.

Objective: The study was undertaken to determine the current demographic and clinical features of cases of deliberate self-poisoning (DSP) presenting to an acute general hospital and to compare the findings with previous work in Ireland and elsewhere. Method: Four hundred and sixty seven consecutive admissions for DSP presenting to a Dublin hospital between 1986 and 1990 inclusive were identified retrospectively and the case notes reviewed. Data was collected on age, sex, marital status, past history, date of DSP, drugs used, motivating factors and outcome. Results: The peak age of DSP was 15-24 years. The female:male ratio was 1.5:1. There was an increased incidence of DSP in women in July and August. In 32% there was a previous history of DSP. Benzodiazepines, antidepressants and analgesics/anti-inflammatories were the commonest drugs taken. There was a significant medical complication in 10.5% of cases, but no fatalities. Twenty-five percent of patients were subsequently admitted to psychiatric inpatient care. Conclusions: DSP is an ongoing problem. The summer peak in females may be related to the parenting burden during the summer recess. The high rate of repetition suggests a significant reduction could be achieved with successful strategies for secondary prevention. The high rate of psychiatric in-patient referral may be related to a low threshold for admissions to Irish psychiatric hospitals.

Of three hundred and sixty-one cases seen in a liaison psychiatry service over a twelve-month period, fifteen cases presented with psychiatric symptoms related to epileptic activity, or the treatment thereof. Seven new cases of epilepsy were diagnosed on the basis of primarily psychiatric phenomenology. The fact that twenty-five per cent of patients with epilepsy seen during this period had been incorrectly diagnosed gives cause for concern, and examination of the factors which caused diagnostic difficulty in these cases reveals details of interest to practising clinicians.

A case of schizophrenia with the belief and behaviour of being a dog has been presented with a review of literature of lycanthropy.

Objective: To estimate the prevalence of alcohol dependence syndrome in a rural General Hospital. Method: The entire inpatient population of 107 patients was administered the CAGE questionnaire to detect alcohol dependency. Patients scoring two or more (maximum score 4) were diagnosed alcohol dependent. Results: Sixteen patients were unable to complete the questionnaire due to severity of illness or dementia. Of the 91 patients who completed the CAGE questionnaire, 20 scored one or more, and 12 scored two or more, giving a prevalence of probable alcohol dependency in this population of 13%. There were significantly more male alcohol dependent patients than female, 30% vs 2% (p<0.001). Fifty percent of the patients who scored on the CAGE as alcohol dependent were not recognised by medical staff as being problem drinkers. All of the alcohol dependent patients came from the medical and surgical units including Ear, Nose and Throat surgical unit (ENT). Conclusion: Administration of the CAGE questionnaire to all medical and surgical admissions seems to be one of the most economical way of detecting alcohol dependency and engaging patients in treatment as early as possible.

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.

A patient who developed obsessive compulsive disorder within a year of developing multiple sclerosis is described. Possible reasons for an association between these two conditions are discussed. The role of serotonergic pathway dysfunction in obsessive compulsive disorder is also suggested by the pharmacological response in this case.

Objective: The aim of this study was to examine the provision of psychiatric care to inpatients in two Irish general hospitals without psychiatric units and to comment on (a) how this service model compares with previous Irish studies, (b) whether it meets the goals of liaison psychiatry, and (c) the implications for future service planning. Method: Demographic and clinical details relating to all the psychiatric consultations to inpatients (i.e. there was no emergency service to the casualty department) in two general hospitals were collected over a six month period. Results: Although the service was provided on a nonemergency basis the referral rate [1.6% of total admissions], patient characteristics, reasons for referral, diagnoses, and suggested management strategies were very similar to previous Irish studies. Assessment of deliberate self-harm cases was the most common reason for referral [37.9% of 145 referrals]. Notably, there was a high level of diagnostic accuracy from non-psychiatric colleagues in this liaison model. Conclusions: This study, of a service model characterised by an emphasis on liaison, points to efforts on the part of the psychiatrist to improve communication with medical and surgical colleagues as being of primary importance in the development of general hospital psychiatry services.

Objective: To investigate the relationship between disappointment in a community and deliberate self poisoning. Method: The Accident and Emergency department records of Nottingham's University Hospital were scrutinised for cases of deliberate self poisoning presenting during the weekend of Nottingham Forest's F.A. Cup Final defeat in 1991 and the weekend of their subsequent failure at the quarter-final stage in 1992. Rates of deliberate self poisoning during these periods of intense expectation and disappointment in Nottingham were compared to the weekends either side of these important football matches. Results: Nottingham Forest's defeat in the F.A. Cup Final in 1991 and in the quarterfinals a year later was associated with a short-term excess of cases of deliberate self poisoning in Nottingham. This was statistically significant following the cup final (p<0.01) but not so after only reaching the last eight (p=0.057). Conclusion: The repeatability of these findings supports the hypothesis that a sudden disappointment experienced through an entire community may prove one stress too many for some vulnerable members of that community.

A Council of Europe Fellowship was used to visit several centres in England managing and treating child sex abusers in a community setting. Aspects of the services reviewed included organisation, training of staff, assessment of abusers, methods of treatment and resources and facilities available. The application of the English experience to the establishment of treatment programmes in Ireland is discussed.

A case is described of a severe depressive episode following withdrawal from anabolic steroids which were being misused to enhance body-building. The subject was a twenty-two year old unemployed male who had left school without formal qualifications and had been brought up by his grandparents since his parents' separation. He had been a bodybuilder for four years and misused combinations of oral and parenteral anabolic steroids in increasing doses for two years. His depressive symptoms included lowered mood, loss of energy, anhedonia, suicidal preoccupations, disturbed sleep, poor appetite and impaired concentration. It is proposed that unusually prolonged exposure to steroids followed by withdrawal was the most likely cause of the depression in this case and that biological vulnerability to affective disorder may explain the severity of the episode. Misuse of steroids needs to be considered in young physically active people presenting with depression.