A case is presented of multiple tooth autoextraction performed by a 22 year old male known to be afflicted with the Gilles de la Tourette syndrome.

This unusual and rarely reported aspect of the syndrome caused initial diagnostic confusion and improved following psychiatric therapy.

A case of the Fregoli syndrome in a patient meeting the DSM-III-R criteria for Cannabis Delusional Disorder is presented. It appears to the authors, after reviewing the literature on the subject, that the delusion ascribed to the Fregoli syndrome, which occurs mainly in Schizophrenia, is being noted in a slowly widening group of psychotic disorders, of which Cannabis Delusional Disorder is the latest.

Objective: To investigate the relationship between behavioural disturbance and psychiatric diagnosis in male mentally handicapped adults resident in a long stay unit. Method: The case notes of all 144 residents of St. Raphaels were reviewed. Diagnoses were classified according to the International Classification of Diseases Ninth Revision (ICD-9) and grouped into one of four categories Infantile Autism, Functional Psychoses, Personality/Behavioural Disorder and Emotional Disorders. Carers (Senior Nursing Staff) were interviewed using the Adaptive Behaviour Scale Part 2 (ABS Part 2) as a measure of behavioural disturbance in the preceding year for the 144 residents. Results: 56% of residents had significant psychiatric disorder. Those with a psychiatric diagnosis showed increased behavioural disturbance across a wide range of measures (p<0.001) with Hyperactivity, Self Abuse and Violence showing greatest discriminative power. However there was not a relationship between diagnostic category and pattern of scoring on the ABS Part 2. There was a significant relationship between Degree of Mental Handicap and Psychiatric Diagnostic Category (p<0.001). Neither psychiatric morbidity nor behavioural disturbance was associated with epilepsy, age or duration of stay. Conclusions: Mentally handicapped adults in residential care show high rates of psychiatric disturbance. Those with psychiatric diagnoses exhibit a wide range of disturbed behaviours but similar patterns of maladaptive behaviour occur across the spectrum of psychiatric disorders. These findings refer to a male residential population and cannot be generalised to all mentally handicapped.

We report a case of carbon monoxide poisoning where symptoms of Neuroleptic Malignant Syndrome developed following use of neuroleptic medication. Literature review has failed to reveal a previous report of neuroleptic malignant syndrome following carbon monoxide insult.

A patient suffering from psychotic morbid jealousy is reported and a formulation to understand the psychopathology cognitively is presented demonstrating that cognitive formulation can be utilized for understanding of psychotic morbid jealousy patients as well.

A patient is presented who resorted to frequent hospitalisation to avoid economic hardships. Psychiatric assessment and admission relieved the medical unit but was achieved at the cost of a valuable psychiatric bed. The question is raised: Is psychiatric hospitalisation an answer?

A 61 year old man presented to the psychiatric services with an eight month history of musical hallucinations, unresponsive to neuroleptic medication. Investigation revealed hypertension with brain infarcts in the left temporal and left parietal lobes. Following reassurance that his hallucinations were organic rather than psychiatric in origin, they faded in significance.

A case of Asperger's syndrome is presented with evidence of left hemisphere and cerebellar abnormalities.

A case report of father-son incest is described. A review of the literature suggests that father-son incest may be significantly under-reported. We suggest that this may be because it is seldom sought after and even less readily recognised. The possibility of the male incest victim should be considered in males who present with depression, severe anxiety, low self-esteem and difficulties with sexual orientation.

Urinary incontinence commonly occurs in the setting of organic brain damage. However a literature search found no previous reports of an association between urinary incontinence and functional psychosis. Three cases are described in which patients with organic predisposing factors for the development of urinary incontinence showed an association between the degree of incontinence and the severity of their mental illness. It is suggested that the underlying psychosis may have contributed to the worsening of urinary incontinence, perhaps through non-specific factors such as poor attention, memory and psychotic symptoms. An association between functional psychosis and urinary incontinence has not been previously reported, and thus merits further investigation.

A seventeen year old man attended the National Drug Treatment Centre with a paranoid psychosis following ingestion of Methylene dioxy methamphetamine (MDMA). He had been taking MDMA on a recreational basis over a five month period. Although chronic psychosis after heavy use of MDMA has been reported there are no pervious reports of psychosis following recreational use. This report highlights the psychological dangers of this drug, which has become widely misused in Dublin over the last two years.

Fifteen consecutive cases of moderate and severe depression were treated with moclobemide in recommended dosage and followed for six months. Eleven developed excitatory side effects including agitation, insomnia, restlessness and aggressivity; five patients reported unreality experiences. Subject to confirmation, these findings, together with indications of similar side effects in published studies and in non fatal overdose, raise the possibility that the potential of moclobemide to cause excitation in depressed patients refractory to other treatments may have been hitherto underestimated.

Objective: Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women. Method: Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements. Results: Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted. Conclusions: Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.

William Sealy Gosset [1876-1937] was a brewer in Arthur Guinness and Co. Dublin from 1899 to 1935 when he moved to London. In 1907, writing under the nom de plume Student he published his paper on “the probable error of a mean” which was later developed by R A Fisher into Student's test of significance now in everyday use in biology and industry.

Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction to neuroleptic medication. Both the incidence and aetiology of the NMS are matters of considerable controversy. We present a clustering of cases of NMS in a distinct geographical area in South Wales. Five cases were reported in an eight month period in 1990 and more recently, a second cluster of three cases occurred in a three week period in November, 1991. We discuss some of the possible explanations for this apparent “epidemic” of cases in South Wales.

A patient with epilepsy developed panic and agoraphobia. A large right temporo-parietal, arteriovenous malformation was detected. The relationship between these disorders is discussed.

Objective: Various studies have shown an association between ABO blood groups and both physical and mental illness. This pilot study was conducted to find out whether there is any association between ABO blood groups and senile dementia of Alzheimer's type. Methods: The sample was selected from 107 patients admitted to the psychogeriatric assessment unit of the district psychiatric hospital over a period of one year. All Caucasian patients of United Kingdom origin above the age of 70 with confirmed diagnosis of Alzheimer's dementia according to DSM-III criteria who had developed dementia after the age of 65 were included (N = 33); 74 patients were excluded for various reasons. Results: Out of the 33 patients there were 21 (64%) with group A, 3 (9%) with group B, 9 (27%) with group O and none with group AB blood. Among the United Kingdom population there were 79,334 (42%) with group A, 16,280 (9%) with group B, 88,782 (47%) with group O and 5,781 (3%) with group AB blood (p = 0.038). Conclusions: Although the number of cases were not large, the results of this study suggest that the prevalence of type A blood group was greater and O was less for Caucasian Alzheimer's subjects than for the general population.

Clozapine was substituted for standard antipsychotic drugs in the treatment of 24 chronic schizophrenic inpatients and the response assessed after a mean of ten months. The majority (71%) improved (33.3% markedly), on their previous level of functioning. The response was better in those under 40 years of age, but neither duration of illness nor previous neuroleptic dose appeared to predict response to clozapine. The drug was ultimately discontinued in five (21%) patients – in three because of non-response and intolerance of sedation and in two because of neutropenia.

Increasing exposure to video technology has provoked descriptions of psychopathology related to playing video games. However, there exists no description of hallucinatory phenomena occuring in psychotic illness deriving from such material. The subject of this report is one such patient suffering from a persistent auditory hallucination of computer music and other non-verbal information.