One hundred and twenty-seven white male alcoholics, treated in a rural setting, were assigned to one of two groups. Seventy-three subjects received intensive aftercare by Community Psychiatric nurse and fifty-four control subjects received standard aftercare with outpatient appointments. Subjects were assessed one year after treatment. Fifty-four per cent of those given Community Psychiatric Nurse follow-up were completely abstinent compared with twenty per cent of those in the control group. Those receiving Community Psychiatric Nurse follow-up were less likely to have blackouts, hospital admissions or marital discord in the year following treatment. They were more likely to attend hospital meetings regularly. This form of aftercare is an effective way of maximising the benefits of expensive inpatient treatment.

Anorexia nervosa in males is relatively uncommon and therefore is difficult to research. Nevertheless, the study of such cases is important and may yield valuable clues to the aetiological mechanisms and expression of this disorder. This study compared the characteristics of 12 males with primary anorexia nervosa with 36 female anorectics. The pattern of the disorder was remarkably similar in both sexes. Our findings are discussed with relevance to the available literature on this topic.

Suicide is recognised as the most devastating possible outcome of a schizophrenic illness. This study examined the characteristics of 15 schizophrenic patients who committed suicide. These patients were older and less socially isolated than noted in other research. Drowning was the commonest method of suicide and overall, the methods chosen were comparable to those reported among the general Irish population. A past history of deliberate self harm was common although no temporal relationship between such behaviour and suicide emerged. The findings are discussed in the light of the existing literature on this topic.

Using urine specific gravity testing to estimate fluid intake Compulsive Water Drinking (CWD) was found to occur, without an age or sex bias, in 19.1% of rehabilitation inpatients in a Canadian psychiatric hospital. Chart review indicated that Water Intoxication had not been a major problem for these patients during their hospitalisation. Nursing opinion appeared to be a relatively weak test for CWD. In a comparison with age and sex matched control patients no significant association with alcohol abuse for the CWD patients or their relatives was found.

A time series analysis of suicide in Northen Ireland and the USA for 1960 to 1984 revealed different correlates. Whereas divorce rates predicted national suicide rates in the USA, birth and marriage rates predicted suicide rates in Northern Ireland.

The major sociological theory proposed for understanding variations in national suicide rates was that of Durkheim. Durkheim proposed that two broad social characteristics were in large part responsible for the appearance of suicidal behaviour: social integration, the degree to which the people in a society were interconnected through social relationships, and social regulation, the degree to which the emotions and desires of people in the society were controlled and channeled by the social norms and customs.

Durkheim argued that suicide would be common when social integration was very strong (altruistic suicide) or very weak (egoistic suicide) and when social regulation was very strong (fatalistic suicide) or very weak (anomic suicide). Later theorists have argued that Durkheim placed more emphasis than was warranted on very strong social integration and regulation. Johnson argued, for example, that suicide would be more common when social integration and regulation were weak.

This study examines the changes in behaviour following residential relocation in 2 groups of adults with mental handicap. Both groups were transferred (one from the community and one from psychiatric hospitals) to small bungalow dwellings in a village type setting at a centre for persons with mental handicap. Relocation had a major impact on a number of behaviours, most prominently, ‘domestic activities’. The impact of the transfer on both groups, the relevance of the findings for future transfer projects and suggestions for future research are discussed.

In an Irish general hospital 82 admissions were given the MAST questionnaire and 331 patients were given the CAGE questionnaire for alcoholism. Of those who were given the CAGE 67 scored 1.0 or more, (maximum socre: 4.0), and 36 scored 2.0 or more, denoting a prevalence of probable alcoholism in this population of 11%.

Of those scoring 3.0 or 4.0 on the CAGE, 38% of males and 100% of females claimed to have abstained from alcohol for at least one year and 54% and 100% respectively had a heavily drinking relative.

Twenty-three per cent of patients tested with the CAGE and MAST questionnaires claimed never to have drunk alcohol.

The number of patients diagnosed in the medical charts as having an alcohol problem was fewer than those detected by the CAGE questionnaire. It is suggested that the CAGE questionnaire may be a simple and efficient way of detecting excess alcohol consumption in a general hospital population.

An account is given of an approach to group therapy for stuttering using Kelly's personal construct theory as a basis for exploring the understanding of stuttering and the process of change. All five clients who participated showed considerable improvement in fluency on the Riley Stuttering Severity Instrument. Although the improvement may be due to concurrent individual fluency therapy, feedback on the group sessions suggested that group therapy had a positive effect on personal behaviour and facilitated transfer and maintenance of speech fluency.

A group of psychiatric nurses (N = 15) rated the impact of participation in a one year post-experience training course in behavioural psychotherapy on their personal/family life; professional practice; and professional relationships. Levels of stress associated with different phases of the course were also monitored.

Results indicated that the main stresses were associated with re-adjustment of family life over the period of the course and ensuring stability of training placements at the outset of the course. The course fulfilled participants' expectations with regard to improving their clinical practice, and confirmed their view that relationships with psychiatrist colleagues would be unaffected by their participation on the course. Impact on relationships with nurse colleagues was more positive than had been anticipated during the period of the course.

We present a case of the Charles Bonnet syndrome the onset of which appears to have been associated with vascular pathology. The syndrome typically involves the appearance of mute, colourful and pleasing visual images with the retention of insight into their hallucinatory nature. However, the case progressed in a very atypical way and a system of paranoid delusions developed around the visual hallucinations. The syndrome is reviewed and the possible reasons for the atypical course discussed.

We present a descriptive study discussing the reasons why patients remained as in-patients within the psychiatric unit over the Christmas period. In over 50% of cases continuation of in-patient stay was necessitated by the severity of mental illness. However, a significant minority of patients were unable to leave because of either poor family support or reduced input from the community mental health services. There was some evidence of Christmas good will influencing admission policy with a significantly greater number of patients admitted with alcohol problems over the week before Christmas all of whom were lonely and expressed a preference to be in hospital.

A more long term problem was also evident as an important minority of patients' hospital stay was unnecessarily prolonged because of unavailability of suitable community placements.

A number of psychiatric syndromes are characterised by the conscious or unconscious production of factitious symptoms. These include Munchausen Syndrome, the Ganser Syndrome and malingering. Here we describe a patient who rapidly changed her symptomatology according to material from her environment. Her presentation does not meet criteria for any of the above syndromes, but is best described as a factitious disorder (DSM-III-R). This case provides a framework for discussion of the validity of this concept.

A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.