Objectives: To estimate the prevalence of postnatal depression in a community sample of women in a disadvantaged urban area in West Dublin, and to examine the factors which may be associated with it.

Method: All women who had a live birth in the area over a one year period were identified (944) and the self-rated Edinburgh Postnatal Depression Scale (EPDS) was distributed to those who could be contacted by the public health nurses. Those scoring in the depressed range (> 12) were compared to non-depressed for age, marital status, employment, parity, presence of a confidant, mode of delivery, previous miscarriage and previous psychiatric history.

Results: Contact was made with 596 women and 377 responded. Responders were older and more likely to be first time mothers, but there was no significant difference between responders and eligible population for marital status. One hundred and eight women (28.6%) scored in the depressed range. Ten sociodemographic and clinical variables were entered into a logistic regression. Scores over the threshold (> 12), suggesting clinical depression, were significantly associated with four variables, lower age, absence of a confidant, previous miscarriage and previous treatment for depression by a GP.

Conclusions: A high prevalence of postnatal depression of 28.6% was reported, which may be associated with overall high levels of social disadvantage in this sample. There were implications for the targeting of resources into such areas. The associated factors are discussed.

Objectives: To examine the mental health status of homeless children and their families living in a supported temporary housing project.

Method: The assessment measures used: (i) the 28-item General Health Questionnaire (GHQ); (ii) the Child Behaviour Checklist (CBCL); and (iii) the Parenting Stress Index (PSI). The population studied consisted of 14 families and 31 children. Children aged two to 16 years were eligible for the study. Most of the families (12/14) assessed were single parent (mother only) family units.

Results: The General Health Questionnaire was completed by the 14 mothers and two fathers. Of the mothers 28% (4/14) indicated the presence of psychiatric ‘caseness’. The Child Behaviour Checklist (CBCL) was completed on 31 children by the mothers. More than a third of the children (12/31) had a Total Problem Score above the ‘clinical’ threshold, indicating the presence of mental health problems of sufficient severity to merit referral for treatment. Of the children 45% (14/31) manifested externalising problems in the ‘deviant’ range, while 29% of the children (9/31) manifested internalising problems in the ‘clinical’ range. In all, when the CBCL scores were examined within each family, 78% (11/14) had at least one child with a CBCL dimension of clinical significance. The Parenting Stress Index was completed by each mother. Of the mothers 70% (10/14) obtained scores in the critical range. They reported feeling incompetent in their parenting role, being dominated by their children's needs and feeling social isolated from their relatives and peers. Their scores also indicated poor self-esteem and significant depressive symptoms. Of note the peak score was the lack of emotional and active support from the other parent.

Conclusion: This study revealed a high level of stress and clinical morbidity in this group of homeless mothers and their children and the need to provide appropriate mental health supports and services for them.

Objectives: Up to one third of patients presenting to neurology outpatients clinics have medically unexplained symptoms, but the aetiology of such symptoms is not well understood. In the current study we sought to investigate the role of anxiety, depression, cognitive factors and early experience in the development of medically unexplained symptoms.

Method: Fifty-seven new patients presenting to a neurology outpatients clinic were studied. Demographic details were recorded and a Hospital Anxiety and Depression Scale, an Illness Perception Questionnaire, and a Childhood Development Questionnaire were administered. An assessment was made by trained medical investigators as to whether the patients symptoms were medically unexplained or accounted for by organic pathology.

Results: We found that 17 out of 56 patients (30%) had medically unexplained symptoms. Such patients complained of a greater number of symptoms, were more anxious, were more likely to have a past history of depression, and were more likely to attribute their illness to stress than patients with a presumed organic basis for their disease. They were also more likely to have been in foster care as children. High levels of depression and anxiety were strongly associated with the number of physical symptoms and the perceived negative consequences of the illness.

Conclusions: The recognition and treatment of anxiety and depressive disorders may contribute to the management of patients with medically unexplained symptoms. Open discussion of beliefs regarding aetiology are also likely to be of benefit regardless of the presence or absence of organic pathology.

Objectives: Prompted by the current debate in Ireland regarding involuntary detention, we undertook a survey of psychiatric trainees to examine their level of knowledge of the legislation governing such admissions.

Method: Eighty psychiatric trainees working in centres affiliated to a particular training scheme were invited to complete a purpose-designed instrument.

Results: Response rate was 52/80. Trainees were well informed concerning the procedures necessary to initiate detention. Their knowledge of the legal indications for involuntary detention and restrictions on its duration was patchy.

Conclusions: We suggest that training in the area of mental health legislation needs to be increased and to focus on satisfying legal requirements in real-life scenarios.

Objectives: To investigate the extent and quality of substance use history taking by trainee psychiatrists.

Method: A retrospective clinical casenote audit of admissions to an acute inner city psychiatric unit during three randomly selected months. Data on substance use history taking was recorded by means of a specially designed study checklist.

Results: In almost three-quarters (45, 73%) of admission episodes trainee psychiatrists had made some mention of substance misuse. However, substance use history taking often occurred subsequent to the initial clinical assessment and varied greatly in quality.

Conclusions: The need for a brief, standardised substance use screening questionnaire, easily incorporated into the existing psychiatric interview format is highlighted.

Low serum and urinary Cortisol has been a consistent finding in post traumatic stress disorder (PTSD). Glucocorticoid receptor numbers are increased. PTSD patients have a significantly lower adrenocorticotropic hormone (ACTH) in response to corticotrophin releasing hormone (CRH) when compared to a control group of normal volunteers. The dexamethasone suppression test exhibits an exaggerated suppression response of Cortisol to dexamethasone, when the dose utilised is lower than that utilised to test patients with depression. Increased urine levels of noradrenaline and dopamine has been noted in patients with PTSD. This is believed to be related to the hyperarousal state of PTSD.

Research is currently recognised as an integral part of higher training in psychiatry, but can become a poorly structured training experience. The Collegiate Trainees' Committee (CTC) suggests that clear objectives should be set for the use of a trainee's research time, allowing far greater flexibility over the methods by which those training objectives are met. The process of setting and meeting these objectives requires a fundamental review with the possibility of teaching and supervision being increasingly solicited from other professional groups. Without adequate supervision and support many trainees will continue to struggle unnecessarily with research, and lack confidence in using research findings (for their patients benefit) throughout their consultant careers.

Suicide, assisted suicide and euthanasia are elusive and controversial issues worldwide. To discuss such issues from only one perspective may be limiting. Therefore, this paper was written by authors from various regions, each of whom has been asked to reflect on the issues. The countries/cultures are: Australia, China, Cuba, Ireland, India, Japan, Russia, South Africa, The Netherlands, North America (Turtle Island) and United States. Historically and today, suicide is viewed differently. Assisted suicide and euthanasia are equally seen from multifarious perspectives. Highlighting development in the Netherlands, Australia's Northern Territory and Japan (ie. the famous Yamanouchi Case), the review shows growing re-examination of the right to die. There appear, however, to be no uniform legal and ethical positions. Further debate and discussion globally is needed to avoid myopic perspectives.