Objectives: In view of the apparent public discontent that has been expressed by individuals towards temporary certification and involuntary treatment, this study was set up to assess patients' reactions to their involuntary admission. The study compared the demographic characteristics of voluntary and involuntary patients and assessed their attitudes towards and knowledge of the certification process that presently exists in Ireland.

Method: A total of 68 patients, 38 involuntary patients consecutively admitted over a six month period and 30 voluntary patients selected over the same period, were interviewed with a standard questionnaire, on average six months after discharge.

Results: Involuntary patients were more likely to be single, live with their families and showed no demonstrable gender bias. Involuntary patients had limited knowledge of specific aspects of their individual certifications, particularly with regard to knowledge of their rights, admission status and knowledge of the identity of the applicant of the certificate. Of these, 10% were aware of their rights on admission and only 14% could recall that their rights had been explained to them on admission.

Conclusion: Although patients initially expressed strong feelings of anger on admission towards committal, these feelings were found to reduce over time. Recommendations for improving the present Mental Health Act were suggested by those interviewed and these included a need for an initial assessment period before certification is completed and a need for improved communication by medical staff regarding information on the admission status, the identity of the applicant and on the person's rights.

Objectives: Several reports have suggested that, despite the high prevalence of cigarette smoking, the incidence of lung cancer is lower than would be expected in patients with schizophrenia. In addition, patients with lung cancer have been shown to have a lower expression of glutathione-Stransferase-μ (GST-μ) compared to healthy controls. In this study, we tested the hypothesis that GST-μ was a trait marker that protected patients with schizophrenia from developing lung cancer.

Methods: One hundred patients who fulfilled DSMIIIR criteria for schizophrenia were examined for the presence or absence of GST-μ.

Results: Significantly more male (86%) and female patients (64%) were smokers compared to general population rates of 30% and 30% respectively (p < 0.0001). There were no significant differences in the expression of GST-μ in patients (48%) compared to controls (46%).

Conclusions: We found no difference in the expression of GST-μ in patients with schizophrenia compared to normal controls. It is therefore unlikely that GST-μ acts as a trait marker protecting patients with schizophrenia from lung cancer. However, a significantly large smoking prevalence rate was ascertained in the patient population.

Objective: As the provision for the involuntary admission to hospital of alcoholics is likely to be discarded in a new Irish Mental Health Act, the characteristics of patients committed under the 1945 Irish Mental Treatment Act were explored and compared with those alcoholics admitted voluntarily.

Method: All alcoholics admitted compulsorily from 1989-1992 to a general psychiatrichospital in Dublin were compared retrospectively with voluntarily admitted alcoholics. Data was taken from case notes.

Results: Results showed that patients admitted compulsorily were older (t = 3.74, df = 62, p < 0.001) and had more physical complications (X2 = 8.4, df = 1, p < 0.004) than those admitted voluntarily. Although results did not reach a statistically significant level, there were proportionately more females in the compulsorily admitted group compared with the voluntary group. The outcome of admission overall was better in those admitted voluntarily, although this was influenced both by length of stay and previous admissions for treatment of alcohol dependence. One particularly interesting finding, regardless of admission category, was that duration of admission was statistically significantly longer for women when compared with men.

Conclusions: Compulsory admission of alcoholics to a psychiatric hospital for very brief periods was not shown to be strikingly helpful, but this study cannot decide whether or not longer periods of compulsory admission would be valuable.

Objective: The aim of this study was to screen a group of medically ill elderly hospitalised patients for depression and to facilitate this using a new screening questionnaire called the Evans Liverpool Depression Rating Scale (ELDRS).

Method: The questionnaire was administered by a geriatric registrar to a consecutive series of 37 acutely ill elderly medical inpatients admitted to an acute hospital ward. They were subsequently interviewed by a member of the psychiatry of old age team.

Results: Seven of the 37 acutely ill elderly patients admitted to hospital were found to be suffering from a major depressive illness according to DSMIIIR criteria. Of the patients screened, two were already on antidepressant medication. Five of the depressed patients were identified by using the ELDRS. All of the depressed group were judged to require antidepressant medication and two were referred to a psychiatry of old age day hospital.

Conclusions: Our results suggest that there is a raised prevalence of depressive illness in elderly acutely ill medical patients which remains undetected. Use of a screening questionnaire such as the ELDRS would increase the likelihood of its identification in this group.

The suicide rate for county Kerry in 1988 was determined by clinical means using postmortem records as a starting point. Sixteen deaths due to suicide were thus identified (eight males and eight females). The official figure for the year is 19 (13 males and six females). Four of the clinically determined suicides did not appear in the official figures. Combining information from both sources gives a figure of 23 suicide deaths, a rate of 18.58 per 100,000. The authors conclude that there are continuing deficiencies in suicide recording practices.

Objective: To conduct an audit of the patients treated at a day hospital or in an inpatient unit of a district general hospital from the South Kildare sector of the Kildare Mental Health Service, a new community based psychiatric service.

Method: Retrospective case note review of all admissions over a six month period. ICD-9 diagnosis used.

Results: There were 39 and 29 admissions to the inpatient unit and day hospital respectively. The average duration of stay in the inpatient unit was 14 days, 66% were discharged home and 33% discharged to the day hospital. The average duration of stay was 30 days in the day hospital, 62% were discharged home and 17% discharged to the inpatient unit.

Conclusions: The trend was to treat more neurotic patients in the day hospital; psychotic patients were treated in both settings; the proportion of patients discharged home was similar. The duration of stay was longer in the day hospital.

Objectives: To examine the evidence concerning the recent developments in the genetics of schizophrenia.

Methods: An extensive literature search was performed and relevant papers were examined and analysed.

Findings: There is overwhelming evidence that schizophrenia shows familial aggregation. Recent molecular genetic studies support the presence of susceptibility genes on chromosomes 6 and 22. In addition, an association between schizophrenia, the dopamine D3 receptor gene and the 5-HT2a receptor gene has also been demonstrated.

Conclusions: Recent advances in DNA technology have paved the way for the detection of genes of major and minor effects in the aetiology of schizophrenia. If the presence of the recently identified susceptibility genes is confirmed, it is likely that these genes will be recognised in the near future.

Objective: Genetic mapping, the method of comparing an inheritance pattern of a disease to that of a chromosomal region, has brought about a revolution in the field of human inherited diseases. Diseases which exhibit a more complex pattern of inheritance now afford the next challange in the application of genetic mapping to the field of human disease. This article aims to review the application of genetic mapping to affective disorders.

Method: Review of literature concerning the molecular genetics of affective disorders.

Findings: This article describes the evidence for a genetic role in affective disorders, reviews the research to date and describes the difficulties arising out of the complex nature of these disorders.

Conclusions: Although progress to date in psychiatric genetics has been somewhat disappointing, the combined approach of using all the genetic tools currently available on large collections of affected individuals and families should enable the genetic basis of affective disorders to be identified.

Death faces us all. Preoccupation with it however is commonly regarded as morbid. As a way of dying, suicide is seen as being abnormal. This is certainly so in a statistical sense. In 1993, there were 31,896 deaths in the Republic of Ireland of which officially 357 were suicides. This means that approximately one in a hundred deaths today are self-inflicted. The proportion of suicide deaths to other deaths varies across age groups, however. Generally speaking among the young, suicide is a more common cause of death because other types of death are less common. In the past the official Irish suicide figures may have under-estimated the true picture. Recent research however has shown that the official Irish suicide statistics are likely not to underestimate the true rate and are also more likely to be reliable than are the equivalent statistics from England and Wales.

The word ‘abnormal’, however, in medicine is also used in a nonstatistical sense to imply deviation from the ideal or desirable. If we say someone is abnormal, we imply that he is either mentally ill or suffering from a defect or blemish of personality. Most people assume that those who intentionally end their lives are abnormal in this latter medical sense, immediately prior to death. The opposite holds in murder. Society assumes the perpetrator is not mentally ill unless evidence is brought forward to the contrary. Not all believe this, however, and some actively canvass the viewpoint that suicide, in certain circumstances, is to be encouraged.

Early psychodynamic formulations of obsessive compulsive disorder (OCD)suggest that its aetiology lies in repressed sexual impulses. Despite this, sexual aberration has rarely been reported in conjunction with OCD or arising following treatment. This paper describes two case histories of patients with severe, chronic OCD whose sexually deviant behaviour increased following successful behavioural psychotherapy. Classical Freudian, behavioural cognitive and neuropsychological models for this finding are discussed.

A 24 year old man with established Gilles de la Tourette Syndrome (GTS)and schizophrenia of recent onset is described. Other comorbid reports of schizophrenia and GTS are reviewed showing this association to be rare, with only nine previous reported cases. GTS and schizophrenia have many phenomenological similarities and a link has been considered between the two disorders but never clearly established. Reasons for the lack of an association where one might be expected are considered. Possibilities include under reporting or misdiagnosis of GTS or the possible masking of psychotic symptoms by treatment of the GTS.

Therapeutic drug monitoring of tricyclic antidepressants is a controversial issue. A case is reported in which a patient with recurrent depression developed asymptomatic tricyclic toxicity while on trimipramine, a tricyclic antidepressant, and diltiazem, a calcium channel blocker. A metabolic interaction involving cytochrome P450 3A (CYP3A) is postulated. It is suggested that routine therapeutic drug monitoring of tricyclic levels should be an essential part of the management of depression.