The case of an acromegalic man who became depressed and developed major behavioural changes, characterised by the onset of pathological gambling is described. The inter-relationship of these conditions and the literature on the psychiatric aspects of acromegaly is reviewed.

An audit of Consultant Psychiatrists' views on and uses of antidepressant drugs is reported. At present senior prescribers largely opt for the older tricyclic antidepressants despite a knowledge of their shortcomings. MAOIs are less popular and newer drugs are viewed cautiously and apprehensively. Lofepramine is largely viewed as an alternative to dothiepin and amitriptyline. Non-drug strategies in the management of depression consist largely of support, environmental manipulation and electroconvulsive therapy. The relatively novel treatment, cognitive therapy, has a strong minority following.

A case of cerebral lupus is described over a three year period. The association of chronic brain syndrome, symptoms of derealisation and a suicide bid has not been reported previously. A hypothesis integrating organic and functional symptoms is suggested.

Carl Wernicke [1848-1905] gave the first description of sensory aphasia [1874] and of ophthalmoplegic encephalopathy [1881]. In addition, his notion of ‘Sejunction’ [1894] foreshadowed Bleuler's ‘schizophrenia [1908], and he may be justly said to have been the first successful organic neuropsychiatrist.

This paper explores the contribution of psychoanalytic theories to mental handicap and proposes that mental handicap can be seen primarily as a problem of communication with others (discourse), with oneself (thinking) and with one's own past (history).

This paper also examines concepts of curiosity and thinking, knowledge of history and mental handicap as discourse. To illustrate certain points, examples from case histories are used (real names not used).

A group of 183 longstay psychiatric patients were evaluated regarding their immediate and future discharge potential in order to assist in the future planning of the Mayo Psychiatric Services. Comparisons were made between new longstay patients, who were defined as those who had been in hospital for greater than one but less than five years, and old longstay patients who were in hospital for greater than five years. Age and sex comparisons were also made.

While 28% of those included in the survey were thought fit for immediate discharge, a further 18% were thought to require further active rehabilitation before discharge into the community within one year. The accommodation requirements of those needing continuing inpatient care are discussed. Age and length of time in hospital were found to be associated with discharge potential. Sex difference was not found to be significant. Implications for the development of the service are dicussed on the basis of the findings.

St. Clare's Unit, in the Children's Hospital, Temple Street, and St. Louise's Unit, in Our Lady's Hospital for Sick Children, Crumlin, were set up by the Department of Health in Dublin in 1987 to carry out child sexual abuse assessments. Each unit is staffed by multidisciplinary teams and works closely with Community Care teams, the Gardaí, and treatment agencies. Assessment involves gathering information from referrers, the parents and the child at interview, and from physical examination. The information obtained is interpreted in context, and conclusions are based on the composite picture.

Analysis of the first two years' work shows that sexual abuse was confirmed in approximately half the cases seen, the abuser being known to the child and within the child's family or community network in the majority of cases.

As more professionals become trained in child sexual abuse assessment it is envisaged that more cases will be managed at local level, with perhaps more complex cases being referred to the units. This will enable unit staff to further develop a role in consultation, education, training and research.

Edouard Hitzig [1838 – 1907] may have been an autocratic, proud and overbearing psychiatrist, but his pioneer work in using electrical stimulation changed utterly the approach to research into the localisation of function in the cerebral hemispheres. If he was vain he had much to be vain about.

This paper reports on client satisfaction and other benefits of having a Clinical Psychologist attached to a General Practice. A review of the existing literature on this topic is presented, based mainly on the British experience. The results of a survey carried out on clients who attended the Clinical Psychologist are presented. These results suggest that there are significant benefits of having a Clinical Psychologist working closely with a General Practitioner. Finally both authors give their own personal comments on the work that they do.