This lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.

Hepatitis B surface antigen and antibody to hepatitis B core antigen were measured in 232 long-term psychiatric patients. The aims of the study were to determine the prevalence of infection and to relate it to factors such as age, sex, duration of hospital stay and diagnosis.

There was both an increased rate and increased evidence of past infection amongst the patients tested relative to the general population. There was no statistical significant difference between the antibody positive group compared to the antibody negative group for age, sex and duration of hospital stay, unlike that found in studies of mentally handicapped patients. There was a positive association between the presence of antibody and patient diagnosis. Patients with mental handicap appear to have a predilection for hepatitis B.

Further work needs to be done to elucidate the epidemiology of hepatitis B in psychiatric patients and evaluate the reservoir of infection present.

Findings of the influence of hospital training experience in a particular medical speciality on subsequent GP referral patterns to that speciality are outlined. Specialist training appears to sensitise doctors and increase the referral rate to a given speciality. The nature of this sensitisation in medical education is discussed.

To date there has been no study of prescribing habits in a psychiatric hospital in Ireland, as has happened elsewhere.

In a survey over one weekend at St. Brendan's Hospital, the prescription sheets and case notes of all 772 patients were examined.

The principal findings were polypharmacy, the use of benzodiazepines for disturbingly long periods of time, the preponderant prescription of drugs by their proprietary names and the extensive use of neuroleptics for apparently non-psychotic conditions. These results are discussed in the light of other similar surveys.

Sexual dysfunctions are common in S.T.D. (Sexually Transmitted Diseases) Clinic attenders. Marital/relationship dysfunctions frequently follow specific sexual dysfunctions such as erectile, impotence and premature ejaculation. In addition concomitant marital therapy has been shown to enhance treatment for sexual dysfunction. Polypartnerism or multiple or serial sexual partners is also a common feature of S.T.D. clinic attenders. To date, no study has fully evaluated the social, psychological and medical determinants of this behaviour.

The study examined the relationship between sexual dysfunction, marital difficulties and polypartnerism in 50 heterosexual STD clinic attenders. Thirty-one per cent of the sample had pathological scores on the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Forty-two per cent of the sample has pathological scores on the Golombok-Rust Inventory of Marital Satisfaction (GRIMS). There was a significant relationship between sexual dysfunction and marital dysfunction. Polypartnerism was also correlated with sexual and relationship dysfunction. It was felt that by offering treatment for specific sexual dysfunctions identified at STD clinics, marital/relationship difficulties could be averted. Subsequently polypartnerism could be reduced. By altering polypartnerism in this way, an important opportunity to influence vector spread of STD, including HIV infection is afforded.

The case of a 20-year old female prostitute with a five year history of anorexia nervosa, bulimia nervosa and substance abuse is described. The author was unable to find a previous reference to eating disorders occurring in a prostitute.

Alcohol is a reproductive toxin in animals but little is known about its effects on the production of semen in humans. Nothing is known about the reversibility of any changes. The authors here present a case of alcohol dependence with abnormal semen parameters which improved after two months total abstinence.

Thirty two trainees with mental handicap were resettled from two psychiatric hospitals into a centre for people with mental handicap. The progress and problems encountered are described. Recommendations are made for future resettlement programmes.

The earliest signs and symptoms of manic relapse in eight bipolar patients after lithium discontinuation were changes in talkativeness, motor performance, self-confidence and sleep pattern; only two patients reported a change in mood. These changes were initially subtle and did not occur in patients who stayed well after stopping lithium. The lack of affective symptoms might result in clinicians ascribing the changes to the removal of the sedative and cognitive slowing properties of lithium, rather than signs of an impending relapse; similar changes may well occur in patients whose relapse is not associated with lithium discontinuation. Prompt early treatment with lithium (and additional thioridazine in some cases) resulted in only two patients requiring readmission, both for ten days. It is concluded that such symptoms may indicate an impending relapse and prompt treatment is recommended.

Sixty seven opiate dependent addicts receiving methadone maintenance completed the Beck Depression Inventory. A high level of depressive symptoms was found. Eighteen (27%) scored in the moderately depressed range while thirty eight (56%) scored in the severely depressed range. There was no statistically significant association between either sex or HIV status and level of symptom reporting. The clinical implications of depressive symptoms in opiate addicts are discussed.

Some problems related to the formal diagnosis of Post-Traumatic Stress Disorder (PTSD) and the social implications of the concepts incorporated in the diagnosis are addressed. Increasing worldwide evidence of the circumstances likely to produce a PTSD and of patients of all ages and races satisfying the criteria for the diagnosis suggests a problem of epidemic proportions requiring intensive study.

The author proposes that the propensity to develop obsessional modes of reaction is virtually ubiquitous and, for most people, highly adaptive. As for other parameters of functioning (e.g. blood pressure, blood glucose etc.) there is a range of “obsessionality” which is essential for survival. From the standpoint of the clinician the following questions need to be addressed: (1) Is there a pattern of developmental experiences which can be correlated with the emergence of obsessional phenomena? (2) Are there defineable life circumstances which can be related both to the failure to develop appropriate levels of obsessionality and to the development of a level of obsessionality which is maladaptive? (3) How to distinguish the obsessional character from the individual suffering from an obsessional neurosis? and (4) What therapeutic interventions are likely to be effective in the managment of the obsessional individual?

In the avian cerebrum and in the spinal cord, sympathetic ganglia, hypothalamico pre-optic area and cerebral cortex of the rat sexually dimorphic' nuclei are clearly recognisable. Similar differences have been described in the human brain. Morphometric analysis has shown a sexually dimorphic nucleus in the pre-optic area. There is continuing controversy over differences in the size and shape of the corpus callosum, but there is accumulating evidence of cerebral asymmetry with more focal representation of language and praxic functions in the left cerebral hemisphere in females. The various sensory modalitites also show gender differences. The significance of these secondary sexual variations in brain structure resides in the developmental and behavioural characteristics of the underlying neural circuits.

The incidence, characteristics and patterns of female homicide are reviewed, with special reference to England and Wales. The male:female ratio for homicide offences (7.6) is similar to the ratio for other offences of violence. However, murder is almost exclusively committed by men, and in the 1980's the annual average of female murder convictions was only 6.5 per annum. By contrast, females relatively more often commit homicide offences related to mental disorder (diminished responsibility manslaughter and infanticide). Women have a better chance of acquittal of murder and are more likely to be dealt with by a Probation Order than imprisonment. About 80% of the victims of female homicide are family members; 40-45% kill their children and about one-third kill their spouse or lover. The patterns of female filicide and parricide are reviewed. Further research is required into patterns of spouse-murder.

In the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.