Objective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.

Objective: To describe the clinical characteristics and demographic details of a sample of patients with a principal diagnosis of obsessive compulsive disorder (OCD). Method: A retrospective review of fifty patients with DSM-III-R OCD referred to the Department of Behaviour Therapy at St. Patrick's Hospital, Dublin, Ireland between 1990 and 1991. Standard clinical ratings were made before and after treatment. Ratings used included the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ), and the Yale-Brown obsessive compulsive score (YBOCS). Results: The male to female ratio was almost equal and the mean duration of illness was 6.1 (SD 11 years). OCD presented in isolation in a minority of cases (14%). A life time history of at least one other DSM-III-R axis I diagnosis, especially depression, was found in 72% of patients. Co-morbid Gilles de la Tourettes syndrome or epilepsy was rare. The majority of patients were on medication prior to presentation (78%). Levels of symptomatology were reduced in 91% of patients who completed treatment. Conclusions: Epidemiological research into the mass aspects of this disorder is required.

Objective: An audit was carried out to evaluate the performance of a telephone consultancy service in adolescent psychiatry. Its objective was to answer the following questions: What does a telephone consultancy service actually do? Is it worth having? If so, how can we improve it? Method: Proforma data sheets on 69 consecutive calls to the Telephone Consultancy Service over a 16-month period were analysed. Results: Seventy-seven percent of enquirers used the service to request a referral or to ask about the appropriateness of referral but only 46% of enquiries were responded to in this way. Twenty-two percent of enquiries were given counselling or advice on how to proceed with the cases themselves. Almost 50% of calls came from the social work department and they enquired principally about conduct problems (27% of their calls) and sexual abuse victims (18% of their calls). General practitioners infrequently used the service (7 calls over a 16-month period). Conclusions: These findings appear to indicate that a telephone consultancy service can provide a counselling service and highlight community resources that may be overlooked by other agencies. However, infrequent use of the service by general practitioners suggests that there has been poor dissemination of information about the service – therefore it is important to bolster awareness of the service itself on a periodic basis amongst potential users.

A case of Monosymptomatic hypochondriacal psychosis responding to paroxetine is described. Conventional treatments had failed.

Of three hundred and sixty-one cases seen in a liaison psychiatry service over a twelve-month period, fifteen cases presented with psychiatric symptoms related to epileptic activity, or the treatment thereof. Seven new cases of epilepsy were diagnosed on the basis of primarily psychiatric phenomenology. The fact that twenty-five per cent of patients with epilepsy seen during this period had been incorrectly diagnosed gives cause for concern, and examination of the factors which caused diagnostic difficulty in these cases reveals details of interest to practising clinicians.

A patient who developed obsessive compulsive disorder within a year of developing multiple sclerosis is described. Possible reasons for an association between these two conditions are discussed. The role of serotonergic pathway dysfunction in obsessive compulsive disorder is also suggested by the pharmacological response in this case.

A case is described of a severe depressive episode following withdrawal from anabolic steroids which were being misused to enhance body-building. The subject was a twenty-two year old unemployed male who had left school without formal qualifications and had been brought up by his grandparents since his parents' separation. He had been a bodybuilder for four years and misused combinations of oral and parenteral anabolic steroids in increasing doses for two years. His depressive symptoms included lowered mood, loss of energy, anhedonia, suicidal preoccupations, disturbed sleep, poor appetite and impaired concentration. It is proposed that unusually prolonged exposure to steroids followed by withdrawal was the most likely cause of the depression in this case and that biological vulnerability to affective disorder may explain the severity of the episode. Misuse of steroids needs to be considered in young physically active people presenting with depression.

A case of musical hallucinosis is presented, which failed to respond to neuroleptics but responded to carbamazepine. Parallels with the Charles Bonnet syndrome are discussed.

A case of delusional disorder in a patient with the demyelinating disease tropical spastic paraparesis is presented. Only one similar case has previously been described. The implications are discussed.

Two separate cases are reported in which a woman believed that her pet dog had been replaced by an identical double. The psychodynamic issues which these reports raise are discussed. In the Capgras delusion the double is usually a key figure in the life of the patient. These reports highlight the fact that this key figure may be a domestic animal.

The clinical and pathological features are described in a case of prolonged dementia in a 59 year old man with familial dementia and extrapyramidal disorder. Postmortem examination showed severe fronto-temporal and basal ganglia atrophy, with many “ballooned neurons” in the residual cortex most likely representing Pick's disease. The differential diagnosis is discussed and aspects of this rare condition are reviewed.

Objective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.

Objective: General practitioners play a crucial role in the delivery of psychiatric treatment to patients who have many similarities to those attending the general psychiatric services. The purpose of this study was to elicit attitudes of general practitioners to an existing local service. Methods: We used an anonymous questionaire hand delivered to 54 general practitioners with practices in the catchment area of one of Dublin's psychiatric hospitals. Results: We received responses from 40 of the GP's indicating a high level of psychiatric morbidity in the primary care setting, a moderate level of satisfaction with psychiatric service, a low level of knowledge of the catchment area system, limited interest in taking on an increased role in the care of psychiatric patients and a high popularity rating for the community psychiatric nurse. Conclusions: This study confirms previous estimates of psychiatric morbidity in general practice, a need for improved communication between psychiatrists and general practitioners to identify more realistic expectations on both sides of the equation, and a huge potential for the expanding community psychiatric services to improve liaison between general practitioners and psychiatrists and yield considerable patient and doctor gains.