Objectives: The prescription of stimulant medication to children with attention deficit hyperactivity disorder remains topical. Few reports target children's views about taking long-term medication. The aim was to assess child and parent views of stimulant medication. To compare attitudes to medication between two groups of children, those with attention deficit hyperactivity disorder taking stimulant medication and those with epilepsy taking anti-epileptic medication.

Method: Forty children (n = 40) with attention deficit hyperactivity disorder on stimulant medication, and 40 children (n = 40) with epilepsy on anti-epileptic medication formed the study population. A semi-structured interview was carried out with each child and parent. Each parent completed the Dosage and Side-effects Questionnaire and the Attitude to Medication Questionnaire. Each child completed the Attitude to Medication Questionnaire.

Results: Sixty per cent of children (n = 24) with attention deficit hyperactivity disorder and 62.5% (n = 25) of those with epilepsy knew the name and purpose of their medication. Forty per cent (n = 16) of children in the stimulant group and 32.5% (n = 13) in the anti-epileptic group reported themselves as being non-compliant with medication. In both groups children reported positive aspects to taking medication. More children with epilepsy reported negative aspects. Only 32.5% (n = 13) of children with attention deficit hyperactivity disorder said that they would tell a friend about their medication, while 55% (n = 22) of the children with epilepsy indicated that they would do so. In both groups parents were better informed than their children were about the purpose of the medication. Parents of children with attention deficit hyperactivity disorder tended to be more positive about medication than their children and than the parents in the comparison group.

Conclusions: The majority of children and their parents express positive views about the stimulant medication. Children's views about medication compliance and side-effects should be sought, as they may differ significantly from those of their parents. Where parents have noticed positive changes, but children have not, this information can be used therapeutically to help children feel more in control of their behaviour.

Objectives: People with intellectual disabilities are increasingly living in more domestic style accommodation, either in housing provided within a specialised campus setting or in ordinary houses in community settings. The main objective of the study was to determine if the extent of residents' involvement with their families and with the local community varied when they resided in campus settings (n = 55) or community housing (n = 51) and to investigate the main predictors of this involvement.

Method: With the resident's permission, their key-workers – mainly nurses – completed standard questionnaires that covered resident characteristics, contact with families and a range of life experiences.

Results: Although the type of accommodation did have a significant effect on residents' social inclusion in families and communities, the best predictor of this was the individual's level of dependency in personal self-care. Those who were more dependent tended to be more excluded.

Conclusions: Staff working with more dependent residents need to proactively promote their social inclusion although this could be harder to achieve for those living in campus style settings.

Objectives: The study reports on benzodiazepine use among opiate dependent patients attending National Health Service community prescribing services and examines current practice in the clinical management of benzodiazepine dependence.

Method: A postal questionnaire survey of 174 NHS substance misuse services in England and Wales.

Results: A 71% response rate was achieved. Services estimated the prevalence of benzodiazepine use to be 40% and the prevalence of benzodiazepine dependence to be less than 25% among opiate dependent patients in treatment. Illicit supplies (street) and general practitioners were regarded as the most common source of benzodiazepines. The most commonly reported reasons for benzodiazepine use were for the direct intoxicating effects and for the treatment of anxiety/insomnia. The majority of services (93,75%) reported prescribing benzodiazepines to patients for benzodiazepine detoxification while 43 (35%) reported prescribing for benzodiazepine maintenance treatment. The variations in benzodiazepine prescribing practices across services are described.

Conclusions: Benzodiazepine use remains common among opiate addicts in contact with treatment services. The majority of services surveyed reported prescribing benzodiazepines but there was much variation in clinical practice nationally. There is need for further research to identify effective treatment approaches for comorbid benzodiazepine dependence in opiate misusers.

Objectives: We sought to determine the frequency of learning disability (IQ > 70) among referrals over a period of six years to a community child psychiatric service in a socially disadvantaged area of Dublin.

Methods: We investigated the gender and age characteristics, as well as the frequency of speech and language, emotional, and behavioural problems in this group. We tried to determine what educational help each child was receiving at the time of referral.

Results: Sixty-five of 942 patients referred to the clinic had a mild (60) or moderate (five) learning disability. Forty-eight patients were male and 17 were female. The mean age at referral was 10.5 years, and there was no gender difference. All were referred because of educational problems. Behavioural disorders were present in 31, emotional disorders in 13 and speech and language disorders in 37. Six had suffered some form of abuse, mostly emotional. Five had problems with concentration or markedly impulsive behaviour. At the time of referral, 10 were in special schools, seven were in special classes in normal schools, and nine had a special resource teacher. Adequate educational support was not being adequately provided for 33 at the time of psychiatric referral.

Conclusions: Learning disability occurs in 7% of children referred to the child psychiatry clinic of a disadvantaged urban community and, while this may reflect the late onset of psycho-social and educational problems in such children, these findings give cause for concern that delayed referral may exacerbate their and their families' problems. The educational needs of most of the children were not being addressed. Reasons for these findings are discussed.

The neuropsychiatric effects of corticosteroids are well described in the literature but relatively little is known specifically about their effects among older people. As the population ages, and increasing numbers of older people receive assertive medical treatment for physical conditions, more patients are likely to present to psychiatric services suffering from adverse neuropsychiatric effects associated with corticosteroid use. A review of the effects of corticosteroids among older people was carried out through Medline and PubMed searches and a review of article references. Very little has been specifically written about steroid use and the effects on older people. This paper briefly outlines the current level of knowledge of neuropsychiatric effects of steroids, and relates this to general treatment considerations for older subjects. Recommendations for further research and early identification of complications are made.

This report describes a case of folie à famille in which an African man (Mr X), his wife and three daughters travelled around the world as Mr X transmitted his persecutory delusions to his family members. Mr X who had previously had two brief admissions in the UK and in Ireland, received an adequate trial of antipsychotic treatment in his third admission with us in Dublin. During informal contact with his daughter B, it became apparent that the whole family shared his delusions. On her advice, the other family members voluntarily consented for assessment and psychological interventions, they were interviewed separately. All the family members recovered following separation and psychological interventions without antipsychotic treatment. This case illustrates folie imposée, one of the four subgroups summarised by Gralnick1 from the 20th century literature. This family undertook an extreme measure of travelling around the world because of their induced delusions.

‘Handedness’ as an expression of cerebral lateralisation is valuable in analysis of hemispheric asymmetries, carrying implications for implementation (as well as interpretation) of complex cognitive functions. In recent decades it has become possible to categorise handedness in a reproducible manner and, independently, to estimate accurately the degree of language lateralisation of the brain. These advances have re-focussed attention on cerebral organisation and hemispheric asymmetries, and there is now considerable interest in the neuropsychology of left-handedness. Because of procedural and ethical constraints there are relatively few large scale studies on language dominance, whereas handedness has been studied extensively in recent decades. Language is represented in the left hemisphere in all but 1% of right-handers, and in 60% of left-handers; in 15% of right-handers speech representation was bilateral.

Precise determination of handedness or lateralisation does not appear to have been assessed in major studies of electroconvulsive therapy (ECT). Results in 29 reports, when the electrodes were placed over either the non-dominant or both hemispheres, were tabulated and briefly discussed by d'Elia and Raotma, but the criterion of lateral dominance assignment was not clearly specified; the unilateral and bilateral placements were equally efficacious in their antidepressant effect. d'Elia, who introduced unilateral therapy in 1970, accepted the assumption that the left hemisphere was ‘dominant’, but later workers were more circumspect.