Objectives: The purpose of the study was to define various aspects of epilepsy in a population based sample of adults with a learning disability.

Method: A purpose-designed questionnaire was used to collect information on various aspects of epilepsy on 143 adults with a learning disability and epilepsy. Names of these subjects were collected from a hospital for learning disabled adults, specialist epilepsy clinics and social services department. Data was gathered from case notes and direct patient examination.

Results: Generalised tonic clonic seizure was the most common seizure type. Seventy-three per cent sustained a seizure within the previous 12 months of the study. Abnormal EEG findings including excessive slow background activities and epileptiform waves were documented in a high proportion of subjects with a learning disability and epilepsy.

Conclusions: Both resistant epilepsy and generalised tonic clonic seizures seem to be more frequent among the learning disabled population compared with the general population.

Objectives: Renewed scientific and media interest in suicidal behaviour has resulted in a number of initiatives examining and defining this complex and tragic phenomenon. However, in comparison to the study of adult suicidal behaviour, that of adolescents is still under researched. This study aimed to identify the extent and nature of parasuicide in young people under 17 years of age in the Foyle area in the 28 month period up to and including April 1997.

Method: The psychiatric assessments of all those admitted to hospital as the result of parasuicide during this period were examined. A psychosocial and clinical profile of this group of young people was then constructed. Any reported stressors recorded in the assessments were noted, and an attempt was made to ‘track’ contact with helping agencies in each case during the months immediately before and after admission.

Results: One hundred and twenty four young people were admitted during the period under review, the vast majority following an overdose.

Conclusions: Family conflict, family illness and bullying were the three most frequently recorded stressors. Twothirds had no apparent contact with services in the three months prior to admission, and of these, half were not referred on to specialist services after they had been discharged from hospital.

Objectives: To compare the electroconvulsive therapy response of a sample of depressed elderly patients as a function of the presence or absence of psychosis.

Method: Retrospective study of patients over age 65 treated with ECT at three psychiatric hospitals over a three year period.

Results: One hundred and eighty-nine ECT courses were administered to 135 patients. Almost 8 5% of patients made a marked or moderately good response to treatment. There was no difference in ECT response between psychotic and non-psychotic depressed patients.

Conclusions: ECT should be considered as a treatment option for severe depressive illness, regardless of depressive subtype.

Objectives: To ascertain whether or not there had been any improvement in the registration of deaths in Co. Mayo, Ireland, since 1970. At the time is was shown that 7.5% of deaths, in a sample of parishes in the west of Ireland had not been registered.

Method: A list of all those who died and were buried in Co. Mayo in 1992, was obtained and compared with a list of deaths registered in that and subsequent years.

Results: One hundred and twenty eight deaths (11.5%) occurring in the county in 1992 had not been registered by the time of this study in 1997.

Conclusions: Non-registration of deaths continues to pose serious problems for research and for the planning of health services. It is suggested that the government introduce legislation to address the issue. Registration of deaths should be standardised throughout the EU.

Abnormalities of circadian rhythms in depressed patients have been noted, including decreased amplitude, distorted waveform, day-to-day instability, and unusual 48 hour periods. Consistent electroencephalographic sleep recording in these patients show a shortened rapid eye movement latency and slow-wave sleep (stages 3 and 4), resulting in an increase in rapid eye movement sleep. This phenomenon appears to be a dependable, measurable marker for diagnosing primary depression. Total sleep deprivation appears to significantly improve mood in a high percentage of depressed patients. Current pharmacological research suggests that drug treatment such as lithium would not affect the intra sleep cycles of the REM stagebut would shift the phase backward and lithium would also shift the phase of circadian rhythm of the daytime sleepiness backward. This paper highlights some of the new approaches for investigating the molecular substrate for the control of circadian rhythmicity and sleep in man and critically examines the hypothesis of the alteration of this mechanism in psychopathology, particularly depression. What is known of the endogenous clock mechanism is discussed with known molecular circadian mechanisms with a view towards understanding how circadian information is transmitted to the rest of the central nervous system and how it is affected in depression.

This year we celebrate the 60th anniversary of the death of that famous cat artist, Louis Wain. It is therefore appropriate to reflect briefly on his life, his art, and in particular the rather controversial nature of his mental illness.

Louis Wain was born in London in 1860, the eldest child of William, a textile traveller, and Felicia, a designer of carpets. Louis had five younger sisters. As a child he was regarded as physically weak, not starting school until the age of 10 where his academic performance was indifferent, and from which he played truant frequently. In 1877 he went to the West London School of Art, qualifying in 1880. His first job was that of an art teacher, but he needed to supplement his income from this job by doing freelance illustrations for magazines. Eventually he gave up art teaching and became a full-time illustrator, working initially with the Illustrated Sporting and Dramatic News.

In 1884 he married Emily Richardson, a governess in the Wain household and 10 years his senior. Their happy marriage ended two years later when Emily died of breast cancer. During her illness a stray black and white kitten joined the Wain household. The kitten was named Peter and he was a great comfort to Emily in her terminal illness. While Louis sat frequently by his wife's sick bed he began drawing Peter from every possible angle. This was the first time he showed any interest in drawing cats, as prior to that he had been a general illustrator.

A case of abnormal bereavement is described in a man with borderline learning disability and Asperger's syndrome. Bereavement issues and concurrent assessment of psychiatric illness in people with pervasive developmental disorders are discussed. Particular reference is made to relevant psychopathology and possible underlying psychodynamic mechanisms.

The case of a 32 year old man with moderate intellectual disability, severe behavioural problems and psychotic symptoms is described. Having tried various traditional antipsychotics he was commenced on clozapine with a marked improvement in symptoms. Clozapine is a useful drug for the treatment of schizophrenia in the intellectually disabled who are refractory to the conventional antipsychotics. It improves aggressive and self-injurious behaviour which may be in addition to its antipsychotic effect.