Objective: The aim of this study was to determine the one-month frequency of hopelessness and suicidal feelings in a community dwelling elderly sample in Dublin.

Method: A total of 891 individuals of 65 years and over, without a dementia, were interviewed using the Geriatric Mental State (GMS)-AGECAT system. Items from the GMS relating to reports of hopelessness and suicidal feelings over the previous month were identified and the relationship of these items to gender and age was studied.

Result: Serious suicidal feelings were rare with 0.2% of the sample expressing a pervasive wish to die, but less intense feelings were more common with 15.5% reporting that life was not worth living. Hopelessness and suicidal feelings were present with similar gender frequencies unlike other studies which have demonstrated a higher frequency among females. Any feeling of hopelessness or suicidality was present in 18.4% of those aged 65-74 years (‘young elderly’) compared with 14.8% of those over 75 years (‘old elderly’). Depressed elderly who reported hopelessness or suicidal feelings were not more likely to be taking antidepressants than the depressives without such feelings.

Conclusion: Cultural factors may explain the pattern of suicidal feelings reported in our sample, with the more intense feelings being rare, and may influence the gender distribution. Hopelessness and suicidality is not more common in the ‘old elderly’ than in the ‘young elderly’ and should not be regarded as an integral part of ageing. The small number of elderly depressives with feelings of hopelessness or suicidality wh o are being treated with antidepressants is a cause for concern.

Objective: Gender appears to have a significant impact on the prevalence, age at onset, symptoms and outcome of schizophrenia. This study examines gender effects in a population of familial schizophrenic patients in Ireland.

Method: Families with two or more siblings suffering from schizophrenia, as defined by DSM-III-R were ascertained in Ireland. The final sample comprised 169 siblings from 80 families. Siblings were interviewed using the Structured Clinical Interview for DSM-III-R (SCID), the Scale for the Assessment of Negative Symptoms (SANS) and the Strauss-Carpenter Levels of Functioning Scale. The difference between males and females for various clinical features were calculated.

Result: There was a marked excess of affected males (65% male and 35% female). When the excess of male subjects was taken into account there was no significant excess of same-sex as compared to opposite-sex pairs. There were no significant difference between males and females for age at onset, age at first admission, symptoms or level of outcome.

Conclusion: The excess of males and the lack of gender differences for clinical features found in this study may, in part, be due to the narrow diagnostic criteria used. Alternatively, at least some of these findings may be specific to this Irish sample. Further research is a need to see if these findings can be replicated in other countries.

Objective: The following case report describes a child with autistic symptoms who experienced early emotional deprivation and institutionalisation. The paper discusses her symptoms in relation to Melanie Klein's theories on object relationships.

Method: LM was a four year old Rumanian adoptee, when she was first assessed by a child service in Dublin. On presentation, she exhibited a spectrum of autistic symptoms including an impairment in social interaction, absence of separation anxiety, poor attachment formation with others and restricted, repetitive, stereotyped patterns of behaviour. While attending the pre-school, she was involved in an individualised programme which focused on her specific needs.

Result: After attending the pre-school programme, L exhibited a greater ability to express various emotions and her social interaction with others had improved, but she continued to have marked deficits in her personality. This child's symptoms are discussed with reference to the paranoid schizoid and depressive positions associated with ego development.

Conclusion: By applying Melanie Klein's theories on object relations, one can gain a further understanding of a child's pathological symptoms, ego development and the necessary treatments required to improve these symptoms.

Objective: The report considers the utility of the Achenbach Child Behaviour Checklist in the differential diagnosis of the disruptive behaviour disorders.

Method: Subscale scores on the parent completed Achenbach Child Behaviour Checklist were compared for three of 15 boys, the first diagnosed with attention deficit hyperactivity disorder, the second diagnosed with oppositional defiant disorder and a third non-clinical control.

Result: The attention subscale of the Achenbach Child Behaviour Checklist was found to have a high level of sensitivity to children diagnosed with attention deficit hyperactivity disorder, but relatively poor specificity. The delinquent subscale was found to have limited sensitivity for oppositional defiant/conduct disorder group, but high levels of specificity. The aggressive subscale were found to have relatively high sensitivity for the oppositional defiant/conduct disorder group and relatively high specificity.

Conclusion: The Achenbach Child Behaviour Checklist is useful in distinguishing between children with disruptive behaviour disorders and a non-clinical sample. The aggressive subscale appears to have potential clinical utility in the differential diagnosis of the disruptive behaviour disorders.

Objective: The blood platelet has been proposed as a model of central neurons and may therefore be used as a peripheral marker of psychiatric illness. One method of investigating serotonin function in panic disorder has relied on the use of the platelet as a model of serotonergic neurons. This article reviews the studies of platelet function in panic disorder.

Method: A literature search and review of relevant papers was undertaken.

Result: Studies examining platelet serotonin uptake and concentration in panic disorder patients have to date yielded conflicting results, with some investigators reporting increased serotonin uptake, others reduced uptake. Similarly studies of platelet 3H-imipramine binding have also yielded conflicting results. Two studies of platelet 3H-paroxetine binding have shown a reduction in the density of binding sites (Bmax) in patients with panic disorder. Platelet monoamine oxidase activity in anxiety disorders has been reported to be increased by some investigators but decreased by others. Methodological considerations may have been responsible for these differences. Finally, studies of α2 adrenoceptor density have also produced contrasting findings.

Conclusion: The findings of these studies indicate that platelet function is altered in panic disorder. Such changes may allow an insight into the biochemical aetiology of the illness. Further studies are required to delineate the role of serotonin and non-adrenaline in panic disorder.

There has been increased interest recently in the implications of Darwinian theory on psychology, psychiatry and in medicine generally. As a result a large number of publications have appeared that attempt to reformulate a range of psychiatric disorders in the light of evolutionary theory. However, relatively little attention has been paid to the subject of suicide from the evolutionary perspective with some notable exceptions. The purpose of this brief paper is to bring the Darwinian perspective to the notice of a wider psychiatric readership hoping that this will add a further dimension to the debate on suicide and selfdestructive behaviour. Darwinia n theory had found it difficult to account for the existence of altruistic behavioural strategies in social animals until it was explained by Hamilton that the focus for selection was not the individual but the gene. Altruism here refers to any behaviour that reduces the reproductive fitness of the donor while increasing the reproductive fitness of the recipient. According to Hamilton's formulation (the kin selection theory) the individual will behave in a nepotistic manner (ie. altruistically towards kin) as this will enhance the overall chances of his genes to pass to the next generation not only through his own descendants but through non-descendant kin, a measure he termed ‘inclusive fitness’. Therefore it would not be surprising that individuals would be more likely to behave altruistically towards kin than non-kin.

We report a case of neuroleptic malignant syndrome (NMS) secondary to clozapine treatment in which re-introduction of two different antipsychotics led to elevation of creatinine kinase (CK) levels without associated symptoms of NMS. The significance of CK levels as a marker for NM S is discussed in the light of previous findings in this area. We suggest clinical guidelines for antipsychotic rechallenge after the occurrence of NMS.

A case of folie a famille is described. The presenting symptom bearer was a child thus necessitating psychiatric contact with his family. This prevented the folie a famille from remaining covert as may have occurred had an adult presented in a similar manner. The possibility is raised that folie a plusieurs has a higher incidence than previously believed. Criticism is made of the tendency of adult psychiatry and its diagnostic systems to focus purely upon the individual. The investigation, formulation and management of the case using the family is outlined.

We report the case of a patient with schizophrenia who demonstrated increased serum clozapine and norclozapine levels in association with hypertension, when treated with fluoxetine and clozapine in combination.