Objective: To ascertain the outcome of depression and factors associated with outcome over a minimum followup period of 12 months in patients referred to an Old Age Psychiatry Service.

Method: A retrospective study was performed. All depressed patients assessed by the service between January 1989 and December 1990 were followed up. This included patients seen on domiciliary and consultationliaison visits. Follow up data included information on physical, psychological, cognitive and social parameters using standardised scales where appropriate. Outcome of depression was assessed using a six point scale to enable comparison with other studies.

Results: 86 patients with a primary diagnosis of depression were seen in 1989 and 1990. At follow up, 37% were dead. 50% of patients alive at follow up were well and 7% were demented. Patients seen on domiciliary visits had the best outcome, and those with physical illness or cognitive impairment at presentation the worst outcome.

Conclusion: The association between physical status and outcome highlights the need for close monitoring of both physical and mental status of depressed elderly patients.

Objective: The groupwork programme in this study sought to engage HIV positive drug misusers within a prison setting in order to introduce ideas and information, and by so doing promote desired behavioural changes in terms of risk behaviour and drug addiction. Such an effort was also seen as a strategy to help prisoners cope with imprisonment and to prepare them for the demands that they might face following release.

Method: Various methods of giving information and discussion were employed in order to influence members' views and behaviour. The interactions between group members were recorded using a modified version of Bale's Interaction Process Analysis Instrument during each session. In this way it was possible to analyse individual member's functioning as well as that of the whole group over the duration of the programme.

Results: While significant changes in members' views and behaviour could not be proven, an analysis of the group's communication, control, evaluation and decision making profiles reflected effort and engagement in tackling the subject inputs. Analysis of individual member's contributions was, however, open to more speculative interpretation.

Conclusion: The positive response from group members, combined with an analysis of the results suggests that the approach adopted in the programme was an encouraging step in devising an acceptable and relevant educational and treatment strategy in dealing with this usually reluctant client group, many of whom are unresponsive to traditional treatment methods.

Objective: Irish psychiatrists may begin to spend, as their British have counterparts have, at least some of their time delivering a psychiatric service from primary care settings. It was therefore decided to review the origins and development of attitudes towards and outcome this practice in Britain.

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

Results: Collaboration between psychiatrists and general practitioners began to expand significantly in the 1970s and 1980s. Three main models are used, the shifted outpatient model, the selected consultation model and the liaison-attachment team model. The shifted out-patient model is liked by patients whose attendance rate is better at such clinics and in some areas this model has resulted in a fall in hospital admission rates. There is a paucity of papers examining outcome of the other models. Results of the one extensively studied team liaison approach reports higher treated prevalence rates and lower admission rates for those patients referred. There was no effect on detection of illness by GPs and the service was much more costly.

Conclusions: While some benefits may result from use of the shifted out-patient approach, they are not compelling enough to enable a firm recommendation for its widespread implementation to be made. The results to date suggest the team-liaison approach does not produce benefits sufficient to outweigh the increased cost. The selected consultation model may hold greater potential but needs to be more extensively researched. Finally the structure of general practice in Ireland, with so few GPs working in multiple partner practices makes it highly unlikely that the widespread introduction of collaboration will be feasible.

There is broad agreement in the literature that depression in the community dwelling elderly is under-diagnosed and under-treated by general practitioners. Somatisation, overlap with medical illness, bereavement and atypical presentations of depression in this age-group may contribute to the difficulties in diagnosis in primary car settings. Furthermore, the apparent reluctance of primary care physicians to treat depression in the elderly may reflect the mistaken notion that depression in this population is a benign condition, an understandable reaction to physical illness and as such untreatable. Fundamental changes in the patterns of collaboration between psychiatry and general practice will be necessary to overcome these barriers to the detection and treatment of depression in the community dwelling elderly.

A case of Munchausen syndrome associated with habitual voluntary false confessions is described. It is suggested that voluntary false confessions may be an overlooked feature ofMunchausen syndrome. Furthermore, it is suggested that this case raises the possibility that a yet unidentified variant of Munchausen syndrome may exist which substitutes prison for hospital.

A 21 year-old woman with Prader-Willi syndrome (PWS) and a delusional disorder (paranoid psychosis) is described. Other reports of psychoses associated with PWS are reviewed. Reasons for the co-existence of the two disorders are considered, with discussion of the possible role of auditory information processing deficits in the genesis of psychotic symptoms. Such symptoms must be differentiated from maladaptive behaviours not arising from psychosis, the latter being relatively common in PWS. Treatment with a small dose of flupenthixol greatly reduced the impact of the patient's psychotic symptoms, with a corresponding improvement in her quality of life.

There are few reports in the literature of schizophrenia in individuals with Down's syndrome, but a suggestion that such individuals may be protected from schizophrenia. We report six cases of schizophrenia fulfilling ICD-10 guidelines, occurring in people with Down's syndrome. In one case, hypothyroidism was associated. Response to neuroleptic treatment was good. Reasons for the paucity of previous reports on this association are discussed.

Objective: Case notes on 116 patients aged 65 or more admitted to a general psychiatry hospital over a three month period were examined to assess the current use of haematological screening tests.

Method: Retrospective justification for tests performed, rate of abnormal results, and consequences for patient management were assessed by case note review.

Results: A total of 200 screening tests, 105 of which appeared justified, were performed; 66 patients were screened, of whom 85% had at least one abnormal result. Those who were older were less likely to be screened. There was no relationship between diagnosis and being screened. Of the 90 abnormal results received, less then one third affected clinical management.

Conclusions: The financial and other costs of screening tests are discussed. The current use of haematological screening tests in this population appears erratic and often adds little to patient management.

Objective: In recent years a number of articles have highlighted deficiencies in drinking histories taken by junior doctors. This study examines whether standards have improved as a result. It also examines for the first time: 1. the quality of drinking histories taken from patients following parasuicide; and 2. the quality of illicit drug usage histories.

Method: An audit of case notes was undertaken of 114 patients admitted to a district hospital's acute psychiatric wards or assessed following overdose. Two periods were considered; one preceding many of the articles, and the second four years later.

Results: There was an overall improvement from 58% of histories in 1988 having no mention of alcohol usage to 25% in 1992. (X2MH=10.57, p<0.01). There was, however, insufficient improvement of quantitative histories to reach statistical significance. Histories taken as part of an overdose assessment were not significantly different from those taken for inpatient admission. In 1992, 27% of patients had any illicit drug usage history recorded which represented a statistically significant improvement (X2MH=5.91, p<0.02) compared with four years earlier.

Conclusions: Although improvements have been noted, alcohol and drug histories remain inadequate.