During the past 35 years, a series of Court decisions have developed and refined the concept of automatism, defined in law as unconscious involuntary action. Two varieties of automatism have come to be recognised. In insane automatism, the absence of mens rea is caused by disease of the mind, and the defence leads to an insanity verdict with compulsory detention in hospital. In non-insane automatism, the mind is affected by some external factor and the findings result in complete acquittal. However, from the medical point of view, the distinction between exogenous and endogenous factors is naive and may lead to decisions that are contrary to natural justice and common sense. The main practical problems arise because of the mandatory commital to hospital when there is an insanity verdict and legal reform is required.

PET represents the most powerful tool available for the measurement of in-vivo brain function. The basic principles of the technique and its application to the study of brain energy metabolism and neuroreceptor function are described by reference to findings from clinical studies of cerebral metabolism in neurological and psychiatric disorders. The extension of such resting state investigations by the application of activation paradigms in dynamic studies is discussed. The potential of PET as a tool to investigate neuroreceptor function is outlined in the context of preliminary findings from studies of dopaminergic function in schizophrenic patients.

The literature on alprazolam is reviewed. It is concluded that it is an effective anxiolytic but that it is not an antidepressant. When used in sufficiently high dosage it can block panic attacks, but it is not the only antipanic agent available. It may be used as an alternative to other benzodiazepines in the acute detoxification of alcoholics. It should be avoided where there is strong individual likelihood of abuse. Chronic usage (more than a few weeks) demands a very slow tapering of dosage. Carbamazepine may ameliorate withdrawal symptoms. The use of alprazolam in other conditions remains unproven.

The two major psychiatric disorders, schizophrenia and the major affective disorders are among the most common genetic conditions in man. The precise biochemical defects which cause these disorders are unknown. This article reviews the new recombinant DNA techniques and their application to date in attempting to locate the genes responsible for these disorders. As has been demonstrated for other genetic conditions, these techniques may help to elucidate the biochemical defects which lead to the development of the more genetic forms of these psychiatric illnesses.

Over the past thirty years Lacanian psychoanalysis, by mapping psychoanalytic concepts onto the terminology of modern linguistics has seemed to radically alter the former, and to a large extent has done so. However, Lacan's insistence that we are formed by, and enmeshed in, language, occults an opposite truth; one that is evidenced by the history of politics and of art, and although psychoanalysis has traditionally remained rigidly apolitical, concentrating on the private and familial rather than the public sphere, it can hardly avoid, even in this sphere, a confrontation with the politics of feminism. Because of its particular appropriation of ‘word’ and ‘language’, Lacanian psychoanalysis finds itself in a contraditory position here. In the private sphere it liberates the little girl by the true ‘word’, while continuing to maintain, in the wider world of language, a now archaic discourse which subsumes both discourses into one, masculine one.

Caffeine remains the most widely used psychoactive drug and psychiatric populations tend to ingest more caffeine than the general community. It is important to assess caffeine intake in psychiatric patients as it may distort diagnostic signs and is known to interact with psychotropic medications. A blanket condemnation of caffeine use by psychiatric patients is, however, unwarrranted for while it may exacerbate some conditions (eg. anxiety disorders) it may prove beneficial to others (eg. schizophrenics) when used in moderate quantities. A scale for the estimation of caffeine intake is provided.

Recent research on the neurochemical deficits that accompany Alzheimer's disease (AD), senile dementia (SD) and Korsakoff's dementia (KD) have prompted renewed interest in the involvement of central cholinergic systems in learning and memory processes. Evidence for the role of cholinergic systems in the dementias is now overwhelming and has been reviewed in detail elsewhere, e.g. Briefly, such evidence includes findings of decreased cortical activity of the cholinergic marker enzyme choline-acetyltransferase (CAT), reduced activity of the acetylcholine degrading enzyme acetylcholinesterase (AChE), and degeneration of the cholinergic cells of the nucleus basalis of Meynert (nBM) and medial septal nucleus (MS). Pharmacotherapy based on a knowledge of these cholinergic deficits has included (i) ACh precursor therapy, e.g. choline, lecithin; (ii) anti-cholinesterase treatments e.g. physostigmine, tetrahydroaminoacridine (THA), disopropylfluorophosphate (DFP); or (iii) cholinergic synthesis agonists e.g. oxotremorine, arecholine. These have had some success, but it has only been modest. While lack of efficacy has been attributed in specific cases to the pharmacokinetics of some of these drugs e.g. physostigmine, bethanecol, a more general explanation is that SD not only results from a cholinergic deficit but also involves abnormalities in many other neurotransmitter systems.

Thus, more recent findings on the neuropathology of AD and the dementias have implied that while a cholinergic hypothesis of cognitive dysfunction in dementia has strong support, dementia can be considered to be a multi-system disorder. Newer studies indicate pathologies involving serotonergic, dopaminergic, glutaminergic and noradrenergic systems. This review will focus on dysfunction of the noradrenergic system and will conclude that degeneration of this system is an important substrate of cognitive impairments found in dementia.

Twenty-one drug free patients fulfilling the DSM-111-R criteria for major depressive disorder were administered an alpha2 adrenoceptor challenge test. They were then treated with an antidepressant or ECT. Six weeks later, alpha2 function was again tested and found to be universally downregulated in treatment responders. Those who failed to respond to treatment (33%) had evidence of continuing alpha2 adrenoceptor activity. These results suggest central noradrenergic overactivity as a possible mechanism for depression, which runs counter to the classic catecholamine hypothesis.

Childhood behavioural problems and social competence in children of mothers attending a Dublin general practice were studied; they were found to have a prevalence of 30%, and to be associated with maternal depression, and marital disharmony. This relationship is explored, and the possible implications for management in a general practice discussed.

The relationship between significant life events and pulmonary tuberculosis was studied with a view to ascertaining whether such events were more prevalent in patients with tuberculosis than in patients with other respiratory diseases. The study was carried out at Peamount Chest Hospital, Newcastle, Co. Dublin. Sixty-five patients with pulmonary tuberculosis and 45 patients with non-tuberculous respiratory diseases were interviewed. We found that there was a significant increase in life events in patients with active tuberculosis when compared with non-tuberculous patients.

A questionnaire containing the Multidimensional Health Locus of Control scale, a focus of coping scale, the Centre for Epidemiological Studies Depression scale, and the Hopelessness scale was posted to 50 male and 50 female Dublin members of the Multiple Sclerosis Society of Ireland. The aim of the study was to examine ways in which people with multiple sclerosis cope with their illness, and to determine whether the coping strategies used were effective or ineffective in terms of the relations between the scales that were used. Sex differences on each of the scales were also examined. Results indicated that there were some sex differences on the locus of control scale. However, no sex differences were found on the focus of coping, or on the depression and hopelessness scales. Rather, both sexes were found to have mean depression and hopelessness scores above what is considered to be the norm for both of these scales.

Minor aggression is common in a closed female villa in a hospital for the mentally handicapped. In this study it occurred most frequently between 8a.m. and 10p.m. with a lunch-time peak. More incidents occurred on Saturday than on any other day. Few of the patients were psychotic and incidents were related to meal-times and reduced supervision. The most common targets for aggressive behaviour were property and the patient herself. The most common locus for aggression was outside the Sister's office. Attention to improving communication skills and providing more supervision should help to reduce the level of aggression.

Man functions both as an individual and as part of his group, the two roles sometimes leading to conflicting needs. If mental disorder contributes to such conflict then a psychiatrist may be expected to take a leading role in arbitrating between the needs and rights of the individual patient before him and the needs and rights of society. This is not an easy task. This paper seeks to clarify the range of roles the psychiatrist may have to adopt when attempting such a task: his role as an individual, as a member of the general public, as an agent of the patient, as an agent of the patient's representative or even as an agent of state authority or society. Some of the dilemmas that arise in each of these roles are discussed.

The Kleine-Levin Syndrome (KLS) a rare disorder comprising of periodic bouts of hypersomnia and megaphagia is reviewed. The syndrome chiefly affects males. The four accepted female cases in the literature are reviewed and a new female case described. This patient had an IQ in the normal range, unlike the other three female cases where the IQ was measured. She showed an abnormal Cortisol rhythm during both a well and an unwell phase replicating the findings of other workers in some KLS patients. This patient showed normal dexamethasone suppression, a test not previously reported on in KLS. The patient also smoked excessively during the bouts, an occurrence not previously remarked on in this disorder.

Since the establishment of St. Brendan's Hospital in 1815 many changes have been seen in the pattern of psychiatric illness but none as dramatic as that of neurosyphilis. When Professor John Dunne first worked there in 1922, 20% of the patients suffered from general paralysis of the insane (G.P.I.) for which there was no cure. Around this time Wagner Von Jauregg – a Viennese physician, observed that patients who had suffered malaria during war did not suffer from G.P.I. He introduced malarial therapy successfully for which he received the Nobel Prize in 1927. Professor Dunne introduced this therapy into St. Brendan's after visiting Wagner Von Jauregg in Vienna. Unfortunately the mosquitos used would not bite! He resorted to injecting malarial infected blood. Only benign tertian malaria was effective and it is believed that the high temperatures induced – 40-41°C killed the spirochaete. This was followed by quinine treatment for malaria. The treatment was very successful but superceded in latter years by penicillin. The incidence of syphilis fell dramatically from 1942-1977, although recently it has been reported that it is rising in females and heterosexual males.

One hundred consecutive samples routinely tested for syphilis (using the Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Haemagglutination (TPHA) test), between January and April 1988 were examined. Ninety-eight were negative for VDRL and TPHA. Two patients, both male, revealed evidence of previous infection i.e. VDRL neg, TPHA positive with Fluorescent Treponema Antibody tests (FTABS) reactive and FTA IGM negative in both cases. Neither of the two patients had any signs or symptoms suggestive of neurosyphilis.

All deaths occurring in the in-patient population of the Central Mental Hospital during the period 1963 to 1987 inclusive were examined. The death rate during the total period was 11.7 per 1,000 admissions. The suicide rate during the total period was 3.9 per 1,000 admissions – there had been no suicides during the most recent five year period. Although the admission rate has been rising since the mid-1970s, the death rate over the last fifteen years has remained stable.

Many of the deaths prior to 1970 were in elderly long stay patients who died from natural causes. Five deaths in young patients are described separately – in two of these anticholinergic side effects of medication may have contibuted to the deaths. Seven suicides occcuring during the study period are described separately – four of these occurred in the months soon after admission.

Herbert Spencer Gasser (1888-1963) deserves to be remembered for introducing the oscilloscope into biology and medicine; with a prototype still in the early stages of development he overcame the evanescent nature of the nerve impulse and thus opened the way to the study of cellular electrical potentials in the nervous system. In tracing the origins of the cortical extracellular currents reflected in the waves of the scalp electroencephalogram the oscilloscope has been indispensable.

The graphic methods developed in the nineteenth century were adequate (indeed, admirable) for recording events that were measured in seconds but even the Einthoven string galvanometer that conquered millivolt changes was defeated when the unit on the time scale was the millisecond. The stream of electrons from the cathode in an evacuated (Crookes) tube, which incidentally excited X-rays in Roentgen's tube and served for amplification purposes in the thermionic valve, provided the answer. Progressive refinement of Karl Ferdinand Braun's (1850-1918) original 1897 invention into the cathode ray oscilloscope had the versatility required to follow biological processes that had previously been inaccessible because of the exceeding brevity of their duration. The realisation that the oscilloscope would capture fleeting clinical and experimental events we owe to Herbert Gasser.

Herbert Spencer Gasser was born on 5 July 1888 in the small Wisconsin town of Platteville. After local schooling he entered the nascent medical school of the University of Wisconsin at Madison where Joseph Erlanger (1874-1965) had just set up the department of physiology. After completing his clinical under-graduate course at Johns Hopkins Medical School in 1915 Gasser returned for a year to Madison before rejoining Erlanger who had moved in 1910 to Washington University in St. Louis.