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.

Computerized tomographic procedures have been used extensively since their introduction to examine specific language disabilities in aphasic patients and to correlate anatomical and clinical changes. The resulting overwhelming evidence in favour of lateralisation and localisation has been confirmed by regional blood flow studies and punctate electrical stimulation as well as by the topographic maps provided by neurometries. That specific lexical functions are localised within the peri-Sylvian cortex in the left cerebral hemisphere is now generally accepted, but the macroscopic mapping, which largely ignores the contribution of the ipsilateral thalamus and possibly of the basal nuclei, must not be mistaken for the language encoding processes in the parallel pathways which have been identified.

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.

Despite more than a decade of studies, biological psychiatry has yet to satisfactorily resolve the issue of whether new brain imaging technologies reliably indicate the presence of abnormal cerebral morphology in schizophrenia. The present Perspective offers an alternative view on this topic, as a counter-point to one previously offered in the Journal. It addresses several of the methodological problems inherent to such studies, and evaluates some of the more recent aspects of the literature. Those structural abnormalities which have been reported in schizophrenia appear most readily explicable as a consequence of neurodevelopmental anomalies.

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.

All twenty-nine bipolar 1 patents who satisfied DSM-111 criteria following their first hospitalisation for mania and subsequently discontinued their prophylactic lithium after a mean of 29 ± 21 months were studied. Patients were classified into poor prognosis (relapsed within 3 months of discontinuation, n = 8) and good prognosis groups (relapsed after 3 months or did not relapse, n = 21). Poor prognosis patients were more likely to have been prescribed additional psychotropic medication in the previous year (P = 0.026) and had higher serum lithium levels immediately prior to lithium discontinuation (P = 0.0043). Recent additional psychotropic medication may indicate that the patient is at an increased risk of early relapse if lithium prophylaxis is being stopped for any reason. The increased risk for those patients with higher lithium levels suggest that gradual phased reductions would be prudent.

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.

This paper presents the programme perceptions of male young offenders involved in 2 Dublin community training workshops. Most of the sample indicated that they perceived their training to have had an overall positive impact (ranging from a moderate to a very substantial extent) in various areas of skills and personal development. Those emerging with a higher level of self-confidence, predictably, had also perceived themselves to have benefited more in almost all areas. Ambivalent predictions of the sample in respect of their future employment and re-offending tended to be associated with fewer perceived programme benefits, than were optimistic predictions.

We studied the impact of a first myocardial infarction or episode of unstable angina on four areas of subjective health: wellbeing, perceived functional status, body confidence and emotional symptoms. A questionnaire in which the patient was asked to compare status before and after hospital admission was given to 61 cardiac patients attending follow-up rehabilitation clinics.

Worries about health and fears of straining oneself were common in the 24 patients surveyed less than 3 months from discharge. But in patients over 3 months from discharge, sense of wellbeing was significantly improved post-infarction compared with pre-infarction: 86% of patients noting a change reported an improvement. Perceived family role performance was significantly improved, while confidence in work performance and general competence remained unchanged. The prevalences of depression, anxiety and worry were unchanged from pre to post attack, patients in whom these symptoms developed being off-set by patients who lost symptoms.

Previously-reported adverse sequelae of acute coronary disease may exaggerate the extent of the problem. Restriction of studies to neurotic symptoms and failure to compare pre and post attack periods may fail to elicit improvements in quality of life associated with rehabilitation and secondary prevention programmes.

Running Title: Subjective health in post-coronary patients

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.

One hundred and sixteen new referrals who attended a psychosexual clinic and one hundred and twenty non-attenders are compared on characteristics derived from their referral letters. Only the widowed and divorced are more likely to attend. It is concluded that non-attendance cannot be predicted from the referral letter.

92 adolescents (mean age 13.8 yrs) at a North Dublin school completed the GHQ - 30 and the attitude to authority scale. A high level of psychological distress (as measured by the GHQ - 30) was found, with 44% of the sample reporting 6 or more symptoms. The majority of students (84%) however expressed pro-authority feelings. A negative correlation was found between the level of distress and positive attitude towards parents. The possible clinical relevance is discussed

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.

Suicide and attempted suicide are common phenomena amongst psychiatric inpatients and outpatients. Self-immolation or self-incineration are dramatic attention seeking events which may have religious or political significance. Deliberate self burning which incorporate these may also encapsulate elements of attention seeking, parasuicidal and suicide behaviour. The present study shows that psychiatric inpatients who choose to injure themselves by self burning are a seriously disturbed group whose intention is largely suicidal and who have a previous history of attempted suicide. They tend to be female, single, suffering from either schizophrenia or personality disorder in contrast to the majority of people who take their lives by other methods who tend to suffer from depression, alcoholism or both.

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.