The Gazette 1990

GAZETTE

SEPTEMBER 1990

duction of the drugs its use is less often required. When the patient has become accessible the main focus of treat- ment is on resocialising andhelping him to resume employment. This can be a long term problem re- " . . . since the introduction of . . . drugs [the use of ECT] is less often required." quiring careful gradation of activities from simple occupational therapy in hospital through day hospital and on to sheltered work- shops. Open employment is of course the goal but is not always reached. Impairment of volition or drive and difficulty with concen- tration may be permanent features and impossible to overcome in some cases. It is for chronic cases of schizophrenia that the whole gamut of community psychiatric care is required. Longterm main- tenance drug treatment is neces- sary in the majority of cases. • Part 2 of this article will be published in the November Gazette, and will examine the medico-legal aspects of schizophrenia.

"Most psychiatrists believe that there is a biological disorder underlying schizophrenia." phrenia are probably unduly susceptible to stress in general, be it of biological, psychological or social origin. Most psychiatrists believe that there is a biological disorder under- lying schizophrenia. In recent years weight has been given to this view by the emergence of the Dopamine theory of aetiology. Dopamine is a neurotransmitter, that is one of the chemicals which convey messages through the nervous system. It is related to Noradrenaline. The Dopamine hypothesis is based partly on the evidence that amphetamine abuse produces a syndrome very similar to schizo- phrenia and can aggravate schizo- phrenia. Amphetamines are known to enhance the effects of Noradrenaline and Dopamine. Secondly, the antipsychotic drugs which relieve the symptoms of schizophrenia produce Parkinson- ism as a side effect. Dopamine is known to be deficient in Park- inson's disease, which can be relieved by giving L.Dops. It is believed that the drugs exert their actions on schizophrenia by block- ing the Dopamine receptors. The suggestion is that the underlying disorder in schizophrenia is some disturbance of dopamine trans- mission. This is clearly not the whole answer as these drugs are much more effective in treating the acute symptoms of schizophrenia than in relieving the basic chronic symptoms. Recently CT brain scans have revealed dilated ventricles in the brains of some schizophrenics and even more recently Positron Emission Tomography has shown differences in the metabolism of the brains of patients suffering from schizophrenia when contrast- edwith the brains of normal control subjects. Treatment I will only briefly touch on the subject of treatment. For the acute phase drugs of the phenothiazine group, such as Largactil, are used to produce relief from hallucina- tions, delusions and disturbed behaviour. Sometimes ECT can be beneficial, but since the intro-

I r i sh S t e nog r a ph e rs L imi t ed

Sheila Kavanagh)

(Director:

Qualified Experienced Stenographers. Fast, efficient service. Overnight Transcripts by arrangement

Contact: Secretary, "Hillcrest", Dargle Valley, Bray, Co. Wicklow. Telephone: 0 1 - 8 6 2 1 84

A 10 WE EK C O U R SE I N P L A N N I NG LAW

A 10week lecture course in planning law will commence on October 10th, 1990 and continue until 12th December in Earlsfort Terrace, Dublin 2. The course will focus on the introduction of environmental impact assessment and on recent case law on planning enforcement. A comprehensive set of lecture materialswill be distributed at the end of the course. Further information may be obtained from T he D i r e c t o r , Ex t ra M u r a l S t ud i e s, U . C . D . , Be l f i e l d, Dub l in 4 . Te l : 6 9 3 2 4 4 .

276