Methylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencing a response-adjusted dosing regimen of sustained release methylphenidate. Despite priapism being a rare adverse reaction associated with methylphenidate, physicians and parents need to be aware as it can have significant long-term complications.

The largest single incident of the Northern Ireland conflict took place in Omagh on 15August 1998 when a car bomb exploded in the town centre killing 29 people in addition to two children (unborn twins). Four hundred were injured, 135 were hospitalised and 26 families were bereaved. The Community Trauma and Recovery Team was established following the bombing and was operational for almost three years from August 1998 to May 2001. During this period, there were 130 (83 female, 47 male) referrals of children and young people under the age of 18 years. Most were referred within the first year of the atrocity, with only 18% referred thereafter. Adolescents accounted for over 60% of those referred. Almost 68% were in town at the time of the explosion, 26% were injured and 18% bereaved. The major diagnostic category (47%) was that of post-traumatic stress disorder, followed by depression (13%) and anxiety (3%). Fifteen per cent had more than one diagnosis. The most common form of intervention available was psychodynamically informed psychotherapy followed by cognitive behavioural therapy. Parents were also seen to provide support and information about the impact of trauma on children and young people and given advice regarding management.

Montelukast (a leukotriene receptor antagonist) is a commonly prescribed medication used in the management of asthma in both children and adults. It has been associated with a possible increased risk of various neuropsychiatric events in post-marketing analyses of clinical trial data and surveillance studies. When establishing a link between a medication and side effects, it is usual to establish and enquire whether there is a chronological relationship between the commencement of the medication and the onset of the symptoms. We report a case where a number of unusual neuropsychiatric events were reported several years after commencement of montelukast in a young boy who may have a genetic predisposition and a likely psychological trigger. There was complete resolution of these symptoms upon the withdrawal of montelukast.

Establishing a physical health monitoring clinic for CAMHS patients prescribed antipsychotic medication.

This paper describes a community response to a major disaster. In this instance the disaster was the Omagh Bomb of the 75th August 1998. This event was the single most severe in terms of loss of lives and injuries throughout the course of the troubles of the past thit-fy years. The response of the local health care trust was to acknowledge in a symbolic and real way the extent of the tragedy. This paper describes the origins and evolution of this response and describes more specifically the therapeutic work of the team with children and young people over the past two years.It is sometimes mistakenly believed that children are 'resilient' to the kind of distress engendered by major trauma. The role of a Trauma and Recovery Service must be to inform and educate other health professionals, teachers and parents about the possible effects of trauma on young people, as well as offering a therapeutic service to these young people and their families.An effective service for children and adolescents needs to be multi-disciplinary. As well as 'talking therapies' there is a need for art or play therapy since children have difficulty verbalising emotional distress. A flexible approach geared to respond to the individual needs of the child also must involve the family which is the context in which the child dwells. This paper describes how various therapists have engaged some children from Omagh and in different ways helped them and their families express and integrate their experience of the bomb.