A comparison of prescribed medication in learning disability patients before and after resettlement from hospital into the community

The use of prescribed medication was examined in 34 people with learning disability who underwent a planned resettlement from a hospital into the community. No significant differences were found in the number of subjects receiving antipsychotic, antimuscarinic, antidepressant, and anticonvulsant medication, lithium preparations, and non-psychoactive medication, just prior to discharge and 1 year after discharge. This study indicates that long-stay hospitalised adults with moderate, severe or profound mental retardation can successfully be relocated into the community--in spite of suffering from behavioural and major psychiatric disorders--with the aid of appropriate medication, psychiatric follow-up, and community resources.

Expressed emotion and a hypothetical model of relapse in schizophrenia

A hypothetical model is proposed that connects the risk of relapse in schizophrenia and expressed emotion in relatives with genetic factors in the individual, familial schizophrenia, severity of illness, family psychopathology, age of onset of the illness, and length of family exposure to a psychotic relative.

Doctors' holding power in practice: section 5(2) of the Mental Health Act 1983

Section 5(2) of the Mental Health Act 1983 (England and Wales) is a commonly used short term power of detention often implemented by junior medical staff, which has no statutory right of appeal. There is little published analysis of its use in clinical practice. A detailed case note study of its use in a psychiatric service with a large catchment area is presented. Fifty-seven per cent of the patients detained under s.5(2) were female. Affective psychosis was over-represented in detained females, while schizophrenia and paranoid states were over-represented in males. Eight per cent of s.5(2) detentions were initiated via the nurses' holding power, s.5(4). None of these patients were subsequently regraded to s.2 or 3, which may be accounted for by the finding that personality disorder and alcohol dependence were more commonly diagnosed in this subgroup. Of s.5(2) detainees, none of those with a non-psychotic disorder were regraded to s.2 or 3. Three patients had not accepted in-patient admission prior to implementation of s.5(2). Moreover, 38 per cent of all s.5(2) detentions took place within 24 hours of admission. Patients with a psychotic disorder were more likely to be detained within 24 hours of admission. Doubts regarding the validity of consent to voluntary admission in these patients are raised.

Season of birth in Down's syndrome

Previous studies have found a summer peak in the birth of individuals with Down's syndrome but have not tended to examine them into adulthood. The aims of this study were to look for evidence of a seasonal effect in birth and to uncover any differences in adulthood between those born in different seasons. The casenotes of all adults with Down's syndrome from the catchment area of a hospital for people with learning disability were examined. A summer peak in births was confirmed. Only 6% of births took place during January and February compared with the 17% expected (P = 0.019); birth during these 2 months was associated with female sex (P = 0.047). There was a trend for those born in December to March not to develop epilepsy (P = 0.053).

The treatment of refractory depression using paroxetine with lithium augmentation

1. The case is described of a 68-year-old woman with DSM-III-R major depression who was treatment-resistant to paroxetine. 2. Low dose lithium addition, at a plasma level of 0.2 mM, led to a rapid and sustained remission of her illness.

Characteristics of fire-setters. A study and proposed multiaxial psychiatric classification

BACKGROUND

The study set out to review the relationship between mental disorder and fire-setting.

METHOD

Sociodemographic, psychiatric, and medical data were retrospectively obtained from case notes of a group of 36 fire-setters referred to the North West Thames Forensic Psychiatry Service over a four-year period.

RESULTS

Of the sample, 28% were female and one-third had no mental illness; 28% had a previous medical history of possible relevance. Psychoactive substance abuse was common. There was a significant disturbance of interpersonal relationships. Eighty-five per cent lived alone, and 44% of the female fire-setters had a history of sexual abuse.

CONCLUSION

On the basis of this study, a multiaxial classification system of fire-setting is proposed.

SPECT in adult mosaic Down's syndrome with early dementia

A 52-year-old patient with mosaic Down's syndrome exhibiting clinical features of early dementia who underwent high resolution SPECT neuroimaging is reported. While a CT scan of the brain showed no abnormality, cranial SPECT confirmed the presence of marked cortical blood flow deficits.

Cerebral hemiatrophy and schizophrenia

BACKGROUND

Neuroimaging of a treatment-resistant patient with schizophrenia revealed the existence of cerebral hemiatrophy. The association of schizophrenia with cerebral hemiatrophy has not previously been reported.

RESULTS

Neuroimaging with X-ray computerised tomography showed marked reduction in the volume of the left cerebral hemisphere with secondary enlargement of the left lateral fissure and cortical sulci. High resolution cranial single-photon emission computerised tomography showed a functional deficit of the regional cerebral blood flow in the left lateral parietal and left temporal lobes.

CONCLUSIONS

Cerebral hemiatrophy may belong to the lengthening list of neurodevelopmental cerebral anomalies associated with schizophrenia.

Differential-pulse polarographic determination of zinc and manganese in various pharmaceutical and biological samples after adsorption of their morpholine-4-carbodithioates on microcrystalline naphthalene

A highly selective, sensitive, rapid and economical differential-pulse polarographic method was developed for the simultaneous determination of trace amounts of zinc and manganese in various standard alloys and pharmaceutical, biological and environmental samples after adsorption of their morpholine-4-carbodithioates on microcrystalline naphthalene in the pH range 4.1-9.0 for manganese and 6.5-10.2 for zinc. After filtration, the metal complexes are shaken with 10 ml of 1 mol l-1 HCl and determined simultaneously using a differential-pulse polarograph. There is no need to remove naphthalene from the solution. Dissolved oxygen is removed by adding a few millilitres of 4% NaBH4 solution. The detection limits are 0.06 ppm for Mn and 0.1 ppm for Zn (signal-to-noise ratio = 2). Linearity is maintained in the concentration ranges 0.06-10 ppm for Mn and 0.1-12 ppm for Zn with a correlation factor of 0.9997 and relative standard deviations of 0.95 and 0.81%, respectively. The characterization of the electroactive process included an examination of the degree of reversibility. Various parameters such as the effect of pH, volume of aqueous phase and interference of a number of metal ions on the determination of manganese and zinc were studied in detail to optimize the conditions for their simultaneous determination (based on the large difference in their Ep values) in various biological, pharmaceutical and environmental samples.

Self-inflicted intracranial injury

A man suffering from persecutory delusions attempted to commit suicide by holding the head of a three-inch masonry nail against a wall and head-butting its point until he had driven it fully into his forehead.

The clinical efficacy of maintenance electroconvulsive therapy in a patient with a mild mental handicap

A 32-year-old chronically relapsing depressed male patient with a mild mental handicap had tried different forms of pharmacotherapy which were either not tolerated or failed to prevent recurrences of episodes of psychotic depression. The use of maintenance ECT as the mainstay of the therapeutic regime led to a marked consistent clinical improvement.

Single-photon emission computerized tomography (SPECT) in neuropsychiatry: a review

Cranial single-photon emission computerized tomography (SPECT or SPET) can now give regional cerebral blood flow images with a resolution approaching that of positron emission tomography (PET). In this paper, the use of high resolution SPECT neuroimaging in neuropsychiatric disorders, including Alzheimer's disease, multi-infarct dementia, Pick's disease, progressive supranuclear palsy, Korsakoff's psychosis, Creutzfeld-Jakob disease, Parkinson's disease, Huntington's disease, schizophrenia, mood disorders, obsessive-compulsive disorder, HIV infection and AIDS is reviewed. Finally, further potential research and clinical uses, based on ligand studies, are outlined.

Determination of arsenic in crude petroleum and liquid hydrocarbons

Total arsenic was determined in crude petroleum and liquid hydrocarbons derived from crude petroleum by extraction with boiling water or boiling aqueous nitric acid (concentration 0.25 to 2.5 M), mineralization of the extracts with concentrated nitric/sulphuric acid, and reduction of the arsenate to arsine in a hydride generator. The arsine was flushed into a helium-DC plasma. The arsenic emission was monitored at 228.8 nm. The total arsenic concentration in 53 crude oil samples ranged from 0.04 to 514 mg L(-1) (median 0.84 mg L(-1)). Arsenic was also determined in several refined liquid hydrocarbons and in a commercially available arsenic standard in an organic matrix (triphenylarsine in xylene). The method was checked with NIST 1634b "Trace Elements in Residual Fuel Oil". The arsenic concentration found in this standard agreed with the certified value (0.12±0.2 μg g(-1)) within experimental error. Viscous hydrocarbons such as the fuel oil must be dissolved in xylene for the extraction to be successful. Hydride generation applied to an aqueous not-mineralized extract from an oil containing 1.67 μg As mL(-1) revealed, that trimethylated arsenic (520 ng mL(-1)) is the predominant arsenic species among the reducible and detectable arsenic compounds. Monomethylated arsenic (104 ng ml(-1)), inorganic arsenic (23 ng mL(-1)), and dimethylated arsenic (low ng mL(-1)) were also detected. The sum of the concentrations of these arsenic species accounts for only 39% of the total arsenic in the sample.

Mast cell response during the early phase of tuberculosis: an electron-microscopic study

Guinea pig lungs were infected with Mycobacterium tuberculosis by intratracheal route and examined under electron microscope to investigate the morphological alterations of the organisms, if any, and the response of the host tissue. The bacilli showed no changes in their morphology, while the host tissues revealed several cells containing many electron-dense intracytoplasmic granules. These cells were predominantly seen during the 1st week of infection. The electron-dense bodies of these cells may be the ones observed by earlier workers and suggested to be the altered forms of tubercle bacilli. The present investigation, however, revealed them to be the granules of the mast cells. These cells were observed to respond to tuberculous infection during the first few days by appearing in large numbers crowded with intracytoplasmic granules and soon disintegrating as the result of subsequent degranulation. The above observation is presented and its significance discussed.