A survey of male homicide cases resident in an English special hospital

The study examines a sample of 120 male special hospital patients whose index offence was one of homicide. Demographic, criminological and psychiatric details are described and the characteristics of those committing psychotic and non-psychotic homicides are compared. The results generally confirmed most of the findings reported in international studies of abnormal homicide. Compared with other studies on in-patient populations we found a greater than expected proportion of non-psychotic homicide offenders, the majority of whom had a clinical diagnosis of personality disorder. Key factors distinguishing psychotic from non-psychotic homicide included a pre-offence criminal history, the objective relationship between perpetrator and victim and the behaviour after the offence. Psychotic men were less likely to have a prior history of criminality and substance abuse than their non-psychotic pears but they were more likely to have had previous contact with the psychiatric services and to have known their victims. Compared with the non-psychotic group the majority of psychotic offenders remained at the crime scene or summoned help. A marked age differential between psychotic and nonpsychotic offenders was not apparent in this study.

The effectiveness of cognitive therapy in the treatment of non-psychotic morbid jealousy

BACKGROUND

Although a cognitive-behavioural formulation of morbid jealousy has been described there is little empirical research into the practical usefulness of this model. This study evaluated the effectiveness of treating non-psychotic morbid jealousy using a cognitive approach.

METHOD

Cognitive-behavioural and emotional measures of jealousy were calibrated by comparison with 40 non-jealous normal controls. These instruments were used as measures of change to assess the effectiveness of cognitive therapy in altering cognitive errors in 30 morbidly jealous out-patient referrals, divided into delayed and immediate treatment subgroups to assess the stability of the condition. Both groups completed all measures immediately before and after treatment, and at follow-up.

RESULTS

The instruments demonstrated significant differences between jealous and non-jealous subjects on cognitive-behavioural and emotional aspects of jealousy. The delayed treatment group showed no significant alteration in scores on any of the instruments after 12 weeks on the waiting list, confirming the stability of the condition. In the majority of cases cognitive therapy aimed at the modification of dysfunctional cognitive processes resulted in a significant improvement on all jealousy measures, immediately after treatment and at follow-up. The improvement reported by patients was supported by the partner's ratings.

CONCLUSION

The results support the postulation of the cognitive model that modification of cognitive schema by a schema-focused treatment package results in a significant reduction in disturbance in all aspects of the jealousy syndrome.

Diversity of eukaryotic microorganisms: computer-based resources, "The Handbook of Protoctista" and its "Glossary"

The kingdom Protoctista comprises some 30 phyla, including the eukaryotic anaerobes that permanently lack mitochondria, the Phylum Archaeprotista, with its three classes: (i) Archamoebae, e.g., Pelomyxa, Mastigina, (ii) Metamonada, e.g., Giardia, Pyrsonympha, and (iii) Parabasalia, e.g., Trichomonas, Calonympha, and the Phylum Microspora (Microsporidia), e.g., Vairimorpha. These and all algae, protozoa, labyrinthulids, "water molds" (oomycota, plasmodiophorans, hyphochytrids, chytrids, etc.) and other eukaryotes excluded from plants, animals and fungi are detailed in the Handbook of Protoctista. The Illustrated Glossary of Protoctista contains descriptions of the morphology and taxonomy of these microorganisms, including the many equivalent and homologous structures with different names. The Glossary has also been made into a Macintosh-compatible CD-ROM disk.

DIAGNOSIS OF OSTEOMYELITIS IN NEUROPATHIC FOOT ULCERS

We reviewed all patients with a clinically infected foot ulcer attending a specialised neuropathic foot clinic. Neuropathy was confirmed by the inability to feel a 5.07 Semmes-Weinstein hair, areflexia and impaired vibration sense, as measured by a biothesiometer.

Of 40 patients who attended the clinic over a two-year period, six with ischaemic ulcers were excluded. The remaining 34 had plain radiographs of the foot followed by a 99mTc-MDP bone scan. If the latter was positive, an 111In-labelled WBC scan was performed with planar and/or tomographic dual-isotope studies where appropriate. Bone and WBC scans were performed in 31 patients. In ten, isotope imaging showed infection localised to the soft tissues only and conservative treatment was successful in them all. Eighteen patients were treated surgically with excision of the involved bone, which was sent for culture and histological examination.

Dual-isotope scans had a sensitivity of 93% and a specificity of 83%. 99mTc-MDP bone scans with the appropriate 111In-labelled WBC scans can reliably determine the site and extent of osteomyelitis in the neuropathic diabetic foot.

A physical map of chromosome 2 of Arabidopsis thaliana

A yeast artificial chromosome (YAC) physical map of chromosome 2 of Arabidopsis thaliana has been constructed by hybridization of 69 DNA markers and 61 YAC end probes to gridded arrays of YAC clones. Thirty-four YACs in four contigs define the chromosome. Complete closure of the map was not attained because some regions of the chromosome were repetitive or were not represented in the YAC library. Based on the sizes of the YACs and their coverage of the chromosome, the length of chromosome 2 is estimated to be at least 18 Mb. These data provide the means for immediately identifying the YACs containing a genetic locus mapped on Arabidopsis chromosome 2.

Diagnosis of osteomyelitis in neuropathic foot ulcers

We reviewed all patients with a clinically infected foot ulcer attending a specialised neuropathic foot clinic. Neuropathy was confirmed by the inability to feel a 5.07 Semmes-Weinstein hair, areflexia and impaired vibration sense, as measured by a biothesiometer. Of 40 patients who attended the clinic over a two-year period, six with ischaemic ulcers were excluded. The remaining 34 had plain radiographs of the foot followed by a 99mTc-MDP bone scan. If the latter was positive, an 111In-labelled WBC scan was performed with planar and/or tomographic dual-isotope studies where appropriate. Bone and WBC scans were performed in 31 patients. In ten, isotope imaging showed infection localised to the soft tissues only and conservative treatment was successful in them all. Eighteen patients were treated surgically with excision of the involved bone, which was sent for culture and histological examination. Dual-isotope scans had a sensitivity of 93% and a specificity of 83%. 99mTc-MDP bone scans with the appropriate In-labelled WBC scans can reliably determine the site and extent of osteomyelitis in the neuropathic diabetic foot.

Large-scale genomic sequencing: optimization of genomic chemical sequencing reactions

We have developed a streamlined, reproducible method for performing genomic chemical sequencing reactions on the genomic DNA of Mycoplasma capricolum, which has a genome size of about 750,000 base pairs and whose composition is 75% AT. The general modifications that ensure reproducibility and allow the processing of multiple samples can be widely adopted to other large-scale sequencing projects, while the specific modifications to the chemical reactions are applicable to the sequencing of other DNAs with a high AT content.

Transfer delays in a special hospital population

Forty-four cases referred for transfer/trial leave from a Special Hospital in the latter part of 1989 were followed up and their progress on 1 January 1992 was examined. Thirty-four were accepted but only 19 moved out to psychiatric units offering treatment under conditions of lesser security. Three of the original 44 patients were discharged by Mental Health Tribunals and one has died. Twenty-three have never left maximum security. Factors largely beyond the control of Special Hospital consultants accounted for most of the delay in the transfer procedure. Fifty-eight per cent of the total time taken for transfer was attributable to delays by regional/district services i the assessment, response and admission of cases. Noticeable delays in receiving Home Office recommendations were also encountered in restricted cases. Suggestions for improving current standards are made.

Exploring the Mycoplasma capricolum genome: a minimal cell reveals its physiology

We report on the analysis of 214kb of the parasitic eubacterium Mycoplasma capricolum sequenced by genomic walking techniques. The 287 putative proteins detected to date represent about half of the estimated total number of 500 predicted for this organism. A large fraction of these (75%) can be assigned a likely function as a result of similarity searches. Several important features of the functional organization of this small genome are already apparent. Among these are (i) the expected relatively large number of enzymes involved in metabolic transport and activation, for efficient use of host cell nutrients; (ii) the presence of anabolic enzymes; (iii) the unexpected diversity of enzymes involved in DNA replication and repair; and (iv) a sizeable number of orthologues (82 so far) in Escherichia coli. This survey is beginning to provide a detailed view of how M. capricolum manages to maintain essential cellular processes with a genome much smaller than that of its bacterial relatives.

Neuroleptic induced sudden death--a case report and critical review

A case report illustrates possible pathophysiological mechanisms of sudden death in psychiatric patients. Difficulties with the tendency to implicate phenothiazines as the cause of death are discussed in light of evidence that the death investigation and autopsy are often incomplete. Some suggestions are made to reduce the risk of a fatal outcome following a violent incident.

Violent incidents in an adolescent forensic unit

Violent incidents in psychiatric institutions have been the focus of much study over the past few decades. But there has been little work looking at similar incidents in child and adolescent units. The authors set out to examine whether some of the patterns observed in adult populations are true of adolescent groups. The Gardener Unit was considered appropriate in light of reports of a higher frequency of assaultative behaviour among younger clients and because of the nature of problems presented by clients needing a secure environment. All violent incidents are automatically recorded. The violent incident register was examined between 1 June 1991 and 1 June 1992 and the information cross-checked with case notes and nursing reports. Demographic details, etc. were obtained from case notes. The results indicated a slightly higher daily incident rate than adult studies. At least half of the population were involved in some form of violent episode over the 12-month period. The majority of incidents were minor in nature. Nursing staff were the most frequent targets, although females showed an excess of inwardly directed aggression (self harm). A prior history of violent behaviour did not serve as a realistic predictor of frequency of violent incidents in this study. With increasing concern regarding the care of this disturbed group of young people, it was felt important to look closely at the nature of and handling of violent incidents on this unit. A second paper will consider in detail how these incidents were dealt with.

Infection control instruction and screening for students

Cook County Hospital is a large, municipal teaching hospital with multiple academic affiliations. We sought to provide uniform infection control orientation and screening for students because many had no previous training in body substance isolation systems or infection control and trainees may be more likely to be exposed to hospital-acquired infections because of their inexperience. Each student or visiting resident must complete an educational program once each year. The program consists of a pretest, a video, and group discussion, with examples of needle-disposal boxes and protective gear, information about ways to avoid needlesticks and mucosal splashes, what to do if a contact occurs, and information on isolation and tuberculosis. The session ends with a posttest, which is then retained on file. All trainees are also required to provide a "certificate of compliance" with the hospital's infectious disease serology screening program, which includes measles, rubella, and hepatitis B surface antigen testing, as well as tuberculin skin testing. Trainees must provide an updated form annually. The program is costly, both in dollars and in personnel time, for visiting students and the hospital. Tuberculin skin test screening detected a cluster of purified protein derivative skin test conversions in medical students.

Discovery of an enzootic cycle of Borrelia burgdorferi in Neotoma mexicana and Ixodes spinipalpis from northern Colorado, an area where Lyme disease is nonendemic

An intensive enzootic cycle of Borrelia burgdorferi was seen in populations of the Mexican wood rat, Neotoma mexicana, and Ixodes spinipalpis ticks in northern Colorado. Cultures of rodent ear tissue and ticks yielded 63 spirochetal isolates: 38 N. mexicana, 2 Peromyscus difficilis, and 23 I. spinipalpis. All 63 isolates were identified as B. burgdorferi sensu lato by polymerase chain reaction; a representative subset was characterized as B. burgdorferi by SDS-PAGE and immunoblotting. A tick-derived spirochete isolate was infectious to laboratory mice and I. scapularis, the principal vector of Lyme disease in endemic areas of the United States. The risk of human contact with infected I. spinipalpis appears to be minimal from this epidemiologically silent focus in northern Colorado, since this tick is restricted to wood rat nests in this semiarid environment.

Psychopathy--a neurobiological perspective

BACKGROUND

Diagnostic and conceptual issues relating to psychopathy are widely debated, but advances in our understanding of the aetiology are limited.

METHOD

A PSYCHLIT computerised database search of publications covering five decades was supplemented by tracing back through references from existing review work.

RESULTS

Over 200 articles were extracted, and 95 were selected for review.

CONCLUSIONS

It is timely to evaluate the rôle of brain dysfunction. Biological determinants are under-researched and the lack of consistency in operational definitions in published research precludes anything more than tentative conclusions about the genetic, biochemical or electrophysiological correlates of psychopathy and antisocial behaviour. A multi-modal research programme is required in the search for a comprehensive model of psychopathy that can guide both research efforts and clinical interventions.

The correlation between clinical diagnosis of knee pathology and findings at arthroscopy

175 patients referred for arthroscopy were studied prospectively to assess the accuracy of clinical examination supplemented by standard radiology in the evaluation of knee symptoms. Clinical diagnosis of medial meniscal tears was inaccurate while greater confidence could be placed in the diagnosis of anterior cruciate ligament and lateral meniscus tears. Clinical accuracy rates could be improved if patients with minimal symptoms were excluded from arthroscopy examination.

Coming down from the ivory tower. Putting research into practice

Nursing research is often seen as belonging to the world of academics, far removed from the everyday practicalities of clinical practice. By making it accessible and asking nurses to define their response to research, a nursing development unit caused nurses to re-evaluate their practice.

Ethnicity: post-traumatic stress disorder (PTSD) differences among black, white, and Hispanic veterans who differ in degrees of exposure to combat in Vietnam

Clinical observations and empirical evidence suggest that, among Vietnam combat veterans, Blacks are more maladjusted than Whites (e.g., Parsons, 1985; Penk et al., 1985). The prediction that minority group status is associated with poorer post-war adjustment and higher rates of PTSD was examined among Vietnam combat veterans who were seeking treatment for addiction disorders. Adjustment scores among groups comparable in combat exposure were found to be similar for both Whites and Hispanics; Blacks, however, score significantly higher on both PTSD symptoms on MMPI scales. These findings indicate that ethnicity contributes importantly to PTSD in selected instances, but that minority group status alone does not account for observed differences. Additional research is indicated in which careful attention is given to the complicating and interacting role of addiction disorders in sampling.