After the horror

Post traumatic stress disorder symptoms in prisoners following a cell mate's hanging

Post traumatic stress disorder (PTSD) is a well recognised condition which occurs in people who have been exposed to severe trauma as victims, potential victims or witnesses. A review of case notes of all prisoners transferred since 1988 to a national forensic psychiatric hospital following traumatic hanging events in prison revealed that all patients had psychological symptoms and four had symptoms probably fulfilling PTSD according to DSM III R criteria. Our findings are discussed with reference to the literature on PTSD, the nature of the prison environment, the premorbid personality of prisoners, and the implications for dealing with the effect of suicide within a prison setting.

Focal retrograde amnesia and the attribution of causality: An exceptionally critical view

A detailed critique of the literature on focal retrograde amnesia is provided. Some of the cases commonly cited in this literature had, in fact, severely impaired anterograde memory, most often involving visuospatial material. Other cases showed poor anterograde memory in more moderate or subtle form, begging the question of whether "like" had really been compared with "like" across the retrograde and anterograde domains: there may be alternative explanations for the observed patterns of performance. One suggestion is that these patients suffer an impairment of long-term consolidation, an attractive hypothesis but one which requires much more rigorous testing than has occurred to date and which implies that the underlying problem is not specific to retrograde memory. Moreover, within the literature on cases of focal retrograde amnesia, differing patterns of performance on tests of autobiographical memory or remote semantic knowledge have been reported, and sometimes these may have reflected factors other than the sites of lesions. Many of the most convincing cases in this literature have been those in whom there was an initially severe anterograde amnesia as well as an extensive retrograde loss: in these cases, the critical issue is what determines differential patterns of recovery across these domains-it is likely that both physiological and psychological factors are important. A second, somewhat different, group are patients with semantic dementia, who show a pronounced recency effect in remote memory but, in these cases, the most parsimonious explanation may be in terms of predominantly semantic/linguistic and/or strategic factors. A third group are those with transient epileptic amnesia but, in these cases, the memory gaps may reflect past (anterograde) ictal activity. A fourth group are those in whom psychogenic factors may well be relevant. Although it is difficult to "prove" psychological causation, the logical difficulties in attributing causation where brain lesions are either very subtle or multiple have been considerably underestimated in the neuropsychological literature. Given these problems, in uncertain or equivocal cases, it is as critical to present the relevant psychological data for the reader to evaluate as it is to provide the pertinent memory test scores: this is underemphasised in many of the studies reviewed. Publication of cases in the absence of such data may lead to faulty clinical, neuropsychological, and cognitive conclusions. Abbreviations : AA: anterograde amnesia; AMI: Autobiographical Memory Interview; PTA: posttraumatic amnesia; RA: retrograde amnesia; RMT: Recognition Memory Test; TEA: transient epileptic amnesia; TGA: transient global amnesia; WMS: Wechsler Memory Scale.

Violence towards doctors: prevalence and effects

Violence against doctors has already been identified as a matter of particular concern. Both the severity and the psychological sequelae of violence are difficult to quantify. This study was aimed at measuring the rates and severity, and determining the effects, of violence in doctors working in a general hospital.

The Bhopal accident and methyl isocyanate toxicity

The Bhopal accident, the world's worst industrial disaster, in which nearly 40 metric tons of methyl isocyanate (MIC) was released from the Union Carbide pesticide plant, occurred nearly 10 yr ago during the night of December 2 and 3, 1984. Over 3000 people residing in areas adjacent to the plant died of pulmonary edema within 3 d of the accident. Follow-up studies revealed pulmonary, ophthalmic, reproductive, immunologic, neurological, and hematologic toxicity among the survivors. Despite high reactivity, MIC can traverse cell membranes and reach distant organs, perhaps as a reversible conjugate with glutathione, which may explain some of the systemic effects of MIC. MIC can be degraded as a result of pyrolysis and interaction with water, but none of the breakdown products can duplicate the toxicity observed in Bhopal and in animal models. MIC may be the most toxic of all isocyanates because of its very high vapor pressure relative to other isocyanates and because of its ability to exert toxic effects on numerous organ systems.

The Ramstein airshow disaster

In August 1988 an aircraft of the Italian aerobatic display team fell into the spectator enclosure at the Ramstein Airshow, causing over 500 casualties. The survivors were triaged, treated and evacuated from Ramstein within 96 minutes. The speed and efficiency of this evacuation was a result of prior planning, thorough training, medical reinforcement, co-operation with other agencies and the availability of an abundance of vehicles for both air and road evacuation. Not suprisingly, though, problems did occur, especially with communications, casualty identification and documentation.