A controlled evaluation of assessments by doctors and nurses in a magistrates' court mental health assessment and diversion scheme.

In this study, assessments of prisoners by doctors and nurses were compared in a provincial magistrates' court mental health assessment and diversion scheme, and outcomes were compared with the outcomes of those for whom no assessments were available during a control period. Substance misuse was relatively common and psychosis uncommon in the prisoners referred. Assessment by doctors enabled magistrates to reduce remands in custody of persons suspected of suffering from mental disorder and to grant bail in more cases. Only a small proportion of prisoners were admitted to hospital and although doctors and nurses recommended out-patient treatment in many cases, the attendance rate was low. Doctors were more likely than nurses to identify prisoners with medical needs that needed to be brought to the attention of the prison health care service, and to recommend out-patient psychiatric treatment and identify relevant medicolegal issues. Prisoners assessed by nurses were less likely than those assessed by doctors to attend alcohol or drug treatment services if recommended to do so. Prisoners who were admitted to hospital after a remand in custody spent longer on remand if assessed by nurses compared with those assessed by doctors.

Silence in interview: psychiatry and the Argent conditions.

A man charged with serious sexual offences was advised by his solicitor not to answer the questions which were put to him during the police interview and in the absence of an appropriate adult whose assistance he had declined. At his trial, counsel for the prosecution wanted the jury to be allowed to draw an adverse inference from his silence. Psychiatric evidence was admitted to the effect that he had a paranoid personality disorder. On the basis of the ruling in R v. Argent 1997, in which grounds were set out for not allowing a jury to draw an adverse inference, it was submitted that the jury should not be allowed to draw an adverse influence. These grounds include mental capacity, state of of health, tiredness and personality. The trial judge accepted the submission.

Blood or needle phobia as a defence under the Road Traffic Act 1988.

A man was charged with driving over the prescribed alcohol limit. Both specimens of breath contained less than 50 micrograms of alcohol per 100 ml and he refused to submit to a blood test. His defence was that he had a phobia of blood and that he should have been allowed to claim to replace the breath specimens with a specimen of urine. Evidence that he had a phobia was accepted by the prosecution. A woman was arrested on suspicion of driving whilst unfit through drink or drugs. She was charged with refusing to provide a specimen of blood. It was her defence that she had a phobia of needles. Evidence that she had a phobia was not accepted by the prosecution. In both cases the court was asked to decide whether or not the forensic medical examiner had been seriously wrong in deciding that there was no medical reason for refusing a specimen of blood. The man was acquitted and the woman was found guilty. These cases are used to describe the law relating to blood or needle phobias and to suggest how such cases should be approached by the police and forensic medical examiners.

Pilot mental health assessment and diversion scheme for an English Metropolitan Petty Sessional Division.

A three-month pilot mental health assessment and diversion scheme was carried out at one of the busiest magistrates' courts outside London. In terms of demographic characteristics the sample of prisoners seen in this study was similar to those seen in diversion schemes in London and Manchester. Although 77 per cent of prisoners were found to be suffering from a psychiatric disorder, almost half were suffering from alcohol or drug dependence or misuse and the number with psychotic illnesses was small compared with the London sample. These differences may be partly due to the earlier diversion of acutely mentally ill prisoners from police custody into the health care system in Leeds. The low rate of psychiatric admission from the pilot scheme largely reflected these differences although in the cases of four patients admission was recommended by the assessing psychiatrist but not effected because of the lack of regional secure beds. Other problems identified by those involved in the scheme were the need for the provision of bail hostels specializing in the care of those with psychiatric difficulties and the need for the involvement of community psychiatric nurses within the assessment and diversion scheme.

Recorded psychiatric morbidity in a large prison for male remanded and sentenced prisoners.

The purpose of the study was to establish the proportion of remanded and convicted prisoners who were known from their records to have a psychiatric history. The inmate medical records of 834 out of 864 inmates resident on one day at HM Prison, Leeds, were studied. There was a recorded history of 23 per cent having seen a psychiatrist, 15 per cent having taken drugs and 16 per cent having a history of depression or self-harm. Out of 43 inmates interviewed, 18 admitted to failing to report such a history upon reception. There were eight former long-stay psychiatric patients, but only two of these had been in a hospital other than a special hospital or Regional Secure Unit. Out of the 36 residents of the hospital wing, 33 had psychiatric disorders and 10 were awaiting transfer to NHS or private psychiatric services. Various recommendations are made which may lead to an improvement in the medical reception procedure, more informed screening for suicide risk and mental disorder, greater understanding of the psychiatric histories of patients, an audit of prison health care and more effective planning of aftercare.

A psychiatric study of adult arsonists.

A series of 153 adult arsonists is described with particular reference to motives for fire-raising and psychiatric diagnosis. All had been referred for pretrial psychiatric reports and were assessed by routine clinical methods, supplemented where possible by the Personality Assessment Schedule. The series comprised mainly men, and most were relatively young, although these are also the characteristics of criminals in general. Most suffered from some form of mental disorder. Half of them had a personality disorder and a tenth were mentally handicapped. In addition to the mentally handicapped, a further 13 per cent had a history of special schooling, so that arsonists with some educational or learning difficulties made up a quarter of the total. Revenge was the most common motive, although present in only a third of the total, and the sexual element in motivation was much less common than appears to have been the case in the past. The motive of re-housing, not previously identified, was more common in women than in men. Almost two-thirds of the properties set on fire were domestic dwellings, and over a third of arsonists were intoxicated when they started the fires. Suggestions are made for further research focusing on personality characteristics which may be associated with fire-setting.

A short history of medical degrees in the University of Aberdeen.

Aberdeen University was the first university in Great Britain to recognise the teaching of medicine by the creation of a teaching post, that of "mediciner." It was first occupied by James Cumyne, the burgh medical officer. The first medical degree granted by the university was doctus in medicina--learned in medicine. The degree was first awarded in 1630. The first examination paper for the M.D. was set in 1787 at the time of proposal to unit King's and Marischal Colleges and following criticism of the sale of degrees in medicine and midwifery "for ready money." The present degrees of M.B., ChB. were introduced in 1895.

'Alcohol intoxication' or 'drunkenness': is there a difference?

The terms 'alcohol intoxication' and 'drunkenness' have hitherto been used interchangeably. A distinction between these terms is justified. Anthropological research suggests that the behaviour displayed by people who have consumed alcohol has more to do with culturally-determined expectations than with the properties of alcohol. Subjects who believe they have consumed alcohol when they have not behave more aggressively than those who believe that they have not consumed alcohol. There are significant false-positive and false-negative rates when doctors use clinical signs to judge whether or not a patient is intoxicated. People who die in police custody after arrest for offences of drunkenness include a proportion who have a negligible quantity of alcohol in the body and whose cause of death is unrelated to alcohol. It is proposed: (1) that the term 'alcohol intoxication' should refer to a state in which alcohol is present in the body; (2) its diagnosis should be based on toxicological evidence for the presence of alcohol in body fluids or tissues; and (3) the term 'drunkenness' should be used to describe behaviour displayed by people who have consumed, believe that they have consumed, or want others to believe that they have consumed, alcohol. Some clinical and legal implications of this distinction are discussed.

Alexander Wood (1725-1807): deacon of the incorporation of surgeons, surgeon-in-ordinary, Edinburgh Royal Infirmary, and 'doctor of mirth'.

This account of the Edinburgh surgeon, Alexander Wood (1725-1807), brings together information from a number of sources including the diaries of his friend and patient, James Boswell, and anecdotes recorded by James Paterson who wrote the biographical notes for Kay's Portraits. Wood was a fashionable eccentric who took a sheep and raven on his home visits and he was as popular with the poor and working classes as he was with more well-to-do patients. He was a Deacon of the Incorporation of Surgeons and one of the first Surgeons-in-Ordinary at Edinburgh Royal Infirmary. His clinical skills were admired by patients and colleagues alike and he did much to enrich the life of the Edinburgh medical fraternity.

The Manchester Nurse Rating Scales for the daily simultaneous assessment of depressive and manic ward behaviours.

Two nurses' rating scales, the Manchester Nurse Rating Scale for Depression (MNRS-D) and the Manchester Nurse Rating Scale for Mania (MNRS-M) are described. The scales were designed for the daily rating of depressive and manic ward behaviours. The inter-rater reliability coefficients (r) for pairs of qualified nurses were found to be 0.790 (MNRS-D) and 0.949 (MNRS-M). All but one of the individual items yielded significant reliability coefficients. The validity coefficients, using psychiatrists' global ratings as the criterion, were 0.533 (MNRS-D) and 0.650 (MNRS-M); somewhat higher correlations were obtained between the MNRS-D and the Montgomery-Asberg Scale and the Beck Depression Inventory, and between the MNRS-M and the Young Mania Scale. The MNRS-D was shown to be sensitive to clinical change following treatment with antidepressant drugs.

Videotapes for undergraduate psychiatry examinations: Part I--Production and assessment.

In this paper the production is described of two videotaped clinical examinations for use in assessing the ability of medical students to observe, name and interpret psychopathology. The method of preparing the videotape is described in detail and data are presented concerning the ability of each item to respond to knowledge and skills acquired during the clerkship, as well as the item-whole correlations for each text item. Examination of the changes in scores over the course of the clerkship and item-whole correlations led to a reappraisal of teaching in certain topic areas.

Videotapes for undergraduate psychiatry examinations: Part II--Comparison with other methods of assessment.

The previous paper (Rix et al., 1985) described the production of two videotaped clinical examinations for use in assessing undergraduate medical students during their psychiatry clerkship. In this paper assessments by videotape are compared with conventional assessments available to the examiners. The highest correlations were between the videotape examination results and written multiple choice questionnaire results, suggesting that they test a common area of clinical competence: knowledge and interpretation of psychopathology. Videotape examination results correlated poorly or not at all with the teachers' global ratings and clinical examination results, which may be indicative of relative success in devising procedures for the assessment of fairly independent abilities.

Sexual jealousy in alcoholics.

A hundred patients referred to an alcoholism service were assessed in terms of sexual jealousy by interview and with a Sexual Jealousy Questionnaire. The overall incidence of sexual jealousy was 35% in men and 31% in women as judged by the interview. Twenty-seven per cent of the men and 15% of the women had morbid jealousy. There was no relationship between sexual jealousy, as measured by the questionnaire, and sexual dysfunction. However, in the men there were inverse relationships between the scores for sexual jealousy and measures of sexual satisfaction and marital stability, and in the women sexual jealousy scores correlated negatively with duration of the marriage and positively with severity of alcohol dependence.

Food antibodies in acute psychoses.

Antibodies to a variety of foods, and in particular cereals, were measured in serum from 100 patients with acute psychoses and 100 elective surgical patients. For 13 out of 14 foods to which non-IgE antibodies were detected the schizophrenics had slightly more antibodies than the controls. There was an association between a possible secondary mania and the presence of IgE antibodies to wheat or rye. However, neither the schizophrenia nor the mania findings can be regarded as evidence for food allergy causing psychiatric disorder, since the immunological findings in both cases may represent consequences of the illnesses or their treatment, rather than causes of the illness.

A psychiatric study of patients with supposed food allergy.

Twenty-three patients who believed they suffered from food allergy were studied at the time of their presentation to an allergy clinic. The presence of organic food hypersensitivity could not be confirmed in 19 who attributed common neurotic symptoms to allergy; this group was almost identical, in terms of psychiatric symptomatology and general characteristics, with a group of new psychiatric out-patient referrals. There was no evidence of psychiatric disorder of food-related psychological symptoms in four patients with proven food-related atopic symptoms. The study failed to find evidence that psychological symptoms might be the result of organic reactions to foods.

Food hypersensitivity in irritable bowel syndrome.

Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.