A new dithiolopyrrolone antibiotic triggered by a long fermentation of Saccharothrix algeriensis NRRL B-24137 in sorbic acid-amended medium.

Saccharothrix algeriensis NRRL B-24137 is an actinobacterium isolated from Algerian Saharan soil. It produces bioactive compounds belonging to the dithiolopyrrolone class of antibiotics, which are characterized by the possession of a unique pyrrolinonodithiole nucleus. Dithiolopyrrolones are known for their strong antibacterial and antifungal activities. This class of antibiotics generated great interest after the discovery of their anticancer properties. In this study, an antibiotic named PR11, produced after a long bacterial fermentation (11 days) in sorbic acid-containing culture broth, was characterized as a new dithiolopyrrolone derivative. After HPLC analysis and purification, the chemical structure of this antibiotic was determined by 1 H- and 13 C-nuclear magnetic resonance, mass and UV-visible data. PR11 was thus characterized as an iso-hexanoyl-pyrrothine, a novel dithiolopyrrolone derivative. The minimum inhibitory concentrations of the new induced antibiotic were determined against several pathogenic micro-organisms. A moderate to strong activity was noted against all Gram-positive bacteria, filamentous fungi and yeasts tested. SIGNIFICANCE AND IMPACT OF THE STUDY: Given the strong activities of dithiolopyrrolones against diverse prokaryotic and eukaryotic micro-organisms including potent selective-anticancer activity, the discovery of new-related derivatives draw continuous attention for therapeutic research. Depending on nature and concentration of added precursor, Saccharothrix algeriensis NRRL B-24137 produce several dithiolopyrrolone coumpounds. In this study, sorbic acid addition combined to long fermentation duration was shown to induce the biosynthesis of a novel dithiolopyrrolone derivative. After purification and full spectroscopic and spectrometric study, the compound was characterized as iso-hexanoyl-pyrrothine. In the future investigation for novel dithiolopyrrolone discovery, fermentation duration should be regarded as a key parameter as well.

Effective biosynthesis of benzoyl-pyrrothine dithiolopyrrolone antibiotic by cinnamic acid-precursor addition in culture of Saccharothrix algeriensis NRRL B-24137.

Dithiolopyrrolone antibiotics, produced by several micro-organisms, are known for their strong antimicrobial and antitumor activities. Among of this micro-organisms, Saccharothrix algeriensis NRRL B-24137, a rare actinobacterium, has the ability to produce several dithiolopyrrolones derivatives depending on precursors added in the culture medium. After 10 days of strain fermentation on semi-synthetic medium supplemented with cinnamic acid and HPLC purification, biosynthesis of benzoyl-pyrrothine dithiolopyrrolone was evidenced through complete spectroscopic (UV-visible and 1H and 13C NMR) and spectrometric (electron impact mass spectrum) analyses. The pure molecule showed appreciable minimum inhibitory concentration values against several Gram-positive bacteria and filamentous fungi. SIGNIFICANCE AND IMPACT OF THE STUDY: Dithiolopyrrolone antibiotics, known for their strong antimicrobial activities, gained greater interest after the discovery of their antitumor properties. Depending on precursors added, Saccharothrix algeriensis NRRL B-24137 has the ability to produce several dithiolopyrrolones derivatives. Since biological activities of dithiolopyrrolones are related to their variable structure, discover of new natural analogues to be therapeutically explored remains a significant framework of research. In this study, a new dithiolopyrrolone derivative was purified from the fermentation broth of S. algeriensis NRRL B-24137. This new antibiotic, characterized as benzoyl-pyrrothine dithiolopyrrolone, was induced by adding cinnamic acid, as precursor, to a semi-synthetic medium.

Computed-tomography angiography in arterial acute intestinal ischemia: prognostic interest of vascular semiology.

PURPOSE: To investigate vascular features on abdominal Computed-Tomography Angiography (CTA) correlated with 48-h mortality in patients who underwent arterial acute intestinal ischemia (AAII) surgery. The secondary objective was to create a prognostic score on the 48-h mortality after surgery, based on the most relevant signs. METHOD: We included 104 patients who underwent surgery for acute mesenteric ischemia. 2 radiologists retrospectively blind reviewed the preoperative CTA scans. They used a standardized analysis grid for the arterial and venous vascular signs described in angiography. When signs were present, the affected abdominal quadrant was specified in coronal reconstruction. Each sign was analyzed for 48-h mortality on CTA. A score based on signs correlated with early mortality was developed and evaluated by ROC curve analysis. RESULTS: 22 patients died within 48 h. The number of superior mesenteric artery (SMA) branches was significantly reduced in deceased patients (p = 0.006). Other prognostic factors associated with 48-h mortality were decreased venous return in area number 1 corresponding to right colic flexure, proximal half of the transverse colon, proximal ileum (p = 0.04) and decreased venous return in more than 2 zones (p = 0.01). The weighted AAII48 score included 1 protective clinical item and 5 radiological items. The area under the ROC curve was 0.784 with, for a 6-point threshold value, a sensitivity of 68% and a specificity of 77%. The intraclass correlation coefficient for interobserver reproducibility of the score was 0.81 [95% CI 0.73; 0.87]. CONCLUSION: Three vascular signs on CTA were found to be prognostic factors for early mortality: SMA branches number ≤ 5 (p = 0.006), decreased venous return in area 1 (p = 0.04), and > 2 areas of decreased venous return (p = 0.01). They were incorporated into the AAII48 score. This score could help to identify patients at risk and to adapt subsequent management.

COVID-19 enabled co-authoring networks: a country-case analysis.

In this paper we seek to examine the co-authoring pattern of a select group of researchers that are affiliated with a specific country. By way of making use of standard bibliometric analysis, we explore the publication evolution of all COVID-19-related peer reviewed papers that have been (co)-authored by researchers that are affiliated with Greek institutions. The aim is to identify its advancement over time, the institutions involved and the countries with which the co-authors are affiliated with. The timeframe of the study spans from the moment that WHO Director-General declared the novel coronavirus outbreak a public health emergency of international concern (WHO, 2020. Archived: WHO timeline-covid-19. Retrieved from Archived: Who Timeline-COVID-19. https://www.who.int/news/item/27-04-2020-who-timeline---covid-19. Accessed on 10 May 2020., Archived: WHO timeline-covid-19), January 2020, to October 2020. Findings indicate that there is a steady increase in the number of publications as well as the number of scientific collaborations over time. At a cross-country level, results suggest that the affiliated institutional sectors such as the Higher Education Sector (HES) and the Government Sector (GOV) contributed the most in terms of scientific output. On an international scale, the evolution of the scientific collaboration is imprinted and distributed as a chain of affiliations that linked nations together. Such chains are represented as clusters of countries, in which the scientific connections between different countries can be visualised. It can be reasoned that a significant amount of publications (20%) is affiliated with countries having "traditionally" major scientific impact on the field of Medicine. Supplementary Information: The online version contains supplementary material available at 10.1007/s11192-021-03952-9.

Overcoming the barriers experienced in conducting a medication trial in adults with aggressive challenging behaviour and intellectual disabilities.

BACKGROUND: Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base. METHOD: A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo. RESULTS: The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited. CONCLUSIONS: Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials.

Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals' views.

BACKGROUND: There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group. METHOD: A consultation of multidisciplinary professionals was carried out by using a three-round Delphi exercise. Participants were recruited nationally. They rated their views on the importance of 139 items for the care of adults with psychosis and ID. These included 85 routine service components, 23 service user characteristics for those needing a more intensive service and 31 more intensive service components. RESULTS: Forty-nine out of 52 participants completed all three rounds of the Delphi consultation. Consensus of opinion (> or = 80% agreement as essential) was obtained on 18 of the routine service components, nine of the service user characteristics and five of the more intensive service components. The routine service components considered essential can be broadly considered under a need for a focused approach on the service user and their illness (e.g. monitoring of mental state) and the added need to work within the wider context of the service user with psychosis and ID (e.g. access to social, leisure or occupational activities). Five of the more intensive service components were considered to be essential (e.g. can react to a crisis that day). However, the routine service components considered essential already contained many components such as out-of-hours support and crisis plans also relevant to more intensive services. CONCLUSION: These findings can be used to develop further the evidence base for services in the community for this user group and to assist in the preparation of much needed service evaluation studies.

Oligomycins A and E, major bioactive secondary metabolites produced by Streptomyces sp. strain HG29 isolated from a Saharan soil.

An actinobacterial strain, HG29, with potent activity against pathogenic, toxigenic and phytopathogenic fungi was isolated from a Saharan soil sample of Algeria. On the basis of morphological and chemotaxonomic characteristics, the strain was classified in the genus Streptomyces. Analysis of the 16S rRNA gene sequence showed a similarity level of 99.3% with Streptomyces gancidicus NBRC 15412T. The comparison of its cultural and physiological characteristics with this species revealed significant differences. Moreover, the phylogenetic tree showed that strain HG29 forms a distinct phyletic line within the genus Streptomyces. Production of antifungal activity was investigated by following kinetics in shake broth. The highest antifungal activity was obtained after five days of fermentation, and in the dichloromethane extract. Two active compounds, NK1 and NK2, were purified by HPLC using a C18 column. Their chemical structures were identified through nuclear magnetic resonance experiments and mass spectrometry as oligomycins E and A, respectively, which have not been reported to be produced by S. gancidicus. The two bioactive compounds exhibited significant antifungal activity in vitro, showing minimal inhibitory concentrations (MICs) values between 2 and 75µg/mL.

Social challenges of contemporary psychiatry.

Psychiatry and society are interrelated and the biopsychosocial model continues to dominate the clinical psychiatric practice. Some doubts have been expressed in recent years about the value and the wide acceptance of the biopsychosocial model. Ghaemi (2009)1 considers it to be anti-humanistic and advocates the use of less eclectic, less generic, and less vague alternatives. The fundamental changes that have been witnessed in our times across the spectrum of biology, psychology and sociology have made necessary that a conceptual clarity should prevail. The remarkable advances in neurosciences, neurobiology and genetics tend to swing the emphasis towards a more biological basis. Psychosis for example is the condition often regarded as being biologically constructed and most independent of the social context. The symptoms, however, of hallucinations and delusions in psychosis have social meaning for the person experiencing them and are primarily defined socially.2 Furthermore, vulnerability is often the result of social trauma, whether in the form of recent stressors that trigger onset, or earlier circumstances that shape cognitive and emotional style. Moreover, the approved treatment and management of long term psychiatric disorders has involved interventions that are either directly social, or psychosocial. Furthermore, doubts have also been raised by the endophenotype project,3 related to the genetics of schizophrenia. Cohen4 suggested that there may be more individual genotypic patterns associated with schizophrenia than people with schizophrenia on the planet. A recent alternative interpretation (network approach) is gaining some support. It suggests that a stressor causes symptoms that activate other symptoms, in a circular, self-reinforcing way.5 This theory moves away from psychiatric disorders being traditionally conceptualised as categorical or dimensional models. While psychiatry has shifted its focus to a more biological approach, social factors still have an important role in crosscultural diagnosis, psychiatric disorders relating to social deprivation, rehabilitation and enabling social inclusion. The degree to which society is willing to accept people with mental health problems has an obvious impact on their quality of life. We live in a period of cataclysmic social changes with disastrous wars, increased poverty and growing income inequality. The consequences on mental health are phenomenal with epidemics of self-harm and suicidality, higher rates of depression, and intensifying diagnosis of mood and conduct disorders in children and young adults. Other adversities include the disproportional number of people with mental health problems in prisons and penal institutions, the massive escalation of dementia sufferers and the shortcomings of the aspirations of community mental health care. In addition, there is an escalating social pathology with significant numbers of refugees and asylum seekers and rising numbers of homeless particularly in urban areas of the developed world. We should not, however, overlook the better rates of treatment for mental health problems, the emphasis on human rights, the empowerment and the service users' participation and the development in global mental health. All these social factors are important to contemporary psychiatry presenting complex challenges and demanding urgent attention and action.6 There is a need to embrace the development of evidence-based mental health services and a pluralistic approach, which balances appropriately the relevance of biological, psychological and social factors associated with mental health problems. The concept Meta-Community mental health builds on the successes of biological, psychological, social and community psychiatry.7 It incorporates neurosciences, sociology, psychology and anthropology and is delivered wherever the evidence shows that it makes a difference, whether in community or hospital, prisons, schools, court-room, place of work, refugee camp or battle-front. New technologies should be included for public information and education together with e-mental health, training of providers, tele-psychiatry and self-help methods delivered via IT. The boundaries of mental health are enlarging very rapidly and indeed new stakeholders and partners should be welcomed. This opens exciting possibilities but also creates some risks and strong evidence base should continue to guide us. Likelihood of finding early diagnostic and individualized treatment for psychosis, autism and dementia are likely to be of high financial cost. The importance of the social challenges of modern psychiatry was recognised by including mental health for the first time in the New Sustainable Development Goals of United Nations that will determine the global development by 2030 aiming at the promotion of life expectancy for all.8 Strengthening the prevention and treatment of mental health problems is a massive task for sustainable development as mental health has a direct impact on the whole range of Sustainable Development Goals.

Antifungal activity of a Saharan strain of Actinomadura sp. ACD1 against toxigenic fungi and other pathogenic microorganisms.

A new strain of actinobacteria, designated ACD1, was isolated from a Saharan soil sample in the Hoggar region (Algeria). Morphological study led to this strain being classified as a member of the Actinomadura genus. Phylogenetic analysis based on the 16S rRNA gene showed that the strain is closely related to Actinomadura sediminis DSM 45500(T) (98.5% sequence similarity). Furthermore, strain ACD1 presented a strong activity against mycotoxigenic and phytopathogenic fungi, including Aspergillus and Fusarium strains, and other pathogenic microorganisms. The kinetics of antimicrobial activity were investigated on ISP-2, Bennett and TSB media. Four solvents (n-hexane, dichloromethane, ethyl acetate and n-butanol) were used for the extraction of the produced antibiotic. The highest antimicrobial activity was obtained using the butanolic extract from the ISP-2 medium after seven days of fermentation culture. The active antibiotic was purified by reverse-phase HPLC using a C18 column. The UV-visible and mass spectra were determined. The minimum inhibitory concentrations (MIC) of this antibiotic were determined against pathogenic microorganisms.

Mental health services commissioning and provision: Lessons from the UK?

The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers, and transparency too. On the other hand, it is hard to implement necessary governance and control without worsening bureaucracy and inefficiency. The pursuit of market efficiencies has been particularly contentious in mental health care, where many professionals are defensive about the risks to vulnerable patients and to traditional ways of professional working. Developments and debates in the UK may be instructive for others. We conclude this paper with a set of questions that may help inform debate and evaluation of mental health services internationally.

A randomized double blind group comparative study of sulpiride and amitriptyline in affective disorder.

A randomized double blind group comparison study of sulpiride and amitriptyline was carried out in 36 patients suffering from major depressive disorder (DSM III criteria). Sulpiride showed equivalent antidepressant activity to amitriptyline at 4, 6 and 12 weeks, using the Hamilton Rating Scale (HRS) and the Wakefield Self-Rating Scale for depression (WRS). However, at 24 weeks the antidepressant activity of amitriptyline was just statistically significantly better than that of sulpiride. Timing of onset of action was comparable in both drugs. The anxiolytic activity of sulpiride was equivalent to that of amitriptyline at 4, 6, 12 and 24 weeks using the Salkind Manifest Anxiety Inventory as a measure. There were no significant differences between the two groups, of variables measured by the Crown-Crisp Experiential Index, a life events scale and Paykel's Social Adjustment Scale.

Trazodone--a comparison of single night-time and divided daily dosage regimens.

The antidepressant efficacy, influence on sleep variables and incidence of side-effects of trazodone (100-400 mg daily), given either as a single night-time dose or thrice daily, were compared in a double-blind, 4 week, parallel group, multicentre hospital study. Of 56 patients who entered the study, full data was available for 37, of whom 20 took the medication at night and the other 17 received divided doses during the day. The results showed equivalent therapeutic efficacy for the two dosage regimens and tolerance was good in both groups. For onset and also duration of sleep, significantly more patients in the single night-time group improved than worsened in response. Both groups of patients tended to report a more satisfying sleep and greater freshness on waking, although these latter effects were not statistically significant. For the group taking trazodone thrice daily, there was a trend for more complaints of side-effects, particularly dry mouth, headache and drowsiness which led to more of these patients requiring modification of dosage. Thus trazodone appears to have clinically useful sedative properties. It has relatively few side-effects and these are generally reduced by giving a single dose at night.

Amino acid levels in depression: a preliminary investigation.

Plasma, cerebrospinal fluid and brain tissue amino acid levels were measured in 14 patients with affective illness and generally confirm previous findings. There was no correlation between these values and age, sex, family history and levels of anxiety. GABA levels measured in cortex tissue were negatively correlated with depressive mood (P less than 0.05), supporting a possible involvement of GABA in depressive illness.

Bromocriptine in depression.

A double-blind trial was carried out in 9 patients with endogenous depression to compare the effectiveness of bromocriptine (15 mg per day, 4 patients) with that of imipramine (75 mg per day, 5 patients) over a period of 10 weeks. The results of assessments using the Hamilton Rating Scale for Depression showed that both drugs produced comparable reduction in mean scores and there was no significant difference between the two treatment groups. Fewer patients han anticholinergic type side-effects on bromocriptine although some had transient nausea.

[Cancer of the uterine cervix in young women. A retrospective study of 337 cases]. / Cancer du col utérin chez la femme jeune. Etude rétrospective de 337 cas.

A retrospective study of 337 cases of cervix cancers in women aged 35 years and under, treated between 1980-1990 at the Ibn Rochd Oncology Center in Casablanca, was analyzed in order to determine the main characteristics of this disease and the influence of age on prognosis. The incidence of these cases was stable throughout the 11 years study period with a mean of 7.4% of all cervix cancers. The rate of early sexual activity in age under 18 years was particularly high, with 80%, of which 45.4% before the puberty. The advanced cases were predominating (58.2%). Earlier cases were treated with combined radiotherapy and surgery and advanced cases with radiotherapy alone. Overall survival rate was 41% at 5 years. It was 45.2% for the 31-35 years of age group and 32% for women aged 30 years and less. The prognosis of these younger women was especially poor in tumoral volume more than 3 cm, in advanced cases, in undifferentiated carcinoma and in cases of lymph node involvement. The comparative analysis of all prognostic factors in function of the age had permitted to show that women aged 31-35 years old have been a good prognosis, concerning survival at 5 years, in regard to women less 30 years.

[Colorectal cancer in patients younger than 40 years of age]. / Cancers rectocoliques chez le sujet de moins de 40 ans.

Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.

[Combination of endoscopic resection and external radiotherapy in carcinoma of the bladder]. / Association de résection endoscopique et de radiothérapie externe dans les carcinomes de la vessie.

The authors present results that were obtained by combining endoscopic resection and external beam radiation therapy in a population of 55 patients presenting with bladder cancer. They also explain the difficulties they encountered in the management of bladder cancer at the Ibn Rochd Cancer Center (Casablanca, Morocco).

[Conformal therapy of locally advanced cholangiocarcinoma of the main bile ducts]. / Radiothérapie conformationnelle des cholangiocarcinomes de la voie biliaire principale localement évolués.

PURPOSE: Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma. PATIENTS AND METHODS: Eight cases were irradiated after a radical resection (R0), because they were N+; seven after microscopically incomplete resection (R1); seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases. RESULTS: Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among R0N+ cases might be related to the absence of a boost to the "tumor bed". In R1 patients, relapses were mainly distant metastases, whereas local and peritoneal recurrences predominated in R2. CONCLUSION: Conformal radiochemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma.

Services for people with mental retardation and psychiatric disorders: US-UK comparative overview.

Mental health services for people with mental retardation have been receiving greater attention over recent years following a long period of inactivity. The main policy factors which influenced the developments of services were in the USA, the emphasis on deinstitutionalisation and normalisation, and in the UK the focus on social care. Progress in the assessment of psychiatric disorders and improved diagnostic techniques have stimulated the development of a wide range of mental health services for people with mental retardation, compatible with current ideology of community care on both sides of the Atlantic. Specialist multidisciplinary, community based and easily accessible mental health services should be available for people with mental retardation. Economic cost, quality of care, and training of professionals and direct care staff, remain some of the challenges faced by purchasers and providers of mental retardation and mental health services in both countries.

General practitioner referrals to an ambulatory psychiatric service. The effects of establishing an ease of access service.

The effects of establishing an ease of access 'walk-in' service on General Practitioner referrals to the ambulatory services of a catchment area psychiatric service are outlined. The characteristics of the patients referred are described. GPs made immediate and sustained use of the walk-in service and its creation expanded use of the ambulatory services by an overall 50%. Individual GPs were found to use the ambulatory services disproportionately and to discriminate between their use of the walk-in service and the coexisting traditionally run outpatient clinic. The walk-in service also allowed patients to refer themselves; a policy which did not result in a flood of inappropriate referrals but enabled patients, already familiar with the service, to re-establish contact in times of distress. The findings are discussed in terms of the current growth of Community Mental Health Centres in the United Kingdom and their implications for GP/Psychiatric Service liaison.