Fitness to plead. A prospective study of the inter-relationships between expert opinion, legal criteria and specific symptomatology.

BACKGROUND: Psychiatrists are asked to give opinions as to fitness to plead, a legal concept. There is a dearth of research into fitness to plead in the UK, with no prospective studies and no studies involving the comparison of fit and unfit subjects. In particular, there have been no investigations into the meaning of 'unfit to plead' in terms of psychiatric symptomatology, or as to the relative importance of each legal fitness criterion in psychiatrists' conclusions as to fitness. METHOD: The study comprised a prospective evaluation of 479 consecutive referrals to psychiatrists at court. Individual legal fitness criteria were examined as predictors of unfitness. Associations of unfitness, and of individual legal fitness criteria, were examined with Brief Psychiatric Rating Scale (BPRS) symptom scores. RESULTS: The two most important of the legal criteria in clinical decisions as to unfitness were whether the person could follow the proceedings of the trial or give adequate instructions to their solicitor. The legal criteria concerning trial were more predictive of unfitness than those concerning plea. Unfitness was significantly associated with the presence of positive psychotic symptomatology, in particular conceptual disorganization and delusional thinking, but not with symptoms of anxiety, depression or withdrawal. CONCLUSION: Unfitness is most significantly associated with symptoms affecting comprehension and communication. The fitness criteria could be simplified without loss of power. These results, predominantly concerned with mental illness, may not generalize to the mentally impaired.

Mental status and functional abilities: change in institutionalized elderly women.

A study of 40 institutionalized elderly women was undertaken to determine if changes occurred in mental status and functional abilities over the course of 1 year. Although a number of studies examine factors that impact on successful adaptation in persons admitted to long-term care facilities, the longitudinal changes on functional abilities and mental status have not been addressed. These variables were examined in relation to the concept of self-care, which has been applied to the elderly only recently. Findings indicate a decline in mental status and an increase in functional dependency. Nursing implications and questions that merit further study in the area of self-care are presented.

Setting up psychiatric liaison schemes to magistrates' courts: problems and practicalities.

Guidelines are set out to aid those wishing to establish psychiatric liaison services to magistrates' courts, as recommended by the Home Office. The account is based upon 20 months' experience of running such a scheme at Clerkenwell magistrates' court in inner London. The practical problems in initiating such a service are explored together with difficulties likely to be encountered in its running. These include questions of personnel, interviewing facilities, relations with other disciplines, legal issues concerning the Mental Health Act and problems encountered in negotiating with catchment area services. Suggestions are given as to how difficulties may be overcome. The future of liaison schemes to magistrates' courts is discussed.

The Clerkenwell scheme: assessing efficacy and cost of a psychiatric liaison service to a magistrates' court.

OBJECTIVE: To determine the efficacy of psychiatric liaison schemes to magistrates' courts in shortening the period that mentally ill accused people spend in custody between arrest, the provision of psychiatric reports, and admission to hospital under the Mental Health Act 1983 and to establish the direct costs of setting up such schemes. DESIGN: A nine month prospective study of court referrals and concurrent analysis of prison records. SETTING: An inner London magistrates' court (Clerkenwell) and a large remand prison (Brixton). PATIENTS: Consecutive series of 80 remand prisoners receiving psychiatric assessment through a liaison scheme; 50 remand prisoners placed on hospital orders by magistrates' courts after being remanded to prison for reports; 364 psychiatric prisoners undergoing second opinion assessments at a remand prison; 520 offenders in a remand prison placed on hospital orders. MAIN OUTCOME MEASURES: Comparison of lengths of time spent in custody for different stages of the assessment and disposal process. RESULTS: For the 50 remand prisoners assessed in prison the mean time from arrest to appearance in court with a psychiatric report was 33.7 days and from arrest to admission to hospital 50.8 days. For those examined in court under the liaison scheme the equivalent figures were 5.4 days (t = 12.63, p less than 0.0001) and 8.7 days (t = 13.04, p less than 0.0001). The number of hospital orders made at the court increased fourfold after the liaison scheme began. The additional direct costs of the scheme were negligible. CONCLUSION: Psychiatric liaison services to magistrates' courts can greatly reduce the length of time that offenders with mental disorders spend in custody. Such schemes may increase recognition of offenders suitable for admission to hospital. A scheme could be established in some areas within existing service provision.

Disruption of appetite but not hunger or satiety following small lesions in the amygdala of rats.

Discretely localized lesions were made in the amygdala to examine how specifically they might alter various measures of feeding behavior in male rats. Behavioral tests included spontaneous intake and body weight regulation, reactivity to saccharin and quinine solutions, conditioned taste aversion, the feeding response to food deprivation, the response to glucose gavage, and teh response to dietary amino acid imbalance. Lesions in virtually all regions of the amygdala disrupted feeding behavior in some respect, but alterations in specific tasks were associated only with highly circumscribed brain damage. Body weight regulation, spontaneous food and water intake, and the responses to glucose gavage and long-term food deprivation were not altered by lesions in the amygdala. The results provide evidence that, in the rat, the amygdala may play a greater role in appetite than in hunger or safety. In particular, amygdaloid nuclei may participate in maintaining a negative bias in the reactivity to all appetitive stimuli.

Caloric consequences of sugar solutions: a failure to obtain gustatory learning.

Rats decrease total caloric intake, sometimes to the point of starvation, when sugar solutions are offered in conjunction with a daily pellet meal. This phenomenon appears to be based on a tendency to behave as if overestimating the caloric value of simple sugars. In these experiments, rats were exposed to a variety of conditions that allowed the opportunity to monitor the taste and postingestive properties of sucrose or glucose solutions. Despite these repeated opportunities to learn the true caloric value of the solutions, the rats continued to exhibit the exaggerated response. The results suggest that the gustatory receptors that have evolved to detect the normally low concentrations of sugars in the natural environment may be inherently inaccurate in response to relatively high concentrations of pure sugars. Furthermore, the rat may be contraprepared to form the quantitative gustatory associations that would be necessary to correct this error tendency.

Impact of EFNEP on some nutrition-related practices. Developing a tool to record changes.

Described are the design and preliminary administration of an instrument to measure the impact of the Pennsylvania Expanded Food and Nutrition Education Program (EFNEP) on food storage and safety, kitchen sanitation, and food money management practices of program participants. No significant differences among these practices were found when each was correlated with duration of program participation. Overall improvement, however, was revealed, particularly in the first six months in the program.

Multiple factors in short-term behavioral control of protein intake in rats.

The availability and concentration of dietary protein was varied in an examination of the nature of the day-to-day intake of protein solutions by 60-day-old male rats. It was found that the rats consumed a remarkably constant absolute amount of protein each day, adjusting overall caloric intake to maintain protein at a roughly constant proportion of total calories. Factors such as the time of access to a protein source or the extent of prior experience with a protein source were seen to influence the overall constancy of protein intake, whereas daily shifts in preference between two available concentrations of protein did not interfere with such short-term control. The mechanism for this behavioral control is likely to be different from mechanisms mediating the conditioned response to dietary protein, as in the response to dietary amino acid imbalance.

The effect of minor tranquilizers on psychomotor performance.

The effect of a standard daily regimen of chlordiazepoxide, prazepam (a new benzodiazepine tranquilizer), and placebo were examined in a three way double-blind comparison for a sample of normal volunteers. The criteria include a limited spectrum of psychomotor functions. A learning effect was conspicuous for all drugs on all criteria during the day-long sequence of ten trials. For the most part the differences between the drug groups were insignificant, but there were distinctive modifications in the performance of the chlordiazepoxide group. The clearest effect of the tranquilizer medications was found in the time estimation tests. Paradoxically, the drugs correct a naturally occurring perceptual error.

Ontogenetic dissociation of two classes of habituation.

The rates of decrement of two classes of response (an elicited startle reflex and emitted exploratory behavior) were determined in rats of two different ages (15 and 36 days). The rate of decrement in the startle reflex was not clearly differentiated as a function of age. In contrast, there was no evidence of habituation of exploration in the younger animals, whereas the older rats uniformly showed profound response decrements. This ontogenetic dissociation of the two instances of response decrement indicates that accounts of both instances in terms of a common process called habituation may be unwarranted. In addition, these data, in conjunction with earlier findings, indirectly support the possibility that reflex decrements may be relatively more dependent on brain serotonin whereas decrements in exploration may be more dependent on normal cholinergic activity in brain.

Faster acquisition of an olfactory discrimination following septal lesions in male albino rats.

Normal rats and rats with septal lesions were maintained on a 23.5-hr water deprivation schedule and trained to bar press for water reinforcement, which was available during the presentation of one odor (SD) but not another (Sdelta). Vanilla and vinegar were the olfactants. Both groups showed evidence of discrimination within the first 2-hr of training and reached asymptotic discrimination ratios greater than 90 percent, but the rats with septal lesions reached successively higher levels of discrimination faster than the controls. The results suggest a septal inhibitory influence on the olfactory bulbs.