Psychiatric treatment in prison: a missed opportunity?

National Health Service Executive guidelines require psychiatric services to maintain links with prisoners previously subject to the Care Programme Approach (CPA) and to participate in discharge planning. We are unaware of previous studies assessing the involvement of general psychiatric services with patients in prison or prisoners' perceptions of their needs. Consecutive referrals to a prison psychiatric liaison service over a three-month period were screened for previous psychiatric contact. Half of those interviewed reported previous psychiatric contact. Two-thirds were in contact with services at the time of detention. One-third believed services knew of their imprisonment. Ninety-three per cent believed they would require psychiatric support after release. Few patients received input from general psychiatric services during imprisonment despite a high level of perceived need. Improved liaison would help facilitate both care in prison and discharge planning in the spirit of CPA and the government directive.

Proactive interference and complexity.

C. L. Isaac and A. R. Mayes (1999a, 1999b) compared forgetting rates in amnesic patients and normal participants across a range of memory tasks. Although the results are complex, many of them appear to be replicable and there are several commendable features to the design and analysis. Nevertheless, the authors largely ignored 2 relevant literatures: the traditional literature on proactive inhibition/interference and the formal analyses of the complexity of the bindings (associations) required for memory tasks. It is shown how the empirical results and conceptual analyses in these literatures are needed to guide the choice of task, the design of experiments, and the interpretation of results for amnesic patients and normal participants.

A context noise model of episodic word recognition.

Item noise models of recognition assert that interference at retrieval is generated by the words from the study list. Context noise models of recognition assert that interference at retrieval is generated by the contexts in which the test word has appeared. The authors introduce the bind cue decide model of episodic memory, a Bayesian context noise model, and demonstrate how it can account for data from the item noise and dual-processing approaches to recognition memory. From the item noise perspective, list strength and list length effects, the mirror effect for word frequency and concreteness, and the effects of the similarity of other words in a list are considered. From the dual-processing perspective, process dissociation data on the effects of length, temporal separation of lists, strength, and diagnosticity of context are examined. The authors conclude that the context noise approach to recognition is a viable alternative to existing approaches.

Expecting dirt but saying dart: the creation of a blend memory.

During a naming task, time pressure and a manipulation of the proportion of related prime-target pairs were used to induce subjects to generate an expectation to the prime. On some trials, the presented target was orthographically and generally phonologically similar to the expected target. The expectancy manipulation was barely detectable in the priming data but was clearly evident on a final recognition test. In addition, the recognition data showed that the nearly simultaneous activation of an expectation and sensory information derived from the orthographically and phonologically similar target produced a false memory. It is argued that this represents a blend memory.

Target similarity effects: support for the parallel distributed processing assumptions.

Recent research has begun to provide support for the assumptions that memories are stored as a composite and are accessed in parallel (Tehan & Humphreys, 1998). New predictions derived from these assumptions and from the Chappell and Humphreys (1994) implementation of these assumptions were tested. In three experiments, subjects studied relatively short lists of words. Some of the lists contained two similar targets (thief and theft) or two dissimilar targets (thief and steal) associated with the same cue (robbery). As predicted, target similarity affected performance in cued recall but not free association. Contrary to predictions, two spaced presentations of a target did not improve performance in free association. Two additional experiments confirmed and extended this finding. Several alternative explanations for the target similarity effect, which incorporate assumptions about separate representations and sequential search, are rejected. The importance of the finding that, in at least one implicit memory paradigm, repetition does not improve performance is also discussed.

Dual processes in recognition: does a focus on measurement operations provide a sufficient foundation?

Current theoretical thinking about dual processes in recognition relies heavily on the measurement operations embodied within the process dissociation procedure. We critically evaluate the ability of this procedure to support this theoretical enterprise. We show that there are alternative processes that would produce a rough invariance in familiarity (a key prediction of the dual-processing approach) and that the process dissociation procedure does not have the power to differentiate between these alternative possibilities. We also show that attempts to relate parameters estimated by the process dissociation procedure to subjective reports (remember-know judgments) cannot differentiate between alternative dual-processing models and that there are problems with some of the historical evidence and with obtaining converging evidence. Our conclusion is that more specific theories incorporating ideas about representation and process are required.

Anal ultrasound predicts the response to nonoperative treatment of fecal incontinence in men.

OBJECTIVE: To assess the etiology, treatment, and utility of anal ultrasound in men with fecal incontinence and to review the outcomes of conservative (nonoperative) treatment. SUMMARY BACKGROUND DATA: The etiology of fecal incontinence in women is almost exclusively from obstetric or iatrogenic surgical injuries resulting in damage to the anal sphincters and/or pudendal nerves. Corresponding data on men with fecal incontinence are sparse. METHODS: Between January 1995 and January 1998, 37 men with fecal incontinence were evaluated in the John Radcliffe Hospital anorectal ultrasound unit. Their clinical histories, anal ultrasound results, anorectal physiology studies, and responses to conservative therapy were reviewed. RESULTS: Median age was 57 years. Major incontinence was present in 27% of the patients. Anal ultrasound localized anal sphincter damage in nine patients, and the characteristics of these nine patients with sphincter damage were then compared with the remaining 28 without sphincter damage. Prior anal surgery was more common in patients with sphincter damage. Hemorrhoids were more common in patients without sphincter damage. Anorectal physiology studies revealed significantly lower mean maximum resting and squeeze pressures in patients with sphincter damage, confirming poor sphincter function. With 92% follow-up, patients without sphincter damage were more likely to improve with nonoperative therapy. CONCLUSIONS: Anal ultrasound is extremely useful in the evaluation of fecal incontinence in men. Unlike women, the majority of men do not have a sphincter defect by anal ultrasound, and conservative management is usually successful in these patients. In contrast, in men with anal sphincter damage, almost all of these defects resulted from previous anal surgery. Conservative management rarely is successful in these cases, and surgical repair of the anal sphincter may be indicated. Therefore, because the presence or absence of sphincter damage on anal ultrasound usually predicts the response to nonoperative treatment, anal ultrasound should be used to guide the initial management of men with fecal incontinence.

Creating proactive interference in immediate recall: building a dog from a dart, a mop, and a fig.

Phonemic codes are accorded a privileged role in most current models of immediate serial recall, although their effects are apparent in short-term proactive interference (PI) effects as well. The present research looks at how assumptions concerning distributed representation and distributed storage involving both semantic and phonemic codes might be operationalized to produce PI in a short-term cued recall task. The four experiments reported here attempted to generate the phonemic characteristics of a nonrhyming, interfering foil from unrelated filler items in the same list. PI was observed when a rhyme of the foil was studied or when the three phonemes of the foil were distributed across three studied filler items. The results suggest that items in short-term memory are stored in terms of feature bundles and that all items are simultaneously available at retrieval.

Psychiatric morbidity and skin disease: what dermatologists think they see.

It has been suggested that skin disease and psychological disturbance may be linked. Recent work has focused on the fatal outcome associated with some dermatological disorders as a result of suicide. The impressions of dermatologists about how much psychological or psychiatric morbidity they see related to dermatological disease has not been addressed. The survey reported here revealed that most dermatologists recognized the relationship and demonstrated the perceived need for clinical psychology and psychiatric services for patients with dermatological disorders. It confirmed the impression that in a small number of cases, skin complaints are associated with attempted or completed suicide.

A naturalistic study of the word frequency effect in episodic recognition.

In order to separate the effects of experience from other characteristics of word frequency (e.g., orthographic distinctiveness), computer science and psychology students rated their experience with computer science technical items and nontechnical items from a wide range of word frequencies prior to being tested for recognition memory of the rated items. For nontechnical items, there was a curvilinear relationship between recognition accuracy and word frequency for both groups of students. The usual superiority of low-frequency words was demonstrated and high-frequency words were recognized least well. For technical items, a similar curvilinear relationship was evident for the psychology students, but for the computer science students, recognition accuracy was inversely related to word frequency. The ratings data showed that subjective experience rather than background word frequency was the better predictor of recognition accuracy.

Cuing effects in short-term recall.

Past research indicates that short-term memory can be immune to the effects of proactive interference (PI). Past research also indicates that immunity to PI is found only in those circumstances where phonemic representations of to-be-remembered items are present and provide discriminative information. The first three experiments demonstrate the existence of a further boundary condition. PI is observed only if interfering and target items are subsumed by the same cue. This finding suggests that short-term recall, like long-term recall, is cue dependent. Cuing effects are further explored in two experiments that manipulate category dominance. The finding that category dominance effects parallel PI effects strongly suggests that retrieval cues play a critical role in short-term recall.

Prevalence of psychiatric morbidity among remand prisoners in Scotland.

BACKGROUND: Determining the prevalence of psychiatric disorders among remand populations has been made a priority in England and Wales. Differences in legal process and psychiatric services in Scotland make similar research there important. METHOD: Demographic data were collected on 389 prisoners, the clinical Interview Schedule was completed and cognitive function assessed. RESULTS: The prevalence of major psychiatric disorders was low. Less severe symptoms were more common. The sample was of average IQ, but low educational attainment. Reported drug abuse was high. CONCLUSIONS: Few of those interviewed required hospital care, but other symptoms and drug-related problems may place heavy demands on prison medical and psychiatric services.

Transient phonemic codes and immunity to proactive interference.

Empirical data indicate that when memory for subspan lists of taxonomically related material is tested immediately after study, prior experience with lists involving the same material has no effect upon recall or recognition. In six experiments, we explored the possibility that immunity to proactive interference (PI) is related to discriminative information that is provided by transient phonemic codes. In these experiments, we manipulated the strength of phonemic codes as well as their presence or absence. Immunity to PI was found only when it was presumed that a phonemic representation of the target items existed and that information provided discriminative information. In all other cases, PI was observed. The finding that PI effects correspond with the manipulation of phonemic information in a principled fashion provides strong evidence for the role of phonemic codes in producing short-term PI effects.

Associative priming in perceptual identification: effects of prime-processing requirements.

Three experiments assessed the effects of prime-processing instructions on associative priming in word identification and episodic memory for primes. In Experiment 1, groups instructed to read the prime silently or generate silently an associate of the prime showed a larger accuracy benefit for related over unrelated targets than did a group that decided whether an asterisk was to the right or left of the prime. The asterisk-search group showed a weaker repetition effect on a subsequent identification test of primes, indicating that the weaker priming in this group was a result of poorer perceptual processing. On a cued-recall test for primes, the generate group was superior to the other groups. In Experiment 2, we found that with weak prime-target associations, priming was comparable for read and generate groups and stronger than estimated for a guessing strategy, on the basis of single predictions made from each prime by an additional group. In Experiment 3, we demonstrated that the read and generate instructions produced similar mispriming and inhibitory effects. The results suggest that the depths of prime-processing manipulations do not have parallel effects on priming and episodic memory, and that associative priming in word identification, as in other tasks, may involve an expectancy process.

Persuasion, coercion, medical paternalism or the Mental Health Act: the dilemma of detention in the general hospital.

This paper describes the cases of three patients where the question of the need for formal detention arose due to mental disorder, apparently primarily due to physical illness, which in each case required further investigation and treatment in a general hospital. It states some of the issues facing those caring for patients under these circumstances and offers advice on overcoming some of the problems.

Dangerous behaviour preceding first admissions for schizophrenia.

Of 253 patients in their first schizophrenic episode, 52 behaved in a way threatening to the lives of others before their admission to hospital. These 52 patients were studied from data collected at the time of their initial presentation. Despite a history of illness in excess of 1 year in 24 cases, and evidence that violence was motivated by psychotic symptoms in 23 cases, fewer than half of the patients were admitted to hospital as a direct result of their dangerous behaviour. Life-threatening behaviour was more common where the patient had been ill for longer, and where there were delusions of being poisoned.

The anal continence plug: a disposable device for patients with anorectal incontinence.

Anorectal incontinence is most commonly found in the elderly, but colorectal surgeons now see an increasing number of younger patients with this condition. Although medical and surgical treatments are available, a proportion of patients remain refractory to therapy. We investigated the efficacy of three designs of anal continence plug. 8 women and 2 men (mean age, 52 years) who were incontinent to both liquid and solid stool tested each plug for three consecutive weeks. 1 patients withdrew from the study. The median weartime for the optimum plug design was 12 h, and there were no episodes of incontinence in 82% of the periods during which the plug was in place. Patients required a median of eleven plugs per week, and in 82% of cases insertion was as easy as with a suppository. Plugs may have a place in the management of patients with anorectal incontinence.

Recency effects in direct and indirect memory tasks.

In three experiments, subjects learned two lists under incidental conditions and were then given either a part-word or a word (extralist associate) cue. Each cue was related to one word in each list. Half the subjects were given production instructions (an indirect memory test), and half were given cued recall instructions (a direct memory test). When the interval between List 2 and the test was shortened, recency effects were found for part-word cues for both cued recall and production instructions. Little or no recency effects were found with word cues. These results are incompatible with a simple distinction between the types of memory trace or information that are tapped by direct as opposed to indirect memory tasks. Possible causes for the recency effect and for the difference between word and part-word cues are discussed.