The role of climate variability in the inter-annual variation of terrestrial net primary production (NPP).

Eleven years data set of global net primary production (NPP) and long-term climatic and land use data were used to explore the patterns of inter-annual variability of terrestrial NPP in relation to potential causal factors. Global anomalies in temperature, precipitation and cloud cover were found to significantly contribute in different ways and magnitudes to the variability of NPP of global ecosystems particularly forests and grasslands. El Niño/La Niña events represented an important factor affecting forests, woodlands and grasslands while deforestation was found to largely contribute to the NPP variability of tropical forests. Regionally, NPP variability is related to variation of precipitation in the tropics but is related to both variation and annual mean of temperature and cloud cover in the mid-northern latitudes. We hypothesized that the increase in variability of potential causal factor(s) will provoke more declines of NPP in the tropics but will yield more pulses or at least maintain a mean NPP in the mid-northern latitudes.

Educating psychiatric patients about their treatment: do fact sheets work?

Psychiatric patients are sometimes given fact sheets about their treatment but the benefits of these are uncertain. We tested three strategies in three cohorts of psychiatric inpatients--fact sheets alone, fact sheets and subsequent discussion, and control. Knowledge of medication was assessed by questionnaire. For various reasons, only 33 of the 77 patients were included in the study or analysis. Of the patients who had been given fact sheets, 87% independently read them and reported finding them helpful whilst all asked for more information. Receiving a fact sheet alone had no significant effect, whereas having discussed it with a health care professional was associated with a significant increase in knowledge about medication. Patients receiving fact sheets selectively learned more about side-effects than about drug action or precautions. This strategy for patient education could be used by ward nurses and deserves further evaluation.

Do psychiatric patients know what is good for them?

The paper reports the findings of a medical audit exercise which monitored 192 consecutive psychiatric admissions. Approximately two-thirds of patients, consultants and referrers provided information on admission objectives and the degree to which they were attained. One-third of the patients furnished information on social problems and satisfaction with treatment. Sanctuary was rated as an important admission objective by patients but neglected by consultants and referrers. Patient satisfaction with treatment was significantly correlated with attainment of patient as well as consultant objectives, and negatively correlated with social problems. Agreement between consultant and patient on admission objectives was inversely related to both duration of contact with psychiatric services and number of previous admissions suggesting that congruence with consultants may be lost over time. The limitations imposed by variable response rates are acknowledged. It is concluded that serious note should be taken of psychiatric patients' own treatment objectives.

Object-name selection in psychiatric patients before and after neuroleptic therapy.

An object-name selection test was administered to 16 newly admitted schizo phrenic, non-schizophrenic psychotic and non-psychotic patients on admission when they were drug-free, and again 4-6 weeks later, following treatment with neuroleptics. Sixteen healthy, drug-free age-matched and sex-matched controls were similarly tested on two occasions 4-6 weeks apart. Schizophrenic and non-schizophrenic psychotic subjects made significantly more association-type errors than non-psychotic subjects and controls. A signifi cant reduction in association-type errors which was observed in both psychotic patient groups on the second testing occasion may be attributed to medication. The data suggest that overinclusive thinking, as measured by the object-name selection test, is a feature of both schizophrenic and non-schizophrenic psychosis. It is concluded that tests of overinclusion are therefore of limited diagnostic utility although they may be of value in monitoring response to treatment.

How useful is riboflavin as a tracer of medication compliance?

A quantitative spectrofluorometer assay of urinary riboflavin is described. Using the method, levels produced by prescribed riboflavin are reliably distinguished from normal background levels without requiring dietary restrictions. The method is successfully used to verify the intake of a single 50-mg dose of riboflavin. However, when more frequent dosage is used, verification becomes unreliable because of a "spillover" effect produced by the slow rate of elimination of the substance. This seriously limits the utility of riboflavin as a tracer, as does its tendency to change the appearance of therapeutic compounds into which it is incorporated. The need for further work on validating combined measures of compliance is stressed.

The perception of visual ambiguous figures in schizophrenia and Parkinson's disease.

The frequency of reversal and dominance of aspect of three versions of an ambiguous Schröder staircase were studied in patients with a diagnosis of either schizophrenia or Parkinson's Disease (PD), and in a mixed group of psychiatric patients before and after prolonged neuroleptic therapy. It was found that schizophrenics perceived the staircases from above for significantly less time, and had a (nonsignificant) tendency to have more reversals than controls. PD patients saw the staircases from above for significantly more time, and also had (nonsignificantly) more reversals than controls. In the psychiatric patients, long term neuroleptic therapy had no significant effect on either reversal rate or dominance of aspect. When the contrast and the luminance of the stimulus were manipulated, normal subjects reported significantly less reversals and significantly increased dominance of the superior aspect when the contrast of the stimulus was reduced. Changing the luminance had no significant effect. The implications of these results for visual abnormalities in schizophrenia and Parkinson's Disease are discussed.

Rehabilitation in psychiatry.

Psychiatric rehabilitation is the process of enablement and enhancement of personal autonomy of individuals with chronic psychiatric disabilities. Its governing principles are those of common sense and sound psychiatric practice. These principles are outlined and some specific aspects of the process described. This article provides a brief guide and overview rather than a comprehensive account.

Comparative efficacy of long-acting depot and oral neuroleptic medications in preventing schizophrenic recidivism.

Two health service data bases provided data on the use of neuroleptic medications in the maintenance therapy of schizophrenic patients in the Canadian province of Saskatchewan. The pattern of prescribing medication appeared to be influenced by the bed-to-population ratio. For 1235 discharged schizophrenic patients, the 2-year rehospitalization rate (56%) was higher than expected. Although oral maintenance therapy predominated, patients maintained on long-acting depot neuroleptic medication had a significantly lower (p less than .05) rehospitalization rate than those on oral preparations. The highest rehospitalization rate was found among patients prescribed combined depot and oral preparations, confirming the ineffectiveness of combined medication. Using data bases avoided the sampling bias inherent in prospective controlled trials and provided a complementary epidemiologic dimension to the study of maintenance neuroleptic therapy of schizophrenia under normal treatment conditions.

Noncompliance in schizophrenia.

Compliance research is reviewed with particular reference to neuroleptic treatment of schizophrenia. Reported noncompliance rates of up to 50 per cent are likely to be an underestimate. Models of compliance and health-seeking behaviour borrowed from physical medicine are of questionable relevance to schizophrenia where perception of illness is often distorted. Factors thought to be implicated in noncompliance need to be evaluated and a theoretical model applicable to schizophrenia constructed. In the meantime there is evidence to suggest that behavioural intervention strategies may be superior to simple educational ones in the management of noncompliance. A discussion of methodological issues relating to the assessment of compliance is offered and a strategy for further research outlined.

Social and clinical correlates of the "new" long-stay.

Out of a total admission cohort of 1,934 patients 162 and 101 patients remained continuously in hospital for 6 months and 1 year respectively. The study describes the characteristics of these patients and at each stage compares them with those who were discharged on a number of social and clinical variables. The findings confirm the importance of social factors in determining continued retention and support the suggestion of a process of early selection of "new" long-stay patients put forward by Mann & Sproule (1972). The findings are discussed and a case is argued in favour of continuing to provide such patients in hospital.