Schizophrenia-spectrum psychoses in people with and without intellectual disability.

BACKGROUND: Although there is an increased risk of schizophrenia-spectrum psychoses (SSP) in people with intellectual disability (ID), there is a paucity of research evidence into clinical presentation of the disorder in comparison with research into SSP in people without ID. AIMS: The aims of the study were to compare clinical, functional, and social factors in patients with mild ID (ICD-10: F70) and SSP (ICD-10: F20-9) attending a specialist mental health service for people with ID, with a control group of patients without ID but with SSP attending a generic adult mental health (GAMH) outpatient clinic. METHOD: A total of 106 patients with SSP (53 with ID and 53 from GAMH) were assessed on psychopathological symptoms, functioning scales and quality of life. They were compared using chi-squared and regression analysis where appropriate. RESULTS: People with ID and SSP appear to be more debilitated by the co-occurring disorder than those with the same disorder but without ID. Increases in observable psychopathology and "negative" schizophrenic symptoms, and decreased functional abilities were observed in the group with ID when compared to the GAMH group. The clinical implications of these findings are discussed.

A controlled evaluation of small-group education of general practitioners in the management of drug users.

We evaluated the effectiveness of small-group education of general practitioners (GPs) in the management of drug users. A total of 40 doctors were trained. Some 28 doctors who were unable to attend and 30 who did not want training participated as comparison groups. Sixteen months after the education, trained doctors notified significantly more drug users to the British Home Office database and more often prescribed methadone at first consultation with a drug user.

Characteristics of drug misusers and their perceptions of general practitioner care.

BACKGROUND: Little is known about drug misusers' views of the care they receive from general practitioners. AIM: This study set out to determine drug users' views about primary health care and their relationship with their general practitioners. METHOD: A semi-structured interview was conducted with 180 drug users who were consecutive attenders at five treatment services in north east London--a general practice with a special interest in treating drug users, a private drug clinic, a community drug team, a drug dependence unit and a street agency for drug users. RESULTS: The majority of the 145 London-based drug users attending the four treatment centres other than the general practice with a special interest were registered with a general practitioner (88%). Forty-two per cent of users sought out a general practitioner prepared to treat them, rather than register with a local or the family doctor. Most drug users reported that their general practitioners were aware of their drug problems (88%) but half of the general practitioners were not prescribing replacement drugs with almost 20% of the users not receiving prescriptions claiming that this was due to lack of knowledge or trust on the part of the doctor. Sixty per cent of the drug users attending the four centres perceived that their general practitioners held negative or neutral views about them. However, 34 of the 35 drug users interviewed in the specialist general practice believed their doctors had a positive view of drug users. CONCLUSION: Most drug users were registered with general practitioners but the relationship between doctor and patient was not always easy or productive. There is a need to clarify the role of general practitioners in this field and provide them with better educational opportunities.

Anorexia nervosa: change over time in age of onset, presentation and duration of illness.

The question as to whether anorexia nervosa as an illness has transformed itself was partially addressed in an investigation into the possible change over time in age of onset, age of presentation and the derived variable, delay between onset and presentation. These three variables were examined in 827 patients diagnosed as suffering with anorexia nervosa, who had attended the Eating Disorders Unit at the Middlesex and St George's Hospitals from 1960 to 1990. This analysis revealed a stable age of onset but a lengthening in duration of illness and associated increase of age at presentation. However, investigation of data obtained from two other tertiary referral centres revealed stability of all three variables over time. The overall conclusion was that there has been no change in the age of onset of anorexia nervosa during the past 30 years. The increasing delay in presentation to the eating disorders clinic is most likely attributable to a change in the practice of patient referrals to a national tertiary referral centre.

Epilepsy and violence.

Epileptic automatism and violence are seldom found among temporal lobe epileptics. The case of a 19-year-old girl who killed a 20-month-old child during an epileptic attack is described, and the literature and medico-legal issues are briefly reviewed.

Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects and a description of psychosis attributed to khat chewing.

There have been relatively few reported cases of psychosis due to khat usage despite its heavy consumption in certain East African and Arabian countries. Four cases have been reported in the UK. We report here on three further cases of psychotic reactions to this substance in Somalian males, and emphasize the need to be aware of khat as a potential substance of abuse, with both medical and psychiatric complications. The features of khat psychoses are described and the relationship to amphetamine and ephedrine psychoses is discussed. The forensic aspects of two of the cases which involved homicide and combined homicide and suicide are highlighted, as is the possible role of social dislocation from the culture of origin.

A case of anorexia nervosa with Klinefelter's syndrome.

This is the first reported case of anorexia nervosa in association with Klinefelter's syndrome. Although the patient was initially diagnosed as suffering from 'atypical' anorexia nervosa, Klinefelter's syndrome was cytogenetically proven and other organic pathology ruled out.