Mental illness that is difficult to classify: a case study.

A case is presented of a man who has been detained in secure psychiatric hospitals for the majority of his life. Although his index offence was minor he has a long history of violence. The patient has collected a vast number of diagnoses over the years. His treatment demonstrates a role for clozapine in ameliorating violent behaviour and aggression. We conceptualise this as being linked to the properties of this drug. From the patient's history we believe that reserpine may have had a similar effect to clozapine regarding mental state and reduction of violent behaviour. This case illustrates the consequences of inaccurate diagnosis and therefore the provision of adequate treatment. It highlights that the continuity of care and the communication of information is essential for the patient's quality of life. It also illustrates how the use of certain antipsychotics may prove essential in the control of violence so that institutionalisation can be prevented.

The serotonin transporter length polymorphism, neuroticism, and depression: a comprehensive assessment of association.

BACKGROUND: A promoter-based length polymorphism (5-HTTLPR) of the human serotonin gene (SLC6A4) has exhibited inconsistent association with emotionality phenotypes, such as major depression (MD) and the personality trait neuroticism (N). Several explanations have been posited to account for this discrepancy, including underpowered experimental design and variation in gender ratio, age, and ethnicity. METHODS: Here, we describe three independent tests of association between the 5-HTTLPR locus and both N and MD in samples selected for extremeness of N-score from two homogenous populations (n = 88,142, and 20,921). Calculations of statistical power indicated that at a 5% alpha level, these samples retain 100% power to detect a genetic effect accounting for just .5% of phenotypic variance. Effects of age were regressed out of the phenotypic measure, and gender was included as a covariate. RESULTS: No statistically significant effects of genotype could be identified on either N or MD phenotypes (in all cases, p > or = .26), independently of the genetic mode of action applied. CONCLUSIONS: Our data do not support the hypothesis that the 5-HTTLPR variant contributes significantly toward human emotionality as indexed by either the Eysenck Personality Questionnaire N scale or the DSM-IV for MD.