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Biomedical subjects

D V James

Publications and source records attributed to D V James.

At least 19 recordsLinked to original sources
PubMed2001

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.

Adult↗
PubMed2000

Time to exhaustion during severe intensity running: response following a single bout of interval training.

The primary aim of this study was to examine any change in performance caused by a fatiguing interval training session (TS). A secondary aim of this study was to examine the change in oxygen uptake (VO(2)) during moderate and severe intensity running, and the relationship with the change in performance. Seven male runners [mean age 24 (SD 6) years, height 1.79 (SD 0.06) m, body mass 67.9 (SD 7.6) kg, maximal oxygen uptake (VO(2max)) 4.14 (SD 0.49) l. min(-1)] were studied. The VO(2) during moderate and severe intensity running and running performance were studied immediately prior to, 1 h following, and 72 h following TS. The TS was performed on a treadmill, and consisted of six bouts of 800 m at 1 km. h(-1) below the velocity at VO(2max) (v(V)O(2max)), with 3-min rest intervals. Performance was also assessed at 1 km. h(-1) below v(V)O(2max), in the form of time to exhaustion (t(lim)). The VO(2) and heart rate (f(c)) were assessed both during the severe intensity performance trial, and the moderate intensity run at 50% v(V)O(2max). Whilst a significant change was observed in running performance and the VO(2) during both moderate and severe intensity running prior to and following TS, no relationship was observed between the magnitude of change in these variables. At 1 h following TS, t(lim) had decreased by 24%, VO(2) during moderate intensity running had increased by 2%, and the difference in VO(2) between 2 min 45 s and the end of severe intensity running had increased by 91% compared with values recorded prior to TS. At 1 h following TS, f(c) had also increased significantly during moderate intensity running by 5% compared to the value recorded prior to TS. These findings demonstrated that TS resulted in a reduction in performance, and that the relationship between running performance and VO(2) during running may be altered under conditions of prolonged fatigue.

Adult↗
PubMed2000

Increasing the power of psychiatric court diversion: a new model of supra-district diversion centre.

The object was to develop and evaluate a new concentrated model of psychiatric diversion scheme at the magistrates' court, designed to maximize the potential of such interventions. A one-year prospective study was undertaken of a consecutive series of 264 referrals to the new diversion project at an Inner London magistrates' court, with concurrent examination of police station custody records, magistrates' court returns, hospital admission data and remand prison transfer records for an area with a population of 500,000. The results showed that this one scheme originated 12.8% of all the unrestricted hospital orders in England under section 37 of the Mental Health Act 1983, 4.2% of section 35 orders, and 6.4% of section 48 and 48/49 remand prisoner transfers. Of all arrests in the central London area, 0.46% were referred to the scheme, with 0.28% being admitted. The seriousness of the charge did not have a significant effect on whether or not admission was achieved (p = 0.5365). The new model is a powerful intervention in the assessment and diversion of mentally disordered offenders. Similar supra-district diversion centres may have a role to play in other areas, complementing other local diversion exercises, some of which might better be relocated to the police station.

Adolescent↗
PubMed1999

Oxygen uptake during high-intensity running: response following a single bout of interval training.

Elevated oxygen uptake (VO2) during moderate-intensity running following a bout of interval running training has been studied previously. To further investigate this phenomenon, the VO2 response to high-intensity exercise was examined following a bout of interval running. Well-trained endurance runners were split into an experimental group [maximum oxygen uptake, VO2max 4.73 (0.39)l x min(-1)] and a reliability group [VO2max 4.77 (0.26)l x min(-1)]. The experimental group completed a training session (4 x 800 m at 1 km x h(-1) below speed at VO2max, with 3 min rest between each 800-m interval). Five minutes prior to, and 1 h following the training session, subjects completed 6 min 30 s of constant speed, high-intensity running designed to elicit 40% delta (where delta is the difference between VO2 at ventilatory threshold and VO2max; tests 1 and 2, respectively). The slow component of VO2 kinetics was quantified as the difference between the VO2 at 6 min and the VO2 at 3 min of exercise, i.e. deltaVO2(6-3). The deltaVO2(-3) was the same in two identical conditions in the reliability group [mean (SD): 0.30 (0.10)l x min(-1) vs 0.32 (0.13)l x min(-1)]. In the experimental group, the magnitude of the slow component of VO2 kinetics was increased in test 2 compared with test 1 by 24.9% [0.27 (0.14)l x min(-1) vs 0.34 (0.08)l x min(-1), P < 0.05]. The increase in deltaVO2(6-3) in the experimental group was observed in the absence of any significant change in body mass, core temperature or blood lactate concentration, either at the start or end of tests 1 or 2. It is concluded that similar mechanisms may be responsible for the slow component of VO2 kinetics and for the fatigue following the training session. It has been suggested previously that this mechanism may be linked primarily to changes within the active limb, with the recruitment of alternative and/or additional less efficient fibres.

Adult↗
PubMed1999

Elective combined electroconvulsive and clozapine therapy.

Clozapine therapy does not produce the rapid response that may be required in severely disturbed patients. The latter, not uncommonly, obstruct treatment by refusing to give blood for haematological monitoring or refusing to swallow tablets. Whereas electroconvulsive therapy (ECT) may be used for rapid behavioural control, the effects wane once the treatment course comes to an end. This paper reports an alternative strategy in such patients--combined jointly initiated therapy with clozapine and ECT. Six disturbed patients with treatment resistant schizophrenia were given a course of 12 ECT over 6 weeks. Blood was drawn for clozapine monitoring during the first anaesthetic, allowing the introduction of clozapine on day 6. There was a mean 32% improvement in Brief Psychiatric Rating Scale scores at week 6. This improvement persisted after the cessation of ECT, by which time all patients were compliant with blood testing and tablet taking. There were no adverse reactions apparent in the combination of the two therapies. Elective combined ECT and clozapine therapy may be useful in treatment-resistant schizophrenics where the clinical state necessitates a rapid therapeutic response and where blood tests are refused. A possible synergistic reaction between clozapine and ECT is worthy of further investigation.

Adult↗
PubMed1998

Oxygen uptake during moderate intensity running: response following a single bout of interval training.

Eight male endurance runners [mean+/-(SD): age 25 (6) years; height 1.79 (0.06) m; body mass 70.5 (6.0) kg; % body fat 12.5 (3.2); maximal oxygen consumption (VO2max 62.9 (1.7) ml x kg(-1) x min(-1)] performed an interval training session, preceded immediately by test 1, followed after 1 h by test 2, and after 72 h by test 3. The training session was six 800-m intervals at 1 km x h(-1) below the velocity achieved at VO2max with 3 min of recovery between each interval. Tests 1, 2 and 3 were identical, and included collection of expired gas, measurement of ventilatory frequency (fr), heart rate (Fc)r rate of perceived exertion (RPE), and blood lactate concentration ([La-]B) during the final 5 min of 15 min of running at 50% of the velocity achieved at V02max (50% v-VO2max). Oxygen uptake (VO2), ventilation (VE), and respiratory exchange ratio (R) were subsequently determined from duplicate expired gas collections. Body mass and plasma volume changes were measured preceding and immediately following the training session, and before tests 1-3. Subjects ingested water immediately following the training session, the volume of which was determined from the loss of body mass during the session. Repeated measures analysis of variance with multiple comparison (Tukey) was used to test differences between results. No significant differences in body mass or plasma volume existed between the three test stages, indicating that the differences recorded for the measured parameters could not be attributed to changes in body mass or plasma volume between tests, and that rehydration after the interval training session was successful. A significant (P < 0.05) increase was found from test 1 to test 2 [mean (SD)] for VO2 [2.128 (0.147) to 2.200 (0.140) l x min(-1)], fc [125 (17) to 132 (16) beats x min(-1)], and RPE [9 (2) to 11 (2)]. A significant (P < 0.05) decrease was found for submaximal R [0.89 (0.03) to 0.85 (0.04)]. These results suggest that alterations in VO2 during moderate-intensity, constant-velocity running do occur following heavy-intensity endurance running training, and that this is due to factors in addition to changed substrate metabolism towards greater fat utilisation, which could explain only 31% of the increase in VO2.

Adult↗
PubMed1992

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.

Community Mental Health Services↗
PubMed1991

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.

Adult↗
PubMed1991

Violence among psychiatric inpatients.

A considerable body of evidence suggests increasing levels of violence among psychiatric inpatients. The literature on the subject is reviewed, highlighting correlates of violence among psychiatric patients and methodological flaws in the published literature. Improvement in the definition of violence and the methodology as well as future areas of research are discussed.

Hospitalization↗
PubMed1991

Suicidal ideation as a presenting complaint. Associated diagnoses and characteristics in a casualty population.

A prospective study was conducted of all referrals to the emergency psychiatric service of an inner-London hospital over one year. There were 53 individuals who presented with the specific and spontaneous complaint of suicidal ideation without any accompanying act of self-harm. The main diagnoses in this group were personality disorders (40%) and alcohol dependence (15%); only 13% were suffering from depressive illness. Members of the group differed from the other 369 presenters to the service in that they were less likely to be accorded a diagnosis of a defined mental illness, twice as likely to have a criminal record, and more likely to have a previous history of deliberate self-harm. A quarter of the suicidal complainants were admitted to hospital following assessment.

Adolescent↗
PubMed1990

An increase in violence on an acute psychiatric ward. A study of associated factors.

The increase in violent incidents on an acute psychiatric ward over a 15-month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.

Acute Disease↗