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Biomedical subjects

H G Morgan

Publications and source records attributed to H G Morgan.

At least 19 recordsLinked to original sources

Suicide and other unexpected deaths among psychiatric in-patients. The Bristol confidential inquiry.

By matching information collected from coroner inquest records with hospital admission and discharge registers, 27 suicides and 5 other unexpected deaths were identified over 30 months among persons who either were psychiatric in-patients at the time or had been up to eight weeks previously. The relevant consultant completed a questionnaire concerning assessment and management in each case. It is suggested that such an approach might usefully be adopted widely as an audit of unexpected deaths. In 20 of the suicides the seriousness of the risk was not fully recognised; 13 absented themselves from the hospital ward without leave. Misleading clinical improvement in the absence of corresponding alleviation of situational problems, and patient alienation appeared important hazards. The findings have implications for service development, particularly when major reduction of bed numbers is planned.

Adult

The transmission of onchocerciasis at a forest village in Sierra Leone. I. Simulium damnosum s.l. biting densities and infection with Onchocerca volvulus at five representative sites.

Previous studies in the forest area of Sierra Leone have shown that transmission of Onchocerca volvulus takes place many kilometers away from large breeding rivers and sometimes in open farmland. To determine where and when people in a forest village were most likely to be infected, catches of Simulium damnosum s.l. were carried out every week for 12 months, at five sites in and near a village where onchocerciasis was mesoendemic. The number of flies caught per man a day at open farm sites was significantly higher than the number caught at riverside sites. Infective flies were caught only in farmland and only during the early rainy season. The combined Annual Transmission Potential for the five sites was 129 larvae per man per year. Isoenzyme electrophoresis and morphology of biting flies identified the S. sanctipauli/soubrense subcomplex as the most common vector species. Simulium yahense and S. squamosum were sometimes present. It was concluded that the classical riverside monitoring sites do not represent high risk areas for the transmission of onchocerciasis in a forest village sited well away from the main S. damnosum s.l. breeding sites. The highest risk areas are in open farmland.

Animals

Managing suicide risk in the general ward.

In this paper we look first at those groups and situations which denote a high risk for suicide. Thorough assessment, which is the first essential step in approaching any clinical problem, is then addressed. Finally we consider the many potential hazards that may complicate assessment and management of individuals at risk of killing themselves.

Emergencies

Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule.

The Morgan-Russell outcome assessment schedule is described and statistically analysed with reference to two independent series of patients suffering from anorexia nervosa. The value of check lists and simple scaling of data is emphasised as one way of improving the standards of routine case-note documentation in clinical psychiatric practice.

Anorexia Nervosa

Our response to AIDS.

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Acquired Immunodeficiency Syndrome

Functional vomiting.

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Adaptation, Psychological

Apolipoprotein A and B (Sf 100-400) metabolism during bezafibrate therapy in hypertriglyceridemic subjects.

This study describes the effects of bezafibrate, an analogue of clofibrate, on the plasma lipid and lipoprotein profiles of 11 hypertriglyceridemic subjects and on their metabolism of apolipoproteins A-I, A-II, and B. The major action of the drug was to lower plasma triglyceride (by 58%; P less than 0.01). This was accompanied by a reduction in the level of very low density lipoprotein apoprotein B (Svedberg units of flotation [Sf] 60-400), whose mean residence time in the plasma fell threefold (from 3.4 to 1.0 h). Synthesis of the B protein in this fraction was not significantly altered, so the drug acts to accelerate the transit of very low density lipoprotein particles down the delipidation cascade. The metabolism of very low density lipoprotein remnant apoprotein B (Sf 12-100) changed little in response to treatment, although we detected a 30% increment (P less than 0.05) in the plasma concentration of this fraction. The mean residence time of these remnant particles in the plasma did not correlate with that of Sf 100-400 very low density lipoprotein apoprotein B, nor was this parameter altered by the drug. The most consistent and significant perturbation seen in the Sf 0-12 fraction (low density lipoprotein) was a reduction in the fractional catabolism of its apoprotein B moiety (26%; P less than 0.05). In those subjects who were grossly hypertriglyceridemic and who responded well to treatment, the level of this protein rose substantially owing to a combined increase in its synthesis and a reduction in its catabolism. In the group as a whole, high density lipoprotein cholesterol rose 13% (P less than 0.02), and detailed examination showed that this was associated with a small but significant increment in the plasma concentration of the high density lipoprotein subfraction 2. High density lipoprotein subfraction 3 also rose on the average, but this was not a consistent feature in all patients. The plasma concentrations and turnovers of the A proteins (A-I and A-II) were not significantly altered by bezafibrate therapy.

Apolipoproteins A

Psychiatric hospital admissions in Bristol. I. Geographical and ethnic factors.

The distribution of in-patient psychiatric admissions throughout the city of Bristol during the period 1978-1981 is described. High rates were found from the central urban areas of low social class and with a high concentration of immigrants. The findings suggest that immigrant groups (mainly of West Indian origin) are no more likely than others living in the city centre to become psychiatric hospital in-patients, but when they do so, they are more likely to require compulsory admission.

Commitment of Persons with Psychiatric Disorders

Psychiatric hospital admissions in Bristol. II. Social and clinical aspects of compulsory admission.

Three groups of patients admitted compulsorily from populations with markedly different rates of compulsory psychiatric admissions were compared on a range of social and clinical data. Whilst West Indian and white patients from inner city areas differed in many respects, they were both more likely than other patients to be referred to the psychiatric services through police agencies, with little GP involvement and were often admitted from public places following disturbed behaviour. However, levels of violence and threatening behaviour were no higher among inner city patients, black or white, and once admitted, these groups showed similar treatment compliance to white patients who had been admitted compulsorily from suburban areas. Implications for primary care and delivery of psychiatric services are discussed.

Adult

Management and outcome in anorexia nervosa. A standardized prognostic study.

The outcome of 78 patients with anorexia nervosa treated in a special clinic is described, using a standardized follow-up technique. The findings are compared with two previous studies which utilized an identical evaluation procedure. Certain predictors of poor outcome already identified by previous studies (long duration of illness before referral, previous personality problems, difficulties in relationship between family and patient) are confirmed. The findings suggest that early intervention may be an important component of effective treatment. The possible advantages of long term continuity of outpatient care are also discussed and the need for careful scrutiny of criteria for hospital admission emphasized. It is concluded that chronic morbidity due to anorexia nervosa represents an important topic for further research. There is need for further identification of factors associated with chronicity, some of which may be secondary repercussions of the illness itself, and prospective evaluation of treatment programmes which focus on predictors of poor outcome.

Adolescent