Biomedical subjects
Publications and source records attributed to J Coid.
A female psychopath presented multiple forms of psychopathology, including features of 'multiple personality disorder'. It is proposed that a diagnosis of borderline personality disorder, or the psychodynamic features of borderline personality organisation, should be the exclusion criteria for this condition.
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A point prevalence survey of all acute beds in the Bromley district found that more than one in 10 patients were classified by their doctors as bed blockers (one in five in the medical wards). There were appreciable clinical and demographic differences distinguishing bed blockers from patients whose stay had been prolonged and who were judged as still requiring acute beds. Social and administrative problems also contributed to bed blocking so that further action by geriatricians, psychogeriatricians, and social workers was required to reduce the numbers. A substantial proportion of bed blockers, however, were highly dependent and could be transferred only to long stay wards or nursing homes. Bed blocking seems inevitable in wards that are attempting to cope with the steadily increasing proportion of elderly patients according to traditional models of acute care.
The paper compares the prevalence of psychiatric morbidity amongst sentenced prisoners and in the general population. Major psychosis was no more common in the majority of studies of criminal populations. Although prisoners have a higher level of neurotic symptomatology, this was mainly found to be secondary to imprisonment itself. Long term imprisonment was not found to be a precipitant of severe psychiatric morbidity or intellectual deterioration, and prisoners adopt elaborate coping mechanisms which may themselves be protective. However, there is a higher prevalence of mentally handicapped and epileptic prisoners, and doctors in the Prison Medical Service have to cope with frequent, serious behavioural problems. Prisons appear to be a particularly important area for future psychiatric research.
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Mean plasma metenkephalin concentration was significantly higher in ten patients who habitually mutilated themselves than in matched, healthy controls. No differences were found in corticotropin, N-lipotropin or C-lipotropin (beta-endorphin). Plasma metenkephalin was raised only in the five patients receiving hospital treatment because of their behaviour disorder. It was not raised in those patients sufficiently well to have been discharged from hospital.
A comparison of the homicide rate of mentally abnormal offenders and murderers who subsequently commit suicide, from a range of different populations, shows a uniform consistency when compared with the overall rates. 'Laws' are proposed which govern the rates within these subgroups in comparison with the population as a whole and which determine fluctuations. Qualitatively different psychiatric and sociological factors are thought to account for these findings and require further elucidation.
The relationship between alcoholism and violent behaviour is complex, and five different hypotheses of association between the two are examined. No direct relationship is apparent. Sociological factors can have considerable effect upon the incidence of violent behaviour by populations of drinkers. However, a common theme emerges from the literature of a subgroup, existing in different cultures, whose underlying personality disorder predisposes them both to violent behaviour and to alcoholism. The quantity and quality of their violence further distinguishes them from other violent individuals, and their poor prognosis from other alcoholics.
A case of procyclidine abuse is described in which the clinical presentation was indistinguishable from mania. The patient was a long-standing poly-drug abuser and was obtaining the drugs from medical sources. Controlled exposure on the ward to drugs of abuse, including a double-blind comparison with placebo, confirmed that procyclidine caused a manic response in this patient.
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Explore the source record for details and available documents.