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Biomedical subjects

J Neeleman

Publications and source records attributed to J Neeleman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Drugs taken in fatal and non-fatal self-poisoning: a study in south London.

This study compared the number and type of substances taken in deliberate self-poisoning with fatal (n = 127) and non-fatal (n = 521) outcome. The aims were (i) to describe substances typically involved in self-poisoning in England and Wales, (ii) to examine the role of drug "cocktails' and (iii) to examine whether toxic substances are over-represented in cases with fatal outcome. Over-the-counter (OTC) analgesics, minor tranquillizers and antidepressants accounted for about 70% of substances taken, irrespective of outcome. Compared with survivors, cases who died had taken a higher mean number of substances. Among self-poisonings with a single substance, antidepressants and paracetamol-opiate combinations were over-represented in fatal-outcome cases. This report emphasizes the role of OTC analgesics and antidepressants in overdose-related mortality in England and Wales.

Adult↗
PubMed1997

Fatal methadone and heroin overdoses: time trends in England and Wales.

STUDY OBJECTIVE: Although the total number of self poisonings in England and Wales has dropped by 32%, the number involving methadone and/or heroin rose by 900% in 1974-92. Because of concern about the role of methadone in this increase, the part played by methadone and heroin in poisoning deaths in England and Wales in 1974-92 was investigated. DESIGN: A proportional mortality design was used to study whether the ratio between deaths involving methadone or heroin and other substances had increased. The time trend was examined with logistic regression. SETTING: England and Wales, 1974-92. SUBJECTS: Accidental, undetermined, and suicidal poisoning deaths (n = 43,231). MAIN RESULTS: The proportions of poisoning deaths involving methadone (alone or in combination with heroin) rose by 80% (95% CI 69%, 92%) per 3 year period. The proportion of poisoning deaths involving heroin without methadone rose by 76% (95% CI 60%, 93%) per 3 year period. Similar results were obtained when poisoning deaths were examined in relation to gender and legal category (suicide and undetermined versus accidental deaths). CONCLUSIONS: The impact of opiate addiction on rates of death by poisoning is rising quickly. This may reflect the growth of the addict population and is an important public health problem. There is no evidence that methadone's involvement in these deaths has risen disproportionately in relation to that of heroin up to 1992.

Accidents↗
PubMed1997

Suicide by age, ethnic group, coroners' verdicts and country of birth. A three-year survey in inner London.

BACKGROUND: Information on suicide in ethnic and immigrant groups in England and Wales is limited. METHOD: A three-year (1991-1993) survey was conducted of all unnatural deaths of residents of an urban area. 'True likely' and 'official' age-adjusted suicide rates were compared by ethnicity and, for Whites, birthplace. RESULTS: Irrespective of verdict, 329 likely suicides were identified. Relatively few ethnic minority and White immigrant suicides had received a suicide verdict. Afro-Caribbeans had relatively low, and young Indian women relatively high suicide rates. Rates of Scottish- and Irish-born residents were 2.1 to 2.9 times higher than the local base rate. Young White males' rates were higher than those of the elderly. CONCLUSIONS: Classification of suicide is biased with respect to ethnicity and national origin. Rate patterns for ethnic minority groups reflect patterns seen in attempted suicide. In this deprived area, young White male suicide rates have surpassed those among the old.

Adult↗
PubMed1996

Parasuicide in Camberwell-ethnic differences.

Over a 6-month period, this study compared referral rates amongst different ethnic groups to an inner city deliberate self-harm (DSH) team, using native British (in the remainder of this paper referred to as whites) as standard and age-standardized referral ratios as the measure of effect. Indian female rates were 2.6 times those of whites. Amongst United Kingdom born Indian females, (crude) rates were 7.8 times those of United Kingdom born white females. Unemployment was associated with a 9 times increased referral rate amongst whites and a 3 times increased referral rate amongst ethnic minorities, suggesting that ethnicity modifies the association between unemployment and DSH rates. This study suggested that ethnic minority and white DSH differ in important respects; DSH teams serving multicultural communities may need to develop special expertise to meet the needs of minority ethnic groups.

Adolescent↗
PubMed1996

Suicide as a crime in the UK: legal history, international comparisons and present implications.

Suicide was a crime in England and Wales until 1961. This paper compares the English legal treatment of suicide with that in other Western countries. The delayed English decriminalization of suicide is a likely result of the nature of English common law, rather than a reflection of actual public opinion and medico-legal practice. This subject remains of interest. Coronership, the cornerstone of English suicide certification, developed out of anti-suicide legislation, and important biases result from this. The Church of England may still deny ordinary burial rites to certain suicide victims. Assisted suicide, to be distinguished from euthanasia and suicide pacts, became a separate offence in 1961. Legislative reform regarding these issues, similarly to that regarding suicide, is likely to lag behind the development of public opinion and medical practice.

Burial↗
PubMed1996

Preventing the admission of difficult psychiatric patients--a questionnaire survey.

By means of a postal survey of all consultant psychiatrists (n = 143) in the South East Thames Region, the authors examined factors associated with psychiatrists' decisions to impose restrictions on certain patients' access to admission. Twenty-two per cent of respondents reported the use of admission restrictions. Usage of this measure was associated with a local absence of psychotherapy services (OR 0.34; 95% CI 0.17-0.63) which might suggest that there is a need for more equal access to specialist psychiatric services across health districts.

Attitude of Health Personnel↗
PubMed1995

Why do psychiatrists neglect religion?

This paper analyses a number of possible reasons why modern psychiatry has neglected the therapeutic effects of religious beliefs. The gap which exists between psychiatry and religion is a relatively recent phenomenon and is partly related to psychiatry's progress in elucidating the biological and psychological causes of mental illness, rendering religious explanations superfluous. In addition, it is often assumed that religious attitudes are inevitably linked with phenomena such as dependence and guilt which are frequently seen as undesirable. Psychiatrists and psychologists tend to be less religiously orientated than their patients, which may further increase the professional's idea that religious beliefs are associated with disturbance. However, it has long been suspected that a positive relation exists between religion and mental health, and recently, the psychology of religion has provided empirical support for this idea. Psychiatry faces the challenge to accommodate this evidence into theory and practice.

Attitude of Health Personnel↗
PubMed1994

Caring for mentally ill people.

Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity in psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental illness show definite international differences. Everywhere, though, mental health care for patients with psychotic illnesses is a "cinderella service," and there is a general move towards care falling increasingly on the family and the community.

Attitude to Health↗
PubMed1994

Social support and depression in three groups of psychiatric patients and a group of medical controls.

Levels of depression and aspects of social support were examined in groups of chronic schizophrenic (n = 21), depressed (n = 26) and parasuicide patients (n = 26) and in a group of medical controls (n = 25). Depression was equally severe in the parasuicide and depressed groups and low in the schizophrenic and control groups. The psychiatric groups reported lower perceived levels of social support than did the controls. The depressed and parasuicide patients, but not the psychotic patients, felt dissatisfied with the available support. These results are interpreted as suggesting that deficiencies in social support may be more important in neurotic disorder, in particular depressive disorders, than in psychoses.

Adult↗
PubMed1994

Religious identity and comfort beliefs in three groups of psychiatric patients and a group of medical controls.

In order to assess the religious beliefs and practices of psychiatric patients, a self-report questionnaire was developed. The questionnaire was administered to 73 psychiatric patients and 25 non-psychiatric controls. Older age, membership of an ethnic minority and the presence of psychiatric disorder were all significantly associated with higher scores on the questionnaire. Psychotic subjects obtained the highest scores whilst those of depressed and parasuicide subjects were intermediate between those of the control and the psychotic groups. These results emphasise the importance of religion for many patients with common psychiatric problems. Specialist religious help may be of value in the management of such problems.

Adolescent↗
PubMed1993

Psychiatrists' religious attitudes in relation to their clinical practice: a survey of 231 psychiatrists.

A total of 231 psychiatrists working in several London teaching hospitals were surveyed about their private religious attitudes and how these affected their reported clinical practice. Although only 27% reported a religious affiliation and 23% a belief in God, 92% felt that psychiatrists should concern themselves with the religious concerns of their patients. Although the psychiatrists who were religious were more likely to make referrals to religious leaders or to disclose their own beliefs to patients, contrary to reports from the United States there was no evidence that psychiatrists' private religious beliefs had an important influence on their clinical practice.

Adult↗
PubMed1993

Treatment of hysterical aphonia with hypnosis and prokaletic therapy.

A patient with chronic refractory hysterical aphonia was treated by prokalesis (challenge) and hypnosis within a psychotherapeutic relationship. A temporary remission was achieved but this was followed by subsequent relapse. This report illustrates the therapeutic effectiveness of prokaletic techniques. It also emphasises that these potent interventions are unlikely to achieve abiding change unless they are applied within the context of a longer-term relationship with a clinical team.

Adult↗