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Biomedical subjects

L Appleby

Publications and source records attributed to L Appleby.

At least 19 recordsLinked to original sources
PubMed1992

Diagnostic criteria in schizophrenia: accentuate the positive.

In a recent article, Andreasen and Flaum (Schizophrenia Bulletin, Vol. 17, No. 1, 1991) argued that greater emphasis should be placed on negative symptoms in the diagnosis of schizophrenia, leading to a less important role for positive symptoms. This article presents a counter-argument to this view. Positive symptoms are common and reliable and therefore highly useful diagnostically. First-rank symptoms, although not specific to schizophrenia, show good discriminability. No other type of symptom or investigative method can make such claims to usefulness. Although positive symptoms do not predict outcome, this is not a necessary function of diagnostic criteria. The predictive power of negative symptoms is, in any case, based largely on studies of patients with chronic disorder. Premorbidly impaired social development may interact with schizophrenia, worsening the prognosis. We believe positive symptoms have always been the essence of psychiatric disorder and should remain so. Increasing the diagnostic weight given to negative symptoms risks restricting the definition of schizophrenia excessively.

Activities of Daily Living↗
PubMed1992

Structure and function of the spoIIIJ gene of Bacillus subtilis: a vegetatively expressed gene that is essential for sigma G activity at an intermediate stage of sporulation.

The spo-87 mutation is one of two sporulation mutations originally used to define the spo0J locus of Bacillus subtilis. We now show that it blocks sporulation after completion of prespore engulfment (stage III). Surprisingly, the operon is expressed vegetatively, probably from a sigma A-dependent promoter, and its expression is shut down at the transcriptional level at about the onset of sporulation. DNA sequencing reveals that the locus defined by spo-87, which we now designate spoIIIJ, consists of a bicistronic operon. However, only the first gene is essential for sporulation; the function of the second cistron is cryptic. The predicted SpoIIIJ product has an M(r) of 29,409. It probably forms a lipoprotein and is rich in basic and hydrophobic amino acids. Mutations in spoIIIJ abolish the transcription of prespore-specific genes transcribed by the sigma G form of RNA polymerase but not transcription of the spoIIIG gene encoding sigma G. The SpoIIIJ product could be involved in a signal transduction pathway coupling gene expression in the prespore to events in the mother cell, or it could be necessary for essential metabolic interactions between the two cells.

Amino Acid Sequence↗
PubMed1992

Suicide in psychiatric patients: risk and prevention.

The prevention of suicide requires an understanding of protective as well as risk factors, and the recognition of high-risk groups. Factors which increase the risk in patient populations include previous parasuicide, recent relapse or discharge, features of mental state (depression, psychosis), social circumstances (isolation, unemployment), and demographic characteristics (male sex, young age). Protective factors are under-researched but are likely to lie in the nature of psychiatric care. Consequently, community care may affect suicide by altering the level of protection at critical periods in an episode of illness. The clinical prevention of suicide should therefore be a priority for community services, and the relationship between suicide and mental health care should be researched by a national process of monitoring.

Adult↗
PubMed1991

Baby stealing.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Suicide during pregnancy and in the first postnatal year.

OBJECTIVES: To calculate age adjusted mortality ratios for suicide by women in the first year after childbirth and during pregnancy, and to identify characteristics of postnatal suicide in childbearing women. DESIGN: Retrospective study based on population data for England and Wales from 1973 to 1984. SUBJECTS: Women aged 15-44 who committed suicide in the year after childbirth or during pregnancy. MAIN OUTCOME MEASURES: Observed to expected mortality ratios for the total postnatal sample, for five year age groups, for unmarried mothers, and for suicide after stillbirth; observed to expected mortality ratios for all suicides during pregnancy and for five year age groups; the timing of suicides in relation to delivery; and the frequency of the various methods of suicide. RESULTS: The standardised mortality ratio for postnatal suicide was calculated to be 0.17--that is, the actual total was only one sixth of that expected. The low ratio was not found after stillbirth, which was associated with a rate six times that in all women after childbirth. The low ratio was less pronounced, but still present, in teenage mothers and in unmarried mothers. Women who committed suicide after childbirth most often did so in the first month, and there was a tendency to use violent methods. The standardised mortality ratio for suicide during pregnancy was calculated to be 0.05 of all pregnant women. Teenagers were at substantially increased risk. CONCLUSIONS: Women in the first year after childbirth and during pregnancy have a low risk of suicide despite their high rate of psychiatric morbidity. Underreporting of maternal suicides is unlikely to explain the findings, though it may affect their magnitude. Motherhood seems to protect against suicide. Concern for dependants may be an important focus for suicide prevention in clinical practice.

Abortion, Spontaneous↗
PubMed1990

Postgraduate training in psychiatry 1977-87: disturbing trends in the pattern of international collaboration.

A descriptive account is given of changes in the composition of the postgraduate medical student population at the Institute of Psychiatry from 1977 to 1987, focusing on total numbers, country or region of origin, previous experience, source of sponsorship and training requirements. It is concluded that economic influences in the UK and abroad exert profound effects on the pattern of training demand, the overall recent trend being away from government-sponsored developing-world trainees towards self-sponsored students from developed countries. The combined effect of developing-world poverty and financial pressure on UK academic institutions could be a failure to cater for the mental health needs of developing countries.

Education, Medical, Graduate↗
PubMed1989

Nucleotide sequence of the Bacillus licheniformis homologue of the sporulation locus spoIIA of Bacillus subtilis.

The spoIIA locus of Bacillus licheniformis was cloned into the phage vector phi 105J9; selection was based on the ability of the clone to complement mutations in both the first and the last of the spoIIA genes of B. subtilis. The B. licheniformis DNA was subcloned into M13 and sequenced; it includes three genes of identical lengths to those of B. subtilis. The average interspecies difference in nucleotide sequence is 24%; C occurs at the third position of codons 55% more often in the B. licheniformis than in the B. subtilis sequence. The average difference in predicted amino acid sequence is 11%, but the distribution of these differences is far from random, and there are several long stretches of amino acid sequence that are identical in the two organisms. The distribution of non-conservative amino acid changes between the species is also strikingly non-random; no such changes are found in those regions in which missense mutations are known in B. subtilis. Each species has an open reading frame 5' of the spoIIAA gene, but the predicted amino acid sequence, and the distribution of differences between the two species in both nucleotides and predicted amino acids, suggest that these open reading frames are not expressed. Both species have regions 3' of the open reading frames which resemble rho-independent terminators of transcription, but that in B. licheniformis is longer and could form a more elaborate secondary structure than that in B. subtilis.

Amino Acid Sequence↗
PubMed1989

Mutations that alter the helix-turn-helix region of the spollAC protein: a Bacillus subtilis sporulation-specific sigma factor.

It has previously been shown that spollAC561, a mutation that diminishes the incidence of sporulation by more than six orders of magnitude, alters the residue at position 13 of the helix-turn-helix region of the sporulation-specific sigma factor encoded by spollAC from valine to methionine (Yudkin, 1987b). We have now found that four spontaneous revertants, which sporulate at an incidence of 30-60%, all contain transitions within the codon that was altered by spo-561. The mutant methionine is replaced by isoleucine in two revertants, and by threonine in the other two.

Amino Acids↗
PubMed1989

The psychiatrist in the obstetric unit. Establishing a liaison service.

The establishment and first 18 months of a psychiatric liaison service to a general hospital obstetric unit are described. The service was initially intended to predict antenatally those at risk of post-natal depression and to offer follow-up throughout pregnancy and in the post-natal period. However, a large proportion of referrals were of women currently unwell. Furthermore, post-natal follow-up in the community proved difficult. Referrals, diagnoses and disposal are analysed, leading to conclusions about the effectiveness and problem of such a service. The components of a comprehensive obstetric liaison provision are proposed, emphasising the need for strong community links built around a CPN service, allowing adequate postnatal psychiatric care.

Adult↗
PubMed1988

Personality disorder: the patients psychiatrists dislike.

A sample of psychiatrists was asked to read a case vignette and indicate likely management and attitudes to the patient on a number of semantic-differential scales. Patients given a previous diagnosis of personality disorder (PD) were seen as more difficult and less deserving of care compared with control subjects who were not. The PD cases were regarded as manipulative, attention-seeking, annoying, and in control of their suicidal urges and debts. PD therefore appears to be an enduring pejorative judgement rather than a clinical diagnosis. It is proposed that the concept be abandoned.

Adjustment Disorders↗