Predicting the past or risk management?

Within mental health services, the development of risk assessment templates has been driven by a desire to reduce the rates of major adverse events. A number of theoretical problems exist with such an approach. Empirical and observational evidence suggests the exercise may be paradoxically counter productive, partly by distracting from comprehensive clinical management planning and partly by contributing to inefficiencies.

Religion, spirituality and psychiatry: steps towards rapprochement.

Objectives: To consider the claim that there is a fundamental epistemological conflict between religion and psychiatry over what constitutes rational explanation, and what impediment this might be to rapprochement between the two.

Conclusions: An epistemological gap most certainly exists, but there is a growing acceptance of the importance of religion and spirituality to psychiatry. Rapprochement may best be achieved by increasing psychiatric awareness and knowledge of the issues, and by a willingness to embrace intellectual, cultural and religious pluralism.

Nonconvulsive generalised status epilepticus following electroconvulsive therapy.

Objective: To describe a case of nonconvulsive generalised status epilepticus (NGS) following electroconvulsive therapy (ECT).

Clinical Picture: A 40-year-old woman suffering from a major depressive episode was treated with ECT following treatment with clonazepam, haloperidol and paroxetine. After her fifth treatment she became acutely confused.

The meaning and function of ritual in psychiatric disorder, religion and everyday behaviour.

Objective: Ritual is a central feature of obsessive-compulsive disorder (OCD) and is found in other psychiatric conditions. Defined in a general sense, it is seen in the everyday behaviour of animals and of humans, in secular ceremonies, and in religion. This paper examines the various types of ritual.

Religion, spirituality and psychiatry: conceptual, cultural and personal challenges.

Objective: Recent psychiatric literature and contemporary sociopolitical developments suggest a need to reconsider the place of religion and spirituality in psychiatry. This paper was written with the aim of encouraging dialogue between the often antithetical realms of religion and science.

Method: Material from psychiatric, sociological and religious studies literature was reviewed, with particular emphasis on New Zealand sources.

Depot neuroleptic medication and serum levels by radioreceptor assay: prolactin concentration, electrocardiogram abnormalities and six-month outcome.

Twenty-six chronic schizophrenic patients on well-established depot neuroleptic regimes with stable doses (16 on fluphenazine decanoate, 10 on flupenthixol decanoate) had serum neuroleptic levels measured by radioreceptor assay (RRA) and were followed for six months. The serum prolactin (PRL) concentration and resting electrocardiogram (ECG) were also taken at the beginning of the study period. Correlations had previously been noted between RRA measured neuroleptic levels and outcome in both acute and chronic patients on oral medication.

Neuroleptic serum levels measured by radioreceptor assay in patients receiving intramuscular depot neuroleptics. Some preliminary findings.

Twenty-six chronic schizophrenic patients on well established depot neuroleptic regimes with stable doses (16 on fluphenazine decanoate, ten on flupenthixol decanoate) had serum neuroleptic levels measured by a radioreceptor assay (RRA) method. The assay was sufficiently sensitive to measure serum levels in all cases, with acceptable levels of inter-assay variation. Blood level measurements were repeated on two occasions, at the same time interval from the last injection, in 18 patients (11 on fluphenazine decanoate, seven on flupenthixol decanoate) and remained reasonably stable in most cases, although others showed a wider variation.

The peripheral kinetics of norepinephrine in depressive illness.

Sympathetic nervous system function was studied in patients with primary depressive illness. Tritiated norepinephrine was used to measure the rate of entry to plasma of norepinephrine released from sympathetic nerves ("norepinephrine spillover rate"), and to assess the neuronal uptake of norepinephrine by studying the removal of norepinephrine from plasma. Norepinephrine spillover was elevated in five of 11 patients.

Differing noradrenaline kinetics in essential hypertension and depressive illness, two diseases in which the plasma concentration of noradrenaline is sometimes elevated.

1. The rate of spill-over of noradrenaline to plasma, and neuronal noradrenaline uptake, which influences spill-over, were studied in patients with essential hypertension and depressive illness. 2.

Morbid jealousy - an unusual presentation with the reciprocal appearance of psychopathology in either spouse.

This report concerns a married couple. The husband presented first to a psychiatrist with delusional jealousy. As his jealousy rapidly subsided with treatment his wife developed a florid paranoid psychosis for which she refused therapy.