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SUMMARY: Despite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly delayed discharge, resulting in trauma. This article draws on the cases of four people to illustrate the limitations of current mental health system approaches to the challenges experienced by autistic people and people with an intellectual disability. The importance of relational working and listening to people is explored, and we demonstrate how this can facilitate the provision of bespoke housing and care packages to enable a successful return to life in the community. Finally, we offer recommendations on the changes urgently needed to ensure that autistic people and people with an intellectual disability can live ordinary lives in their own homes, with timely and effective support from mental health services when needed, just like everyone else. [ABSTRACT FROM AUTHOR]

Purpose It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this work is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists. Design/methodology/approach The development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process. Findings The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists in the UK. Practical implications The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles. Originality/value Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the UK Department of Health to involve service users in the training of healthcare professionals. [ABSTRACT FROM AUTHOR]

BackgroundThe identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare.MethodThis secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression.ResultsApproximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores.ConclusionsHomotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions. [ABSTRACT FROM PUBLISHER]

Background. Tuberous sclerosis complex (TSC) is associated with intellectual disability, but the risk pathways are poorly understood. Method. The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of the natural history of TSC. One hundred and twenty-five UK children age 0-16 years with TSC and born between January 2001 and December 2006 were studied. Intelligence was assessed using standardized measures at ≥2 years of age. The age of onset of epilepsy, the type of seizure disorder, the frequency and duration of seizures, as well as the response to treatment was assessed at interview and by review of medical records. The severity of epilepsy in the early years was estimated using the EChess score. Genetic studies identified the mutations and the number of cortical tubers was determined from brain scans. Results. TSC2 mutations were associated with significantly higher cortical tuber count than TSC1 mutations. The extent of brain involvement, as indexed by cortical tuber count, was associated with an earlier age of onset and severity of epilepsy. In turn, the severity of epilepsy was strongly associated with the degree of intellectual impairment. Structural equation modelling supported a causal pathway from genetic abnormality to cortical tuber count to epilepsy severity to intellectual outcome. Infantile spasms and status epilepticus were important contributors to seizure severity. Conclusions. The findings support the proposition that severe, early onset epilepsy may impair intellectual development in TSC and highlight the potential importance of early, prompt and effective treatment or prevention of epilepsy in tuberous sclerosis. [ABSTRACT FROM AUTHOR]

Background Optimisation of the process and outcomes of service user involvement in research is dependent on understanding current practice, challenges and opportunities. Aims To describe activities, roles and experiences of service users involved in mental health research. Method National cross-sectional online questionnaire survey, using snowball sampling. Descriptive statistics and framework analysis undertaken collaboratively with a service user reference group. Results The survey revealed a previously undescribed, highly qualified service user research workforce. Positioned within and alongside mainstream research, respondents reported drawing on extensive service use, and passion for service improvement to challenge perceived clinical academic dominance of research. The support of peers was crucial to involvement, which typically enhanced mental health but for some, pervasive stigma and scrutiny undermined self-confidence and practical difficulties challenged equitable participation. Conclusions Recognition of the service user research workforce will support the constructive amalgamation of academic and experiential expertise needed to shape and realise investment in mental health research. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about the provision of reasonable adjustment of healthcare for vulnerable patients or people with intellectual disabilities under the British Equalities Act 2010, which appeared in the previous issue.

Previous studies have highlighted the paucity of knowledge possessed by people in a number of jurisdictions with regard to specific legal issues and processes, yet what has not been fully understood is the practical impact of this lack of knowledge. This paper looks at how knowledge of rights affects the resolution of civil justice problems. Data were extracted from a large-scale survey of adults’ experience of rights problems throughout England and Wales (10,537 adult respondents). The results demonstrated that most individuals were not aware of their rights at the time the problem occurred (64.8 per cent). Knowledge was shown to be poorest amongst those with mental illness, those without higher qualifications and those renting their homes. Problems where knowledge was poor included clinical negligence, welfare benefits and neighbours issues. Knowledge did not appear to be related to a particular problem-solving strategy but had an impact on the fulfilment of objectives and the obtaining of advice. Our findings depart from existing literature by indicating that knowledge of rights alone is not associated with legal self-sufficiency in terms of a reduced dependence upon legal advice services. We find, however, that individuals, with knowledge of rights, experience better outcomes when they opt to handle their problem alone. Accordingly, the presence or absence of knowledge of rights may be a useful proxy measure of legal advice need and relevant to the process of legal aid rationing. Our findings highlight the role that Public Legal Education (PLE) (both ‘rights-based education’ and ‘just-in-time/self-help’) may play in disposing of less complex problems, while presenting a strong case for the continued availability of free legal advice services. The research is discussed in the context of the recently announced legal aid reforms in England and Wales and their anticipated impact. [ABSTRACT FROM PUBLISHER]

Background: Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.Aims: To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.Method: Following identification of units, data were collected by a postal general survey with telephone follow-up.Results: Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.Conclusions: A national approach is needed to the planning and commissioning of this specialist service. [ABSTRACT FROM AUTHOR]

Background The Department of Health and UK funding bodies have suggested that clinical academics work closely with mental health service users in research projects. Although there are helpful guidelines on the issues that have to be dealt with, there have been few examples of how this partnership research might be undertaken. Aims To illustrate the challenges in joint research projects. Method We subjected the process of user involvement to ten questions which arose in the development of a joint research project. The answers are an amalgamation of the user and clinical researcher considerations and are affected by hindsight. Results The involvement of the user-researcher changed the focus of the study and its design and content. More attention was paid to the intervention itself and the way in which it was delivered. This process increased the amount of time taken to carry out and write up the project as well as incurring financial costs for user consultation payments and dissemination. Conclusions This experience has clarified the contribution that users can make, for example by raising new research questions, by ensuring interventions are kept user friendly', and the selection of outcome measures. [ABSTRACT FROM AUTHOR]

A response to a letter to the editor is presented on an article about the provision of reasonable adjustments during in-patient care of vulnerable patients or people with intellectual disabilities under the Equalities Act 2010, which appeared in the previous issue.

Background: Because of continuing concern regarding the inadequacy of existing NHS provision for mentally disordered remand prisoners, the Bentham Unit was commissioned as a pilot project to provide rapid assessment and, where appropriate, hospital admission for such prisoners from the former North West Thames catchment area.Method: Information is presented on the 150 referrals and 62 admissions in the first year of the service's operation.Results: The service met the Reed Report targets for assessment time. Most of those referred were previously known to psychiatric services. The alleged offences were more serious than anticipated. Those admitted were transferred to appropriate services at the conclusion of their court cases, and remained in contact with services three months later. Waiting for the conclusion of court proceedings significantly prolonged the length of stay. Substantial cost transfers from the criminal justice system to the health system were evident.Conclusions: Adequate services for mentally disordered remand prisoners are entirely achievable; provision of such services is a resource issue, not a clinical problem. [ABSTRACT FROM AUTHOR]

The article provides information about the classification and treatment of dysthymia in Great Britain. In the "Diagnostic and Statistical Manual of Mental Disorders," third edition (DSM-III), dysthymic individuals was described as being bothered most of the time by symptoms characteristic of the depressive syndrome but are not of sufficient severity and duration to meet the criteria for a major depressive episode. However, due to the difficulty of distinguishing the dysthymia from a number of mental disorder, a proposal to subclassify the disorder has been submitted. Meanwhile, the use of 5-TH2 receptor antagonist ritanserin has been reported to have a positive effect on patients.

A comparison was made of initial assessment, treatment, and pattern of care of two groups of non-psychotic patients, referred to a Central London psychiatric outpatient department. The patients, none of whom had been in recent psychiatric treatment, were differentiated into those receiving short-term care (less than one year) and those having long-term care (greater than one year). Chronic psychiatric disorders predominated in both groups. It was also common to have physical illness and contact with other hospital departments. Short-term care consisted of very brief contact for 70% of patients, and psychiatrists seemed unable to engage these referrals in treatment. Long-term attendance was associated with acutely ill young, or chronically ill older patients, more active initial intervention, and referral within the same hospital group. Follow-up revealed that long-term patients reported little symptomatic improvement, experienced considerable disruption in course of care, made increased demands on all aspects of psychiatric service, and often proved to have personality disturbance and social problems that were not perceived on initial contact. Types of intervention and their effects on other hospital departments were examined. [ABSTRACT FROM AUTHOR]

The article presents a lecture by Professor F.S.W. Brimblecombe about the needs of young intellectually retarded adults that was delivered before the Royal College of Psychiatrists in February 1984 in Great Britain. Brimblecombe defined the words impairment, disability and handicap and discussed three vital aspects of the lives of mentally handicapped young adults, namely, occupation, housing and extra help. He also illustrates the influences which determine the outcome of the interactions between the agencies which will determine the adult life-style of a handicapped child and the needs and wishes of the individual and his family.

The article discusses some contradictions in the discovery of mental illness in England as a response to Edward Hare's study on the number of mentally ill people. One contradiction is the boost in the number of mentally ill people when an approach which aimed at treating these people was carried out. Hare argues that the growth in numbers mirrors a real increase in the most serious forms of the disorder, schizophrenia. Despite the efforts to minimize such cases except on extreme cases, psychiatrists were forced to announced that one is insane because of embarrassment.

This article discusses a study on the ethical aspects of getting informed consent from mentally ill patients who are unable to understand the nature of the risks and benefits of a drug trial. This study explains the rules of getting informed consent from psychiatric patients in Great Britain. However, there is a gap in the law that can cause considerable difficulties in experimental procedures with severely ill and handicapped psychiatric subjects. A proposed trial was done on piracetam, a drug that enhance the transfer of information across the corpus callosum. Investigators were interested in establishing whether the drug would be of benefit to schizophrenics.

The article shares the author's insights concerning on the imprisonment of mentally disordered offenders in Great Britain. The author said that he has no wish to understate the difficulty of looking after the mentally disordered, but he do not think it any less self-evident than it was to Sir Lionel Fox in 1934 that the insane and mentally defective should not be in prison.

Some conceptual problems in relation to the interaction of genetic influence and social disadvantagement are discussed, and some of the results of a study of 144 families with mentally handicapped children reported. The work of Heber and his associates in Milwaukee is briefly reviewed, and the Edinburgh data discussed in relation to the study in Aberdeen by Birch et al. (1970). Possible strategies for intervention are considered. [ABSTRACT FROM AUTHOR]

This study begins with a detailed analysis of the population of a large psychiatric hospital in South Wales. Attempts are made to determine the incidence of chronicity, with its various underlying causes. This is followed by details of the current admissions to the hospital from a catchment area where general hospital and psychogeriatric units have been established, and estimates of future bed requirements. Finally there is a description of the several facilities of the general hospital unit and of the problems of developing a fully comprehensive mental health service. [ABSTRACT FROM AUTHOR]

In 1972 three old hospitals were closed and patients transferred to a new hospital for the mentally handicapped. Four to six weeks before transfer, disturbed and a sample of non-disturbed patients were rated on a selected scale; they were again rated four to six weeks after transfer. The disturbed patients numbered 39 per cent of the total and both men and women shared a significant improvement, though the men did not improve to the same extent as the women. There was also a significant improvement among the non-disturbed patients, though this did not apply to the epileptic patients. [ABSTRACT FROM AUTHOR]

The article examines the influences on the development of clinical services for psychologically disturbed students in Great Britain. Here, the researchers attempt to relate personality factors to the different patterns of study disturbance as well as to explore how emergent patterns relate to social-cultural factors. In addition, the researchers used a modified and updated medical model to retain considerable interest both for the advance understanding of psychological and social factors in aetiology.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, `in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this `implementation gap' in respect of services for people with mental handicaps-a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve. [ABSTRACT FROM AUTHOR]

The author comments on the study which examines the significance of out-patient and in-patient services in treating mentally ill patients in Great Britain. He highlights the conclusion of the study which states that patients receiving out-patient care are socially and clinically distinct population. The author emphasizes lapses of the study through comparing its finding with material for some Regional Hospital Board, which include new outpatient referrals and inverse relationship.

The article examines the five generations of ill-treated children in one familial ancestry who represented a number of kindreds in a locality from Great Britain. The study accounted that the family pedigree contain numerous members who suffered from mental illness, degree of subnormal intelligence and who experienced profound personality disturbances. The research suggests that the prevention of prolonged physical and mental suffering inflicted to children should be the main focus of preventive medicine in the area of psychiatry relative to family planning.

The article presents a study where a comparison is made between psychiatry in the West, mainly the British psychiatry, and Sudanese psychiatry. The authors emphasizes on the ways the two differ from each other, and the differences are attributed to differences in cultural patterns. A summary of the Sudanese culture pattern is presented including the discussion of the differences in manifestations of psychiatric illness. Hysteria, obsessive compulsive neurosis and sexual anomalies are some of the mental disorders being mentioned in the discussion.

The article cites a study on the diagnostic change of psychiatric patients in Great Britain. It investigates the reason behind the change in the diagnosis of 200 mental hospital patients who were admitted in hospitals four times in two years. Table I shows the large number of diagnostic changes in a specially selected subgroup. It asserts that there is substantial connection in the modification of the psychiatric patients' condition with the assignment of new physicians. The study also determines the clinical state of these patients.

The article presents a three-year study conducted to 68 male oligophrenics aged 18-65 to determine the serum uric acid and cholesterol levels in Great Britain. Out of 68, 18 were mongols, less than one third had histories of epilepsy, convulsions or encephalitis, while the remaining subjects were unclassified. The subjects received the same meals, where 2,300 calories were consumed daily. They were given fats with different fatty acid compositions for the period of 5-6 weeks, and the effects on various blood lipid fractions were studied. As a result, serum uric acid and cholesterol levels were determined during the four subsequent periods. The mongoloid subjects were found to have higher serum uric acid level. The serum cholesterol levels have changed as expected.

The article presents a study on the mental health of West Indian immigrants in London, England. The subjects were 112 immigrants who were admitted over a period of three years to Long Grove Hospital. Among the symptoms of the mental illness displayed by the patients were religious delusions, paranoid ideas, and suicidal thoughts. Factors that contributed to the illness included predominantly negative family histories, and socioeconomic-related environmental stresses. The findings of this study were used as a reference to previous studies of mental immigrant groups and to relevant cross-culture investigations. Frequent presentation of mixed and atypical psychoses and reactions among patients is emphasized.

The article presents a study that evaluates the functions which the Maudsley Hospital Emergency Clinic is currently performing and compares patients attending the clinic with outpatients attending by appointment at the hospital and patients in an observation ward in Great Britain. The study involved 100 patients, of which 53 were women and 47 were men. It was found that the emergency clinic patients differed from the routine outpatients in terms of behavior. The researcher concluded that the emergency clinic has established three distinct functions including a rapid psychiatric evaluation for patients referred by family doctors, responsibility for the correct allocation of patients to the available services and an advisory service for old and current hospital patients.

The article presents a follow-up study on the conditions of schizophrenics after their discharge to the community in Great Britain. A survey of 81 patients suffering from schizophrenia for hospital care was conducted. The study included an interview guide dealing with resettlement problems, employment and family relations, as well as adjustment to community life. It was found that the impact of poor employment record and high degree of chronicity on the family life of the patients was less disturbing. This result was attributed to the emergence of a comprehensive psychiatric service in the community.

The article presents a study on the relationship between sleep patterns, and reactive and endogenous depressions conducted to all patients admitted to the Munroe Wing mental hospital by Master's of Management Science (MMS) in Great Britain. Patients were interviewed unless they were found completely unable to cooperate, or unless the psychiatrist found the need for sedatives during their first night of hospitalization. Sleep patterns and reports on sleep of a group of reactive and a group of endogenous depressions were investigated. Result shows that observations of sleep has indicated no difference in their patterns. Such patterns also has appeared to vary considerably under different conditions.

The article discusses the study concerning the neurology of psychotic speech in Great Britain. Speech has been called a soci-economic device for saving effort in the attainment of objectives. The complicated field of language-disorder in psychotic patients has formed an intriguing topic for aphasiological study, especially when linguistic techniques of research were employed. Demented patients are likely to show the progressive poverty of speech, which may be overlaid by true dysphasic manifestations when the brain-atrophy happens also to involve the mid-third of the dominant hemisphere to a significant degree.

The authors focus on the issue about the offering of separate psychiatric services for ethnic minority groups in Great Britain. According to them, the idea of a separate mental health services for ethnic minorities is wrong. They emphasize that the segregated services will create a gap in service provision and in the training and continuing professional development of practitioners. They denote that such idea will create an ultimately colonial discourse of transcultural psychiatry. Indeed, they suggest that addressing the issue of institutional racism will result to a fair and equal services for all.

The article discusses the study concerning the quality of life (QOL) of the mentally ill in Great Britain. The QOL of the mentally ill has always been the matter of concern. In addition, it has become a more valued assessment not just in psychiatry, but also in many branches of medicine. The World Health Organization (WHO) developed a project in 1991 to define and create a measure for QOL in such a way as to allow inputs from a broad range of cultures around the world. It could be argued that perceived QOL should not have a prominent position among the assessment of patients.

The Psychopathology Instrument for Mentally Retarded Adults, a recently developed, empirically derived measure of psychiatric disturbance for the mentally handicapped, gives a total of eight scales which correspond to DSM-III diagnostic categories. This paper reports its psychometric properties in a British population and the psychometric properties of three scales derived by factor analysis. The internal consistencies of the scales were only barely acceptable in this sample and less acceptable than in previous studies. [ABSTRACT FROM AUTHOR]

The systematic application of guidelines derived from the British National Formulary resulted in a substantial reduction of the amount and frequency of medication used in two hospitals for the mentally handicapped. [ABSTRACT FROM AUTHOR]

In a representative sample of the UK population we found that common mental disorders (as a group and in ICD-10 diagnostic categories) and subthreshold psychiatric symptoms at baseline were both independently associated with new-onset functional disability and significant days lost from work at 18-month follow-up. Subthreshold symptoms contributed to almost half the aggregate burden of functional disability and over 32 million days lost from work in the year preceding the study. Leaving these symptoms unaccounted for in surveys may lead to gross underestimation of disability related to psychiatric morbidity. [ABSTRACT FROM AUTHOR]

Some people with phenylketonuria who were born before screening began were never treated and are still alive. Here we report that far fewer people with untreated phenylketonuria were detected than are thought to exist (about 2000). The majority of those traced had high support needs, challenging behaviour and other symptoms of phenylketonuria. No significant differences were found between those who had or had not tried the phenylalanine-restricted diet. A randomised controlled trial is required to examine the effect of trying the low-phenylalanine diet for people with untreated phenylketonuria. [ABSTRACT FROM AUTHOR]

The article examines the mental health services delivered to adults with learning disabilities and comorbid psychiatric disorders in Great Britain. It has been argued whether psychiatric care for patients should be made by mainstream mental health services or by specialized services. It emphasizes the need for the alliance of academic institutions, health and social care providers, and service user group to develop a research strategy that will promote evidence-based practice.

The article comments on the importance of community care for people with severe mental in Great Britain. The author noted that there has been extensive evidence that assertive community is a useful and effective intervention. He stressed that the key to the success of community care lies in having a coordinated team approach to the care of the severely mentally ill.

The article discusses the reports released by the National Health Commission (NHC) Executive concerning psychotherapy in Great Britain. The reports display improvements in establishing both a baseline of information and recommendations for good practice, regarding the provision of workers at the different levels of mental health specialism. The first report focuses on the efficacy and effectiveness of psychotherapy and the second report reviews the strategic policies imposed for psychotherapy services. Moreover, the third report covers two issues which are the fundings for purchasing and psychotherapy training.

The article focuses on a paper about the care of the feeble-minded which was published in the June 1892 issue of "British Medical Journal." The author notes that feeble-minded is a class of persons for whom at present scarcely any provision is made, but public opinion has of late been directed to the subject. He adds a special committee of the British Medical Association has taken the matter in hand and are occupied in making provision for thirty of these cases, who will be housed in a cottage and be occupied with laundry work. Meanwhile, he also states that Birmingham has carried out a plan for improving the feeble-minded adults who reside in the town.

The article presents a case study about a man who had multiple tics with vocalization and XYY karyotype in Great Britain. This person was born in 1954 and was seen in September 1973 for headaches of seven month's duration. History of the person's illness is being discussed in the study along with his childhood experiences in school, family and friends. Here, doctors who examined the person suggests that XYY karyotype does predispose to some forms of neurological abnormality, of which tremor and tic may be representative.

The article cites a study that presents the medical assessment of hospitalized mentally retarded children in Great Britain. The study is part of a computer evaluation of medical records of 285 severely retarded children that were admitted in a hospital during the period of 1964-1966. Of the 285 children on the records, 57% were 4 years old or younger during admission, 35% were 4-10 years old, and 8% were 10-13 years old. Results of the study were found to be in congruence with results of previous studies conducted that only 0.4%, 10%, and 12% were hospitalized as a result of medical advice or that the patient required active hospital treatment.

The article focuses on the debate over the political correctness of the terms "mental handicap" and "learning disability" in Great Britain. The term "mental handicap" had been introduced as counterpart to "physical handicap." However, some critics maintained that public perception of "mental" was of madness and of "handicap" was of physical disability. Parents of severely handicapped children claim that the term "learning disability" does not describe their child who is helpless.

The article reports on homicidal insanity in the North of England in 1893. A mentally ill man shot a police officer who was trying to secure him. Another mentally ill shot at two bank clerks with a revolver and wounded them, and then shot himself fatally. It appears that the lunatic brooded over some supposed wrong, for he had an entry in his suicide note that "bank clerks and post-office clerks were all the same." The article was taken from a study published in the May 1893 issue of the periodical "Lancet."

The article recalls a paper about feeble-minded children in Great Britain published in the March 5, 1892 issue of "The Lancet." Studies have shown that the number of children in board schools who are feeble-minded is much larger than was previously observed. However, boards of guardians and authorities have no powers to place feeble-minded children in suitable institutions. The results of the studies will be discussed at the Milroy lectures to be delivered in a course at the Royal College of Physicians.

The article presents a review of a case of general paralysis of a mentally ill person that occurred in 1890 in the highlands and wilds in Great Britain and Ireland. The case was reviewed during a meeting by a psychiatrist, where he considered the general paralysis to be disease of higher civilization. According to the psychiatrist, the disease commonly occurs in middle-aged married men, inhabitants of cities, flesh eaters and drinkers of alcohol. He described patients having convulsive seizure or an attack of emotional excitement or one of mania. An overview of the etiology and other symptoms of the disease is offered.