Medicine,Science and the Law

The Special Hospital Service Authority for England and Wales undertook an extensive international literature review on seclusion as a basis for a proposed extended research project on seclusion in the Special Hospital system. The review highlighted the theoretical foundations of seclusion to be based on therapy, containment or punishment; however, there appeared little work carried out in examining the underlying attitude to these central themes. It was suggested that a further level of analysis, by measuring these attitudes along a benevolent-malevolent scale, may prove helpful in advancing our conceptual understanding of the role seclusion plays as a psychiatric intervention.

The influence of the person's age upon reproducibility in duplicate breath alcohol analyses is investigated. A total of n = 30,324 duplicate results (with both ≥0.01 g/210L) were selected and divided into eight age groups from 10–19, 20–29, and up through 80+. Two duplicate agreement criteria, +/- 10% of the mean and +/- 0.02 g/210L, were evaluated according to age. A X² _trend analysis was employed and resulted in: +/- 10% of mean criteria, P < 0.001 and +/- 0.02 g/210L criteria, P > 0.05. The proportions of duplicates not conforming to the two agreement standards along with 95% confidence intervals were: +/- 10% of mean, 0.026 (0.024 to 0.028) and +/- 0.02 g/210 L, 0.052 (0.050 to 0.054). Depending on the agreement criteria selected there will be proportional differences, but neither appears to be importantly influenced by the subject's age. The breath sampling criteria employed in the instrument studied does not appear to inhibit acceptable agreement, even in elderly subjects where the risk of respiratory disfunction increases.

Monoclonal antibodies(MoAbs) very specific to diquat (DQ) were produced. An immunogen was synthesized by binding DQ to bovine serum albumin via a diazo-coupled derivative. BALB/c mice were immunized i.p. monthly with 0.25mg of the immunogen for five months. Their spleen cells were fused with P3U1 myeloma cells and hybridoma clones secreting MoAbs were obtained. Two MoAbs were selected and subtyped to be IgM and IgG₃. The MoAbs recognized DQ but did not bind to paraquat and other analogues at all. A datum obtained from a clinical sample demonstrates that an enzyme-linked immunosorbent assay system using one of the MoAbs is useful in the practice of toxicological analysis.

This paper reviews the literature on prison suicide. The characteristics of suicide within the Canadian Federal Penetentiary Service are compared with previous data. In the population examined, prison suicide was found to be a predominently male phenomenon, not associated with age, offence type, previous convictions or length of sentence. It was most commonly committed by hanging, frequently occurring in the period shortly after sentencing. Suicide was associated with single marital status, earlier suicide attempts, a history of drug or alcohol abuse, and a previous history of psychiatric illness.

In the past decade especially, a number of studies have appeared on suicide among court-involved persons, chiefly in jail and prison remand settings, and to a lesser degree among longer-term prisoners. Confinement is not everywhere equally suicidogenic, and the types of people who find themselves confined do not represent uniformly high risk groups. This article reports on rates of completed suicides over long periods of time in two very different US institutions operated by the Massachusetts Department of Correction: the Addiction Centre and its antecedent faculties (1886–1990); and the Defective Delinquent Department (1922–1971). For perspective, the paper compares suicide rates among its two populations to rates for other very distinctive institutions operated by the Massachusetts Department of Correction, the Bridgewater State Hospital and the Massachusetts Treatment Centre for Sexually Dangerous Persons. The results are remarkable for the rarity of suicide in three distinct populations—the Addiction Center, the Defective Delinquent Department and the Treatment Center for Sexually Dangerous Persons—but considerably higher rates in the State Hospital, a population often dismissed as “criminally insane.” The possible significance of these results for debates about “importation” versus “deprivation” explanations of custodial suicide is discussed.

This paper examines the problem of suicide among patients discharged from a Regional Secure Unit. The stereotype that emerges is a young man with anti-social personality traits, suffering from an affective psychosis, with a history of substance abuse and impulsive violence directed both towards himself and others, who is alienated from care staff and social supports because of his provocative and uncooperative behaviour. In contrast with the general population, forensic patients are more likely to commit suicide using a violent method and are more likely to have a suicide verdict recorded by the coroner. The implications of these findings for treatment and preventive interventions are discussed.

The characteristics of a series of patients referred to a psychogeriatric service over a one-year period were examined. Patients exhibiting aggressive behaviour as a feature of the presentation were compared to those without. Aggressive patients were less likely to be living in their own homes, less likely to receive services, more likely to be referred from social services institutions, and be on multiple psychotropic drugs, particularly neuroleptics. The implication of this for adequate provision of psychiatric and social service is discussed. Only a small number of patients exhibited aggressive behaviour as a feature of their presentation.

This article examines whether to be lawful a cremation must be carried out in accordance with the Cremation Acts. It argues that it need not be but points out that any lacuna in the Acts will be plugged if and when the new consolidated Cremation Regulations are passed. It then considers the implication of this reform for the disposal of babies born dead before the legal age of viability.

In England and Wales 5–10 per cent of homicides are followed by the suicide of the assailant. Fifty-two episodes of homicide-suicide occurring in Yorkshire and Humberside have been studied. Forty-nine of the assailants were male with a mean age of 49 years. There were 65 victims, who were usually the spouse and/or children of the killer. Shooting was the most frequent method of killing and subsequent suicide. The results are compared with other homicide statistics and previously published studies of homicide-suicide.