A novel care pathway for prisoners with intellectual disability designed through a Delphi process.

Individuals with an intellectual disability (ID) form a significant minority in the Irish prison population and worldwide prison populations. There is growing recognition that specialist services for such individuals are in need of development. The purpose of this paper is to propose a care pathway for the management of individuals with an ID who present in prison, based on expert elicitation and consensus. A convenience sample of professionals with a special interest in forensic intellectual disabilities was invited to participate in a Delphi exercise. In total, 12 agreed to participation and 10 subsequently completed the study (83.3 per cent). Expert views were elicited using a semi-structured questionnaire. Content analysis was completed using NVivo 11 software. A care pathway was subsequently proposed, based on the outcomes of the analysis, and circulated to participants for debate and consensus. A consensus was reached on management considerations. Ten experts across a range of disciplines with a combined experience of 187 years participated in the study. Current provision of care was seen as limited and geographically variable. The vulnerability of prisoners with ID was highlighted. The need for equivalence of care with the community through multidisciplinary input and development of specialist secure and residential placements to facilitate diversion was identified. Consensus was achieved on a proposed care pathway. This study proposes a care pathway for the assessment and management of prisoners with an ID and is, therefore, potentially relevant to those interested in this topic internationally who may similarly struggle with the current lack of decision-making tools for this setting. Although written from an Irish perspective, it outlines key considerations for psychiatrists in keeping with international guidance and, therefore, may be generalisable to other jurisdictions

The (not so) controversial role of DNA methylation in epigenetic inheritance across generations.

It has been demonstrated originally in plants that phenotypic traits, such as floral symmetry, can be caused by changes of methylation patterns of specific genes. Such traits can be transgenerationally inherited for multiple generations and remain associated with cytosine methylation patterns. Whether genomic methylation may also contribute to epigenetic inheritance across generations in vertebrates and notably in mammals is still more controversial. One reason for this tentativeness is the dual occurrence of global genomic de-methylation first in pre-implantation embryos and subsequently in primordial germ cells (PGCs) of mammals. Although gene focused cases of epigenetic inheritance associated with genomic DNA methylation have been well studied mostly in rodents (such as imprinted genes and the Agouti viable yellow, Avy, allele), it is still a matter of debate whether genomic DNA methylation may provide a more general mechanism for the epigenetic inheritance of acquired traits across generations. We review the current literature on this topic with a focus on the potential role of DNA methylation for epigenetic inheritance across generations in mammals