Restricting Movement or Depriving Liberty?

This judicial appeal for clarity exposes a jurisprudential problem which threatens one of our most fundamental human values; the right to liberty. For no-one really knows what it means to be “deprived” of one’s “liberty”. The extremities are straightforward. Prisoners are deprived; picnickers are not. But liberty deprivations may “take numerous other forms [whose] variety is being increased by developments in legal standards and in attitudes”. Technology, too, has played its part in such developments by introducing novel ways of restricting movement beyond the paradigmatic lock and key. The more expansive those other forms, however, the greater the risk of legal uncertainty

Protecting the Suicidal Patient

Savage v South Essex Partnership NHS Foundation Trust[2007] EWCA Civ 137

Is Capacity “In Sight”?

Convicted of rape, Mr B was sent to Broadmoor. His psychiatrist diagnosed bipolar affective disorder and wanted, if necessary, to compulsorily treat him with anti-psychotic medication. In his professional opinion, Mr B lacked insight into his condition and lacked the capacity to refuse the treatment. Baroness Hale once remarked that “psychiatry is not an exact science”. If there was ever a case to confirm that view, this is it

First Do No Harm. Second Save Life?

Some 50,352 people killed themselves in England and Wales between 1997 and 2006. Reducing this human toll of inner turmoil has long been a key national priority for health services. But protecting us from ourselves is no easy task when the apparent benefits of escaping life outweigh the agony of having to endure it. Often it is too late for someone’s suicidal ideation to come to the attention of the authorities. Sometimes, however, the risk to life is more readily apparent: on average, 1300 patients already known to mental health services commit suicide every year.The European Convention for the Protection of Human Rights and Fundamental Freedoms 1950 is slowly realigning the moral and legal obligations of public bodies to protect life, with Article 2 imposing three duties upon the state. Firstly, a negative duty to refrain from taking life, save in prescribed exceptional circumstances. Secondly, a procedural obligation to investigate deaths for which it might bear some responsibility. Finally, there is a positive obligation to take steps to protect our lives which is the exclusive focus of this paper

The Role of the Serotonergic Neurotransmitter System in the Development and Treatment of Affective Disorders

Serotonin, arising from neurons of the raphe nuclei, is intimately involved in the treatment of depression and anxiety disorders. Serotonin selective reuptake inhibitors (SSRIs) are frontline therapy for both of these conditions, and have well-described behavioral effects in animal models of emotional behavior. Yet, administration of SSRIs during postnatal development produces an opposing phenotype, including increased anxiety- and depression-like and reduced social behaviors. Because the serotonin transporter, the target of these drugs, is expressed primarily in serotonergic neurons of the raphe, I sought to identify biological mechanisms for behavioral effects of both adult and postnatal SSRI treatment in this cell population. Initially, we compared the transcriptome of serotonergic neurons to whole brain homogenate, in order to both validate the experimental methods, and to provide a descriptive analysis of gene expression in this neuron type. Many transcripts were enriched in raphé samples, including both known markers of serotonergic neurons, and novel genes, most of which could be confirmed from by in situ hybridization data from the Allen Brain Atlas. In postnatal fluoxetine treated mice, we report alterations at the anatomical, electrophysiological, and transcriptional levels. Serotonergic innervation of the prefrontal cortex and hippocampus was reduced by fluoxetine treatment, consistent with the neurodevelopmental role serotonin plays. The firing rate of serotonergic neurons was also reduced due to an increase in inhibitory transmission. Additionally, the transcriptome of serotonergic neurons was altered by postnatal SSRI: a preponderance of downregulated transcripts was observed, particularly among genes involved in mitochondrial and ribosomal function. These findings combine to suggest a hypotrophic serotonergic system is produced by postnatal SSRI treatment. Studying the effect of adult treatment with SSRIs, we report a normalization of elevated serotonin 1A receptors in depressed, medication-naive patients. However, we did not detect a relationship with clinical response, raising the possibility that serotonin 1A downregulation is an epiphenomenon of SSRI treatment. In adult fluoxetine treated mice, gene expression profiling identified a number of differentially regulated transcripts. We further used postnatal fluoxetine treatment as a model of treatment resistance, investigating the transcriptional actions of adult fluoxetine treatment in postnatal fluoxetine- vs. saline-treated mice, in order to identify transcripts that track with behavior. We found upregulation of a number of promising candidate genes, including vesicular glutamate transporter 3, histamine receptor 2, and the neuropeptide processing enzyme Ece2

Anaphylaxis: a study of the condition and treatment

Anaphylaxis is a sudeen, severe and life threatening hypersensitivity reaction following exposure to a foregin protein. The majority of anaphylactic deaths are caused by envenomation from stings followed by adverse reactions to drugs and food.Treatment tends to be  through the use of intra muscular adrenaline, nebulised salbutamo, anti histamines and steroids, although evidence has shown that the time required for the anti histamines and steroids to work shows little benefit for the patient in the early treatment stage.Given the nature of anaphylaxis, research on human subjects is fraught with ethical dilemas and a status quo in treatment regimes is likely for the foreseeable futur