Challenges and pitfalls of antipsychotic prescribing in people with learning disability

No abstract available

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

Background: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. Aims: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. Method: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. Results: Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. Conclusions: In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group

The PAAFID project:exploring the perspectives of autism in adult females among intellectual disability healthcare professionals

Purpose: The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism. Design/methodology/approach: The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel. Findings: ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area. Practical implications: These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism. Originality/value: This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID

Clozapine use in personality disorder and intellectual disability

Purpose: Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the context of personality disorder and intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual disabilities and personality disorder that present with a complex picture of serious risk of harm to both their life and the lives of others. Design/methodology/approach: The authors present five patients with intellectual disabilities and serious life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary treatment plan to manage their presentation. The authors completed baseline assessment of five main symptom domains and then repeated this assessment following treatment with clozapine. Findings: In all five cases use of clozapine was objectively associated with an improvement in symptomatology, quality of life and a safe transfer to the community. Originality/value: The findings suggest that judicious use of clozapine could be considered as one of the effective pharmacological strategies in the management of patients with intellectual disabilities and personality disorder who present with serious life-threatening challenging behaviours

Behaviour of buried water supply pipelines in earthquake zones

Imperial Users onl

Characters with autism spectrum disorder in fiction : where are the women and girls?

Purpose Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue. Design/methodology/approach Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful. Findings The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability. Originality/value This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation

A photograph of four orientalists (Bombay, 1885): knowledge production, religious identities, and the negotiation of invisible conflicts

Abstract By analyzing the history of a photograph taken in a Bombay photo studio in 1885, this article explores notions of the production of knowledge on India and cultural dialogues, encounters, appropriations, and conflicts in colonial British India in the late nineteenth century. The photograph was taken after a Hindu religious ceremony in honour of the Italian Sanskritist Angelo de Gubernatis. Dressed as a Hindu Brahman, he is the only European photographed next to three Indian scholars, but what the image suggests of encounter and hybridity was challenged by the many written texts that reveal the conflicting dialogues that took place before and after the portrait was taken. Several factors were examined in order to decide who should and who should not be in the photograph: religion, cast, and even gender were successively discussed, before the category of “knowledge” became the bond that unified the four men who studied, taught, and wrote on India

Investigating the biosynthesis of the streptomycete antibiotic pacidamycin

Abstract There is an ever increasing need for the development of new antibiotics to fight the emergence of antibacterial resistant strains of pathogens. Developing antimicrobials with ‘novel scaffolds’ and modes of action is an effective way to combat pathogens that are resistant to compounds currently in clinical use. The pacidamycins are a member of the uridyl peptide class of antibiotics that are produced by the soil dwelling bacterium Streptomyces coeruleorubidus. They show specific activity against the pathogen Pseudomonas aeruginosa, using a currently unexploited mode of action against a cell wall biosynthetic enzyme target. This thesis reports the investigation into the biosynthesis of pacidamycin, more specifically, into the function of the hypothetical protein genes present in the pacidamycin gene cluster and the biosynthesis of the non-proteinogenic amino acid, (2S, 3S)-diaminobutyric acid (DABA), which is at the core of the pacidamycin structure and other related antimicrobials. A multidisciplinary approach has been taken in this investigation, utilising biophysical, biochemical and genetic approaches. Protein crystallographic studies have deduced the structure of Pac17, postulated to be a lyase involved in DABA biosynthesis along with structural determination of the protein bound to the proposed substrate aspartate. Site directed mutagenesis of a number of the Pac17 active site amino acids also showed their essentiality for aspartate binding. In vitro biochemical approaches to study the enzymatic activity of the DABA biosynthetic proteins were inconclusive, with no activity observed. Genetic disruptions of the genes under investigation revealed the function of pac13 as a dehydratase, responsible for dehydrating the furan ring of the uridyl nucleoside present in the pacidamycin structure. Further to this, these studies established the essentiality of the DABA biosynthetic genes pac19 and pac20 for pacidamycin production in the native producer