Hugh Series - Academia.edu (original) (raw)
Papers by Hugh Series
Cambridge University Press eBooks, Apr 30, 2024
Journal of Medical Ethics, Feb 1, 1997
Oxford University Press eBooks, Oct 19, 2017
This chapter considers some of the physical options for the treatment of the affective disorders,... more This chapter considers some of the physical options for the treatment of the affective disorders, depression, and mania. It first provides an historical overview of physical treatments for depression, including drugs such as opium, morphine, and diamorphine, chloral, and barbiturates, as well as electroconvulsive therapy (ECT). It then examines whether antidepressants work and how they are used before describing the biological basis of depression. It also looks at different classes of antidepressants, including monoamine oxidase inhibitors (MAOIs), reuptake inhibitors, and mood stabilizers. Finally, it evaluates non-pharmacological physical treatments ranging from ECT to transcranial magnetic stimulation (TMS), psychosurgery and deep brain stimulation, and novel therapies.
Psychopharmacology, Dec 1, 1994
Previous work has suggested that repeated treatment with substituted amphetamines including PCA, ... more Previous work has suggested that repeated treatment with substituted amphetamines including PCA, MDMA and d-fenfluramine produces a persistent neurodegeneration which is relatively selective for the fine serotoninergic terminals arising from the dorsal raphe nucleus. The aim of the present study was to investigate whether the acute releasing effect of d-fentturamine might also be sensitive to lesions produced by PCA, MDMA and d-fenfluramine itself. Basal and 5-HT release evoked by d-fenfluramine or t00 mM KC1 was measured by microdialysis in frontal or parietal cortex of rats 2 weeks after they had been treated with a neurodegenerative regime of PCA, MDMA, d-fenfluramine, or vehicle. In frontal cortex of vehicle controls, d-fenfluramine (10 mg/kg IP) and KCI (100 mM via microdialysis probe) evoked an increase in 5-HT of 1740% and 779% of basal, respectively. PCA pretreatment reduced d-fenfluramineevoked 5-HT release by 90.9% while potassium-evoked release was reduced by only 66.8%. Similar results were obtained in parietal cortex. MDMA (20 mg/kg × 8) and d-fenfluramine (12.5mg/kgxS) pretreatment reduced d-fenfluramine-evoked release of 5-HT in frontal cortex by 45.2% and 72.0%, respectively. Overall, the present data are consistent with the hypothesis that the acute release of 5-HT evoked by d-fenfluramine occurs via those terminals destroyed by pretreatment with PCA, MDMA and dfenfluramine, while KC1 evokes release from both PCAsensitive and PCA-insensitive terminals. The significance of these results for the interpretation of neuroendocrine data from d-fenfluramine challenge tests is discussed.
Life Sciences, 1987
This short article reviews HPLC-EC methodology that we are currently applying to measure DA, 5-HT... more This short article reviews HPLC-EC methodology that we are currently applying to measure DA, 5-HT and their acid metabolites in rat brain dialysates collected in vivo. HPLC-EC systems based on standard-bore HPLC columns are described which are sufficiently sensitive to allow detection of the monoamine transmitters and their metabolites in regional brain dialysates collected at 10-20 min intervals. A large reduction in sample requirement was achieved by "down-scaling" the conventional HPLC-EC assay to incorporate small-bore HPLC columns. The small-bore systems allowed monoamines to be detected in samples collected over 1 to a few minutes.
Journal of Neurology, Neurosurgery & Psychiatry, 1995
International Journal of Social Psychiatry, 2010
A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplifi... more A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplification of the current categories and the use of clinically relevant specifiers. Such changes have implications for the positioning of diagnostic groups and lead to a range of possibilities for improving terminology and the juxtaposition of individual conditions. The development of ICD-11 provides the fi rst opportunity in almost two decades to improve the validity and reliability of the international classification system. Widespread change in broad categories and criteria cannot be justified by research that has emerged since the last revision. It would also be disruptive to clinical practice and might devalue past research work. However, the case for reorganization of the categories is stronger and has recently been made by an eminent international group of researchers (Andrews et al., 2009). A simpler, interlinked diagnostic system is proposed here which is likely to have fewer catego...
Journal of Medical Ethics, 1996
<p>This chapter reviews the legal regulation of treatment of depression as it exists in Eng... more <p>This chapter reviews the legal regulation of treatment of depression as it exists in England and Wales, where medicinal products are regulated largely by the Medicines Act 1988 and the Misuse of Drugs Act 1971. The Medicines Act divides medicinal products into pharmacy only medicines, which can only be purchased under the supervision of a pharmacist, over-the-counter medicines, and prescription only medicines. The Misuse of Drugs Act is concerned with controlled drugs. These are divided into three classes according to their perceived degree of harmfulness. This chapter considers treatment with valid consent and two pieces of legislation that govern people who are sufficiently ill and need to be admitted to hospital: the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). It also discusses treatment of mentally incapacitated patients and the issue of liberty regarding the admission of a compliant but incapacitated patient to hospital. Finally, it looks at three types of non-medical prescribing in England, issued by independent prescribers, supplementary prescribers, and community practitioners.</p>
Current treatment options in neurology, 2016
Inappropriate sexual behavior (ISB) is a relatively common and potentially disruptive form of beh... more Inappropriate sexual behavior (ISB) is a relatively common and potentially disruptive form of behavior in people with dementia. It can cause considerable distress and put placements and people at risk. Yet it is poorly researched and understood. In addition to non-pharmacological approaches to management, a wide range of classes of medication has been used in ISB, and the results have been reported as single cases or short series, though none has been the subject of a randomized clinical trial, in part because of the lack of a well-defined method of observing and measuring ISB, as well as the significant ethical considerations. Pharmacological treatments for which there is low-level evidence of efficacy in the literature include antidepressants, antipsychotics, anticonvulsants, cholinesterase inhibitors, hormonal agents, and beta-blockers. None of the drugs discussed here is licensed for use in ISB, and elderly people, particularly those with dementia, are at high risk of adverse ef...
Journal of Psychopharmacology, 1995
The amphetamine derivatives p-chloroamphetamine ( pCA), 3,4-methylenedioxymethamphetamine (MDMA, ... more The amphetamine derivatives p-chloroamphetamine ( pCA), 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy') and D-fenfluramine can, if given repeatedly in high doses to rats, produce a degeneration of serotonergic nerve terminals which we have previously shown to result in a reduction in D-fenfluramine-evoked release of 5-HT in vivo. It is therefore possible that fenfluramine-evoked responses may have value as a probe of 5-HT neurodegeneration in man. The present study examined the effect of pre-treatment with these three agents ( pCA 12 mg/kg×2; MDMA 20 mg/kg×8; D-fenfluramine 12.5 mg/kg×8, 14 days prior to testing) on behavioural (5-HT syndrome) and neuroendocrine [prolactin and adrenocorticotrophin (ACTH)] responses in rats to acute administration of D-fenfluramine and other serotonergic agonists. All three pre-treatments attenuated the D-fenfluramine-evoked behavioural syndrome, but did not affect the prolactin or ACTH responses to acute challenge with D-fenfluramine (ap...
International Journal of Geriatric Psychiatry, 1991
An algorithm that uses the cycle structure of the rows, or the columns, of a Latin square to comp... more An algorithm that uses the cycle structure of the rows, or the columns, of a Latin square to compute its autotopy group is introduced. As a result, a bound for the size of the autotopy group is obtained. This bound is used to show that the computation time for the autotopy group of Latin squares that have two rows or two columns that map from one to the other by a permutation which decomposes into a bounded number of disjoint cycles, is polynomial in the order n.
International Journal of Geriatric Psychiatry, 2006
Background Evidence from open label studies has indicated that patients with dementia with Lewy b... more Background Evidence from open label studies has indicated that patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) do better than those with other diagnoses, including Alzheimer's disease (AD). In addition, those with dementia of moderate severity do better than those with mild severity. Method Data collected for the monitoring of cholinesterase inhibitor prescribing in Oxfordshire over four years were supplemented with retrospective case notes inspection. 'Clinical response' was defined as improvement sufficient to merit continuation of therapy. A mini-mental state examination (MMSE) improvement of 2 or more points was defined as a 'cognitive response'. Results Medication was prescribed for 1322 patients and outcome data was available on 1250. Subsequently, 939 patients were reassessed after a mean of 120 days (SD 64.1). Medication was discontinued early by 311, mainly due to side effects. Of those who reached reassessment, 82% (771 of 939) were clinical responders and 37% (232 of 622) were cognitive responders. Overall, MMSE scores improved by þ0.6 points [95% Confidence Intervals (CI) 0.3-0.9] and by þ1.0 points (95% CI 0.7-1.3) in clinical responders; and deteriorated À1.5 points (95% CI À0.9-À2.1) in clinical non-responders. A greater probability of clinical response was seen for DLB/PDD compared to AD patients (Odds Ratio (OR) ¼ 2.28, 95% CI 1.07-4.89], and in men (OR ¼ 1.51, 95% CI 1.02-2.23). A positive cognitive response was predicted by DLB/PDD compared to AD (OR ¼ 2.07, 95% CI 1.16-3.70), moderate dementia compared to mild dementia (OR ¼ 3.90, 95% CI 2.75-5.52), and by increasing age (OR 1.03 for each incremental year, 95% CI 1.01-1.06). Those with moderate dementia were not more likely to have a positive clinical response than those with mild dementia. Conclusions DLB/PDD patients were more likely to be both clinical and cognitive responders than those with AD. The finding that cognitive, but not clinical, response was more likely in those with moderate dementia than in those with mild dementia accords with the findings from randomised studies in the January 2006 revision of the NICE Appraisal Consultation Document.
Alzheimer's & Dementia, 2006
mice (4.5 months) were treated with IP galantamine 3.5 mg/kg/day or memantine 30 mg/kg/day in dri... more mice (4.5 months) were treated with IP galantamine 3.5 mg/kg/day or memantine 30 mg/kg/day in drinking water, or with both drugs for 2.5 months. Control groups consisted of WT and AD11 mice (all groups, n 10), treated with vehicle. Due to deaths in the galantamine (n 5), memantine (n 1) and combination treated (n 5) AD11 mice, doses were reduced (galantamine 3.5 mg/kg/alternate days or memantine 20 mg/kg/day) for an additional 4.5 months. AD11 mice were tested for object (OR) recognition and context (CTX), before and during treatment. Spatial deficits were determined after treatment using the Morris water maze test (MWM). Results: Intragroup and intergroup analysis was performed. Vehicle treated AD11 mice showed significant OR (P 0.001), CTX (P 0.045) and MWM deficits (P 0.05). Despite reduced samples, drug efficacy could be tested. Galantamine (n 6) and the combination (n 4) rescued OR deficit (P 0.009 and P 0.007, respectively). Galantamine and the combination rescued CTX deficit during the initial phases of the treatment, with a reduced efficacy 5 months after treatment started (P 0.06, P 0.29, respectively). Memantine alone rescued OR deficit but did not ameliorate the late CTX deficit. All treatment regimens ameliorated the learning deficit during the acquisition phase of MWM, but only the combination improved the performance in the retention phase of MWM (P 3.85 E-5). Conclusions: These data suggest that galantamine ameliorates OR and CTX deficits in AD11 mice and that the simultaneous administration of two drugs addressing AD at two different molecular levels reduces the spatial deficits in a mouse model for sporadic AD. Study sponsored by Janssen-Cilag Medical Affairs EMEA, a division of Janssen Pharmaceutica N.V.
Advances in Psychiatric Treatment, 2012
SummaryThe article briefly describes the structure of the civil courts in England and Wales and e... more SummaryThe article briefly describes the structure of the civil courts in England and Wales and explains how laws are drafted. This information is used as a basis for understanding the rule of precedent: how earlier court decisions may be binding in later cases. The article explains what law reports are, how cases are reported in the legal literature and how they may be located and cited. A number of key cases are summarised to illustrate the process of judicial reasoning and to show how case law contributes to psychiatric practice and defines the legal structure of medical work. A list of useful legal websites is given.
Advances in Psychiatric Treatment, 2012
SummaryVascular dementia is associated with a group of diverse pathologies affecting the cerebrov... more SummaryVascular dementia is associated with a group of diverse pathologies affecting the cerebrovascular circulation and with other dementia pathologies, particularly Alzheimer's disease. It is rather rare on its own. There is a spectrum of severity of cerebrovascular disease ranging from pathology but no cognitive impairment, to mild cognitive impairment to a dementia syndrome (vascular dementia). Where present, cerebrovascular disease can magnify the impact of other pathologies such as Alzheimer's disease. Current criteria for diagnosing vascular dementia are inadequate. Neuroimaging can be very helpful in defining the extent of pathology. Assessment needs to take into account a wide range of issues. Specific evidence-based treatments are limited, but attention should be given to managing risk factors and associated psychiatric problems such as depression.
Cambridge University Press eBooks, Apr 30, 2024
Journal of Medical Ethics, Feb 1, 1997
Oxford University Press eBooks, Oct 19, 2017
This chapter considers some of the physical options for the treatment of the affective disorders,... more This chapter considers some of the physical options for the treatment of the affective disorders, depression, and mania. It first provides an historical overview of physical treatments for depression, including drugs such as opium, morphine, and diamorphine, chloral, and barbiturates, as well as electroconvulsive therapy (ECT). It then examines whether antidepressants work and how they are used before describing the biological basis of depression. It also looks at different classes of antidepressants, including monoamine oxidase inhibitors (MAOIs), reuptake inhibitors, and mood stabilizers. Finally, it evaluates non-pharmacological physical treatments ranging from ECT to transcranial magnetic stimulation (TMS), psychosurgery and deep brain stimulation, and novel therapies.
Psychopharmacology, Dec 1, 1994
Previous work has suggested that repeated treatment with substituted amphetamines including PCA, ... more Previous work has suggested that repeated treatment with substituted amphetamines including PCA, MDMA and d-fenfluramine produces a persistent neurodegeneration which is relatively selective for the fine serotoninergic terminals arising from the dorsal raphe nucleus. The aim of the present study was to investigate whether the acute releasing effect of d-fentturamine might also be sensitive to lesions produced by PCA, MDMA and d-fenfluramine itself. Basal and 5-HT release evoked by d-fenfluramine or t00 mM KC1 was measured by microdialysis in frontal or parietal cortex of rats 2 weeks after they had been treated with a neurodegenerative regime of PCA, MDMA, d-fenfluramine, or vehicle. In frontal cortex of vehicle controls, d-fenfluramine (10 mg/kg IP) and KCI (100 mM via microdialysis probe) evoked an increase in 5-HT of 1740% and 779% of basal, respectively. PCA pretreatment reduced d-fenfluramineevoked 5-HT release by 90.9% while potassium-evoked release was reduced by only 66.8%. Similar results were obtained in parietal cortex. MDMA (20 mg/kg × 8) and d-fenfluramine (12.5mg/kgxS) pretreatment reduced d-fenfluramine-evoked release of 5-HT in frontal cortex by 45.2% and 72.0%, respectively. Overall, the present data are consistent with the hypothesis that the acute release of 5-HT evoked by d-fenfluramine occurs via those terminals destroyed by pretreatment with PCA, MDMA and dfenfluramine, while KC1 evokes release from both PCAsensitive and PCA-insensitive terminals. The significance of these results for the interpretation of neuroendocrine data from d-fenfluramine challenge tests is discussed.
Life Sciences, 1987
This short article reviews HPLC-EC methodology that we are currently applying to measure DA, 5-HT... more This short article reviews HPLC-EC methodology that we are currently applying to measure DA, 5-HT and their acid metabolites in rat brain dialysates collected in vivo. HPLC-EC systems based on standard-bore HPLC columns are described which are sufficiently sensitive to allow detection of the monoamine transmitters and their metabolites in regional brain dialysates collected at 10-20 min intervals. A large reduction in sample requirement was achieved by &amp;amp;amp;amp;amp;amp;amp;quot;down-scaling&amp;amp;amp;amp;amp;amp;amp;quot; the conventional HPLC-EC assay to incorporate small-bore HPLC columns. The small-bore systems allowed monoamines to be detected in samples collected over 1 to a few minutes.
Journal of Neurology, Neurosurgery & Psychiatry, 1995
International Journal of Social Psychiatry, 2010
A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplifi... more A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplification of the current categories and the use of clinically relevant specifiers. Such changes have implications for the positioning of diagnostic groups and lead to a range of possibilities for improving terminology and the juxtaposition of individual conditions. The development of ICD-11 provides the fi rst opportunity in almost two decades to improve the validity and reliability of the international classification system. Widespread change in broad categories and criteria cannot be justified by research that has emerged since the last revision. It would also be disruptive to clinical practice and might devalue past research work. However, the case for reorganization of the categories is stronger and has recently been made by an eminent international group of researchers (Andrews et al., 2009). A simpler, interlinked diagnostic system is proposed here which is likely to have fewer catego...
Journal of Medical Ethics, 1996
<p>This chapter reviews the legal regulation of treatment of depression as it exists in Eng... more <p>This chapter reviews the legal regulation of treatment of depression as it exists in England and Wales, where medicinal products are regulated largely by the Medicines Act 1988 and the Misuse of Drugs Act 1971. The Medicines Act divides medicinal products into pharmacy only medicines, which can only be purchased under the supervision of a pharmacist, over-the-counter medicines, and prescription only medicines. The Misuse of Drugs Act is concerned with controlled drugs. These are divided into three classes according to their perceived degree of harmfulness. This chapter considers treatment with valid consent and two pieces of legislation that govern people who are sufficiently ill and need to be admitted to hospital: the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). It also discusses treatment of mentally incapacitated patients and the issue of liberty regarding the admission of a compliant but incapacitated patient to hospital. Finally, it looks at three types of non-medical prescribing in England, issued by independent prescribers, supplementary prescribers, and community practitioners.</p>
Current treatment options in neurology, 2016
Inappropriate sexual behavior (ISB) is a relatively common and potentially disruptive form of beh... more Inappropriate sexual behavior (ISB) is a relatively common and potentially disruptive form of behavior in people with dementia. It can cause considerable distress and put placements and people at risk. Yet it is poorly researched and understood. In addition to non-pharmacological approaches to management, a wide range of classes of medication has been used in ISB, and the results have been reported as single cases or short series, though none has been the subject of a randomized clinical trial, in part because of the lack of a well-defined method of observing and measuring ISB, as well as the significant ethical considerations. Pharmacological treatments for which there is low-level evidence of efficacy in the literature include antidepressants, antipsychotics, anticonvulsants, cholinesterase inhibitors, hormonal agents, and beta-blockers. None of the drugs discussed here is licensed for use in ISB, and elderly people, particularly those with dementia, are at high risk of adverse ef...
Journal of Psychopharmacology, 1995
The amphetamine derivatives p-chloroamphetamine ( pCA), 3,4-methylenedioxymethamphetamine (MDMA, ... more The amphetamine derivatives p-chloroamphetamine ( pCA), 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy') and D-fenfluramine can, if given repeatedly in high doses to rats, produce a degeneration of serotonergic nerve terminals which we have previously shown to result in a reduction in D-fenfluramine-evoked release of 5-HT in vivo. It is therefore possible that fenfluramine-evoked responses may have value as a probe of 5-HT neurodegeneration in man. The present study examined the effect of pre-treatment with these three agents ( pCA 12 mg/kg×2; MDMA 20 mg/kg×8; D-fenfluramine 12.5 mg/kg×8, 14 days prior to testing) on behavioural (5-HT syndrome) and neuroendocrine [prolactin and adrenocorticotrophin (ACTH)] responses in rats to acute administration of D-fenfluramine and other serotonergic agonists. All three pre-treatments attenuated the D-fenfluramine-evoked behavioural syndrome, but did not affect the prolactin or ACTH responses to acute challenge with D-fenfluramine (ap...
International Journal of Geriatric Psychiatry, 1991
An algorithm that uses the cycle structure of the rows, or the columns, of a Latin square to comp... more An algorithm that uses the cycle structure of the rows, or the columns, of a Latin square to compute its autotopy group is introduced. As a result, a bound for the size of the autotopy group is obtained. This bound is used to show that the computation time for the autotopy group of Latin squares that have two rows or two columns that map from one to the other by a permutation which decomposes into a bounded number of disjoint cycles, is polynomial in the order n.
International Journal of Geriatric Psychiatry, 2006
Background Evidence from open label studies has indicated that patients with dementia with Lewy b... more Background Evidence from open label studies has indicated that patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) do better than those with other diagnoses, including Alzheimer's disease (AD). In addition, those with dementia of moderate severity do better than those with mild severity. Method Data collected for the monitoring of cholinesterase inhibitor prescribing in Oxfordshire over four years were supplemented with retrospective case notes inspection. 'Clinical response' was defined as improvement sufficient to merit continuation of therapy. A mini-mental state examination (MMSE) improvement of 2 or more points was defined as a 'cognitive response'. Results Medication was prescribed for 1322 patients and outcome data was available on 1250. Subsequently, 939 patients were reassessed after a mean of 120 days (SD 64.1). Medication was discontinued early by 311, mainly due to side effects. Of those who reached reassessment, 82% (771 of 939) were clinical responders and 37% (232 of 622) were cognitive responders. Overall, MMSE scores improved by þ0.6 points [95% Confidence Intervals (CI) 0.3-0.9] and by þ1.0 points (95% CI 0.7-1.3) in clinical responders; and deteriorated À1.5 points (95% CI À0.9-À2.1) in clinical non-responders. A greater probability of clinical response was seen for DLB/PDD compared to AD patients (Odds Ratio (OR) ¼ 2.28, 95% CI 1.07-4.89], and in men (OR ¼ 1.51, 95% CI 1.02-2.23). A positive cognitive response was predicted by DLB/PDD compared to AD (OR ¼ 2.07, 95% CI 1.16-3.70), moderate dementia compared to mild dementia (OR ¼ 3.90, 95% CI 2.75-5.52), and by increasing age (OR 1.03 for each incremental year, 95% CI 1.01-1.06). Those with moderate dementia were not more likely to have a positive clinical response than those with mild dementia. Conclusions DLB/PDD patients were more likely to be both clinical and cognitive responders than those with AD. The finding that cognitive, but not clinical, response was more likely in those with moderate dementia than in those with mild dementia accords with the findings from randomised studies in the January 2006 revision of the NICE Appraisal Consultation Document.
Alzheimer's & Dementia, 2006
mice (4.5 months) were treated with IP galantamine 3.5 mg/kg/day or memantine 30 mg/kg/day in dri... more mice (4.5 months) were treated with IP galantamine 3.5 mg/kg/day or memantine 30 mg/kg/day in drinking water, or with both drugs for 2.5 months. Control groups consisted of WT and AD11 mice (all groups, n 10), treated with vehicle. Due to deaths in the galantamine (n 5), memantine (n 1) and combination treated (n 5) AD11 mice, doses were reduced (galantamine 3.5 mg/kg/alternate days or memantine 20 mg/kg/day) for an additional 4.5 months. AD11 mice were tested for object (OR) recognition and context (CTX), before and during treatment. Spatial deficits were determined after treatment using the Morris water maze test (MWM). Results: Intragroup and intergroup analysis was performed. Vehicle treated AD11 mice showed significant OR (P 0.001), CTX (P 0.045) and MWM deficits (P 0.05). Despite reduced samples, drug efficacy could be tested. Galantamine (n 6) and the combination (n 4) rescued OR deficit (P 0.009 and P 0.007, respectively). Galantamine and the combination rescued CTX deficit during the initial phases of the treatment, with a reduced efficacy 5 months after treatment started (P 0.06, P 0.29, respectively). Memantine alone rescued OR deficit but did not ameliorate the late CTX deficit. All treatment regimens ameliorated the learning deficit during the acquisition phase of MWM, but only the combination improved the performance in the retention phase of MWM (P 3.85 E-5). Conclusions: These data suggest that galantamine ameliorates OR and CTX deficits in AD11 mice and that the simultaneous administration of two drugs addressing AD at two different molecular levels reduces the spatial deficits in a mouse model for sporadic AD. Study sponsored by Janssen-Cilag Medical Affairs EMEA, a division of Janssen Pharmaceutica N.V.
Advances in Psychiatric Treatment, 2012
SummaryThe article briefly describes the structure of the civil courts in England and Wales and e... more SummaryThe article briefly describes the structure of the civil courts in England and Wales and explains how laws are drafted. This information is used as a basis for understanding the rule of precedent: how earlier court decisions may be binding in later cases. The article explains what law reports are, how cases are reported in the legal literature and how they may be located and cited. A number of key cases are summarised to illustrate the process of judicial reasoning and to show how case law contributes to psychiatric practice and defines the legal structure of medical work. A list of useful legal websites is given.
Advances in Psychiatric Treatment, 2012
SummaryVascular dementia is associated with a group of diverse pathologies affecting the cerebrov... more SummaryVascular dementia is associated with a group of diverse pathologies affecting the cerebrovascular circulation and with other dementia pathologies, particularly Alzheimer's disease. It is rather rare on its own. There is a spectrum of severity of cerebrovascular disease ranging from pathology but no cognitive impairment, to mild cognitive impairment to a dementia syndrome (vascular dementia). Where present, cerebrovascular disease can magnify the impact of other pathologies such as Alzheimer's disease. Current criteria for diagnosing vascular dementia are inadequate. Neuroimaging can be very helpful in defining the extent of pathology. Assessment needs to take into account a wide range of issues. Specific evidence-based treatments are limited, but attention should be given to managing risk factors and associated psychiatric problems such as depression.