Petrol Sniffing: A Case Study

A case study of a petrol sniffer, under intermittent psychiatric surveillance over several years, is presented, together with the results of some psychological tests.     

Alcoholism Among Outpatients of a Rural District General Hospital in Kenya

This article presents the results of a study of alcoholism among outpatients of a rural district hospital in Kenya. One hundred and twelve outpatients aged 18 years or over attending Kisii District Hospital were interviewed using the alcohol section of the Diagnostic Instrument Schedule (DIS). The participants consisted of 56 males and 56 females. Of these, 54% of the males and 25% of the females met the DIS criteria for alcohol abuse and/or alcoholism. Those classified as alcoholics differed significantly from the non-alcoholics on variables associated with sex, age, past marital state, religion and types of alcoholic drinks consumed. No significant differences were found with respect to present marital state, education, occupation, family size, age of first intoxication or physical illness.     

Pseudocyesis and its Modern Perspective

EDITORIAL COMMENT: We accepted this paper for publication because we have not reported previously on pseudocyesis, which is a rare condition, especially if 'first trimester cases' are excluded where there has been confusion with interpretation of intervals of amenorrhoea. These cases can occur at the climacteric when elevated levels of LH can give a false positive HCG test result with older methods of assay and add further to the temporary clinical confusion. The classical clinical picture, unlike the 3 cases reported in this paper, is said to be the nullipara approaching the time of the climacteric who is anxious to conceive. Queen Mary's case must be the most famous on record and also the best documented by means of the serial bulletins issued for her loyal subjects concerning the progress of her royal pregnancy (A). The editor can remember only 1 case of 'late pregnancy' pseudocyesis in 40 years of obstetric practice. This woman was finally convinced of her nonpregnant status by failure of a fetal skeleton to show on an abdominal X-ray. This was many years ago. This test was claimed to be definitive. One wonders how these women coped thereafter. We agree with the authors that follow-up, not necessarily by a psychiatrist, is important. In the editor's experience pseudocyesis of late pregnancy is less common than advanced true normal pregnancy in a nullipara aged more than 40 years, married for many years, who presents with abdominal pain and finds out to her delighted surprise that she is in labour at term and shortly thereafter produces a surviving normal infant. The reviewers of this paper did not agree with the suggestion that curettage would be an appropriate procedure to convince a woman with pseudocyesis that she was not pregnant. However, the authors, having read this editorial comment, stated that curettage is mentioned in the pseudocyesis literature (4).
(A) Dewhurst J. Royal Confinements. Weidenfeld and Nicolson, London. 1980; 28–29.     

Medication in residential treatment: Administration and clinical experiences

This paper describes a clinical procedure for the administration of medication for children in residential treatment, utilizing seven well-defined steps. Clinical procedures for monitoring medication are outlined. Experiences with various drugs during a 3-year period are noted. The use of medication for symptom control and to enable the child to gain a feeling of mastery of his or her symptoms is emphasized as a primary goal of drug treatment.     

Risikoscreening als systematischer Zugang zu Frühen Hilfen

Selective primary prevention programs for child abuse and neglect depend on risk screening instruments that have the goal of systematically identifying families who can profit most from early help. Based on a systematic review of longitudinal studies, a set of established risk factors for early child abuse and neglect is presented. Nearly half of the items included in screening instruments can be seen as validated. Available studies indicate a high sensitivity of risk screening instruments. Positive predictive values, however, are low. Overall, the use of risk screening instruments in the area of primary prevention for families at risk represents a feasible method, as long as stigmatizing effects can be avoided and participating families also benefit beyond preventing endangerment.     

Observing decision‐making in the general practice consultation: who makes which decisions?

OBJECTIVE: To investigate opportunities for, and types of decision making in the general practice (primary care) consultation, and examine differences in skills of those doctors who are successful at meeting their patients' preferences and those who are less successful. DESIGN: Observation study of doctor-patient consultations in general practice. PARTICIPANTS: Patients attending for routine appointments in 12 general practice surgeries across Oxfordshire. METHODS: A total of 212 doctor-patient consultations were video-recorded. The patients involved completed a questionnaire to elicit their perceptions of how decisions were made. The video-taped recordings were coded with a new instrument, the Evidence Based Patient Choice Instrument (EBPCI), to classify the number and type of decision-making opportunities arising during each consultation. A total of 149 recordings were coded using the Oxbridge Rating Scale to assess the doctors' consultation styles. RESULTS: There was a range of decision-making opportunities in addition to those involving medical treatment. With the exception of 'fitness for work', decisions were generally 'doctor led'. There was only moderate agreement between patient perceptions of their level of involvement in decision making and the objective ratings using the EBPCI. There was wide variation in the ability of doctors to meet their patients' preferences for involvement. CONCLUSIONS: There are many decisions made in primary care consultations, in addition to those about medical treatments, in which patients could be involved to a greater extent than they currently are. Some doctors are significantly better than others at meeting different patients' preferences for their decision-making role. Patients' perceptions of shared decision making appears to be influenced by the doctors' general consultation skills.