No abstract

SummaryA double-blind trial failed to demonstrate any significant short-term effects of clomipramine in doses recommended for use in general practice (in addition to the usual range of psychotherapeutic help) in the treatment of children with school refusal and neurotic disorder. Patterns of improvement were also studied for the sample as a whole irrespective of treatment. Neither age nor sex were significantly related to improvement, except on one behavioural measure where girls initially did better than boys. In addition, it was found that there was a rapid relief of depression but neurotic symptomatology tended to persist.

An investigation in a large mental handicap hospital revealed that 24% of the in-patients were receiving antipsychotic drugs. Chlorpromazine and thioridazine prescriptions accounted for 62% of the total while 10% of patients received depot preparations. Fifty-five per cent of the patients receiving these drugs had no established psychiatric diagnosis; most of these could be categorised as having a behaviour disorder. Patients aged 30-50 received higher doses, and female patients received a significantly higher mean dosage than male ones. In the patients receiving neuroleptic drugs who had also been taking them four years previously, there was a significant reduction in the dosage of the drugs received and the extent of polypharmacy of these agents. A mandatory requirement to review all prescriptions annually, implemented in 1984, may be a reason for this.

Fifty-one school phobic children, aged nine to fourteen years, were assessed for psychiatric diagnosis; this revealed the presence of two clinically meaningful sub-groups--depressed and residual school phobic. A wide range of symptoms were studied to identify those which might prove useful in diagnosing adult-type depression in childhood and early adolescence, both in terms of frequency of symptoms in the depressed group and the extent of the distinction between the two groups. Eleven such key symptoms were identified and based on these, a formula for diagnosing adult-type depression was evolved. The validity of several different ways of classifying the above cases were explored; these covered: kind of disorder; type of onset; adolescence versus pre-adolescence; and sex of the child. However, on only one dichotomy--depression versus absence of depression--were there many significant discriminants. Affective symptomatology of more recent onset was contrasted with pre-morbid personality traits, usually associated with school phobia. There was no evidence to support the concept of 'masked depression' in childhood.

Purpose Autism spectrum disorder (ASD) brings out the limitations of the Criminal Justice Service. The purpose of this paper is to review some of the salient issues and their remedies. Design/methodology/approach A narrative review based on the literature and the clinical experience of the authors. Findings ASD’s hidden disabilities, even without the frequent coexistence of other disorder, derail the standard responses to offending. Practical implications Management of these individuals as offenders depends on awareness of the issues, adaptation and the input of a variety of other services, especially health, social care and employment. Originality/value Although this is a very active field of work, there is relatively little written about it.