A joint meeting with the Royal Medico-Chirurgical Society of Glasgow. Professor Oxford is not only an expert on this topic - Britain's 'flu-guru' - but also an excellent speaker. The evening promises to be informative and stimulating.
Speaker:
Prof. John Oxford Professor of Virology, St Bartholomew's Hospital
Please note altered time and venue
Date and time:
Thursday 17th January 2008, 7 for 7.30pm
Venue:
Royal College of Physicians and Surgeons of Glasgow, 234-242 St Vincent Street, Glasgow
30 December, 2007
06 December, 2007
30 November, 2007
Wine diet
Looking forward to our meeting on 14th February with Professor Alan Crozier talking about the benefits of wine, you might like to have a taster courtesy of Scientific American:
http://www.sciam.com/article.cfm?id=forget-resveratrol-tannin
Photo: http://www.flickr.com/photos/mcmichelclair/
25 November, 2007
Chronic pain after surgery - meaning
Chronic pain after surgery. More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr David Craig discuss the meaning to patients of chronic pain. This is followed by audience discussion.
Listen again:
Download mp3 of lecture 20.3Mb Duration: 42:13
Listen to lo-fi stream
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr David Craig discuss the meaning to patients of chronic pain. This is followed by audience discussion.
Listen again:
Download mp3 of lecture 20.3Mb Duration: 42:13
Listen to lo-fi stream
Chronic pain after surgery - molecules
Chronic pain after surgery. More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr Mick Serpell discuss the drug treatment of neuropathic pain.
Listen again:
Download mp3 of lecture 13.4Mb Duration: 27:54
Listen to lo-fi stream
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr Mick Serpell discuss the drug treatment of neuropathic pain.
Listen again:
Download mp3 of lecture 13.4Mb Duration: 27:54
Listen to lo-fi stream
Chronic pain after surgery - magnitude
Chronic pain after surgery. More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr Bill Macrae discuss the magnitude of the problem.
Listen again:
Download mp3 of lecture 16.7Mb Duration: 34:53
Listen to lo-fi stream
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture we hear Dr Bill Macrae discuss the magnitude of the problem.
Listen again:
Download mp3 of lecture 16.7Mb Duration: 34:53
Listen to lo-fi stream
14 November, 2007
Notice of meeting: Chronic pain after surgery—More than just a nuisance?
Chronic pain after surgery—
More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the West of Scotland Pain Group:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
Date and time:
Thursday, November 22nd 2007, 6.15 for 7.00pm
Buffet available from 6.15pm
Venue:
Ebenezer Duncan Centre
Victoria Infirmary, Langside, Glasgow
More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the West of Scotland Pain Group:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
Date and time:
Thursday, November 22nd 2007, 6.15 for 7.00pm
Buffet available from 6.15pm
Venue:
Ebenezer Duncan Centre
Victoria Infirmary, Langside, Glasgow
19 October, 2007
Presidential Address: Helping drug misusers - Dr Richard Watson
2007 Presidential Address given to the Glasgow Southern Medical Society by Dr Richard Watson.
Dr Watson describes his work as a newly qualified doctor in Nicaragua, political activities, the misuse of illicit drugs by leading figures in literature and popular culture, and experiences of prescribing harm reduction regimens for his patients.
The meeting is introduced by Past President, Mr David Ritchie, and the vote of thanks is proposed by Dr Duncan MacIntyre.
Listen again:
Download [ mp3] 28.4MB
Listen to [streaming audio]
Further reading:
Dr Watson describes his work as a newly qualified doctor in Nicaragua, political activities, the misuse of illicit drugs by leading figures in literature and popular culture, and experiences of prescribing harm reduction regimens for his patients.
The meeting is introduced by Past President, Mr David Ritchie, and the vote of thanks is proposed by Dr Duncan MacIntyre.
Listen again:
Download [ mp3] 28.4MB
Listen to [streaming audio]
Further reading:
09 October, 2007
Notice of meeting: Presidential Address - ‘Helping drug misusers without getting struck off’
You are cordially invited to attend the meeting:
Presidential Address - 'Helping drug misusers without getting struck off'
Dr Watson reflects on his practice, and on Bob Dylan, Saddam Hussein, Anna Karenina and other matters.
Speaker: Dr Richard Watson
Date and time: Thursday, October 11th 2007, 6.15 for 7.00pm
Buffet meal available from 6.15pm
Venue:
Ebenezer Duncan Centre
Victoria Infirmary, Langside, Glasgow
Presidential Address - 'Helping drug misusers without getting struck off'
Dr Watson reflects on his practice, and on Bob Dylan, Saddam Hussein, Anna Karenina and other matters.
Speaker: Dr Richard Watson
Date and time: Thursday, October 11th 2007, 6.15 for 7.00pm
Buffet meal available from 6.15pm
Venue:
Ebenezer Duncan Centre
Victoria Infirmary, Langside, Glasgow
23 June, 2007
Programme for Session 163 – 2007/8
All meetings in the Ebenezer Duncan Centre at 7pm with members' buffet supper from 6.15 unless otherwise stated.
Thursday August 30th - Council meeting. Conference Room, Floor E, Victoria InfirmaryTuesday September 11th - Golf outing. Williamwood golf course from 2.30pm
Thursday October 11th - Presidential address. Dr Richard Watson. 'Helping drug misusers – without getting struck off'Thursday October 25th - Annual dinner
Thursday November 22nd - Symposium. 'Chronic pain after surgery – more than just a nuisance?'Magnitude - Dr William Macrae, Consultant Anaesthetist, Dundee
Molecules - Dr Mick Serpell, Consultant Anaesthetist, Glasgow
Meaning - Dr David Craig, Consultant Clinical Psychologist, Glasgow
Thursday February 14th - 'The Wine Diet' Professor Alan Crozier, Institute of Biomedical and Life Sciences, University of Glasgow
Followed by wine tasting
Thursday April 24th - Annual General Meeting. Conference Room, Floor E, Victoria Infirmary
23 March, 2007
Honorary Presidential Address - Summary of the meeting by Dr MacIntyre
THURSDAY MARCH 8th 2007
The Society was addressed by its Honorary President, Dr John Clark. He reflected on a career in forensic medicine in and beyond Glasgow starting with a look at the image of the forensic pathologist and then making a series of observations arising from work elsewhere and comparison with Glasgow.
The media focus on high profile cases and television image of drama belie the more mundane causes of sudden or unexplained death - coronary disease, alcohol and drugs, suicide rather than homicide. It remains a busy job with around 2,000 post mortems a year.
He described work providing a forensic service to the Falkland Islands where sudden deaths tended to occur in a younger group – often related to the fishing industry. He followed this up with reflection on the epidemiology of sudden death under the age of 30 with almost half involving the illicit use of drugs.
Experience in Korea had included contact with an unusual case of neonaticide – the death of newborn either by immediate neglect or active killing. This unfortunate area of work involved the important distinction between a stillborn baby and live birth.
Dr Clark had played a substantial role in forensic work following the Balkan conflict – particular in relation to the massacre at Srebrenica. After describing some of the background to this episode he described some of the process of identification and establishing precise cause of death which could lead to prosecution in this ongoing criminal investigation. One unusual set of findings was explained by the use of captive bolt devices, general available in farming communities, as a weapon of injury and perhaps murder. There had been one such case in Glasgow.
Finally he compared experiences of forensic investigation in Yorkshire with Glasgow. His striking observation had been the extent which alcohol is involved in episodes in Glasgow - marked intoxication in 58% of those killed in fires for example (15% in Yorkshire). This was a personal observation but a consistent one highlighting the role of alcohol abuse in the work in which he is involved.
Following a period of discussion Dr Weetch thanked Dr Clark for his address. The meeting was brought to a close with intimation of the Annual General Meeting in April by Mr Ritchie.
A recording of the meeting is available to members on request from Dr J Oates.
The Society was addressed by its Honorary President, Dr John Clark. He reflected on a career in forensic medicine in and beyond Glasgow starting with a look at the image of the forensic pathologist and then making a series of observations arising from work elsewhere and comparison with Glasgow.
The media focus on high profile cases and television image of drama belie the more mundane causes of sudden or unexplained death - coronary disease, alcohol and drugs, suicide rather than homicide. It remains a busy job with around 2,000 post mortems a year.
He described work providing a forensic service to the Falkland Islands where sudden deaths tended to occur in a younger group – often related to the fishing industry. He followed this up with reflection on the epidemiology of sudden death under the age of 30 with almost half involving the illicit use of drugs.
Experience in Korea had included contact with an unusual case of neonaticide – the death of newborn either by immediate neglect or active killing. This unfortunate area of work involved the important distinction between a stillborn baby and live birth.
Dr Clark had played a substantial role in forensic work following the Balkan conflict – particular in relation to the massacre at Srebrenica. After describing some of the background to this episode he described some of the process of identification and establishing precise cause of death which could lead to prosecution in this ongoing criminal investigation. One unusual set of findings was explained by the use of captive bolt devices, general available in farming communities, as a weapon of injury and perhaps murder. There had been one such case in Glasgow.
Finally he compared experiences of forensic investigation in Yorkshire with Glasgow. His striking observation had been the extent which alcohol is involved in episodes in Glasgow - marked intoxication in 58% of those killed in fires for example (15% in Yorkshire). This was a personal observation but a consistent one highlighting the role of alcohol abuse in the work in which he is involved.
Following a period of discussion Dr Weetch thanked Dr Clark for his address. The meeting was brought to a close with intimation of the Annual General Meeting in April by Mr Ritchie.
A recording of the meeting is available to members on request from Dr J Oates.
06 March, 2007
Glasgow's health priorities – where now?
Glasgow’s health priorities – where now?
A summary of the meeting - by Dr Duncan MacIntyre
Dr Burns, once consultant surgeon and Director of Public Health in Glasgow, now Chief Medical Officer at the Scottish Office was introduced by the President, Mr David Ritchie. He started by looking at life expectancy changes over the 20th century in Western Europe – rapid and then slower improvement but with Scotland being overtaken in that process. In 1900 it had better than average life expectancy. The problems in the west of Scotland and in particular in deprived areas of Glasgow are well documented. Standardised mortality rate for Glasgow are approximately twice the English average and significantly worse than other "post industrial" UK cities. There is a fourteen year difference in life expectancy between deprived and affluent areas of the west of Scotland. The traditional killers such as coronary disease and cancer are diminishing in importance with increased death rates from violence, drugs and alcohol effects. Once again the new killers are most obvious in those population groups with a highest depcat scores.
The challenge is to understand the underlying reasons and intervene appropriately. There are obvious major social issues. In a general sense the fabric of Glasgow remained poor while other cities were improving. However, relying on change in social environment to produce health returns is a long term and uncertain policy. Similarly changing personal habits is slow. The Health Service can have a more immediate role in ensuring access to currently available care.
Dr Burns then developed his thesis that deprivation itself contributes to poor health outcomes. Analysis of traditional risk factors and intervention approaches shows that they do not provide all the answers. The increasing health risk of smoking is uniform in most studies but the risk is multiplied for each level of tobacco consumption in the west of Scotland. Dietary interventions in Finland correlated with changes in coronary heart disease but these changes were mirrored in Scotland where there were no such interventions. The initial clue to other factors came from detailed investigation in Finland at the time of these interventions. It was found that psychological profiling or the feeling of hopelessness correlated with mortality risks and interestingly with more aggressive carotid atheroma (Doppler assessment). The conclusion was that a chronic low grade stress might contribute to physical illness. There is good evidence that stress hormone levels are increased with deprivation. From the WOSCOPS study came data correlating CRP with deprivation and showing that both smoking and obesity further increased CRP levels. CRP in turn correlates with risk of myocardial infarction and of development of diabetes. Interestingly the statins have an anti inflammatory effect – perhaps a mechanism of disease reduction. Another interesting recent observation looking at telomere levels as a correlate of DNA repair activity indicates that this marker of stress at the molecular biology level also reflects measures of individual stress – findings replicated in twin studies. This gives rise to the concept of molecular biological age as opposed to chronological age.
What can we do about all this? Dr Burns used the example of Dr Tudor-Hart in Wales and his groundbreaking work in general practice in taking care to individuals in activities such as blood pressure control. This produced locally improved life expectancy and has been an example of how the application of proven medical interventions can be effective. Such an approach is effectively applying the founding principles of the NHS and filled Harry Burns with enthusiasm that Scotland could address its medical problems.
There followed half an hour of stimulating debate around the reasons for the west of Scotland’s problem, what possible interventions could be considered, and how these might be achieved. Dr Keith Beard who had been a medical and rugby playing colleague of Dr Burns at university expressed the audience's considerable thanks for a fascinating evening.
A summary of the meeting - by Dr Duncan MacIntyre
Dr Burns, once consultant surgeon and Director of Public Health in Glasgow, now Chief Medical Officer at the Scottish Office was introduced by the President, Mr David Ritchie. He started by looking at life expectancy changes over the 20th century in Western Europe – rapid and then slower improvement but with Scotland being overtaken in that process. In 1900 it had better than average life expectancy. The problems in the west of Scotland and in particular in deprived areas of Glasgow are well documented. Standardised mortality rate for Glasgow are approximately twice the English average and significantly worse than other "post industrial" UK cities. There is a fourteen year difference in life expectancy between deprived and affluent areas of the west of Scotland. The traditional killers such as coronary disease and cancer are diminishing in importance with increased death rates from violence, drugs and alcohol effects. Once again the new killers are most obvious in those population groups with a highest depcat scores.
The challenge is to understand the underlying reasons and intervene appropriately. There are obvious major social issues. In a general sense the fabric of Glasgow remained poor while other cities were improving. However, relying on change in social environment to produce health returns is a long term and uncertain policy. Similarly changing personal habits is slow. The Health Service can have a more immediate role in ensuring access to currently available care.
Dr Burns then developed his thesis that deprivation itself contributes to poor health outcomes. Analysis of traditional risk factors and intervention approaches shows that they do not provide all the answers. The increasing health risk of smoking is uniform in most studies but the risk is multiplied for each level of tobacco consumption in the west of Scotland. Dietary interventions in Finland correlated with changes in coronary heart disease but these changes were mirrored in Scotland where there were no such interventions. The initial clue to other factors came from detailed investigation in Finland at the time of these interventions. It was found that psychological profiling or the feeling of hopelessness correlated with mortality risks and interestingly with more aggressive carotid atheroma (Doppler assessment). The conclusion was that a chronic low grade stress might contribute to physical illness. There is good evidence that stress hormone levels are increased with deprivation. From the WOSCOPS study came data correlating CRP with deprivation and showing that both smoking and obesity further increased CRP levels. CRP in turn correlates with risk of myocardial infarction and of development of diabetes. Interestingly the statins have an anti inflammatory effect – perhaps a mechanism of disease reduction. Another interesting recent observation looking at telomere levels as a correlate of DNA repair activity indicates that this marker of stress at the molecular biology level also reflects measures of individual stress – findings replicated in twin studies. This gives rise to the concept of molecular biological age as opposed to chronological age.
What can we do about all this? Dr Burns used the example of Dr Tudor-Hart in Wales and his groundbreaking work in general practice in taking care to individuals in activities such as blood pressure control. This produced locally improved life expectancy and has been an example of how the application of proven medical interventions can be effective. Such an approach is effectively applying the founding principles of the NHS and filled Harry Burns with enthusiasm that Scotland could address its medical problems.
There followed half an hour of stimulating debate around the reasons for the west of Scotland’s problem, what possible interventions could be considered, and how these might be achieved. Dr Keith Beard who had been a medical and rugby playing colleague of Dr Burns at university expressed the audience's considerable thanks for a fascinating evening.
27 February, 2007
Glasgow's Health Priorities
In his lecture to the joint meeting of the Glasgow Southern Medical Society, Chief Medical Officer for Scotland, Dr Harry Burns, discusses the origins of Glasgow's poor health.
The meeting is introduced by Mr David Ritchie, President of the Glasgow Southern Medical Society and the vote of thanks is proposed by Dr Keith Beard.
Listen again:
Download [ mp3] 42.3MB
Listen to [streaming audio]
Further reading:
The meeting is introduced by Mr David Ritchie, President of the Glasgow Southern Medical Society and the vote of thanks is proposed by Dr Keith Beard.
Listen again:
Download [ mp3] 42.3MB
Listen to [streaming audio]
Further reading:
20 February, 2007
Notice of meeting: Honorary Presidential Address 'Forensics'
Thursday 8th March, 2007
"Forensics"
Dr John Clark will reflect on a varied and wide experience of forensic pathology around the globe.
Speaker: Dr John Clark
Consultant in Forensic Pathology, University of Glasgow
Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow
If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk
"Forensics"
Dr John Clark will reflect on a varied and wide experience of forensic pathology around the globe.
Speaker: Dr John Clark
Consultant in Forensic Pathology, University of Glasgow
Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow
If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk
Notice of meeting: 'Glasgow's health priorities - where now?'
Thursday 22nd February, 2007
"Glasgow's health priorities - where now?"
Dr Burns has long been an advocate for addressing the particular health problems and disparities of the Glasgow population. He has taken these concerns with him in his translation from Glasgow to the Scottish Executive Health Department.
Speaker: Dr Harry Burns
Chief Medical Officer for Scotland
Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow
If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk
"Glasgow's health priorities - where now?"
Dr Burns has long been an advocate for addressing the particular health problems and disparities of the Glasgow population. He has taken these concerns with him in his translation from Glasgow to the Scottish Executive Health Department.
Speaker: Dr Harry Burns
Chief Medical Officer for Scotland
Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow
If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk
09 February, 2007
Does everyone have an autistic syndrome? - notes
Comments from Dr D MacIntyre
Professor Gillberg gave a fascinating review of the patterns and aetiology of autistic syndromes, a lot of it based on his own work in the field over a 30 year period. He described four main variants. Classical autistic syndrome is apparent before the age of three. Occasionally there is initial normal development in the infant and then regression but that is the exception. The dominant feature is a lack of reciprocal interaction with others in both social activity and communication. Any interaction with others is on the individual's own terms. This is associated with a restricted development of imagination.
The definition of Asperger's Syndrome seemed a little more difficult. The ICD10 classification requires normal development for the first three years which doesn’t always happen, and requires only three separate symptoms which could lead to a very broad inclusion within the diagnosis. Chris Gillberg following Asperger's original description suggested five of six separate features were required – social impairment e.g. lack of empathy or no friends; a narrow all absorbing specific interest; habits or behaviours which become an abnormal routine or ritual; a speech or language peculiarity e.g. delayed or pedantic speech or poor comprehension of normal conversation implying a lack of awareness of the mental prospective of others – "concrete conversation"; poor non verbal communication; motor clumsiness.
Two other groups – atypical autism or autistic like condition where individuals don’t fill the full criteria for diagnosis; and childhood disintegrative disorder – a condition which appears after three years of age and may be associated with provocative factors.
Recent publicity has suggested an increase in autistic syndromes however Professor Gillberg quoted his own survey from Gothenberg in 1977 which suggested prevalence figures similar to now at 0.7%. Some surveys using a less rigid diagnosis suggest higher prevalence but this may simply reflect a distribution of some features of autism as a continuum within society. This raised the question of whether autism is simply one end of a spectrum of behavioural characteristics – a disorder of empathy. Professor Gillberg preferred to see a variety of different syndromes which have autism as a cardinal feature. In many of these syndromes other developmental or psychiatric features are prominent – mental retardation, epilepsy and other aspects of visual hearing or sensory impairment. This co-morbidity is an important general issue – in the past autism was under diagnosed; now there can be a risk of missing other conditions in the presence of autism – attention deficit, depression, eating or sleep disorders for example. It is likely that the apparent increased prevalence of autism is due to increase awareness and diagnostic substitution.
There is a clear genetic link. Between 10 and 20% of siblings of a proband with classic autism exhibit features of the autistic spectrum – in identical twins this rises to between 60 and 90%. In general first degree relatives have an increase incidence of assorted social or functional disorders. There is some evidence pointing to specific genetic involvement in neurological development. Studies of histological changes in the brain have shown a number of different patterns of damage – varying from specific brain stem and cerebellar or frontal / temporal damage in classic autism to more widespread damage in patients with associated mental retardation. The general concept of aetiology is therefore of genetic predisposition possibly with an environmental insult during development leading to neurochemical damage which results in impaired social and neurocognitive functions leading in turn to the full blown syndrome.
The outcome in autistic syndromes is very variable depending on initial features but in at least 50% there remains major disability. Nonetheless more detailed and early diagnosis does allow interventions giving prospect of improvement. A high rate of secondary psychological problems is a major complicating factor. In future more detailed knowledge of specific subgroups might allow more effective management or treatment options. Greater awareness on the problem and better acceptance of people with autism might also improve their prospects.
In discussion Professor Gillberg was asked about the male preponderance (3:1). He wondered about the normal range of male and female behaviour, about the possibility of some testosterone effect, and about whether certain behaviours might be regarded more readily as abnormal in a boy. In further discussion of prognosis he suggested that very few with classic autism managed gainful employment. In Asperger’s Syndrome this figure might be around 50%. There is no currently useful specific drug treatment though treatment of identified complicating psychological factors is important.
In thanking Professor Gillberg for his address Dr Elaine Morrison, President of the Medical Chirurgical Society reflected the views of the audience that we had heard a fascinating and informative review of the subject from someone who is clearly a world expert speaking from a background of major clinical and research experience.
Professor Gillberg gave a fascinating review of the patterns and aetiology of autistic syndromes, a lot of it based on his own work in the field over a 30 year period. He described four main variants. Classical autistic syndrome is apparent before the age of three. Occasionally there is initial normal development in the infant and then regression but that is the exception. The dominant feature is a lack of reciprocal interaction with others in both social activity and communication. Any interaction with others is on the individual's own terms. This is associated with a restricted development of imagination.
The definition of Asperger's Syndrome seemed a little more difficult. The ICD10 classification requires normal development for the first three years which doesn’t always happen, and requires only three separate symptoms which could lead to a very broad inclusion within the diagnosis. Chris Gillberg following Asperger's original description suggested five of six separate features were required – social impairment e.g. lack of empathy or no friends; a narrow all absorbing specific interest; habits or behaviours which become an abnormal routine or ritual; a speech or language peculiarity e.g. delayed or pedantic speech or poor comprehension of normal conversation implying a lack of awareness of the mental prospective of others – "concrete conversation"; poor non verbal communication; motor clumsiness.
Two other groups – atypical autism or autistic like condition where individuals don’t fill the full criteria for diagnosis; and childhood disintegrative disorder – a condition which appears after three years of age and may be associated with provocative factors.
Recent publicity has suggested an increase in autistic syndromes however Professor Gillberg quoted his own survey from Gothenberg in 1977 which suggested prevalence figures similar to now at 0.7%. Some surveys using a less rigid diagnosis suggest higher prevalence but this may simply reflect a distribution of some features of autism as a continuum within society. This raised the question of whether autism is simply one end of a spectrum of behavioural characteristics – a disorder of empathy. Professor Gillberg preferred to see a variety of different syndromes which have autism as a cardinal feature. In many of these syndromes other developmental or psychiatric features are prominent – mental retardation, epilepsy and other aspects of visual hearing or sensory impairment. This co-morbidity is an important general issue – in the past autism was under diagnosed; now there can be a risk of missing other conditions in the presence of autism – attention deficit, depression, eating or sleep disorders for example. It is likely that the apparent increased prevalence of autism is due to increase awareness and diagnostic substitution.
There is a clear genetic link. Between 10 and 20% of siblings of a proband with classic autism exhibit features of the autistic spectrum – in identical twins this rises to between 60 and 90%. In general first degree relatives have an increase incidence of assorted social or functional disorders. There is some evidence pointing to specific genetic involvement in neurological development. Studies of histological changes in the brain have shown a number of different patterns of damage – varying from specific brain stem and cerebellar or frontal / temporal damage in classic autism to more widespread damage in patients with associated mental retardation. The general concept of aetiology is therefore of genetic predisposition possibly with an environmental insult during development leading to neurochemical damage which results in impaired social and neurocognitive functions leading in turn to the full blown syndrome.
The outcome in autistic syndromes is very variable depending on initial features but in at least 50% there remains major disability. Nonetheless more detailed and early diagnosis does allow interventions giving prospect of improvement. A high rate of secondary psychological problems is a major complicating factor. In future more detailed knowledge of specific subgroups might allow more effective management or treatment options. Greater awareness on the problem and better acceptance of people with autism might also improve their prospects.
In discussion Professor Gillberg was asked about the male preponderance (3:1). He wondered about the normal range of male and female behaviour, about the possibility of some testosterone effect, and about whether certain behaviours might be regarded more readily as abnormal in a boy. In further discussion of prognosis he suggested that very few with classic autism managed gainful employment. In Asperger’s Syndrome this figure might be around 50%. There is no currently useful specific drug treatment though treatment of identified complicating psychological factors is important.
In thanking Professor Gillberg for his address Dr Elaine Morrison, President of the Medical Chirurgical Society reflected the views of the audience that we had heard a fascinating and informative review of the subject from someone who is clearly a world expert speaking from a background of major clinical and research experience.
20 January, 2007
Does everyone have an autistic syndrome?
In the introduction to his book, Mirror Mind, Eric Chen wrote 'How can a non-autistic hear the heart of an autistic child?'
Of course we can't. But one person who approaches closer than most is Christopher Gillberg, Professor of Child and Adolescent Psychiatry at the Universities of Gothenburg and London, and Visiting Professor to the University of Strathclyde.
In his lecture to the joint meeting of the Glasgow Southern Medical Society and Royal Medico-Chirurgical Society of Glasgow, Chris Gillberg poses the question 'Autism – epidemic, endemic or just there?'
The meeting is introduced by Mr David Ritchie, President of the Glasgow Southern Medical Society and vote of thanks proposed by Dr Elaine Morrison, President of the Royal Medico-Chirurgical Society of Glasgow.
Listen again:
Download [ mp3] 45.9Mb
Listen to [streaming audio]
Further reading:
Of course we can't. But one person who approaches closer than most is Christopher Gillberg, Professor of Child and Adolescent Psychiatry at the Universities of Gothenburg and London, and Visiting Professor to the University of Strathclyde.
In his lecture to the joint meeting of the Glasgow Southern Medical Society and Royal Medico-Chirurgical Society of Glasgow, Chris Gillberg poses the question 'Autism – epidemic, endemic or just there?'
The meeting is introduced by Mr David Ritchie, President of the Glasgow Southern Medical Society and vote of thanks proposed by Dr Elaine Morrison, President of the Royal Medico-Chirurgical Society of Glasgow.
Listen again:
Download [ mp3] 45.9Mb
Listen to [streaming audio]
Further reading:
Subscribe to:
Posts (Atom)
