Many cancer patients use complementary alternative medicines (CAMs) but may not be aware of the potential risks. There are no studies quantifying such risks, but there is some evidence of patient risk from case reports in the literature. A cross-sectional survey of patients attending the outpatient department at a specialist cancer centre was carried out to establish a pattern of herbal remedy or supplement use and to identify potential adverse side effects or drug interactions with conventional medicines. If potential risks were identified, a health warning was issued by a pharmacist. A total of 318 patients participated in the study. Of these, 164 (51.6%) took CAMs, and 133 different combinations were recorded. Of these, 10.4% only took herbal remedies, 42.1% only supplements and 47.6% a combination of both. In all, 18 (11.0%) reported supplements in higher than recommended doses. Health warnings were issued to 20 (12.2%) patients. Most warnings concerned echinacea in patients with lymphoma. Further warnings were issued for cod liver/fish oil, evening primrose oil, gingko, garlic, ginseng, kava kava and beta-carotene. In conclusion, medical practitioners need to be able to identify the potential risks of CAMs. Equally, patients should be encouraged to disclose their use. Also, more research is needed to quantify the actual health risks.

It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice (a harm done to a person in their capacity as an epistemic subject) than healthy people. This editorial claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory factors are outlined, global and specific. Some suggestions are made to counteract the effects of these factors, for instance, we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients.

SYNOPSIS To examine whether poor verbal fluency in schizophrenia represents a degraded semantic store or inefficient access to a normal semantic store, 25 normal volunteers and 50 DSM-III-R schizophrenic patients, matched for age, sex and IQ, were recruited. Although schizophrenic patients were impaired on both letter and category fluency, they showed a normal pattern of output in that category was superior to letter fluency, and an improvement in category fluency when a cueing technique was employed (Randolph et al. 1993). These results resemble those found in disorders of frontostriatal systems (Parkinson's and Huntington's disease) and suggest that poor verbal fluency in schizophrenia is because of inefficient access to semantic store. A measure of improvement with cueing was directly related to performance on the Stroop executive task. Of all symptom measures derived from SANS and Manchester Scales, only alogia was related to verbal fluency in that superior improvement correlated inversely with the degree of alogia. It is suggested that both alogia and poor verbal fluency are mediated by the same underlying cognitive abnormality that reflects frontostriatal dysfunction.

This study examined the nature and prevalence of abnormal movements in adults with Down's syndrome and also the clinical correlates of orofacial dyskinesia and the relationship between dyskinesia and the level of functional and intellectual disability. Movement disorder, language age, and disability were assessed in an epidemiologically based sample of 145 individuals with Down's syndrome. Abnormal involuntary movements were common, with > 90% exhibiting dyskinesia, predominantly orofacial. Stereotypes were present in one-third of the sample. There was an association between the severity of dyskinesia and both current language age and functioning in terms of self-care and practical and academic skills, which suggested that dyskinesia may be a marker of the severity of mental handicap. The presence of dyskinesia was unrelated to neuroleptic exposure. Dyskinesia and stereotypies are very common in individuals with Down's syndrome and may represent an inherent manifestation of the disorder. The relationship between mental age and dyskinesia in Down's syndrome warrants further research.

FRS -a chance cluster?Part of the attraction of FRS is their â€oe¿ free-floating― quality: they do not presuppose or imply any aetiological theories, which often have the regretta ble characteristic of being disproven and discarded, nor do they have prognostic implications ( Heis not,hesays,usingâ€oe¿ symptom― in thenormal medical sense of evidence of a disease, but to referto a â€oe¿ more or less characteristic, invariably detectable feature of a purely psychopathological ‘¿ state-course complex' (Zustand-Verlauf-Gebilde)― (Schneider, 1980). In other words, FRS are not in fact symptoms at all in the usual sense of that word. Methodological problems in Schneider's workAnother serious and fundamental problem about FRS is this: what reasons are there for Schneider, and for us, to believethat some symptomsof schizophrenia are more important for the diagnosis than others and that the particular symptoms which Schneider lists are especially important? Information about methodology is virtually non existent in Kivusche Psychopathologie(1980) and we can really only guess how he determined which symptoms should be promoted to the first rank. We know, however, from this monograph that he accepted Kraepelin's system of classification and distinguished between â€oe¿ abnormal personalities―, â€oe¿ abnormal reactions―, â€oe¿ organic psychoses―, â€oe¿ schizophrenia― and â€oe¿ cyclothymia―. One possibi lity is that, given his view of schizophrenia, he could have taken a group of psychotic patients, excluded those with a clearly organic psychosis, those with a reactive psychosis and those with obvious cyclothymia, performed a statistical analysis of the symptoms of the remaining psychotic patients (presumed to have schizophrenia) and dubbed the most frequently found symptoms in this group â€oe¿ first-rank symptoms―. I strongly suspect, however, thatif he had useda methodsimilarto this,or indeed any method at all, he would have said so and supplied us with the numbers of patients in his diagnostic groups and some statistics about symptom frequencies. Although some contempor ariesof Schneider usedstatistics extensively intheir psychiatric research, it must also, in fairness, be admitted that the statistical approach was fairly alien to many of the more clinically and psychopathologically orientated psychiatrists of Schneider's generation. Statistical methods were also much less sophisticated than they are today. Schneider, 1980). This study points to another problem which has bedeviled schizophrenia research for nearly a century: is the Schwabing cohort comparable to Kraepelin's cohort and to the many other cohorts which have subsequently been studied? In addition, it seems likely that both cohorts contained un recognised cases of organic psychosis, some of which would now be more readily detected with modern investigative techniques. For these reasons it seems difficult to resist the conclusion that FRS were derived solely from Schneider's clinical experience. Indeed, throughout KiinLcche Psychopathologie he...