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Miss Toulson investigates the employment prospects of epileptics and points out their personal difficulties in finding a job. A strong plea is made for objective and unprejudiced consideration of the epileptic's employ ability, based on specific facts related to the individual case rather than folk fears of the condition.

This case report highlights the complex factors in prescribing psychotropic medication for people with intellectual disability with significant co‐morbid physical and mental health problems. The case study is of a young man with a mitochondrial disorder, secondary sensory impairments, mild intellectual disability, epilepsy and autism spectrum disorder who developed a psychotic illness. The report focuses on the use of psychotropic medication in this man and discusses the issues regarding psychotropic medication that need to be considered with service users and their carers.

Clinical risks can be contained through risk management initiatives, and can also be used to demonstrate effective clinical governance. The purpose of this paper is to outline a new risk assessment tool that monitors the risk factors of sudden unexpected death in epilepsy (SUDEP).

A systematic review of the literature was undertaken to determine the contributory risk factors of SUDEP. A total of 18 factors were identified, of which 11 were modifiable and therefore have the potential to influence the risk of SUDEP.

The factors identified from the literature review have been populated into a Microsoft Excel® spreadsheet with drop-down boxes for the responses to each factor. No attempt has been made to rank these risk factors. Neuropsychiatrists piloting the tool in clinical practice have found the tool simple and quick to use. A printout of the checklist is placed in the patient's medical notes as evidence. Where an overall SUDEP risk rating is increasing, the clinical team can intervene to mitigate the risks.

The checklist brings together factors identified in a systematic review of the literature in order to inform clinical practice in mental health. In parallel with using the checklist in practice, a broader team is undertaking an explorative retrospective case-control research study to determine whether it is possible to rank the risk factors; this will inform a more sophisticated risk assessment tool.

The 30 MOCHA (Models of Child Health Appraised) countries are diverse socially, culturally and economically, and differences exist in their healthcare systems and in the scope and role of primary care. An economic analysis was undertaken that sought to explain differences in child health outcomes between countries. The conceptual framework was that of a production function for health, whereby health outputs (or outcomes) are assumed affected by several ‘inputs’. In the case of health, inputs include personal (genes, health behaviours) and socio-economic (income, living standards) factors and the structure, organisation and workforce of the healthcare system. Random effects regression modelling was used, based on countries as the unit of analysis, with data from 2004 to 2016 from international sources and published categorisations of healthcare system. The chapter describes the data deficiencies and measurement conundrums faced, and how these were addressed. In the absence of consistent indicators of child health outcomes across countries, five mortality measures were used: neonatal, infant, under five years, diabetes (0–19 years) and epilepsy (0–19 years). Factors found associated with reductions in mortality were as follows: gross domestic product per capita growth (neonatal, infant, under five years), higher density of paediatricians (neonatal, infant, under five years), less out-of-pocket expenditure (neonatal, diabetes 0–19), state-based service provision (epilepsy 0–19) and lower proportions of children in the population, a proxy for family size (all outcomes). Findings should be interpreted with caution due to the ecological nature of the analysis and the limitations presented by the data and measures employed.

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

An estimate is made of the connectivity of a mammalian neuron, i.e., the number of other neurons to or from which an average neuron directly connects. The value derived is about 10. Some functional implications of the value of the connectivity are considered, particularly mental illness, epilepsy, and intelligence. The “length” and “width”, in terms of neurons, of a functional neural channel are discussed.