Journal of the Royal College of Physicians of Edinburgh

Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering and improve the quality of life of patients and their families. The existence of psychopathology is common in patients undergoing palliative care, and psychiatric comorbidities, such as depression and anxiety, are frequent and often underdiagnosed. This work constitutes a review of the literature and a reflection on the potential role of psychosocial rehabilitation in mental health in palliative care. Psychosocial rehabilitation may play a role in the mental health of patients undergoing palliative care, contributing to the minimisation of symptoms, support in daily life activities, the improvement of quality of life and the preparation for death.

Hyperparathyroidism may be a precipitating factor to the development of myelofibrosis; however, this is extremely rare with only a few documented case reports of myelofibrosis caused by secondary hyperparathyroidism. We describe a case of a 24-year-old female who had a failed live donor renal transplant and secondary hyperparathyroidism. While on haemodialysis she became increasingly pancytopenic despite erythropoietin injections and adequate iron, vitamin B12 and folate replacement. Her secondary hyperparathyroidism evolved to tertiary hyperparathyroidism despite vitamin D supplementation and phosphate binders. In order to determine the cause of her pancytopenia, a bone marrow biopsy was performed that confirmed myelofibrosis due to her secondary hyperparathyroidism. Following a successful parathyroidectomy in a tertiary hospital, her pancytopenia resolved and she is now awaiting a second transplant.

We present a case of sudden-onset reversible blindness secondary to severe diabetic ketoacidosis. The exact mechanism is not fully understood but is postulated to be due to uncoupling of retinal electrical transmission in a severe acidic environment. This report adds to the small number of reported cases of reversible blindness secondary to severe diabetic ketoacidosis and serves to raise awareness of this unusual diagnosis. It should be considered in patients who present with acute-onset reversible bilateral blindness only after other causes are excluded via detailed retinal examination and cranial imaging.

Behçet's disease is a chronic, relapsing, systemic inflammatory disease affecting the orogenital mucosa, eyes, joints, blood vessels, nervous system and intestines. The prevalence of neurological involvement varies geographically and can include psychiatric manifestations. Current evidence for a causal association between Behçet's disease and bipolar disorder is limited to a small number of case reports.

We report a case of a patient with a recent diagnosis of bipolar disorder who was subsequently diagnosed with Behçet's disease. The 38-year-old male presented with a 6-month history of right eye visual blurring, 5-month history of mouth ulcers and 3 months of genital ulceration. His inflammatory markers were raised. An MRI of the brain was conducted in the absence of any focal neurological signs or symptoms owing to his past psychiatric history. The MRI showed changes in the medial aspect of the right temporal lobe highly suspicious of neuro-Behçet's disease. His inpatient care was coordinated with neurology, rheumatology, ophthalmology and psychiatry teams, and he was later discharged with outpatient follow up owing to a clinical improvement on high-dose steroids.

This case shows that, although widely unrecognised, neuro-Behçet's can occur in the absence of focal neurology. Additionally, neuro-Behçet's should be considered in patients with bipolar disorder presenting with symptoms suggestive of Behçet's disease. The case emphasises how patients presenting with ulceration, mood disorder and visual changes should not have these symptoms considered in isolation and multisystem disease should be considered. Furthermore, the coordinated multidisciplinary approach required for the care of patients with Behçet's disease is demonstrated.

A 20-year-old female presented to us with bibrachial diplegia and dysarthria. She had an earlier history of craniosynostosis, multiple cranial surgeries and recent meningitis followed by ventriculoperitoneal shunting. Her symptoms started with a cruciate paralysis followed by rapid descending quadriparesis. Imaging revealed a trapped fourth ventricle as the cause of her descending paralysis.

More people are using electronic cigarettes (e-cigarettes) and fewer people are smoking conventional tobacco cigarettes. A wide variety of e-cigarettes are available and there is emerging evidence that they may help with smoking cessation. This evidence-based clinical review summarises the latest evidence regarding use of e-cigarettes as smoking cessation aids. The ongoing debate surrounding the safety and regulation of e-cigarettes is also discussed.

Sir Alexander Morison's The Physiognomy of Mental Diseases and the original art work that formed the basis of the book have not had the scholarly attention they deserve. The published book and the commissioned portraits have not been studied in any detail. Historians have tended to offer cursory assessments that have reflected their own preconceived ideas rather than properly engaging with the material. This is a pity because Morison's work is a rich source that tells us much about the history of psychiatry. The pictures and text give us a glimpse into the world of the asylum and that of the patient. Although we see the patient through the eyes of the artist and Dr Morison, they do emerge as individuals. The accompanying texts reflect the psychiatric approach of the time and reveal contemporary notions of diagnosis, aetiology and treatment. Morison's work can also be located in the history of ideas about physiognomy. He himself was particularly influenced by Jean-Étienne-Dominique Esquirol, and Morison's work, in turn, influenced WAF Browne. These papers will outline Morison's career and consider in detail his book on The Physiognomy of Mental Diseases.

Axes, knives, truncheons and several home-made weapons are some of the feature pieces of a newly deposited collection within the Royal College of Physicians of Edinburgh archive. This paper uses examples from this unusual collection, consisting of 40 weapons and over 400 glass slides, to demonstrate the significance and contribution it has to understanding late 19th- and early 20th-century forensic science and medicine in Scotland. Previously belonging to the late Sir Sydney Smith, these objects and glass slides supplement the Sydney Smith paper collection that contains numerous casefiles spanning his career as a forensic practitioner both in Britain and internationally. The records from these collections offer the potential for understanding developments in early 20th-century forensic practices whilst highlighting some of Britain's macabre criminal history.

Liquorice is a very ancient plant widely used in the East for millennia. It has often been employed in sweets and confectionery and also for minor ailments including cough, constipation and dyspepsia. It was probably carried to Europe by the Cluniac order of monks. Then, almost by accident, it became established in West Yorkshire at Pontefract after the dissolution of the monasteries in the 1530s. Abuse of liquorice is not uncommon. It can occur in the anorexia/bulimia syndrome and also in the dangerous condition of pseudoaldosteronism, which is characterised by severe hypertension and hypokalaemia and can lead to death. Liquorice remains a useful sweetener for all sorts of confectionery, including sweets and cakes (together with beer and liqueurs).