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Catatonia is increasingly recognised as a comorbid syndrome of Autism Spectrum Disorder (ASDs). The assessment and management of individuals with comorbid ASD and intellectual disability (ID) adds a further dimension to this already complex presentation, with few cases identified in the literature. The paper aims to discuss these issues.

This paper presents four cases of catatonia in individuals with comorbid ASD and ID. The diagnostic challenges, response to treatment and prognosis are discussed whilst comparing with the existing literature.

A high index of suspicion is required to recognise the subtle catatonic features seen in patients with ASD and ID. Clinicians should be particularly vigilant following stressful events in young adults. The assessment of catatonia in ASDs and ID requires a pragmatic approach given the lack of suitable diagnostic tools and difficulties completing investigations. Caution is advised when using rating scales as they are not validated in ID. The mainstay of treatment is lorazepam, although responses vary.

The discussion of these four cases strengthens the existing literature, and highlights the implications a comorbid diagnosis of ID has on the assessment and management of catatonia in ASDs.

The purpose of this paper is to examine whether the current Royal College of Psychiatrists Membership (MRCPsych) written examination is a suitable assessment tool to distinguish between candidates in a high-stakes examination.

Review of current educational theory and evidence in relation to the use of multiple-choice questions (MCQs) as an assessment form.

When MCQ’s are constructed correctly they provide an efficient and objective assessment tool. However, when developing assessment tools for high-stakes scenarios, it is important that MCQs are used alongside other tests that may scrutinize other aspects of competence. It may be argued that written assessment can only satisfy the first stage of Miller’s pyramid. The evidence outlined demonstrates that this may not be the case and higher order thinking and problem solving can be assessed with appropriately constructed questions. MCQs or any other singular assessment alone, cannot demonstrate clinical competence or mastery.

Increasingly, the MRCPsych examination is used around the world to establish levels of competency and expertise in psychiatry. It is therefore essential that the Royal College of Psychiatrists lead the way in innovation of assessment procedures which are linked to current educational theory. The author has evidenced how the current MRCPsych, may at least in part, hold inherent biases which are not related to a candidate’s competency.

In 2016, 1 in 54 children were estimated to have autism in the USA compared to 1 in 2,500 in 1955. This study aims to consider whether there has been a worldwide rise in incidence over time that is contributing to the rise in prevalence.

A systematic review of the literature with strict inclusion criteria was performed to identify large population-based studies that include raw incidence rate data with clearly defined diagnostic criteria. The data from the included studies were pooled and analysed descriptively to compare incidence rates by decade.

Seven studies were included in the final quantitative analysis including incidence rate data from 1988 to 2015 with 29,026 cases, over a total of 69,562,748 person years. Considering the most robust data, the incidence rate ratio between the decade 1990–1999 and 2000–2009 provides an estimated relative risk of 4.21 (95% CI; 4.11–4.32). If we compare the limited data available in 1988–1989 and 2010–2015, there is an estimated 75 times (95% CI 49.56–115.04) increased rate of diagnosis.

The broadening of diagnostic criteria and its increasing application in clinical practice needs further consideration to ensure individuals receive the most appropriate personalised support. A true rise in the incidence of autism will influence the level of service provision required in future with the potential for significant under resourcing. More detailed assessment of the clinical characteristics of those diagnosed will help predict risk factors for specialist service involvement in future.

To develop and implement an educational programme to improve medical students’ attitudes towards intellectual disabilities. The purpose of this paper is to improve the healthcare outcomes for individuals with intellectual disability.

The development of an educational programme involving actors with an intellectual disability as simulated patients. Scenarios were developed involving basic healthcare interactions. The programme was piloted in three sessions with 45 students. A qualitative analysis of student feedback was then used to develop a student attitude questionnaire for completion pre- and post-educational intervention.

The student attitude questionnaire was completed by 23 different medical students. Two domains were analysed: affect and understanding domain scores, mean difference (95% CI) 3.17(2.41-3.94) p<0.001, knowledge and skills domain scores, mean difference (95% CI) 4.22(3.3-5.14) p<0.001.

Student feedback reveals significant positive changes in affect and understanding, and an improvement in knowledge and skill levels when interacting with people with an intellectual disability following the educational intervention. Some major institutions now offer comprehensive programmes involving people with intellectual disabilities as tutors, and in the role of simulated patients. However, more needs to be done to encourage the increased participation and good practice for all of tomorrow’s doctors to benefit.

Following the publication of recent enquiries into the deaths of people with intellectual disabilities. We know that many of these deaths are premature and potentially preventable. The main failing identified repeatedly is that healthcare staff lack of awareness of the needs of people with intellectual disabilities. This emanates from poor quality and limited curricula time dedicated to intellectual disabilities. There is a need to drastically change the approach to teaching about intellectual disabilities to medical students. All the evidence promotes the involvement of people with intellectual disabilities and their careers in designing and delivering this teaching.

A pæan of joy and triumph which speaks for itself, and which is a very true indication of how the question of poisonous adulteration is viewed by certain sections of “the trade,” and by certain of the smaller and irresponsible trade organs, has appeared in print. It would seem that the thanks of “the trade” are due to the defendants in the case heard at the Liverpool Police Court for having obtained an official acknowledgment that the use of salicylic acid and of other preservatives, even in large amounts, in wines and suchlike articles, is not only allowable, but is really necessary for the proper keeping of the product. It must have been a charming change in the general proceedings at the Liverpool Court to listen to a “preservatives” case conducted before a magistrate who evidently realises that manufacturers, in these days, in order to make a “decent” profit, have to use the cheapest materials they can buy, and cannot afford to pick and choose; and that they have therefore “been compelled” to put preservatives into their articles so as to prevent their going bad. He was evidently not to be misled by the usual statement that such substances should not be used because they are injurious to health— as though that could be thought to have anything to do with the much more important fact that the public “really want” to have an article supplied to them which is cheap, and yet keeps well. Besides, many doctors and professors were brought forward to prove that they had never known a case of fatal poisoning due to the use of salicylic acid as a preservative. Unfortunately, it is only the big firms that can manage to bring forward such admirable and learned witnesses, and the smaller firms have to suffer persecution by faddists and others who attempt to obtain the public notice by pretending to be solicitous about the public health. Altogether the prosecution did not have a pleasant time, for the magistrate showed his appreciation of the evidence of one of the witnesses by humorously rallying him about his experiments with kittens, as though any‐one could presume to judge from experiments on brute beasts what would be the effect on human beings—the “lords of creation.” Everyone reading the evidence will be struck by the fact that the defendant stated that he had once tried to brew without preservatives, but with the only result that the entire lot “went bad.” All manufacturers of his own type will sympathise with him, since, of course, there is no practicable way of getting over this trouble except by the use of preservatives; although the above‐mentioned faddists are so unkind as to state that if everything is clean the article will keep. But this must surely be sheer theory, for it cannot be supposed that there can be any manufacturer of this class of article who would be foolish enough to think he could run his business at a profit, and yet go to all the expense of having the returned empties washed out before refilling, and of paying the heavy price asked for the best crude materials, when he has to compete with rival firms, who can use practically anything, and yet turn out an article equal in every way from a selling point of view, and one that will keep sufficiently, by the simple (and cheap) expedient of throwing theory on one side, and by pinning their faith to a preservative which has now received the approval of a magistrate. Manufacturers who use preservatives, whether they are makers of wines or are dairymen, and all similar tradesmen, should join together to protect their interests, for, as they must all admit, “the welfare of the trade” is the chief thing they have to consider, and any other interest must come second, if it is to come in at all. Now is the time for action, for the Commission appointed to inquire into the use of preservatives in foods has not yet given its decision, and there is still time for a properly‐conducted campaign, backed up by those “influential members of the trade” of whom we hear so much, and aided by such far‐reaching and brilliant magisterial decisions, to force these opinions prominently forward, in spite of the prejudice of the public; and to insure to the trades interested the unfettered use of preservatives,—which save “the trade” hundreds of thousands of pounds every year, by enabling the manufacturers to dispense with heavily‐priced apparatus, with extra workmen and with the use of expensive materials,—and which are urgently asked for by the public,—since we all prefer to have our foods drugged than to have them pure.

This Food Standards Committee Report has been with us long enough to have received careful appraisal at the hand of the most interested parties — food law enforcement agencies and the meat trade. The purposes of the review was to consider the need for specific controls over the composition and descriptive labelling of minced meat products, but the main factor was the fat content, particularly the maximum suggested by the Associaton of Public Analysts, viz., a one‐quarter (25%) of the total product. For some years now, the courts have been asked to accept 25% fat as the maximum, based on a series of national surveys; above that level, the product was to be considered as not of the substance or quality demanded by the purchaser; a contention which has been upheld on appeal to the Divisional Court.

CANADA, until the last generation or two, has been basically a pioneer country but two world wars have changed all this and the economy has moved from an agricultural to a manufacturing community able to provide a standard of living second to that of the United States. (At the present time only 10.8 per cent of Canadians live on farms according to the 1961 census.) Natural resources, such as timber, wheat and mining, continue to play, however, an important role in the life of the nation. As in most developing and pioneer countries, learning has had to assume a secondary role compared with other enterprises and activities. This is gradually beginning to change as more people continue in school and the percentage of individuals attending university increases. Established organizations, like the National Film Board and the Canadian Broadcasting Corporation, catering to mass culture, have been strengthened and enlarged and new establishments, like the Canada Council and the Stratford Shakespearean Festival, of narrower function and appeal, have been set up. The Library movement, not the least of learning agencies, is gaining strength every day. In this paper some of the interesting new developments of the last ten years in the latter field will be discussed. Of necessity, much is abbreviated; a lot is ignored. Data selected has been based on the most recent sources; hence the variety in dates.