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Apply a small amount of zovirax cream directly to the infected area 5 times per day. Kenneth duckworth, medical director for the national alliance on mental illness, agreed. Yet it is rare in psychiatric settings, primarily because of the relatively short periods of observation compared with the lifetime risk. Mehtonen et al 1991 ; found only 49 sudden deaths among 25 000 people with psychiatric disorders followed for 3 years. Jusic & Lader 1994 ; emphasised that most sudden deaths in psychiatric settings are unexplained by post-mortem examination. A modest-sized study of 74 cases of sudden death from five psychiatric hospitals in the north-east of England over a 12-year period generated some useful epidemiological information Reilly et al, 2002 ; . Sudden death accounts for about 5% of all deaths in psychiatric hospitals. Around 20% of sudden deaths of people with mental health problems occur in those under 65. Contrary to early fears, only very rarely do deaths occur during restraint, behavioural disturbance or shortly after rapid tranquillisation. Antipsychotics are the most commonly prescribed drug in reported cases of sudden death, but in this series of 74 deaths, 40% of the individuals were not prescribed antipsychotics at the time of the event. About a third of individuals have schizophrenia, a third have a mood disorder and a third have an organic diagnosis such as delirium or dementia ; . Witnessed accounts suggest that sudden death is heralded by abrupt loss of consciousness within 1 h of the onset of acute symptoms. The symptoms can be of chest pain, weakness or fatigue, and palpitation. If there are no witnesses, it has been suggested that the description of sudden death may be appropriate if an individual known to have been medically stable less than 24 h previously dies without clinical evidence of a cause of death Myerberg, 1997; Priori et al, 2001 ; . In the sudden death of young people, post-mortem examination reveals a pre-existing cardiac cause in most cases often called sudden cardiac death ; . Yet in the majority of cases of sudden death of young people with mental health problems there is thought to be no structural abnormality, although no good postmortem series in psychiatric cases has been reported Reilly et al, 2002; Maron, 2003 ; . In one of the few autopsy series of sudden cardiac death in 14 patients taking antipsychotics, Green 1988 ; reported the cause of death as `chronic cardiac toxicity'. In a survey of autopsies associated with psychotropic medication in Finland, of the individuals who succumbed to sudden cardiac death despite structurally normal hearts, half had been entirely asymptomatic previously Chugh et al, 2000 ; . This suggests that arrhythmias are responsible in most cases rather than one of a myriad of other possible causes such as hypertrophic cardiomyopathy, commotio cordis Box 3 ; , coronary artery anomalies, ruptured aortic.
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127. Nine laboratories tested four doses of p, p'-DDE DDE ; in order to assess the ability of the Hershberger bioassay to detect androgen antagonists. Five laboratories performed the studies using coadministration with 0.2 mg kg d TP, and four laboratories performed the studies using coadministration with 0.4 mg kg d TP. All laboratories conducted the assigned studies as intended, submitted their laboratory and study data electronically using standardized Excel spreadsheets, audited the study data, and, if necessary, informed the Secretariat of data corrections. Results of p, p'-DDE studies using 0.4 mg kg d TP coadministration 128. The summary results of the accessory organ and tissue weights and the statistical analyses for the DDE studies conducted using 0.4 mg kg d TP coadministration are reported in Table 26. The results show that the Hershberger bioassay successfully and reproducibly detected DDE in three of the four laboratories. The absolute weights of all five male sex accessory tissues decreased with increasing DDE doses in a doseresponsive manner. The SVCG and GP did not achieve statistical significance in one of the four laboratories. 129. Ventral Prostate VP ; . There were statistically significant dose-dependent decreases in the weights of the VP in all four laboratories with DDE. Laboratory 8 achieved a statistically significant decrease for the DDE-treated VP at 50 mg kg d DDE with both statistical methods, and lab 3 and 9 using the pairwise comparison approach. In laboratory 9, the VP was significantly decreased at 160 mg kg d Table 26 ; . The overall mean CVs for the VP ranged from 15 to 35 Table 27 ; . 130. Seminal Vesicles and Coagulating Glands SVCG ; . There were statistically significant dosedependent decreases in the weights of the SVCG in all laboratories with DDE. Labs 8 and 9 achieved a statistically significant decrease for the DDE-treated SVCG at 50 mg kg d DDE, lab 3 achieved significance at 160 mg kg d with both statistical approaches, and lab 4 at the same dose only when using the pairwise comparison approach Table 26 ; . The overall mean CVs for the SVCG ranged from 13 to 32 Table 27 and adalat. 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