Psychiatric screening of civil service candidates with particular reference to police applicants.

This prelimary report has reviewed the activities of a Medical Review Board for a Civil Service Commission. The responsibility of the Board is to review conflicting data in cases where the hiring authority has attempted to exclude a candidate, particularly a police candidate, on the grounds that the applicant is mentally unfit to perform the duties of the position. This rule has been applied primarily to police applicants, secondarily to fireman applicants, and rarely to other. Psychiatrists who participate must be aware of the underlying conflicts within civil service systems, the possibility of manipulation, and the rigidity of the system which is designed to protect the greatest number. Civil service systems have limited discretion on personnel policies. Therefore, psychiatrists must be careful not to act as arbiters for social institutions without a sound and meticulous basis for their participation. For those psychiatrists who participate in the process, the urgent need to do so in accord with professional standards is stressed, recognizing that standards change and that the nature of participation will be scrutinized by many in society outside the profession.     

Correlates of outcome following acute glutethimide overdosage

Potential predictors of outcome following acute glutethimide overdosage were assessed in 63 patients hospitalized with this diagnosis at a large urban medical center between 1962 and 1975. Their mean age was 34 years (range, 15 to 84 years) and 62% were female. Assisted ventilation was required in 59% of cases, and 32% developed hypotension. Six patients died, including all three aged 60 years or older. Multiple regression analysis confirmed that age was the major identifiable determinant of survival, regardless of other factors. Among identifiable determinants of coma grade, glutethimide dose, glutethimide plasma concentration, and coingestion of barbiturates were the most important. An ingested dose of 10 g or more, or a plasma concentration exceeding 30 microgram/ml, was almost always associated with deep coma. However, a relatively small ingested dose or a low plasma level by no means ruled out development of serious intoxication, particularly in those patients who also ingested barbiturates. Thus elderly individuals are at high risk for fatal outcome following glutethimide overdosage and should receive priority for intensive care and monitoring. Glutethimide dose, plasma concentration, and history of coingestion of barbiturates are of value in predicting development of deep coma. These items of information should be obtained on admission whenever possible.