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The clinical specialty of psychogeriatrics developed to provide dedicated mental health services for people over age 65, often treating people with complex combinations of mental, physical and social difficulties. Clinical reports in 1943/4 showed that physically and mentally unwell older people could benefit from active treatment, but the old age health specialties -geriatrics and psychogeriatrics - followed different paths of development. By 1970 there were about 200 consultants in geriatrics, but merely a handful of psychogeriatricians. Psychogeriatric services did not fit conveniently into policies and plans categorised as either psychiatric or geriatric, and suffered from lack of defined responsibility at all levels of health service management. Political, economic, demographic, legal, social, epidemiological, clinical and scientific factors influenced service development. Negative attitudes towards older people and unwillingness of society, including the medical profession, to provide actively for them were repeated obstacles. Tensions existed between doctors advocating better mental health services for older people and various influential committees nationally and locally. Debates over responsibilities and allocation of resources, and professionals’ attitudes towards the new psychogeriatricians and their specialty, contributed to its tortuous development. Leaders in the specialty showed determination, dedication, clinical acumen, organisational and research skills, and the ability to motivate and inspire others. In 1989, the Department of Health recognised psychogeriatrics as a medical specialty. By that time, specialist psychogeriatric services had increased substantially and were available to over 70% of the UK population. Until recognition, there were obstacles to providing appropriate specialist training for psychiatrists and the government did not collect relevant and specific data to assist with developing and monitoring services. Lack of data was associated with difficulty obtaining an equitable allocation of resources, despite clinical and epidemiological research indicating that dedicated, specialist-led services were needed and effective.

The objective of this study was to investigate the physiology and toxicology of Arcobacter in particular the type strain A. butzleri NCTC 12481. A. butzleri grew optimally at 25-35°C and pH 6-8. The presence of nitrate (0.1- 5mM) in the growth medium increased the growth rate. A. butzleri cells in the exponential phase were more resistant to heat than stationary phase cells (D₅₅ 1.1 & 0.4 min respectively) suggesting enhanced stress resistance. Heat treatment caused cell membrane damage shown by high fluorescence values due to the uptake of DNA-binding fluorescent dyes and more UV-absorbing material being released. At +4°C A. butzleri (stationary phase) viability decreased gradually, with increasing exposure time (1 x 10⁹ to 8 x 10⁵ cfu ml⁻¹, 21 day period). Freezing caused a 2 log decrease in viability after only 24 h in storage, thereafter the viability remained constant (0.6-1 x 10⁵ cfu ml⁻¹). No significant cytotoxicity (as determined by the MTT assay) was detected in either cell-free extracts from stationary phase cells or in the BHI spent media. Cytotoxic activity towards N2a and to a lesser extent ECV was detected in cell-free extracts from exponential phase cells. This toxicity was greater following heat treatment of the bacterial cells (55°C, 3 min) suggesting a membrane bound cytotoxin. Morphology studies showed that the toxin caused a decrease (>50%) in the number of neurite outgrowth on N2a cells. The toxin was heat stable and resistant to proteolytic enzymes. SDS-PAGE showed the presence of low molecular weight lipopolysaccharide in material released from cells in exponential phase. The most sensitive cell line was N2a, probably due to a greater abundance of CD14 lipopolysaccharide receptor on its surface. In conclusion, this study has quantified the growth and survival characteristics of A. butzleri NCTC 12481 and has demonstrated the production of an endotoxin by four human A. butzleri isolates.