Lost in translation

A middle-aged male was transferred to our low secure forensic unit from a medium secure unit under hospital order with an accompanying restriction order. He had a diagnosis of paranoid schizophrenia, and was on antipsychotic treatment which caused a gradual improvement of his psychotic symptoms. Although he was documented to have high premorbid functioning, ward staff attending the patient reported a marked cognitive decline in the weeks following his admission. He was referred for a neuropsychological assessment, which confirmed the cognitive decline and also detected lack of initiative and a reduction in processing speed. These were deemed not to be concordant with the negative symptoms of schizophrenia and an organic cause was suspected. An initial computed tomography scan and a subsequent magnetic resonance imaging (MRI) scan revealed mild cerebral atrophy.

Over subsequent months, his cognitive function continued to deteriorate and a further MRI scan showed a possible multi-infarct dementia; follow-up neurocognitive testing also suggested a further decline in cognitive abilities compared with the previous assessment. Therefore, we decided to refer him to the Burden Neurological Institute for a more detailed evaluation of the aetiology of his cognitive decline and with a view to organise future placement in the community. Burden Neurological Institute is a specialist neuropsychiatry unit based at Frenchay Hospital, Bristol, founded in 1939 by Mrs Rosa Burden, wife of the Revd Harold Nelson Burden, who set up the first national hospital for people with mental and psychiatric disorders. ¹ However, when a colleague communicated the decision to our patient's family, they became upset, saying they did not feel he was a ‘burden’ and needed to be bundled off to a ‘burden centre’. Our hapless colleague, being unaware of how the Burden centre came to be named thus, was unable to placate them, and it fell to us to assuage their feelings. Fortunately, the Institute's website (www.bristol.ac.uk/neuroscience/clinical/bni) and an excellent article in the Psychiatric Bulletin from 20 years ago² came to our rescue. We too came to realise that the ‘Burden centre’, far from being an unfortunate moniker, was a fitting tribute to the Burdens, who dedicated their lives to improving the lot of mental health patients in this country.