8430/1989

		  Second Report on Mr Panos Koupparis

(Additions since receiving further documents, including Mr. Koupparis'
Comments on the statements of Dr. Sophocleous and Dr. Evthokas).

(1)	Medical History of depression
		(see First Medical Report: VI(1) Mental state in 1981)

		The statement that Mr. Koupparis suffered a depressive illness
	requiring hospital admission in 1974 on the death of his father, and
	that two maternal relatives suffered from depression was taken from
	Dr. Evthokas' statement. This impression is probably false and is
	explained by Mr. Koupparis' comments on Dr. Evthokas' Statement. I am
	convinced by Mr. Koupparis' explanation (which is confirmed by the
	normal psychological tests and psychiatric report in 1981), and
	believe that he had no history of psychiatric illness prior to his use
	of prescribed psychotropic drugs.

(2)		It is impossible to be absolutely certain of the exact nature,
	dosage and sequence of drugs prescribed for Mr. Koupparis because:

	(a)	The records of both Dr. Sophocleous and Dr. Evthokas are unclear
		and unreliable,
	(b) 	The records of the pharmacist are only fragmentary,
	(c) 	It would not be expected that Mr. Koupparis (or anyone else in
		his position) would remember the exact drugs, in exact dosages,
		combinations and sequence, or the exact relationships of each
		drug to any ensuing symptoms, over a period of years.



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(3)		There seems to be a particular doubt about the period over which
	Mr. Koupparis took Parstelin. At the minimum, it seems to be agreed
	that he took it for 2 months between June 10 and August 15, 1985, and
	that he took it again from January to June, 1986. These periods would
	have been sufficient for Mr. Koupparis to experience adverse effects
	(e.g. a psychotic reaction) from this drug.

(4)		In any case, the extra documentation does not materially alter
	the conclusions stated in the First Medical Report that:

	taking account of all the evidence available, Mr. Koupparis was
	prescribed excessive doses of psychotropic drugs, in inappropriate
	mixtures, with frequent changes of dosage. Even allowing for
	inaccuracies in records or recollections, the prescriptions could have
	precipitated psychotic, paranoid, and/or manic reactions as a result of:

	(a)	excessive doses, and or inappropriate combinations, and/or
	(c)	withdrawal effects, as described in my First Medical Report.



              C H Ashton
Signed________________________________MA.DM.FRCP.


               21.3.89
Date__________________________________



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