Showing papers in "American Journal of Psychiatry in 1944"

Symptomatology and management of acute grief

Abstract: At first glance, acute grief would not seem to be a medical or psychiatric disorder in the strict sense of the word but rather a normal reaction to a distressing situation. However, the understanding of reactions to traumatic experiences whether or not they represent clear-cut neuroses has become of ever-increasing importance to the psychiatrist. Bereavement or the sudden cessation of social interaction seems to be of special interest because it is often cited among the alleged psychogenic factors in psychosomatic disorders. The enormous increase in grief reactions due to war casualties, furthermore, demands an evaluation of their probable effect on the mental and physical health of our population. The points to be made in this paper are as follows: i. Acute grief is a definite syndrome with psychological and somatic symptomatology. 2. This syndrome may appear immediately after a crisis; it may be delayed; it may be exaggerated or apparently al)sent. 3. In place of the typical syndrome there may appear distorted pictures, each of which represents one special aspect of the grief syndrome. 4. By appropriate techniques these distorted pictures can be successfully transformed into a normal grief reaction with resolution. Our observations comprise tot patients. Included are (i) psychoneurotic patients who lost a relative during the course of treatment, (2) relatives of patients who uied in the hospital, (3) bereaved disaster victims (Cocoanut Grove Fire) and their close relatives, ( ) relatives of members of the armed forces.

The american journal of psychiatry

Abstract: Articles 1278 An Inflammatory Biomarker as a Differential Predictor of Outcome of Depression Treatment With Escitalopram and Nortriptyline Rudolf Uher et. al 1287 Identification and Replication of a Combined Epigenetic and Genetic Biomarker Predicting Suicide and Suicidal Behaviors Jerry Guintivano et. al 1297 Clinical Outcomes and Genome-Wide Association for a Brain Methylation Site in an Antidepressant Pharmacogenetics Study in Mexican Americans Ma-Li Wong et. al

The process of hypnotism and the nature of the hypnotic state

Abstract: 1. The process of inducing hypnosis and the fully developed hypnotic state are a continuum which can be studied satisfactorily only in the novice, and which under such circumstances consists of three stages which shade from one into the next. 2. In the initiation of the process there is a progressive elimination of all channels of sensori-motor communication between the subject and the outside world, with the exception of the channels of communication between the subject and the hypnotist. As a consequence, during this phase the hypnotist becomes temporarily the sole representative of and contact with the outside world. 3. In this essential characteristic, the induction phase parallels the sensori-motor relationships of the infant to the outside world during the earliest phase of infancy, during which the parents play in the psychology of the infant a role almost identical to that of the hypnotist in the mental life of the subject. 4. The onset of the hypnotic state consists of a partial sleep in which ac...

Intellectual impairment in head injuries

Abstract: 1. This investigation is concerned with the frequency and nature of intellectual impairment in head injuries. 2. The methods for evaluation of defects are discussed with special reference to the two criteria used in this study: comparison of performance with estimated intelligence, and improvement on repeated examinations. 3. The following tests measured the impairment best: 100-7 test, pictorial absurdities, hole-in-the-board test, pictorial discrimination, naming of colors, and reading. 4. The mental functions affected are primarily: speed, judgment, and ability to keep up a sustained effort. 5. About one-half of all subjects suffering from head injury show slight intellectual defects. These become less marked with increasing remoteness from the time of the injury. If the impairment is reversible, the duration is usually a matter of less than 3 months. 6. The impairment seems to be related to the severity of the brain damage. The more serious the intellectual defect, the higher is the incidence of abnor...

Rapid changes in the o2 tension of cerebral cortex during induced convulsions

Abstract: A relative anoxia of the cerebral cortex occurs before, during and after convulsions induced electrically or by a variety of drugs. This relative anoxia is believed to be caused by increased cerebral metabolism.

Electroencephalographic studies immediately following head injury

Abstract: 1. If mild cerebral trauma such as we were investigating produced changes in the electroencephalographic tracing the abnormality disappeared within a period of minutes in the vast majority of cases. 2. Patients who gave a history of amnesia following cerebral trauma, but were clear mentally at the time the EEG was taken, showed only a slight increase in the percentage of abnormal records as compared to the control series. This was true even when the records were taken within a few hours of the accident. 3. If there was an impairment of consciousness of any degree at the time the EEG was taken, abnormality in the EEG was the rule. 4. Electroencephalographic records taken within 30 minutes after patients sustained head injury showed a greater percentage of abnormality than those taken after 30 minutes had elapsed. The rapid disappearance of abnormal electroencephalographic findings points, in our opinion, to some mechanism in concussion other than petechial hemorrhage, cerebral contusion, embolic phenomenon...

Clinical and eeg studies in obsessive-compulsive states

Abstract: 1. A series of 31 patients presenting as a dominant feature in their clinical picture obsessive-compulsive phenomena were studied clinically and electroencephalographically. Twenty-four of these cases were classifiable as psychoneurotic, obsessive-compulsive type, 2 as epileptic and the remaining 5 as schizophrenia. 2. Twenty of the total of 31 patients, or 64 per cent, exhibited patterns which were classifiable as abnormal. Of these 20 cases 14 showed serial 2-4 cps potentials of high amplitude either before or after a two minutes period of hyperventilation. Approximately 29 per cent of the obsessive-compulsive patients studied exhibited records which were classified as definitely normal. 3. The greatest incidence of records exhibiting electrocortical dysfunction occurred in the age group below 30 years of age. 4. Approximately 35 per cent of the entire group gave definite positive histories of psychopathy in the family. Of the cases showing electrocortical dysfunction 40 per cent gave positive histories...

An appraisal of the personality types of the addict

Abstract: An attempt has been made to discuss addicts from the standpoint of types set up on the basis of manifestations of personality. It must be remembered, however, that any classification is of value only if it leads to better understanding the patient, which is essential to intelligent therapy. Indefinite or overlapping groupings not only serve no useful purpose, but may obstruct proper therapy. There is a danger in too much insistence on classification, since there is then a tendency to think of addicts in terms of groups or constellations rather than as individuals with individual personalities. At best the personalities of addicts in the same category are only similar; rarely can sweeping statements as to therapy be made on the basis of such groupings. The groups shade into one another and there will always be difficulty in classifying the borderline cases. This should cause us little concern from the therapeutic point of view since the patient should be treated according to the individual findings in any ...

Age and electroencephalographic abnormality in neuropsychiatric patients

Abstract: The EGGs of 1,593 neuropsychiatric cases are analyzed and the tracings are classified as "normal" or "abnormal." "Abnormality" is defined as activity with a predominant frequency outside the range of 8 to 12 per second or a tendency to change greatly with overbreathing. This criterion is applied to all records regardless of age or clinical condition. "Abnormal" records are further classified as slow, fast, and mixed slow and fast. The percentage of "abnormal" records found in the various neuropsychiatric conditions varies from 22 per cent in alcoholic psychosis to 54 per cent in senile and artericsclerotic disorders. The order is as follows: alcoholic psychosis, 22 per cent; Schizophrenia, 23 per cent; psychopathic personality and behavior disorders, 31 per cent; manic-depressive depressed, 31 per cent; psychoneurosis, 34 per cent; manic-depressive manic, 42 per cent; psychosis with mental deficiency, 50 per cent; involutional psychosis, 51 per cent; senile and arteriosclerotic psychosis, 54 per cent. A c...

A psychiatric study of 250 sex offenders

Abstract: 1. The clinical records of 250 male nonpsychotic sex offenders, admitted consecutively to the psychiatric division of Bellevue Hospital over a period of thirteen months, were studied. Clinical data regarding type of offense, age, racial origin, nativity, education, religion, marital status, and previous offenses are presented. 2. Pedophilia and exhibitionism were the most frequent types of offense, together comprising two-thirds of the cases. The remaining four types of offense—statutory rape, incest, sex relations associated with force, and homosexuality—together comprising one-third of the cases. 3. The statutory rape group was, on the average, younger than the pedophilia and exhibitionism groups. There were 53 (22%) Negroes in the series. This represents a greater incidence of Negro offenders than would be expected from the population percentages in New York City. 4. Fifty-six (23%) were of foreign birth. This represents a smaller incidence of sex offenders among the foreign born than would be expected...

Mental disease among mental defectives

Abstract: It is fitting at this joint meeting of The American Psychiatric Association and the American Association on Mental Deficiency that consideration be given to the disorders that come within the purview of the members of both Associations. In our topic “Mental Disease Among Mental Defectives” we embrace a portion of the two great classes of unfortunates that are the special concern of our organizations. Ordinarily, we regard the mentally ill and the mentally defective as separate and distinct groups. For the one we provide hospitals and for the other schools; for the one we seek restoration and cure, for the other protection and social competency. The two classes might be kept entirely separate were it not for the fact that a considerable number of patients are afflicted by both mental disease and mental defect. The latter, in the main, is a static condition while the former is more or less dynamic and transitory. Adult mental defectives and some types of chronic mentally-ill patients constitute somewhat similar institutional problems and are cared for together in many mental hospitals of Europe. Fortunately, this practice has not been adopted to any considerable extent in America. Several noteworthy studies dealing with the psychotic symptoms found among certain types of mental defectives have been published in recent years. Among these may be mentioned the excellent papers presented at former annual meetings of the American Association on Mental Deficiency by Drs. Vanuxem, Whitten, Pearson, Mclntire and Hunsicker. These papers dealt with a large variety of cases and included several interesting case histories. A study of similar import was made by Drs. Herskovitz and Plesset of the Norristown, Pennsylvania, State Hospital and was published in the Psychiatric Quarterly for July, 1941.

The incidence of nocturnal enuresis after age five

Abstract: Nocturnal enuresis persists into adult life much more commonly than generally recognized. Although normal children are supposed to gain bladder control before age 3, 16. 1 per cent of a group of 1000 consecutive selectees questioned at an army induction station reported enuresis after age 5. Two and one half per cent did not gain control until age 18 or later and isolated cases continued bed-wetting to age 33. Associated nervous or mental conditions were noted in 63 per cent of the cases reporting enuresis. A study of 369 inmates of a state school for mental defectives revealed enuresis in 83.8 per cent of a group of 54 idiots, 12.8 per cent of 164 imbeciles and only 4 per cent in 125 morons. It is suggested that nocturnal enuresis may frequently be regarded as a developmental defect which disappears spontaneously when maturation within the central nervous system is completed. Since the incidence of enuresis tends to decline with increasing creasing age it follows that almost any method of treatment will ...

The effect of pleasant and unpleasant ideas on the respiratory pattern (spirogram) in psychoneurotic patients

Abstract: 1. The spirogram tracings were analyzed for irregularities in pattern in a series of 64 psychoneurotic patients and 24 normal control subjects during periods of induced ideational stimuli. During the second, third and fourth periods, the subjects were directed to think of pleasant, unpleasant, and again of pleasant ideas. During the first period no direction was given, and during the last period the patients were asked to relax. 2. The respiratory tracings were analyzed for sighing respirations, minor fluctuations, major fluctuations, and points off an arbitrary line for the upper and lower border of the tracings. 3. The most consistent changes were observed on comparing the unpleasant period with its preceding pleasant period. Significant changes were found in all of the items in 43 patients (Group I) with diagnoses of hysteria, anxiety neurosis and reactive depression. In the remaining 21 patients (group II) whose diagnoses were hypochondriasis, compulsion neurosis and questionable schizophrenia, a sign...

Four years' experience with music as a therapeutic agent at eloise hospital

Abstract: Limited time makes it impossible to enter into details of four years’ experience with music at Eloise. We shall confine ourselves, therefore, to the broader theoretical aspects, the general principles, and the major techniques. Dr. Samuel W. Hamilton in his preface to Music in Institutions by van-de-Wall expresses the following fecund thought: “Medicine, music, engineering-indeed every body of knowledge or practice-lives through a long period of empiricism before it can be formulated and passed along by any method except the most intimate apprenticeship. It is but yesterday that fever therapy was put under control for the benefit of the victims of a certain disease of the brain. Liver has been a foodstuff for ages, but only a few years ago we learned that a baffling and formerly fatal disease can often be checked by its use.” Why does music affect human beings? Because tone and rhythm, put into proper order, appeal to the pleasure principle. Musical rhythm, which has a strong affinity to bodily rhythm, affects the Id, offers an opportunity for the ego to indulge in open erotisation as in “jitterbugging.” The raw material of music is intimately linked with instinctual drives. Nature makes use of “music” in its work of sexual selection and self-preservation. Charles Darwin referred to music as “charming” and “fascination”; his concept of music was that it possesses a sort of hypnotic influence, the male animal using it to overcome the instinctive coyness of the female. Whether the music is self-made as in the stridulating insect, the drumming of the sniper’s tail, or the singing of the birds; or by man-invented instruments, is another question. The chief point is that music has the property of attracting attention by appealing to the

The relationship of neurotic traits to the electroencephalogram in children with behavior disorders

Abstract: 1. In 122 children with behavior disorders, enuresis was reported more frequently (38 or 31.2 percent) than any other neurotic trait. 2. Male children and those in the age group of 13 to 18 years had abnormal EEGs more commonly than females or children in a younger age group, suggesting that age and sex are important variables that must be controlled in a study of this kind. 3. A history of enuresis in children with behavior disorders was associated in a positive manner with electroencephalographic abnormality, whereas behavior disorders without enuresis were not positively associated with electroencephalographic abnormality. 4. The EEG does not correlate with the vague and complex syndrome of behavior disorder but with certain specific aspects of this syndrome.

Brain lesions associated with experimental "epileptiform" seizures in the monkey

Abstract: By means of a single application to the cerebral motor cortex of certain chemical and immunologic agents, it has been possible to produce convulsive seizures in the rhesus monkey. Of more significance than the acute manifestations observed, was the state of chronic convulsive reactivity induced. A histopathologic examination of monkeys exhibiting recurrent convulsive seizures indicated a pathologic process which was essentially that of a chronic progressive meningocortical cicatrix. However, a similar type of lesion was produced by control preparations which failed to induce convulsive seizures at any time during a long observation period. From this study it must be concluded that the pathologic changes observed were insufficient to account by themselves for the convulsive manifestations.

The electroencephalogram in post-traumatic epilepsy

Abstract: The electroencephalograms of 175 cases of post-traumatic epilepsy and of 215 cases of head injury without epilepsy were compared. The group of head injury patients without epilepsy was subdivided into 113 cases of mild injury and 102 cases of severe injury. In all cases the electroencephalogram was taken three months or more after the injury so that only the chronic post-traumatic state was considered. Comparisons were made between the electroencephalograms of these three post-traumatic groups, a group of 1,161 unselected epileptics and a group of 1,000 normal control subjects. On the basis of differences between the five groups, the following conclusions are drawn with regard to the electroencephalogram in the chronic post-traumatic state: 1. Among patients with severe head injuries but no seizures, the incidence of abnormal electroencephalograms continues to decrease from three months to two years after injury. 2. Among post-traumatic epileptics, there is a relatively slight decrease in the incidence of...

Neurosis and alcohol

Abstract: Sixteen cats were trained to adapt to situations of increasing complexity; first they opened a box of food, then they were taught to feed only after specific sensory stimuli, and finally they learned to manipulate a switch in various positions to actuate their own feeding signals. When alcohol was administered, these patterns disappeared in the order of decreasing complexity of integration, until only the original, primitive feeding reactions remained. After recovery, the animals were subjected to a severe motivational conflict, and developed inhibitions, phobias, loss of dominance, somatic manifestations of anxiety, and other behavioral abnormalities typical of an experimental neurosis. Alcohol partially disintegrated these complex responses, restored direct goal-behavior and thereby temporarily relieved the neurosis. Ten of the animals, after sufficient experience with this effect, continued to prefer alcohol to non-alcoholic liquids until their neuroses were relieved by various experimental procedures....

The rôle of the premorbid personality in arteriosclerotic psychoses

Abstract: A study of the clinical-anatomic relationships in arteriosclerotic psychoses reveals numerous inconsistencies, which indicate that different persons vary greatly in their ability to withstand cerebral damage. The observations suggest that individuals who are in any way handicapped psychologically are highly vulnerable to arteriosclerotic psychoses. A considerable number of patients displayed inadequate and unstable personalities; less frequently, situational stress was noted. Such patients break down mentally in the face of damage which persons of a stable make-up could successfully withstand. Extensive cerebral changes may produce a psychosis in anyone, but the anatomic factor can be regarded as all-important in only a minority of the group. In the other cases, responsibility for the psychosis is shared by factors of personality.

The clinical aspects of traumatic epilepsy

Abstract: Epilepsy is an infrequent complication of injury to the head in general. All present information indicates that laceration of the brain is an essential factor, whether or not accompanied by injury to the skull or dura, though accompanying laceration of the dura and especially sepsis greatly increase the liability. It is considered important from the point of view of prognosis to separate early conclusions (within for example the first eight weeks) from epilepsy of later onset. There are also indications that it is advantageous to grade different severities of convulsions, of which the only index we have at present is degree of generalization. Intellectual impairment is an unsatisfactory clinical index of prognosis for the type of head injury which it most frequently follows is one that does not have high liability to convulsive disorder.