Showing papers in "American Journal of Psychiatry in 1962"

Psychiatric reaction patterns to imipramine

Abstract: 1. One hundred and eighty voluntary inpatients (102 schizophrenic subjects, 67 subjects with affective disorders, and 11 "other" diagnoses) were studied during treatment with imipramine. 2. Seven imipramine induced behavioral reaction patterns and their relationships to diagnosis, age, sex, patterns of medication use, and hospital discharge evaluation are presented. These include mood elevation, explicit verbal denial, manic, reduction of episodic anxiety, agitated disorganization, anhedonic socialization, and non-response. 3. Imipramine was favorably evaluated in 79% of subjects with affective disorders and 51% of schizophrenic patients. 4. The use of psychiatric reaction patterns to psychotropic drugs for categorizing patients and providing a basis for a more rational pharmacotherapy are emphasized.

Model psychoses and schizophrenia.

Abstract: All model psychoses may be conceptualized as resulting from disruption in the central processing or from interference with the normal sensory influx from body or distance receptors. The experimental findings of the effects of sleep deprivation, sensory isolation, drugs, and a combination of drugs and sensory isolation in control and schizophrenic subjects warrants the development of a hypothesis within this context to explain some of the mechanisms responsible for schizophrenic behavior. Such a hypothesis must be operational in the sense that its elements must be susceptible to experimental verification. Evidence has been presented that sleep deprivation is at first accompanied by an adaptive high biologic energy turnover, but that finally a point is reached after several days when energy producing mechanisms decompensate. Moreover, it appears possible that a "stressor substance" develops in the serum of these subjects which may be responsible for the progressive failure of the mechanism of energy turnove...

Reliability of psychiatric diagnoses: 2. a study of consistency of clinical judgments and ratings

Abstract: 1. An investigation of the reliability of psychiatric diagnoses was designed to minimize factors that would artificially lower or inflate the rate of concordance. A series of 153 patients were examined independently by paired psychiatrists and diagnoses were made independently according to the standard nomenclature. The degree of agreement (54%) on specific diagnoses was statistically significant (p<.001) and was higher than that obtained in other comparable studies. 2. In cases where both diagnosticians indicated they were certain of the diagnosis, the agreement rate (81%) was found to be significantly higher than in the remaining cases. 3. When the diagnosticians gave both a preferred diagnosis and an alternative diagnosis, it was found that the rate of agreement between either diagnosis offered by one diagnostician and either diagnosis of the other was 82%. This suggested that the diagnosticians may have been closer in their appraisals than indicated by the scoring of only the preferred diagnoses. 4. A...

An urban population's opinion and knowledge about mental illness

Abstract: 1. I believe the authors have obtained from their sample a response which is very likely more in keeping with the true level of knowledge, understanding, and tolerance, in spite of the fact that their data proved contrary to what was apparently their original hypotheses. 2. The population sample is, in my opinion, different from those studied elsewhere and this may account in part for the responses. 3. For at least a significant segment of the study population, it is unlikely that they have responded to mental health education as carried out in the past few years and, therefore, that this does not indicate that such educational programs have brought about the findings of this study. 4. I should like to congratulate the authors for carrying out a well planned study which will likely lead the way to a more accurate appreciation of the opinion and knowledge of population groups with respect to the mental illnesses.

Reliability of psychiatric diagnoses : 1. a critique of systematic studies

Abstract: Pertinent systematic studies of the reliability of psychiatric diagnosis were critically examined It was pointed out that each of these studies presented certain methodological problems which made their findings inconclusive An experimental design was presented to meet these problems and thus yield a more informative index of reliability By systematically varying the important variables, such as the level of experience of the psychiatrists, the time interval between interviews, the use of ancillary information, and the degree of refinement of the nosological categories, it will be possible to determine their effects on reliability

Suicide and suicidal attempts in children and adolescents.

Abstract: A study of 102 children and adolescents who presented suicidal thoughts and actions is described. They represented approximately 11% of all admissions under 16 years of age. The majority were adolescent females diagnosed as character disorders, who were reacting to stressful situations. The majority came from chaotic homes where one or both parents were absent. It is our belief that suicidal thoughts and attempts are either ignored or undervalued in adolescents because of the erroneously accepted tenet that adolescents do not become depressed, ergo, suicide is unlikely. If we can successfully recognize the signs by which depression is manifested in younger persons we shall then be in a position to prevent many serious suicidal attempts.

Gross stress reaction in combat--a 15 year follow-up.

Abstract: While there are similarities between the combat patients and the non-combat controls, a clear-cut picture emerges of the combat veteran syndrome with a severely disabling condition involving startle reactions, sleep difficulties, dizziness, blackouts, avoidance of activities similar to combat experience, and internalization of feelings. He is not however psychotic. The achievements of the medical and allied professions especially in dealing with the acute combat cases have been valuable but less and less interest is being shown to this particular group of veterans. In many hospitals and clinics there is no official record kept as to whether a patient was ever in combat. It is suggested that if we are to continue to study this group of patients we must at least keep track of them. Particularly with the recent emphasis on "here and now" in psychotherapy a combat veteran's tendency to avoid discussing his traumatic combat experiences may easily create a tacit agreement between the therapist and the veteran t...

Some relationships between social class and the practice of dynamic psychotherapy.

Abstract: From both a practical and a theoretical point of view, the psychiatric literature has, in the past few years, been increasingly concerned with the practice of dynamic psychotherapy in outpatient clinics. This concern has been sparked by several considerations. In the first place, from an economic standpoint psychotherapy as now practiced will permit only limited care of a selected number of applicants. Roughly calculated, the number of therapists needed to follow our present orientation is estimated at around 40,000 and it is not expected that we could provide anywhere near this figure in the near future. In the second place, as a professional group, we seem to share the rather pleasant delusion that those who support the mental hygiene clinic movement should eventually find the finances to provide enough therapists to meet the current demands. This is despite the fact that we have no sure evidence that the results from psychotherapy are better than other modes of treatment, or possibly no treatment at all. This becomes even more disconcerting when we consider that evidence is beginning to accumulate that present methods of clinic treatment may be suitable for only a limited group of people within our society. There are indications that our practice of psychotherapy is biased in favor of the so-called upper classes of our culture, and that our prized patients are those who share the same values and traits that we as a professional group cherish. The authors have been particularly interested in this problem, i.e., the role of social status in the practice of psychotherapy. Hollingshead and Redlich( 1), from their broad survey, indicate that the upper classes preferentially receive more intensive

Automobile accidents, suicide and unconscious motivation.

Abstract: Thirty alcoholic and 30 non-alcoholic Patients were evaluated to determine past serious suicidal preoccupation or previous suicidal attempts. These data were correlated with the total number of automobile accidents for which the patient was responsible. The 33 patients deemed to be suicidal averaged 2.70 accidents per patient whereas the 27 non-suicidal patients averaged 1.30 accidents. In the 30-patient alcoholic group, the 17 suicidal patients were responsible for 63 accidents, whereas the 13 non-suicidal patients were responsible for 24 accidents, yielding mean values of 3.70 and 1.77 accidents per person respectively. These differences were statistically significant. Due to the accepted and real hazards of driving, the automobile constitutes an ideal self-injurious or self-destructive instrument, particularly for persons intent upon camouflaging their suicidal motivation from others–and from themselves. With one exception, all patients believed their traffic accidents were fortuitous. Alcohol intoxica...

Common characteristics of epilepsy and schizophrenia: clinical observation and depth electrode studies.

Abstract: Data presented, gathered by special techniques, add some clarification to the nature of the seemingly similar and related disease processes of schizophrenia and epilepsy. These data indicate that schizophrenia and epilepsy probably are different entities.

Ulcerative colitis in children.

Abstract: A brief review of the literature regarding idiopathic ulcerative colitis in both children and adults is presented. The results of our study of 17 children suffering from ulcerative colitis are given, including social, psychological, and psychiatric data. These findings are then discussed and conclusions regarding the work of other investigators and certain psychological formulations are drawn. A speculative hypothesis concerning the etiology of this disease is offered, and some therapeutic principles are suggested.

The course and outcome of pseudoneurotic schizophrenia.

Abstract: 1. This is a 5-20 year follow-up report of the course and outcome of 109 patients with pseudoneurotic schizophrenia, 60% seen initially at Psychiatric Institute and 40% in clinics or private practice. 2. About two-fifths of these patients had had previous episodes of mental illness (inpatients: 42%; ambulatory patients: 31%). 3. There appeared to be a high incidence of a life-long history of illness, though age at onset is difficult to determine. There was a striking concentration of patients in the third (50%) and fourth (25%) decades at the time of beginning treatment. 4. There was a significant incidence of subsequent hospitalization following initial contact: approximately 40% of the entire group was hospitalized 1-9 times (11% of Group 1 and 56% of Group 2). 5. Ten percent of the patients attempted suicide but only 2 patients died by suicide. There were no other deaths in this series. 6. Approximately 20% of the patients developed overt schizophrenic symptomatology at some time during the follow-up p...

A comparative study of selected antidepressant medications and EST.

Abstract: The effectiveness of 3 antidepressant medications was compared with that of EST in 128 depressed hospitalized patients at 3 state mental hospitals. The results of this double blind study employing 4 different measures of treatment outcome present a consistent trend. They indicate that: 1. In this sample, the 4 treatments produced 50% marked improvement, 25% moderate improvement, and only 25% minimal improvement or lack of response. Although the absolute number of patients in the 3 hospitals differed, no appreciable deviation from this distribution was found in any of the 3 institutions. 2. There was no difference in treatment outcome between the 33 males and the 95 females. However, patients in the 16-39 age group showed more marked improvements than older patients. In addition, exogenous depressions responded significantly better to the 4 somatic treatments than schizo-affective and endogenous patients. 3. Patients treated with EST manifest a higher degree of improvement than patients treated with the 3 ...

Clinical-statistical analysis of population changes in new york state mental hospitals since introduction of psychotropic drugs

Abstract: 1. Fall of population in the New York State mental hospitals has continued through its sixth year. The rate of overall decrease has been about 1½% per year. Several elements in the total population can be identified as most affected by the change and with the exceptions of paresis and psychoses of the senium noted above, the decreases mostly involve those groups where drug therapy has the greatest clinical advantage over previous methods, this effect subsequently having been intensified by stepped-up total programs. (a) In general, the decrease is most marked in the younger age groups and in the 2- and 3-year cases and there is an actual increase of the very long term older cases (Figures 6 and 7). Releases have risen in cases of all durations of hospital life (Figure 4). (b) The 5-year fall (1955-60) of schizophrenic cases is the most impressive of all diagnostic groups and amounted to 3,376. This began abruptly after the introduction of large-scale drug therapy in January 1955 and has continued ever sin...

Attempted suicide in adolescents.

Abstract: Two important findings emerge from this study of 100 children and adolescents who attempted suicide. The first is the association between attempted suicide and family disorganization. This has been demonstrated for adults by Batchelor and Napier who reported broken homes (deprivation in childhood of a normal life with parents) in 58% of 200 consecutive cases of attempted suicide admitted to a general hospital(1). Although the cases ranged in age from 15 to 83, only 6 were under 20. The second finding is the association between attempted suicide and delinquency, each representing acting-out behavior, not stemming from mental illness, in an attempt to control the social environment. The interrelatedness of attempted suicide, family disorganization, and delinquency is in line with the finding of investigators who have shown that family disorganization, with the concomitant factor of emotional deprivation in the formative years, gives rise to a host of problems which take different forms, e. g., mental illnes...

My Name is Legion

Abstract: One day, you will discover a new adventure and knowledge by spending more money. But when? Do you think that you need to obtain those all requirements when having much money? Why don't you try to get something simple at first? That's something that will lead you to know more about the world, adventure, some places, history, entertainment, and more? It is your own time to continue reading habit. One of the books you can enjoy now is my name is legion here.

Mother's milk and chlorpromazine

Abstract: The amount of chlorpromazine was measured in the breast milk of a lactating psychotic woman after 1200 mg. Cpz. was given in a single oral dose. The microgram amounts found were probably insignificant physiologically. Our study suggests that babies of mothers receiving large doses of chlorpromazine can be safely breast-fed.

Abnormal states of consciousness and muscle tone in infants born to schizophrenic mothers.

Abstract: The evaluation of the changing pattern of consciousness can be used as a measure of the growing integrative capacity of the central nervous system in infancy. In the first months of life, at least two skills develop which are necessary for the maintenance of the quiet, open-eyed alert state. There is an increased general level of arousal(17) sufficient to permit responses to minimal visual and auditory stimuli. There is also a gradual modulation of spontaneous excitability and an increase in the toleration of proprioceptive stimuli. This permits a continuing stable state of awareness and prolonged, focused attention. These abilities are essential prerequisites for the well-integrated development of specffic alerting responses(17), which involve differentiated attentiveness, perceptual discrimination, patterns of accommodation, and the more complex functions which modify the accessibility of the CNS to different stimuli. The organization of a stable, sustained state of alertness by 8 weeks of age, as measu...

The orientations of leaders in an urban area toward problems of mental illness

Abstract: It is necessary to sound a note of caution about these results. They are obtained from interviews with leaders in only one urban area. Viewed as a case study, our findings provide knowledge of the leaders in this area. Viewed as evidence for general contrasts among leaders in different spheres of activity, our work requires replication in other settings. At the very least, however, the differences we have described should provide hypotheses for further research. Our results suggest that orientation towards problems of mental disorder does vary with the individual's order of leadership activity. The differences cannot be accounted for by such factors as educational level, but appear traceable, in large part to the norms governing activities in these orders and serving as major bases for appraising deviant behavior. That these frames of reference dictate orientations varying greatly in the degree to which they are compatible with psychiatric views may well have strong implications for community programs. Le...

Implications for psychotherapy derived from current research on the nature of hypnosis.

Abstract: We have applied to psychotherapy some hypotheses that arose from our current research on hypnosis. Whether or not there exists a valid analogy between the therapeutic process and the hypnotic state, the specific hypotheses may be potentially fruitful in our inquiries about the nature of the therapeutic process. Any conclusions about their validity will of course have to await concrete results of research. Some of the methodological considerations and tools we have developed to deal with problems in the study of hypnosis may be useful in testing similar hypotheses about psychotherapy.