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Showing papers in "American Journal of Psychiatry in 1968"


Journal ArticleDOI
TL;DR: The authors have delineated the symptoms of normal bereavement by systematically interviewing relatives of a series of hospital patients who died and found that only three symptoms—depressed mood, sleep disturbance, and crying—occurred in more than one-half of the subjects.
Abstract: By systematically interviewing relatives of a series of hospital patients who died, the authors have delineated the symptoms of normal bereavement. Only three symptoms—depressed mood, sleep disturbance, and crying—occurred in more than one-half of the subjects. At follow-up two to four months later 81 percent were improved and only four percent were worse. Those improved dated their improvement to six to ten weeks after the death. Ninety-eight percent of these relatives did not seek psychiatric assistance during the bereavement period.

289 citations


Journal ArticleDOI
TL;DR: Although manifestations of tardive dyskinesia occur in a number of diseases of the central nervous system, there is considerable evidence that the largescale use of phenothiazines or similar drugs in recent years is responsible for the great number of patients in mental hospitals exhibiting myoclonia and choreo-athetoid symptoms.
Abstract: Since 1959 a growing number of reports have described a new type of neurological disorder in mental patients. This disorder, known as tardive dyskinesia, has been observed in approximately 500 cases but, judging from the accurate observations made by three separate groups of investigators, the syndrome is likely to be more frequent than one may suspect. Although manifestations of tardive dyskinesia occur in a number of diseases of the central nervous system, there is considerable evidence that the largescale use of phenothiazines or similar drugs in recent years is responsible for the great number of patients in mental hospitals exhibiting myoclonia and choreo-athetoid symptoms.

235 citations


Journal ArticleDOI
TL;DR: There is sufficient consensus to support the independence of the endogenous and reactive factors, but it is suggested that these factors may not represent two etiologically distinct types of depression.
Abstract: Controversies surrounding the distinctions between endogenous and reactive types have characterized the literature on depression. Reviewing seven pertinent factor analytic studies, these authors found sufficient consensus to support the independence of the endogenous and reactive factors. It is suggested, however, that these factors may not represent two etiologically distinct types of depression. The endogenous factor may reflect a "classical" depressive syndrome, whereas the reactive factor may reflect a psychiatric disorder in which depression is only one symptom "contaminated" by other nondepressive clinical features.

187 citations


Journal ArticleDOI
TL;DR: A reappraisal of the social and legal policies regarding marihuana use is needed to resolve the crisis brought about by the rapid increase in its use despite the severe penalties prescribed for violation of the marhuana laws.
Abstract: Current knowledge of the use of marihuana, its physical and mental effects, and its relation to crime and to other drug use are reviewed. The authors feel that a reappraisal of the social and legal policies regarding marihuana use is needed to resolve the crisis brought about by the rapid increase in its use despite the severe penalties prescribed for violation of the marihuana laws.

177 citations


Journal ArticleDOI
TL;DR: A clinical procedure for introducing patients who appear to lack motivation for treatment to psychotherapy if they are taught what to expect and if they understand the "rules of the game" is outlined.
Abstract: There is a strong positive relationship between a patient's perception of psychotherapy and its ultimate success. Some patients who appear to lack motivation for treatment may be capable of profiting from psychotherapy if they are taught what to expect— if they understand the "rules of the game." A clinical procedure for introducing such patients to psychotherapy is outlined by the authors, who also present excerpts from a hypothetical socialization interview.

173 citations


Journal ArticleDOI
TL;DR: A study of 30 kidney transplant patients who had received cadaver homografts focused on their overall adaptation, changes in life-style, and the occurrence of the themes of rebirth, ambivalence over accepting a cadavers organ, and death.
Abstract: A study of 30 kidney transplant patients who had received cadaver homografts focused on their overall adaptation, changes in life-style, and the occurrence of the themes of rebirth, ambivalence over accepting a cadaver organ, and death. In general the problems in living with a transplanted kidney did not appear to be overwhelming. Many of the patients expressed relief at their escape from the rigors of dialysis.

153 citations


Journal ArticleDOI
TL;DR: After two to three weeks, there was evidence of a moderate to strong antidepressant effect of imipramine, while lithium produced only a weak to mild antidepressant effect.
Abstract: A double-blind study involving 29 patients was designed to investigate the efficacy of lithium compared with imipramine in the treatment of acute endogenous depression. After two to three weeks, there was evidence of a moderate to strong antidepressant effect of imipramine, while lithium produced only a weak to mild antidepressant effect. The authors discuss these findings in the light of other reports on the use of lithium in the treatment of acute endogenous depression.

146 citations


Journal ArticleDOI
TL;DR: Patients with paranoid schizophrenic reaction developed diabetes after phenothiazine therapy relatively more frequently than did those with other forms of schizophrenic reactions or with nonschizophrenic psychiatric diagnoses.
Abstract: Between 1955 and 1966 the prevalence of diabetes among hospitalized psychotic women patients rose from 4.2 to 17.2 percent. The increase followed the introduction of chlorpromazine therapy in 1954. About every fourth patient who had been treated for one year or longer with more than 100 mg. daily of chlorpromazine or corresponding doses of another psychoactive pheno thiazine developed hyperglycemia and glycosuria. The disturbance resembled adult-onset diabetes, but there were fewer complications. In 25 percent of the patients remissions occurred either after withdrawal of the drug or reduction in dosage. Obese patients over 50 years old and those with a family history of diabetes were more often affected. Patients with paranoid schizophrenic reaction developed diabetes after phenothiazine therapy relatively more frequently than did those with other forms of schizophrenic reactions or with nonschizophrenic psychiatric diagnoses.

145 citations


Journal ArticleDOI
TL;DR: Most of the subjects experienced an increase rather than a decrease in anxiety and depression; no subject reported subjective craving for alcohol following his first drink; the subjects maintained a high degree of social interaction with other patients and disruptive behavior was rare.
Abstract: Psychiatric observations of mood, thought content, and social behavior of 12 volunteer subjects prior to, during, and following an experimental drinking situation were carried out. Contrary to commonly-held impressions concerning alcoholics, most of the subjects experienced an increase rather than a decrease in anxiety and depression; no subject reported subjective craving for alcohol following his first drink; the subjects maintained a high degree of social interaction with other patients and disruptive behavior was rare.

141 citations


Journal ArticleDOI
TL;DR: Preventive efforts channeled through the school at this time may ease the immediate shock for the child and help him to resume the normal tasks of maturation more quickly.
Abstract: Although it is only the culmination of a more traumatic emotional upheaval in the family, the legal event of parental divorce presents acute problems for the very young child since it involves an abrupt change in his daily life. During the immediate period of parental divorce, ten of the 16 nursery school children discussed here showed dramatic changes in behavior, often characterized by impairment of the ability to master anxiety and depression through play. Preventive efforts channeled through the school at this time may ease the immediate shock for the child and help him to resume the normal tasks of maturation more quickly.

120 citations


Journal ArticleDOI
TL;DR: It is concluded that a preoperative psychiatric interview, accompanied by individual recommendations for postoperative care, and minimization of the environmental stresses of the recovery room, lessen the risk of postoperative psychotic reaction among heart-surgery patients.
Abstract: The high risk of postoperative psychotic reaction occurring in patients who have undergone open-heart surgery has been attributed to several factors. The authors studied two of these—preoperative psychological state of the patient and environment in the recovery room—to determine their influence upon the incidence of postoperative reactions in two groups of heart-surgery patients. They conclude that a preoperative psychiatric interview, accompanied by individual recommendations for postoperative care, and minimization of the environmental stresses of the recovery room, lessen the risk of postoperative psychotic reaction among heart-surgery patients.

Journal ArticleDOI
TL;DR: The authors argue that stricter controls for drivers are necessary if the authors' highways are to be made safer.
Abstract: Significantly more psychopathology and social stress were present in 96 drivers causing fatal accidents than in a matched control group. In the fatality group, prior accidents were significantly related to psychopathology but not to social stress. Twenty percent of the fatality drivers had acutely disturbing experiences within six hours of causing a fatal accident. The authors argue that stricter controls for drivers are necessary if our highways are to be made safer.

Journal ArticleDOI
TL;DR: A systematic survey of consecutive admissions to the general medical wards of a large metropolitan teaching hospital revealed a high rate of alcoholism, although approximately one-third of the patients with alcoholism appeared to be in remission.
Abstract: A systematic survey of consecutive admissions to the general medical wards of a large metropolitan teaching hospital revealed a high rate of alcoholism, although approximately one-third of the patients with alcoholism appeared to be in remission. Illness patterns of alcoholic patients differed from those of nonalcoholic patients. However, physicians and staff caring for these patients generally did not recognize the alcoholism.

Journal ArticleDOI
TL;DR: The authors have attempted to study the frequency and significance of hysterical personality features in hospitalized depressed women by devising a reliable measure for the hysterical personality and using the Hamilton Rating Scale for Depression.
Abstract: Lack of clarity of definition has contributed to the difficulty in studying the phenomena of hysteria and depression. The authors, by devising a reliable measure for the hysterical personality and by using the Hamilton Rating Scale for Depression, have attempted to study the frequency and significance of hysterical personality features in hospitalized depressed women.

Journal ArticleDOI
TL;DR: The authors suggest that the beliefs and attitudes of the group may have arisen as learned consequences of frequent, intense LSD experiences in susceptible individuals.
Abstract: Twenty-one paid volunteers who were chronic users of LSD were interviewed and participated in a series of cognitive and perceptual tests and EEG studies. Among other observations derived from both interviews and testing, the authors noted that the group shared a set of magical-mystical beliefs and profound nonaggressive attitudes, as well as a unique sensitivity to certain types of sensory stimulation. The authors suggest that the beliefs and attitudes of the group may have arisen as learned consequences of frequent, intense LSD experiences in susceptible individuals.

Journal ArticleDOI
TL;DR: The results of this clinical study emphasize that lithium is highly beneficial in preventing and alleviating acute mania and the hypomanic aspects of schizo-affective psychoses.
Abstract: Lithium carbonate has been widely acclaimed as a useful drug in the treatment of manic-depressive psychoses. The results of this clinical study emphasize that lithium is highly beneficial in preventing and alleviating acute mania and the hypomanic aspects of schizo-affective psychoses. When used alone, lithium was found to be relatively ineffective as an antidepressant. However, in combination with a tricyclic or MAO-inhibiting antidepressant, it was often effective in alleviating depressions, including those refractory to single psychopharmacological agents.

Journal ArticleDOI
TL;DR: The major finding was a definite increase in mania, reflected in the daily ratings, during placebo periods within 24 hours of the withdrawal of lithium, even when the placebo period lasted only one day.
Abstract: A longitudinal double-blind study of two manic patients treated in a random fashion with lithium carbonate and placebo is reported. Daily ratings of mania were recorded independently by a trained psychiatric nursing team and by a psychiatrist. The major finding was a definite increase in mania, reflected in the daily ratings, during placebo periods within 24 hours of the withdrawal of lithium, even when the placebo period lasted only one day. The rapidity and predictability of the response to withdrawal of lithium offers important advantages both in the clinical use of this drug and in its use as a research tool.

Journal ArticleDOI
TL;DR: The authors conclude that the brief psychiatric interview in an emergency setting is most useful if goals are modest and all that is required is a decision about whether to hospitalize the individual.
Abstract: Determinants of the evaluation and disposition of psychiatric emergencies were studied at Detroit General Hospital. Although the decision to hospitalize an individual was based at least in part upon subjective factors influencing the emergency room resident, this initial decision to admit was generally well supported by later observations made about the patient on the ward. Other judgments made in the emergency room, such as diagnosis and prognosis, were not later validated. The authors conclude that the brief psychiatric interview in an emergency setting is most useful if goals are modest and all that is required is a decision about whether to hospitalize the individual.

Journal ArticleDOI
TL;DR: A number of performance tests proved insensitive to marihuana in the doses used and effects on complex reaction time and on digit code memory tasks were impaired, but there were marked individual differences.
Abstract: The study reported here, designed to extend knowledge of the behavioral toxicity of marihuana, illustrates some of the problems involved in measuring the effects of such drugs. A number of performance tests proved insensitive to marihuana in the doses used. Effects on complex reaction time and on digit code memory tasks were impaired, but there were marked individual differences.

Journal ArticleDOI
TL;DR: The authors conclude that neither treatment mode is uniformly superior; the choice should be made in each case on the basis of patient needs and available treatment facilities.
Abstract: The relative merits of bilateral and unilateral electroconvulsive therapy in the treatment of depressed patients were investigated in a double-blind clinical comparison. Although most patients who received the unilateral mode of treatment experienced significantly less immediate memory loss, they required an average of one more treatment and two additional days of hospitalization, as compared with the bilaterally treated group. In addition, a wide range of responses was evident among individuals within each treatment group. The authors conclude that neither treatment mode is uniformly superior; the choice should be made in each case on the basis of patient needs and available treatment facilities.

Journal ArticleDOI
TL;DR: In a longitudinal outpatient study, the authors found that lithium produced a mild decrease in depth of depression scores among patients who had been on the drug for more than seven months, as compared with patients whoHad been receiving lithium less thanSeven months.
Abstract: In a longitudinal outpatient study, the authors found that lithium produced a mild decrease in depth of depression scores among patients who had been on the drug for more than seven months, as compared with patients who had been receiving lithium less than seven months. They assess the factors contributing to reported positive clinical results of maintenance lithium treatment in recurrent affective disorder.

Journal ArticleDOI
TL;DR: Although DOM did not affect visual discrimination, it altered the perception of tachistoscopically presented TAT cards and enhanced performance on serial learning tasks.
Abstract: DOM, a hallucinogen related to mescaline and amphetamine and designated "STP" by hippies, along with DOET, the ethyl homologue of DOM, were given in small doses to normal subjects in a double-blind study. Both drugs increased self-awareness and produced mild euphoria but no hallucinogenic or psychotomimetic effects. The two drugs "freed up" subjects' word associations without impairing memory or concentration; in fact, DOM enhanced performance on serial learning tasks. Although DOM did not affect visual discrimination, it altered the perception of tachistoscopically presented TAT cards.

Journal ArticleDOI
TL;DR: The totality of urban life is the only rational focus for concern with mental illness, and the citizenry of the cities must determine what they want and how to achieve it.
Abstract: The totality of urban life is the only rational focus for concern with mental illness. No longer can we be concerned solely with treatment institutions; our problem now embraces all of society and we must examine every aspect of it to determine what is conducive to mental health. And just as the psychiatric patient must participate in his own treatment, the citizenry of the cities must determine what they want and how to achieve it.

Journal ArticleDOI
TL;DR: The basic principles in treatment of patients suspected of, or known to be, physically dependent on barbiturates, nonbarbiturate sedatives, and/or "minor tranquilizers" are stabilization on pentobarbital in daily amounts and frequency of dosage sufficient to completely suppress barbiturate-type abstinence phenomena and produce minimal signs ofBarbiturate intoxication.
Abstract: The basic principles in treatment of patients suspected of, or known to be, physically dependent on barbiturates, nonbarbiturate sedatives, and/or "minor tranquilizers" are: stabilization on pentobarbital in daily amounts and frequency of dosage sufficient to completely suppress barbiturate-type abstinence phenomena and produce minimal signs of barbiturate intoxication; and progressive reduction of pentobarbital dosage at the rate of not more than 100 mg. a day after three to five days of stabilization.

Journal ArticleDOI
TL;DR: Four individuals reported the recurrence, in a drug-free state, of unusual visual or somatic sensations previously experienced during marihuana reaction, and none had used other hallucinogens.
Abstract: Four individuals reported the recurrence, in a drug-free state, of unusual visual or somatic sensations previously experienced during marihuana reaction. None had used other hallucinogens. Two of the four were distressed by these recurrences. Such events should be distinguished from the recurrence of clinical psychopathology first experienced during marihuana reaction and from reports of nonspecific heightening of perception subsequent to marihuana use.

Journal ArticleDOI
TL;DR: The author proposes a basic model which involves two therapists, one representing each culture, together with additional consultation depending upon their degree of cultural "fit."
Abstract: One of the major obstacles in the development of mental health services in large areas of the non-Western world is the difficulty in making culture- and language-specific adaptations of Western scientific approaches. Individual psychotherapy is a powerful tool in the generation of such culture-specific concepts; it can be a highly useful technique for transcultural psychiatry. Toward this goal the author proposes a basic model which involves two therapists, one representing each culture, together with additional consultation depending upon their degree of cultural "fit."

Journal ArticleDOI
TL;DR: Many depressive syndromes are manifested initially in a masked fashion that belies their presence even though the masking process varies, depending upon such factors as the age of the patient, ethnics, and so on.
Abstract: Many depressive syndromes are manifested initially in a masked fashion that belies their presence even though the masking process varies, depending upon such factors as the age of the patient, ethn...

Journal ArticleDOI
TL;DR: The results in both sexually normal and deviant groups suggest that the drug is of value in reducing sexual drive and performance, with no undue side effects observed provided antiparkinsonian drugs are given.
Abstract: Various techniques have been tried in an endeavor to control deviant sexual drive. This paper presents the results obtained using a long-acting phenothiazine given intramuscularly and working on a depot basis, the theoretical advantages being a lesser incidence of gynecomastia than with estrogens, and the necessity for less patient cooperation than with oral medication. The results in both sexually normal and deviant groups suggest that the drug is of value in reducing sexual drive and performance, with no undue side effects observed provided antiparkinsonian drugs are given.

Journal ArticleDOI
TL;DR: This author concludes that depressive illness can be seen as disease in thesense that its manifestations are deviations from normal biological functions, and as reaction in the sense that it is a response to a crisis situation, resulting in a catastrophic lowering of self-esteem.
Abstract: The question posed by the title of this paper has been debated in the psychiatric literature both here and abroad for many years, as evidenced by such distinctions as endogenous vs. psychogenic or reactive, and psychotic vs. neurotic, forms of depression. This author concludes that depressive illness can be seen as disease in the sense that its manifestations are deviations from normal biological functions, and as reaction in the sense that it is a response to a crisis situation, resulting in a catastrophic lowering of self-esteem. But the therapeutic skill of the psychiatrist is best displayed when he understands the patient's depression as posture, the symptoms of which are forms of communication.

Journal ArticleDOI
TL;DR: Three groups of clinic children, separated by computer clustering of their symptoms, are described by the author, each likely to have an anxious infantilizing mother and socialized delinquents likely to come from large families characterized by parental neglect and delegation of parental responsibilities.
Abstract: Three groups of clinic children, separated by computer clustering of their symptoms, are described by the author. The overanxious children are likely to have an anxious infantilizing mother. The critical, depreciative, punitive, inconsistent mother or stepmother is typical for the unsocialized aggressive child. Socialized delinquents are likely to come from large families characterized by parental neglect and delegation of parental responsibilities. Their parental pathology is typically more paternal than maternal and frequently includes the alcoholic father or stepfather.