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Showing papers in "American Journal of Psychiatry in 1976"


Journal Article•DOI•

2,433 citations



Journal Article•DOI•
TL;DR: The authors compared the sleep laboratory recordings of 122 drug-free subjects who complained of chronic insomnia with the subjects' estimates of their habitual sleep characteristics and their estimated sleep time on the morning after sleeping in the laboratory, finding that most subjects consistently underestimated the amount of time they slept and overestimated the time it took them to get to sleep.
Abstract: The authors compared the sleep laboratory recordings of 122 drug-free subjects who complained of chronic insomnia with the subjects' estimates of their habitual sleep characteristics and their estimated sleep time on the morning after sleeping in the laboratory. Most subjects consistently underestimated the amount of time they slept and overestimated the amount of time it took them to get to sleep in comparison with laboratory data. All subjects consistently underestimated the number of arousals they experienced. The authors discuss the implications of these findings for the treatment and definition of insomnia and for further research.

534 citations


Journal Article•DOI•
TL;DR: The author suggests that biochemical labeling of the dopamine receptor with 3H-dopamine and3H-haloperidol may clarify mechanisms of drug effects on the dopamine receptors.
Abstract: Alleviation of schizophrenic symptoms by phenothiazines and butyrophenones is associated with blockade of dopamine receptors, while exacerbation of symptoms by amphetamines appears to result from enhanced synaptic activity of dopamine and/or norepinephrine. The author suggests that biochemical labeling of the dopamine receptor with 3H-dopamine and 3H-haloperidol may clarify mechanisms of drug effects on the dopamine receptor.

520 citations


Journal Article•DOI•
TL;DR: Interestingly, medical nemesis the expropriation of health that you really wait for now is coming, so it's significant to wait for the representative and beneficial books to read.
Abstract: Interestingly, medical nemesis the expropriation of health that you really wait for now is coming. It's significant to wait for the representative and beneficial books to read. Every book that is provided in better way and utterance will be expected by many peoples. Even you are a good reader or not, feeling to read this book will always appear when you find it. But, when you feel hard to find it as yours, what to do? Borrow to your friends and don't know when to give back it to her or him.

440 citations


Journal Article•DOI•

338 citations


Journal Article•DOI•
TL;DR: It is suggested that lithium can have a clinically useful effect upon impulsive aggressive behavior when this behavior is not associated with psychosis.
Abstract: The authors conducted a double-blind, placebo-controlled study of the effect of lithium on aggressive behavior The 66 subjects, who were prisoners in a medium security institution, ranged in age from 16 to 24 years, were physically healthy and nonpsychotic, and had histories of chronic impulsive aggressive behavior Subjects received lithium or placebo daily for up to 3 months There was a significant reduction in aggressive behavior in the lithium group as measured by a decrease in infractions involving violence The authors suggest that lithium can have a clinically useful effect upon impulsive aggressive behavior when this behavior is not associated with psychosis

314 citations


Journal Article•DOI•
TL;DR: A kindling model for psychological stimuli that combines neurophysiological, biochemical, and psychological perspectives is suggested and reviewed, supporting a pharmacological kindling mechansim.
Abstract: The authors review the evidence that repetitive administration of central nervous system stimulants and other compounds may be associated with progressively increasing effects on pathological behavior and seizures rather than tolerance. They suggest that the progressive effects of these compounds may be related to electrical kindling, a phenomenon in which repetitive subthreshold stimulation of the limbic system is eventually associated with major motor seizures. They review the studies supporting a pharmacological kindling mechansim and suggest a kindling model for psychological stimuli that combines neurophysiological, biochemical, and psychological perspectives.

274 citations



Journal Article•DOI•
TL;DR: The author presents a model of anger arousal that emphasizes the adaptive as well as the maladaptive roles of anger in terms of the diverse functions anger serves in affecting behavior.
Abstract: Anger is paradoxically one of the most talked about but least studied of human emotions The author presents a model of anger arousal that emphasizes the adaptive as well as the maladaptive roles of anger in terms of the diverse functions anger serves in affecting behavior In light of the fact that competence in anger management involves dealing with stress situations that require patience, composure, and constructive thought for their resolution, he discusses cognitive self-control processes affecting the regulation of anger

219 citations


Journal Article•DOI•
TL;DR: It is concluded that autism is a behaviorally defined, specific syndrome that is manifested at birth or shortly thereafter and its symptoms are expressive of an underlying neuropathophysiological process that affects developmental rate; modulation of perception; language, cognitive, and intellectual development.
Abstract: The authors review the clinical features and behavioral characteristics of autism; differential diagnosis of the syndrome; clinical, neurophysiological, and biochemical research; and its medical management and treatment. They conclude that autism is a behaviorally defined, specific syndrome that is manifested at birth or shortly thereafter. Its symptoms are expressive of an underlying neuropathophysiological process that affects developmental rate; modulation of perception; language, cognitive, and intellectual development; and the ability to relate. The long-term prognosis is guarded; almost all patients manifest severe symptomatology throughout their lives. Further basic research into the neuropathophysiological process underlying the syndrome is necessary in order to reach the ultimate goal of developing etiologically specific treatment programs.

Journal Article•DOI•
TL;DR: This paper found that the methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.
Abstract: Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.

Journal Article•DOI•
TL;DR: The author focuses on children under 12, describing their responses to fantasy-eliciting techniques and their observed behavior after the flood compared with developmental norms for their age and reports of their previous behavior.
Abstract: Most of the 224 children who were survivor-plaintiffs of the Buffalo Creek disaster were emotionally impaired by their experiences. The major factors contributing to this impairment were the child's developmental level at the time of the flood, his perceptions of the reactions of his family, and his direct exposures to the disaster. The author focuses on children under 12, describing their responses to fantasy-eliciting techniques and their observed behavior after the flood compared with developmental norms for their age and reports of their previous behavior. These children share a modified sense of reality, increased vulnerability to future stresses, altered senses of the power of the self, and early awareness of fragmentation and death. These factors could lead to "after-trauma" in later life if they cannot make the necessary adaptations and/or do not receive special help to deal with the traumas.

Journal Article•DOI•
TL;DR: The authors studied the arrest rates of 867 patients from the Bellevue catchment area who were discharged from the psychiatric division of Bellevue Hospital and found that the Arrest rates of these patients for two years preceding and two years following their admissions to the study were higher.
Abstract: The authors studied the arrest rates of 867 patients from the Bellevue catchment area who were discharged from the psychiatric division of Bellevue Hospital. They found that the arrest rates of these patients for two years preceding and two years following their admissions to the study were higher than the arrest rates for the general population of the Bellevue catchment area as well as those for 4,601 cities in the United States. They discuss the implications of this finding for the post discharge care of mental patients, particularly in the light of current discharge policies.

Journal Article•DOI•
TL;DR: The author concludes that the growing realization that maintenance treatment is necessary to prevent recurrences of both mania and depression in bipolar disease and Depression in unipolar disease is one of the most important advances in psychiatric therapeutics.
Abstract: In the first part of this overview the author reviewed the clinical literature on prophylactic treatment of schizophrenia with maintenance antipsychotic drugs. In this second part he reviews the literature on maintenance treatment of affective disorders with lithium and tricyclics. He concludes that the growing realization that maintenance treatment is necessary to prevent recurrences of both mania and depression in bipolar disease and depression in unipolar disease is one of the most important advances in psychiatric therapeutics. The effectiveness of maintenance treatment provides the potential for a truly preventive approach to the treatment of affective disorders.

Journal Article•DOI•
TL;DR: The authors analyzed the reported coping behavior of 92 women diagnosed as having rape trauma, finding that most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed.
Abstract: The coping behavior of rape victims can be analyzed in three distinct phases--the threat of attack, the attack itself, and the period immediately thereafter The authors analyzed the reported coping behavior of 92 women diagnosed as having rape trauma Most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed The actual rape prompted coping behaviors in all but 1 victim Escaping the situation or the assailant is the primary task immediately after the attack In counseling the rape victim, it is important to understand her individual style of coping, to be supportive of it, and to suggest alternatives for future stressful situations

Journal Article•DOI•
TL;DR: The authors found a 60% incidence of difficulties in sexual functioning in 57 male patients who had taken thioridazine;jaculatory problems were the most frequent dysfunction; a third of these patients experienced retrograde ejaculation.
Abstract: The authors found a 60% incidence of difficulties in sexual functioning in 57 male patients who had taken thioridazine. Ejaculatory problems were the most frequent dysfunction; a third of these patients experienced retrograde ejaculation. The incidence of sexual difficulties in 64 patients who had taken other major tranquilizers was only 25%. None of the latter group experienced retrograde ejaculation-most had difficulty achieving and maintaining erection. The authors recommend consideration of the possibility of sexual dysfunction in patients given thioridazine.

Journal Article•DOI•
Kai T. Erikson1•
TL;DR: The survivors of the Buffalo Creek disaster suffered both individual and collective trauma, the latter being reflected in their loss of communality as discussed by the authors, and these parts are now having great difficulty finding the personal resources to replace the energy and direction they had once found in their community.
Abstract: The survivors of the Buffalo Creek disaster suffered both individual and collective trauma, the latter being reflected in their loss of communality. Human relationships in this community had been derived from traditional bonds of kinship and neighborliness. When forced to give up these long-standing ties with familiar places and people, the survivors experienced demoralization, disorientation, and loss of connection. Stripped of the support they had received from their community, they became apathetic and seemed to have forgotten how to care for one another. This was apparently a community that was stronger than the sum of its parts, and these parts--the survivors of the Buffalo Creek flood--are now having great difficulty finding the personal resources to replace the energy and direction they had once found in their community. Language: en

Journal Article•DOI•
TL;DR: Melatonin exacerbated symptoms of dysphoria in patients with Huntington's chorea and increased cerebrospinal fluid 5-hydroxyindoleacetic acid and calcium in three of four patients studied, and the authors discuss the implications of this finding.
Abstract: In order to test the efficacy of the pineal neurohumor melatonin on depression, the hormone was administered in varying doses to six moderately to severely depressed patients and two patients with Huntington's chorea in double-blind crossover study. Melatonin exacerbated symptoms of dysphoria in these patients, as well as causing a loss of sleep and weight and a drop in oral temperature. Melatonin increased cerebrospinal fluid 5-hydroxyindoleacetic acid and calcium in three of four patients studied. The authors discuss the implications of this finding.

Journal Article•DOI•
TL;DR: There is convincing, although not conclusive, evidence for an antidepressant effect of lithium and that only by identifying the subgroup of patients for whom it is effective can the continuing uncertainty surrounding lithium's role in affective disorder be resolved.
Abstract: The author reviews the studies of lithium as an antidepressant, evaluates the evidence that there might be specific subgroup of patients for whom it is effective, and reports a study he and his associates conducted that found lithium to be effective for 13 of 21 depressed patients. He concludes that there is convincing, although not conclusive, evidence for an antidepressant effect of lithium and that only by identifying the subgroup of patients for whom it is effective can the continuing uncertainty surrounding lithium's role in affective disorder be resolved. He also calls for a reevaluation of the relationship between mania and depression.

Journal Article•DOI•
TL;DR: Psychiatrists were most often assaulted in the early stages of their career or while they were working in high-risk settings such as prisons or emergency rooms, and it is recommended that clinicians learn techniques for managing potentially assaultive patients.
Abstract: The authors describe the results of a survey of 115 psychiatrists regarding assaults by patients. Forty-eight psychiatrists stated that they had been assaulted; a total of 68 assaults was reported. Psychiatrists were most often assaulted in the early stages of their career or while they were working in high-risk settings such as prisons or emergency rooms. Many reported retrospectively that they might have had a role in provoking the assault and that they could have anticipated it. The authors believe that psychiatrists avoid dealing with the issue of violence by patients for a variety of reasons, and they recommend that clinicians learn techniques for managing potentially assaultive patients.

Journal Article•DOI•
TL;DR: Observations suggest that dopaminergic mechanisms may be involved in the mediation of manic episodes in at least some patients.
Abstract: The authors present a case study that explores the relationship of dopamine function and manic illness through the use of two drugs with relatively specific effects in stimulating and blocking dopamine receptors--piribedil (ET--495) and pimozide, respectively. Piribedil, as well as d-amphetamine, was associated with manic episodes, while pimozide had an antimanic effect. These observations suggest that dopaminergic mechanisms may be involved in the mediation of manic episodes in at least some patients.

Journal Article•DOI•
TL;DR: The authors attempted to assess the extent to which bipolar patients are misdiagnosed as unipolar by evaluating the development of mania in patients who had recognized bipolar illness and by means of follow-up data on Patients who had recurrent depressions.
Abstract: The authors attempted to assess the extent to which bipolar patients are misdiagnosed as unipolar by evaluating the development of mania in patients who had recognized bipolar illness and by means of follow-up data on patients who had recurrent depressions. Mania occurred early in the course of bipolar illness: almost 80% of the bipolar patients were initially hospitalized for mania. Follow-up data and theoretically based calculations suggest that the chance of a patient with recurrent depressions becoming bipolar is about 5%. Based on these findings, the authors make suggestions for the classification of unipolar patients.

Journal Article•DOI•
TL;DR: The authors urge clinicians to evaluate each patient on maintenance antipsychotic therapy in terms of feasibility of drug withdrawal and offer practical guidelines for withdrawal and subsequent management.
Abstract: The serious long-term complications of maintenance antipsychotic therapy led the authors to undertake a critical review of outpatient withdrawal studies. Key findings included the following: 1) for a least 40% of outpatient schizophrenics, drugs seem to be essential for survival in the community; 2) the majority of patients who relapse after drug withdrawal recompensate fairly rapidly upon reinstitution of antipsychotic drug therapy; 3) placebo survivors seem to function as well as drug survivors--thus the benefit of maintenance drug therapy appears to be prevention of relapse; and 4) some cases of early relapse after drug withdrawal may be due to dyskinesia rather than psychotic decompensation. The authors urge clinicians to evaluate each patient on maintenance antipsychotic therapy in terms of feasibility of drug withdrawal and offer practical guidelines for withdrawal and subsequent management.

Journal Article•DOI•
TL;DR: In counseling, the victim's previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.
Abstract: Rape challenges a woman's ability to maintain her defenses and thus arouses feelings of guilt, anxiety, and inadequacy. Women's individual responses are determined by life stage considerations as well as their defensive structures: concerns about separation-individuation may be aroused in the young woman; a divorced or separated woman may find her credibility questioned; older women's fears of sexual inadequacy may be compounded. In counseling, the victim's previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.

Journal Article•DOI•
TL;DR: The authors believe that lithium prophylaxis of depression has been demonstrated in these three subtypes but note the need for further research particularly in the use of tricyclic antidepressants.
Abstract: The authors investigated lithium prophylaxis of depression in bipolar I (N=35), bipolar II (N=18), and unipolar I (N=28) outpatients. Depression indices included frequency of depressive episodes, three measures of severity, dropouts due to depression, and time in study. There were significantly fewer episodes and dropouts due to depression in the lithium-treated than in the placebo-treated bipolar I patients. Lithium was superior to placebo on all indices in the bipolar II group (although the sample size did not permit statistical analysis) and on 3 indices in the unipolar group. The authors believe that lithium prophylaxis of depression has been demonstrated in these three subtypes but note the need for further research particularly in the use of tricyclic antidepressants.

Journal Article•DOI•
TL;DR: The authors found that although the sedative characteristics of amitriptyline did not differentiate good responders from poor responders until the third week of drug treatment, the good responders showed significant increases in REM latency, decreases in REM sleep time, decreasesIn REM sleep percent, and decreases inREM activity after only 2 nights of drug Treatment.
Abstract: The authors conducted a study of 18 depressed patients to see whether EEG sleep measurements might provide a predictive tool for response to antidepressant medication. They found that although the sedative characteristics of amitriptyline did not differentiate good responders from poor responders until the third week of drug treatment, the good responders showed significant increases in REM latency, decreases in REM sleep time, decreases in REM sleep percent, and decreases in REM activity after only 2 nights of drug treatment.

Journal Article•DOI•
TL;DR: In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression.
Abstract: In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression. The depressive symptoms were associated with a decrease in social functioning, increase in stress in the past 6 months, and a history of alcohol abuse. Because the combination of depression and drug addiction creates a high risk for suicide, depressive symptoms require early detection and treatment. The authors point to the need for more research on treatment approaches, particularly the use of psychotropic drugs. Language: en

Journal Article•DOI•
TL;DR: Those patients who failed to attain CPZ levels of more than 70 ng/ml despite doses of 400-1000 mg/day were receiving lithium throughout the study and had discharge diagnoses of manic-depressive psychosis, manic type, and schizo-affective schizophrenia--a finding with implications for future research.
Abstract: Plasma chlorpromazine (CPZ) levels of 50 psychotic inpatients were measured by gas liquid chromatography; the clinical progress of 29 of these patients with acute psychoses was also assessed. CPZ levels of 50-300 ng/ml were usually associated with clinical improvement; there was also a relationship between CPZ levels and increases in certain symptoms. The 50-300 ng/ml level was best attained by doses of 400-800 mg/day. Trihexyphenidyl decreased plasma CPZ by a mean of 44.7% in 12 of 15 patients. A single 400-800-mg dose of CPZ at bedtime produced steady states equal to or better than those achieved with multiple doses. Those patients who failed to attain CPZ levels of more than 70 ng/ml despite doses of 400-1000 mg/day were receiving lithium throughout the study and had discharge diagnoses of manic-depressive psychosis, manic type, and schizo-affective schizophrenia--a finding with implications for future research.

Journal Article•DOI•
TL;DR: The findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.
Abstract: Postpsychotic depression is an important clinical phenomenon about which little is known. Using data from a cohort of 30 schizophrenic patients, the authors examine the frequency of the syndrome, predictive variables, and its prognostic implications. Their findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.