Showing papers in "American Journal of Psychiatry in 1977"
TL;DR: The authors suggest that the automatically activated forebrain synthesizes the dream by comparing information generated in specific brain stem circuits with information stored in memory.
Abstract: Recent research in the neurobiology of dreaming sleep provides new evidence for possible structural and functional substrates of formal aspects of the dream process. The data suggest that dreaming sleep is physiologically determined and shaped by a brain stem neuronal mechanism that can be modeled physiologically and mathematically. Formal features of the generator processes with strong implications for dream theory include periodicity and automaticity of forebrain activation, suggesting a preprogrammed neural basis for dream mentation in sleep; intense and sporadic activation of brain stem sensorimotor circuits including reticular, oculomotor, and vestibular neurons, possibly determining spatiotemporal aspects of dream imagery; and shifts in transmitter ratios, possibly accounting for dream amnesia. The authors suggest that the automatically activated forebrain synthesizes the dream by comparing information generated in specific brain stem circuits with information stored in memory.
860 citations
798 citations
TL;DR: The authors describe the various tests of competency to consent to treatment used today and analyze the applicability of these tests to patients' decisions to accept or refuse psychiatric treatment.
Abstract: The authors describe the various tests of competency to consent to treatment used today, which include the following: 1)evidencing a choice, 2)"reasonable" outcome of choice, 3)choice based on "rational" reasons, 4)ability to understand, and 5)actual understanding. They analyze the applicability of these tests to patients' decisions to accept or refuse psychiatric treatment and illustrate the problems of ap-lying these tests by citing clinical case examples. They find that the circumstances in which competency becomes an issue determine which elements of which tests are stressed and which are underplayed.
606 citations
TL;DR: The authors conclude that these findings provide evidence for a cyclothymic-bipolar spectrum.
Abstract: The authors identified 46 cyclothymic probands from a random pool of 500 psychiatric outpatients and prospectively followed them over a 2-3 year period. They used 50 bipolar patients with a definite history of mania and 50 patients with personality disorders as control groups. Although 66% of the cyclothymic outpatients had previously received the diagnosis of hysteria or sociopathy, their pedigrees were similar to those seen in classical bipolar manic-depressive illness; furthermore, 44% of the cyclothymic group experienced brief hypomanic episodes while taking tricyclic drugs, and 35% developed full-blown hypomanic, manic, or depressive episodes during drug-free follow-up. The authors conclude that these findings provide evidence for a cyclothymic-bipolar spectrum.
549 citations
TL;DR: The authors ranked accounts from 133 offenders and 92 victims for the dominant issue and found that the offenses could be categorized as power rape (sexuality used primarily to express power) or anger rape (use of sexuality to express anger).
Abstract: Accounts from both offenders and victims of what occurs during a rape suggest that issues of power, anger, and sexuality are important in understanding the rapist's behavior. All three issues seem to operate in every rape, but the proportion varies and one issue seems to dominate in each instance. The authors ranked accounts from 133 offenders and 92 victims for the dominant issue and found that the offenses could be categorized as power rape (sexuality used primarily to express power) or anger rape (use of sexuality to express anger). There were no rapes in which sex was the dominant issue; sexuality was always in the service of other, nonsexual needs.
319 citations
TL;DR: Teichman, H.Gilaie self-esteem, realization of life-purpose and level of anxiety in the Aged, I.Paspalanov Emotional Patterns In Stress Situations And Their relationship to somatic disease, K.Wrzesnieski an experimental analysis of sport related trait anxiety, D.Hackfort as mentioned in this paper.
Abstract: Personality factors in stress and anxiety, J.Brebner personal and interpersonal determinants of children's anxiety, Y.Teichman, H.Gilaie self-esteem, realization of life-purposes and level of anxiety in the Aged, I.Paspalanov Emotional Patterns In Stress Situations And Their relationship to somatic disease, K.Wrzesnieski an experimental analysis of sport related trait anxiety, D.Hackfort.
237 citations
TL;DR: The authors draw together the disparate scholarly and judicial commentaries on consent to medical treatment to develop a model of the components in the decision-making process regarding consent to or refusal of psychiatric treatment, which offers two models of valid consent.
Abstract: The authors draw together the disparate scholarly and judicial commentaries on consent to medical treatment to develop a model of the components in the decision-making process regarding consent to or refusal of psychiatric treatment. The components consist of the precondition of voluntariness, the provision of information, the patient's competency and understanding, and, finally, consent or refusal. They offer two models of valid consent: the objective model, which focuses on the congruence or lack of it between the patient and a "reasonable" person, and the subjective model, which focuses entirely on the patient's actual understanding.
226 citations
TL;DR: The authors suggest a need for more carefully controlled studies using blind data collection and clear operational definitions of "emotional disturbances", and the "risk" status of offspring of alcoholics should be compared to that of children whose parents have other types of serious psychiatric disturbance.
Abstract: In their review of the literature on the effects of parental alcoholism on the offspring of alcoholics, the authors focus on sample collection, criteria used for the diagnosis of parental alcoholism, and definitions of "emotional disturbances." Studies are grouped according to age of offspring; within each age group, the various approaches to the issue are described. The authors suggest a need for more carefully controlled studies using blind data collection and clear operational definitions. In addition, the "risk" status of offspring of alcoholics should be compared to that of children whose parents have other types of serious psychiatric disturbance. Although the literature has focused on the "casualties," the authors note that much could be learned from studies of the "successes"--those children who do not seem to be at increased risk for pychosocial illness despite the alcoholism of their parents. Language: en
222 citations
TL;DR: The authors compared several aspects of early sexual experience found in two earlier studies of prostitutes with results of research on "normal" women, finding that prostitutes had in common many negative experiences not found or found less often in other populations of young women.
Abstract: The authors compared several aspects of early sexual experience found in two earlier studies of prostitutes with results of research on "normal" women. The prostitutes had in common many negative experiences not found or found less often in other populations of young women. These include incestuous and/or coerced sex, lack parental guidance, intercouse at a young age, and few or no meaningful relationships with males. These women had discovered that sex could lead to a kind of status, even though that status is negatively labeled by the wider culture. In a society that values women on the basis of their sexuality, a woman who views herself as "debased" may see prostitution as a viable alternative--perhaps the only alternative.
215 citations
207 citations
TL;DR: The typical family constellation in this study of 14 cases of incest was that of a chronically depressed mother, an alcoholic and violent father or stepfather, and an eldest daughter who was forced to assume many of her mother's responsibilities, with ensuing role confusion.
Abstract: The typical family constellation in this study of 14 cases of incest was that of a chronically depressed mother, an alcoholic and violent father or stepfather, and an eldest daughter who was forced to assume many of her mother's responsibilities, with ensuing role confusion. The authors stress the need for physicians to be alert to the possibility of incest in such high-risk families.
TL;DR: The author discusses the theoretical, investigative, clinical, and teaching aspects of psychosomatic medicine in the seventies as well as major research and clinical developments in relation to key theoretical postulates and concepts.
Abstract: The author discusses the theoretical, investigative, clinical, and teaching aspects of psychosomatic medicine in the seventies. Major research and clinical developments are discussed in relation to key theoretical postulates and concepts. The rapidly expanding field of psychosomatic medicine is far more divant than ever before. Its hallmarks include a multifactorial approach to the study of health and disease, formulation of testable hypotheses and their careful validation, concern with the clinical applicability of research, and development of integrative theories. Current advances in the field have far-reaching inplications for medicine, psychiatry, and the behavioral sciences.
TL;DR: Findings provide at least a partial explanation for the increased susceptibility of the older patient to tricyclic antidepressant side effects and also provide a pharmacological rationale for use of lower dosages in this age group.
Abstract: Older depressed patients treated with imipramine or amitriptyline developed higher steady-state plasma levels of imipramine, desipramine, and amitriptyline. In imipramine-treated patients this finding was associated with a decreased rate of drug elimination from plasma. These findings provide at least a partial explanation for the increased susceptibility of the older patient to tricyclic antidepressant side effects and also provide a pharmacological rationale for use of lower dosages in this age group.
TL;DR: In the placebophenytoin-placebo sequence, not only did phenytoin reduce the number of binges from pretreatment levels, but there was no reversal of this effect during the placebo period, and this sequential effect was unexpected and is still unexplained.
Abstract: Nineteen subjects completed a 12-week double-blind crossover study comparing phenytoin with placebo in the treatment of severe binge eating. In the placebophenytoin sequence the number of binges decreased during phenytoin treatment from both placebo and pretreatment levels. However, in the phenytoin-placebo sequence, not only did phenytoin reduce the number of binges from pretreatment levels, but there was no reversal of this effect during the placebo period. This sequential effect was unexpected and is still unexplained. The mechanism of phenytoin action and the significance of EEG abnormalities found in 7 of the subjects remain uncertain.
TL;DR: The authors believe that group therapy is a valuable modality for the treatment of terminally ill patients and that much can be learned from such groups for the everyday therapy of the living.
Abstract: The authors describe their four-year experience with a therapy group for patients with metastatic carcinoma. Patients in the group are helped by helping one another, by moving out of a morbid self-absorption, and by finding that they have much of value to share and to teach. The most important aspect of the group experience is the "presence" it offers; patients find support and the opportunity to express their needs and fears openly. The authors believe that group therapy is a valuable modality for the treatment of terminally ill patients and that much can be learned from such groups for the everyday therapy of the living.
TL;DR: The treatment of schizophrenia has become so extensively drug oriented that a significant impediment has a,:isen to the exploration of alternati ve therapeutic approaches, and the situation has reversed from the 1950s.
Abstract: proaches to schizophrenia have been used for years ·f and have provided a rich source of information on phe:~ nomenology and treatment effects. However, in the ab;i, sence of rigorous research methodology this informa;~ tion base is often dismissed as anecdotal, and the influ:.; ;jJ ence of psychoanalysis and related psychological; approaches on the treatment of schizophrenic patients l: has waned. There are formidable intricacies involved;: in developing appropriate measures of change specifi-.;~ cally relevant to the aims of psychotherapy, and until '~ recently little attention has been paid to such assess: ment problems (4-8). Thus. for example. it is possible) to demonstrate that drugs are more effective than psyJ chotherapy in reducing a paranoid patient's belligj erency. but there is no way to assess the effectiveness~:1 of either mode of treatment on this palient's capacity~ for inti acy.i Pharmacological treatment of schizophrenia is ex-}; traordinarily important in psychiatry. We bel ieve, how-! ever, that the treatment of schizophrenia has become ~ so extensively drug oriented that a significant impediment has a,:isen to the exploration of alternati ve therapeutic approaches. The situation has reversed from;l~ the 1950s, when a commitment to psychological treat-'~ ment philosophies posed a serious resistance to phart macological innovations. Klein (9) has noted that the A automatic and immediate administration of neurolep-' tics to disturbed patients often precedes and precludes even a diagnostic evaluation. This widespread and premature foreclosure on the optimal treatment of schizophrenia is reflected by the fact that millions of people take neuroleptics as the only important component of their treatment. \
TL;DR: It is conceivable, the author concludes, that these compounds could enhance the antipsychotic activity of dopamine receptor blockers, which could lead to the use of lower doses and therefore fewer extrapyramidal side effects.
Abstract: gamma-Aminobutyric acid (Gaba) has been shown to influence dopamine activity in the brain The author suggests that Gaba could be involved in the hypothesized dopamine hyperactivity in schizophrenia He discusses pharmacological interventions that may raise Gaba-mediated function in the brain and states that further development of Gaba analogues seems clearly indicated It is conceivable, he concludes, that these compounds could enhance the antipsychotic activity of dopamine receptor blockers, which could lead to the use of lower doses and therefore fewer extrapyramidal side effects
TL;DR: The authors studied the hospital records of 400 hospitalized mentally ill patients for evidence of violent behavior leading to admission and found that 36% of 321 admissions were preceded by some form of violent, fear-inspiring behavior.
Abstract: The authors studied the hospital records of 400 hospitalized mentally ill patients for evidence of violent behavior leading to admission. They found that 36% of 321 admissions (excluding patients diagnosed as having a personality disorder or as drug-and/or alcohol-dependent) were preceded by some form of violent, fear-inspiring behavior. They suggest that mental health professionals deal with the general public's fear of the mentally ill on the basis of such findings rather than dismiss it as illogical. Language: en
TL;DR: Depression is most closely related to the social stressors of marriage and parenting, and symptoms increase proportionately to the total number of stress areas, suggesting that a focus on intervention and prevention in areas of family and marital life is desirable.
Abstract: The author explores the relationship of current social stressors (cirumstances of daily social roles that are generally considered problematic or undesirable) to depressive symptoms. Subjects were 2,299 adults aged 18-65 in the Chicago area. Over a fourth of the variance in depressive symptoms is accounted for by five social stressors. Depression is most closely related to the social stressors of marriage and parenting, and symptoms increase proportionately to the total number of stress areas. These data suggest that a focus on intervention and prevention in areas of family and marital life is desirable.
TL;DR: Revisions are needed in the neurobiologically derived psychoanalytic concepts, especially those of Freud's wish fulfillment-disguise theory of dreams, especially the areas in which many of his neurobiological assumptions are inacurrate.
Abstract: Freud built his model of the mind and his hypotheses about dreaming directly on the structure of his neurobiological model of the brain, which was developed in the "Project for a Scientific Psychology", written in 1895. Among the concepts modeled in this work were ego, somatic drives as motivationally critical, cathexes of psychic energy, wish fulfillment, and primary and secondary process. From the vantage point of more than 80 years later, the authors indicate the areas in which many of Freud's neurobiological assumptions are inacurrate. Revisions are needed in the neurobiologically derived psychoanalytic concepts, especially those of Freud's wish fulfillment-disguise theory of dreams.
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TL;DR: The author reviews several studies that clarify the nature of the memory loss associated with ECT and concludes that right unilateral ECT seems preferable to bilateral ECT because the risks to memory associated withilateral ECT are smaller.
Abstract: The author reviews several studies that clarify the nature of the memory loss associated with ECT. Bilateral ECT produced greater anterograde memory loss than right unilateral ECT and more extensive retrograde amnesia than unilateral ECT. Reactivating memories just before ECT did not produce amnesia. Capacity for new learning recovered substantially by several months after ECT, but memory complaints were common in individuals who had received bilateral ECT. Other things being equal, right unilateral ECT seems preferable to bilateral ECT because the risks to memory associated with unilateral ECT are smaller.
TL;DR: An extensive pharmacological analysis of a patient severely affected by tardive dyskinesia found that no drug treatment gave lasting clinical improvement and a paradoxical and unexpected improvement was observed with apomorphine injections and with low-dosage oral L-dopa.
Abstract: The authors conducted an extensive pharmacological analysis of a patient severely affected by tardive dyskinesia. No drug treatment gave lasting clinical improvement. Several agents recently recommended for this condition, dimethyl aminoethanol, clozapine, and thioridazine, failed to modify the dyskinesia. Reserpine caused a worsening of the symptoms. A paradoxical and unexpected improvement was observed with apomorphine injections and with low-dosage oral L-dopa. These two drugs may have acted by stimulating presynaptic inhibitory dopamine receptors.
TL;DR: The authors present two representative case histories and suggest that study of more patients with dysmorphophobia is needed to determine whether it is a symptom of an underlying disease or is itself a separate disease entity.
Abstract: Although dysmorphophobia, a subjective feeling of ugliness in a person of normal appearance, constitutes a distinctive symptom cluster occasionally seen in patients requesting cosmetic surgery, it is not included in current major psychiatric diagnostic systems. Patients with dysmorphophobia are usually young and perfectionistic and have both schizoid and narcissistic traits. The authors present two representative case histories and suggest that study of more patients with dysmorphophobia is needed to determine whether it is a symptom of an underlying disease or is itself a separate disease entity.
TL;DR: In the unipolar group, the TSH response showed a significant negative correlation with the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF, suggesting neuroendocrine responses may constitute markers of specific monoamine dysfunction in subgroups of patients with affective illness.
Abstract: The authors studied pituitary thyrotropin, i.e., thyroid-stimulating hormone (TSH), response to thyrotropin-releasing hormone (TRH) in patients with primary affective disorder. There were no overall differences between either depressed or manic patients and normal controls; however, the TSH response was significantly lower in the unipolar depressed patients than in either bipolar depressed patients or normal subjects. Bipolar patients in the manic phase tended to have a lower response than bipolar depressed patients. In the unipolar group, the TSH response showed a significant negative correlation with the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF. These neuroendocrine responses may constitute markers of specific monoamine dysfunction in subgroups of patients with affective illness.
TL;DR: It is suggested that patients are more likely to be rehospitalized because of their psychopathology than because of family burden, and that the standard group families were judged to have a higher overall level of burden than the brief-day families.
Abstract: The author present two-year follow-up data of a controlled study of 175 newly admitted inpatients who lived with families, comparing the relative efficacy of brief hospitalization (with and without transitional day care) and standard hospitalization (with all patients offered outpatient aftercare). The long-term results confirm the preliminary finding that brief hospitalization is preferable to longer term hospitalization for most patients. Briefly hospitalized patients spent significantly less time as inpatients and showed less psychopathology and impairment in role functioning. In contrast to preliminary findings, the long-term results indicate that use of day care reduced the number of inpatient days.
TL;DR: Postsynaptic dopamine receptor sensitivity in schizophrenic patients is examined by means of a neuroendocrine strategy using the DA receptor agonist apomorphine and growth hormone release as the measurable postsynaptic event.
Abstract: In the context ofthe dopamine hypothesis of schizophrenia , the authors examined postsynaptic dopamine (DA) receptor sensitivity in schizophrenic patients by means ofa neuroendocrine strategy using the DA receptor agonist apomorphine and growth hormone (GH) release as the measurable postsynaptic event. The activity ofplatelet adenylate cyclase, an enzyme intimate/v associated with catecholamine receptor activity , was also studied following stimulation by prostaglandin E1 (PGEI). Patients diagnosed as having acute schizophrenia had significant/v higher GH responses and adenylate cyclase activity than normal control subjects and patients diagnosed as having chronic schizophrenia. Chronic schizophrenic patients with and without tardive dyskinesia showed GH responses slightly lower than but not significant/v differentfrom those of