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Showing papers in "American Journal of Psychiatry in 1978"


Journal ArticleDOI

624 citations



Journal ArticleDOI
TL;DR: Although a primary disturbance in dopamine function in schizophrenia cannot be ruled out, the intimate relationship between dopaminergic and other neuronal systems must be emphasized and the possible involvement of other amine, amino acid, or peptide transmitters in schizophreniaannot be disregarded.
Abstract: Inhibition of central dopamine functions appears to be a common basic property of antipsychotic drugs. The mesolimbic and nigrostriatal portions of the dopaminergic system are probably the main targets for the mental and the extrapyramidal actions, respectively, of these drugs. The fact that dopaminergic hyperfunction induced by amphetamines or dopa may lead to a disturbance mimicking paranoid schizophrenia lends further support for a key role of dopamine in mental functions. Although a primary disturbance in dopamine function in schizophrenia cannot be ruled out, the intimate relationship between dopaminergic and other neuronal systems must be emphasized. The possible involvement of other amine, amino acid, or peptide transmitters in schizophrenia cannot be disregarded.

478 citations


Journal ArticleDOI
TL;DR: The clinical finding of prolonged psychotic reactions, together with previous reports of the effects of phencyclidine, suggests that phenycyclidine provides an intriguing drug model for schizophrenia.
Abstract: During a 13-month period, 9 patients with phencyclidine-induced psychosis were admitted to Darnall Army Hospital. They exhibited hostility agitation, and tangentiality and had delusions of influence and religious grandiosity. Six subjects reported auditory hallucinations, and 4 were disoriented in at least 1 sphere. Despite treatment with antipsychotic medication, the psychotic episodes often persisted for more than 30 days. Our clinical finding of prolonged psychotic reactions, together with previous reports of the effects of phencyclidine, suggests that phenycyclidine provides an intriguing drug model for schizophrenia.

449 citations


Journal ArticleDOI
TL;DR: The authors discuss the treatment implications of the cognitive approach to depression and suggest that long-term identifiable psychological patterns that influence attitude and behavioral responses may constitute a cognitive dimension of the depression-prone individual's personality.
Abstract: According to the cognitive view, the individual's negative and distorted thinking is the basic psychological problem in the depressive syndrome The distorted cognitions are supported by maladaptive cognitive schemata, which involve immature "either-or" rules of conduct or inflexible and unattainable self-expectations These schemata are probably acquired early in development and, if uncritically carried into adulthood, serve to predispose the individual to depression Since these schemata are long-term identifiable psychological patterns that influence attitude and behavioral responses, they may constitute a cognitive dimension of the depression-prone individual's personality The authors discuss the treatment implications of the cognitive approach to depression

420 citations


Journal ArticleDOI
TL;DR: The data indicate that the nodal points in the process are the involvement of partners in the decision-making process, the frequency of hospital visits, resumption of the sexual relationship, and the man looking at his partners hod�' after surgen'.
Abstract: The authors administered a questionnaire to 41 women who had had mastectomies to investigate aspects of the procedure itself, pre- and postmastectomy adjustment, effects on sexual relationships, and the influence of age. Although most women reported good overall adjustment, there were strong indications of psychological suffering (suicidal ideation, increased use of alcohol and tranquilizers, etc.). Psychological intervention may be called for in many cases, and age, support systems, and premorbid functioning may be indicators of the amount and type of intervention needed. Counseling is particularly important before surgery, since this was viewed as the period of maximum stress by most women. Further research with larger, more random samples and postsurgical control groups is indicated to determine more precisely the factors related to adjustment to mastectomy.

372 citations



Journal ArticleDOI
TL;DR: The hypothesis that chronic dopaminergic agonism may, via such a kindling mechanism, play a role in the development of some types of psychoses is supported.
Abstract: Of 88 patients with idiopathic Parkinson's disease, without prior psychotic symptoms, and without significant dementia, nearly half had experienced vivid dreams, hallucinations, illusions, and nonconfusional as well as confusional psychoses as side effects of chronic levodopa therapy within the previous year of treatment. It was found that 61.3% of all hallucinations were associated with preexistent or concurrent vivid dream phenomena, that all psychotic states were associated with preexistent or concurrent vivid dreams and/or hallucinations, and that nonconfusional psychotic states tended to become confusional. These findings raise the possibility that chronic levodopa therapy may result in dopaminergic kindling and support the hypothesis that chronic dopaminergic agonism may, via such a kindling mechanism, play a role in the development of some types of psychoses.

307 citations


Journal ArticleDOI
TL;DR: Borderline patients can be discriminated with high accuracy from matched comparison groups with whom diagnostic confusion is common, and Seven criteria provided a clinically sensible and practical means of approaching the diagnosis of borderline disorder.
Abstract: Borderline patients were compared with schizophrenic patients, neurotic depressed patients, and a group of patients with differing diagnoses. The purpose of this comparison was to find out whether borderline patients could be discriminated from other psychopathological groups and whether a discrete list of recognizable characteristics discriminating borderline patients could be isolated. According to the results of the comparison, borderline patients can be discriminated with high accuracy from matched comparison groups with whom diagnostic confusion is common. Seven criteria provided a clinically sensible and practical means of approaching the diagnosis of borderline disorder.

295 citations


Journal ArticleDOI
TL;DR: 37 children who are being raised by female homosexuals or by parents who have changed sex (transsexuals) report or recall childhood toy, game, clothing, and peer group preferences that are typical for their sex.
Abstract: The author reports on 37 children who are being raised by female homosexuals or by parents who have changed sex (transsexuals): 21 by female homosexuals, 7 by male-to-female transsexuals, and 9 by female-to-male transsexuals. The children range in age from 3 to 20 years (mean = 9.3) and have lived in the sexually atypical households for 1-16 years (mean = 4.9). Thirty-six of the children report or recall childhood toy, game, clothing, and peer group preferences that are typical for their sex. The 13 older children who report erotic fantasies or overt sexual behaviors are all heterosexually oriented.

294 citations


Journal ArticleDOI
TL;DR: It is concluded that schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding consisting of the sequential appearance of hierarchically ordered, distinguishable, and recognizable psychological states.
Abstract: On the basis of a review of the literature describing the process of schizophrenic illness, the authors conclude that schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding consisting of the sequential appearance of hierarchically ordered, distinguishable, and recognizable psychological states. They present on illustrative case history of a patient who was able to describe her feelings during the process of decompensation to schizophrenic psychosis and two case histories of patients whose decompensations were rated according to the authors' State of Illness Rating Scale.

Journal ArticleDOI
TL;DR: A brief rating scale for emotional blunting is described that is highly reliable, predicts short-term treatment response, and discriminates between patients with affective disorder and schizophrenia.
Abstract: Although emotional blunting has always been considered a core symptom of schizophrenia, it has been excluded from recently developed sets of diagnostic criteria because of its alleged unreliability The authors describe a brief rating scale for emotional blunting that is highly reliable, predicts short-term treatment response, and discriminates between patients with affective disorder and schizophrenia They suggest that this scale will permit restoration of the important criterion of emotional blunting to modern diagnostic systems, including that proposed for DSM-III



Journal ArticleDOI
TL;DR: REM activity and intermittent nocturnal awakening accurately discriminated two subtypes of patients with secondary depression at a level of 81%, suggesting that EEG sleep measurements can yield significant data to aid in differential diagnosis in psychiatry.
Abstract: On the basis of two EEG sleep criteria, REM latency and REM activity, the authors achieved 81% accuracy in distinguishing between 47 patients with primary depression and 48 patients with secondary depression using discriminant analysis. Sleep efficiency, the percentage of delta sleep, and the percentage of REM sleep discriminated between psychotic and nonpsychotic subgroups in the group with primary depression with 75% accuracy. REM activity and intermittent nocturnal awakening accurately discriminated two subtypes of patients with secondary depression at a level of 81%. These results suggest that EEG sleep measurements can yield significant data to aid in differential diagnosis in psychiatry.

Journal ArticleDOI
TL;DR: Arrest rates among the two recent samples of psychiatric patients released from psychiatric centers were considerably higher than general population rates, primarily because of the large proportion of patients previously arrested.
Abstract: The arrest rates of nearly 2,000 psychiatric patients released from psychiatric centers in 1968 and those of nearly 2,000 patients released in 1975 were compared with the arrest rates of a group of 5,000 patients studied 25 years earlier. In general, arrest rates among the two recent samples were considerably higher than general population rates, primarily because of the large proportion of patients previously arrested. Other characteristics related to subsequent arrest were age and admitting diagnosis. One additional finding was that the number of patients with prior arrests had increased markedly over the years. Language: en

Journal ArticleDOI
TL;DR: Self-destructive behavior, including suicide attempts and self-mutilation, was potentiated by interrelated variables operating in the abused child and his environment.
Abstract: Fifty-nine physically abused children demonstrated a significantly higher incidence of self-destructive behavior than two control groups of nonabused children, one neglected and one normal. The self-destructive behavior, including suicide attempts and self-mutilation, was potentiated by interrelated variables operating in the abused child and his environment. Often enhanced by the ego deficits and impaired impulse control of the abused children, this behavior seemed to represent a learned pattern originating in early traumatic experiences with hostile primary objects. VioLit summary: OBJECTIVE: The purpose of this study by Green was to test the hypothesis that a child's experience of repeated physical abuse potentiates his or her development of self-destructive behavior. METHODOLOGY: An quasi-experimental design was employed. The study included an experimental group of 60 abused children and control groups of 30 "neglected" and 30 "normal" children who were not maltreated. The children ranged in age between 5 years and 12 years. The number of boys and girls were proportional and the groups were comparable with respect to the mean age of the children. The children were predominantly black and Hispanic and all were from low-income families. This sample was judged by the author to be representative of the ghetto areas from which it was drawn. The abused children were referred by the Bureau of Child Welfare and the Family Court of New York City. Abuse meant specifically that it was continuing or recurrent and confirmed; the majority of abused children lived at home. The sample of neglected was obtained from the Family Court. The criterion for neglect consisted of the court finding that the parent(s) failed to provide adequate physical care including food, clothing, medical care, and supervision. A neglected control group was included to control for the background of physical deprivation and neglect that often accompanies physical abuse in this ghetto population. The normal control group children were randomly referred volunteers from the pediatric out-patient clinic at Kings County Hospital. Detailed interviews, 1 to 1 1/2 hours, were conducted with the mother or maternal guardian by a psychiatrist or psychiatric social worker to determine the presence of self-destructive behavior among the children. Questions indicating child self-destructive behavior concerned possible forms of self-mutilation and self-destructive activity such as self-biting, self-cutting, self-burning, hair pulling, and suicide attempts, threats, or gestures. The presence or absence of self-destructive behavior and/or suicidal ideation was determined for each child and then summed into each group. Chi-square was used to analyze the differences between the 3 groups. Final analysis was done on 59 abused and 29 neglected children because of missing data. FINDINGS/DISCUSSION: A significantly higher incidence of self-destructive behavior was reported in the abused children. Of 59 abused children, 24 (40.6%) exhibited self-destructive behavior, and only 5 of the 29 neglected children (17.2%) and 2 of 30 normal controls (6.7%) were self destructive (p EVALUATION: This study reports yet more of the damaging effects of parental abuse on children. The sample size was large for a study of this sort. The selection of the sample was biased in that only those children who had been actually referred to official authorities were included, and Blacks and Hispanics were oversampled. Collection of data from interviews with mothers could have been supplemented with other data. The findings would have been more convincing if controls for such variables as SES, gender, and other potential antecedents had been included. This research points to another area in the phenomenon of child abuse that needs study. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - New York KW - Child Development KW - Child Victim KW - Child Abuse Effects KW - Child Abuse-Behavior Link KW - Child Abuse Victim KW - Child Physical Abuse Effects KW - Child Physical Abuse Victim KW - Child Behavior KW - Self Destructive Behavior KW - Self Mutilation KW - Psychological Victimization Effects KW - Domestic Violence Effects KW - Domestic Violence Victim Language: en

Journal ArticleDOI
TL;DR: The anticholinergic effects of chlorpromazine, amitriptyline, scopolamine (Sominex) (0), and tropicamide were probably additive and although her disorientation cleared rapidly, Ms. A maintained that her hallucinations persisted during her 2-week hospitalization.
Abstract: drops from neurologic disease, pilocarpine, a parasympathomimetic agent, is safe and reliable. It causes ·constriction of the iris sphincter unless atropine or an·other postsynaptic blocker, such as tropicamide, the substance involved in this case, has been used. Physostigmine salicylate (Antilirium) was not used, · but it is effective in treating anticholinergic intoxica.' tion when administered intramuscularly (l mg repeated in 15-20 minutes if necessary). In Ms. A's case, the anticholinergic effects of chlorpromazine, amitriptyline, scopolamine (Sominex) (0), and tropicamide were probably additive. Although her disorientation cleared rapidly, Ms. A maintained that her hallucinations persisted during her 2-week hospitalization. However, it is difficult to know : whether this was actually the case. Given the previous diagnosis of Munch~lUsen syndrome and her unusual willingness to assume the psychiatric patient role as well as the medical-surgical patient role, it is not unlikely that she was attempting to prolong her hospitalization.

Journal ArticleDOI
TL;DR: In a follow-up study of 150 women who had undergone treatment on an outpatient basis for acute depression, it was found that the most important predictor of their long-term clinical outcome was personality as measured by the Neuroticism Scale of the Maudsley Personality Inventory (MPI-N).
Abstract: In a follow-up study of 150 women who had undergone treatment on an outpatient basis for acute depression, it was found that the most important predictor of their long-term clinical outcome (8, 20, and 48 months after the acute episode) was personality as measured by the Neuroticism Scale of the Maudsley Personality Inventory (MPI-N). Age, race, social class, marital status, religion, number of previous depressions or suicide attempts, diagnosis, history of early deaths of or separations from significant others, history of neurotic traits as a child, amount and type of stress in the 6 months before onset, and severity and pattern of pretreatment symptoms were not predictive of outcome.

Journal ArticleDOI
TL;DR: New findings in psychiatric genetics and psychopharmacology support the heterogeneity of psychiatric disorders, and data on the current rates of specific psychiatric disorders are presented using a recently developed diagnostic technique in a survey conducted during 1975-1976.
Abstract: The authors point out that new findings in psychiatric genetics and psychopharmacology support the heterogeneity of psychiatric disorders. They present data on the current rates of specific psychiatric disorders, using a recently developed diagnostic technique in a survey conducted in New Haven, Conn., during 1975-1976. The survey showed that depressive disorders are the most common diagnoses.

Journal ArticleDOI
TL;DR: Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers.
Abstract: Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms, felt that their physical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels, inhibits phosphodiesterase breakdown of cyclic AMP, and sensitizes receptor sites, association of caffeinism with both anxiety and depressive symptoms is possible.


Journal ArticleDOI
TL;DR: The principal value of the concept of covert dysKinesia is in the secondary and tertiary prevention of tardive dyskinesia through early discovery and treatment.
Abstract: Withdrawal symptoms frequently follow abrupt discontinuation of antipsychotic compounds. In addition to other somatic symptoms, withdrawal-emergent dyskinesias may be observed. "Covert dyskinesia" refers to a masked form of tardive dyskinesia that becomes clinically detectable only after antipsychotic drugs are withdrawn or their dosage is reduced. Withdrawal dyskinesia appears under similar circumstances but disappears spontaneously in 6 to 12 weeks. Cholinergic overactivity and changes in dopamine-acetylcholine balance in the basal ganglia may underlie these withdrawal syndromes. The principal value of the concept of covert dyskinesia is in the secondary and tertiary prevention of tardive dyskinesia through early discovery and treatment.


Journal ArticleDOI
TL;DR: In a double-blind placebo-controlled study, both pimozide and haloperidol significantly decreased tic frequency in nine patients with Gilles de la Tourette's syndrome as discussed by the authors.
Abstract: In a double-blind placebo-controlled study, both pimozide and haloperidol significantly decreased tic frequency in nine patients with Gilles de la Tourette's syndrome. These findings are consistent with the catecholamine hypothesis of tic generation. Pimozide was associated with significantly fewer complaints of lethargy. Follow-up 4-20 months later showed that six of seven patients receiving pimozide and one of two receiving haloperidol had had greater than 75% improvement in symptoms.

Journal ArticleDOI
TL;DR: The authors used data from an earlier nonblind study to identify 16 autistic-type child outpatients who had apparently improved when given vitamin B6 (pyridoxine) and in a double-blind study each child's B6 supplement was replaced during two separate experimental trial periods with either a B 6 supplement or a matched placebo.
Abstract: The authors used data from an earlier nonblind study to identify 16 autistic-type child outpatients who had apparently improved when given vitamin B6 (pyridoxine). In a double-blind study each child's B6 supplement was replaced during two separate experimental trial periods with either a B6 supplement or a matched placebo. Behavior was rated as deteriorating significantly during the B6 withdrawal.


Journal ArticleDOI
TL;DR: The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana.
Abstract: The use of marijuana as the independent variable produced a serious exacerbation of a psychotic process in four schizophrenic patients whose illness was otherwise well controlled with antipsychotic medication. Each patient served as his own control--the sole substance abused was marijuana and antipsychotic medication intake remained constant. Each time marijuana use at moderate levels began, there was exacerbation and deterioration. The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana. Language: en

Journal ArticleDOI
TL;DR: The author presents a method through which findings from anthropological and cross-cultural research can be applied to problems affecting patient care and introduces clinical social science into medical and psychiatric teaching and practice.
Abstract: The author presents a method through which findings from anthropological and cross-cultural research can be applied to problems affecting patient care. The clinical social science approach emphasizes the distinction between disease and illness and cultural influences on the ways "clinical reality" is conflictingly construed in the ethnomedical models of patients and the biomedical models of practitioners. The relevance of such research extends beyond special clinical concerns arising from ethnic differences to ubiquitous problems that result from cultural influences on all aspects of health care. Consultation-liaison psychiatry is a particularly appropriate vehicle for introducing clinical social science into medical and psychiatric teaching and practice.

Journal ArticleDOI
TL;DR: The author discusses the current state of clinical and pathological knowledge regarding chronic brain disease, focusing particularly on the dementias, and his review of clinical studies deals with diagnostic issues and methods, etiology, and treatment.
Abstract: The author discusses the current state of clinical and pathological knowledge regarding chronic brain disease, focusing particularly on the dementias. His review of clinical studies deals with diagnostic issues and methods, etiology, and treatment. More basic research on brain alterations with aging, their relation to clinical manifestations of dementia, and studies of specific disorders are also reviewed. These disorders have been receiving increasing attention from psychiatrists, who are becoming more aware of the importance of organic cerebral factors in their patients' complaints. The need to understand the chronic brain diseases and their appropriate diagnosis and treatment will continue to grow as the proportion of older individuals in our society increases.