Showing papers in "American Journal of Psychiatry in 1986"

The Overt Aggression Scale for the objective rating of verbal and physical aggression.

Abstract: The authors describe the design and reliability of a rating scale that measures aggressive behaviors in adults and children. On the Overt Aggression Scale (OAS), aggression is divided into four categories: verbal aggression, physical aggression against objects, physical aggression against self, and physical aggression against others. In addition, specific interventions related to each aggressive event can be recorded on the OAS. The clinical and research applications of this scale are discussed.

Prevalence of smoking among psychiatric outpatients.

Abstract: The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%) The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented

Clinical characteristics and family history in DSM-III obsessive-compulsive disorder.

Abstract: The authors present the clinical characteristics, demographic features, and family history of a clinical sample of 44 patients who met DSM-III criteria for obsessive-compulsive disorder. Their findings are consistent with those of previous epidemiologic studies completed before the introduction of DSM-III with regard to phenomenology, course, and demographic characteristics. Most of the 44 patients had concomitant or lifetime histories of a major depressive disorder or another anxiety disorder. A number of first-degree relatives of these patients had probable obsessive-compulsive disorder or obsessive traits. The findings of this study should prove useful in further epidemiologic, biologic, and behavioral studies.

Lower Purkinje cell counts in the cerebella of four autistic subjects: initial findings of the UCLA-NSAC Autopsy Research Report.

Abstract: As part of an autopsy research project, the brains of four autistic subjects were examined and compared with those of three comparison subjects without CNS pathology and one with phenytoin toxicity. The cerebellum was selected for initial investigation because pathognomonic symptoms and neurophysiological measures suggest that pathology may exist in the cerebellar-vestibular axis in certain patients. Total Purkinje cell counts were significantly lower in the cerebellar hemisphere and vermis of each autistic subject than in the comparison subjects.

Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC).

Abstract: Psychometric characteristics of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) were evaluated with 148 child and adolescent psychiatric inpatients. Test-retest reliability, internal consistency, and concurrent validity were adequate. Principal components analysis identified three distinct factors: behavioral and cognitive components of depression and a happiness dimension. However, subsequent factor scores and CES-DC total scores were unable to discriminate DSM-III diagnoses, including depressive and nondepressive categories. The CES-DC showed poor reliability and validity in the children alone but had good psychometric properties for the adolescents. More validational research is required before standard clinical use can be recommended.

Models for the joint effect of genotype and environment on liability to psychiatric illness

Abstract: The authors present three major models for the joint effect of genes and environment on liability to psychiatric illness: additive effects of genotype and environment, genetic control of sensitivity to the environment, and genetic control of exposure to the environment. Each model is illustrated by several examples, including a quantitative one. The authors attempt to demonstrate that genes and the environment can interact in several interesting and potentially subtle ways, that these interactions can be expressed in simple models from which clear empirical predictions can be generated, and that elucidation of the etiology of psychiatric disorders will require the consideration of both genetic and environmental risk factors.

Depression in the medically ill: An overview.

Abstract: Depressive symptoms and syndromes are common in the medically ill, although they are frequently unrecognized and untreated The authors review the epidemiology, differential diagnosis, clinical presentations, and response to treatment of this clinical problem They address such methodological issues in the current literature in this area as the advantages and limitations of standardized assessment measures and discuss treatment modalities for depression in the medically ill, including antidepressant medication and ECT This clinical problem warrants attention for a variety of reasons: its prevalence, associated morbidity, and treatability Elucidation of the mechanisms of depression in the medically ill may also contribute to a broader understanding of depression in other populations

Genetic and clinical implications of alcoholism and affective disorder.

Abstract: The association between alcoholism and affective disorders is complex and has fomented much debate. Problems occur because of confusion in definitions (e.g., the distinction between drinking and alcoholism on the one hand and sadness and major affective disorders on the other) and because sadness and even intense temporary secondary affective episodes are often seen in the course of alcoholism. The author notes five possible factors contributing to the confusion between these two disorders and points out several ways to approach the problems of patients who have more than one concurrent clinical syndrome. Using the data from a literature review, he concludes that alcoholism and affective disorder appear to be independent diseases with some overlap in clinical symptoms. Language: en

Social Organization of Medical Work

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Psychiatric reactions to disaster: the Mount St. Helens experience.

Abstract: Following the 1980 Mount St. Helens volcanic eruption, psychiatric reactions were studied in the disaster area and in a control community. Using the new criterion-based diagnostic method for psychiatric epidemiologic research, the Diagnostic Interview Schedule, the authors found a significant prevalence of disaster-related psychiatric disorders. These Mount St. Helens disorders included depression, generalized anxiety, and posttraumatic stress reaction. There was a progressive "dose-response" relationship in the comparison of control, low-exposure, and high-exposure groups. The dose-response pattern occurred among both the bereaved and the property-loss victims.

Prevalence of mental illness in a community nursing home.

Abstract: A research psychiatrist using a standardized interview found that 94% of a random sample of residents at a large, intermediate-care nursing home had mental disorders according to DSM-III criteria. Primary degenerative dementia and multi-infarct dementia were the most common diagnoses. In addition, the majority of demented patients also had noncognitive symptoms such as delusions and hallucinations, and these residents were significantly more likely to have an associated behavioral disorder than were residents without delusions or hallucinations. Replications of these results would point out the need for major revisions in the funding and delivery of psychiatric care for nursing home residents.

Long-term effects of incestuous abuse in childhood.

Abstract: The authors studied two groups of adult women with histories of incest, a nonclinical sample (N = 152) and an outpatient sample (N = 53). Women in the community sample reported a range of long-term effects from the incest. The great majority said they had been upset by their incest experiences, but about half said they had recovered well from their trauma. Most women who had suffered forceful, prolonged, or highly intrusive sexual abuse, or who had been abused by their father or stepfather, reported long-lasting negative effects. The patient sample reported histories comparable to the most severe traumatic histories in the community sample.

Obsessive-compulsive disorder with psychotic features: a phenomenologic analysis.

Abstract: The authors review the literature on obsessive-compulsive disorder and present clinical vignettes to illustrate that delusions can arise in the course of this illness. These delusions do not signify a schizophrenic diagnosis but represent reactive affective or paranoid psychoses, which are generally transient. Using a phenomenologic analysis of 23 patients, the authors further argue that obsessive-compulsive disorder represents a psychopathological spectrum varying along a continuum of insight. Patients at the severe end of this spectrum are best described as having an "obsessive-compulsive psychosis." The authors discuss the implications of these considerations for DSM-III revisions.

Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital.

Abstract: Neuroleptic malignant syndrome, a dangerous but little-known complication of antipsychotic drugs, is often assumed to be rare. To assess the frequency of the syndrome in a large psychiatric hospital, the authors first reviewed the literature and developed operational diagnostic criteria. Using these criteria to survey nearly 500 neuroleptic-treated patients admitted during a 1-year period, they found that seven (1.4%) had experienced definite or probable neuroleptic malignant syndrome. In several cases, including one fatal case, the diagnosis of neuroleptic malignant syndrome was not immediately considered. The authors conclude that neuroleptic malignant syndrome may be more common than previously thought and may be underdiagnosed.

Systematic analysis of research on religious variables in four major psychiatric journals, 1978-1982.

Abstract: The authors conducted a systematic analysis of quantitative research on religious variables found in four psychiatric journals between 1978 and 1982. Of the 2,348 psychiatric articles reviewed, 59 included a quantified religious variable. In this research, the religious variable chosen was most often a single static measure of religion rather than multiple dynamic measures. In addition, other available religious research was seldom cited. Comparison with systematic analyses of religious research in psychology and sociology suggests that psychiatric research lacks conceptual and methodological sophistication. The data suggest that the academic knowledge and skills needed to evaluate religion have not been absorbed into the psychiatric domain.

Is it normal for terminally ill patients to desire death

Abstract: Among 44 terminally ill patients, the majority (N = 34) had never wished death to come early. Of the remainder, three were or had been suicidal and seven more had desired early death. All 10 patients who had desired death were found to be suffering from clinical depressive illness. The methodologic difficulties encountered by the authors were the lack of a brief, efficient interview schedule suitable for debilitated patients and criteria for depressive disorder that do not depend on suicidal thoughts or on symptoms that can also be caused by physical disease. Language: en

Continuation drug therapy for major depressive episodes: how long should it be maintained?

Abstract: A major problem for the practitioner is the lack of satisfactory guidelines as to how long continuation drug treatment of depressive episodes must be maintained to ensure that the episode is over. This often leads to either premature withdrawal of the drug and subsequent relapse or unnecessarily prolonged treatment. Results from a collaborative project of the National Institute of Mental Health provide the first study-derived guidelines on the length of continuation therapy. Findings indicate that withdrawal of such therapy is safe only after the patient has been free of significant symptoms for 16 to 20 weeks and that focusing on mild as well as severe symptoms is critical in this decision.

The application of positron emission tomography to the study of panic disorder.

Abstract: Positron emission tomography was used to study eight patients with panic disorder who were vulnerable to lactate-induced panic, eight patients with panic disorder who were not vulnerable to lactate-induced panic, and 25 normal control subjects. Patients who were vulnerable to lactate-induced panic had several abnormalities in the resting, nonpanic state: an abnormal hemispheric asymmetry of parahippocampal blood flow, blood volume, and oxygen metabolism; abnormally high whole brain metabolism; and abnormal susceptibility to episodic hyperventilation. A hypothetical model for the neurobiology of panic disorder, involving the abnormal parahippocampal region and its afferent and efferent connections, is proposed.

Psychiatrist-patient sexual contact: results of a national survey. I: Prevalence.

Abstract: In a nationwide survey of U.S. psychiatrists, 7.1% (N = 1,057) of the male and 3.1% (N = 257) of the female respondents acknowledged sexual contact with their own patients. Eighty-eight percent of the sexual contacts occurred between male psychiatrists and female patients. All offenders who had been involved with more than one patient were male. Forty-one percent of the offending psychiatrists sought consultation because of their sexual involvement with patients. The authors compare these results with those of previous surveys of psychiatrists and psychologists and discuss the need for addressing this problem within the psychiatric profession.

The prognostic significance of obsessive-compulsive symptoms in schizophrenia.

Abstract: Obsessive-compulsive symptomatology has been described in schizophrenia for more than 60 years, but its clinical significance has yet to be explored systematically. This report details the clinical characteristics and long-term course of a group of 21 schizophrenic patients with prominent obsessive-compulsive symptoms from the Chestnut Lodge Follow-Up Study. While this group differed on admission only minimally from schizophrenic patients without obsessive-compulsive symptoms, their long-term outcome in the areas of social relations, employment, psychopathology, and global functioning was significantly, and almost uniformly, poorer. Persistent obsessive-compulsive symptoms thus appear to be a powerful predictor of poor prognosis in schizophrenia.

The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up.

Abstract: The authors report on the course of illness in 101 patients who were in an episode (the "index episode") of major depressive disorder when they entered a clinical research study, recovered from that episode, and then relapsed into a new episode (the "first prospective episode") of the disorder. They found a 22% probability that these patients' first prospective episode would last at least 1 year, similar to the 21% rate of chronicity previously reported for the index episode. A long prior episode, older age, and low family income were found to predict chronicity in the first prospective episode.

Cortisol and Alzheimer's disease, I: Basal studies

Abstract: Patients with Alzheimer's disease and nondemented elderly control subjects participated in studies of cortisol secretion during sleep and at 9:00 a.m. and were given dexamethasone suppression tests (DSTs) and lumbar punctures. Nocturnal and 9:00 a.m. cortisol concentrations were significantly higher in the demented patients. CSF MHPG negatively correlated with mean nocturnal cortisol. The most severely demented patients had the highest 9:00 a.m. and mean nocturnal cortisol concentrations. DST results did not distinguish samples with substantially different nocturnal cortisol concentrations. These results suggest that measurements of basal plasma cortisol concentrations and dexamethasone suppression provide different information but support the notion of somewhat higher than normal cortisol concentrations in Alzheimer's disease patients.

Antidepressant effects of carbamazepine.

Abstract: Thirty-five depressed patients diagnosed by DSM-III criteria participated in a double-blind study of the acute antidepressant effects of the anticonvulsant carbamazepine, at average doses of 971 mg/day, achieving mean +/- SD blood levels of 9.3 +/- 1.9 micrograms/ml (range, 3-12.5 micrograms/ml). Twenty patients (57%) showed at least mild improvement, and 12 showed more substantial improvement. Possible clinical predictors of antidepressant response to carbamazepine are discussed. These preliminary data suggest that carbamazepine has some acute antidepressant efficacy in addition to the growing evidence that it has acute antimanic and longer-term prophylactic efficacy in both phases of manic-depressive illness.

Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders.

Abstract: Thirty-two patients with coexisting substance abuse and other psychiatric disorders were treated in a unique outpatient pilot program that used techniques drawn from both psychiatric and substance abuse treatment. Eleven patients remained in treatment for 3 or more months, and seven completed a year or more of treatment. Severity of associated psychiatric illness did not affect retention in treatment. Drug-abusing patients and those with personality disorders dropped out quickly; patients with a history of reliable outpatient treatment involvement tended to remain in treatment. Treatment retention was associated with reduced hospital utilization. The authors suggest guidelines for management of patients with coexisting substance abuse and other psychiatric disorders.

The specificity versus nonspecificity dilemma: toward identifying therapeutic change agents.

Abstract: The author examines the specificity versus nonspecificity dilemma that characterizes the unresolved question of how psychotherapy works. He explores different meanings and arguments on both sides of the controversy and attempts to identify three therapeutic change agents that all schools of therapy share as the basis of their different techniques: affective experiencing, cognitive mastery, and behavioral regulation. The roles and functions of these agents are discussed with regard to their potential complementarity in clinical practice.

Mortality among outpatients with anxiety disorders.

Abstract: An earlier follow-up of inpatients with panic disorder attributed excess mortality among men to death from unnatural causes and from cardiovascular disease. The present study sought to determine the stability of this finding with a 12-year follow-up of 155 outpatients with anxiety neurosis. As in the first study, men were twice as likely to die as expected, and this excess in deaths was attributable to cardiovascular disease and suicide. Given the small numbers in both studies, however, the link between panic disorder and excess cardiovascular mortality remains tentative.

Family violence and child adjustment: a comparative analysis of girls' and boys' behavioral symptoms.

Abstract: The authors compared behavior problems and social competence in 126 boys and girls (age 6-11) from violent and nonviolent families, on the basis of maternal ratings on the Achenbach Child Behavior Checklist. Girls from violent families were reported as showing more internalizing behavior problems and a lower level of social competence than their nonviolent comparison group. Boys from violent families were reported as demonstrating both internalizing and externalizing behavior problems, in addition to having a lower level of social competence. For boys, the level of exposure to violence between parents was significantly associated with greater adjustment problems. Language: en

Right-hemisphere deficit syndrome in children.

Abstract: The author describes 15 children with behavioral disturbances, a characteristic neuropsychological profile, and neurological findings consistent with right-hemisphere damage or dysfunction. Almost all of the children had attention deficit disorder. Some were obtuse or unable to interpret social cues, others could not express their feelings but appeared to be sensitive and aware of the emotions of others. The older children were generally in psychotherapy or counseling but responded poorly, suggesting that a different approach to treatment may be indicated.