Showing papers in "Archives of General Psychiatry in 1969"

A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.

Abstract: With the vast research interest in sleep and dreams that has developed in the past 15 years, there is increasing evidence of noncomparibility of scoring of nocturnal electroencephalograph-electroculograph records from different laboratories. In 1967 a special session on scoring criteria was held at the seventh annual meeting of the Association for the Psychophysiological Study of Sleep. Under the auspices of the UCLA Brain Information, an ad hoc committee composed of some of the most active current researchers was formed in 1967 to develop a terminology and scoring system for universal use. It is the results of the labors of this group that is now published under the imprimatur of the National Institutes of Health. The presentation is beautifully clear. Techniques of recording, scoring, and doubtful records are carefully considered. Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.

General System Theory: Foundations, Development, Applications.

Abstract: It is often disconcerting to learn that a discovery that one has made has been around a long time, and thus is no discovery at all; but this should not deter one from sharing his good fortune. Ludwig von Bertalanffy has been writing about a general systems theory since at least 1945 but it did not become a component of psychiatric study until introduced by Dr. William Gray in 1965 at an APA panel. It has not, however, managed to sustain much over-all enthusiasm in psychiatry except for a small group of investigators. The present volume by Bertalanffy, as its title suggests, covers the foundations, the development, and the applications of this theory. This reviewer can only suggest and urge that every psychiatrist read it. Once that has been done, I would next urge you to read it again. The book consists of ten chapters

Life Events and Depression: A Controlled Study

Abstract: AN extensive literature exists regarding the relationship of life events and depression. The largest group of studies has concerned the descriptive characterization of those events occurring at the onset of depression. There has been particular emphasis on actual or symbolic losses, 1-4 including loss of self-esteem. 5 Others have been concerned with the general presence or absence of stress at onset and have attempted to define a group of endogenous depressions, occurring in the absence of stress, and showing characteristic clinical features. 6-8 Although it has been generally assumed that most depressions are reactions to events, some dissent has been expressed. Hudgens 9 and his colleagues found events uncommon in the six months prior to onset of illness in 40 patients hospitalized with affective disorders. Winokur and Pitts 10 reported reactive depressions to be infrequent and threw doubt on the validity of

Animal model of depression. I. Review of evidence: implications for research.

Abstract: THIS PAPER has three major purposes: (1) to present the need for an experimental animal model of "depression," ie, why the creation of such a model would be useful; (2) to review pertinent evidence from a variety of fields which points to the feasibility of such a model; and (3) to discuss possible research strategies which could be used to create an experimental animal model of depression. Depression in man is a poorly defined entity. As Lehmann1points out, the term may refer to a symptom, a syndrome, or a nosological entity. We are interested in the depressive syndrome which is often defined as consisting of both primary and secondary symptoms. The primary symptoms in man consist of a despairing emotional state and the depressive mood. The secondary symptoms vary and are less regularly found. They may include such things as social withdrawal, psychomotor retardation, an

Hallucinations and delusions as points on continua function. Rating scale evidence.

Abstract: PSYCHIATRIC symptom rating scales can be used for testing and reformulating clinical concepts as well as for categorizing patients. Hallucinations and delusions are two symptoms that take on new meanings when defined more operationally for use in such scales. It is especially important to conceptualize these symptoms adequately because they are key diagnostic criteria of the psychoses, especially of schizophrenia. Even those who classify hallucinations and delusions as "secondary" tend to use these symptoms to establish the diagnosis of psychosis since they are among the easier symptoms to identify clinically. Generally hallucinations and delusions are considered to be discrete and discontinuous, a patient either has them or he does not. The notion of the discreteness of these symptoms encourages the conception of psychosis and schizophrenia as states that are also discrete and discontinuous and the further conception that patients with these diagnoses are somehow qualitatively different from other

Mental changes accompanying thyroid gland dysfunction. A reappraisal using objective psychological measurement.

Abstract: AN APPARENT association between the function of the thyroid gland and the concurrent mental state has been acknowledged since the earliest descriptions of both myxedema and thyrotoxicosis. 1,2 Subsequently, clinical reports and studies attempting to clarify this relationship have led to an extensive literature on the subject. Some workers have attempted to define a specific mental disturbance secondary to thyroid gland dysfunction and conversely, perhaps stimulated by the protean actions of thyroid hormone, others have sought a disturbance of thyroid function in individuals with various psychiatric syndromes, speculating that the gland might play a contributing part in the pathogenesisof the disorders. 3-6 With such extensive previous study one might question the purpose of a further evaluation of the mental changes occurring in thyroid gland dysfunction. It is our opinion, however, that much remains to be clarified. Many previous studies have been

Lithium-Carbonate Treatment in Depression and Mania A Longitudinal Double-Blind Study

Abstract: THE PURPOSE of this paper is to present the clinical results of an intensive longitudinal double-blind study in 30 manic-depressive and depressed patients; preliminary aspects of this work have been presented elsewhere.1,2In addition, we have reported on some biochemical changes occurring at various stages in the course of the lithiumcarbonate treatment of these patients2; this aspect of our work is the subject of other recent communications3,4and will not be reviewed here. The therapeutic use of lithium-carbonate in affective disorders has recently been the focus of considerable interest, particularly in light of clinical evidence that it may have beneficial effects not only in mania but also in some cases of depression.5An additional and perhaps unique feature of this drug is its reported long-term mood-stabilizing properties when used prophylactically.6If the initial clinical studies can be further substantiated, then the theoretical implications for a

Interaction Concepts of Personality.

Abstract: Dr. Carson, a clinician and social psychologist, sets out to explain the transactions that occur between people. Although he focuses on the dyadic relationship, his findings are purportedly applicable to larger social matrices. The author has borrowed heavily from the thinking of earlier social theorists, especially Erickson, Leary, Lewin, and Sullivan. Perhaps this book's most important single contribution is its lucid and careful restatement of Sullivanian theory. Unfortunately, the author experiences some difficulty when he attempts to extend and make explicit the thinking of Sullivan. In particular, the richness and vitality of the original writings of Sullivan receive at times an awkward and pseuedotechnical treatment. Nonetheless, several chapters devoted to the processes of learning, perception, and cognition are carefully planned and thoughtfully integrated; they provide an operational paradigm for understanding behavioral phenomena in terms of learned and perceived events. The author writes a great deal

Perception of mental illness in a Mexican-American community

Abstract: THERE are almost 2 million persons of Mexican birth or descent in California, about 10% of the state's population. Mexican-Americans also represent about 10% of the 7 million residents of Los Angeles County, forming a larger ethnic minority group than the Negro population in both the state and the county. Like Negroes, Mexican-Americans have been the objects of prejudice in the United States. Tenacious stereotypes of, and discrimination against the Mexican-American have been the focus of scattered attention, 1-5 but extensive documentation has not yet been provided. Both peoples continue to be characterized by a chronically depressed socioeconomic status marked by a low educational level with a high degree of functional illiteracy, crowded and deteriorated housing, a high incidence of communicable disease, limited employment opportunities, and limited political power until the recent period of rapid growth of political strength. Mexican-Americans, however, are a unique people in

Follow-up studies in obsessional neurosis.

Abstract: The follow-up is the great exposer of truth, the rock on which many fine theories are wrecked and upon which better ones can be built; it is to the psychiatrist what the postmortem is to the physician. — P. D. Scott THE CAUSE of most medical and psychiatric illnesses is unknown. Even without knowledge of etiology, however, the physician can diagnose, predict and treat. To accomplish this he may rely to some extent on personal experience, but this alone is rarely sufficient. A knowledge of "the literature" is usually essential. Especially helpful are follow-up studies: published reports of groups of patients having similar symptoms followed over time to determine both "natural" outcome and outcome as influenced by treatment. To illustrate their usefulness we have reviewed follow-up studies pertaining to one illness, obsessive compulsive neurosis, and summarized the findings. Of the 13 studies reviewed,

Types of hopelessness in psychopathological process.

Abstract: It is memory that gives us the power of foresight: We push into the future with images in which we fixed the past. Full consciousness therefore looks both ways, and its most important look ... is into the future. All biological processes are directed toward the future, but man is distinguished by being consciously directed−his consciousness includes the future. J. Bronowski 1

The Token Economy: A Motivational System for Therapy and Rehabilitation.

Abstract: The advent of behavior therapy was heralded by the appearance of Wolpe's book Psychotherapy By Reciprocal Inhibition in 1958. In contrast to freudian psychotherapy, behavior therapy did not arise out of empirical observations in the clinical situation from which a theory was then induced, but rather from a deliberate attempt to apply to the treatment of patients laboratory-derived learning theory which has so preoccupied American psychology for 50 years. Wolpe, as might be expected from a physician, worked largely within a framework of pavlovian learning theory and his technique or systematic desensitization has earned a solid place in the treatment of neurosis. However, the more recent developments in behavior therapy, especially with psychotic patients and children, have involved the application of that peculiarly American branch of learning theory—operant conditioning—and, in the process, behavior therapy has undergone a change of name to

Determinants of the decision for psychiatric hospitalization.

Abstract: IN THE recent history of American psychiatry, the use of the hospital as a therapeutic intervention in the treatment of mental illness has been seriously questioned. Studies by Lafave, 1 Mendel, 2 and Pasamanick 3 have shown that patients who are treated without the use of the hospital in the management of their acute and chronic illness tend to display less morbidity and make more satisfactory extramural adjustment than those who have been hospitalized. As a result of these studies and the general recognition of the antitherapeutic effects of prolonged and inappropriate hospitalization, much emphasis has been placed on the clarification of the indications for hospitalization. It is generally agreed, even by the most conservative thinkers in psychiatry, that the patient should not be hospitalized simply because he is mentally ill or because the decision maker does not know what else to

Alcoholism: I. Two Types of Alcoholism in Women

Abstract: ALCOHOLISM may not be a single disease. 1 A recent study by Pitts and Winokur 2 points to the close relationship of alcoholism and affective disorder while other studies have shown the possible tie between alcoholism and schizophrenia, 3-5 psychoneurosis, 5 and sociopathy. 6 In addition, it has been suggested that alcoholism may not be the same disease in the two sexes. 4 A workable definition of alcoholism has emerged from Jellinek and the World Health Organization, 7,8 but such a definition allows assemblage of a heterogeneous group of alcoholics with other associated psychiatric illnesses. 5 An examination of alcoholism both as a primary disease entity and as a secondary complication of other psychiatric illnesses is lacking. The purpose of this paper is to describe an attempt to delineate alcoholism into nosologically homogeneous groups. We shall limit our present discussion to alcoholism in the female.

Gandhi's Truth: On the Origins of Militant Nonviolence.

Abstract: It takes a great man to write a book about a great man and both the author and his subject fit this description. Erikson has previously written Childhood and Society and Identity: Youth and Crisis , both of which brought fresh insights into the stagnant areas of childhood and adolescence. His volume entitled Young Man Luther is a fascinating psychohistorical inquiry. The author is not only a psychoanalyst, but also an educator, a social scientist, and a poetic writer. I would place a man combining these attributes as a distinguished humanist, a fitting person to understand Gandhi and interpret him to the world as no biographer has previously done. In 1962 Erikson was invited to lead a seminar in Ahmedabad, India, the place of Gandhi's first strike on behalf of the millworkers where, in fact, he tested out strategies and tactics later to be applied

The Psychological World of the Teenager: A Study of Normal Adolescent Boys.

Abstract: This book is written in an effort to establish some of the normal characteristics of today's teen-ager. It represents a study of 73 adolescent boys over a four-year period covering the high-school years. The sample is drawn from two suburban, middle-class schools. The book is divided into four parts. Part I describes the author's intent and procedure. The author mentions the many confusing usages of the term ``normal'' and the frequent assumptions made about the ``normal'' adolescent, based on data gathered from patient populations. In this study, the author prescreened his sample by using a self-perception questionaire and also eliminated any youngsters having obvious difficulties in the school. From this he drew his model population of 73 subjects. These were then evaluated by various methods, including the self-image questionnaire already mentioned, psychological tests, parent interviews, teachers' ratings, and six clinical interviews with each

Stage 4 sleep in schizophrenia.

Abstract: THE stage 4 EEG (employing the Dement and Kleitman 1 nomenclature) of sleep, as measured in our laboratory, consists of high-voltage (over 50V) slow (under 4 cycles per second) activity occurring with a stipulated density (over 16 waves per 20second epoch, or over 50% of the epoch occupied by such slow waves). Stage 3 EEG represents a lesser density (10 to 16 waves per 20-second epoch) of this slow-wave activity. Stage 3 and 4 EEG constitute, along with spindles and K-complexes, the distinguishing features of nonrapid eye-movement (NREM) or slow-wave sleep. Both stage 3 and 4 EEG are maximal during the first few hours of sleep 1 and their distributions across the night may usefully be described as a function of the successive sleep cycles. 2 Stage 4 EEG reaches its highest level in early childhood 3 and then shows a hyper

Roles of denial in chronic hemodialysis.

Abstract: DURING the past decade, hemodialysis has become an established treatment for chronic renal failure. The use of long-term intermittent hemodialysis is now successful in maintaining the lives of individuals who otherwise, in the past, would have succumb to a uremic death. With this procedure, these patients are sustained to return to their home, and assume a more or less usual life. With the beginning of treatment, two to three times weekly, the dialysand (hemodialysis patient) is initiated to the endless series of accommodations and compromises that are to follow. These not only involve the dialysand, but also significantly affect members of his family and community. The early adjustments may require moving his home closer to the dialysis center, modifying his employment, or changing his responsibilities in the home. These initial modifications may be major changes, but they generally prove to be the least of the many accommodations, that he

Behavioral Antecedents of Adult Schizophrenia: A Review

Abstract: AT A glance the literature on the behavioral antecedents of adult schizophrenia appears to be hopelessly contradictory, first suggesting that most preschizophrenics are withdrawn during childhood, then indicating that aggressive antisocial children are at high risk for serious psychiatric problems including schizophrenia as adults, and finally demonstrating that children of all behavioral types may become schizophrenics. The central issue is whether certain behavior patterns in childhood identify children who are at high risk for adult schizophrenia. If this were the case, it possibly would give us some clue about the etiology of the disorder and would allow us to identify and study groups of children with a high expectancy for adult schizophrenia before the overt onset of the disease. This paper will review the literature on the behavioral antecedents of adult schizophrenia. While anterospective studies starting with a group of children

Insulin tolerance test in depression.

Abstract: A RECENT investigation from this laboratory 1 demonstrated that psychotic depression is associated with low rates of glucose utilization (k) and high levels of serum insulin following glucose injection. Patients with neurotic depression did not demonstrate these abnormalities. This abnormality, a resistance to endogenous insulin, returned toward normal when the patient improved. These findings, which could not be accounted for by initial levels of serum human growth hormone (HGH), age, or nutritional state, suggested that psychotic depression is associated with a type of endogenous insulin resistance unlike that of any previously described condition. Recent studies by Steiner et al 2 and Shaw and Chance 3 have shown that the routine serum insulin radioimmunoassay measures both insulin and the insulin precursor, proinsulin, but that proinsulin is not biologically active until enzymatically degraded to insulin. It is, therefore, possible that the higher serum

Development of a Coping Scale: A Preliminary Study

Abstract: CURRENTLY, interest in coping strategies is considerable. The coping behavior first investigated was that of persons involved in acute crises, eg, severe burn victims, 1,2 grieving relatives, 3 surgical patients, 4 and parents of children with malignant diseases. 5,6 Studies have also been done on major psychosocial transitions, eg, high school to college, 7,8 marriage, 9-11 and first pregnancy. 12,13 Murphy 14 wrote extensively on coping strategies in childhood. Mechanic 15 studied students under stress; Lazarus 16 discussed the coping process and psychological stress in general. Much of this literature was recently reviewed by Hamburg and Adams 17 from the vantage point of the seeking and utilizing of information under stressful conditions. Most of these studies were largely descriptive: observations from interviews from which it has been difficult to abstract general coping principles. One of the few coping instruments available is

Further Evaluation of Urinary 17-Hydroxycorticosteroids in Suicidal Patients

Abstract: THIS PAPER reports longitudinal steroid data on nine patients who subsequently committed suicide or who made a serious attempt and compares the significance of the elevations of these levels with 134 other individuals studied in our own laboratory and reviewed from the psychiatric literature. Behavioral and biochemical studies of severely depressed inpatients suggested the hypothesis that an association might exist between high urinary 17-hydroxycorticosteroids (17-OHCS), which were utilized as an index of psychological distress, and increased suicidal risk. This hypothesis was initially based on a retrospective study 1 of three depressed patients who committed suicide and a comparison group of 33 depressed impatients. These studies occurred during the course of five years of study which involved contact with 250 depressed patients, 36 of whom were treated in an inpatient setting. In the three years since this initial report, longitudinal steroid data have

Dextroamphetamine Sulfate in Children With Learning Disorders Children With Learning Disorders: Effects on Perception, Learning and Achievement

Abstract: THE USE OF amphetamine for the therapy of behavior disorders and learning disorders in children is a well-established clinical tradition. 1-3 As early as 1937 Molitch and Eccles 4 published a placebo-controlled study of the effects of benzedrine sulfate on intelligence and performance scores of 93 delinquent boys between the ages of 11 and 17. Though the data are presented in percentage improvements, and not subject to statistical evaluation, the study strongly indicated that there were significant improvements in performance. Nevertheless, as noted in Freeman's critical review 5 the early strong claims for the value of amphetamines appear to have stifled further controlled research with children until very recently. Eisenberg and his colleagues 6 studied effects of amphetamine on delinquent boys and found a striking symptomatic improvement of the drug-treated group over placebo and no treatment groups, using cottage parents' ratings and sociometric ratings. Weiss et

Muscle Enzyme Release in the Acute Psychoses

Abstract: ACOMMON expression of the disease process in an organ is the spilling of large amounts of normally intracellular enzymes into the circulation. For example, increased serum activity of creatine kinase (CPK) and aldolase, two soluble cytoplasmic enzymes of muscle and brain, has diagnostic and prognostic significance in skeletal or cardiac muscle disease, particularly myopathies and myocardial infarction, or both. 1,2 Recent reports indicate that increases of the activity of these enzymes can also occur in the serum of some patients with such neurologic and psychiatric disorders as brain trauma, cerebral vascular disease, encephalitis, meningitis, and acute psychosis. 3-10 Three of the latter studies particularly relevant to the investigations reported here. Schiavone and Kaldor found elevated serum CPK activity in 60% of 109 patients with cerebral dysfunction, including nine of 24 cases of schizophrenia. 4 Bengzon et al, after finding an elevation of serum alkaline

Manic-depressive illness, diabetes mellitus, and lithium carbonate.

Abstract: OUR interest in the glucose metabolism of manic-depressive patients originated with the discovery of a diabetic condition in a patient whose complaints of polyuria, thirst, fatigue, and spells of profuse perspiration were initially interpreted as toxic manifestations of lithium carbonate therapy. In addition to a diabetic response to the glucose tolerance tests, a review of her hospital record revealed high-fasting blood sugar levels on several previous admissions. Similar findings among other manic-depressive patients formed the rationale of the following studies. Procedures Repeated glucose tolerance tests were performed on 42 manic-depressive patients hospitalized at Norwich Hospital. The diagnoses of these patients were independently agreed upon by the referring hospital and research staff, and confirmed by their past histories as documented in their hospital records. Most of these patients were readmissions and not on medication. Some patients were receiving lithium carbonate. A second glucose tolerance survey was carried out on

Predicting mortality in the institutionalized aged. A seven-year follow-up.

Abstract: INFORMATION about the course of aged persons in a variety of settings is of value in planning for their care and in comparing the effectiveness of protective programs or types of institutions. For this reason the Office of the Consultant on Services for the Aged of the Department of Mental Hygiene, State of New York, as part of its work in the past ten years collected information on the death rate of aged persons in three types of institutions: old age homes, nursing homes, and state hospitals. Most persons who work with the institutionalized aged recognize that they are, in large part, caring for slowly dying patients. The question is often raised about the aims and goals of such service: Are we attempting to prolong a terminal state? Are we contributing to longevity? Who of these declining can emotionally or psychologically benefit from special programs?

Factors of Symptom Distress: Doctor Ratings of Anxious Neurotic Outpatients

Abstract: IN A SERIES of related papers by Mattsson et al,1Williams et al,2and Lipman et al,3a Symptom Distress Check List (SCL), developed by Parloff, Frank, and their coworkers,4,5containing items covering the spectrum of common psychoneurotic complaints, was factor-analyzed, employing the self-ratings of more then 1,500 anxious-neurotic outpatients. These Factors were tested for their sensitivity in discriminating pharmacologic and nonpharmacologic influences within the context of a double-blind, placebo-controlled trial of meprobamate in which doctor medication attitudes were experimentally manipulated via role-playing techniques.6 Of the five stable and clinically meaningful factors extracted from the patients' selfratings, Somatization and Fear-Anxiety proved most sensitive to main drug effects, whereas the remaining three factors—General Neurotic Feelings, Cognitive-Performance Difficulty, and Depression—were more reliably influenced by the interaction of pharmacologic and nonpharmacologic variable in the treatment context.

Suicidal Behavior as a Child Psychiatric Emergency: Clinical Characteristics and Follow-up Results

Abstract: THIS PAPER reports the results of a retrospective and follow-up study of 75 children and adolescents with suicidal behavior at the child psychiatry clinic at University Hospitals, Cleveland. They were part of a total group of 170 child psychiatric emergencies seen over a two-year period at our clinic. In an earlier paper 1 clinical and follow-up data on these emergencies were presented and compared with those of a randomly selected group of regular clinic intakes of children not considered emergencies. Similarly to other authors 2,3 we were impressed by the prominence of suicidal behavior as a major cause of emergency referrals to a child psychiatry clinic. Some of the demographic and clinical differences between our group of emergencies and that of regular clinic intakes lost their significance when the subgroup of 75 suicidal children was removed from the emergency group and the

Psychic Trauma: Return of Images After a Stress Film

Abstract: SOME PERSONS who experience psychic trauma report that memories of the precipitating event intrusively enter their awareness long after the traumatic event takes place. Such clinical observations have led to the theory that there is a compulsion to re-enact traumas, perhaps as a belated attempt at mastery. This paper reports an experimental study of this theory in which a stressful film induced subsequent unbidden images in volunteer subjects. The Repetition of Psychic Trauma.—Freud and Breuer1described psychic trauma as an event in which perceptual and affective stimuli overwhelm the processes that ordinarily bind them and maintain homeostasis. These stimuli tend to return to mind, sometimes as visual images. In the "Project for a Scientific Psychology,''2Freud calls such vivid images ``untamed memories." When affects associated with the trauma are worked through, the memories become "tamed"; that is, reduced in intensity and sensory quality. But, if conflict interferes

Intravenous Glucose Tolerance Test in Depression

Abstract: REPORTS on glucose utilization in depressive illness, as measured by the intravenous glucose tolerance test (GTT), are in conflict. In 1958 pryce 1,2 reported that depressed patients had lower glucose utilization rates (k) than normal subjects. This lowered k was not related to loss of body weight, and it did not change significantly following successful treatment with electroconvulsive therapy (ECT). Herzberg et al in 1968 3 reported, however, no clear association between depression and lowered oral or intravenous GTT. These authors reported no significant change in glucose utilization rate following recovery whether ECT, tryptophan, or no somatic treatment was employed. They attributed previously reported positive findings of the GTT in depression to either malnutrition or inactivity. Pryce's data were more consistent with the report by Van Praag and Leijnse in 1965 4 6 where decreased glucose utilization, as measured by forearm arteriovenous glucose difference, was associated with depressive illness.