Showing papers in "Journal of Nervous and Mental Disease in 1975"

Alcoholism and the hyperactive child syndrome.

Abstract: Comparisons were made between alcoholics and nonalcoholics in a sample of Danish adoptees (mean age 30) and it was found that the alcoholics, as children, were more often hyperactive, truant, antisocial, shy, aggressive, disobedient, and friendless. The literature suggesting a relationship between t

A review of the effects of diazepam on cognitive and psychomotor performance.

Abstract: Studies evaluating the effects of diazepam (Valium) on psychomotor and cognitive functions are reviewed an integrated. The importance of the full and clear documentation of such drug effects lies in the wide usage of diazepam today for a variety of medical, psychiatric, and dental purposes. The various tasks used to assess drug effects were classified into six major groups based on apparent similarity of functions tapped. These groupings are: reflex speed; critical flicker fusion threshold; attention and vigilance; decision making; learning and memory; psychomotor performance. In all functions except simple reflexive responding; some indications of impaired performances were reported, the results being most definitive for the critical flicker fusion where even small doses lowered the threshold and for a slower performance on letter cancellation tasks. There appeared to be some interaction between diazepam and alcohol although the nature of this interaction is still unclear. Because of the extensive use of both of these drugs and the possibility of a synergistic or a potentiation effect, it is important that this area receive further study. It was suggested that future studies either control for or analyze the data to assess the possible interactive effects of diazepam with subject variables such as sex, personality type, and for population characteristics. These variables have been shown to affect responses in other studies and hence could also interact with cognitive and psychomotor performance. It was noted that most of the studies reviewed used normal, healthy, male volunteer subjects and may not be comparable to the clinical populations for whom the drug is typically prescribed.

Lithium in the treatment of aggression.

Abstract: Lithium has become a widely accepted treatment for manic-depressive psychosis. It is dramatically effective for many cases of mania and is useful in the prevention of manic and depressive episodes. Hyperaggressiveness and hypersexuality are frequent components of manic-depressive illness and abate under the influence of lithium. A brief review is presented of the behavioral and biochemical pharmacology of lithium. This documents the inhibitory role which lithium can play in several examples of animal aggressive behavior including pain-elicited aggression, mouse killing in rats, isolation-induced aggression in mice, p-chlorophenylalanine-induced aggression in rats, and hypothalamically induced aggression in cats. The use of lithium to control human aggressive behavior has resulted in controversial findings. In epileptic conditions, improvement has been reported in interseizure aggressivity, but other reports indicate the possibility of increased seizures. Improvement in aggressive behavior in childhood has occasionally been reported as well as in emotionally unstable character disorders in young female patients. Te was a single blind study and the other a large but uncontrolled study. Both studies reported an improvement in aggressiveness as indicated by fewer recorded reports (tickets) for fighting. The final study reported is a study of 12 male delinquents age 16 to 23. They received lithium or placebo for 4 months inside an institution and then a trial of lithium for 1 to 12 months on an outpatient basis. Analysis of results in terms of the number of aggressive antisocial acts showed fewer serious aggressive episodes when the lithium level was between 0.6 and 1 meq/liter than when it was between 0.0 and 0.6 meq/liter. These results must be viewed with caution and are only suggestive since the study was not double blind.

Outpatient alcoholics give valid self-reports.

Abstract: Thirty-nine male alcoholics in a voluntary outpatient treatment program were interviewed individually on two separate occasions about their social and drinking history. Critical test questions were identical for both interviews but embedded among different filler items. The validity of the subjects' self-reports about both alcohol and nonalcohol-related questions was assessed through official records and documents. Self-reports of life history data provided by this group of outpatient alcoholics under specified interview procedures were highly reliable and valid. Differential item reliability and validity were obtained. Further, the value of using the technique of double interviews to predict valid and invalid self-reports is discussed. Suggestions for future research are offered. Language: en

Deprivation in the childhood of depressed women.

Abstract: With recent developments in community psychiatric services, concern with prevention has become an urgent social, as well as medical challenge. Comprehensive investigation into causation must therefore be given systematic emphasis. This paper is an effort toward clarification of etiology, specifically of the depressive disorder, in terms of early childhood experiences. The work is based on social and psychiatric history data collected by experienced psychiatric social workers on two groups of subjects from the National Institute of Mental Health (NIMH) Collaborative Depression Studies under the direction of Allen Raskin, Ph.D, of the NIMH Psychology Research Branch, and a third group of subjects from Boston State Hospital. The hypothesis that childhood deprivation, defined as "the lack, loss or absence of an emotionally sustaining relationship prior to adolescence", has a meaningful association with the occurrence of adult depression was tested in a sample of 347 depressed inpatient women and 114 outpatient women in comparison to 198 normal women used as a control or reference population. The subjects were all Caucasian. Events occurring during childhood that could be considered within the definition of deprivation were documented. Further, subjects were assessed as to depriving childrearing experiences. The findings revealed no association of adult depression with overt childhood loss events, but did provide evidence to support an association of depriving childrearing processes with adult depression. The findings also revealed evidence of a relationship between the degree of the depriving childrearing experience with the severity of the adult illness as measured by hospital status. The results are discussed in relation to findings from other studies of childhood deprivation and psychiatric disorder.

Sexual functioning in patients with chronic renal failure.

Abstract: Until recently, failure of kidney function was a fatal illness. The development of renal dialysis and kidney transplants has changed this picture, and patients now survive for many years with one or both of these procedures.

Effects of repeated administrations of a comprehensive neuropsychological battery among chronic epileptics.

Abstract: Effects of repeated administrations of the neuropsychological battery originated by Halstead and developed by Reitan were assessed by administration of the battery on four occasions at 6- to 12-month intervals to 17 epileptics with stable neurological dysfunction. Changes in drug regimen complicated interpretation to some degree, but it appeared that: a) the majority of the neuropsychological measures did not demonstrate significant practice effects; and b) there were statistically and clinically significant practice effects on some of Halstead's most sensitive measures (Category Test, Tactual Performance Test--Localization, Impairment Index). In addition, the question was raised as to whether or not the Wechsler Adult Intelligence Scale may be more effected by the administration of anticonvulsants than are many of the other neuropsychological procedures. Caution was urged in interpretation when the battery is used on a repeated basis.

Learned helplessness, depression, and anxiety.

Abstract: The learned helplessness model of depression predicts that depressives should tend to perceive reinforcement as response-independent in skill tasks. Depressed-anxious, nondepressed-anxious, and nondepressed-nonanxious college students estimated their chances for success in a skill or a chance task. (Virtually no depressed-nonanxious subjects could be obtained.) Depressed-anxious subjects showed less expectancy change in skill than nondepressed-anxious subjects, while these two groups exhibited similar expectancy change in chance. Nondepressed-anxious and nondepressed-nonanxious subjects did not differ in either skill or chance. The results for a discrimination learning problem were mixed. The groups did not differ in latency to shut off an aversive noise. So, depressed subjects perceptually distort the outcomes of skilled responding as being response-independent, and they may, under certain conditions, show deficits at learning the consequences of responses. These deficits may reflect learned helplessness and are specific to depression.

Brain function and behavior. I. Emotion and sensory phenomena in psychotic patients and in experimental animals.

Abstract: For the past 25 years, the research program of the Tulane University Department of Psychiatry and Neurology has been directed primarily to the development of treatment for patients with certain psychiatric and neurological disorders that have been resistant to commonly used therapy. In the course of investigations, using a variety of approaches, new techniques have evolved which have permitted simultaneous exploration of brain activity and behavior. The data reported substantiate an anatomical localization in the brain for the syndrome of psychotic behavior. Further, observations in patients, coupled with animal investigations, have led to the demonstration of brain pathways and previously undisclosed anatomical connections which provide a physical substrate for the clinically observed relation between perception and emotionality. These findings provide a basis for the development of specific biological methods for the treatment of behavioral disorders.

Hormone and hormonal agents in the treatment of aggression.

Abstract: Evidence for the role of androgens in the male aggressive and sexual behavior is reviewed. Medroxyprogesterone acetate (MPA; Provera, Upjohn) has a marked antiandrogen property; it is effective in lowering the testosterone level and controlling certain otherwise intractable sex deviations. The finding in 6 patients treated for sex deviation are summarized. The effects of MPA in the treatment of 11 temporal lobe epileptics and 5 other patients with severe angry-aggressive behavior disorder are reported. Most temporal lobe epileptics responded well to MPA. Weight gain and earlier sleep were consistent side effects. The values of plasma testosterone, serum luteinizing hormone, and urinary 17-ketosteroids were decreased by the treatment. Four patients were XYY individuals with lack of control over their sexual-aggressive or angry-aggressive impulses.

Computerized EEG: predictor of outcome in schizophrenia.

Abstract: Based on a double blind cross-over study, it was determined that schizophrenic patients who have more high frequency fast activity and a lesser degree of alpha and slow waves in computerized EEG before the treatment have a better therapeutic outcome to the major tranquilizer (neuroleptic) treatment. The correlation between pretreatment high frequency computer EEG measurements and better therapeutic outcome reached the level of statistical significance. “Therapy resistant” schizophrenic patients were characterized by a lesser degree of very fast beta activity, more alpha waves and slow waves, higher amplitudes in computer EEG, and a lesser degree of acute (florid) psychotic symptomatology but more “negative” symptoms such as motor retardation and blunted affect. One of the most striking results of the study is the finding that schizophrenic patients with certain psychopathological profiles also have similar computer EEG profiles.

Anticonvulsants in the treatment of aggression.

Abstract: A significant number of violent acts are committed by individuals in whom central nervous system instability can be demonstrated by special electroencephalographic (EEG) activation procedures utilizing α-chloralose as the activating agent. Furthermore, subcortical electrograms suggest that this inst

Temporal lobe epilepsy and aggression.

Abstract: Research on temporal lobe epilepsy (TLE) and aggression is reviewed in order to learn why it has not contributed more to our understanding of the neural basis of aggression. The research problem can be resolved into two questions: Are temporal lobe epileptics more aggressive? What inferences can be drawn about the factors underlying aggression in TLE? Difficulties in finding suitable operational definitions for TLE and for aggression have, to date, received insufficient attention. In published studies, sample bias and lack of regard for the validity and reliability of behavioral assessments prevent our deciding whether an association exists between interictal aggressive behavior and TLE. Even if this association were demonstrated, one could not draw direct neurobehavioral inferences from it, since a variety of social and psychological, as well as neurophysiological variables could contribute to the association. These would have to be controlled. Methodological refinements could lead to more satisfactory answers to the first question, but the second is considerably more difficult. Some sources of complexity and apparent contradictions in the experimental literature on the neurology of aggression are discussed. They consist of technical problems, the complexity of the neural substrate of aggression and the influence of environmental cues and learning. The combined use of electrophysiological and interview techniques has yielded some interesting results with TLE patients.

Assessing treatment outcome. I. Adjustment in the community.

Abstract: In recent years, the re-examination of treatment outcome has substantially advanced the sophistication with which the issues involved have been conceptualized. This study is directed toward the empirical elaboration of four of these issues as they relate to adjustment in the community. They may be stated briefly as the extent to which a) a common outcome pattern exists across different dimensions of adjustment; b) the vantage point of the observer influences adjustment ratings; c) judgments of overall improvement encompass the major dimensions of adjustment; and d) judgments of overall improvement represent changes in adjustment levels. With regard to the first issue, the data indicate that each major dimension of adjustment has a somewhat different pattern over time. Secondly, a substantial consensus exists between patients and their significant others concerning patients' adjustment relative to the adjustment of other patients as described by them and their significant others, although not in terms of the actual magnitude of their adjustment. Third, global improvement ratings are related to two dimensions of adjustment primarily (symptomatology and social involvement), and they are virtually unrelated to other major dimensions. Finally, global improvement ratings are highly reflective of the current level of adjustment. The relevance of these findings to outcome assessment is discussed and some suggestions are offered.

Therapeutic reversal with benxtropine in schizophrenics. Practical and theoretical significance.

Abstract: The effect of an anticholinergic antiparkinsonism drug, benztropine, on the therapeutic course of neuroleptic treatment in 18 schizophrenics was investigated in a double blind cross-over study involving haloperidol and chlorpromazine. Significant therapeutic reversal was observed with benztropine in terms of the social, affective,and cognitive dysfunctions chracteristically seen in schizophrenic psychosis. The hallucinatory behavior and disturbed attention were not so affected. The aspects of the clinical picture to show significant nontherapeutic change with benxtropine differed with the stage of treatment and seemed to be determined by the kinetics of the therapeutic process. The effect was one of exacerbation of the disorder and not a toxic confusional state sometimes associated with anticholinergic drugs. The practical and theoretical significance of these findings was discussed. It was suggested that the benztropine reversal of therapeutic changes provided a valuable pharmacological model for understanding the neurobiological basis of schizophrenic decompensation and its restitution with neuroleptics. The reported data were considered as indirect evidence suggesting that cholinergic neuronal mechnisms are involved in both of these processes. It was speculated that these mechanisms may well be the cholinergic suppressor systems, such as the periventricular catecholamine pathways in the limbic organization and bsal ganglia known to be affected by neuroleptics.

Electroconvulsive therapy and memory.

Abstract: Recent research on the effects of electroconvulsive therapy (ECT) on memory is critically reviewed. Despite some inconsistent findings, unilateral nondominant ECT appears to affect verbal memory less than bilateral ECT. Adequate research on multiple monitored ECT is lacking. With few exceptions, the research methodologies for assessing memory have been inadequate. Many studies have confounded learning with retention, and only very recently has long term memory been adequately studied. Standardized assessment procedures for short term and long term memory are needed, in addition to more sophisticated assessment of memory processes, the duration of memory loss, and qualitative aspects of memories.

Hypnosis and the EEG. A quantitative investigation.

Abstract: A quantitative investigation of the EEG during hypnosis was made by analyzing the analogue power frequency spectrum of one group of subjects in the awake and hypnotized conditions, and another group (random sample) in the awake condition. Individuals of the first group were thoroughly experienced in self-hypnosis and highly hypnotizable, whereas those of the second group had never been hypnotized and were low in waking suggestibility. There were no statistically significant differences in mean power of the whole EEG spectrum between the awake and hypnotized conditions of the experimental group, although a trend toward increased theta (4 to 8 Hz) density during hypnosis was apparent. This group, however, exhibited significantly more theta activity during both the hypnotized and the awake conditions than the random sample of controls in the awake condition, irrespective of whether the eyes were closed or open. We suggest that this increased theta density in the EEG is related to frequent experience of self-hypnosis, high hypnotizability, or both.

Transcendental meditation, altered reality testing, and behavioral change: a case report.

Abstract: This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practice of TM and altered

A context analysis of psychological states prior to petit mal EEF paroxysms.

Abstract: This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during nonparoxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally silences than during the patient's speech (for two of the three patients)--talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.

Hysteria, hypnosis, psychopathology. History and perspectives.

Abstract: A historical outline is given of the search for an explanation of the still elusive nature of hysteria and hypnosis, their mutual relationship, and that which they bear to psychopathology. Charcot regarded hypnosis as an artificially induced hysterical neurosis, and it was he who first introduced Freud to these two states. Freud was the first to see in hypnosis an experimental instrument for understanding psychopathological mechanisms. His subsequent conceptualization of psychoanalysis derived from these two phenomena at this decisive period. In 1895 Freud attempted to achieve a psychophysiological synthesis of the mental apparatus in his "Project for a Scientific Psychology," but then decided not to publish it. Whether or not recent advance in neurophysiology are sufficiently important bo bring about this synthesis remains an open question. In recent years some psychoanalysts have become interested in hypnosis, which one of them described as a focus for psychophysiological and psychoanalytic investigations. Any theory of the psychical apparatus which does not account for such an obvious psychical phenomenon must necessarily be incomplete. Since Charcot, hysteria presents hardly any new openings for experimental work. It is suggested that the solution of psyche-soma interaction might be sought in the study of hypnosis. It is postulated that hypnosis is a "fourth organismic state," not as yet objectifiable (in contradistinction to the waking state, sleep, and dreaming): a kind of natural or inborn mechanism which acts as one of the regulators of man's relationships with the environment. The author discusses briefly the aims and methodology of future interdisciplinary research on hypnosis, and the study of the transition from one state of consciousness to another, and their potential application to a wide range of subjects, namely, wherever man's relations with the environment are involved.

Psychiatric complications following coronary bypass surgery.

Abstract: Previous studies of psychiatric complications following open heart surgery have included few if any patients who had coronary bypass surgery. This experiment reports the relative incidence of psychiatric complications in a sample of 97 open heart surgery patients of whom 51 patients (53 per cent) ha

Clinician attitudes toward the suicide attempter.

Abstract: The clinical and sociodemographic characteristics and dispositional outcome of 248 suicide attempters were studied in a general hospital emergency room. A mood adjective checklist was completed by evaluating psychiatric residents and three orthogonal factor analytically derived mood clusters were related to sociodemographic, clinical, and dispositional variables. Residents expressed warmth toward patients having low suicide risk and limited overall psychopathology. They felt anxious toward patients with high suicidal risk and significant psychopathology. Angry feelings were reported toward patients with high suicidal risk in the absence of recent precipitating events. Residents reported warmth toward patients admitted to private or mental health center vs. state hospital facilities and tended to devote more time to their clinical assessment of these patients. Feelings of anxiety and anger characterized the responses to state hospital admissions who were only briefly assessed. The findings have implications for the organization of clinical services and the training of mental health professionals. Supervision needs to be directed to the recognition and modification of therapist emotional attitudes as well as to the understanding of patient psychopathology. Clinician feelings can then be effectively utilized to "capture" a high risk, high drop-out population into effective follow-up care. Language: en

Rapidity of symptom reduction in depressions treated with amitriptyline.

Abstract: A group of depressed women treated with amitriptyline was studied with particular attention to the speed of response in different symptoms of depression and in psychotic as compared to neurotic depressives. The findings showed rapid improvement in suicidal feelings, insomnia, and anorexia, but slower and more gradual improvement in impaired work and interests, retardation and pessimism and hopelessness. Psychotic depressives did not show substantial improvement until the third week of treatment whereas neurotic depressives improved markedly within the first week. It is suggested that the psychotic classification may be more useful as a predictor of speed of response than as a predictor of final treatment outcome.

The self-esteem motive and change in self-attitudes.

Abstract: The theoretical significance of the postulate of the self-esteem motive and related empirical findings are reviewed. Two hypotheses implied by the postulate are tested by way of further consideration of its justification. Hypotheses were tested using questionnaire data from 3148 junior high school students collected annually at three points in time. It was hypothesized and observed that a) mean self-derogation scores of the population would decrease significantly over time; and b) individuals with initially more negative self-attitudes relative to those with initially more positive self-attitudes would display significantly greater decreases in self-derogation over time. The findings are interpreted as support for the prevalence of the self-esteem motive. The observed increase in self-derogation over a 1-year period in persons with initially positive self-attitudes is discussed with regard to the literature on developmental disturbances in self-image; differential volunerability to self-devaluing experiences; and the relationship between change in, and level of, self-acceptance.

The family histories of manic-depressive patients with and without alcoholism.

Abstract: An investigation of family histories of bipolar affective disorder patients with and without an additional diagnosis of alcoholism showed that affective disorder was seen with equal frequency in both populations of relatives. Alcoholism was significantly more prevalent in relatives of the alcoholic probands than in the relatives of those who did not themselves have alcoholism. These data suggest that bipolar affective disorder and alcoholism may be transmitted independent of one another.

Integration and sealing-over as recovery styles from acute psychosis.

Abstract: Integration and sealing-over are terms frequently used to describe different types of recovery from acute psychosis Metapsychological and dynamic propositions regarding integration and sealing-over as recovery styles are presented and illustrated with clinical case material Particular emphasis is placed on the different modes of conflict resolution characteristic of integration and sealing-over The ego operations underlying these modes of conflict resolution are discussed

Patterns of neuropsychological test performance in Huntington's disease.

Abstract: Neuropsychological test performances of Huntington's disease (HD) and a mixed brain-damaged group were compared. Wechsler patterns in the present samples were compared to those of HD patients in the study of Boll et. al. (1), and some correspondence specific to HD is suggested. Minnesota Multiphasic Personality Inventories (MMPIs) were found not to differ between the HD and mixed brain-damaged groups.

Lithium in treatment failures.

Abstract: Thirty-five patients with chronic and incapacitating mental illness who had not responded to the usual pharmacological and interactional therapies were treated with lithium. None of these patients appeared to be suffering from manic-depressive illness. If a trial of lithium resulted in unexpected improvement, lithium's contribution was assessed by double blind substitution of a placebo followed by lithium in an A-B-A-B design in which the patient served as his own control. Five patients (14 per cent) improved dramatically; in retrospect, four of these five patients suffered from nonremitting forms of manic-depressive illness, and the fifth patient suffered from a severe obsessive compulsive neurosis. Six other chronically hospitalized patients improved to the point of unexpected discharge. A trial of lithium therapy is recommended for the "backward" or intractable patient.