Showing papers in "Journal of Nervous and Mental Disease in 1977"

The stress-buffering role of social support. Problems and prospects for systematic investigation.

Abstract: Over the pase 20 years, a sizable body of literature has developed which serves to establish that stressful life events are associated with the onset, incidence, and prevalence of a wide range of physical and psychiatric disorders. As measured by the Holmes and Rahe Social Readjustment Rating Scale, or similar instruments, the stressful life events are fundamentally sociological in nature. Yet, paradoxically, the research has been largely limited in the relevant basic sociological theory and data brought to or yielded from investigation. Recently, however, several prominent researchers have emphasized the importance of studying the role of social support systems as possible buffers or mediators of stress. The most basic objective of this paper is to contribute to the advancement of such studies by clearly identifying key empirical, theoretical and methodological problems and suggesting some approaches to their resolution. Specifically, this paper offers: a) a selective review of the essential status of empirical knowledge; b) an examination of the nature and significance of social support systems; c) clarification of methodological and theoretical problems; and d) detailed proposals for approaching problems of measurement and research design.

Conditions predisposing to suicide: a review

Abstract: By reviewing causes of death among cohorts of various major disease entities or conditions, one may infer that a large majority of suicides are associated with a relatively small number of conditions. From the available follow-up studies, we might estimate that the following percentage of affected individuals will die by suicide: primary (endogenous) depression, 15 per cent; reactive (neurotic) depression, 15 per cent; alcoholism, 15 per cent; schizophrenia, 10 per cent; psychopathic personality, 5 per cent; opiate addiction, 10 per cent or more. Rough estimates of the number of suicides per year in the United States attributable to each condition might be as follows (using low incidence figures): depression, 12,900; alcoholism, 6,900; schizophrenia, 3,800; psychopathy, 2,000 (?); drug addiction, 900.

Modulation of emotion with a brain pacemamer. Treatment for intractable psychiatric illness.

Abstract: A treatment involving chronic implantation of a receiver that can be activated by an external power source to stimulate specific brain sites has been used in 11 patients with intractable psychiatric illness. All of the patients, a heterogeneous group, had failed to respond to all indicated treatments. Length of illness varied from 6 to 23 years without significant remission. Of the 11 patients, four had uncontrollable violence-aggression (two with no demonstrable organic brain disease and two with brain pathology), five were chronic schizophrenics, and two had lifelong patterns of severe neurosis in addition to the disabling disorder for which the procedure was performed. Three of the 11 patients had seizures in addition to behavioral pathology. Ten of the 11 patients are out of the hospital and functioning without medications or other treatment. Some are symptom-free and others have shown significant improvement. The one patient who failed to respond had an organic lesion over the cerebellar site that was to be stimulated. The rationale for the procedure was based on data gathered during earlier therapeutic studies in patients with depth electrodes and extensive anatomical and physiological experiments in animals. The transistorized stimulator used in treating these patients is similar to stimulators being used for treatment of epileptic and spastic patients.

Illness behavior, social adaptation, and the management of illness. A comparison of educational and medical models.

Abstract: Motivational needs and coping are important aspects of illness response. Clinicians must help guide illness response by suggesting constructive adaptive opportunities and by avoiding reinforcement of maladaptive patterns. This paper examines how the patient's search for meaning, social attributions, and social comparisons shapes adaptation to illness and subsequent disability. It proposes a coping-adaptation model involving the following five resources relevant to rehabilitation: economic assets, abilities and skills, defensive techniques, social supports, and motivational impetus. It is maintained that confusion between illness and illness behavior obfuscates the alternatives available to guide patients through smoother adaptations and resumption of social roles.

Psychological Effects of Mastectomy on a Woman's Feminine Self-Concept

Abstract: Previous literature on mastectomy indicates that the operation may be perceived by the patient as a threat to her femininity. Accordingly, the present study attempted to measure changes in body image, self-concept, and total self-image in mastectomy patients and two control groups (biopsy and surgical controls). Patients were given a questionnaire measuring the concepts in question three times. 1 day before surgery: 6 days after surgery; and 6 to 11 months later. There were distinctly different patterns of results for the three groups. Mastectomy patients did indeed evince a decline in body image and total self-image, but not until months after surgery. This was not unexpected in light of previous findings of massive denial in mastectomy patients. Immediately after surgery, this denial would be at its strongest, and it is feasible that it would take some months of reality testing until the denial is no longer a necessary defense. Biopsy patients showed a decline in body image and total self-image immediately after surgery, when their denial was no longer needed. Surgical control patients showed little overall change Thus, mastectomy patients do appear to react to the operation with a decline in self-image, although this does not appear until some time after the operation.

Handedness and the lateral distribution of conversion reactions.

Abstract: The purpose of this investigation was to determine whether the observation of Ferenczi and Purves-Stewart that conversion reactions occur with higher frequency on the left side of the body than on the right side could be confirmed. Both right-handed and left-handed patients experienced a higher proportion of left-sided symptoms (weakness or paralysis; sensory loss or numbness) than would be expected by chance, indicating a lack of support for the hypothesis that unilateral conversion symptoms occur most frequently on the most "convenient" (nondominant) side of the body. These findings and prior reports of left-sided lateralization of psychogenic pain were interpreted as support for the hypothesis that the right cerebral hemisphere is particularly involved in the mediation of affectively or motivationally determined somatic symptoms. The question of a possible link between these results and certain symptoms of disease of the right hemisphere was raised.

Suicide prevention centers. Ecological study of effectiveness

Abstract: While suicide prevention services are continually expanding, efforts to measure their efficacy are seldom found in the literature. This study examines the effect of suicide prevention centers in North Carolina on the suicide rate in 1970. The data are examined in a ecological context, i.e., pertinent demographic variables are included in the analysis of the suicide rate in North Carolina counties with an emphasis on structural and contextual effects. A review of the literature on suicide prevention center efficacy, a description of those counties in North Carolina that support such centers, and a rigorous testing of their effect on the countywide suicide rate are undertaken in the present analysis. All of the analyses of the data indicate that the centers have minimal effect on the suicide rate.

A controlled study of siblings of hyperactive children.

Abstract: A controlled study of siblings of hyperactive boys resulted in the following findings The hyperactive child syndrome is more common among brothers of hyperactive children than among brothers of controls (26 per cent vs 9 per cent) Both probands and their brothers presented with more symptoms of depression-anxiety than controls The probands, but not their sibs, presented with more antisocial symptoms than controls Although differences in intelligence and achievement scores were found between probands, their sibs, and controls, both intelligence level and academic achievement were within normal limits in all groups

Psychopathology in children of inpatients with depression: a controlled study.

Abstract: One quarter of 29 parents hospitalized for depression had children with episodes of depression (eight out of a total of 75 children). None of the children in 41 families with well parents had episodes of depression (a total of 152 children). The differences were significant at the .01 level.It is su

Neuropsychological aspects of multiple sclerosis.

Abstract: Twenty-six persons (five males and 21 females) with the neurological diagnosis of multiple sclerosis, and an equal number of control subjects matched on age, sex, and education were given a battery of tests designed to assess motor and intellectual functioning. Subjects in the multiple sclerosis gro

Depersonalization in accident victims and psychiatric patients.

Abstract: A transient depersonalization syndrome was identified in nearly one third of persons exposed to life-threatening danger (accident victims) and close to 40% of a group of hospitalized psychiatric patients. Although the syndrome was similar in these populations, mental clouding developed more commonly among patients and alertness was more prominent among accident victims. Anxiety was significantly associated with the development of depersonalization among psychiatric patients and was almost certainly a factor in its appearance among accident victims. The findings suggest that this syndrome is a specific response to extreme danger or its associated anxiety. Language: en

Neuropsychological correlates of chronic alcoholism and aging.

Abstract: Independent investigations of alcoholism and aging have demonstrated significant parallels between the two phenomena suggesting the possibility of “premature aging” as a result of alcoholism. To test this hypothesis a cross-sectional design was utilized with three groups of 20 male subjects: young n

Dimensions of family therapy.

Abstract: This article is a description of different approaches to therapy with a family orientation. There are general categories of family therpay which had their origins in individual therapy, such as the approaches based upon psychodynamic theory, those derived from experiential procedures, and the behavioral approaches. There are also family therapies which have not developed from individual therapy, such as the extended family system approach and the communication school of family therapy. The different therapy approaches are described within a set of dimensions which characterize most therapy. Such dimensions include whether the past or present is emphasized, whether the therapist uses interpretation or directives, whether the approach is in terms of growth or specific problems, whether hierarchy is a concern, and whether the unit is an individual, two people, three people, or a wider network. Illustrations of the different family therapy approaches are given in terms of the kinds of information that would interest the therapist of each school and the kinds of actions he or she would take to bring about change.

Catatonia and malignant syndrome: a possible complication of neuroleptic administration. Report of a case involving haloperidol.

Abstract: An unusual, acute extrapyramidal reaction, which resulted from treatment with haloperidol and which was unresponsive to standard anticholinergic treatment and indistinguishable on clinical grounds from acute catatonia, is described. Because the etiology of this reaction was not appreciated, progressive, life-threatening physiological deterioration ensued accompanied by unremitting neuromuscular symptoms, a clinical picture resembling both "lethal catatonia" and the rare "neuroleptic malignant syndrome." The literature on these conditions is reviewed and various problems in differential diagnosis are discussed. It is proposed that some cases of the neuroleptic malignant syndrome and perhaps lethal catatonia may represent the evolution of severe extrapyramidal reactions.

Responses of paranoid and nonparanoid schizophrenics in a dichotic listening task.

Abstract: Differences in attentional processes between normals, paranoid schizophrenics, and nonparanoid schizophrenics were studied by delivering dichotically presented digits for identification. Thirty paranoid schizophrenics (20 acute and 10 chronic), 30 nonparanoid schizophrenics (20 acute and 10 chronic), and 20 normal controls were tested. The data were analyzed in terms of the overall level of correct identification of stimuli presented to the two ears, the number of shifts in report from one ear to the other, and the magnitude of ear differences in recall. The results showed that overall level of performance was higher for the normals than for the schizophrenics; the number of ear shifts was greater for normals and nonparanoid than for paranoid schizophrenics; and ear differences were biggest for the paranoid schizophrenics and smallest for the normals. The results were interpreted in terms of differences in attentional style and rate of information processing.

Auditory imagery and hallucinations.

Abstract: Theories of hallucination and research on the formal properties of imagery suggest that vividness and controllability of volitional auditory imagery are important variables in the relationship between imagery and hallucination. A sample of 20 hallucinating schizophrenics, 20 nonhallucinating schizop

Levodopa, parkinsonism, and recent memory

Abstract: Much controversy has existed concerning behavioral changes attributed to L-dopa treatment in parkinsonian patients. Disagreement existed pertaining to the question of whether improved functioning was temporally limited. The present study proposed to research the shorter and longer range effects of L-dopa onmemory. It was hypothesized that equated nonparkinsonian individuals would perform better than parkinsonian patients on all memory measures, and that shorter range L-dopa would perform better than longer range L-dopa patients. It was also hypothesized that the greater the functional deficiency, and the greater the symptom severity, the poorer memory functioning would be. Level of dosage was hypothesized to have no differential effect on memory functioning. Three groups of 20 subjects were tested. The short term (20 parkinsonian patients on L-dopa for 22 months or less) and the long term (20 parkinsonian patients on L-dopa for 40 months or more) patients were chosen from the neurological clinic at St. Barnabas Hospital, Bronx, N.Y. Testability was assessed by the neurologis and by WAIS Vocabulary performance. The third group consisted of spouses of the patients. All groups were equated with regard to sex, age, education, and where applicable, length of illness, functional status, and symptom severity. The instruments used to measure memory consisted of the Guild Memory Test, the Memory Span for Objects, the Knox Cube, and the Tactile Memory Test. WAIS Vocabulary scaled score was used as a covariate in an analysis of covariance on each of the nine memory subtests. Statistically significant differences were obtained at the .01 level among groups on all measures. Orthogonal comparisons resulted in significant differences at the .01 level between parkinsonian patients and nonparkinsonian subjects on all measures. Short term and long term L-dopa patients differed significantly on six of the nine measures, notably those testing verbal types of memory. Significant correlations were obtained between functional deficiency and eight measures; however, symptom severity correlated with only one measure. None of the memory measures correlated significantly with level of dosage. The major conclusion was reached that all of the initial improvement shown following L-dopa initiation is not sustained permanently; the elevated level of memory functioning appears to be temporally limited.

Personality connotations of psychiatric diagnoses. Implications for a similarity model

Abstract: The major concern of this study was to identify the personality traits connotated by a number of diagnostic labels such as paranoid, schizoid, hysterical, and cyclothymic. Twenty psychiatrists were given a list of nonpsychotic personality disorders and were asked to indicate what personality traits were typically associated with them. Results showed good agreement among psychiatrists on the personality traits they believed to be implied by the diagnostic terms. A factor analysis of the ratings showed a circular configuration of relative similarity among the different diagnoses. The results are interpreted as indicating that diagnostic labels are types of codes for various sectors of an implicit space of traits, signs, and symptoms.

MMPI correlates of adaptive ability deficits in patients with brain lesions.

Abstract: In the present study the relationship between MMPI variables and adequacy of function in verbal and performance intelligence, concept formation, sensory-perceptual and motor skills was examined in 129 subjects with definite evidence of cerebral lesions. Patients with greater impairment of abilities showed higher elevations on the MMPI variables, suggesting more emotional difficulties. Based on the present results and those of two previous studies by the same authors it was concluded that: a) MMPI variables are more closely related to measures of adequacy of function in adaptive abilities than they are to measures of lesion localization based upon pathoanatomical characteristics of the brain; and b) except for verbal skills the relationship between the MMPI variables and various adaptive skills is relatively minor. Interpretive limitations of the MMPI with brain-damaged patients and the need for devising other tests sensitive to the nuances of emotional difficulties of patients with brain lesions were discussed.

An investigation into the psychological effects of hysterectomy.

Abstract: The major aim of the present study was to determine whether women exposed to a hysterectomy procedure showed any greater evidence of postsurgery mood disorder than a cholecystectomy control group. In addition, the investigation also considered whether sterilization by hysterectomy resulted in more frequent mood disturbance than in tubal ligation where the uterus remains undisturbed. Fifty-five hysterectomy patients were compared with 38 cholecystectomy and 60 tubal ligation patients by means of the Profile of Mood States. Presurgery, 6-weeks postsurgery, and 3-months postsurgery measures were obtained. No evidence was found to support the view that the special psychological significance of the uterus results in greater postsurgery mood disturbance than occurs with a control procedure such a cholecystectomy. Neither did the results suggest that sterilization involving organ removal was psychologically more traumatic than where the sterilization procedure left the uterus undisturbed. The two significant group X occasion interactions implied that the groups differed in their pattern of responding to surgery with respect to the Tension-Anxiety and the Fatigue-Inertia variables.

The effectiveness and safety of electroconvulsive therapy (ECT).

Abstract: Over the past several decades, psychopharmacological treatments in psychiatry have been subjected to intensive methodological scrutiny in the continual assessment of their efficacy and safety. Although one of the most dramatic and controversial therapeutic approaches in psychiatry, electroconvulsive therapy (ECT) has not received the same concentrated, systematic attention. Through a comprehensive literature search, the present authors have attempted to provide answers relating to the efficacy and the safety of conventional ECT and some of its more prominent variations. Although specific discernible trends are reported in the text, results of the survey are too disparate for a simplistic summary statement to be made regarding efficacy in all diagnostic categories. As with most somatic treatments in psychiatry, bilateral ECT does present some apparent risk, reduced but not entirely eliminated by precautionary techniques, which must be weighed against the possible benefits to be derived in a given case. Other variations of ECT offer promise of fewer side effects but must be thoroughly evaluated as to effectiveness before they can be accepted as standard clinical practice.

The importance of psychiatric illness in newly arrested prisoners.

Abstract: One hundred ninety-nine male prisoners without prior felony convictions were evaluated through a structured personal interview administered within 24 hours of this arrest. While 46 per cent met psychiatric diagnostic criteria, only 5 per cent demonstrated a need for acute treatment for their affective disorder or organic brain syndrome. It is felt that the alcoholics (15 per cent) and drug-abusing prisoners (12 per cent) might benefit from counseling but were not in need of emergency care. The characteristics of men in each diagnostic group are discussed. Language: en

Depression spectrum disease versus pure depressive disease. Clinical, personality, and course differences.

Abstract: In a group of 191 women admitted to the University of Iowa Psychiatric Hospital for depression over a 45-year period and selected on the basis of alcoholism or antisocial personality, vs. depression, in a parent, 105 probands fit into the depression spectrum group (parental alcoholism or antisocial personality) and 86 into the pure depression group (parental depression). Few differences were found between the presenting clinical pictures (including precipitating factors) of the two groups; but depression spectrum patients and pure depressive patients showed study differences in the areas of personal problems and personality as well as course of illness. The depression spectrum patients were significantly less likely to have loss of interest in usual activities as a symptom at index admission. They were significantly more likely to have had a history of sexual problems, to have been divorced or separated before, to have been described as irritable, and to report having previously been depressed. They are nonetheless significantly more likely to recover completely and have no relapse of depression. The pure depression group were significantly more likely to have depressed sisters, and suicide was much more frequent in their ill parents. Thus, important personality and course differences separate depressive spectrum disease from pure depressive disease; Language: en

Carbamazepine in the dyscontrol syndrome associated with limbic system dysfunction.

Abstract: The literature has long demonstrated an association between certain behavioral problems and EEG abnormalities, particularly the association of aggressive and sometimes violent behavior with foci in the temporal lobes. The concept of “dyscontrol syndromes” has also been established and it is possible

Premorbid social competence and paranoid-nonparanoid status in female schizophrenic patients.

Abstract: The relation between premorbid social competence and paranoid-nonparanoid status was examined in a sample of 300 female schizophrenic patients. The subjects were drawn from the same state hospital employed in an earlier study conducted with male patients. The female paranoid patients were found to have better premorbid adjustment histories than the female nonparanoids. Tentative evidence was presented suggesting that the difference in premorbid social competence between paranoid and nonparanoid groups was greater for first and second admission patients than for patients with three or more admissions. The results were discussed in the context of their relation to previous research in this area. Differences between the female and male studies were noted, and the implications of sex differences in social competence were discussed both in terms of conventional measures of social competence and of the competence construct itself.

Verbal auditory hallucinations: mind, self, and society.

Abstract: Verbal auditory hallucinations of schizophrenic patients are usually sensed as coming from m-ltiple voices. The voices are usually not recognized by patients; they are anonymous. They are expressed mainly in the second person (as if directed to the patient by others), occasionally in the third person (as if two or more persons are overheard talking about the patient), very rarely in the first person. They are sensed as separate from the self and out of the patient's control. All of these characteristics can be said to describe how a person generalizes from his social experiences a societal evaluation of himself. In addition, the voices of schizophrenic patients are predominantly disparaging, call approbrious names, or are accusatory. Schizophrenics tend to come from and be of low socioeconomic status. The hallucinations appear to be related to the schizophrenic's sense of society's disparagement of him because of his low socioeconomic status and achievement.

Psychological correlates of survival on renal dialysis.

Abstract: The Minnesota Multiphasic Personality Inventory was administered to 47 male patients on the Renal Dialysis Unit at the Seattle VA Hospital. The patients were divided into three survival groups for comparison. Group A died within 1 year of initiating dialysis. Group B had been alive on dialysis between 3 and 7 years, while group C had been alive between 7 and 10 years at the time of data analysis. Group A differed significantly from group B on the Hs, D, and Hy scales, and from group C on the F, Hs, D, and Pt scales. Interpretation of the mean MMPI profiles implies that persons in group A are characterized by feelings of helplessness, high levels of depression, anxiety, and preoccupation with somatic difficulties, whereas those in groups B and C tended to be dependent, have mild levels of depression, and have a sense of hopefulness about the future. The authors suggest that psychiatric intervention might increase the longevity of those patients judged to be moderately to severely depressed with somatic preoccupations.