Showing papers in "Journal of Nervous and Mental Disease in 1978"

Social adjustment by self-report in a community sample and in psychiatric outpatients.

Abstract: Data are presented on social functioning derived from a self-report social adjustment scale (SAS-SR) administered to 774 subjects including a community sample and three psychiatric outpatient populations: acute depressives, alcoholics, and schizophrenics. This self-report scale derives from an interview form and was developed and tested on depressed outpatients. Since its publication, it has been used in populations other than depressives including other psychiatric patients, nonpsychiatric patients, and nonpatients. The purpose of this paper is to make data available to other investigators on results of this self-report social adjustment scale in a broad range of subjects and to describe further the psychometric properties, limitations, and utility of the scale. Findings show that the scale has wide applicability in a range of subjects but that certain cautions should be followed in using it with chronically impaired psychiatric populations who may not be involved in the major roles assessed by the scale.

Life event stress, social support, coping style, and risk of psychological impairment.

Abstract: The effects of life event stress, coping style, and social support on psychological impairment were examined in a survey of a representative Australian suburban sample (N = 863). Psychological impairment was defined as a score of 4 or more on the 20-item General Health Questionnaire. Life event stress, coping style, and one of the social support variates, crisis support, were related to impairment, significantly decreasing or increasing the risk of being identified as impaired from the total sample frequency of 24 per cent. There was no evidence that coping style or social support became associated by moderating the relationship between life event stress and impairment, but rather because of their independent relationship with psychological impairment.

Some Issues in Research on Stressful Life Events

Abstract: We will start with a question: Do you believe that life stress can cause illness? If this question were included in a poll of either the general public or of concerned professionals, we would expect a nearly unanimous affirmative response; “nearly unanimous” only because if we asked a cross-section of the population whether they believed that the sun would rise tomorrow, probably someone would express doubt. At one time in human history, when belief in the rising of the sun was a matter of hope and faith, this doubt might have seemed reasonable. It no longer seems so because this daily event has long since become scientifically predictable. Can we say the same about the belief in the relation between life stress and illness? Is it firmly based on scientific evidence, or is it still a matter of faith? We will argue that at present the belief that life stress causes illness is based on faith bolstered by some scientific evidence. Given this argument, we will then describe the kind of work that seems to be needed in order to shift the balance to favor scientific evidence.

Psychological correlates of monoamine oxidase activity in normals.

Abstract: This study replicates and extends earlier work by finding that low levels of platelet monoamine oxidase (MAO) activity correlate with sensation seeking, high ego strength, positive affect, and high leisure time activity levels, somewhat similar psychological correlates also being found for plasma am

The frequency and persistence of depressive symptoms in the alcohol abuser.

Abstract: A survey of 61 outpatients admitted to a mental health center for the treatment of alcoholism determined that a majority of them (59 per cent) were clinically depressed The depressive symptoms were rarely treated with anti-depressant agents and, at 1-year follow-up, were found to persist even though the patients had attended the standard treatment program for alcoholics There is need for new treatment strategies that recognize the diagnostic heterogeneity of the alcoholic and that consider the use of appropriate psychopharmacological agents

Toward a rationale for the seclusion process.

Abstract: The present paper summarizes three studies focusing on different aspects of seclusion room practices. The first study involved chart reviews to collect empirical data on reasons for seclusion, length of seclusion, and characteristics of secluded patients. The second study focused on staff attitudes toward seclusion; the third dealt with the attitudes of both secluded and nonsecluded patients. The average time of seclusion was approximately 4 hours and in most cases aggressive behaviors of various types were cited as the precipitating event. In addition, patient and staff attitudes implied that a major function of the seclusion process was to isolate patients from disturbing interactions and to maintain the smooth functioning of the ward minisociety. Two models of seclusion, an ethological model and a behavioristic “time out” model, were developed in order to integrate the results of these studies. Implications of the findings and models are presented for changes in seclusion room procedures.

Is a familial definition of depression both feasible and valid

Abstract: On the basis of familial constellations it is possible to separate out most of the unipolar depressive patients that are seen in the hospital. The groups may be called depression spectrum disease, pure depressive disease, and sporadic depressive disease. The sporadic depressive disease group is olde

Using neuropsychological and personality tests to assess the likelihood of patient employment

Abstract: This study assessed the ability deficits and personality disturbances associated with three levels of employment in patients referred for neuropsychological testing. Highly significant group differences were found, with the unemployed group consistently showing greatest pathology on the tests, the full time employed group performing relatively normally, and the part time employed group earning intermediate scores. A discriminant function which used both neuropsychological and personality measures was found to discriminate unemployed from full time employed patients satisfactorily. Classification rates achieved by the function for validation and cross-validation samples support its clinical utility in identifying new patients who are at high risk for unemployment. It appears that psychological tests commonly used in neurological and psychiatric diagnosis can also help predict some aspects of patients' abilities to function in everyday life.

Secondary depression in anxiety neurosis.

Abstract: Forty-four per cent of 112 patients with anxiety neurosis reported episodes of depression during the course of their illness compared with only 7 per cent of surgical controls. Although the majority developed in response to environmental circumstances and were of brief duration, they commonly led to psychiatric treatment or hospitalization in this group of patients. Patients who developed this complication were shown to have a more chronic and severe underlying illness.

The diagnosis of antisocial and hysterical personality disorders: An example of sex bias.

Abstract: The author submits evidence to support the contention that antisocial and hysterical personality disorders are essentially sex-typed forms of a single condition The features of each condition, he argues, are either common to both disorders or are related to sexual stereotypic traits He reports on a study which indicates that mental health professionals tend to label men as antisocial personalities and women as hysterical personalities, even when these patients have identical clinical features It is suggested that a unification of the two labels could have a beneficial effect on research and on understanding and treating the disorder and related conditions

A multivariate analysis and modification of a preattentive, perceptual dysfunction in schizophrenia.

Abstract: Preattentive information processing was examined in matched samples of process nonparanoid schizophrenics, reactive paranoid schizophrenics, and nonschizophrenic psychiatric inpatients. Three measures of visual preattentive processing were administered under standard conditions and also enriched conditions in which preattentive discriminability was enhanced through increased perceptual grouping and segregation. Nonparanoid schizophrenics displayed a differential performance deficit under standard conditions on each measure. Under conditions of enhanced preattentive discriminability, nonparanoid schizophrenics differentially improved to the extent that no significant differences were found between groups on two of the measures. Paranoid schizophrenics and psychiatric controls did not differ significantly across measures or conditions.

Cerebral dysfunction in repetitively assaultive adolescents.

Abstract: A series of neuropsychological tests and an EEG examination were given to three groups of male adolescents who were inpatients in a psychiatric hospital. The groups were as follows: group 1: a group of seven patients with a diagnosis of behavior disorder, each with a history of multiple assaultive i

The Klüver-Bucy syndrome in man.

Abstract: It is apparent that the importance of the limbic system is essentially for survival. The inability to discriminate enemy from friend as well as loss of the proper affective response to what is dangerous or safe to the organism may be thought of as more central to survival than what is described as "other higher intellectual functions." The case described is a dramatic expression of such a transient limbic dementia originally described by Kluver and Bucy in their syndrome. Since Kluver and Bucy originally described their syndrome, the structural and functional understanding of the limbic system has been greatly increased. Although a rare occurrence in man, the Kluver-Bucy syndrome serves as a demonstration of an unusual brain syndrome whose theoretical and experimental basis has been greatly enlarged since first described.

Single case study. Possible organophosphate-induced parkinsonism.

Abstract: A case of possible organophosphate-induced parkinsonism is presented. The patient was a crop duster with numerous episodes of acute organophosphate intoxication and chronic organophosphate exposure. The etiology of parkinsonism is discussed in terms of a balance hypothesis between cholinergic and dopaminergic neurotransmission in the striatum. A possible relationship between chronic organophosphate exposure and alterations in central cholinergic or dopaminergic activity is suggested. The course of this patient raises the possibility that agricultural workers may be at risk for the late development of parkinsonism.

Evangelical religion and meditation: psychotherapeutic effects

Abstract: Members of a religious sect, the Divine Light Mission, were evaluated for psychological effects of their experience in the group, in order to study systematically the psychotherapeutic effect of evangelical religious experience. Responses given by 119 members to a multiple choice questionnaire refle

BRIEF COMMUNICATION: Tricyclic Exacerbation Of Steroid Psychosis

Abstract: Four patients in a series of 14 cases of steroid psychosis where steroids were used to treat disease not effecting the central nervous system, are reported. All demonstrated a predominantly affective mood change prior to initiation of treatment with tricyclic antidepressants by the primary physician. In each case, the patient's mental state deteriorated rapidly following initiation of tricyclics in mid-dose range (i.e., 100 to 150 mg q.d.). These agents produced a qualitative change in the nature of the patient's psychosis rather than simply aggravating pre-existent features. All patients experienced visual hallucinations within 4 days of tricyclic administration. Persistent auditory hallucinations (two cases) became threatening, accusatory, and constant. The exacerbated psychosis cleared rapidly with the discontinuation of the antidepressant and the addition of a phenothiazine. Phenothiazines, in doses of 400 to 800 mg q.d., were necessary to reverse the symptoms of these patients. Phenothiazines were also required to produce a salutary effect in the 10 patients who did not receive tricyclics, but at an average dose of only 200 mg. Steroids raise the effective blood level of tricyclics and alter central catecholamine movement across membranes. These changes may represent the mechanism for exacerbation of steroid psychoses.

Neuropsychological assessment of schizophrenia versus brain damage: a review.

Abstract: The previous 10 years of research comparing neuropsychological test performances of adults diagnosed as schizophrenic with adults diagnosed as brain damaged is reviewed. Current concepts and criteria for classifying and sub-classifying patients in terms of brain damage and schizophrenia are presente

Pedophilia occurring after onset of cognitive impairment

Abstract: Four married patients are reported who first manifested pedophilia and other signs of disinhibition after sustaining illnesses that led to cognitive impairments. Although pedophilia may often be related to a long-standing inadequacy of sexual functioning, the onset of pedophilia in an individual without a previous histroy of sexual perversion may indicate the presence of recently sustained cognitive impairments.

Clinical course of adult metachromatic leukodystrophy presenting as schizophrenia. A report of two living cases in siblings.

Abstract: Adult metachromatic leukodystrophy is a demyelinating disease due to an inherited lack of arylsulfatase A activity. The purpose of this paper is to present the characteristics of this disorder as they occurred chronologically in two siblings, prior to and subsequent to the appearance of gross neurological deficits. A deficit in spatial relationships, as contrasted with verbal abilities, was observed initially in both cases at age 13. Initial psychiatric symptoms were noted at age 16 and 18, with both patients being diagnosed subsequently as schizophrenic. Gross neurological deficits were observed 2 and 13 years, respectively, after the appearance of psychiatric symptoms. A deficit in spatial relationships may be a very sensitive early indicator of adult metachromatic leukodystrophy.

Clinical assessment: use of nonphysician interviewers.

Abstract: A comprehensive structured psychiatric interview suitable for use by nonphysicians is described and its reliability evaluated. The schedule, called the Home Environment and Lifetime Psychiatric Evaluation Record (HELPER), includes extensive social background data, assessment of home environmental factors, and all items necessary for psychiatric diagnoses using several available sets of operational criteria. This schedule emphasizes the lifetime chronology of events and includes more detailed assessment of nonaffective symptomatology and social environmental background than other available instruments. Thirty-four psychiatric inpatients were assessed by physicians and nonphysicians using an interviewer/observer design. Inter-rater agreement for psychiatric symptoms and 11 possible syndromes was substantial (mean K 0.70 and 0.72, respectively) and for home environmental experience it was excellent (mean K 0.88). Nonphysician interviewers made ratings comparable to those of physicians even for those items thought to require the most clinical and medical judgment. The reliability and usefulness of nonphysician interviewers as part of a research team are demonstrated by these findings. More extensive application of structured psychiatric interviewing is encouraged.3

Urinary catecholamines and amphetamine excretion in hyperactive and normal boys.

Abstract: Urinary catecholamines and metabolites and urinary amphetamine excretion were examined for hyperactive and normal boys following a single dose of dextroamphetamine (0.5 mg/kg) and placebo. Hyperactive children showed a significantly faster rate of excretion of amphetamine which could not be accounted for by previous exposure to drug or by signs of neurological involvement. Urinary norepinephrine (NE) was significantly higher for hyperactive than for normal children, but NE excretion did not correlate with motor activity or any measures of arousal. The single dose of amphetamine produced a significant rise in urinary epinephrine excretion (EP) for the normal children but not for the hyperactive group, supporting the notion of a more sluggish catecholamine response to stimulants for hyperkinetic children.

A psychological profile of the transsexual. I. The male

Abstract: The present research introduced standardized psychological measurement into the clinical assessment of the male transsexual. Thirty-one males with a presenting complaint of gender dysphoria were carefully screened as to their correspondence with current nosological conceptions of transsexualism, and administered the Derogatis Sexual Functioning Inventory (DSFI) as part of their clinical psychometric work-up. The DSFI is an omnibus self-report scale providing measurement in the primary domains of sexual information, sexual experiences, sexual drive, sexual attitudes, psychological symptoms, affects, gender role definition, and sexual fantasy. Transsexual profiles were contrasted with those of a comparison group of 57 normal heterosexual males. Results of the comparisons revealed the transsexuals to show a significant decrement in accurate sexual information, and a marked reduction in the variety of sexual experiences they have been involved in. They also revealed a reduction in drive levels; however, this was qualified by which indicator of drive was used. Significant elevations in psychological symptoms and dysphoric affect were also noted, particularly of a depressive nature. Gender role definitions were markedly polarized in the feminine direction for male transsexuals, and their fantasy endorsements revealed some of the classic transsexual themes. The ability to develop this quantified and standardized psychological profile is viewed as an important step in accurately assessing the nature of these complex individuals, and developing a more accurate understanding of their condition.

Patterns of disorder in first admission psychiatric patients.

Abstract: Are there patterns of characteristics in psychiatric patients, different from traditional diagnostic considerations, that could provide important information for understanding, treatment, and research? To pursue this question, this report describes an investigation of clinical and demographic characteristics in a representative sample of first admissions for functional psychiatric disorder. Analyzing the patterns of these characteristics showed that social class had a particularly key role relating to a larger number of characteristics than did symptom and functioning measures. Symptoms when analyzed together revealed replicated factors not corresponding to diagnostic types. The implications of these and other findings for considering a broad perspective in conceptualizing, studying, and treating psychiatric disorder are discussed.

Alcoholic MMPI subtypes. Relationship to drinking styles, benefits, and consequences.

Abstract: The present study was designed, first, to attempt to replicate the previously derived Goldstein and Linden Minnesota Multiphasic Personality Inventory alcoholic personality subtypes, and second, to relate these personality patterns to a multidimensional measure of alcohol usage. Two of the previously obtained profile types were replicated through two independent cluster analytic procedures. These subtypes were defined as psychopathic and neurotic-depressive, respectively. Higher levels of drinking-related impairment were associated with anxiety and depression, while lower levels of impairment were related to psychopathic features among patients hospitalized primarily for alcoholism. However, relatively heterogeneous, distinctive configurations of reported drinking benefits, styles, and consequences were found across the Goldstein-Linden subtypes. Methodological factors potentially contributing to the failure to replicate two of the previously derived subtypes were discussed. The potential therapeutic utility of a multivariate classification of personality functioning and the use of a multidimensional assessment of alcohol usage within alcoholic populations was also discussed.

Cognitive and evoked response measures of information processing in schizophrenics with and without a family history of schizophrenia.

Abstract: Twenty-four male schizophrenics, 12 (SFH) with schizophrenia in the immediate family and 12 (SNFH) with no evidence of schizophrenia in the family background, and 24 male control subjects, 12 highly educated (HEC), and 12 minimally educated (MEC), were assessed for premorbid social adjustment and were administered the Digit Symbol Substitution Test, a size estimation task, and the EEG average evoked response (AER) at different levels of stimulus intensity. As predicted from the stimulus redundancy formulation, the SFH patients were poorer in premorbid adjustment, were less often paranoid, functioned at a lower level of cognitive efficiency (poor digit symbol and greater absolute error on size estimation), were more chronic, and, in some respects, had size estimation indices of minimal scanning. Contrary to prediction, the SFH group had the strongest and most sustained augmenting response on AER, while the SNFH group shifted from an augmenting to a reducing pattern of response. The relationship between an absence of AER reducing and the presence of cognitive impairment in the SFH group was a major focus of discussion.