Showing papers in "Journal of Nervous and Mental Disease in 1981"

Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs.

Abstract: A 63-year-old woman with diagnosis of Parkinson's disease developed an unusual symptom complex which consisted of extrapyramidal symptoms, disturbances of consciousness, diaphoresis, fever, and increased serum creatine phosphokinase following the discontinuation of large doses of combined antiparkinsonian drugs. After the patient's condition did not improve with the first 14 days of treatment consisting of intravenous fluids and antibiotics, a trial administration of L-dopa and carbidopa brought about definite clinical improvement. The symptoms strongly resembled neuroleptic malignant syndrome which is often a serious complication of antipsychotic drugs. The symptoms and the treatment of the present case suggest that dopaminergic hypoactivity in the brain may be an important factor in antiparkinsonian drug withdrawal syndrome and that similar neurochemical mechanisms may exist in neuroleptic malignant syndrome.

Catharsis in Healing, Ritual, and Drama

Abstract: Catharsis In Healing Ritual And Download Catharsis in Healing, Ritual, and Drama, Thomas J. Scheff, University of California Press, 1979. Catharsis in Healing, Ritual, and Drama, Thomas J. Scheff, University of California Press, 1979, 0520041259, 9780520041257, 246 pages. . DOWNLOAD HERE Patients and Healers in the Context of Culture An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry, Arthur Kleinman, 1980, Anthropologie mГ©dicale, 427 pages. .

Postdisaster morbidity of the bereaved. A possible role for preventive psychiatry

Abstract: Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.

Are the "addiction-related" problems of substance abusers really related?

Abstract: The “addiction-related” medical, social, and psychological problems of substance abusers are often considered by-products of prolonged alcohol or drug abuse which will be generally improved following achievement of abstinence. As a test of this view, measures of problem severity in six areas commonl

Major depressive disorder. Initial results from a one-year prospective naturalistic follow-up study.

Abstract: The authors present a 1-year prospective, naturalistic, longitudinal follow-up of 101 patients with the Research Diagnostic Criteria diagnosis of definite major depressive disorder. Seventy-four per cent of patients recover by 1 year. Of those who do recover, 36. per cent have subsequent Research Diagnostic Criteria affective episodes within the year. Episodes are of long duration for both the recovered and nonrecovered patients, being 30 weeks and at least 99 weeks, respectively. Certain commonly accepted ideas about the effects of age, sex, and marital status on the course and outcome of depression are not confirmed. It is demonstrated that factors which predict recovery and relapse must be differentiated. Duration of illness predicts recovery but not future relapse, whereas number of previous episodes does not predict recovery but does predict future relapse.

The relationship between learning disability, neurological impairment, and delinquency. Results of a follow-up study.

Abstract: In a follow-up study of 203 adolescents and young adults who between the age of 8 and 12 had been referred to a neuropsychology clinic because of learning problems and of 52 control subjects, encounters with the police, offenses, and penalties were explored through a structured interview with the former clients and with their parents. Subgrouping of learning-disabled (LD) subjects into brain damage, suggested brain damage, and no evidence of brain damage in a neurological examination showed that no association between brain damage and delinquency can be demonstrated. The presence of learning disability (LD) generally did not confirm an increased likelihood of encounters with the police or a greater number of offenses although the LD group without neurological handicap did receive a slightly higher number of somewhat more severe penalties than then neurologically handicapped groups or the control group. The results of the study are at variance with the results of retrospective studies demonstrating a close association between LD and delinquency and with the association between LD and neurological disorder frequently assumed on the basis of psychological test indicators of neurological dysfunction. These discrepancies with previous studies are discussed in relation to the prospective/retrospective research design and to test vs. clinical indicators of neurological impairment.

Obsessive-compulsive disorder and primary unipolar depression. Comparisons of background, family history, course, and mortality.

Abstract: Research criteria were applied to 110 charts with a principle discharge diagnosis of obsessive-compulsive illness. The family history, course, and mortality experience of the resulting 44 patients clearly distinguished them from carefully matched inpatients with primary unipolar depression. Among se

Patterns of seclusion. A prospective study.

Abstract: The clinical use of seclusion was studied prospectively on two acute treatment units of a university hospital. The incidence, frequency, duration, precipitant, and type of seclusion were documented for 59 secluded patients through 107 episodes and compared to 159 nonsecluded controls on a variety of demographic, diagnostic, and legal variables. Chronicity, legal status on admission, and race were patient characteristics correlated with the incidence of seclusion. Mental status and diagnosis were not significantly related to the incidence or the frequency of seclusion. Seclusion was used primarily to contain physical assault upon staff. There was no relationship between the precipitating event and duration of seclusion, nor any change in duration or restrictiveness of seclusion with repeated episodes. These findings differ markedly from previous reports. The clinical bias toward increased use of seclusion with committed, chronic, and black patients, as well as the independence of cause and duration of seclusion raise legal issues already being pursued in federal courts.

How to break the logjam in schizophrenia. A look beyond genetics.

Abstract: Despite recent advances in methodology, research in schizophrenia has reached an impasse. A new thrust for research in the field is proposed, and ways for testing its validity are indicated. The status of schizophrenia research is evaluated from the vantage point of six current scientific models for its etiology: genetic, ecological, developmental, learning theory, internal environmental, and neurophysiological (including neuroanatomical), Integration of these models is proposed based on the assumption that schizophrenic episodes occur in vulnerable individuals who under sufficient stress develop a time-limited episode from which all but a small proportion recover. However, even the recovered remain vulnerable to future episodes. Potential markers for vulnerability and for the beginning and end of episodes are classified according to the six etiological models from which they emanate. Recent research in vulnerability is summarized, and directions for future research are recommended.

The treatment of social phobia. Real-life rehearsal with nonprofessional therapists.

Abstract: Sixteen socially phobic outpatients underwent a 4-week course of social skills training that attempted to maximize rehearsal in real-life settings. The therapy was largely conducted by nonprofessional volunteers after a 2-hour training workshop. It consisted of multiple role-played practice in the clinic, followed immediately by rehearsal in a real-life setting in the company of a nonprofessional therapist and a fellow patient. Subsequently, patients were randomly paired to perform further rehearsals between sessions. Drug therapy was controlled by double blind assignment to propranolol or inert placebo throughout the course of treatment. Measures of specific fears, generalized social anxiety, self-image, and global tension and anxiety were administered 1 month before treatment, immediately before and after treatment, and at 6 months follow-up. During a 4-week drug-free period prior to active treatment no improvement was noted on any measures. After the 4-week treatment period significant improvement had occurred on all outcome measures. Propranolol and placebo subgroups showed very similar results. Treatment gains were sustained at follow-up. It was concluded that repeated behavior rehearsal, both in the clinic and in real life is a cost-effective treatment procedure for many social phobias. The approach is straightforward and can be applied by nonprofessionals, including the patients themselves, after limited training and with minimal supervision.

Flurazepam-induced sleep apnea syndrome in a patient with insomnia and mild sleep-related respiratory changes.

Abstract: Sleep EEG and respiratory measures were examined in a 38-year-old man with a long-standing history of insomnia and daytime sleepiness. He was found to have seven to 18 primarily obstructive apneas per night on four baseline recordings, a finding not generally considered to be indicative of pathology. On the first two nights on which he received 30 mg of the benzodiazepine hypnotic flurazepam, there were 22 and 100 apneas, and during the daytime he became extremely sleepy. Upon cessation of medication, his clinical condition improved, and the number of apneas decreased to 11 and 6 on withdrawal nights 4 and 6. Although respiratory depression is neither invariable nor unique to flurazepam, this case suggests that it may be a clinically significant problem with recommended oral doses in some individuals.

Behavioral and cognitive effects of caffeine in boys and adult males.

Abstract: The behavioral and cognitive effects of single doses of caffeine (3 and 10 mg/kg) were studied using a double blind placebo-controlled crossover design. Subjects were 19 prepubertal boys and 20 college age men. In general, children tended to show more objective effects of caffeine than did adults, with increased motor activity, increased speech rate, and decreased reaction time. Adults generally reported side effects following caffeine while children did not, and side effects were more prominent for adults with low habitual caffeine intake. Autonomic measures of arousal were similarly affected for both age groups. Caffeine had some effects that differed from those of amphetamine, indicating distinctive actions of the two stimulants.

Bilateral skin conductance, finger pulse volume, and EEG orienting response to tones of differing intensities in chronic schizophrenics and controls.

Abstract: Skin conductance (SCOR), finger pulse volume (FPV-OR), and EEG orienting responses were examined to repeated tones of either 60- or 90-dB intensity in chronic schizophrenics, nonschizophrenic psychiatric patients, and normals. SCOR reaffirmed previous findings with schizophrenics displaying significantly more frequent nonresponsiveness to 60-dB tones, and faster habituation among patients who did respond. Increased stimulus intensity decreased the incidence of nonresponsiveness to the level of controls, but did not alter the rapid habituation of schizophrenics. These results generalized fully to the FPV-OR, despite the independence demonstrated between SCOR and FPV-OR, but did not generalize to EEG response. There were no significant differences between schizophrenics and controls in EEG reactivity-only in background activity, particularly in a slowing of dominant alpha frequency in schizophrenics. Schizophrenics displayed the same degree of bilateral asymmetry as controls in both SCOR and EEG; there was no evidence of a specifically schizophrenic asymmetry. Schizophrenics nonresponsive in either SCOR or FPV-OR showed significantly greater Conceptual Disorganization and Emotional Withdrawal, and significantly less Excitement than responders in blind clinical ratings on the Brief Psychiatric Rating Scale. None of the findings could be attributed to the effect of neuroleptics. Comparisons between medicated and nonmedicated patients showed no drug-associated effect on any OR variable under study. Drug effects were apparent only in skin conductance level (SCL). Neuroleptics were associated with a significant reduction in SCL in both schizophrenics and nonschizophrenics, together with a flattening of an otherwise incrementing SCL among schizophrenics.

Adolescent mothers' vulnerability to stress.

Abstract: This study sought to discover situational and individual variables which modify the emotional stress experienced by adolescent mothers. Sixty-four black mothers between 14 and 19 years of age were interviewed. The results of a regression equation showed that the amount of support received by an adolescent mother accounted for the greatest amount of variance in emotional stress. Adolescents who received high levels of support. A third important predictor variable was coping style. Adolescent mothers who used direct action as their method of coping with their problems reported lower levels of stress than did mothers who dealt with the emotional effects of the problem, redefined, or avoided the problem.

Do “Near Death Experiences” Occur Only Near Death?

Abstract: Near death experiences are being reported with increasing frequency, but whether the constellation of factors comprising these experiences is unique to near death situations is unknown. This investigation compared near death experiences to other out-of-body experiences to determine if there are uniq

Prevalence of depressive symptoms among mexican americans

Abstract: The evidence from most previous research suggests that Mexican Americans may have less mental illness because they either report less psychological distress than other population groups or use mental health services less frequently. Data from two surveys conducted in Alameda County, California, in 1974 and 1975 do not support either body of research. Responses to items relating to depressive symptoms suggest that the prevalence of depression may be as high or higher than it is in other groups. These results, although at variance with previous surveys and the bulk of the studies based on treatment data, do substantiate the few studies which report that mental health services utilization rates of Mexican Americans are equal to or greater than those for other groups. Although interesting, these results emanate from one community, and are based on self-reports of psychological distress. More definitive investigation of the incidence and prevalence of depression, and of other psychiatric disorders among Mexican Americans, will require epidemiological surveys using diagnostic procedures which are linguistically and culturally appropriate to this population.

A psychosocial study of chronic, circumscribed amnesia.

Abstract: N. A. has been amnesic since 1960 when he sustained a penetrating stab wound to the region of the left dorsomedial thalamus. The amnesia occurs as a strikingly circumscribed disorder in an intelligent (IQ = 124) individual without other cognitive dysfunction. Here, we attempt to characterize the nature of this amnesic disorder as revealed in daily activities, conversations, and personality. These observations are considered in the context of current views about the nature of normal memory and its neurological foundations.

The current status of urban-rural differences in psychiatric disorder. An emerging trend for depression.

Abstract: Evidence for differences in rates of psychiatric disorder by size of community is examined. Epidemiological studies reporting rates for specific diagnoses (treated and untreated) as well as those making only global assessments of psychiatric caseness are examined. An interesting trend toward higher rates of depressive disorders (excluding manic-depressive psychosis) in urban areas emerges. Differences in the availability of social support in communities in varying size is proposed as a possible explanation for this finding.

Inpatient evaluation of aggression in psychiatric patients.

Abstract: The authors rated violent and violence-related behavior of patients on a psychiatric intensive care unit, and found that despite the restricted environment such behavior was manifested to a considerable degree. The amount of violent behavior was significantly correlated with admission Brief Psychiat

Symptoms of depression among blacks and whites in an urban community.

Abstract: Prevalence of reported depressive symptoms among blacks and whites is examined using data from a survey (N = 3119) conducted in Alameda County, California, in 1974. Based on crude rates, depressive symptoriis were more prevalent among blacks than whites. However, adjusting statistically for the effects of age, sex, education, income, marital status, and employment essentially eliminated the black/white differential. These data corroborate the results reported by Comstock and Helsing (Psychol. Med., 6: 551–563, 1976) as well as the results of several other investigations carried out in various U. S. communities.

MMPI scores in young men with alcoholic relatives and controls.

Abstract: The MacAndrew (A Mac), Rosenberg (A Ros), and Revised (A Rev) "alcoholic scales" of the Minnesota Multiphasic Personality Inventory were administered to 30 nonalcoholic men aged 20 to 25 who have a first-degree alcoholic family member (the family history positive, or FHP, group) Those scores were then compared to a control population matched on demography and drinking history but lacking a family history of alcoholism (the family history negative, or FHN, group) Although the two groups did not differ on the total score made up of all 81 items common to the three scales and scores were almost identical on the A Ros and A Rev scales, the FHP subjects scored an average of 1886 (SD = 408) whereas FHN controls scored 1682 (SD = 324) on the A Mac scale (p less than 05) The two groups differed on only one of the six A Mac subfactors, Interpersonal Competence, with the former scoring 429 (SD = 151) and the later 325 (SD = 135) (p less than 05) Although the results on the A Mac are consistent with the possibility of some personality differences between individuals at high risk for the future development of alcoholism and controls, the fact that both groups scored in the "normal range" and the very small numerical differential between FHP and FHN individuals indicate the test is of limited clinical significance However, the scores may indicate the presence of some aspects of personality which might correlate with greater likelihood for the future development of alcoholism

Depression and social adjustment among chronic schizophrenic outpatients.

Abstract: An examination of the relationship between symptoms and social adjustment among 98 chronic schizophrenic outpatients revealed that depressive mood contributed most to overall social dysfunction. Correlational patterns between depressive mood and factors of social dysfunction among these patients were found to be similar to those found among acutely depressed outpatients.

Emergency control measures for psychiatric inpatients.

Abstract: This survey of a large number of patients in psychiatric hospitals found that emergency medication, seclusion or restraint, and one-to-one supervision were used infrequently. However, certain types of patients, namely the young and those in hospital for less than 2 years, were more likely to have received these control measures, Furthermore, psychiatric diagnosis was related to the use of these measures probably as a reflection of the effectiveness of treatment for these disorders. It appeared that these measures were justified based on the fact that patients receiving these controls were more likely than those not receiving controls to manifest active psychosis as well as dangerous behaviors such as physical and sexual assault, fire-setting, and deliberate self injury. Language: en

Social class and depressive symptomatology. The role of life change events and locus of control.

Abstract: This paper considers the hypothesis that the relationship between social class and impairment may be accounted for by the greater prevalence of life events among lower-class individuals. This hypothesis was evaluated on data from 713 rural Tennessee adults. The data indicated that, although social class indices were inversely related to psychiatric impairment as expected there was no significant tendency for lower-class individuals to report a greater number of life events. For total number of events, as well as total number report a greater number of life events. For total number of events, as well as total number of undesirable, unexpected, or unpreventable events, middle- and upper-class individuals tended to report more events. Controls for the event indices did not affect the relationship between social class and symptomatology as the stress hypothesis would predict. However, locus of control was positively related to social class and was found to influence the event-impairment relationship. These data raise questions regarding the etiological role of life events in the relationship between social class and psychiatric impairments. The data suggest that observed social class differences in impairment may arise from the coping styles of certain social classes (as measured by locus of control) rather than from the differential prevalence of life events.

Temperament characteristics and behavior problems in three-year-old children.

Abstract: This paper examines the relationship of temperament characteristics to behavioral adjustment in preschool children. The study is part of an epidemiological project exploring the origins of psychiatric disorder in childhood. The sample represents the total population of 3 year olds living in a rural island community in the Northeastern United States. Data were collected in parent interviews in which mothers and fathers were separately interviewed, and in direct observations of their children's play. The independent variable, temperament characteristics, was measured by a self-report parent questionnaire. The dependent variable, behavior problems, was measured in two ways. The first was based on parent reports which were coded according to a symptom loading technique of known reliability and validity. The second measure of behavioral adjustment was based on the averaged ratings of two clinical judges who based their decisions on several sources of data including play observations, parent reports, and characteristics of the home environment. Results indicate that three temperament characteristics—low distractibility, high intensity, and high adaptability—are closely linked to poor behavioral adjustment. Over half of the variance in either measure of poor behavioral adjustment is explained by one of the temperament characteristics, low distractibility. Analysis of the content of this temperament category reveals that many of the items composing it suggest the child's negativistic or oppositional behavior is particularly prone to parental distortions in reporting. A factor analysis of all temperament items permitted a slight improvement in the clustering of items making up this distractibility-oppositionalism category. After statistically removing the potentially biasing effect of parent-child interaction, the positive relationship between temperament and behavior problems remained. The findings are discussed in relationship to the particular limitations placed on questionnaire data of the sort used in this study. Considering these limitations, it is concluded that certain characteristics of temperament, distractibility-oppositionalism ranking first among them, are positively associated with behavior problems during the preschool period. Longitudinal studies such as the one now under way in this same population are needed to determine to what extent these findings carry predictive significance for the behavioral adjustment of older children.

Computerized EEG as a predictor of drug response in treatment resistant schizophrenics.

Abstract: Thirteen chronic schizophrenics were identified who failed to improve with physician's choice medication and 1 year of systematic treatment with a long acting phenothiazine. These patients were considered to be treatment resistant. Computer analyzed electroencephalogram (CEEG) or these treatment resistant schizophrenics was characterized by a large amount of alpha activity and less fast activity, in comparison with previous results from therapy responsive schizophrenics. The therapy resistant subjects did not display the typical neuroleptic CEEG profile following test dosages of four neuroleptics, and instead displayed CEEG profiles which more closely resembled the typical profile for psychostimulants. These findings may point to an altered metabolism, neurotransmitter defect, or other problem which alters the physiological and clinical response of therapy resistant schizophrenics to neuroleptic medication.

The management of chronic behavior disorders in mentally retarded adults with lithium carbonate.

Abstract: The authors review the medical literature and present two case histories regarding the efficacy of lithium carbonate in the treatment of chronic behavior disorders in mentally retarded adults. They conclude that the available data lend tentative support for the use of lithium to manage behavior diso