Showing papers in "Journal of Nervous and Mental Disease in 1983"

Performance of schizophrenic patients on tests sensitive to left or right frontal, temporal, or parietal function in neurological patients.

Abstract: The performances of schizophrenic patients and normal control subjects were compared on an extensive battery of psychological tests that have been found at the Montreal Neurological Hospital to be differentially sensitive to atrophic lesions of the left or right frontal, temporal, or parietal cortex. Schizophrenic patients were significantly impaired at all tests that are disrupted by left or right frontal or temporal lobe lesions but performed within normal limits on all tests that are sensitive to parietal lobe damage. These results imply that schizophrenia results, at least in part, from a bilateral dysfunction of the frontal and temporal lobes.

Social interaction and blood pressure. Influence of animal companions

Abstract: The effect of the presence of a friendly animal on children's blood pressures and heart rates while resting and their cardiovascular responses to verbalization were examined. The presence of the dog resulted in lower blood pressures both while the children (N = 38) were resting and while they were reading. The effect of the presence of the dog was greater when the dog was present initially than when it was introduced in the second half of the experiment. We speculate that the animal causes the children to modify their perceptions of the experimental situation and the experimenter by making both less threatening and more friendly. This study provides insight into the use of pets as adjuncts in psychotherapy.

The near-death experience scale. Construction, reliability, and validity.

Abstract: Near-death experiences (NDEs) have been described consistently since antiquity and more rigorously in recent years. Investigation into their mechanisms and effects has been impeded by the lack of quantitative measures of the NDE and its components. From an initial pool of 80 manifestations character

Two helping alliance methods for predicting outcomes of psychotherapy. A counting signs vs. a global rating method.

Abstract: This paper reports on the development of measures of helping alliances in psychotherapy, i.e., the patient's experience of the treatment or relationship with the therapist as helpful, or potentially helpful. The helping alliance counting signs measure, which is the special focus of this paper, entails the counting of certain types of patient statements (signs) which are identified in a manual. The main findings were: a) these types of statements were found to be "scorable" with moderate interjudge agreement; b) scores based on the manual showed moderate agreement with a similar helping alliance manual based upon global ratings; c) scores were fairly to moderately consistent from early to late in treatment; d) scores predicted outcome significantly, e.g., early positive signs of helping alliance correlated .57 (p less than .01) with rated benefits, and .59 (p less than .01) with change in the first target complaint (Battle, C., Imber, S., Hoehn-Saric, R., et al. Target complaints as criteria of improvement. Am. J. Psychother., 20: 184-192, 1966); and e) basic background similarities between patient and therapist, such as in age and religious activity, attained highest correlations with the helping alliance measure, e.g., the sum of 10 similarities correlated .60 (p less than .01) with early positive helping alliance counting signs.

Postpartum depression. A role for social network and life stress variables.

Abstract: Depressed (N = 11) and nondepressed (N = 19) women who had recently given birth were compared on several life stress measures and indices of structural and qualitative characteristics of their social networks. We predicted that depressed subjects diagnosed on the basis of Research Diagnostic Criteria would have experienced more stressful life events since the beginning of pregnancy and since delivery. We also predicted that depressed subjects would have fewer confidants and receive less instrumental and emotional support from their network members. These predictions were largely confirmed, except that the two groups did not differ on number of confidants. The social support provided by spouses appeared to be especially important. Implications of these findings for life events and social network research are discussed.

Concurrent validity of the addiction severity index.

Abstract: The concurrent validity of the Addiction Severity Index (ASI), a new scale for assessing a range of clinical dimensions in drug and alcohol abusers, was evaluated in 204 opiate addicts applying for treatment. This study is the first independent validation study of this measure. The ASI subscales were found to have good concurrent validity with self-report measures in the areas of psychological problems, social adjustment problems, legal problems, and employment problems (r = .55 to .39). Drug abuse problems showed limited concurrent validity and medical problems were not concurrently assessed in our study. Addicts with psychiatric diagnoses beyond opiate abuse were effectively identified by the ASI, and depressed addicts were particularly well screened with a sensitivity of 89 per cent and a specificity of 67 per cent. A cluster analysis demonstrated that the six ASI scales could be used to discriminate depressed addicts, antisocial addicts, and addicts without psychiatric disorders. Thus, the ASI was demonstrated to be a potentially important evaluation instrument for opiate addicts.

Increased effectiveness of substance abuse treatment. A prospective study of patient-treatment "matching".

Abstract: An earlier study retrospectively evaluated the effectiveness of six separate substance abuse treatment programs and generated a set of hypotheses for matching patients to the most appropriate programs. In the present study, these predictors and the matching strategy were tested in a prospective design, using the same treatment programs and a new sample of 130 alcohol- and 256 drug-dependent patients. The new group of patients who were treated in their predicted program (matched patients) were compared with those patients from the same sample who were not treated in their predicted program (mismatched patients). Treatment staff were not apprised of the matching criteria or which patients were matched, thus permitting an experimental test of the predictions. Results indicated superior performance during treatment and an average of 19 per cent better 6-month outcomes for the matched patients than for their mismatched counterparts. The matching effect was seen in both the alcohol- and drug-dependent samples and in all treatment programs. The authors discuss the application of these findings to other types of patients and treatments in substance abuse and other fields of psychiatry.

Diagnostic interactions. Alcoholism and antisocial personality.

Abstract: The association of alcoholism with other psychiatric disorders is important from both a research and a therapeutic point of view. In a medically hospitalized inpatient sample, we found a strong relationship between alcoholism and antisocial personality. Controlling for the overlap of diagnostic symp

The core symptoms of depression in medical and psychiatric patients.

Abstract: The internal consistency of the Beck Depression Inventory (BDI) is assessed in 335 randomly selected medical inpatients, and in another sample of 101 depressed psychiatric inpatients with 104 interviewed normals. The data for the two samples were analyzed separately using a latent trait model. The analysis confirms that the BDI measures a single underlying dimension of depressive severity for both patient samples. Fourteen symptoms discriminate well for severity of depression in the psychiatric-normal sample, seven symptoms in the medical sample, and six symptoms in both samples. The latter six symptoms (suicidal ideation, sense of failure, sense of punishment, loss of social interest, indecision, and dissatisfaction) may represent criteria for depressive severity that are not confounded by the presence of physical illness or the attendant distress.

Post-traumatic stress disorder in Hispanic Vietnam veterans. Clinical phenomenology and sociocultural characteristics.

Abstract: The complex symptomatology of Hispanic Vietnam veterans receiving treatment for post-traumatic stress disorders (PTSD) was explored with the National Institute of Mental Health Diagnostic Interview Schedule, a structured diagnostic interview that yields current and lifetime operational diagnoses (e.g., DSM-III). Social networks and level of acculturation of these veterans were also examined and compared to those of a "control" group and a sample of veterans with DSM-III schizophrenic disorder (both samples included only Hispanic veterans from the Vietnam and post-Vietnam eras). All subjects reported heavy combat stress and met DSM-III criteria for PTSD. Most were very symptomatic and had significant social impairment. PTSD was rarely seen as a discrete entity but appeared instead mixed with symptom clusters cutting across various DSM-III diagnoses. Social networks of PTSD veterans were intermediate in size, frequency of contact with network members, and network density to those of the comparison groups. A distinctive feature of the PTSD group was the high proportion of negative relationships with close family members, especially spouses. "Highly" symptomatic PTSD veterans reported significantly smaller networks, fewer contacts outside the close family circle, and more negative emotionality directed toward family members than "minimally" symptomatic veterans. While all Hispanic groups studied were not significantly different in level of acculturation, PTSD veterans appeared more alienated from their cultural heritage than the other groups. The severe and polymorphous psychopathology found among these veterans suggests that "rap" groups alone may not constitute an adequate therapeutic approach and that more formal psychiatric therapies should be additionally considered in the management of Vietnam-linked PTSD.

Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality

Abstract: The prior psychiatric histories, dispositions, and treatment plans for a group of patients with borderline personality, evaluated in an outpatient clinic, were compared to those of evaluated patients diagnosed as having neurotic and/or other personality disorders or schizophrenia. Variables that wer

Effects of Age of Onset of Partial and Generalized Seizures on Neuropsychological Performance in Children

Abstract: Neuropsychological performance data from 106 children with epilepsy were evaluated to determine the effects of seizure type and age of onset. The performance of children with partial seizures (N = 49) was similar to that of children with generalized seizures (N = 57). Only one of 13 tests showed a significant difference between groups, with children with partial seizures performing better on that test. The effects of age of onset were also similar in the two seizure groups. Children whose seizures began before the age of 5 years performed significantly worse than children whose seizures began later on four measures (Verbal IQ, Performance IQ, Trails A, and Trails B) and performed more poorly, but not significantly so, on the other nine measures in the battery. A breakdown of the partial group into simple partial, complex partial, and secondarily generalized partial seizure groups found a significant difference between the groups on only one variable, but there were suggestions in the data that the performance of the partial secondarily generalized group was worse than the other two groups. These results indicate that variables associated with an early onset of seizures, regardless of type, place a child at risk for cognitive dysfunction.

Intellectual performance in children of alcoholics.

Abstract: Alcoholics tend to show some cognitive deficits relative to nonalcoholics. The present study of a sample from a Danish birth cohort examined whether these deficits might be present in children at high risk for later alcoholism. The subjects were tested at age 12 with a Danish translation of the Wesc

Integration of schematic faces and other complex objects in schizophrenia.

Abstract: Twenty-one acute schizophrenic patients and 26 neurotic patients sorted each of six sets of 15 objects into three groups. A set consisted either of schematic faces, nonsense objects, or histoforms, each composed of five independently varying features. For the faces and nonsense objects these features could be integrated into a whole, whereas for the histoforms they could not. The distribution of four of the features was such that a set could be divided into three groups. The fifth feature either remained constant and had no effect on sorting performance or it varied randomly and acted as a distractor. Performance was assessed from the variance in common between the grouping actually present in a set and the grouping produced by the subject. For the control patients faces were sorted much better than histoforms if no distractor was present. However, performance with faces was massively impaired by a distractor while performance with histoforms was not. For the schizophrenic patients faces were not sorted better than histoforms and the effect of distraction was similar for every type of material. The performance of the controls suggest that the gestalt quality of the faces dominated over their constituent details. This enabled more features to be handled at once, thus achieving better sorting with faces than histoforms. However, it also made it more difficult for subjects to ignore a distracting component in the faces. The performance of the schizophrenics suggests that for them the integrated gestalt of the face was not dominant over its components.

Hostile words and assaultive behavior on an acute inpatient psychiatric unit.

Abstract: This report analyzes the relationship of hostile verbalizations to assaultive acts committed by 110 male schizophrenic patients on an acute psychiatric unit. It was found that patients who were verbally assaultive and threatening also tended to be physically assaultive. Assaults rarely occurred in the absence of verbal threats or abuse, and 32 per cent of violent patients could be identified on the basis of the occurrence of hostile verbalizations.

Migration and mental health among Hmong refugees. Association of pre- and postmigration factors with self-rating scales

Abstract: To date there have been no epidemiological studies of a refugee population using self-rating scales. This method was used in a study of Hmong refugees in Minnesota. Self-reported symptoms were compared with premigration and postmigration factors to assess those characteristics associated with increased symptom reporting. Relatively few premigration factors influenced these self-reports, whereas several postmigration factors were significantly correlated with symptoms. These findings suggest certain interventions which might enhance the adjustment of subsequent refugees.

Familial subtypes of childhood hyperactivity.

Abstract: On the basis of family history data we defined two subtypes of childhood hyperactivity: family history-positive (FH+), in which at least one biological parent of the child had a diagnosis in the antisocial spectrum; and family history-negative (FH-), in which neither parent had such a diagnosis. Whi

Refugees who do and do not seek psychiatric care. An analysis of premigratory and postmigratory characteristics.

Abstract: Social psychiatric research can provide information about the role of interpersonal and societal factors in the genesis of psychiatric disorder. This discipline relies heavily on "experiments in nature" which expose a large number of people to a potentially pathological social stimulus. It also depends in large part upon the study of nonpatients to serve as a comparative group for patients. Both conditions are met in this study of Hmong refugees from Indochina. While the population and the event are esoteric to some extent, their experiences of sudden sociocultural change, geographic migration, role discontinuity, identity crisis, and massive loss are common experiences among many psychiatric patients, regardless of their origin. Thus this study contributes to our understanding regarding the social genesis of psychiatric disorder. This prospective study of refugees to the United States was undertaken among the Hmong population in Minnesota (N = 97) during 1977. Subsequently 17 of this group became psychiatric patients over a 12-month period. Premigration and postmigration factors associated with patient status are described. Hypotheses are offered regarding those postmigration experiences or social strategies which favored or prevented psychiatric status.

Aluminum and Alzheimer's disease.

Abstract: There are many medical conditions that increase brain Al concentrations without producing the dementia or neuronal degeneration (with "paired-helical filaments" [PHFs]) typical of Alzheimer's disease (AD). Aluminum accumulations have been found in the nuclei of PHF-containing neurons in the brains of AD patients and elderly normal controls. We have, however, found no elevations of Al concentrations in the serum, cerebrospinal fluid, or hair in AD patients. These findings suggest that Al alone is not a "cause" of AD. Aluminum may be just a "marker" of PHF-bearing neurons, or AD patients may be "vulnerable" to Al neurotoxicity on the basis of some other neuronal dysfunction allowing Al to enter neuronal nuclei. It is too soon to tell whether any of the variety of experimental anti-Al approaches currently being evaluated have any effect on the rate of progression of AD symptoms.

Psychiatric problems among adolescent Southeast Asian refugees. A descriptive study.

Abstract: When first faced with evaluating and/or treating a Southeast Asian adolescent psychiatric patient, the American therapist may be overwhelmed by the vast cultural differences. We have reviewed 28 cases of adolescents encountered in a psychiatric setting in order to provide a description of their presenting complaints and problems. Diagnostic categories and demographic characteristics are described, as well as current areas of needs for adolescent psychiatric patients from Southeast Asia.

Cognitive capacities of juvenile violent, nonviolent, and sexual offenders

Abstract: Juvenile violent, nonviolent, and sexual offenders were compared across a broad range of intellectual, neuropsychological, and psychoeducational measures. No systematic group differences were noted, nor was cognitive status related to the severity of violent behavior. These findings cast doubt on the generalizability of previous investigations implicating cerebral dysfunction in juvenile delinquents.

Span of apprehension performance, neuropsychological functioning, and indices of psychosis-proneness.

Abstract: Fifty subjects without a history of psychiatric disorder were selected from temporary employment agencies. Subjects were then assigned to two groups based solely on their performance on a forced-choice version of the span of apprehension task which previous research suggests may be associated with vulnerability to schizophrenia. The group of subjects characterized by poor performance on the span of apprehension scored significantly higher on the Schizophrenia scale of the MMPI, two indices of schizotypy--the Schizoidia and Schizophrenism scales--and an index of subclinical schizophrenic thinking, the Magical Ideation scale, than the balance of the subjects. The poor span group did not show generalized elevations on the MMPI, suggesting that there is some degree of specificity for the relationship between the span of apprehension performance and scores on indices of schizotypy and psychotic-like experiences. These results are consistent with the hypothesis that impairment in early aspects of information processing is associated with vulnerability to schizophrenic disorders. Subjects with poor performance on the span of apprehension task also scored more poorly than the balance of the group on three neuropsychological tasks: the Trail Making Test, the Digit Symbol Substitution Test, and Rey's Tangled Line task.

Men who batter: Some pertinent characteristics.

Abstract: The recent literature on domestic violence has done little to characterize the man who batters. The authors report statistics on five major correlates of such men: violence between the batterer's parents, abuse of the batterer when he was a child, alcohol abuse, drug abuse, and employment status. After reviewing the literature, the authors present data from 188 face-to-face interviews with men who sought counseling for their abusive behavior toward their mates. Nearly three quarters saw violence between their parents, almost one half were abused as children, over one half abused alcohol, more than one third abused drugs, and nearly one quarter were unemployed. It is concluded that professionals dealing with domestic violence need to be alert to alcoholism problems, and that there may be some support for the belief that such violence may be a behavior in part learned from childhood experience. Language: en

Encoding and retrieval in schizophrenics' free recall.

Abstract: L'auteur a fait l'hypothese que la faiblesse des performances de memorisation realisees par les sujets schizophrenes etait imputable a leur incapacite a utiliser les strategies d'encodage ou d'evocation des souvenirs couramment employees par les etudiants de college. Ces sujets atteints de schizophrenie processuelle ou reactionnelle, ainsi que des etudiants de college ont appris des listes de mets ressortissant a 3 categories taxinomiques. Des consignes d'endocage et d'evocation par categories ont ete donnees. En l'absence de ces consignes, la memorisation des sujets schizophrenes demeurait faible et significativement inferieure a celle dont etaient capables les etudiants. A l'aide de consignes explicites, les performances des sujets schisophrenes s'amelioraient et meme egalaient celles des etudiants. L'auteur discute le role des strategies de memorisation dans l'amelioration des capacites memorielles des patients schisophrenes

An empirical analysis of specific syndromes of violent behavior

Abstract: One hundred thirty-eight neuropsychiatric outpatients were rated according to relevant behavioral parameters of violence. A cluster analysis based on these ratings yielded five homogenous subgroups. Two groups, which differed only in severity of violence, were defined by a behavioral pattern closely resembling the episodic dyscontrol syndrome. One group was defined by infrequent but very severe violence, one by relatively infrequent violence of lesser severity, and one by no history of violence. These groups were clearly differentiated by a number of variables including neurological and psychiatric diagnoses, verbal aggression parameters, and neurological and psychiatric history variables. A specific etiology for violence, even within relatively homogenous subgroups, was not supported, with results suggestive of multiple determination by biological and psychosocial factors. On the other hand, different patterns of potential etiological factors were identified for different groups, which holds implications for theoretical understanding of violence and for differential diagnosis, treatment, and prevention. VioLit summary: OBJECTIVE: The aim of this study by Mungas was to describe the complexity of understanding violence and nonviolence through analysis of five homogeneous subtypes of neuropsychiatric outpatients. METHODOLOGY: A quasi-experimental, retrospective analysis was used to analyze 138 neropsychiatric outpatients who had been evaluated at the UCLA Neurobehavioral Clinic during an 18 month period in 1979-80. This clinic specialized in evaluation and treatment of patients manifesting concomittant behavioral, psychiatric, psychological, and neurological abnormalities or those with behavioral abnormalities where neurological dysfunction was suspected. Twenty percent of the patients had a primary complaint of violence; 35-40 percent had attacked property or persons, and 40 percent had no history of violent behavior and were referred to the clinic for neuropsychiatric reasons. This latter group served as a control group of psychiatric but not violent patients. Patients were dropped from the consideration if there was incomplete information. The author stated that this was not a concern because this was a retrospective analysis. The variable of violent behavior rating was defined as "overt physical behavior with clear-cut aggressive intent" and was measured with Likert scales for severity in four behavioral parameters--frequency, severity, appropriateness to the environmental content, and directedness (p. 355). These ratings were done solely by the author and based on thorough, retrospective chart reviews which included written accounts of patient histories from clinical evaluation, results from self-report questionnaires (administered by external observers familiar with the patients) asking about past history of violent behavior. Inter-rater reliability estimates were determined using product-moment correlation coefficient--frequency (.92), appropriateness (.75), severity (.78), and organization/directedness (.76). Ratings for verbal aggression were frequency (.85), severity (.91), and appropriateness (.79). Seven historical variables were rated based upon a thorough chart review; all were composite variables with the presence of several different historical variables contributing in an additive fashion to the overall score. These historical variables were history of behavior disorder as a child, history of development abnormalities, lifelong level of independent functioning, home environment as a child, drug abuse history, results of neurodiagnostic evaluation including EEG and CAT scan, and history of head trauma. Neurological diagnoses and DSM-III psychiatric diagnoses were recorded from the patient's chart. All diagnoses were recorded in the case of multiple diagnoses. The homogeneous subgroups of patients were empirically defined by submitting the ratings on the four parameters of physically violent behavior to a cluster analysis algorithm, the K-means clustering algorithm of the BMDP statistical package. MANOVA was used to analyze these groups once they had been identified. FINDINGS/DISSCUSION: The five groups were differentiated in the following ways. The first group (n=20) was characterized by high frequency, high severity, high inappropriateness, and relatively high organization. The second group (n=15) was characterized by low frequency, high severity violent behavior. The third group (n=15) looked like the first group except severity was more moderate. Group four (n=31) was characterized by relatively infrequent acts of mild to moderate severity that tended to be more provoked and better organized in comparison to the first three groups. Group five (n=57) consisted of nonviolent patients. The differences on the four behavioral parameters were significant (p= AUTHOR'S RECOMMENDATIONS: The author argued that more reseach is needed to clarify the relationship between research aimed at clarifying the relationship between particular behavioral symptoms and specific etiologies of violence. This will, it is claimed, add to the ability to more specifically diagnose and treat violent patients. EVALUATION: Different violent offenders are often treated as a single, homogenous group. However, this study shows that there are several distinct differences between types of violent persons that can be empirically verified, at least in this particular sample. The sample size is large but not very generalizable. This is a very specific group of individuals who are neuropsychiatric patients in Los Angeles, CA. There is clearly a need for a broader sample base in further research to see if distinguishing features still hold up. This study approached its question from a data-first-theory-later standpoint which allows for the questions to be asked, but further deductive study is needed to sort out the relationships and control for confounding factors. Association is helpful, but treatment will need to not only categorize patients but also know what led up to differences in violent persons. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - California KW - 1970s KW - 1980s KW - Violence Causes KW - Biological Factors KW - Neurological Factors KW - Psychological Factors KW - Psychosocial Factors KW - Mental Illness KW - Mentally Ill Adult KW - Mentally Ill Offender KW - Mentally Ill Patient KW - Patient Violence KW - Patient Studies KW - Adult Offender KW - Adult Mental Health KW - Adult Patient KW - Adult Violence KW - Mental Health Patient KW - Offender Characteristics Language: en

Validity of the Minnesota multiphasic personality inventory (MMPI) to psychopathology in patients with epilepsy

Abstract: Information regarding the sensitivity of the Minnesota Multiphasic Personality Inventory (MMPI) to psychopathology and the meaning of MMPI elevations in neurological patients, particularly in those with epilepsy, is of both theoretical and clinical concern. Such information has a particular relevance to the temporal lobe epilepsy-psychopathology controversy. In order to investigate evidence for increased psychopathology as a function of complex partial seizures (temporal lobe epilepsy in the old nomenclature), three groups of epilepsy patients differing in seizure type were compared on the MMPI. No supportive evidence was present for such an association. Second, the sensitivity of the MMPI to psychopathology was examined by comparing three groups of epilepsy patients differing in history of psychiatric problems. The results clearly indicated that the MMPI is sensitive to psychopathology in patients with epilepsy. Finally, the Sc scale was examined in relation to items descriptive of "disease-related experiences" and the psychiatric implications of endorsing such items. About one third of the items were identified as descriptive of "real experiences." Nevertheless, patients with psychiatric histories endorsed more of such items. In conclusion, the MMPI appears to be sensitive to psychopathology in epilepsy. Therefore, insensitivity of this instrument cannot be advanced as an explanation for the results of many studies that have not supported the temporal lobe epilepsy-psychopathology controversy.

Depression, problem recognition, and professional consultation.

Abstract: Data are from a 1979 community sample (n = 1000) of adults in Los Angeles County. The analysis examines how depressive symptoms, measured with the Center for Epidemiologic Studies Depression (CES-D) scale, and a variety of other factors influence problem recognition and use of mental health services. Of those people with a high level of depressive symptoms, nearly one third view themselves as having a nondepressive problem, while another third view themselves as having no personal problem. After controlling for demographic and other factors, depressive symptoms emerge as the most important element enhancing problem recognition; being female and having more education also enhance recognition of depressive problems and enable people to distinguish depressive from other problems. Among those with a high level of depressive symptoms, only one third had consulted a mental health service in the prior year. Factors promoting use of mental health services among those who acknowledge a personal problem include depressive symptoms, prior use of mental health services, use of services by friends and relatives, and discussion with friends and relatives about counseling; no significant effects emerge for sex, age, education, income, or insurance coverage. Data from the untreated show that a self-reliant attitude and some practical barriers prevent people with depressive symptoms from obtaining professional help.