Showing papers in "Journal of Nervous and Mental Disease in 1986"
TL;DR: The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations and was able to distinguish between subjects with a dissociative disorder (multiple personality) and all other subjects.
Abstract: Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale
3,434 citations
TL;DR: A possible role of defensive organization as a basis for the low, constricted cortisol levels in PTSD and paranoid schizophrenic patients is suggested and the possible usefulness of hormonal criteria as an adjunct to the clinical diagnosis of PTSD is suggested.
Abstract: Urinary free-cortisol levels (micrograms per day) were measured by radioimmunoassay at 2-week intervals during the course of hospitalization in the following patient groups: posttraumatic stress disorder (PTSD); major depressive disorder; bipolar I, manic; paranoid schizophrenia; and undifferentiated schizophrenia The mean cortisol level during hospitalization was significantly lower in PTSD (333 +/- 32) than in major depressive disorder (496 +/- 59), bipolar I, manic (627 +/- 67), and undifferentiated schizophrenia (501 +/- 89), but was similar to that in paranoid schizophrenia (375 +/- 39) The same differences across groups are evident in the first sample following hospital admission This finding of low, stable cortisol levels in PTSD patients is especially noteworthy, first because of the overt signs of anxiety and depression, which would usually be expected to accompany cortisol elevations, and second because of the concomitant chronic increase in sympathetic nervous system activity shown in prior psychophysiological studies of PTSD and reflected in marked and sustained urinary catecholamine elevations previously reported in our own PTSD sample The findings suggest a possible role of defensive organization as a basis for the low, constricted cortisol levels in PTSD and paranoid schizophrenic patients The data also suggest the possible usefulness of hormonal criteria as an adjunct to the clinical diagnosis of PTSD
415 citations
371 citations
TL;DR: Suggestions on ways to minimize such sociocultural artifacts are provided in efforts to improve the epidemiological significance of the instrument, particularly as it concerns crosscultural research.
Abstract: The Mini-Mental State Evaluation (MMSE) was used in an epidemiological survey of a community of mixed ethnicity (Hispanic, white non-Hispanic) as part of the Los Angeles Epidemiologic Catchment Area Program. Results of the study showed that age, educational level, ethnicity, and language of the interview influenced the number of MMSE errors. Items on which the effects of ethnicity and language were most pronounced were identified, and suggestions on ways to minimize such sociocultural artifacts are provided in efforts to improve the epidemiological significance of the instrument, particularly as it concerns cross-cultural research.
368 citations
TL;DR: It is concluded that emotional illness is associated with both poorer metabolic control and the increased report of clinical symptoms of diabetes.
Abstract: The lifetime prevalence of psychiatric illness was determined in 114 patients with diabetes mellitus (types I and II) who were selected randomly from patients undergoing diabetes evaluations at a large medical center. The relationship of psychiatric illness to diabetic control was studied using glycosylated hemoglobin (HbA1) and self-report measures of metabolic symptoms. Seventy-one percent of the patients had a lifetime history of at least one criteria-defined psychiatric illness; affective and anxiety disorders were the most common diagnoses. A significant difference (p = .02) in mean glycosylated hemoglobin levels was observed comparing patients with a recent psychiatric illness (mean = 10.8%) to those never psychiatrically ill (mean = 9.6%). These psychiatrically ill patients also reported more symptoms of poor metabolic control and more distress associated with these symptoms than did patients never psychiatrically ill (p less than .0001 for both). The overall report of diabetes symptoms was unrelated to HbA1 (p = .25) and was influenced primarily by the recent presence of psychiatric disorder (p less than .0001). We conclude that emotional illness is associated with both poorer metabolic control and the increased report of clinical symptoms of diabetes.
313 citations
TL;DR: The five most frequently cited bedside screening tests that use an interview format and require brief administration times are reviewed, finding that all have adequate inter-rater reliability, but do not detect many types of cognitive deficit that may bear critically on differential diagnosis and case management.
Abstract: Bedside cognitive screening instruments are used increasingly in clinical and research settings to detect cognitive impairment and to quantify its severity. The authors review the five most frequently cited bedside screening tests that use an interview format and require brief administration times:
258 citations
TL;DR: Reading is a hobby to open the knowledge windows, and concomitant with the technology development, many companies serve the e-book or book in soft file.
Abstract: Reading is a hobby to open the knowledge windows. Besides, it can provide the inspiration and spirit to face this life. By this way, concomitant with the technology development, many companies serve the e-book or book in soft file. The system of this book of course will be much easier. No worry to forget bringing the the silent world of doctor and patient book. You can open the device and get the book by on-line.
247 citations
TL;DR: The unexpectedly high prevalence of cognitive impairment in SLE patients with either inactive or absent neuropsychiatric symptomatology provides evidence for subclinical nervous system involvement in Sle.
Abstract: We administered a battery of neuropsychological tests to 62 female patients with systemic lupus erythematosus (SLE), 12 female patients with rheumatoid arthritis (RA), and 35 normal control subjects. By applying objective decision rules to individual test protocols, an overall prevalence of cognitive impairment of 66% was obtained in the SLE patient sample. Independent clinical, radiological, and laboratory data were used to determine neuropsychiatric (NP) symptomatology and to group SLE patients as 1) "active" (N = 21), 2) "inactive" (N = 15), and 3) "never" (N = 26) NP-SLE. More than 80% of the patients in groups 1 and 2 and 42% in group 3 showed significant cognitive impairment as compared with 17% of the RA patients and 14% of the normal control subjects. Neither steroid medication nor psychological distress could account for these findings. The unexpectedly high prevalence of cognitive impairment in SLE patients with either inactive or absent neuropsychiatric symptomatology provides evidence for subclinical nervous system involvement in SLE.
232 citations
TL;DR: Bargaining with reading habit is no need as discussed by the authors, reading is not kind of something sold that you can take or not, it is a thing that will change your life to life better.
Abstract: Bargaining with reading habit is no need. Reading is not kind of something sold that you can take or not. It is a thing that will change your life to life better. It is the thing that will give you many things around the world and this universe, in the real world and here after. As what will be given by this psychotherapy in a new key, how can you bargain with the thing that has many benefits for you?
228 citations
TL;DR: Anxiety states almost always required additional diagnoses whereas for the phobic disorders additional diagnoses occurred less frequently, but depression was more strongly associated with some anxiety disorders, specifically obsessive-compulsive disorder.
Abstract: One hundred twenty-six patients presenting at an anxiety disorders research clinic were administered a structured interview. Diagnoses were made on the basis of DSM-III criteria but without regard to current exclusionary systems within DSM-III. Rather, clinicians decided whether anxiety and depressive symptoms that met DSM-III criteria for additional diagnoses were associated features of the presenting problem or represented an independent coexisting complication. Diagnoses and accompanying psychometric data delineated groups of patients with somewhat different clinical and psychometric characteristics. But additional anxiety and depressive diagnoses were required in a number of cases. Anxiety states almost always required additional diagnoses whereas for the phobic disorders additional diagnoses occurred less frequently. Simple and social phobia were the most frequent additional diagnoses, but depression was more strongly associated with some anxiety disorders, specifically obsessive-compulsive disorder. In view of the treatment implications of comorbidity, establishing the functional relationships among anxiety symptoms without regard to exclusionary systems would seem important in both clinical and research settings.
209 citations
TL;DR: Long-acting propranolol treatment was associated with reductions of assaultive behavior without apparent sedative effects, andautions are noted regarding potential undesirable side effects which may necessitate careful patient monitoring during treatment.
Abstract: A double-blind, placebo-controlled crossover study was conducted to examine the effects of long-acting propranolol in the treatment of violent behavior associated with organic brain disease in 10 patients whose symptoms had proved refractory to various conventional medications. Long-acting propranolol treatment was associated with reductions of assaultive behavior without apparent sedative effects. Cautions are noted regarding potential undesirable side effects which may necessitate careful patient monitoring during treatment.
TL;DR: The remarkable lifetime rate of affective illness in ISD patients suggests that there may be a common biological etiology or that affective psychopathology may be contributing to the pathogenesis of the ISD dysfunction.
Abstract: Lack of interest in sexual activity is one of the most prevalent psychosexual problems seen by clinicians. No consensus exists on etiology, symptomatology, appropriate therapeutic intervention, or prognosis. Desire disorders are believed to be highly refractory to treatment because of severe intrapsychic conflict, but no systematic data have been gathered about the histories of psychopathology in these individuals. Forty-six married subjects with a primary DSM-III diagnosis of global inhibited sexual desire (ISD) were compared with 36 matched controls on lifetime psychopathology, current psychological profiles, and premenstrual syndrome. A clinical interview, the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and the SCL-90-R were administered to all subjects. Only ISD subjects free from any other axis I disorder, medical illness, medication use, or substance abuse were selected; controls met similar criteria but had no sexual dysfunction. Despite the fact that all ISD subjects had nearly normal psychological profiles at the time of assessment, more ISDs than controls had significantly elevated lifetime prevalence rates of affective disorder. The proportion of ISD individuals with histories of major and/ or intermittent depression alone was almost twice as high as controls. Additionally, the initial episode of the depressive disorder almost always coincided with or preceded ISD onset. Significantly more ISD women than controls also had severe symptoms of premenstrual syndrome. The remarkable lifetime rate of affective illness in ISD patients suggests that there may be a common biological etiology or that affective psychopathology may be contributing to the pathogenesis of the ISD dysfunction.
TL;DR: Comments recorded before the seizures confirmed the decline in mood preceding seizures and showed an increase in negative life events for the patients whose mood declined before seizures.
Abstract: Mood ratings were obtained for at least 56 days from 27 patients with diverse forms of epilepsy, 13 of whom suffered at least one seizure over the course of the study. For these 13 patients, mean ratings of mood on eight of the 10 scales showed a decline on the day(s) preceding the seizure and an increase after the seizure. Data from six patients accounted for most of the decline. Decline was most prominent on the Depression, Anxiety, Freedom, and Anger Scales. One patient's mood ratings rose significantly before seizures. Comments recorded before the seizures confirmed the decline in mood preceding seizures and showed an increase in negative life events for the patients whose mood declined before seizures. The relations of life events and mood to seizures apparently did not depend on each other.
TL;DR: A second, retrospective study on the misdiagnosis of hysteria demonstrated that women, homosexual men, the psychiatrically ill, and patients presenting plausible psychogenie explanations for their illness are most liable to be misdiagnosed.
Abstract: In an attempt to validate recent assertions that the strongest indicators of hysteria are the “positive” findings in the neurological examination, seven of the most accepted features (history of hypochondriasis, secondary gain, la belle indifference, nonanatomical sensory loss, split of midline by p
TL;DR: The study of unsolicited psychiatric patients who became ill because of their experience in a natural disaster can assist in the design of future disaster research and suggests that exposure and losses sustained in the disaster alone are inadequate predictors of psychiatric disorder.
Abstract: The study of unsolicited psychiatric patients who became ill because of their experience in a natural disaster can assist in the design of future disaster research. A clinical report of 36 such patients illustrates the problems of case detection, the delayed presentation of much of the morbidity, and the need to separate stress-related symptoms which are common in disaster victims from psychiatric illness. Unless these issues are taken into account, estimates of the prevalence of psychiatric disorders after major disasters may be subject to substantial error. The role of vulnerability factors assessed to be operating in these patients suggests that exposure and losses sustained in the disaster alone are inadequate predictors of psychiatric disorder. The risk factors for the development of disaster-related psychiatric morbidity will be more accurately defined if the contribution of a range of constitutional, personality, and social factors as well as the personal impact of the disaster are investigated in future research.
TL;DR: The measure called “expressed emotion” is conceptualized as an indicator of family attempts to socially control the schizophrenic person's behavior in a particular way, supported by a review of the type of information in the measure.
Abstract: Research shows a higher risk of relapse among schizophrenics in high “expressed emotion” families. In this paper, the measure called “expressed emotion” is conceptualized as an indicator of family attempts to socially control the schizophrenic person's behavior in a particular way. This social contr
TL;DR: The hospital records of 1687 psychiatric patients were rated for the presence of assaultive or other fear-inducing behaviors associated with the reasons for their hospital admissions to conclude that clinical variables appear to have a more consistent relation to violent behavior than demographic variables.
Abstract: The hospital records of 1687 psychiatric patients were rated for the presence of assaultive or other fear-inducing behaviors associated with the reasons for their hospital admissions. Data analyses indicated that significant associations existed between these behaviors and sex, race/ethnicity, diagnosis, previous admissions, referral source for hospitalization, legal status at admission, and legal status at discharge. No associations were found for age, education, marital status, employment status, number of days hospitalized during the index hospitalization, and referral at discharge. A comparison of these results with the results of studies by other investigators led to the conclusion that clinical variables appear to have a more consistent relation to violent behavior than demographic variables. Future research examining for the correlates of violent behavior in psychiatric patients may be more productive by focusing on the type and degree of patients' psychopathologies rather than on patients' demographic characteristics.
TL;DR: When clozapine was administered (in conjunction with lithium) to a patient with a past history of NMS with fluphenazine, the syndrome reappeared after about 3 weeks of treatment, the first report of apparent neuroleptic malignant syndrome with clozAPine.
Abstract: Clozapine is an antipsychotic drug reported to be virtually free of extrapyramidal effects. On the basis of this, we hypothesized that it would be unlikely to cause the neuroleptic malignant syndrome (NMS), a rare but severe reaction observed with other antipsychotic drugs. However, when we administered clozapine (in conjunction with lithium) to a patient with a past history of NMS with fluphenazine, the syndrome reappeared after about 3 weeks of treatment. This represents, to our knowledge, the first report of apparent NMS with clozapine.
TL;DR: Although the data did not permit rigorous epidemiological or definitive etiological conclusions, the survey did reveal that some offspring of World War II combat veterans demonstrate long-term, transgenerational effects from their father's combat trauma.
Abstract: A clinical survey examined the experiences of children who grew up in families in which a father suffered from posttraumatic stress disorder as a result of combat experience in World War II. Although the data did not permit rigorous epidemiological or definitive etiological conclusions, the survey did reveal that some offspring of World War II combat veterans demonstrate long-term, transgenerational effects from their father's combat trauma. Although the children's conscious knowledge of the veteran's combat experience and the impact of the veteran on the affective life of his family and on his children varied among the five families studied, the continuing legacy of wartime trauma was apparent in the adult lives of many of these offspring.
TL;DR: The authors describe and discuss features in which the Indian cases differ from a larger sample of American cases, and note that some of these features seem to be culture-bound.
Abstract: The authors report some features of 16 cases of near-death experiences that they investigated in India. After presenting brief accounts of four such experiences, the authors describe and discuss features in which the Indian cases differ from a larger sample of American cases. They note that some of these features seem to be culture-bound, but they caution against accepting this observation as adequate evidence that the case derive only from culture-bound beliefs. Some differences may derive from the effects of a person's beliefs on what actually does happen after death, and some different features may, on closer examination, be found to be basically similar in nature if not in detail.
TL;DR: The results of the present study are contrary to the hypothesis that selective attention deficits are characteristic of negative-symptom schizophrenia and suggest that positive symptoms are associated with greater susceptibility to distraction.
Abstract: Two tasks designed to measure selective attention were administered to schizophrenics, patients with bipolar disorder, and normal subjects. Schizophrenics were divided into three subgroups: positive-, negative-, and mixed-symptom patients. Positive-symptom schizophrenics showed significant deficits on a digit-span task when compared to normal subjects. Furthermore, the positive group was the only one to show a significant performance decrement in the distraction condition of the digit-span task. There were no significant group differences in performance on a dichotic listening test. The results of the present study are contrary to the hypothesis that selective attention deficits are characteristic of negative-symptom schizophrenia. Instead, the findings suggest that positive symptoms are associated with greater susceptibility to distraction.
TL;DR: The author argues that the current classification of chronic pain is adequate to deal with the varieties of depression associated with chronic pain and that psychogenic pain disorder should be remerged with conversion disorder for the sake of clarity.
Abstract: The assessment of patients with chronic pain is receiving increasing attention by psychiatrists. Recent publications have put forward the concept of the “pain-prone disorder” as a variant of depressive illness. This study describes a series of 50 consecutive patients with chronic pain in terms of the five axes of the DSM-III nosology. Diagnoses were made after a 90- to 120-minute psychiatric interview, and a check on diagnostic reliability was made on a small subsample. Psychological factors affecting physical condition were diagnosed in 34% and dysthymic disorder was diagnosed in 28%, while major depression, psychogenic pain disorder, somatization disorder, and anxiety disorders were each respectively diagnosed in 8%. Only 6% had no diagnosis on axis I and 4% had no diagnosis on axis III. Personality disorder was diagnosed in 40%, and traits of dependence, compulsiveness, and anxiety were common. Overall, the patients had experienced a high degree of psychosocial stress with fair to poor adaptive functioning. The notion of chronic pain as a variant of depressive disease is questioned on the basis of these findings. The author suggests that although pain-proneness is a useful psychodynamic concept, the case for its establishment as a new psychobiological disorder is not proven. Furthermore, the concepts of pain-proneness, depression, and psychogenic pain have become confused. The author argues that the current classification is adequate to deal with the varieties of depression associated with chronic pain and that psychogenic pain disorder should be remerged with conversion disorder for the sake of clarity.
TL;DR: Clinical management of potentially suicidal children needs to encompass symptomatic treatment of depression and amelioration of adverse family interactions.
Abstract: A comparison was made of demographic and clinical variables between 481 children aged 15 or less who exhibited symptomatic depression and 147 children who had this symptom and who also had suicidal ideas. Suicidal ideation was associated with disturbed, hostile intrafamilial relationships. It was also associated with age in girls. Significantly, experiences of loss were associated with symptomatic depression rather than with suicidal ideation per se. No specific psychiatric, emotional, or conduct disorder symptoms were found to differentiate between the two groups. Similarly, extrafamilial and social characteristics were not differentiating features. The children with suicidal ideation had no more disturbance of peer relationships or social withdrawal than did their nonsuicidal depressed counterparts and may not, therefore, be readily identifiable by teachers or other responsible adults. Clinical management of potentially suicidal children needs to encompass symptomatic treatment of depression and amelioration of adverse family interactions.
TL;DR: Alcohol consumption may become adaptive from the evolutionary viewpoint when drinking settings and intoxication can be used to enhance the “cheating” reproductive strategy of antisocial personality disorder.
Abstract: Alcohol consumption may become adaptive from the evolutionary viewpoint when drinking settings and intoxication can be used to enhance the "cheating" reproductive strategy of antisocial personality disorder. This may explain the selective pressures leading to the association of familial alcoholism and antisocial personality disorder.
TL;DR: How the unreliability of interviewer assessments limits the amount of agreement between self-reported and clinician ratings of individual symptoms of major depressive disorder is discussed.
Abstract: The authors examine the relationship between self-reported and interviewer ratings of individual symptoms of major depressive disorder. The overall rate of agreement between the self-reported and clinician ratings was about 80% for 14 of the 18 symptoms, and the median Kappa for determining the presence or absence of the symptoms was .62. Disagreement was greatest for psychomotor disturbance, decreased concentration, and indecisiveness. The authors discuss how the unreliability of interviewer assessments limits the amount of agreement between self-reported and clinician ratings.
TL;DR: A 39-item life event measure, devolped previously in one sample of 1018 adolescents, was adminitered to a second sample of 376 teenagers, andrelates of the scales with drug use and personality revealed interpretable associations within the cross-validation sample and were quite similar to these in the original sample.
Abstract: Recent critiques in the stress literature have identified several methodological shortcomings, including ignoring control over event occurrence, the confounding of life event and outcome measures, the lack of consistent and reliable measures, and few cross-validational studies. Each of these problems is addressed empirically by examining two independent samples of adolescents. A 39-item life event measure, developed previously in one sample of 1018 adolescents, was administered to a second sample of 376 teenagers. Second-order factors of six stress scales were clustered into controllable and uncontrollable events, both of which were related to psychological distress. Poor health was significantly related to an uncontaminated factor of uncontrollable events. Means and covariances of the seven stress factors were compared between the derivation sample and an age-matched subset of the cross-validation sample. Correlates of the scales with drug use and personality revealed interpretable associations within the cross-validation sample and were quite similar to those in the original sample. Finally, few sex differences were evident, whereas scores on controllable events scales increased with age.
TL;DR: Panic and agoraphobia were found to be familial, to have a chronic course, and to respond best to a combination of pharmacological and behavioral treatment.
Abstract: In a literature review the best estimates for prevalence of anxiety disorders were determined to be 3% for panic, 6% for agoraphobia, 3% for generalized anxiety, 2.5% for simple phobia, and 1.5% for social phobia. Anxiety disorders tended to have a 2:1 female preponderance. Age of onset was 17 years for social and simple phobia, 22 years for generalized anxiety, and 26 years for panic and agoraphobia. Simple phobia was found to respond best to behavioral treatment and to have a good prognosis. Panic and agoraphobia were found to be familial, to have a chronic course, and to respond best to a combination of pharmacological and behavioral treatment.
TL;DR: This paper provides a brief historical introduction to the new field of artificial intelligence and describes some applications to psychiatry, focusing on a model of paranoid processes and an expert system for the pharmacological management of depressive disorders.
Abstract: This paper provides a brief historical introduction to the new field of artificial intelligence and describes some applications to psychiatry. It focuses on two successful programs: a model of paranoid processes and an expert system for the pharmacological management of depressive disorders. Finally, it reviews evidence in favor of computerized psychotherapy and offers speculations on the future development of research in this area.