Showing papers in "Psychological Medicine in 1975"
TL;DR: Among predictors of an unfavourable outcome were found a relatively late age of onset, a longer duration of illness, previous admissions to psychiatric hospitals, a disturbed relationship between the patient and other members of the family, and premorbid personality difficulties.
Abstract: This is a prognostic study on 41 patients with anorexia nervosa (including three males) who satisfied defined diagnostic criteria. The patients had all been admitted to a metabolic unit where the mainstay of treatment was nursing care aimed at rapid restoration of body weight. A follow-up was conducted after a minimum lapse of four years after each patient's discharge from hospital. The outcome of the patient's illness was expressed in terms of an 'average outcome score' and a 'general outcome'. The series included a relatively high proportion of patients with a long illness who had received previous psychiatric treatment. Their families tended to come from higher social classes; a disturbed relationship with the patient was frequent. Premorbid disturbances in personality development were also common. The immediate response to treatment was excellent, with the majority of the patients returning to a normal weight, but relapses after discharge were common and readmissions were necessary in half the patients. At follow-up, the patients fell into the following defined categories: 'good' (39%), 'intermediate' (27%), 'poor' (29%), died (5%). Most of the patients who failed to recover continued to display the clinical features characteristic of anorexia nervosa. Among predictors of an unfavourable outcome were found a relatively late age of onset, a longer duration of illness, previous admissions to psychiatric hospitals, a disturbed relationship between the patient and other members of the family, and premorbid personality difficulties. It is suggested according to the severity of their illness, rather than on the method of treatment itself. The illness may last several years before eventual improvement or recovery, and a follow-up study must be extended over at least four years to be meaningful. An accurate prediction of eventual outcome is almost impossible, but late recoveries justify an optimistic outlook and continued therapeutic endeavour.
721 citations
TL;DR: Among patients who scored relatively low on depression or neuroticism pleasant memories were recalled more speedily than unpleasant; among those who scored high this relationship was reversed.
Abstract: An experiment is described in which depressed patients were asked to recall pleasant or unpleasant experiences from their past life in response to a standard series of stimulus words. The ratio between the time for recall of pleasant and unpleasant experiences was found to fall progressively with increasing severity of depression or of "neuroticism" and to be significantly related to each. Among patients who scored relatively low on depression or neuroticism pleasant memories were recalled more speedily than unpleasant; among those who scored high this relationship was reversed. Possible mechanisms to account for these findings are discussed.
310 citations
TL;DR: In the alien tissue group, females, especially left-handed females, were the most likely to have developed a schizophrenia-like psychosis and a marked interaction occurred between psychosis and 'left handedness'.
Abstract: From a series of 255 patients who had undergone temporal lobectomy for the relief of intractable psychomotor epilepsy, all 47 patients with ‘alien tissue’ (small tumours, hamartomas, focal dysplasia) in the resected temporal lobe were contrasted with a group of 41 patients who showed mesial temporal sclerosis in their resected lobe. Five per cent of the mesial temporal sclerosis group and 23% of the alien tissue group were psychotic. A marked interaction occurred between psychosis and ‘left handedness’. In the alien tissue group, females, especially left-handed females, were the most likely to have developed a schizophrenia-like psychosis.
225 citations
TL;DR: A hierarchy of classes of personal illness model is proposed and was assessed using a new self-report measure, the Delusions-Symptoms-States Inventory (DSSI), finding that single syndrome patterns occurred significantly more often than those not classifiable in any higher class.
Abstract: A hierarchy of classes of personal illness model is proposed and was assessed using a new self-report measure, the Delusions-Symptoms-States Inventory (DSSI). Of 480 psychiatric patients 93.3% had symptom patterns conforming to the model. It was additionally found that single syndrome patterns, within a particular class, occurred significantly more often in those not classifiable in any higher class. Finally, the relationship between each possible pair of the 12 syndromes was examined. Some of the implications of the model and the data are discussed in terms of the development, remission, assessment, and treatment of personal illness.
222 citations
TL;DR: Maintenance amitriptyline gave a significant advantage over early withdrawal in preventing symptom recrudescence and psychotherapy produced no significant advantages over low contact on symptoms, although it did improve social adjustment ratings reported elsewhere.
Abstract: Depressives responding to initial treatment were maintained on amitriptyline for eight months, withdrawn double-blind to placebo after two months, or withdrawn overtly onto no medication. In each group half the patients received weekly psychotherapy and half were seen, once monthly. Effects on symptom ratings were examined. Maintenance amitriptyline gave a significant advantage over early withdrawal in preventing symptom recrudescence. There were no differences between double-blind or overt withdrawal. There were no interactions between drug withdrawal and psychotherapy. Psychotherapy produced no significant advantages over low contact on symptoms, although it did improve social adjustment ratings reported elsewhere.
141 citations
TL;DR: A plea is made for the development of a functional psychopathology, in which psychiatric syndromes are "dissected" into their constituent psychological dysfunctions, to stimulate human brain and behaviour research.
Abstract: The probenecid technique was used in study of the central dopamine DA metabolism in patients with depressions, psychotic disorders, and Parkinson's disease. The disturbances found were neither nosologically nor syndromally specific, but appeared to be symptom-specific. Decreased DA turnover was associated with hypomotility, and increased DA turnover with hypermotility. Decreased DA turnover was probably related aetiologically to the hypomotility: the symptoms subsided after replenishment of the DA deficiency. The relation between increased DA turnover and hypermotility is still under investigation. In view of the findings obtained, a plea is made for the development of a functional psychopathology, in which psychiatric syndromes are "dissected" into their constituent psychological dysfunctions. This development is expected to stimulate human brain and behaviour research. It can be achieved only by intensive collaboration between psychiatrists and experimental psychologists.
134 citations
TL;DR: Epileptic patients with a high current psychiatric morbidity were characterized by a raised incidence of previous neurotic illness and raised neuroticism scores on the Eysenck Personality Inventory.
Abstract: A comparison was made of the mental state of patients with chronic epilepsy and matched controls with locomotor disorders, using a reliable psychiatric interview technique. The symptom profiles of the two groups were similar. The profiles of temporal lobe and other epileptics were also similar. Epileptic patients with a high current psychiatric morbidity were characterized by a raised incidence of previous neurotic illness and raised neuroticism scores on the Eysenck Personality Inventory.
128 citations
TL;DR: The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared and male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts were compared.
Abstract: The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared. The following items differentiated the suicide group: male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts. The value of these items in assessing suicide risk in depressive illness is discussed.
124 citations
TL;DR: Nostalgia, a psychopathological condition affecting individuals who are uprooted, whose social contacts are fragmented, who are isolated and who feel totally frustrated and alienated, was first described in the 17th century and was a problem of considerable interest to physicians in the 18th and 19th centuries as discussed by the authors.
Abstract: Nostalgia, a psychopathological condition affecting individuals who are uprooted, whose social contacts are fragmented, who are isolated and who feel totally frustrated and alienated, was first described in the 17th century and was a problem of considerable interest to physicians in the 18th and 19th centuries. By the 20th century it seemed to have disappeared, but reappeared under other labels.
103 citations
TL;DR: The systematic inclusion of an ecological and cultural dimension in the study of schizophrenia in recent decades has been the result of a need that has been appreciated mostly by epidemiologically-oriented psychiatrists.
Abstract: The cross-cultural study of schizophrenia is not a new avenue of research. It was opened almost simultaneously with the early formulations of the concept of schizophrenia and developed in the spirit of a recognition of the relationship between psychopathological phenomena and the sociocultural context, exemplified by the classical studies of Durkheim. Some of the founders of modern European psychiatry visited what were then regarded as 'exotic' cultures and returned with observations which on the whole tended to strengthen their theoretical formulations which were based originally on patient populations in European institutions (for example, Kraepelin in Java, 1904; Bleuler in India, 1930). In spite of a great number of insightful and penetrating observations, the methodological aspects of the early research in schizophrenia in different cultures have been criticized for a number of reasons: observers' limited periods of contact with the foreign culture, frequent reliance on evidence that was no better than anecdotal, 'Eurocentric' assessment of the cultural background against which the features of the disorder were described, and lack of uniformity in the diagnostic criteria of schizophrenia. The period between the two world wars was characterized by marked advances in cultural anthropology which resulted in attempts at theoretical formulations of the relationship between psychological adjustment and some essential elements of culture. However, there was only a limited degree of collaboration between this discipline and psychiatry, and conspicuously little was added to the knowledge on schizophrenia. At the same time, empirical studies of the ecology of mental disorder utilizing an epidemiological approach—for example, Faris and Dunham's (1939) study of mental illness in Chicago and Odegaard's (1932) study of psychiatric morbidity among Norwegian immigrants in the USA—were marking milestones on a road which was to attract increasing attention in the decades after the second world war. The influence of the environment on the disease process had long been recognized by clinical psychiatrists in the individual case, but the impact of these studies consisted in the convincing demonstration that ecological factors were consistently and significantly associated with certain disease characteristics in large populations of schizophrenic patients. The systematic inclusion of an ecological and cultural dimension in the study of schizophrenia in recent decades has been the result of a need that has been appreciated mostly by epidemiologically-oriented psychiatrists. It has led to a renewed interest in the closer collaboration between psychiatry and the social sciences. The leading part in this alliance is now sometimes played by the psychiatric epidemiologist and sometimes by the sociologist or cultural anthropologist: this explains the differences of emphasis in a number of studies and the broad spectrum of theoretical approaches, ranging from a recognition of schizophrenia as a biologically founded disease entity, a result of faulty interpersonal relationships (Bateson et al., 1956), a product of social labelling (Scheff, 1966), or an artefact of society's repressive structure (Laing, 1967). Most psychiatrists now accept the assumption that the study of the cultural aspects of schizophrenia can provide important clues to the nature of this disorder—that is, its aetiology, pathology, and response to treatment. Before attempting to examine how well this assumption is supported by the known facts, however, we must refer briefly to two difficulties inherent in this kind of inquiry. In the first place, the scope and content of the concept of culture are difficult to define. Quoting
83 citations
TL;DR: The results indicate that the experimental service conferred some benefit on the patient population.
Abstract: A study was designed to assess the therapeutic value of attaching a social worker to a metropolitan group practice in the management of chronic neurotic illness. The psychiatric and social status of a group of patients before treatment and after one year was compared with the status of a control group treated more conventionally over the same period. The results indicate that the experimental service conferred some benefit on the patient population.
TL;DR: There have been many battles in the last 100 years between those who consider hysteria to be a "morbid entity" or "disease" and those who would like to drop it once and for all as mentioned in this paper.
Abstract: There have been many battles in the last 100 years between those who consider hysteria to be a ‘morbid entity’ or ‘disease’ and those who would like to drop it once and for all. The controversy still goes on. It has not been settled by follow-up studies or by applying genetic considerations. Hysteria is a tough subject, unlikely to be killed so long as clinicians find it useful, if not indispensable.
TL;DR: A study of 120 inpatients diagnosed as suffering from hysteria is presented and it is concluded that the 13% are suffering from a condition that can only be diagnosed as hysteria.
Abstract: A study of 120 inpatients diagnosed as suffering from hysteria is presented and the validity of the diagnosis questioned. Clinical study showed that 13% showed only hysterical symptoms, 33% showed hysterical symptoms occurring with affective symptoms, 28% showed affective symptomatology only, and the remainder were either of other or uncertain diagnostic grouping. It is concluded that the 13% are suffering from a condition that can only be diagnosed as hysteria.
TL;DR: In a prospective study of rheumatoid disease, clinical, serological, radiological, and biochemical factors were assessed on 102 patients and scores obtained on the Middlesex Hospital Questionnaire suggest a possible subclassification of RD into a less severe form in which psychosocial factors may be important, and a more severeForm in which heredity or some other constitutional factor (or factors) may beImportant.
Abstract: In a prospective study of rheumatoid disease (RD) clinical, serological, radiological, and biochemical factors were assessed on 102 patients and scores obtained on the Middlesex Hospital Questionnaire (MHQ). Patients with early RD had MHQ scores closely resembling those in the normal population. Using a new clinical prognostic index, patients who develop severe RD tended to have low scores at initial testing on the MHQ. Patients whose serum was positive for rheumatoid factor also tended to have low scores on the MHQ. Together these findings suggest a possible subclassification of RD into a less severe form in which psychosocial factors may be important, and a more severe form in which heredity or some other constitutional factor (or factors) may be important, rheumatoid factor acting as a ‘marker’.
TL;DR: Two experiments concerned with the statistical characteristics of speech in presenile dementia are described and apart from a lowered rate of production of words under certain conditions no speech abnormalities were detected on the variables examined.
Abstract: Two experiments concerned with the statistical characteristics of speech in presenile dementia are described. Apart from a lowered rate of production of words under certain conditions no speech abnormalities were detected on the variables examined.
TL;DR: Differences between the rates in the two areas are discussed with a view to identifying those variables that selectively affect referral to a community service.
Abstract: The annual rates of referral to two differently organized comprehensive psychiatric services in separate but demographically similar areas are presented for various demographic social and clinical categories In Part 1 the rates are examined for similarities both between the two areas and with findings from other studies in order to obtain pointers to factors affecting the inception of psychiatric disorders In Part 2 an attempt is made to evaluate an aspect of the community service Differences between the rates in the two areas are discussed with a view to identifying those variables that selectively affect referral to a community service
TL;DR: Plasma levels of chlorpromazine (CPZ) and prolactin were measured repeatedly in 14 psychiatric patients throughout CPZ treatment and only patients with mean plasma Prolactin above 35 ng/ml developed Parkinsonian side-effects.
Abstract: Plasma levels of chlorpromazine (CPZ) and prolactin were measured repeatedly in 14 psychiatric patients throughout CPZ treatment. Mean prolactin level was elevated in 11 subjects (all six women and five of eight men). Mean plasma prolactin correlated significantly with mean plasma CPZ but not with the dose of the drug. Only patients with mean plasma prolactin above 35 ng/ml developed Parkinsonian side-effects.
TL;DR: Within a sample of 308 depressed psychiatric inpatients, suicide attempters were younger than non-attempters and were identified by a pattern of chronic interpersonal maladjustment reflected clinically in withdrawal from social contact and the display of hostility or irritability toward others.
Abstract: An attempt was made to identify background, sociodemographic and clinical variables which are associated with attempted suicide in depression Within a sample of 308 depressed psychiatric inpatients, suicide attempters were younger than non-attempters and were identified by a pattern of chronic interpersonal maladjustment reflected clinically in withdrawal from social contact and the display of hostility or irritability toward others Language: en
TL;DR: A review of the literature relating to multiple personality and a study of a single case of hysterical aetiology that demonstrates the development of multiple personality from a fugue amnesic state demonstrate a tendency towards remission.
Abstract: A review of the literature relating to multiple personality is presented together with a study of a single case of hysterical aetiology that demonstrates the development of multiple personality from a fugue amnesic state. A re-examination of this case after 15 years without significant psychotherapeutic intervention demonstrates a tendency towards remission. The view that multiple personality is a form of fugue, not necessarily hysterical, in which an alternative personality is adopted and that this behaviour is reinforced by the attention that it receives, is discussed.
TL;DR: Cognitive function was evaluated in 11 patients with Huntington's chorea, using eight subtests of the WAIS, and their performance was compared with that previously reported for a normal aged population, suggesting that the choreic patients had no selective impairment of immediate memory.
Abstract: Cognitive function was evaluated in 11 patients with Huntington's chorea, using eight subtests of the WAIS, and their performance was compared with that previously reported for a normal aged population. The pattern of impairment was similar in the two groups. Tests of immediate memory were given to nine of these patients, and to 10 healthy but aged subjects. In both groups, there was a significant correlation between the performance of individuals in these tests and their IQ, suggesting that the choreic patients had no selective impairment of immediate memory. The clinical and psychological records of the 11 patients revealed no evidence of focal deficits, and the majority of patients were fully orientated and retained insight to their condition. These observations are discussed in relation to the pattern of intellectual impairment seen in other presenile dementias.
TL;DR: Factor analysis was performed on objectively measured and subjectively reported characteristics of 46 nights' sleep in four healthy male subjects to establish the bases of four separate factors of fragmentation of sleep by awakenings during the night, the delay before falling asleep, and the total duration of sleep.
Abstract: Factor analysis was performed on objectively measured and subjectively reported characteristics of 46 nights' sleep in four healthy male subjects. The fragmentation of sleep by awakenings during the night, the delay before falling asleep, the total duration of sleep, and the amount of delta-wave sleep formed the bases of four separate factors.
TL;DR: In no group was there any evidence of accelerated recovery, indicating that the process of conversion to normal mood may be more complex than suggested by most versions of the amine hypothesis.
Abstract: Depressed patients (unipolar) were given one of the following combinations in an attempt to test aspects of the ‘amine hypothesis’ and to find a preferential therapy: (1) clomipramine; (2) clomipramine and tryptophan; (3) desipramine and clomipramine, and (4) desipramine and tryptophan. Treatment (2) should have given optimal potentiation of 5-HT neurones and (3) and (4) should have acted similarly on both serotoninergic and adrenergic pathways. In no group was there any evidence of accelerated recovery, indicating that the process of conversion to normal mood may be more complex than suggested by most versions of the amine hypothesis.
TL;DR: Patients diagnosed on the basis of structured interviews as having affective psychoses were less sensitive in detecting the presence of a transient auditory signal than were schizophrenic patients or non-patients and benefited more than the other two groups from the existence of a second auditory transient.
Abstract: Patients diagnosed on the basis of structured interviews as having affective psychoses were less sensitive in detecting the presence of a transient auditory signal than were schizophrenic patients or non-patients. Patients with affective psychoses also benefited more (their reaction time was more reduced) than the other two groups from the presence of a second auditory transient.
TL;DR: The psychiatric ratings, using the In-Patient Multi-dimensional Psychiatric Scale, of a group of over 200 psychiatrists from the British Isles, third year psychology students, and general practitioners attending a postgraduate course in psychiatry, were compared to find that non-psychiatrists rate higher levels of symptoms than psychiatrists.
Abstract: The psychiatric ratings, using the In-Patient Multi-dimensional Psychiatric Scale, of (1) a group of over 200 psychiatrists from the British Isles, (2) third year psychology students, (3) trainee sister tutors, (4) general practitioners attending a postgraduate course in psychiatry, and (5) a group of new registrars at the Maudsley Hospital, were compared. The first hypothesis, that, whereas the non-psychiatrists would rate similar levels of symptoms, the psychiatrists would tend to rate lower than other professional groups, was upheld. The second, that the pattern or profile of symptoms as shown by the IMPS syndromes would differ little between the groups, was also upheld. The third hypothesis, that because of their special training in the recognition of symptoms, psychiatrists would tend to show greater intra-group agreement on the levels of symptoms than the other groups, was not upheld. Some possible reasons for the findings are discussed. The importance for a screening schedule, designed to be used by non-psychiatrists for the detection of psychiatric illness, of the finding that non-psychiatrists rate higher levels of symptoms than psychiatrists, is also discussed.
TL;DR: The validity of the General Health Questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is established by showing that in matched samples the expected Psychiatric morbidity in generalPractice can be compared with the much greater morbidities in psychiatric outpatient referrals.
Abstract: A sample of 91 new referrals to a community based psychiatric outpatient service was compared with a cross-matched control sample of 107 patients attending the general practitioner's surgery. The subjects in both groups completed the General Health Questionnaire and there was a very marked difference between the scores of the two groups. Seventy-five of the psychiatric group had a high score on the questionnaire, and a large number of these were extremely high, while 74 of the general practice group had a low score. The 'false' positives and negatives are discussed. It is considered that the validity of this questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is further established in this study by showing that in matched samples the expected psychiatric morbidity in general practice can be compared with the much greater morbidity in psychiatric outpatient referrals. For the psychiatric sample more patients showed high scores and these tended to be much higher.
TL;DR: Factor analysis was performed on variables used to describe subjectively the sleep habits of three groups of subjects--male patients, female patients, and medical students, indicating the existence of dimensions of variation which are common to normal sleep habits and insomnia.
Abstract: Factor analysis was performed on variables used to describe subjectively the sleep habits of three groups of subjects--male patients, female patients, and medical students. Similarities in the six factors from each analysis indicate the existence of dimensions of variation which are common to normal sleep habits and insomnia.
TL;DR: No difference was found between these cases and all resident Cardiff maternities for the same period in respect of social class, maternal parity, weight gain in pregnancy, length of gestation, birth weight, and sex of infant.
Abstract: This study is based on a sample of 35,486 consecutive confinements in Cardiff (1965-72) which gave rise to 67 cases of post partum mental illness. No difference was found between these cases and all resident Cardiff maternities for the same period in respect of social class, maternal parity, weight gain in pregnancy, length of gestation, birth weight, and sex of infant. A statistically significant cyclic variation in month of conception and date of birth was found with a peak frequency among conceptions in the first quarter of the year. The bearing this finding may have on the prevention of post partum mental illness and the implications of the observation that post partum mental illness and the functional psychoses have a remarkably similar temporal behaviour are discussed.
TL;DR: The thyroid stimulating hormone (TSH) response curve after TRH administration in the depressive patients group was blunted in comparison with that in a matched control group of normals.
Abstract: In a double reversal design the potency of thyrotropin releasing hormone (TRH) (500 mug intravenously) as a quick-acting antidepressive agent was evaluated. A first injection did seem to give rise to a very slight short-lasting effect, though this could not be ascertained clearly. There were no visible effects after a second injection. The thyroid stimulating hormone (TSH) response curve after TRH administration in the depressive patients group was blunted in comparison with that in a matched control group of normals.