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PubMed1990

An epidemiologic study of Tourette's syndrome in a single school district.

To evaluate the frequency of Gilles de la Tourette's syndrome (TS) in children, 3034 students in three schools in a single school district in greater Los Angeles were monitored frequently over a 2-year period by a school psychologist thoroughly familiar with the symptoms of the disorder. A portion of the cases were also evaluated in a TS clinic. A total of 14 males fulfilled the Tourette Syndrome Association research criteria for definite TS. When corrected for the number of students in special education classes in the monitored schools, the frequency of definite TS in males was 1 in 152. An additional 7 males who differed only in that they were not observed for a full year were termed definite TS less than 1 year. When the two groups were combined, the frequency of definite TS was 1 in 95 for males and 1 in 759 for females. These figures do not include an additional 10 males diagnosed as having definite transient tic disorder, 2 males diagnosed as having probable TS, and 10 males diagnosed as having possible TS. In addition to tics, most of these children had problems with attention span, obsessive compulsive behavior, and learning and/or conduct disorders. Seventy percent of the students with definite TS or definite TS less than 1 year were in special education classes. Twelve percent of the children in special education classes had definite TS or definite TS less than 1 year, and 28% were in one of the diagnostic categories of definite, probable, or possible. All of the 10 definite TS patients that were seen in the clinic had attention-deficit hyperactivity disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Psychogenic purpura (autoerythrocyte sensitization): an unsolved dilemma.

Experience at University Hospitals of Cleveland with 71 cases of Gardner and Diamond's syndrome of autoerythrocyte sensitization is reviewed. Gardner and Diamond attributed the pathogenesis of the inflammatory bruises typical of this syndrome to sensitization to the stroma of the patients' own erythrocytes, as demonstrated by reproduction of the lesion on intracutaneous injection of erythrocytic stroma. Nearly all the cases my colleagues and I have seen were in adult women, in whom the onset of inflammatory bruising could often be precisely dated, frequently some weeks after an injury or surgical procedure or, more often, severe emotional stress. Bouts of bruising were often preceded by sensations localized to the affected site. Cutaneous responses to the injection of erythrocytes were erratic. The patients described a wide range of both hemorrhagic and nonhemorrhagic complaints, including, among others, severe headaches, paresthesias, repeated syncope, diplopia (sometimes monocular), and "nervousness." Psychiatric studies indicated that patients had overt depression, sexual problems, feelings of hostility, and obsessive-compulsive behavior. The patients had traits that can be described as typical of a hysterical character disorder. Therapy of autoerythrocyte sensitization--that is, psychogenic purpura--has been difficult; in younger individuals, psychiatric therapy has appeared to be beneficial.

Adult↗
PubMed1989

Normal and disordered compulsivity: evidence against a continuum.

Sixteen patients with obsessive compulsive disorder and 16 mentally healthy control subjects of comparable gender, age, and educational level underwent psychometric testing with the Obsessive-Compulsive subscale of the Comprehensive Psychiatric Rating Scale, the Maudsley Obsessive-Compulsive Inventory, and the Obsessive subscale of the Lazare-Klerman-Armor (LKA) Personality Inventory. An interviewer also rated each subject as positive or negative for each of the five DSM-III elements of compulsive personality disorder. Patients scored significantly higher than controls on all measures except the Obsessive subscale of the LKA Personality Inventory, on which the controls actually scored slightly higher. The authors suggest that the failure of this last instrument to differentiate the subject groups can be interpreted as evidence against a continuum between a certain type of supposed normal personality pattern (obsessive or compulsive) and a corresponding psychopathologic state (obsessive compulsive disorder).

Adult↗
PubMed1989

What about mandatory AIDS testing?

Mandatory testing for AIDS is controversial. Such screening has been suggested for prisoners, immigrants, prostitutes, military personnel, and persons contemplating marriage or pregnancy. Quarantining and even tatooing have also been recommended for persons with AIDS. The advent of mass testing raises the issues of (1) proper allocation of scarce AIDS resources; (2) the need for confidentiality of examination reports; (3) the value of this assessment without the existence of a definitive treatment; (4) the possibility of both false positive and false negative results; and (5) the provision of counseling for people with positive testing. Other concerns involve public health needs versus individual rights, and the confidentiality of the doctor-patient relationship. Past epidemics serve as paradigms for the role of mandatory screening and quarantine in a public health crisis. As testing for AIDS is expanded, anticipate that adverse reactions such as panic, depression, grief, compulsive behavior, and suicide attempts will increase. The physician must provide counsel on such matters as "safe sex" practices, avoidance of needle sharing, and early warning signs of AIDS and ARC.

AIDS Serodiagnosis↗
PubMed1987

[The treatment of children with Gilles de la Tourette's syndrome].

Tourette syndrome is a neuropsychiatric disorder of motor and vocal tics, with associated symptoms of obsessive-compulsive behaviors and attention deficit disorder with hyperactivity. Genetic factors seem to play a major role, but the precise mode of inheritance is still not known. Intervention includes reassurance and support of child and family, medication if needed and guidance and advocacy in relation to school achievements. The major goal of treatment is to help the child succeed in moving along the various lines of development. Clonidine, a centrally active alpha2-noradrenergic agonist is the first choice of medical treatment in most cases. If clonidine fails, pimozide and haloperidol are considered to be good alternatives.

Antipsychotic Agents↗
PubMed1988

Tic disorders of childhood.

Tic disorders may be classified as simple tics, chronic motor tics or Tourette syndrome, the most severe of the three types. Tourette syndrome is rather uncommon and is often misdiagnosed. Tic disorders of childhood probably have an organic etiology and a genetic component. An increased incidence of obsessive-compulsive behavior, attention deficit disorder and other abnormalities have been reported in Tourette patients. Haloperidol is often useful in controlling severe tic symptoms, while stimulant drugs may worsen the symptoms.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

The role of compulsiveness in the normal physician.

This article presents some observations from a workshop setting about the role of compulsiveness in the normal physician. Case examples illustrate the effect of this character trait on the professional, personal, and family life of the typical physician. Doubt, guilt feelings, and an exaggerated sense of responsibility form a compulsive triad in the personality of the physician. This triad manifests itself in both adaptive and maladaptive ways. This article focuses primarily on the maladaptive, including difficulty in relaxing, reluctance to take vacations from work, problems in allocating time to family, an inappropriate and excessive sense of responsibility for things beyond one's control, chronic feelings of "not doing enough," difficulty setting limits, hypertrophied guilt feelings that interfere with the healthy pursuit of pleasure, and the confusion of selfishness with healthy self-interest.

Compulsive Behavior↗
PubMed1983

Psychological correlates of compliance.

A urinary assay (17 kgs/creatinine) was used to measure compliance in 31 acute lymphocytic leukemia patients under 15 years of age receiving oral prednisone. Demographic data and psychological test responses of patients and their parents were correlated with the urinary assays. Results indicated that while the rate of compliance was the same for boys and girls, the psychological correlates were very different. Parental personality traits and attitudes were more involved with boy's compliance than with girl's. Some of the parent variables associated with compliance in boys were hostility, anxiety, and obsessive-compulsive behavior. Parents described compliant boys as vulnerable. These traits usually are considered maladaptive but in this case appear to facilitate boy's compliance. For girls, far fewer parent variables were associated with compliance. Parents seemed to have less worry and concern about their daughters and presumably give them the responsibility for their own medication. It was the girl's own anxiety which predicted compliance.

Adolescent↗