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PubMed1984

Organic brain syndromes: new classification, concepts and prospects.

The concept, definitions and classification of organic mental disorders have been radically revised in DSM-III, the new American classification. Seven organic brain syndromes have been included and their diagnostic criteria explicitly formulated. The boundary between so-called functional and organic mental disorders has been blurred. The author discusses these changes in the light of growing importance of organic psychiatry due to aging of the population and the high incidence and prevalence of organic mental disorders in the elderly.

Aged↗
PubMed1989

EEG mapping applications in psychiatric disorders.

A number of techniques have been developed for EEG mapping in recent years. The clinical and research applications of these techniques in psychiatry are reviewed with regard to schizophrenia, affective disorder, learning disorders, dementia, psychopharmacology and ruling out neurological disorders. Limitations and advantages of EEG mapping as well as its relation to other imaging techniques are discussed.

Alzheimer Disease↗
PubMed1990

Affect regulation and psychopathology: bridging the mind-body gap.

A failure of affect regulation is put forward as central to the development of psychopathology. Giving affect regulation this pivotal role allows one to explain how the various theories of intervention (for example, dynamic, behavioural, medical) can all have relatively similar results. As well, it provides an explanation for the common findings of brain and language dysfunction in psychopathology, the co-occurrence of anxiety disorders in various other mental disorders and the responsiveness of individuals with severe pathology to the affect in their environments. A model is presented linking the reticular, limbic and frontal systems of the brain with the conceptual frameworks used by mental health workers in their efforts to intervene. To illustrate how the model may be used, it is applied to various disorders.

Arousal↗
PubMed1992

Psychiatric morbidity in patients with HIV infection.

A psychiatric examination was conducted on 144 patients at various stages of HIV infection and on 29 controls found to be seronegative. One-half of the control group had at least one DSM-III-R Axis I diagnosis, most commonly cannabis abuse, alcohol abuse, or adjustment disorder. Compared to this baseline, HIV-infected subjects had higher rates of adjustment disorder. AIDS patients were also more likely to suffer from organic mental disorder. The rate of unemployment increased as the disease progressed. Major depression was seen in only ten patients, and there were no differences between controls and HIV-infected subjects. Formal assessment of mood state and feelings of pessimism also showed no differences among the groups. The importance of helping improve the patient's lifestyle through the control of alcohol and drug abuse is underscored.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Iron deficiency in two adolescents with conduct, dysthymic and movement disorders.

Enquiry into a marginally subnormal hemogram in two adolescents with complex conduct, dysthymic and movement disorders uncovered a striking iron deficiency and prompted a trial of replacing psychotropic medication with iron therapy. The rationale of iron therapy for behavioural disturbance was examined from the clinical, neurochemical and psychopharmacological points of view. Although further study is required to confirm the therapeutic efficacy and to define the precise nature of iron deficiency in conduct disorder, the weight of the evidence suggests that correcting the nutrient deficit may be an essential step toward a refinement of therapeutic strategies. The presence of a borderline hemogram, hypermenorrhea and malnutrition should alert clinicians to the possibility of iron deficiency, and laboratory screening for hypoferremia should be considered when assessing conduct disorder.

Acting Out↗
PubMed1998

Psychiatric morbidity in HIV patients.

OBJECTIVE: To provide an accessible source of clinical information related to the diagnosis and treatment of psychiatric morbidity associated with HIV infection. METHOD: A selective MEDLINE literature search was used to identify 225 relevant articles, 67 of which were selected for inclusion based upon the presence of psychiatric morbidity. Psychiatric morbidity was defined by the presence of a DSM-IV diagnostic code reflecting psychiatric illness. RESULTS: HIV-infected patients have high rates of psychiatric morbidity. CONCLUSION: The psychiatric evaluation and treatment of psychiatric morbidity improve the quality of life of HIV and AIDS patients.

AIDS Dementia Complex↗
PubMed1998

The prevalence of mental disorders in the elderly in Edmonton: a community survey using GMS-AGECAT. Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy.

OBJECTIVE: To estimate the current prevalence rate of Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) disorders in the elderly population in Edmonton, Alberta. To compare the prevalence rate of GMS-AGECAT depression with the prevalence rate of Diagnostic Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders (DIS-DSM-III) major depression based on an earlier survey in Edmonton. METHOD: A sample of 1119 community residents age 65 years and over was selected using the provincial health insurance database. Data on mental disorders were collected using the Geriatric Mental State questionnaire, and diagnoses were made with the Automated Geriatric Examination for Computer Assisted Taxonomy computer program. Prevalence rates, standard errors, and logistic regression coefficients were estimated using software designed to analyze survey data. RESULTS: The prevalence rates of GMS-AGECAT depression and organic disorder were 11.2% and 2.9% respectively. For depression there was a statistically significant difference in the prevalence rates for males (7.3%) and females (14.1%) (P = 0.003), and for organic disorder there was a statistically significant increasing trend across age-groups for females (P < 0.0001). The prevalence rate of GMS-AGECAT depression in Edmonton is comparable to rates reported from several European studies but is much higher than the 6-month prevalence rate of DIS-DSM-III major depression of 1.2% based on an earlier Edmonton survey. CONCLUSIONS: GMS-AGECAT depression is a depressive syndrome that has a larger prevalence rate than DIS-DSM-III major depression. Community surveys that measure only the prevalence rate of DSM-III major depression may be missing clinically significant cases of geriatric depression.

Aged↗
PubMed1987

Psychiatric symptomatology in language-impaired children: a comparison.

This paper reports a detailed comparison of two groups of children from the same psychiatric clinic, one with a delay in language development and an age- and sex-matched control group with no such delay. The language-delay group was highly likely to have either a diagnosis of mental retardation or infantile autism. Very few psychiatric symptoms occurred more frequently in the language-delay group than in the comparison group, and those that did were characteristic of retarded or autistic children. The language-delay group was more likely to have other developmental abnormalities, hearing impairment, and evidence of central nervous system dysfunction.

Adolescent↗
PubMedDate not supplied

Characteristics of elderly patients admitted for the first time to a psychiatric facility.

There has been little investigation of patients admitted to a psychiatric facility for the first time late in life. We therefore examined characteristics of a group of 100 consecutive patients over the age of 65, admitted for the first time to the psychiatric service of a private, university-affiliated hospital. Almost two thirds of these patients received a primary discharge diagnosis of major depression, while another one fourth received a diagnosis of dementia. Patients with dementia were significantly older and more likely to be men. The frequency of dementia climbed with each decile affecting 15% of those less than 75 years, 39% of those 75 to 84, and 47% of those over age 85. Thirty-six percent of all patients were psychotic on admission, including 28% of those with major depression and 48% of those with dementia. Visual hallucinations were significantly more common in the group with dementia. In turn, eye disease was significantly more common in those with visual hallucinations. Nine patients were admitted with a history of recent assaultive behavior. Four of these were psychotic and eight of nine were demented. Five patients had attempted suicide prior to their admission. All were diagnosed as having major depression.

Aged↗
PubMedDate not supplied

Psychiatric commitment of the elderly.

Involuntary hospitalization of the elderly has been the focus of controversy. In many jurisdictions, commitment criteria are stringently and narrowly defined, require a showing of "dangerousness," and are difficult to apply toward securing proper treatment for the elderly. In other areas, broader criteria apply, but some authors argue that such criteria are inappropriately used with the elderly and leave them vulnerable to the abuse of unnecessary institutionalization. The authors examined 274 consecutive admissions aged 55 years and over, comparing voluntary and involuntary patients. Patients admitted involuntarily were significantly more likely to have organic mental disorders, be violent before admission, and be disoriented, withdrawn, and apathetic. Voluntary patients were significantly more likely to have major mood disorders. Patients who lived with others were more likely to be committed than those living alone. The authors discuss these findings with attention to the appropriateness of broader commitment standards and the more stringent dangerousness criteria as they apply to the geriatric population.

Aged↗
PubMed1996

Psychiatric illnesses in the elderly: a review.

Neuropsychiatric disorders in the elderly, such as dementia, depression, anxiety, and psychosis, may occur alone or in combination with neurologic or medical illness. Geriatricians must be familiar not only with diagnostic issues but also with treatment options and medication-induced alterations in mental status.

Aged↗
PubMed1990

Psychiatric correlates of repetitive rhythmic blinking on a routine EEG.

Our findings suggest that EEG tracings dominated by repetitive rhythmic blinking (RRB) may be indicative of a functional rather than an organic brain disorder. Evaluation of organicity in psychiatric patients is the most common reason for obtaining an EEG. As a normal EEG does not totally rule out organic involvement, such findings as the presence of RRB on the record may strengthen the value of EEG in such evaluations. More research is necessary to further delineate the relation between increased blinking and functional psychiatric disorders.

Blinking↗
PubMed1996

A review of the usefulness of the standard EEG in psychiatry.

The goal of this paper is to draw conclusions about the usefulness of the standard EEG in psychiatry. In general, two thirds of psychiatric referrals for an EEG are expected to provide useful information. The emphasis in schizophrenia is placed on left-sided abnormalities, especially on the left temporal area. In mood disorders the emphasis is on right-sided foci, in addition to the controversial 6/sec spike and wave complexes, small sharp spikes and positive spikes. In the acute stage of alcoholism, a relationship is seen between the degree of intoxication and the amount of slow activity, while in the chronic stage an increase in slow activity is seen, but another change is fast activity on the temporal areas. During withdrawal a low seizure threshold can be seen as irregular bilateral spike and wave complexes. During abstinence 2-4 yr may be required before slow wave sleep is normal in all regards. Among the organic mental syndromes, delirium shows slow activity, except in delirium tremens, which often is associated with a normal record with fast activity. In dementia the prevalence of EEG abnormalities is related to the degree of impairment. After five sessions of ECT diffuse slow waves are often seen. In other conditions, among developmental disorders about one half of autistic children show abnormalities and epileptiform activity is not uncommon. Mild nonspecific abnormalities are seen in about 40% of dyslexics and also in behavior disorders. Anxiety disorders include anorexia nervosa, showing abnormal background activity related to the effect of starvation on cerebral metabolism. In panic attacks paroxysmal activity can be seen. In borderline personality positive spikes have been (again) associated with impulsivity and 6/sec spike and wave complexes with interpersonal problems. Of the drugs of abuse psilocybin and phencyclidine are often associated with generalized epileptiform patterns and with marijuana the alpha shows a decreased frequency with increased amplitude. Typically, an increase in slow activity is seen with psychotropic drugs if there is a change in the level of awareness. Finally, distinctive personality traits are, at times, seen in temporal lobe epilepsy and the phenomenon of "forced normalization" may appear when seizures stop and psychotic symptoms appear.

Adult↗
PubMed2006

Dietary and other lifestyle correlates of serum folate concentrations in a healthy adult population in Crete, Greece: a cross-sectional study.

BACKGROUND: Folate has emerged as a key nutrient for optimising health. Impaired folate status has been identified as a risk factor for cardiovascular disease, various types of cancers, and neurocognitive disorders. The study aimed at examining the distribution and determinants of serum folate concentrations in a healthy adult population in Crete, Greece. METHODS: A cross-sectional sample of 486 healthy adults (250 men, 236 women) aged 39 +/- 14 years, personnel of the Medical School and the University Hospital of Crete in Greece, was examined. Serum folate and vitamin B12 concentrations were measured by microbiological assay, and total homocysteine was determined fluorometrically and by high-pressure liquid chromatography. Lifestyle questionnaires were completed, and nutrient intakes and food consumption were assessed by 24-h dietary recalls. Multivariate analyses were performed using SPSS v10.1. RESULTS: The geometric mean (95% confidence interval) concentrations of serum folate were 15.6 micromol/l (14.6-16.8) in men and 19.2 micromol/l (17.9-20.7) in women (p < 0.001). Inadequate folate levels (<or=7 nmol/l) were present in 6.8% of men and 2.1% of women (p < 0.001). Approximately 76% of men and 87% of women did not meet the reference dietary intake for folate (400 microg/day). Serum folate was inversely related to total homocysteine levels (p < 0.001). Increased tobacco and coffee consumption were associated with lower folate concentrations (p < 0.05 for both) but these associations disappeared after controlling for nutrient intakes. In multivariate analysis, intakes of MUFA, fibre, calcium, magnesium, folate, and vitamins A, E, C, B1, and B6 were positively associated with serum folate. Consumption of potatoes, legumes, fruits, and vegetables were favourably related to the serum folate status. CONCLUSION: Serum folate concentrations were associated with various demographic, lifestyle and dietary factors in healthy Cretan adults. Large-scale epidemiological studies should be conducted within the general Greek adult population to assess the prevalence of impaired folate status and further examine associations with dietary patterns and chronic disease risk. Considering the importance of folate in health maintenance, it is important to increase the public's awareness of modifiable lifestyle patterns and diet and tobacco use in particular, which may be associated with improved folate status.

Adult↗