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The psychiatric complications of Parkinson's disease.
Although James Parkinson in 1817 excluded mental symptoms from his original description of paralysis agitans, it has become clear that a wide range of psychiatric disorders can develop in patients with this disease. The principal conditions of dementia, depression and confusional syndromes, many of which are precipitated by drugs used in the treatment of parkinsonism, are reviewed. Particular attention is given to the frequency of dementia and its likely pathogenesis, to the nature of depression in Parkinson's disease and to the effects of different drugs, notably levodopa. A number of rare disorders characterised by parkinsonian and psychiatric symptoms are also discussed.
Diagnostic reasoning and treatment planning: III. A case example.
A diagnostic formulation and treatment plan are derived from the case history of a psychiatrically disturbed adolescent admitted to hospital. This paper illustrates the goal-directed method of treatment planning outlined in the two previous papers.
Biologism in psychiatry.
A recent study visit to North America impressed on me the seriousness with which Australian psychiatry should consider the recent ideological shift in the USA to an extreme biological model of mental disorders. There is increasing evidence that proponents of this model are not simply promoting the value of biological research (with which few psychiatrists would quibble), but that the field is at risk of being overwhelmed by a reductionistic "biologism" which assumes an organic causation for all abnormal human behaviour.
Clinical assessment of psychiatric symptoms in mentally retarded individuals.
Mentally retarded Australians with emotional and behavioural disorders are seriously under-served by psychiatrists, despite such individuals being as prevalent as those with schizophrenia. These disorders have serious consequences for the individual, family and carers, and the community as a whole. In the psychiatric assessment of mentally retarded persons, a key principle is that while intellectual handicap increases vulnerability to psychiatric illness, it does not of itself cause psychopathology. A biopsychosocial framework provides a model whereby those factors which are contributing to psychopathology can be systematically elucidated. Biological factors include brain pathology associated with particular mental retardation syndromes, drug side-effects and epilepsy. Psychological factors include temperament, a history of abuse, and current life stresses. Social factors include distortions in family roles and hostel or workshop conflicts. Although clinical assessment can be challenging, and confident syndrome diagnosis is not always possible, a systematic approach to the analysis of symptoms will provide a guide to useful interventions.
A critique of 'organic' and its proposed alternatives.
OBJECTIVE: A critical examination of the term 'organic' in psychiatry and its proposed alternatives. METHOD: An examination of the published literature on the concepts of 'organicity' in mental syndromes, and of the mind-brain problem. RESULTS: The term 'organic' presents a number of problems, some of which can be described as those of historical schism, duality, method, practice, scholasticism and semantics. The currently available alternatives are not without their difficulties, and examples are provided. CONCLUSION: Whether the term 'organic' is retained or replaced, we are condemned to an unsatisfactory position while we await a radically new paradigm to understand the role of neurobiological and psychosocial factors in psychiatric disorders.
Neuroplasticity and psychiatry.
OBJECTIVE: There is increasing concern that the course of psychiatric disorders may be affected by parameters such as the duration and intensity of symptoms of initial episodes of illness. As this indicates that abnormal function produces long-term changes within the brain, a review of the neuroscience literature regarding neuroplasticity is warranted. METHOD: This article is a selective review, focusing in particular on results obtained from physiological experiments assessing plasticity within the mammalian neocortex. The possible relevance of results to psychiatry is discussed. RESULTS: While the most dramatic examples of neuroplasticity occur during a critical period of neural development, neuroplasticity can also occur in adult neocortex. Neuroplasticity appears to be activity-dependent: synaptic pathways that are intensively used may become strengthened, and conversely, there may be depression of transmission in infrequently used pathways. CONCLUSIONS: Results from neurophysiological experiments lend support to the clinical observation that the intensity and duration of a psychiatric disorder may adversely alter its long-term course. Rapid aggressive treatment may prevent this from occurring. While pharmacotherapy may reduce the duration and severity of symptoms, it may also have an independent, as yet unknown, effect on neuroplasticity.
Revised ipsative comparison tables for the summary and localization scales of the Luria-Nebraska Neuropsychological Battery.
Revised tables for ipsative comparison of scores on the Luria-Nebraska Neuropsychological Battery (LNNB) were constructed based on coefficient alpha estimates of item consistency for each of the LNNB summary and localization profile scales. Separate ipsative score tables are provided for comparison of a single score with the mean of the basic 11 summary scales, the complete 14-scale summary profile, and each of the eight localization scores with the localization profile. The complementary roles of ipsative, normative, and qualitative item analyses across profiles is discussed as an integrated model for evaluation of LNNB results.
The delayed neurobehavioural sequelae of traumatic brain injury.
This is a comprehensive review of the late-occurring effects of traumatic brain injury (TBI). It appears that TBI increases the risk over basal rates for the general population, to this degree: for depression, by a factor of five or 10; for seizures, by two to five; for psychotic disorders, by the same factor; and for dementia, by four or five. Severe TBI, or injuries with special characteristics, may increase the risk of delayed sequelae even further. One is not able, at this point, to estimate the relative occurrence of a newly described entity--delayed amnesia. An initial TBI increases the risk for subsequent TBI, by a factor of two. A second TBI increases the risk of yet another TBI eightfold.
Neuroleptics in the elderly: guidelines for monitoring.
The Nursing Home Reform Amendments of the Omnibus Reconciliation Act of 1987 provided guidelines for the use of neuroleptic medications in nursing home patients. Although the guidelines have been successful in reducing the inappropriate use of such drugs in this population, neuroleptics remain indicated in the treatment of many elderly patients. For these patients the new regulations also specified maximum daily neuroleptic doses, and they mandated monitoring for neuroleptic-induced movement disorders, although they did not provide guidelines for such monitoring. We review the existing empirical data base in an effort to refine the recommendations for neuroleptic dosage limits and to derive standards for the monitoring of neuroleptic-induced movement disorders in the elderly.
Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients.
BACKGROUND: Subsyndromal depressive symptoms are highly prevalent and associated with substantial impairments of daily function in the general population. Depressive symptoms are common in schizophrenia. However, few studies have examined the relationship of functioning and well-being to the presence of depressive symptoms in schizophrenia. METHOD: 202 middle-aged or elderly outpatients with schizophrenia (DSM-III-R or DSM-IV criteria) were categorized by severity of depressive symptoms on the Hamilton Rating Scale for Depression (HAM-D) using previously validated cutoff points, i.e., HAM-D total score < or = 6 (low), from 7 to 16 (medium), and > or = 17 (high). We also assessed severity of positive and negative symptoms, movement disorders, neurocognitive performance, daily functioning, and health-related quality of well-being with standardized measures. RESULTS: A total of 11.4% of patients had HAM-D scores > or = 17, and 56.4% had HAM-D scores from 7 to 16. Even after adjusting for severity of other psychopathology, patients with more severe depressive symptoms had significantly worse everyday functioning (p < .02), except for physical functioning, and health-related quality of well-being (r = -.365, p < .001) than did those with lower HAM-D scores. These differences were unrelated to those in demographics, extrapyramidal symptoms, tardive dyskinesia, neurocognitive performance, or number of physical illnesses. CONCLUSION: The results suggest the importance of evaluating schizophrenia patients for the presence of depressive symptoms. Effectiveness of adjunct treatment of depressive symptoms with antidepressants and psychosocial management in improving functioning of schizophrenia patients deserves further study.
The effectiveness of sensory stimulation for geropsychiatric inpatients.
The objectives of this study were (a) to explore the effectiveness of sensory stimulation therapy under controlled conditions, and (b) to ascertain the short-term effectiveness after treatment ceased. Thirty geropsychiatric patients were divided into three treatment condition groups: sensory stimulation, staff attention, and standard hospital treatment. Twenty-seven subjects completed the 12 weeks of treatment and 6 weeks of follow-up. Assessments were made prior to treatment, upon completion of treatment, and six weeks after treatment was completed. The results showed that those subjects who completed the sensory stimulation treatment significantly improved and maintained their improvement in the areas of personal hygiene and interest in group activities relative to the subjects in the other two treatment approaches studied. Discussion focuses on the implications of sensory stimulation for the treatment of elderly psychiatric patients.
A study of 100 consecutive admissions to a psychogeriatric unit.
A series of 100 consecutive admissions to a psychogeriatric unit in a large public psychiatric hospital is described. Fifty-four of these were readmissions. Most of the patients presented with moderate to severe acute psychiatric disorders, and many of these were admitted under detention orders. Their disorders were often readily treatable and most patients returned to their local communities in less than three weeks. Unexpectedly, only one-third of patients had a primary diagnosis of organic cerebral disorder, and few had received a diagnosis from the referring doctor. The principal reason for the referral of patients was that they were obviously severely disturbed and disturbing within their community. Patients who do not cause a disturbance may thus be underdiagnosed and their treatment unnecessarily compromised. The traditional system of health care seems to be working well and in the interests of these psychogeriatric patients and there is no evidence that radical changes are needed.
Organic brain syndromes.
Awareness of the medical disorders that frequently present with neuropsychiatric signs and symptoms and careful attention to a basic medical evaluation in every "psychiatric" patient will obviate referral of such patients to mental health facilities where their medical problems are less likely to be property diagnosed and treated. These disorders can be organized according to the predominant area of psychopathology (delirium, dementia, organic amnestic, delusional, hallucinatory, affective, and personality syndromes).
The utilization of the 16PF with adolescents in a state hospital setting.
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Objective psychiatric and psychologic signs of brain disorders.
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[Clinical evaluation of the Honigfeldt and Klett scale (NOSIE-30) to be used by the nursing staff in depressive and other psychopathological syndromes].
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