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Infectious psychoses were studied clinically in 60 children divided into three age groups: 3-7 years, 7-12 years and 12-17 years. Acute respiratory diseases, influenza, tonsillitis, otitis were the etiologic factors of psychoses. Short-term delirium states characterized by visual and tactile hallucinations prevailed in the first group. Affective-asthenic syndromes prevailed in the second group children. Their psychoses were characterized by both visual and acoustic illusions. Protracted or periodical disorders of the consciousness including psychosensory, senestopathic and depersonalization ones prevailed in the third group.
In a retrospective study, 16 of 80 mothers of chronic DSM III-R schizophrenics reported having had a serious infectious disease during pregnancy. Eleven of the infections had occurred during the second trimester. Influenza and the common cold with fever were frequent. Ten of 80 female controls also recalled having had an infectious illness during pregnancy. Compared to the controls, mothers of schizophrenics reported more infectious illness during pregnancy, particularly during the fifth month of gestation (p < 0.05). Mothers of familial and of sporadic DSM III-R schizophrenics reported equal frequencies of infections in pregnancy. In contrast, when Leonhard's classification of psychoses was applied, significant differences appeared. Infections during pregnancy were scarcely found in unsystematic schizophrenics (mainly genetically determined according to Leonhard). In systematic schizophrenics (mainly exogenously determined according to Leonhard), a significantly higher frequency of infectious diseases was reported for the second trimester as compred both to controls (p < 0.01) and to unsystematic schizophrenics (p < 0.001). Infections during the fifth month of gestation were exclusively reported in systematic schizophrenics. Thus, in the systematic forms of schizophrenia infections during the second trimester and particularly during the fifth month of gestation seem to play an important role in the etiology and seem to be of causal importance for the various cytoarchitectural abnormalities detected in the central nervous system of schizophrenics.
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By introducing the definition "hallucinosis" (Wernicke) it has become possible to confine the psychoses of organic origin more closely. Therefore, this term should also be used in pediatry and pedopsychiatry in order to designate cases with corresponding clinical aspects. Thus, accordance to the phenomenological characteristics of such syndromes as described in this paper, it is justified to emphasize that the acute hallucinosis in children is a special type of disease as compared to other psychoses caused by exogenic influences in this age group. The 10 case reports deal with visual hallucinoses which turned out to be characteristically different compared to those in adults. Hallucinating children at the age of 3 to 9 years predominantly visualized animals and legendary beings. Contrary to findings in adults, scenic and systematized visions were scarcely noticed, which psychodevelopmentally may be attributed to the fact that creative power in children is still little pronounced. Etiologically intoxications and infectious diseases were the cause for the visual hallucinations of the 10 children described. In the development of visual hallucinations somatic and psychic factors are significant. They have been discussed on the basis of today's knowledge. As today, however, there exists no satisfactory theory concerning the conditions favoring the development of hallucinations. To explain the somatogenesis of visual hallucinations three theories have been outlined, based on the present neurophysiological findings. It has been worked out that especially in children emotion plays an essential role in the origin of hallucinations. In infancy and early school age, while rational control of reality is still suppressed to a great extent, domination of emotional life goes along with lack of differentiation. At the same time the difference between imagination and perception is still little precise; therefore, phenomena, impressing as hallucinations in the adult, occur with greater facility in children.
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233 patients, older than 60 years old, from daily gerontologic out-patients hospital (DGH) were observed during 5 years. They had almost all forms of mental pathology inherent to the elderly. Treatment under DGH conditions was effective in patients with borderline conditions as well as in those with endogenic psychoses without psychotic states. Besides, a therapeutic effect was found in individuals with either organic or vascular cerebral diseases manifesting with pseudoneurotic syndrome, as well as in patients with residual symptomatology resultant from previous organic damage of the brain of traumatic or infectious origin. For patients with atrophic cerebral diseases (senile dementia, Alzheimer's disease) treatment was useless.
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The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate in this Institute was 10.8%. The "Instituto Central" was responsible for 65.6% of all the patients discharged from the "Hospital das Clínicas" (26,015 cases). As to the diagnostic categories the predominant chapter was that of "Injury and Poisoning" (12.8% of cases) followed by the "Diseases of the Digestive System" (10.9%) "Neoplasms" (10.8%) and the "Diseases of Circulatory System" (9.2%). The mortality rate in the "Instituto Central" was 7.2%.
AIMS: The estimation of alcohol-related human losses in Russia in the 1980s and 1990s. DESIGN: The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time. SETTING: The anti-alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol-consumption in Russia. FINDINGS: In the early 1980s, the aggregate number of direct and indirect alcohol-related life losses was more than 500,000 per annum, or 32% of total deaths. Half of the alcohol-related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti-alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100,000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti-alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so-called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol-related deaths for 1994 was 751,000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999-2000. CONCLUSION: The results of this study show the enormous scale of alcohol-related mortality in Russia. It has been revealed that alcohol-related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.
When studying etiology of childhood psychosis, causes may be divided in biological and psychodynamic. The present paper focuses on the first, which are divided in infectious, toxic, neurologic, endocrine, biochemical and genetic; these last include chromosomic alterations and hereditary factors. The relevant bibliography is reviewed. In spite of a growing list of research work, a single etiologic factor has not been found. It is probable that brain disorder in the psychotic child is psychological, mediated by chemical disturbance and with environmental correlates.
Subtle developmental (motor, emotional, cognitive, and behavioral) abnormalities are often present in apparently healthy individuals who later develop psychosis, suggesting that some aspects of causation are established before overt psychosis. These impairments may restrict information processing and social achievements years before manifesting psychosis. The main known risk factors in the development of schizophrenic psychosis are genetic factors, pregnancy and delivery complications, slow neuromotor development, and deviant cognitive and academic performance. However, their effect size and predictive power are small. Developmental precursors are not necessarily specific to schizophrenia, but also common to other psychotic disorders. No powerful risk factor, premorbid sign, or risk indicator has been identified that is useful for prediction of psychoses in the general population.
In a retrospective study of 80 chronic DSM III-R schizophrenics and 80 controls, the occurrence of obstetric complications (OCs) into the development of chronic schizophrenias was investigated using Leonhard's distinction in systematic schizophrenia (no obvious familial loading) and unsystematic schizophrenia (mainly genetically determined according to Leonhard). The Lewis & Murray and Fuchs scales were used for evaluation. In both scales, unsystematic schizophrenias did not differ from controls, but those with OCs were significantly (p < 0.01) earlier hospitalized (20.5 years) than those without OCs (25.6 years). Systematic schizophrenics had an increased frequency, severity and total score of OCs compared to controls in the Fuchs scale (p < 0.01). Likewise, in the Lewis & Murray scale systematic schizophrenia showed an increased presence of OCs compared to controls (p < 0.05) and to unsystematic schizophrenia (p < 0.1). Systematic schizophrenias were significantly allocated to maternal infectious diseases during mid-gestation. Patients with maternal infections showed more additional OCs than those without (p < 0.05; Lewis & Murray scale). In systematic schizophrenia, a history of OC was not associated with an early onset of the disease. In the genetic determined schizophrenias prenatal and perinatal disturbances lead to an early onset of the disease, however, in systematic schizophrenias they seem to be of causal importance for the development of the disease.
The nosological heterogeneity of catatonic schizophrenia was the focus of a family study involving 139 catatonic patients. The clinical dichotomization of catatonia into periodic catatonia and systematic catatonia revealed good inter-rater reliability and stability of the diagnoses at follow-up. Analysis of the cumulative morbidity risk among first-degree relatives gave an excessive familial aggregation of homogenous psychoses in periodic catatonia with a risk of 26.9%. The mode of inheritance was consistent with an autosomal dominant model. In contrast, first-degree relatives of probands with systematic catatonia had a morbidity risk of 4.6%. Subsequent investigations pointed to a potential association of systematic catatonia to exposure to midgestational infections in the index cases and linked these sporadic disorders to disturbances of fetal neurodevelopment. The periodic catatonia, an unequivocally genetically transmitted illness, is at present under investigation in a genome-wide linkage analysis.
The recent literature on CNS-SLE has been reviewed. An improved prognosis is noted that is thought to be due to the use of high-dose corticosteroids. The frequencies of the various neurologic and psychiatric findings are discussed, and a distinction is noted between organic psychoses and functional psychiatric complaints. The question of corticosteroids versus cerebral vasculitis as the cause of the neuropsychiatric symptomatology in SLE is examined, and the necessity of clear psychiatric diagnosis and treatment is stressed. Recent observations on HL-A antigens, complement, immunoglobulins, virus, and immunocomplexes suggest that the latter are prominent in CNS-SLE, but that an infectious agent may be etiologic in the genesis of SLE. Fifty-four patients not previously reported are discussed. Thirty-eight of them had neuropsychiatric manifestations. The treatment of CNS-SLE with cytotoxic agents, in addition to corticosteroids, is considered, and the experience of the authors with such treatment is presented.
Pioneer investigators in Nigeria have presented a gloomy picture of epilepsy as a highly infectious and disastrous disease in the eyes of the public. As a result, epileptic persons suffer untold social deprivations and discrimination in education, employment, housing, marital life, etc. These assertions have been repeated over the years more as a result of incidental observations while reviewing hospital cases than as products of attitude research on the subject. We assumed, therefore, that these statements should be considered as impressive hypotheses needing to be tested. By employing the Osgood semantic differential and the behavioral differential of Triandis, we assessed the attitude of the normal literate general public toward persons with epilepsy and "cured" psychotic patients and how closely the public would associate or socialize with these people. We also inquired into the public's opinion about the causes of epilepsy and psychosis, since this knowledge is necessary for attitude formation and change. On the whole, the general attitude toward epileptic patients is negative, and toward "cured" psychotic patients, positive. There are sex differences, in that males perceive epileptic patients more favorably than females do. However, both males and females would discriminate against both the epileptic and "cured" psychotic person in terms of employment, residential accommodation, friendship, and marital relations. The major perceived causes of epilepsy reported were heredity, witchcraft, and brain damage, in that order, not infection. About 25% admitted ignorance of the cause of epilepsy, as against 1% for psychosis. The psychoses were reportedly caused mainly by Indian hemp smoking, drug abuse, brain damage, and witchcraft, in that order.(ABSTRACT TRUNCATED AT 250 WORDS)