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PubMed1981

[The potential of psychopathological symptoms to differentiate diagnostic groups (author's transl)].

We investigated the extent psychiatric illnesses can be differentiated by means of psychopathological symptoms. The present condition of 2269 patients was analyzed; they had been admitted to the psychiatric clinic of the Free University of Berlin during 1971-1976, as documented by the AMP (PAS) documentation system. The most frequent diagnosis in the sample was schizophrenia (32%), followed by neurosis (22%), affective psychosis (14%), addiction (6.7%), and organic psychosis (6.2%). We could demonstrate that even such diagnostic groups are usually discernible by symptoms, where the differential diagnosis is often difficult. Organic psychosis vs paranoid schizophrenia and depressive neurosis vs depressive psychosis can be determined, but manic syndromes in schizoaffective psychosis vs manic syndromes in affective psychosis are hardly discernible. The potential to differentiate, however, only pertains to diagnostic groups, since many individual patients cannot accurately be classified into diagnostic groups by psychopathological symptoms alone. Only a few symptoms are pathognomonic, and if there are pathogomonic symptoms characterizing a diagnostic group, only a few patients in this group show these symptoms. These results indicate, at least for the high number of patients without severe and typical symptomatology, that we must: 1. Achieve better differentiation on the diagnostic axis "psychopathology" by means of empirically derived syndromes instead of isolated symptoms. 2. Use other diagnostic axes (like etiology and course) for differential diagnostic purposes.

Adult↗
PubMed1976

[Psychiatry, morphology and behaviour genetics (author's transl)].

No organic substrate is known for endogenous psychoses, neuroses and behaviour disorders. Therefore genetic studies have to depart from the behavioural level. This approach has yielded the empirical risk figures which depend on genetic and environmental factors. Beyond this level behaviour genetics endeavours to clarify the genetic mechanisms underlying normal and abnormal behaviour. In the schizophrenias f.i. several stretegies have been developed to approach the genetic basis: Mathematial models as to the mode of inheritance; use of modified classificatory and diagnostic criteria for genetic analysis; search for phenomena representing steps between genotype and phenotype and showing a clear mode of inheritance, f.i. biochemical or electrophysiological characters. In case the neurotransmitters are not changed in quality or total quantity but in compartmentation in the genetic defect might be localized in the pre- or postsynaptic membranes or receptors. Genetic factors are also involved in nonpsychotic behaviour disorders but to a lesser degree. They can be demonstrated even in psychoses with somatic background.

Catecholamines↗
PubMed1986

The health of the chronically mentally ill: a review of the literature.

This paper reviews three areas of research on the health of the chronically mentally ill: epidemiological studies on this population, studies exploring the clinical interface of physical and psychiatric disorder, and studies illuminating barriers to adequate health care for this population. Its purpose is to increase our understanding of the unique health problems facing the chronically mentally ill so that appropriate interventions can be developed. The review suggests that greater attention to this area should result in improved physical health as well as improved psychiatric intervention. The implications for policy, practice, and research are discussed.

Chronic Disease↗
PubMed1984

Pharmacotherapy of the chronic patient: gender and diagnostic factors.

Clinical data from 1752 patients in five, ambulatory community mental health centers were used to test hypotheses about the diagnosis and psychopharmacotherapy of chronic patients. Analysis focused upon the interrelationships among gender, diagnosis, and the number of medications and dosages prescribed. Men and women differed in their age distributions and in the diagnoses received. Women were more often diagnosed with affective disorders than were men. There were also notable interaction effects with ethnicity. There was little evidence of differential drug prescribing practices, although women were somewhat more likely than men to be prescribed anti-psychotics and anti-depressants in the absence of an appropriate diagnosis.

Adolescent↗
PubMed1977

Distribution of DSM-II diagnoses in a child psychiatric setting.

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.

Adolescent↗
PubMed1975

Psychological correlates of the course of Sydenham's chorea. Repeat evaluations of a case.

Published reports provide contradictory evidence concerning the cause, nature, and course of Syndeham's chorea: physiological, psychological, and interractional hypotheses have been advanced. Reports supporting any of these views suffer from lack of detail, objective observations, and/or longitudinal behavioral sampling. This case was studied longitudinally with numerous psychological tests. They revealed acute encephalopathy and severe personality disturbance in the acute stage, followed by rapid and lasting clearing of both symptoms. Thus, this case provided evidence consistent with virtually all published reports and with each hypothesis about Sydenham's chorea, suggesting the need for more careful longitudinal studies and a conceptual framework which can more fully embrace all the data.

Adolescent↗
PubMed1988

Clinical and demographic characteristics of 15 patients with repetitively assaultive behavior.

The 15 patients with the highest numbers of assaultive incidents over a one year period in a state mental hospital were identified and information collected regarding a variety of clinical and demographic characteristics. The results showed a group of patients who are relatively young, manifest severe symptomatology that is generally unresponsive to treatment, and have now been hospitalized continuously for greater than four years. The patients experienced the onset of symptoms as teenagers in most cases, showed poor psychosocial adjustment beyond childhood, and had positive family histories for mental illness or alcohol abuse. Patients with psychotic disorders predominated and tended to have positive symptoms rated as severe to very severe on the Global Rating Scale for Psychosis. Patients with nonpsychotic or personality disorders always showed a high frequency of self-injurious behavior in addition to their aggressive behavior toward others. A number of patients had a history of head trauma with EEG abnormalities. This information provides a starting point for subsequent studies examining potential distinctions between this subpopulation of patients and others, the motivation and circumstances of such incidents, and the interaction between the behaviors and their effects on those around them.

Adult↗
PubMed1978

Diagnosis and chronic mental illness.

This paper describes the occurrence of chronicity in varying psychiatric illnesses. There is not an unequivocal definition of chronicity, but with the exception of the illnesses that will be described below and that lead directly or indirectly to death from CNS complications of the illness, chronicity will require a duration of a minimum of five years without a significant remission. Chronicity is further differentiated into four different kinds of chronicity: chronic--death, chronic--self-limited, chronic--remission, and chronic--recurrent. The illnesses that may be considered as possibly fulfilling the criteria for chronic will be noted and a method for deciding whether an illness qualifies will be outlined.

Alcoholism↗
PubMed1978

The emergence of the Bowery as a psychiatric dumping ground.

The drastic reduction of State Hospital population in New York over the past decade has led to a demographic relocation of the mentally ill, rather than any real decline in the rate or severity of mental disorders. Unable to function on their own in society and without adequate supportive facilities available, many discharged patients live in the streets and eventually end up on the Bowery, where they are cared for at The Men's Shelter. Studies have shown that over 50% of the current Bowery population has a history of mental illness and that alcoholism is often a secondary, rather than primary diagnosis. The most frequently encountered diagnostic syndromes are mentioned and commented upon. Possible alternative treatment interventions are suggested.

Age Factors↗
PubMed1988

Clinical and demographic characteristics of chronic inpatients: implication for treatment and research.

Clinical and demographic data were collected on 203 state mental hospital patients whose length of stay was greater than one year. They comprised 45% of the average adult census and 37% were less than 35 years old. Males were younger and females more educated and likely to have been married at one time. The majority have diagnoses of schizophrenia or organic mental disorders; a few have personality disorders. Patients were treated with drugs but risk/benefit parameters remain to be defined. Thirty-two percent of patients have had a violent episode during the past six months. The prevalence of neurological abnormalities supports the need for specialized neurological and neuropsychological consultation and medical consultation. Most patients require the level of care provided by a hospital, while 15% are ready for discharge but have no housing available. Intermediate care facilities could provide alternatives for some patients otherwise unable to leave the hospital. The implications raised by these findings are discussed.

Adult↗
PubMed1984

Psychobiology of the borderline disorders--a heuristic approach.

A psychophysiologic approach to understanding borderline behavior is presented in which psychological and biological explanations complement, rather than exclude, one another. Descriptive-objective diagnoses or a target symptom approach are not sufficient to explain borderline behaviors. Phenomena are described that suggest underlying pathophysiologic processes, although they are usually accorded ego psychological explanations. Their underlying common denominator may be inadequate limbic system "filtering" of irrelevant stimuli. Each patient must be seen as an individual, rather than be fitted to a chosen model. Though the borderline constitutes a unique descriptive category, borderline behaviors result from processes generalizable across a broad range of psychopathology.

Arousal↗
PubMed1991

Behavioral neuropsychology: past, present, and future direction with organically based affect/mood disorders.

Affective/mood disturbances have been widely described in association with central nervous system dysfunction. There have been multiple divergent viewpoints regarding the origin of these disorders, however. This is not surprising, as theories evolve in relation to our degree of technological advancement. This review describes the evolution of some of these views, and discusses the advantages of behavioral neuropsychology as an effective approach to assessment/treatment in this context. Although there have been few articles published describing the use of behaviorally based approaches to treat these disorders, it is thought that this approach shows promise, particularly when combined with information based on neuropsychological assessment data. Future directions for the continued evolution of this field are outlined.

Behavior Therapy↗
PubMed1987

Functional imaging of the brain in psychiatry--mapping of EEG and evoked potentials.

Topographic brain mapping of EEG and evoked potentials permits the display of spontaneous and event-related activity of the brain. This new method is superior to conventional polygraphy because of the topographic approach which delineates structural and functional brain lesions. Data from 16 to 20 scalp electrodes were evaluated. Not only spontaneous EEG but also EEG during various testing conditions which activated particular brain regions was measured. For EEG fast Fourier transformation (FFT) was used for mapping. For late evoked potentials (VEP, AEP, SEP and P300) a single value representing the amplitude of EP at each 2-ms poststimulus latency point was used. Statistical techniques (Students'-test, correlation coefficient) were used to render the regions where a clinical population differs from normal subjects. The results show abnormalities of EGG and EP in patients with psychiatric and neurological diseases.

Arousal↗