[Epidemiological research in child psychiatry. Diagnostic reference of specific developmental disorders (psychomotor, speech and language disorders)].
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The authors studied the problem of parental attitudes assuming that in epilepsy, besides the coexistent CNS damage, the intensity and frequency of convulsive seizures, and the mode and duration of treatment which influence the functions of the child, the attitude of the parents is also very important. In the studied material of 272 cases (146 boys and 126 girls) treated in the psychiatric department and out-patient clinic in the Institute of Paediatrics, Medical Academy in Warsaw for at least 3 years three main patterns of parental attitude towards the epileptic child have been recognized: 1. overprotective attitude (58%). 2. inconsistent attitude (32%). 3. rejecting attitude (8%). Depending on these attitudes certain disturbances of psychomotor development manifested themselves or intensified, mainly in the form abnormal development of emotions and cognitive functions as well as social adaptation. In the conclusions the authors stress the widespread occurrence of incorrect parental attitudes and the necessity of psychotherapeutic influence on the parents.
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In a group of 85 men with alcohol dependence syndrome occurrence of depressive symptoms was examined and the intensification of psychomotor activation disorders was assessed. 60% of patients showed symptoms of depression during alcohol intoxication. Relationship between the intensification of depressive symptoms and psychomotor activity disorders was testified.
A group of 50 patients with a diagnosis of affective disease was examined. Dependence between the intensification of depression psychomotor activity measured according to Widlöcher scale was established. Neurophysiological factors (such as thinking productivity, letter drafting, tapping test, simple reaction time) correlated with the intensification of psychomotor activation disorders.
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Three groups of four monkeys were trained to negotiate a small hand ("stylus") maze, and to use a "pointer" to guide response in a two-choice position discrimination task. One group was given bilateral lesions of posterior parietal cortex, and the second bilateral lesions of lateral frontal cortex. Postoperative impairment on the maze was evident in three of the four parietal animals, and both operated groups showed impairment on the pointer task. Since maze performance was positively associated with speed of stylus recovery in a control version of the task but was not correlated with pointer task performance, it is suggested that the parietal deficit resulted primarily from a sensory-motor dyscoordination rather than a spatial perceptual disorder. The latter could however be the cause of parietal impairment on the pointer task. Error analysis suggests an interpretation of the frontal deficit on the pointer task in terms of perseveration on position.
Visual matching and visual exploration were examined in 7 normal subjects and 20 brain-damaged patients with drawing impairment measured by the Bender Gestalt Visual-Motor Test. Right brain-damaged patients made significantly more errors of rotation and integration than left brain-damaged patients. Selecteded Bender figures were also used as stimuli for both visual matching and visual exploration tests. The ability to match Bender figures was found to be impaired in right but not left brain-damaged patients. All patients showed eye movement and fixation patterns different from those normals. Patients essentially had more fixations and shorter fixation durations. Significant intercorrelations were found between the total Bender Gestalt score and visual matching and visual exploration scores. These findings indicate that visual matching and visual exploration measures can be used to evaluate perceptual impairment in individuals who do not have adequate motor responses or where impaired motor responses may confound interpretations about visual cognitive impairment.
The cases presented here are intended to illustrate an approach to the patient with complaints which may be vague, evanescent, or related to emotional factors. A scheme to analyze only five factors, mood, movement, sensation, cognition, and consciousness is presented to simplify the complexity of human behavior in order to arrive at correct diagnoses. The importance of a complete medical evaluation is stressed. Psychosis and other major psychiatric illness have been alluded to, but space does not permit discussion of the very important issues of the genetics, the neurochemistry, and the differential diagnosis of schizophrenia, mood disorders, and the organic brain syndromes. Some of the many manifestations of epilepsy have been presented, and the importance of electroencephalography and computed axial tomography is stressed. The references have been chosen for their general utility to practicing clinicians, especially the works of Pincus, Glaser and Tumulty.
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A 28 year old woman with multiple sclerosis has been followed for 10 months with serial brain scans on 5 admissions. The correlation between the clinical picture and the brain scans was clearly demonstrated.
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The first skills are motor ones and these depend on perceptual development and the organisation of movement. If development is deviant the child will be clumsy. The clinical picture is considered, and the effects this may have in the school situation. Disorders of language development may be secondary to other factors such as deafness or brain injury, or may be a specific disability. The various grades of the latter are described. Both perceptual and language disorders can underlie reading retardation and the analysis of a particular child's difficulties is stressed. The etiology of these conditions is discussed with particular reference to the failure of integration. Intracerebral connections may not form, be destroyed, or not be used. The role of the Doctor is an important one, and this includes not only diagnosis and assessment but also helping the child in the home and school, especially when emotional and behaviour complications occur. The doctor must also act as a questioner and co-ordinator.
112 of an original sample of 134 children with febrile convulsions were reviewed between 8 years and 9 years 10 months after their initial attack. 17% of those followed up had had at least one spontaneous fit. A significant correlation was found with perinatal abnormalities. 12% had continuing recurrent fits. Persisting grand mal occurred most commonly in lower social class children who had had perinatal abnormalities and continued to have long-term neurological disorders. Psychomotor epilepsy correlated significantly with a prolonged or repeated initial convulsion with unilateral features. It is suggested that the development of grand mal and temporal lobe epilepsies after convulsions with fever are determined by different mechanisms.