Cerebral evoked responses in schizophrenia

Results of previous studies of evoked responses in schizophrenic disorders are reviewed, and data from a new study of somatosensory recovery functions in schizophrenia are presented. Subjects in the latter study were 18 schizophrenic patients and 18 nonpatients matched for age and sex. Latencies and amplitudes of eight consecutive evoked-response peaks were measured. Only one amplitude and one latency of the response to the first stimulus discriminated between patients and controls, whereas four amplitudes and three latencies of the second response did so. Amplitude recovery was less in patients, whereas latency recovery was greater. The data verified previous findings of impaired amplitude recovery in schizophrenia, but did not confirm previous findings of increased amplitude in response to a single stimulus. Evoked-response deviations so far determined are not specific to schizophrenic disorders, inasmuch as they have been found in several other psychiatric syndromes. The data are in accord with the idea that psychiatric disorders involve deviant cerebral processing of sensory information.     

Replicating the five factor model of personality in a psychiatric sample

In this study we examined whether the factor structure and traits of the five-factor model of personality (FFM), derived from non-clinical samples, could be replicated in a sample of psychiatric patients. The revised NEO Personality Inventory (NEO PI-R) was administered to a study group of psychiatric patients (n=176). The test scores from these patients were intercorrelated, factor analyzed and the obtained factor structure was then compared to the factor structure of the normative data from the NEO PI-R. The factor structure from the psychiatric study group and that from the normative sample were virtually identical, with all five factors showing significant congruence. These results argue favorably for the clinical applicability of the FFM with psychiatric patients.     

Clinical and pathol-anatomic findings in corpus callosum deficiency, enlarged cavum septi pellucidi, and septal defect]

A comparison is made of the pathological changes of the median line structures such as corpus deficiency, enlarged cavum septi pellucidi (Csp.) and septal defects in 10,457 pneumo-encephalography (PEG) examinations of neurological and psychiatric patients, and in 11,016 general autopsy cases. Clinical peculiarities in corpus deficiency and other development anomalies of the median line structures are discussed along with case reports. A predominance of the male sex in cases of enlarged Csp. together with frequent combinations with neurological and psychiatric illness were noticeable, particularly oligophrenia, behavioral disorders, epilepsy and cerebral tumours. Thus, certain inferiority of the dysrhaphic mutation of the central organ can be assumed.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

Motoric indicators of laterality and determination of lateral dominance in schizophrenia

The literature suggests that schizophrenics exhibit reduced or reversed cerebral lateral dominance relative to normal control subjects. An hypothesis which predicted reduced or reversed cerebral laterality for schizophrenics was tested on 60 young, familially right-handed males, with 20 men in each of the following three groups: schizophrenic inpatients, nonschizophrenic psychiatric inpatient controls, and normal controls. The subjects were administered a battery of seven measures of cerebral laterality. The application of multivariate statistical techniques showed groups did not differ significantly in the degree or the direction of their cerebral lateral dominance. Also there were no significant correlations between the measures of laterality. The findings suggest that cerebral lateral dominance is not necessarily altered concomitantly with psychopathology but rather that it is a complex phenomenon which may not be reliably determined on the basis of simple behavioral characteristics.     

Psychiatric Symptoms and Quality of Life in Patients Affected by Epidermolysis Bullosa

The aim of our study was to provide a psychosocial and psychiatric evaluation of patients with epidermolysis bullosa (EB; a rare genetic disorder characterized by skin fragility), to assess psychological status, ascertain the presence of any psychiatric disorders and understand the impact of EB on quality of life. Twenty-five patients were assessed using a case record form and several standardized instruments. In 82% of patients, EB had a negative impact on quality of life and 80% of patients experienced psychiatric symptoms. Our findings revealed a high prevalence of psychosocial problems and psychiatric symptoms in patients with EB and suggested that a combined bio-psychosocial approach is the most appropriate therapeutic intervention.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Interpersonal Features of Interviews Between Psychiatric Patients and Nursing Staff1

Observer ratings of one-half hour interviews were undertaken to test two basic concepts of interpersonal relations in a sample of 51 randomly paired male psychiatric patients and female psychiatric nurses. It was hypothesized that the behavior of psychiatric patients could be organized around two orthogonal dimensions reflecting status and feeling, and that patients and nurses would exhibit complementary interpersonal behavior consistent with their institutionally ascribed roles. Interviews were rated with the Leary Interpersonal Checklist. Interjudge reliability was established for Leary's coding system. The hypothesis of status and feeling reference points for patient behavior received strong support when the results of analysis of variance were supplemented by factor analysis. Patient scores on the eight variables measured by the Leary Interperonsal Checklist and nurses' scores for 17 complementary variables were submitted to correlational analysis to test the hypothesis of interpersonal complementarity. As predicted, two hypothesized dependence-assistance response combinations provided the highest correlation coefficients. It was concluded that the study provided empirical support for the utility of an interpersonal model within psychiatric settings that has more commonly been identified with relationships free of psychiatric disturbance.     

Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

Personal efficacy, external locus of control, and perceived contingency of parental reinforcement among depressed, paranoid, and normal subjects

Bandura (1982) suggested that judgments of personal efficacy and outcome expectancies (i.e., locus of control) jointly affect behavior. We hypothesized that different combinations of these two sets of beliefs would characterize the thought structures of normal subjects and of psychiatric patients suffering from distinctly different disorders. Normal subjects, depressed subjects, and paranoid subjects completed scales with which we measured beliefs in personal efficacy and beliefs that outcomes are controlled either by chance or by powerful others, as well as a scale with which we assessed perceived contingency of parental reinforcement. The major findings were as follows: Normals judged themselves to be more efficacious than did psychiatric subjects; whereas depressives expected outcomes to be controlled by chance, paranoids expected outcomes to be under the control of powerful others; among the normals, outcome expectancies were strongly associated with personal efficacy, but among the psychiatric patients, these beliefs were unrelated; depressives and paranoids equally reported more noncontingent parental reinforcement than did normals; and perceived contingency of parental reinforcement was predictive of outcome expectancies but not of personal efficacy. The data suggest that low personal efficacy may be a distinguishing characteristic of all psychiatric patients, whereas outcome expectancies may determine the specific nature of the psychiatric disorder.     

Relationships between the Test of Attentional and Interpersonal Style and psychiatric subclassification

Examined the ability of a self-report measure of attentional and interpersonal characteristics to discriminate between groups of psychiatric patients and normal controls. Seventy-eight psychiatric patients and 30 nonpsychiatric medical inpatients completed the Test of Attentional and Interpersonal Style (TAIS). Discriminant analyses of TAIS scores showed that: (a) psychiatric patients in comparison with normal controls described themselves as more overloaded by external and internal stimuli and as less effective in narrowing their attentional focus to task-relevant stimuli; (b) good premorbid schizophrenics appeared more externally overloaded and less able to narrow attentional focus than poor premorbid schizophrenics; and (c) psychotics and neurotics described themselves as more introverted and less pleasant in social encounters, while individuals diagnosed as character or personality disorders tended to be more extroverted and impulsive. The results were compatible with past experimental work and clinical reports identifying attentional and interpersonal differences among psychiatric subgroups.     

22q11.2 Deletion Syndrome: Attitudes towards Disclosing the Risk of Psychiatric Illness

22q11.2 Deletion Syndrome (22q11.2DS) is a common microdeletion syndrome with multisystem features. There is a strong association with psychiatric disorders. One in every four to five patients develop schizophrenia. Despite studies showing that early diagnosis and treatment are likely to lead to improved outcome, genetic counselors may be reluctant to discuss the risk of psychiatric illness. The aim of this research was to explore parental attitudes and genetic counselors’ perspectives and practice regarding disclosure of the clinical manifestations of 22q11.2DS, particularly the risk of psychiatric illness. We delivered a questionnaire to genetic counselors via established list-serves, 54 of which were completed. We also conducted interviews with four parents of adults with 22q11.2DS and schizophrenia. The majority of counselors and parents felt that the increased risk to develop a psychiatric illness is important to disclose. However, in the initial counseling session when the diagnosis was made in infancy genetic counselors were significantly less likely to discuss the risk of psychiatric disorders compared to other later onset features such as hypothyroidism (41?% vs. 83?%, p?=?0.001). When the diagnosis of 22q11.2DS was made in infancy, counselors’ responses in regard to timing of disclosure about psychiatric illnesses were fairly evenly divided between infancy, childhood and adolescence. In contrast, for other major features of 22q11.2DS, disclosure would predominantly be in infancy. The respondents reported that the discussion of psychiatric issues with parents was challenging due to the stigma associated with mental illness. Some also noted limited knowledge about psychiatric illness and treatment. These results suggest that genetic counselors could benefit from further education regarding psychiatric illness in 22q11.2DS and best strategies for discussing this important subject with parents and patients.     

The Hécaen-Zangwill legacy: Hemispheric dominance examined

The research of Henry Hécaen and Oliver Zangwill on patients with unilateral brain lesions in the later 1940s and early 1950s ushered in the modern era of investigation of hemispheric cerebral dominance. The field of inquiry expanded far beyond language and visual perception to encompass audition, somesthesis, motor performance, attentional processes, emotionality, and psychiatric disorders. The hundreds of studies dealing with the topic indicate that hemispheric dominance is not an all-or-none phenomenon and that, to some degree, it is an unstable phenomenon dependent upon bihemispheric factors. The basic cognitive processes that are preferentially mediated by each hemisphere and the factors that produce changes in performance still require adequate definition.Adapted from an invited address, Division 40, 1991 APA Convention, San Francisco.     

Alcohol use: Views of people receiving in-patient care for mental health conditions

This study explored the perceptions of psychiatric in-patients concerning their use of alcohol in a context of community living. A total of 70 psychiatric in-patients at an Ethiopian hospital were the informants in this study (males = 73%; females = 27%, majority diagnosis schizophrenia = 63%). The patients completed a structured interview on possible reasons for and effects associated with alcohol use in psychiatric illness. These were thematically analysed. The patients cited positive features when using alcohol to include keeping one warm, acting as a digestive, controlling the side effects of psychotropic drugs, alleviating boredom or anxiety and improving one’s mood. They noted negative aspects of alcohol consumption as being the risk of bodily harm, absenteeism from work, familial neglect and a loss of control of one’s life. Some patients believed that the use of alcohol while they were under psychiatric care carried the risk of social exclusion and discrimination; yet they also believed that abstinence from alcohol would be difficult for them.     

Characteristics of a French African Caribbean Epidemiological Psychiatric Sample with a History of Suicide Attempt

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics and lifetime history of suicide attempts were recorded. Sixty‐five patients (18%) had a history of at least one suicide attempt. Presence of professional qualifications, children, poor social contacts, treatment with benzodiazepine at inclusion, and poor treatment compliance were all associated with a lifetime history of suicide attempts.     

An Indicator of Suicidal Ideation on the Bender Visual-Motor Gestalt Test

Hospitalized psychiatric patients responding on the Bender-Gestalt Test with the ‘penetration’ of Design 6 into Design 5, did display significantly more suicidal ideation in the predicted direction than did a matched control group (P < .005). The results were taken to suggest the utility of combining this variable with other predictive criteria derived from Rorschach research to help the clinician make recommendations about suicidally ideated psychiatric patients.     

Auditory perception of speech and speech sounds in recent and recovered cases of aphasia

Auditory perception of speech and speech sounds was examined in three groups of patients with cerebral damage in the dominant hemisphere. Two groups consisted of brain-injured war veterans, one group of patients with high-frequency hearing loss and the other, a group of patients with a flat hearing loss. The third group consisted of patients with recent cerebral infarcts due to vascular occlusion of the middle cerebral and internal carotid artery. Word and phoneme discrimination as well as phoneme confusions in incorrect responses were analyzed from conventional speech audiometry tests with bisyllabic Finnish words fed close to the speech reception threshold of the patient. The results were compared with those of a control group with no cerebral disorders and normal hearing. The speech discrimination scores of veterans with high-frequency hearing loss and patients with recent cerebral infarcts were some 15–20% lower than those of controls or veterans with flat hearing loss. Speech sound feature discrimination, analyzed in terms of place of articulation and distinctive features, was distorted especially in cases of recent cerebral infarcts, whereas general information transmission of phonemes was more impaired in patients with high-frequency hearing loss.     

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.     

Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism scale scores of 140 male patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Application of the MacAndrew Alcoholism Scale to Alcoholics With Psychiatric Diagnoses

The MacAndrew Alcoholism scale scores of 140 mate patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.