Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

Two cohorts of schizophrenic patients admitted to a psychiatric hospital for the first time either during 1949-50 or 1965-67 were compared with matched controls for reproductive rates before and 13 years after onset of psychosis. Patients of both admission periods had reduced marriage rates. After onset of the disease the rate of reproduction was decreased in males of both periods, but not in females. Patients of both periods did not differ from control values with respect to marital fertility. It has repeatedly been reported that fertility of schizophrenics has been increasing in recent times. Comparison of total reproduction, rate of marriage and marital fertility in patients of the two admission periods and matched controls did not yield any evidence for increasing rates. Instead, the results favour the idea that the patients parallel at a lower level the general decline of birth rates observed in Western Germany.

We carried out a study on 63 patients suffering from alcoholism in order to determine the frequency of 27 HLA antigens. In comparison to healthy blood donors no significant deviation of HLA distributions in alcoholics was found. The data on alcoholic patients with physical consequences such as cerebral seizures, liver cirrhosis and polyneuropathy failed to identify an association with HLA.

This study addresses the issue of need for and provision of psychotherapy care in urban and rural areas. In the first part, prevalence of mental disorders based on epidemiological field studies in the county of Traunstein and the city of Mannheim are discussed. Among patients of general practitioners the prevalence of mental disorders was slightly higher in Mannheim than in Traunstein. Concerning the provision of care, results of a questionnaire survey of a random sample of 1542 nonmedical counsellors or psychotherapists in Traunstein, Mannheim and the metropolitan area of West Berlin are presented. The rate of nonmedical therapists/100,000 inhabitants was the same for Traunstein and Mannheim. A more detailed analysis of their service capacity revealed that it was by 17% to 20% higher for Mannheim than for Traunstein; the prevalence of mental disorders in patients of general practitioners was shown to be about 10% higher in Mannheim than in Traunstein. Under the assumption that there is a linear relationship between prevalence and need for care, there appears to be a slight, but not marked undersupply of services by doctors and nonmedical counsellors or psychotherapists in Traunstein as compared to Mannheim. In comparison, the districts of West Berlin were classified into those with high and those with a low percentage of blue collar workers. The rate of nonmedical counsellors or psychotherapists in the "upper class" districts in West Berlin was almost four times higher than that for the "lower class" districts of West Berlin, in Mannheim and Traunstein. The rate/100,000 for the service capacity of nonmedical counsellors or psychotherapists in the "upper class" districts of West Berlin was much higher, and in the "lower class" districts of West Berlin much lower, than in Traunstein or Mannheim. Our data show that there are some discrepancies in the provision of care between rural and urban areas, which however are not large when Traunstein is compared with Mannheim; there were however, substantial discrepancies in the provision of care between cities (Mannheim and West Berlin) and between districts within the same city (West Berlin).

A total of 140 epileptic patients were examined using psychological tests in a combined psychiatric and psychological study to assess cognitive malfunctions. Compared with a control group, significantly lower levels of performance were shown in intelligence, concentration and psychomotoric speed, but not in memory. Surprisingly, there was no uniform relationship between the degree of performance deficit and the severity of fits, perhaps with the exception of intelligence. Missing significant memory malfunctions restrict the value of a so-called organic psychosyndrome, the relevance of which is doubtful from the neurospychological point of view, anyway.

In 30 families with a schizophrenic son conjoint family discussions which had been generated by Strodtbeck's "Revealed Differences Technique" were analyzed on the strength of the "Relationship-Scale" developed by Riskin and Faunce. All three members of the family triad (two parents and son) proved to be more hostile and rejecting than their parallels in a control group of families whose sons had been admitted because of an acute surgical condition. However, no significant difference could be ascertained in the sequential patterning of interaction assessed by means of time-series analysis. In both family groups Bernoulli processes predominated, i.e. there was no dependence between the sequentially recorded speech units. A 2-year follow-up of the schizophrenic patients showed a contradictory pattern of results. In families with re-hospitalized sons there was only a slight and statistically insignificant tendency towards more negative relationships but the sub-groups of families containing a schizophrenic son differed clearly on the level of sequential data; more families with re-hospitalized sons showed autoregressive (morphogenetic) or moving average (morphostatic) processes.

A total of 36 patients with chronic unilateral circumscribed medial and dorsolateral frontal lobe lesions were investigated with a range of neuropsychological tests. Lateralized deficits in tasks depending on language functions were found with dorsolateral but not with medial lesions. The specific role of Broca's area could not be confirmed. Lesions of the supplementary motor area led to mild deficits in tests of "concept formation". Frontomedial lesions situated more deeply in the interhemispheric fissure resulted in memory deficits. The results are discussed on the basis of recent neurophysiological theories of brain function.

All cases of seclusion and emergency sedation at a regional psychiatric university hospital were studied for a period of 3 months. The patients involved, and their nursing staff, were questioned on the day following the above mentioned incidents and the patients again after their remission from the exceptional state that had caused them. Every sixth patient underwent, at least once, either seclusion or emergency sedation, or both. These occurred most frequently during the first week of hospitalization, and in patients with a predominantly negative attitude. Women showed violent behaviour more often than men and also admitted to it more frequently. Seclusion was generally better accepted than emergency sedation. In less than half the cases the patients clearly rejected the past coercive measure; cases of total acceptance, however, were even less frequent, though acceptance tended to increase with remission. The authors dealt with the legal status of coercive measures. They also stressed the importance of discussing them afterwards both with patients and nursing staff in order to preserve the self-respect of all concerned.

Data supporting the glutamate hypothesis of schizophrenia are presented. The glutamate hypothesis is linked to the dopamine hypothesis by the fact that dopamine synapses inhibit the release of glutamate in the striate and mesolimbic system. The glutamate hypothesis of schizophrenia may open a way to find better drugs for treatment. The concept of schizophrenia I is described. It consists of "negative symptoms" such as disconcentration or reduction of energy. Schizophrenia I precedes and follows schizophrenia II with "positive symptoms," e.g. hallucinations and delusions. Schizophrenia I so far cannot be diagnosed as schizophrenia unless schizophrenia II appears. Chemical, physiological or neuropsychological methods for the diagnosis of schizophrenia I would render an earlier treatment of schizophrenia possible and thus make social and occupational rehabilitation more efficient. An objective diagnosis of schizophrenia I may also elucidate the mode of genetic transmission of schizophrenia. Several neuropsychological methods distinguish schizophrenic patients as a group from normals. Some of them are based on a specific disturbance of long term concentration. The EEG also distinguishes schizophrenics from normals when analyzed during voluntary movement. For schizophrenics it takes more effort to initiate a voluntary movement, and there are several features of the EEG correlated to this. Moreover, the longer motor reaction time of schizophrenics is paralleled by a longer duration of the Bereitschaftspotential in schizophrenia. Furthermore, there is a difference in the theta rhythm between schizophrenic patients and normals in a task which requires concentration. Some of the children of schizophrenic parents show a disturbance of concentration in both reaction time tasks and the d 2 test.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-nine patients with moderate to severe tardive dyskinesia (TD) and 29 age- and sex-matched controls (C) with long-term neuroleptic therapy comparable to that of the patients were all examined using computerized tomography. Significant differences were found between the two groups in the width of the third ventricle (TD greater than C), the bicaudate distance (TD greater than C), the computed area of the head of the caudate nucleus (TD less than C), and the area of the lenticular nucleus (TD less than C). No significant differences were established in the ventricular or cella media indices. These results suggest that structural abnormalities, primarily in the basal ganglia system, are present in TD patients. Psychological testing with the Benton visual retention test also showed significant differences with regard to cerebro-organic functional impairment among TD patients.

Case histories of 128 patients suffering from functional psychoses were evaluated. The operational definitions for schizoaffective psychoses (SAP) of Kendell, Welner, Spitzer (RDC) and Feighner were applied. Of the 30 cases of SAP based on ICD 8 (295.7), Kendell's criteria were fulfilled in 97% Welner's in 77%, Spitzer's in 70% and Feighner's in 30%. The highly sensitive criteria of Kendell are best qualified for delineating the schizoaffective (sa) syndroms, but have the disadvantage of not requiring a time limitation when examining the longitudinal course of the illness. In this respect, the Welner criteria which also demonstrate high sensitivity were found to be more appropriate for the disease concept of the ICD 8. When using the schizoaffective criteria, a striking overlap was found with catatonic schizophrenia (Kendell and Welner diagnosed 33% as sa), paranoid schizophrenia (Spitzer 39%, Kendell and Welner 28%) and mania (Kendell and Welner 50% sa diagnoses). Of the SAP only 30% satisfied Perris' criteria for cycloid psychoses. Except for catatonic schizophrenia (47% overlap), the cycloid psychoses could be well distinguished from the other psychoses. cycloid psychoses therefore should not form a subgroup of the SAP. Kendell's criteria were found to be best qualified for the determination of the schizoaffective group. A higher specificity of the disease concept SAP may be achieved if we use time limitations such as Welner's. To avoid placing cycloid psychoses in the SAP category, the Perris criteria should be applied. Because of their high specificity, the criteria of Feighner and Spitzer were found to be inappropriate. In DSM-III the definition of "psychotic disorders not elsewhere classified" is weak. It lacks an operational definition for SAP so that DSM-III was not used for this investigation. In order to obtain a more homogeneous population not only in the schizoaffective group, but also in both of the two major psychoses, we find it legitimate to maintain the schizoaffective group and, at the same time, recognize the exceptional position of cycloid psychoses as separate groups.