The Hillside journal of clinical psychiatry最新文献

Evaluations of neuroendocrine abnormalities and possible relationship to major affective disorder in normal weight bulimic women have utilized the Dexamethasone Suppression Test (DST). In our sample of 29 bulimic women, 59% showed DST nonsuppression (DSTNS). Two diagnostic correlates were significant in relation to DSTNS: prior history of anorexia nervosa and current clinical DSM III diagnosis of depression. Eating Attitudes Test (EAT) scores were also significantly higher in the DSTNS group. The findings suggest that more extensive psychiatric disorder and ingestive abnormalities may be present in this subgroup of normal weight bulimic women who exhibit DST nonsuppression.

Transitions in the categorization of variables can contribute to changes in the concept of a psychiatric disorder. These transitions can occur with expansion of knowledge and without a concomitant change in the form of diagnostic labels. For example, the definitions of "mass" within the framework of Newtonian and Einsteinian theory are incompatible even though the same label is used to denote both concepts. Implications of the principles discussed for theory and practice in psychiatry are emphasized.

The antipsychotic effects of verapamil were tested in a double-blind, placebo-controlled, randomized study in 18 patients who met Research Diagnostic Criteria for acute schizophrenia. The antipsychotic effect of verapamil as measured by the Bunney-Hamburg Global Rating Scale were equal to those of haloperidol. Both verapamil and haloperidol were superior to placebo in decreasing psychotic symptoms. The results indicate that verapamil may have clinical utility in the treatment of schizophrenia.

In 1811 Mary Reynolds, a somber Pennsylvania spinster, awoke from a prolonged sleep as a new personality. Family memoirs describing her 18 years of shifts between two personalities shaped nineteenth century thinking about multiple personality disorder. As in other early case histories, no mention was made of childhood trauma, a factor found in 97% of contemporary cases. This discussion reviews genealogical and historical documents which suggest that Mary Reynolds did experience early trauma as a victim of religious persecution, which finally forced her family to leave Birmingham, England, when Mary was eight. Review of her illness indicates it may have functioned to eradicate memories of traumatic early experiences.

This report examines the differing types of psychiatric diagnoses served by different institutions as a result of differing social or institutional forces. Four-hundred-eighty-eight emotionally disturbed subjects from three different groups (competency to stand trial, chronic pain, and social security disability (SSI) applicants) were compared across psychiatric diagnostic categories. After adjusting for age, race, sex, education and marital status significant differences were found in the categories of affective disorders, schizophrenia, personality disorders and drug abuse. Interaction between institution and diagnosis is discussed.

In the Diagnostic and Statistical Manual (DSM), depressive symptoms severe enough to warrant hospitalization--regardless of the time requirement--should be adequate for a diagnosis of Major Depressive Episode.

Mycoplasma pneumoniae has long been recognized as an important agent of respiratory infections in humans. Less well known is the variety of extrapulmonary conditions associated with M. pneumoniae (Cassel, 1981; Ponka, 1979; Levine, 1978). The most common of these are central nervous system (CNS) complications (Lind, 1979) including meningitis, encephalitis, cranial nerve palsies, ascending paralysis (Guillain-Barre-like), transverse myelitis, cerebellar ataxia, polyradiculitis and acute psychosis. This paper describes a woman who developed an acute psychosis in the setting of a M. pneumoniae respiratory infection.

Changes in psychiatric treatment have rendered the "therapeutic community" concept inapplicable to the present day inpatient milieu. In this paper, the quality of staff interactional processes is used as the basis for reconceptualizing the milieu of the short-term psychiatric unit. Patient psychopathology and rapid patient turnover are among the sources of anxiety for the inpatient staff. However, under optimal circumstances staff interaction generates a matrix of relatedness, communication, and stability which becomes a "positive group introject" for staff members. The "positive group introject" enhances the integrative functioning of the unit staff, thereby facilitating patient reintegration and the development of a therapeutic alliance. Failure to establish a "positive group introject" as a countervailing structure to staff anxiety and fragmentation leads to the dominance of pathological forms of staff interaction. These come to characterize a particular ward as a collective entity. Three forms of pathological staff interaction are described; of special interest, because of its seemingly high prevalence on short-term receiving units, is the milieu characterized by the suppression of staff relatedness, affective expression, and communication. The structure of a psychiatric unit can be seen as a function of staff interactional processes, thus the quality of interpersonal relationships, and emotional experience of staff and patients, rather than the specifics of the ward program itself, holds the key to understanding the milieu's efficacy.