Psychiatric comorbidity of smoking and nicotine dependence

Recent epidemiologic studies have revealed that comorbidity of psychiatric disorders is far more pervasive than previously suspected. Strong associations have been reported between specific substance use disorders and between any mental disorder and any substance use disorder. This report focuses on comorbidity of nicotine dependence, a substance use disorder on which little epidemiologic information is available. Data come from an epidemiologic study of approximately 1000 young adults in southeast Michigan, in which the NIMH-DIS, revised according to DSM-III-R, was used. Lifetime prevalence of nicotine dependence was 20%. Males and females with nicotine dependence had increased odds for alcohol and illicit drug disorders, major depression, and anxiety disorders, compared with nondependent smokers and nonsmokers combined. Major depression and any anxiety disorder were associated specifically with nicotine dependence. Increased odds for alcohol or illicit drug disorders were observed also in nondependent smokers, compared to nonsmokers. History of early conduct problems increased the odds for nicotine dependence among smokers. Potential mechanisms in the comorbidity of nicotine dependence are discussed.     

Patterns of coverage of psychiatric emergencies

A massive change in the detection of psychiatric cases in the emergency room was recorded when pattern of coverage was changed from "on-call" basis to "continuous physical presence" of psychiatry residents in the emergency room.     

精神病专科医院经济运行调查和建议

精神卫生专业机构既是我国精神卫生服务体系的重要组成部分,也是精神卫生防治工作的主体。精神障碍发病率逐年增加,已经成为严重威胁我国居民健康的一类疾病。在新冠疫情防控期间,精神病专科医院在维持社会稳定方面起到的作用不可或缺。与综合医院和其他专科医院相比,精神病专科医院无论是在运营成本还是运营能力上都有所欠缺。研究揭示了精神病专科医院运行存在的一系列问题,建议社会和政府在要求精神病专科医院"公益"服务的同时,应切实了解精神病专科医院的运行现状并给予足够的支持。     

博乐欣与阿米替林治疗抑郁障碍对照观察

目的：探讨博乐欣与阿米替林对抑郁障碍的疗效及副反应。方法：对５０例抑郁障碍患者应用博乐欣（２５例）与阿米替林（２５例）进行对照治疗,疗程６周。     

Symptoms in children of British and of Bangladeshi parents measured by the Rutter B2 questionnaire

Objectives. Bangladeshi children are less frequently referred to a child psychiatric clinic than their British peers. This study aimed to ascertain if teachers observed less psychological symptoms in Bangladeshi than British children.

Method. Teachers completed a Rutter B2 Scale on samples of 113 ‘Bangladeshi’ and 61 British children aged between 5 and 11 years.

Results. Teachers recognised less symptomatology in the Asian children than their British peers. This trend was significant in children under the age of 8, but there was no significant difference in those aged 8–11 years. Only 13% of Bangladeshi children were fully fluent in English.

Conclusions. Two alternate hypotheses are put forward to explain these findings: (a) because more of the younger children could not speak English and communicate freely with their teachers, their symptoms were not noted by teachers; (b) the symptoms of the older children were a response to the pressures both the children and families faced as new immigrants. This study clearly needs to be replicated with a larger sample and also with interviews with both children and parents in order to validate the Rutter B2 questionnaires as an appropriate measure of disturbance in Bangladeshi children. It should be replicated with validated assessments of the children's fluency in English. It is also important to discuss with Bangladeshi parents what support they would like from both the school and from child psychiatric services, to promote their children's psychological health.     

Do bilineal pedigrees represent a problem for linkage analysis? basic principles and simulation results for single-gene diseases with no heterogeneity

Some investigators have expressed concern--especially for psychiatric disorders--that bilineal pedigrees should not be included in linkage studies. This study compares the "informativeness" of bilineal and unilineal families for a homogeneous single-gene disorder. Three approaches were used: (1) simulation studies of three-generation pedigrees, (2) calculation of expected lod scores (ELODs) in nuclear families, and (3) calculation of Fisher's information number I(theta) in nuclear families. The simulation studies in (1) permitted a realistic comparison between bilineal datasets and purely unilineal ones. The calculations in nuclear families in (2) and (3) then made it possible to analyze the sources of information loss in bilineal families. Overall, in datasets of five three-generation pedigrees each, the drop in mean maximum lod score was approximately 50% from purely unilineal datasets to extremely bilineal ones. In less-extreme bilineal datasets, which are closer to most real data than the extremely bilineal ones, the drops in lod score were very small--less than 10% in some, and practically zero in others. The details will vary, depending on size and structure of the pedigree, genetic model, true value of the recombination fraction, and informativeness of the marker. However, these results imply that the information loss due to bilineality is not necessarily very great. The nuclear-family calculations showed that for phase-known matings there is relatively little information loss in bilineal families, but for phase-unknown matings there the loss is much greater. In conclusion, for single-gene disorders with no genetic heterogeneity, whereas bilineal families can be less informative than comparable unilineal families, they are not so much less informative that they should automatically be discarded from linkage datasets. The implications of bilineal pedigrees for linkage studies of heterogeneous disorders are also discussed.     

Facial pain

Summary In a prospective material of 1052 patients the precipitating factors, associated symptoms, psychological and neurological deficits have been examined.Mastication and talking are the most frequently occurring precipitating factors, 76% as regards Neuralgia, with typical starting difficulties. As regards Non-neuralgiform Pain 24%, with precipitation late in the masticatory process. There were trigger zones in 50% of the cases of Typical Trigeminal Neuralgia and in 9% of the patients with Non-neuralgiform Pain. In a series of cases the jaw joint is perceived as a trigger zone. Cold precipitates pain in 48%–39%. Other precipitating factors are much more rare-psychological stress in 15% of the patients with Non-neuralgiform Pain, however.Vegetative associated symptoms were relatively frequent, lacrimation occurred in 31% of the cases of Typical Trigeminal Neuralgia and in 20% of the cases of Non-neuralgiform Pain. Rhinorrhea and salivation were less frequent. In terms of figures migrainoid associated symptoms had no connection with vegetative associated symptoms or with pain in the eye.In 11 % of the patients pain occurred most frequently during the night and in 20% the frequency of pain was the same day and night. About 1/3 of the patients with Neuralgia experienced seasonal variations.Tenderness of foramina is a symptom of no significance. Very few patients had primary sensory loss. No eye or ear symptoms have been found which may be referred to as the patho-anatomical basis of the pain.About 1/3 of the patients with Non-neuralgiform Pain had psychological symptoms whereas hardly any patients with Neuralgia had them. MMPI test performed on a small matched material showed no difference between Neuralgia and Non-neuralgiform Pain.In material B an examination has been made of the jaw joint arthrosis symptoms. A restriction of the diagnosis of arthrosis has had the effect that it must be recognized that patients with facial pain do not have the high frequency of jaw joint diseases previously assumed. As was also the case in a series of normal material previously published, between 1/5 and 1/3 of the patients with Neuralgia had jaw joint arthrosis which was due to old age.This study has not revealed any connection between previous diseases, the onset of pain, the character and course of the pain, the character of the attack, the localization of pain, precipitating factors, associated symptoms and symptoms of loss on the one hand and the patho-anatomical substratum on the other.The psychological examinations were performed by Mr. Peter Bruun, chief psychologist, for whose cooperation I am grateful.     

Distribution of lithium elimination rates in a selected population of psychiatric patients

Summary Chronic treatment with conventional lithium carbonate was interrupted in a selected group of 40 psychiatric patients of mixed sex and race. All patients had normal renal function. Serum samples were taken 12, 24, 36 and 48 h after the last dose and lithium was assayed by atomic absorption spectrophotometry. Decay rates calculated for the 12–24 h and 36–48 h periods yielded different values. This was ascribed to the presence of an incomplete redistribution phase during the earlier period. The distribution of elimination rates determined during the later period gave a more symmetrical spread and approximated a normal distribution. The mode, median, mean and standard deviation of the lithium elimination half-lives were 12.5, 14, 18.2 and 7.3 h and 22.5, 24.5, 29.8 and 10.1 h for the two periods, respectively. The results contrast sharply with another report of the distribution spread of elimination half-lives in a much larger sample. The current values have implications for dosage prediction, serum level monitoring and dosage formulation, especially sustained-release preparations. The evidence was against the possibility that some individuals retain lithium.     

Hysterical neurosis, conversion type: clinical and epidemiological considerations.

This paper considers data on hysterical neurosis, conversion type from the Monroe County (New York) Cumulative Psychiatric Case Register, from the Psychiatric Case Register in Iceland, and from a psychiatric consultation service in a university teaching general hospital in Monroe County (New York) during the period 1960 to 1969. The rate of hysterical neurosis, conversion type in Monroe County during this period was 22 per 100,000 per year, whereas in Iceland it was 11 per 100,000 per year. It was highest for women, non-whites and those of low social economic status. The rate of hysterical neurosis, conversion type and "probable" hysterical neurosis, conversion type combined among patients seen in psychiatric consultation was 4.5%. The most often noted diagnostic criteria were inconsistency with somatic process and precipitation of symptoms by psychological stress. Most patients had more than one conversion symptom at the same time. Pain was the most common symptom. The majority of patients had an accompanying organic or functional illness.