EYE SIGNS IN PATIENTS WITH ANOREXIA NERVOSA

Thirteen anorexia nervosa patients and 13 control subjects were examined for cataract and xerophthalmia. Although 11 patients had Vitamin A intakes below recommended daily levels for significant periods of time, there was no evidence to suggest that they had an increased incidence of pathological changes in conjunctiva or lens.     

Good nurse, bad nurse…

The construction of the nursing subject is discussed The paper takes a historical perspective, arguing that the range of speaking positions available to the nurse is limited by gender, class and education It evaluates the position of nursing in the university, showing how this also has the propensity to limit the development of the nursing profession     

Jealousy,general creativity,and coping with social frustration during the menstrual cycle

Sensitivity to feelings of jealousy in women (n=16) at three phases of their menstrual cycle differing in serum hormone concentrations (menses, preovulatory phase, midluteal phase) was investigated. Nonspecific electrodermal activity indicating sympathetic excitation was measured while subjects listened to stories and imagined situations inducing (i) nonsexual jealousy (the partner forms a deep emotional attachment to another woman), (ii) sexual jealousy (the partner has sexual intercourse with another woman), and (iii) no jealousy (social interaction lacking intense emotionality). Subjective ratings of the intensity of jealousy during both stories of jealousy were also assessed. In addition, changes in cognitive coping abilities, in general, and in the context of socially frustrating events, were assessed by tests of divergent thinking (creativity) and the Rosenzweig Picture Frustration Test. Frequency of nonspecific electrodermal reactions was generally enhanced during the preovulatory phase. This increase was particularly strong when the women listened to stories inducing nonsexual jealousy, i.e., a story characterized by cues of a complete loss of the partner's investment. Rated jealousy tended to be enhanced during the ovulatory phase, especially after the story of nonsexual jealousy. These changes in emotionality were paralleled by an improved divergent thinking performance and less aggressive coping with socially frustrating events around the time of ovulation. Research supported by a grant from the Deütsche Forschüngs Gemeinschaft to J. Born.     

Monitoring plasma levels of fluphenazine during chronic therapy with fluphenazine decanoate

This study was conducted to examine the interpatient variability in steady–state plasma concentrations of fluphenazine by repeat depot intramuscular administration, and to determine the relationship between these concentrations and clinical state. Steady–state pre–dose concentrations of fluphenazine in plasma were measured using a sensitive and specific gas chromatography/mass spectrometry (GC/MS) assay in 24 patients with schizophrenia who were receiving continuous treatment with depot intramuscular fluphenazine decanoate. Clinical response was measured using the Andreasen Scale for positive and negative symptoms. Steady–state plasma concentrations of fluphenazine ranged from undetectable (< 0–l ng/ml) to 27-9 ng/ml, with a median of 0–5 ng/ml. No significant associations were found between plasma concentration and dosage, or age and sex of the patient. Steady–state plasma concentrations in patients taking anticholinergic agents were significantly higher than in patients not receiving such drugs (P < 0–05 by MannWhitney U–test). Poorer control, expressed as the sum of the negative symptom scores or the sum of the positive and negative symptom scores, was related to higher log transformed plasma concentrations of fluphenazine and higher fluphenazine decanoate dosage. The log transformed plasma concentrations of fluphenazine and the fluphenazine decanoate dosages were weakly related. Patients receiving another antipsychotic drug in addition to fluphenazine decanoate tended to have poorer clinical control and higher dosages of fluphenazine decanoate. These results indicate the useful role that plasma level monitoring can fulfil in identifying patients who are therapy–resistant despite high plasma levels.     

A brief mental health outcome scale: relationships between scale scores and diagnostic/sociodemographic variables in the long-term mentally ill

A brief mental health outcomes scale: relationships between scale scores and diagnostic/sociodemographic variables in the long-term mentally ill The Global Assessment of Functioning (GAF) scale is a quick and simple measure of overall psychological disturbance. A recent study by our group reported the reliability and validity of the scale in a population of severely mentally ill people. The current study extends the analysis of this population to consider a number of questions, i.e. what are the associations for this group between variations in GAF scores and sociodemographic variables? Are lower scores associated with particular diagnoses for the group assessed? What are the characteristics of those patients whose scores were most variable? What were the completion rates for use of the scale? No associations were observed between GAF score and the sociodemographic variables used in this study. Lower GAF scores were associated with psychotic diagnoses. Those with most varying scores were, in the main, white European nonimmigrant males with a diagnosis of schizophrenia. Completion rates for the study were reasonable at 73.8%. This study involved the repeated assessment of a large number of clients by a changing multidisciplinary team. Inspite of the extended nature of the study, completion rates remained reasonable, suggesting that the scale was acceptable for routine clinical use. The GAF in itself, however, appears to be unsuitable for making individual treatment decisions but could be used as a first step before using more sophisticated scales.     

Pseudocyesis and its Modern Perspective

EDITORIAL COMMENT: We accepted this paper for publication because we have not reported previously on pseudocyesis, which is a rare condition, especially if 'first trimester cases' are excluded where there has been confusion with interpretation of intervals of amenorrhoea. These cases can occur at the climacteric when elevated levels of LH can give a false positive HCG test result with older methods of assay and add further to the temporary clinical confusion. The classical clinical picture, unlike the 3 cases reported in this paper, is said to be the nullipara approaching the time of the climacteric who is anxious to conceive. Queen Mary's case must be the most famous on record and also the best documented by means of the serial bulletins issued for her loyal subjects concerning the progress of her royal pregnancy (A). The editor can remember only 1 case of 'late pregnancy' pseudocyesis in 40 years of obstetric practice. This woman was finally convinced of her nonpregnant status by failure of a fetal skeleton to show on an abdominal X-ray. This was many years ago. This test was claimed to be definitive. One wonders how these women coped thereafter. We agree with the authors that follow-up, not necessarily by a psychiatrist, is important. In the editor's experience pseudocyesis of late pregnancy is less common than advanced true normal pregnancy in a nullipara aged more than 40 years, married for many years, who presents with abdominal pain and finds out to her delighted surprise that she is in labour at term and shortly thereafter produces a surviving normal infant. The reviewers of this paper did not agree with the suggestion that curettage would be an appropriate procedure to convince a woman with pseudocyesis that she was not pregnant. However, the authors, having read this editorial comment, stated that curettage is mentioned in the pseudocyesis literature (4).
(A) Dewhurst J. Royal Confinements. Weidenfeld and Nicolson, London. 1980; 28–29.     

The etiology,diagnosis and treatment of the fire-setting behaviour of children

This article considers the etiology, diagnosis and treatment of fire setting. The causes reported include child abuse, identification problems, poor parent relationship and severe conduct disorders. Diagnosis is varied and rarely specific. Treatment approaches vary and include close observation, negative practices or satiation procedures and positive and negative reinforcement.