Twenty-first century managed mental health: Point-of-service treatment networks

The managed care product of the twenty-first century in behavioral health is the point-of-service plan now favored by many employers. This paper describes the nature of such a managed care product and its impact on mental health. Those designing the new delivery system must (1) construct the right system which husbands resources for the good of the patient, (2) choose the right providers, (3) employ the right financial incentives, and (4) undertake the right oversight training of network providers and analysis of care outcomes.     

Zur bilateralen Nekrose von Ammonshorn und basalem Schläfenlappen

Zusammenfassung Es wird über einen 70 Jahre alt gewordenen Mann berichtet, der nach einem apoplektiformen Insult ein inkomplettes Korsakow-Syndrom geboten hat, dessen klinische erscheinungen über 25 Jahre ohne Progredienz nachweisbar geblieben sind. Pathologisch-anatomisch haben sich bilaterale Erweichungscysten des Ammonshornes und des Schläfenlappens gefunden. Das Verteilungsmuster der Läsionen legt nahe, daß der Patient damals eine akute nekrotisierende Encephalitis durchgemacht hat.

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Bilateral necrosis of ammon's horn and basal parts of the temporal lobe

Summary A 70-year-old man displayed an incomplete Korsakow's syndrome following an apoplectic insult. The clinical manifestations of the syndrome were present for more than 25 years without further detorioration. Examination of the lesions revealed bilateral soft cysts within Ammon's horn and the temporal lobes. In retrospect the distribution pattern of the lesions suggests that at the time the patient had suffered from acute necrotizing encephalitis.

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Herrn Professor Dr. Fr. Panse zu seinem 70. Geburtstag gewidmet.     

Hyperkinetic children: Early indicators of potential school failure

Hyperkinetic children are identified as a population-at risk upon admission to kindergarten. The etiology of hyperkinetic behavior is controversial. Organic driveness, hyperkinetic behavior disorder, postencephalitic behavior, brain damage with behavioral and conceptual deficit, Strauss syndrome, have all been used to label essentially similar symptom constellations. Bypassing the area of controversy, a study is reported that demonstrates that children who were identified as hyperkinetic (using behavioral criteria developed in an earlier study) were (1) absent from school more frequently, and (2) did remarkably less well on standardized tests of school readiness than their peers rated nonhyperkinetic. The implications are discussed and suggestions made for the development of intervention programs.An earlier version of this paper was presented at the Annual Meeting of the American Orthopsychiatric Association, March, 1967.     

Development and evaluation of a diagnostic algorithm for depression in childhood

This paper describes the development and validation of a brief questionnaire intended for the rapid assessment of depression in childhood. It is primarily a clinical interview but there is an associated algorithm for the diagnosis of a syndrome of depression. It can equally be used for the clinical diagnosis of a depressive disorder. The current battery includes features representative both of depressive cognitions and endogenous depression. However, it is less effective in the identification of a syndrome of endogenous depression than depressive cognitions.

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Zusammenfassung Wir stellen die Entwicklung und Validierung eines kurzen Fragebogens vor, der zur raschen Feststellung einer Depression im Kindesalter dienen soll. Es handelt sich primär um ein klinisches Interview, aber es gibt zusätzlich einen Algorithmus für die Diagnosestellung eines depressiven Syndroms. Er kann ebenso für die klinische Diagnose einer depressiven Störung benutzt werden. Die vorliegende Batterie umfaßt Merkmale, die sowohl für depressive Kognitionen als auch für die endogene Depression repräsentativ sind. Jedoch können erstere hiermit besser identifiziert werden als das Syndrom einer endogenen Depression.

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Résumé Ce travail décrit le développement et la calidation d'un bref questionnaire ayant pour but l'évaluation repide de la dépression dans l'enfance. Il est en premier un interview clinique, mais il y a un algorythme associé pour le diagnostic d'un syndrome de dépression. Il peut également être utilisé pour le diagnostic clinique d'un trouble dépressif. La batterie courante comprend des traits représentatifs à la fois des cognitions dépressives et de la dépression endogène. Cependant, il est moins efficace dans l'identification d'un syndrome de dépression endogène que dans le cas des cognitions dépressives.

     

Cerebral hemodynamics and “re-build-up” phenomenon on electroencephalogram in children with moyamoya disease

Re-build-up phenomenon, induced by hyperventilation, is a characteristic finding on electroencephalogram (EEG) in children with moyamoya disease, and suggests close correlation with cerebral ischemic attack. Its mechanism, however, remains obscure. In this study, we examined the relationship between the cerebral hemodynamics and this phenomenon before and after vascular reconstructive surgery. Regional cerebral blood flow and its reactivity to acetazolamide were analyzed using the xenon-133 inhalation method and single photon emission computed tomography in six children with moyamoya disease. These results were compared with the EEG. Regional vasoreactivity to acetazolamide was significantly lower in re-build-up-positive regions than in re-build-up-negative regions. Postoperative studies revealed a significant improvement of reactivity in the regions where the re-build-up phenomenon disappeared after surgery. These results suggest that the re-build-up phenomenon represents a focal reduction of the cerebral perfusion reserve in moyamoya disease.     

Plasmocytoma of the brain in Kahler's disease (multiple myeloma)

Summary A 77 year old man suffered from an acute form ofKahler's disease. The diagnosis was established after cerebral symptoms developed, at a time when the morphological blood picture was still relatively normal. The patient died seven days after the onset of the disease in a state described as coma paraproteinaemicum byWuhrmann ⁸².On postmortem examination a myeloma of the bone-marrow and of a lung hilus lymph node were found, but apart from this there were no specific alterations of the viscera. Within the right temporal pole of the brain and its leptomeninges a more or less diffusely scattered perivascular reticulo-endotheliosis (plasmocytosis) was present together with a central solid aggregation of reticulo-endothelial cells (plasmocytoma, myeloma). It is suggested that these alterations developed primarily in the brain through proliferation of perivascular reticulum cells, just as in the bone-marrow.

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Zusammenfassung Ein 77 jähriger Mann litt an einer akuten Form der Kahlerschen Krankheit. Die Diagnose wurde nach dem Auftreten cerebraler Symptome gestellt, zu einer Zeit, da das morphologische Blutbild noch relativ normal war. Der Patient starb 7 Tage nach dem Auftreten der Krankheit in einem Zustand, der vonWuhrmann als coma paraproteinaemicum beschrieben wurde.Bei der Autopsie wurden ein Myelom des Knochenmarks und eines Hiluslymphknotens gefunden, sonst keine weiteren spezifischen Veränderungen an den inneren Organen bemerkt. Im rechten Temporalpol des Gehirns und seinen Leptomeningen fand sich eine mehr oder weniger diffuse perivasculäre Reticuloendotheliose (Plasmocytose) sowie eine zentrale geschlossene Anhäufung von reticuloendothelialen Zellen (Plasmocytom, Myelom). Es wird vermutet, daß sich diese Veränderungen primär im Gehirn, ebenso wie im Knochenmark, durch Wucherung perivasculärer Reticulumzellen entwickelten.

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With 5 Figures in the Text     

The effect of non-response bias on the results of two-stage screening surveys of psychiatric disorder

Summary The effects are examined of two varieties of non-response bias (that due to illness and that due to defensiveness, as defined in this paper) on two-stage screening surveys for psychiatric disorder. Equations to model these effects are first derived; these are then used, in conjunction with pre-existing data, to estimate the sixe of the non-response bias. It is concluded (a) that bias due to illness results in prevalence estimates being some 5% lower than the true prevalence; (b) that specificity is little affected by either variety of bias; but that (c) bias due to defensiveness results in the sensitivity being overestimated by about 6%.     

Depression in Parkinson disease: a disabling but neglected factor

20 depressed and 20 non depressed patients with Parkinson disease were rated for disability on the Northwestern University Disability Scale and for severity of the typical motor symptoms on the Columbia University Rating Scale and were assessed for mental deterioration. The severity of the typical symptoms was practically equivalent in the two groups but the depressed patients not only presented mild mental deterioration but were significantly more disabled (less independent) than the patients without depression. A significant correlation was found between severity of depression and degree of disability but not between severity of depression and severity of typical motor symptoms. Depression was diagnosed much later than the typical symptoms. Only 25% of the depressed parkinsonians had received tricyclic antidepressants, about 20% had been treated with dopamine-antagonist psychotropic drugs and some 50% had received no treatment at all against depression. Timely diagnosis and appropriate treatment of depression in parkinsonian patients limits the effects of a major disabling factor.Party supported by Regione Piemonte, grant n. 17     

DL-lysine-H3 uptake in “light” and “dark” neurons of the inferior olivary nucleus of euthyroid and dysthyroidal rats

Summary Uptake of DL-Lysine-H³ into light and dark cells of the rat inferior olivary nucleus was studied by radioautographiy. Uptake in light cells was higher than in dark cells and appears to be possibly related to the greater frequency of relationship with glial satellites. Dysthyroidal states were also observed to increase uptake of radioactivity which was prominently observed in hypothyroid rats. Since dark cells appear to take up less lysine than normal cells and are less frequently closely associated with glial satellites it is suggested these cells may represent a less physiologically active unit than the light cells rather than being simply artifactually produced by the procedures employed.

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Zusammenfassung Die Aufnahme von DL-Lysin-H³ in hellen und dunklen Zellen im unteren Olivenkern der Ratte wurde mit Autoradiographie beobachtet. Die Aufnahme war höher in den hellen Zellen als in den dunklen, was möglicherweise mit einer größeren Häufigkeit von Glia-Satellit-Verbindungen in Zusammenhang gebracht werden könnte. Veränderungen im hormonalen Zustand der Schilddrüse konnten auch dazu beitragen, die Aufnahme von Radioaktivität zu erhöhen, was besonders bei Ratten mit niedriger Schilddrüsenaktivität hervortrat. Da dunkle Zellen offenbar weniger Lysin aufnehmen als normale Zellen, und sie seltener mit Glia-Satelliten verbunden sind, wird angenommen, daß diese Zellen möglicherweise eine weniger aktive physiologische Einheit darstellen als die hellen Zellen und daß es sich nicht einfach um ein Kunstprodukt handelt.

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This investigation was supported in part by a PHS research grant (NB-456802) from the division of Neurological Disease and Blindness and in part by Contract NONR 4018(01), (NR 101-592), between the Office of Naval Research, Department of the Navy, and the Research Foundation of the State University of New York.     

Reliability of circadian heart pattern analysis in psychiatry

The assessment of circadian heart patterns represents a new methodology for documenting physiological dysregulation associated with psychiatric illness. Previous research has demonstrated abnormal heart rate patterns, especially during the bedtime interval, that are associated with depression, generalized anxiety disorder, panic disorder, and schizophrenia. These patterns are derived from heart rate data obtained while wearing an unobtrusive, two-lead heart rate monitor over a 24-hour period. To establish basic reliability, the second author blindly rated heart-monitored data from 50 subjects on two occasions, separated by an average of 6.6 weeks (range = 2.9–15.7 weeks). Subjects were classified as definitely psychiatric, probably psychiatric, borderline, broadly normal, and signature normal. The exact category agreement rate was 78%. If a one-category difference is permitted (e.g., definitely psychiatric and probably psychiatric counted as an agreement), the agreement rate was 92%. Circadian heart pattern analysis is a promising new technology in psychiatric research and warrants further investigation.     

Prevalence of known and hidden alcoholism in the revisited lundby population

Summary Using the new data from a second followup of the Lundby 1947 cohort, the aim of the present paper has been to analyze some relationships between known and hidden alcoholism in a Swedish general population sample. Information was collected by psychiatrists trough free, exploratory field interviews checked against documentary records. Alcoholism was medically defined for present purposes. Information was obtained for 98% of the 952 men surviving the cross-section date July 1, 1972. The distribution of alcoholism and other psychiatric disorders in the total population and in age subgroups was analyzed epidemiologically. The true prevalence of alcoholism in the adult men was 9.5%, comprising 7.2% known and 2.3% hidden. The proportion of hidden to known cases was 0.301 (Temperance Boards 0.871, Psychiatric Agencies 0.961, Drinking and driving offences 4.31). The main finding that about 70% of male alcoholics in Lundby appears to be known to the agencies is at variance with current views that there is an iceberg under the tip, though consistent with Rubington's suggestion that so-called hidden alcoholism is not totally but partially invisible in welfare societies.     

Lateral differences in the GABAergic system of the rat striatum

Asymmetric differences have been found in the pre- and postsynaptic activity of the GABAergic system of the left and right striata of the rat.³H-GABA binding shows a higher dissociation constant (K_D) and a higher number of sites (Bmax) in the left striatum than in the right. Moreover,³H-diazepam binding seems to be more extensively activated by GABA in the right striatum suggesting a more sensitive postsynaptic GABAergic activity than on the left side. However, when the presynaptic marker (GAD activity) was measured, the asymmetry was in the opposite direction. The results provide further neurochemical evidence of the functional asymmetry of the rat brain.

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Sommario Un'ulteriore dimostrazione neurochimica dell'assimetria funzionale del cervello di ratto è data dallo studio dell'attività pre- e postsinaptica del sistema GABAergico dello striato di destra e di sinistra di ratto.Il binding di³H-GABA ai siti recettoriali postsinaptici dimostra un più alto numero di siti binding (Bmax) e una più alta costante di dissociazione (K_D) nello striato di sinistra rispetto allo striato di destra. Inoltre, in accordo con una più sensibile attività postsinaptica GABAergica, si osserva nello striato di destra un maggiore incremento del binding di³H-diazepam da parte del GABA anche se non significativo. Tuttavia, lo studio dei markers presinaptici dimostra una più elevata attività GAD nello striato di sinistra rispetto al suo controlaterale.

     

Neuroectodermal tumors of the peripheral and the central nervous system share neuroendocrine N-CAM-related antigens with small cell lung carcinomas

Summary The current study describes the presence of neuroendocrine antigens of peripheral and central neural tumors using eight monoclonal antibodies raised to small cell lung carcinoma (SCLC), which recognize neural/neuroendocrine or neural antigens, as defined by their reaction pattern in normal tissues and tumors. At least five of them recognize different epitopes of the neural cell adhesion molecule (N-CAM). It was found that all of 12 neuroblastomas, 2 ganglioneuroblastomas and 4 ganglioneuromas as well as 23 central primitive neuroectodermal tumors, 13 astrocytomas and 4 ependymomas share neural/neuroendocrine antigens (as defined by the anti-N-CAM antibodies Moc-1,-21,-32,-52 and-191) with SCLC. The neural/neuroendocrine antigen defined by Moc-171 was also found in all peripheral tumors, but only in further differentiated central tumors. Non-N-CAM related neural antigens (as defined by Moc-51 and-172) were found only in better-differentiated peripheral and central tumors, but they could be demonstrated in all three medulloblastoma cell lines studied. In addition, the antigen defined by Moc-51 was demonstrated in an immunoblot of a neuroblastoma cell line. Antibodies recognizing epithelia antigens of SCLC and other epithelia and their tumors (Moc-31 and-181) were non-reactive. It was concluded that these findings give further support for a relation between neural and neuroendocrine tumors and that some of the antibodies may be useful for the detection of differentiation in neural tumors. Antibodies with an epithelia recognition pattern may serve to distinguish neural from neuroendocrine tumors.Supported by NIH grant CA 36245 W.M.M. was a Fullbright scholar     

A comparison of five diagnostic systems for childhood schizophrenia and infantile autism

Five diagnostic systems designed to differentiate infantile autism and early childhood schizophrenia were compared by deriving scores on 44 children referred consecutively to the same clinical center. While the autistic scales devised by Rimland, Polan and Spencer, Lotter, and the British Working Party correlated significantly, the degree of correspondence (35%) indicated that several children obtained high autistic scores in one system but low scores in another. The BWP's term schizophrenia has more correspondence with the term autism used by others than with Rimland's schizophrenia. In the DeMyer-Churchill categorical system (early schizophrenia, primary autism, secondary autism, and non-psychotic subnormal), primary autism most resembles Rimland's concept of infantile autism as measured by his E-1 version. All other systems differentiate psychotic from non-psychotic children but do not distinguish any of the psychotic subgroups.This study was supported in part by Public Health Service Grant No. MH05154 and also by LaRue D. Carter Memorial Hospital, State of Indiana, Indianapolis, Ind.The authors wish to thank Dr. Bernard Rimland for providing his scoring key.     

Genealogic study of patients with admission diagnosis of functional psychosis

Summary The results are reported of a genealogic study of 313 patients (171 males and 142 females) consecutively admitted to the psychiatric department of the Medical School of Charles University in Prague, Czechoslovakia. Patients suffering from psychosis were selected and divided into five groups: schizophrenia, bipolar psychosis, unipolar depressive psychosis, schizoaffective psychosis and unspecified disorder (the diagnosis of psychosis suspected but not yet certain at the time of investigation). A total of 1086 first degree relatives (parents and siblings) were ascertained and one or more first degree relatives of each proband were interviewed. The total morbidity risk of psychiatric disorder for parents and siblings was 12.6% for schizophrenic probands, 17.8% for bipolar probands, 10.7% for unipolar probands, 12.0% for schizoaffective probands and 12.6% for probands with unspecified psychosis. A striking increase of the frequency of affective disorders was found among secondary cases of schizoaffective probands.Heterogeneity between schizophrenia and primary affective disorders was tested and demonstrated.The pros and cons of the study design was discussed.     

AMP-rated psychopathology in chronic alcoholics

Summary In a group of 39 alcoholics within a withdrawal process, the psychical situation was rated using AMP scales (Angst et al. 1969). Cluster analysis of the items rendered the following five-cluster solution: (1) aggressive-depressive patients, (2) less impaired persons, (3) slowed persons with diminished contact, (4) emotionally inadequate persons, (5) appealing depressive persons. These results are discussed with respect to other data from clinical history and diagnostic findings.Supported by Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 115, Teilprojekt C21     

Electrophysiological evidence for visuocognitive dysfunction in younger non caucasian patients with Parkinson's disease

Summary A study of primary (VEPs) and cognitive (ERPs) visual evoked potentials was carried out in a group of non-demented Afro-American Parkinson's disease (PD) patients. Current studies suggest that differences exist in the clinical manifestations of PD in Caucasian and non-Caucasian populations. Two horizontal sinusoidal gratings differing in spatial frequency, i.e., 1 and 4 cycles per degree (cpd), were presented in an oddball paradigm to 17 patients with PD and 17 age-matched control subjects. While the 1 cpd stimulus, is not expected to reveal retinal dopaminergic deficency, but only visuocognitive deficits, the 4 cpd may give direct information of both retinal and cognitive visual deficits. We measured the latencies and amplitudes of N70, P100 and P300 components, and derived the normalized measures of P300-N70 latency difference (Central Processing Time-CPT70), the P300-P100 latency difference (CPT100) and the P300 amplitude responses normalized to either N70 and P100 amplitude (Amplitude Ratios AR70 and AR100). Our results do show that cognitive electrophysiological deficits in younger PD patients exist in non-Caucasians, perhaps to an even greater degree than in Caucasians, and confirm that absolute and normalized ERP amplitude and latency abnormalities are a distinguishing feature of younger PD patients from controls. In particular P300 measures are abnormal for 1 cpd pattern. A negative correlation exists between P300 amplitude and the motor score. By comparing the results for 1 and 4 cpd stimuli it can be concluded that primary and cognitive visual abnormalities are independently affected in PD, implying that visuo-cognitive abnormalities are not passively determined by retinal dopaminergic deficiency.     

Obsessive-Compulsive Disorder in Popular Magazines

To examine what the general public is learning about Obsessive-Compulsive Disorder (OCD) through popular magazines, all articles listed in the Reader's Guide to Periodical Literature under the topic headings of obsessive-compulsive behavior or obsessive-compulsive disorder between 1983 and 1997 were read and rated. Only 31 of the 107 articles under these headings dealt explicitly with OCD, and these were found to be reasonably accurate in their presentations of symptoms, causes, and treatments. Many of the other articles under the target headings, however, focused on incidents of stalking of famous people by obsessed fans. The implications of the content patterns of these articles for understanding and misunderstanding of OCD are discussed.     

Enlarging skull fractures in children

Large skull fractures are conventionally followed radiographically until healing occurs. Fractures which enlarge or remain unhealed are commonly termed leptomeningeal cysts or growing skull fractures. This study of ten children with this injury and a review of the literature shows that a true leptomeningeal cyst is seldom present and that skull fractures do not grow. Moreover, careful history-taking and physical examination will correctly identify all enlarging or unhealed skull fractures of childhood without the need for plain radiographs or computed tomography of the skull.     

Mental Hygiene of the Special Schools Teachers in Kerman,Iran

The goal of this research is to identify and study the mental hygiene and its related factors (individual, family, organizational) in the Kerman special schools teachers. 266 teachers of the special schools of the cities of the province Kerman were chosen as the research sample. The necessary data were obtained by questionnaire which its validity and reliability were determined. The statistical analysis of the research findings (by Spearman coefficient test) Man-Whithey and Kruskal wallis tests showed that there was a positive and meaningful relationship between Level of education, service of record the number of the members of teachers family, income, dwelling-place, economic power, acceptance of the teachers job in their family, leadership style, suitable educational possibilities, suitable educational space, job satisfaction with the mental hygiene of the teachers. The results of the research also showed that the Kerman special schools teachers enjoyed a relatively desirable mental hygiene.