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.     

Attitudes toward mental health professionals in a hospital-based community mental health center

This study examined the attitudes of several diverse subject groups in a large medical center toward various mental health professionals. The groups consisted of: 1) general hospital staff; 2) professional mental health workers; and 3) psychiatric in-patients. Subjects evaluated a selection of 11 professional health related role titles (clinical psychologist, physician, psychiatrist, etc.) and the categories me and mental patient by marking a series of 19 seven-step rating scales, each composed of bipolar anchoring adjectives. Additionally, a familiarity rating for each of the role titles was obtained. An understanding and a value cluster were derived from the 19 adjectives along with an overall favorability-unfavorability score for each role title. It was expected that subjects would value mental health professional roles more strongly than they would indicate an understanding of these same roles. Secondly, it was expected that the hospital setting itself, the subject's role within that setting, and the degree of familiarity with the role being rated would have a significant impact on the subject's attitude. Results generally supported the above expectations. Overall ratings of the professional groups were consistently high, with less difference between the health designations (physician, nurse) and the psych designations than has been previously reported in the literature.     

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.     

Clinical Evaluation of Attention-Deficit Hyperactivity Disorder by Objective Quantitative Measures

This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: hyperactive-impulsive, hyperactive-inattentive, impulsive-inattentive, hyperactive, impulsive, inattentive, mixed, and unspecified type. These classifications may be useful in diagnosing ADHD.     

The assaultive psychiatric patient

In the light of rather widespread aggressive feelings and frequently poor controls among psychiatrically hospitalized patients, the number of serious assaults and even incidents is remarkably low. Nevertheless, there is an indisputable need for institutions to put the same kind of effort into identifying cases calling for Violence Precautions as has always obtained with regard to Suicide Precautions.     

Quality of life in multiple sclerosis: The disability and impact profile (DIP)

Seventy-three Dutch and Flemish patients with definite multiple sclerosis (MS) were assessed by means of the Disability and Impact Profile (DIP), which is a 2 × 39 item, self-administered questionnaire with parallel questions aboutdisabilities and their importance for orimpact on the patient, resulting in a profile of weighted scores. It was designed as a tool for clinical assessment of quality of life (QoL) domains in MS patients. Group data showed more than 50% loss on weighted scores for walk, clean home, work and worry about deterioration. In individual patients a median of 7 (range 0–23) major disruptions of quality of life (MD-QoL: loss on weighted score more than 50%) was found. Prevalence of MD-QoL in more than 10% of the patients was found for as many as 31 disabilities and > 50% for 3 (clean home, work and worry about deterioration). Results in the MS group were compared with available data from 25 patients with rheumatoid arthritis (RA) and 25 patients with a spinal cord lesion (SCI). Weighted scores of read, memory and concentration were significantly lower in the MS group than in the RA and SCI groups. Significantly lower weighted scores in both the MS and RA groups compared with the SCI group were found for worry about deterioration, physical endurance, clean home, work, see and write. In conclusion, major disruptions in many domains of QoL were found in MS patients. Weighted score profiles for MS were in accordance with clinical manifestations. Unlike Kurtzke's Extended Disability Status Scale, DIP assesses a wide range of potentially MS-affected human activities, and also takes into account the subjective perception of disabilities.     

Quantitative changes in number of “synaptic” ribbons in rat pinealocytes after orchidectomy and in organ culture

Summary A quantitative study of synaptic ribbons in rat pinealocytes was performed after orchidectomy and in organ culture. Both orchidectomy and culturing the pineal organ caused an increase in number and size of these structures.Present study indicate that microtubular sheaves and/or microtubules may represent precursors of synaptic ribbons.It is suggested that synaptic ribbons of rat pinealocytes, far from being phylogenetic relics of no functional significance play a role in the function of the pineal organ. An exact functional interpretation of the synaptic ribbons, however, is still a matter of conjecture.In gratitude and with admiration this paper is dedicated to Professor Dr. J. Ariëns Kappers.     

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.     

The well-baby clinic

The termwell-baby clinic (literally, a clinic that concerns itself with healthy infants) is probably better known in the United States, where such clinics exist, than in central Europe, where, on the whole, they do not. For the convenience of readers accustomed to it a formal definition is proffered: A well-baby clinic is a service center, with emphasis on physical and mental hygiene and prophylaxis, where mothers are seen with their young, healthy infants and helped to understand and manage the infant's unfolding maturation [1: p. 5] and development [1: p. 5]. This may serve to differentiate well-baby clinics, on the one hand, from clinics for sick children and child guidance clinics (usually resorted to after disturbances have emerged) and, on the other hand, from maternity and child welfare clinics, whose primary object is to safeguard physical health. (Maternity and child welfare clinics are also known as family health clinics, child health clinics, and infant welfare clinics. The extent to which they can cater to the psychological needs of mother and infant depends on their staff's training.)This paper forms part of a research project entitled Childhood Pathology: Impact on Later Mental Health, which is being conducted at the Hampstead Child-Therapy Course and Clinic, London. The project is financed by National Institute of Mental Health Grant MH-05683-11. Appreciation is expressed to Anna Freud, Elizabeth Model, Professor A. J. Solnit, and Dr. Josefine Stross for their valuable suggestions. The authors acknowledge with gratitude the freedom to quote from the Well-Baby Clinic's annual reports, compiled by the clinic's pediatrician, Dr. Josefine Stross, with the active help of her past assistants, Annemarie Curson, Manna Friedmann, and Joyce Robertson, and her present assistants, Irene Freud and E. Model.This paper was originally published in German, in volume 2 of theJahrbuch der Psychohygiene, Ed. Gerd Biermann, Ernst Reinhardt Verlag, München/Basel, 1974.     

Utilization of acute inpatient psychiatric services: “Heavy users” in New York State

The severely and persistently mentally ill (SPMI) population are often forced to rely on emergency/acute inpatient services. The authors analyze Medicaid expenditures and state hospital utilization data to identify and describe the characteristics of heavy users of these services. Also described is New York State's intensive case management (ICM) initiative targeted at this heavy user group. It is postulated that ICM will alter the utilization patterns of participants from over-reliance on the most costly services and more effectively and efficiently serve the SPMI population, specifically the heavy user subpopulation.     

Contents of day and night dreams of emotionally disturbed adolescents

Summary Content analysis of night, day, and repetitive day dreams of three groups of adolescents has been attempted for the purpose of (a) empirical data collection, (b) classification, (c) achievement of quantitative measures useful for dream studies, and (d) correlation studies. There seem to be significant differences between the contents of day and night dreams in the patient and control population groups, although various degrees of positive correlation of the contents of daily preoccupations, emotions, and happenings with night dream contents in each subject and/or group of subjects do exist. The schizophrenic patients show striking differences in their dream reporting and contents compared to other clinical groups. Positive correlation between the themes of repetitive day dreams and night dreams in each subject is much greater in the inpatient group than in the other two groups.This paper was prepared in collaboration with S. Blaesing, R.N., V. Hanses, R.N., M. Schrader, R.N., J. Brockhaus, R.N., M. Hofius, R.N., and S. Albright, M.A. Ed.     

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.     

Styles of Case Management: The Philosophy and Practice of Case Managers

A great deal of discussion and research has gone into defining and clarifying the role of case manager (CM) for persons with severe mental illness. This three state survey examines the philosophy and activities of practicing CMs in an attempt to identify current styles of case management. A cluster analysis based on CM rankings of five CM functions suggested four styles of case management: supportive social worker, individual therapist, therapist broker, and community advocate. Overall, CMs rated supportive interventions as most important and formal psychotherapy as relatively unimportant. CM style was related to CM activity (i.e., distribution of effort). Differences between states are noted and implications for future research are discussed.     

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.     

The structure of social relationships: Analysis of a survey instrument

Summary Part 1 of this paper (Duncan-Jones 1981) described a survey instrument for detailed investigation of interpersonal relationships. This instrument was based on a hypothesis about the structure and dimensionality of relationships. The present paper uses confirmatory factor analysis to test this hypothesis and examine measurement reliability. It is shown that most types of relationship can be broadly accounted for by two major dimensions of attachment and social integration. However, more specific dimensions can be distinguished within social integration. It is further shown that theavailability of attachment and of social integration are nearly independent, but the perceivedadequacy of these two areas is substantially correlated.     

Hypofrontality on topographic EEG in schizophrenia

Summary Topographic EEG was performed in 17 DSM-III-R schizophrenic patients and in 15 sex- and agematched healthy controls. Eleven patients were firstonset (neuroleptic naive) schizophrenics. EEG band power was compared with psychopathology, neuropsychology and neurological soft signs. The EEG was recorded at 14 topographic locations monopolarly and movements of the eye and of the lid were monitored by two bipolar electro-oculogram (EOG) derivations, one vertical and one horizontal. A multivariate correction of EOG artefacts was performed based on regression analysis with respect to EOG channels. Schizophrenic patients showed higher mean and median power in most bands. These differences were most marked in the delta band, in the fast alpha and beta bands, in particular at left frontal sites. Delta power at F7 was by far the best separating variable between schizophrenics and controls in a discriminant analysis. Significant positive correlations were found between the Brief Psychiatric Rating Scale scores Anxiety-depression and Activation and power in the fast bands and negative ones between Anergia and the beta bands. Positive significant correlations emerged between the total score in the Negative Symptoms Rating Scale and the amount of delta power, predominantly over the temporal region. Impairment in the Luria-Nebraska neuropsychological scores Rhythm and Memory correlated highly significantly with EEG band power. No correlations were found between neurological soft signs and EEG band power. Our results are in line with the hypothesis of a hypofrontality in schizophrenia. It is unlikely that these findings are an artefact of prior psychiatric treatment, as they were also observed in firstonset, neuroleptic naive schizophrenics. Moreover, our data suggest that these abnormalities are of clinical and functional relevance, as they correlated significantly with psychopathological and neuropsychological parameters.     

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.     

Cognitive functioning in female patients with 21-hydroxylase deficiency

The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11–41 yrs) and 13 of their healthy sisters (13–31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in full IQ (p<0.05) and subtest scorings for Information, Similarities, and Picture Completion (p<0.05–<0.10). SW patients displayed more masculine behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.

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Zusammenfassung 27 Patientinnen mit dem Adrenogenitalen Syndrom (AGS) (11–41 J.) und 13 ihrer Schwestern (13–31 J.) wurden hinsichtlich intellektueller Funktionen verglichen (Kurzformen von HAWIK, HAWIE). Im Unterschied zu den meisten früheren Untersuchungen wurden weder für Patientinnen (mean: 99.0) noch für Kontrollen (97.7) über dem Durchschnitt liegende IQ-Werte gefunden. Im Gegensatz zur Literatur unterschied sich die Teilgruppe der Salzverlust-Patientinnen (SW)>16 J. (N=6, mean: 111.5) von den Schwestern und den Patientinnen mit einfachem AGS (SV) im Gesamt-IQ (p<0.05) und in den Untertests Allgemeines Wissen, Gemeinsamkeiten und Bilderergänzen (p<0.05–<0.10). SW-Patientinnen hatten signifikant männlichere Verhaltensmuster gezeigt (vs. SV-Patientinnen und Schwestern), die auf differentielle Hormoneffekte pränatal bezogen worden waren. Es fanden sich aber keine klaren Zusammenhänge zwischen IQ-bzw. Untertest-Resultaten und Ergebnissen für Geschlechtsrollenverhalten.

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Résumé Le fonctionnement cognitif de 21 patientes avec une hyperplasie congénitale surrénale (âgée de 11 à 41 ans) et de 13 de leurs soeurs saines (13–31 ans) a été comparé au moyen de versions raccourcies de l'échelle de Wechsler appropriée à l'âge. En contraste avec d'autres études, il n'a été retrouvé un Q.I. plus haut que la moyenne ni pour les patientes (moyenne 99.0) ni pour leurs soeurs (moyenne 97.7). De façon inattendue, et en contraste avec d'autres études, le sous-groupe de patientes déprivées en sel (SW)>16 ans (N=6), moyenne score: 111.5) différait de leurs soeurs aussi bien en tant que patientes présentant des signes de virilsation (SV) pour le Q.I. complet (p<0.05) et les scores aux subtests d'information, de similarité et de complément d'images (p<0.05–0.10). Les patientes déprivées en sel (SW) montraient un comportement plus masculin (vs. SV et leurs soeurs) qui en retour était relié aux influences hormonales prénatales différentes. Il n'y avait pas de relation de différences nettes entre les résultats aux sous-tests cognitifs du Q.I. et le comportement de genre.

     

Are VEP abnormalities in optic neuritis (ON) dependent on plaque size? A reappraisal of the physiopathology of ON based on improved MRI and multiple-lead recordings

Twenty patients with optic neuritis (ON) described in the previous study [23] underwent serial VEP recordings (using multiple electrode arrays) for two years. The VEPs could be correlated with the lesions revealed by MRI, Visual Field tests and other clinical findings. On the basis of their scalp distribution, they were classified as really delayed VEPs and pseudo-delayed VEPs.Real delays could be recorded at the onset of ON or shortly afterwards, and their appearance indicated the recovery of visual function and a good prognosis.Pseudo-delays indicated an alteration in the visual field and, unless a breakthrough of normal or delayed components appeared in the first three months, following acute ON, indicate a poor prognosis for the recovery of visual function.The pseudo-delayed VEPs were mainly observed in patients with longer lesions revealed by means of LTE-STIR MRI [23]; there was no correlation between VEP latency and the length of plaques.Our findings contradict previous theories on the timing of conduction alterations in ON and multiple sclerosis.

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Sommario I 20 pazienti affetti da Neurite Ottica (NO), descritti nel precedente lavoro [23] sono stati sottoposti a registrazioni seriali multicanali dei Potenziali Evocati Visivi (PEV), per un periodo di 2 anni dall'esordio della NO. I PEV potevano correlare con le lesioni evidenziate con la Risonanza Magnetica, con le alterazioni campimetriche e con altri reperti clinici. Basandoci sulla loro distribuzione in mappa, i PEV sono stati classificati come realmente ritardati e pseudo-ritardati. PEV realmente ritardati potevano essere registrati all'esordio, o precocemente dopo l'episodio di NO, e la presenza del ritardo stava ad indicare un recupero della funzione visiva e, quindi, una prognosi fausta.Gli pseudo-ritardi indicavano un'alterazione del campo visivo a prognosi non favorevole per un recupero della funzione visiva, a meno che entro i primi 3 mesi dalla NO si fosse verificata una ricomparsa di componenti normali o ritardate.Gli pseudo-ritardi erano rilievi caratteristici nei pazienti con lesioni maggiormente lunghe alle immagini LTE-STIR MRI [23]. Nessuna correlazione è stata trovata tra latenza dei PEV e lunghezza delle placche.I nostri rilievi sono in disaccordo con precedenti teorie relative ai tempi di instaurazione-recupero delle alterazioni di conduzione nella NO e nella Sclerosi Multipla.

     

Somatosensory evoked potentials in patients with thalamic lesions

Summary Somatosensory evoked potentials (SEPs) were recorded in 20 patients with thalamic lesions confirmed by CT (10 with infarction, 10 with haemorrhage). The changes in SEP configuration are discussed in their relationship to clinical symptoms. Four types of SEP abnormality produced by thalamic lesion are distinguished: (1) FF type, (2) N20/P23 dissociation type, (3) N18/N20 false shift type, and (4) reduced early component type. It was shown that clinically similar lesions might produce different SEP patterns.