The repetition of parasuicide in Edinburgh 1980–1981

Summary We prospectively studied all Edinburgh hospital-referred parasuicides admitted in 1980 until the end of 1981, with regard to their repetition of parasuicide. For those 259 who repeated during this time, parasuicide status at the key 1980 admission was significantly related to age group, the veterans being older than first-timers. Similarly, the total number of episodes of parasuicide in the follow-up period was significantly related to age-group and parasuicide status: those over 45 years and first-timers were less prone to repetition. Survival analysis of all 1980 admissions revealed that veterans were significantly more likely than first-timers to be admitted with a repetition from as little as 4 days after a given episode. This difference was maintained from then until the end of the follow-up period.     

A process analysis of Bender Gestalt Test performance in childhood emotional disorder: A single-case study

This study involves an analysis of the Bender Gestalt Test performance of a young, severely disturbed boy emphasizing the origins of and processes mediating the emergence of deviant responses. Deviant responses are considered to reflect a conflict between primitive motor impulses and an emergent, visually-mediated organization of the designs, corresponding to the several stages of sensory-motor adaptation. The manner of the resolution of visuo-motor conflict may prefigure later dispositional trends significantly embedded within aspects of childhood emotional disorder. Finally, analogy is drawn between specific aspects of performance and the boy's behavioral organization.     

Work and mental health

Abstract. Background: Studies investigating the psychological correlates of types of occupation have focused on such disorders as stress, depression, suicide and substance abuse. There have also been some models proposed to allow understanding of factors common to different types of occupations. We sought to provide an overview of research related to work and mental health and consider future research directions. Methods: A literature search was conducted using the Medline, PsycInfo, Embase and PubMed databases. The key words occupation or work were searched in combination with the key words mental health, risk factors, disorders, depression, suicide, trauma, stress or substance use. Results: Studies of stress tend to be more applicable to specific workplace issues. While some of the studies relating to onset of depression, suicide, substance abuse and trauma pertain to specific occupational issues and results are often not generalizable, they have progressed our understanding of risk factors to those disorders. There are workplace factors involving exposure to danger and crisis that lead to posttraumatic stress disorder (PTSD), substance abuse (including stimulants) and depersonalization. Workplace risk factors for depression involve situations promoting lack of autonomy, and involving caring for others as part of the work role, particularly where there is dependence on others for their livelihood. Risk factors for alcohol abuse include workplaces with access to alcohol and where use of alcohol is sanctioned. There appears to be a bi-directional relationship between personality and work, so that people are drawn to particular occupations, but the occupations then have an effect on them. An interactional model is proposed to consider this. Conclusion: The research questions pertaining to mental health are varied and will determine what mental health issues are of interest and the models of work applicable. There need to be more longitudinal studies and consideration of factors which the worker brings to the workplace (psychosocial issues, personality traits), as well as interpersonal issues and consideration of systemic, organizational, political and economic factors, including leadership styles.     

Coping with stress as a theme in teaching psychopathology to medical students

In an era when non-psychiatric physicians are increasingly aware of their need for at least a rudimentary knowledge of psychology, medical schools are making belated attempts to remedy the situation.The effort described here succeeded because the students did not seem to view the course as one about crazy people. Thus, they did not distance themselves from the course material and patients.... One student said, This was a course about everybody—about what people have to do to live in the world.     

Temperamental factors in children and adolescents with obsessive-compulsive disorder (OCD) and in normal controls

Abstract We studied parent-rated temperamental traits in patients (n=83) with obsessive-compulsive disorder (OCD) as compared with children and adolescents matched for age and gender (n=85) using the EAS (Emotionality, Activity, Sociability) questionnaire. Specifically, two hypotheses of OCD were studied: (1) the presence of behavioural inhibition (BI) and (2) of high levels of emotionality utilising ANOVA analyses, controlling for gender and age group (children vs. adolescents). The presence of BI in OCD patients was confirmed in that they scored higher than controls on Shyness [F (df=7)=2.69, p<0.012] but lower on Activity [F (df=7)=3.01, p<0.005]. Also, our second hypothesis was corroborated in that OCD patients scored higher than controls on Emotionality [F (df=7)=3.59, p<0.001]. A third hypothesis, the presence of temperamental heterogeneity in OCD, was likewise confirmed. We found, using hierarchical cluster analyses, two subgroups of about equal size, an Inhibited/Shy group (n=44), high in Shyness and low in Emotionality, Sociability and Activity, and an Uninhibited group (n=32) that was high in Emotionality, Sociability and Activity, but low in Shyness. However, the temperamental subgroups gave no clear picture with regard to the most common symptom patterns.     

Unconscious Confusion

Abstract Background Imprecise definitions of syncope and related conditions appear common in the medical literature. To investigate the scope of the problem we systematically searched for definitions in high-ranking medical journals. Methods Literature review of articles on syncope, neurocardiogenic syncope, neurally mediated syncope, orthostatic intolerance, and orthostatic hypotension with these keywords in the title, mainly published in the ten journals with the highest impact in the fields of cardiology, internal medicine, and neurology. Results Syncope, neurocardiogenic syncope, neurally mediated syncope, orthostatic intolerance, and orthostatic hypotension were defined in only 41%, 34%, 26%, 38%, and 48% of papers respectively. Definitions, when given, differed considerably among papers. Orthostatic hypotension was most frequently defined, with an increase in number and consistency of definitions after publication of a consensus in 1996. Conclusions Syncope and related conditions proved to be infrequently and inconsistently defined in current medical literature. The lack of consistent terminology is likely to harm medical education, research, and patient care. There is a strong need for a systematic terminology for syncope and related conditions.     

Life stress and depressive outcome: Application of a dissipation model to life events

Summary A group of 71 patients were interviewed seven months after they had been screened for a new episode of unipolar depressive illness and the relationship between symptom severity at this time and the life stresses experienced over this period investigated. On the basis of the follow-up assessment, patients were divided into a well and ill group. The mean number of life events experienced during the study period did distinguish patients ill from patients well at follow-up but with less success than has been claimed for onset. Further analysis took into account both the severity of life stress suffered and the time of its occurrence. This improved the discrimination. Both time of event occurrence and event severity were then included in a model of adversity in which it was postulated that event stress dissipates with time. Application of the model to the study data resulted in the statistical relationship between life stress and outcome being somewhat strengthened. The possible implications of this result for further research in life stress are discussed.This work was supported by the Science Research Council, the Mental Health Research Fund (Scottish Division) and the Medical Research Council.     

Psychiatric morbidity and criminality in ‘schizoid’ children grouwn-up: A records survey

A psychiatric and criminal records search was undertaken in young adult life for two groups of former child psychiatric patients: one given a diagnosis of schizoid personality in childhood and the other, matched for sex, age, IQ and socio-economic background, given other diagnoses. The prevalence of schizophrenia in the schizoid group was low but higher than in the controls and about ten times the expected population rate. The death rate from suicide was greatly raised. Adult criminality was higher than expected in bot groups but, while for men the rates were similar in schizoid and control cases, schizoid women wer more often and more seriously delinquent than their matched controls.

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Zusammenfassung Die psychiatrischen und strafrechtlichen Dokumentationsdateien junger Erwachsener, die ehemals kinder- und jugendpsychiatrische Patienten waren, wurden untersucht, wobei eine Einteilung in zwei Gruppen erfolgte: Die erste Gruppe umfaßte ehemalige kinder- und jugendpsychiatrische Patienten, dei die Diagnose einer schizoiden Persönlichkeit erhalten hatten. Die Kontrollgruppe umfaßte ehemalige kinder- und jugendpsychiatrische Patienten mit anderen Diagnosen, die für Geschlecht, Alter, IQ und sozioökonomischen Status parallelisiert wurden. Die Prävalenz von Schizophrenie in der schizoiden Gruppe war niedfrig aber höher als in der Kontrollgruppe und zehnmal häufiger als der Erwartungswert in der Allgemeinbevölkerung. Die Suizidrate war stark erhöht. Die Kriminalitätsrate war in beiden Gruppen höher als erwartet, wobei eine Geschlechtsdifferenz bestand: Bei Männern waren die Raten beider Gruppen ähnlich, hingegen hatten schizoide Frauen häufigere und schwerwiegendere Delike begangen als in der parallelisierten Kontrollgruppe.

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Résumé Une recherche concernant l'état psychiatrique et des actes criminels a été entreprise chez des jeunes adultes appartenant à deux groupes pour lesquels un diagnostic psychiatrique avait été posé dans l'enfance. L'un avait eu un diagnostic de personnalité schizoïde et l'aure apparié par le sexe. l'âge, le quotient intellectuel et l'environmennement socio-économique avait eu d'autres diagnostics Une prévalence de schizophrénes dans le groupe schizoïde était faible et plus importance que dans le groupe contrôle et environ 10 fois supérieur en taux à la population normale. Le taux de mort par suicide était fortement élevé. La criminalité adulte était plus haute que celle attendue dans les deux groupes mais, tandis que pour les hommes le taux était semblable pour le groupe schizoïde et le groupe contrôle, les femmes chizoïdes étaient plus souvent et plus sérieusement délinquantes que celles du groupe contrôle.

     

Depression: Demographic factors in the distribution of different syndromes in the general population

Summary Epidemiologists attempt to identify the causes of disorders by examining their demographic distribution. Psychiatric epidemiologists have frequently used measures ofgeneralized psychological disturbance. It is argued that the epidemiologist's purpose is better served by the use of measures ofspecific psychological syndromes. Four depressive syndromes, that were derived by Principal Components Analysis and called Anxiety-Depression, Cognitive-Depression, Vegetative-Depression, and Classic-endogenous Depression, were considered. Their relationship with age, sex, marital status, employment status and social class were out-lined and the variability in their demographic distribution was highlighted. It was concluded that the use of general rather than specific measures of depressive disorder may account for some of the disparities in the relevant epidemiological literature.     

Psychopathology and language behavior in schizophrenics

Summary Verbal samples of 30 schizophrenics were analyzed using the Social Alienation—Personal Disorganization (Schizophrenic) Scale developed by Gottschalk and Gleser (1969). The psychopathological status of all patients had been assessed in a semistandardized interview (Present State Examination, Wing et al., 1974). A relatively close relationship was found between productive or plus symptoms and syndromes of psychosis and the scores on the content analytic scale. On the other hand, no significant relationship existed with the minus symptomatology and no relationship with the residual syndrome and the neurotic syndromes. The Schizophrenic Scale may allow a sufficiently reliable estimate of the degree of psychosis. There was no significant effect attributable to sociodemographic factors and to the course of illness (disregarding the duration of the present hospitalization).     

The Zurich study

Summary In the epidemiological Zurich cohort study a syndrome of Recurrent Brief Anxiety (RBA) was identified and operationalized. It had a 1-year prevalence rate of 2.7, males seemed to prevail slightly. RBA was highly associated with Recurrent Brief Depression (RBD) and panic, and to a minor extent with agoraphobia and dysthymia. The family history was positive for depression and anxiety (panic, generalized anxiety disorder). In studies of panic, one should look for the frequently associated syndromes of RBA and RBD.Supported by grant 32-9502/3.873-0.88 from the Swiss National Science Foundation     

Characteristics and management of prisoners at risk of suicide behaviour

This study provides data on the characteristics and management of all prisoners identified at risk of suicidal behaviour over a 12 month period in all Scottish prisons. From a total of 44,093 admissions, 1,984 (4.5%) prisoners were identified at time of reception as at risk while 857 (1.9%) inmates were classified as at risk at some other point during custody. Of those identified at risk at time of reception, 19.1% were retained on suicidal supervision, while 58.2% of those identified at risk during custody were maintained on some form of suicidal supervision. Average length of time kept on strict suicidal supervision for those identified at time of reception was 1.87 days, and for those identified at some other point during custody was 2.59 days. Results are discussed in relation to the problems associated with suicide prediction and prevention in prison settings and the tendency for risk assessment to create significant numbers of false positives at time of reception.     

Sensory neuropathy produced in the cat with thallous acetate

Summary A method of poisoning cats with thallium is described. The chief functional disturbances in the nervous system are hypotonia and ataxia. The pathological changes are confined to the central and peripheral axons of primary sensory neurones and are of the dying back type. No motor nerve fibre degeneration was found in this species.While extensive degeneration of sensory nerves was found, those in muscle were apparently unaffected. The significance of this anomalous finding is discussed in relation to the mechanism of the dying back process.     

Myelin changes in leprous neuropathy

Summary Myelin changes were observed in fibres of nerves from cases of leprosy. The myelin had a loosened appearance caused by increased and irregular separation of the intraperiod line. Loosening might affect all, or only some, of the lamellae forming a myelin sheath. There was a pathcy distribution of fibres with abnormal myelin, and they were seen only in nerves showing other marked pathological changes including the presence of oedema. The appearances are suggestive of intramyelinic oedema which may be related to the presence of endoneurial oedema.Supported by the Brain Research Trust and the British Council, who funded an exchange arrangement between the Institute of Neurology, London and the Foundation for Medical Research (FMR), Bombay     

Aspects of aggression in formerly depressed patients and in healthy controls

Summary Thirty former inpatients (14 male and 16 female) who had suffered from a nonpsychotic depressive syndrome were investigated by means of a new personality inventory—the KSP—when they had recovered from the depressive disorder, and their results were contrasted to those obtained from 53 healthy controls (19 male, 34 female). Attention was focused on the subscales of the KSP which refer to aspects of aggression. Former patients scored significantly higher than controls in the variables irritability, suspicion, guilt, and inhibition of aggression. The findings suggest a particular personality makeup for at least one subgroup of depression-prone subjects and closely resemble classical concepts of hostility and depression.Supported in part by a grant from the Swedish Medical Research Council (Grant No. 21X-5244)     

The prevalence of self-reported problems in young adults from the general population

This study assessed the prevalence of a wide range of behavioral and emotional problems in 706 10-to 24-year-olds from the Dutch general population using the Young Adult Self-Report (YASR). The prevalence rates found can be used to make comparisons with data from individuals or other samples. Large or medium (variance>5.9%) sex effects were found for alcohol use, for the items Brags and Swears (males > females), and for the items Cries a lot and Fears (females > males). With respect to socially desirable items, females more often reported attitudes or behaviors pertaining to helping other people, while males more often reported competitive behaviors or attitudes. For YASR syndromes, higher mean scores for females than males were found for the Withdrawn, Somatic Complaints, and Anxious/Depressed syndromes, while mean scores on the Delinquent Behavior syndrome were higher for males than females. No age effects were found, indicating that normative data were similar across the 19-to 24-year age span. Compared to other problem areas, thought problems and delinquent behavior in males, and social problems and delinquent behavior in females were least likely to be associated with other types of problems. Hence, instruments for the assessment of psychopathology in young adults should include these areas to provide a comprehensive picture of behavioral and emotional problems.     

An epidemiological study of minor psychiatric disturbances

Summary A representative epidemiological field study of minor mental disturbances among 19- to 20-year-old persons in Zurich (Switzerland) is reported. Respondents had completed two selfreport inventories; SCL-90R by Derogatis and a Syndrome List concerning psychosomatic and neurotic syndromes. There is a high prevalence rate of such disturbances. Usually, however, they do not lead to treatment-seeking behaviour. Females show higher prevalence figures on nearly all scales and syndromes. The syndromes of anxiety and depression are most prominent among females. Unexpectedly, there are few differences in prevalence rates between different socio-demographic groups. There are, however, three high-risk groups: (1) persons without occupational training; (2) persons without religious affiliation and (3) persons whose parents or siblings had psychiatric problems. Reasons for the lack of clearcut associations between social status and psychiatric syndromes are discussed.This research is supported by the Swiss National Science Foundation, grant no. 3.804-0.76.     

Housing type,housing location and mental health

A number of studies have suggested a connection between the type of dwellings which people occupy and their mental health. People who live in flats are usually shown to be more prone to mental illness than those who live in houses. Those who live in high-rise accommodation are shown to be particularly vulnerable. These conclusions were examined by comparing rates on an indicator of psychological distress, in different dwelling types located in good and bad council housing areas. The results suggest that psychological distress is more closely associated with the location of a dwelling than with dwelling type. High-rise flats located on inner-city problem estates are associated with high levels of psychological distress, while low levels are found in similar dwelling types located in the suburbs. These findings are consistent when the effect of age, health, sex and household class are taken into consideration.     

Violent death and unemployment in two trade unions in Denmark

Summary The association between unemployment and cause of death (natural or violent) was investigated in a retrospective study of members of the bricklayers' and carpenters/cabinet-makers' trade unions in Denmark during the period 1. 1. 1971 to 31. 12. 1975. The bricklayers suffered more unemployment than the carpenters/cabinet-makers but for both unions as a whole it was found that there were significantly more unemployment periods in the group of violent deaths compared with natural deaths, whereas there was no difference in the frequency of unemployment between suicidal and accidental deaths.     

Dumb-bell schwannoma of the jugular foramen

This case represents the youngest patient recorded with a jugular foramen schwannoma and the first report of the classic dumb-bell configuration of this tumor in a child. The case illustrates the importance of excluding an intracranial component when these tumors present as a swelling in the neck.