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.     

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.     

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.

     

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.     

Gender Differences in Completed Suicide

This report extends the present range of observed gender differences insuicide as demonstrated by a prospective study of 2,756 depressed and/orsuicidal inpatients followed for four years. Each of twelve demographiccategories was examined for its relationship to fifteen variablessignificantly associated with suicidal outcome in the total sample. The oddsratios for males and females in each category were determined and comparedto identify gender differences. In the array of comparisons (ratios of oddsratios) the most prominent variable associated with higher risk for males isthe subjects view of their physical health as other than good in threecategories. In females, significantly higher risk than males is notablyassociated with feelings of guilt or shame (5 categories), prior suicideattempt (3 categories), prior psychiatric hospitalization (5 categories),and presence of suicidal impulses (3 categories).     

Mental illness in a cross-national perspective

Summary Findings for unselected samples of the elderly in two urban populations — one in Mannheim, Germany (n=418) and the other in Sao Paulo, Brazil (n=111)-are compared and contrasted. Each study was restricted to persons aged over 65 years living in private households, and each employed a single-stage method of psychiatric case-identification, based on the Clinical Interview Schedule (CIS). Apart from marked differences in educational standards and proportions living alone the two samples were broadly similar in their recorded socio-demographic characteristics. Comparison revealed no significant difference in total prevalence, though there was a trend towards a higher case-frequency in Sao Paulo (29.7%) than in Mannheim (23.3%). The clinical-item profiles for the two samples indicated a higher rate of symptom reporting in Sao Paulo, whereas the Mannheim sample had higher mean scores for a number of psychiatric abnormalities observed at interview. Separate cluster analyses carried out on the two data sets divided the samples into four pairs of sub-groups with similar clinical profiles, which were designated respectively as organic, depressive, neurotic and normal. While a more careful standardization of method would probably reduce the observed disparities between the samples, some of these are thought to be real and to relate to sociocultural differences, as well as to the greater stresses of daily life in Sao Paulo.     

Specific modulation of sigma binding sites by the anxiolytic drug opipramol

Summary. The atypical anxiolytic and antidepressive drug opipramol binds with high affinity to ₁ and somewhat lower affinity to ₂ sites. After subchronic treatment, opipramol significantly down-regulated ₂ but not ₁ sites. This effect was not seen for imipramine, citalopram, and reboxetine under similar conditions. On the other hand, only imipramine reduced the number of ₁ sites. It is suggested that effects at ₂ sites are involved in the anxiolytic properties of opipramol.Received February 7, 2003; accepted March 24, 2003 Published online July 30, 2003     

Immunohistochemical study on the distribution of α and β subunits of S-100 protein in brain tumors

Summary The immunohistochemical distribution of and subunits of S-100 protein (S-100, S-100, respectively) in 138 cases of human brain tumors was investigated by the avidin-biotin immunoperoxidase method. Brain tumors can be divided into four groups: group 1 [S-100 (+) and/or S-100 (+)]; astrocytoma, glioblastoma, ependymoma, subependymoma, oligodendroglioma, choroid plexus papilloma, gangliocytoma, meningioma, chordoma, malignant melanoma. Group 2 [S-100 (+) and S-100 (-)]; pineoblastoma, pituitary adenoma, craniopharyngioma, rhabdomyosarcoma. Group 3 [S-100 (-) and S-100 (+)]; acoustic Schwannoma. Group 4 [S-100 (-) and S-100 (-)]; medulloblastoma, malignant lymphoma, germinoma. The S-100 immunoreactivity pattern in brain tumors was similar to those obtained using conventional anti-S-100 protein sera. In the first group of brain tumors both the number of positively stained tumor cells and the staining intensity were generally greater for S-100 than for S-100 with a few exceptions including one gemistocytic astrocytoma, one subependymoma, one malignant melanoma, and some cases of glioblastomas. As to the relationship between malignancy and S-100 protein in glioma, S-100 immunoreactivity decreased according to degree of malignancy, while that of S-100 varied, suggesting a heterogeneity of tumor cells in glioblastomas. Immunostaining for S-100 and S-100 might become a useful diagnostic procedure in brain tumors and may give us more detailed and precise data of S-100 protein in brain tumors.     

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.     

Life events and syndromes of depression in the general population

Summary Brown and Harris (1978) contend that life events have causal significance for both psychotic and neurotic depression. This contradicts the psychiatric tradition. Neurotic depression has been regarded as a consequence of life-stress, while psychotic depression has been regarded as a consequence of processes intrinsic to the organism. Empirical evidence is presented to support the view that life events have a differential effect, within the general population. It is argued that Brown and Harris's (1978) conclusion follows from an inappropriate approach to classification. It is argued further that their data lend support to the traditional view. It is noted that their approach may inhibit the development of explanatory models linking life-stress, vulnerability factors and depression.     

Differential diagnosis of 201 possible Creutzfeldt-Jakob disease patients

Abstract. Our objective was to describe the clinical signs of possible Creutzfeldt-Jakob disease (CJD) and to investigate whether current diagnostic criteria can accurately differentiate between different forms of dementia. We studied clinical data of definite CJD, Alzheimers disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VD) patients. Two subgroups were used: the first consisted of patients with clinical signs compatible with possible CJD but in whom another final diagnosis was made and a second group with a typical evolution of the respective dementia. More focal neurological deficits were observed in AD, DLB or VD patients initially classified as possible CJD than in typical patients. A typical electroencephalogram showing periodic sharp wave complexes was observed in 26 (50 %) CJD and 6% of other dementia patients. The 14-3-3 protein was detected in all CJD and 8% of other dementia patients. In patients with rapidly progressive dementia and focal neurological signs, CJD should be considered. When faced with the triad: dementia, myoclonus, and initial memory problems AD should be considered if the disease duration is longer than 1 year. The diagnosis of DLB is suggested, if Parkinsonism or fluctuations are present, whereas a focal onset and compatible brain imaging can indicate VD. Findings suggestive of CJD on EEG, brain imaging, and CSF do not exclude other dementias but make them very unlikely. These observations cannot only assist in the differential diagnosis of CJD but also with the identification of AD, DLB or VD patients with atypical clinical history.     

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.     

The effect of oxidative stress on amyloid precursor protein processing in cells engaged in β-amyloidosis is related to apolipoprotein E genotype

The reduced antioxidative defense in allele 4 carriers is suggested to contribute to -amyloidosis in Alzheimers disease and Downs syndrome. We studied the effect of oxidative stress on accumulation of amyloid- peptide (A) in vascular smooth muscle cells (SMCs) that are engaged in production of amyloid- in vivo. Previously, we found that oxidative stress caused by ferrous ions induced accumulation of A-apolipoprotein E deposits in lysosomes and was associated with a greater oxidative protein damage in 4 carriers. Here, we demonstrate that ferrous ions induce formation of A deposits also in vascular tunica media in organotypic cultures of whole brain vessels, suggesting the role of oxidative stress in development of vascular -amyloidosis. Cellular accumulation of A in SMCs treated with ferrous ions was associated with a greater accumulation of C-terminal amyloid precursor protein (APP) fragments in 4/4 than in 3/3 myocytes and reduced the amount of soluble APP in 3/3, but not 4/4, cultures. Antioxidant vitamin E prevented these effects, and, when applied alone, diminished the amount of APP C-terminal fragments and increased the amount of secreted APP in 3/3, but not 4/4, cells. C-terminal APP-immunoreactive material was accumulated in lysosomes partly with A- and N-terminal APP immunoreactivities. These results suggest that the increased accumulation of APP and its fragments in lysosomes may yield additional amounts of cellular A, particularly in 4 carriers. We hypothesize that the altered processing of APP in SMCs locally exposed to oxidative stress facilitates cellular deposition of A and contribute to the increased risk of development of -amyloidosis in 4/4 carriers.     

Group work with children and adolescents

In her article, Learning From Social Work Traditions, Margot Breton (1990) reviews the impact of the settlement, recreation and progressive education movements on the development of social work with groups. She writes I confess that I am troubled by our virtual abandonment of normal children and youth, or more precisely of the normal in all children and youth. She continues, ... a group can be structured so that the whole person in each member is invited to participate, or it can be structured so that only the troubled, or broken, or hurt part of the person is invited to participate. (p. 27).Andrew Malekoff is Co-Editor ofSocial Work with Groups, quarterly journal of clinical and community practice     

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.     

Estimation of noradrenaline concentrations in the axoplasm of noradrenergic neurones in man

The plasma concentrations of noradrenaline (NA) and its primary neuronal metabolite, dihydroxyphenylglycol (DOPEG), were examined during graded orthostasis and NA infusion in 13 healthy subjects to estimate the NA concentration difference between the site of neuronal DOPEG formation and that in plasma.Stimulation of NA release by graded orthostasis resulted in similar absolute increments in plasma NA and DOPEG with both plasma concentrations being dependent on the degree of orthostasis. The mean value of the DOPEG/NA ratio amounted to 0.999 (0.745; 1.341). NA was infused i.v. during two consecutive 30-min periods at constant rates of 0.43 and 0.86 nmol kg^–1 min^–1, respectively. This infusion resulted in a DOPEG/NA ratio of 0.048 (0.036; 0.064) for the first and 0.078 (0.067; 0.090) for the second infusion period (p < 0.01).For each individual subject, the factor quantifying the NA concentration difference between the site of neuronal DOPEG formation and plasma was calculated from the square root of the ratio of DOPEG/NA during orthostasis to DOPEG/NA during the low rate of NA infusion. The average NA concentration at the site of neuronal DOPEG formation (i.e. the axoplasm of noradrenergic neurones) was found to be 4.6-fold higher than that in plasma.     

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.     

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).     

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)