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.     

Relationship of maternal parenting behaviors to preschool children's temperament

Mothers of 182 preschool nursery school children rated their own parenting responses on a Parent's Report questionnaire. At the same time the mothers responded to the Behavior Style Questionnaire (BSQ) from which scores were determined for nine categories of temperament. On the basis of category scores the children were grouped into one of five temperament clusters i.e. easy, difficult, slow to warm up, high intermediate, low intermediate. The children's membership in BSQ clusters was independent of sex, age, birth order, and mothers employment status but there was a significantly higher ratio of easy children from higher socioeconomic classes I and II. Mothers of children grouped in either the difficult or slow to warmup clusters were more likely to use guilt inducing and temper-detachment parenting styles than mothers of children grouped in the easy cluster.     

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.     

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.     

Vegetative Funktionen und körperliche Aktivität in der endogenen Depression

Zusammenfassung Bei einem 66 Jahre alten männlichen Patienten mit 48-h-Zyklen einer unipolaren endogenen Depression wurden vegetative Funktionen untersucht. Speichelsekretion, Körpertemperatur und körperliche Aktivität wurden am Tage in 3-h-Abständen und einmal nachts gemessen. Die Stimmung wurde mit Hilfe von zwei Selbstbeurteilungsskalen beurteilt. Die Skalenwerte ergaben eine regelmäßige Abfolge von guten und schlechten Tagen. Die Speichelsekretion war an guten Tagen gegenüber den Meß-werten an schlechten Tagen erhöht. Dieser Unterschied war am Morgen besonders deutlich (P<0.002, 10.00). Die Form des 24-h-Profils der Speichelsekretion war an guten und schlechten Tagen unterschiedlich: an guten Tagen lag das Maximum um 10.00 Uhr, an schlechten Tagen um 16.00 Uhr. Dagegen zeigte die Lage des nächtlichen Minimums keinen Unterschied zwischen guten und schlechten Tagen. Die Meßwerte der Körpertemperatur waren gegenüber Normalwerten deutlich erhöht (Mittelwerte um 37,2° C) und zeigten eine geringe Amplitude des Tagesganges. An guten Tagen lag die Körpertemperatur tagsüber im Mittel um 0,1°C höher als an schlechten Tagen. Die körperliche Aktivität (Arm und Bein) wurde mit Hilfe eines Aktometers (activity watch) registriert. Die Meßwerte waren tagsüber an guten Tagen höher als an schlechten Tagen. Die vorliegenden Befunde geben Hinweise auf eine zentrale Regulationsstörung vegetativer Funktionen bei der endogenen Depression.Die Autoren dieser Arbeit sind Mitglieder einer Arbeitsgruppe, die sich am Max-PlanckInstitut für Psychiatrie mit der Pathophysiologie und Chronobiologie depressiver Syndrome befaßt     

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%.     

Sodium valproate "encephalopathy": report of three cases with generalised epilepsy

A report of 3 cases of sodium valproate encephalopathy. The addition of valproate to the treatment in 3 subjects, two adults and one child, all with generalised epilepsy, induced a worsening of the clinical and EEG pattern and in one case disturbances of vigilance as well. The occurrence of this complication in generalised epilepsy and the possibility that EEG alterations are its only manifestation are emphasised.

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Sommario Vengono riportati 3 casi di encefalopatia da sodio valproato. L'aggiunta in terapia del valproato in 3 soggetti, due adulti e un bambino, tutti con epilessia generalizzata, ha indotto un peggioramento clinico ed eegrafico e in un caso anche disturbi della vigilanza.L'occorrenza di questa complicanza anche nella epilessia generalizzata e la possibilità che essa si manifesti solo con alterazioni EEG, è sottolineata.

     

Ultrastructural changes in the anterior horn synapses of rat spinal cord under different locomotor conditions

Summary Ultrastructural changes in axodendritic synapses of the spinal cord ventral horn are studied in rats subjected to different locomotor conditions: immobilization, control and physical loading. Enhanced motor activity results in a reduction of the number of synaptic vesicles in the axon terminal, as well as flattening and diminution of their size. Other changes correlated with the different motor regimes are likewise established in the number of terminal ending's mitochondria, in active zones, in subjunctional dense bodies, and in the bouton area. Data are treated by means of variation analysis. The significance of differences is established by T-criterion.     

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.     

The significance of cytoplasmic inclusions in late infantile and juvenile amaurotic idiocy

Summary The electron microscopic findings of cerebral biopsies from two siblings with late infantile-juvenile amaurotic idiocy are presented. One patient had a mixture of fingerprint and multilamellar inclusions, often in the same cytosome. The second patient had only fingerprint inclusions.Electron microscopic findings in autopsied tissues from two other cases of late infantile-juvenile amaurotic idiocy with multilamellar cytosomes are also presented. Evolution of the multilamellar cytosomes into lipofuscin was not observed. We concluded that cases of late infantile-juvenile amaurotic idiocy with multilamellar and fingerprint inclusions should be distinguished from cases with lipofuscin.The present investigation was supported by Research Grants NS 05572-08, 1 T01 NS 05712-01 and RR 75.     

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.     

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.     

Die potenzierte Narkose und ihre Bedeutung für die Neurochirurgie

Zusammenfassung Es wird ein Überblick über die Entwicklung der Technik der potenzierten Narkose sowie der Hibernation artificielle unter kurzer Würdigung der verschiedenen auf sie hinführenden Forschungsrichtungen gegeben. Die Probleme medikamentöser Synergie, der Unterkühlung, des Schocks und seiner Verhütung werden behandelt, eigene Erfahrungen mit der Hibernation artificielle unter Hinweis auf die entsprechenden Veröffentlichungen kurz gestreift.Der Wert der potenzierten Narkose wie der Hibernation artificielle wird unter Hinweis auf die Notwendigkeit einer streng kritischen Indikationsstellung für die Anwendung dieser Verfahren als unbestreitbar dargestellt.Vortrag, gehalten auf dem Neurochirurgischen Symposium in Freiburg/B. vom 5. bis 10. Juli 1954.     

Apolipoprotein E co-localizes with newly formed amyloid β-protein (Aβ) deposits lacking immunoreactivity against N-terminal epitopes of Aβ in a genotype-dependent manner

Different types of amyloid -protein (A)-containing plaques occur in brains of Alzheimers disease (AD) patients. Diffuse plaques seen during early stages of AD differ from neuritic plaques in later stages both with respect to the length of the A peptides and the presence of other proteins, e.g., apolipoprotein-E (apoE). Since apoE is involved in A transport and clearance, and the 4-allele of the apolipoprotein-E gene (APOE) is a major risk factor for sporadic AD, it is plausible to speculate that apoE plays a pathophysiological role in the initiation of A deposition. To address the issue of whether binding of apoE to A is involved in initial A deposition, we studied the human medial temporal lobe of 60 autopsy cases encompassing the full spectrum of AD-related pathology. In temporal lobe regions, which become involved for the first time at a given stage of -amyloidosis, all plaques represent newly formed plaques, and these were studied with immunohistochemical methods. ApoE was present in 36 cases, and was frequently co-localized with newly formed A deposits detectable with anti-A₄₂ but not with antibodies raised against N-terminal epitopes of A. In 10 additional cases, immunoreactivity against apoE was completely lacking in newly formed plaques, which, at the same time, displayed immunoreactivity against N-terminal epitopes of A. The failure of N-terminal epitopes of A to co-localize with apoE in newly formed plaques indicates that these deposits presumably contain apoE-A complexes, in which the N-terminal epitopes of A are often concealed after complexing with apoE, thus preventing subsequent binding of antibodies. Moreover, apoE-positive newly formed plaques were seen more frequently in APOE 4/4 cases than in non-APOE 4/4 individuals, thereby underlining the potentially crucial role of apoE for the development of A deposits.     

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.     

Administrative influences on psychiatric diagnosis

Summary In order to cut expenditure on mental health care in Brazil, the national authority responsible for the financing of health care imposed in 1977 the following two restrictions on reimbursement: a) the costs for inpatient treatment under the diagnoses neurosis and alcoholism would be paid only for a maximum length of hospital stay of 30 days and b) the costs for inpatient treatment under the diagnoses oligophrenias and epilepsies would no longer be paid. We studied the effects of these administrative measures upon the yearly frequencies of diagnoses and the mean lengths of hospital stay in 27377 treatment episodes between 1975 and 1982. We found significant decreases in both variables for the above mentioned diagnoses after 1977. At the same time the frequencies of the diagnoses alcoholic psychoses, psychoses associated with other cerebral conditions and other psychoses increased significantly. These findings can probably not be attributed to true changes in morbidity, but are rather the results of changes in diagnostic habits in response to administratively imposed austerity measures.     

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.     

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.     

Immunohistological study of senile brains by using a monoclonal antibody recognizing β amyloid precursor protein: significance of granular deposits in relation with senile plaques

Summary Immunochemical analyses revealed that a monclonal antibody Am-3 recognized amyloid precursor protein (APP) in senile plaques extracted from Alzheimer's brain, but did not recognize amyloid protein. Immunohistochemically, however, the staining pattern of Am-3 in frozen section of Alzheimer's brain was almost the same with that of rabbit polyclonal antibody to amyloid peptide which could recognize both amyloid protein and APP. In other words, APP was present in senile plaques of various types, cerebrovascular amyloid and granular deposits. The granular deposits were 5–10 m in size and laminarily distributed in the 1st, 3rd and 4th layers of cerebral cortex. They were especially abundant in 1st and 4th layers where senile plaques were usually fewer in number. Although the distribution in the cerebral cortex was different between the senile plaques and the granular deposits, the number of the granular deposits was well correlated with that of senile plaques. The granular deposits were negative in Congo-red birefringence, but contained amyloid protein as well as APP fragment judging from positive staining by both Am-3 and polyclonal antibody to synthetic amyloid peptide. Thus, they could be regarded as pre-amyloid.     

Mothers with multiple illegitimacies

Summary Investigations were carried out concurrently by a psychiatrist, psychologist, and social worker on 26 mothers who were pregnant with or had delivered their third (or more) illegitimate child at the time of the study. The data were then reviewed and integrated with attempts to offer etiological hypotheses and psychodynamic explanations.Psychometric data excluded mental deficiency as a significant contributory factor and suggested some incongruous data with respect to impulse control. The 48 and 84 profiles of the MMPI were present in 58 per cent of the mothers as the most typical profile. Standard diagnostic classification conveyed little of the multifarious trends which presented. Distortions in object relation with a narcissistic character structure provided the personality configuration for most of the women. Being scapegoated and humiliated were often noted as well as ego states of intense hatred which seemed to serve a defensive purpose against emptiness and longing. Despite the personal and social disadvantages, these mothers continued to function with a minimum of help from anyone.From the Institute of Child Development, University of Minnesota, Minneapolis, Minn.