A statewide survey of ECT policies and procedures

The 1990 American Psychiatric Association (APA) Electroconvulsive Therapy (ECT) Task Force Recommendations include facility policy and procedure guidelines. The objectives of this study were to determine and to improve the adherence to the 1990 APA ECT Task Force Recommendations on policies and procedures among the providers of ECT in Louisiana. Completed surveys on ECT policy and procedures were obtained from the seven major Louisiana ECT providers from the last quarter of 1996. Project coordinators distributed copies of the survey results and a comprehensive set of ECT policies and procedures at a statewide meeting of participating hospitals during the spring of 1997. Most facilities had policies for electrical safety of ECT equipment, testing of new ECT equipment, pre-ECT work-up, ECT informed consent, patient instruction sheets, outpatient ECT, documentation of ECT procedures, clinical privileging, and ECT quality assurance monitoring. Subsequent telephone follow-up found that all participants changed their policies and procedures as a result of the project. Louisiana ECT providers showed general compliance with the facility policy and procedure aspects of the 1990 APA ECT Task Force Recommendations. The awareness model of guideline compliance was applicable to improving facility policies and procedures.     

The influence of French, Spanish, and English legal traditions on early mental health proceedings in Louisiana

Unlike other jurisdictions in the United States where the basis of the law can be traced more exclusively to the common law of England, the legal system in Louisiana also has origins in the laws of France and Spain. In this article, the authors describe the laws and procedures that developed early in Louisiana's history for the involuntary care and civil commitment of the mentally ill, focusing on the laws that were passed after the American takeover in 1803.     

Autism Prevalence Following Prenatal Exposure to Hurricanes and Tropical Storms in Louisiana

Hurricanes and tropical storms served as natural experiments for investigating whether autism is associated with exposure to stressful events during sensitive periods of gestation. Weather service data identified severe storms in Louisiana from 1980 to 1995 and parishes hit by storm centers during this period. Autism prevalences in different cohorts were calculated using anonymous data on birth dates and parishes of children diagnosed with autism in the state mental health system, together with corresponding census data on all live births in Louisiana. Prevalence increased in dose-response fashion with severity of prenatal storm exposure, especially for cohorts exposed near the middle or end of gestation (p < 0.001). Results complement other evidence that factors disrupting development during sensitive gestational periods may contribute to autism.     

Artificial gastric distention and neonatal feeding and hunger reflexes

This paper reports on an experiment, using a gastric balloon, to determine whether the hunger and feeding reflexes would be affected by artificial distention of the gastric walls in newborn infants. The hunger reflex was terminated when the gastric walls were distended by increased air volume in the gastric balloon, and the feeding reflex was initiated by this. Removing the air from the gastric balloon led to cessation of the feeding reflex and the induction of the hunger reflex. The experiment confirms that the human newborn's feeding and hunger reflexes are present from birth and mirror its state of satiation or hunger, respectively.The author wishes to thank Dr. Shelley Jones, Pediatric Resident, and Mr. Patrick R. Joffery, Psysiology Instructor, Louisiana State University Medical Center, New Orleans, Louisiana, for the assistance in this study.     

The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana

We surveyed all neurologists, ophthalmologists, and neurosurgeons in Iowa, eastern Nebraska, and Louisiana over one year to determine the annual incidence of pseudotumor cerebri in residents of Iowa and Louisiana. The results were similar for both states. In Iowa, the annual incidence in the general population was 0.9 per 100,000 persons. When obesity was considered, this increased the incidence to 13/100,000 persons in Iowa and 14.85/100,000 persons in Louisiana for women 20 to 44 years of age who were 10% or more over ideal weight. Furthermore, the incidence became 19.3/100,000 for women in the same age range when they were 20% or more over ideal weight. The female-to-male ratio was 8:1, and the mean weight was 38% above ideal weight for height. Pseudotumor cerebri is a relatively common neurologic illness and may be an important preventable cause of blindness in obese young women.     

Development and characterization of 16 microsatellite markers for the Louisiana pine snake, Pituophis ruthveni, and two congeners of conservation concern

We isolated and characterized 16 microsatellite loci from the Louisiana pine snake, Pituophis ruthveni. Loci were screened in 24 individuals from locations throughout its distribution in Louisiana and Texas. The number of alleles per locus ranged from 4 to 12, observed heterozygosity ranged from 0.200 to 0.875, and the probability of identity ranged from 0.043 to 0.298. We examined cross-species amplification at these loci in P. catenifer (bullsnakes and gopher snakes) and P. melanoleucus (pine snakes). These new markers provide tools for examining the conservation genetics of this species complex. Louisiana pine snakes face numerous threats: population densities are extremely low and their natural habitat has been severely altered and fragmented. In southern Canada, P. catenifer is at the northern extreme of its range and limited by the availability of suitable over-wintering sites. Hence, for these two species reduction of heterozygosity, potential for inbreeding, and increased effects of genetic drift are all of considerable conservation concern.     

A biopsychosocial examination of symptomatic and asymptomatic HIV-infected patients.

This study evaluated twenty-nine symptomatic and asymptomatic HIV-infected homosexual/bisexual men between eighteen and forty-five in the areas of psychiatric/psychosocial, neuropsychological, family, and immunological functioning. The subjects were referred by physicians, nurses, and mental health professionals from the Tulane/Louisiana State University AIDS Clinical Trials Unit and the C-100 outpatient Primary Care Clinic for HIV-infected patients served within the Charity Hospital of Louisiana at New Orleans. All subjects and their significant others were evaluated between November 1987 and October 1988 at the C-100 Clinic. The outcome measures were mood disturbance, psychological distress, and CD4 cell count. The most significant other family member, as selected by each subject, completed family measures. The subjects experienced psychological distress and neuropsychological problems. Active-behavioral coping appeared adaptive (related to enhanced mood) as did perceived social support (related to positive mood and lower psychological distress). Higher levels of neuropsychological functioning (verbal memory, visual memory, motor speed, and visual-motor sequencing) were associated with enhanced psychosocial functioning and/or immunological status. The findings from this study highlight the importance of conducting longitudinal studies using a multidimensional approach in which HIV-infected persons and their most significant other family members are evaluated within a biopsychosocial model.     

Suicidal behavior among psychiatric inpatient children: An estimate of prevalence

The prevalence of suicidal behavior among pre-adolescent child psychiatric inpatients has been estimated to range between 18 and 80 percent of the inpatient population. This study is a chart review of the documentation of suicidal behaviors displayed by 45 consecutive child psychiatric inpatient admissions. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 31 percent of the sample had recently engaged in some form of suicidal behavior and 9 percent had made a life-threatening attempt.Portions of this article were presented at the 1989 annual meeting of the American Psychological Association, New Orleans, Louisiana.     

Gambling behavior of Louisiana students in grades 6 through 12

OBJECTIVES: The prevalence of problem and gambling behavior, the average age of onset of gambling behavior, and the co-occurrence of gambling disorder with substance use were determined in the Louisiana student population grades 6 through 12. METHODS: A stratified randomized sample of 12,066 students in Louisiana schools during the 1996-1997 school year was surveyed about gambling behavior using the South Oaks Gambling Screen--Revised for Adolescents (SOGS-RA). RESULTS: Fourteen percent of the students never gambled, 70.1 percent gambled without problems, 10.1 percent indicated problem gambling in the past year (level 2 according to the SOGS-RA), and 5.8 percent indicated pathological gambling behavior in the past year (level 3). Weekly or more frequent lottery play was reported by 16.5 percent. The average age of onset of gambling behavior was 11.2 years. Fifty-nine percent of the students with problem and pathological gambling behavior reported frequent alcohol and illicit drug use. CONCLUSIONS: A significant minority of Louisiana students in grades 6 through 12-15.9 percent--acknowledged gambling-related symptoms and life problems. The association of problem and pathological gambling with use of alcohol, tobacco, and marijuana provides preliminary support for the inclusion of gambling among other adolescent risk behaviors.     

American Association of Psychiatric Services for Children 43rd Annual Meeting

American Association of Psychiatric Services for Children 43rd Annual MeetingLemeridien Hotel New Orleans, Louisiana February 23–26, 1992     

Working with Children Affected by Hurricane Katrina: Two Case Studies in Play Therapy

In August 2005 Hurricane Katrina hit the Louisiana and Mississippi Gulf Coast Regions. Throughout history, mental health professionals have primarily focused on adults as the identified victims of natural disasters. More recently, mental health professionals are focused on integrating mental health services to children and adolescents. This article discusses the impact natural disasters have on children, and the related traumatic stress response and post traumatic stress disorder often experienced by children. Treating children can be complicated and a developmentally appropriate intervention is needed. Evidenced-based research has shown play therapy to be a developmentally effective intervention with traumatised children. This article presents two case studies of play therapy with children affected by Hurricane Katrina.     

Validity of the Autism/Pervasive Developmental Disorder Subscale of the Diagnostic Assessment for the Severely Handicapped-II

This study was designed to establish the empirical validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of autism in severely and profoundly mentally retarded adults. Participants included 51 individuals residing in a large developmental center in Central Louisiana. The Autism/Pervasive Developmental Disorder subscale of the DASH-II was internally consistent. Additionally, the DASH-II was just as likely as the Childhood Autism Rating Scale (CARS) to classify autistic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of autism.     

Perspectives on community as a social system

This paper seeks to analyze processes and roles within the community as a setting for mental health work. The author contends that social workers can utilize linkages and resources more effectively by treating community as a social system. Furthermore, the community approach to mental health problems appears to be a logical framework to organize and harmonize different subsystems. A two-dimensional, conceptual model brings into focus two mutually supportive considerations within this framework: community and mental health. Systemic linkages between the mental health group and the welfare community are further conceptualized to signify their importance in the MR programs. A critique is presented of the changing professional roles of the community organizer in a society where welfare services are organized for the less competent individuals within a complex web of values and antivalues. Social workers' dynamism in self-shaping their professional roles toward improving the quality of life is highlighted.This paper was presented and discussed at the 2nd in-Service Training Workshop (DMR) on The Social Worker as an Agent of Change, by Dr. Mohan, Workshop Coordinator, April 7, 1977, at Louisiana State University, School of Social Welfare, Baton Rouge, La. 70803.     

Intra-axonal bacilli in lepromatous leprosy

Summary M. leprae bacilli in nerves of 3 patients with lepromatous leprosy were found in the axoplasm of myelinated and unmyelinated nerve fibers. Axonal bacillation occurred in as much as 2% of myelinated axons. Bacilli within Schwann cells were a more common finding in lepromatous leprosy that intra-axonal bacilli. Intra-axonal bacillation probably represents a late stage phenomenon in lepromatous leprosy. Intra-axonal bacilli may contribute to the dissemination of leprosy by migration of bacilli within the axon, and may contribute directly to nerve fiber destruction.This work was supported in part by SRS Grant RC75 MPO, Carville, Louisiana and the Yale Medical School Knight Memorial Fellowship in Nervous and Mental Diseases.     

Gambling Behavior of Juvenile Offenders in Louisiana

The purpose of this paper was to determine the (1) frequency of and (2) types of prearrest gambling (3) prevalence of pathological gambling and (4) the associations of after school activities and gambling related symptoms among juvenile offenders in Louisiana, compared to a contemporaneous school sample. A gambling survey was administered to 343 (jail) and 1293 (prison) offenders, ages 10–19 and compared to random sample of 12,036 Louisiana students in sixth through twelfth grades. Results showed that juvenile offenders gambled more frequently than the school sample on every gambling activity. Juvenile offenders (20.5%) were more likely to be classified as pathological gamblers than students (3.9%). Thirteen per cent of the juvenile justice sample identified their arrest as gambling related. Pathological gamblers were twice as likely to have had a gambling-related arrest. Pathological gambling may pose a risk factor for incarceration in the juvenile age group. After school activities, including church, employment, and athletics were risk factors for gambling related symptoms in both populations.     

Best practices: New York's outpatient mental health clinic licensing reform: using tracer methodology to improve service quality

This column describes how the New York State Office of Mental Health (OMH) redesigned licensing procedures for outpatient clinics by applying a person-centered focus and clinically relevant standards of care. OMH incorporated a tracer methodology to assess services; a licensing instrument that reflected OMH goals; and a systematic piloting, feedback, and implementation process. Clinic staff reported that the new procedures facilitated communication between OMH and clinics, accurately identified clinics' successes, and provided actionable and programmatic feedback. This initiative represents the first step by a state mental health authority to create a system of accountability that is clinically relevant and supported by stakeholders.     

A comparison of time delay and system of least prompts in teaching object identification

This study is a comparison of two response prompting procedures: Progressive time delay and system of least prompts. Three students with severe handicaps were each taught to identify eight functional objects, four objects with each prompting procedure. The procedures were compared in terms of effectiveness (establishing criterion level correct responding) and efficiency, (sessions and trials to criterion, errors to criterion, and the number of minutes of direct instructional time). A combination of two concurrently operating multiple probe designs (Parallel Treatments Design) in which extraneous variables were counterbalanced across sessions was employed. An analysis of the results indicates that both prompting procedures were effective in establishing correct responding at criterion levels, but the time delay procedure required fewer sessions, trials, and errors to criterion, and fewer minutes of direct instruction time than did the system of least prompts. Issues for further comparative research are discussed.     

Etiology and management of coagulation abnormalities in the pain management patient

Coagulation abnormalities and bleeding disorders are frequently encountered in patients undergoing invasive procedures. These are of particular importance in the pain management setting where even small amounts of excessive bleeding can result in devastating complications. It is imperative that physicians treating those patients under-stand the basic concepts of coagulation and be able to identify and manage the common bleeding disorders. This article provides a brief overview of the coagulation system and describes the use of appropriate screening tests and management strategies to limit bleeding in pain management procedures.     

Use of a micromanipulator system (NeuRobot) in endoscopic neurosurgery

NeuRobot, a micromanipulator system with a rigid neuroendoscope and three micromanipulators, was developed for less invasive and telecontrolled neurosurgery. This system can be used to perform sophisticated surgical procedures through a small, 10-mm-diameter, window. The present study was performed to evaluate the feasibility of using NeuRobot in neuroendoscopy. Four different intraventricular neurosurgical procedures were simulated in three fixed cadaver heads using NeuRobot: (1) fenestration of the floor of the third ventricle; (2) fenestration of the septum pellucidum; (3) biopsy of the thalamus; and (4) biopsy of the choroid plexus of the lateral ventricle. Each procedure required less than 2 min, and all procedures were performed accurately. After these surgical simulations, a third ventriculostomy was carried out safely and adequately in a patient with obstructive hydrocephalus due to a midbrain venous angioma. Our results confirmed that NeuRobot is applicable to lesions in which conventional endoscopic neurosurgery is indicated. Furthermore, NeuRobot can perform more complex surgical procedures than a conventional neuroendoscope because of its maneuverability and stability. NeuRobot will become a useful neurosurgical tool for dealing with lesions that are difficult to treat by conventional neuroendoscopic surgery.