An approach to the measurement of suitability for psychotherapy

Summary As a first step toward the measurement of the complex variable, suitability for psychotherapy, this essay defines this variable by a set of criteria. These criteria may be applied to content analysis of transcribed interviews; and they allow a differentiation of patients into easy and difficult candidates for psychotherapy. In the difficult group, patients: (1) cannot describe feelings; (2) they exhibit relationships in which the object is essential but is not overvalued; (3) they tend to use nonspecific pronouns; (4) they make bizarre interpretations of sensations; and (5) they display circumstantiality in their accounts of past experiences.The relation of these criteria to a primitivity of character structure, and in turn to the problem of psychosomatic illness, is discussed. Some implications in the development of human emotional states are briefly suggested.From the department of psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina.     

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.     

Team Leadership: Network Differences in Women's and Men's Instrumental and Expressive Relations

Recent studies have emphasised differences in leadership styles between women and men. Women have an interactive leadership style while men are more directive and authoritative. Social network analysis is used to examine differences in eight mental health case management teams, half formally supervised by women and half by men. The techniques used are graphical displays and measures of centrality. Results show male leaders as the most central team member for both instrumental and expressive relations. Female leaders, however, do not adhere to a single leadership style. Team centralisation also differs with gender composition of teams influencing leadership differences.     

Alpha-1 and alpha-2 adrenoceptor binding in cerebral cortex: Competition studies with [3H]prazosin and [3H]idazoxan

Summary The tritiated adrenergic antagonists prazosin ([³H]PRZ) and idazoxan ([³H]IDA, or RX-781094) bind specifically and with high affinity in membrane preparations from cerebral cortex to alpha-1- and alpha-2-adrenoceptors respectively. Saturation experiments, performed to determine the density of receptors (B_max; maximum binding capacity) and the dissociation constant (K_d 25 °C), were analyzed by the methods of Eadie and Hofstee, iterative modelling, and the procedure of Hill. The pharmacologic properties and specificity of the labelling was verified by displacement experiments using alpha-adrenergic antagonists and agonists. The antagonist drugs showed the following order of potency to displace [³H]prazosin: prazosin phentolamine corynanthine > pyrextramine yohimbine piperoxan > benextramine > idazoxan; for the agonists: clonidine (–)-noradrenaline (–)-adrenaline phenylephrine, while other drugs, such as (–)-propranolol, dopamine, (–)-isoproterenol and serotonin only competed with the alpha-1-ligand at concentrations above 20 M. The alpha₂-sites labelled by [³H]idazoxan were characterized by the antagonist displacement sequence idazoxan phentolamine > yohimbine = > piperoxan pyrextramine benextramine prazosin corynanthine. The agonists order of potency to compete with [³H]idazoxan was clonidine phenylephrine = > (–)-adrenaline > (–)-noradrenaline, and for other related drugs it was (–)-propranolol dopamine serotonin > (–)-isoproterenol. These competition experiments clearly showed two pharmacologically distinct sites, but question the relative specificity of some of the adrenergic drugs.Abreviations [³H]PRZ [³H]prazosin - [³H]IDA [³H]idazoxan - B_max maximum binding capacity - K_d dissociation constant - IC 50 inhibitory concentration that reduces binding by 50% - K_i inhibition-dissociation constant - nH Hill coefficient - CMC coefficient of multiple correlation - fmol/mg p fentomoles per mg of protein - nM nanomolar Recipient of a F.R.S.Q. Studentship.     

Abnormal visual event-related potentials of autistic children

This study compared the visual ERPs and concurrently measured fixation times of autistic children with those of normal children and two psychiatric control groups (socalled externalizers and internalizers). Autistic children had, in contrast with normal control groups, smaller P3 waves (occipital maximum) to visual target stimuli but did not differ in this respect from the two psychiatric control groups. When the autistic group was split into good and bad performers, the latter group had significantly smaller amplitudes than the former. No difference was found between the groups in electrophysiological reactivity to the first, novel stimulus of a habituation series. However, an unexpected change in stimulus location induced an increased Fz N400 in the normal group but not in the autistic group or the two psychiatric control groups. In addition, in a non-task-relevant habituation condition, the autistic group fixated complex visual stimuli for shorter times and had smaller occipital P3 waves than the control groups. Analysis of covariance showed that the smaller P3s could not be explained by the shorter fixation times. In none of the ERP parameters were there differences in habituation rate between the controls and the autistic children.     

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.     

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.     

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.     

Clinical and Human Resource Planning for the Downsizing of Psychiatric Hospitals: The British Columbia Experience

Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned downsizing process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services closer to home by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the downsizing of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the downsizing process continues.     

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.     

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.     

A case history analysis of the “manic type” and the “melancholic type” of premorbid personality in affectively ill patients

Summary The use of case histories in examining the premorbid personality of affectively ill patients is especially useful in the case of patients with a predominantly manic course of the disorder, because this kind of affective illness is very rare. The concept of the manic type of premorbid personality is described in detail and contrasted with the concept of the melancholic type often found in patients with a purely depressive course of the illness.     

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.     

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.     

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.     

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 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.     

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%.