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 study of the role of paraprofessionals in community mental health

In the New York area paraprofessionals are being utilized in community mental health programs but in lesser proportions than throughout the rest of the nation. Their work is considered to overlap with the professional Many are involved in community organization and various forms of psychotherapy. The paraprofessional contribution is perceived as essential or highly desirable by administrators and clinicians. Training and career opportunities for paraprofessionals are generally poor. The findings raise questions not only about the role and training of paraprofessionals but of professionals in community mental health.The authors wish to express their appreciation to Mr. Cecil Seals of The Community Affairs Division of the New York City Department of Mental Health and Mental Retardation Services for his assistance.     

Die Bedeutung der diskontinuierlichen Zonierung des Immunglobulinbereiches für die Diagnose neurologischer Erkrankungen

Zusammenfassung 1. 340 Patienten, welche bei der agarelektrophoretischen Auftrennung der Liquorproteine eine diskontinuierliche Zonierung im Bereiche der -Globuline zeigten, wurden bezüglich Verteilung dieser clonalen -Zonen auf die verschiedenen neurologischen Erkrankungen untersucht.2. Bei der MS und den anderen entzündlichen neurologischen Erkrankungen findet sich eine Häufung der schnell wandernden Zone ₂ und der mittelschnell wandernden Zonen ₃ und ₄.3. Bei den Discushernien und den zentralnervös-nichtentzündlichen Erkrankungen ist die Zonenverteilung ziemlich flach und undifferenziert, wobei hier wie auch bei Tumoren und Polyneuritiden der relativ hohe ₀-Anteil auffällt als ein Phänomen, das bei zentralnervös-entzündlichen Prozessen nur selten anzutreffen ist. In den wenigen Tumorfällen mit -Zonierung scheint die ₄-Position deutlich zu überwiegen.4. In der Hälfte aller MS-Liquoren mit -Zonierung ist das Totalprotein, in einem Sechstel das Total--Globulin (rel%) normal, und nur bei zwei Dritteln finden sich Plasmazellen. Die elektrophoretische Feststellung von -Zonierung ist in der neurologischen Labordiagnostik folglich ein wichtiges Hilfskriterium.5. Mit zunehmendem Anstieg des -Globulin-Gehaltes im Liquor läßt sich bei MS-Patienten, nicht aber bei allen Krankheitsgruppen, eine Zunahme der Häufigkeit der -Zonierung nachweisen.6. Das Auftreten von -Zonierung ist bei den zentralnervös-entzündlichen Krankheiten und der MS sechsmal häufiger als bei den zentralnervös-nichtentzündlichen Krankheiten.7. -Zonierung scheint beim Gesunden, bei psychiatrischen Erkrankungen, Myopathien, bei gewissen Tumoren (Neurinomen) und metabolisch bedingten Polyneuritiden nicht vorzukommen.

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The significance of discontinuous zonation of electrophoretically separated globulins for the diagnosis of neurological diseases

Summary 1. 340 patients in whom discontinuous zonation of the globulin region was observed after electrophoretic separation of the CSF proteins were examined to see how the distribution of these clonal zones is correlated with different neurological diseases.2. In multiple sclerosis (MS) and other inflammatory diseases of the CNS, zones are most frequently found in the medium positions: ₂, ₃ and ₄.3. In disk hernias and the noninflammatory diseases of the CNS, the dispersion of zone frequency is rather undifferentiated. In these conditions and in tumors of the CNS and polyneuritis, the relatively high proportion of ₀ zones is a conspicuous feature; it is scarcely encountered in inflammatory processes of the CNS. The rare cases of tumors with zonation show a preponderance of the ₄ zone.4. The total protein content is normal in half of all MS fluids with zonation; in one sixth the relative amount of total globulin is also normal, whereas plasma cells are demonstrable in only two thirds. The electrophoretic evaluation of zonation is, therefore, an important tool in neurological laboratory work.5. Increased amounts of globulin in CSF are accompanied by an increased frequency of zonation in some diseases, such as MS, but not in tumors or vascular processes.6. The incidence of zonation is about 6 times higher in MS than in noninflammatory diseases of the CNS.7. zonation seems not to be present in healthy persons, in psychiatric diseases, myopathies, some tumors (neurinoma) and polyneuritis of metabolic-toxic etiology.

     

Recruit,screen, and hire: Staff selection and the decision-making process

This article focuses on the role of the clinician-manager in staff selection. The duties of the clinician-manager in a mental health center include those tasks described as recruit, screen, and hire but little or no guidance on the steps involved in this sequence of events is available. The how of hiring is transmitted by word of mouth, by following another's example, or by trial and error. This article examines the component parts of staff selection from the assimilation of procedures, rules, and regulation of the public authority under which a particular mental health center operates, to the compilation of a short list of those to be screened and finally the risk taking and decision-making process by the clinician-manager who makes the choice. Some speculation on the emotional impact it has on the clinician-manager is examined. The impact of personal value judgments of the selector are considered. Recommendations are made for the inclusion of training in staff selection by academic programs for mental health administrators.Sheila Melville, A.C.S.W., is the Director, Partial Hospitalization, Mt. Vernon Center for Community Mental Health, 8119 Holland Road, Alexandria, Virginia 22306.     

Systematic discrimination: A strategy for survival

The Reagan administration's federal policy of underdevelopment, social deficits, and disinvestment in social programs has contributed to widening the service gap between the rich and poor. The expansion of private and public insurance coverage has left the short term and near poor as the most vulnerable segment of our population. The article documents the scope of the problem, the challenges it presents to mental health administrators, and recommends strategies for dealing with the problems.     

Contracting between public and private providers: A survey of mental health services in California

This paper reports on a public authority's decision to make or buy mental health services. Data come from key informant interviews with California county contract or program managers. The questionnaire measures the extent of contracting and the importance of factors that are hypothesized to affect the relative costs of contracting. The percent of contracting by programs ranges from zero to 100, averaging 41%. Sixty-two percent of rural programs perceive little or no competition for public mental health contracts, and contract significantly less than urban programs. The extent of contracting is related to economic and public organizational factors.     

Intelligence and temperament as protective factors for mental health. A cross-sectional and prospective epidemiological study

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible salutogenic (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988–1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988–1989 using the concept love well, work well, play well and expect well. The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988–1989 super capacity (high intellectual function), super validity (high activity level) and super solidity (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.     

Visuoperception and visuospatial and visuorotational performance in Parkinson's disease

Summary Forty patients with Parkinson's disease were compared with 33 normal controls with respect to their performance in the Wechsler Adult Intelligence Scale subtests information, similarities, block design, and picture completion, in a test for visual neglect (Hamsher's line cancellation test) and in tests for visuospatial and visuorotational abilities (cube task from Amthauer's intelligence structure test and Rybakoff figure test, as revised by Meili). The findings show that the patients scored significantly worse than the controls (Mann-WhitneyU test,P=0.004) in the Rybakoff figure test, testing visual concept finding, imagination and visual rotation. In the other tests no significant differences were found between the patients and the controls. The deficit of the patients in the figure test of Rybakoff correlated significantly with tremor (P=0.013), akinesia (P=0.009), disability (P=0.043), and age (P=0.004, Spearman rank correlation).     

The immorality of morality

The psychiatrist cum humanist wonders aloud why euthenics is almost as dirty a word as eugenics—with special emphasis on the psychiatric establishment.For example: Unlike the complaint bureaus of commerical establishments, mental health services operate on the basis that the customer is always wrong.This article is a revision of a longer paper delivered at the 49th Annual Meeting of the American Orthopsychiatric Association in 1972.     

„Fingerprint inclusions” in muscle fibres in dystrophia myotonica

Summary Fingerprint inclusions were observed in numerous muscle fibres of 3 cases of dystrophia myotonica studied by electron microscopy in two different laboratories. They consist of parallel or concentric palisades of short electron dense linear elements. Identical fingerprint inclusions were reported in two other clinical conditions and cannot therefore be regarded as specific for a particular muscle disease. Their origin and significance remain obscure.     

Etic and emic criteria for non-psychotic mental disorder: a study of the CISR and care provider assessment in Harare

The paper describes the relationships between the Revised Clinical Interview Schedule (CISR) and the assessment of psychiatric status by primary care providers in Harare. Primary care clinic (PHC) and traditional medical practitioner (TMP) clinic attenders (n=302) were interviewed with the Shona Symptom Questionnaire, the CISR and the Explanatory Model Interview. The PHC nurses and TMP were interviewed to elicit diagnostic formulation using the WHO Health Staff Rating codes. Etic cases were those who scored 12 or more on the CISR and emic cases were those whom the care provider had assessed as having a mental disorder. In all, 52% of subjects were classified as etic cases and 59% as emic cases. Overall agreement between the two criteria was 55%. Three-quarters of care provider false-positives were accounted for by a failure to take into account the varying reasons for consultation, such as social or spiritual problems. Most of the false-negative groups were symptomatic subjects, though with fewer symptoms than those who were definite cases. One etic conceptphobia-was not considered as a mental disorder and appeared to lack concept validity in this setting.     

Liquorkomplement und Multiple Sklerose

Zusammenfassung 1. In 239 Liquores, darunter 47 MS-Fälle und 91 normale Kontrollen, wurden Komplement und Komplementfaktoren (C₁, C₂, C₃ und C₄) bestimmt.2. Im normalen Liquor ist in der Regel keine Gesamtkomplementaktivität vorhanden. Dagegen ist die C₁- wie C₄-Aktivität praktisch immer und C₂-sowie C₃-Aktivität in über der Hälfte der Fälle zu finden. Das Komplementmuster im Liquor ist daher im Gegensatz zum Serum unvollständig.3. Bei erhöhtem Eiweiß zeigt der Liquor dagegen häufig Gesamtkomplementaktivität. Je höher das Liquoreiweiß ist, um so höher ist der Gehalt an C₂, C₃ und Gesamtkomplement. Diese Beziehungen zwischen Gesamteiweiß und Komplementaktivität gelten für normalen wie pathologischen Liquor einschließlich der MS-Fälle.4. Im MS-Liquor sind C₂, C₃ und Gesamtkomplement seltener zu finden als bei den Kontrollen. Bei den MS-Patienten ist C₂ und C₃ im akuten Schub herabgesetzt. C₃ nimmt im Verlauf der Erkrankung wahrscheinlich ab.5. Mit Antikomplementserum wurde _1C-Globulin, ein Teilfaktor von C₃, im Liquor von 55 MS-Patienten und 42 Kontrollen bestimmt. Es besteht kein Unterschied zwischen MS und Kontrolliquor. Auch bei akut entzündlicher MS ist _1C nicht vermindert.6. In der Diskussion wird auf widersprechende eigene Befunde über _1C-Inaktivierung im Serum während der akut entzündlichen MS-Phase hingewiesen.

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Summary 1. Complement and complement factors (C₁, C₂, C₃ and C₄) were determined in 239 specimes of cerebrospinal fluid (CSF) including 47 cases of Multiple Sclerosis (MS) and 91 normal controls.2. In general, total complement activity is absent in normal specimens while that of C₁ and C₄ can be found practically always and that of C₂ and C₃ in more than half of the cases. Therefore, the pattern of complements in the CSF is incomplete as opposed to that of serum.3. In contrast, samples with increased protein content frequently yield total complement activity. The higher the protein content of CSF the higher the content of C₂, C₃ and total complement. This relationship between amount of total protein and complement activity applies both to normal and pathological CSF specimens including those from MS.4. In cerebrospinal fluid from patients with MS, C₂, C₃ and total complement are found less frequently than in that from controls. C₂ and C₃ are diminished in patients with an acute exacerbation of MS. C₃ decreases probably in the course of the disease.5. _1C-globulin, a component of C₃, was determined with anticomplement sera in specimens from 55 patients with MS and from 42 controls. There is no difference between CSF of MS and controls. Even in acutely inflammatory cases of MS, _1C is not diminished.6. Discussing his results the author points out discrepancies concerning the nactivation of _1C in serum during acutely inflammatory episodes of MS.

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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Über die sogenannte „zentrale Tonusdifferenz“ mit Nystagmusbereitschaft nach einer Seite

Zusammenfassung An Hand von 71 sowohl otologisch als auch neurologisch-psychiatrisch untersuchten Fällen wird zur Frage der sog. zentralen Tonusdifferenz Stellung genommen.1. In 40% der Beobachtungen waren als Ursache des einseitigen Nystagmusüberwiegens Schäden im Labyrinth bzw. im Bereich des 1. vestibulären Neurons anzunehmen.2. Bei 35% der Untersuchten war sowohl eine periphere als auch zentrale Verursachung möglich. Überwiegend handelt es sich um Patienten mit einem klinischen Halswirbelsäulensyndrom. Der funktionelle Charakter der Störung wird diskutiert.3. In 25% unserer Fälle lagen sicher zentrale Schäden vor, jedoch fand sich mit 2 Ausnahmen kein Anhalt für die Annahme einer Hirnstammläsion als Ursache der Nystagmusbereitschaft nach einer Seite.Therapieversuche werden erwähnt.Der Begriff zentrale Tonusdifferenz wird als mißverständlich abgelehnt und betont, daß dem einseitigen Nystagmusüberwiegen keineswegs ein Hinweischarakter auf eine Hirnstammcontusion zukommt. Die Nystagmusbereitschaft nach einer Seite kann von jedem Abschnitt des vestibulären Systems ausgelöst werden.Teilergebnis eines Forschungsauftrages des Bundesministeriums für Arbeit.     

Refraktärperioden und frequente Impulsfortleitung im gemischten N. ulnaris des Menschen bei Polyneuropathien

Zusammenfassung Bei 30 Patienten mit Neuropathien unterschiedlichen Schweregrades (subklinisch, leicht, mittelschwer und schwer) wurden am N. ulnaris neben den üblichen neurophysiologischen Parametern [distale Latenz, maximale motorische und gemischte Nervenleitgeschwindigkeit (Nlg.)] die Refraktärperioden (Rp.) (absolute Rp. und relative Rp.-Amplitude und -Latenz) und die unteren Grenzfrequenzen (u. F.) (u. F.-Amplitude und -Latenz) bestimmt.Beim Vergleich mit einem Normalkollektiv (n=31, s. Lowitzsch u. Hopf, (1972a)) war die Nlg. nur in 37% der Fälle pathologisch verlangsamt, während die relative Rp.-Latenz in ca. 80% und die u. F.-Latenz in ca. 60% pathologisch verändert waren.In zwei Stichproben (13 Normalfälle und 13 Polyneuropathien) mit einer normalen gemischten Nlg. von 51,0–63,5 m/sec unterschieden sich die Mittelwerte für die distale Latenz sowie die motorische und gemischte Nlg. statistisch nur auf dem 1%-Niveau, für die relative Rp.-Latenz und die u. F.-Latenz hingegen auf dem 0,5-Niveau.Die Bestimmung der Refraktärperioden, insbesondere der rel. Rp. L., sowie der unteren Grenzfrequenz (u. F. L.), stellt eine im Vergleich mit den üblichen neurophysiologischen Verfahren (Nlg.-Bestimmung) wesentlich empfindlichere Untersuchungsmethode zur Erfassung auch geringer (subklinischer) Funktionsstörungen des peripheren Nervensystems dar.Die unterschiedliche Beeinflussung der Refraktärperioden und der Grenzfrequenzen durch die Art des zugrundeliegenden pathologischen Prozesses (axonale Degeneration — segmentale Demyelinisierung — Mischtyp) wird an Hand der in 9 Fällen nervenbioptisch (N. suralis) gewonnenen Befunde diskutiert.

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Refractory periods and frequent impulse conduction in mixed N. ulnaris of man in polyneuropathies

Summary Some electrophysiological parameters were studied in the ulnar nerve of 30 patients suffering from neuropathy of various origin and severity.Absolute and relative refractory periods and lower limiting frequencies were measured and compared to the usual parameters (distal motor latency, conduction velocity of motor fibres, and the mixed nerve action potential).The conduction velocity was indicative of the diseased function in 37% whereas the relative refractory period (latency) was abnormal in nearly 80% and the lower limiting frequency (latency) in about 60%.Two samples taken at random, each of them consisting of 13 patients with normal conduction velocities between 51.0 and 63.5 m/sec showed differences only at the 1% level (p<0.01) as far as the mean values of the distal latency and the maximum conduction velocity were concerned. The difference between the mean values of the relative refractory period (latency) and of the lower limiting frequency (latency), however, was highly significant (p<0.0005). Thus, in our experience, the relative refractory period (latency) and the lower limiting frequency (latency) are more sensitive indicators of mild functional disturbances of peripheral nerves than the maximum conduction velocity.

Die Untersuchungen wurden in dankenswerter Weise von der Deutschen Forschungsgemeinschaft unterstützt.     

Community Mental Health and Information Underload

As is generally recognized, the community mental health movement has run into many serious obstacles which have caused it to fall short of original expectations. Lack of needed information on the part of policy makers, planners, administrators and workers is presented in this article as comprising much of the problem. Scientific understanding with regard to the nature of both community and mental health have been deficient and often substituted by idealistic myths based on wishful thinking. In the case of community, the problem has been an overall failure to generate appropriate research. In the matter of mental health, the research has been extensive but unbalanced, with serious neglect of important areas subsumed by the social and behavioral sciences. A perspective for dealing with these problems is outlined based on the total spectrum of efforts society makes in the mental health field from curing to health promotion. Two illustrations for utilizing this perspective are given. The first shows the integration of primary prevention with the rest of the effort spectrum, and the second shows the total effort spectrum united by the common target of reducing prevalence.     

Electroconvulsive therapy in Parkinson's syndrome with “on-off” phenomenon

Summary During long-term treatment with L-dopa in Parkinson's syndrome on-off phenomenon develops in many cases, often entailing considerable therapeutic problems. Decreased sensitivity in postsynaptic striatal dopamine (DA) receptors has been shown to occur in parkinsonian patients during long-term treatment with L-dopa. This has been suggested as one possible mechanism for development of the on-off phenomenon. In contrast to L-dopa treatment electroconvulsions have been shown to increase sensitivity in the DA receptors, when administered to animals.The antiparkinsonian effect of electroconvulsive therapy (ECT) was investigated in five parkinsonian patients with on-off phenomenon, with or without concomitant signs of mental depression. ECT was administered according to praxis in treatment of mental depression. Drug therapy, including L-dopa, was maintained on previously adjusted doses during and after ECT.A marked improvement in the parkinsonian symptoms as well as in the on-off phenomenon occurred in three of the patients, persisting for several months. The other two patients showed only slight and transient improvement.It thus seems that ECT may be useful as a supplementary treatment in parkinsonian patients with on-off phenomenon. The antiparkinsonian effect of ECT is probably mediated by increased sensitivity in postsynaptic DA structures.     

Is the DSM-III-R category of mood disorders too broad?

Summary In the DSM-III and DSM-III-R the affective or mood category has been widened and moodincongruent psychotic affective illness (MICPAI) included. The present study was undertaken to determine whether this broad mood category is still homogeneous. Personality factors were used as parameters. Minnesota Multiphasic Personality Inventory findings of 54 patients with MICPAI were compared with those of 21 probands with a DSM-III typical affective disorder and with those of 15 DSM-III schizophrenics. It was shown that MICPAI differed significantly from typical affective disorder, but not from schizophrenia, in particular regarding the subscales schizophrenia and psychopathic deviate. When MICPAI was subdivided into the depressed and manic type, the depressed type was found to be more closely related to schizophrenia (with respect to the subscales paranoia and schizophrenia), whereas the manic type hardly differed from affective disorder. Whether this result is due to diagnostic inaccuracies is discussed. Our finding that MICPAI differs from typical affective disorder with respect to personality is in accordance with heredity and outcome studies demonstrating that MICPAI is associated with a higher risk for schizophrenia in firstdegree relatives and with worse outcomes when compared with typical affective disorder. It can thus be concluded that the decision to include MICPAI in the affective or mood category of the DSM-III or DSM-III-R has rendered this category more heterogeneous.     

A new low-dose formulation of selegiline: clinical efficacy,patient preference and selectivity for MAO-B inhibition

Summary. Three studies were performed using a fast dissolving formulation of selegiline hydrochloride designed for buccal absorption Zydis Selegiline. The aim of the first study was to compare the therapeutic efficacy of Zydis Selegiline (1.25mg or 10mg) with conventional selegiline hydrochloride tablets conventional selegiline tablets (10mg) in patients with Parkinsons disease (PD) who were previously treated with conventional selegiline tablets as an adjunct to levodopa/dopamine agonist therapy. Patients were observed for 4 weeks to ensure that they were stable. Stable patients (n=197) were then randomised to continue with conventional selegiline tablets 10mg (n=68), or to treatment with Zydis Selegiline 1.25mg (n=64) or Zydis Selegiline 10mg (n=62) for 12 weeks in this randomised, parallel group study. A further aim was to establish the acceptability of Zydis Selegiline compared with conventional selegiline tablets. Patient preference for Zydis Selegiline was also evaluated in a second study, a single-dose, randomised, two-way crossover study conducted in patients with PD (n=148). Patients were stratified by the presence or absence of swallowing and salivation problems and were randomised to either Zydis Selegiline 5mg or a placebo fast-dissolving formulation. In a third study, the degree of potentiation of the tyramine pressor effect following Zydis Selegiline was compared with that following conventional selegiline tablets in healthy volunteers. A total of 24 healthy volunteers were randomised to receive Zydis Selegiline 1.25mg or conventional selegiline tablets 10mg for 14–16 days in an open-label, randomised parallel group study.Both Zydis Selegiline (1.25mg and 10mg) treatments were shown to be therapeutically equivalent to conventional selegiline tablets 10mg based on comparison of mean total Unified Parkinsons Disease Rating Scale (UPDRS) scores. Therapeutic equivalence was defined a priori as the 90% confidence interval (CI) for the difference in total UPDRS scores between groups to lie entirely within the range ±5. The difference (90% CI) in mean adjusted total UPDRS between Zydis Selegiline 1.25mg and conventional selegiline tablets 10mg was –2.50 (–4.84, –0.17), and for Zydis Selegiline 10mg and conventional selegiline tablets 10mg, 0.04 (–2.30, 2.38). For the motor subscores of the UPDRS, differences between adjusted means (90% CI) compared with the conventional selegiline tablets group were: Zydis Selegiline 1.25mg, –2.14 (–3.94, –0.33) and Zydis Selegiline 10mg, –0.90 (–2.70, +0.91). Patients who switched from conventional selegiline tablets to Zydis Selegiline 1.25mg showed a slight improvement in UPDRS scores following 12 weeks of treatment (standard error of difference 1.039; p=0.01).In the single-dose crossover study, most (61%) patients liked Zydis Selegiline 5mg; a significantly greater proportion than the null hypothesis of 50% (p<0.002). However, only 62 patients (46%) indicated that they liked the taste of Zydis Selegiline. Nevertheless, the proportion of patients who preferred Zydis Selegiline (65%) to their usual medication was significantly greater than the null hypothesis of 50% (p<0.001).Similar findings were demonstrated in the 12-week study where a higher proportion of patients who received up to 3 months of treatment indicated a preference for either Zydis Selegiline 1.25mg (90%) or Zydis Selegiline 10mg (86%) over conventional selegiline tablets 10mg. More than 90% of patients found Zydis Selegiline easy to take, with 61% rating it as extremely easy. Most (81%) patients taking Zydis Selegiline 1.25mg liked the taste compared with 45% taking Zydis Selegiline 5mg (in the previous study).Zydis Selegiline did not potentiate the tyramine effect: a pressor effect was elicited after 400mg tyramine both before and after 14 days of treatment with Zydis Selegiline 1.25mg. In contrast, after 14 days treatment with conventional selegiline tablets 10mg, the threshold dose required to elicit the tyramine pressor response was significantly (p<0.0001) reduced from 400mg to 200mg.In summary, Zydis Selegiline at doses of 1.25mg and 10mg was therapeutically equivalent to conventional selegiline tablets 10mg. The Zydis Selegiline formulation was well-liked by all patients, with most preferring Zydis Selegiline 1.25mg to their usual selegiline tablet. Furthermore, Zydis Selegiline was well tolerated and, unlike conventional selegiline tablets, appeared to retain specificity for inhibition of monoamine oxidase type B (MAO-B), since it did not potentiate the pressor response to tyramine.Present address: Cephalon UK Ltd., Surrey Research Park, Guildford, United KingdomPresent address: Safetymednet, Ruscombe, United KingdomPresent address: Oxford Glycosciences (UK) Ltd., Abingdon, United KingdomReceived December 3, 2002; accepted July 23, 2003     

Community mental health: Training program in a School of Public Health

The new look implied by the label community mental health is understood by many to mean the adoption of a public health approach to mental health. In this paper, a psychologist outlines the salient elements in such an approach as embodied in a community mental health training program located for a decade at the Harvard School of Public Health. To make the role transition from traditional mental health clinician to community mental health worker, it may be mandatory to become familiar with the theoretical models, principles of practice, and specific research tools of the public health profession. Since only a few can arrange to undertake formal training at schools of public health, it is hoped that each mental health discipline will increasingly include exposure to key public health concepts in its own professional training program.This paper was presented at the annual convention of the American Psychological Association, September 4, 1964, Los Angeles, California. Since this paper was written, N.I.M.H. has sponsored the Boston Conference on the Training of Psychologists in Community Mental Health, May 4–8, 1965, Swampscott, Massachusetts. Proceedings of this conference are expected to be published and available by the fall of 1965.     

Reliability of death certificates in the study of stroke mortality. A retrospective study in a Sicilian municipality

The subjects who died in the Sicilian municipality of Riposto between 1985 and 1992, and whose death certificates reported diagnoses of cerebrovascular disease, were re-evaluated with the aim of verifying the reliability of the certificates themselves. The relatives of the deceased were interviewed to confirm or exclude stroke, and about 35% of the cases proved to be false positives. Among the causes reported on the death certificates, stroke, cerebral hemorrhage and cerebral thrombosis presented the smallest number of false positives. Our results show that the sensitivity and specificity of the death certificates was poor, and there would also seem to be a large number of false negatives. However, the official mortality rates for cerebrovascular disease are probably not very far from the truth.

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Sommario Abbiamo rivalutato i soggetti deceduti nel comune siciliano di Riposto tra il 1985 e il 1992 il cui certificato di morte rioportava diagnosi di malattia cerebrovascolare, allo scopo di valutare l'attendibilità dei certificati di morte. Abbiamo intervistato i parenti dei deceduti per confermare o escludere l'ictus cerebrale e circa il 35% dei casi sono risultati falsi positivi. Tra le cause riportate sul certificato di morte, ictus, emorragia cerebrale e trombosi cerebrale hanno presentato il minor numero di falsi positivi. Dai nostri risultati emerge una bassa sensibilità e specificità dei certificati di morte, infatti anche i falsi negativi sembrerebbero numerosi. I tassi ufficiali di mortalità per vasculopatia cerebrale tuttavia non sono probabilmente molto lontani dalla realtà.