Black suicide attempters in 1980: A preventive focus

A retrospective chart review of black suicide attempters was completed to describe the sample in comparison to prior studies and to develop preventive strategies. This sample of 56 black suicide attempters was composed of 17 males and 39 females, a ratio of 1:2.3. Female attempters were younger, 54% had made a prior attempt and had a diagnosis of either affective illness (33%) or an adjustment reaction with depressive features (31%). Male attempters were older, 76% had a prior psychiatric history, and 59% had a psychotic diagnosis. The potential for life-threatening behavior in psychotic black male patients was noted. The necessity of monitoring the access to medication by stressed impulsive youth was emphasized. As significant others involved in the stressers that precipitated the attempt accompanied the patient to the emergency room (ER), crisis intervention in the ER with the signficant other and/or family members was identified as an important strategy.     

The patient evaluation grid: A systematic approach to comprehensive care

A comprehensive approach to patients requires a systematic method that complements the clinical approach to disease. The method described here utilizes a patient evaluation grid that takes into account the biological, personal, and environmental dimensions of the patient and the current, recent, and background contexts of illness. It allows the clinician to anticipate problems relating to patient care and to assign priorities to management plans formulated in the three dimensions. It may also facilitate further research into the interrelationships among the multiple determinants of illness. This approach may help to bridge the gap between psychiatry and medicine by providing an integrated conceptual framework for organizing information.     

Psychological reaction to chronic skin disorders: a study of patients with vitiligo.

Diseases that cause physical handicaps can seriously interfere with the life of a patient. Some disorders such as vitiligo cosmetically disfigure patients without producing any physical disabilities. The effects of such diseases as vitiligo on the life of a patient have not been widely investigated. The investigation reported here utilized a questionnaire survey to focus on emotional disturbances caused by vitiligo and on the factors that differentiated patients who cope well from those who cope poorly with this stress. The results indicate that the cosmetic disfigurement of a seemingly inconsequential skin disease also can seriously disrupt the lives of a large number of patients. Those who cope well with their disfigurement have higher self-esteem than a matched control group without the disorder. Those who cope poorly have significantly lower self-esteem, which suggests that response to disfiguring diseases is affected by basic ego strength. Younger patients and those individuals in the lower socioeconomic groups show especially poor adjustment. A number of suggestions for better patient care are offered.     

Predictors of outcome in treatment of opiate addicts: Evidence for the multidimensional nature of addicts' problems

This report describes the characteristics of treatment outcome and the relationship between predictors and outcome in a sample of opiate addicts who were first evaluated on admission to a drug dependence treatment unit and then reevaluated 6 months later. Results indicate the independence of five different aspects of treatment outcome in opiate addicts including program retention, psychological symptoms, illicit drug use, illegal activities and occupational functioning. Evaluation of the relationship between seven categories of predictor variables and the different outcome factors revealed that the stronger predictors of outcome were indices of past functioning in that area, with, for example, pretreatment occupational functioning being the best predictor of occupational functioning following entrance to treatment. In addition, no single category of predictors was significantly related to all of the outcome factors. These findings are interpreted as supporting a multidimensional approach to the understanding and assessment of addicts' functioning.     

Anorexia nervosa masking the diagnosis of spinal meningioma: A case report

A case report of an adolescent female with signs and symptoms of both anorexia nervosa and high thoracic spinal cord meningioma is presented. Similarities in the presentation of both conditions are discussed, with emphasis on the early diagnosis of anorexia nervosa masking and delaying diagnosis of the thoracic meningioma. The contribution of the family and doctor-patient relationship in delaying the diagnosis are discussed. Pertinent literature is also reviewed.     

Neurochemical and morphological studies of bulk isolated rat brain cells. II. Preparation of viable cerebral neurons which retain synaptic complexes

The bulk isolation from rat cerebral cortex of viable neurons retaining synaptic complexes is described. The basis of this procedure is to dissociate the neurons in situ from the surrounding glial cells. The glial structures that are normally adjacent to the neuronal cell body and to the proximal parts of the neuronal processes are largely destroyed by perfusion of the brain under special conditions. The most important of these conditions was found to be a hyperosmolar concentration of hexoses in the perfusion medium. In addition, the presence of collagenase and hyaluronidase in the perfusion medium and specific perfusate flow characteristics were required to produce the structural changes throughout the brain tissue. When the perfused brain was further dissociated into a cell suspension by mincing and sieving, isolated neurons were obtained, the majority of which retained the proximal parts of their processes. A novel feature of these neurons was the retention of synaptic boutons on the plasma membrane. Presynaptic terminals with mitochondria and vesicles as well as pre- and postsynaptic membranes and densities were observed on the isolated neurons. The neurons were fractionated to 90--95% purity using discontinuous Ficoll density gradient centrifugation with a liquid fluorocarbon as cushion. Highly purified, viable cerebral neurons retaining synaptic complexes are thus available in bulk for neurobiological studies.     

Marital disputes and treatment outcome in depressed women

This study assesses the relationship between improvement of marital disputes and other treatment outcomes. The subjects are 76 women who received 8 months of individual psychotherapy as part of a controlled clinical trial testing the efficacy of various outpatient maintenance treatments for depression. The presence or absence of marital disputes was rated at the beginning of treatment, and improvement or failure to improve was noted at the end of treatment. Three marital groups (no marital disputes, marital improvement, and no marital improvement) were compared in terms of symptom status and overall social adjustment at the beginning and end of treatment. The results reveal that depressed women with marital disputes at the onset of treatment have a generally poorer treatment outcome than women who are single or in supportive relationships. Only a minority of women with marital disputes effected an improvement in the relationship during the course of treatment. Those who improved their marriages also experienced an improvement in depressive symptoms, while those whose marriages did not improve experienced less improvement or a worsening of symptoms.     

Jaw-wiring for obesity

Fourteen of nineteen self-referred obese women were treated for weight reduction by jaw-wiring. Most were immature, passive-dependent or passive-aggressive personalities. Only one-third of the group completed the study, which was six months in length. All lost weight initially, but about two-thirds later regained some weight. At first all responded with enthusiasm, but later most felt discouraged and found jaw-wiring difficult to accept. Only two patients derived significant benefit. There were no dental complications. Jaw-wiring appears to be a safe but ineffective means of controlling weight, especially if applied to patients with poor motivation and immature personalities.     

Quantifying lifetime risk of psychiatric disorder

Lifetime risk for a particular psychiatric disorder is the proportion of a given population that would develop that disorder if no unaffected individual died prior to some specified age. Since it is impossible to quantify risk beyond some normal or maximum lifespan, lifetime risk can only be meaningfully considered “as of some particular age t”. In this paper lifetime risk to age t (LTR_t) is defined in terms of a hazard function and its relationship to other possible measures of risk is examined. The commonlly used morbidity risk ratio (MRR_t) is shown to differ from LTR_t; the value of MRR_t depends not only on the hazard function for onset of the disorder of interest but also on mortality among unaffected individuals. LTR_t, MRR_t and two other measures of risk are also compared in terms of the nature of the sample data that are required in order to estimate them. A numerical example illustrating estimation procedures is discussed in detail.     

Estrogen formation in the developing rat brain: sex differences in aromatase activity during early post-natal life

Aromatase activity in the brain of the rat was measured during perinatal development and in adulthood. In pooled hypothalamus, preoptic area, septum and amygdala (HPAS), estrogen formation per gram protein increased between embryonic days 15 and 19 and then declined. Results for males and females were indistinguishable, except for post-natal days 1 and 2 and 3 and 4 when estrogen formation was significantly higher in the male. Aromatization was not convincingly demonstrated in cerebral cortical tissue at any time studied. Regional dissection of the HPAS in 2-3 day post-natal animals revealed significant sex differences in aromatase activity in the corticomedial amygdala and the hypothalamus, but not in the preoptic-septal region or the remainder of the amygdala. These results are consistent with the idea that perinatal androgen secretion in the male rat may stimulate estrogen formation in the brain.     

Factitious illness: A multidisciplinary consideration of ethical issues

Case histories of two women with surreptitious self-induced vomiting were presented to a multidisciplinary conference which included representation from the disciplines of psychiatry, internal medicine, law, nursing, and anthropology. Ethical issues including the topics of confidentiality, responsibility to the patient, and the relationship to third party payers were discussed. The medical and legal viewpoints were frequently at variance, in unexpected ways.     

Relating literature to medicine: Blending humanism and science in medical education

There is a need to add a humanistic component to scientific aspects of medical education. It must be adequately organized and evaluated to compete successfully in an already overcrowded curriculum. This study reports an educational experiment involving three consecutive freshman classes in a new community-based medical school. A specialist in literature and a psychiatrist teach a two-week course to first-year students in which themes and topics relevant to medical practice are explored through selected readings and patient interviews that are integrated into daily experiential groups. The outcome of the course and similarities and differences between years are explored inrelation to group sessions, class composition, reading assignments, and patient interviews.     

Hypnosis with medical/surgical patients

The role of hypnosis as a tool in the treatment of problems commonly encountered among medical and surgical patients is examined. Hypnosis is defined as a change in state of mind far more akin to intense concentration than sleep. Diagnostic implications of differences in hypnotic responsivity are explored, and scales suitable for use in the clinic are examined. Uses of hypnosis in treating anxiety, pain, childbirth, psychosomatic symptoms, seizure disorders, neuromuscular dysfunction, and habits are described and evaluated. The phenomenon of hypnosis is presented as a means of exploring the mind-body relationship in a controlled fashion, providing information of diagnostic importance while at the same time allowing hypnotizable patients to intensify their concentration and interpersonal receptivity in the service of a therapeutic goal.     

Lithium treatment in a very elderly nursing home population

We studied the result of long-term lithium therapy in 12 very elderly nursing home residents. Good treatment results occurred most often when the diagnosis was bipolar disorder-manic or manic episode. Many of the side effects encountered were well known (tremor, ataxia, lethargy, disorientation, and hypothyroidism) and were easily reversible. The development of significant sinus bradycardia in 25% of the group raised a question concerning lithium-induced cardiotoxicity. Nephrotoxicity was not apparent in spite of very advanced age and long duration of therapy. We conclude that the question of cardiotoxicity is important and requires further study. Other side effects were not sufficiently serious to contraindicate the use of lithium therapy in appropriately selected and well-monitored elderly patients.     

Grief: A mediating process between a loss and illness

Conjugal bereavement has ranked high among other losses and life events when rated by adults on a continuum of life stress.^1,2 A review of the literature on the mortality of bereaved spouses subsequent to a conjugal loss leads to the conclusion that such a loss is, in fact, a severe stressor and a significant public health problem.³There remains the question of how this loss affects the bereaved spouse. Loss of a conjugal partner is a well defined event that is followed by complex emotional, behavioral, and social reactions. At what point and in what manner grief itself becomes pathologic or leads to medical complications is not established. Yet, it is reasonable to postulate that the behavioral and physiologic responses of the organism to a conjugal loss may lead to complications. For this reason, the emotional, behavioral, and social changes produced by conjugal loss hold considerable interest as mediating variables in explaining the high risk of the bereaved.This paper will review modern thinking about the process of grief. It will relate that knowledge to several postulated pathogenetic mechanisms that lead to illness and death among the widowed. The goal is to determine if our knowledge of grief as a mediating process will enhance our understanding of the etiology of the psychological or bodily illness that may occur after a conjugal loss.