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.     

Are VEP abnormalities in optic neuritis (ON) dependent on plaque size? A reappraisal of the physiopathology of ON based on improved MRI and multiple-lead recordings

Twenty patients with optic neuritis (ON) described in the previous study [23] underwent serial VEP recordings (using multiple electrode arrays) for two years. The VEPs could be correlated with the lesions revealed by MRI, Visual Field tests and other clinical findings. On the basis of their scalp distribution, they were classified as really delayed VEPs and pseudo-delayed VEPs.Real delays could be recorded at the onset of ON or shortly afterwards, and their appearance indicated the recovery of visual function and a good prognosis.Pseudo-delays indicated an alteration in the visual field and, unless a breakthrough of normal or delayed components appeared in the first three months, following acute ON, indicate a poor prognosis for the recovery of visual function.The pseudo-delayed VEPs were mainly observed in patients with longer lesions revealed by means of LTE-STIR MRI [23]; there was no correlation between VEP latency and the length of plaques.Our findings contradict previous theories on the timing of conduction alterations in ON and multiple sclerosis.

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Sommario I 20 pazienti affetti da Neurite Ottica (NO), descritti nel precedente lavoro [23] sono stati sottoposti a registrazioni seriali multicanali dei Potenziali Evocati Visivi (PEV), per un periodo di 2 anni dall'esordio della NO. I PEV potevano correlare con le lesioni evidenziate con la Risonanza Magnetica, con le alterazioni campimetriche e con altri reperti clinici. Basandoci sulla loro distribuzione in mappa, i PEV sono stati classificati come realmente ritardati e pseudo-ritardati. PEV realmente ritardati potevano essere registrati all'esordio, o precocemente dopo l'episodio di NO, e la presenza del ritardo stava ad indicare un recupero della funzione visiva e, quindi, una prognosi fausta.Gli pseudo-ritardi indicavano un'alterazione del campo visivo a prognosi non favorevole per un recupero della funzione visiva, a meno che entro i primi 3 mesi dalla NO si fosse verificata una ricomparsa di componenti normali o ritardate.Gli pseudo-ritardi erano rilievi caratteristici nei pazienti con lesioni maggiormente lunghe alle immagini LTE-STIR MRI [23]. Nessuna correlazione è stata trovata tra latenza dei PEV e lunghezza delle placche.I nostri rilievi sono in disaccordo con precedenti teorie relative ai tempi di instaurazione-recupero delle alterazioni di conduzione nella NO e nella Sclerosi Multipla.

     

Somatosensory evoked potentials in patients with thalamic lesions

Summary Somatosensory evoked potentials (SEPs) were recorded in 20 patients with thalamic lesions confirmed by CT (10 with infarction, 10 with haemorrhage). The changes in SEP configuration are discussed in their relationship to clinical symptoms. Four types of SEP abnormality produced by thalamic lesion are distinguished: (1) FF type, (2) N20/P23 dissociation type, (3) N18/N20 false shift type, and (4) reduced early component type. It was shown that clinically similar lesions might produce different SEP patterns.     

Visual pattern evoked responses and blink reflexes in assessment of MS diagnosis

Summary VEPs were measured after pattern reversal in 135 MS patients and 30 control subjects. Neurological findings were documented in a standard manner. An extensive ophthalmological examination of all subjects was part of the study. The latency of P₂ was abnormally delayed in 82% of the definite, in 60% of the probable and in 65% of the possible MS groups respectively. The VEP was more often delayed in relation to ophthalmological disturbances. Changes in the MS classification had to be made in more than 10% of the patients, due to delay of VEP latency. These were patients with a spinal form of MS, which is known to create diagnostic problems.Optically and electrically evoked blink reflexes were recorded in 107 MS patients. All patients with mesencephalic lesions had delayed responses of the optically evoked reflex. 74% of the patients with caudal brainstem lesions had delayed latencies of the components of the electrically evoked blink reflex. The blink reflex was delayed in 18 additional patients without brainstem signs. The possibility of delineating clinically silent brainstem lesions by investigating blink reflexes is discussed.Supported by the Deutsche Forschungsgemeinschaft (Dr. Fischer Bosch-Stiftung).     

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.     

Cognitive functioning in female patients with 21-hydroxylase deficiency

The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11–41 yrs) and 13 of their healthy sisters (13–31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in full IQ (p<0.05) and subtest scorings for Information, Similarities, and Picture Completion (p<0.05–<0.10). SW patients displayed more masculine behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.

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Zusammenfassung 27 Patientinnen mit dem Adrenogenitalen Syndrom (AGS) (11–41 J.) und 13 ihrer Schwestern (13–31 J.) wurden hinsichtlich intellektueller Funktionen verglichen (Kurzformen von HAWIK, HAWIE). Im Unterschied zu den meisten früheren Untersuchungen wurden weder für Patientinnen (mean: 99.0) noch für Kontrollen (97.7) über dem Durchschnitt liegende IQ-Werte gefunden. Im Gegensatz zur Literatur unterschied sich die Teilgruppe der Salzverlust-Patientinnen (SW)>16 J. (N=6, mean: 111.5) von den Schwestern und den Patientinnen mit einfachem AGS (SV) im Gesamt-IQ (p<0.05) und in den Untertests Allgemeines Wissen, Gemeinsamkeiten und Bilderergänzen (p<0.05–<0.10). SW-Patientinnen hatten signifikant männlichere Verhaltensmuster gezeigt (vs. SV-Patientinnen und Schwestern), die auf differentielle Hormoneffekte pränatal bezogen worden waren. Es fanden sich aber keine klaren Zusammenhänge zwischen IQ-bzw. Untertest-Resultaten und Ergebnissen für Geschlechtsrollenverhalten.

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Résumé Le fonctionnement cognitif de 21 patientes avec une hyperplasie congénitale surrénale (âgée de 11 à 41 ans) et de 13 de leurs soeurs saines (13–31 ans) a été comparé au moyen de versions raccourcies de l'échelle de Wechsler appropriée à l'âge. En contraste avec d'autres études, il n'a été retrouvé un Q.I. plus haut que la moyenne ni pour les patientes (moyenne 99.0) ni pour leurs soeurs (moyenne 97.7). De façon inattendue, et en contraste avec d'autres études, le sous-groupe de patientes déprivées en sel (SW)>16 ans (N=6), moyenne score: 111.5) différait de leurs soeurs aussi bien en tant que patientes présentant des signes de virilsation (SV) pour le Q.I. complet (p<0.05) et les scores aux subtests d'information, de similarité et de complément d'images (p<0.05–0.10). Les patientes déprivées en sel (SW) montraient un comportement plus masculin (vs. SV et leurs soeurs) qui en retour était relié aux influences hormonales prénatales différentes. Il n'y avait pas de relation de différences nettes entre les résultats aux sous-tests cognitifs du Q.I. et le comportement de genre.

     

Neuroectodermal tumors of the peripheral and the central nervous system share neuroendocrine N-CAM-related antigens with small cell lung carcinomas

Summary The current study describes the presence of neuroendocrine antigens of peripheral and central neural tumors using eight monoclonal antibodies raised to small cell lung carcinoma (SCLC), which recognize neural/neuroendocrine or neural antigens, as defined by their reaction pattern in normal tissues and tumors. At least five of them recognize different epitopes of the neural cell adhesion molecule (N-CAM). It was found that all of 12 neuroblastomas, 2 ganglioneuroblastomas and 4 ganglioneuromas as well as 23 central primitive neuroectodermal tumors, 13 astrocytomas and 4 ependymomas share neural/neuroendocrine antigens (as defined by the anti-N-CAM antibodies Moc-1,-21,-32,-52 and-191) with SCLC. The neural/neuroendocrine antigen defined by Moc-171 was also found in all peripheral tumors, but only in further differentiated central tumors. Non-N-CAM related neural antigens (as defined by Moc-51 and-172) were found only in better-differentiated peripheral and central tumors, but they could be demonstrated in all three medulloblastoma cell lines studied. In addition, the antigen defined by Moc-51 was demonstrated in an immunoblot of a neuroblastoma cell line. Antibodies recognizing epithelia antigens of SCLC and other epithelia and their tumors (Moc-31 and-181) were non-reactive. It was concluded that these findings give further support for a relation between neural and neuroendocrine tumors and that some of the antibodies may be useful for the detection of differentiation in neural tumors. Antibodies with an epithelia recognition pattern may serve to distinguish neural from neuroendocrine tumors.Supported by NIH grant CA 36245 W.M.M. was a Fullbright scholar     

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.     

Positive practice overcorrection combined with additional procedures to teach signed words to an autistic child

The present study evaluated the effectiveness of using positive practice over-correction in combination with other techniques to teach two manual signs (milk and cookie) to an autistic boy. This boy had a great deal of difficulty informing any type of discrimination and often became confused in learning the most simple simultaneous discrimination. Intervention primarily consisted of positive practice overcorrection in which the subject was physically guided to form a required hand sign 10 times when he responded incorrectly and was positively reinforced when he signed correctly. The study used a changing criterion within a multiple-baseline design across responses. The results indicated that overcorrection plus positive reinforcement was effective in teaching one sign (milk), however, and added contingent exercise (having to stand up and sit down 10 times for an incorrect response) was required to teach the second sign (cookie). Once the two signs were learned to a criterion level, it was a relatively easy task for the subject to respond correctly with the signs in a matching-to-sample task.     

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.     

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.     

Does social deprivation during gestation and early life predispose to later schizophrenia?

Summary We employed a case-control study design to investigate whether schizophrenic patients differed from non-psychotic psychiatric patients in terms of place of birth and paternal occupation. Cases were first-contact schizophrenic patients ascertained from the Camberwell Cumulative Psychiatric Case Register. Controls were the next (non-psychotic) patient on the Register matched for age and sex. In comparison with controls, cases were more likely to have: (1) been born in the deprived innercity Camberwell catchment area (odds ratio 2.3), and (2) had fathers who had manual as opposed to non-manual occupations (odds ratio 2.1). The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.     

Schizophrenia suspecta

Summary We investigated what makes a Schneider-oriented psychiatrist diagnose suspected schizophrenia yet nevertheless stop short of a definitive diagnosis of schizophrenia. We compared the case records of 1208 patients hospitalised for schizophrenia for the first time in their life and all patients with discharge diagnosis suspected schizophrenia (n = 358).We found that the main factors for making the diagnosis of suspected schizophrenia are, as when using Bleuler's concept, intrasymptomatological ones, i.e. type, structure and constellation of symptoms. Hereby the non-committal character of the expression symptoms in the wider sense (Schneider), i.e. disorders of thought, of affect and behaviour, is of particular importance. Psychotic productive symptoms in the form of delusions or hallucinations alone are not always sufficient to confirm the diagnosis of schizophrenia. Even first rank symptoms cannot establish the diagnosis schizophrenia if certain factors reducing their pathognomonic value are present.Elaboration of the computer programme: Dr. rer. nat. E. Godehardt, Cologne University Institute of Medical Documentation and Statistics (Director: Prof. Dr. V. Weidtman)     

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.     

Assessment of complicance-related attitudes in psychiatry

Summary In a study of 118 psychiatric patients two questionnaires of similar content that are supposed to predict compliance with pharmacotherapy in psychiatry were examined, COSS and KK-Skala. These questionnaires assess the patient's attitudes towards his illness, pharmacotherapy, and the physician. Patient compliance was judged by the treating physicians. The results of discriminant analyses indicated that about two thirds of the patients were correctly classified into compliant and moderately or not compliant (as judged by the physicians) by means of COSS and KK-Skala, respectively. It is a matter for further research whether these results reflect in fact moderate associations between patient attitudes and compliant behavior or are due to limitations of the questionnaires and of the study design.     

Analytic work with LSD 25

Summary In this paper, work with LSD 25 as an aid to analysis has been described. Of particular interest, has been theseeming unpredict-ability and arbitrariness of experiences elicited by the drug, and an attempt has been made at finding the determining factor in emerging material. This appears to be the selection of complementary and compensatory unconscious contents; selected in accordance with Jung's idea of the psyche as a self-regulating system, striving toward wholeness.Clinical material has been grouped in five categories, in which different aspects of complementation are illustrated. Some questions of transference and resistance in connection with LSD treatment have been discussed; and ideas about typical mechanisms in certain categories of neuroses, as suggested by the patient's response to the drug, have been put forward.This report is based on a paper read at a meeting of the (British) Society of Analytical Psychology in 1957.     

Assessing the potential of change in institutions

The present article discusses the importance of evaluating the strengths and weaknesses of key institutional personnel prior to attempting program innovations. The importance of such individuals in making or breaking effective programs is emphasized, and various key hospital staff members are described. A simple evaluation process is discussed with the purpose of better anticipating problem areas in program development. It was concluded that in some cases, project implementations should not be attempted when assessed personnel problems appear capable of seriously limiting the effectiveness of a program.     

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.     

Intuition VI. The psychodynamics of intuition

Summary The psychodynamics of intuition are considered from the viewpoints of psychoanalysis and structural analysis.⁸ An example is offered to illustrate the fact that ethical as well as logical thinking can interfere with the intuitive process. Defenses against scopophilia, the need to be alert, and oral receptivity seem to give rise to a resistance against the whole topic. Conversely, intuitive faculties are probably most readily available to individuals who have successfully sublimated scopophiliac, paranoid, and oral receptive tendencies. Sources of error, and the role of the intellect in clinical intuition, are discussed.     

An ultrastructural analysis of remyelination following segmental demyelination

Summary Electron microscopic observations were made of early remyelination after segmental demyelination in experimental allergic neuritis (EAN) and experimental diphtheritic neuropathy. In EAN 71% of axons which had been demyelinated were invaginated each within a single Schwann cell; remyelination associated with this cellular relationship was in accordance with the spiral myelin concept, 29% of demyelinated axons in EAN were initially enveloped each by several Schwann cell processes and the associated mechanism of remyelination was by tunication resulting in a transient irregular distribution of myelin lamellae around the axon circumference. In diphtheritic neuropathy regeneration more closely paralleled development in ontogeny. 88% of demyelinated axons were invaginated each within one Schwann cell, only 12% of axons were each enveloped by more than one Schwann cell process. Early remyelination by tunication was not observed in diphtheritic neuropathy. Additional loosely associated Schwann cell processes lying within the old Schwann cell basement membrane occurred frequently in both experimental conditions. Schmidt-Lanterman clefts, redundant myelin, and desmosomes were observed in the sheaths of incipient remyelination.