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.     

The dexamethasone suppression test and thyroid stimulating hormone response to TRH in RDC schizoaffective patients

Summary The dexamethasone suppression test (DST) brought to light significantly more non-suppression of cortisol secretion in RDC schizoaffectives of the depressed (89%) and of the manic type (67%) than in RDC schizophrenia (25%). However, only in the RDC endogenous depressives, whose pathological DST rate was 57%, was the thyroid stimulating hormone (TSH) response to thyrotrophin releasing hormone (TRH) found to be significantly blunted. It is suggested that the DST results can be interpreted as partially validating DSM-III's wide major affective disorder since this concept also encompasses all cases with mood-incongruent psychotic features. Furthermore, it is hypothesized that the coupling of DST non-suppression and TSH blunting may be important for defining a valid depressive subgroup within these extended clinical boundaries for affective illness.     

Types of authority and two problems of psychiatric wards

This paper concerns the relationship between authority structures and two problems reported in the literature as common to milieu or therapeutic community wards. Psychiatric wards with rational-legal and charismatic authority structures are found more likely to experience mood and morale swings on the part of patients and staff and to spend excessive time and energy changing ward rules.     

Responsibilities and training needs of mental health administrators

This paper reports findings of a needs assessment in the area of training programs for senior mental health administrators. Questionnaires (N=530) were sent; 169 to county and regional state mental health administrators; 331 went to community mental health administrators. The response rate was 43%. Thirty-four percent of the public sector respondents listed general administration as their first topic; fiscal issues were listed by 19%; 18% listed personnel administration first. Second topics chosen for training by the public sector administrators were general administration (17%), financial management (24%), and personnel (20%). As their first topics of choice for future training, 37% of the community mental health administrators selected general administration areas, 27% selected financial management, and 10% personnel. Training for mental health administrators has the potential for substantial enrichment through the design and implementation of carefully planned programs. Results from this needs assessment show the continued strong need for such training.     

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.     

An open-system approach to the mental health treatment of violent offenders

Conclusion The New York State Office of Mental Health has attempted to provide mental health treatment to convicted people at a level in keeping with acceptable community standards (Joint Commission on Accreditation of Hospitals). Since April, 1977, this has been provided through a network of services which have provided both short-term inpatient psychiatric services and a full range of community services within the domain of the state's corrections system. To date, the system has been successful in providing services at an acceptable professional level, controlling often violent individuals, and meeting all of the inpatient hospital's security objectives. Most important, C.N.Y.P.C. has demonstrated the efficacy of a treatment model of organization for meeting both security and treatment needs. In addition, an open system approach to evaluating and modifying the C.N.Y.P.C. organization has been a helpful approach. These models are recommended to others in the field as fruitful and worthy of further investigation.     

Birth Patterns in Mentally Retarded Autistic Patients

Some studies claim to have shown that, compared to the general population, autistic children are born more often in the spring. The current study sought to replicate this finding in a large Dutch sample of mentally retarded autistic patients. Birth data for 1,031 patients with a diagnosis of Infantile Austism or other psychoses with origin specific to childhood were compared to those of the Dutch national population. Separate analyses were performed on diagnostic subgroups (i.e., infantile autism vs. other psychoses with origin specific to childhood), gender, and intelligence. No evidence was found to suggest that autism is characterized by a deviant birth pattern.     

Konsiliarisch-psychiatrische versorgung eines Allgemeinkrankenhauses im zusammenhang mit stationärer kriseninterventio

Zusammenfassung In der vorliegenden Arbeit untersuchten wir die konsiliarisch-psychiatrische Versorgung eines großen Allgemeinkrankenhauses in Verbindung mit der Aufnahme auf eine Kriseninterventionsstation.Besonders interessierten uns Zusammenhänge zwischen der Häufigkeit des Auftretens von Suizidalität, psychiatrischer Krise und Übernahme von konsiliarisch-psychiatrisch untersuchten Patienten. Von insgesamt 6004 Patienten des Allgemeinkrankenhauses wurden in einem Zeitraum von 2 Monaten 227 (130 Frauen, 97 Männer) psychiatrisch untersucht. Am häufigsten wurden psychogene Reaktionen und Anpassungsstörungen (ICD-9: 308.0–309.9) mit 36.6%, am zweithäufigsten Suchterkrankungen (ICD-9: 303, 305.0, 304.0–304.9, 305.1–305.9) mit 26.8% diagnostiziert. In 90 Fällen lag eine psychiatrische Krise vor. Das Durchschnittsalter dieser Patienten war niedriger als das der Übrigen. Bei 91 Patienten fand man ein suizidales Syndrom. Es wurden 23 Patienten innerhalb und 7 nach Ablauf von 24 Std auf die Kriseninterventionsstation (KIS) übernommen.Mit Hilfe der Konfigurationsfrequenzanalyse (KFA) fanden wir 3 signifikante Typen: (1) Krisen-Patienten (N = 18), bei denen sowohl Suizidalitat, Krise und Ubernahme auf die Kriseninterventionsstation innerhalb von 24 Std zusammentraf; (2) typische Nicht-Krisen-Patienten (N = 111), bei denen keine der 3 Variablen bejaht wurde; (3) eine Gruppe (N = 48), die trotz des Vorliegens eines suizidalen Syndroms und einer aktuellen Krise nicht auf die KIS übernommen wurden.Bei der Gruppe von Patienten (N = 23), die eine angebotene Aufnahme auf die Kriseninterventionsstation ablehnten, bestätigte sich durch eine Nachuntersuchung nach Ablauf eines Jahres unsere Hypothese eines hohen Risikos.Die vorliegende Arbeit ist Herrn Prof. Dr. med. Wilhelm Feuerlein zum 65. Geburtstag gewidmet.     

Die Hamburger Schätzskala für Psychische Störungen nach Herzoperationen (HRPD)

Zusammenfassung An einer Stichprobe von 99 herzoperierten Patienten wurde zur Erfassung, Beschreibung und Klassifikation früh-postoperativer psychischer Störungen aus dem psychopathologischen Befundbogen des AMP/AMDP-Systems eine Kurzform (HRPD) entwickelt. Weitgehend mit Hilfe einer klassischen Itemanalyse wurde eine Auswahl von 36 Symptomen vorgenommen.Eine Faktorenanalyse dieser Kurzform ergab 8 Merkmalsfaktoren bzw. Syndromskalen: Desorientierung, Konzentrations-/Denkstörungen, paranoid-halluzinatorische Symptomatik, Angstsymptomatik, gehemmt-depressive Symptomatik, Hostilität, Kontrollverlust sowie Selbstaufgabe.Clusteranalytisch wurden 6 psychopathologisch verschiedene Patientengruppen gefunden: unauffällig, fast unauffällig, leichte psychoorganische Symptomatik mit Affektstörungen, schwere psychoorganische Symptomatik mit Kontrollverlust, Hostilität mit paranoid-halluzinatorischer und psychoorganischer Symptomatik, sowie delirante Symptomatik.Ein Vergleich der Ergebnisse der HRPD mit Syndrombeschreibungen anderer AMP/AMDP-Untersucher ergab zum Teil gute Übereinstimmungen, zum Ted aber auch deutliche Unterschiede, die am ehesten durch die besondere Situation herzoperierter Patienten bedingt sein dürfte.Vorform in englischer Sprache: HRPD = Hamburg Rating Scale for Psychic Disturbances     

Primary intracranial germ cell tumours

Summary A histological study has been made of a retrospective series of 17 primary intracranial germ cell tumours found in a collection of 3550 intracranial neoplasms (incidence of 0.48%). All, except for two differentiated teratomas (one extracerebral in a neonate and another in the lateral ventricle), were situated in the midline in persons aged 5 to 37 years (13 males, 4 females). 12 tumours were located in or originated from the (para)pineal region, two of them also invaded the hypothalamus, while three germinomas occupied the retrochiasmal (supra/intrasellar) region without pineal involvement. There were 11 rather pure tumours (7 germinomas, 4 teratomas of various differentiation) and six mixed neoplasms (2 germinomas with teratoid areas, 3 embryonal carcinomas containing elements of endodermal sinus tumour, choriocarcinoma and germinoma, and one teratocarcinoma with endodermal sinuses). Only one case showed prominent features of endodermal sinus tumour, but characteristic elements of this type were present in four other mixed tumours. All germinomas and germinomatous parts of mixed neoplasms showed an inflammatory reaction of varying intensity, in 6 cases associated with multinucleated giant cells, which may be related to the prognosis of these tumours (one patient with hypothalamic germinoma is alive 6 years after radiotherapy). The close structural similarities between the various types of intracranial and gonadal dysgerminomas and their frequent combination within the same tumour support the concept of a common histogenesis of germ cell tumours regardless of their site of origin. Difficulties of classification may arise from the rather frequent occurrence of mixed germ cell neoplasms.Dedicated to E. Frauchiger, on the occasion of his 70th anniversary.     

AMP-rated psychopathology in chronic alcoholics

Summary In a group of 39 alcoholics within a withdrawal process, the psychical situation was rated using AMP scales (Angst et al. 1969). Cluster analysis of the items rendered the following five-cluster solution: (1) aggressive-depressive patients, (2) less impaired persons, (3) slowed persons with diminished contact, (4) emotionally inadequate persons, (5) appealing depressive persons. These results are discussed with respect to other data from clinical history and diagnostic findings.Supported by Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 115, Teilprojekt C21     

Group psychotherapy and the mosaic adolescent society

Discussion of the influence of peer group mores and values on the adolescent patient's dysfunctional behaviors and treatment outcome. When the group therapist thinks peer, the group will focus on important issues such as inclusion, acceptance and awareness of the contrasting beliefs of the numerous peer subcultures within adolescent society. Strategies and approaches to create a therapeutic group milieu and structure are outlined to enable unwanteds to enter peer groups which support rather than impede the attainment of treatment goals. The need for leadership to be responsive to group members who have not experienced negentropic or functional systems is emphasized.     

Zum Problem der sogenannten Simultanagnosie

Zusammenfassung Bei einem Patienten mit einem vorzugsweise lobär verlaufenden hirnatrophischen Prozeß wurden die Störungen der Gesamtauffassung bildlich dargestellter Situationen (Simultanagnosie), die er neben Wortfindungsschwierigkeiten, Paraphasien, Dysgraphie, Dyskalkulie und Merkschwäche bot, einer Analyse unterzogen. Die gestörte Intellektualität der Wahrnehmung zeigte sich als ein Darniederliegen ihrer sinngerichteten Aktivität. Der Patient war nicht in der Lage, Strukturen in eine Wahrnehmungsgegebenheit zu bringen, war unfähig, eine Gestalt aufzubauen. Durch Störungen des Übersehens hatte die Überschaubarkeit des Wahrnehmungsfeldes gelitten. Bei schneller Absättigung des Sinnfindungsbedürfnisses kam es zum sinngemäßen Illusionieren innerhalb kurzschlüssig hergestellter Sinneinheiten. Die durch das Zurücktreten der Gestalt gegenüber der Physiognomie des Gegenstandes gekennzeichneten Zeichnungen des Patienten wurden den raumagnastischen Gestaltungsstörungen zugeordnet. Die Bedeutung der Störungen für das Leben des Patienten erhellen sein Verzicht auf Wahrnehmung und seine Unsicherheit gegenüber einer eindringlicher gewordenen, nicht mehr dahingestellten Welt.     

The validity of the Parental Bonding Instrument as a measure of maternal bonding among young Pakistani women

Abstract Background Parenting may have an important influence upon womens mental health in societies characterized by strong male gender preference. The Parental Bonding Interview (PBI) has been very widely used, but not yet formally evaluated in a South Asian context. The purpose of this pilot study was to assess the factor structure, face and concurrent validity of the PBI as an assessment of maternal bonding among young Pakistani women. Methods A total of 86 women, aged 20–35 years, were identified by door-knocking in two small catchment areas in Islamabad/Rawalpindi, one characterized by higher and one by lower socio-economic status. The PBI, the Clinical Interview Schedule Revised (CIS-R) and the Marital Satisfaction Scale (MSS) were each administered by a female interviewer in the respondents home. Results All women agreed to be interviewed privately, the response rate was 100%. Consistent with previous reports, PBI items loaded on two well-characterized internally consistent scales, care and overprotection. In a three-factor solution, the overprotection scale divided into two subscales previously characterized as Encouragement of Behavioral Freedom and Denial of Psychological Autonomy. Concurrent validity was supported by correlations in the expected direction between PBI care and overprotection subscales and both psychological morbidity (CIS-R) and marital satisfaction (MSS). Conclusions Pakistani women seem to perceive and respond to PBI items as addressing parental control or overprotection in a similar similar way to respondents from western Anglophone cultures. This study provides further support for the core construct validity of the PBI, and indicates a perhaps surprising degree of sensitivity to cultural nuances.     

Chronic mental hospital dependency as a character defense

Summary Prolonged hospitalization may cause atrophy of the patient's self-confidence, through excessive dependent gratifications of an oral-receptive nature. Hospital dependency results, and the possibility of discharge arouses such anxiety that the patient exhibits increased psychotic behavior with the effect of maintaining the hospital adjustment. Certain persons are excessively predisposed by previous experience to develop this dependency. The basic predisposition, however, is rooted in the normal course of childhood development.Hospitalization results in three major gains for the mentally disturbed patient: (1) primary relief from anxiety caused by instinctual impulses overwhelming the ego defenses; (2) secondary gains resulting from the socially-recognized sick role; and (3) the satisfactions of becoming an accepted member of a stable social system. If a mental patient is hospitalized, the danger of chronic dependency must be recognized and guarded against. Limited hospitalization is an important therapeutic modality, but as with other therapies, excess may cause secondary complications.Therapy of the chronic patient seeks first to convert dependence on the hospital as an ego-fortifying agent into a general confidence that help will be available if needed. Subsequently, the therapy aims to work through the secondary gains of illness byh viewing psychotic behavior as resistance to giving up the hospital. For the purpose of therapy, the chronic patient is viewed as environmentally-oriented, his behavior as based in present reality; and his active co-operation as essential to any change.The author, now program chief, mental health section, County Department of Public Health and Welfare, San Mateo, Calif., takes full responsibility for the contents of this paper, but wishes to acknowledge his intellectual debt to the staff of the Winter Veterans Administration Hospital, Topeka, Kansas.     

Styles of Case Management: The Philosophy and Practice of Case Managers

A great deal of discussion and research has gone into defining and clarifying the role of case manager (CM) for persons with severe mental illness. This three state survey examines the philosophy and activities of practicing CMs in an attempt to identify current styles of case management. A cluster analysis based on CM rankings of five CM functions suggested four styles of case management: supportive social worker, individual therapist, therapist broker, and community advocate. Overall, CMs rated supportive interventions as most important and formal psychotherapy as relatively unimportant. CM style was related to CM activity (i.e., distribution of effort). Differences between states are noted and implications for future research are discussed.     

Mitochondrial genotype and risk for Alzheimer’s disease: cross-sectional data from the Vienna-Transdanube-Aging “VITA” study

Summary. The Vienna Transdanube Aging (VITA) study searches for early markers of Alzheimers disease (AD) by examining the mental status in a community-based cohort of 606, 75-years old volunteers that are then related to various clinical and genetic analyses. To determine whether mutations in mtDNA are involved in expression of AD, the mtDNA of 79 control participants is screened for alterations by sequencing of hot-spot-regions. This study on mtDNA mutations has eliminated the influence of aging on the occurrence of mtDNA alterations by sequencing samples from persons at the age of exactly 75 years. Thus, our cohort reveals a snap-shot of mitochondrial sequences of elderly persons.So far, a high percentage (56%) of persons with known or unknown mutations in the fragments analyzed were found. These data will be compared in due time to a cohort of participants with proven late-onset AD.     

From state hospital to community psychiatry: Problems in two kinds of communities

A division of a decentralized state hospital has experienced a 75% drop in census since practicing community psychiatry. Soon, it is anticipated that two comprehensive mental health centers will develop in the area it serves and that the division will go out of business. In working with the natural community and the therapeutic community, recurrent problems have been noted. Examples are offered in the areas of communication, working toward a community mental health center, deciding who should come to the hospital, and in the particular problems of the therapeutic community, including the problems of change, hospital size, and training.Dr. Emde, formerly Chief of the Western Division.This paper was originally presented to the Colorado Psychopathic Hospital in September 1965. The author wishes to acknowledge the suggestions and criticism offered by Artie B. Jones, M.S.W., and David M. Kaplan, M.S.W., Ph.D.     

Public-academic linkages: A “linchpin” model

The linchpin model of collaboration between state mental health agencies and university training programs has been developed in two states. This paper describes the model, pointing out both strengths and weaknesses. Recommendations for institutions seeking this type of collaboration and persons who are in the collaborative role are provided.     

Corrective socialization in foster care of children

While the phrase, interminable foster care is becoming a damning cliché in the dialogues of juvenile courts and child welfare organizations, many children are growing up in foster homes. Human love must move us to approve and enrich these foster families; childhood is too brief and important to be knowingly allowed disapproved or impoverished experience. This paper describes the foster situation: families, children, and the involved professionals. It then presents a teachable developmental theory weaved from threads of numerous known theories, and describes a process whereby interminable foster experience was used therapeutically for a group of handicapped homeless children.