Self-injurious behaviour before and after deinstitutionalization

The deinstitutionalization movement is presently spreading in Europe. Studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) have been inconclusive. The present paper focuses on people without self‐injurious behaviour (SIB) who developed SIB after deinstitutionalization. The present authors studied individual and environmental characteristics before and after deinstitutionalization to look for factors associated with the development of SIB which could also be possible intervention points for preventive action. All those individuals in an institution for people with ID who did not have SIB before deinstitutionalization were included in the present study. The individuals who developed SIB after deinstitutionalization (n = 15) formed the study group (group A) and those who did not (n = 53) comprised the control group (group B). The population was examined both before and after deinstitutionalization. As far as possible, the same methods were used at both occasions. The covariates were both individual (e.g. mental health, behaviour disturbances and behaviour deficits) and environmental (e.g. caretaker education, caretaker:patient ratio, housing and leisure activities). Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults, which was filled in by the caretakers. In 1987, the people in group A who acquired SIB had lower developmental quotients, used wheelchairs more often and had trouble with moving around without help. They also had a greater frequency of epileptic seizures, and hearing and communication impairment. In 1995, there were only minor environmental differences between groups A and B. There were significantly more individuals involved in the rotation period and more unskilled caretakers working with the people in group A than group B. The present authors found no differences between the two groups on variables such as global mental health and behaviour disturbances, or in the use of neuroleptics before or after deinstitutionalization. Groups A and B did not show differences in behaviour disturbances or psychiatric disorders in 1987. In both 1987 and 1995, there were no differences between groups A and B on variables such as accommodation, caretaker:patient ratio, the number of caretakers involved in direct care, the caretakers' education, or the time spent in structured activities before and after deinstitutionalization. The individual characteristics indicating that a person may acquire SIB are behaviour deficits which are suggestive of central nervous system dysfunction or damage, even if the results are inconclusive. The development of SIB may also be facilitated by communication deficits or by reinforcement of a incidentally occurring SIB if the staff includes many unskilled caretakers in the rotation period.     

Heart-focused anxiety before and after cardiac surgery

OBJECTIVE: We investigated the degree and course of heart-focused anxiety (HFA) in patients with cardiac diseases before and after cardiac surgery. METHODS: We examined 90 patients undergoing coronary bypass, valve replacement, or combined surgery before surgery, 6 weeks after surgery, and 6 months after surgery. Patients completed the Cardiac Anxiety Questionnaire (CAQ), which assesses heart-focused fear, attention, and avoidance, and a set of other questionnaires assessing general anxiety, depression, and quality of life. Data were compared with an age- and sex-controlled contrast group of 72 orthopedic patients with no history of cardiac disease. RESULTS: All dimensions of HFA were elevated in patients before surgery. CAQ-Fear was significantly reduced 6 weeks after surgery and at 6-month follow-up. CAQ-Avoidance was stable after surgery but declined on follow-up, while there was only a statistical tendency indicating reduction in CAQ-Attention. Approximately 20% of patients continued to experience clinically elevated levels of HFA at 6-month follow-up. Furthermore, we found decreases in global anxiety and depression, and an increase in quality of life after surgery. CONCLUSIONS: In contrast to global psychosocial indicators, the more specific assessment of HFA may help identify individuals with elevated levels of HFA who might benefit from interventions to help them adjust to the effects of surgery and lingering cardiac problems.     

Somatoform disorders: before and after DSM-III

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.     

EMG before and after cervical anterior discectomy

Introduction - In patients with cervical root syndromes, the relation between clinical findings and EMG results, the value of the registration of the H-reflex latency of the flexor carpi radial muscle (HFCR) and the rate of recovery of EMG abnormalities following surgery are unclear. Methods -In 68 patients with cervical radicular syndromes caused by intervertebral disc lesions, EMG was made shortly before anterior cervical discectomy and four months later. EMG consisted of needle myography and bilateral determination of the HFCR. Results - Results of HFCR were unrelated to findings on needle myography. Preoperative EMG abnormalities were related to more severe clinical and myelographic findings. A preoperative abnormal HFCR correlated with good clinical outcome. No relation was found between the clinical outcome and EMG-findings during follow-up. Conclusion - Determination of HFRC is a useful EMG-test, but further comparison to tendon reflexes is necessary. EMG identifies patients with more severe root lesions, but cannot be used for evaluation of persistent complaints within the first half year following surgery.     

Vascular risk factor awareness before and pharmacological treatment before and after stroke and TIA

Background and purpose:  Educating the public to screen for vascular risk factors and have them treated is a major public health issue. We assessed the vascular risk factor awareness and frequency of treatment in a cohort of patients with cerebral ischaemia.
Methods:  Data on awareness and pharmacological treatment of vascular risk factors before hospital admission of patients with confirmed ischaemic stroke/transient ischaemic attack (TIA) were analyzed. A follow-up questionnaire assessed the frequency of treatment 1 year after discharge and assessed non-adherence to antithrombotic medication.
Results:  At time of stroke/TIA, individual awareness regarding existing hypertension, diabetes, hyperlipidemia and atrial fibrillation (AF) was 83%, 87%, 73% and 69% respectively ( n  = 558). Pharmacological treatment for hypertension, diabetes, hyperlipidemia and AF was being administered in 80%, 77%, 37% and 62% of patients aware of their conditions. The follow-up was completed by 383 patients (80% recall rate): of the patients with hypertension, diabetes, hyperlipidemia and AF, 89%, 78%, 45% and 86% were receiving risk factor targeted medication. This represents a significant increase concerning AF and hyperlipidemia. Non-adherence to recommended antithrombotics (15%) was higher in patients who had had a TIA.
Conclusions:  All risk factors leave room for improvement in screening and treatment efforts. Adherence to treatment is higher for hypertension and diabetes than for hyperlipidemia. Education efforts should bear in mind less well recognized risk factors.     

PET before and after surgery for tumor-induced parkinsonism

We studied a patient with left frontal meningioma and right-sided parkinsonism that resolved completely after operation. PET scans were performed before and after operation to measure regional cerebral blood flow, oxygen extraction ratio, oxygen utilization, and blood volume. A specific pattern of severe functional changes returned to normal postoperatively. The data suggest increased local tissue pressure due to edema, causing a functional disorder in the left basal ganglia that gave rise to reversible contralateral parkinsonism.     

Postural stability before and after hyperbaric oxygen treatment

OBJECTIVE: The purpose of this study was to determine the effect of hyperbaric oxygenation (HBO) on postural stability in healthy volunteers. The study was performed in accordance with treatment protocols for divers' decompression sickness and carbon monoxide poisoning. METHODS: Twenty-one healthy male divers, aged 31 +/- 6.88 years (mean +/- SD), were tested with quantitative Romberg's test before and after HBO (90 min in a pressure chamber at an ambient pressure of 253 kPa, approximately 15 m of sea water, breathing pure oxygen). The quantitative Romberg's test is a calculation of the average sway for 50 s. RESULTS: No difference was found between sway before and after the HBO (P < 0.05), i.e. we were unable to show that the results of quantitative Romberg's test are affected by HBO. Thus, the quantitative Romberg's test may be a valuable tool in evaluating patients with decompressions sickness, carbon monoxide intoxication and other neurological diseases normally treated with HBO.     

Ocular torsion before and after 1 hour centrifugation

To assess a possible otolith contribution to effects observed following prolonged exposure to hypergravity, we used video oculography to measure ocular torsion during static and dynamic conditions of lateral body tilt (roll) before and after 1 h of centrifugation with a G_x-load of 3 G. Static tilt (from 0 to 57° to either side) showed a 10% decrease in otolith-induced ocular torsion after centrifugation. This implies a reduced gain of the otolith function. The dynamic condition consisted of sinusoidal body roll (frequency 0.25 Hz, amplitude 45°) about an earth horizontal and about an earth vertical axis (respectively, “with” and “without” otolith stimulation). Before centrifugation the gain of the slow component velocity (SCV) was significantly lower “with” otolith stimulation than “without” otolith stimulation. Apparently, the contribution of the otoliths counteracts the ocular torsion response generated by the semicircular canals. Therefore, the observed increase in SCV gain in the condition “with” otolith stimulation after centrifugation, seems in correspondence with the decreased otolith gain in the static condition.     

Cerebrospinal fluid lymphocyte subpopulations before and after pneumoencephalography

Pneumoencephalography (PEG) did not cause significant changes in cerebrospinal fluid (CSF) lymphocyte subpopulations. Sheep erythrocyte rosette-forming cells (E-RFC) percentage was higher in CSF before (84.0) and after (81.1) PEG than in blood (63.7). The percentage of complement receptor bearing cells was significantly higher in CSF (65.3 and 64.6) than in blood (33.1). Fcγ receptor bearing cell levels were only slightly higher in CSF (35.6%) than in blood (31.5%), and increased after PEG to 43.9%. The high percentages of both E-RFC and complement receptor bearing cells in CSF, suggest that a considerable number of these cells bear both receptors, in contrast to blood.     

Interhemispheric EEG coherence before and after partial callosotomy

Measures of interhemispheric EEG coherence during REM and NREM sleep reflect the functional connectivity of the right and left hemispheres mediated by the corpus callosum. Surface recordings of interhemispheric coherence in two patients reflected fairly accurately the degree of anatomical section produced by partial callosotomy. With further development, EEG coherence may prove useful as a noninvasive method for assessing interhemispheric integration under different physiological and experimental conditions.     

Tranquilizer use before and after coronary bypass operation

High rates of tranquilizer use in coronary disease have been previously reported. In patients being evaluated for coronary disease, tranquilizer use has been related to myocardial infarction, angina pectoris, neurotic traits, employment and the use of cardioactive and other medications. In this study, responses of 1046 male patients to a questionnaire assessing biological, psychological and social variables before and after coronary bypass surgery were related to tranquilizer use. The effect of CABG was to decrease tranquilizer use. Tranquilizer use prior to coronary bypass operations was related to neuroticism, myocardial infarction and taking cardiac and analgesic medication. Similar findings were noted after coronary bypass operations except that angina pectoris was added as a contributor to tranquilizer use. The multivariate analysis tended to confirm the univariate findings, except that neurotic traits did not make an independent contribution. These results indicate that in patients undergoing coronary evaluations, cardiac disease variables other than coronary atherosclerosis determine tranquilizer use. Neurotic traits play a secondary role. Relief of angina pectoris appears to be particularly important in reducing tranquilizer use. The finding of angina pectoris after coronary bypass operation may have special significance for the continuation of tranquilizer use.     

Health care contacts before and after attempted suicide

Objective The prevalence and timing of contact with health care predicting and after a suicide attempt are not well known. This study systematically investigated the pattern of all health care contacts both before and after attempted suicide. Methods All consecutive 1,198 suicide attempters treated in hospital emergency rooms in Helsinki during a 12-month period were identified. Data were gathered on all health care contacts 1 year before and after the index attempt. Results The vast majority of the suicide attempters had contact with health care during the 12 months before and after the index attempt. However, half were without a treatment contact during the final 30 days before the index attempt and one-third in the 30 days following the attempt. Suicide attempters who were not referred to aftercare, did not suffer from a previously recognised major mental disorder, were male, or made non-violent attempts were less likely to be receiving treatment after the attempt. Conclusion Although most suicide attempters have contact with health care within the year before and after the parasuicide, far fewer actually have a treatment contact at the time of the attempt. Accepted: 20 September 2001