Biomedical subjects
Publications and source records attributed to E Walker.
A questionnaire was given to nurses in two hospitals, one general and one psychiatric. Answers to the questions revealed a lack of knowledge of the natural history of hepatitis B infection. There were no apparent differences between specialities or grades of nursing staff. Confusion of hepatitis A infection with hepatitis B infection was not the cause of incorrect answers.
The oral (PABA) pancreatic function test (PFT), the secretin-pancreozymin test and endoscopic retrograde pancreatography (ERCP) have been carried out in 32 patients with suspected chronic alcohol induced pancreatitis (CAIP) in order to evaluate which, if any, test was most likely to confirm the provisional diagnosis. Thirty one patients had changes of minimal (n = 6) moderate (n = 7) or advanced (n = 18) chronic pancreatitis on pancreatography, whilst one patient had a pancreas divisum. Eight hour urinary PABA excretion was significantly reduced in patients with moderate and advanced structural changes (p less than 0.001) and correlated significantly with all parameters of the PFT, although eight patients with an abnormal pancreatogram and pancreatic function test had a normal PABA value. The PFT was abnormal in 23 patients, but normal in five patients with an abnormal pancreatogram and low PABA value. Most patients with minimal change pancreatitis had a normal PABA test and PFT. We conclude that pancreatography appears to be the most sensitive method for detecting chronic pancreatic damage and for confirming a clinical diagnosis of chronic alcohol induced pancreatitis. Both the PFT and PABA test are useful confirmatory tests and whilst the PFT is slightly more sensitive for assessing pancreatic exocrine function, the PABA test is well tolerated and simple to perform. It may therefore be the complementary investigation of choice for this group of patients.
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This article combines a review and meta-analysis of research on IQ in schizophrenia, with emphasis on areas of convergence in the findings, as well as questions that remain to be answered. Taken together, the findings suggest that early-onset and adult-onset schizophrenia are associated with intellectual deficits across the lifespan. Preschizophrenic children, adolescents, and young adults perform below matched controls on a variety of standardized measures of intelligence. Significant IQ deficits are also apparent after the onset of the disorder. Moreover, IQ is positively related to several indices of prognosis, and, among hospitalized patients, there is negative within-subject covariance between intellectual performance and symptom severity. Although there is fairly consistent evidence that Verbal IQ is higher than Performance IQ among schizophrenic patients, a more specific pattern of subtest performance is not apparent. A central question raised by the results is whether IQ is an independently determined factor that can serve to mitigate the vulnerability of individuals who are constitutionally predisposed to schizophrenia, or whether intellectual deficit is one manifestation of the constitutional predisposition to the disorder. The findings also raise the question of possible sex differences in the developmental determinants of schizophrenia: Meta-analyses revealed that premorbid IQ deficits are more prevalent among males than females.
A method is presented for measuring the activities of case management in the care of the severely mentally disabled in catchmented public community mental health systems. Two variants of the method were compared, interviewing case managers and record abstracting. The methods were tested in two community mental health center (CMHC) sites, and appear to yield comparable results. The record abstract method seems workable for retrospective examination of case management in a CMHC system, and for the comparison of case management in different systems.
Schizophrenics have been shown to manifest a significant deficit in identifying facial expressions of emotion. The present study sought to determine whether this deficit lay at the level of decoding facial cues of emotion, or whether it is specific to the process of labelling emotional faces. The latter specific deficit would be consistent with the hypothesis of left-hemisphere dysfunction in schizophrenia. Samples of schizophrenics, patients with affective disorders and normal controls were tested on a battery of facial tasks that had previously been shown to be capable of distinguishing between patients with left- and right-hemisphere lesions. The battery was comprised of four tests: facial discrimination, emotion discrimination, emotion labelling, and a multiple choice emotion task. The performance of affective patients fell midway between that of schizophrenics and normals on all the tasks. Schizophrenics performed significantly below normals on all but the facial discrimination task, and below affective patients on the emotion labelling task. There were no other significant group differences in performance. The performance pattern manifested by schizophrenics across the four tasks is not comparable to that shown by patients with unilateral brain damage. These results indicate that previously reported emotion identification deficits in schizophrenia were not solely a function of the labelling requirements of the tasks. Instead it appears that schizophrenics, although capable of deciphering facial cues of identity, are impaired in the ability to extract salient emotional cues from faces.
The authors used the backward masking paradigm to compare visual information processing in schizophrenic patients with predominantly positive or predominantly negative symptoms. The results indicate significantly slower information processing in patients with negative symptoms.
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In 1970 42% of antenatal patients had an X-ray examination (88.6% involving abdominal exposure) but with the introduction of an ultrasound service in 1976 this figure had dropped to 3% by 1980. Looking at the indications for these it can be seen that X rays were still commonly performed for the detection of fetal abnormality and a further reduction in X-ray exposure of pregnant women could be achieved by using ultrasound in this situation. There was a dramatic decline in the use of erect lateral pelvimetry when the fetal presentation was known to be cephalic, especially when the head was engaged, reflecting an increasing awareness by obstetricians that this investigation is unrewarding in clinical practice.
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