Biomedical subjects
Publications and source records attributed to I M Lesser.
The successful merger of a crisis clinic with an adult outpatient clinic suggests that the traditional splitting of crisis and outpatient care in American psychiatry may not optimal. In the combined clinic more patients were seen, staff time was utilized more efficiently, staff morale was increased, and educational needs were more easily satisfied. Patient care was not compromised in any way.
Aexithymia is a clinical concept referring to the difficulty some people have in verbalizing their feeling states. It is prevalent in patients suffering from a variety of psychosomatic illnesses. The authors conduced a controlled study to investigate the presence of this trait among patients attending a psychosomatic clinic and those attending a traditional outpatient psychiatric clinic in a county general hospital. The results indicate that, in this lower socioeconomic population, alexithymia is equally present in both clinics. The discrepancy between these results and those previously reported are discussed, as are the ramifications of the findings.
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Secondary depressive symptomatology in 435 subjects with panic disorder and phobic avoidance was studied before and after alprazolam treatment. No subject who had a primary affective disorder was included. Calculation of Hamilton Depression Rating Scale factor scores revealed that the agitation/anxiety, sleep disturbance, and somatization factors accounted for approximately 75% of the HAM-D total score; these all showed significant improvement with alprazolam treatment. There were few differences in dimensions of depressive symptomatology between those subjects with and those without major depression; the main difference was in the overall intensity of the depression.
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The behavioral, neuropsychological and single photon emission computerized tomography characteristics of 5 patients with progressive degeneration of the right hemisphere are described. In all, the brain regions with greatest involvement were right-frontal and temporal. Psychosis, compulsions and behavioral disinhibition were the dominant, and often first, symptoms. Affect was flattened and the patients seemed distant and remote. Neuropsychological testing did not reveal a consistent pattern that helped localize the abnormality to the right frontotemporal region. These patients contrast dramatically to those with left frontotemporal degeneration in whom behavior and psychiatric status is often normal. This study suggests that the right hemisphere may be primary for the control of social conduct.
The empirical literature has been contradictory regarding whether frontal functions decline with age, perhaps due to important differences across studies in medical and psychiatric exclusion criteria. We review literature and present preliminary data suggesting that frontal lobe functions are particularly affected by several medical and psychiatric disorders common in old age. Investigations of frontal lobe functions in aging require careful screening of subject samples; otherwise, any impact of age on cognition is contaminated by the effects of coexistent physical and/or psychiatric illness.