Is relapse a justification for the use of high-dose antipsychotics?
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Biomedical subjects
Publications and source records attributed to J A Chiles.
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This case report extends the discussion of pseudodementia into the area of manic behavior. An elderly patient whose manic symptoms are considered to be an early sign of an organic brain syndrome should be given timely repeat evaluations before this diagnosis is allowed to guide treatment. Our case presentation emphasized the paucity of the data base we have to diagnose cognitive and emotional disturbances of the elderly. It is difficult to identify the essential features of cognitive dysfunction associated with primary neuronal degeneration especially in the early stages of the disease. A careful differential diagnostic evaluation is important to eliminate variables such as affective disorders and underlying physical conditions as causes of confusion and cognitive dysfunction in the elderly patient.
Psychiatric diagnostic patterns were examined in two different samples of adolescents, one a group of psychiatric inpatients and the second youth apprehended by the law for alcohol-related difficulties. Affective disorder in parents was most closely correlated with a similar patient diagnosis or constellation of depressive-type symptoms in both samples of youth. Parental antisocial personalities, alcohol abuse, or drug problems correlated most closely with high levels of similar difficulties in individuals in the two studied groups. However, antisocial, alcohol, or drug problems of a mild degree were present in all subgroups of the two samples, perhaps representing a nonspecific reaction to parental illness or the occurrence of a broken home. A follow-up of future problems in both samples will be carried out to determine the importance of the family history and clinical picture in predicting the future course of problems.
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The authors describe a short-term inpatient program for adolescents that uses a variety of group sessions to help them deal with their immediate problems and, when necessary, prepare them for outpatient treatment. No attempt at complete ego reconstruction is made. The program includes family therapy and sessions on practical living skills, such as job hunting, productive use of leisure time, transportation, food planning, and renting and leasing. Assertiveness techniques are taught in small groups, and their use is encouraged on the unit, where staff attempt to create an acceptable social environment and provide a model for group decision-making.
The authors present a case of the Kleine-Levin syndrome, and review the literature to assess the various ways this illness can appear. Psychiatric manifestations not only obscure the diagnosis, but may lead to inappropriate treatment.
Diurnal EEGs of a 17 year old male with the Kleine-Levin syndrome revealed moderate diffuse abnormalities and stage REM at sleep onset during attacks. Overnight, stages 3, 4, and REM of sleep were decreased, but sleep onset REM stage was not seen. These records returned to normal between attacks.
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This study examined the risk prediction efficiency of the Reasons for Living Inventory Survival and Coping Beliefs Scale, Beck Hopelessness Scale, Beck Depression Inventory, and the Life Experiences Survey with a sample of 51 newly hospitalized parasuicides. The index of suicidal potential chosen for this study was suicide intent as measured by Beck's Suicide Intent Scale. Regression analyses indicated that the Survival and Coping Beliefs Scale emerged as the single most important predictor of suicide intent. Hopelessness and depression made secondary and nonsignificant contributions. Hopelessness was a significant predictor of suicide intent when analyzed apart from Survival and Coping Beliefs, but not among a subsample of 43 repeat parasuicides. Classification analyses showed that neither hopelessness nor survival and coping beliefs were accurate at classifying low- or high-intent parasuicides. Factors contributing to the efficacy of survival and coping beliefs as a risk prediction index are discussed, as is the false-negative dilemma in suicide risk assessment and prediction.