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Psychotic illness after prenatal exposure to the 1953 Dutch Flood Disaster.

We tested the hypothesis that maternal stress during pregnancy increases the risk of non-affective psychosis for the child. The concept of non-affective psychosis includes the ICD categories schizophrenic disorder, paranoid state and other non-organic psychosis. Data from the Dutch Psychiatric Registry were examined for an effect of the Flood Disaster of 1 February 1953. On this day, a gale caused a flood in the South-west of The Netherlands and 1835 people perished. Our study concerned the 19 villages where mortality exceeded 0.25%. The risk of non-affective psychosis for the cohort born in the period February-October 1953 was compared to the risks for the cohorts born in the corresponding periods of the previous and subsequent 2 years. The relative risk of non-affective psychosis for those exposed during gestation was 1.8 [95% Confidence Interval (CI): 0.9-3.5]. Thus, our study failed to demonstrate a significant association between prenatal exposure to maternal stress and risk of non-affective psychosis. The possible explanations for this finding are discussed.

Cohort Studies↗

Dynamic content analysis.

An experiment was performed to demonstrate that methods of linguistic content analysis suitable for the study of intra-interview processes are both possible and practicable. Six hundred thirty-eight randomly selected psychiatrist were sent rating protocols of machine-mediated interview transcripts (transcripts of interviews conducted by means of remotely located teletypes) and were asked to rate each patient communication on one or more of 13 diagnosis-related rating dimensions. Rank correlation statistics on the raters' levels of agreement were found to be significantly high in 11 of the 13 dimensions. In contrast to the commonly held opinion that psychiatrist lack consistency in their application of diagnostic terms, this study suggests that psychiatrists generally agree in their usage of these terms, provided that the behavioral samples being evaluated are appropriately delimited.

Humans↗

Reactive psychoses. A family study.

Reactive, or psychogenic, psychoses have been given the most attention in the literature by Scandinavian investigators. We defined diagnostic criteria for reactive psychoses emphasizing differences with manic-depressive psychoses and schizophrenia. Forty Danish probands were selected and family history data was obtained by personal interview and record review. In order to compare our results with other investigations, we age corrected family history data. Siblings of reactive probands were found to have significantly more reactive psychoses than siblings of manic-depressives or schizophrenics, and significantly less schizophrenia than siblings of schizophrenics. Although there was some genetic overlap with manic-depressive psychosis, we believe that the findings are sufficiently distinct to warrant the separate diagnostic category of reactive psychoses.

Adolescent↗

The spectrum concept of schizophrenia. Problems for diagnostic practice.

The spectrum concept of schizophrenia posits that a number of psychopathologic states, both psychotic and nonpsychotic, may share some genetic basis with schizophrenia, and may therefore constitute, together with schizophrenia itself, a genetic spectrum of schizophrenic disorders. While this is a valuable and promising research concept, its application to diagnostic practice could broaden the boundaries of schizophrenia to include patients with other conditions, thus rendering a larger population at risk for the untoward effects of the schizophrenia disgnosis itself. This may have already occurred in the Soviet Union, where a diagnostic system derived from a variant of the spectrum concept is used in routine diagnostic practice. The adoption of a spectrum-based diagnostic system should await further research on the boundaries of the spectrum, and more detailed descriptions of confirmed spectrum states.

Bipolar Disorder↗

Increased excretion of dimethyltryptamine and certain features of psychosis: a possible association.

The excretion of the hallucinogen dimethyltryptamine (DMT) and its precursor N-methyltryptamine (NMT) was studied among 74 recently admitted psychiatric patients and 19 normal persons. Both compounds were detected in 24-hour urine samples from all subjects. Dimethyltryptamine excretion was greatest in schizophrenia, mania, and "other psychosis" and tended to decline as clinical state improved. Psychotic depressives excreted smaller amounts of DMT more akin to those excreted by neurotic and normal subjects. Urinary NMT excretion was unrelated to psychiatric diagnosis. Ratings on the Present State Examination (PSE) also indicated that increased excretion of DMT was associated with psychotic rather than neurotic psychopathology. Forty-three percent of the variance in urinary DMT levels could be explained in terms of six of the 38 PSE syndromes. Syndromes suggesting elation, perceptual abnormalities, and difficulty in thinking and communicating were most correlated with raised urinary DMT excretion.

Adolescent↗

Psychiatric morbidity in the first-degree relatives of schizophrenic patients.

There is increasing evidence that genetic factors play a role in the etiology of schizophrenic disorders. One thousand eighty-nine first-degree relatives of schizophrenics and 1,137 controls were studied to discover their psychiatric morbidity. Psychiatric morbidity was found in 16.34% of the first-degree relatives (FDR) of schizophrenics (parents, 5.69%; siblings, 7.71%; offspring, 2.94%) as compared to 6.9% in the controls (P < 0.001). Schizophrenia was found in 8.3% of the patient group, which was significantly higher (0.2%) as compared to the controls. Schizoid-schizotypal personality disorder was found in 3.03% of FDRs of the schizophrenic group. Depressive disorder was found in 4.4% and 2.1% in the control and patient group, respectively, which was statistically significant. Morbidity risk of schizophrenia was found in 16.97%, 6.22% and 5.79% of schizophrenia, schizoid-schizotypal personality disorder and depressive disorder, respectively, in the FDR of schizophrenic group.

Adolescent↗

Consultations for 'maladaptive denial of illness' in patients with cancer: psychiatric disorders that result in noncompliance.

Patients who present with late stages of cancer often have complicated medical and psychiatric problems which are labeled as 'maladaptive delay or denial.' In some of these patients, psychiatric problems have either contributed to the delay in medical presentation for care or have interfered with treatment of the late stage cancer. The authors review some of the factors that contributed to delay and noncompliance in a series of patients with cancer who were evaluated by the psychiatric consultation service of a university hospital. Specifically, psychoses and cognitive impairment played a major role in delay and noncompliance. The authors discuss recommendations for management of such patients, and suggest that clinicians often benefit from the assistance of the psychiatric consultant as part of the treatment team. Multiple resources and multiple types of intervention are needed in order to help such patients negotiate the clinical environment.

Adult↗