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PubMed1993

Prevalence and significance of electroencephalographic abnormalities in patients with suspected organic mental syndromes.

OBJECTIVE: To determine the prevalence of electroencephalogram (EEG) abnormalities at different levels of cognitive impairment and to assess the possible diagnostic usefulness of the test. DESIGN: Combined prospective assessment of subjects receiving EEGs and retrospective chart review of symptoms and medications. SETTING: Academic geriatric psychiatry service. PATIENTS: 350 adults age 50 and above; 312 were patients being evaluated for possible organic mental syndrome and 38 were normal controls. MEASUREMENTS: All subjects had EEGs and Mini-Mental State Examinations (MMSE) performed at the time of the EEG. EEGs were rated for the presence and type of abnormality, and subjects were stratified according to the severity of impairment. Charts were reviewed by a person blinded to EEG results to determine clinical diagnosis and medications received. MAIN RESULTS: Abnormal EEGs were significantly more common among all patients (67%) in the study than among controls (11%), and the prevalence of abnormality increased with increasing impairment. Many demented patients with equivocal impairment (42%), and most with mild-to-moderate impairment (65%) had abnormal EEGs. An abnormal EEG was not indicative of dementia even when clear cognitive impairment was present, since patients with depression frequently also had abnormal EEG results. CONCLUSIONS: These findings suggest that the EEG is a moderately sensitive but non-specific indicator of brain dysfunction in the elderly. The significance of abnormalities among patients with equivocal impairment should be more fully assessed by longitudinal follow-up to determine if greater cognitive impairment develops.

Aged↗
PubMed1975

A social psychiatric investigation of a rural district in Northern Norway: a preliminary communication.

The psychiatric morbidity of Berlevaag in Northern Norway (71 degrees North) was studied in 1944 by Bremer. A follow-up and a re-examination of the persons in the community was initiated in 1972. Preliminary data suggest that the prevalence of psychoses is practically the same in 1973 as in 1944. Various registers have provided a fairly complete count of psychoses even before the onset of an intensive field study. Only a minor part of the non-psychotic psychiatric disorders appears to have been identified.

Alcoholism↗
PubMed1977

Gangliosides in the treatment of mental deterioration. A double-blind comparison with placebo.

Thirty patients showing signs of mental deterioration were submitted to a neuropsychological battery before and after treatment with gangliosides. Their performances were compared, in a double-blind study, with those obtained on the same tests by 30 patients affected by similar degrees of dementia and treated with placebo. The improvement shown on Raven's Coloured Progressive Matrices and on Immediate Visual Memory by the active group was significantly higher than that shown by the placebo group. Furthermore, an evaluation of the overall effect of gangliosides therapy showed a highly significant difference between the active and placebo group, still in favour of the subjects treated with gangliosides. It is concluded that gangliosides may exert a positive effect in the treatment of demential syndromes.

Clinical Trials as Topic↗
PubMed1980

Reliability of the AMDP-system. A preliminary report on a multicentre exercise on the reliability of psychopathological assessment.

The AMDP-System is a documentation system for psychiatric data widely in use in the German-speaking countries. A summary of results of a multicentered study of interrater agreement of the Psychopathology Scale is presented. A new index of rater agreement was tested and the notion is discussed that the judgement of the presence and the absence of a symptom are two different processes with different reliability.

Germany, West↗
PubMed1982

Immunological factors in senile dementia.

Sixty-four patients suffering from senile dementia were compared with 71 age-matched controls suffering from functional psychiatric illness, in terms of their chromosome complement, tuberculin and dinitrochlorobenzene response and total immunoglobulin levels. No significant differences emerged between these groups except for slightly reduced levels of immunoglobulin G in the dement sample. We conclude that senile dementia as a whole is not related to a defect in immunological function.

Aged↗
PubMed1984

The reliability of psychiatric diagnosis in Israel's Psychiatric Case Register.

To determine the reliability of psychiatric diagnoses in the Israel Psychiatric Case Register, DSM-III criteria were applied to case record abstracts of first admissions to a large psychiatric hospital in Jerusalem. The DSM-III diagnoses were compared with ICD-8 records diagnoses. Between 40 and 50% of those originally diagnosed as schizophrenia were re-diagnosed into less severe categories. The proportion diagnosed as affective disorder doubled from 21% for ICD-8 diagnoses to 40% for DSM-III diagnoses. The unreliability concerned the diagnoses of schizophrenia and affective disorder. Findings suggest that the introduction of standardized diagnostic criteria in Israel will lead to a substantial increase in the number of cases diagnosed as affective disorder, although difficulties involved in differentiating schizophrenia from the major affective disorders remain. The DSM-III findings suggest a high prevalence of affective disorders among Jews.

Adolescent↗
PubMed1984

Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age.

The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut-off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD-classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild-moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive-compulsive neuroses of moderate-severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67-85% of subjects with psychoses, about one half of them in psychiatric services, and by 35-65% of subjects with neuroses, about one fifth of them in psychiatric services.

Aged↗
PubMed1986

Introducing community mental health services. The effects on a suburban patient population.

By means of a computerised psychiatric case register, the effects on a defined population with 71,371 inhabitants were studied when the mainly hospital-based psychiatric services in the area were changed to community mental health units with substantial outpatient resources. Diagnostic, social and demographic variables and care utilisation rates were compared. A 29% increase in patients under the new system was observed. Most of the newcomers had acute crisis reactions, were younger, on average, than previous patients and registered alcohol abuse and somatic diseases. Outpatient utilisation increased (170%) and hospital admissions decreased (22%). Compulsory admissions increased (43%), as did sick-leave registrations (21%). These trends are discussed in light of the new organization.

Borderline Personality Disorder↗
PubMed1986

Five years of experience with the DSM-III system in clinical work and research: some concluding remarks.

The reliability of the DSM-III is superior to other classification systems available in psychiatry. However, reliability depends on proper knowledge of the system. Some pitfalls reducing reliability of axis 1 diagnosis which commonly are overlooked are discussed. Secondly, some problems of validity of axis 1 and 2 are considered. This is done by discussing the differential diagnosis of organic mental disorders and other psychiatric disorders with concomittant physical dysfunction, and the diagnoses of post-traumatic stress disorders and adjustment disorders among others. The emphasis on health care seeking behaviour as a diagnostic criteria in the DSM-III system, may cause a social, racial and sexual bias in DSM-III diagnoses. The present discussion of the DSM-III system from a clinical point of view indicates the need for validation studies based on clinical experience with the DSM-III. These studies should include more out-patients and patients with psychopathology who do not seek psychiatric treatment. Such studies must also apply alternative diagnostic standards like the ICD-9 and not only rely on structured psychiatric interviews constructed for DSM-III diagnoses. The discussion of axis 4 points to the problem of wanting to combine reliable rating with clinically meaningful information. It is concluded that the most important issue to be settled regarding axis 4 in the future revisions is the aim of including this axis. The discussion of axis 5 concludes that axis 5 is biased toward poor functioning and thus may be less usefull when applied on patients seen outside hospitals. Despite these problems of the DSM-III, our experiences indicate that the use of the DSM-III is fruitful both for the patient, the clinician and the researcher. Thus, the cost of time and effort needed to learn to use the DSM-III properly are small compared to the benefits achieved by using the system.

Adjustment Disorders↗
PubMed1987

Mental health in the population approaching retirement age. Preliminary findings of the TURVA project.

The present paper deals with a Finnish long-term prospective study, the objective of which is to shed light on adjustment to retirement and old age. In this phase, only the preliminary findings of the initial survey carried out in 1982 are available. For the purposes of the study, a random sample of 200 individuals was drawn from among Turku inhabitants born in 1920. Another sample, consisting of 189 persons of the same age, was drawn from rural municipalities in the neighborhood of Turku. An extensive structured psychosocial interview could be conducted with a total of 339 subjects. The research methods used included e.g. the 36-item version of Goldberg's General Health Questionnaire (GHQ). Relatively little mental disturbance was revealed in the interview, and no major differences occurred between the urban and the rural sample. Somewhat over one-third of both samples were probable psychiatric cases as defined according to the GHQ.

Adaptation, Psychological↗
PubMed1989

Inherited mental disorders.

A compilation of all mental disorders with known genetic etiology is presented. Of 139 disorders the gene location is known in 36. Eleven of the genes are located on the X chromosome and 24 on the autosomes. When a gene for a disorder is located, linkage analysis can be used for diagnosis. In the future the gene map will expand and more mental disorders be diagnosed with linkage analysis.

Chromosome Aberrations↗
PubMed1989

Spatial concentration of the incidence of treated psychiatric disorders in Mannheim.

The spatial concentration of the incidence of treated psychiatric disorders in Mannheim was determined in 2 ways. The first, the classical zone model according to Neller (1), distinguishes an inner, intermediate and outer zone. This concept was applied to data from an ecological study conducted by Häfner et al. (2) in 1965 and to those derived from the Cumulative Psychiatric Case Register for the years 1974-1980. For the second period of time we developed, in addition, a factor ecological concept. The 23 districts of Mannheim were divided into 5 areas that were as homogeneous as possible in terms of segregation and density. There was a marked increase in the concentration index for schizophrenia in the inner zone, as well as for neuroses and personality disorders between 1974-1980 as compared with 1965. There were strong concentrations in the inner zone during both periods of study for the diagnosis of alcoholism and drug addiction. Although in 1965 there was a visible concentration trend in the inner zone for affective psychoses, it had almost vanished between 1974-1980. Using the factor ecological classification we demonstrated that, with the exception of affective psychoses and neurotic depression, all diseases concentrate in the city areas that, besides being centrally located, are characterized by high population density, poor housing conditions, low social status of the residents and where foreign nationals were segregated in the 1970s.

Adolescent↗
PubMed1997

MRI findings in patients with affective disorder: a meta-analysis.

A review of the literature on primarily magnetic resonance imaging (MRI) scans of patients with affective disorders is presented. Several studies have indicated an increased ventricle/brain ratio and other signs of cerebral atrophy, as well as an increased frequency of lesions (so-called signal hyperintensities) in the brains of unipolar and bipolar patients. This notion is strongly supported by two meta-analyses performed in the present study. The lesions are often localized in the frontal lobes and the basal ganglia, indicating a defective basal ganglia/frontal circuit, and are correlated with the degree of cognitive impairment seen in these conditions. No studies have indicated that psychoactive drugs or electroconvulsive therapy (ECT) might cause the lesions, but on the other hand they can probably increase the risk of delirium complicating the treatment.

Adult↗
PubMed1998

Cognitive deficits in schizophrenia and affective disorders: evidence for a final common pathway disorder.

This study was designed to determine whether patients with schizophrenia and those with affective disorders display a common pattern of cognitive deficits. Cognitive performance was assessed with a neuropsychological test battery in consecutively admitted in-patients with schizophrenia (n=100) and affective disorders (n=100). The two groups of patients showed a similar pattern of cognitive deficits, especially in tests focusing on attentional capacities. The groups only differed significantly in their performance on the Wisconsin Card Sorting Test (WCST), with the schizophrenic patients performing less well. These results suggest that, with the exception of the deficit as measured by the WCST, similar cognitive impairments exist in schizophrenia and affective disorders, even at very early stages of the illness. Therefore, patients with schizophrenia and those with affective disorders cannot be qualitatively distinguished with sufficient reliability. We postulate that the cognitive deficit pattern represents a final common pathway disorder in the two groups of patients.

Adolescent↗
PubMed1984

ERPs and psychopathology. II. Biological issues.

We have briefly covered important issues and considerations in four topic areas likely to be of use to the ERP researcher who is also interested in biological psychiatry. We cannot ignore diagnosis because of its basic role in the field of psychiatry. Although there are reliability problems, especially in the field of psychiatric diagnosis, ERPs may help in the painstaking task of validating diagnosis based on behavioral observation. In addition, the ERP researcher can use diagnosis to obtain potentially more homogeneous samples of patients so as to reduce between-subject error variance in studies. We have considered research areas like PET scan and CT scan which provide data of more anatomical precision than ERPs for deep neurological sites. While the potential may be there, it is essentially unrealized as yet. Finally, neurochemistry and psychopharmacology seem to be the areas most likely to bear fruit in the immediate future. If this potential is to be realized, it is necessary to formulate new questions and a new methodology to handle these questions. An important question, for example, is whether a biological profile is a more useful criterion than a behavioral profile for predicting response to pharmacological intervention. In biological psychiatry, this question is a human suffering issue of considerable importance.

Antipsychotic Agents↗
PubMed1985

Assessment of families in psychiatric emergencies.

Families of patients coming to a psychiatric emergency service pose severe professional and emotional challenges. Interviewing the patient and family together has advantages for patient, family, and interviewer. The traditional emergency assessment is greatly enhanced by attention to the family perspective and to the broader social context. Such information effectively facilitates problem-solving and negotiation of disposition. The importance of the interviewer's mature, flexible functioning is emphasized.

Crisis Intervention↗