Some notes on 'Helplessness in the Helpers' by Gerald Adler.
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A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.
Fourteen patients with renal osteodystrophy were treated for at least one year with 1-alpha-hydroxycholecalciferol (1-alpha-OHD3) in a dose varying from 1 microgram/week to 3 microgram/day. Plasma calcium and inorganic phosphorus concentrations increased significantly. The plasma alkaline phosphatase concentration fell in 11 of the 12 patients in whom it was initially raised and returned to normal in seven. Serum parathyroid hormone concentrations were initially raised in all patients, but they decreased significantly with treatment and became normal in eight patients within one year. The 10 patients with radiological abnormalities showed some improvement. Hypercalcaemia occurred in 11 patients, and necessitated a reduction in the dose of 1-alpha-OHD3 in some. 1-alpha-OHD3 was effective in reducing the biochemical and radiological abnormalities of renal osteodystrophy, but it should be used wtih care, and plasma calcium concentrations should be monitored.
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Hypercalcaemia regularly occurs when "prophylactic" 1,25-dihydroxyvitamin D3 (1,25[OH)2D3) in a dose of 1.0 microgram daily is given to haemodialysis patients without clinical biochemical or radiological evidence of osteodystophy. This dose is too large for such patients. Hypercalcaemia may persist for several weeks after withdrawal of 1,25(OH)2D3, particularly when previous attempts at control by dosage reduction have failed. Hypercalcaemia is better managed by stopping 1,25(OH)2D3, albeit temporarily, than by reducing the dose.
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Fifty-nine physically abused children demonstrated a significantly higher incidence of self-destructive behavior than two control groups of nonabused children, one neglected and one normal. The self-destructive behavior, including suicide attempts and self-mutilation, was potentiated by interrelated variables operating in the abused child and his environment. Often enhanced by the ego deficits and impaired impulse control of the abused children, this behavior seemed to represent a learned pattern originating in early traumatic experiences with hostile primary objects.
The authors investigated the relationship between physical and sexual abuse and psychiatric illness. The life experiences of 188 male and female psychiatric patients were reconstructed through an in-depth examination of psychiatric inpatient records. Almost half of the patients had histories of physical and/or sexual abuse; 90% of the abused patients had been victimized by family members. The abused patients' responses to chronic victimization included difficulty in coping with anger and aggression, impaired self-esteem, and inability to trust. The authors compare male and female victims and discuss the clinical implications of abuse.