Hospitals, madhouses and asylums: cycles in the care of the insane.
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All patients with puerperal psychosis admitted to the Royal Edinburgh Hospital within 90 days of childbirth during the periods 1880-90 and 1971-80 were compared. The majority of cases in both groups had an affective illness with an acute presentation and a fixed interval of onset. The 19th-century cases had a more florid presentation and a greater length of admission (mean, 151 days) to the hospital than the 20th-century ones (mean, 39 days). The incidence of the disorder rose from 0.34 per 1000 childbirths per year in the 19th-century group to 1.04 in the 20th-century one, but this could be explained by nosocomial factors. Most 19th-century cases occurred in multigravid women, which questions the association of puerperal psychosis with primiparae.
A historical review of Kahlbaum's Catatonia is presented. He attributed the condition to organic cerebral disease. It is now best considered as a neuropsychiatric syndrome due to a wide variety of organic disease processes, manifest in catelepsy in a setting of an abnormal mental state, most commonly an affective disorder. Chronic catatonic states were common sequelae of encephalitis lethargica; this disease has now disappeared in epidemic form with a resulting fall in the incidence of catatonia in psychiatric hospitals. Acute catatonia, due to medical and particularly pharmacogenic causes, continues to occur in current psychiatric practice.
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The MMPI and 16 PF were administered to 45 forensic patients and scores on five derived measures of defensiveness were computed. The 10 highest and 10 lowest scoring subjects were assigned to either a high or low defensiveness group and their responses analyzed with regard to the Schizophrenia, Paranoia, Psychopathic Deviate and Hostility clinical scales and sub-scales of the MMPI according to past or present items. Results confirm that high defensiveness subjects are selectively and cautiously interpreting items so as to admit to significantly less overall pathology and relatively less present pathology than low defensiveness subjects. This finding represents a consistent strategy of defensiveness rather than an artifact of false response bias. This study has implications for personality assessment in Forensic Psychology and the potential of trend analysis for the prediction of future dangerous behavior in a forensic patient population.
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