[Administrative aspects of psychopathies which relate to pension neuroses of civil servants].
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Antisocial Personality Disorder↗
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Psychological reactions and other problems in civil disasters.
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Anxiety↗
Continuous ECG monitoring on civil air crews during flight operations.
Cardiovascular disease is one of the disorders resulting in sudden incapacitation and is the most common malady leading to medical retirement. It is very important for us to control this disease among pilots. Generally, pilots undergo medical checkups at health control service on the ground, but they do not undergo these checkups during flight operations. We obtained a continuous ECG recording on four pilots to assess cardiac reserve capacity for mental load during flight operation. Results show that no significant ischemic changes of ST-segment and T-wave during flight were noticed except in one case of atrial fibrillation in which significant depression of ST-segment occurred while walking up a stairway after flight. An increased number of ectopic beats was found in another normal case. In general, it was suspected that mental load is greater at landing than takeoff.
Accidents, Aviation↗
Introduction to this issue: international perspectives on psychopathic disorders.
The importance of characterological disturbances, that contribute towards individual patterns of law breaking behavior, to legal systems in all countries should be self-evident. Contributors to this international perspective issue represent Canada, Germany, Great Britain, and the United States, and data from several additional European countries were included in Hare's article. This issue addresses emotional deficiency, molecular genetics, construct and predictive validity of the PCL-R, psychosocial predictors and treatment. Critical analyses of current models for civil commitment and criminal responsibility vis-à-vis psychopathic disorders contribute towards informed dialectic on these compelling public policy issues. We hope that readers will find that these articles collectively advance our understanding of the nature of these disorders, currently available therapeutic interventions, and today's critical social issues.
Affect↗
Prevalence of depression in rural Rwanda based on symptom and functional criteria.
The authors' objective was to estimate the prevalence of major depressive disorder among Rwandans 5 years after the 1994 genocidal civil war. They interviewed a community-based random sample of adults in a rural part of Rwanda using the Hopkins Symptom Checklist and a locally developed functional impairment instrument. The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria (A), distress/functional impairment criteria (C), and bereavement exclusionary criteria (E). They also examined the degree to which depressive symptoms compromise social and occupational functioning. Three hundred sixty-eight adults were interviewed, of whom 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Work on appropriate, feasible, safe, and effective mental health interventions should be a priority for this population.
Adaptation, Psychological↗
DSM-III-R and religion.
The interpretation of religion in DSM-III-R contains considerable negative bias and contributes to unfair stereotypes of religious persons. Particularly new religious movements and religious conversion are unfairly interpreted under the DSM-III-R heading, 'Dissociative Disorder Not Otherwise Specified'. It is suggested that a more balanced and respectful interpretation of religion is needed in DSM-III-R, since psychiatry through its official nomenclature should not contribute to social intolerance of religious nonconformity.
Attitude of Health Personnel↗
[Psychiatry at the turn of the 20th and 21st centuries].
The author makes an attempt at considering the most important achievements in psychiatry which have taken place in the global scale during the passing century, and the direction taken up by the development of global psychiatry in the coming century. The 20th century was characterised not only by the impressive development of science, thanks to which completely new possibilities opened up for global psychiatry, but also by the presence of extreme events that took place as a result of false ideologies such as fascism and communism. In the 20th century concepts like homicide, holocaust, the extermination of the mentally ill, experiments on people that are prohibited by the ethics of medicine and the elementary rules of humanity, etc. The paper includes the achievements of diagnosis and therapy of psychiatric disorders and the latest organisational solutions as well as the perspectives for further development of psychiatry. The author also implies the aims that psychiatry has to take up due to the numerous threats from our civilization: the technical-technological development, pollution of the natural environment, the negative changes in human values, the rising brutality in interhuman relations due to racial, national and religious conflicts and terrorism, the disappearing feeling of being safe in society, vision of hunger and poverty in many countries on a few continents, the danger of an epidemic outbreak of new unknown diseases caused by viral mutations, or genetics--the possible negative effects of genetic engineering (cloning of humans), etc. The author tries to define the role of psychiatry in preventing the threats of civilization.
History, 20th Century↗
The structure of psychosomatic symptoms.
1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.
Humans↗
Perception of patients' unpredictability and beliefs on the causes and consequences of schizophrenia- a community survey.
BACKGROUND: The belief that mental disorders involve a high risk of unpredictable behaviours is a factor which influences negatively the social acceptance of the mentally ill. In this paper, we compare the beliefs about the causes and psychosocial consequences of schizophrenia expressed by 536 respondents who had the firm conviction that patients with schizophrenia are unpredictable and by 457 respondents who firmly believed that they are not. METHODS: The survey was conducted in 30 Italian geographic areas, randomly selected taking into account their location and population density. The data were collected by the Questionnaire about Opinions on Mental Illness (QO). RESULTS: Respondents who believed that patients with schizophrenia are unpredictable reported more frequently factors such as use of alcohol and drugs and frequenting bad company as being involved in the development of the disorder. In addition, this group showed more restrictive opinions about patients' civil and affective rights. Low education was found to be significantly associated with perception of "unpredictability" in schizophrenia. CONCLUSIONS: These results suggest the need to: a). inform the general public on the main clinical characteristics of schizophrenia and on the risk of unpredictable behaviours in the acute phases of this mental disorder; b). carry out sensitisation campaigns against discrimination toward people with schizophrenia emphasising successful experiences of social integration.
Adult↗
[Misdiagnosis and labeling in psychiatry and their consequences: Part II].
The complexity of arriving at a correct psychiatric diagnosis in cases in which physical and mental disorders are interrelated is discussed. A case is presented in which a psychiatric diagnosis had been made and malingering suspected, although the patient actually had a severe neurological disorder. The psychiatric diagnosis had not been changed despite recurrent medical and psychological examinations which clearly indicated a physical disorder. The difficulties that follow misdiagnosing organic disorders as psychiatric disorders are illustrated. Various aspects of the effects of psychiatric misdiagnosis on functional, legal and civil aspects of life are discussed. Emphasis is given to the problems facing those discharged from military service for medical reasons, especially mental disorders. Important measures are currently being applied to overcome some of these problems. It is strongly emphasized that there is need for greater openness and tolerance among psychiatrists when making psychiatric diagnoses.
Adult↗
Brief therapy of civil war-related trauma: a case study.
The incidence of posttraumatic stress disorder is widespread among refugees who have been exposed to violence or torture. Many families struggle with side effects of this condition, such as recurrent nightmares, flashbacks, emotional detachment, and difficulty trusting people. Some unwittingly become involved in a pattern of alcoholism, family violence, and somatic illness that is rooted in traumatization. Service providers must often struggle with overwhelmed clients whose multiple needs make long-term therapy impractical. Thus, brief treatment appears to be especially well suited to this population. This article describes a case study using short-term psychotherapy (10 to 20 sessions) that aims to restore refugees who are in reasonable emotional health to their premorbid level of functioning. A 4-stage treatment process involving specific tools is described, and the case study is used as an illustration. Contraindications for time-limited therapy are also outlined.
Adaptation, Psychological↗
[The role of autonomic dysfunction in the pathogenesis of lipid and lipoprotein metabolic disorders in patients with metabolic-alimentary obesity].
Obesity is a "disease of civilization" that leads to the formation of vascular pathology. Vegetodystonia, a heterogeneous syndrome both as regards the type and clinical course, is a pronounced clinical manifestation of obesity. The role of vegetodystonia in the formation of atherogenic potential of obesity has not been studied yet. 77 patients with metabolic alimentary obesity were examined for blood lipidograms as compared to the vegetative status and anthropometric data. Based on a correlation analysis performed, a relationship was discovered between the changes in the parameters indicated. The character of the correlation was determined by the type of vegetodystonia. The leading part in the formation of atherogenic potential is played by sympathoadrenal influences which are most manifest is permanent vegetovascular dystonia of the vagoinsular type. The treatment of obesity should be carried out with regard to the concrete variety of vegetative dysfunction.
Adolescent↗
Conservatorship: an involuntary legal status for 'gravely disabled' mentally disordered persons.
Since 1969 in California, conservatorship has been the only form of civil, longterm involuntary psychiatric legal process. It does not require hospital-based treatment. This paper reports a preliminary study of this process through a retrospective analysis of conservatorship records in Sacramento County, California, from 1969 through 1976. There is a steady overall increase in the incidence of conservatorships each year. A dramatic decrease in state hospital admissions preceded this increase. Referrals were predominantly (69 percent) from the private sector. Once the first legal step was taken 87 percent of the patients completed the process and were placed on full conservatorship. Median age was 50; 52 percent were male and 90 percent were white. The relative proportion of single persons was high (45 percent). Diagnoses of schizophrenia and organic brain syndrome accounted for 86 percent of conservatees. About half (52 percent) terminate conservatorship after one year. No data were found which could be related to the character of treatment of conservatees. Future research in this area is urgently needed.
California↗
Post-traumatic stress disorder and the law: critical review of the new frontier.
Since its debut in the psychiatric nomenclature in 1980, post-traumatic stress disorder (PTSD) has had a dramatic impact on criminal and civil jurisprudence. PTSD has created a cottage industry among both criminal and negligence attorneys and mental health practitioners. The diagnosis first achieved public notoriety when it was introduced as a new basis for the insanity defense. More recently "syndrome evidence" of the subtypes and variations of PTSD have encroached on the substantive criminal law of self-defense. In addition, the diagnosis may have an impact on such traditionally legal and factual determinations as the credibility of witnesses and may undermine conservative tort doctrine that attempts to cabin psychic injury. The emerging legal area of victims' rights has been strengthened and paradoxically divided by PTSD. Yet the newly defined disorder of PTSD has not borne such a heavy forensic burden easily. Indeed the diagnosis poses for psychiatry some of the very problems it supposedly solves for legal purposes, including the illusory objectivity of the causative traumatic event and the expert's dependence upon the victim's subjective and unverifiable reports of symptomatology for the diagnosis.
Combat Disorders↗
Protecting the rights of the mentally disordered in police stations: the use of the appropriate adult in England and Wales.
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Adult↗
Incompetency to stand trial and mental health treatment: a case study testing the subversion hypothesis.
This study is a test of the so-called subversion hypothesis, which posits that mentally disordered persons who commit minor offenses are prosecuted primarily for the purpose of imposing mental health treatment on them through evaluation and treatment for incompetency to stand trial. These persons, according to the subversion hypothesis, find themselves in the criminal process because they do not meet the stringent civil commitment standards, but do meet the less stringent criteria for a disorderly conduct prosecution. The findings, based on 893 disorderly conduct prosecutions in a single jurisdiction over a two-year period, do not lend general support to the subversion hypothesis.
Case-Control Studies↗
[Contemporary opinions on osteoporosis in neurological disorders].
Osteoporosis is a generalized skeletal disease characterized by low bone mass and leading to an increased fracture risk. It is classified by the World Health Organization as one of the main civilization diseases. Given the aging society, its significance is continuously increasing. There is also a number of neurological disorders predisposing to osteoporosis, such as poor mobility, exposure to corticosteroids, epilepsy and some rare congenital diseases. The present paper reviews literature concerning osteoporosis in the mentioned disorders and gives a diagnostic and therapeutic algorithm in chronic therapy with corticosteroids. Quoted studies show poor neurologists' vigilance regarding the possibility of osteoporosis in their patients and the need for improvement.
Algorithms↗