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Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function.

The development of the first standardized "scratch 'n sniff" olfactory test is described. Over 1600 subjects participated in five experiments. In Experiment 1, 50 microencapsulated odorants were rated as to their intensity, pleasantness, irritation, coolness, and familiarity, and two procedures for releasing them were compared. In Experiment 2, the results of the first experiment and other data were used in the development of the test, which was administered to a large number of subjects. Using multiple regression analysis, scores on this test were shown to be significantly related to the subjects' gender, ethnic background, and smoking behavior. Average test scores decreased as a function of age, with the greatest decline occurring between the sixth and tenth decades of life. These age-related changes were not correlated with scores on the Wechsler Memory Scale. Women performed better than men within all age categories. In Experiment 3, the test was shown to differentiate between subjects with known olfactory disorders (e.g., Kallmann's syndrome; Korsakoff's syndrome) and normal controls, and to reliably detect persons instructed to feign total anosmia. In Experiment 4, the test-retest reliability was established (6-month interval; r = 0.918, p less than 0.001), and in Experiment 5 the test was shown to correlate thresholds with odor detection (r = -0.794, p less than 0.001). This self-administratered test now makes it possible to rapidly and accurately assess general olfactory function in the laboratory, clinic, or through the mail without complex equipment or space-consuming stores of chemicals.

Adolescent↗

A psychoanalyst-liaison psychiatrist's overview of DSM III.

There has been a groundswell of reaction, mostly favorable, to the most recent edition of the Diagnostic and Statistical Manual. In this paper the author attempts to evaluate the Manual, which purports to provide an atheoretical and descriptive diagnostic model on its own ground, as well as from a psychodynamic and ego-psychological point of view. More specifically, the Manual is evaluated in terms of its usefulness in the diagnosis and management of the Somatoform Disorders, as well as other typical general hospital problems. This assessment raises many questions about the basic tenets of DSM III in general. Concomitantly, suggestions are made to enhance the reliability, validity, and clinical relevance of the Manual.

Diagnosis, Differential↗

The self-inflicted dermatoses: a critical review.

The self-inflicted dermatoses, namely dermatitis artefacta, neurotic excoriations, and trichotillomania, have been reported to be associated with various degrees of psychopathology in the dermatologic literature, but have received surprisingly little emphasis in the psychiatric literature. This probably reflects, firstly the fact that most of these patients initially deny any psychologic problems and hence may not receive psychiatric interventions, and secondly a lack of adequate collaboration between the psychiatrist and dermatologist. These disorders may be associated with serious sequelae, such as suicide and repeated major surgical procedures. Their treatment is also primarily psychiatric. This article critically reviews the literature and comments upon the salient clinical features and treatments for these disorders, which are relevant for the psychiatrist doing consultation-liaison work. Knowledge of these disorders is important in the evaluation of any psychiatric patient, as these disorders are essentially a cutaneous sign of psychopathology.

Dermatitis↗

Neuro-ophthalmology and psychiatry.

Neuro-ophthalmology and psychiatry interact over several issues. The neuro-ophthalmologist can confirm the suspicion of nonorganic visual dysfunction by demonstrating the functional integrity of the visual system and the nonphysiologic nature of the visual complaints. He or she may recognize evidence of organic dysfunction in the patient with a presumed psychiatric diagnosis. In some cases, the pathology may be related to the use of certain psychiatric medications. Specialized examination techniques within the realm of neuro-ophthalmology may provide subtle information about the functional integrity of the central nervous system in patients with psychiatric disease. Clinical and investigational collaboration between the neuro-ophthalmologist and the psychiatrist will provide the most appropriate patient management and may further our understanding of the biological basis of psychiatry.

Brain Diseases↗

In defense of Pseudoseizure.

There continues to be disagreement over the best term for behavior that simulates an epileptic seizure. In the author's view, pseudoseizure is the most accurate of the expressions currently in use, and fears about its potentially damaging effects are unfounded. Even pseudoseizure, however, fails to convey the behavioral nature of the phenomenon in question, for it identifies what the problem is not, rather than what it is.

Conversion Disorder↗

Acquired pseudo eating disorder. An imitation or fabrication of anorexia nervosa.

Acquired pseudo eating disorder is a condition characterized by the development or fabrication of symptoms corresponding to an eating disorder in a patient hospitalized for an unrelated medical illness, who has previously been exposed to a patient(s) with anorexia nervosa. Two adolescent patients developed an eating disorder during medical hospitalization. Both acquired the condition while hospitalized for another reason (myelomeningocele and multiple sclerosis, respectively). The potential psychodynamics suggested the selection of an "eating disorder," amenable to control, over the reality of a threatening illness that was experienced as being out of control. Thus, the new and dramatic symptoms appeared to serve as a defense against a pervasive underlying depression. The patient's loudly proclaimed "eating disorder" seemed to originate from the imitation of anorexia nervosa patients. Recognition of this hospital-acquired pseudo eating disorder and appropriate counseling resulted in rapid resolution of the symptoms. It is possible to identify a pseudo eating disorder developing during a hospitalization and differentiate it from "true" anorexia nervosa.

Adolescent↗

Influence of alpha stimulants and beta blockers on yohimbine toxicity.

1. Potentiation of yohimbine-induced sublethality has been largely used to predict antidepressant action. 2. Several products were tested in order to understand the mechanism of this toxicity better: an alpha-1 central stimulant (adrafinil); an alpha-2 central stimulant (clonidine); and 4 beta-blockers (propranolol, atenolol, penbutolol and metoprolol). 3. It was found that atenolol and adrafinil could not antagonize toxicity, whereas clonidine and the other 3 beta-blockers could. 4. It is suggested that a central beta-origin toxicity exists since only beta-blockers which cross the blood-brain barrier are capable of antagonizing this activity. 5. The fact that clonidine also antagonized this toxicity may be explained by the beta-antagonist action of this substance at the high doses used.

Adrenergic alpha-Agonists↗

Controlled comparison of the effects and abrupt discontinuation of buspirone and lorazepam.

1. The purpose of this study was to compare the effects and abrupt discontinuation of buspirone 15 or 20 mg tid and lorazepam 3 or 4 mg tid following 8 weeks of treatment. A total of 43 outpatients with generalized anxiety disorder were included in the study and 39 entered the withdrawal phase. 2. Clinical assessments were performed at baseline, 2, 4, 6 and 8 weeks (active phase) and after 9 and 10 weeks (withdrawal phase). These included the Hamilton anxiety scale, the visual analogue scale, the CHESS 84 (a check list for the evaluation of somatic symptoms) and the Lader tranquilizer withdrawal scale (translated in french). 3. Results show similar efficacy for lorazepam and buspirone during the active phase with a higher significant difference for buspirone on the CHESS 84 in relation with neurovegetatives symptoms: lorazepam D0 :16.30 +/- 3.14 D56: 5.10 +/- 0.93 (p < or = 0.01) buspirone D0 :18.82 +/- 3.4 D56: 4.73 +/- 1.18 (p < or = 0.001) No withdrawal phenomena was observed for both drugs using HAM-A lorazepam D63 :12.59 +/- 2.26 D70: 12.0 +/- 1.75 (p = ns) buspirone D63 :10.05 +/- 1.28 D70: 10.32 +/- 1.82 (p = ns) and the same significant difference using Lader scale: lorazepam D63 :4.44 +/- 0.89 D70: 6.96 +/- 1.28 (p < or = 0.05) buspirone D63 :2.95 +/- 0.66 D70: 4.15 +/- 0.92 (p < or = 0.05). 4. This study confirmed that buspirone was as effective as lorazepam at D56 in monitored outpatients with generalized anxiety disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

A new design of trial for hypnotics comparison: a double-blind cross-over trial with patient's preference assessment and continuation of the preferred treatment.

1. This study compared two hypnotics administrated at comparable therapeutic dosages: triazolam (0.25 mg) and loprazolam (1 mg), were administered using an original scheme (cross-over on the first 2 nights, and continuation of the preferred treatment or new randomization). 2. Sixty-seven outpatients complaining of common insomnia participated in this study conducted by general practitioners. 3. Both drugs provided improvement in sleep quality (decreased sleep latency, increased total duration of sleep, decreased number of night awakenings), and are equally well tolerated. 4. For the first 2 nights, triazolam was evaluated to be more efficient than loprazolam (p < 0.001), and patients felt more rested the following day (p < 0.01) with the former drug. Moreover, triazolam is more frequently preferred than loprazolam by 47.7% and 29.2%, respectively, (p = 0.09). 5. No interaction was found between treatment and order of administration or specific effects and order of administration.

Adult↗

Sirenomelia in a twelve weeks abortus.

The anatomical findings of sirenomelia in a 12-weeks aborted embryo are reported. The occurrence of sirenomelia in material from spontaneous abortions is discussed.

Abnormalities, Multiple↗