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Correlates of patient participation in the large group meetings of a therapeutic community.

In view of the importance of verbal communication in community meetings, an attempt was made to identify the characteristics of patients with differing average levels of communication. Paper-and-pencil recordings of 117 consecutive community meetings in a psychiatric unit run along therapeutic community lines yielded average communication scores on 237 patients. Scores were unrelated to sex, age, social class, length of stay, in-patient or day-patient status and questionnaire measures of total hostility and attitude towards psychiatric treatment. Patients who talked much were characterized by manic and personality disorder diagnoses and were hysteroid and extrapunitive on questionnaire measures. They attended a high proportion of meetings held during their admission and contributed verbally to almost all meetings they attended. They frequently became the subject of discussion in meetings, and they tended to be high on objective and consensual measures of rule-breaking. Patients with low level of verbal communication were likely to have anorexic, organic or psychotic depressive disorders. The results are discussed in terms of Berne's distinction between 'performers' and 'audience' and the presumed functions of community meetings.

Adolescent↗

Narcolepsy.

The symptom of excessive sleepiness in children and adolescents does not necessarily cause great concern to families and professionals involved in their care. Children may deny the symptom and minimise the adverse effects. These factors contribute to an underdiagnosis of narcolepsy in this age group when clinical diagnosis is difficult as associated symptoms may not have appeared or are hard to elicit. In this paper three children whose difficult behaviour contributed to the presentation of their sleep disorder are described.

Child↗

Organic psychosis.

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Acute Disease↗

Social phobia: a comparative clinical study.

Eighty-seven people with the symptom of social phobia were compared with 57 people with the symptom of agoraphobia to determine whether these symptoms were part of distinct syndromes. Comparisons were made on demographic, clinical and questionnaire data. Significant differences were found on important variables. The social phobics were younger and more often male, unmarried, and from social classes I and II. The pattern of phobic situations was different in the two groups and so was the pattern of autonomic symptoms experienced in these situations. Symptoms visible to others were more frequent among social phobics. Fainting was more frequent among the agoraphobics.

Adolescent↗

Successive generations of child maltreatment. The children.

Families were identified, in north-east Wiltshire (UK), (population 200,000), in which there was a pattern of two or more generations of child maltreatment and where there were also two or more children maltreated in the current generation (born between 1960 and 1980). These children had high rates of mental handicap, backwardness, and antisocial behaviour, and there were also characteristic patterns of emotional disturbance. The post-neonatal death rate for the 294 index children was very high, but higher still for their brothers and sisters. Some of the deaths, and at least 11 cases of violence-induced mental handicap (VIMH), were caused by characteristic types of child abuse - particularly violent shaking and throwing of infants, and secret suffocatory practices. There were very strong indications that larger numbers of children than the 11 proven VIMH cases had also suffered blunting of the intellect, physical complications such as epilepsy, and educational problems, as well as emotional and social maladjustment as the consequence of ill-treatment and neglect. Within the families, for children remaining at home, forms of ill-treatment and poor quality care persisted and ultimately affected most, or all, of the children in each family unit. Many families were chaotic, and within each family unit there were children frequently in care who suffered multiple placements, and who needed sustained specialist support throughout their childhood, encompassing a huge range of professional and other social support services. Such detail was generally underplayed or not accessible, and its full significance for children in each family could only be assessed by combining direct personal clinical involvement with record linkage methods, depending in turn on good co-operation from all agencies concerned wholly or partly with child protection.

Adolescent↗

Aberrant social relations in the personality disorders.

Research on the interpersonal aspects of personality disorders (PDs) has generally sought to describe them in terms of behavioural dispositions, often mapping these dispositions onto the interpersonal circumplex. The present study, in contrast, tested a theory that accounts for PDs as systematic disturbances in relationships between people. Self-reports of 57 participants experiencing significant interpersonal difficulties showed many predicted associations between PD symptoms and aberrant enactment of four elementary forms of social relationships (Fiske, 1991). Symptoms were associated with aberrant motivations for, and cognitive implementations of, these 'relational models', and with difficulties conducting them. These associations were comparable in strength to, but largely independent of, those obtained with a circumplex measure. Aberrations of authority- and equality-based relationships were central to many PDs, but not captured well by the circumplex. A relational analysis affords a fruitful and largely unexplored perspective on PDs.

Adolescent↗

The disease concept of alcoholism revisited.

The history of the conception of alcoholism as a disease is outlined. Recent opposition to that conception and the specific reasons therefor are discussed. On the basis that addiction constitutes a disablement in the medical sense, it is concluded that alcoholism is properly defined as a disease.

Alcohol Drinking↗

A preliminary study on the prevalence of challenging behaviours.

The purpose of this study was to estimate the prevalence of challenging behaviour among subjects with learning disabilities in an English health district. Subjects' disabilities included incontinence, lack of communication skills, and need of assistance with domestic activities, feeding, washing, and dressing. Some also had physical impairments. The most common behaviours were hyperactivity and irritability and the most common psychiatric disorders included severe anxiety, affective disorder, and adjustment disorder.

Activities of Daily Living↗

Multiproblem families and their psychiatric significance.

The characteristics of multiproblem families are described, and the investigations in a research project are reported. A note is made of their epidemiological significance. Reasons are suggested as to why they have received little psychiatric attention. In particular their child upbringing practices, including child rearing and learning disorders, are described. The psychiatry of inadequacy is considered and the validity of the various diagnoses used. Finally it is suggested that the place of psychiatry in their care should be reconsidered and that a better knowledge of social handicap should be acquired.

Adult↗

[The treatment of internees: a breakthrough in a new law?].

Mentally disordered offenders can be declared criminal irresponsible according the Belgian Law of Social Defense (1 July 1964) and as a consequence they are "interned". The treatment of this population of "internees" is inadequate and the law must be revised. A commission "internment" has, at the request of the Minister of Justice, put forward conclusions in his report of 1999. Proposals are made to introduce the multidisciplinary psychiatric expert report, to improve the labeling of the question asked to the experts according to current psychiatric knowledge, and to operationalise important concepts as for example "dangerousness". The quality of the psychiatric treatment in the Belgian Prison system is bad for all the categories of inmates, detainees on remand, condemned or interned. The commission proposed that the Minister(s) in charge of Public Health and Social Affairs should be responsible for the treatment for the treatment of psychiatric disordered offenders, be it inside or outside prison. The political authorities plan to review this law of Social Defense, but these efforts will remain vain if no decisions are taken to implement the medical requirements of the law, and if no valuable forensic psychiatric treatment network is developed.

Belgium↗

Social integration and the therapeutic community.

The therapeutic community should be defined as an environment which is enabling but not directive. The staff need to become aware of their therapeutic as well as anti-therapeutic potential. Conflict should be overt rather than covert. That society now sees the delinquent as 'sick' is two-edged: Abdication of responsibility is encouraged, and the sick role rewarded. This paper shows how the therapeutic community is effective in encouraging the delinquent to take responsibility for himself and for others. It shows what features make the therapeutic community effective for neurotics for schizophrenics.

Humans↗