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PubMed1977

Communicative and cognitive deterioration in dialysis dementia: two case studies.

We studied the cognitive and communicative deterioration of two patients who were treated by maintenance dialysis and developed a fatal progressive encephalopathy, "dialysis dementia." Detailed language, speech, and psychological evaluations support the contention that this neurologic syndrome is in fact a dementia. Stuttering and intermittent mutism characterize the disorder and may be valuable in the differentiation of dialysis dementia from other neuropsychiatric syndromes. Some of the speech and language defects are not explicable on the basis of intellectual deterioration and probably represent involvement of the cortical language centers.

Aged↗
PubMed2001

Equity of access to a memory clinic in Melbourne? Non-English speaking background attenders are more severely demented and have increased rates of psychiatric disorders.

OBJECTIVES: The aim of this study was to compare demographic and clinical features of patients from Non-English Speaking Background (NESB) with those from English Speaking Background (ESB) who attended a memory clinic in Melbourne, Australia. METHODS: Data on 556 consecutive patients attending the memory clinic were analysed retrospectively. All patients were assessed by a geriatrician (Italian speaking) or psychogeriatrician with the aid of Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) interview schedule. Patients were classified into the categories of dementia, functional psychiatric disorder (including depression), cognitive impairment other than dementia and normal, using ICD 10 criteria. Severity of dementia was determined using the Clinical Dementia Rating scale. Demographic information and use of community services were also documented. RESULTS: Of those seen, 148 (28.8%) were of NESB, the majority Italian (69, 12.4%). Patients of NESB were younger (p = 0.001), less educated (p = 0.001) and less likely to live alone (p = 0.009) compared to persons of ESB. Those of NESB were more likely present with a functional psychiatric disorder (particularly depression) or normal cognition (p = 0.001). Patients of NESB with dementia presented at a later stage of their disease as determined by CDR (p = 0.003). Those of NESB scored significantly lower (more impaired) on CAMCOG in all patients seen (including normal and psychiatric groups) (p = 0.02). CONCLUSIONS: The clinical and demographic features of people of NESB referred to a memory clinic in Melbourne, Australia, differ from their ESB counterparts, with specific groups being under represented. This has implications for equity of assessment, service provision and utilisation for those of ethnically diverse backgrounds.

Aged↗
PubMed1993

Behavioral assessment in Alzheimer's disease: use of a 24-hr log.

Although behavioral problems are a central feature of Alzheimer's disease (AD), measurement of these behavioral problems has been limited in most studies to retrospective reports of the frequency of behaviors by caregivers. In the present study, 32 caregivers of AD patients completed detailed behavioral logs of their patients' adaptive and ineffective behaviors over a 48-hr period; these logs were then compared with more widely used instruments assessing patients' cognitive functioning, self-care, and behavioral problems. Results illustrate the nature of common behavioral problems in dementia, provide information on the time distribution of behavioral problems, and support the convergent and discriminant validity of one widely used measure of behavioral problems, the Memory and Behavior Problems Checklist. Potential clinical and research uses of the behavioral-log method are discussed.

Activities of Daily Living↗
PubMed2001

The relationship between insight and social skill in persons with severe mental illness.

The relationship of insight with the social behaviors of outpatients with severe mental illness (SMI) was investigated. Participants' engaged in two social interactions (i.e., stigmatizing and nonstigmatizing), each with a different research confederate. The participant's behavior was later coded for the presence of various self-presentation and social skill variables. Results indicated that greater insight was associated with better overall social skill, less observed strangeness, and greater self-disclosure of one's mental illness. Furthermore, the three measures of insight, one based on self-report and two interview-based, were all highly intercorrelated, suggesting that they are measuring a similar construct. Finally, consistent with previous research in the area, greater insight was associated with less severe psychiatric symptoms. Implications of these findings for future research are discussed.

Adult↗
PubMed1978

Family interaction and communication deviance in disturbed and normal families: a review of research.

Recent family interaction studies are reviewed with an emphasis on looking for dimensions along which disturbed and normal families differ. Several areas of consistency in the literature were found, including: family coalition patterns, patterns of conflict, flexibility versus rigidity, family effectiveness and efficiency, and deviant styles of communication. It was concluded that several measures reliably discriminate disturbed from normal families and that one type of measure in particular is a reliable predictor of thought disorder in offspring. Implications for clinical practice and future research are discussed.

Affective Symptoms↗
PubMed1984

Arson: an unforeseen sequela of deinstitutionalization.

Did the shift from institutional to community-based services brought about by deinstitutionalization affect the nature or function of pathological fire setting? The author studied admissions to a state hospital that were precipitated by arson. During a 200-day period, 14 patients accounted for 16 admissions and 17 fires. The data indicate that fires are set by consumers of public sector mental health services to communicate a wish or a need for a change in location of those services. Communicative arson has caused property damage, personal injury, and death and has resulted in a backlash against community alternatives for psychiatric treatment.

Adolescent↗
PubMed1997

Offspring-induced nurturance: animal-human parallels.

Offspring provide mothers with stimuli that impel their own nurturance. In rats, distal sensory stimuli from pups--sight, sound, odor--contribute to contact-seeking, whereas tactile stimuli from pups to dam's snout and ventrum elicit essential maternal behavioral reflexes involved in retrieval, licking, and the quiescent, upright nursing posture (kyphosis). Brain sites involved with maternal behavior--assessed by lesions, immunocytochemical visualization of gene activity, and neurophysiological mapping--include the midbrain central gray, medial preoptic nucleus, limbic system, and somatosensory cortex; these may change with experience. Human mothers inadvertently learn to identify their own baby rapidly after birth and can do so via a single sensory modality. Subsequently maternal responsiveness and gratification are impaired by inappropriate, insufficient, or nonreciprocal interactions such as occurs when the baby cries excessively, is blind, deaf, or autistic. Thus, maternal behavior characterized by elicited responses and emotional reactions to stimuli from offspring may be evolutionarily conserved.

Adult↗
PubMed2004

Examination of potential overlap in autism and language loci on chromosomes 2, 7, and 13 in two independent samples ascertained for specific language impairment.

Specific language impairment is a neurodevelopmental disorder characterized by impairments essentially restricted to the domain of language and language learning skills. This contrasts with autism, which is a pervasive developmental disorder defined by multiple impairments in language, social reciprocity, narrow interests and/or repetitive behaviors. Genetic linkage studies and family data suggest that the two disorders may have genetic components in common. Two samples, from Canada and the US, selected for specific language impairment were genotyped at loci where such common genes are likely to reside. Significant evidence for linkage was previously observed at chromosome 13q21 in our Canadian sample (HLOD 3.56) and was confirmed in our US sample (HLOD 2.61). Using the posterior probability of linkage (PPL) to combine evidence for linkage across the two samples yielded a PPL over 92%. Two additional loci on chromosome 2 and 7 showed weak evidence for linkage. However, a marker in the cystic fibrosis transmembrane conductance regulator (7q31) showed evidence for association to SLI, confirming results from another group (O'Brien et al. 2003). Our results indicate that using samples selected for components of the autism phenotype may be a useful adjunct to autism genetics.

Autistic Disorder↗
PubMed2000

[Comparison of complications in elderly and non-elderly patients with neurological diseases during admission to a rehabilitation hospital].

Medical complications seen in admitted patients in a one-year period in a rehabilitation hospital were evaluated, and patients with neurological diseases were subdivided with age in order to determine trends of complications with occurred in the aged patients. Ninety-five of 117 patients (81.2%) suffered from complications, the most common were respiratory diseases, genitourinary diseases and psychoneurological diseases and events. Infectious diseases were very common throughout all ages. Significantly more cases and occasions of complications occurred in the aged patients (ages 65 or more, n = 59) than in the younger patients (aged under 65, n = 58), which suggests that complications tended to recur in the same patient in the aged group. Genitourinary diseases, especially urinary tract infection, was far more common in the aged group, predominating in women. Recurrences of stroke or poststroke epilepsy were more frequently seen in patients aged under 65. Traumas and fractures related to falls occurred more commonly in the aged group. Elderly patients were more susceptible to complications not directly related to the illness for which they were admitted. Complications occur quite commonly in aged patients admitted to our rehabilitation hospital, and careful attention should be paid to conditions unrelated to the illness causing admission, such as infectious diseases, especially for aged patients.

Aged↗
PubMed2003

[Motivational conflict, attachment "amae" and emotional communication between infants with autistic spectrum disorders and their caregivers].

To date, many researchers in Japan have been working on the assumption that the cause of autistic spectrum disorders is attributable to some disorder in the ability of the child. We have been working on the premise that the autistic spectrum disorders are brought about by some form of relationship disturbances in early infancy, and have been attempting to validate this hypothesis through early intervention. We have been examining the developmental process of affective communication in infants with autistic spectrum disorders. We postulated approach-avoidance motivational conflict (Richer, 1993) as the primary factor impeding development of affective communication, focusing therapeutic intervention on this perspective. As a result, attachment behavior was remarkably improved in the children. Through a clinical course of an example, the problem pertaining to the process of acquiring the function of language cognition is discussed. Starting with the concept that the meaning of any given object is not stipulated as a unique existence, but by context, it is pointed out that in order to relate the meaning of some object to a child, sharing with the child "which" attributes of the object the child should focus upon and "how" it should be dealt with are indispensable. This is then followed by discussion of how this cannot be accomplished without deepening of affective communication upon the basis of attachment formation.

Adult↗
PubMed1984

The implications of bilingualism in the study and treatment of psychiatric disorders: a review.

This review of the data on bilinguals in relation to hypnosis, psychotherapy and psychotic disorders presents evidence for the bilateral representation of language in the cerebral hemispheres of bilinguals, and outlines possible links between the neuropsychology of psychotic disorders and the lateralization of language in these patients. The relationship between affective states and the retrieval of memories and language is also explored.

Aphasia↗