Psychiatric aspects of the acquired immunodeficiency syndrome. A case report.
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The purpose of the present work was to evaluate the clinical course of epilepsy with infrequent partial attacks with complex manifestations derived from the temporal lobe. Thirty patients aged 14 to 64 years treated on an outpatient basis and discovered during epidemiological investigations were followed-up. In half the cases only attacks without generalization occurred, in the remaining cases isolated generalized seizures appeared during many years of disease duration. In both groups a decrease was observed in the frequency of seizures in patients treated systematically or irregularly, as well as in those who had never been treated. Despite a long duration of the disease (above 6 years in 24 cases) the patients had normal mental level and good social adaptation.
Progeny of women, whose thyroid function was studied gestationally, had psychological and/or neurologic examinations at 8 months, 4 years and 7 years of age. In more than 100 pregnancies (at least 3 per cent of total pregnancies) hypothyroxinemia occurred and was treated adequately or inadequately. Children were delivered after uncomplicated pregnancies (except hypothyroxinemia), had birth weights of at least 2,500 grams, and were excluded when postnatal insults intervened. At 8 months and 4 years progeny of inadequately treated hypothyroxinemic women had the lowest psychological scores. Now 246 7-year-old children have been examined psychologically and neurologically (earlier data on only 101). Definite trends and a few statistically lower psychological scores of progeny of inadequately treated hypothyroxinemic pregnant women are compared with better psychological scores of 7-year-old children born to euthyroid and adequately treated hypothyroxinemic women. In six sibling sets outcome was better when hypothyroxinemic women were treated with adequate thyroid replacement therapy. If a woman has a poor reproductive history, early in a subsequent gestation, thyroid status should be examined and adequate thyroid medication considered seriously.
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A single case with severe static left hemisphere cerebral damage was used to illustrate some deficiencies in the Bender-Gestalt (B-G) test and to compare its results with the Halstead-Reitan battery. The B-G did not indicate the existence of any brain damage because visuoconstructional tests evidently are related directly only to the right parietal area. The Halstead indicated the existance of brain damage, the amount of impairment to various mental functions, the location, process status, and general type of pathology and provided an evaluation of residual functions. Used as a screening test, the B-G is useful because it measures nondominant functions and is a "don't hold" test. The Halstead should be used when a more complete evaluation or critical test for brain damage is required.
The relationship of cognitive impairment to the course of schizophrenia remains uncertain. By studying psychotic adolescents, 90% of whom were hospitalized for the first time, we hoped to reduce the influence of such confounding variables as lengthy disease process, neuroleptic treatment, and institutionalization. 39 psychotic adolescent subjects who fulfilled DSM-III criteria for schizophrenia, schizophreniform psychosis, paranoid schizophrenia, or atypical psychosis were compared to 41 non-psychotic adolescent psychiatric controls. Subjects were administered the Wechsler Intelligence Scale for Children-Revised, Peabody Individual Achievement tests of reading, reading comprehension, and mathematics, Bender-Gestalt, and Purdue Pegboard test within 3 weeks of admission to a psychiatric hospital. Performance IQ was significantly lower in the psychotic group (72 versus 93, P = 0.03). Thus, the IQ pattern in adolescent psychotic patients at an early stage in their illness was similar to the pattern displayed by chronic adult schizophrenic patients. Results were not consistent with theories of left hemisphere involvement in schizophrenia. Academic achievement was similar in both groups despite marked differences in performance IQ. Psychotropic medication had no significant impact on the results. In summary, deficits in processing novel material seem at the very least to be present at the onset of the psychotic disorder, though they may be non-progressive thereafter.
Bender-Gestalt protocols from a clinical sample (N = 100) were scored according to the Pascal-Suttell method and r11 derived for all possible split-half combinations (n = 35). The distribution of these 35 reliability coefficients proved to be negatively skewed, justifying the use of the maximum split-half reliability rather than the usual odd-even or alpha coefficients. The maximized r11, using only eight designs, was .72, which was higher than has heretofore been reported. Implications of low ns and negative skews for correlational distributions are discussed, and the maximization procedure is recommended even for psychometric tests when the number of items is low.
The neuropsychological and behavioral status of children exposed to narcotics in utero was investigated using the Wechsler Intelligence Scale for Children-Revised, the Bender-Gestalt, the Quick Neurological Screening Test, and the Burks Behavior Rating Scales. The narcotic-exposed children scored significantly lower than control children on Performance and Full-Scale IQs and most of the performance subtests. They scored significantly in the more pathological direction on Hand Skill, Figure Recognition and Reproduction, and Behavioral Irregularities. The narcotic-exposed children were significantly lower on the neurological indicators of the Bender-Gestalt. They scored significantly in the more pathological direction on almost all of the behavioral variables. The children exposed to methadone in utero scored in the more pathological direction than those exposed to heroin so as to raise questions directed toward the societal and ethical implications of methadone treatment.
Neurobehavioural tests were performed by 98 dentists (mean age 32, range 24-49) exposed to elemental mercury vapour and 54 controls (mean age 34, range 23-50) with no history of occupational exposure to mercury. The dentists were exposed to an average personal air concentration time weighted average (TWA) of 0.014 (range 0.0007-0.042) mg/m3 for a mean period of 5.5 (range 0.7-24) years and had a mean blood mercury concentration of 9.8 (range 0.6-57) micrograms/l. In neurobehavioural tests measuring motor speed (finger tapping), visual scanning (trail making), visuomotor coordination and concentration (digit symbol), verbal memory (digit span, logical memory delayed recall), visual memory (visual reproduction, immediate and delayed recall), and visuomotor coordination speed (bender-gestalt time), the performance of the dentists was significantly worse than that of the controls. The dentists scored 3.9 to 38.9% (mean 13.9%) worse in these tests. In trail making, digit span, logical memory delayed recall, visual reproduction delayed recall, and bender-gestalt time test scores were more than 10% poorer. In each of the tests in which significant differences were found and in the block design time, the performance decreased as the exposed dose (product of the TWA of air mercury concentrations and the years of exposure) increased. These results raise the question as to whether the current threshold limit value of 0.050 mg/m3 (TWA) provides adequate protection against adverse effects of mercury.
Hyperactive children (N = 15) and nonhyperactive children (N = 15) were compared. Hyperactive children were found to possess significantly higher (p less than .002) muscular tension levels and, in addition, presented more behavioral problems and had lower test scores. Both electromyographic (EMG) biofeedback and progressive relaxation exercises were successful in the significant reduction of muscular tension, hyperactivity, distractability, irritability, impulsivity, explosiveness, aggressivity, and emotionality in hyperactive children. The greatest improvement was seen in the area of "emotionality-aggression" (irritability, explosiveness, impulsivity, low frustration tolerance, aggresion). No differences were seen in the EMG improvement of drug and nondrug hyperactive children; both made progress under these self-control techniques. However, nondrug children made greater improvements in the behavioral area. Both EMG biofeedback and progressive relaxation resulted in improvements on the test scores of hyperactive subjects (Bender-Gestalt, Visual Sequential Memory, Digit Span, Coding). The therapy would appear to be improved by the inclusion of mental relaxation, concentration, meditation, and mind-blanking exercises for mental control.
This article calls into question the diverse perceptions of the street children in Colombia. Through the use of participant observations and the administration of the Bender-Gestalt, Kohs Block Designs, and Human Figure Drawing tests, the author explains the psychology of the street children. Their behavior on the streets is explained as being rational and appropriate to their circumstances. Since most of the children are not actively rejected by their families, and because they receive support among their peers and from private benefactors in the society, their mental health is not as bad as popularly believed. The misperceptions of them and of the way they are treated by the society are explained in the context of the family and class structure in Colombia. The dominant society consists of patrifocal families that raise children to be submissive to their fathers, whereas the lower social classes raise their children in matrifocal families, which do not have men in them, and which encourage their children to be independent at an early age. The children in their early public display of liberty symbolically threaten the man's dominance in the patrifocal family system. As a result the children's skills are devalued.
One hundred two cardiac surgery patients were tested with the Minnesota Multiphasic Personality Inventory (MMPI) preoperatively and 98 of these patientts (two diet, two were untestable) were tested both pre- and postoperatively with the Wechsler Adult Intelligence Scale, Bender-Gestalt, and the Wechsler Memory Scale. A large number of the patients obtained preoperative "neurotic"-type MMPI profiles. Postoperative deficits in intellectual ability were slight for the group as a whole, however, there was marked within-group variance. The MMPI was not found to be useful as a predictor of postoperative intellectual changes.