ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A spectrum concept of schizophrenia is described which hypothesizes that classical schizophrenia results at least in part from a genetic diathesis; that certain other, usually milder, psychopathological states, which do not satisfy the classical criteria for the diagnosis of schizophrenia, represent varying clinical expressions of the same diathesis; and that all of these states can, therefore, be said to constitute a genetically based spectrum of schizophrenic disorders. This concept is, in its broad outlines, not new, but it has had an increasing impact within psychiatry in recent years. Most importantly, it provides a conceptual framework for a variety of schizophrenia studies, particularly those dealing with biological markers, genetic vulnerability, clinical phenomenology, and modes of inheritance. A program of research which has attempted to test the concept, and to identify, describe, and classify the components of the genetic spectrum, is reviewed. Its methodology makes possible an approach to schizophrenia which simultaneously takes into account its two most vexing problems—nosology and etiology.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A comprehensive system of community treatment in southwest Denver has reduced the need for adult psychiatric inpatient beds to less than 1/100,000 population. Six small, community-based therapeutic environments, crisis intervention, home treatment, social systems intervention, and rapid tranquilization comprise the essential components of this total community care system. The system operates within a framework of citizen participation and community control, the elimination of formal staff offices, and a focus on working in the real-life setting of the client and his family. To evaluate the effectiveness of community care, patients about to be hospitalized were randomly assigned to a psychiatric hospital or to community alternative treatment. Outcome measures at discharge and at follow-up completed by the client himself, treatment staff, and family members indicate that community treatment was more effective than psychiatric hospitalization.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The interaction of alcoholics and their spouses in a simulation game was systematically observed and compared to the behavior of nonalcoholic couples. Overall, 28 couples played a mixed-motive bargaining game, the “tax game,” which is a modification of Kelly's “game of nines.”Alcoholic couples as a group did not manifest a distinct game “style.” They were less uniform in this respect than “normal” couples and a mixed group of “psychiatrically disturbed” couples. Subgroup trends without the alcoholic sample were suggested and discussed. Extreme behavior, rigidity, and lack of communication were common features in the game behavior of alcoholic couples that did not appear to relate to a particular game style, but did distinguish the game play of alcoholic couples from that of nonalcoholic couples.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

There is a historical dilemma concerning the civil rights of psychiatric patients who are believed to need a protected status because of incompetency. California's Lanterman -Petris-Short Act provides a mechanism for putting the patient under the care of a conservator if the patient is unable to provide for his own personal needs of food, clothing, and shelter. If successful, this legislation will likely be the model for the country.Fifty-one patients for whom the clinical staff desired to initiate conservatorship proceedings were given a test consisting of behavioral tasks specifically designed to be appropriate to the legal definition of grave disability. The natural groupings were: chronic organic brain syndrome, chronic schizophrenia, and other.We found that the grave disability of the organic brain syndrome patients was fairly predictable from their mental status examination, while the grave disability of the chronic schizophrenic patients was unpredictable from their mental status examination and required the application of the behavioral test for an appropriate determination of their ability to perform the functions specified in the law: The Lanterman Petris-Short Act to provide for personal needs of food, clothing, and shelter. When the method or the proceedings were applied to patients of other diagnostic categories, they were found to be inappropriate.At this writing, our method of evaluation is being recognized and requested by public and legal agencies in our area. It has been used as evidence in court. The procedure is clear, relevant, and easily taught to new workers. The results, given in plain English and in essay form, are readily understood by physician, social worker, judge, and jury alike. We began our study with vexation, ambiguous criteria, and a chronic medical and legal problem; we conclude with a practical and relevant answer.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The evidence dealing with suicide among physicians was reviewed. Special attention was paid to the statistical treatment of the data, the presence or absence of adequate standardization, and the significance of the sample size. No conclusive evidence was found that suicide rates among physicians, or among any medical specialty, were higher than those in the general population.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Although definitive studies regarding the correlation between tricyclic antidepressant plasma levels and therapeutic effect are lacking, preliminary data suggest that measurement of tricyclic antidepressant plasma levels provides a rational approach to improve clinical management of the depressed patient. Data were collected to determine if the routine measurement of plasma tricyclic antidepressant levels was practical in a large clinic population, and to determine if such levels could improve patient care. Individual differences in drug metabolism and frequent unreliable ingestion of medication make the measurement of drug plasma levels the only sure means of determining if a patient is receiving a fair therapeutic trial on a particular tricylic antidepressant. Plasma analysis revealed both the failure to ingest adequate amounts of medication as prescribed and also the abuse of medications. Although generalizations regarding individual variation in drug metabolism or generalizations concerning drug compliance do little to improve patient care, whenever such problems are met on an individual basis, many clinical management problems can be resolved.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A number of reports indicate that many women experience minor physical and psychological symptoms just prior to or during menses. Rarer episodic psychotic states associated with menses have received scanty attention. In the few available case reports, many hypotheses about their etiology have been advanced, usually unsupported by systematic studies.A 15-year-old girl with periodic psychotic episodes associated with menses was studied over many months. The interval between her periods was around 45 days. Psychotic episodes usually started a few days before or in association with menstural bleeding. Typically characterized by withdrawal, negativism, an apprehensive attitude, and suspiciousness, they remitted fully in 10 to 12 days with or without treatment. To facilitate necessary behavioral observations and complete various investigations, the patient was kept for nearly 60 days without treatment as an inpatient. Repeated vaginal smear cytology examinations during the menstrual cycle indicated a predominant estrogen influence throughout the cycle with an absence of the expected progesterone predominance in its later part. The patient gained 5 pounds between two cycles. Therapy with progesterone was instituted following the observation period. This patient's Rorschach revealed strong conflicts in relation to her sexuality. Concomitant with change in vaginal cytology reflecting a more balanced estrogen/progesterone influence, the patient stopped having psychotic episodes with menses. During a trial period when progesterone therapy was stopped, the psychotic episodes recurred but were prevented with its subsequent reinstitution.A complex interplay of hormonal factors that brings heightened sexual drive and possibly water retention in a predisposed patient can contribute to the causation of psychotic episodes at menstrual onset. Menstrual bleeding can assoociatively facilitate sexual fantasies and heighten conflict. Under this combined stress, the ego's defensive structure is likely to crumble with resultant psychotic episodes.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A 1.5-year-old schizophrenic girl with many autistic features was observed to have minimal gains from verbal (individual and family) psychotherapy. A course of six rage-reduction sessions was carried out. Effects of the treatment was assessed by daily ratings made by attendants in the ward setting and by a recreation therapist. Both short term and long term effects were assessed. Short term improvement was noted in the ward ratings on dimensions assessed: eye contact when requested; eye contact, spontaneous; speech quality; expression of feelings; interaction with peers; frequency of autistic behaviors; and interaction with adults. In recreation therapy (using fewer observations), short term improvements were noted in all except two of the dimensions: eye contact, spontaneous; and interaction with peers. Long term ( pretreatmentv.s.post-treatment) gains were evident in the ward ratings on all areas except expression of feelings. In the recreation therapy setting, only frequency of autistic behavior showed a stable improvement. The therapist working with the patient also noticed more global changes, and suggested that rating such dimensions as depth of self-disclosure and willingness to confront important issues in verbal psychotherapy would also show interesting results. Methodological weaknesses of the study are mentioned, and guidelines for future work on this problem are suggested.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A patient with a 24-year history of blood-illness-injury phobia associated with bradycardia and syncope was treated behaviorally. He was taught to prevent bradycardia and resulting syncope occurring in the presence of phobic stimuli by provoking anger in himself using appropriate imagery. Within a few weeks, the patient was able to use the procedure successfully to prevent syncope in everyday situations. At 6 months follow-up he remained comfortable in the presence of previously phobic stimuli and he no longer needed to use self-induced anger to prevent syncopal episodes.

ISSN:0022-3018    

出版商:OVID    

年代:1976

数据来源: OVID