Organic Psychosis Research Articles

Three examples of hypnosis in the treatment of organic brain syndrome with psychosis.

Abstract Hypaotic procedures with 3 psychotic patients are discussed. Short-term hypnotherapy using a direct authoritative approach resulted in better orientation to time and place, less confusion, some pain relief, and ability to achieve a level of self-hypnosis for 2 patients with cerebral cancer. The other patient, who had an undetermined organic psychosis, benefited from an indirect technique which avoided direct suggestion and emphasized the patients control of her thinking and bodily reactions. She was able to control anxiety and delusional thinking. A trusting relationship with the therapist was developed before hypnosis with the delusional patient was begun. Possible factors involved in the treatment were a positive interpersonal relationship, therapist attitude, and therapeutic goals.

Schizophrenia--disease or syndrome?

The extensive literature concerning disorders which may sometimes be associated with a picture closely resembling schizophrenia is discussed. The results of a survey of such conditions in Victoria, Australia, mental hospitals are summarized, and several illustrative case histories described. The futility of attempts to distinguish at a given point in time between certain organic psychoses and schizophrenia itself is emphasized, and a proposed reclassification of schizophrenia into symptomatic and idiopathic types is again suggested. This is merely an extension of the idea of a number of prominent psychiatrists, but should prove of value in psychiatric thinking.

Ten-year follow-up of 100 patients admitted to a mental hospital.

A ten-year follow-up study of 100 patients admitted consecutively to a mental hospital revealed the following information. The patients used the hospital beds for an average of one year and two months of the ten years, that is, about. one-eighth of the time. The co-operative schizophrenic patients could be kept out of hospital with proper maintenance therapy. Patients admitted with organic psychoses died after an average of one and three-quarter years. Of the ‘functional’ cases nearly a half were alive after ten years, 8 were dead (2 or 3 suicides) and the rest could not be traced. The patients had an average of 23 physicians but this large number does not appear to have harmed them. Nearly all patients had some drug therapy, the two most frequently prescribed categories being neuroleptics and antidepressants. About half the patients had occupational and work therapy. The condition of the 68 survivors was considered to be: ‘recovered’ or ‘much improved’ in 55 per cent; ‘moderately or slightly improved’ in 40 per cent and ‘unimproved or worse’ in 3 per cent. Their last known vocational status was ‘working or self-sufficient’ in 34 per cent, ‘dependent’ upon relatives or government support in 43 per cent and not known in 23 per cent.

The Causes of the Schizophrenias

Editorials1 October 1972The Causes of the SchizophreniasROBERT CANCRO, M.D., MED.SC.D., F.A.C.P.ROBERT CANCRO, M.D., MED.SC.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-77-4-647 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptEugen Bleuler (1) took an important step away from the disease-entity model when he introduced the concept of a group of schizophrenias. He recognized the existence of a number of end states that shared certain clinical similarities. He drew an analogy between the schizophrenias and the organic psychoses. Today we have gone beyond this position and recognize the schizophrenias, not only as a group of clinically similar end states, but as deriving from different initial states through different pathways. There is no single cause for the schizophrenias. The very complexity of this group of disorders suggests that the causes are...

The present status of vitamin B 12 and folic acid deficiency in psychiatric illness.

Vitamin B12 Deficiency Among the many causes of organic psychoses are a number of processes which may be cured or arrested by the right treatment and by early recognition. This includes deficiency of vitamin B12. There is, therefore, a temptation to carry out sophisticated tests for vitamin B12 deficiency in all psychiatric patients. However, until cheaper and fully-automated techniques become available, routine vitamin B12 assays cannot be justified in psychiatric patients. At the present time a hemoglobin estimation and a careful inspection of the peripheral blood film by an experienced hematologist appear to be the most economic primary screening test for vitamin B12 deficiency. Nevertheless, psychiatrists should be alert to the possibility of vitamin B12 deficiency in patients with unexplained fatigue and in those with confusional states or dementia of unknown origin. Another presentation may be impotence which sometimes precedes other neurological manifestations of the disease. Even in patients who are not anemic or have no blood film abnormalities (which is uncommon) the possibility of missing cases of hypovitamin B12 deficiency can be further diminished by doing serum B12 assays in patients who are clinically at risk. For example, this includes post-gastrectomy patients, those with a familial history of pernicious anemia and those with an associated auto-immune disorder, such as thyroid disease. Folic Acid Deficiency The available evidence linking folate deficiency with psychiatric disorders is inconclusive. It is probable that the observed excess of folic acid deficiency in psychiatric patients can be explained on the basis of malnutrition, chronic physical illness, alcoholism or other drug usage. An important exception is brain damage and mental retardation in infants with inborn errors of folic acid metabolism. Further evaluation of folate deficiency is indicated, particularly in the affective disorders and in ambulatory, non-institutionalized, epileptic patients receiving anticonvulsant medication.

Influenza infection causing manic psychosis.

Although depression is well known as a sequel to influenza, mania is not. We describe a patient with a severe psychotic illness who first showed features of a confusional state but then developed a manic psychosis. The occurrence of functional affective psychoses during or following systemic physical illness has been well described (Bonhoeffer, 1909; Kraepelin, 1921; Kiloh, 1961; Post, 1965), but the nature of the relationship has never been clear. In some instances, the physical illness may simply act as a form of non-specific stress precipitating the mental disorder; evidence for a more direct patho-physiological relationship has been lacking. When, in addition to a background of physical illness, a patient shows disorientation and clouding of consciousness together with signs of a manic psychosis, the diagnostic problem is especially difficult, particularly so since a confusional state can occur as part of a severe manic illness (Maudsley, 1895; Kraepelin, 1921). Conversely, hypomanic symptoms can occur in an organic psychosis (Bonhoeffer, 1909).

Modern Perspectives in International Child Psychiatry

This volume is one of three in the series, Modern Perspectives in Psychiatry. Two of the volumes, including the one here reviewed, are devoted to child psychiatry. A variety of subjects is discussed helpfully, starting with intrauterine hazards, through birth and early infancy, to mother-child and father-child relations. The clinical part includes discussion on electrocerebral activity and sleep disturbances, psychosomatic conditions, psychogenic retardation and organic psychosis. A comprehensive discussion of school problems and residential care of children is followed by a very interesting article on the strategy of follow-up study, which is so important in improving our ability to better predict the outcome of emotional problems in childhood. However, the word modern, in the title, promises more than it fulfills. Indeed, although this book is comprehensive and includes a variety of important topics, much new information is missing, eg, the use of imipramine in enuretic children, or the salutary effects

Social breakdown syndrome: environmental and host factors associated with chronicity.

Eight years ago APHA Program Area Committee on Mental Health stated:' There is one type of mental malfunctioning which occurs in many different chronic mental disorders, particularly schizophrenia, mental retardation, and various organic psychoses. (See Table I.) It is responsible for a very large part of institutionalized mentally disordered; it is responsible for much of other forms of extreme social disability seen in these illnesses. This form of mental reaction in presence of mental disorders is largely a socially determined reaction pattern which committee believes can be identified as a major target for community mental health programs today. It is called the Social Breakdown Syndrome. The Program Area Committee had indicated that acute episodes of SBS were very common and that chronic, long-term episodes were major preventable cause of severe disability. Our research group has developed ascertainment techniques to locate cases of severe Social Breakdown Syndrome by determining a set of some 22 objective facts regarding a person's functioning during a particular week.2 Around 1960 when these Program Area Committee statements were being written, we ascertained that annual incidence of chronic SBS (over 1 year in duration) was about 24 per 100,000 in ages 16-64 in Dutchess County, N.Y. Following a reorganization of delivery of psychiatric services for residents of that county-a reorganization designed to prevent chronic forms of SBS-the annual incidence dropped to about 12 per 100,000.3 This is a major improvement, because recovery rates from SBS episodes over one year in duration are very low. Only about half of these episodes will terminate in next five years.4 The handicap is severe, disability almost total. But a remaining incidence of 12 per 100,000 is not trivial-it is higher than suicide rate. What can be done to still further reduce annual incidence of chronic SBS? We first delineated personal factors which could identify a group of new SBS cases at high risk of becoming chronic. We looked at factors known Ernest M. Gruenberg, M.D., Dr.P.H.; Danielle M. Turns, M.D.; Steven P. Segal, M.S.W.; and Murray Solomon, M.S.

Relationship of cerebrovascular disease to senile, presenile and cerebral arteriosclerotic dementia

Abstract A study of mortality among psychiatric patients diagnosed as senile, presenile, and cerebral arteriosclerotic dementia was conducted in Maryland in order to estimate relative death rates. During a 3-yr period, 1802 out of 12,363 subjects admitted to in- and out-patient psychiatric facilities died. The total case-fatality rate was higher in males of both races as compared with females of both races. Age-specific death rates were much higher in the organic group as compared with the functional group. The death rates increased with advancing age. The senile and cerebral arteriosclerotic white males had higher mortality rates than white females, non-white males and non-white females. Patients affected by organic or functional psychoses showed a higher mortality experience than the general population. The possible explanations for this excess mortality are discussed.

Affective disturbance in hypothyroidism.

Since the classic report in 1888 by the Committee on Myxoedema of the Clinical Society of London, there has been a wide interest in the psychiatric aspects of hypothyroidism. Despite many reports which followed, Asher (who in 1949 coined the term ‘myxoedematous madness’) had this to say: ‘Myxoedema is one of the most important, one of the least known and one of the most frequently missed causes of organic psychosis'. Most studies have been clinical descriptions with no correlation of the degree of affective disturbance with the severity of disease process.

Camberwell psychiatric Case Register

A Psychiatric Case Register for the Camberwell area of south-east London yields detailed information on the workings of the mental health services in the locality. This paper presents some of the findings from the first three years' data. — The characteristics of a cohort of long-stay in-patients from Camberwell are discussed in some detail. The number of such patients is found to be falling over time, but at a slower rate than that forecast in official publications. — Figures are presented concerning patients who have shorter in-patient spells, but who may have several periods in hospital during the course of their illness. Admissions for organic psychosis show the highest retention rate over time, and those for reactive depression the lowest. A conscious replanning of short- and medium-term in-patient beds has been initiated in Camberwell, and changes in the functions of the local in-patient agencies are being examined using Register material. — The final section of the paper contains data on out-patient services, provision of which is higher for Camberwell than nationally, due largely to the several teaching hospitals in London which have out-patient departments. — The likely direction of future developments in the Camberwell area, and the importance of a Case Register in monitoring such developments, are discussed.

Associations of subnormal serum folate and vitamin B12 values and effects of replacement therapy.

An investigation of some of the clinical associations of low serum folate and B12 values found in a previous survey of 432 psychiatric inpatients is presented. There were 105 (22.5 per cent) “low folate” (<2.0 ng) patients and 53 (14.2 per cent) “low B12” (<150 pg) patients, 19 of whom had low values for both vitamins. Most low serum values were associated with extrinsic provocative factors. Thus 89 per cent of low folate, 58 per cent of low folate-low B12, and 44.1 per cent of low B12 patients had received drugs during the three preadmission weeks; barbiturates, phenothiazines, and antidepressants (in that order) were the commonest drugs among low folate patients, and phenothiazines among low B12 patients. Significantly more low B12 patients (38.2 per cent) than low folate patients (18.6 per cent) were physically ill. Many low folate (61.6 per cent) and low B12 (47.1 per cent) patients had been ill for more than 1 year, and serious malnutrition was frequent among both low folate (22.1 per cent) and low B12 (32.4 per cent) groups. Low serum levels were infrequently associated with pregnancy and gastrectomy, and no case of intestinal malabsorption was seen. These extrinsic factors were not found in only 21 low folate and 14 low B12 patients (“primary” or “idiopathic” group) among whom no particular mode of psychiatric presentation was seen. Low folate patients had significantly more hematological abnormalities than normal folate patients, whereas low B12 compared with normal B12 patients did not. A retrospective survey of the results of treatment with folic acid and vitamin B12 supplements was carried out because it was found that they had been given to patients with low values in such a haphazard way as to be distributed virtually randomly. Among the low folate patients, 39 received folate and 63 did not. Folate-treated patients with organic psychoses, endogenous depression, and schizophrenia, when assessed on a 4-point scale, were found to be in a better clinical state at discharge than untreated patients; and their stay in the hospital was significantly shorter. There was no evidence that cyanocobalamin-treated low B12 patients were in a better clinical state at discharge or spent a shorter time in the hospital than similar untreated patients, though the assessment period was probably too short for firm conclusions to be drawn.

Mortality among psychiatric patients.

A 5-year follow-up study was carried out of all referrals to the psychiatric services in a Regional Board area. The death registers of the Registrar General for Scotland were searched for all patients who were not known to be alive at the end of the study. Of the 2103 patients included in the original study, 343 were found to have died. This represents 15.9 per cent of males and 16.7 per cent of females referred. Most of the deaths (41%) occurred in the first year of follow-up, 20 per cent in the first 3 months. The overall death rate was approximately twice the expectation based on death rates in the general population of the area. The excess was greatest in those aged under 55 years. All areas of residence, occupations and social classes had increased mortality. Those patients diagnosed as organic psychosis had highest mortality (70%) but all diagnoses had an excessive number of deaths when standardised for age. Of the initial referrals, 1.4 per cent committed suicide during the follow-up period. Apart from neoplasms where deaths were close to expectation, all other broad categories of causes of death were equally involved in the increase. This survey of a total psychiatric referral group (in-patients, out-patients and domiciliary visits and private patients) supports previously reported studies, mainly of in-patients, in their finding of an association between high mortality rates and psychiatric illness. It is possible that this association may result from selective referral to the psychiatric services of those psychiatrically ill patients who exhibit physical symptomatology.

Hypopituitarism (Sheehan's syndrome presenting with organic psychosis.

Hypopituitarism (Sheehan's syndrome presenting with organic psychosis.

Comparative study of consultant psychiatrist and clinical psychologist among psychiatric patients, using Rorschach test

This comparative study among psychiatric patients attending College of Medical Sciences, teaching hospital, Bharatpur, Nepal was carried out to determine responses on Rorschach test (RT). A total of 65 diagnosed psychiatric patients as per international classification of diseases (ICD-10) criteria attending psychiatric OPD between ages of 15 to 65 years, both male and female in the period of January 2009 to July 2009 were selected. RT was administered and results were tabulated as per diagnosis by clinical psychologist. Out of total 65 patients who underwent RT, 41 were male and 24 were female in the ratio of 63:37. In clinical psychologist diagnosis- 38 were schizophrenia, 7 were psychotic depression, 6 were depression, 3 were mania, 1 was organic psychosis and 10 were underlying psychosis and in consultant psychiatrist diagnosis- 36 were schizophrenia, 5 were psychotic depression, 12 were depression, 8 were mania, 3 were organic psychosis, 1 was underlying psychosis. Key words: Rorschach test; international classification of diseases; psychotic depression; organic psychosis; underlying psychosis. DOI: 10.3126/jcmsn.v6i1.3597 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 14-17

Flattening of affect and personal constructs.

Affective flattening is a disorder of emotional expression, of which a good definition is ‘a gross lack of emotional response to the given situation’ (Fish, 1962). It is a clinical sign whose assessment depends upon the clinician's intepretation of the patient's facial expression, tone of voice and content of talk (Harris ' Metcalfe, 1956). Although these are subtle cues, it has been shown that experienced clinicians can assess the severity of affective flattening with a high level of inter-rater agreement (Miller et al., 1953; Harris ' Metcaife, 1956; Wing, 1961; Dixon, 1968). The disorder is usually associated with a diagnosis of schizophrenia, although it may occur in other conditions, such as the organic psychoses (Bullock et al., 1951).

Memory loss due to hippocampal lesions. Report of a case.

MEMORY has been defined as that property of the nervous system whereby it is effective both in the storage and the retrieval of information. 1 Instances of pure memory loss without associated impairment of other intellectual functions and not complicated by the presence of other neurologic signs or symptoms or by clouded or altered states of consciousness are rarely encountered in neurologic practice or reported in the neurologic literature. Memory loss is most frequently found in association with widespread disturbance of cerebral function in conditions such as senile brain disease, the presenile and other organic psychoses, toxic and deficiency states, encephalitis, posttraumatic and postanoxic sequelae, and after electroshock therapy and status epilepticus. 2 In all of these, however, there are usually other associated neurologic abnormalities as well as disturbances of other intellectual functions and of consciousness. Even in those conditions in which the lesions are somewhat localized (Korsakoff-Wernicke encephalopathy,

Drawing in the "transit syndrome" of organic psychoses. Quantitative correlations between graphic performance and grading in the Böcker test

Drawing in the "transit syndrome" of organic psychoses. Quantitative correlations between graphic performance and grading in the Böcker test

Psychiatric disorders in primary hyperparathyroidism.

ABSTRACT Mental disturbances are found in more than 50% of patients with hyperparathyroidism. The mental disturbances consist of slight or severe neurasthenic personality change, principally characterized by lack of initiative and depression, and acute organic psychosis in the most severe cases. The mental disturbances are wholly reversible when the serum calcium returns to normal after successful extirpation of the parathyroid adenoma. Experience has shown that the mental changes and serum calcium levels are correlated: the higher the serum calcium, the more severe is the mental disturbance.

Reliability of a procedure for measuring and classifying "present psychiatric state".

It is generally agreed that psychiatric illnesses can fairly reliably be categorized into four broad groups—organic psychoses, functional psychoses, neuroses and personality disorders. Cases are assigned with greatest confidence to the first group and with least confidence to the fourth. The reliability of specific diagnoses within these classes is much less secure and decreases in the same order. The best recent reviews of the literature are by Kreitman (1961) and Foulds (1965).