Psychiatric Signs Research Articles

Biophysical shunt theory for neuropsychopathology: Part I

We present a new model of the origin of schizophrenia based on biophysical ionic shunts in neuronal (electrical) pathways. Microstructural and molecular evidence is presented for the way in which changes in the neuronal membrane ionic channels may facilitate membrane property rearrangement, leading to a change in the density and composition of the ion channel charge which in turn causes a change in ionic flow orientation and distribution. We suggest that, under abnormal conditions, ionic flow shunts are created which redirect the biophysical collateral neuronal (electrical) pathways, resulting in psychiatric signs and symptoms. This model is complementary to the biological basis of schizophrenia.

Factitious disorders and the psychosomatic continuum in children.

A continuum may be described as spanning between the psychological reactions of children and families to a child's illness, the exaggeration or simulation of symptoms for psychological reasons, and the production of factitious symptoms in the child by the parent. However, there are critical clues that allow the alert clinician to recognize where his patient falls on the continuum. Because factitious disorders are uncommon and Munchausen syndrome by proxy is rare, awareness of psychiatric and clinical signs is important to prevent morbidity or mortality.

Classification of alcoholism with reference to comorbidity.

Classification of individuals with alcoholism is currently limited. The purpose of this analysis was to determine whether antisocial personality disorder and other primary psychiatric syndromes identified subgroups of alcoholics with differing characteristics. Alcoholic probands (n = 224) with alcoholism were divided into those with primary alcoholism (n = 128), antisocial alcoholism (n = 50), and secondary alcoholism (n = 46). These groups were evaluated with regard to alcohol-related symptoms and upon a variety of psychiatric signs and symptoms. The secondary alcoholism. The antisocial alcoholic and primary alcoholic groups demonstrated many similarities, but overall, the antisocial alcoholic group appeared most severe. The antisocial alcoholic group additionally exhibited a dissociation between the subjectively reported and the observed behavior. These findings support the concept of heterogeneity within the alcoholism spectrum. Longitudinal data are needed to determine whether the observed cross-sectional differences predict outcome differences.

Pathological Grief: An Intensive Case Study

Pathological mourning is such an excessive, blocked, or distorted process that psychiatric signs and symptoms develop. Explanation of how and why these signs and symptoms form could deepen an understanding of both normal and pathological mourning. Because many variables are involved in such explanations, intensive case study is a desirable methodology because it permits a detailed look at how various factors interact (Brewer and Hunter 1989; Luborsky and Mintz 1972; Luborsky and Spence 1971; Nessleroade and Ford 1985). While a patient may complain of symptoms as experiences that endure or occur episodically over days and weeks, a clinician observes psychiatric signs in the here-and-now seconds and minutes of an interview. Relating signs and symptoms to each other and to other variables in order to form a theoretical model of their formation requires exploration of data across long and short time frames. It is important to understand how the here-and-now phenomena combine to form patterns across longer periods of the individual's life. Hence, we developed a combined macro- and microanalytic approach to intensive case studies.

Psyclops: an exploratory graphical system for clinical research and education.

We present Psyclops, an interactive computer graphic system designed to help address a growing information dilemma in the examination of individual psychiatric cases. Ever more information is needed to better understand conscious experience, interpersonal behavior, and the formation of psychiatric signs and symptoms, yet the information load already exceeds our usual methods of handling it. Psyclops consists of a suite of software modules, manual sections, and standards that have been developed according to guiding concepts intended to help one collect, organize, access, and explore complex data about a single subject for research, education, and ultimately, clinical care purposes. This document provides background in clinical information science and a description of the system; the reader interested in its application in clinical research theory development is referred to the companion paper in this issue (Horowitz et al., Pathological Grief: An Intensive Case Study).

Sex differences in the psychiatric manifestations of Alzheimer's disease.

To test the null hypothesis, ie, that there are no gender differences in psychiatric problems manifest in patients with Alzheimer's disease. Survey. Patients living in the community and evaluated at Alzheimer's disease and geriatric outpatient programs. Three hundred twenty-eight women and 186 men clinically diagnosed with Alzheimer's disease using NINCDS/ADRDA or DSM-III-R criteria. Psychiatric signs and symptoms recorded following a psychiatric interview, including the Hamilton Depression Rating Scale. Approximately two-thirds of both men and women had psychiatric problems, but women had significantly more multiple symptoms. When pairs of symptoms were analyzed for independence, agitation was only significantly associated with paranoia in men, whereas in women agitation was significantly associated with most other psychiatric problems. The higher prevalence of multiple psychiatric problems in women may be due to many factors, including sociodemographic influences, physician bias, and/or other differences between men and women. The finding of a different pattern of association of symptoms with agitation in men and women deserves replication.

Subclinical dementia: relevance of cognitive symptoms and signs.

In 1971 and 1972, a representative sample of 70-year-old people (n = 392) from a population study was rated with regard to psychiatric symptoms and signs. Subjects showing evidence of dementia of any degree, including slight and questionable, were excluded (n = 18). The remaining 374 subjects were followed longitudinally for 9 years. Thirty-eight subjects developed severe dementia during this period. They were compared to those who did not with regard to 19 reported and 17 observed items concerning general psychopathology, seven reported items concerning sleep, and a global rating of mental health. Five items correlated with the development of severe dementia: number of remembered dreams per week, latency of speech, speed of speech, difficulties in finding words, and memory for recent events. A stepwise logistic regression procedure demonstrated that a low frequency of remembered dreams, a reduced memory for recent events, and difficulties in finding words made independent contributions to the prediction of dementia. There were no differences with regard to affective items. There were no differences between the subjects who developed senile dementia of the Alzheimer type and those with multi-infarct dementia. The results thus support the hypothesis that symptoms pertaining to cognitive functions are the first to appear in the development of dementia.

The value of quality of life rating in psychiatry

There is increasing interest – and an urgent need both in research and in practice – to measure quality of life factors. In the psychiatric context I would stress the importance of using the patient's subjective evaluation of items associated with well-being and not basically contaminated by social factors. The evaluation should be health-related but not primarily concern psychiatric symptoms and signs, items that should be unrelated to the quality of life domains. Global ratings with the visual analogue scale should preferably be used, and the values thus obtained transformed to utilities and practical life situations.

Psychiatric symptoms and mental changes as major features of multiple sclerosis

A patient is presented with clinically and laboratory supported definite multiple sclerosis who developed severe depression followed by mental deterioration. Magnetic resonance imaging MRI demonstrated multiple hemispherical lesions. It is suggested that the psychiatric and cognitive signs and symptoms observed in this patient are due to severe cerebral demyelination.

Decreased hippocampal expression of a glutamate receptor gene in schizophrenia.

'A striking and specific loss of the messenger RNA that encodes a non-N-methyl D-aspartate (non-NMDA) glutamate receptor was found in hippocampal tissue obtained at necropsy from 6 patients with schizophrenia, when compared to specimens from 8 controls without neurological or psychiatric signs or symptoms. These findings support suggestions of aberrant glutamatergic function in schizophrenia. Evidence that gene expression may be abnormal in schizophrenia, with decreased production of an excitatory neurotransmitter receptor, may have therapeutic as well as pathogenetic implications.'

Delayed Diagnosis of a Frontal Meningioma

AbstractThe case of a 42-year-old homeless, previously high-functioning woman is presented. Over the course of 1 year she developed headache, visual loss, visual hallucinations and personality change that were attributed by several medical services to conversion disorder or malingering. When admitted to the psychiatry service a large frontal meningioma was diagnosed. Psychiatric and neurologic signs and symptoms of brain tumors, as well as indicators of psychiatric presentations of organic disease, are discussed.

Decreased hippocampal expression of a glutamate receptor gene in schizophrenia

A striking and specific loss of the messenger RNA that encodes a non-N-methyl D-aspartate (non-NMDA) glutamate receptor was found in hippocampal tissue obtained at necropsy from 6 patients with schizophrenia, when compared to specimens from 8 controls without neurological or psychiatric signs or symptoms. These findings support suggestions of aberrant glutamatergic function in schizophrenia. Evidence that gene expression may be abnormal in schizophrenia, with decreased production of an excitatory neurotransmitter receptor, may have therapeutic as well as pathogenetic implications.

Set-covering diagnostic expert system for psychiatric disorders: the third world context

This paper presents an implementation of the set-covering model for diagnosing psychiatric disorders. Such a model is useful as the basis for the inference mechanism of an expert system in that it provides a satisfactory solution to the difficult problem of multiple simultaneous disorders. The set covers have been formed through the ‘diagonal search method’ in which the combination of an element with the rest of the elements along the diagonals in the combination matrix was found to be adequate. ‘Abductive logic’ has been used to reach the possible final solution. Another feature of this expert system is its elicitation system. Provision has been made in the expert system for observations to be made and questions to be asked of the patient in difficult-to-elicit psychiatric signs. It makes this expert system usable by the non-expert clinicians. This has been specially designed in the context of third-world conditions. The system has been tested on cases given in the DSM-III case book with 100% success. However, the system's knowledge should be expanded and refined if it is to be used in psychiatric clinical practice.

Interobserver reliability of a "Standardized Psychiatric Examination" (SPE) for case ascertainment (DSM-III).

The authors describe the Standardized Psychiatric Examination (SPE), a new method for conducting psychiatric examinations in both clinical and research settings that preserves the clinical method. The SPE provides a consistent replicable format for eliciting and recording psychiatric history, signs, and symptoms without perturbing the patient-clinician interaction. By means of the SPE, the clinician can formulate diagnoses using DSM-III or ICD-9 criteria and yet generate CATEGO profiles derived from the Present State Examination, 9th edition. Psychiatrists using the SPE demonstrated high interrater reliability in ascertaining individual psychopathological symptoms (Kappa range, 0.55 to 1.0) and in making DSM-III diagnoses (Kappa range, 0.79 to 1.0) among a sample of study subjects (N = 43) drawn from both a psychiatric inpatient population and a large community sample of nonpatients from the Epidemiological Catchment Area (ECA) study. The implications of the SPE for clinical practice and for research are discussed.

Adrenoleukodystrophy: Frequency of presentation as a psychiatric disorder

Adrenoleukodystrophy (ALD) is an inheritable clinical disorder in which very long chain fatty acids accumulate in several tissue types. ALD is underrepresented in the psychiatric literature, although the disorder may cause an organic brain syndrome, often misdiagnosed as another psychiatric problem. A survey of 109 reported cases of ALD revealed that 39% presented with some psychiatric sign or symptom, whereas 17% presented exclusively as a psychiatric problem. A computed axial tomogram (CAT) head scan is recommended to rule out ALD in psychiatric patients suspected of having organic brain disease, as a characteristic image may be found in ALD patients who have brain involvement.

Decision criteria for predicting adherence for psychiatric emergency room patients with referral appointments

This paper describes and evaluates a method of predicting referral appointment-keeping behavior for psychiatric emergency room patients. Studies have shown that referral systems which provide appointments and reminders achieve higher appointment adherence. However, studies have not been conducted of those experiencing a good referral system to predict adherence behavior and indicate further areas for improvement. Discriminant analysis is applied to patient's psychiatric signs and symptoms for selecting variables that predict referral appointment keeping behavior. All patients seen during a 6 week period were selected from a 1,000 bed hospital's Psychiatric Emergency Room. The data were collected during the patient's visit to the psychiatric emergency room and prior to aftercare treatment. The subset of non-psychotic patients requiring outpatient psychiatric care was the focus of this analysis. The model indicates that patient's adherence with referral appointment can be predicted with 76% accuracy using the best three discriminating variables. This prediction per cent increases to 97% with all contributing variables. The non-adherers are identified with 66% and 100% accuracy, respectively. Distressingly, “Suicidal Behavior” and “Potentially Harming Others” relates to non-adherence. If the non-compliant emergency patient, especially those dangerous to themselves and others, can be identified in advance, the care systems can be changed to increase the number of patients following referral recommendations. This reduces both initial treatment cost and avoids cost resulting from more severe illnesses arising for lack of initial treatment.

Appointment compliance behavior of community mental health patients: a discriminant analysis.

This study evaluated various demographic and psychiatric signs and symptoms of community mental health clients in an attempt to identify those variables which influence appointment compliance behavior. A sample of 172 non-psychotic clients with a primary diagnosis of neurosis, personality disorder, or transient-situational disturbance were studied utilizing discriminant analysis. The results indicate that approximately 85 percent of the clients were properly classified as either compliant or non-compliant in their appointment behavior. The implications for mental health care are discussed.

Les epilepsies benignes partielles: 11 cas d'epilepsie partielle frontale a evolution favorable

The authors report a retrospective study of 11 observations of partial frontal epilepsy. Cases have been selected on the basis of a complete lack of any associated neurological or psychiatric sign and a disappearance of seizures with normalization of the EEG trace for more than 5 years. This peculiar type of focal epilepsy characterized by an EEG frontal spike focus is first shown to share clinical and electroencephalographic signs with other forms of benign epilepsy of childhood and adolescence. Then the predictive value of some electro-clinical criteria to indicate a favourable outcome is examined.

Diagnosis of organic depressive disorders

Psychiatrists need to “think medically” about their patients, because underlying medical disorders often present with prominent psychiatric signs and symptoms, and referring nonpsychiatric physicians can overlook medical illness in persons with psychiatric symptoms. The authors single out key warning complaints to keep in mind, and describe an approach to diagnosis of concealed medical illness in patients presenting with depressive disorders, based on specific symptoms, general medical history, physical examination, and laboratory tests.

Psychiatric effects of thyroid hormone disturbance: Psychosomatic illness review: No. 5 in a series

Neuroendocrine disorders often present and/or are associated with psychiatric signs and symptoms. The author reviews the literature on psychiatric findings in hypothyroidism and hyperthyroidism and provides recommendations for diagnostic and treatment procedures.