Psychiatric Signs Research Articles

Diagnosis and treatment possibilities of extracranial occlusive processes of the carotid artery (author's transl)

Extracranial stenoses and occlusions of the carotid artery have in the last years found increasing interest on account of the possibilities of preventive therapy. On the basis of a survey of literature the incidence of extracranial carotid obliterations, pathogenetic significance and causes of vascular disease are reviewed. Following a brief description of the ophthalmic, neurologic and psychiatric clinical signs, the value of non-invasive diagnostic methods and the risks of angiography are presented. This is followed by a discussion of spontaneous course of different clinical stages, the value of anticoagulant therapy, treatment with acetylsalicylic acid and carotid surgery according to long-term results, with special reference to an own follow-up study of patients in whom carotid surgery had been performed.

Effect of a drug holiday on plasma chlorpromazine levels in chronic schizophrenic patients.

Low chloropromazine (CPZ) levels have been measured in chronically treated schizophrenics. We tested six such patients to determine whether a 2-week CPZ-free period (drug holiday) would improve plasma CPZ levels. We also monitored psychiatric symptoms, autonomic function, and extrapyramidal signs. We found these patients to have low predose CPZ levels that did not change appreciably after the drug holiday. Peak levels following the holiday averaged 28 +/- 7 ng/ml higher than those measured prior to the holiday. Drug holidays are safe and should be examined more thoroughly as a means of improving plasma neuroleptic levels in chronically treated schizophrenics.

Acute hyperparathyroidism. Clinical, laboratory and ultrastructural findings in a variant of primary hyperparathyroidism.

In a series of 6 patients out of 47 cases with extrarenal hyperparathyroidism we investigated the clinical, laboratory and ultrastructural peculiarities of acute hyperparathyroidism. It was found that there are characteristic differences between both entities which, however, are fluid. Clinically more severe were neuromuscular psychiatric and mental signs. In the laboratory parameters PTH determined by radioimmunoassay and calcium were higher whereas hemoglobin was lower. The weights of the adenomas did not differ in both groups and this was also true for light microscopy findings. Electron microscopy revealed accelerated hormone extrusion and autodigestion of retrived membrane material in the cases of acute hyperparathyroidism similar to characteristics of parathyroid cells stimulated by hypocalcemia in tissue culture.

Digitalis delirium: psychiatric considerations.

Digitalis is a ubiquitous drug in modern clinical medicine and digitoxicity is one of the more common iatrogenic disorders. Psychiatric problems are often overlooked as manifestations of digitalis excess and may range from mild disorientation, lethargy, or restlessness to full blown delirium. In this paper we discuss two patients who presented to a psychiatric inpatient unit and were later found to be digitoxic. Psychiatrists are advised to consider digitalis as a possible cause of mental abnormalities and are reminded that psychiatric signs may be the first indication of a potentially lethal drug toxicity. Psychiatric patients may also be at special risk for the development of digitoxicity because of erratic drug taking, electrolyte imbalance or increased autonomic tone.

Clinical and psychological test findings in cerebral dyspraxia associated with hemodialysis.

Cerebral dyspraxia associated with hemodialysis is a progressive, fatal syndrome. Patients suffer from a combination of psychiatric and neurological signs and symptoms. Psychiatric manifestations include anxiety, depression, paranoid ideation, and a progressive dementia with impaired concentration, decreased memory, personality changes, and hallucinations. Neurological findings include deliberate speech, stuttering, dysarthria, dyspraxia of speech and movement, tremulousness, myoclonic activity, asterixis, and seizures. These symptoms are aggravated during and immediately following dialysis. Patients usually die within 6 months of its onset. The etiology is unknown. Treatment efforts have failed to reverse its course. Recognition of this syndrome is highlighted so that informed, critical decisions can be made as to whether to continue dialysis therapy.

Behavioural and biochemical effects of l-dopa in psychiatric patients

Publisher Summary This chapter elaborates the behavioral and biochemical effects of l -dopa in psychiatric patients. Administration of the dopamine precursor, l -dopa to Parkinsonian patients has frequently precipitated psychotic reactions of various types. Patients who consented to participate were maintained on matched placebo for 5–10 days before l -dopa was administered. The first patient showed hypersexuality and compulsive masturbation without other signs suggestive of hypomania such as euphoria or hyperactivity. The second showed no objective behavioral effects and tolerated dosages of 10 g l -dopa day. Two other patients showed a combination of nausea, diaphoresis, a sense of dysphoric stimulation and anxiety. One of these developed ideas of reference. The remaining patient, who had no history of psychosis or psychiatric signs suggestive of schizophrenia, developed a paranoid schizophreniform psychosis. The precipitation of a schizophreniform psychosis by administration of l -dopa in a patient documented to be non-schizophrenic prior to receiving the drug also supports the hypothesized relationship between psychosis and central dopaminergic activity.

Psychiatric symptoms in relationship to the intensity of anxiety.

Anxiety is a highly organized psychophysiologic process that follows definitive patterns that are predictable in a vast majority of patients. In a study of 624 patients over a period of 18 years I found that the vast majority of patients, no matter what the nature of the original stress, demonstrate definite evidence of mounting anxiety before there is any evidence of other clinical psychiatric symptoms and signs. Four components of anxiety were studied on a quantitative basis, namely: (1) motor (tension); (2) affective; (3) autonomic, and (4) verbal. The various secondary psychiatric symptoms and signs in almost all instances begin to manifest themselves only after there is a definite appearance of the affective component independent of the type of stress. The vast majority of patients show essentially the same sequence of symptom appearance with each bout of anxiety in response to the same or different types of stress. The intensity of anxiety must first be decreased before symptoms or a succession of symptoms disappear. The various components of anxiety are not ameliorated simultaneously in response to various therapies. The pattern of improvement does not depend upon the nature of the therapy. Only the rate of improvement is dependent upon the type of therapy employed. A symptom or sign does not disappear until the affective component of anxiety is decreased below a certain threshold. The last symptom or sign to appear is usually the first symptom or sign to disappear as the level of anxiety is reduced.

Social and psychiatric aspects of impotence and premature ejaculation.

A population of 201 Swedish nonpsychotic outpatients with complaints of impotence and premature ejaculation was examined. Impotence was defined as the inability to achieve erection and premature ejaculation as anteportal ejaculation, ejaculation immediately after insertion, or ejaculation which the patient desperately attempts to delay, invariably without success. This study concerns the family background of the patients, especially parental age, the patients' social background, occupation, socioeconomic status, and the occurrence of psychological disturbances. More than one-third of the patients who had been raised in a complete family were only sons, in contrast to the estimated corresponding frequency of only sons in the Swedish population of 6%. Parental age of the patients was higher than the estimated average for Swedes of the same age as the patients. There was no difference between the number of patients who had been born out of wedlock and the frequency in the ordinary population. The occupational status of the patients more often included technical and economic professions compared to the average distribution of professions in Sweden; there was a marked preponderance of engineers. No common psychiatric signs or symptoms characterized the patients in the two groups.

Abortion counseling.

Abortion counseling has 3 purposes: 1) to aid the applicant in making a decision about the unwanted pregnancy, 2) to help her implement the decision, and 3) to assist her in controlling her future fertility. To accomplish the 1st objective, the compulsory use of psychiatrists to prove emotional disorders has been unsatisfactory. Counseling needs to be supportive and nonjudgmental regardless of circumstances. Hostile feelings of the counselor must be suppressed. The applicant should be informed regarding the physical and emotional aspects of the abortion procedure. Also, good counseling should aim at future prevention by determining the reasons for failure that caused the unwanted pregnancy. Of importance in selecting abortion counselors are qualities described as personality traits. These include empathy, nonpossessive warmth, and genuineness. Also, maturity and flexibility are needed in allowing the woman to make the decision, particularly in cases of ambivalence and uncertainty. A program in New York City has used women counselors who themselves have had abortions. This experience alone is not sufficient, but may be significant. The counselor needs basic knowledge of sexual physiology, psychology, and contraceptive technology. Also, the counselor should be able to recognize prodromal psychiatric signs of an imminent crisis, and be able to initiate steps of prevention. Training programs vary widely. Flexibility is needed. Experience in counseling couples is important. Assistance by an experienced counselor is helpful on a continuing basis, particularly for the new counselor. Group sessions and didactic presentations are needed. To obtain acceptance of postabortal contraception may pose special problems. A history of previous psychiatric disturbance may require referral to a trained consultant. Strong religious or ethical feelings modify attitudes. The woman must not feel coerced. She should be able to integrate the experience in such a way as to prevent a recurrence.

Handbook of Psychiatry

Assisted by a large staff of relatively young contributors, Solomon and Patch have put together a text aimed at the general practitioner, first-year psychiatric resident and ancillary personnel. To paraphrase, rarely have so many covered so much ground in so relatively little space. Although the book follows fairly classical lines of presentation, it extends somewhat beyond the usual boundaries, viz, the chapter on statistics in psychiatry. An initial section on history, examination, theory, etc, precedes the sections devoted to clinical syndromes and treatment. The somewhat novel chapter on common psychiatric signs and symptoms and the suggested differential diagnoses appears particularly worthwhile. I would, however, take some exception to the statement that anxiety neurosis is largely a diagnosis of exclusion. The discussion of adolescent and college psychiatry is also most pertinent in view of the burgeoning problems in this area. Thirteen chapters on therapy cover kaleidoscopically all phases of treatment. The

Psychiatric Signs and Symptoms Due to Medical Problems

Psychiatric Signs and Symptoms Due to Medical Problems

Psychiatric Signs and Symptoms due to Medical Problems.

Psychiatric Signs and Symptoms due to Medical Problems.

Psychiatric Signs and Symptoms Due to Medical Problems.

Psychiatric Signs and Symptoms Due to Medical Problems.

Review of Psychiatric Signs and Symptoms Due to Medical Problems.

Review of Psychiatric Signs and Symptoms Due to Medical Problems.

Auditory hallucination as a conversion symptom: A theoretical proposal with two case illustrations

Summary o 1. Two case histories are presented which describe patients suffering from auditory hallucinations of acute onset and rapid remission, and who were without other psychiatric signs or symptoms. Follow-up after 2 1/3 years and 8 months, respectively, found both patients relatively asymptomatic and functioning adequately. 2. Evidence is presented to suggest that such patients contradict the traditional viewpoint that hallucinatory phenomena are symptoms of psychosis and indications of serious ego decompensation. 3. An alternative hypothesis is proposed to suggest that the special senses may be affected by the process of conversion, resulting in hallucinatory experiences similar to the conventionally recognized conversion reactions in terms of dynamics and implications for diagnosis and prognosis. Several possible determinants of conversion hallucinations are discussed. 4. The diagnostic problem presented by patients with hallucinations is discussed in terms of the concept that the auditory hallucination is a symptom which may be manifested in a variety of syndromes, both neurotic and psychotic. It is not a syndrome or pathognomonic of any syndrome, in and of itself.

Proximal occlusion of the anterior cerebral artery.

Between September, 1948, and January, 1958, we have encountered by angiographic studies 50 patients with nonfilling or thread-like filling of the proximal portion of one anterior cerebral artery (in 1 case bilateral) associated with neurologic and/or psychiatric (dementia, impaired insight, anxiety, loss of initiative, and impaired mentation) signs and symptoms. Stenosis or occlusion of one anterior cerebral artery has been seen in about 11% of the patients who either are admitted with a diagnosis of stroke or are proved to have cerebrovascular disease before discharge from the hospital. A portion of this material was reported in a former paper. 17 When nonvisualization of one anterior cerebral artery was encountered, a second, and sometimes a third, attempt was made to fill the vessel. In the more recent cases, simultaneous contralateral carotid compression was also used. Head turning was not used at the time of injection, and thus was not a factor