[Characteristics of psychologic features of tantalum production workers]

The article covers results of psychologic examination of apparently healthy workers of contemporary tantalum production. The authors describe changes in psychoemotional state of workers engaged into major tantalum production workshops, in accordance with occupational length of service.

[Psycho-emotional state of workers engaged into chlorine and soda production through electrolysis with mercury-pool cathode]

Workers engaged into the studied production are exposed to occupational factors complex as vapor, gas and aerosol mixture. Metallic mercury vapors and its compounds exceed MAC over 10 times in this mixture, noise level at the enterprise is 10 dB over the maximal allowable level, general vibration is 8 dB over the MAL, the occupational hazards also include unfavorable microclimate, work hardiness and intensity. Psychoemotional state of the workers demonstrate significantly disordered emotions and will, premorbid personality changes, lower memory and attention level, indisposition and mood changes, increased reactive and personal anxiety, decreased performance level. Informative parameter in occupational examination of workers is memory and attention level evaluation.

Psychotic symptoms in young adults exposed to childhood trauma--a 20 year follow-up study

Childhood adversity has been shown to increase the risk of psychotic symptoms in adult life. However, there are no previous studies looking at the association between experiencing a natural disaster during childhood and the development of psychotic symptoms in young adulthood. Eight hundred and six bushfire-exposed children and 725 control children were evaluated following the 1983 South Australian bushfires. Five hundred and twenty nine (65.6%) of the bushfire group and 464 (64%) controls participated in a follow up study 20 years later. Childhood data on emotional and behavioural disorders and dysfunctional parenting was available. The adult assessment included the Australian National Health and Well-Being psychosis screen and detailed information about trauma, childhood adversity and alcohol and cannabis abuse. 5.6% of subjects responded positively to the psychosis screen and 2.6% responded positively to a further probe question. Psychotic symptoms were more common in subjects exposed to a greater number of traumas, and were associated with higher rates of childhood adversity, emotional and behavioural disturbance, dysfunctional parenting, and alcohol and cannabis abuse. Subjects exposed to bushfires as children did not have a greater risk of psychosis. Our results indicate that exposure to multiple traumas, rather than a single major trauma, increases the risk of later psychosis.

The aging of Anna Freud's diagnostic profile: a re-examination and re-application of the psychoanalytic assessment for older adults

In 1962 Anna Freud published her pioneering paper on the Diagnostic Profile, proposing a framework for organizing relevant clinical material and observations for the assessment of a child's inner world. Since that time, the Profile has been applied, with modifications, to work with babies, adolescents, adults, blind children, and others. This paper strives to demonstrate the Profile's applicability to a group often neglected in the psychoanalytic literature, namely the older population, a vibrant group frequently seeking psychotherapy and even psychoanalysis. A case study of a woman in her 70s is used to illustrate the advantages for clinicians of the Profile for a clearer understanding, both diagnostically and intrapsychically, of the older adult.

NeuroVR 2--a free virtual reality platform for the assessment and treatment in behavioral health care

At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 2000 users who downloaded the first versions (1 and 1.5), we developed a new version--NeuroVR 2 (http://www.neurovr2.org)--that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. More, when running a simulation, the system offers a set of standard features that contribute to increase the realism of the simulated scene. These include collision detection to control movements in the environment, realistic walk-style motion, advanced lighting techniques for enhanced image quality, and streaming of video textures using alpha channel for transparency.

Neuropsychological functioning in PLS: a comparison with ALS

OBJECTIVE

In order to characterize the nature and extent of neuropsychological dysfunction in primary lateral sclerosis (PLS), we studied prospectively cognitive, emotional, and behavioral functioning in PLS, and compared performances to functioning in amyotrophic lateral sclerosis (ALS).

METHODS

Eighteen patients with PLS and 13 patients with ALS completed a neuropsychological test battery assessing both cognitive skills and emotional/behavioral functioning.

RESULTS

Both PLS and ALS groups scored broadly within normal limits (mean T-scores greater than 40) on all cognitive measures and no significant between-group differences were found with the exception of one variable. However, when examined on a case by case basis, the data revealed considerable heterogeneity amongst patients in both groups. Overall, 39% of PLS patients and 31% of ALS patients were considered cognitively impaired. Ahigher than expected frequency of abnormal scores was noted for several tests of executive function in both groups, and a majority of PLS patients also exhibited abnormal behavioural symptoms. There was no relationship in PLS or ALS groups between cognitive functioning and disease duration, current site of disease, site of onset, functional status, and respiratory variables. Comparison between the PLS and ALS groups indicated virtually no differences in cognitive test scores and overall emotional/behavioural symptoms.

CONCLUSIONS

We observed deficits in cognition and behaviour in a significant proportion of PLS patients which were comparable to those observed in ALS cases. Although deficits were not in the range of frontotemporal dementia, both ALS and PLS cases demonstrated deficits most prominently on tests of executive functioning.

[Behavioral and psychological symptoms of dementia and their management]

The decline in cognitive function is a core feature of dementias. However, other symptoms of the disease are also crucial. These symptoms are the behavioral and psychological manifestations of dementia and include symptoms such as delusions, hallucinations, delusional misindentification syndromes (DMS), illusions, anxiety, aggression, depression, personality changes, disinhibition-impulsivity, violation of social and moral norms, changes in dietary or eating behavior and repetitive behaviors. Delusions, hallucinations, anxiety, depression and aggression are highly prevalent in Alzheimer's disease, vascular dementia and dementia with Lewy bodies, whereas symptoms that include severe disturbance of behavior are highly prevalent in frontotemporal dementias. Psychotic symptoms are associated with subcortical disturbances mainly of the limbic system. Patients with depression present greater loss of noradrenergic cells in the locus coeruleus and loss of serotonergic nuclei of dorsal raphe. Furthermore, disturbances of behavior are associated with frontal lobe dysfunction. Atypical antipsychotics is the first treatment option for delusions, hallucinations, misidentifications, anxiety and aggression. Furthermore, antidepressants may be useful for moderate or severe depression as well as for disinhibition-impulsivity, aggression, changes in dietary or eating behavior and repetitive behaviors. Cholinesterase inhibitors may also improve apathy, anxiety, disinhibition, aberrant behavior, mood disorders and hallucinations. Moreover, non-pharmacological methods alone or in combination with psychotropic drugs may also improve patient's symptomatology.

Adult outcomes of childhood dysregulation: a 14-year follow-up study

OBJECTIVE

Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) were examined.

METHOD

Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-class-defined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models.

RESULTS

Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant.

CONCLUSIONS

A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.

Frequency and perceived effectiveness of coping define important subgroups of patients with chronic pain

OBJECTIVES

Investigate the relationship between frequency and perceived effectiveness of coping strategies used to cope with chronic pain. Examine the association between these variables and pain-related negative mood.

METHODS

Retrospective review of psychological measures completed by 122 adult chronic pain patients seen at a multidisciplinary pain clinic at the University of Florida. Empirical subgroups according to reported frequency and perceived effectiveness of coping strategies used were identified resulting in a 4-group solution based on combinations of high versus low effectiveness and high versus low frequency of use.

RESULTS

Analysis of variance results revealed significantly higher levels of distress (depression and pain-related anxiety) for selected subgroups [F(2,99)=4.902, P<0.05, η2=0.09 and F(2,93)=3.504, P<0.05, η2=0.07, respectively]. Post-hoc analyses revealed significantly more depression (mean=20.20, SD=9.77) and more pain-related anxiety (mean=101.07, SD=35.78) in individuals frequently using ineffective coping as compared with those reporting frequent use of effective coping (Mean(depression)=14.88, SD(depression)=7.40; Mean(pain-related anxiety)=78.93, SD(pain-related anxiety)=32.26) and those reporting infrequent use of ineffective coping (Mean(depression)=13.89, SD(depression)=9.44).

DISCUSSION

Perceived effectiveness and frequency of coping strategy use may influence pain-related negative mood. Maladaptive coping may be a risk factor associated with more emotional distress; it is also possible that more emotional distress predisposes maladaptive coping. Taking into account both the frequency of coping strategy use and the perceived effectiveness of strategy type is suggested for future studies.

'Triage center' takes pressure off EDs

Behavioral health care is a major concern for EDs. Lee Memorial Health System helped relieve the ED burden with a shelter for homeless and uninsured individuals. A former director of emergency services provided ED-specific input into the planning process. A contracted nurse with ED experience provides the initial assessment of patients referred to the shelter. System EDs now have a referral option for patients with behavioral health issues and no longer have to discharge them "onto the street".

Medically Unexplained Symptoms and Neuropsychological Assessment

Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin. There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress.

Patients' subjective initial response and the outcome of inpatient and day hospital treatment

OBJECTIVE

This study aimed to establish whether psychiatric patients' subjective initial response (SIR) to hospital and day hospital treatment predicts outcomes over a one-year follow-up period.

METHOD

We analysed data from 765 patients who were randomised to acute psychiatric treatment in a hospital or day hospital. SIR was assessed on day 3 after admission. Outcomes were psychiatric symptom levels and social disability at discharge, and at 3 and 12 months after discharge.

RESULTS

After controlling for socio-demographic and clinical characteristics, a more positive SIR was significantly associated with lower symptom levels at discharge and 3 months after discharge and lower social disability at 3 months and 12 months after discharge.

CONCLUSION

SIR can predict outcomes of complex interventions over a one-year period. Patients' initial views of acute hospital and day treatment should be elicited and considered as important.

The structure of risk factors and outcomes for family caregivers: implications for assessment and treatment

PURPOSE

We examined the associations among risk factors (e.g., behavioral problems, family conflict) and outcomes (e.g., overload, depression) commonly used in the research literature in order to inform the design of caregiver assessment and interventions.

METHODS

A sample of 67 caregivers caring for a family member in the middle stages of dementia were assessed on 15 risk factors and six outcome measures.

RESULTS

Risk factors were at best only moderately correlated with one another, suggesting their relative independence. Outcome measures showed somewhat higher correlations with one another, but participants varied in terms of the number and type of outcomes that were elevated. Multivariate results showed that risk factors differed in their contribution to models, predicting various outcomes.

IMPLICATIONS

Caregivers possess unique combinations of risk factors and outcomes that suggest the need for individualized or tailored interventions. Designing an effective caregiver assessment and corresponding targeted intervention requires careful planning and selection of appropriate risk factors and outcomes.

[Somatopsychic and cenesthetic types of schizophrenia: common features and discrepancies]

The aim of this paper is to discuss the development of the concepts of cenesthetic type of schizophrenia and somatopsychic type of schizophrenia along with the review of differences between those two diagnostic approaches in scope of their historical background and the current diagnostic concepts. Those independently described diagnostic phenomena have some common features. However, the cenesthetic type of schizophrenia emphasises sensory elements of the disorders and includes a broader spectrum of the psychopathology while the somatopsychic type of schizophrenia focuses on the thought disorders and strictly schizophrenic psychopathology.

[PSYCHOLOGICAL FEATURES IN CHILDREN AND ADOLESCENTS WITH RESPIRATORY TUBERCULOSIS]

The development of a biopsychosocial model of disease acquires a great practical value for modern phthisiology, which presupposes an in-depth study of the psychological and social constituents of disease as important factors of therapy optimization and an increase in the efficiency of the rehabilitative measures being implemented. The problem of psychological causes and factors associated with the occurrence of a tuberculous process in children and adolescents has been inadequately developed in phthisiology. A psychodiagnostic study was conducted in 90 patients from Moscow pediatric tuberculosis facilities. The children and adolescents with respiratory tuberculosis were ascertained to have the personality characteristics distinct them from their somatically healthy coevals: tenderness, responsibility, honesty, diligence, deliberate observance of generally accepted moral rules and regulations, inclination to moralize, anxiety, irritability, infantilism, low frustration tolerance, dependence, sensitivity, and a need for support. The revealed psychological features enhance the pathogenicity of stressors, lead to the tension of adaptive mechanisms and may contribute to the development of the disease. Psychocorrective measures aimed at expanding the behavioral range and molding self-regulation skills in these patients should be developed within the complex rehabilitation system for children and adolescents with respiratory tuberculosis, which will aid in enhancing the efficiency of their psychoemotional adaptation and preventing the recurrences of the underlying disease.

Cognitive-behavioral flexibility in anorexia nervosa

Anorexia nervosa (AN) patients are characterized by perfectionism and obsessional personality traits. This anorectic personality type is associated with an exaggerated cognitive control and impaired cognitive-behavioral flexibility. Neuropsychological studies addressing flexibility have supported an impaired cognitive set-shifting (i.e., concrete and rigid behaviors to changing rules) as well as an impaired behavioral response shifting (i.e., stereotyped or perseverative behaviors) in AN patients independent of nutritional status and body weight. Furthermore, impaired set-shifting was found in healthy sisters of AN patients suggesting that cognitive inflexibility is a trait marker in AN patients. Brain imaging studies have provided new insights in striatocortical circuit dysfunctions that may underlie both the clinical symptoms of obsessive-compulsive personality traits and the neuropsychological observations of impaired cognitive-behavioral flexibility. The conceptualization of AN as a neurodevelopmental striatocortical disorder may help to develop new promising treatment approaches for this severe disorder.

Transient cocaine-associated behavioral symptoms rated with a new instrument, the scale for assessment of positive symptoms for cocaine-induced psychosis (SAPS-CIP)

Chronic use of cocaine is associated with a variety of behavioral symptoms. The current report describes the assessment of cocaine-related behavioral symptoms (CRB) using the Scale for Assessment of Positive Symptoms of Cocaine-Induced Psychosis (SAPS-CIP). The CRB section, one of the three domains in the SAPS-CIP, consists of sub-domains, including Aggressive/Agitated Behavior, Repetitive/Stereotyped Behavior, and Unusual Social or Sexual Behavior. Severity scores are assigned according to operational criteria, and range from 0 (not present) to 5 (severe). We interviewed 261 unrelated cocaine-abusing adults using the SAPS-CIP, and 243 of them met criteria for inclusion in the study. The proportion of subjects endorsing different classes of CRBs varied across categories, with 109 of 243 (44.9%) subjects reporting aggressive and agitated behaviors, 180 subjects (74.1%) repetitive/stereotyped behaviors, and 192 (79.0%) unusual social/sexual behaviors. A substantial minority of the subjects (10.3-25.1%) reported that they experienced marked-to-severe behavioral symptoms associated with cocaine use. The proportions of subjects endorsing CRB did not differ by ethnic/racial group or by sex. Correlations among the different domains of CRB were strong, but behaviors rated in the CRB section were less well correlated with psychotic symptoms, which were rated in the hallucination and delusion sections of the instrument. A variety of CRBs are common in cocaine-dependent subjects, and many of these are highly intercorrelated. CRBs also correlate with hallucinations and delusions induced by cocaine, but to a lesser degree. Our findings suggest that there may be some common vulnerability factors that contribute to both cocaine-induced psychosis and CRBs.

Developing Korean Academy of Medical Sciences Guideline for rating the impairment in mental and behavioral disorders; a comparative study of KNPA's new guidelines and AMA's 6th Guides

Quantifying and rating the impairments due to mental and behavior disorders are difficult for their own characteristics. Korean Academy of Medical Sciences (KAMS) is developing guidelines of rating impairment in mental and behavioral disorders based on Korean Neuropsychiatric Association (KNPA)'s new guidelines. We compared the new KNPA's guidelines and the American Medical Association (AMA)'s 6th Guides in assessing impairment due to mental and behavioral disorders to develop new guidelines of KAMS. Two guidelines are different in diagnosing system, applicable disorders, qualification of assessors, application of scales, contents of assessment and rate of impairment of the whole person. Both AMA's and the proposed guidelines have individual merits and characteristics. There is a limitation in using the 6th AMA's Guides in Korean situation. However to improve objectivity in Korean assessment of psychiatric impairment, the new AMA's Guides can serve as a good reference.

Behavioral deficits after distal focal cerebral ischemia in mice: Usefulness of adhesive removal test

Distal occlusion of the middle cerebral artery (dMCAo), which closely mimics human stroke, is one of the most used animal models. However, although assessment of histological and functional outcome is increasingly recommended for preclinical studies, the latter is often excluded because of the high difficulties to estimate, especially in mice, behavioral impairments. The aim of our study was to deeply screen functional consequences of distal permanent MCAo in mice to target relevant behaviors for future studies. A set of sensorimotor and cognitive tests were performed during 3 weeks postsurgery in 2 groups of mice. Afterward, brain infarctions were estimated by histological staining or magnetic resonance imaging. Overall, while no long-term functional impairments could be detected, the adhesive removal was the only test showing a deficit. Interestingly, this sensorimotor impairment was correlated to cortical damage 3 weeks after surgery. In conclusion, despite the fact that dMCAo-induced deficits could not be evidenced by most of our behavioral tests, the authors showed that the adhesive removal test was the only one, sensitive enough, to highlight a long-term deficit. This result suggests therefore that this mouse model of ischemia is relevant to efficiently assess therapeutic strategies with histological but also behavioral analysis, provided that relevant tests are used.

[Non-motor disorders in Parkinson's disease]

INTRODUCTION

Parkinson's disease (PD) is a progressive disorder that is strongly linked to non-motor symptoms (NMS). Unfortunately, these symptoms have been almost neglected for many years and only recently have researchers begun to assess how they affect the quality of life in patients with PD.

AIMS

To review our current understanding of the subject and to highlight the importance of NMS in PD.

DEVELOPMENT

Recent studies have emphasised the fact that the basal ganglia play an important role in a number of non-motor functions. At the same time, the exclusive involvement of the substantia nigra in PD is being reviewed and the development of PD has been defined as a continuum that covers a range of different stages, including non-dopaminergic systems and nuclei. This would account for the constellation of non-motor symptoms that do not respond to dopamine replacement therapy and which affect patients with PD, such as depression, apathy, sialorrhea and urinary incontinence, among others.

CONCLUSIONS

NMS make a significant contribution to the morbidity and mortality rates of PD and are often the main cause of hospitalisation of patients with PD. Current evidence suggests that some NMS, such as constipation, hyposmia and REM sleep disorders, could even be preclinical markers of PD. Both of these reasons stress the importance of reaching a diagnosis faster and earlier.