Pediatric Pericarditis: Update

PURPOSE OF REVIEW

While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis.

RECENT FINDINGS

We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis.  Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis.

CASE VIGNETTE

A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.

Arrhythmogenic cardiomyopathy is under-recognized in end-stage pediatric heart failure: A 36-year single-center experience

BACKGROUND

Although ventricular failure is a late finding in adults with AC, we hypothesize that this is a presenting symptom in pediatric heart failure patients who undergo HT and that their ventricular arrhythmia burden could differentiate AC from other cardiomyopathies.

METHODS

We performed a single-center retrospective cohort study reviewing 457 consecutive pediatric (≤18 years) HT recipients at our institution. Explanted hearts were examined to establish the primary diagnosis, based on pathologic findings. Demographic and clinical variables were compared between AC versus non-HCM cardiomyopathy cases.

RESULTS

Forty-five percent (n = 205/457) had non-HCM cardiomyopathies as the underlying primary diagnosis. Ten cases (10/205 = 4.9%) were diagnosed with AC. All 10 had biventricular disease. In 8/10 patients (80%), AC diagnosis was unrecognized pre-HT. Compared with non-AC cardiomyopathies, the AC group was older at diagnosis (9.3 years vs. 4.3 years, p = .012) and transplant (11.1 years vs. 6.5 years, p = .010), had more ventricular arrhythmias (80.0% vs 32.8%, p = .003), and required more anti-arrhythmic use (80.0% vs 32.3%, p = .001). Genetic testing yielded causative pathogenic variants in all tested individuals (n = 5/5, 100%).

CONCLUSION

AC is often an unrecognized cardiomyopathy pretransplant in children who undergo HT. Pediatric non-HCM phenotypes with heart failure who have a significant ventricular arrhythmia burden should be investigated for AC.

Outcomes following use of pediatric and young adult donor hearts with bicuspid aortic valves: A single-center case series

BACKGROUND

Valvular disease in pediatric and young adult donor hearts may be a relative contraindication to graft use. Outcomes following the use of donor hearts with bicuspid aortic valve (BAV) have not been previously reported in children. We describe 4 cases of pediatric heart transplantation (HTx) utilizing a donor heart with a BAV.

CASE SERIES

Of the 469 HTx included in this study, 4 utilized a donor heart with a BAV. All recipients were female; median age was 11 years (range 0.3 to 19 years). In all cases, the BAV was not discovered until after HTx. All donors were less than 30 years old. The patients were followed for a median of 6 years (range 2 to 9 years) with all patients alive at last follow-up. Two patients have transitioned to adult care, and 2 patients continue to follow in our clinic. In follow-up, no patient has required an aortic valve intervention or had infective endocarditis. At last review, no patient had greater than mild aortic insufficiency or more than mild aortic stenosis. Three patients developed mild-to-moderate left ventricular hypertrophy in the first year post-transplant that improved over time. One patient experienced a peri-operative embolic stroke at time of transplant unrelated to the BAV.

CONCLUSION

On short- and intermediate-term follow-up, pediatric and young adult donor hearts with BAV demonstrated acceptable graft longevity and valvular function. A functionally normal BAV in a pediatric heart transplant donor should not be a contraindication to organ acceptance.

Role of a Pediatric Cardiologist in the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) has affected patients across all age groups, with a wide range of illness severity from asymptomatic carriers to severe multi-organ dysfunction and death. Although early reports have shown that younger age groups experience less severe disease than older adults, our understanding of this phenomenon is in continuous evolution. Recently, a severe multisystem inflammatory syndrome in children (MIS-C), with active or recent COVID-19 infection, has been increasingly reported. Children with MIS-C may demonstrate signs and symptoms of Kawasaki disease, but also have some distinct differences. These children have more frequent and severe gastrointestinal symptoms and are more likely to present with a shock-like presentation. Moreover, they often present with cardiovascular involvement including myocardial dysfunction, valvulitis, and coronary artery dilation or aneurysms. Here, we present a review of the literature and summary of our current understanding of cardiovascular involvement in children with COVID-19 or MIS-C and identifying the role of a pediatric cardiologist in caring for these patients.

Equine chlamydiosis-An emerging infectious disease requiring a one health surveillance approach

Psittacosis is a rare but potentially fatal zoonosis caused by Chlamydia psittaci, an organism that is typically associated with bird contact. However C. psittaci is capable of infecting other non-avian hosts, such as horses, sheep, cattle and goats. Stud staff and veterinarians have significant exposure to parturient animals and reproductive materials in their routine work. To investigate the zoonotic potential associated with the emergence of C. psittaci as an abortifacient agent in horses, we established a programme of joint human and animal surveillance in a sentinel horse-breeding region in Australia. This programme comprised cross-notification of equine cases to public health agencies, and active follow-up of known human contacts, including stud workers, foaling staff, veterinarians and laboratory staff. We identified no confirmed cases of acute psittacosis despite intensive surveillance and testing of heavily exposed contacts; however, further work in the area is needed.

Souvenaid®: a new approach to management of early Alzheimer's disease

Synaptic loss correlates closely with cognitive deficits in Alzheimer's disease and represents a new target for intervention. Souvenaid® is the first medical nutrition product to be designed to support synapse formation and function in early Alzheimer's disease, and has undergone an extensive, 12-year development programme. The relatively large amount of clinical data available for Souvenaid® is unusual for a medical nutrition product. Souvenaid® contains omega-3 polyunsaturated fatty acids (docosahexaenoic acid and eicosapentaenoic acid), uridine (as uridine monophosphate) and choline which are nutritional precursors required for synaptic membrane phospholipid synthesis, together with phospholipids and other cofactors. Souvenaid® has demonstrated cognitive benefits in patients with mild Alzheimer's disease but not in patients with mild-to-moderate Alzheimer's disease. Two randomised, double-blind, controlled trials (duration 12 and 24 weeks) in patients with mild Alzheimer's disease untreated with acetylcholinesterase inhibitors and/or memantine have demonstrated that Souvenaid® is well tolerated and improves episodic memory performance. The daily intake of Souvenaid® has not been associated with any harmful effects or interactions with medications and none are anticipated. The ongoing, 24-month, European Union-funded LipiDiDiet trial in subjects with prodromal Alzheimer's disease is evaluating the potential benefits of Souvenaid® on memory and in slowing progression to Alzheimer's dementia. If Souvenaid® induces synaptogenesis and improved synaptic function, it may provide benefits in other clinical conditions characterised by neurodegeneration. A number of trials are ongoing and planned to evaluate the potential wider benefits of Souvenaid®.

Towards new ways of working in dementia: perceptions of specialist dementia care nurses about their own level of knowledge, competence and unmet educational needs

It is expedient to consider new ways in which dementia care services may be configured to meet increasing demographic, societal and regulatory demands. Greater equity in the distribution of clinical responsibility across multidisciplinary teams has been suggested as one method that may offer a range of benefits to both the service user and the service itself. However, within the dementia workforce there are concerns about inconsistency and variability in both knowledge of dementia and competency in meeting the needs of those affected. Taking this into account it was felt important to explore perceived knowledge and competency of specialist dementia care nurses who would not only be expected to possess higher levels of knowledge and skill but are positioned as the obvious clinical group to engage with new ways of working. Consequently, this paper offers the results and subsequent discussion of a survey of senior nurses working in dementia care across the UK.

12 INDUCTION OF OVARIAN ACTIVITY IN THE MANED WOLF (CHRYSOCYON BRACHYURUS) USING A GnRH-AGONIST

Induction of ovarian activity and ovulation is a valuable tool for the genetic management of ex situ populations of wildlife. Deslorelin, a gonadotropin releasing hormone (GnRH)-agonist, has been used earlier to induce oestrus in the grey wolf (Canis lupus). The objective of the present study was to determine the efficacy of Deslorelin (2.1 mg, Ovuplant®, Peptech Animal Health, Australia) for manipulating ovarian activity of the maned wolf, a species speculated to be an induced ovulator. Eight female (4–12 years old) maned wolves were (i) paired with a male (n = 3) or (ii) housed alone (n = 5). Of the 8 females, 1 (1 in a pair and 1 singleton) were implanted with Deslorelin under the vulvar mucosa for 12 days. The remaining 6 received implants in the subcutaneous layer of the ear for 7 days. Fresh fecal samples were collected 5 to 7 days/week for 1 month before Deslorelin treatment through 6 weeks after implant withdrawal. Reproductive steroid metabolites were extracted from the fecal samples and quantified using a validated enzyme immunoassay. Baseline progestagen concentrations for each individual were calculated by an iterative process, whereby high values exceeding the mean plus one standard deviation were excluded. Comparisons of oestrogen and progestagen concentrations among pre-, peri-, and post-Deslorelin implant periods were performed using analysis of variance. Site and duration of the GnRH agonist treatment had no effect (P > 0.05) on subsequent ovarian responses. In paired females, oestrogen metabolites reached the highest (P < 0.05) concentration during Deslorelin (i.e. peri-) treatment (441.7 ± 20.2 ng g–1 of feces) compared to pre- (174.9 ± 16.7) and post- (177.8 ± 9.1) treatment. Progesterone metabolites rose (P < 0.05) above the baseline (indicative of ovulation) starting on Day 10 after the onset of Deslorelin implantation and remained elevated throughout the study (pre-, 11 645 ± 4798; peri-, 31 521 ± 6444; post-, 55 843 ± 2924 ng g–1 of feces). In singleton females, oestrogen metabolites increased (P < 0.05) immediately after implantation (from pre-, 184.2 ± 45.3 to peri-, 334.2 ± 29.8 ng g–1 of feces) and then declined (post-, 192.3 ± 12.4). Progestagen metabolites exhibited a similar pattern with a rise (P < 0.05) during Deslorelin treatment (from pre-, 3870 ± 1336 to peri-, 10 546 ± 880 ng g–1 of feces) followed by a decline after implant withdrawal (post-, 6171 ± 366), indicating that ovulation did not occur. These results suggest that Deslorelin can induce ovarian activity in the maned wolf. However, administration of an ovulatory agent after Deslorelin treatment may be required in females managed in the absence of a male, further supporting the assertion that this species is an induced ovulator. Funded by the Morris Animal Foundation.

Nurses making a diagnosis of dementia--a potential change in practice?

OBJECTIVES

To compare nurse initial diagnoses following domiciliary visits with subsequent formal multidisciplinary formulation based upon the full possession of investigations, neuropsychological tests and brain imaging.

DESIGN

Retrospective case note study.

SETTING

Home-based nurse assessments, secondary care based multidisciplinary memory clinic.

PARTICIPANTS

Four hundred and four consecutive referrals over an 18-month period.

RESULTS

One hundred and seventy-five patients (43.3%) were diagnosed by the multi-disciplinary team as having a dementia. Seventy-three (41.5%) were classified as Alzheimer's disease, 81 (46%) of mixed sub-type and 20 (11.4%) of vascular origin. Overall nurse-MDT diagnosis agreement was 0.88 (Kappa = 0.82). Together, two nurses were able to detect dementia with 94% accuracy (Kappa = 0.88) Sensitivity was 92% and specificity 96%. The positive and negative predictive values of their judgements were 94% and 98% respectively. Nurses were able to sub-diagnose dementia with 86% (kappa = 0.76) accuracy. Multivariate logistic regression modelling showed a MDT dementia diagnosis to be independently and significantly associated with lower scores on the KOLT and total MMSE, and with the absence of biological markers of depression. Nurse dementia diagnoses were associated with lower KOLT scores and the absence of biological depression markers, high past alcohol consumption or a history of hypercholesteraemia.

CONCLUSIONS

In this study, structured initial assessment by a specialist nurse was shown to be an accurate method of determining a diagnosis of cognitive impairment, when compared with formal MDT judgement. The principal benefit of this approach was that signposting to subsequent care pathways was expedited. Arguably, such distributed responsibility affords a viable option for the future detection of early dementia.

Outcomes after breast cancer in an ethnically diverse cohort of high-risk patients: Differences in survival based on BRCA1/BRCA2 mutation status

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Background: Most studies of hereditary breast cancer report that BRCA1 associated tumors are characterized by high grade and hormone receptor negativity, while those associated with BRCA2 are more similar to sporadic cases. Several groups have demonstrated that BRCA1 mutations, but not BRCA2 mutations, are associated with reduced survival in women with breast cancer. These studies have primarily included women of European and Ashkenazi Jewish heritage. No study to date has assessed outcomes in an ethnically diverse cohort of high-risk individuals. Methods: High-risk individuals were identified through the University of Chicago Cancer Risk Clinic (UCCRC). Clinicopathologic data was collected on all patients with breast cancer who had undergone genetic testing and consented to inclusion in research protocols. Recurrence-free survival (RFS) and overall survival (OS) for BRCA1, BRCA2 and non-carriers was compared using the log-rank test. Hazard ratios (HR) and 95% Confidence Intervals (95% CI) were calculated from Cox proportional hazard models. Results: 280 patients from 258 families were studied. 67 were BRCA1 mutation positive, 36 were BRCA2 positive and 177 were non-carriers. 65% of patients were non-Hispanic non-Jewish whites, 15% African American, 15% Ashkanazi Jewish, 3% Hispanic and 2% Asian. At a median follow up of 5 years, 40 patients had relapsed and 22 had died. HRs (95% CI) for RFS of the BRCA1 and BRCA2 carriers relative to non-carriers were 1.6 (0.77–3.33) and 1.3 (0.55–3.09) respectively, when adjusted for year at diagnosis. The adjusted HRs (95% CI) for OS for the BRCA1 and BRCA2 carriers relative to non-carriers were 1.82 (0.48–3.02) and 0.67 (0.15–3.04), respectively. Conclusions: In this study of an ethnically diverse cohort of high-risk individuals, BRCA1 mutation carriers had a poorer outcome as compared to those with BRCA2 mutations or those without identifiable mutations in either gene, although this difference was not statistically significant. This observation is consistent with previous studies of women of predominantly Ashkenzi Jewish and European ancestry. This study was funded by the Falk Medical Research Trust, the Breast Cancer Research Foundation and the Entertainment Industry Fund.

No significant financial relationships to disclose.

The first line of response for people who self-poison: exploring the options for gut decontamination

The trend for increasing numbers of self-poisoning incidents has been noted and a variety of policy initiatives have been launched. Nurses, particularly in emergency room environments occupy a pivotal place in the chain of response to such acts. Any such response needs to be firmly rooted in evidence-based practice yet the initial management of self-poisoning often involves a consideration of procedures, the application of which can vary enormously. This paper offers some contextual information prior to a critical perspective of management modes, namely emesis, lavage, the use of activated charcoal and whole bowel irrigation. A comparison of the relative advantages and disadvantages of each mode precedes suggestions for nursing practice.

From novice to competent practitioner: tracking the progress of undergraduate mental health nursing students

This study explores the perceptions of, and outcomes for, a group of undergraduate mental health nursing students over a 3-year period from the point at which they made their choice to take the mental health branch of a 4-year degree programme in nursing, to working in the practice setting as registered nurses. Semi-structured interviews were completed at three points in their career: (a) at the end of the common foundation programme, when students had made their choice to take the mental health option; (b) at the end of the fourth year of the undergraduate programme; and (c) 1 year post-qualification. Questions were generated around five main themes: career choice, personal change and development, evaluation of the curriculum, ideas about mental health nursing and career plans. Despite some initial ambivalence at the start of the branch, students were happy with their career choice at follow-up, which was reinforced by significant clinical progress. All of the group were working in acute hospital settings despite being in possession of the community mental health qualification. Substantial evidence of these students' 'fitness for purpose' is offered, although some disillusionment with the contrast between student life and the real world of work is noted. Questions are posed as to the role of clinical supervision and education in preventing negative professional socialization. Recommendations are also made about recruitment to and design of mental health nursing courses.

Influence of gender on post-tetanic potentiation in human dorsiflexors

Twitch contractions of the ankle dorsiflexors were evoked before and after 7 s of tetanic stimulation at 100 Hz in young women and men. Torque decreased more in men (18%) than in women (12%) during the tetanus. There was no gender difference in twitch peak torque potentiation over the 5-min post-tetanus. Potentiation was 42% (women) and 45% (men) at 5 s post-tetanus, and still present at 5 min (women 24%, men 25%). The immediate (5 s) shortening of twitch rise time was similar in women (14%) and men (13%), but during the 5-min men's rise time came to exceed whereas women's only approached pretetanus values (e.g., +9% vs. -1% at 5 min). The immediate decrease in half-relaxation time was also similar in women (24%) and men (22%); however, women's but not men's values remained less than pretetanus values for most of the 5-min period. Twitch rate of torque development increased similarly (75%) in women and men at 5 s, with no gender difference over 5 min. In contrast, rate of torque relaxation increased significantly only in men. Rate of torque development normalized to peak torque was similar in women and men pretetanus and increased similarly 5 s post-tetanus, but women had greater values through most of the 5-min post-tetanus. Normalized rate of torque relaxation was similar in women and men and not affected by tetanus. In the dorsiflexor muscles, young women and men show a similar amount and pattern of twitch force potentiation, but there are gender differences in time-related twitch contractile properties in the first 5 min after tetanus.

Posttetanic potentiation of human dorsiflexors

Twitch contractions of the ankle dorsiflexors were evoked before and after applied 7-s tetanic stimulation at 100 Hz in 20 young adults. Torque decreased 15% during the tetanus. At 5 s after tetanus, twitch peak torque had potentiated 45%. Potentiation declined to 28% after 1 min, rose slightly to 33% at 2 min, and declined slowly with potentiation still 25% after 5 min. There was large intersubject variation in the amount of potentiation (5-140%) and its persistence (5 to >/=20 min). The muscle compound action potential (M wave) did not change significantly (from pretetanic value) at 5 s after tetanus but increased sharply (26%) at 2 min and then subsided. Twitch half relaxation time (23%) decreased significantly more than twitch rise time (13%) 5 s after tetanus and recovered more slowly. Twitch rates of torque development (75%) and relaxation (71%) increased similarly 5 s after tetanus and were still elevated (approximately 25%) at 5 min. The extent of twitch torque potentiation was significantly inversely correlated with pretetanic twitch rise time (r = -0.69), half relaxation time (r = -0.61), and twitch-to-tetanus ratio (r = -0.66). The data indicate that posttetanic potentiation has a greater effect on twitch half relaxation time than on time to peak torque and is more prominent in muscles with a short twitch time course and small twitch-to-tetanus ratio.

Using multi-sensory environments with older people with dementia

This paper examines the utilization of multi-sensory rooms as an adjunct to the care of older people with dementia. Their evolution into the field of dementia care is explored and analysed. The degree to which the aims of therapy can be realized is addressed in terms of process issues experienced whilst utilizing the therapy in practice. These are initiation of therapy, transfer of patients, selection of patients and resources. On the basis of these findings recommendations are offered, the focus of which is the active promotion of such therapy within the remit of trained nursing staff.

Predictors of absenteeism among hospital staff nurses

An organizational dynamics paradigm is examined for effectiveness in predicting absenteeism among staff RNs in four hospitals. Different predictor variables were important within each hospital. Discussion is focused on the manager role and organizational policies related to criteria for excessive absence, incentives for attendance, and deterrents to absence.

A survey of the qualifications of ophthalmology nurses

A study was conducted to ascertain the numbers of nurses working in ophthalmology with appropriate qualifications. A questionnaire was sent to 168 ophthalmic nurse managers in the UK which revealed that a much greater proportion of nurses employed at grades I, H, G and F hold an ophthalmic qualification compared with those employed at grades E, D and C. Those nurses working at higher grades were far fewer in number, however. The results also indicated that the smaller the unit is, the less likely it is to employ nurses holding the specialist qualification. More funding and access to courses is recommended.

What kind of nurses do patients want?

This article discusses whether certain aspects of 'New Nursing' which involve changes in nurse-patient relationships and the emphasis of the nurse's role fit with patients' preferences for their care. It reports on a study investigating these issues, and concludes that patients in general want a warm and friendly style of nursing, but a substantial minority do not agree with the use of patients' first names. Patients' evaluations of the most important nursing activities focus on listening to patients' worries, teaching them about their conditions, and relieving pain.

The pregnant adolescent prostitute

The issue of teenage pregnancy is one of paramount concern and has been covered extensively in the professional literature. Teenage prostitution, as well, has drawn attention from medical and social science researchers. An increasing number of teenage prostitutes are becoming pregnant and delivering infants. These young women constitute a high-risk group that merits professional investigation and requires sensitive clinical approaches. We describe the pregnancy and early postpartum outcomes of 61 teenage prostitutes (age range, 13 to 18 years) in Seattle, Wash, during the period from January 1987 to February 1988. The subjects' environment, prenatal care, drug use, contraceptive practices, repeated pregnancies, and risk for sexually transmitted diseases (including acquired immunodeficiency syndrome) are discussed. Two case examples are used for illustration.

The complete analysis of data matrix: application and interpretation

In a recent article (Hope, 1969a) the author has demonstrated the theoretical relations between what psychologists call the analysis of persons and the analysis of tests. The demonstration was illustrated by an analysis of a hypothetical matrix M whose rows were called entities and whose columns were called variables. It was shown that, by combining Slater's (1964) method of spherical co-ordinate mapping with a method of numerical taxonomy suggested by the author, it is possible to perform a comprehensive and self-consistent pair of analyses whose conclusions can be read off three diagrams: a map of variables, a dendrogram of entities, and a profile diagram of the multivariate means of groups of entities.

The complete analysis of a data matrix

In the biological and social sciences the research worker is frequently faced with a two-dimensional, entity by variable, matrix of numbers. The matrix may contain scores of persons on tests, judgments of persons or objects by persons, measurements of physical characteristics of insects, economic statistics of areas, party votes in electoral districts, demographic or epidemiological or ecological counts of areas, and so on.

A delusional scale

A psychotic v. neurotic scale has been presented in the manual of the Symptom-Sign Inventory (Foulds and Hope, 1968). This scale was constructed after comparing each of four female neurotic groups with each of four female psychotic groups and each of four male neurotic groups with each of four male psychotic groups. For an item to be included in the scale 14 of the 16 comparisons within each sex had to show differences significant at least at the 5 per cent. level. On 18 items the psychotic groups had frequencies in excess of the neurotic; on only one item was it the other way round. The scale score is the sum of these 18 items minus the one.

Cognitive disorder among the szhizophrenias. 3. Retardation

As part of a larger study of cognitive disorder among the schizophrenias (Foulds et al., 1967a, 1967b), aspects of retardation were investigated. The relation of retardation to other forms of thought disorder in schizophrenia has been extensively investigated by Payne (Payne, 1960, 1962; Payne, Ancevich and Laverty, 1963; Payne, Caird and Laverty, 1964; Payne and Caird, 1967) who has used the three Babcock tests (Babcock and Levy, 1940), and the Wechsler Digit Symbol test as his measuring instruments.

Cognitive disorder among te schizophrenias. II. Differences between the sub-categories

Several workers have suggested that important differences exist in the cognitive disorders shown by patients in the various sub-groups of schizophrenia (Shakow, 1962, Lothrop, 1961). In this report the cognitive disorders investigated are those measured by the following tests: the Bannister-Fransella test (1966), which aims to measure “looseness and inconsistency in the use of constructs (concepts)” and two tests from the Payne-Friedlander (1962) battery intended to measure “over-inclusive thinking”—the Payne Object Classification test (Payne, 1962) and a modification of Benjamin's Proverbs (Benjamin, 1944). The differences among the schizophrenics which are considered are those between the acute and chronic stages of the illness and between paranoid schizophrenia and the non-paranoid varieties of the illness—hebephrenia, catatonia and simple schizophrenia.