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GOLDFARB, ALVIN I.; TURNER, HELEN
doi: 10.1176/appi.ajp.109.12.916pmid: 13050818
II. Utilization and Effectiveness of "Brief" Therapy ALVIN I. GOLDFARB M. D. 1 , and HELEN TURNER M. S. 2 1 Attending Neuropsychiatrist, Home for Aged and Infirm Hebrews, New York. 2 Research Psychiatric Social Worker. This study is essentially an attempt to elaborate on a method of giving reassurance and emotional support to aged people. The method is based on clinical data organized in terms of observed adaptational efforts of aged persons. Our results are promising. While there is no doubt that a number of these patients would have done fully as well without treatment it also seems clear that treatment reveals a clue as to how they would have achieved their improvement or stabilization. This is the important aspect of Supportive treatment; it crystallizes a relationship in which the patient can heal some of his psychological wounds, and it watches and controls this process. Certainly if the patient can find a favorable relationship elsewhere the same healing will occur, but not for our enlightenment and without the assurance that everything possible to help keep it a healing process will be done. The results of treatment are in accordance with expectations based on well-known psychiatric facts. Past performance is the best criterion for prognosis in cases of disordered behavior; and also the probability of good result in treatment is greater where the remaining cortical-integrative function is greater. When predisposition to behavior disorder is great, a small amount of brain damage may prove enough stress to develop a severe reaction highly resistant to treatment. Conversely, well-automatized patterns of social adaptation may obviate the development of behavior disorder even in the presence of severe brain damage; and where stress does produce mental disorder in such cases, treatment may nevertheless be helpful. Thus the chief contribution of this study seems to be not so much the elucidation of new facts as indication that, where treatment of chronic brain syndrome with mental disorder may be effective, it can be achieved with the expenditure of very little psychiatric time. It is of great interest that only 7 hours of a psychiatrist's time spaced over a period of 2 years was the greatest amount of time required in our series of improved patients. Also, one of our most salutory results occurred after 6 sessions or 1 hours of psychiatric help. In both these patients as in the majority of our cases, presence of organic encephalopathy was verified by psychological testing. In those cases that remained unimproved, this outcome could be forecast very early in treatment. We have found repeatedly that emotional disorganization often exaggerates the picture of brain damage and makes for mistaken belief that treatment will be futile. Many patients who, on cursory study, might have passed as "confused" and "senile" individuals, were found on psychiatric examination to be psychoneurotic in the absence of significant degree of brain damage. As a corollary it therefore seems worth while to give all cases of disordered behavior in aged people a trial of treatment. Our results indicate that, while our treatment is ineffective in psychosis, it is of some value in psychoneurotic and allied disorders of the minimally brain-damaged aged. In the group with chronic brain syndrome, the results were better than expected. Changes in psychological and social functioning were achieved that permitted continuance of residence in the Home for Aged and Infirm Hebrews for patients who were referred when transfer, usually to a mental hospital, seemed to be the only solution.
MOSS, B. F., JR.; THIGPEN, C. H.; ROBISON, W. P.
doi: 10.1176/appi.ajp.109.12.895pmid: 13050815
B. F. MOSS JR. M. D., C. H. THIGPEN M. D., , and W. P. ROBISON M. D. 1 1 Department of Neuropsychiatry, Medical College of Georgia, University Hospital, Augusta, Ga. Succinyl choline dichloride i.v. is a useful drug to produce muscular relaxation in patients receiving ECT who would otherwise be poor risks because of susceptibility to fractures and pre-existing fractures. It has also proved of value in treating severely disabled cardiac patients for whom even slight exertion may be dangerous. This drug is potent and effective, but ultra-short-acting, seldom lasting more than 5 minutes. Artificial respiration is easily and adequately performed by standard routine methods. Oxygenation can be maintained at levels superior to that of bed rest. No untoward effects have yet been observed in over 300 electric treatments.
doi: 10.1176/appi.ajp.109.12.929pmid: 13050820
A Clinical Study J. NOTKIN M. D. Frontal bone hyperostosis in psychoses was observed in 9 women. Certain laboratory changes, especially in blood cholesterol content and blood sugar tolerance, were noted. Obesity was not observed as a characteristic feature. Five cases began with functional types of psychosis, later showing evidence of organic mental deterioration. Four patients had organic mental reactions from the beginning, one showing pronounced neurologic signs.
WEINSTEIN, EDWIN A.; KAHN, ROBERT L.; SUGARMAN, LEROY A.; LINN, LOUIS
doi: 10.1176/appi.ajp.109.12.889pmid: 13050814
EDWIN A. WEINSTEIN M. D. 1 , ROBERT L. KAHN M.A. 1 , LEROY A. SUGARMAN M. D. 1 , , and LOUIS LINN M. D. 1 1 The Neurological and Psychiatric Services of The Mount Sinai Hospital, New York. The use of amobarbital sodium (amytal sodium R ) as a diagnostic test for brain disease is described. In 57 of 88 patients with proven brain disease, who on clinical examination showed no disturbances in behavior, the intravenous administration of the drug produced patterns of disorientation for time, place, and person and denial of illness. These changes were not obtained in any of 50 control patients. The applicability of the procedure to the study of alterations in brain function caused by structural, iatrogenic, metabolic, and toxic agents is discussed.
doi: 10.1176/appi.ajp.109.12.922pmid: 13050819
LOUIS J. WEST USAF (MC) 1 1 The Department of Psychiatry of Cornell University Medical College and The New York Hospital. The MMPI is widely accepted as the best of the questionnaire-type personality tests. It is simple to administer and score, conservative of the clinician's time, well accepted by patients, and provides an extensive anamnesis and a graphic indication of psychopathological status that is easy to interpret. It Should not be used as a substitute for the physician's history-taking (which is so important in the early development of a therapeutic relationship), nor should it be used alone to "make" a diagnosis. With experience in the use of the MMPI, characteristic profiles can be recognized as indicative of personality structure and disturbance that are not limited to diagnostic categories of any particular school. Examples have been selected to demonstrate how the MMPI can be used in measurement of changing psychopathology, thus indicating its value in analysis of clinical progress and results of treatment.
MAY, PHILIP R. A.; EBAUGH, FRANKLIN G.
doi: 10.1176/appi.ajp.109.12.881pmid: 13050813
Its Therapeutic Use in Psychiatric Patients PHILIP R. A. MAY M. D. 1 , and FRANKLIN G. EBAUGH M. D. 1 1 The Department of Psychiatry, University of Colorado School of Medicine. Dormison is a drug of a new type that, when used as a hypnotic, is highly efficient and relatively nontoxic and noncumulative. It is the hypnotic of choice in elderly, senile, and arteriosclerotic patients and it has definite advantages over other hypnotics in other types of patients. The hypnotic effect is highly specific, and Dormison is of little value as a sedative since toxic or near-toxic doses are required to produce an adequate sedative effect in disturbed patients. We have observed cumulative effects only when large doses were given as a sedative. The danger of addiction may be less than with other hypnotic-sedative drugs, as Dormison is ultra-short-acting and tends to lack their stupefying and euphorigenic action. Nevertheless, Dormison should not be given as a sedative to patients who have previously been addicted to other drugs, and it should be used as a hypnotic in these cases only under hospital conditions. In view of previous reports, and our findings on cumulation and addiction, barbiturates should not be given to patients receiving Dormison until such time as extensive data are available on the potentiating effect of Dormison on barbiturates in man.
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