Daniel T. Gianturco

Computer Simulation of Sleep EEG Patterns with a Markov Chain Model

For the most part, recent investigations of sleep and dream states of human subjects have followed a procedure which calls for the analysis of continuous electroencephalographic (EEG) recordings made during an all-night sleep on the part of various populations of subjects [1–5]. Comparisons of sleep EEG data from different investigations of human subjects have been found to be exceedingly difficult to achieve, in part because of the very large number of EEG tracings recorded during a single night of continuous sleep. For example, the analysis of one night’s sleep EEG recording may involve the rather formidable task of reducing as much as one third of a mile of EEG tracings into a meaningful form. Furthermore, the complete lack of standardization of methods of data presentation in sleep research renders comparisons among the results of sleep studies published by different authors exceedingly difficult. Therefore, it is not surprising to find that existing methods of data reduction and reporting such as histograms, tables showing percentage of time spent in different stages of sleep, and all-night sleep graphs are all either completely inadequate or lead to gross oversimplifications of results and do not facilitate easy comparisons. In addition, none of the existing methods of analyzing all-night sleep EEG patterns lend themselves to the analysis of the observed phenomenon of continuous shifts in the stages of sleep.

Effect of Psychiatric and Autonomic Symptoms on the Incidence of Fourteen and Six per Second Positive Spikes among Adolescents

INTRODUCTION In 1951 Gibbs and Gibbs (1) described an electrographic pattern that they entitled fourteen and six per second positive spikes. This pattern was found mainly in adolescents. The general symptomatology in their series of patients with this entity can be categorized into three types: (1) autonomic symptoms, (2) behavior disorder and (3) convulsive phenomena. The relatively high incidence of fourteen and six per second positive spikes among unselected children and adolescents has been noted by Gibbs and Gibbs (2), 21%, Metcalf (3),21%, and Demerdash (4), 14.2%. Loomis (5) found an incidence of 30% with positive spike in 150 adolescent male delinquents. Wiener and his co-workers (6) compared the EEGs of delinquent adolescents with normal adolescents and found an equal incidence of fourteen and six per second positive spikes, 13%. Walter, et al. (7) were unable to find evidence of any marked difference in emotional makeup between patients with positive spikes and those of other children referred for EEGs, regardless of the EEG findings. Small, et al. (8) found an association between organic impairment of the CNS and positive spikes in children. Yoshiis study (9) of juvenile delinquents with and without positive spikes did reveal more emotional blunting, impulsion, and depression in the positive spike group. These conflicting studies have led many psychiatrists to doubt that the entity has clinical psychiatric meaning and often the findings of positive spikes are dismissed as an interesting curiosity. It is our contention that the overt behavior part of this syndrome has been overemphasized to the exclusion of those clinical signs which fall in the realm of autonomic complaints. In a previous study by Hughes, Gianturco, and Stein (10), over 60% of the patients manifested not only behavior disorders but autonomic symptoms as well. Kellaway et al. (11) examined 456 children age five through sixteen with episodic autonomic disturbances, the majority of whom had the fourteen and six per second positive spike pattern in their electroencephalograms. Sixty years of psychiatric research have pointed to a variety of etiologies for psychiatric disturbances. Particularly in adolescence, socio-economic factors, family problems, and the well-known psychological identity crises of adolescence are already implicated in their psychiatric problems. It is not surprising that, when study patients are picked solely on the basis of a behavioral problem, differentiation both in regard to specific psychiatric symptoms and the incidence of fourteen and six per second positive spikes is difficult. In this paper we shall report on testing the hypothesis that a fourteen and six per second positive spike syndrome exists. They manifest both psychiatric and autonomic symptoms. This is the group we hypothesize to have an increased incidence of fourteen and six per second positive spikes when compared to control group.

TOCRS—The therapy-oriented computer record system

A computerized system has been developed to provide treatment records for patients in the Duke Psychiatric Outpatient Clinic. Demographic, diagnostic, and therapeutic data are incorporated into a concise summary provided to the therapist for each patient visit. Variables were carefully chosen to capture essential therapeutic information while minimizing the burden of data entry on the therapist. Suggestions by the users have led to a number of modifications in the system, including the addition of special data-keeping functions for therapy groups and record generations of summary reports for clinicians and administrators. Essential information is gathered in a format well suited to analysis by standard computerized statistical techniques. Record keeping, in this fashion, provides an information base that describes the process of psychiatric treatment.

A conversational psychiatric information network

A pilot network consisting of IBM 2741 terminals connects Cherry Hospital to Duke University which is 75 miles away. The system we have devised allows users to write narrative reports, score behavioral scales, search patient files,and store census data. In addition it allows the physician to write medication orders. The system has been in active use for nine months. The major benefit of the system to the physician user is regular narrative and graphical information about patients, which enables him to keep well informed, to utilize consultation more effectively, and to provide continuity of care.

DROWSINESS AND DRIVING IN A MIDDLE AGED POPULATION

QUESTIONNAIRE RESULTS INDICATED THAT THE INCIDENCE OF DRIVERS AGED 45-70 ADMITTING DROWSINESS WHILE DRIVING IS HIGH. THIS APPEARS RELATED TO MALENESS, YEARLY MILEAGE LOGGED, AND LONG TRIP DRIVING. CATTELL PERSONALITY TESTING REVEALED NO CONSISTENT GROUP OF PERSONALITY TRAITS WHICH CORRELATES WITH GETTING DROWSY. SUBJECTS WHO HANDLED DROWSINESS ESPECIALLY POORLY (THAT IS, FALLING ASLEEP) WERE CHARACTERIZED BY EMOTIONALITY, A TENDENCY TO WORRY, GIVE UP, AND EVADE RESPONSIBILITIES. MANY PHYSICAL FACTORS WERE EXAMINED, BUT ALL FAILED TO REVEAL A CONSISTENT PATTERN OF PHYSICAL DEFECT IN THE DROWSINESS GROUP. /NHTSA/

Treatment Goals in Geropsychiatry

Each geriatric patient has observable problems which can generate treatment goals implemented by a treatment plan. Extensive record keeping would be required to document this tripartite scheme. In practice, either problem‐oriented or goal‐oriented records are used. Problem records tend to drift toward a goal concept, since problems are usually stated in only sufficient detail to serve as a guide to treatment. The results of a problem‐oriented format are described for 143 state hospital patients whose mean age was 74 years. The most common number of problems was 5 per patient. Physical problems were the most frequent (N = 456), followed by behavioral (N = 203), thought‐related (N = 156), administrative (N = 99), affective (N = 69), and attitudinal (N=10). The authors’ experience with both systems leaves them with a preference for the problem‐oriented system with geriatric patients since physical problems are so numerous.

Use of the computer in caring for the elderly.

Computers are effective adjuncts to medical care of the elderly. However, their rightful place as an aid, not an alternate, to sound medical care must be recognized. A number of technics believed to have potential for improving medical care have been developed. Those selected for discussion here are measurement of cerebral blood flow, computer-based medical history systems, psychologic testing, mental status examinations, and patient data systems.