Haroutun M. Babigian

Epidemiology of anorexia nervosa in Monroe County, New York 1960-1976.

&NA; The Monroe County Psychiatric Case Register and hospital records were used to investigate the incidence of anorexia nervosa in Monroe County, New York, during the periods 1960‐1969 and 1979‐1976 to determine whether the number of newly diagnosed cases has increased over time. The results support the general clinical impression of a recent increase in the incidence of anorexia nervosa. This pattern of overall change was accounted for by the sharp increase in the number of females with the disorder, particularly those aged 15‐24. The data also suggest that the disorder occurs more often in the higher socioeconomic levels.

Reasons for hospitalization from a psychiatric emergency service

The reasons for hospitalization of 341 patients from a university-based psychiatric emergency service were studied. The need for protection was the most frequent reason for hospitalization (51%), with the need for inpatient diagnostic studies or treatment second in frequency (36%). The hospitalization rate was higher for older patients, widowed patients, nonwhite men, psychotics, patients having prior psychiatric care, and those accompanied by other people.

Catatonic Schizophrenia: Epidemiology And Clinical Course: A 7-year Register Study Of 798 Cases

The epidemiology of catatonic schizophrenia is presented, based on 798 cases from a county-wide psychiatric register. The cases in this catatonic cohort represent 10 per cent of all patients ever to receive a diagnosis of schizophrenia in the Monroe County Psychiatric Case Register. The 7-year prevalence of catatonic schizophrenia, based on the span of this study, is close to 1 per 1,000 county inhabitants. Far from being a vanishing entity, the catatonic type of schizophrenia now represents 5 per cent of all first diagnoses of schizophrenia. There are significantly more women than men in the catatonic cohort when compared to the register schizophrenics, the entire register population, or the Monroe County population (p <.02). The age-adjusted rates for the catatonic cohort, and especially for those consistently diagnosed as catatonic schizophrenia, are 2 to 8 times higher in the lower socioeconomic classes than in the upper socioeconomic classes. The over-representation of the lower classes and under-representation of the upper classes are even more marked than they are in the register schizophrenics, where the lower-class rates are 2.3 times higher than the upperclass rates. The relative risk of death is 2.6 to 3.6 times greater in the catatonic cohort than in the age-adjusted county population. Multiple episodes requiring hospitalization occurred in 57 per cent of the catatonic cohort. Indeed, 68 per cent of the cases not in custodial care at the onset of the study had more than one hospitalization. For the entire cohort, episodes longer than 180 days occurred for 49 per cent of the men and 35 per cent of the women. A significantly greater proportion of men than women had admissions lasting longer than 180 days (p <.01). Conversely, a significantly greater proportion of women than men had all their episodes lasting less than 45 days (p <.01). The diagnostic outcome of a cohort with no psychiatric treatment prior to entry in the register and with a diagnosis of catatonic schizophrenia made at an acute treatment facility is presented. These 51 cases were followed for 3 to 6 years. Some other type of schizophrenia than catatonia was diagnosed more frequently for 22 cases. Six other cases were more frequently diagnosed as having nonschizophrenic psychiatric illnesses. Of the 23 cases who were most frequently called catatonic schizophrenia, two fatalities occurred. Both these cases had organic disease, proved at autopsy, which produced catatonic behavior. Although catatonia was thought to have a relatively favorable outcome 100 years ago, those cases now that are so diagnosed do not appear to have a better prognosis than that of other types of schizophrenia. And a small percentage of cases with catatonic behavior mask potentially lethal organic disease.

The epidemiology of treatment for chronic and nonchronic mental disorders.

To estimate the annual treated incidence and prevalence of chronic and nonchronic mental disorders, data from the Monroe County Psychiatric Register were analyzed. Patients were classified as either chronic or nonchronic based upon their utilization of inpatient psychiatric treatment. A chronic illness was defined as one requiring at least three psychiatric hospitalizations or at least 365 inpatient days during a 5-year follow-up period. Based upon this definition, the annual treated incidence of chronic mental disorders did not change significantly between 1964-65 (.47/1000) and 1969-70 (.41/1000), unlike the annual treated incidence of nonchronic disorders, which rose by 37 per cent (p less than .001). The annual treated prevalence of chronic mental disorders also remained unchanged at approximately .6 per cent between 1965 and 1970, but the treated prevalence of nonchronic mental disorders rose by 43 per cent from 1.4 per cent in 1965 to 1.9 per cent in 1970 (p less than .01). These increases in treatment for nonchronic disorders coincided with the development of community mental health centers. The rates of chronicity and peak ages of treatment varied considerably across diagnostic groups. Approximately one fifth of new cases of organic brain disorders, schizophrenia, and alcohol disorders became chronic according to our definition during the first 5 years after illness onset, compared to only 9 to 11 per cent of cases of major affective disorders and less than 2 per cent of all other disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Migrant farm workers: social conditions, adaptive belief systems, and psychiatric care.

Two migrant farm labor camps were observed during two summer harvesting seasons. A part of the observations consisted of interviews with 104 farm laborers, with 16 of them being interviewed intensively. Migrant farm workers were exploited by the crew boss and the farm owner, and they in turn exploited each other. Consequently, many workers left farm work. Those who remained in the camps adapted their attitudes and their views to the conditions. Though they had a begrudging respect for the crew boss, they showed an overriding concern with exploitation. They conveyed a numbness about life, themselves, and their place in society; this numbness was combined with self-criticism and an attempt to maintain some self-respect. They expressed distrust for and suspicion of others, and though they could not articulate it very well, they felt great fear and anxiety. In order to diagnose and treat disorder in migrant farm workers, psychiatrists must understand the exploitive social setting of migrant farm work and the adaptations of workers to that setting.