James R. Slaughter

Occurrence and Implications of Seizures in Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysms

The records of 100 consecutive cases of subarachnoid hemorrhage due to ruptured aneurysm were reviewed to determine the incidence and the prognostic implications of seizures during the acute phase. Seizures occurred in 26% of the patients. Sixty-three per cent of the seizures occurred near the onset of the initial hemorrhage. The occurrence of these early seizures did not correlate with the location of the aneurysm or the prognosis. Most of the remaining seizures occurred immediately after rebleeding, with no greater morbidity or mortality compared to all patients who rebled. Pathogenic mechanisms of seizures associated with subarachnoid hemorrhage are proposed and discussed.

Risk Factors in Childhood That Lead to the Development of Conduct Disorder and Antisocial Personality Disorder

With juvenile crime on the rise, understanding and preventing juvenile delinquency is one of the greatest challenges facing mental health professionals today. Recognizing early signs of conduct disorder (CD) can be difficult, but identifying risk factors is an important step in preventing a childs progression to CD or Antisocial Personality Disorder (APD). This paper focuses on various risk factors for CD and APD, such as intrinsic individual differences, psychosocial/environmental factors, genetic and neurochemical factors. Early recognition and intervention may prevent the progression from aggressive and maladaptive behaviors to CD and later APD.

Risk factors for depression in rheumatoid arthritis

OBJECTIVE To identify risk factors for the development of depression in persons with rheumatoid arthritis (RA). METHODS Subjects were divided into depressed versus nondepressed groups on the basis of the Center for Epidemiologic Studies-Depression Scale; a range of psychological, pain-related, disease-related, and demographic variables were analyzed to predict depression. Both cross-sectional and longitudinal predictive models were examined. RESULTS A series of analyses, including multiple logistic regression, found that the optimal predictors of depression in RA were average daily stressors, confidence in ones ability to cope, and degree of physical disability. The model was successfully cross-validated on separate data sets (i.e., same subjects at different time points). CONCLUSION All of the identified risk factors for depression in RA are preventable to some extent and, therefore, should be addressed in comprehensive, rheumatology team care.

An approach to the treatment of psychogenic parasitosis

BackgroundPatients with psychogenic parasitosis typically seek help from nonpsychiatric physicians and can be difficult and time‐consuming to treat. Pimozide has been promoted as the treatment of choice but is not indicated for every patient presenting with this symptom. Our purpose was to develop a realistic treatment protocol for the nonpsychiatric physician faced with these patients.

The usefulness of the Brief Symptom Inventory in the neuropsychological evaluation of traumatic brain injury

Changes in the health care delivery system are forcing clinicians to use less timely and more cost efficient measures. In rehabilitation, more efficient measures of emotional-behavioural functioning are being administered to patients with traumatic brain injury (TBI), including the Brief Symptom Inventory (BSI), a 53 item short version of the Symptom Checklist-90 that assesses nine different dimensions of emotional-behavioural functioning. Because the BSI was developed for use with psychiatric populations, research of the measure with TBI populations is needed. The current study evaluated the utility of the BSI in a sample of 62 patients (34 male, 28 female, average age 35, average education 12 years) with TBI evaluated as outpatients at a midwestern rehabilitation hospital. Results indicated that: (1) subjects endorsed clinically elevated distress on seven of the nine subscales when compared to the normative sample; (2) the Obsessive-Compulsive (OC) subscale achieved the highest t-score (70.31); 3) the most frequent two-point profiles included the OC-Somatic (21%) and OC-Psychoticism (13%) subscales; and (3) the Global Symptom Index was significantly correlated with all nine subscales. It was concluded that caution must be used when administering the BSI to individuals with TBI due to a lack of a TBI standardization sample, the limited number of test items per subscale, and questionable labels for the different subscales (e.g. OC subscale items appear to be more reflective of TBI-related cognitive impairment than obsessive-compulsive traits).

Selective serotonin reuptake inhibitor treatment of post traumatic Klüver-Bucy syndrome

Two cases of Klüver-Bucy syndrome following severe traumatic brain injury (TBI), are described during the period of recovery from acute TBI. These patients posed significant management problems, until successfully managed with selective serotonin reuptake inhibitors (SSRIs). These cases support the benefit of SSRIs in treating associated Klüver-Bucy syndrome.

Determining neuropsychological impairment using estimates of premorbid intelligence: comparing methods based on level of education versus reading scores.

When inferring brain dysfunction, test scores are typically compared to normative data based on estimates of premorbid intelligence (e.g., by educational level or reading scores). However, these methods are likely to lead to differing results, with important diagnostic and forensic implications. The current study compared estimates of impairment (reported in z-scores) based on educational level versus reading scores in a population with traumatic brain injury. The study included 174 patients (M age = 27.3; M education = 12.3) evaluated as outpatients at a university hospital rehabilitation department. Wilcoxen ranked sign tests indicated that the two methods yielded estimates that were statistically different (p <.0001) for all variables. The education based method yielded greater estimates of impairment than the reading score method for WAIS-R FIQ. Grip Strength, and Finger Tapping, with a pattern of generally consistent impairment across cognitive/motor areas (z-score range = -0.59 to -.97). In contrast, the reading score based method yielded greater estimates of impairment in processing speed (Trails A) and flexibility (Trails B), with a wider range of impairment noted between cognitive and motor domains (z-score range = +0.21 to -2.95). Clinical implications are discussed.

Relationship of psychiatric history to pain reports in rheumatoid arthritis

Objective: The purpose was to examine the relationship of pre-existing psychiatric history to pain reports in a cohort of persons with RA and concomitant major depression who were receiving a trial of antidepressant medication. Method: RA patients (n = 41) with a current episode of major depression were divided into two subgroups comprised of those with a previous psychiatric history (PSY+) (n = 20) and those without a previous psychiatric history (PSY-) (n = 21). The groups were compared with regard to their responsiveness to a regimen of antidepressive medication on measures of depression, pain, coping, and life stress over a period of 15 months. Results: Although depression scores for both the PSY+ and the PSY- groups decreased significantly from baseline to 15-month follow-up, the composite pain score was found to be significantly decreased only for the PSY- group. Conclusion: Psychiatric history appears to predispose persons with concomitant RA and major depression to report less pain reduction following antidepressive treatment than those persons without a psychiatric history.

The man who called himself 'hockey stick': a case report including misidentification delusions.

Delusional Misidentification Syndromes (DMS) were first recognized in 1923 when Capgras and Reboul-Lachaux described a woman who believed impostors replaced people she knew and doubles of herself existed [1]. Since that time, approximately 600 cases with seven subdivisions of DMS have been reported [2]. Each subdivisions’ delusions are similar in that they each are characterized by the belief(s) that the physical and/or psychological identity of others and/or self have changed into someone else. Thus, DMS will be referred to as simply misidentification delusions with different presentations, rather than attempting to categorize them individually. Neuropsychological testing has revealed that these delusions are not prosopagnosia (the profound inability to recognize previously familiar faces). That is, DMS are misidentifications of select individuals and not a global inability to recognize faces [3]. Delusional disorders often have `organic’ causes [4]. DSM-IV refers to psychotic disorders which have an identifiable aetiology as disorders due to a general medical condition [5]. Misidentification delusions have been reported in association with systemic illnesses including Vitamin B12 deficiency, diabetes, hepatic encephalopathy, hypothyroidism, and pseudohypoparathyroidism [6], and with CNS disturbances including Alzheimer’s disease, stroke, brain tumours, infarcts and traumatic brain injury (TBI) [7]. The structural brain disorders, such as TBI or infarcts, are most valuable for studying the brain because they provide an anatomic region with destruction and dysfunction. Benson and Stuss [8] reported frontal lobe damage in association with delusions in a case review, which included one misidentification delusional case. From these reports, Benson and Stuss postulated that damage to the frontal lobe could be responsible for delusions. Jibiki et al. [9] reported of an organic