Kenneth Z. Altshuler

Sleep in herniorrhaphy patients

The nocturnal sleep patterns of 10 elective herniorrhaphy patients were documented by continuous, 8 hour polygraphic recordings from night 1 of hospitalization until discharge on day 4 or 5. Subjects showed a dramatic loss of REM sleep and stages III and IV and major increases in time awake and drowsy for the first 2 postoperative nights, with a gradual return toward normal sleep over the hospitalization period. The significance for healing of the loss of stages REM, III, and IV is discussed, especially with regard to hospital procedures and the use of medications.

Measuring use of outpatient care among mentally ill individuals: a comparison of self reports and provider records

Abstract Psychiatric nurses administered structured interviews to 80 clients in a county mental health clinic. Clients were asked to describe their use of medical and psychiatric outpatient care services during a 180-day period. Responses were compared with medical records abstracted from a comprehensive listing of health care providers. Taken as a group, clients reported only slightly more visits than that found in medical records. Individually, however, client responses were poor predictors of visits reported in provider records. Those considered low utilizers by providers tended to overstate, and high utilizers tended to understate, the number of outpatient visits. Reporting validity did not vary with client demographic characteristics or psychiatric diagnoses.

The effect of dosage on the dexamethasone suppression test in normal controls

A sample of 23 drug-free, normal adult subjects, aged 23 to 50 years, received 1 mg dexamethasone p.o. at midnight. Serum cortisols were obtained at 0800h, 1600h, and 2330h pre- and postdexamethasone. Only 1 of these 23 subjects (4.3%) evidenced nonsuppression, as defined by any postdexamethasone serum cortisol value of greater than 4.0 micrograms/dl. A dose of 0.75 mg dexamethasone was administered to 23 drug-free, normal adult subjects, 20 of whom participated in the above 1 mg trial. Six of these 23 (26.1%) showed nonsuppression at a threshold of 4.0 micrograms/dl. Another 11 normal adults who were taking various prescription medications (e.g., sympathomimetics, nasal decongestants, birth control pills, thyroid hormones) or who were suffering from untreated upper respiratory infections, venereal infections, or allergies were tested with 1 mg of dexamethasone. In this sample, 7 of 13 (53.8%) showed nonsuppression. These findings suggest that: (1) 1 mg of dexamethasone is the lowest effective dose that can be used in diagnostic testing for melancholic depression; (2) a false-positive response to the dexamethasone suppression test (DST) may occur with infections, allergies, or possibly with certain prescription medications. Further studies of the effects of illness and/or medications on DST responses are needed.

Toward a psychology of deafness

A large scale study comparing Yugoslavian and American adolescents with normal hearing and with early profound deafness suggests that a relative tendency to impulsivity is a notable characteristic of the deaf group. Despite the conclusiveness of the study overall, there was little intercorrelation among individual subjects on the several test measures employed. A stereotype should be avoided therefore, and the tests viewed as perhaps tapping different personality aspects or avenues of development for what clinically becomes a final common pathway. Comparable and comparative studies of deaf children of deaf parents and of children whose hearing parents have learned manual language early may define how much the tendency is based on qualities of parental discomfort with a deaf child, on the unavailability of language, or on the absence of sound alone.

Computerizing medication algorithms and decision support systems for major psychiatric disorders.

&NA; In this article, the authors discuss the rationale for the use of computerized medication algorithms and decision support systems in the treatment of major psychiatric disorders. The field of psychopharmacology has advanced tremendously in the last two decades, with the resulting vast array of new information yielding a marked disparity between actual practice and what is commonly called “best practice.” As a remedy, clinical practice guidelines and algorithms have been widely developed. These algorithms are used to disseminate up‐to‐date information, effect change in physician behavior, and reduce untoward variation in care. Review of the literature reveals advantages and limitations in trying to implement these paper and pencil guidelines and algorithms. Available research also suggests that computerized decision support systems have the potential to overcome such limitations, increase the use of treatment guidelines and algorithms, and improve physician adherence to recommended practices. The advantages of computerized medication algorithms and decision support systems are discussed. Finally, the computer platform elements that are necessary to make such systems effective and user‐friendly are described.

Phenomenology of Hallucinations in the Deaf

Fifteen years ago, a group of us at the New York State Psychiatric Institute began what was to become a unique involvement with our totally deaf population, persons who were born deaf or who lost their hearing in early childhood.[1,2] In the course of establishing a comprehensive mental health program we encountered deaf people on many levels. Professionally we have worked with a few deaf people of outstanding achievement who have overcome their handicap and obtained advanced education. Personally we have become friendly with leaders of the deaf community and ordinary deaf citizens. We have seen deaf children go through school and of course we have developed an unusual amount of experience with psychiatrically ill deaf patients.

Computerized Medication Algorithms in Behavioral Health Care

Advancements in medicine have occurred rapidly over the last several decades. These advances have taken place in areas such as basic medical knowledge, treatment strategies, interpretation of clinical data, diagnostics, and pharmacology, thus changing the extent and complexity of medical practice. Physicians in clinical practice (specialists as well as primary care physicians) are called upon to assimilate a substantial volume of complex data for a multitude of medical conditions. Physicians’ decisions in clinical practice not only are contingent on a considerable knowledge base, but also require the physician to stay well informed of current advancements in order to optimally treat patients.

Flurazepam and the sleep of herniorrhaphy patients

Abstract: The effects of flurazepam on the nocturnal sleep patterns of 20 pre‐ and postoperative herniorrhaphy patients were studied polygraphically, in double‐blind fashion, in the clinical setting. Compared to patients who received no hypnotic, patients treated with flurazepam had, preoperatively, significantly more Stage 2 and less REM and, postoperatively, significantly greater total sleep time, fewer awakenings, and less total awake time. The flurazepam group also initially had more delta sleep, but then showed a steady decrease of delta sleep over the hospitalization.

The emotionally disturbed deaf child: a first program of research and therapy.

Psychiatric interest in the deaf was born only 20 years ago (Altshuler, 1971; Rainer et al., 1969), and systematic observations, over time, of emotionally disturbed deaf children are still virtually nonexistent.’ Of the population at large, one in a thousand has profound early deafness and among the school-aged deaf, close to a third have additional handicaps that interfere significantly with their classroom progress (only 510% in the general school population have such difficulties) (Jensema and Trybus, 1975; Meadow and Schlesinger, 1971; Schein and Delk, 1974). Professional meetings of those who work in deafness repeatedly issue strident calls for help with these children, but there is at this point in time no facility in the entire country geared to meet their special needs: the multiple problems of communicative handicap, emotional disturbance, and other handicapping conditions associated with the deafness causing agent (Altshuler, 1975; U.S. Department of Health, Education and Welfare, 1968). It was this situation that led us to mount the pilot program to be described. New York State has pioneered in the provision of mental health services for the deaf since 1955. By early 1975, the Department of Mental Hygiene had, for several years, a well-established, state-wide inand outpatient treatment unit, which also included halfway house and rehabilitation services and a preventive and consultative service at a school for the deaf (Rainer and Altshuler, 197 1). At that time, Dr. John Rainer and ourselves from the Deafness Unit and Kendall Litchfield, Dr. David Spidal, and staff of the New York School for the Deal joined forces to plan and then to form two special classes for severely disturbed children. These classes began in September of 1975. Each consisted of five students, almost all residential, with one group in the age range of 4 to 6 and the other 7 to 10. The school also provided each class with a teacher and a teacher’s

On the inter-relationship of cognition and affect: Fantasies of deaf children

A few projective studies focusing on the impact of cognition on affect in the deaf have reported strikingly disparate results with little systematic inquiry. A new and previously unreported play situation (with the deaf) was devised to elicit a detailed story. Fantasies were obtained in a uniform fashion from four groups of five-year-old boys comprising middle-class deaf and hearing children and lower socio-economic-class deaf and hearing children. Results suggest that: (1) The impact of deafness on cognitive functioning in these children is akin to—but apparently no worse than—the cultural deprivation phenomenon experienced by low socio-economic-status children. (2) There is no paucity of fantasy life in the deaf or deprived child, despite the absence or relative lack of verbal skills. (3) A problem common to both disadvantaged children and the deaf children tested is the intrusion of anxiety into autonomous ego functions, so that practice necessary for the firm development of cognitive schemata is interfered with. (4) The clinical impulsivity secondary to these emotional pressures may perpetuate itself by interfering with cognitive decentration in time and space in relation to others.