The structure of posttraumatic stress symptoms.

Posttraumatic stress disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. and 4th ed.; American Psychiatric Association, 1987, 1994, respectively), is characterized by 17 symptoms, descriptively clustered into 3 groups: (a) intrusions, (b) hyperarousal, and (c) avoidance and numbing. The present study sought to identify the basic dimensions (factors) that underlie these symptoms. Two samples were assessed: 103 victims of motor vehicle accidents and 419 United Nations peacekeepers deployed in Bosnia. A principal axis factor analysis was conducted for each sample. In each sample, 2 correlated factors were obtained, which were very similar across samples. Factor 1 was labeled Intrusions and Avoidance, and Factor 2 represented Hyperarousal and Numbing. These factors loaded on a single higher order factor. The higher order factor accounted for 13% to 38% of variance in symptom severity, and the lower order factors accounted for an additional 8% to 9% of variance. If the authors assume that each factor corresponds to a distinct mechanism (R. B. Cattell, 1978), then the results suggest that posttraumatic stress reactions arise from a general mechanism, with contributions from 2 specific mechanisms.

Social influences on factored dimensions of the McGill Pain Questionnaire.

The McGill Pain Questionnaire (MPQ) was administered to 268 subjects following electrical stimulation to pain-tolerance limits. Subjects received stimulation under four social modeling conditions: tolerant, intolerant, control, and no model. The number of factors and degree of obliqueness most appropriate for the MPQ scores were determined using multiple criteria. Five factors, reflecting 46.6% of the total variance, were derived and labelled as follows: affective-arousal, sensory-pressure, perception of harm, somesthetic pressure, and cutaneous sensitivity. The various modeling conditions did not produce any significant between-group differences on the factors. The repeated demonstration that the MPQ assesses substantially more than the three components originally proposed suggests that considerable caution is warranted with respect to using the 'sensory-evaluative-affective' method of scoring this test. Considered in relation to previous research, the present findings are consistent with the conclusion that social influences affect fundamental components of subjective reactions to pain.

Primacy and recency effects in the assessment of memory using the Rey Auditory Verbal Learning Test.

The present study examined the manifestation of the primacy and recency effects in patients with anterior brain damage, posterior brain damage, and psychiatric inpatients with no known organic impairment. All three groups of patients demonstrated both a primacy and a recency effect on the Rey Auditory Verbal Learning Test (RAVLT). Differences among the three groups with respect to the magnitude of primacy and recency as well as with other variables reflecting free recall were nonsignificant. These findings limit the use of primacy and recency for the differentiation of memory deficits due to organic and nonorganic causes.

Systems model of cortical organization: positron emission tomography and neuropsychological test performance.

Positron Emission Tomography (PET) has allowed researchers to examine in vivo brain-behavior relationships. Correlations of metabolic increases measured by PET with simple sensory tasks involving hearing, vision, and tactile/motor responses have generally produced metabolic changes in agreement with known neuronal pathways. However, complex neuropsychological tests such as Raven's Matrices and Verbal Fluency have resulted in cortical activation of unexpected areas as well as some negative correlations between test performance and metabolism. These observations provide the first demonstration of complex relationships between neuropsychological functioning and activation of the normal brain. Since PET technology offers a means of computing the simultaneous proportional contribution of multiple brain regions, the issue of "localization" of neuropsychological test performance might appropriately be considered for redefinition in terms of a "systems" approach. In spite of the advances brought about by PET, methodological problems still remain for researchers. Future studies will need to take into account the subtle regional effects of neuropsychological paradigms.

Electrocortical mapping, MRI, and neuropsychological measures: evidence of Alzheimer's disease in the presence of vascular lesions.

We report here a case study of a 76-year-old woman with a high school education, whose presenting psychiatric symptomatology indicated dementia of unknown etiology. Neuropsychological test results were consistent with AD, but diagnosis was complicated by an MRI showing a large right hemisphere cortical infarct and scattered subcortical changes leading to a diagnosis of possible AD. Electrocortical mapping showed the right hemisphere infarct, and gave independent evidence suggestive of AD in the relatively intact left hemisphere. This case demonstrates the utility of multidimensional assessment as an aid to differential diagnosis.

Multivariate comparison of Howes' and Weisenburg and McBride's models of aphasia on the neurosensory center comprehensive examination.

The verbal production of 57 aphasic patients was rated and used to assign these patients into two sets of groups reflecting Howes' and Weisenburg and McBride's models of aphasia. Test scores covering a broad range of communication skills and modalities were compared between these groups to examine the assumption that salient features of verbal production could be used to establish groups which would show significant differences on other important linguistic variables. Neither Howes' nor Weisenburg and McBride's model provided groups showing significant multivariate differences. It was suggested that these models be improved by expanding them to include other important psycholinguistic components of language skills. Since these models did not account for significant between group differences, caution was suggested in using these models for assessment or treatment purposes.

Cross-validation of WAIS-R prototypical patterns of intellectual functioning using neuropsychological test scores.

A heterogeneous sample of neuropsychiatric patients were classified with respect to the nine prototypical patterns of intellectual functioning observed previously in the WAIS-R standardization sample. Of the manifestly right-handed patients, all but 9.9% could be classified with respect to membership in a prototypical group. This suggested that the most frequent consequences of neuropsychiatric disorders may be to produce patterns which are similar to those found in the standardization sample. However, the prevalence of these groups within the neuropsychiatric sample was dramatically different from those found in the standardization sample. Prototypical patterns with lower levels of overall functioning were also found to have lower scores on neuropsychological tests consistent with a wide range of cognitive, psychomotor, and memory deficits. By demonstrating an association between group membership and neuropsychological performance, these results contribute to the cross-validation of the prototypical patterns observed in the WAIS-R standardization sample.

A comparison of empirically derived groups of aphasic patients on the Neurosensory Center Comprehensive Examination for Aphasia.

Rating scales were used to identify characteristic aphasic phenomena in a sample of natural language from aphasic patients. These variables were used to derive empirically four groups of aphasic patients. These groups showed significant multivariate differences on the basis of their performance on the Neurosensory Center Comprehensive Examination for Aphasia. Seven subtests showed significant univariate differences among the four groups: Visual Naming, Description of Use, Sentence Repetition, Repetition of Digits, Reversal of Digits, Identification by Sentence, and Oral Reading Sentences. Two of the groups reflected Howes dichotomy of articulate-nonarticulate language disorders. Another group was thought to reflect Schuell's single dimension of language disorders that could be differentiated only in terms of severity. Afourth group was characterized by a major impairment of memory. These results indicated that aphasic phenomena could be identified reliably on the basis of rating of verbal output on scales that reflect language disorders. These scales were used in a statistical fashion to derive empirically oriented groups that were identified on the basis of psychometric measures of language skills.

An operation for the treatment of cutaneous neurofibromatosis.

An operation for the rapid removal of multiple cutaneous neurofibromata is described. It is possible to excise about 250 lesions during an operation lasting 1 hour.

Use of background interference procedure to assess visual retention deficits in multiple-sclerosis, psychiatric, and brain-damaged patients.

The performances of three groups of patients were compared during two conditions of interference on a visual retention task. During the noninterference condition, the psychiatric, multiple-sclerosis, and brain-damaged patients functioned at a comparable level. The introduction of a distracting background reduced the level of functioning for only the brain-damaged group. This effect remained significant for the correct score when age and postmorbid intelligence functioning were controlled. These results were interpreted as reflecting the cortical nature of the deficits in resisting the distracting influence of the background interference procedure. Serial testing was recommended for the evaluation of the multiple-sclerosis group.

Differences in neuropsychological performance in psychiatric, anterior- and posterior-cerebral dysfunctioning groups.

The neuropsychological performance of psychiatric, anterior- and posterior-cerebral dysfunctioning groups was compared using both raw scores and scores statistically adjusted for the effects of age, education, gender, and overall level of intellectual functioning. Between 5% and 37% of the variance of the subtests of the WAIS-R and between 9% and 58% of the variance associated with the neuropsychological variables was accounted for by the demographic variables. Using raw scores, ten of the twenty-five tests showed significant overall differences among the groups, while only five of the contrast using adjusted scores were significant. Anterior- and posterior-cerebral dysfunctioning groups generally were significantly more impaired than the psychiatric group. Memory and problem-solving variables were the most sensitive to the removal of demographic variance, while psychomotor test scores were the most robust. Differences among cerebrally impaired and psychiatric groups may be obscured by demographic variables or levels of general intellectual functioning.

An application of the background interference procedure to the Benton Visual Retention Test.

This study involved applying Canter's Background Interference Procedure to the Benton Visual Retention Test. In a heterogeneous sample of psychiatric and brain-damaged patients, it was found that brain-damaged patients reproduced fewer designs and made more errors in reproducing those designs than did psychiatric patients. Right-hemisphere and diffusely brain-damaged patients reproduced fewer designs correctly and made more errors than did left-hemisphere damaged patients. This pattern was maintained when the effects of level of intellectual functioning and age were statistically controlled. These results suggest that the Background Interference Procedure in conjunction with the Benton Visual Retention Test may make a contribution to the assessment of brain-injured patients.

A comparison of treatment modes in the management of myofascial pain dysfunction syndrome.

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.

Assessment of prognosis in cutaneous malignant melanoma.

A retrospective study of 103 patients with histologically proved cutaneous malignant melanoma was made in order to assess the validity of a simple prognostic index, based upon a multivariate analysis of weighted pathological and clinical factors, in predicting the expected outcome in a given case. The results of the study were almost identical to those observed by Cochran (1968); 16 per cent of the patients with a low prognostic index (less than 20) died or developed recurrence of melanoma during the period of follow-up, in contrast to those with a high prognostic index (greater than 25) of whom 64 per cent were similarly affected. It is concluded that the predicted outcome based upon such an index is valid for the 5 postoperative years in some 90 per cent of patients with cutaneous malignant melanoma. It is suggested that the use of such an index may be of great value in selecting patients in whom the expected outcome to surgical therapy is poor and in whom adjuvant therapy may be of value.

Repair of lower leg injuries with fascio-cutaneous flaps.

Experience with sixteen consecutive cases of lower leg skin loss has confirmed the reliability of Pontén's fascio-cutaneous or "super flap" (1981) in the management of these difficult injuries. The technique has several important advantages compared with the conventional lower leg flaps of both the ipsi-lateral and cross-leg variety.

Birth weight and pathogenesis in phenylketonuria.

The birthweights of an ethnically homogeneous sample of infants with phenylketonuria, their unaffected siblings, and control infants were compared after adjusting for the effects of: mother's age, mother's date of birth, mother's height and obstetric history, the length of gestation, the infant's sex, the place and date of birth. There were no significant differences between the infants with phenylketonuria and their unaffected siblings either in adjusted or unadjusted birthweights. Control infants had slightly, but statistically significant, greater adjusted and unadjusted birthweights than the combined phenylketonuria and unaffected sibling groups. This effect of the phenylketonuria gene is a previously unreported finding but unlikely to be related to the pathogenesis of phenylketonuria. Our results do not provide support for the "justification" hypothesis that the mental and neurological defects in phenylketonuria result from prenatal tyrosine deprivation which would be reflected in lower birthweights.

Treatment of burns casualties after fire at Bradford City football ground.

On 11 May 1985 the main stand of Bradford City Football Club caught fire. Within four minutes the stand was alight from end to end. Fifty three people were burnt to death and about 250 injured; 83 required admission to hospital, and 55 of these were treated by primary excision of their burns and skin grafting. In such disasters the help of staff from other hospitals and areas is essential. Patients should be assessed to see whether they have burns that will ultimately be fatal; if they have they should not be sent to regional burns units, where they would take up beds that could be used for patients with treatable burns. All districts should ensure that their plans for accidents in which burns injuries predominate are adequate.