Birth patterns in mentally retarded autistic patients.

Some studies claim to have shown that, compared to the general population, autistic children are born more often in the spring. The current study sought to replicate this finding in a large Dutch sample of mentally retarded autistic patients. Birth data for 1,031 patients with a diagnosis of "Infantile Autism" or "other psychoses with origin specific to childhood" were compared to those of the Dutch national population. Separate analyses were performed on diagnostic subgroups (i.e., infantile autism vs. other psychoses with origin specific to childhood), gender, and intelligence. No evidence was found to suggest that autism is characterized by a deviant birth pattern.

A tentative model of aggression on inpatient psychiatric wards.

Violence in psychiatric hospitals threatens the safety and well-being of patients and staff members. The determinants and correlates of inpatient aggression are not well understood. The authors present an explanatory model of aggressive behavior that attempts to integrate patient, staff, and ward variables. In the proposed model, the patient's psychopathology and distorted cognitions are exacerbated by environmental and communication stressors found on psychiatric wards. The model emphasizes that repeated inpatient aggression may be the result of a vicious circle, whereby a patient's violent behavior is often followed by an increase in stress on the patient caused by environmental or communication factors, heightening the risk of another outburst of violence.

Prevention of aggressive incidents on a closed psychiatric ward.

OBJECTIVE: This study examined whether staff members' use of interventions for preventing patients' aggression reduced the number of incidents of aggression on a closed acute admissions ward of a psychiatric hospital in the Netherlands. METHODS: The number and severity of incidents of aggression on three closed wards were measured using the Dutch version of the Staff Observation Aggression Scale (SOAS). Measurements were made for three months before and after staff implemented interventions for preventing aggression on one of the wards. Interventions included a protocol for talking to patients who exhibited aggressive behavior, discussing treatment goals with the patient shortly after admission, explaining why the ward's door was locked and the exit rules, providing a schedule of staff meetings to explain staff members' absence from the ward, and clarifying the procedure for making an appointment with the psychiatrists. RESULTS: The frequency of aggressive incidents was reduced on all three wards, with no significant difference between the ward where the interventions were implemented and the two control wards. A marginally significant difference in the severity of aggressive incidents was found between experimental and control wards after the introduction of the preventive measures, with incidents in the experimental ward tending to be less severe. CONCLUSIONS: This study failed to find a robust effect of specific intervention measures on aggressive incidents. However, it did find evidence suggesting that standardized reporting by staff of aggressive incidents on closed psychiatric wards may in itself result in straightforward reduction of violent incidents.

Self-mutilating behaviour of psychiatric inpatients.

In the present study two broad hypotheses about the origins of self-mutilation in psychiatric patients were evaluated. The first hypothesis states that self-mutilation originates from child abuse and experiences of neglect and is connected to dissociation in later life. The second hypothesis views self-mutilation as the consequence of impulse control problems. To test these two hypotheses, data concerning traumatic childhood experiences and dissociative symptoms (hypothesis 1), as well as data concerning aggressiveness, obsessive-compulsiveness and sensation seeking (hypothesis 2) were collected in a sample of 54 psychiatric inpatients. Twenty-four out of 54 patients (44%) reported having engaged in self-mutilation. Mean age of onset of this behaviour was 23 years. Self-report measures of self-mutilators were more in line with the first than with the second hypothesis. That is, patients who engaged in self-mutilation reported more traumatic childhood experiences and dissociative symptoms than did control patients. The two groups did not differ in terms of aggressiveness, obsessive-compulsiveness, and sensation seeking. In line with earlier studies, the current results indicate that self-mutilating behaviour is linked to a history of abuse and neglect.

[Gender identity disorders as a symptom of psychosis, schizophrenia in particular]. / Genderidentiteitsstoornissen als bijverschijnsel van psychose, in het bijzonder schizofrenie.

In the Netherlands it has recently become possible for transsexual patients to receive hormonal treatment from the onset of puberty. Until the age of 16, pubertal development can be prevented with luteinizing hormone-releasing hormone (LHRH) agonists. From 16 years of age onwards, gender adjustment can be initiated by administration of hormones of the opposite sex. Surgical treatment can be offered once the patient reaches 18 years of age. Although such treatment will only be initiated with reticence and after a long phase of intense diagnostic screening, the question arises whether a clear differentiation can be made between pure gender identity disorders and secondary transsexual feelings that are part of an ongoing psychopathological development, such as schizophrenia. The potential diagnostic confusion is illustrated by a case history of a male schizophrenic patient. This patient had been treated hormonally for transsexualism for years before acute psychotic decompensation occurred. Neuroleptic treatment of the psychosis rapidly reduced the psychotic symptoms. In retrospect, the patient regards his transsexual period as a 'mistake'. Delusions about one's physical appearance and the urge to drastically change the way one looks appear to be relatively common in patients suffering from schizophrenia.

Skin conductance and schizophrenic symptomatology.

Skin conductance is a psychophysiological parameter that reflects fundamental processes such as attention and arousal. The present study explored whether deviations in skin conductance activity are associated with severity of schizophrenic symptoms. For this purpose, Skin Conductance Responses (SCRs) to discrete stimuli (80 dB noises) and Skin Conductance Levels (SCLs) of 37 schizophrenic patients and 31 healthy volunteers were recorded. In accordance with previous studies, schizophrenic patients were found to be hyporesponsive compared to healthy controls. More specifically, almost half of the patients (46%) did not react with any SCR to the first 3 stimuli, whereas only 10% of the control group exhibited such a non-responding. Accordingly, the mean amplitude of the first 3 SCRs - as measured in u Siemens - was found to be significantly lower in patients compared to controls. As well, mean SCL was found to be (marginally) elevated in the patient group. This was especially the case for patients who did exhibit SCRs. In the patient group, a negative correlation was found between amplitude of SCRs and symptom severity. This association was mainly carried by a significant correlation between positive symptoms and reduced SCRs. The clinical relevance of these findings is discussed in detail.

Do retrospective and prospective quality of life assessments differ for pancreas-kidney transplant recipients?

The literature indicates that chronically ill patients have a remarkable capacity to adapt to their illness. For example, they will generally report a better quality of life (QoL) than individuals in the general population who are asked to imagine themselves as chronically ill and to rate their QoL. The present study further explores this phenomenon in type I diabetic transplant recipients with end-stage renal disease. In a prospective, longitudinal study, we assessed the QoL in 22 patients, both before and after they received a combined pancreas-kidney transplant. After transplantation, the patients were also asked to assess their pretransplant QoL by rating it on a 10-point scale. What we found was that prior to transplantation, QoL was prospectively given a mean rating of 5.23; this score increased to 7 after a successful transplant procedure. During follow-up assessments 5, 12, and 18 months after successful transplantation, patients retrospectively scored their pretransplant QoL as 3.27, 3.14, and 3.05, respectively. We conclude that when type I diabetic patients with end-stage renal disease undergo a transplant procedure to improve their health status, they re-evaluate their pretransplant QoL, and this retrospective assessment is significantly lower than their prospective one when transplantation is successful.