Psychiatric emergency rates during the Christmas season in the years 1991 to 1997.

We compared the number of psychiatric admissions from the emergency room during the Christmas season, defined as the rate for the month of December, with those in other months. The psychiatric emergency rates were recorded for each month over six consecutive years, 1991 to 1997. The average number of emergency patients in none of the 12 months differed significantly from any of the remaining months (ANOVA, p > .05). Our data and those of other authors do not support the clinical lore that Christmas season is associated with higher rate of psychiatric emergencies.

Are some motives more linked to suicide proneness than others?

This research examines the importance of assessing motivations that crisis patients attribute for considering a suicide attempt. For 251 consecutive patients attending a crisis unit, suicide attempters and ideators indicated agreement with each of 14 reasons for attempting suicide. Principal components analysis of these agreement ratings yielded two factor scales of motives: Extrapunitive/Manipulative Reasons and Internal Perturbations. Scores for internal perturbations correlated significantly with patients' wishes to die, clinicians' ratings of patients' suicidal desire and preparation for suicide, and clinicians' overall evaluation of patients' suicidal risk. Associations between internal perturbations and these suicide measures were nonredundant with hopelessness. It is concluded that evaluating a suicidal person's internal reasons for attempting suicide has unique assessment value.

Neuroleptic malignant syndrome. Recognition, prevention and management.

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia characterised by mental status changes, muscle rigidity, hyperthermia and autonomic dysfunction. Increased awareness and early recognition will lead to prompt management. The diagnosis of NMS presents a challenge because several medical conditions generate similar symptoms. The presentation and course of NMS can be quite variable ranging from a stormy and potentially fatal course to a relatively benign and self-limiting course. The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of suspected cases and prompt discontinuation of the offending agent. All patients with psychosis should be monitored daily for dehydration and elevated temperature, have vital signs checked and agitation should be watched for. Antipsychotics should be used conservatively with gradual titration of doses. The management of NMS should be based on a hierarchy of symptom severity. Following an episode of NMS, the patient should be reassessed for further treatment with antipsychotics and rechallenge should not be attempted at least 2 weeks following resolution of symptoms of NMS. The patient and family should be educated about the episode and consent for further medication use obtained after a clear explanation of the risk-benefit analysis.

Key features of maltreatment of the infirm elderly in home settings.

OBJECTIVE: To identify contributory factors of elder abuse by caregivers in home settings. METHOD: Using a reliable instrument, visiting nurses rated observations symptomatic of abuse and neglect found in their current caseload of elderly patients. Their observations were also classified as related or unrelated to wilfull maltreatment. RESULTS: Regression analysis produced the following significant findings: 1. signs of poor physical care were found to be predictors of physical abuse; 2. signs of psychosocial distress and exploitation were identified as predictors of emotional abuse; 3. defensiveness and irritability shown by caregivers and strained family relationships, in general, were also associated with abuse. CONCLUSION: It appears that emotional abuse is more prevalent than, and not a necessary precursor of, physical abuse; however, reliable signs of impending or actual abuse of the elderly can be found in a home during visitation.

Influence of object size on prehension in leukotomized and unleukotomized individuals with schizophrenia.

The aim of this study was to investigate the influence of schizophrenia and frontal leukotomy on the control and perceptual-motor coordination of reaching and grasping movements. Reaches to various-sized drinking glasses were videotaped for unleukotomized and leukotomized adults with schizophrenia, and for healthy age-matched controls. Kinematic analyses showed that while the two patient groups moved more slowly than the controls, the proportion of overall movement time spent accelerating to reach peak velocity and the proportion of overall movement time spent decelerating before contact with the glasses was similar for all three groups. For grasp formation, the two patient groups, which did not differ, opened their hands wider than did the controls; however, all three groups opened their hands to the appropriate size in response to the various glass sizes. The frontal lesions of the leukotomized patients were not related to motor control deficits when compared to the control schizophrenic patients. As well, the perceptual abilities of the patients were adequate as evidenced by their ability to scale their grasp to glass size.

Management of suspected neuroleptic malignant syndrome.

OBJECTIVE: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia. The objective of this paper is to provide data regarding early and suspected cases as well as offer guidelines for managing this condition. Knowledge of suspected cases will lead to early recognition and prompt management of this condition in the future. METHOD: To address the gap in knowledge, we present 2 case reports of patients with early NMS-like symptoms. The case reports are followed by a brief review of the literature on differential diagnoses, risk factors, early signs and treatment data. CONCLUSIONS: The most rational approach to treating NMS entails a hierarchy of interventions determined by the severity and progression of symptoms.

Manual performance in leukotomized and unleukotomized individuals with schizophrenia.

Seven leukotomized adults with schizophrenia (LS), eight unleukotomized adults with schizophrenia (ULS), and eight healthy control (C) individuals were required to reach toward and grasp a small object that was either stationary or moving. Reflective markers were placed on the subject's index finger, thumb and wrist, and movements were videotaped. As expected the LS and ULS groups moved slower than the C group when the target was stationary. However, when the target was moving, all three groups moved faster, with the LS and C groups having the same movement times, and the ULS group having the fastest movement time. When the timing of the reaching trajectory was assessed, the LS group spent less time decelerating and closing their hands around the object, indicating their movements were controlled with less precision. When grasp formation was analyzed, for the stationary condition, the maximum apertures of the LS and ULS groups were not different, and both were larger than those of the C group. For the moving target condition, aperture increased for all groups but was smallest for the C group, intermediate for the LS group and largest for the S group. There was actually less within subject variability in peak aperture and maximum aperture closing speed for the LS and ULS groups in comparison to the C group, perhaps indicating a limited repertoire of potential motor responses for the patient groups. These results suggest that individuals with schizophrenia are able to use redundant information as well as controls, and that leukotomized individuals with schizophrenia have greater motor control deficits than unleukotomized schizophrenics.

Effects of schizophrenia and prefrontal leukotomy on movement preparation and generation.

The purpose of this study was to investigate the ability of leukotomized and unleukotomized schizophrenic patients to use advance information in the process of movement preparation. Subjects participated in an aiming task in which movements could be defined on the basis of hand used to perform the task, and distance travelled to the target. Subjects were provided with full, partial, or no prior information about the upcoming movement by either precueing hand, distance, both hand and distance, or by providing no precue. The leukotomized and unleukotomized schizophrenic patients were able to use this advance information to facilitate the speed of their responses in much the same way as did subjects in a normal control group. These results are discussed in terms of models of movement preparation, and the role of the frontal lobes in schizophrenia and movement planning.

Progression of symptoms in neuroleptic malignant syndrome.

The neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disorder characterized by mental-status changes, muscle rigidity, hyperthermia, and autonomic dysfunction. Systematic examination of early signs and the progression of symptoms in NMS may be worthwhile to facilitate prompt recognition and interventions to abort the syndrome in its incipient stage. The authors present the results of a preliminary review of the temporal sequence of the four predominant signs of NMS as described in 340 clinical reports of NMS in the literature. Of all order implications, 70.5% were consistent with the sequence of mental-status changes, rigidity, hyperthermia, and autonomic dysfunction. Changes in either mental status or rigidity were the initial manifestations of NMS in 82.3% of cases with a single presenting sign and were significantly more likely to be observed before hyperthermia and autonomic dysfunction. Methodological limitations of these data and clinical implications are discussed.

A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships.

Fifteen patients with DSM-III diagnoses of borderline personality disorder and 14 schizophrenics were administered two questionnaires by an interviewer blind to the diagnoses. The questionnaires were the Childhood Life Events and Family Characteristics Questionnaire and the Parental Bonding Instrument. A scale to monitor denial was also included. Borderlines, when compared with schizophrenics, reported having significantly more childhood sexual and physical abuse, more early separation from their mothers, more paternal criminality, and also more paternal overprotection and less maternal care. When compared with normal population data, they received significantly less care and were significantly more overprotected by both parents.

Unemployment and the nature of suicide attempts.

The purpose of the study was to compare the perceptions of twenty unemployed and thirty employed British patients recovering from an attempted suicide as regards motives for self poisoning, intent to die, presence of warning, past history of attempts, history of psychiatric treatments, and types of problems reported as antecedents to the suicide attempt. Their key relatives/friends were also interviewed concerning their views of the emergency. Analysis of the responses failed to show significant differences between the employed and unemployed. The implications of these findings as regards further research is discussed.

Incipient neuroleptic malignant syndrome?

Recognising confusion as an antecedent to NMS may help abort the full-blown syndrome. Two such cases are reported, along with a third.

Some factors relating to satisfactory post-discharge community maintenance of chronic psychotic patients.

The length of time a group of 70 psychiatric patients could be maintained in the community following discharge from a provincial hospital was found to be significantly related to post-discharge compliance with medication and to the level of discharge planning (well planned versus unplanned, or patient prematurely self-discharged against medical advice). Various demographic and clinical variables were unrelated to the length of post-discharge survival in the community.