Attitudes of psychiatrists toward elderly patients.

A group of 179 psychiatrists responded to a questionnaire requesting their opinions concerning four clinical vignettes. Analysis of their responses indicated that these psychiatrists, at a highly statistically significant level, regarded older patients as less ideal for their practices than younger patients with identical symptoms. The respondents viewed the older patients as having a poorer prognosis, and their treatment plans for them were less likely to emphasize psychotherapy. In general, there was a negative correlation between the age of the respondent psychiatrists and their estimate of the "idealness" of and favorable prognosis for older patients.

Severe aggression in rats induced by mescaline but not other hallucinogens.

Pairs of male Sprague-Dawley rats were administered mescaline, lysergic acid diethylamide (LSD), psilocin, N,N-dimethyltryptamine (DMT), 3,4-dimethoxyphenylethylamine (DMPEA), or 5-hydroxydopamine (5-OHDA) IP prior to being placed in a shock-elicited aggression situation. When foot shock was delivered, controls struck each other with their forepaws, but never engaged in either biting or injurious fighting. Mescaline-treated rats (50 or 250 mg) rarely struck each other, but engaged in nearly lethal biting. While LSD (25--400 micrograms/kg), psilocin (2.0 mg/kg), and DMT (5 mg/kg) produced some biting, this did not significantly differ from controls and never resulted in injuries. At higher doses, psilocin, DMT, and DMPEA decreased the amount and intensity of fighting. Rats treated with 5-OHDA (8--200 mg/kg) or LSD (25--400 micrograms/kg) did not differ from controls. These results suggest that mescaline's ability to induce pathological aggression in rats exposed to foot shock is not shared by other hallucinogens or nonhallucinogenic mescaline analogues.

Phobic symptoms in an elderly woman: a multidisciplinary case conference.

A 67-year-old woman, previously self-sufficient, became housebound by phobic symptoms. During the patient's hospitalization for treatment of these disabling symptoms, a multidisciplinary case conference served to identify the underlying psychodynamic issues, which were related to separation anxiety. Treatment included helping the patient understand her relationships with her daughter and her own mother, and behavior modification to reduce the secondary gains of her symptoms. After treatment, the patient successfully returned to self-care.

Drug-induced ataxia in opponents elicits "pathological" fighting in undrugged rats exposed to footshock.

One member of a pair of rats was administered either mescaline, lysergic acid diethylamide (LSD), pentobarbital, or ethanol intraperitoneally twenty minutes prior to exposure to footshock in the presence of an undrugged opponent. At high doses, all drugs elicited biting from the undrugged rat of sufficient intensity to produce injury to its drugged opponent. Low doses produced species-typical fighting behavior which consisted of striking each other with their forepaws while upright and failed to elicit biting. Biting attacks by the undrugged rat were highly correlated with ataxic behavior by the drugged rat. Conversely, species-typical aggressive behavior was highly correlated with behaviors such as boxing or upright threat posture. These results suggest that drug-induced ataxic behavior may disinhibit mechanisms that regulate intra-species behavior, thus producing behavior that is more typical of inter-species aggression.

Mescaline produces pathological aggression in rats regardless of age or strain.

Several measures of aggressive behavior were investigated in three ages (40-50, 90-110, and 180-200 days old) and in three strains (Sprague-Dawley, Wistar, and Long-Evans) of rats before and following the administration of mescaline hydrochloride in a shock-elicited aggression situation. The measures included the number of fights, duration of fighting, latency of fighting, number of bites inflicted, and a composite index of pathological aggression. During predrug baseline testing it was found that older rats, regardess of strain, engaged in more frequent fights that were longer in duration and more intense than younger animals. When the animals were tested with mescaline, they engaged in significantly more fights, biting, and pathological aggression than during baseline testing regardless of their age of strain. These results suggest that mescaline-induced pathological aggression in rats is a robust phenomenon.

The use of significant others to enhance the detection of malingerers from traumatically brain-injured patients.

Cognitive and neurobehavioral symptoms are common following traumatic brain injuries (TBIs). Because malingerers are likely to complain of such symptoms and perform poorly on neuropsychological tests, clinicians may have considerable difficulty distinguishing malingerers from TBI patients. In this study, we compared the subjective complaints of malingerers to TBI patients and then compared both groups to the problems observed by their respective significant others. We tested the assumption whether significant others could add one more piece to the challenging puzzle of diagnosing malingering. Our results demonstrated that the malingerers complained of more problems than patients who had sustained moderate or severe TBI. However, the significant others of the malingerers observed fewer cognitive, emotional-behavioral, and total problems than did the significant others of patients with severe, moderate, and even mild TBI. These findings suggest that the detection of malingering can be enhanced by interviews with significant others.

Limitations of neuropsychological testing to predict the cognitive and behavioral functioning of persons with brain injury in real-world settings.

While neuropsychological tests have been designed to identify cognitive impairments stemming from a brain insult and their severity, the vast majority of these tests were never designed to predict how these patients were likely to function in real-world settings, live independently, return to work, or maintain competitive employment. No one specific neuropsychological test or measure can accurately predict how an individual who has sustained a brain insult will function in everyday or vocational settings. Predictions based on neuropsychological test data tend to be more accurate if the particular tasks utilized during testing closely match or simulate the individual's everyday and vocational demands. Predicting an individual's vocational potential also requires a careful assessment of his or her work and medical history, injury characteristics, emotional and behavioral functioning, motivation to return to work, and family circumstances.

Hazards of blind analysis of neuropsychological test data in assessing cognitive disability: the role of confounding factors.

Neuropsychological testing has frequently been perceived by many health care and rehabilitation professionals as simply the administration and scoring of standardized neuropsychological tests followed by a comparison of the patient's scores to normative standards for the purposes of determining the patient's cognitive strengths and deficits, and whether or not the patient has sustained brain damage. Unfortunately, this simplistic model often results in inaccurate and misleading assessments of the patient's cognitive and behavioral functioning, erroneous diagnoses, and improper treatment. The issue of whether or not a patient has actually sustained a traumatic brain injury, or what specific cognitive and behavioral functions are impaired and to what degree, particularly in reference to a specific accident or event, cannot be determined solely by examining the patient's test data. Such data are frequently confounded by numerous factors which necessitate that the neuropsychologist proceed with caution and avoid arriving at any diagnostic impressions without a full appreciation of the impact of these factors, which may contribute significantly to the patient's neuropsychological test performance. This paper examines numerous potential confounds to test performance and discusses how the neuropsychologist can utilize a vector analysis approach to address the issue of the ecological validity of the neuropsychological test data.

Can psychologists recognize neurological disorders in their patients?

A variety of insidious neurological disorders may present initially as psychological difficulties. In an effort to determine whether psychologists could recognize these disorders in their patients and refer them to a neurologist or nonneurological physician, a questionnaire containing four clinical vignettes was sent to a total of 566 members of the Los Angeles Psychological Association. Each vignette contained a salient description of an underlying neurological disorder with a psychological presentation. No explicit indication was made that the psychological problem represented an underlying neurological disorder. Each psychologist was instructed to read each vignette carefully and to decide what to recommend for each patient. Analysis of the data revealed that nearly one-third of the psychologists failed to recognize the underlying neurological disorder.

Mild traumatic brain injury does not produce post-traumatic stress disorder.

It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.

Recovery of function following severe traumatic brain injury: a retrospective 10-year follow-up.

It has been widely assumed that most of the recovery following severe traumatic brain injury (TBI) occurs within the first 6 months, and that virtually all of the recovery occurs within the first 1-2 years post-injury. In an effort to evaluate the long-term recovery of patients who had sustained severe TBI, we interviewed the relatives and significant others of 20 patients who had sustained TBI at least 5 years earlier, using a modified version of the Portland Adaptability Inventory. Retrospective ratings were collected to evaluate the patients' psychosocial, cognitive, physical, and emotional status prior to their injury, and at 1, 2, 5, and an average of 10.3 years post-injury. The results indicated that TBI patients exhibit significant improvements in their social, cognitive, physical, and emotional functioning after 2 years post-injury regardless of the severity of their initial brain trauma. These data suggest that patients who sustain severe TBI continue to make gradual improvements in their functioning for at least 10 years post-injury. Our findings contradict the widely held assumption that the recovery process ends after 1 or 2 years post-injury.

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.