Early parental loss and development of adult psychopathology.

We assessed the effect of parental loss during childhood on the development of psychopathology in 90 adults. The subjects with a history of adult psychopathology (PATH group), in comparison with subjects with no history of a psychiatric disorder (NO PATH group), had poorer quality of childhood home life and personal adaptation subsequent to parental loss as assessed by the Home Life and Personal Adaptation (HAPA) scale developed by us. Total HAPA scale scores were the single most powerful predictor of adult psychopathology, accounting for correct prediction of adult psychopathology in 80% (72/90) of the subjects. The PATH subjects had significantly increased plasma levels of cortisol and beta-endorphin immunoreactivity. Moreover, cortisol and adrenocorticotropic hormone levels significantly correlated with total HAPA scores. First-degree family history of psychiatric disorders, age at loss, and parental vs maternal loss were not significantly different between PATH and NO PATH subjects. We conclude that the quality of home life subsequent to early parental loss is critically related to the development of adult psychopathology. The hypothesis that early trauma results in enduring neuroendocrine alterations in hypothalamic-pituitary-adrenal axis function is examined.

Long-term outpatient treatment of senile dementia with oral physostigmine.

The authors describe five patients with senile dementia of the Alzheimer type (SDAT) who were treated with oral physostigmine from 1 to 3 3/4 years. An abbreviated form of the Buschke selective reminding test was used to assess the patients' short-term verbal memory at periodic clinic visits. Although one of the patients deteriorated progressively from the start of the physostigmine therapy and was taken off the drug after 1 year, there was no evidence of deterioration in memory performance on the average in the other four patients. Equally important, this open trial provides evidence of the safety of long-term treatment with physostigmine on an outpatient basis. The authors view their results as supporting the potential value of cholinesterase inhibition as a means of forestalling memory decline in SDAT patients.

Efficacy of oral physostigmine in primary degenerative dementia. A double-blind study of response to different dose level.

To examine the efficacy of cholinergic enhancement in senile dementia of the Alzheimer type (SDAT), oral physostigmine was given to eight patients in a cross-over trial of three dose levels and a matching placebo. A dose-related improvement in memory as measured by objective verbal memory tests was observed. Performance was significantly better on the highest dose, 2 mg every 2 h, than on the lower doses. The effect was most systematically present for very short-term memory, which raises the question of whether the improvement may involve attention rather than longer term storage and retrieval.

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit.

Factor analysis of symptom ratings recorded on the Brief Psychiatric Rating Scale (BPRS) for a sample of 87 geropsychiatry inpatients resulted in five relatively independent factors. The factor structure differed in two important respects from that previously observed in numerous analyses of BPRS ratings of patients from the general adult psychiatric population. The symptom of depressive mood combined with emotional withdrawal and motor retardation to define a withdrawn depression factor, whereas depressive mood has routinely evidenced greater affinity for anxiety and tension in younger adults. In addition, the unitary thinking disturbance factor that has been observed routinely in data from the younger adult psychiatric population split into separate factors of cognitive dysfunction and psychotic distortion. Construct validity of the cognitive dysfunction factor was examined with reference to an objective mental status questionnaire.

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: II. Representative profile patterns.

Cluster analysis methods were used to classify Brief Psychiatric Rating Scale profiles for a sample of 88 geropsychiatric patients. Five distinct profile patterns were found to represent adequately most differences in symptom and behavior characteristics of the aged patients. The five phenomenological types are described as agitated dementia, retarded dementia, anxious depression, withdrawn depression, and paranoid psychosis. The appropriateness of this nomenclature is examined with reference to clinical diagnosis, mental status examination, and drug treatment. Prototype profile patterns that can be used to classify future geropsychiatric patients are presented, and a sequence of clinical decisions that should result in similar partitioning of the patient population is discussed.

Drug therapy in the elderly: effects on mental status.

Persons over age 65 receive 25 to 30 percent of all drug prescriptions. Since the elderly often require numerous medications for multiple medical problems, the opportunity for deleterious drug interactions is increased. Overmedication, coupled with the older patient's susceptibility to drug toxicity, increases the risk of poor compliance and behavioral disturbances.