In an attempt to evaluate retrospectively the three‐year course and outcome of treated adolescent schizophrenics, the medical data of 19 patients were collected from the first admissions over a period of 10 years (1971‐1981). According to the DSM‐III criteria, 17 were diagnosed as having schizophrenic disorders and the remaining 2 were schizophreniform disorders. The outcome at the time of first‐ to third‐year follow‐up was assessed on the outcome rating scale. The three‐year outcome was favorable with respect to both the length of hospitalization and the presence of psychotic symptoms. However, there was a sustained impairment in occupational (or scholastic) functioning throughout the three‐year follow‐up period. The female sex and the initial diagnosis of schizophreniform disorder might be factors affecting the good third‐year clinical (or symptomatic) outcome. The younger age at onset, the longer duration of the prodromal phase, and the longer period of time between the onset and the first presentation appeared to predict the poor third‐year occupational outcome.
A lithium and carbamazepine combination was reported in five patients with bipolar disorder (DSM-111), who had not received benefits from conventional treatments. Patients 1, 2 and 4 showed favorable antimanic responses to carbamazepine used in combination with lithium carbonate. Patient 3 did not respond well to either lithium or carbamazepine alone, but improved dramatically on the simultaneous administration of the two drugs. The prophylactic benefit was observed in two patients. These clinical results suggest that a lithium and carbamazepine combination may be more efficacious in the treatment of acute manic episode and the prevention of affective recurrences than each drug alone.
This is a report on the clinical experience in consultation‐liaison psychiatric service for patients with end‐stage renal disease undergoing renal transplantation. Among a total of 30 patients (23 men and 7 women) 13 (43%) developed psychiatric disturbances: depressive state, 8; anxious‐irritable state, 5; and delirious state, 1 (One patient had both depressive and delirious states). Five patients got depressed following the episodes of a rejection reaction. Three of them had a graftectomy which exacerbated their depressions. The occurrence of rejection reaction was thought to be a major precipitating factor. Four patients became anxious‐irritable within a week following transplantation. Patient's intolerance to stressors seemed more responsible for the anxious‐irritable state than stressors per se. Steroid medications were thought to be a predisposing, not a causal, factor to psychiatric disturbances in transplant patients. In the 21 patients who were assessed preoperatively and who had no rejection reactions, the Basic Rorschach Score of less than – 20 was a predictor of posrtransplant psychiatric disturbances. Psychiatric interventions were done for the 13 mentally ill patients in collaboration with the surgeons in charge and ward nurses. For the patients with the anxious‐irritable state, listening, reassurance, and anxiolytics (sometimes with additional antipsychotics) were effective. For those who had a depressive state and who became uncooperative, “conjoint” sessions with the patients and their family members (e.g. spouses) were of therapeutic use.
This is a report on six psychiatric patients who indulged in excessive ingestion of water and subsequently developed tonic‐clonic seizures in the course of the underlying mental disorders. On the basis of the DSM‐III criteria, they were diagnosed as follows: schizophrenic disorder, 4; schizoaffective disorder, 1; borderline personality disorder, 1. The levels of serum electrolytes were estimated during five episodes of seizures in three patients. Hyponatremia was a consistent finding (serum sodium: mean = 120.6 mEq/liter). Plasma osmolality and plasma levels of arginine vasopressin (AVP) were determined during two episodes in two patients. The inappropriately high circulating levels of AVP relative to plasma hypoosmolality were documented. However, the response to the overnight fluid deprivation and acute water load during the period of no seizures in two patients revealed no evidence of the persistent SIADH, suggesting the temporal association of hyponatremic encephalopathy with inappropriate AVP secretion. It is not conclusive whether the transient SIADH is the cause or the consequence of hyponatremic encephalopathy, although a delusion or an auditory hallucination could play a critical role in drinking water excessively in three patients.
The suppression of protein adsorption must be required for a surface of biomaterials to avoid undesirable biological reactions. Understanding the interactions between proteins and surfaces is necessary to construct new biomaterials that have ultimate nonbiofouling property. Protein adsorption causes in an aqueous medium, therefore, we focused on the hydration state at the interface of the aqueous medium with proteins and the contacting materials, and investigated the effects of hydration state on protein adsorption behavior towards the surface. We could successfully establish the method for evaluation of dynamics of water molecules in the vicinity of the surface by using proton nuclear magnetic resonance spectroscopy for the hydrated polymer brush layermodified micro-silica beads. The zwitterionic and cationic polymer brush surfaces were used for the measurement. The results clearly indicated that the dynamics of water molecules determined protein adsorption onto the surfaces. Thus, the polymer brush surfaces with hydration layer and high-diffusion of water molecules in the layer, such as phosphorylcholine group-bearing polymer brush surface, were effective to inhibit protein adsorption.
The present paper describes cognitive approaches to the treatment of a major depressive episode in a patient with residual schizophrenia. The goal of therapy was to increase and stabilize the patient's physical activity through decreasing dysfunctional cognition pertinent to inertia. A therapeutic strategy of 'scheduling activities' was first selected, but to no effect. The vicious circle of alternating excessive activity and total inertia remained unchanged. Based on a revised cognitive case conceptualization, a second strategy, 'scheduling inertia', was then introduced, in which the patient was asked to stay in bed or take a rest for planned periods of time every day. This intervention helped the patient to counteract her perfectionist beliefs. The results suggest that 'scheduling inertia' may be a useful strategy for improving inactivity in a major depressive episode during the residual phase of schizophrenia.
Cognitive behavioral therapy (CBT) is one of the recommended therapeutic approaches for anorexia nervosa (AN). CBT for AN often needs to be designed for individual cases, 1 and previously we have developed a behavioral therapy program combined with liquid nutrition for AN: Kyoto Prefectural University of Medicine Behavior Therapy (KPT).2 Here, we describe a newly designed video-assisted CBT for a patient with AN refractory to KPT.The patient was a 16-year-old girl who had been diagnosed with restricting-type AN at age 14, based on DSM-IV criteria, and was refractory to KPT. To acquire credits for graduation, she attended school during the day and returned to hospital at night. The patient repeatedly stated that she could not communicate with her classmates easily because she was too fat. Psychological interventions were started to address this belief, in addition to KPT. However, she continued to maintain her belief. We focused on her maladaptive eating behavior related to AN, rather than on her distorted cognition. At meals, she took too much time to eat and tended to mash her food into paste using chopsticks and a spoon. The therapist suggested to her that this abnormal eating behavior might be strange to those around her, and that it tended to complicate her communication with others. The patient resisted the verbal advice regarding her maladaptive eating behavior.We then tried a video-assisted visual tool to bring awareness of her abnormal eating behavior. We proposed following a structured CBT and the patient accepted this treatment. Once a week, we filmed her eating dinner at hospital, and on another day the patient and her therapist watched the video together and talked about her approach to eating. In the first three sessions, the patient responded, 'My way of eating is normal.' However, at the fourth session, she laughed at a scene in which she spilled mashed food onto herself from her mouth, and said to the therapist that she always crushed sandwiches into small parts. She then asked, 'Do my friends find me strange in any way?' and the therapist replied, 'I think so'. In that session, the patient agreed to the challenge to eat food in normally sized pieces and to spend less time at meals. By the seventh session, she commented, 'My way of eating might have caused a curious impression and alienated my classmates from me; since I have now changed my eating habits, I can start to talk to my classmates in a more friendly way.' The patient gradually developed a more normal eating manner and her bodyweight increased. After 10 sessions over 6 months she had completed her inpatient treatment.In the present case we kept records of abnormal eating behavior using a video-assisted visual tool. Being asked to watch a scene of herself eating a meal contributed to objective reorganization of the abnormality of the patient's eating behavior and acceptance of her illness. Because patients with AN often show cognitive impairment and disturbed self-awareness in association with low bodyweight, a video-assisted approach mi...
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