Lithium therapy for affective disorders.

Lithium is effective in the treatment of bipolar disorder. Management of patients receiving prophylactic lithium therapy requires alertness to the development of neurologic, endocrine, cardiac and renal toxicity, as well as to dermatologic and gastrointestinal side effects. Lithium is involved in many drug interactions. Careful laboratory monitoring is essential, and treatment must be individualized.

Children of heroin addicts.

Fourteen Black male, opiate addicts, their wives, and their children were studied intensively using psychiatric interviews and psychological tests. Their 32 children were compared to 37 pediatric clinic children. The children raised in a home where father is an opiate addict function cognitively less well than their father, and the teenagers show earlier and stronger antisocial trends than pediatric clinic peers. On the other hand, there is a surprising absence of other psychopathology that one might expect, taking into consideration the deviant environment from which they come.

Who are the "committed"?

A record review of patients who were committed by the court during the course of a hospitalization at an acute urban facility was carried out. Court-committed patients represented 4% of total patients admitted during a 2-year period. Black patients and patients over the age of 70 were more likely to reach the stage of a court hearing and be committed. Schizophrenia was the most frequent diagnosis, being present in well over one half of court-committed patients. Approximately one third of the patients had a hospital stay exceeding 3 months, and transfer to a long term inpatient program occurred significantly more often among court-committed patients as compared to the rest of the hospitalized population. The majority of court-committed patients were eventually returned to the community; about one fifth were placed in intermediate facilities such as boarding or nursing homes. When legal status of previous and subsequent hospitalizations of this sample of court-committed patients was examined, a clear predominance of uncomplicated voluntary hospitalization became apparent.

Forensic psychiatry: female offenders.

The authors examined the records of 127 female and 1,068 male offenders referred by the courts to a forensic service over a 22-year-period. Female offenders were less likely than male offenders to be referred for psychiatric evaluations when they were charged with criminal behavior. They were more likely to be charged with homicide, arson, forgery, or fraud and more frequently received diagnoses of affective disorder and neurosis.

Notes on epidemiology of homicide in an urban area.

Over the past 30 years, there was a slow but steady increase of the homicide rate in the United States. The increase was faster in the urban areas. In St. Louis, Missouri, the rate had increased from 7/100 000 in 1943 to 33/100 000 in 1973. The development of meaningful preventive measures depends upon repeated epidemiologic investigations to determine the changes in patterns of crime to see if our approach to the problem is still adequate to meet the need. The police records of 214 homicide victims in the city of St. Louis during 1973 were examined. Mean age of the victims was 35 years. Eighty-five per cent of them were men and 81% were black. There are 2 distinctly different profiles of homicide victims, "younger" under 30 years old, and "older" 30 years old and over. "Young" victims had a mean age of 21 years. They were more likely to be black, killed after an argument over money or property, or while committing a crime, and killed by a gun. There were more black victims killed by other blacks and the murderer was usually older (mean age 26 years). These homicides were less frequently victim-precipitated, killed by a relative or friend, or while drinking. "Older" victims had a mean age of 49 years. Among them there were more whites, more victim-precipitated and more victims drank prior to their death, while the murderer was usually younger (mean age 35 years).

Psychiatric illness in homicide victims.

The authors studied the demographic characteristics and history of psychiatric treatment of 214 homicide victims and 67 suicide victims. Thirty-two (15%) of the homicide victims and 12 (18%) of the suicide victims had a record of psychiatric care; these rates were higher than the treatment rate of the general population. The authors suggest that there may be a connection between the occurrence of homicide and the increased frequency of psychiatric disorders among victims of this crime.

Forensic psychiatry: profiles of two types of sex offenders.

The authors examined records of 239 individuals charged with sexual offenses and referred by the courts to a forensic service. Defendants charged with rape were typically under 30 with histories of antisocial behavior that included other types of violence. Major mental illness was rare in this group. Child molesters in the sample were of no particular age, usually had no history of violent behavior, and had a low incidence of psychosis. The most common secondary diagnosis in both groups was alcohol or drug abuse.

Forensic psychiatry: diagnosis and criminal responsibility.

An examination of the primary and secondary diagnoses of 1195 defendants admitted to an urban forensic service was carried out. This indicated that personality disorders dominated the referral patterns from the court. Of those conditions which could produce thought disorders, schizophrenia dominated. An analysis of the prevalence of schizophrenia among defendants charged with homicide in St. Louis revealed a rate of schizophrenia similar to that found in the general population. Organic brain syndromes resulted in a large proportion of assaultive behavior, and these cases also involved a large number of secondary diagnoses. Alcohol and drug abuse were the most common secondary diagnoses. In general, no correlation between psychiatric diagnosis and types of criminal activity was found.

The use of problem-oriented medical records in community mental health centers.

The authors' questionnaire survey of 147 community mental health centers revealed that 36 (24%) were using problem-oriented medical records (POMR), 34 (23%) planned to use them, 23 (16%) were uncertain and 54 (37%) had no considered using them. According to the responses of centers that were using POMR and the authors' experience, the advantages of POMR in psychiatry are similar to their advantages in other specialties, and the difficulties in implementing this system are related to the definition of "problems."

Are children reliable reporters?

Fifty children, ranging in age from 6 to 16 years, and their mothers were interviewed using the same structured interview, which in its content follows the usual psychiatric examination of a child. Their answers were compared and it was found that there was an 80% average agreement on all questions. The agreement (between child and parent) was highest on questions relating to factual information (84%) and the agreement (between child's interviewer and parent) was lowest in the section dealing with mental status (69%). Girls were more reliable informants than boys.