Clinical symptom presentation in suspected malingerers: an empirical investigation.

To empirically investigate the usefulness and validity of clinical presentation and recent history variables in the detection of malingered psychiatric disorder, 30 criminal defendants involved in forensic evaluations, who had a documented history of psychiatric hospitalization preceding their arrest on the instant offense (low risk of malingering group) and 30 defendants who complained of psychiatric difficulties but had no history of psychiatric hospitalization or treatment (suspected malingering group) were studied. Each subject's mental status was rated, blind to psychiatric history, diagnosis, and psycholegal opinions, on a Likert-like scale for the uncommon nature of their symptom presentation. In addition, the final outcome of the court cases, whether they were found competent to stand trial, not guilty by reason of insanity, or evidenced diminished capacity was determined by obtaining the court disposition in each case. Based on the unusual nature of their presentation, the defendants suspected of malingering were discriminated from the low risk of malingering defendants with a 90 percent rate of correct classification. Suspected malingerers were found to evidence current psychiatric presentations inconsistent with their recent Global Assessment of Functioning, unusual symptom presentation, and hallucinatory experiences rated as atypical for psychiatric disorder. A high proportion of suspected malingerers were found competent to proceed. The results are discussed in terms of the usefulness of clinical identification of malingering.

Tardive dystonia in a psychiatric hospital.

Tardive dystonia is a relatively uncommon long term complication of neuroleptic therapy. The prevalence of this syndrome is unknown. This study, of chronic hospitalised psychiatric patients, revealed a tardive dystonia prevalence of 1.5%. Risk factors in this small population appeared to be mental retardation and convulsive therapy.

The influence of early malnutrition on subsequent behavioral development. IV. Soft neurologic signs.

Soft neurologic signs were evaluated in 101 Barbadian school children, ages 4-11 years, who were malnourished in the first year of life, and 101 comparison children matched for age, sex, and handedness, but who had no history of malnutrition. Previously malnourished children performed significantly slower than comparison children on several timed motor tasks when using the nondominant hand only. Boys were found to perform significantly slower than girls, and younger (4-7 years of age) children performed slower than older (8-11 years of age) children. A model is presented that displays interrelationships among previous malnutrition, soft neurologic signs, classroom behavior, intelligence, and physical growth. In summary, slow motor performance was associated with lower verbal and performance IQ and the presence of attention deficit disorder, as assessed by the child's teacher. The time to perform the motor tests was unrelated to measures of physical growth.

Serum neuroleptic concentrations and clinical response: a radioreceptor assay investigation of acutely psychotic patients.

Twenty-two acutely psychotic patients were rigorously assessed for psychopathology at baseline and after 14 days of neuroleptic treatment. The neuroleptic radioreceptor assay (NRRA) was used to determine serum neuroleptic concentrations. Serum neuroleptic concentration was significantly, nonlinearly related to changes in BPRS Total Score, and BPRS Factor Scores for Thought Disturbance and Anxiety-Depression. Clinical improvement was associated with intermediate (11-50, 51-126 ng/ml haloperidol equivalents) while poor clinical outcome was related to both low (less than or equal to 10 ng/ml) or high (greater than 125 ng/ml) serum levels. The results are discussed in terms of a possible "therapeutic window" for the neuroleptics and the implications this might have for clinical practice.

Tripelennamine: enhancement of brain-stimulation reward.

Thresholds for reinforcing electrical stimulation to the medial forebrain bundle were determined in rats by means of a rate-free psychophysical method. The acute administration of tripelennamine lowered the threshold for rewarding brain stimulation in a dose-dependent manner. These results suggest that the abuse liability of tripelennamine may be related to its ability to sensitize the central neural pathway that mediates reward.

The effects of levonantradol on rewarding brain stimulation thresholds in the rat.

Rats were implanted bilaterally with electrodes aimed at the medial forebrain bundle (MFB) and trained to deliver intracranial stimulation. Reward thresholds were determined using a modification of the psychophysical method of limits. Levonantradol, a cannabinoid with reported analgesic activity, was tested at doses between 0.0125 to 0.3 mg/kg. Significant elevations of reward thresholds were observed at 0.2 and 0.3 mg/kg. Since none of the doses tested lowered the reward threshold, an effect believed to be predictive of abuse, these results suggest that levonantradol has little or no abuse liability.

Symptomatic treatment of tardive dyskinesia: a word of caution.

The search for a treatment of tardive dyskinesia (TD) has focused largely on cholinergic and GABAergic agents that are believed to attenuate striatal imbalances and bring about symptomatic control of dyskinetic movements. While numerous reports of the partial effectiveness of acute treatment with cholinergic or GABAergic agents have appeared, the effects of chronic administration of these substance are unclear. Results of chronic administration of cholinergic or GABAergic agents to animals are presented, and it is argued that these substances have the potential of eventually worsening TD. Alternative approaches aimed at modifying the theorized pathophysiology of TD, as opposed to symptom control methods, are presented.

Tardive dyskinesia and hospital discharge.

Two hundred ninety-three schizophrenic inpatients were rated for dyskinetic movements on the Abnormal Involuntary Movement Scale (AIMS). Two years later, discharge status on 265 of these patients was related to the AIMS ratings. Results indicated that the discharge group had significantly lower AIMS ratings than the nondischarged group. The effect was not an artifact of age but was evident across nearly all age groups. The groups were also different on length of current hospitalization, age at time of first psychiatric hospitalization, and time since first psychiatric hospitalization. Possible reasons for the results are discussed, including the development of functional deficits, stigmatization, and tardive psychosis, as well as the possible association between tardive dyskinesia, discharge, and treatment refractoriness.

A systematic investigation of tardive dyskinesia in inpatients.

Although many scales to measure tardive dyskinesia have been developed, none has been widely accepted. The authors used the Abnormal Involuntary Movement Scale (AIMS) to evaluate a group of 293 inpatients who had been given a primary or secondary diagnosis of schizophrenia. They found a tardive dyskinesia prevalence of 30% using a criterion rating of 3 (moderate symptoms) or more on the AIMS. The prevalence figure declined as the criterion became more severe. They also found that women had a much higher prevalence of the disorder only when more severe symptoms were used as the criterion. They conclude that the AIMS is a reliable instrument for assessing tardive dyskinesia.

An assessment of tardive dyskinesia in schizophrenic outpatients.

An examination of tardive dyskinesia in 213 schizophrenic outpatients using the Abnormal Involuntary Movement Scale (AIMS) indicates that increasing age is significantly associated with the presence of this disorder while sex is not. Both sexes showed significant linear increases with increasing age. Although males did not evidence the statistically significant curvilinear trend previously reported in an inpatient study using the same methodology, they displayed an attenuated effect at the older age levels. A comparison of prevalence values between the outpatient sample and the inpatient sample previously studied indicated no greater prevalence in the outpatients. However, an examination of differences in AIMS total scores between these samples suggested the presence of many more marginal and mild movements in the outpatients. Reasons for the differences between the inpatient and outpatient studies are discussed.

Age bias, referral for psychological assistance and the private physician.

The responses of 60 physicians to a questionnaire comprised of a brief section for demographic information and eight vignettes describing patients with obvious psychiatric symptoms were analyzed. On alternate forms of the questionnaire, the age of the patient was reversed for each vignette. Old patients were referred for psychological assistance significantly less frequently (p less than .001) than were young patients, although both groups were described as presenting identical symptomatology. For those vignettes that described more severe behavioral disturbances, differences in the referral rates of young and not old patients was most pronounced. The results are discussed in terms of age bias on the part of the referring physician and the effect this may have on the provision of mental health treatment for elderly persons.

Tardive dyskinesia: age and sex differences in hospitalized schizophrenics.

An examination of the severity of tardive dyskinesia in psychiatric inpatients using the Abnormal Involuntary Movement Scale (AIMS) indicates differing trends with age for each sex. Females show a significant linear increase with age, while males display a significant curvilinear relationship. Reliable differences between males and females are found only for the 70-79 and greater than or equal to 80 year age groups. The differences between the sexes cannot be accounted for by differences in length of current hospitalization or by current level of neuroleptic medication. Possible reasons for the results are discussed.