Reliability and validity of the psychiatry resident in-training examination.

The Psychiatry Resident In-Training Examination (PRTTE) has been produced annually since 1979. On each test from 1980 through 1987, the Kuder-Richardson reliability coefficient for the global score in psychiatry was above .90. This is adequate reliability for making comparisons among individual examinees. The reliability coefficients for the neurology score and psychiatry subscores were lower and correlated with subtest length. Small differences in these scores may reflect measurement error. Mean raw scores showed statistically significant increases across groups of examinees with increasing levels of training completed. This supports the presence of construct validity.

Serum and red cell folate concentrations in outpatients receiving lithium carbonate.

We measured serum and RBC folate levels in 17 outpatients taking lithium for the prophylaxis of recurrent major affective disorder. In contrast to a previous report, we found no evidence for low folate concentrations or for any significant correlation between folate levels and affective morbidity.

Appropriate and inappropriate use of psychotherapeutic medications for institutionalized mentally retarded persons.

Evaluation of psychiatric treatment in institutions must be based not only on the numbers and types of drugs prescribed but also on diagnoses and other characteristics of the patients. We crosstabulated psychotherapeutic medication regimens against diagnoses for 242 institutionalized mentally retarded adolescents and adults selected for psychiatric treatment. The drugs had generally been prescribed by nonpsychiatrists, but diagnoses were determined by consensus of evaluation teams that included fully trained psychiatrists. According to widely accepted standards for psychopharmacologic treatment, 45.4% to 60.9% of the regimens were rated as appropriate and 39.1% to 54.6% were rated as inappropriate for the conditions diagnosed.

Affective disorder in the families of women with normal weight bulimia.

The authors determined the lifetime prevalence of affective disorder in the first- and second-degree relatives, excluding children, of 27 bulimic women who had never had anorexia nervosa and 27 women with no history of an eating disorder. Family diagnoses were made blind to the proband's diagnosis. The prevalence of affective disorder was 9% in the relatives of the bulimic probands and 10% in the relatives of the control probands, a nonsignificant difference. These findings are in contrast to reports of an increased prevalence of affective disorder in the relatives of patients with anorexia nervosa.

Age-related neuropsychological deficits in Down's syndrome.

Down's syndrome (DS) has been suggested as a high-risk condition for Dementia Alzheimer's type (DAT). In the present study, neuropsychological variables were assessed in 165 DS subjects and 163 matched mentally retarded controls. Overall, DS subjects had lower scores for orientation, digit span, visual memory, object-naming, and general knowledge, as well as more "released" reflexes. Impairments were most evident in DS subjects greater than 50 years old. These findings provide further support for an association between aging and DAT in Down's syndrome. Methodological issues and areas for future research are discussed.

Electroconvulsive treatment of psychotic self-injurious behavior in a patient with severe mental retardation.

This report describes a severely retarded adult patient whose self-injurious behavior became acutely life threatening. Electroconvulsive therapy (ECT) was prohibited by law, but it was administered after the law was judged unconstitutional. The patient's response to ECT was excellent, and there were no adverse consequences.

Hyperkinesis treated by vestibular stimulation: an exploratory study.

In crossover design with alternate assignment to order, 18 hyperkinetic children were treated with eyes-open rotational vestibular stimulation and with control contact, each eight times over 4-week periods. On behavioral ratings by teachers, they scored better after eight sessions of rotational stimulation than after eight control sessions. This treatment advantage was restricted to the ten children younger than age 10 without undersocialized-aggressive features. Few side effects occurred. Ratings by parents, but not by teachers. showed significant (p less than 0.05) placebo effect from the control situation. These findings suggest that vestibular stimulation be explored as a treatment modality for young children. The importance of concomitant visual stimulation needs to be investigated.

Megavitamins for minimal brain dysfunction. A placebo-controlled study.

Preliminary to a stimulant comparison study, 31 children with minimal brain dysfunction randomly received either placebo or a megavitamin combination. During a two-week trial, only two children responded so well that stiumlants were not considered necessary; both were in the placebo group. Change scores from pretest to posttest on four blind ratings by teachers and parents did not show a significant difference between the placebo and vitamin groups.

Methylphenidate vs dextroamphetamine vs caffeine in minimal brain dysfunction: controlled comparison by placebo washout design with Bayes' analysis.

Double-blind crossover comparison of methylphenidate hydrochloride, dextroamphetamine sulfate, and caffeine after placebo washout in 29 children with minimal brain dysfunction (MBD) showed on six ratings that methylphenidate and dextroamphetamine were significantly (P less than .05 to P less than .001) better than placebo and caffeine, but not significantly (P less than .05) different from each other. Placebo, caffeine, and ratings before drug did not differ significantly. Of 26 drug responders, 12 responded best to dextroamphetamine, ten to methylphenidate, and one to caffeine. The latter child showed no improvement at all with either prescription stimulant. Methylphenidate and dextroamphetamine were each efficacious for six children who did not respond to the other stimulant. All three drugs showed significant (P less than .05) weight loss and cardiovascular side effects, the latter possibly spurious. Dextroamphetamine showed a significant (P less than .05) decrease from placebo in "tummyaches."

A survey study of the use of electropupillogram in predicting response to psychostimulants.

To confirm the conclusions from a previous study supporting the usefullness of electropupillogram (E.P.G.) in predicting clinical response, data from three separate studies with hyperkinetic and learning disabled (L.D.) children treated with stimulants were surveyed. Change in extent of pupillary contraction (E.C.) after a test dose of stimulant as measured by E.P.G. did not correlate significantly with actual clinical rating change (with one exception out of 14 correlations calculated). These negative results are reported with a reservation regarding their validity because of technical difficulties in data collection.