Clinical electroencephalography in a psychiatric service.

An audit of the use of clinical electroencephalography in a psychiatric service was carried out by examining the referrals for an EEG from the service over one year (11% of all referrals), comparing them with matched patient controls, rating the EEGs blindly and estimating the clinical value of the investigation for each patient; 37% were abnormal, 19% anomalous and 44% normal. The following two clusters of symptoms and signs were associated with EEG referral--the patients with "organic" mental state phenomena and/or CNS signs; EEG usually abnormal and the patients with behavioural changes that raise the suspicion of an organic process but, taken alone, are not compelling evidence of such (for example, impulsive behaviour, acute and atypical psychoses, perceptual or behavioural phenomena of the type associated with temporal lobe epilepsy in the absence of frank complex partial seizures); EEG usually normal or anomalous. Ninety-two percent of EEGs were judged to be of clinical value; 53% positive and 39% negative. Eight percent of referrals made no contribution to the clinical evaluation.

Anticholinergic drug effects on quantitative electroencephalogram, visual evoked potential, and verbal memory.

Electroencephalographic (EEG) power and coherence spectrum and visual evoked potential (VEP) recordings were made in a group of control subjects on two occasions, a week apart, before and after the subcutaneous administration of either 0.6 mg scopolamine (hyoscine-hydrobromide), a centrally acting anticholinergic drug, or 0.5 mg methscopolamine nitrate, a peripherally acting anticholinergic drug. After scopolamine administration, the EEG power spectrum significantly slowed and EEG coherence at the alpha and beta frequencies decreased. Left interhemispheric coherence increased at 1 Hz and 3-7 Hz. Methscopolamine had no significant effect on the quantitative EEG. The latency of the major positive components of the VEPs, to both flash and pattern stimuli, were not significantly affected by either drug. Verbal memory was significantly reduced after scopolamine. The results suggest that previous reports of scopolamine-induced changes in the EEG power spectrum and in verbal memory can be attributed to the central action of the drug rather than to peripheral side effects.

An audit of substance use disorders on a general hospital psychiatric unit.

This study found that one-fifth of patients admitted to a general hospital psychiatric unit meet the diagnostic criteria for abuse of, or dependence on, psychoactive substances other than alcohol. Many of the substances involved are prescribed medications. Dependence on benzodiazepines and other sedatives was the most common substance use disorder among patients with a variety of other psychiatric diagnoses. We are also concerned by the extent of reported abuse of analgesic compounds and feel it is necessary to modify our initial diagnostic assessments so that patients with these disorders can be recognized at an early stage and managed appropriately.

Structured interviews and the diagnosis of personality disorders.

Structured interviews were developed to improve the reliability of the diagnosis of personality disorders, as it has occurred in other areas of psychopathology. Several such interviews are described in this review, which draws together reports scattered across a wide literature. The appearance of structured interviews in Britain reflected the early interest there in the special problems associated with diagnosing personality disorders, whereas in America their development had to await publication of the DSM-III. Studies using these techniques have illustrated important aspects of clinical diagnosis and can be expected to assign value to the diagnosis of personality disorders in the future.

Examining the relationship between clinical concepts of personality disorder and dimensional measures of normal personality.

Psychiatric epidemiologists acknowledge the value of combining psychometric and clinical diagnostic approaches. However, in the description of personality disorders, the approaches have developed independently of one another. In two recent studies, the Socialization scale of the California Psychological Inventory and the E and N scales of the Eysenck Personality Inventory were found to be compatible with broad clinical concepts of personality disorder. It is suggested that these scales could be employed in epidemiological studies as screening tests.

Socialization scores in psychiatric patients and their implications for the diagnosis of personality disorders.

The distribution scores on the Socialization (So) scale of the California Psychological Inventory was examined in a series of 83 admissions to a general hospital psychiatric service. The series was divided into groups of low and high scorers (Low So and High So). Low So scorers were younger than high scorers and had a raised mean Neuroticism score. A strong association was found between So scores and the quality of parental care which patients reported receiving from their fathers. Other parental attributes are reported. Patients with a clinical diagnosis of personality disorder were found in the Low So, but not the High So group.

An investigation of role-taking in histrionic personalities.

Gough's theory that psychopathy stems from a deficiency in role taking, the ability to perceive and evaluate one's own behaviour as it is perceived and evaluated by others in the same culture, was tested. The Socialization scale, developed by Gough to assess role taking, was administered to a group of 20 female psychiatric patients with histrionic personality disorders, and a control group of female depressives of similar age and intelligence. Socialization scores of the histrionic personalities were significantly lower, indicating impaired role taking, and this difference was not attributable to depression of mood. The Socialization scale was a better discriminator between the groups than the scales of two other personality inventories or a test to elicit meta-impressions.

Observations on the handedness preferences of patients with personality disorders.

A new series of patients with personality disorders has provided an opportunity to extend to both sexes an earlier finding that personality disordered women tend to be mixed handed. Eighty-one subjects completed Annett's handedness questionnaire. The frequency of mixed hand preference in both sexes was similar to that found in the previous study, though deviations from consistent preference were small and dependent on the method used to classify handedness. The hysterical, antisocial and explosive personality types were particularly likely to have mixed handedness. These associations were reflected in small but significant trends among several psychometric variables.

The use of Schneider's typology for the diagnosis of personality disorders--an examination of reliability.

Schneider's typology of the personality disorders is described briefly. Three psychiatrists made diagnoses on two sets of patients, both of which contained one example of each type. The diagnoses were made with the help of a glossary and based upon the examination of clinical summaries and audio-recordings. Values of two reliability coefficients showed considerable variation between types. High reliability was found for Schneider's asthenic, explosive, depressive and affectionless types. Low reliability was found for the fanatic, labile and hyperthymic types. The insecure and attention-seeking types were overused. Some possible causes of this variation are discussed.

The diagnosis of personality disorders: a pilot study.

A pilot study was carried out to see what levels of agreement on the diagnosis of the different types of personality disorder, described by Schneider, could be obtained by observers with different amounts of clinical experience. Audio-recordings of eight patients were examined by 10 raters, who represented three levels of experience. Two patients had the same diagnosis made by 80 percent of the raters and these cases seemed best described as "typical". In all the cases agreement was increased when a second choice diagnosis was permitted. Significantly greater agreement was recorded by clinical clerks than by psychiatrists or psychiatric residents, though this was probably due to their making use of fewer of the types. It seemed probable that some types were less likely than others to be used for a first choice diagnosis. It is recommended that the most typical patients be employed in research in the field of the personality disorders if high diagnostic reliability is required.

Handedness in psychiatric patients.

Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.

Psychiatric symptom profiles of patients with epilepsy: a controlled investigation.

A comparison was made of the mental state of patients with chronic epilepsy and matched controls with locomotor disorders, using a reliable psychiatric interview technique. The symptom profiles of the two groups were similar. The profiles of temporal lobe and other epileptics were also similar. Epileptic patients with a high current psychiatric morbidity were characterized by a raised incidence of previous neurotic illness and raised neuroticism scores on the Eysenck Personality Inventory.

A double-blind study of electrosleep for anxiety and insomnia.

Despite largely negative findings, several subjects reported a remarkable improvement in their symptoms some two to three weeks after electrosleep (ES) treatment was concluded, so that it remains unclear whether or not ES may be an effective treatment. The clinical experience reported suggests that five half-hour ES treatments may not be sufficient to produce significant changes in the patient's anxiety and insomnia. Further investigations are required to examine the effects of varying durations of treatment.