Psychiatric complications of some basal-ganglia disorders.

Many basal-ganglia disorders are complicated by psychological disturbances and most are aggravated by emotional tension. These relationships are considered in the context of parkinsonism, Sydenham's chorea, Huntington's disease, Wilson's disease and a number of generalized and localized varieties of dystonia.

The psychiatric complications of Parkinson's disease.

Although James Parkinson in 1817 excluded mental symptoms from his original description of paralysis agitans, it has become clear that a wide range of psychiatric disorders can develop in patients with this disease. The principal conditions of dementia, depression and confusional syndromes, many of which are precipitated by drugs used in the treatment of parkinsonism, are reviewed. Particular attention is given to the frequency of dementia and its likely pathogenesis, to the nature of depression in Parkinson's disease and to the effects of different drugs, notably levodopa. A number of rare disorders characterised by parkinsonian and psychiatric symptoms are also discussed.

Mortality and late-onset affective disorder.

Psychiatric illness is associated with increased morbidity and mortality from physical illness. A particular association between depression and reduced expectation of life in males has been previously noted. If depression is a manifestation of incipient fatal illness, it might be predicted that those who had not previously been depressed would be at greater risk of dying in the next few years. This was not confirmed in a 5-year follow-up study, which found a higher overall mortality from natural causes in male patients with both late and early onset of depression.

The psychiatry of vertebro-basilar insufficiency with the report of a case.

Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, 'unusual reports', cortical blindness, agitated delirium, the Capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.

Some observations on the meaning of confabulation.

Confabulation is poorly defined and understood, judging by accounts in some psychiatric textbooks. Many authors appear to consider confabulation as a purposive act on the part of the patient designed to fill in memory gaps by fabricating false statements to spare himself embarrassment and to deceive the interviewer. Clinical observation shows tha the confabulating patient is almost wholly unaware of his memory defect and that his statements are derived from an accessible store of memories dating from before the onset of his illness. The basic problem is the patient's inability to remember that he cannot remember. Consequently it is incorrect to assume any active intention on his part other than a simple wish to provide information in response to questions.

Adverse psychiatric reactions to modern medication.

From this survey it will be apparent that many psychiatric reactions to drugs are largely caused by their direct toxic actions or from combinations of drugs. As such, they are often dose related, although age and slow speed of detoxification will increase the risk of patients developing delirium, hallucinations, sleep disturbances, anxiety etc. Similar toxic reactions can also occur when drugs to which a patient has developed some measure of tolerance are abruptly withdrawn. In this context the effects of drugs upon patterns of sleep may be important determinants of adverse withdrawal symptoms. In contrast are the reactions which resemble one or other of the functional psychoses. In these patients it appears that a past history of an affective or schizophrenic psychosis is the best predictor of a similar illness being precipitated by a particular drug. Nonetheless, with substances like reserpine and cycloserine there is good reason for thinking that, given a sufficient quantity, practically any patient can develop an adverse psychiatric reaction.

Depression as a major symptom of multiple sclerosis.

Thirty patients suffering from multiple sclerosis have been compared with 30 patients suffering from other chronic neurological diseases. The degree of disability was similar in these two groups. The patients with multiple sclerosis had experienced more episodes of severe depression both before and after the onset of neurological symptoms. The possible reasons for these episodes are discussed and it is concluded that in some patients serious affective disorder may be a presenting or complicating feature of multiple sclerosis.

Mental illness and road traffic accidents.

One hundred psychiatric patients were carefully matched with 100 physically ill patients and their driving records compared. The psychiatric patients were consuming far greater quantities of psychotropic drugs and included a larger number of alcoholics and heavy drinkers. During the six months before admission there were no significant differences between the two groups of patients with respect to accident and traffic code infringements. Apart from individual patients, drugs did not appear to be influencing the outcome in statistical terms. Alcoholics and heavy drinkers showed an increased lifetime accident liability. No specific psychiatric diagnosis was otherwise associated with increased accident rates. The majority of accidents reported were relatively trivial.

Depression and cancer: a follow-up study.

Thirty-nine male and 90 female patients aged 40 and over, who had been given a primary diagnosis of depression, were followed up for 2 1/3-4 years. During this period 9 male and 9 female patients died. Five male patients and 1 female died from cancer that had not been diagnosed at the time of their psychiatric admissions. The male cancer deaths are significantly higher than expected. The possible relationships of malignant neoplasm to affective disorder are discussed.

Religious stigmatization: an historical and psychophysiological enquiry.

The historical accounts of religious stigmatization occurring during the past 750 years have been surveyed, with more detailed attention being given to late nineteenth- and twentieth-century medical investigations of some well-known cases. A case showing some features of religious stigmatization is described. The possible relationship of the phenomena of religious stigmatization to disease and psychophysiological processes in the subject is examined.

Accidents in old age.

Elderly persons particularly are liable to falls which in women often cause major fractures and other injuries. In Australia, some two per cent of deaths of women aged 65 and over are attributed to non-traffic accidents, and the length of hospital care and subsequent disability following fractures are both important aspects of the total morbidity resulting from falls suffered by older persons.