The American journal of psychiatry
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Comment Letter Comparative Study
Double standard on capacity and consent?
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This article reviews the assessment and management of psychiatric problems among the oldest old. ⋯ Comprehensive, interdisciplinary assessment and therapy were the cornerstones of geriatric psychiatry 30 years ago. As psychiatry has moved toward a medical model and emphasized pharmacological therapies, it has moved away from the mainstream of geriatric practice. The time has come for geriatric psychiatry to rejoin geriatric medicine so that psychiatry can recapture its roots and deliver optimal care to the oldest old.
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DSM-IV specifies that Asperger's disorder is a type of pervasive developmental disorder without clinically significant cognitive or language delay. There are no data, however, on the outcome of children with Asperger's disorder or on whether their outcome differs from that of children with autism. The objectives of this study were to compare the outcome of groups of children with these disorders over a period of 2 years on variables independent of the defining criteria and to identify variables that might account for these differences. ⋯ Although the exact mechanism for the differences in outcome remain to be determined, it appears that Asperger's disorder and autism represent parallel but potentially overlapping developmental trajectories.
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Cytoarchitectonic changes in the anterior cingulate cortex, hippocampus, subiculum, entorhinal cortex, amygdala, mammillary bodies, and septum were reported in a postmortem study of autism. Previously, the authors found smaller cingulate volume and decreased metabolism of the cingulate in seven autistic patients. In this study, they measured the volume and glucose metabolism of the amygdala, hippocampus, and cingulate gyrus in an expanded group of 17 patients with autism spectrum disorders (autism [N=10] or Asperger's disorder [N=7]) and 17 age- and sex-matched healthy volunteers. ⋯ Compared with age- and sex-matched healthy volunteers, patients with autism spectrum disorders showed significantly decreased metabolism in both the anterior and posterior cingulate gyri.