The Journal of nervous and mental disease
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Bedside cognitive screening instruments are used increasingly in clinical and research settings to detect cognitive impairment and to quantify its severity. The authors review the five most frequently cited bedside screening tests that use an interview format and require brief administration times: the Mini-Mental State Examination, the Cognitive Capacity Screening Examination, Mattis Dementia Rating Scale, Kahn's Mental Status Questionnaire, and the Short Portable Mental Status Questionnaire. The tests all have adequate inter-rater reliability, and adequate test-retest reliability has been established for three of the tests. ⋯ False-positive errors may be more common among patients with less education and lower socioeconomic status. The tests reviewed do not detect many types of cognitive deficit that may bear critically on differential diagnosis and case management. Suggestions are given for further research on the current measures and for the development of new screening tests that would meet a broader range of clinical purposes.
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J. Nerv. Ment. Dis. · Jan 1986
Case ReportsTreatment of neuroleptic malignant syndrome with electroconvulsive therapy.
A case of neuroleptic malignant syndrome unresponsive to supportive medical therapy was successfully treated by electroconvulsive therapy. Electroconvulsive therapy may offer a safe and rapidly effective intervention in cases of neuroleptic malignant syndrome complicated by high fever and severe muscular rigidity which do not improve with supportive care.
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Does thought disorder emerge solely as a function of psychosis, or is it a function of diagnosis? The present research investigated whether thought disorder is more frequent in specific diagnostic groups, such as schizophrenia and mania, than in other types of psychotic disorders. The frequency and severity of positive thought disorder was assessed in 324 Research Diagnostic Criteria and DSM-III schizophrenics, manics, other psychotic patients, and nonpsychotic patients, and a normal comparison group. Fifty-seven percent of the sample were first hospital admissions. ⋯ Rather surprisingly, the current research suggests that nonpsychotic manic patients may be as thought disordered as psychotic manic patients at acute phases of disturbance. This would indicate that the presence of positive thought disorder in mania is not primarily a function of most of these patients' being psychotic at the acute phase of disturbance. Thought disorder was not simply a function of psychosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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A careful study of 106 patients, diagnosed as borderline using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, is in progress at a private psychiatric facility. Three distinct subcategories of the borderline personality disorder have been identified: history of no organicity, history of trauma, encephalitis, or epilepsy, and history of attentional deficit disorder/learning disabilities. ⋯ The borderline personality disorder is viewed as either on a continuum with affective disorders and atypical psychoses, or with organic brain dysfunction including the episodic dyscontrol syndrome and/or adult minimal brain dysfunction. Future research should be directed toward further classifying homogeneous subgroups of borderline patients in order to provide more specific and effective treatment.
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J. Nerv. Ment. Dis. · Nov 1982
Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome.
This paper reports the neurological findings in 286 patients with a history of recurrent attacks of uncontrollable rage occurring with little or no provocation and dating from early childhood or from a physical brain insult at a later date. Objective evidence of developmental or acquired brain defects was found in 94 per cent. The most common abnormality was minimal brain dysfunction, which was present in 41 per cent. ⋯ One third of the patients presented a variety of psychiatric disorders persisting for days, weeks, or months in addition to episodic rage. Another type of periodicity was exhibited by women whose episodes occurred solely or mainly in the premenstrual week. Detection of both adult minimal brain dysfunction and complex partial seizures requires detailed and well informed interrogation because many of the symptoms are far from obvious and are unlikely to be uncovered by a superficial medical history or neurological examination.