The effects of paranoia and dopamine on perception of cohesion and conspiracy: a pre-registered, double-blind, placebo-controlled experiment

Paranoia is a common symptom of psychotic disorders but is also present on a spectrum of severity in the general population. Although paranoia is associated with an increased tendency to perceive cohesion and conspiracy within groups, the mechanistic basis of this variation remains unclear. One potential avenue involves the brain's dopaminergic system, which is known to be altered in psychosis. In this study, we used large-N online samples to establish the association between trait paranoia and perceptions of cohesion and conspiracy. We further evaluated the role of dopamine on perceptions of cohesion and conspiracy using a double-blind, placebo-controlled laboratory experiment where participants received levodopa or a placebo control. Our results were mixed: group perceptions and perceptions of cohesion were higher among more paranoid individuals but were not altered under dopamine administration. We outline the potential reasons for these discrepancies and the broader implications for understanding paranoia in terms of dopamine dysregulation.

Mushrooms as future generation healthy foods

The potential of edible mushrooms as an unexploited treasure trove, although rarely included in known food guidelines, is highlighted. Their role in shielding people against the side effects of an unhealthy stylish diet is reviewed. Mushrooms complement the human diet with various bioactive molecules not identified or deficient in foodstuffs of plant and animal sources, being considered a functional food for the prevention of several human diseases. Mushrooms have been widely used as medicinal products for more than 2,000 years, but globally the potential field of use of wild mushrooms has been untapped. There is a broad range of edible mushrooms which remain poorly identified or even unreported which is a valuable pool as sources of bioactive compounds for biopharma utilization and new dietary supplements. Some unique elements of mushrooms and their role in preventative healthcare are emphasized, through their positive impact on the immune system. The potential of mushrooms as antiviral, anti-inflammatory, anti-neoplastic, and other health concerns is discussed. Mushrooms incorporate top sources of non-digestible oligosaccharides, and ergothioneine, which humans are unable to synthesize, the later a unique antioxidant, cytoprotective, and anti-inflammatory element, with therapeutic potential, approved by world food agencies. The prebiotic activity of mushrooms beneficially affects gut homeostasis performance and the balance of gut microbiota is enhanced. Several recent studies on neurological impact and contribution to the growth of nerve and brain cells are mentioned. Indeed, mushrooms as functional foods' nutraceuticals are presently regarded as next-generation foods, supporting health and wellness, and are promising prophylactic or therapeutic agents.

Factors affecting conspiracy theory endorsement in paranoia

Paranoia and conspiracy thinking are known to be distinct but correlated constructs, but it is unknown whether certain types of conspiracy thinking are more common in paranoia than others. In a large (n = 1000), pre-registered online study we tested if endorsement of items on a new Components of Conspiracy Ideation Questionnaire varied according to whether harm was described as being (a) intentional and (b) self-referential. Our predictions were supported: paranoia was positively associated with endorsement of items on this questionnaire overall and more paranoid individuals were more likely to endorse items describing intentional and self-referential harm. Belief in any item on the Components of Conspiracy Ideation Questionnaire was associated with belief in others and items describing incidental harm and harm to others were found to be more believable overall. Individuals who endorsed conspiracy theory items on the questionnaire were more likely to state that people similar to them would as well, although this effect was not reduced in paranoia, counter to our expectations.

Paranoia, sensitization and social inference: findings from two large-scale, multi-round behavioural experiments

The sensitization model suggests that paranoia is explained by over-sensitivity to social threat. However, this has been difficult to test experimentally. We report two preregistered social interaction studies that tested (i) whether paranoia predicted overall attribution and peak attribution of harmful intent and (ii) whether anxiety, interpersonal sensitivity and worry predicted the attribution of harmful intent. In Study 1, we recruited a large general population sample (N = 987) who serially interacted with other participants in multi-round dictator games and matched to fair, partially fair or unfair partners. Participants rated attributions of harmful intent and self-interest after each interaction. In Study 2 (N = 1011), a new sample of participants completed the same procedure and additionally completed measures of anxiety, worry and interpersonal sensitivity. As predicted, prior paranoid ideation was associated with higher and faster overall harmful intent attributions, whereas attributions of self-interest were unaffected, supporting the sensitization model. Contrary to predictions, neither worry, interpersonal sensitivity nor anxiety was associated with harmful intent attributions. In a third exploratory internal meta-analysis, we combined datasets to examine the effect of paranoia on trial-by-trial attributional changes when playing fair and unfair dictators. Paranoia was associated with a greater reduction in harmful intent attributions when playing a fair but not unfair dictator, suggesting that paranoia may also exaggerate the volatility of beliefs about the harmful intent of others.

Conflict and cooperation in paranoia: a large-scale behavioural experiment

BACKGROUND

Paranoia involves thoughts and beliefs about the harmful intent of others but the social consequences have been much less studied. We investigated whether paranoia predicts maladaptive social behaviour in terms of cooperative and punitive behaviour using experimental game theory paradigms, and examined whether reduced cooperation is best explained in terms of distrust as previous studies have claimed.

METHODS

We recruited a large population sample (N = 2132) online. All participants completed the Green et al. Paranoid Thoughts Scale and (i) a Dictator Game and (ii) an Ultimatum Game, the former with an option for costly punishment. Following distrust-based accounts, we predicted highly paranoid people would make higher offers when the outcome depended on receiving a positive response from their partner (Ultimatum Game) but no difference when the partner's response was irrelevant (Dictator Game). We also predicted paranoia would increase punitive responses. Predictions were pre-registered in advance of data collection. Data and materials are open access.

RESULTS

Highly paranoid participants actually made lower offers than non-paranoid participants both in the Dictator Game and in the Ultimatum Game. Paranoia positively predicted punitive responses.

CONCLUSIONS

These findings suggest that distrust is not the best explanation for reduced cooperation in paranoia and alternative explanations, such as increased self-interest, may apply. However, the tendency to attribute harmful intent to partners was important in motivating punitive responses. These results highlight differing motivations underlying adverse social behaviour in paranoia and suggest that accounts based solely on the presenting features of paranoia may need to be rethought.

Verification of cleaning efficiency and its possible role in programmed hygiene inspections of food businesses undertaken by local authority officers

AIM

The aim of this study was to determine whether or not the assessment of surface cleanliness could make a contribution to visual inspections of food premises.

METHODS AND RESULTS

Forty-five premises were studied with both rapid (ATP) and traditional microbiological swabbing being used to test surfaces that either come into direct contact with prepared foods or were likely to be touched by hands during food preparation. A significant link was found between aerobic colony counts and ATP measurements. In most cases, the visual appearance of surfaces could not be used to accurately predict either microbial or ATP results.

CONCLUSION

This study suggests that ATP testing is a useful indicator of surface cleanliness and could be helpful to local authority officers as part of risk assessment inspections.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides further evidence that visual inspection alone may not always be adequate to assess surface cleanliness. In high-risk premises, ATP could, if appropriately targeted, help identify potential problem areas. The results are available at the time of the inspection and can be used as an on-the-spot teaching aid.

Two separate outbreaks of Salmonella enteritidis phage type 14b food poisoning linked to the consumption of the same type of frozen food

OBJECTIVES

To ascertain, using a combination of epidemiological, environmental and microbiological methods of investigation, a possible link between two outbreaks of salmonella food poisoning.

METHODS

Case-control studies were carried out on the known at-risk populations. Environmental investigations took place in the food preparation areas used for the social functions and microbiological examinations were carried out on faecal specimens obtained from cases, environmental swabs, and food specimens when these were available.

RESULTS

In both outbreaks, illness was associated with the consumption of sesame prawn toast (outbreak one P<0.004; outbreak two P<0.0001). Salmonella enteritidis phage type 14b was cultured from the faecal specimens of cases in both outbreaks and from a packet of sesame prawn toast used for the second outbreak function. Molecular typing methods indicated that the salmonella cultures obtained in both outbreaks were indistinguishable from each other and from cultures obtained from imported Spanish eggs in a previous survey. Imported Spanish eggs were used in the manufacture of the sesame prawn toast.

CONCLUSIONS

Adequate cooking must take place of raw food products, which should be clearly labelled as such. Manufacturers should consider, when possible, the use of pasteurized egg in the preparation of food products.

The "knack" of Alzheimer's care

Some caregivers just seem to have a "knack" when it comes to dealing with people with Alzheimer's disease. But you don't have to be born with it--many coping techniques can be learned.

Comparison of ThinPrep and conventional preparations: nongynecologic cytology evaluation

ThinPrep processing, an automated cytopreparatory method, has been reported to show good correlation with conventional preparations and to reduce the rate of false-negative diagnoses. In a retrospective review of 230 consecutive nongynecologic cytology cases, we compare the ThinPrep (TP) method with conventional preparations (CP). There were 129 fine-needle aspiration (FNA) specimens from various sites, including 51 breasts, 40 thyroids, 14 lungs, 8 livers, and 16 miscellaneous sites. The sources of 101 body cavity fluids included 68 pleural/peritoneal effusions, 25 peritoneal/pelvic washings, and 8 miscellaneous sites. Each case was evaluated for cellularity, morphologic, details, and obscuring background material. Diagnoses of the TP slides were classified as insufficient, normal, benign, suspicious, or malignant. Each case was then correlated with the tissue diagnosis when available. In TP slides, cellular arrangements, nuclear details, and nuclear cytoplasmic ratio were preserved, while blood and diathesis were eliminated. There was no statistically significant difference between TP and CP in the diagnostic categories. However, in six cases of "insufficient for diagnosis" on FNA by CP, TP yielded sufficient cells and tissue fragments for diagnosis. One case each of FNA and body fluid with a diagnosis of "suspicious for malignancy" by CP was considered "positive" on TP slides. The overall sensitivity of TP was 97.6%, and the specificity was 92.9%. The positive predictive value was 93.0%. We conclude that the ThinPrep method shows good correlation with conventional preparations in both FNA and body fluids.

[Quantification of dementia-related disabilities in daily behavior with the DAFS (Direct Assessment of Functional Status): reliability and validity of a German test version]

The DAFS (Direct Assessment of Functional Status) is a new test for the assessment of competence of demented patients in situations of everyday life. The present study assesses objectivity, temporal stability, concurrent and discriminative validity of a German version of the DAFS. Sixteen patients with a DSM-III-R-diagnosis of dementia of the Alzheimer's type, 8 of which with a mild (MMSE 18-25) and 8 with a moderate (MMSE 12-17) dementia, and 8 control subjects without any symptoms of dementia (MMSE 28-30), matched with the patient groups in age, gender and education, were assessed three times within 3 weeks with the DAFS and once with the NOSGER (an ADL rating scale). The DAFS showed high objectivity (correlation between two test administrators r = .97) and stability (2 week retest reliability r = .98) and was able to discriminate significantly between the study groups and with a strong effect size. Correlations with the total score and the IADL subscale score of the NOSGER were high (r = .81 and r = .86, resp.), whereas correlations with the mood and the disturbing behavior subscale were much lower (both r = .54). This investigation could demonstrate that the DAFS is an objective, stable and valid test instrument. It has a high power to discriminate between demented and non-demented subjects as well as between various degrees of severity of illness. The test items are highly relevant for everyday functioning and the test itself is a good and necessary addition to the use of ADL or IADL rating scales.

Antimicrobial treatment of occult bacteremia: a multicenter cooperative study

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of false DNA aneuploidy and false DNA multiploidy in flow cytometric DNA analysis

Although false DNA aneuploid peaks have previously been described in normal tissue, criteria for distinguishing them from 'true' near-diploid peaks have not been established. Normal thyroid (n = 4) and kidney (n = 1) tissue were allowed to autolyze over a fixed period of time and DNA content was analyzed by flow cytometry (FCM). Autolysis was associated with the development of distinct separate G0/G1 peaks which had low DNA indices (1.09-1.18) and showed decreased forward light scatter (FSC) when compared to fresh tissue. Using DNA content and FSC measurements similar false DNA aneuploid peaks were identified in 29/94 surgical specimens. These cases included both benign and malignant lesions from thyroid (n = 63) with the remaining 31 neoplastic cases being from breast (16), lymphoma (8), sarcoma (4), lung (2) and uterine (1) tissue. In addition, false DNA multiploidy was identified. None of these cases showed histological evidence of necrosis. In a parallel comparison study using image cytometry (ICM) on the thyroid nodules, the presence of false DNA aneuploidy was supported. Investigators should routinely employ quality control criteria to identify possible cases of false DNA aneuploidy when measuring DNA content using FCM.

Improved endocervical sampling with the Cytobrush

OBJECTIVE

To evaluate the effectiveness of the Ayre wooden spatula, the cotton-tipped swab and the Zelsmyr Cytobrush in obtaining endocervical cells.

DESIGN

Cross-sectional comparison study.

SETTING

Family practice unit.

PATIENTS

All postpubertal, nonpregnant women who underwent a routine Papanicolaou smear during a 7-month period.

INTERVENTIONS

The three devices were used in each patient in a randomized sequence. An experienced cytotechnologist blinded to the device used evaluated the slides for overall epithelial cellularity (graded from 0 [acellular specimen] to 12 [overloaded sample]), density (the number of groups of five or more endocervical cells) and size of cell clusters (5 to 10 cells per cluster [score of 1], 11 to 100 [2] or more than 100 [3]).

MAIN RESULTS

Samples from 2 of the 136 women were rejected because of improper labelling of the slides or failure to use all three devices. Seventy-six (57%) of the smears obtained with the spatula and 71 (53%) with the swab had no endocervical cells, as compared with only 14 (10%) obtained with the Cytobrush (p = 0.001). The overall cellularity (and standard deviation [SD]) of the smears obtained with the Cytobrush (5.69 [SD 1.17], p = 0.001) and the spatula (5.70 [SD 1.46], p = 0.001) was significantly greater than the cellularity of those obtained with the swab (4.31 [SD 1.17]). The Cytobrush yielded significantly more groups of endocervical cells (109.84 per slide) than either the spatula (4.17) or the swab (6.25) (p = 0.001). The Cytobrush also produced larger cell clusters (1.56 [SD 0.67], p = 0.001) than either the swab (0.83 [SD 1.70]) or the spatula (0.64 [SD 0.67]).

CONCLUSIONS

The Cytobrush and the spatula should be used instead of the spatula alone or the spatula and the swab for collecting endocervical cells.

[Integration and reintegration of first admission psychiatric patients]

In the framework of a prospective follow-up study, development and outcome of the occupational and social status in 258 first-admission psychiatric patients was investigated. Interviews were made at the time of discharge, 1 year and 5 years later. For that reason prospective data exist on the prehospital and hospital time as well as on short-term and long-term course. Social adjustment, occupational rehabilitation, early retirement, social status and pre- and post-hospital occupational integration were investigated. It must be placed on record, that psychiatric patients are subjected to severe negative changes in their occupational and social life even after the first hospital treatment. Type and quantity of disintegration depended on the diagnostic group. Schizophrenic patients differed from the other patients in every intergration area.

Dopaminergic involvement in the cocaine-induced up-regulation of benzodiazepine receptors in the rat caudate nucleus

One group of 12 rats received discrete 6-hydroxydopamine (6-OHDA) injections into the caudate nucleus on one side of the brain and sham infusions on the other. Following chronic daily injections of cocaine (20 mg/kg, i.p.) or saline (1 ml/kg, i.p.) for 15 days, the caudate nuclei were separately dissected, and the number of benzodiazepine receptors labeled with [3H]Ro 15-1788 were assessed using individual homogenate receptor binding assays. A second group of 24 rats received bilateral infusions of 6-hydroxydopamine or sham infusions into the lateral ventricles followed by chronic cocaine or saline administration as described above. The animals were sacrificed by cardiac perfusion, and the brains were sectioned and prepared for light microscopic quantitative autoradiography. The extent of the lesion was assessed by measuring dopaminergic and noradrenergic uptake sites visualized with [3H]mazindol, while [3H]Ro 15-1788 was used to estimate the number of benzodiazepine receptors. Chronic cocaine administration resulted in significant increases in benzodiazepine receptors in the caudate nucleus, and these effects were attenuated following dopamine depletion. These data suggest that the effects of cocaine on benzodiazepine receptors may be mediated, in part, through the effects of the drug on dopaminergic neuronal activity.

Work and psychiatric illness: the significance of the posthospitalization occupational environment for the course of psychiatric illnesses

The value of the reintegration and rehabilitation of inpatients vocationally was studied. Certain of the vocational experiences (unemployment and stressful working conditions) of former psychiatric inpatients were examined, with attention being paid to their stabilizing or destabilizing effect on symptomatic behaviour. A cohort of 230 first-time admissions for treatment of various disorders were interviewed while hospitalized and 1 year later. A 20-item list prepared by INFAS was used for indexing stressful working conditions. Psychopathological states were assessed with the help of the Present State Examination of Wing et al. (1973). The results indicate that mentally ill persons (especially those with organic or affective disorders), when confronted with unemployment after discharge from hospital, will usually respond by developing new or worse syndromes. Stressful working conditions appear to have very different effects in schizophrenia and affective disorders, viz. deterioration and amelioration of psychopathological syndromes respectively.

Mortality and rate of suicide of first admission psychiatric patients. A 5-year follow-up of a prospective longitudinal study

Patients who commit suicide in a psychiatric hospital are, in general, patients who have had previous admission or who have already made at least one suicide attempt. The following study focuses upon an earlier time within the course of a psychiatric illness, that is the time of first admission, and examines the rate of suicide of 258 patients after 5 years. Two control groups were selected: first admitted psychiatric patients who did not commit suicide, and patients who died a 'natural death'. We analyzed how the suicides were integrated into the vocational, social and medical areas of life before they were admitted to the hospital. Further it was possible to identify predictors of future suicide.

The problem of readmission with respect to occupational factors. Course and predictive influences after 5 years

In this study the course of Readmission after one, 2.5 and 5 years was examinated at a sample of 258 first admitted psychiatric patients of different diagnostic groups. In the analysis occupational, soziodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the readmission also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2.5 year analysis however above average. Beside these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

[Readmission of psychiatric patients hospitalized for the first time--course and predictive factors after 5 years]

In this study the course of rehospitalisation after one, 2 1/2 and 5 years was examined in a sample of 113 readmitted patients of different diagnostic groups. In a second step of analysis occupational, sociodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the rehospitalization also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2 1/2 years analysis however above average. Besides these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

[Rehabilitation of pension--which course do psychiatric patients follow after their first inpatient treatment in a psychiatric hospital? Results of a prospective longitudinal study]

Placing persons having a mental illness in the open labour market has in recent years become increasingly difficult. The question therefore arises whether an attempt should be made to improve occupational access through rehabilitative measures, or whether pensioning would not be the more appropriate action. In the framework of a prospective 5-year catamnestic study of first-admission psychiatric patients, the course taken by them was investigated, as well as the factors that had been relevant in the decision to pension the patients, or to provide rehabilitative services. It was found that pensioning and rehabilitative measures differ in no essential degree as to their shares, and that both types of approach had occurred in only very few cases. Disease-specific factors (psychopathological symptoms, readmission) are suggested to be involved concerning the route taken. Pensioning on the one hand, and rehabilitation service provision on the other, are linked with the age and diagnoses of the patients, as well as the extent of their social activities.

Hemodynamic effects of flestolol, a titratable short-acting intravenous beta-adrenergic receptor blocker

The hemodynamic effects of flestolol were evaluated in 30 patients undergoing routine cardiac catheterization. Hemodynamic measurements were obtained during baseline (prior to flestolol), at steady state during IV flestolol infusion (1, 5, and 10 micrograms/kg/min) and at 20 to 30 minutes after discontinuation (postinfusion). Flestolol-induced hemodynamic changes were similar to those induced by other beta blockers without intrinsic sympathomimetic activity. Significant dose-dependent reduction in heart rate, rate pressure product, and increase in peripheral vascular resistance were seen. Flestolol produced clinically insignificant decrease in myocardial contractility as shown by slight decrease in LVdp/dt, CI, and LVEF. Hemodynamic data from patients with paced heart rate, further confirms a direct mild cardiac depressant effect of flestolol, a finding common to other beta blockers. Consistent with the short elimination half-life of flestolol (t1/2 = 6.5 minutes), most of the hemodynamic changes rapidly returned to preinfusion level within 20 to 30 minutes following its discontinuation. Thus flestolol, with its unique pharmacokinetic profile and titrability, may be beneficial in the treatment of critically ill patients.

[Outcome, course and prognosis of the vocational status of psychiatric patients hospitalized for the 1st time--results of a multiple factor study]

In the framework of a prospective longitudinal investigation, the occupational course of first-admission psychiatric patients was analyzed for the first year (1980) and the fifth (1984) post-discharge from the clinic. Findings indicate that, to quite an important degree, tendencies towards occupational disintegration had existed already immediately after the first in-patient treatment episode. This applied almost totally independent of the clinical diagnosis given at the time of the first hospitalization. Only persons with substance abuse illness had been affected clearly less often, the situation four years later being however comparable. Except for the groups of neurotic and personality disorders, the occupational situation had by then however tightened drastically for all of the diagnostic groups, a structural analysis making it clear that this development had initiated already in the course of the first year. Thus, all patients who had been without work over the entire first year of the five-year period, had already reached the "terminal point" in their employment history. As far as diagnoses are concerned, our study confirms the experience that a schizophrenic illness will by no means always entail a straight course toward an unfavourable outcome. The investigation at the same time however also indicated that non-schizophrenic illnesses take a more unfavourable course than had been expected. In relation to earlier longitudinal catamnestic studies of persons with schizophrenia, the findings for our schizophrenic patients moreover were markedly worse, this discrepancy being presumed to be accounted for by the different methods applied, different selection criteria, as well as differences in economic activity at the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognoses about vocational achievement behavior of first admitted psychiatric patients under special consideration of the diagnoses of depressive illnesses

In this study prognoses about the posthospital vocational achievement behavior of 55 first admitted depressive patients were made at the time of discharge. With a structured and standardized questionnaire the patients themselves, the treating physicians, and the nurses were interviewed. As a first step of analysis the prognoses of the three groups were compared with each other and tested in respect of differences. This comparison was made with other psychiatric diagnoses too, whereby endogenic depressive patients and neurotic depressive patients were discriminated. In the second step of analysis the prognoses of the three 'rater groups' were compared with the real vocational reintegration of 1 year after discharge. The result was that the prognoses of the treating physicians and the nurses were more compatible with reality than those of the patients themselves.

Pharmacokinetics and pharmacodynamics of flestolol, a new short-acting, beta-adrenergic receptor antagonist

The pharmacokinetics and pharmacodynamics of flestolol, a new short-acting, beta-adrenergic receptor antagonist, were examined in nine healthy subjects after a constant intravenous infusion of 5 micrograms/kg/min for 72 hours. Flestolol blood levels were determined by high-performance liquid chromatography. In all subjects, flestolol blood concentration attained steady state 30 minutes after initiation of infusion. The mean +/- standard deviation steady-state concentration of flestolol was 31.1 +/- 12.0 ng/mL. The elimination half-life averaged 7.2 minutes. The mean +/- standard deviation total body clearance was 181 +/- 66 mL/min/kg. The apparent volume of distribution and the area under the curve averaged 1.89 L/kg and 2.23 micrograms-hr/mL, respectively. Flestolol did not cause any significant change (P greater than .05) in the heart rate or systolic or diastolic blood pressure from the baseline. Flestolol significantly (P less than .05) attenuated the isoproterenol-induced increase in heart rate and systolic blood pressure and decrease in diastolic blood pressure in comparison with baseline. The average maximum reduction in isoproterenol tachycardia was in the range of 63% to 79% during flestolol infusion. There was a rapid recovery from beta blockade after termination of flestolol infusion; the recovery averaged 96% 20 minutes after the infusion was stopped. We conclude that flestolol exhibits a very short half-life and is cleared mainly by extrahepatic routes. It is an effective beta blocker and possesses a short duration of action.

Predictors for the social adjustment of first admitted psychiatric patients

In a prospectively designed follow-up study of 258 first admitted psychiatric patients, 1 year after discharge 224 patients and 175 significant others were asked about the social adjustment of these patients and some predictors for this aspect of outcome could be identified. The sample consisted of five different diagnostic groups: organically caused psychiatric diseases, schizophrenic psychoses, affective psychoses, neurotic or personality disorders and alcohol or drug dependency. The study shows that statements about the social adjustment of psychiatric patients largely depend on the diagnostic group, both with respect to degree of adjustment and the predictors. Schizophrenic patients were found to be less well socially adjusted than the other patients, with the exception of the alcohol- and drug-addicted patients. For schizophrenic patients, post-hospital social adjustment was primarily determined by indicators of mental illness, such as psychopathological symptoms and length of hospitalization. The social adjustment of addicted patients was primary influenced by vocational variables. For the patients with organic psychiatric disorders, affective psychoses or neurotic/personality disorders, prediction by pre-hospital or hospital variables did not prove to be very useful.

[Occupational reintegration of psychiatric patients hospitalized for the first time in the year following their discharge--results of a prospective longitudinal study]

A short-term occupational prognosis had been given for first-admission psychiatric patients, occasioned by information from the field that, in case of mentally ill persons, measures for their vocational rehabilitation frequently either are started too late, or are inappropriate in scope, because associated impairments are insufficiently dealt with, underrated, or even overlooked at all in the early stages of the illness. Following Wing's concept of disability, an attempt was moreover made to identify barriers for occupational resettlement. The findings provided the basis for considering the question of scope and type of within-clinic or external measures to be initiated, or stepped up, to facilitate these clients' access to gainful employment and, hence, able to positively influence the future course of their condition.

[Occupational handicaps as risk factors for the readmission of psychiatric patients hospitalized for the first time--results of a prospective longitudinal study]

In dealing with the issue of readmission of psychiatric patients into in-patient care, the focus had in the past primarily been on clinical variables such as diagnosis, or severity of the clinical picture. The present study, however, had centered on occupational variables, such as vocational training, occupational status, periods of gainful employment, and unemployment. This complex was studied in a sample of psychiatric patients, with analyses directed at: percentage of the initial sample readmitted after a catamnestic period of 1 and 2 1/2 yrs. resp., diagnostic groups with increased readmission incidence, and occupational variables associated with the need for readmission. Summing up, it may be stated that occupational handicaps arose in particular in the diagnostic groups of endogenous psychoses, whereas in other groups (such as neuroses, alcoholism) the issue of "social handicaps", in particular, had been in the foreground.

Tolerance and beta-adrenergic blocking activity of flestolol, a short-acting beta blocker

The tolerance and beta-adrenergic blocking activity of flestolol, a short-acting beta-blocker, was investigated in 30 subjects. Flestolol infused intravenously at doses up to 100 micrograms/kg/min was found to be well tolerated. A dose-dependent attenuation of isoproterenol-induced tachycardia and increase in systolic blood pressure occurred with flestolol at doses ranging from 0.5 to 15.0 micrograms/kg/min. The average percent reduction in isoproterenol-induced tachycardia (beta-blockade) at each dose of flestolol, 0.5, 2.5, 5.0, 15.0, and 50.0 micrograms/kg/min, was 15.1%, 45.9%, 67.0%, 85.9%, and 90.3%, respectively. The onset of beta-blockade occurred within 30 minutes. After the end of flestolol infusion there was a marked reduction in beta-blockade within 6 minutes, with complete recovery from beta-blockade within 30 to 45 minutes. There was a statistically significant (P less than 0.01) positive correlation between flestolol dosage and its blood levels (r = 0.91) as well as between the flestolol-induced beta-blockade and its dosage (r = 0.62).

Effects of esmolol on airway function in patients with asthma

In a double-blind, randomized, crossover study in ten patients with asthma, the effects on specific airway resistance of esmolol, a new ultra-short-acting beta 1-selective adrenoceptor blocker, were compared with those of placebo. Specific airway resistance was measured during increasing doses of esmolol infusion, during dry air provocation tests, and following isoproterenol inhalation. These same studies were later carried out on six of ten patients following intravenous propranolol infusion. All patients were able to tolerate the maximum dose of esmolol (300 micrograms/kg/min); treatment differences between esmolol and placebo were not found. In contrast, intravenous propranolol produced marked symptomatic bronchoconstriction after the lowest dose (1 mg) in two of six patients. Esmolol produced slight but statistically significant enhancement of patients' sensitivity to dry air provocation. Similarly, a slight but significant inhibition of bronchomotor sensitivity to isoproterenol was noted during esmolol infusion. After infusion of 5 mg of intravenous propranolol, one of four patients had a clinically significant increase in sensitivity to dry air. It is concluded that esmolol, because of its short duration of action and relative lack of effect on airway resistance, may be preferred over propranolol in patients with asthma who require treatment with an intravenous beta-blocking agent.

[The need and actually successful work-related rehabilitation measures for first-admission psychiatric patients]

Presented are the findings of a follow-up study of 258 psychiatric patients who had for the first time been admitted to inpatient psychiatric treatment in 1979. Using standardized forecasting instruments, the patients themselves, their treating physician, and a member of the care staff were asked to give their views of the patient's occupational outlook, his chances for resettlement, and the need for vocational rehabilitation services following discharge. The needs statements made at discharge are contrasted with the vocational and job-related rehabilitation measures actually initiated and carried out in the year following discharge; additionally, the patients' vocational situation at discharge is compared with their situation twelve months later, and the course of the rehabilitation measures provided is described. Along with the discrepancies between needs statements and amount of vocational rehabilitation services actually initiated and carried out, the empirical findings point to a non-specific, dispersive approach to providing rehabilitation services. The possible causes for this discrepancy between needs and service provision, with its rather serious implications, as well as the doubtful effectiveness of the rehabilitation services provided are discussed, practice-related consequences are outlined.

[Familial stresses as a sequel of psychiatric diseases in a relative. Results of an interview with relatives]

The results of interviews with relatives of 179 patients committed to psychiatric treatment are reported. The relatives were interviewed in 1980, one year after discharge of the patient--who had been hospitalized for psychiatric problems for the first time--usually in the family setting. Our main interest was to investigate the concern of the relatives induced by the illness of a family member, and to take stock of the nature and extent of family stress at a relatively early stage of a psychiatric illness. We also wished to know what support the relatives had received, and from what sources, and from what other sources they would have wished such support. The results confirm what other investigators have suggested, i.e that community-centred care apparently leads to an increase in family stress, and that outpatient services and facilities have, to date, played a very minor role in overcoming the problems in the families of psychiatric patients.

[After care behavior of first-admission psychiatric patients during the year after their discharge]

228 patients who had been admitted for the first time to a psychiatric hospital were questioned one year after their discharge in respect of the use they made of the medical and non-medical facilities or institutions. The article describes the actual state of affairs in the after-care behaviour of the psychiatric patients, and goes into details with regard to the diagnosis-specific differences in their behaviour. It is especially in this group of patients that a great demand exists with regard to treatment facilities. 90% of the patients have some kind of contact with our health system, and almost 3/4 have undergone treatment for mental disturbances. The main burden of medical outpatient follow-up of psychiatric patients continues to rest with the family physicians. This is equally true for almost all groups of diagnosed diseases. The patients with schizophrenic psychoses represent the only difference, since they will tend to preferably look up a neurologist for the treatment of their mental complaints.

The man who became angry once: a study of overcontrolled hostility

Recent developments in the study of violent behaviour have led social scientists to examine the concept of Overcontrolled Hostility. This case report describes the history of an overcontrolled individual who was examined in a Maximum Security Hospital after having shot his wife. The presentation of this case includes a brief theoretical perspective, as well as the results of psychiatric and psychological examinations.