Play therapy with the elderly: A case study.

This article reviews a project conducted with nursing home residents using child-centered play therapy. Play therapy was chosen as a therapeutic modality in order to reach this population more creatively. Three case studies are presented. Therapeutic changes were reported by the social worker, staff members, the elderly participants, and the author. Observed outcomes of therapy reported were decreased depression, heighten self-esteem, improved socialization skills, and what appeared to be resolution of difficult issues. A discussion of limitations, selection of clients, and suggestions for future use of play therapy with this population are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The grammatical properties of mass nouns: an aphasia case study

A total of 168 consecutive patients with predominant rheumatic mitral stenosis were evaluated by transthoracic (TTE) and transesophageal echocardiography (TEE). Of the 168 patients, 35 had previous embolic events (group I) and 133 had no emboli (group II). A total of 77 (45.8%) patients had atrial fibrillation. The frequency of atrial fibrillation was higher in group I than group II (68.6% vs 39.8%, p < 0.001). The incidence of left atrial enlargement was greater in group I (p < 0.001). Mitral valve area was found to be smaller in group I compared to group II (p < 0.001). In group I 83.3% and 29.2% of the patients with atrial fibrillation had left atrial spontaneous echo contrast (SEC) and left atrial thrombus, respectively, and 72.7% of the patients with sinus rhythm had left atrial SEC. In group II 79.2% and 20.8% of the patients with atrial fibrillation had left atrial SEC and left atrial thrombus whereas 28.6% and 2.6% of the patients with sinus rhythm had left atrial SEC and left atrial thrombus, respectively. The incidence of left atrial thrombus was significantly different in those patients with compared to those without embolic events (20% vs 9.7%, p < 0.01). In groups I and II, 28 of 35 (80%) and 64 of 133 (48.1%) patients had left atrial SEC (p < 0.01). Patients with left atrial SEC had a greater left atrial size (p < 0.01) and smaller mitral valve area (p < 0.01). Left atrial size was normal in 2 patients with left atrial SEC and SEC was not found in 55 patients with enlarged left atrium. Multiple logistic regression analysis showed that atrial fibrillation, mitral valve area and left atrial enlargement were independent predictors of the SEC (p < 0.001) and left atrial SEC was the principal determinant of thromboembolism. These data suggest that regardless of rhythm and atrial size, left atrial SEC is a principal determinant of thromboembolic risk in mitral stenosis. TEE may be able to detect those patients with mitral stenosis at risk for emboli and guide appropriate therapy.     

The epidemiology of eating disorder behaviors: an Australian community-based survey

In spite of the importance of the corpus luteum in human reproduction, little is known about its formation after ovulation and during regression in the absence of conception. This is largely due to constraints on the availability of normal human tissue; therefore an appropriate model which could be studied and could provide information applicable to the human was sought. The baboon (Papio), a non-human primate, has been determined to be one such model. Thus, in the past several years our studies have examined the role of luteal peptides in corpus luteum function, and, when possible, we have attempted to examine corpora lutea from the human and baboon in parallel. Although a milk-ejection factor was recognized to be present in luteal tissue in 1910 (Ott and Scott, Proc. Soc. Exp. Biol. Med., Vol. 8, p. 49), the role of oxytocin in luteal physiology has not been easy to ascertain. This is in part due to the methodologies employed to assess its role. Our studies summarized below suggest that oxytocin does not directly affect luteal steroidogenesis but that it may play a role in cell to cell communication involving the expression of the gap junction proteins, the connexins. In view of the fact that oxytocin, its receptor, gap junctions and associated proteins are not unique to the human and non-human primates, the model of luteal development and demise proposed may be applicable to most species.     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms

PURPOSE: Food preferences, eating patterns, and physical activity patterns were examined in a cohort of adolescent females and males participating in a longitudinal study of the developmental antecedents of eating disorders. METHODS: All adolescents (n = 1494) in grades seven through ten in an entire school district completed a survey about their dieting behaviors, eating, and exercise patterns. RESULTS: Principal components analysis showed similar factor structures for food preferences and eating patterns among males and females. Gender differences were present in physical activity patterns. Sports participation was correlated with healthy food preference and was a significant predictor of eating disorders symptoms. Junk food preference was marginally inversely related to eating disorders symptoms in females. Preference for other types of foods and reported intake of foods were not related to eating disorders symptoms. The percent of variance in risk score accounted for by dietary intake and physical activity patterns was small. CONCLUSIONS: Psychological and social/environmental variables may explain a larger proportion of the variance in eating disorders risk than the dietary and physical activity variables examined in this study. Implications for understanding the etiology and behavioral expression of eating disorders are discussed.     

Changing eating patterns of American children: a view from 1996

Whipple's disease (WD) is an uncommonly diagnosed infection caused by the recently characterized bacillus, Tropheryma whippelii. The association of WD with pericarditis and endocarditis is widely recognized, although less attention has been paid to the myocardium as a site of disease. Although the disease was uniformly fatal before antibiotic therapy, current treatment usually results in cure. We report two patients whose deaths were directly related to cardiac involvement by WD and whose underlying disease escaped diagnosis for years. The first, a 60-year-old white woman, suffered a cardiovascular collapse, and lymphocytic myocarditis was demonstrated at autopsy. The second, a 48-year-old black man, had a lengthy history of progressive cardiac failure that terminated in arrhythmia. Extensive myocardial fibrosis, with lymphocytic and granulomatous inflammation, was demonstrated at autopsy. The presence of T. whippelii was confirmed by electron microscopic examination in both cases and by polymerase chain reaction in one. Patients with WD might harbor an undiagnosed lymphocytic or granulomatous myocarditis, and this diagnosis should be considered in the evaluation of cardiac failure.     

Scope and significance of eating disorders.

Anorexia nervosa and bulimia are major health concerns in many industrialized societies. Both disorders appear to be increasing in prevalence, and both (particularly anorexia nervosa) are associated with significant morbidity and mortality. Genetic studies have suggested that there may be a genetic risk for the development of anorexia nervosa. Various treatment strategies have been advocated for these conditions. Both pharmacotherapy and psychotherapy, particularly psychotherapy that incorporates cognitive-behavioral principles, appear to be useful. Recent biological studies on appetite and weight regulation are beginning to yield findings of clinical significance in the treatment of these disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The significance of a coexisting opioid use disorder in cocaine dependence: an empirical study

This study was undertaken to compare cocaine-dependent patients with and without an opioid use disorder, in an effort to identify important clinical similarities and differences between the two groups. Ninety patients hospitalized for cocaine dependence were divided according to whether or not they had a coexisting opioid use disorder; 32 patients (35.6%) had an opioid diagnosis and 58 (64.4%) did not. The groups were compared on substance use histories, psychopathology, severity of drug-related problems, and 3-months cocaine use outcome. Patients with an opioid diagnosis had more current major depression, antisocial personality disorder, and other substance use disorders. They also had higher medical and drug scores on the Addiction Severity Index, and longer cocaine use histories. Nonetheless, 3-month cocaine use outcome was similar for both groups. Interestingly, patients with an opioid diagnosis engaged in more treatment during the follow-up period. Cocaine-dependent patients with a coexisting opioid use disorder may thus constitute a subgroup with worse prognostic characteristics, for whom differential treatments may improve outcome.     

The perfectionism model of binge eating: Tests of an integrative model.

This study proposes, tests, and supports the perfectionism model of binge eating (PMOBE), a model aimed at explaining why perfectionism is related to binge eating. According to this model, socially prescribed perfectionism (SPP) confers risk for binge eating by generating exposure to 4 triggers of binge episodes: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. In testing the PMOBE, a daily diary was completed by 566 women for 7 days. Predictions derived from the PMOBE were supported, with tests of mediation suggesting that the indirect effect of SPP on binge eating through triggers of binge episodes was significant. Reciprocal relations were also observed, with certain triggers of binge episodes predicting binge eating (and vice versa). Results supported the incremental validity of the PMOBE over and above self-oriented perfectionism and neuroticism and the generalizability of this model across Asian and European Canadian participants. The PMOBE offers a novel view of individuals with high levels of SPP as active agents who raise their risk of binge eating by generating conditions in their daily lives that are conducive to binge episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrameal eating patterns of obese and nonobese humans.

Conducted 2 experiments to test whether the intrameal eating patterns of obese and norman-weight human Ss are different. Exp I, with 85 undergraduates, was conducted in a laboratory under the pretense of a taste test. Eating was observed and data were compiled for 7 parameters related to eating. Exp II, with 40 college students, was conducted under field-study conditions with the Ss unaware of their participation. Few statistically significant differences in eating behavior were observed between obese and normal-weight Ss. Results are in contrast to the majority of previous work. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The significance of choroid plexus cysts in an unselected population: results of a multicenter study

BACKGROUND: Cytotoxic T lymphocytes and Kupffer cells are essential components of the immune response during liver diseases. Recent studies have highlighted the role of cytotoxic T lymphocytes using Fas and its ligand in induced hepatocyte death during acute and chronic hepatitis. METHODS: In the present work, the main purpose was to investigate perforin and granzyme B expression in liver biopsies of patients with chronic hepatitis (10 HBV, 14 HCV and 10 autoimmune hepatitis) using immunohistochemistry. The liver biopsies of two normal individuals were also studied in the same conditions. RESULTS: Few intrahepatic T lymphocytes expressed perforin and granzyme B, while a large number of Kupffer cells were positive for both proteins in all the patients tested. The co-localization of perforin and granzyme B, and CD3 or CD68 antigens was visualized, respectively, in T cells and Kupffer cells, using confocal microscopy. In situ hybridization assays confirmed that perforin and granzyme B mRNAs were present in the liver during chronic hepatitis. The results were similar among the three groups of patients and whatever the activity of the disease. Perforin and granzyme B expression was lacking in liver samples from normal individuals. Conclusions: These data suggest a minor role for the T cell-mediated perforin/granzyme B death pathway, and a putative role for Kuppfer cells via lytic protein release, during chronic hepatitis.     

Multicenter study of case finding in elderly emergency department patients

OBJECTIVES: To assess the feasibility of a brief comprehensive case-finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have. METHODS: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. RESULTS: Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 +/- 10.2 minutes was required to complete the screen. CONCLUSIONS: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.     

Predictive significance of early giftedness: The case of precocious reading.

Results of a longitudinal study of 59 10–22 year olds who had been precocious readers when first tested at 5–6 years of age suggest that extraordinary early achievement in reading predicts above-average, but not necessarily extraordinary, ability in reading and related skill areas during the middle elementary school years, as measured by performance on Level 18 of the California Achievement Test (CAT). Median CAT subtest scores were between 1 and 2 SDs above age-appropriate grade norms. Verbal Ability at 5–6 years of age predicted individual differences in precocious readers' later reading comprehension accuracy as well or better than initial reading skills did. General Reading Ability, reading Speed, and letter naming speed at 5–6 years were associated with speed to complete the reading comprehension subtest of the CAT. This study illustrates theoretical and methodological issues that must be addressed in other investigations of early development of giftedness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental calculation in an autistic savant: a case study

We present a detailed investigation of mental calculation in RH, an autistic savant. In Experiment 1 RH performed faster and more accurately than control subjects in mentally solving multi-digit multiplication problems. However, we found no evidence that RH employed short-cut strategies to solve these problems. His response times were consistent with application of a left-to-right computational procedure employed by expert calculators. He also responded extremely quickly to 2-digit squares, suggesting that he may have memorized the answers. In Experiment 2 we taught RH a new computational algorithm for converting temperatures from Celsius to Fahrenheit. RH was able to learn the new algorithm, but required much assistance and made only slight gains with practice. RH did not recognize an easy solution strategy based on inverting steps in the conversion algorithm. We suggest that the inflexible nature of RH's performance may reflect his autistic tendencies coupled with limited intelligence.     

Cause of casualty and drinking patterns: an emergency room study of unintentional injuries

A probability sample of 1494 adult casualty patients sampled in four hospitals in a single Californian county were breathalyzed and interviewed regarding the cause of injury, drinking prior to the injury, quantity and frequency of usual drinking, frequency of drunkenness and prior alcohol-related accidents. In the total sample, 9% were positive on the breathalyzer (4% were at or above 0.10), 17% reported drinking within 6 h prior to the injury, and 29% reported heavy drinking during the last year. Overall, 15% reported a prior alcohol-related accident and this was significantly greater among heavy drinkers than other drinkers. Cause of casualty (fall, cutting/piercing, motor vehicle accident, other collision, fire, other cause) in relation to alcohol consumption variables was analyzed separately in gender- and age-specific categories. Few significant associations were found between drinking variables and individual causes of injury. While these findings may be due to the relatively small number of cases for some causes, as well as to other variables not examined here including severity and type of injury, such baseline exploratory data are important in furthering our understanding of alcohol's involvement in casualty occurrence and point to the need for additional research on alcohol and causes of injury.     

Visual activation patterns in patients with optic neuritis: an fMRI pilot study

We studied the use of functional MRI (fMRI) with visual stimulation in nine patients with unilateral optic neuritis. Eight healthy subjects served as controls. Patients showed reduced activation upon stimulation of the affected eye, on average 33% (range 0 to 156%) of the average monocular activation in the control group. Decreased activation was also seen for the unaffected eye (61% of control values, range 3 to 133%). We conclude that fMRI with visual stimulation is feasible in patients with optic neuritis and deserves future study.     

Diffuse panbronchiolitis in an elderly patient. A case report]

The purpose of this study was to examine the association between recurrent sleep, panic, and suicidal behavior in panic disorder. We compared the recurrent sleep panickers (N = 33) with other panickers (N = 34). The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that recurrent sleep panickers also had a higher percentage of insomnia and comorbid major depression than the others. A multivariate analysis demonstrated an association between recurrent sleep panic and suicidal tendencies in patients with panic disorder. Although recurrent sleep panic alone is not an independent risk factor for suicidal behavior, it may modify the severity of illness in patients with panic disorder.