A contribution to the study of psychoses in young people with special reference to prognosis

This thesis is concerned with the occurrence of acute psychotic reactions in adolescents and young adults. The study of the causation, the symptoms, and the course of these reactions, furnishes a series of problems of importance and interest. The thesis depends on the examination of the psychoses as reactions brought on by an interplay of the social environment and the individual endowment.The fundamental problem that is discussed is the problem of prognosis. The question that we will address ourselves to is the question of what the prognosis depends on in these reactions. There are various subsidiary questions, each in itself a method of approach to the main problem. For example, the factors which conduce to a recovery are fully discussed and the factors which constitute a basis of malignancy in the reactions are considered. The problems are approached by an examination of the evidence manifested in the endowment of character and personality, in the environmental circumstances, and in the psychotic reaction itself. The points suggestive of the reaction being of a more easily recoverable nature are evaluated along with those which might indicate that the final and satisfactory social adjustment is more difficult of achievement.The problem of the relation to prognosis of the character and personality, the environmental circumstances, and the psychiatric symptomatology may be approached in many ways. What are the best methods of approach? In what way, for example, should the pre -psychotic personality be assessed? To what extent in the majority of cases is it possible to arrive at a satisfactory estimate of the type of pre- psychotic personality or the adequacy of the pre -psychotic character? To what extent is it the case that the better the pre -psychotic adjustment, the better the prognosis? Can the pre-psychotic history be regarded as a reliable guide to prognosis? To what extent can mental illness or eccentricity in the parents or ancestry be taken as a guide to the unsoundness of the individual endowment?The study of the environmental circumstances similarly raises many points. Can abnormality in the reactions of the parents be considered also in this connection? Can the reactions in some such cases indicate an understandable reaction in the circumstances, or is the parental abnormality more suggestive of the likelihood of a bad endowment in the offspring and of the probability that an illness occurring in early life is likely to be malignant in proportion to the eccentricity of the parents? If patients come from a part of the country where there is a greater tendency to psychotic reactions, is it likely that the majority will not recover on account of their coming from a bad stock, or is it likely that the factors that in other people would 'lead to adolescent emotional difficulties of a minor nature, lead, in such people, to a frank psychotic reaction and that this reaction is therefore a temporary upset. In the case of patients who have espoused strange beliefs, or have been interested in strange sects, can it be assumed that there has been an insidious tendency to abnormal thinking indicative of a progressively asocial type of reaction? Or does the fact that a patient has for long been involved in, say, spiritualistic beliefs indicate that the psychosis is not so bad as it looks, that the patient is not so ill, having regard to his usual standard of mental health, and that as he has been associated with others in the abnormal trend of beliefs, so he may be influenced by others towards a recovery?With regard to the study of the patient in the psychosis, there are also many factors to consider. Is an acute onset always of good prognosis, or sufficiently so to serve as a useful guide? If regression is not a true indication of a bad prognosis, is it any guide at all? How should a stupor reaction be assessed in terms of prognosis? Is apparent absence of affect a bad sign? Is preservation of affect always a good sign? Can the extent to which affect is present always be assessed with any degree of confidence? Can any of the features of the psychosis be regarded with any degree of confidence as of good or bad prognosis? Is the acute recoverable schizophrenia of young people a true condition?Do cases of chronic depression occur, beginning in youth? Is it legitimate to divide all cases of psychosis occurring before the age of thirty between the manic depressive group and the schizophrenic group? Is it to be recommended that these names should carry as much prognostic significance as they are accustomed being acceded? Is it possible to continue the use of these terms without such impli- cations having regard to the tenacity with which the diagnosis and course have clung together in spite of all efforts at separation?It is generally appreciated that a prognostic classification has more disadvantages and advantages and that diagnosis by outcome is wholly unsatisfact- ory. The disadvantages of a prognostic classification have been a constant subject of dissension for the past thirty years, and diagnosis by outcome has been held up to ridicule. At the same time the present methods are but modifications of the methods of classifying by prognosis and diagnosing by outcome. The current practice is somewhat as follows:If the examiner's bias is in favour of basing a prognosis on the features of the psychosis, he first assesses the relative prominence of manic - depressive and schizophrenic features and then makes a diagnosis which bears great prognostic significance since the manic depressive elements are equivalent to the more favourable prognostic signs and the schizophrenic to the less favourable. If the manic depressive patient recovers and the schizophrenic patient dements, then the diagnosis is supported by the course. If, on the other hand, the manic depressive patient proceeds to dementia, the diagnosis requires to be changed although the schizophrenic patient may be allowed to recover without the necessity of change of diagnosis.If the examiner's bias is in favour of basing prognosis mainly on the pre -psychotic history, he first arrives at an estimate of the comparative adequacy of the adaptation, assesses the prognosis on this estimate, and calls the patient "manicdepressive" or "schizophrenic" according to the prognosis already arrived at.There is sufficient truth in this account of present methods of diagnosis and prognosis to make it clear that the criticisms of the more rigid type of prognostic classification have not had the desired effect.If the term "schizophrenia" is to be robbed of much of its prognostic importance, then an assessment of the prognosis on the basis of the psychosis, or the pre -psychosis, being so much schizophrenic and so much manic -depressive psychosis will no longer be valid. Are the essentially schizophrenic and the essentially malignant the same? If not, then the term "schizophrenia" can embrace recoverable conditions. How wide should the net be cast? Are all cases of malignant psychosis occurring in young people cases of schizophrenia? If so, is it reasonable to hammer away at the necessity of separating diagnosis from prognosis? If cases other than schizophrenia occur in youth and run a malignant course, can the division remain, or must a new search be made for the essential and fundamental characters of the psychosis?If there is so much misgiving with regard to diagnosis, is prognosis in a better position? Are the prognostic principles of the past thirty years justified? Is a prognosis based on the psyd2 osis and the pre -psychotic history sufficiently accurate to permit us to be satisfied with the present methods, or are such studies as the present merely indicative of an awareness of the limitation of present methods and of an admission that the secant of reversibility in the psychoses must await the development of psycho pathology, or of the methods of psychometry, biophysics and biochemistry?In the present contribution, the psychosis is considered in relation to the life situation. This relationship is studied with a view to finding indications of importance for prognosis. It should be made clear that in the selection of case material, the less malignant rather than the more malignant have been chosen. The approach to the study of the prognosis can be made in two ways. One way is to attempt to establish the essential signs of malignancy, to search for what are assumed to be the essentially malignant features, and to assess the prognosis on their relative prominence. This is best done in association with a report of cases which are running a chronic course. In the present contribution, the other method is chosen; namely, an attempt is made to estimate the value of what may be considered to be favourable signs in the pre -psychotic history, the onset of illness, and the features of the psychosis. Reports are given of groups of cases where such favourable signs can be noted. By means of brief historical surveys, the development of the present -day methods of approach to the problem of prognosis is studied. It is hoped that if this thesis were read by anyone unfamiliar with twentieth century methods in psychiatry, it would prove sufficiently comprehensive for the value of the approach to mental illness in terms of the life situation and the psychobiological reaction to be appreciated. If present -day methods have their limitations, it is surely because the deeper implications in the psychobiological approach have yet to be realised.It is my belief that an examination of the psychosis in its relation to the environmental circumstances and the development of the individual from childhood is as important in the study of mental illness as i8 the examination of the symptoms and physical signs in relation to gross pathology in the study of physical diseases. On this basis an attempt is made to indicate the possibilities of prognostic forecasts.An examination of the psychosis in relation to the development of the individual in early childhood may prove' more analogous to the study of sickness in relation to the finer pathology of disease, and may reveal methods of surer guidance in prognosis. This thesis is not concerned with any such study

Models of pastoral counselling: An ethnographic study

This study, which seeks a model of pastoral counselling, examines twelve interviews of clergy and lay pastoral counsellors involved in counselling in a hospital, parish or social service agency. From the interviews the counsellors appear to have identified five themes. The first is the variety of psychological therapies and diagnostic tools upon which the counsellors draw. Secondly there is circumstance that organized a client-centred and flexible approach which describes the basic pattern and attitude the counsellors adopt. The third theme is the integration of psychology and theology in counselling. The fourth theme shows the counsellors exclusive use of scripture/theology during counselling. The metaphors, which the counsellors use to describe the pastoral counselling process is the fifth theme. The findings indicate the predominance of the first three themes in pastoral counselling models with theme four as an addition in specific instances. Theme five provides a descriptive guide to the models

De Facto Merger in Texas: Reports of Its Death Have Been Greatly Exaggerated

This comment examines three issues of Texas de facto merger law. First, whether the Texas Legislature\u27s 1979 amendment to Article 5.10 of the Texas Business Corporations Act was intended to eliminate the de facto merger doctrine, regardless of how closely a transaction resembles a merger. Second, whether the 1987 and 1991 amendments to Article 5.10 are additional evidence of a legislative intent to eliminate the de facto merger doctrine. And, if so, whether it was sound public policy to completely eliminate the de facto merger doctrine

A study of selected junior college students who transferred to the University of Kansas

Thesis (M.A.Ed.)--University of Kansas, Education, 1929

British Policy in West Africa, the Malay Peninsula and the South Pacific During the Colonial Secretaryships of Lord Kimberley and Lord Carnarvon, 1870-1876.

Three experiments in Britain's tropical empire were begun in 1874. The forts on the Gold Coast were added to the island of Lagos to form a crown colony which was given legislative power in the Gold Coast Protectorate, the first Residents were appointed in the Malay States and the Fiji Islands were annexed. As it has "been suggested that these developments formed part of a new forward colonial policy inaugurated by Disraeli, and since the three experiments were sometimes mentioned together, an examination of the background of the changes and a consideration of their place in the history of British policy may be useful. Local events in each area reached a crisis during Gladstone's first ministry at a time when changes in personnel gave the Colonial Office a different bias. The separatist Sir Frederic Rogers gave way as Permanent Under-secretary in 1871 to Robert Herbert, a former Premier of Queensland; Lord Kimberley, a conscientious Colonial Secretary, who gave close attention to the local crises, took office in 1870, and Edward Knatchbull-Hugessen, who became Parliamentary Under-secretary in 1871, showed himself to be an eager expansionist. Between 1870 and 1873 they conducted a careful reappraisal of Britain's role in the three tropical regions, and between February and August 1873 Kimberley decided to intervene in the Gold Coast against Ashanti invaders, he suggested the appointment of Residents in Malaya, and he urged Gladstone to annex Fiji. As the Liberal Government fell in February 1874 before future policy had been determined, the final decisions fell to Lord Carnarvon, Disraeli's Colonial Secretary. He decided to follow Kimberley's policy in each case, but he announced strictly limited aims. Instead of initiating a period of colonial expansion he saw himself conducting three experiments in the administration of tropical dependencies

Numerical solution of the conditionally averaged equations for representing net mass flux due to convection

The representation of sub-grid scale convection is a weak aspect of weather and climate prediction models and the assumption that no net mass is transported by convection in parameterisations is increasingly unrealistic as models enter the grey zone, partially resolving convection. The solution of conditionally averaged equations of motion (multi-fluid equations) is proposed in order to avoid this assumption. Separate continuity, temperature and momentum equations are solved for inside and outside convective plumes which interact via mass transfer terms, drag and by a common pressure. This is not a convection scheme that can be used with an existing dynamical core -- this requires a whole new model. This paper presents stable numerical methods for solving the multi-fluid equations including large transfer terms between the environment and plume fluids. Without transfer terms the two fluids are not sufficiently coupled and solutions diverge. Two transfer terms are presented which couple the fluids together in order to stabilise the model: diffusion of mass between the fluids (similar to turbulent entrainment) and drag between the fluids. Transfer terms are also proposed to move buoyant air into the plume fluid and vice-versa as would be needed to represent initialisation and termination of sub-grid-scale convection. The transfer terms are limited (clipped in size) and solved implicitly in order to achieve bounded, stable solutions. Results are presented of a well resolved warm bubble with rising air being transferred to the plume fluid. For stability, equations are formulated in advective rather than flux form and solved using bounded finite volume methods. Discretisation choices are made to preserve boundedness and conservation of momentum and energy when mass is transferred between fluids. The formulation of transfer terms in order to represent sub-grid convection is the subject of future work