258
illustrative of
a new force likely to have a profound influence on psychiatry in the U.S.A. Not only has President Carter’s Commission on Mental Health61 highlighted many of the deficiencies in current practice and outlined amore scientific and socially responsible approach to psychiatry, but the administration has brought in a new breed of academic psychiatrists to high-level posts in the powerful federal agencies. It is to cooperation between such agencies and academic departments that American psychiatry must look for further research advances and for the integration of such advances into broad-based training programmes and eventually into everyday practice. Meanwhile, one can confidently state that the dark clouds which enveloped American psychiatry in the post-war period have now
largely dispersed. 1. Webster, T. G. in Working Papers of the Conference on Psychiatry and Medical Education. American Psychiatric Association, Washington, 1969. 2. Brown, B. Am. J. Psychiat. 1977, 134, March suppl. p. 1. 3. Arthur, R. J. ibid. July suppl. p. 2. 4. Shepherd, M. ibid. 1957, 114, 417. 5. Shepherd, M. Compreh. Psychiat. 1971, 12, 302. 6. Pulver, S. E. Am. J. Psychiat. 1974, 131, 1400. 7. Blackwell, B., Allen, A., Wales, E., Paper read at the Maurice Levine Society, Cincinnati, September, 1977. 8. Armor, D. J., Klerman, G. L. J. Hlth soc. Behav. 1968, 9, 243. 9. Stone, W., Stein, L. S., Green, B. Archs gen. Psychiat. 1971, 24, 468. 10. Casariego, J. I., Greden, J. F. Compreh. Psychiat. 1978, 19, 241. 11. Kernberg, O. F., Burstein, E. D., Coyne, L., Appelbaum, A., Horwitz, L.
Voth, H. Bull. Menninger Clin. 1972, 36, 1. R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., Whipple, K. Psychotherapy Versus Behavioural Therapy. Cambridge, Mass., 1975. 13. Bergin, A. E., Strupp, H. H. Changing Frontiers in the Science of Psychotherapy. Chicago, 1972. 14. West, N. D., Walsh, M. A. Am. J. Psychiat. 1975, 132, 1318. 15. Kline, W. Paper read at the Royal College of Psychiatrists, London, July, Sloane,
1975. 16. Redlich, F., Kellert, S. R. Am. J. Psychiat. 1978, 135, 22. 17. Coryell, W., Wetzel, R. D. ibid. p. 732. 18. Clare, A. W. Listener. Nov. 9, 1978, p. 608. 19. Maher, J. quoted by Clare.18 20. Vaillant, G. Archs gen. Psychiat. 1976, 33, 535. 21. Menninger, K. The Vital Balance: The Life Process in Mental Health and Illness. New York, 1963. 22. Kuriansky, J. B., Gurland, B. J., Spitzer, R. L., Endicott, J. Am. J. Psychiat.
1977, 134, 631. 23. World Health Organisation. International Pilot Study on Schizophrenia, vol. I. Geneva, 1973. 24. Baldessarini, R. J. Am. J. Psychiat. 1970, 127, 759. 25. Dunne, D. L., Fieve, R. R. in Psychiatric Diagnosis: Exploration of Biological Predictors (edited by H. S. Akiskal and W. L. Webb). New York, 1977. 26. Rosenhan, D. Science, 1973, 179, 250. 27. Clare, A. W. Psychiatry in Dissent. London, 1976. 28. Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G.,
Munoz, R. Archs gen. Psychiat. 1972, 26, 57. R. L., Endicott, J., Robins, E. Research Diagnostic Criteria. New York State Psychiatric Institute, Biometrics Research, New York, 1975. 30. Rakoff, V. M., Stancer, H., Kedward, H. B. Psychiatric Diagnosis. New York, 1977. 31. Akiskal, H. S., Webb, W. L. Psychiatric Diagnosis: Exploration of Biological Predictors. New York, 1977. 32. Spitzer, R. L., Klein, D. Critical Issues in Psychiatric Diagnosis. New York, 29.
CONGENITAL RUBELLA DEAFNESS: A PREVENTABLE DISEASE CATHERINE S. PECKHAM
Department of Medicine, Charing Cross Hospital Medical School, Fulham Palace Road, London W6 8RF
J.
A. M. MARTIN
Nuffield Hearing and Speech Centre, Royal National Throat, Nose and Ear Hospital, Gray’s Inn Road, London WC1 W. C. MARSHALL
REFERENCES
12.
Preventive Medicine
Department of
J. A. DUDGEON
Microbiology, Institute London WC1
of Child Health,
Over a 4-year period (1972-75) an unselected sample of 568 children aged under 4 years attending the Nuffield Hearing and Speech Centre were tested for rubella antibody. Sensorineural deafness was subsequently diagnosed in 349 of these children, and 83 (24%) of this group had rubella antibody. In contrast, only 19 (9%) of the remaining 219 children in whom sensorineural deafness was excluded had rubella antibody. The seropositive and seronegative children with sensorineural deafness showed striking differences in family history, history of maternal rubella, adverse perinatal events, and presence of other defects. Congenital rubella is an important cause of deafness, and the rubella vaccination programme must be pursued more vigorously if this serious defect is to be prevented in the future.
Summary
INTRODUCTION
SENSORINEURAL deafness is the
most common abnorassociated with mality congenital rubella, and it is the defect caused this fetal infection which occurs only by alone with any consistency. 1-4 It has been suggested that the number of children with hearing impairment due to intrauterine rubella has been seriously underestimated,5 probably because of the high incidence of subclinical
Spitzer,
1978.
33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. New York, 1977. 34. Mednick, S., Schulsinger, F., Higgins, J., Bell, B. (editors). Genetics, Environment and Psychopathology. Amsterdam, 1974. 35. Gottesman, I. I., Shields, J. Schizophrenia and Genetics. New York, 1972. 36. Goodwin, D. W., Schulsinger, F., Moller, N. Hermansen, L., Winokur, G., Guze, S. Archs gen. Psychiat. 1974, 31, 164. 37. Levine, J. in Psychopharmacology: A Generation of Progress (edited by M. A. Lipton, A. DiMascio, and K. F. Killam). New York, 1978. 38. Usdin, E., Hamburg, D. A., Barchas, T. Neuroregulators and Psychiatric Disorders. New York, 1977. 39. Hanin, I., Usdin, E. Animal Models in Psychiatry and Neurology. Oxford, 1977. 40. Lipton, M. A., DiMascio, A., Killam, K. F. (editors). Psychopharmacology: A Generation of Progress. New York, 1978. 41. Kety. S. ibid. 42. Bunney, W. E Am. J. Psychiat. 1978, 135, July suppl., p. 8.
43. Koran, L. M. ibid. 1976, 133, 1052. 44. National Institute of Mental Health. Staffing Patterns in Mental Health Facilities. N.I.M.H., Series B., Washington, 1972. 45. Ilfeld, F. W. Archs gen. Psychiat. 1978, 35, 716. 46. Kramer, M. Paper given at the Institute of Psychiatry, London, April, 1976. 47. Torrey, E. F. Washington Post, Sept. 4, 1977. 48. Hustead, E. C., Sharfstein, S. S. Am. J. Psychiat. 1978, 135, 315. 49. Arthur, R. J. ibid. 1973, 130, 841. 50. Zussman, J., Lamb, H. R. ibid. 1978, 134, 887. 51. Weissman, M. M., Klerman, G. L. Archs gen. Psychiat. 1978, 35, 705. 52. Robins, L. ibid. p. 697. 53. Gregg, A. Am. J. Psychiat. 1944, 101, 285. 54. Kubie, L. S. Archs Neurol. Psychiat. 1957, 78, 283. 55. Wedge, B. Science, 1967, 157, 281. 56. Freedman, A. M., Kaplan, H. I., Sadeck, B. J. Comprehensive Textbook of
Psychiatry. Baltimore, 1975. 57. Miller, H. G. World Med. 1969, 5, 44. 58. Cerrolaza, M. Compreh. Psychiat. 1973, 14, 299. 59. Kety, S. Am. J. Psychiat. 1974, 131, 957. 60. Klerman, G. L., quoted by Lebensohn, Z. M. Psychiat. Ann. 1975, 5, 376. 61. President’s Commission on Mental Health. Report for the President. Wash-
ington, 1978.
259
during pregnancy. Rubella deafness is theoretically preventable by active immunisation, and if rubella vaccines are effective and if they are taken up by the none-immune female population the number rubella infection
now
of rubella-deaf children should decline over the next decade. This paper reports the findings of a clinical and laboratory study of children attending a large hospital department concerned with the diagnosis and management of early-onset hearing loss. METHOD
Over the 4-year period, 1972-75, an unselected sample of 568 children aged 6 months to 4 years who were referred for assessment to the Nuffield Hearing and Speech Centre were tested for rubella antibody. Since rubella antibody is seldom acquired from postnatal infection before the age of 4 years, the detection of antibody in young children was used to make a retrospective diagnosis of congenital rubella infection.6 Capillary blood was taken from both mother and child onto absorbent paper and tested for rubella haemagglutination-inhibition (H.!.) antibodies as previously described.6 Children with rubellaH.I. antibody titres of 1:16 or greater were regarded as seropositive and those with titres of
illustrative of
a new force likely to have a profound influence on psychiatry in the U.S.A. Not only has President Carter’s Commission on Mental Health61 highlighted many of the deficiencies in current practice and outlined amore scientific and socially responsible approach to psychiatry, but the administration has brought in a new breed of academic psychiatrists to high-level posts in the powerful federal agencies. It is to cooperation between such agencies and academic departments that American psychiatry must look for further research advances and for the integration of such advances into broad-based training programmes and eventually into everyday practice. Meanwhile, one can confidently state that the dark clouds which enveloped American psychiatry in the post-war period have now
largely dispersed. 1. Webster, T. G. in Working Papers of the Conference on Psychiatry and Medical Education. American Psychiatric Association, Washington, 1969. 2. Brown, B. Am. J. Psychiat. 1977, 134, March suppl. p. 1. 3. Arthur, R. J. ibid. July suppl. p. 2. 4. Shepherd, M. ibid. 1957, 114, 417. 5. Shepherd, M. Compreh. Psychiat. 1971, 12, 302. 6. Pulver, S. E. Am. J. Psychiat. 1974, 131, 1400. 7. Blackwell, B., Allen, A., Wales, E., Paper read at the Maurice Levine Society, Cincinnati, September, 1977. 8. Armor, D. J., Klerman, G. L. J. Hlth soc. Behav. 1968, 9, 243. 9. Stone, W., Stein, L. S., Green, B. Archs gen. Psychiat. 1971, 24, 468. 10. Casariego, J. I., Greden, J. F. Compreh. Psychiat. 1978, 19, 241. 11. Kernberg, O. F., Burstein, E. D., Coyne, L., Appelbaum, A., Horwitz, L.
Voth, H. Bull. Menninger Clin. 1972, 36, 1. R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., Whipple, K. Psychotherapy Versus Behavioural Therapy. Cambridge, Mass., 1975. 13. Bergin, A. E., Strupp, H. H. Changing Frontiers in the Science of Psychotherapy. Chicago, 1972. 14. West, N. D., Walsh, M. A. Am. J. Psychiat. 1975, 132, 1318. 15. Kline, W. Paper read at the Royal College of Psychiatrists, London, July, Sloane,
1975. 16. Redlich, F., Kellert, S. R. Am. J. Psychiat. 1978, 135, 22. 17. Coryell, W., Wetzel, R. D. ibid. p. 732. 18. Clare, A. W. Listener. Nov. 9, 1978, p. 608. 19. Maher, J. quoted by Clare.18 20. Vaillant, G. Archs gen. Psychiat. 1976, 33, 535. 21. Menninger, K. The Vital Balance: The Life Process in Mental Health and Illness. New York, 1963. 22. Kuriansky, J. B., Gurland, B. J., Spitzer, R. L., Endicott, J. Am. J. Psychiat.
1977, 134, 631. 23. World Health Organisation. International Pilot Study on Schizophrenia, vol. I. Geneva, 1973. 24. Baldessarini, R. J. Am. J. Psychiat. 1970, 127, 759. 25. Dunne, D. L., Fieve, R. R. in Psychiatric Diagnosis: Exploration of Biological Predictors (edited by H. S. Akiskal and W. L. Webb). New York, 1977. 26. Rosenhan, D. Science, 1973, 179, 250. 27. Clare, A. W. Psychiatry in Dissent. London, 1976. 28. Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G.,
Munoz, R. Archs gen. Psychiat. 1972, 26, 57. R. L., Endicott, J., Robins, E. Research Diagnostic Criteria. New York State Psychiatric Institute, Biometrics Research, New York, 1975. 30. Rakoff, V. M., Stancer, H., Kedward, H. B. Psychiatric Diagnosis. New York, 1977. 31. Akiskal, H. S., Webb, W. L. Psychiatric Diagnosis: Exploration of Biological Predictors. New York, 1977. 32. Spitzer, R. L., Klein, D. Critical Issues in Psychiatric Diagnosis. New York, 29.
CONGENITAL RUBELLA DEAFNESS: A PREVENTABLE DISEASE CATHERINE S. PECKHAM
Department of Medicine, Charing Cross Hospital Medical School, Fulham Palace Road, London W6 8RF
J.
A. M. MARTIN
Nuffield Hearing and Speech Centre, Royal National Throat, Nose and Ear Hospital, Gray’s Inn Road, London WC1 W. C. MARSHALL
REFERENCES
12.
Preventive Medicine
Department of
J. A. DUDGEON
Microbiology, Institute London WC1
of Child Health,
Over a 4-year period (1972-75) an unselected sample of 568 children aged under 4 years attending the Nuffield Hearing and Speech Centre were tested for rubella antibody. Sensorineural deafness was subsequently diagnosed in 349 of these children, and 83 (24%) of this group had rubella antibody. In contrast, only 19 (9%) of the remaining 219 children in whom sensorineural deafness was excluded had rubella antibody. The seropositive and seronegative children with sensorineural deafness showed striking differences in family history, history of maternal rubella, adverse perinatal events, and presence of other defects. Congenital rubella is an important cause of deafness, and the rubella vaccination programme must be pursued more vigorously if this serious defect is to be prevented in the future.
Summary
INTRODUCTION
SENSORINEURAL deafness is the
most common abnorassociated with mality congenital rubella, and it is the defect caused this fetal infection which occurs only by alone with any consistency. 1-4 It has been suggested that the number of children with hearing impairment due to intrauterine rubella has been seriously underestimated,5 probably because of the high incidence of subclinical
Spitzer,
1978.
33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. New York, 1977. 34. Mednick, S., Schulsinger, F., Higgins, J., Bell, B. (editors). Genetics, Environment and Psychopathology. Amsterdam, 1974. 35. Gottesman, I. I., Shields, J. Schizophrenia and Genetics. New York, 1972. 36. Goodwin, D. W., Schulsinger, F., Moller, N. Hermansen, L., Winokur, G., Guze, S. Archs gen. Psychiat. 1974, 31, 164. 37. Levine, J. in Psychopharmacology: A Generation of Progress (edited by M. A. Lipton, A. DiMascio, and K. F. Killam). New York, 1978. 38. Usdin, E., Hamburg, D. A., Barchas, T. Neuroregulators and Psychiatric Disorders. New York, 1977. 39. Hanin, I., Usdin, E. Animal Models in Psychiatry and Neurology. Oxford, 1977. 40. Lipton, M. A., DiMascio, A., Killam, K. F. (editors). Psychopharmacology: A Generation of Progress. New York, 1978. 41. Kety. S. ibid. 42. Bunney, W. E Am. J. Psychiat. 1978, 135, July suppl., p. 8.
43. Koran, L. M. ibid. 1976, 133, 1052. 44. National Institute of Mental Health. Staffing Patterns in Mental Health Facilities. N.I.M.H., Series B., Washington, 1972. 45. Ilfeld, F. W. Archs gen. Psychiat. 1978, 35, 716. 46. Kramer, M. Paper given at the Institute of Psychiatry, London, April, 1976. 47. Torrey, E. F. Washington Post, Sept. 4, 1977. 48. Hustead, E. C., Sharfstein, S. S. Am. J. Psychiat. 1978, 135, 315. 49. Arthur, R. J. ibid. 1973, 130, 841. 50. Zussman, J., Lamb, H. R. ibid. 1978, 134, 887. 51. Weissman, M. M., Klerman, G. L. Archs gen. Psychiat. 1978, 35, 705. 52. Robins, L. ibid. p. 697. 53. Gregg, A. Am. J. Psychiat. 1944, 101, 285. 54. Kubie, L. S. Archs Neurol. Psychiat. 1957, 78, 283. 55. Wedge, B. Science, 1967, 157, 281. 56. Freedman, A. M., Kaplan, H. I., Sadeck, B. J. Comprehensive Textbook of
Psychiatry. Baltimore, 1975. 57. Miller, H. G. World Med. 1969, 5, 44. 58. Cerrolaza, M. Compreh. Psychiat. 1973, 14, 299. 59. Kety, S. Am. J. Psychiat. 1974, 131, 957. 60. Klerman, G. L., quoted by Lebensohn, Z. M. Psychiat. Ann. 1975, 5, 376. 61. President’s Commission on Mental Health. Report for the President. Wash-
ington, 1978.
259
during pregnancy. Rubella deafness is theoretically preventable by active immunisation, and if rubella vaccines are effective and if they are taken up by the none-immune female population the number rubella infection
now
of rubella-deaf children should decline over the next decade. This paper reports the findings of a clinical and laboratory study of children attending a large hospital department concerned with the diagnosis and management of early-onset hearing loss. METHOD
Over the 4-year period, 1972-75, an unselected sample of 568 children aged 6 months to 4 years who were referred for assessment to the Nuffield Hearing and Speech Centre were tested for rubella antibody. Since rubella antibody is seldom acquired from postnatal infection before the age of 4 years, the detection of antibody in young children was used to make a retrospective diagnosis of congenital rubella infection.6 Capillary blood was taken from both mother and child onto absorbent paper and tested for rubella haemagglutination-inhibition (H.!.) antibodies as previously described.6 Children with rubellaH.I. antibody titres of 1:16 or greater were regarded as seropositive and those with titres of
