P1 Exclusive Series: Dealing with mentally ill citizens on patrol

Part 1: Signs, symptoms & strategies

By Dr. Laurence Miller

Signs and symptoms of abnormal behavior

In medicine, a sign is an objective observation or finding on a clinical examination. Examples include a limp while walking, high blood pressure on a cuff reading, or disorganized and delusional speech content during conversation. A symptom is a subjective experience that is reported by the patient, such as pain in the knee, throbbing headaches on exertion, or voices in his head telling him to fight off the evil forces threatening him.

A syndrome is a standard cluster of signs and symptoms that occur in a regular pattern, are typically associated with a particular causal factor, and/or occur in a particular subset of the population. Examples include degenerative arthritis of the knee in an ex-athlete, hypertensive headaches in an overweight woman with a high-salt diet, and paranoid schizophrenia in a homeless young man who abuses amphetamines and alcohol. A syndrome becomes a disorder when it interferes with important life functions of the patient, such as shortening life, decreasing the quality of health and well-being, or interfering with job, family, or social functioning.

Although different syndromes have different symptom clusters, there are some general signs of mental disorder that police officers should recognize (Pinizzotto & Deshazar, 1997; Russell & Beigel, 1990; Will & Peters, 2004).

General inappropriateness of behavior may be a sign of mental illness, although it may also be due to intoxication or even just youthful exuberance. Individuals with mental disorders tend to have their cognitive and behavioral gyroscopes set to extremes, characterized by either inflexibility and rigidity, or impulsivity and unpredictability. Emotions may range from elated to depressed, calm to panicked, and there may be an unnatural changeability of mood that is inconsistent with the circumstances. Attention, concentration, and memory may be impaired, either due to an organic brain syndrome or heightened distractibility from the anxiety of an internal dialogue. Severely disturbed subjects may be disoriented for time (“What day is this? Is it morning or afternoon?”), place (“Do you know where you are now? Where do you live?”), or person (“What’s your name? How old are you?”).

Speech may be tangential, flitting from topic to topic without a clear connection between them, or it may be circumstantial, remaining on, or returning to, the same topic, even after the conversation has moved on. Perseveration refers to abnormal persistence or repetition of speech or behavior. Pressured speechabnormally slow, occurs in a rapid-fire, jumbled form, as if the person is rushing to spill out all the words as fast as possible; conversely, speech output may seem as if the subject is weighing and measuring every word.

Aphasia refers to a group of organic language disorders characterized by various disturbances in comprehension and expression. Most commonly seen in elderly persons with strokes or dementia, subjects with receptive aphasia fail to comprehend normal speech, and may appear to be ignoring or defying the officer’s commands. The speech output of subjects with expressive aphasia may seem garbled and confused, and in severe cases may be limited to one- or two-word answers that are off the mark. Aprosodia refers to an abnormally flat and unexpressive tone and cadence of speech, even where the vocabulary and grammar are essentially intact. Some subjects may remain completely mute, either due to organic language disturbance or psychotic fear of saying anything. Remember, too, that perfectly healthy suspects may clam up to avoid incriminating themselves or just to be obstinate.

Apoplectic Aphasia Treated by Collaterals-Pricking and Bleeding Method

Case Example The Patient, male, 68 Years Old, had A Sudden Seizure Of Hemiplegia On The Right Body, deviation Of The Eye And Mouth, aphasia And Salivation After Getting Up In The Morning, and Was Sent To The Hospital Immediately, and Was Diagnosed With Cerebral Infarction After Examination And Was Treated Upon Diagnosis For Over Month. Hemiplegia In The Limbs And Deviation Of The Eye And Mouth Had Been Relieved, but Aphasia Was Still There.

Say What?

At the risk of admitting the extent to which I devour pop culture, the first time I was introduced to the concept of aphasia was during an episode of House. The patient on the episode spoke rambled nonsense and was diagnosed with Wernicke’s Aphasia (speaking illogical sentences) and Agraphia (the inability to write rationally). Being the omnipotent doctor that House is, he was able to replace the illogical words for what the patient meant to say and found a way to communicate. While I am ignorant enough to believe a lot of the show (and the consequent hundreds of thousands of dollars in MRI’s) as plausible, I needed to investigate this peculiar neurological disorder for myself.

Translational Research in Aphasia: From Neuroscience to Neurorehabilitation

Purpose: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005.

Method: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles.

Hypertensive Patients Not Following Diets, Corneal Transplantation & Risk of Infection, Link Found Between Speech and Learning Disabilities

(February 11, 2008 - Insidermedicine) From Mississippi - Despite evidence of the importance of dietary modification for the management of high blood pressure, patients with the condition are not complying. Over a decade ago, research showed that a diet high in fruits, vegetables and low-fat dairy products could significantly lower blood pressure. But researchers analyzing data from over 4000 hypertensive patients showed that only 19% regularly follow this diet - down 7% from a decade ago.

From Houston - The source of corneal donation may influence the risk of a post-operative infection in cases of corneal transplantation. In a study of nearly 500,000 corneas distributed by the Eye Bank Association of America, serious eye infections occurred in 3 cases per 10,000. When donor tissue came from hospitalized patients the risk of infection was 3 times higher and if the patient suffered from cancer the risk was twice as high.

And finally, from Chicago - Patients with a progressive neurodegenerative condition that affects speech report a significantly higher likelihood of having previously had a learning disability. In a study of nearly 700 patients, half of whom had Alzheimer's disease, dementia or primary progressive aphasia, those with progressive aphasia were 10 times more likely to report having had a learning disability when compared to controls - particularly dyslexia.

Arts and Aphasia

We are planning a "Celebration of Aphasia" at a locally based venue in 2008 and are looking for talented people from all over the UK to perform -

Would you like to be involved in a theatre performance by people who suffer aphasia?

If you live locally you could get involved in small group rehearsals of bell ringing and/or Eurythmy movement.

Or do you write you own poetry, play an instrument, or you sing?

Don't by shy, contact us and tell us about your [hidden] talents!

We will also facilitate an exhibition for the visual arts !

Columnist earns moment in spotlight

By LISA MARCHESONI, Senior Writer

Columnist earns moment in spotlight

TMP Photo by Kelly Hite. Kathy Hoover relaxes in the sun room of the home she grew up in. Since her stroke, she spends time reading and keeping up with current events in the colorful room.
Newspaper columnist Kathy Hoover wrote about and took photographs of the beautiful people at the fund-raising balls and galas for almost 20 years in Rutherford County.

Now Hoover delivers a more important message — “keep a better handle on your health” by a heart-healthy lifestyle and routine physicals with doctors.

Hoover, 52, of Murfreesboro, took her health for granted until a stroke drastically changed her lifestyle two years ago. She suffers from aphasia, a brain injury that affects speech, language and communications. She lost sight in one eye, so she can’t drive and she lost some use of her hands, so it’s difficult to write.....