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Objective: This study tested the impression that there have been significant shifts in the relative diagnostic frequencies of schizophrenia and major affective disorders. Method: Data on discharge diagnoses from 1972 to 1988 were gathered from six North American psychiatric teaching hospitals (data from one extended through 1991), and rates for schizophrenia and major mood disorders were evaluated. Results: Total annual discharges increased by 6.6% during the study period. Large reciprocal shifts in the frequencies of diagnoses of schizophrenia and major affective disorders were found; schizoaffective disorder was a minor diagnosis. Beginning in the early 1970s, a gradual increase in the frequency of diagnoses of major affective disorders at all sites was accompanied by a corresponding decrease in diagnoses of schizophrenia at five of the six centers. Schizophrenia diagnoses decreased from a peak of 27% in 1976 to 9% in 1989 (a threefold decrease), and diagnoses of major affective disorders rose from a low of 10% in 1972 to 44% in 1990 (a fourfold increase). Conclusions: Several forces may have influenced these changes. 1) DSM-III narrowed the definition of schizophrenia and broadened the category of major affective disorders. 2) Treatment-oriented diagnostic bias associated with the availability of lithium and other mood-altering agents may have encouraged consideration of affective disorders. 3) Economic and social forces, including better third-party reimbursement rates, may have favored affective diagnoses. 4) True increases in the incidence of affective disorders may have occurred. 5) Although a real decrease in new cases of schizophrenia may have occurred, this effect was probably minor and dominated by a larger shift of such diagnoses to affective categories.

A study tour of North American and Canadian hospitals has established practice relevant to cardiothoracic nursing in the Royal Brompton National Heart and Lung Hospital, London, England. Case management and primary nursing provided a model for a thoracic nurse specialist. A telephone help-line based on American practice has been introduced. American emphasis on research has prompted teaching sessions. American practice has also influenced developments in pain control, community liaison, information and support.

Updates By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Section Editor, Updates; Section Editor, HIV, is [...]

Baseline data from an epidemiological cohort study has been analyzed to estimate p revalence of dementia in older Mexican Americans, determine the distri bution of dementia by etiology , and investigate the contributions of stroke, type 2 diabetes mellitus, and apolipoprotein E (ApoE) genotype. It was found that dementia prevalence is similar to that reported in Canadian and European studies, but lower than in Caribbean-Hispanics living in the US. The fraction of dementia attributable to st roke and type 2 diabetes mellitus is substangial. The allele frquency of ApoE was similar to that in other published studies on Me xican Americans. The E4 allele appears with low frequncy vs older people of European background.

The advent of Russian, British and Spanish settlers in the 18th century exposed the people of the Northwest Coast to diseases against which they had no immunity, wiping out large populations. In addition, the settlers took away the land and culture of the natives.