ABSTRACTSA behavioral approach topost-catastrophic illnesswork phobiasBrown MA. Psychiatry in Medicine 8:235­242,1977-1978.

• Following severe illnesses, psy­chologic and social factors inhibitmany individuals from returning totheir previous level of functioning.This paper describes a behavioralapproach to prevent prolongedconvalescence following a severeillness. Individuals who suffer life­threatening diseases often fear thatwork was the cause of their illnessand that return to an active life willlead to another episode. Two casesare presented in which individualswere leading restricted, passivelives following episodes of cerebralvascular disease. A treatment regi­men consisting of systematic de­sensitization focusing on workblocks was set up. Concurrent withprogressive relaxation, the individ­uals were able to overcome anxietyabout active behavior. In addition,co-therapy was utilized to targetdepressive behaviors that wereconsidered to augment the dimin­ished work function. Therapistswere alert to positive and negativereinforcers and enlisted the help offamily members to encourage thepatient. Behavioral assessments ofthe treatment revealed markedsuccess within three months. Withincreasing activity and concurrentdiminution of anxiety, each indi­vidual was able to begin to lead aproductive life. The author notesthat the work function is a criticalindicator of psychologic well-being.Illness provokes a sense of loss ofesteem and self-confidence, whichcan be magnified if the sick indi-

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vidual does not return to work or anactive life. The anxiety and depres­sion, as well as the accompanyingbehaviors of work inhibition, wereovercome by means of this behav­ioral approach.

Thomas N. Wise, M.D.Falls Church, Va.

Bnin aging and Alzheimer'sdiseaseCrapper DR, De Boni U. Can PsychialrAssoc J 23:229-232, 1978.

• The authors review the presentstate of knowledge about the pro­gressive dementias. They empha­size the similar neuropathology insenile dementia and presenile de­mentia ofthe Alzheimer's type, andtrace three lines of etiologic re­search as a possible beginning tothe understanding of each. Theypostulate a viral origin in certainpersons, connecting this to researchin the fairly well defined conditionsof Creutzfeldt-lacob disease, mul­tifocal leukoencephalopathy, andsubacute sclerosing panencepha­litis. The consideration that even abenign virus may be responsible incertain individuals as a result ofimmunologic dysfunction has someappeal and neuropathologic evi­dence. The finding of immuno­globulins and altered serum pro­teins in patients with senile plaquestends to indicate this. Another lineof study makes a connection withthe finding of increased aluminumlevels in some brain areas in certainAlzheimer's patients. This is a simi­lar finding to that uncovered inprogress with dementia related tohemodialysis. For the patient facedwith the bleak future ofpresenile orsenile dementia these speculations

may appear futile. However, forphysicians the finding ofany clue toetiology at least offers a beginningin the better understanding of thisdisease, its possible prevention,and, ultimately, the improvementof treatment for these unfortunatepatients.

David L Keegan, M.D.Stanford, Calif.

Abnormal cr-scans inmignine

Mathews M, Welch N. Headache 16:272­279,1977.

• The authors report a series of 29patients with computerized axialtomography scans of the supraten­torial region with a four-scan se­quence generating tissue sections of13 mm. Ten of the 29 patientsshowed abnormalities. Six showedareas of low density in the paren­chyma of the cerebral hemispheres.Multiple low density areas ap­peared in three of these, either inthe same or both hemispheres.Four cases revealed moderate en­largement of the lateral ventriclesassociated with parenchymal lowdensity zones. Cortical atrophy wasfound in three cases, diffuse andsymmetric in one and localized inthe other two. The changes are pre­sumed due to cerebral edema re­sulting from transient alterations inblood-brain barrier caused by se­vere cerebral vasoconstriction withsubsequent ischemia. Though thechanges were found to be tempo­rary on later examinations, thepossibility of permanent cerebralinfarction is entertained.

Fred O. Henker III, M.D.Little Rock, Ark.

PSYCHOSOMATICS