Biomedical subjects
Publications and source records attributed to M V Seeman.
During a period of 1-2 1/2 years the neuroleptic regimen of 14 schizophrenic outpatients was interrupted every 6 months by drug holidays of 6 weeks' duration. As a result, 10 patients achieved a substantially reduced maintenance dose. The authors were unable to predict for whom the drug holidays would be safe.
This paper describes the author's experience with outpatient groups in schizophrenia and explores the process of ensuring active attendance. Necessary ingredients are the provision of immediate, tangible rewards to patients and therapists, constancy, flexibility, and the long-term benefits of social learning.
This paper outlines the organization and evolution of educational-support groups for the families and friends of schizophrenic patients. The organization involved three phases of expanding services to this target population. Our findings are that: a) relatives experience stage-specific reactions to the fact of schizophrenia in the family; b) topic areas for discussion tend to be the same in different groups; c) as total attendance grows (larger groups), individual attendance rate drops; d) the groups tend to evolve into self-led committees; e) the maximum benefit from the groups, as reported by the participants, is the opportunity to share common, painful experiences. Future goals lie in the encouragement of relative-run community organizations for schizophrenia and the clarification of the role of families in the development and course of the illness.
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All the patients (N = 94) of an outpatient clinic for schizophrenia were evaluated for the presence and severity of neuroleptic induced tardive dyskinesia. Fourty-four percent of the patients showed some degree of tardive dyskinesia. The proportion of patients with tardive dyskinesia increased directly with age and with number of years of neuroleptic treatment. Recent dose reduction exacerbated the syndrome. There were no gender differences in the clinic as a whole. Severity of dyskinesia correlated with anticholinergic drug use, with the piperazine/butyrophenone group of neuroleptics and with the use of depot-administered drugs. The depot correlation was highly significant in the under-30 age group.
This is a single case study of a 22 year old Japanese-Canadian woman who developed schizophrenia, was treated with ECT and several successive neuroleptics and subsequently, three years later, developed a tardive dyskinesia syndrome in association with a behavioral change resembling Gilles de la Tourette disease. This combined syndrome lasted seven months. After neuroleptics were withdrawn, the syndrome diminished in severity and disappeared after four months. Since both tardive dyskinesia and Tourette's disease are thought to be caused by relative overactivity or supersensitivity of the dopamine system, their reversible appearance after long term dopamine receptor blockade by neuroleptics can be expected in susceptible individuals.
Identity, though complex, can be encoded in a name. The name bears the stamp of the namers' traditions and their hopes for the child. The infant's characteristics influence the choice to some degree and, to a degree, a name affects the person who bears it. The interface between names and personal identity is illustrated clinically in syndromes of transsexualism and multiple personality, in twinning, and in the development of the ego-ideal.
Schizophrenia is a continuing and relapsing disorder that begins in early adulthood and lasts indefinitely. Effective treatment, therefore, needs to be long-term and comprehensive. The physician must be able to control disabling symptoms while minimizing the side effects of neuroleptic medication. The lifetime risk remains of depression and suicide, paranoid crisis, social distress and frequent rehospitalization. It is a medical responsibility not only to look after the schizophrenic patient's health but also to coordinate social and emergency services, improve the quality of life, support the family and anticipate problems in offspring. At the time, the physician needs to consider the welfare of the community in which the schizophrenic patient lives.
Five women with excessive and irrational jealousy of their spouses have long defied my therapeutic efforts and have prompted me to explore the sources and the ramifications of conjugal jealousy. This paper presents my experiences and the formulations that have emerged from them.
Four dreams are reported in which associations leading to previously unacknowledged material were elicited by asking about names. Inquiry into names and distortions of names (rhymes, puns, contractions, initials, visual symbols) is a useful technique in the provocation of emotionally-laden connections. A possible explanation lies in the parallel between naturally occurring name transformations and the dream work of regression, displacement, condensation and symbolization.
Marital therapy has developed techniques which do not, for the most part, rely on the individual psychiatric diagnosis of the 2 partners. When both spouses suffer from Borderline personality disorders, the standard techniques do not seem to apply, are difficult to put into effect and the results of therapy are poor. The authors illustrate their experience with the description of a 3 month trial of marital therapy involving a borderline couple. The outcome suggests the need for careful individual and interactional diagnosis prior to marital therapy. Specific psychotherapeutic techniques should be tested for use with Borderline marriage partners.
Erotomania is reexamined by an in-depth study of eight patients. There appear to be two main varieties: the phantom lover syndrome, or fixed delusion elaborated around a person who does not exist, and erotomania proper, a recurrent tendency to believe that one is loved by a powerful, prominent man.
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Thirty patients with a hospital diagnosis of schizophrenia were randomly assigned upon discharge to either 1) a specialized aftercare clinic of 2) to private psychiatrists. At the end of six months, the clinic patients had spent significantly less time as hospital readmissions and were significantly more occupied (i.e. employed or in school) than the private patients. It seems possible that attendance at clinic provides group pressure to maintain drug compliance and may thus work to reduce rehospitalization. It is also likely that the network of clinic paramedical and volunteer staff, by its flexibility and availability, aids the patient's transition into employment.
It is possible, albeit reductionistic, to consider the many dysfunctions of reality testing found in schizophrenia as manifestations of a defective time sense. This perspective on schizophrenic discourse, for instance, permits a new grasp of "schizophrenic logic" and a novel approach to therapeutic interpretation. The present paper describes the use of time-related interventions in the psychotherapy of a schizophrenic patient. Several aspects of time sense are outlined. Under each heading are examples from the psychotherapy of Carrie, demonstrating her idiosyncratic notion of that particular temporal concept. Interpretations are aimed at clarifying the cognitive assumptions underlying the patient's expressions.
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Explore the source record for details and available documents.