Biomedical subjects
Publications and source records attributed to P H Soloff.
A 29-year-old woman with no history of paranoia or homicidal behavior developed paranoia, homicidal behavior, and seizures after abusing a preparation containing phenylpropanolamine. The paranoia and seizures were replicated in a controlled inpatient setting following phenylpropanolamine challenge.
In this study the sleep of borderline patients and patients with primary nondelusional depression showed sleep continuity disturbance and greater REM activity and density (particularly during the first REM period) than that of normal control subjects. First-night REM latencies were more variable in the borderline than in the depressed group, but by the second night both groups showed shorter REM latencies than the controls. The similarities in EEG sleep suggest a relationship between borderline disorder and the affective spectrum and cast doubt on the definition of the borderline disorder as a pure character type.
The prevalence of psychiatric disorders was studied among the families of hospitalized borderline patients, defined by Gunderson and Singer's criteria, and compared with the families of schizophrenic and depressed control patients. Among borderline probands, 38.3% have a first-degree relative with depression, 25.5% had one with pathological mood swings, and 23.4% had one with "eccentric or peculiar behavior." There was no significant increase in the prevalence of schizophrenia among the relatives of borderline patients. Depression was more prevalent in the families of schizotypal borderlines compared with unstable or mixed-pattern patients. There were no schizophrenic diagnoses among the impaired relatives of schizotypal borderlines. A relationship is suggested between affective disorder and criteria-defined borderline disorders.
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The borderline diagnosis is widely used despite a lack of systematic research on its reliability and validity. The recent development of a structured interview incorporating diagnostic criteria for borderline disorders in a replicable format represents a necessary, but not sufficient, methodological step in testing the validity of the borderline concept. To our knowledge, this is the first replication of Gunderson's Diagnostic Interview for Borderlines in a clinical setting and population quite different from the original. Clinically defined borderline patients were compared with control groups of schizophrenic and nondelusional unipolar depressed patients. Of 29 scored statements on the diagnostic interview, borderlines differed significantly from schizophrenics on 19, from depressives on 16, and from both on 19. Stepwise discriminant-function analyses of borderline vs each comparison group gave substantial support to the reliability of the interview and the diagnostic criteria.
The clinical use of seclusion was studied prospectively on two acute treatment units of a university hospital. The incidence, frequency, duration, precipitant, and type of seclusion were documented for 59 secluded patients through 107 episodes and compared to 159 nonsecluded controls on a variety of demographic, diagnostic, and legal variables. Chronicity, legal status on admission, and race were patient characteristics correlated with the incidence of seclusion. Mental status and diagnosis were not significantly related to the incidence or the frequency of seclusion. Seclusion was used primarily to contain physical assault upon staff. There was no relationship between the precipitating event and duration of seclusion, nor any change in duration or restrictiveness of seclusion with repeated episodes. These findings differ markedly from previous reports. The clinical bias toward increased use of seclusion with committed, chronic, and black patients, as well as the independence of cause and duration of seclusion raise legal issues already being pursued in federal courts.
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This paper presents a case report of denial of third trimester pregnancy and discusses practical clinical management of the risks to mother and unborn child, including unanticipated and unprotected labor and delivery, the possibility of neonaticide and/or subsequent child abuse and neglect. Ethically challenging decisions must be made concerning involuntary commitment, use of medication, controlled labor and delivery, curtailment and possible termination of parental rights through court action.
The effect of denial upon mood, perceived quality of functioning and compliance with medical advice was studied in 45 coronary patients three months after completing an intensive cardiovascular rehabilitation program. Deniers reported less mood disturbance before and after the program and at three-month follow-up compared with nondeniers. Denial was inversely related to Total Mood Disturbance at all three evaluations. Both groups showed a decline in mood disturbance with treatment and loss of improvement at follow-up. The degree of change was significantly greater for nondeniers. There was no significant difference between groups in any area of compliance or perceived quality of functioning. Denial showed no relationship to overall compliance or quality scores. Total Mood Disturbance was inversely related to both compliance and perceived quality of functioning and appears to be a majro determinant of rehabilitation outcome.
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Recent legal challenges to the use of therapeutic seclusion in the treatment of the mentally ill have forced psychiatrists to defend this practice in court. The clinical characteristics of 10 nonpsychotic inpatients who required restraint are reviewed. These patients are characterized by intense labile affect, impulsive, manipulative behavior and transient micropsychotic episodes in the context of immature personality patterns suggestive of the borderline syndrome. Restraint was precipitated by transient micropsychotic episodes or impulsive behavior during sustained regression. Physical control in these cases is required to defend the social milieu more often than to prevent injury to self or others. The legal implications of these clinical findings are discussed.
The emergence of homosexual anxieties in heterosexual males following a severe blow to masculine self-esteem has been termed "pseudohomosexual" by Ovesey and has been shown to reflect sexual dependence and power conflicts. This article extends the concept, described largely in neurotic patients, to psychotic reactions occurring in basic trainees following failure to adapt to military life. The military setting is viewed as a culturally specific stress for emergence of pseudohomosexual anxieties in predisposed individuals. Case studies illustrate the power and dependence conflicts, sexual symbolization, projective defenses, and restitutional violence which characterize these patients. The pseudohomosexual psychosis defends the patient against perceiving his inability to effect separation from mother, bear the object loss, and attain cultural manhood.
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