DNA content in the leukocytes of psychiatric patients.
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Adolescent↗
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Empirical study on an inpatient psychogeriatric unit: diagnostic complexities.
Retrospective analysis of the phenomenology and the diagnostic process of 112 consecutive psychogeriatric admissions revealed the majority (61%) were suffering from affective illness. In 53 percent, the reason for admission was depression and 8 percent were in the manic phase of a bipolar disorder. Dementia was diagnosed in 32 percent, with a third of these patients having an associated depression. The remaining 7 percent had a schizophrenic or paranoid disorder. Ninety-two patients (82%) were found to have at least one coexisting medical and/or neurological disorder(s) requiring early intervention. Associated acute organic brain syndromes were common (18%) and often difficult to diagnose. The AOBS was at times the only sign of an underlying active medical condition. The diagnosis of this condition often required serial observations for fluctuations in mental status accompanied by appropriate laboratory investigations. These findings underscore the complexity of the diagnostic process in psychogeriatric patients suffering from concomitant medical and psychiatric disorders. High index of awareness is recommended for the need to search for coexisting delirium, which may be masked at times by the major psychiatric disorder.
Aged↗
Catatonia and the neuroleptics: psychobiologic significance of remote and recent findings.
The previously common occurrence of catatonic schizophrenia and catatonic symptoms among schizophrenic patients has diminished sharply; catatonic symptoms now occur more frequently in association with severe affective disorders or with general medical conditions. Catatonia is generally viewed as a peculiar and puzzling syndrome and attracts limited attention. Yet significant catatonic symptoms tend to be present in close to 10% of patients admitted to psychiatric inpatient facilities. The dynamic significance of catatonia can be recognized by considering the original biologic role of catatonia in schizophrenia as an opposite to the paranoid disorder. Szondi viewed catatonia as an attempt at self-healing of the paranoid psychosis with its threatening total expansion, by extreme constriction of the ego. The previously predominant primary association of catatonia with schizophrenia has been eclipsed as neuroleptics have supplanted the endogenous self-healing attempt of catatonia, preventing the occurrence of catatonic symptoms in schizophrenia. Neuroleptics in fact duplicate or approximate the symptoms of catatonia by producing mental immobilization, hypokinesis (parkinsonism and dystonia), hyperkinesis (akathisia), and pernicious catatonia in the modern guise of the neuroleptic malignant syndrome (NMS). Patients with past or present catatonic symptoms are particularly vulnerable to NMS, and treatment of catatonia requires avoidance of neuroleptics and the use of benzodiazepines or electroconvulsive therapy (ECT). The extreme negativism and constriction of consciousness in catatonia suggest a primary role of the frontal lobes, with secondary involvement of the extrapyramidal system and its movement disorders. In an attempt to integrate clinical, psychologic, neuropharmacologic, and neurochemical findings, a modern dynamic neuropsychiatry must appreciate the major significance of catatonia.
Antipsychotic Agents↗
Psychopathology in Sturge-Weber syndrome.
Sturge-Weber syndrome is a rare congenital disease which can impair a child's brain functions and psychosocial development. Its psychiatric aspects have been ignored in the literature. Two male Chinese patients who presented with paranoid disorders and one female Chinese patient who presented with depressive pseudo-dementia are described. Biological and psychosocial aspects of pathogenesis are discussed, especially in the light of a "shame-humiliation model" of paranoid processes, since shame and humiliation are engrained in Chinese culture. These case descriptions suggest an overlooked association of Sturge-Weber syndrome with psychopathology and have important implications for the prevention and treatment of such potentially crippling psychiatric complications in subjects with this syndrome as well as other visible physical handicaps.
Adolescent↗
A systematic method for clinical description and classification of personality variants. A proposal.
A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulus-response characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.
Animals↗
Folie à trois among two Soviet-Jewish immigrant families to Israel.
In two cases of folie à trois, affecting two Soviet-Jewish families who emigrated to Israel, both elderly parents in both cases shared the paranoid delusional beliefs of an only child. Severe trauma in the past and social maladjustment in the present may be among the precipitating factors for the development of the shared paranoid disorder.
Adult↗
Sleep in schizophrenia: a polysomnographic study on drug-naive patients.
A slow wave sleep (SWS) deficit and a shortened rapid eye movement (REM) sleep latency are commonly reported in schizophrenic patients. However, most of these patients have been off neuroleptic medication for only a short period of time. Therefore, the reported sleep alterations may be due to residual drug effects. We polysomnographically investigated 22 drug-naive patients with a schizophrenic disorder, paranoid type, and 20 normal controls. In addition, we assessed the ventricular brain ratio (VBR) by means of computed assisted tomography. Except for a prolonged sleep onset latency, increased wake time and decreased stage 2 sleep, the patients showed a sleep pattern, i.e., of SWS and REM sleep, comparable with that of controls. The VBR was increased in 71% of the patients but was not associated with the patients' clinical characteristics or their SWS and REM sleep patterns. Our results indicate that the commonly reported SWS and REM sleep changes in schizophrenia reflect the remnant of prior neuroleptic treatment rather than the pathophysiology of the disorder itself.
Adult↗
Epidemiology of psychiatric care of patients with severe mental disorders in Italy. Rationale and design of a prospective study, and characteristics of the cohort. Italian Collaborative Study Group.
The rationale and design of a large, multicentre, prospective follow-up study on the outcome of severe mental disorders is presented. The study is currently under way in Italy, where psychiatric care has been uniquely characterised since 1978 by the statutory prohibition of admitting patients to psychiatric hospitals. The main purpose of the study is to describe the 5-year outcome of patients with a diagnosis of schizophrenia, paranoid disorder, affective psychosis, reactive psychosis or personality disorder with respect to five areas (clinical condition, personal autonomy, work, and family and social relationships); a secondary objective is to describe the heterogeneity of practices and resources of psychiatric services. The study is being carried out by 76 outpatient psychiatric services throughout the country, covering approximately one-tenth of the Italian population.
Adult↗
Clinical and etiopathogenic specificities of the French concept of psychose hallucinatoire chronique compared to schizophrenia.
The French concept of psychose hallucinatoire chronique (PHC) is characterized by late-onset psychosis, occurring predominantly in females. Symptoms are rich and frequent hallucinations but almost no dissociative features or negative symptoms. This diagnosis is classified among schizophrenia disorders (paranoid type) according to DSM-IV. PHC may also describe a group of patients with original clinical presentation and etiopathogenic factors. We compared 38 female PHC patients with two groups of female schizophrenia patients, matched for age at interview for the first group (n = 35), and duration of the disorder for the second group (n = 36). PHC subjects were relatively older patients with homogeneous clinical features characterized by predominantly positive symptoms without deterioration and fewer relatives with schizophrenia than schizophrenia patients. This first controlled study underscores clinical, phenomenological, and possibly etiopathogenic factors that characterized the PHC patients, even when the impact of late onset and late age at interview were taken into account. This study provides evidence that PHC may be a possible diagnosis in clinical practice, although it is difficult to reach a conclusion on its relationship with schizophrenia.
Adolescent↗
Circadian rhythms and psychiatric disorders in the elderly.
This article reviews changes in circadian rhythms that have been reported to occur in the elderly psychiatric population. Data relating to circadian changes in normal aging are included where relevant. Information was obtained from: (1) a computerized MEDLINE search from 1975 to May 1996; (2) a review of bibliographies of papers obtained through the computerized search; and (3) texts on chronobiology. We could not locate any information relating to circadian rhythms and mania, anxiety, or paranoid disorders in old age. Disruption to the sleep/wake cycle, temperature, melatonin, and motor activity rhythms have been reported in dementia and depression, and disruption to some neuroendocrine and cardiovascular rhythms are reported in dementia. Disruption to circadian rhythmicity has implications for the management of dementia patients: for example, the sleep/wake and behavioral disturbances, and for the long-term management of mood disorders. A number of circadian markers have not been studied and several patient groups have received no research attention to date.
Aged↗
Clozapine in the treatment of neuroleptic-induced blepharospasm: a report of 4 cases.
BACKGROUND: Blepharospasm, the forcible closure of eyelids, is an infrequent consequence of neuroleptic treatment that, when severe, can interfere with the ability to walk, drive, or work. Like tardive dyskinesia, blepharospasm can be disfiguring and aesthetically distressing, contributing to the increased stigmatization of patients. CASE REPORTS: We report 4 patients with DSM-IV schizoaffective disorder, paranoid schizophrenia, or chronic undifferentiated schizophrenia who developed neuroleptic-induced blepharospasm. In all patients, blepharospasm remitted without the reemergence of psychosis within 3 to 5 months of treatment with clozapine, 100-200 mg/day. CONCLUSION: The results suggest that clozapine may successfully treat neuroleptic-induced blepharospasm without the reemergence of psychosis in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder.
Adult↗
Antisocial behavior and personality disorders.
Present classifications fall short of helping clinicians to systematically approach syndromes of antisocial (A-S) behavior. Various clinical forms of A-S behavior derive from different levels of personality organization (normal, neurotic, and borderline level) whereas certain personality disorders (PD) display specific antisocial "profiles" and form the horizontal continuum of antisocial behavior. The borderline level of personality and pathological narcissism stand behind A-S PD, Narcissistic PD, and Histrionic PD. The authors propose that the disorders should be regarded as spectrum disorders. Paranoid PD and "pure" Borderline PD complete the list of PDs manifesting A-S behaviors. Finally, diagnostic instruments for clinical approach to and research of A-S PD are presented.
Antisocial Personality Disorder↗
Overview of depression and psychosis in Alzheimer's disease.
The authors reviewed 30 studies on Alzheimer's disease to determine the prevalence and phenomenology of affective and psychotic symptoms in patients with this disorder. Depressive and psychotic symptoms occurred in 30%-40% of the Alzheimer's disease patients. Isolated symptoms were two to three times as frequent as diagnosable affective or psychotic disorders. Paranoid delusions were the most common psychotic symptoms reported. Implications of the relationship of psychiatric symptoms to the clinical presentation of Alzheimer's disease, patterns of cognitive dysfunction, clinical management, and areas for future research are discussed.
Alzheimer Disease↗
Assessing drug abusers with the Millon Clinical Multiaxial Inventory: a review.
This paper reviews studies that used the Millon Clinical Multiaxial Inventory with drug abusers. Although the test has been used with over 2000 such patients in the published literature, there is still a dearth of basic research with the MCMI with this population. Preliminary evidence suggests that the Personality Disorder Scales are quite useful to assess personality styles of drug abusers, but the Clinical Syndrome Scales present some problems. Specifically, the Drug Dependence Scale has had difficulty in reliably "detecting" drug addicted individuals who were in treatment for drug abuse. However, a reliable modal MCMI profile among this population seems to exist, although cluster research suggests several subtypes, each with different personality styles. MCMI computer-narrative reports may overdiagnose paranoid disorder and under diagnose antisocial disorders among this population.
Humans↗
The post-acute functioning of the schizophrenic.
Assessed 44 chronic schizophrenic and 38 chronic nonschizophrenic patients recently discharged from psychiatric hospitals; symptoms as well as social and vocational functioning were evaluated. Results indicated that the recently discharged schizophrenics suffered more from social and vocational dysfunction than acute symptom distress. Furthermore, "neurotic-like" symptoms appeared to be more generally characteristic of this post-acute phase than psychotic symptoms. The nonschizophrenic sample differed in no significant respect from the schizophrenic group. Results were interpreted to support the concept of multidimensional outcome for schizophrenic psychopathology and to suggest that chronicity may be a syndrome in itself, characterized by performance deficit and neurotic-like symptoms, which transcends traditional diagnostic categories.
Adult↗
Manic-depressive illness: evolution in Kraepelin's Textbook, 1883-1926.
BACKGROUND: The syndrome of manic-depressive insanity (MDI), as conceptualized by Emil Kraepelin a century ago, with later refinements, continues to dominate research and clinical practice with mood disorder patients. Current understanding of Kraepelin's views by Anglophones is heavily influenced by the late, highly developed, MDI concept represented in the 1921 partial English translation of the last complete edition of his textbook, the product of gradual development over several decades. METHOD: We reviewed all nine editions and revisions of Kraepelin's Textbook (1883-1926) and other writings by him to document the evolution of his views of MDI, and characterized salient developments within biographical and historical contexts. RESULTS: We found support for the traditional impression that Kraepelin's clinical perception of similarities of various forms of periodic psychiatric disorders marked by fundamental dysregulation of excitation and inhibition of thought and behavior, as well as of mood--as distinct from chronic psychotic illnesses--encouraged his broad, mature concept of MDI. However, our findings indicate a complex evolution of Kraepelin's MDI concept in the 1880s and 1890s, his use of more creative and less empirical clinical methods than traditionally believed, and his considerable personal uncertainty about making clear distinctions among MDI, dementia praecox, intermediate conditions, and paranoid disorders--an uncertainty that persisted to the end of his career in the 1920s. CONCLUSIONS: Kraepelin responded to a compelling international need for diagnostic order in nineteenth-century psychiatry, and effectively promoted his diagnostic proposals with a widely used and influential textbook. Though his methods were less empirical than is usually realized, his legacy includes analysis of large clinical samples to describe psychopathology and illness-course, along with efforts to define psychobiologically coherent and clinically differentiable entities, as steps toward defining psychiatric syndromes. Modern international "neo-Kraepelinian" enthusiasm for descriptive, criterion-based diagnosis should be tempered by Kraepelin's own appreciation of the tentative and uncertain nature of psychiatric nosology, particularly in classifying illnesses with both affective and psychotic features.
Bipolar Disorder↗
[Coenesthesia--an important differential diagnosis in chronic pain syndromes].
BACKGROUND: Coenesthesias can be defined as disorders of body perception or body hallucinations, projected in different parts of the body. Patients complain of intractable pain or dysesthesia. These symptoms are reported even from organs where we usually have no perception. Coenesthesia must be regarded as a symptom that can be observed in various psychiatric diseases, e.g., schizophrenia. However, in rare cases coenesthesias can be documented in neurological diseases, e.g., intracranial tumors or infections. Therefore, accurate assessment of possible differential diagnoses is important. In late stages, coenesthesias can easily be recognized because of their "bizarre" character. In early stages, however, patients often complain of intractable, unlocalizable burning pain. They frequently undergo operations because of their great suffering. The drug treatment of first choice is neuroleptics, but the results are unpredictable. CASES AND THERAPY: The case studies of three patients are presented and discussed (patient 1 with coenaesthetic schizophrenia, patient 2 with coenesthesia in the course of a delusional (paranoid) disorder; patient 3 with coenesthesia caused by carcinomatous meningitis).
English Abstract↗
Psychiatric hospitalization of dementia patients by commitment order in Israel.
Commitment order by a district psychiatrist is one of several modes of involuntary admission into a psychiatric hospital. Data regarding all the commitment orders by district psychiatrists in 1990 for elderly patients age 65 years or more were obtained from the national psychiatric case register. Demographic and clinical characteristics of patients diagnosed as ICD-9 senile organic psychotic conditions have been compared with the same characteristics of patients suffering from ICD-9 affective psychoses, schizophrenic disorders, paranoid states and transient organic psychotic conditions. The conclusions are: (a) Dementia patients are underrepresented in this sample of commitment orders; (b) from a demographic point of view dementia patients are no different from other psychiatric patients, age being the sole exception; and (c) from a clinical point of view dementia patients differ from other committed psychiatric patients in three ways: (i) their commitment is usually their first hospitalization; (ii) they are discharged from hospital within a two-month period; and (iii) they are referred for continuation of treatment in a non-psychiatric system. We conclude that psychiatric admissions under commitment order constitute a temporary solution for a very small group of dementia patients.
Aged↗