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PubMed1981

Comparative studies of psychological function in patients with advanced cancer. II. Interviewer-rated current and past psychological symptoms.

This study compared psychologic function, especially depression, in patients with advanced cancer and in sociodemographically matched, physically healthy patients who had recently attempted suicide. A companion study examined self-report of depressive symptoms; the present study relied on a semistructured interview technique. Eighty patients who were hospitalized on a research oncology ward for treatment of disseminated cancer, acute leukemia, Stage IV Hodgkin's disease, or myeloma were compared by means of the Current and Past Psychopathology Scales (CAPPS) to 80 patients hospitalized on a psychiatric unit for attempted suicide. Interviewer ratings yielded scores on eight scales characterizing each patient's psychologic adjustment during the past month and 18 scales characterizing adjustment prior to the present illness (cancer or suicide attempt). Results showed that by both self-report and observer report, cancer patients wee less depressed and anxious in the past month than the psychiatric group. Approximately one-third on the cancer patients were significantly depressed, depending on the measure used; one-seventh had experienced some suicidal ideation. Cancer patients were better adjusted in the past than the comparison group; however, the cancer patients who were presently most depressed were those who had a prior history of depression and had shown a tendency to brood. Among cancer patients who died during the study period, no correlation between severity of depression and nearness to death could be found. Findings supported use of denial of dysphoric emotions by the cancer patients, but little denial of the diagnosis or the need to accept treatment. Despite stress of advanced illness and threat to life, cancer patient's reality testing and social role performance were superior to that of the suicide attempters, and on the average they had less disturbance of affect and cognition.

Adolescent↗
PubMed2004

Cognitive-behavioral therapy for schizophrenia: a review.

Cognitive-behavioral therapy (CBT) has a proven role as an adjunct to antipsychotic medication and remediative approaches such as social skills training in the management of residual symptoms of chronic schizophrenia. Positive symptoms, depression, and overall symptoms appear to be viable treatment targets for CBT with a less pronounced effect on negative symptoms. The effect size at end of therapy is strong, with durability at short-term follow up. CBT can be used safely in patients with schizophrenia, and caregivers can help with homework exercises. There is also evidence that psychiatric nurses in the community can use CBT effectively with this patient group under supervision. CBT can be combined with family therapy and assertive community treatment programs targeted to reduce relapse. CBT improves the coping of patients with schizophrenia through improved adherence and symptom management. CBT techniques include development of trust, normalizing, coping strategy enhancement, reality testing, and work with dysfunctional affective and behavioral reactions to psychotic symptoms. An enhanced response to CBT would be expected when given with low dose cognitively enhancing atypical antipsychotic medication.

Assertiveness↗
PubMed2005

An open trial of naltrexone in the treatment of depersonalization disorder.

Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a pervasive subjective sense of unreality and detachment with intact reality testing. Two recent controlled medication trials, one with lamotrigine and one with fluoxetine, failed to show efficacy. There is some evidence for dysregulation of endogenous opioid systems in depersonalization, and a few studies have suggested that opioid antagonists may have efficacy in the treatment of dissociation and depersonalization symptoms. In this prospective open treatment trial, 14 subjects were recruited and treated with naltrexone for 6 weeks to a maximum dose of 100 mg/d (first 7 subjects) or 10 weeks to a maximum dose of 250 mg/d (next 7 subjects). Mean naltrexone dose was 120 mg/d. There was an average 30% reduction of symptoms with treatment, as measured by 3 validated dissociation scales. Three patients were very much improved, and 1 patient was much improved with naltrexone treatment. These findings are potentially promising in a highly treatment-refractory disorder for which no treatment guidelines exist and warrant a randomized controlled trial.

Adult↗
PubMed2005

Integrated versus sealed-over recovery in schizophrenia: BORRTI and executive function.

Ego functioning of 222 outpatients with a diagnosis of schizophrenia or schizoaffective disorder was evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI). Sixty-one of these had BORRTI profiles identified as sealed-over recovery style, and 36 had profiles interpreted as integrated recovery style. Groups were compared on demographic characteristics, symptom profiles, and the Wisconsin Card Sorting Test, a performance measure of executive function. Groups had comparably low levels of positive symptoms, but the integrated recovery group had higher scores on the BORRTI uncertainty of perception scale. The integrated recovery group had significantly fewer minority patients, higher IQ, and higher levels of emotional discomfort. The sealed-over recovery group had higher levels of cognitive disorganization. When differences in ethnicity and IQ were controlled for, the integrated recovery group had better executive functioning. Wisconsin Card Sorting Test categories completed emerged as the significant predictor in a logistic regression, explaining 19% of the variance. These findings support the discriminant validity of these two recovery styles and reveal the importance of executive function in a recovery style that allows for investment in relationships, affect tolerance, and acknowledgment of symptoms.

Adaptation, Psychological↗
PubMed2005

Clinical holistic medicine: mental disorders in a holistic perspective.

From a holistic perspective, psychiatric diseases are caused by the patient's unwillingness to assume responsibility for his life, existence, and personal relations. The loss of responsibility arises from the repression of the fundamental existential dimensions of the patients. Repression of love and purpose causes depersonalization (i.e., a lack of responsibility for being yourself and for the contact with others, loss of direction and purpose in life). Repression of strength in mind and emotions leads to derealization (the breakdown of the reality testing, often with mental delusions and hallucinations). The repression of joy and gender leads to devitalization (emotional emptiness, loss of joy, personal energy, sexuality, and pleasure in life). The losses of existential dimensions are invariably connected to traumas with life-denying decisions. Healing the wounds of the soul by holding and processing will lead to the recovery of the person's character, purpose of life, and existential responsibility. It can be very difficult to help a psychotic patient. The physician must first love his patient unconditionally and then fully understand the patient in order to meet and support the patient to initiate the holistic process of healing. It takes motivation and willingness to suffer on behalf of the patients in order to heal, as the existential and emotional pain of the traumas resulting in insanity is often overwhelming. We believe that most psychiatric diseases can be alleviated or cured by the loving and caring physician who masters the holistic toolbox. Further research is needed to document the effect of holistic medicine in psychiatry.

Adult↗
PubMed1975

The concepts: Disturbed state of consciousness and psychosis.

A theoretical analysis is made of the two concepts: "disturbed state of consciousness" (DSC) and "psychosis", and these concepts are defined in ways which are consistent with actual clinical psychiatric work on the Continent. Concerning DSC's two points are emphasized: Whether we, as psychiatrists, are conscious of it or not--one of our premisses for classifying a state as a pathological DSC is an evaluation of the client's ability to change the state voluntarily. Furthermore, stating that a DSC was present in the time interval tl0tn implies stating that all experiences were abnormal in some way during the interval--when the word "experience" is taken in the broad sense, including William James' "fringe" and "embeddedness" in the stream of consciousness. Reality testing may remain the cardinal point in the definition of "psychosis"--if we make the distinction between theoretical, "fullblown", syndromes and concrete syndromes with fewer symptoms clear to ourselves.

Alcoholic Intoxication↗
PubMed1978

Diagnosis of schizophrenic borderline states.

The aim of this paper is to contribute to the clinical description of the group of schizophrenic borderline patients. In the first place important clinical features pointed out in older, basic papers will be restated. Secondly, additional observations, not used in clinical practice before, at least not explicitly, are described, data which are believed to be useful for the diagnosis of the states in question as well as for the differential diagnosis from other conditions, neuroses in particular. In the latter regard the following points are considered to be of outstanding importance: the presence or absence of a primary gain; the presence or absence of strivings to obtain an emotional secondary gain; the nature of the interpersonal relationship; the composition of the single symptoms. Pseudonormal, pseudoneurotic and pseudopsychopathic states are characterized. Micro-psychotic and overt psychotic states are described. Clinical differences from schizophrenic psychosis as observed in patients in the nuclear group of the schizophrenias are pointed out.

Adult↗
PubMed1981

A follow-up study of operated transsexual males.

The opportuneness of operating on transsexuals has often been discussed but it has obviously been the only form of treatment they wish themselves. Most transsexuals in Denmark have been assessed at the Rigshospital prior to surgery. Since 1951, when the first operation on a transsexual took place, we have had a thorough preoperative knowledge of a total of 29 transsexual males who have all obtained official status as females and who have subsequently been followed up. A phenomenologically based clinical theory of the dynamic coherence of the symptomatology of transsexuals has been advanced. A special core group of transsexual males has been described as characterized by a stable defence in the form of a pseudofeminine narcissism, a stable ego strength, an intact reality testing and a poor genital interest. These patients are expected to have a relatively stable life postoperatively. Of the 29 operated transsexual males six were not interviewed, three had committed suicide and two refused to take part in the follow-up. These last five did not belong to the core group, whereas one patient, who emigrated to Canada after sex-reassignment, belonged to the core group. The remaining 23 have all been interviewed, of the 14 belonged to the core group. The average for the follow-up period is 6 years. The operations turned out not to be resocializing, rather the contrary. The majority had no occupation at follow-up and the number of persons with disablement pension had increased considerably. About 66% lived alone and the majority of those with sexual relationships had had problems. Both before and after operation the majority felt socially isolated. About 66% were satisfied with the surgical outcome, nevertheless 50% wished for supplementary plastic surgery. None of the patients showed signs of more severe psychic sufferings or psychoses postoperatively. Psychically, 83% felt better after than before sex-reassignment. The majority have had complications and subjective trouble in connection with plastic surgery leading to reoperations of the vagina in most of them. Almost 75% have had sexual relationships postoperatively but not without difficulties. Characteristic of the persons in the core group is a better economy, a better adjustment to the environment and less problems with neighbours, they are more satisfied with the surgical outcome and have had fewer surgical corrections and also have a better psychic condition than the rest. It is the general impression at follow-up that the advantages of sex-reassignment outweigh the disadvantages where the core group is concerned. But among the persons who do not belong to the core group subjective and objective problems seem so pronounced that operation must be advised against in spite of the often extremely, subjectively unsatisfactory condition of these patients preoperatively.

Age Factors↗
PubMed1988

Ego functions in epilepsy.

Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects served as controls: 15 patients with a non-neurological but relapsing disorder, psoriasis, and 15 healthy volunteers. Compared with the group of healthy volunteers, a decreased adaptive level of ego functioning was found in the epilepsy groups, regardless of seizure types and EEG findings, and, to a lesser extent, compared with the psoriasis group. Areas of ego functioning most affected were "reality testing", "cognitive functioning", "integrative functioning" and "regulation and control of drives". Patients with more than one type of seizure were the most affected, as were patients who were younger than 15 years when the disease began. The number of anticonvulsants administered did not influence the results. No difference on adaptive level of ego functioning was found between the group with primary generalized epilepsy and the group with temporal lobe epilepsy. Similarly, the temporal lobe epilepsy group with predominantly right-sided and left-sided EEG changes, respectively, showed similar adaptive levels of ego functioning.

Adult↗
PubMed1987

Theory-based intervention: a case study using Sullivan's interpersonal theory of psychiatry.

The essence of the schizophrenic dynamism is a confusion in the interpersonal relations by the appearance in awareness of referential processes ordinarily excluded from awareness (Sullivan, 1956; 361). Its etiology can be traced to a pathological symbiotic relationship with the mothering one in which there is an overwhelming degree of anxiety transmitted to the infant. A consistent, frequent, nonthreatening and non-demanding approach is the basis for all nursing interventions. The emphasis of treatment is on identifying and strengthening the patient's assets and raising self-esteem. Interventions are directed toward the patient's resocialization and reality-testing. Staff effort is required to create a milieu in which it is desirable and possible for patients to learn autonomy. Patients should be encouraged to look at their feelings in the light of their past experiences, but with a recognition that the past is over and beyond their control. What happens in the future depends on their efforts now. Finally, nurse-therapists need to be secure, thoughtful, and empathic in treating schizophrenic patients. The challenge for staff is to be absolutely consistent and communicate acceptance and positive regard whatever the patients' behavior.

Adult↗
PubMed1990

The ego competency model of psychiatric nursing: theoretical overview and clinical application.

The Ego Competency Model (ECM) of Psychiatric Nursing provides a focus for the role and function of the psychiatric nurse. The ECM offers a framework for assessing the patient's level of functioning in terms of certain ego strengths and deficits. Emphasizing a balanced health/illness focus, the model identifies three major goals of psychiatric nursing. The ECM scale allows nurses to rate the client on specific ego functions in order to address patient care problems arising from deficits in ego functioning. Ego functions that are systematically assessed with the ECM include impulse control, reality testing, judgment, mood, object relations, activities of daily living, competency, self-perception, thought process, and stimulus barrier.

Ego↗
PubMed2001

Treating the suicidal patient. Basic principles.

Successful psychotherapy with suicidal patients requires an emotionally full, active engagement from the therapist with his patient. Emphasis is on the real relationship, not the transference, and the therapist must be available to the patient as a sturdy, reliable object with whom to identify. The therapist's attitude must be loving, not neutral; the alliance is built upon the therapist's devotion to the patient's growth and the development of the attributes necessary for successful autonomous adult functioning. Patients require emotional containment and support, assistance in modulating painful affect, validation, education, help with reality testing, and kindly limit setting. Countertransference reactions must be expected and kept in check, so that the therapist does not get in the patient's way as he tries to build up the faulty mental structures that got him into trouble in the first place.

Humans↗
PubMed1990

On the measurement of delusions.

Garety (1985) analysed problems with existing definitions of delusions, focusing on the fixity and intensity of delusional beliefs. A quantitative method was proposed to evaluate with greater sensitivity the intensity of delusional conviction and its fixity over time. In this comment, three related points are raised about Garety's analysis and measure. None of the three challenges the fundamental usefulness or value of the measure, although potential problems are noted in the items used to check test-retest reliability and in the wording of one of the two forms described.

Awareness↗
PubMed1988

Management of perinatal loss of a twin.

The death of a twin during pregnancy or around birth gives rise to a bewildering confusion of thoughts and feelings that can impede mourning and disturb the bereaved mother's care of a surviving twin. Every effort should be made to give the parents and siblings an experience of the dead baby. Photographs especially can reduce confusion and assist reality testing and thus facilitate the grieving process and improve the care of the surviving twin.

Bereavement↗
PubMed2000

Cerebral correlates of psychotic symptoms in Alzheimer's disease.

BACKGROUND: Psychotic symptoms are produced by distributed neuronal dysfunction. Abnormalities of reality testing and false inference implicate frontal lobe abnormalities. OBJECTIVES: To identify the functional imaging profile of patients with Alzheimer's disease manifesting psychotic symptoms as measured by single photon emission computed tomography (SPECT). METHODS: Twenty patients with Alzheimer's disease who had SPECT and clinical evaluations were divided into two equal groups with similar mini mental status examination (MMSE), age, sex, and the range of behaviours documented by the neuropsychiatric inventory (NPI), except delusions and hallucinations. SPECT studies, registered to a probabilistic anatomical atlas, were normalised across the combined group mean intensity level, and subjected to a voxel by voxel subtraction of the non-psychotic minus psychotic groups. Subvolume thresholding (SVT) corrected random lobar noise to produce a three dimensional functional significance map. RESULTS: The significance map showed lower regional perfusion in the right and left dorsolateral frontal, left anterior cingulate, and left ventral striatal regions along with the left pulvinar and dorsolateral parietal cortex, in the psychotic versus non-psychotic group. CONCLUSION: Patients with Alzheimer's disease who manifest psychosis may have disproportionate dysfunction of frontal lobes and related subcortical and parietal structures.

Alzheimer Disease↗
PubMed2002

Separating depersonalisation and derealisation: the relevance of the "lesion method".

OBJECTIVES: Depersonalisation (DP) and derealisation (DR) are often met with in patients with a wide range of localisable neurological conditions. This suggests that the "lesion method" might be a valid approach to study the neurobiology of DP/DR. However, the fact that anxiety can trigger DP/DR makes it difficult to establish whether the presence of DP/DR in neurological patients is mainly determined by coexisting anxiety or by lesion location. To overcome this difficulty, we suggest the study of neurological phenomena, which although not considered as DP/DR, bear enough phenomenological resemblance with them as to warrant their use as models. METHODS: One patient with "visual hypoemotionality" and another with "hemiasomatognosia" are described in detail together with a selective literature review. RESULTS: Complaints of patients with visual hypoemotionality are indistinguishable from those of patients with "visual derealisation". There is also a phenomenological overlap between "asomatognosia" and the symptom of "body alienation", which is a central feature of depersonalisation. CONCLUSIONS: Phenomenological similarities between visual hypoemotionality and DR suggest that a disruption of the process by means of which perception becomes emotionally coloured may be an underlying mechanism in both conditions. Likewise, phenomenological overlaps with asomatognosia suggest that DP might result from parietal mechanisms disrupting the experience of body ownership and agency. These findings give validity to the notion that DP and DR may have distinct neurobiological mechanisms.

Adult↗
PubMed1997

On the notion of psychosis: the DSM-IV in perspective.

Using a historical overview and a conceptual analysis of the notion of psychosis, the DSM-IV suggestion to narrow down the notion of psychosis to delusions and hallucinations is examined. It is argued that the suggestion continues a trend in modern psychiatry, and that, perhaps more than others, it might lead to the (mis)identification of the notion of psychosis with the notion of error, which fails to demarcate disordered reality representation--as in delusions and hallucinations--from normal reality representation. Finally, the notion of (impaired) reality testing is presented as permitting such a demarcation, and it is concluded that it is therefore clinically useful and should be preserved, at least for the time being, in the notion of psychosis, including the narrow sense of the notion of psychosis as suggested in the DSM-IV.

Delusions↗
PubMed1975

Platelet monoamine oxidase activity in acute schizophrenia.

The authors found normal monoamine oxidase (MAO) activity in 40 acute schizophrenic patients, in contrast to previous reports of a genetically linked platelet MAO deficit in chronic schizophrenia. Variations in MAO activity were not significantly associated with the 65 clinical variables analyzed, although there was a tendency for patients in the low-MAO group to have more severely impaired reality testing, more paranoid and grandiose delusions, better prognostic scores, and less restlessness.

Adult↗