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Results for “Reality Testing”

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PubMed1979

Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders.

In a pilot study of 150 manic or depressive patients, the authors used the Research Diagnostic Criteria (RDC) and the Schedule for Affective Disorders and schizophrenia (SADS) to perform preliminary analysis of symptom pictures of the index episode of different diagnostic groups, joint diagnostic classification of the different subtypes of major depressive disorder, and differential outcome by diagnostic groups. The results suggest that schizophrenic symptoms in affective disorders do have diagnostic and prognostic significance, that the term "psychotic depression" should be limited to impaired reality testing without reference to degree of incapacitation, that situational-nonsituational and endogenous-nonendogenous classifications are separate depressive subtypes, and that it may not be true that patients with endogenous major depressive disorder have a better prognosis than patients with nonendogenous depression.

Adjustment Disorders↗
PubMed1980

A comparative study of borderline patients in a psychiatric outpatient clinic.

The authors applied a list of operational criteria to all new patients in a large psychiatric outpatient department over a one-year period. A randomly selected group of patients clinically diagnosed as having borderline personality disorder was compared with groups with the diagnoses of schizophrenia, neurosis, and nonborderline personality disorder. The group with borderline personality disorder was significantly different from the other groups according to the criteria, especially on items reflecting impulsivity, affectivity, and overvaluation/derogation of others. Impaired reality testing proved a useful distinguishing criterion as well and should be retained as part of the borderline concept.

Adult↗
PubMed1985

Inpatient and outpatient group therapy for schizophrenic patients.

Group therapy is effective for both inpatient and outpatient schizophrenics. Homogeneous groups are preferred. Important technical issues include: encouraging contact with others; allowing limited expression of emotions; helping patients in reality testing; and giving advice about practical matters. Insight-oriented techniques may harm some schizophrenics and should be avoided.

Ambulatory Care↗
PubMed2006

Innovations: child and adolescent psychiatry: measuring outcomes of real-world youth psychotherapy: whom to ask and what to ask?

To illustrate complexities in outcomes measurement for youths receiving community-based mental health services, this column presents data on 112 youths in publicly funded, usual-care psychotherapy. Youths and their parents separately completed standard measures of outcomes in three domains--symptoms, functioning, and family environment--at baseline and at six months. The results indicate minimal agreement between youths and parents on individual outcome domains and almost no overlap for each informant (youth and parent) across multiple domains. These findings are especially relevant because service providers are increasingly required to demonstrate treatment effectiveness and monitor youths' progress. The results highlight the complexities in measuring the impact of care and indicate the need to develop more feasible methods to measure multidimensional outcomes.

Adolescent↗
PubMed1976

Combining activities and group psychotherapy in the treatment of chronic schizophrenics.

The author reviews literature relating to the use of activities in the treatment of chronic schizophrenia, citing several programs that combined activities and psychotherapy to produce effective modes of treatment. He also describes a program in which he used collage-making to help a group of schizophrenic women improve interpersonal relationships, reality-testing, and self-image as well as to help them express problems and develop feelings of autonomy. The author believes that such combined programs help meet the basic needs of schizophrenic patients and alleviate their tendencies to withdraw from their surroundings.

Art Therapy↗
PubMed1981

The new chronic patient: clinical characteristics of an emerging subgroup.

A subgroup of chronic mentally ill persons who have had little or no state hospitalization and who are difficult to engage in existing systems of community care is emerging in major urban areas. Observations made at a large municipal general hospital indicate the patients are typically young, more likely to be male, and highly transient. They have frequent interactions with emergency psychiatric and crisis units, coupled with intermittent involuntary short-term stays in local inpatient units. They have few skills and virtually no natural support systems. Under stress they show disorders in reality testing, exhibit anger and depression, and are prone to impulsive aggressive and self-destructive behaviors. They are typically unwilling to voluntarily accept continuing care. There is a lack of fit between this group's characteristic style of interaction and existing community-based programs. The costs of this lack of fit, both in staff morale and inappropriate use of expensive services, make the exploration of approaches to these "new chronic patients" a matter of immediate importance.

Adult↗
PubMed1984

Denial in fantasy and hypomania: an exploration.

There is a spectrum of normality and psychopathology in which we see the presence of denial in fantasy, action, and word. The underlying ego distortions, such as the overuse of a denying fantasy in reality testing, will determine the clinical appearance of this mechanism. Traumatic experiences in the first 18 months are a determining factor in the development of these ego distortions. Clinical material is presented that supports a theory of elation put forward by Lewin (1950) who suggests that denying elations are repetitions of childhood dreams with their adult elaborations. In Mrs. A., the denying elations occurred particularly when experiences of castration anxiety or object loss became intolerable.

Adult↗
PubMed1987

The consciousness of being conscious.

Starting with the therapeutic advantage gained when insight acquires consciousness, an investigation of the nature and function of consciousness is undertaken. Consciousness is a state of awareness, having a range of higher mental functions serving a regulatory, controlling, and integrating role in mental activity. There are high levels of thinking, reality testing, experiencing, judging, anticipating; self-awareness and self-reflection enter into these controlling activities. Psychoanalysis has rightly been a science that studies the workings and contents of the unconscious portions of the mind. It has perhaps overlooked the important role that consciousness plays in ordinary life and in providing the levels of control and self-awareness individuals both experience and require. That pathology and disturbances of function may accompany normal states of consciousness as well as altered states of consciousness is a common clinical phenomenon. Psychoanalysis as a therapy widens the scope of the conscious control systems.

Awareness↗
PubMed2004

The development of the therapeutic community in correctional establishments: a comparative retrospective account of the 'democratic' Maxwell Jones TC and the hierarchical concept-based TC in prison.

BACKGROUND: The correction-based therapeutic community (TC) is one of the most described treatment modalities for (substance abusing) incarcerated offenders. The origins and development of the therapeutic community have been traced back to two independent traditions: the American hierarchical concept-based TC and the British democratic Maxwell Jones-type TC. Both branches have developed independently, targeting different people and tackling diverse problems. AIMS: To demonstrate that there are clear and undeniable similarities between the 'two' prison-based therapeutic communities. METHOD: A comparative historical review of the literature and a critical discussion and comparison. RESULTS: The links between the democratic and hierarchical therapeutic communities are summarised under five headings: social learning and behavioural modification; permissiveness and modelling; democracy and hierarchy; communalism and community as method; reality testing and 'acting as if'. CONCLUSIONS: The 'two' correction-based therapeutic communities are on converging pathways. Far from being oppositional models, they can be regarded as being complementary.

Behavior Therapy↗
PubMed1984

Play in the psychotherapy of selfobject relating.

Current literature dealing with narcissistic character disorder attempts to differentiate between mature relating with consensually validated whole objects and immature, more primitive relating with mirroring and validating selfobjects. In the latter case the object is especially valued for its role in buttressing a damaged or fragile self. The persistence into adult life of this more primitive relating to selfobjects can be viewed as a restitutive attempt, a healing by second intent. Through such a mechanism, attempts are made to make good deficits left by perceived failures of the primary object. These attempts include the setting up of relationships with figures whose empathic capacity is in some way sensed to be corrective, and the setting up of relationships with selfobjects which are in part created by the subject to provide himself with the kind of validating selfobject which has been longed for, yet never experienced. Winnicott conceives of transitional experience as an intermediate area allowed to the infant between primary creativity and objective perception based on reality testing. Transitional relating usefully clarifies the concept of selfobjects in emphasizing its common features with the transitional object. Transitional objects and selfobjects both contain the idea that the psychic apparatus is equipped with self-healing capacities. They tell us something about the nature of those self-healing capacities. The mental apparatus, as the physical apparatus, can attempt to heal itself in the face of injury or disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Assessment of Adolescents With the Rorschach: A Critical Review

This paper critically reviews 48 studies which examine the use of the Rorschach in adolescent populations. Several methodological concerns present in this literature are addressed, including (a) small sample sizes, (b) wide age ranges within the samples, (c) limited generalizability due to narrowly defined constructs and examination of highly specific groups, (d) frequent reliance on recorded diagnosis to determine group membership, and (e) limited comparability across studies due to the use of highly variable scoring and interpretation systems. In spite of these difficulties, there is some evidence that the Rorschach does provide useful and valid measures of reality testing, cognitive complexity, and disordered/psychotic thinking; general psychological distress; disturbance in object relations; and depression in specific adolescent groups. Clinical implications and directions for future research are discussed.

Journal Article↗
PubMed1994

A Rorschach investigation of sexual homicide.

A sample of incarcerated sexual homicide perpetrators (n = 18) were compared to a sample of non-sexually offending but violent male psychopaths (n = 23) on select Rorschach variables using the Comprehensive System (Exner, 1991). Results suggest that sexual homicide perpetrators are similar to psychopaths in their attachment abnormality, characterological anger, pathological narcissism, moderate and pervasive formal thought disorder, and borderline reality testing. They are distinguished, however, by a more frequent affectional hunger, a tendency to engage in more dysphoric rumination, and abnormal elevations of nonvolitional ideation (obsessional thoughts) due to unmet instinctual need states. They also show a greater interest in others as whole, real, and meaningful objects. Five psychodynamic factors, supported by the empirical findings, are proposed to partially explain the intrapsychic mechanisms involved in an act of sexual homicide.

Adolescent↗
PubMed1996

MMPI-A profiles of adolescent boys with a history of firesetting.

Firesetting in childhood and adolescence is associated with the more severe end of the conduct-disorder continuum and is considered to be prognostic of later pathology. The literature provides limited understanding of the pathology underlying firesetting in juveniles. This study compared the Minnesota Multiphasic Personality Assessment-Adolescent profiles of 28 psychiatric inpatient adolescent boys with a history of firesetting with the profiles of 96 psychiatric inpatient adolescent boys who do not have a history of firesetting. Using multivariate analyses, the firesetting group appeared more pathological than did the nonfiresetting group as reflected by significantly higher scores on three clinical scales: Psychasthenia (Pt), Schizophrenia (Sc), and Mania (Ma). The firesetting group also scored significantly higher than did the nonfiresetting group on eight of the content scales: Adolescent-Depression, Adolescent-Alienation, Adolescent-Bizarre Mentation, Adolescent-Anger, Adolescent-Conduct Problems, Adolescent-Family Problems, Adolescent-School Problems, and Adolescent-Negative Treatment Indicators. Taken together, these results suggest that the pathology associated with juvenile firesetting is more complex as well as more severe than that associated with nonfiresetting conduct disorder. The firesetting group's profiles suggest that their psychopathology is not merely a severe behavior disorder but rather is indicative of feelings of distress, alienation, depression, and thought disorder or poor reality testing. This degree of inner turmoil may be motivational impetus for the firesetting itself.

Adolescent↗
PubMed1999

Development and first results of the Borderline Personality Inventory: a self-report instrument for assessing borderline personality organization.

This article reports the development of a short 53-item true-false self-report instrument, the Borderline Personality Inventory (BPI). The BPI is based on Kernberg's (1984) concept of borderline personality organization. However, the diagnostic criteria are compatible with both the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and Gunderson's (Gunderson & Kolb, 1978) concept of borderline personality disorder (BPD). The BPI contains scales for assessing identity diffusion, primitive defense mechanisms, and reality testing. Another scale refers to the fear of closeness. The construction of the scales is based on the results of a factor analysis. As a result of several studies, a cutoff score is proposed to make the diagnosis of a BPD. Thus, the BPI combines dimensional and categorical models of BPD. The BPI was tested in several studies. According to the results, internal consistency and retest reliability are satisfactory (Cronbach's alpha = .68-.91, rtt = .73-.89). Results for sensitivity are .85 to .89, and results for specificity .78 to .89. The BPI identifies borderline patients in high agreement with Kernberg's criteria of borderline personality organization, Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria of BPD and Gunderson's criteria of BPD. The BPI is recommended as a screening instrument for borderline personality organization and BPD and for dimensional research of borderline features in Axis I and Axis II disorders.

Adult↗
PubMed2001

The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample.

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.

Analysis of Variance↗
PubMed1997

Anosognosia and confabulation during the Wada test.

Feinberg et al. proposed that right-hemisphere-damaged stroke patients with anosognosia for hemiplegia (AHP) confabulate seeing stimuli on the left side but those without AHP admit to having inadequate visual information. This study examines the relationship between AHP and confabulation using selective anesthesia of the cerebral hemispheres. Seventeen patients with intractable epilepsy were tested during intracarotid methohexital infusion. For half of the trials, subjects were stimulated on their paretic hand with a material (sandpaper, metal, or cloth), and for the remaining trials they were not stimulated. The subjects were trained to use a pointing response to indicate if they been stimulated and the type of material they had felt. Admission of uncertainty was defined as pointing to a question mark. Confabulation was defined as any material response to a no-touch trial. During anesthesia of either hemisphere, subjects with and without AHP confabulated responses. The AHP and non-AHP groups did not differ in admission of uncertainty. Our results support the postulate that confabulation and AHP are independent disorders, and therefore confabulation cannot fully account for AHP.

Adolescent↗
PubMed1999

[Not Available].

Though the use of elaborated and standardized behavioral therapy strategies has been successful in treatment evaluation and in areas of neurobiological research, numerous psychoanalytically orientated therapists will exhibit fear and avoidance behavior while facing terms like "standardization", "treatment evaluation studies" and "neurobiology". In our comment, we aim to initiate a successful therapeutic process by intensified reality testing and repeated exposure therapy.

Neurobiology↗
PubMed2004

The descent into suicide.

Suicidal breakdown requires attention both to attack upon the self (ego) as aggressive forces are unleashed against it by the superego, but also to the phases of self-breakup (ego regression) that follow. Less attention has been directed to ego-regression in suicide than to superego-directed assault on the ego in the psychoanalytic literature; this paper directs attention to the phenomena of ego failure and disarticulation of the self-representation. Clinical study of suicidal patients shows four aspects of suicidal collapse as ego loosens: affective flooding, desperate maneuvering to counter the resulting mental emergency, loss of control as the self begins to disintegrate, and grandiose magical scheming for mental survival as the self-representation splits up and body jettison becomes plausible. These phenomena are discussed theoretically in terms of failed affect regulation, ego helplessness, narcissistic surrender, breakdown of the representational world, and loss of reality testing.

Aggression↗