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Psychiatric commitments of religious dissenters in Tsarist and Soviet Russia: two case studies.
Recent literature suggests that involuntary commitment of dissenters to psychiatric institutions in the Soviet Union is politically motivated. It may be useful to consider two documented cases of commitment from two different historical periods in Russia: the case of Kondratii A. Malevannyi during the Tsarist regime and the case of Patient Pr. during Stalin's rule. Allegedly, both Malevannyi and Patient Pr. claimed to be Jesus Christ. Their public behavior attracted the attention of authorities. Since such behavior was illegal, both could have been charged in court or exiled by administrative action. They were neither charged nor exiled. Instead, both were diagnosed by psychiatrists as paranoiacs and were involuntarily committed. The diagnoses and commitments were challenged by L. N. Tolstoi and I. P. Pavlov. The commitment decisions were consonant with contemporary Western psychiatric practice that conceptualized deviant behavior in terms of "mental illness." The cases suggest that the present commitment of dissenters in the Soviet Union may be based upon a psychiatric judgment, although political factors may be relevant. A reliable documentation regarding current practices is necessary before any definite conclusions can be made.
RORSCHACH DEVELOPMENTAL SCORES AND INTELLIGENCE LEVEL.
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Obtaining 16PF scores from the MMPI, and MMPI scores from the 16PF.
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Autistic traits in obsessive-compulsive disorder.
In contrast to other non-psychotic psychiatric populations, subjects with obsessive-compulsive disorder (OCD) are more prone to have personality disorder from cluster A (the odd and eccentric cluster). The present study aims at further investigating the relationship between these and other personality traits in OCD subjects and their relation to high functioning autism (HFA) and Asperger disorder. Sixty-four subjects with OCD were included. Personality traits were assessed with the Karolinska Scales of Personality (KSP), and personality disorders with DSM-adapted questionnaires. In addition, autistic traits were assessed in 29 videotaped subjects, by 3 independent raters. Twenty percent of the subjects with OCD were identified as also having autistic traits. These subjects scored higher on KSP scales measuring muscular tension, psychasthenia, and inhibition of aggression and lower on socialization as compared with OCD subjects without autistic traits. Additionally, subjects with autistic traits fulfilled criteria for anxious personality disorders and paranoid personality disorders significantly more often than subjects without autistic traits. We propose that OCD is often related to HFA and Asperger disorder. Self-report questionnaires may be useful in establishing the diagnosis. However, those with the most obvious autistic features seem to be less able to identify these traits in themselves.
HETEROGENEITY OF AN ELDERLY STATE HOSPITAL POPULATION.
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Acute zolpidem overdose--report of two cases.
This report describes two cases of acute zolpidem overdose. The decedent in the first case was a 36-year-old female found dead in bed in her secured home. She had a history of psychiatric illness, including paranoid disorder, depression with panic episodes, and post-traumatic stress disorder. She was treated with risperidone and sertraline. Nine months prior to her death, the decedent was also prescribed zolpidem (Ambien). The postmortem examination revealed white foam within the larynx and upper trachea, which is indicative of pulmonary edema. Toxicological analyses of the urine showed the presence of caffeine, risperidone, and zolpidem. Subsequent quantitation of postmortem iliac serum revealed 5.6 microg/L of 9-hydroxyrisperidone and the following zolpidem concentrations: blood (subclavian), 4.5 mg/L; blood (iliac), 7.7 mg/L; vitreous humor, 1.6 mg/L; bile, 8.9 mg/L; urine, 1.2 mg/L; liver, 22.6 mg/kg; and gastric contents, 42 mg. The second case involved a 58-year old female, also found dead in bed, with white foam around her mouth. The decedent had a 25-year history of hypertension and mental illness--manic depression and schizophrenia. She was medicated with carbamazepine, naproxen, risperidone, and zolpidem. The postmortem examination revealed cardiomegaly, pulmonary edema, hepatomegaly, mild coronary atherosclerosis, and no signs of trauma. Toxicological analyses of the urine showed the presence of zolpidem and carbamazepine and metabolite. Zolpidem concentrations were as follows: blood (iliac), 1.6 mg/L; vitreous humor, 0.52 mg/L; bile, 2.6 mg/L; liver, 12 mg/kg; and gastric contents, 0.9 mg. The zolpidem blood concentrations of these cases are consistent with those of the previously published fatalities. The blood/vitreous humor ratios of zolpidem were 2.81 (subclavian) and 4.81 (iliac) in the first case and 3.08 (iliac) in the second case. These ratios, along with the sampling times of blood and vitreous humor for both cases, are not conclusive to indicate a definitive presence or absence of postmortem drug redistribution of zolpidem. The cause of death for both cases was determined to be acute zolpidem overdose, and manner of death was suicide.
Diagnosis and classification of functional psychoses.
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Sensory impairment in late-life schizophrenia.
We reviewed 27 published studies examining a possible association between sensory (visual or hearing) impairment and late-life psychosis with paranoid features. A majority of these investigations supported the postulated association between hearing impairment and late-onset schizophrenia or paranoid disorder. Many of the published studies, however, had important methodological limitations. In a case-control study, we assessed visual and hearing impairments in 87 middle-aged and elderly subjects (16 with late-onset schizophrenia, 25 with early-onset schizophrenia, 20 with mood disorder, and 26 normal comparison subjects). Visual and hearing impairments were assessed in a blind manner by means of standardized quantitative assessments. Compared with normal subjects, both of the schizophrenia groups and the mood disorder group had greater impairment in most variables of corrected visual acuity and in self-reported hearing deficit, but not in uncorrected (constitutional) visual acuity or on pure-tone audiometry. Our results suggest that the observed relationship between sensory impairment and late-life psychosis may be due, at least in part, to a suboptimal correction of sensory deficits in older psychiatric patients.
Psychiatric chronicity and diagnosis.
The relationship between psychiatric chronicity and schizophrenia in the postacute phase was examined by comparing posthospitalized chronic schizophrenics and chronic nonschizophrenics on symptoms, social functioning, and recidivism. No differences were found between the groups on any of these variables, indicating a general similarity of clinical picture for chronic schizophrenics and chronic nonschizophrenics in the postacute phase. These results were contrasted with two other comparisons made irrespective of diagnosis: (1) Patients with better social functioning were compared to patients performing less well socially; (2) patients living with others were compared with patients living in isolated settings. In both these comparisons, significant differences in the clinical picture were found between the two groups. Thus, living situation and degree of social functioning both appear to have more relevance for the postacute phase than does diagnosis. These results were related to the genetic and outcome literature on chronic psychiatric disorder to advance the view that the diagnosis of chronicity is more crucial for the understanding of severe emotional disorders than the traditional symptom-based DSM-III classification system.
Genetic Differences in Reactivity to the Environment Impact Psychotic-Like and Affective Reactivity in Daily Life.
BACKGROUND AND HYPOTHESIS: Consistent with diathesis-stress models, psychosis research has focused on genetic moderation of adverse environmental exposures. In contrast, the Differential Susceptibility (DS) model suggests that the same genetic variants that increase risk-inducing effects of adverse experiences also enhance beneficial effects from positive experiences. This study examined whether individuals with high genetic susceptibility to the environment showed differential psychotic-like and affective reactivity in response to positive and negative events in daily life. STUDY DESIGN: Experience sampling methodology assessed context (positive and stressful) and momentary levels of paranoia, psychotic-like experiences (PLE), and positive (PA) and negative affect (NA) in 217 non-clinical adults oversampled for schizotypy. Linear mixed models examined whether Polygenic Risk Scores of Environmental Sensitivity (PRS-ES) moderated the impact of current context on subsequent experiences. STUDY RESULTS: PRS-ES moderated positive, but not stressful, context on subsequent levels of momentary paranoia, NA, and PA, but not PLE. Genetic and environmental (G × E) interactions indicated diathesis-stress at lower thresholds of PRS-ES, but a DS model at the highest threshold of the PRS-ES. Participants with elevated PRS-ES showed increased paranoia and NA and decreased PA in subsequent assessments when reporting low levels of positive situations, but also decreased paranoia and NA and increased PA when rating contexts as positive. CONCLUSIONS: Findings support the influence of genetic sensitivity to the environment on psychotic-like and affective reactivity in daily life, particularly in response to positive contexts. This highlights the transdiagnostic protective role of positive experiences and informs ecological momentary interventions.
Behavioral symptomatology in dementia of the Alzheimer type.
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Psychosexual problems of the middle years.
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Relationship of phenothiazine intake and psychiatric diagnosis to glucose level and tolerance.
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Features of the manifest dream in schizophrenia.
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Computer diagnosis in psychiatry: a Bayes approach.
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Psychiatric complications following coronary bypass surgery.
Previous studies of psychiatric complications following open heart surgery have included few if any patients who had coronary bypass surgery. This experiment reports the relative incidence of psychiatric complications in a sample of 97 open heart surgery patients of whom 51 patients (53 per cent) had coronary bypass surgery. The results suggest that the incidence of psychiatric symptoms following coronary bypass surgery is significantly lower (16 per cent) than that following cardiac valvular surgery (41 per cent). Several possible reasons for this large discrepancy in incidence of psychiatric complications are considered.