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Treatment-relevant subtypes of schizophrenia.

The heterogeneity of schizophrenia and the failure of classical subtypes to predict treatment response reliably have led to two contrasting assumptions. The first is that the treatment approach is essentially the same for all schizophrenics. The second is that the treatment needs of schizophrenic patients can be based only on clinical "hunches" or the biases of the therapist, because meaningful criteria for making therapeutic decisions are lacking. Both assumptions tend to discourage careful and critically reasoned treatment planning. This report argues that current knowledge permits the formulation of subtypes that can assist in the rational choice of individualized treatment approaches. It proffers a number of such subtypes and deals with their application to therapeutic decision-making at various phases of the illness.

Diagnosis, Differential↗

Frégoli syndrome after cerebral infarction.

A case of a rare form of delusional misidentification, the Frégoli syndrome, is described. Although usually occurring in the setting of primary or secondary schizophrenic psychoses, delusional misidentification has been reported in affective, neurological, and toxic-metabolic disorders. In this instance a diagnosis of paranoia (delusional disorder) secondary to predominantly right hemisphere pathology, rather than schizophrenia, seemed more appropriate.

Aged↗

Psychiatric symptoms in mentally ill chemical abusers.

The purpose of this study was to determine whether mentally ill chemical abusers (MICA patients) report greater distress than do psychiatric patients who do not abuse psychoactive substances. Thirty-two MICA patients and 31 non-substance-abusing patients completed the SCL-90-R. Group comparisons indicated that MICA patients reported greater levels of somatization, depression, anxiety, obsessive-compulsiveness, paranoia, and psychotic symptoms. MICA patients also reported greater overall distress than did psychiatric patients without substance abuse problems.

Adult↗

Belief in life after death and mental health: findings from a national survey.

The present study examined the association between belief in life after death and six measures of psychiatric symptomology in a national sample of 1403 adult Americans. A statistically significant inverse relationship was found between belief in life after death and symptom severity on all six symptom clusters that were examined (i.e., anxiety, depression, obsession-compulsion, paranoia, phobia, and somatization) after controlling for demographic and other variables (e.g., stress and social support) that are known to influence mental health. No significant association was found between the frequency of attending religious services and any of the mental health measures. The results are discussed in terms of the potentially salubrious effects of religious belief systems on mental health. These findings suggest that it may be more valuable to focus on religious beliefs than on religious practices and behaviors in research on religion and mental health.

Anxiety Disorders↗

The relationship between cocaine-induced paranoia and compulsive foraging: a preliminary report.

Two prominent behavioral syndromes associated with chronic cocaine use that have been described in the literature are cocaine-induced paranoia (CIP) and cocaine-induced compulsive foraging (CICF) for cocaine. To help to clarify the relationship between the two cocaine-induced syndromes, the concordance and sequence of onset of the two cocaine-induced behaviors over the course of the patients' lifetime use of cocaine and during the course of a binge was examined in 62 crack cocaine-dependent men. Thirty-four (54.8%) reported experiencing both CIP and CICF. In 18 (29%) of the patients, only one of these cocaine-induced behavioral syndromes was reported. Ten (16.1%) of the subjects reported neither CIP nor CICF. Patterns of cocaine or other substance use and degrees of tolerance to cocaine were not significantly different between the groups endorsing different patterns of cocaine-induced behaviors. CIP typically preceded the onset of CICF both over the course of the patients' lifetime use of cocaine and over the course of a binge. The study results suggest varying thresholds for the expression of these behaviors in chronic cocaine-abusing individuals.

Adult↗

Psychomotor epilepsy and psychosis. I. Physical aspects.

In a controlled investigation the clinical findings in 96 patients with paranoid/hallucinatory psychosis and partial epileptic seizures with complex symptoms, were compared with the findings in 96 control patients with the same type of epilepsy without psychosis of median 24 years' duration. The median age at onset of psychosis was 34 years, after epilepsy of median 21 years' duration. The seizure frequency of complex, partial seizures was significantly lower in the psychotic group, while the frequency of generalized seizures did not differ. A significant preponderance in the psychotic group of left-handed patients, etiological factors and neurological signs reflecting organic damage, and seizures of automatic behaviour indicates that epileptic psychoses are caused by structural lesions affecting the deep parts of the temporal lobe.

Adolescent↗