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PubMed1982

The language of paranoia.

In order to assess which of three current models is most useful in understanding paranoia, the authors applied computer speech content analysis to 55 patients--24 of whom were in four groups expressing paranoid delusions and 31 of whom were in four groups not expressing such delusions. The results delineated a semantic or verbal profile of paranoid self-presentation. This self-presentation is more identifiable than the effects of any other patient characteristic, even if the delusion is not discussed by the patient. The strength of the statistical evidence supports the model of paranoid delusions as a separate disease rather than as a subtype of schizophrenia or as a trait that exists on a spectrum from normality to pathology.

Adult↗
PubMed1994

Supportive psychotherapy of the schizophrenic patient.

The unimpressive results, in several classic studies, of expressive psychotherapy for schizophrenic patients have led to a neglect of all dynamic psychotherapy for these patients. However, there have been significant advances in psychodynamic supportive therapy over the past two decades and currently it is both well grounded in psychodynamic theory and has an accepted set of strategies and techniques. In this paper, we apply the general principles of psychodynamically oriented supportive therapy to the outpatient treatment of the schizophrenic patient. Outpatient treatment is divided into stabilization and maintenance phases. During stabilization, treatment focuses on building a therapeutic alliance, psychoeducation (including the family where appropriate) and establishing a bilaterally acceptable, clinically effective, pharmacological regimen. In the maintenance phase, the therapist becomes more therapeutically ambitious, particularly in undermining maladaptive, and supporting adaptive, defenses. Handling of the alliance, transference, countertransference, resistance, working through and attenuation (instead of termination) are addressed and illustrated with clinical material. The role of the supportive therapist also includes overall executive responsibility for the entire treatment, management of psychopharmacology, and clinically appropriate referrals for family work, social skills training and vocational rehabilitation. Studies are needed to determine the effectiveness of this treatment approach; further, whether it is applicable to all schizophrenic patients or only to a particular subgroup.

Adult↗
PubMed1978

Some personality patterns and dimensions of male alcoholics: a multivariate description.

The assumption that alcoholics form a homogeneous population has been found to be questionable. Recent research has been done to empirically define possible personality subtypes of alcoholics. This study extended the typological work done previously by Goldstein and Linden (1969a) and Whitelock, Overall, and Patrick (1971). They each found four alcoholic subtypes, three of which replicated across studies. For this research, MMPI profiles of 208 male alcoholics were submitted to a hierarchical clustering procedure. Seven subtypes were found. These results were compared to the results of the prior two studies, in addition to actuarial MMPI types previously delineated in clinical settings. Using a hierarchical factor analysis, these data were analyzed to determine the higher order interrelationships among MMPI scales for this alcoholic sample. These results were discussed, especially in terms of the implications for treatment and further research in alcoholism.

Adolescent↗
PubMed2004

Delusional discourse: an investigation comparing the spontaneous causal attributions of paranoid and non-paranoid individuals.

Research into the nature of attributional reasoning in paranoia has for the most part been restricted to questionnaire-based approaches. This fails to address the issue of whether a distinctive attributional style underpins the everyday talk of paranoid individuals. This study aimed to investigate whether attributional models of paranoid delusions applied to spontaneous attributions generated in the discourse of 12 paranoid and 12 non-paranoid speakers. Causal attributions for negative and positive life experiences were extracted from interview transcripts and rated using the Content Analysis of Verbatim Explanations (CAVE) technique. It was found that, as a proportion, paranoids made more attributions for negative events that were of an external-personal, stable and global nature (as attributional models would predict). They also made significantly more external-personal attributions for negative events and, in one of two datasets, showed a more external mean CAVE rating for negative events than the non-paranoid controls. This paper highlights important issues underlying the extraction of attributions from paranoid talk, and discusses the implications for attributional models of paranoia and future discourse-based research in this area.

Adult↗
PubMed2000

A cross-cultural review of sudden mass assault by a single individual in the oriental and occidental cultures.

A nonrandom sample of North American cases of sudden mass assault by a single individual (SMASI, n = 30) is compared with a nonrandom sample of Laotian amok cases (n = 18) and other amok studies. Perpetrators in both studies show evidence of social isolation, loss, depression, anger, pathological narcissism, and paranoia, often to a psychotic degree. The term "innovative perpetrator" is reintroduced and expanded upon. Similarities among samples far outweigh differences, leading the authors to conclude that SMASI and its appearance in different cultures is not a culture-bound syndrome.

Adolescent↗
PubMed1993

On the drive-rootedness of psychoanalytic ego psychology.

This paper attempts, hypothetico-deductively, to conceptualise psychoanalysis on the level of fundamental theory. I begin by exploring the relevance for psychoanalytic theory of recent developments in the brain and cognitive sciences. Their site of articulation is identified as the concept of consciousness. I proceed to develop a conceptual integration of consciousness into psychoanalytic drive theory. This reveals the wish as the original psychical entity, with a self-process imbricated in its structure. Narcissism in shown to be sexually grounded, vitally constitutive, and intrinsically aggressive. It becomes possible, using the neighbouring sciences as well, to work out a theory of the origin of the secondary process and early ego formation. My approach provides a view of mental development in which identification and repression represent two aspects of a unitary activity that structures the mind. This allows the unconscious and consciousness to be brought into dialectical relation. Implications follow for the 'activity of the repressed' and the theory of paranoia.

Drive↗
PubMed2006

Addictions and the quest to control the object.

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.

Adult↗
PubMed1979

Telemetered EEG-EOG during psychotic behaviors of schizophrenia.

In an effort to establish correlations between abnormal behaviors characteristic of schizophrenia and simultaneous cerebral electrical activity, EEGs and electro-oculograms (EOGs) were continuously recorded for 2 to 24 hours by radiotelemetry from 40 patients with schizophrenia and 12 normal control subjects. Trained observers recorded specific behavior patterns permitting visual and computer analysis of EEG during hallucinations, stereotypy, catatonia, psychomotor blocking, and other characteristic manifestations of schizophrenia. Electroencephalographic abnormalities consisting of focal slow or spike activity over either temporal region were found in nearly half of the patients so recorded. In contrast to the EEG during ictal episodes of epilepsy, the abnormal wave forms of schizophrenic patients seldom coincided with episodes of blocking, stereotypy, or other abnormal behaviors. Increased extraocular activity or blinking were recorded in a majority of patients, but were not consistently associated with the abnormal behavior or perceptual events.

Adult↗
PubMed1985

Social disability in schizophrenia: the controlled prospective Burghölzli study II. Premorbid living situation and social adjustment--comparison with a normal control sample.

The assessment of premorbid adjustment in schizophrenia has gained increasing interest in psychiatric research. Numerous studies have provided evidence on the predictive power of premorbid adjustment in the course and outcome of schizophrenic psychoses, but only little systematic research has been done on this topic comparing schizophrenics and healthy persons. In this study we have analyzed the premorbid life situation and social adjustment of 69 first onset schizophrenics in contrast to 60 healthy subjects. The comparisons between these samples showed significant differences for nearly all areas assessed, indicating a premorbid disablement of the schizophrenics both for quantitative and qualitative aspects of social functioning. Compared to that of healthy people, the size of the schizophrenics' social network is markedly reduced and often characterized by a strong link to their family of origin. In general, the schizophrenics fail to establish close relationships or engage in social contact. Moreover, they tend to withdraw from existing relationships, especially heterosexual ones. Even when the schizophrenics appear quite normal on formal criteria (such as partnership or employment situation), further analyses often reveal problems, e.g., conflicts at work or reticence with partners. The results of this study clearly demonstrate the necessity of assessing not only formal criteria but also behavioral patterns and emotions of the persons concerned.

Adolescent↗
PubMed1991

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↗
PubMed2005

The therapeutic alliance in the treatment of personality disorders.

Because personality disorders are associated with significant impairment in interpersonal relationships, special issues and problems arise in the formation of a therapeutic alliance in the treatment of patients with these disorders. In particular, patients with narcissistic, borderline, and paranoid personality traits are likely to have troubled interpersonal attitudes and behaviors that will complicate the patient's engagement with the therapist. While a strong positive therapeutic alliance is predictive of more successful treatment outcomes, strains and ruptures in the alliance may lead to premature termination of treatment. Therefore, clinicians need to consider the patient's characteristic way of relating in order to select appropriate interventions to effectively retain and involve the patient in treatment. Research has shown not only the importance of building an alliance but also that this alliance is vital in the earliest phase of treatment. The author first reviews several definitions of the therapeutic alliance with reference to how they apply to the treatment of patients with personality disorders. Issues relevant to forming a therapeutic alliance with patients with personality disorders are then discussed in terms of the three DSM-IV-TR personality disorder clusters. However, the author notes that these categories do not adequately capture the complexity of character pathology and that clinicians also need to consider which aspects of a patient's personality pathology are dominant at the moment in considering salient elements of the therapeutic alliance. In dealing with Cluster A personality disorders (schizotypal, schizoid, and paranoid personality disorders), what is most relevant for alliance building is the profound impairment in interpersonal relationships. The Cluster B "dramatic" personality disorders (antisocial, borderline, histrionic, and narcissistic) are all associated with pushing the limits. Consequently, clinicians need to exercise great care to avoid crossing inappropriate lines in a quest to build an alliance with patients with one of these disorders. Patients with Cluster C "anxious/fearful" personality disorders (avoidant, dependent, and obsessive-compulsive personality disorders) are emotionally inhibited and averse to interpersonal conflict. These patients frequently feel guilty and internalize blame for situations even when there is none, a tendency that may facilitate alliance building because the patients are willing to take some responsibility for their dilemma and may engage somewhat more readily with the therapist to sort it out, compared with patients with more severe Cluster A or B diagnoses. The author then reviews considerations relevant to treatment alliance that arise in the different treatment approaches that may be used with patients with personality disorders, including psychodynamic psychotherapy/psychoanalysis, cognitive-behavioral therapies, and psychopharmacology. The author also discusses issues, especially splitting, that arise in the alliance when patients with personality disorders are treated in inpatient psychiatric hospital settings.

Adult↗
PubMed1985

Personal efficacy, external locus of control, and perceived contingency of parental reinforcement among depressed, paranoid, and normal subjects.

Bandura (1982) suggested that judgments of personal efficacy and outcome expectancies (i.e., locus of control) jointly affect behavior. We hypothesized that different combinations of these two sets of beliefs would characterize the thought structures of normal subjects and of psychiatric patients suffering from distinctly different disorders. Normal subjects, depressed subjects, and paranoid subjects completed scales with which we measured beliefs in personal efficacy and beliefs that outcomes are controlled either by chance or by powerful others, as well as a scale with which we assessed perceived contingency of parental reinforcement. The major findings were as follows: Normals judged themselves to be more efficacious than did psychiatric subjects; whereas depressives expected outcomes to be controlled by chance, paranoids expected outcomes to be under the control of powerful others; among the normals, outcome expectancies were strongly associated with personal efficacy, but among the psychiatric patients, these beliefs were unrelated; depressives and paranoids equally reported more noncontingent parental reinforcement than did normals; and perceived contingency of parental reinforcement was predictive of outcome expectancies but not of personal efficacy. The data suggest that low personal efficacy may be a distinguishing characteristic of all psychiatric patients, whereas outcome expectancies may determine the specific nature of the psychiatric disorder.

Adult↗