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PubMed1982

Impaired preferences for praise in schizophrenic adolescents.

Explanations of schizophrenia consistently have emphasized a reduced preference for social rewards. However, experiments that purportedly tested these explanations have used performance measures, which are affected by learning as well as preferences. Moreover, these experiments rarely have used nonsocial rewards as controls, in order to determine whether the schizophrenics' impaired responsiveness is specific to praise. The present experiment directly measured the preferences of paranoid and nonparanoid schizophrenic adolescents and of nonpsychotic adolescent controls (N = 60). Both praise and tangible rewards were used. Results consistently supported the preference theories. Schizophrenics exhibited impaired preferences for praise, but unimpaired preferences for tangible rewards. It was concluded that one reason that schizophrenics are withdrawn and uncommunicative is that they are apathetic toward social rewards. Their apathy also may be responsible for their poor social skills.

Adolescent↗
PubMed1991

Relationship of depression and cognitive impairment to self-injury in borderline personality disorder, major depression, and schizophrenia.

Self-injury was studied in 64 adults with borderline personality disorder, major depression, or chronic paranoid schizophrenia. Subjects were rated according to acute depression, chronic depression, self-injurious behaviors, and neurocognitive deficits, as measured by cognitive function examination. Borderline patients showed more self-injurious behaviors and more chronic depressive symptoms than the major depression or schizophrenia groups. Self-injury was not significantly correlated with acute or chronic depression in any group, but self-injury was correlated with neurocognitive deficits in borderline and schizophrenic groups. The results are explained in the context of a neurocognitive model of psychotic thought process in borderline disorder and schizophrenia.

Adaptation, Psychological↗
PubMed1989

Medication refusal and the rehospitalized mentally ill inmate.

Records of all inmates committed to a state forensic hospital in fiscal year 1982 (N = 472) were studied to examine the inmates' hospital utilization between September 1977 and April 1984 and the reasons for their admissions. Medication refusal, hallucinations and delusions, and threatened or potential violent behavior toward others were the most frequently documented reasons for admission. Medication refusal was associated with a greater number of hospitalizations, shorter hospitalizations, diagnoses of paranoid schizophrenia or schizophreniform disorders, longer prison sentences, and convictions for more serious felonies. Inmates admitted for medication refusal were also likely to be referred concurrently for threatened or potential violent behavior toward others. The study demonstrates the particularly violent nature of a large proportion of the hospitalized mentally ill inmates and the important role of medication refusal in their rehospitalization.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

The behavioural profile of psychiatric disorders in persons with intellectual disability.

BACKGROUND: Problems associated with psychiatric diagnoses could be minimized by identifying behavioural clusters of specific psychiatric disorders. METHODS: Sixty persons with intellectual disability (ID) and behavioural problems, aged 12-55 years, were assessed with standardized Indian tools for intelligence and adaptive behaviour. Clinical diagnoses were conferred as per International Classification of Diseases - 10th Revision (ICD-10) criteria. Subsequently Reiss Screen for Maladaptive Behaviors (RSMB) and AAMD Adaptive Behavior Scale-Part II were administered independently. RESULTS: Aggression and rebellious behaviours were more common in affective disorders and personality disorders. Psychotic and paranoid features were significantly more in psychosis group. Those with behavioural problems had significantly low scores on the sub-scales of RSMB. CONCLUSION: RSMB and AAMD Adaptive Behavior Scale-Part II will be useful to identify behavioural clusters, which will complement clinical psychiatric diagnoses in individuals with ID.

Adolescent↗
PubMed1994

Concomitants of visual hallucinations in Alzheimer's disease.

Visual hallucinations (VH) are the most common hallucinations in Alzheimer's disease (AD), but their relationships with other behavioral symptoms and measures of cognitive performance are unclear. Using the BE-HAVE/AD, a semistructured behavioral inventory, we identified 20/160 AD patients (13%) who were currently having VH. Patients with VH performed worse on the Mini-Mental State Examination and had more behavioral symptoms than patients without VH. Symptoms particularly associated with VH included auditory hallucinations, verbal outbursts, delusions, and paranoid ideation. Principal factor analysis of the BEHAVE/AD yielded four factors accounting for 47% of the total variance. VH loaded on two factors involving symptoms of "paranoia" and "agitation/hallucinations." Our findings suggest that VH in AD patients are common, often occur in the presence of specific behavioral disturbances, and may have management implications.

Aged↗
PubMed2000

[Psychogenic polydipsia leading to water intoxication].

Psychogenic polydipsia and its frequent complication, water intoxication, are well-known to psychologists. There are biochemical and psychiatric theories of psychogenic polydipsia which often correlate with each other. A 48-year-old man with chronic paranoid schizophrenia developed symptoms of psychogenic polydipsia. This provoked disturbances in electrolyte balance, resulting in a rapid decrease in serum sodium concentration and eventual death. There is a paucity of information and little awareness of this problem in the professional literature.

Drinking Behavior↗
PubMed2001

The secret life of the psychoanalyst.

In this article I have discussed what philosophers formally call subdoxastic about. Subdoxastic states are unconscious states about something that lead to conscious beliefs and conscious experiences. In the field of psychoanalysis Sullivan's (1953) "malevolent transformation" is a simple example of this. We all known how patients who have unconsciously undergone this kind of transformation of beliefs about people often appear more or less openly, depending on how well they are able to hide it, to be paranoid, suspicious, angry, and mistrustful of everybody, with the result that their conscious behavior and attitude alienate people and drive them away, resulting in experiences serving to verify the patients' beliefs. Psychoanalysts, we hope, are more subtle. Because they operate in a situation where there is little consensual validation and public scrutiny, the temptation to such syndromes as "compromise of integrity" or "partial private schemata" is very strong, leading to enactments that can be damaging to both patient and analyst and ultimately to burnout, as I have described it in this article. It is necessary, therefore, for analysts to keep a careful check on their conscious value systems and beliefs and to maintain continuing self-analysis for the subdoxastic factors that shape such beliefs. It is not possible to hide this from patients, and we must assume that sooner or later the patient gets to know the analyst pretty well. Analysts displaying the syndromes just mentioned, which are more subtle than ordinary character pathology such as that which forms the all-too-pervasive narcissistic analyst, may not even be aware they are doing so if they do not maintain a continual self-scrutiny, and if they do not pay close attention to their patients' material. This material--the patients' dreams, free associations, behavior, and enactments in the analytic process--often reflects not only transference but also constitutes a response to the analyst's unconscious and conscious value systems, which in turn are based on the subdoxastic factors that make the analyst the person that he or she is. Some patients may even precipitate crises or other situations that test the analyst's value system and force the analyst to display his or her secret self in immediate decisions that cannot be avoided. This is especially true if the patient is frightened or terribly threatened by factors in the secret self of the analyst; in this situation the patient may behave like a child who knows his or her father or mother is really very angry under a seemingly calm exterior, and as a result the child deliberately precipitates a display of that parental anger to get it out on the surface, get it over with, and reduce the child's anxiety. I have called for a genealogical study of analysts' choices of theoretical orientation in various cultures, and herein I am calling for a study of the subdoxastic factors in each individual analyst's theoretical orientation. Every theoretical orientation is based on a value system and a set of desires that determine the goals the analyst consciously or unconsciously wishes for the patient to actualize in the treatment process in order for the analyst to feel that he or she has catalyzed a "successful" treatment. This is a preliminary formulation. Further work is needed to distinguish between countertransference in the sense that we ordinarily use that concept today, and these subdoxastic factors determining the analyst's theoretical orientation and value systems, as well as to increase our focus on a subclass of these factors, the cultural ambience and background practices that Heidegger, for example, has identified as being crucial in the formation of the analyst's self as well as that of the patient.

Burnout, Professional↗
PubMed1977

Psychoanalytic notes on suicide.

The typology of and theories on suicidal behavior are reviewed to integrate various points of view in terms of the paranoid process. Freud's theory of internalized aggression, the relation of suicide impulses to depression, the operation of narcissistic components in the complex motivation of suicide are related to the concept of the victim-introject as central to the pathology of suicide. Suicidal patterns play out the dynamics inherent in the victim-introject and its correlative component the aggressor-introject. The victim-introject serves as the core internalization around which a false-self system is organized; the suicide represents the attempt to destroy the false-self as a means of realizing the dynamic purposes of the victim-introject. The concept of the victim-introject integrates previous psychoanalytic formulations of suicide and provides a template for the development of a therapeutic rationale. Implications for therapeutic response are considered, particularly in terms of the need to undermine the patient's attempts to maintain and reinforce his victimization.

Aggression↗
PubMed1981

Schizophrenic/paranoid psychoses: determining diagnostic divisions.

Metadiagnostic guidelines are delineated for evaluating the utility of both existing diagnostic criteria and recently proposed revisions (Magaro 1980). Among the metadiagnostic guidelines are the demonstration of differential treatment-outcome relationships for different disorders and the applicability of the characteristics of a superordinate diagnosis to its subordinate (or subtype) diagnoses. The authors note the conceptual development of the schizophrenia construct. Attempts to verify the existence of subtypes of schizophrenia in psychoanalytic theory, demographic traits, psychological assessment, and behavioral research are reviewed. Data accumulated from these efforts provide evidence regarding the validity of the distinction between paranoid and nonparanoid schizophrenia proposed by Magaro (1980). The authors conclude that a number of alternate relationships between paranoid and nonparanoid subtypes may by hypothesized. Only the notion that paranoid and nonparanoid subtypes are representative of differences in severity of schizophrenia may be rejected. As yet, little evidence exists for choosing one of the remaining alternatives as correct. Integrating research from diverse fields of study is advocated in the effort to refine conceptions of psychiatric disorders. In addition to continued attempts to make improvements in psychiatric diagnosis by changing the clinical symptoms used to define disorders, refinements may be accelerated by assessing the potential utility of other sources of information as the basis for psychiatric diagnosis. Performance on tasks employed in behavioral psychopathology research may represent such an example.

Cognition↗
PubMed1976

Folie á deux in a child.

Folie a deux is the transference of delusional ideas and behaviors from one person to another with whom there has been a close association. Its occurence in children has been rarely described in the literature, which was reviewed for case reports, diagnostic criteria, and etiological theories. A detailed case history of a 10-year-old girl who had delusions of special powers and delusions of persecution as well as hypochondriacal and hysterical symptoms is presented as an example of folie a deux between child and parent. This girl had developed a symbiotic incestuous relationship with her stepfather, a paranoid schizophrenic patient. Six criteria for making the diagnosis of folie a deux in a child were applied to the case studied. General and specific aspects of treating this disorder were discussed.

Anxiety↗
PubMed1989

Behavior, striatal and nucleus accumbens field potential patterns and dopamine levels in rats given amphetamine continuously.

Behavioral, electrophysiological (field potential recordings, analyzed by computer) and biochemical techniques were employed before, during and after 7 days of continuous administration of amphetamine to rats. Significant changes were observed using all three protocols. Behavioral alterations were greatest on the second day of treatment and progressively normalized during the remainder of treatment. Electrophysiological changes in the striatum were significant only on the second day of treatment, while electrophysiological alterations in the nucleus accumbens were significant on all treatment and recording days, and the magnitude of the changes paralleled the pattern of overt behavioral changes. Levels of DA in the striatum progressively decreased from normal throughout the treatment, declining to less than half of the control level by the sixth day of treatment. In contrast, DA levels in the nucleus accumbens were augmented on the second day of treatment and progressively approached the control level as treatment continued, again paralleling behavior and changes in the electrophysiology of the nucleus accumbens. These results indicate that continuous administration of amphetamine in rats differentially affects electrical activity in the striatum and nucleus accumbens as well as concentrations of DA. In addition, these results have implications for the study of paranoid schizophrenia.

Amphetamine↗
PubMed1993

Management of the aggressive and dangerous patient.

Violence is the ultimate maladaptive coping behavior manifested by a small but significant number of psychiatric patients. The management of the aggressive and dangerous patient depends on recognition of predisposing developmental experiences, cognitive and behavioral factors, and situational circumstances that potentiate a violent outburst. The author presents management guidelines, which stem from an understanding of the paranoid process, respect for the limited coping skills of the individual, and appropriate use of verbal, physical, and chemical interventions.

Aggression↗
PubMed2005

[Obsessive compulsive disorder and schizophrenia. An attempt at psychopathologic differentiation by focusing on the single phenomenon of obsession].

This paper follows the hypothesis that differentiation between obsessive compulsive disorder and schizophrenia is possible only by focusing on the single phenomenon of obsession. The declaration of a nosological specificity of obsession is set against the current view of ICD-10 and DSM-IV, of obsession as a ubiquitous nonspecific phenomenon appearing with comorbidities. The historic development of these two most different views of obsession and their combination is explained. The distinction between obsessive compulsive disorder and schizophrenia can be made at the psychopathologic dividing line between obsession and delusional thoughts. Examination of the literature on the transition from obsessive compulsive disorder into schizophrenia shows that there is no clear link between obsession and schizophrenia.

Clinical Trials as Topic↗
PubMed1988

Somatization, paranoia, and language.

Somatization and paranoia are circumscribed distortions of reality that are impervious to the normative process of consensual validation. These distortions are often postulated as a means of bolstering lowered self-esteem. We used computerized content analysis of the free speech of patients with these disorders in order to identify and compare dimensions of self-concept reflected in their lexical choices. Interestingly, patients with these disorders differed in the themes prominent in their speech. The higher frequency categories used by the somatization disorder group conveyed an overwhelming sense of negativism, distress, and a preoccupation with an uncertain self-identity. In contrast, the categories used by the paranoid patients portrayed an artificially positive, grandiose self-image and a defensive abstractness. Our exploratory analysis suggests that circumscribed distortions of reality in somatization and paranoid disorders are not associated with the same common defensive style attempting to bolster self-esteem.

Adult↗
PubMed1989

Seasonal variations in the child and adolescent psychoses.

We examined seasonality effects in a controlled study of children and adolescents with psychotic states. There was a peak of psychotic births between February and March but this pattern did not differentiate psychotics from psychiatrically disturbed controls. Onset of illness was found to be significantly more common in the summer months (June to August) in psychotics than in controls. We discuss possible explanations for this phenomenon.

Adolescent↗
PubMed1997

A new approach to discourse analysis in psychiatry, applied to a schizophrenic patient's speech.

OBJECTIVE: Progress in the science of data analysis and computer technology has led to the development of advanced methods for investigating structure discourse in the psychiatric field, where language constitutes a useful investigative and therapeutic tool. The purpose of this study was to present and use a computer-assisted method of discourse analysis (Alceste-software) to analyse the schizophrenic subject's oral contributions regularly collected for 3 months. METHOD: The method used consisted of modelling the main word distribution in spoken recordings pooled together and identifying the repetitive language patterns most frequently used by the speaker. RESULTS: Four main kinds of discourse emerged from the pool of schizophrenic's speech samples, on specific topics without any lack of ability to organize the material, but the technique analysis showed that the main kinds of discourse were interspersed with unexpected 'language satellites' consisting of a secondary short and specific discourse which was also well planned but had no relevance to the main discourse making for a lack of cohesion in the speech samples. This method allows us direct access to the inner experience of the patient. The technique highlighted a very poor pre-syntax linked to the choice of words and a tendency to make pronoun errors, possibly reflecting some confusion between the patient herself and others, mainly her mother, especially in the discourse about childhood. CONCLUSION: This method of discourse analysis made it possible to investigate various language disturbances at the same time and at different levels. It is particularly adapted for analysing the schizophrenic's speech. The data obtained were consistent with the assumption that schizophrenia involves 'thought disorders': these ones giving rise to the language impairments.

Adult↗