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PubMed1993

Interictal violence in epilepsy. Relationship to behavior and seizure variables.

Interictal violence among epileptic patients could result from factors other than epileptiform activity. We characterized 44 patients who presented for psychiatric evaluation because of violent behavior. Most violent acts consisted of verbal or minor physical aggression. Twenty (45%) of these patients met criteria for a schizophrenic disorder, and one committed murder during a paranoid schizophrenic relapse. In addition to schizophrenia, the violence patients had significantly more mental retardation when compared with 88 age- and sex-matched epileptic patients without prior violent behavior. However, violent and nonviolent patients did not differ on seizure variables such as type and frequency of seizures, auras, electroencephalographic changes, epilepsy age of onset, or anticonvulsant therapy. These findings suggest that interictal violence is associated more with psychopathology and mental retardation than with epileptiform activity or other seizure variables.

Adult↗
PubMed1987

Depression, anxiety, paranoid reactions, hypochondriasis, and cognitive decline of later-life inpatients.

The relationships among the psychopathological states of depression, anxiety, hypochondriasis, paranoid reactions, and cognitive decline for later-life psychiatric inpatients were addressed. The relationship of these variables to life satisfaction, health, pain, and behavior was also considered. Sixty later-life (older than 55 years) psychiatric patients on an acute geropsychiatric unit were administered a battery of psychological scales; Mini Mental State, Beck Depression Inventory (somatic and psychological components), State-Trait Anxiety Scale, MMPI Paranoia scale (and Harris-Lingoes subscales), the Hypochondriasis Scale (Institutional Geriatric), Life Satisfaction Scale-Z, and self-rated pain responses. In addition, these patients were rated on the MACC-Behavioral Adjustment Scale and the Cumulative Illness Rating Scale. Results showed that there is a high degree of interrelationship among the psychopathological variables except cognition. Independent stepwise regression showed that life satisfaction was accounted for by hypochondriasis and anxiety; health, by depression; pain, by hypochondriasis; and behavior, by cognition.

Aged↗
PubMed2005

Dangerousness and management of delusional misidentification syndrome.

Many theories have been proposed to help understand delusional misidentification syndromes (DMS) and the danger associated with them. We report on three cases with histories of paranoid schizophrenia who developed DMS. Two of them acted out on delusional thinking toward their sons. Case 1 managed to kill her son and Case 2 was caught twice trying to choke him. Our case reports suggest that the degree of threat perceived by the patient from the delusionally misidentified object is the most important factor in determining the patient's response to the delusions. Alcohol and substance intoxication facilitated the patients' acting out on their delusions, but did not explain the genesis of the delusions. There is a need to continue to study patients with DMS in order to provide opportunity for greater understanding of the psychopathology of DMS.

Adult↗
PubMed1997

Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders.

OBJECTIVE: Suicide is the single largest cause of premature death among individuals with schizophrenia. This report examines the relationship between positive or negative symptoms, illness subtype, and suicidal behavior among patients with schizophrenia and schizophrenia spectrum disorders in a long-term follow-up cohort. METHOD: Based on index admission records, patients from the Chestnut Lodge Follow-Up Study with schizophrenia (N = 187), schizoaffective disorder (N = 87), schizophreniform disorder (N = 15), and schizotypal personality disorder (N = 33) were retrospectively assessed with the Positive and Negative Syndrome Scale, classical subtype criteria, and criteria for the deficit syndrome. Completed suicide, suicide attempts, and suicidal ideation during the follow-up period (average = 19 years) were ascertained by means of interviews with patients and/or surviving relatives. RESULTS: Over the follow-up period, 40% of the patients reported suicidal ideation, 23% reported suicide attempts, and 6.4% died from suicide. Patients dead from suicide had significantly lower negative symptom severity at index admission than patients without suicidal behaviors. Two positive symptoms (suspiciousness and delusions), however, were more severe among successful suicides. The paranoid schizophrenia subtype was associated with an elevated risk (12%) and the deficit subtype was associated with a reduced risk (1.5%) of suicide. CONCLUSIONS: The impact of positive and negative symptoms on suicide risk has not been reported. These findings suggest that prominent negative symptoms, such as diminished drive, blunted affect, and social and emotional withdrawal, counter the emergence of suicidality in patients with schizophrenia spectrum disorders and that the deficit syndrome defines a group at relatively low risk for suicide. Prominent suspiciousness in the absence of negative symptoms defines a relatively high-risk group.

Adult↗
PubMed1978

[Social psychiatry of migrant workers (author's transl)].

A review of literature about psychic illness in migrant workers (with special reference to the situation in Europe) is presented, including the problems of incidence and prevalence, course of the illness, typical syndromes and treatment. Results concerning incidence and prevalence of psychic disease in migrant workers are contradictory and partly--for methodological reasons--of questionable quality. It cannot be take for granted, that migrant workers suffer more often from psychiatric disturbances than either of the two possible control groups: the populations of the emigration or immigration countries respectively. There are two high risk periods for migrants: shortly after the migration and after a longer period in the guest country. Differences between the migrant's culture and that of the immigration context (language, mythical beliefs, illness behavior) influence the manifestations of psychiatric syndromes. The following syndromes are typical for migrant workers: paranoid reactions, hypochondric-depressive syndromes, psychosomatic conditions and sexual neurosis. Special attention requests the treatment of migrant workers with psychiatric problems; the aspects of psychotherapy, accompanying social measures and the return as therapeutic measure are discussed. In the second part, a general frame of reference for the sociological analysis of the problem of migrant workers is presented. Reasons for the mass immigration of foreign workers to the industrialized countries of central Europe were the demand of labor force and the large gap in socio-economic development between the countries. In the immigration context, the foreign workers find themselves in the lowest social strata and numerous problems accumulate there. Empirical evidence for different sociological explanations of mental illnes of migrant workers ist presented: hypotheses of social selection vs. social causation (low socio-economic status, goal-striving-stress, culture-shock theory, theory of culture change and isolation hypothesis).

Adjustment Disorders↗
PubMed1984

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: II. Representative profile patterns.

Cluster analysis methods were used to classify Brief Psychiatric Rating Scale profiles for a sample of 88 geropsychiatric patients. Five distinct profile patterns were found to represent adequately most differences in symptom and behavior characteristics of the aged patients. The five phenomenological types are described as agitated dementia, retarded dementia, anxious depression, withdrawn depression, and paranoid psychosis. The appropriateness of this nomenclature is examined with reference to clinical diagnosis, mental status examination, and drug treatment. Prototype profile patterns that can be used to classify future geropsychiatric patients are presented, and a sequence of clinical decisions that should result in similar partitioning of the patient population is discussed.

Aged↗
PubMed1999

[Decision-making and delusion. A study on decision-making in delusional, depressive and healthy subjects].

Delusion as a phenomenon was always in the focus of psychiatric interest. Explanations for its origin reach from disturbed perception or affect to deficits in cognition. In our study we investigated 20 deluded, 20 depressive and 20 healthy subjects in order to find out differences in decision making, while a neutral test situation. Our hypothesis was that deluded subjects need less information for decision making and tend less to change their decision, made before, than both control groups will do this. For examination our hypothesis a modified version of "Probabilistic Inference Task" by Philips and Edwards was performed. In summary we found that deluded subjects need less information for decisions making than the control groups. Furthermore, decision making of deluded subjects seems more impulsive and less referring to formal logical criteria than it was found in depressed and healthy volunteers.

Adult↗
PubMed2006

Successful treatment of polydipsia, water intoxication, and delusional jealousy in an alcohol dependent patient with clozapine.

The beneficial effect of clozapine on polydipsia and water intoxication in patients with schizophrenia has been demonstrated many times. The authors report a successful clozapine treatment of polydipsia, intermittent water intoxication, and delusional jealousy of an alcoholic. This is a rare case of clozapine treatment of a non-schizophrenic patient affected by polydipsia.

Adult↗
PubMed2006

The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples.

BACKGROUND: Traditional instruments that measure self-esteem may not relate directly to the schema construct as outlined in recent cognitive models. The Brief Core Schema Scales (BCSS) aim to provide a theoretically coherent self-report assessment of schemata concerning self and others in psychosis. The scales assess four dimensions of self and other evaluation: negative-self, positive-self, negative-other, positive-other. METHOD: We analysed the psychometric properties of the BCSS using a sample of 754 students recruited by email and 252 people with psychosis recruited as part of a trial of cognitive therapy. We report the internal consistency, stability and the factor structure of the scale, and the association of the BCSS with measures of self-esteem and with symptoms of paranoia and grandiosity. RESULTS: The BCSS have good psychometric properties and have more independence from mood than the Rosenberg Self-Esteem Schedule. People with chronic psychosis reported extreme negative evaluations of both self and others on these scales, but their levels of self-esteem and positive evaluations of self and others were similar to the student sample. CONCLUSIONS: Extreme negative evaluations of self and others appear to be characteristic of the appraisals of people with chronic psychosis, and are associated with symptoms of grandiosity and paranoia in the non-clinical population. The BCSS may provide a more useful measure of schemata about self and others than traditional measures of self-esteem.

Adult↗
PubMed2000

Effects of neuroleptic medications on speech disorganization in schizophrenia: biasing associative networks towards meaning.

BACKGROUND: While some cognitive accounts of disorganized speech, or thought disorder, in schizophrenia have emphasized failures in working memory/discourse planning or selective attention, we have suggested that thought disorder resides in the semantic system. In this study we assessed the effect of neuroleptic medication on thought disorder and semantic processing. METHODS: Seventeen patients with schizophrenia were assessed while receiving neuroleptic medications and in crossover fashion, placebo. A number of measures were obtained: clinically rated thought disorder (using the Thought, Language and Communication Scale); working memory letter number span); lexical integrity (naming and receptive vocabulary); and, semantic priming of intracategorical word pairs. RESULTS: Semantic priming measures improved with neuroleptic medication, as did clinically rated thought disorder. No other measure changed significantly. Priming selectively covaried with changes in thought disorder. CONCLUSION: Changes in spreading semantic activation, measured in a semantic priming paradigm and presumably brought about by neuroleptics' influence on dopaminergic neuromodulatory systems, might reflect changes in the biases of pre-existing associative networks that favour or increase the accessibility of representations related by shared features. This study also has implications for the architecture of normal language in that a dissociation between the lexical and semantic levels was observed, due to the selective compromise of tasks demanding semantic processing.

Adult↗