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PubMed1993

[The dynamics of special forms of self injury].

The underlying psychodynamics are described on the basis of investigations undertaken with a total of 23 out-patients with self-inflicted lacerations of the skin. In many cases autoaggression was not the presenting symptom but was only mentioned by the patients in passing. The particular trigger factors and their effect is shown in two case descriptions. It appears that differences are possible between male and female patients. The character structure of the patients is usually narcissistic, the type of defence mechanisms being determined by the extent of borderline circumstances always present on first occurrence of autoaggression. Later, the original dynamics may become over-shadowed by obsessive behavior patterns. Self-inflicted wounds are seen to be part of a multiphase process which ultimately allows the patient to cope with narcissistic crises experienced as conflict situations. Withdrawal into a state of self-elected autarchy enables the patient to distance him/herself from the formerly idealized object now experienced as evil and disappointing. Pathological triangular relationships play a role here with the blood representing an important ersatz partner.

Adult↗
PubMed1996

Cattell's 16 PF and PSY inventory: relationship between personality traits and behavioral responses in patients with acute myocardial infarction.

The aim of this study was to investigate the relationships between personality and behavioral responses in patients with acute myocardial infarction. In a first step, a new instrument (PSY Inventory) for assessment of six behavioral characteristics (Sense of Responsibility, Energy and Competitiveness, Obsessive Behavior, Anger and Hostility, Stress-related Disturbances, Time Urgency) was developed by using factor analysis on intercorrelations of responses from 524 subjects of the general population. Internal consistency reliability for each of the PSY subscales was estimated by Cronbach alpha coefficients. In a second step, the PSY Inventory was administered with the Cattell 16 PF Questionnaire to 838 patients affected by acute myocardial infarction. Significant correlations although relatively low in magnitude for PSY Inventory subscales and certain scales of the Cattell 16 PF were found. With factor analysis on 22 variables (including the six PSY Inventory subscales and the 16 scales of the Cattell 16 PF), five second-order factors were identified, namely, Extraversion, Neurotic Anxiety, Superego Strength, Pathemia, and Neurotic Hostility. While a Pathemia Factor (characterized by sensitivity, imagination, and self-sufficiency) was factorially independent of scales of the PSY Inventory, Extraversion, Neurotic Anxiety, Superego Strength, and Neurotic Hostility Factors were composed of the PSY Inventory scales and Cattell 16 PF scales combined. These relationships would reflect the concordance of internal constructs for behavioral measures of the PSY Inventory and those of personality traits of the 16 PF Questionnaire in patients with acute myocardial infarction.

Adaptation, Psychological↗
PubMed1995

Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa.

OBJECTIVE: It is well recognized that patients with anorexia nervosa have perfectionistic and obsessive behaviors. This study investigated whether such behaviors persist after recovery. METHOD: Twenty subjects who had recovered from anorexia nervosa were recruited for the study. They had been at normal weight and their menses had been regular for more than a year. These subjects were compared with 16 healthy women with the use of the Eating Disorder Inventory, the Frost Multidimensional Perfectionism Scale, and the Yale-Brown Obsessive Compulsive Scale. RESULTS: The recovered anorexic patients had significantly higher scores than the comparison women on the measures of perfectionism on the Eating Disorder Inventory and on overall perfectionism on the Frost scale. Moreover, the recovered patients had higher scores on the Yale-Brown scale, with target symptoms suggesting that many had specific concerns with symmetry and exactness. CONCLUSIONS: Certain characteristics of anorexia nervosa, such as a need for order and precision, persist after good outcome and recovery, raising the question of whether these behaviors are traits that contribute to the pathogenesis of this illness.

Adult↗
PubMed1994

Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗
PubMedDate not supplied

L-tryptophan in neuropsychiatric disorders: a review.

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.

Dopamine↗
PubMed1987

A controlled study of Tourette syndrome. IV. Obsessions, compulsions, and schizoid behaviors.

To determine the frequency of obsessive, compulsive, and schizoid behaviors in Tourette syndrome (TS), we prospectively questioned 246 patients with TS, 17 with attention-deficit disorder (ADD), 15 with ADD due to a TS gene, and 47 random controls. The comparative frequency of obsessive, compulsive, and repetitive behaviors--such as obsessive unpleasant thoughts, obsessive silly thoughts, echolalia, palilalia, touching things excessively, touching things a specific number of times, touching others excessively, sexual touching, biting or hurting oneself, head banging, rocking, mimicking others, counting things, and occasional or frequent public exhibitionism--were significantly more common in TS patients than in controls. The frequency of each of these was much higher for grade 3 (severe) TS. Most of these behaviors also occurred significantly more often in individuals with ADD or in individuals with ADD secondary to TS (ADD 2(0) TS). When these features were combined into an obsessive-compulsive score, 45.4% of TS patients had a score of 4-15, whereas 8.5% of controls had a score of 4 or 5. These results indicate that obsessive-compulsive behaviors are an integral part of the expression of the TS gene and can be inherited as an autosomal dominant trait. Schizoid symptoms, such as thinking that people were watching them or plotting against them, were significantly more common in TS patients than in controls. Auditory hallucinations of hearing voices were present in 14.6% of TS patients, compared with 2.1% of controls (P = .02). These symptoms were absent in ADD patients but present in ADD 2(0) TS patients. These voices were often blamed for telling them to do bad things and were frequently identified with the devil. None of the controls had a total schizoid behavior score greater than 3, whereas 10.9% of the TS patients had scores of 4-10 (P = .02). This frequency increased to 20.6% in the grade 3 TS patients. These quantitative results confirm our clinical impression that some TS patients have paranoid ideations, often feel that people are out to get them, and hear voices.

Adolescent↗
PubMed1993

Behavior therapy for obsessive compulsive disorder in the office-based practice.

The article provides guidance for the clinician in applying scientifically proven behavior therapy techniques for obsessive compulsive disorder. Rationale for considering behavior therapy for all patients with OCD is presented, along with guidelines for determining an adequate trial of this approach and for predicting if a particular patient is likely to benefit.

Ambulatory Care↗
PubMed2001

Personality change as defensive responses of patients evaluated for liver transplant.

Patients affected by endstage liver disease and awaiting liver transplant suffer very stressful conditions. The aim of this study was to evaluate the person ality and behavioral responses of a group of liver transplant candidates, 95 men (M age 50 yr.) and of a group of 18 normal men (M age 49 yr.). The 16 Personality Factor Questionnaire of Cattell, and the PSY Inventory for Behavioral Assessment were administered to assess personality and behavior. On the 16PF Questionnaire, patients had significantly different mean scores from normal subjects on Scale B- (low mental capacity), G (conformity), N (shrewdness), and Q1- (conservatism). They also showed a somewhat lower but not a statistically significant mean on Scale E (submissiveness). In addition, on the four second-order factors of the 16PF (Anxiety, Control, Pathemia, and Extraversion) patients had a significantly higher mean on Control. With respect to PSY Inventors factors, patients showed impairment in energy, sleep, sexual disturbances, and obsessive behaviors. It appears these patients with endstage liver disease, who were evaluated for liver transplant, showed psychological regressive functioning, i.e., high control and dependency on medical staff, submissiveness, which are interpretable as defensive responses to upcoming transplant.

Adult↗
PubMedDate not supplied

Personality disorders do not influence the results of cognitive and behavior therapy for obsessive compulsive disorder.

This study examined whether categorical or dimensional personality disorder variables affected treatment outcome in a sample of 52 patients with obsessive compulsive disorder who followed a standardized cognitive behavior therapy program. Treatment consisted of 12 weekly sessions and was completed by 43 patients. The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was taken before the start of treatment by an independent rater. The treatment outcome measures included questionnaires and a Behavioral Assessment Test. Measurements were taken before and after treatment, and at 1 and 6 month follow-up tests. After the first follow-up test, further treatment was provided if clinically indicated. Neither categorical, nor dimensional personality disorder variables affected treatment outcome significantly. The inclusion of drop-outs in the analyses, did not change these results. Therefore, patients with obsessive compulsive disorder and concomitant personality disorder pathology should not be excluded from cognitive or behavior therapy for their obsessive compulsive complaints. Attributing therapy failure to concomitant Axis II pathology should be approached with caution.

Adolescent↗
PubMed1998

Case study: behavioral treatment of obsessive-compulsive disorder in a boy with comorbid disruptive behavior problems.

Comorbid psychiatric conditions often complicate the treatment of childhood obsessive-compulsive disorder (OCD). Behavioral treatment of OCD using exposure plus response prevention for a boy with disruptive behavior disorders and two previous unsuccessful medication trials is described. Treatment was adapted to his developmental level, his mother was highly involved in treatment, and a contingency management program contained his disruptive behavior so that he could participate in therapy. Posttreatment and 2- and 6-month follow-up measures indicated marked improvement in OCD symptoms. The possibility of successful behavioral treatment of OCD in medication-free children with disruptive behavior problems is highlighted.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed1996

Autism, Asperger's syndrome and the Crick-Mitchison theory of the biological function of REM sleep.

Autism, Asperger's syndrome and other autistic syndromes are developmental brain disorders that cause serious impairments in communication, social interaction, empathy, mood and play. In addition to such deficits, the autistic syndromes involve pathologically high levels of repetitive, stereotypic, ritualistic, compulsive or obsessive behavior, together with extreme resistance to change. According to the Crick-Mitchison theory of the biological function of rapid eye movement sleep, normal brain development in the fetus and infant depends on undisrupted function of a 'reverse learning' mechanism during rapid eye movement sleep. Could abnormalities in this hypothetical reverse learning during rapid eye movement sleep in the fetus explain some aspects of the autistic syndromes? Does the Crick-Mitchison theory suggest if a drug could interfere with rapid eye movement sleep and cross the placental barrier, then that drug might cause developmental brain disorders in the fetus? Should all pregnant women completely avoid caffeine or any agent that might disrupt serotonergic or cholinergic systems?

Autistic Disorder↗
PubMed1994

A case-control study of ulcerative colitis in Japan.

To determine whether risk factors of ulcerative colitis among Japanese are the same as those observed in other countries, we conducted a case-control study in Japan in 1988-90. Patients selected for the study were receiving financial aid for treatment of the disease; an equal number of population-based controls matched by age and sex were selected. Smoking decreased the risk of the disease (odds ratio = 0.30; 95% confidence interval, 0.16-0.56), and stopping smoking increased the risk (odds ratio compared with those who had never smoked = 1.44; 95% confidence interval, 0.73-2.85). In those who drank alcoholic beverages > or = 5 days a week, disease development was less likely than in others (odds ratio = 0.49; 95% confidence interval, 0.30-0.81). In addition, difficulties in human relations at work, a family history of asthma, a medical history of surgical procedures, and personality traits such as nervousness, anxiety, and obsessive behavior were also considered risk factors. Although some findings are similar to those in former studies, a few findings are different: surgical procedures, occupational status, and a family history of the disease. To clarify whether the differences are consistent will require other case-control studies.

Adult↗
PubMed1995

Improvement of right hemispheric functions in a child with Gilles de la Tourette's syndrome by weak electromagnetic fields.

Gilles de la Tourette's syndrome (GTS) is a chronic, familial neuropsychiatric disorder of unknown etiology characterized clinically by the occurrence of motor and vocal tics and by the presence of a variety of neurobehavioral and neurocognitive abnormalities including hyperactivity, self-multilatory behavior, obsessive-compulsive behavior, learning disabilities, and conduct disorder. On the basis of neuropsychological assessments it has been suggested that GTS is associated with greater right than left hemispheric dysfunction which accounts for decrements in visuospatial, visuoconstructional and visuomotor skills in these patients. Recent case studies have demonstrated that extracranial application of electromagnetic fields (EMFs) in the picotesla (pT) range intensity improves visuospatial and visuoperceptive functions in patients with neurodegenerative disorders including Parkinson's disease, multiple sclerosis and Alzheimer's disease. I now present a 6 1/2 year old boy with GTS in whom this treatment modality produced, in addition to symptomatic behavioral improvement, also improvement in visuoconstructional and visuomotor skills as evidenced on various drawing tasks particularly copy of the Rey-Osterrieth Complex Figure, a task which is especially vulnerable to right hemispheric functions. These findings suggest that pT range EMFs may be useful for the treatment of GTS and related disorders and also reverse some of the cognitive impairments associated with the disease which are related to right hemispheric dysfunction and which contribute to learning disabilities in these patients.

Brain↗
PubMed1997

Reversal of a visuoconstructional disorder by weak electromagnetic fields in a child with Tourette's syndrome.

Tourette's syndrome (TS), a chronic familial neuropsychiatric disorder of unknown etiology, is characterized clinically by the occurrence of motor and vocal tics and by the presence of a variety of neurobehavioral and neurocognitive abnormalities including hyperactivity, self-mutilatory behavior, obsessive-compulsive behavior, learning disabilities, and conduct disorder. Cognitive deficits related to right hemispheric dysfunction are common in TS patients accounting for decrements in visuospatial, visuoconstructional and visuomotor skills. An 11 year old boy with a 5 years history of TS exhibited during a routine neuropsychological assessment an unusual visuoconstructional disorder which previously has been observed in dyslexic children. Specifically, when instructed to draw a bicycle from memory, he drew spontaneously a design executed from the perspective of a bird's eye view. After receiving a 20 minute treatment session with picotesla range electromagnetic fields (EMFs) applied extracranially, this visuocontructional disorder was spontaneously reversed and he drew an elaborate and detailed bicycle positioned in profile. A placebo EMF treatment, which was administered prior to magnetic therapy, had no effect on this child's visuoconstructional disorder. During the ensuing week there was a marked reduction in the child's hyperactive behavior with attentuation of motor tics. Spontaneous drawing of a bicycle a week after the administration of magnetic therapy was executed in profile although some elements were presented from a bird's eye view. This case demonstrates the potential impact of treatment with picotesla EMFs in reversing specific cognitive deficits in TS related to right posterior hemispheric dysfunction.

Brain Diseases↗
PubMed1991

[Multiple tics and Gilles de la Tourette syndrome].

Tic disorders are frequent in childhood, varying from transient motor tics over multiple chronic tic disorders to full-blown Gilles de la Tourette syndrome (GTS). GTS is genetically determined. In affected families, relatives of the patient(s) with GTS may show minor symptoms only. The clinical picture is extremely variable, extending from the well known motor tics over complex compulsive obsessive behavior to purely sensory tics. The optimal treatment today is the use of dopamine antagonists.

Antipsychotic Agents↗
PubMed1995

[A case of focal encephalitis with psychological symptoms similar to chorea minor].

We reported a patient with choreic movements, emotional lability, and compulsive-obsessive behavior that developed 4 weeks after onset of fever and lasted for several years. There was no evidence of streptococcal infection or rheumatic fever. T2-weighted MRI showed hyperintense lesions in the bilateral caudate nuclei and putamina. A diagnosis of focal encephalitis was made according to initial fever, convulsion, and CSF pleocytosis. Treatments with haloperidol and prednisolone were effective in some degree. The neurobehavioral syndrome as well as the involuntary movements in this patient can be attributed to the striatal damage, which may disrupt the basal ganglia-limbic-frontal lobe tracts. A symptomatic similarity between the syndrome in this patient and chorea minor suggests a striatal damage in chorea minor, where the causative lesions remain unknown.

Affective Symptoms↗