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Psychiatry in China.
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Evaluation of violence and dangerous behavior associated with mental illness.
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[Somatic and psychosocial factors in the immediate background of mental disorders in the aged].
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[On various features of maniacal states in schizophrenia progressing in an intermittent form].
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The adaptive-style theory of schizophrenic development: current research with schizophrenics.
This paper first reviews the adaptive-style theory of schizophrenia that was published in 1973 along with the evidence gathered from normal male Ss. The theory emphasized the importance of perceived maternal behaviors in the development of maladaptive social and cognitive styles for the son. The problems of interpreting data gathered from normals in terms of their implications for schizophrenic development are considered in the present paper, as well as the rules of evidence adopted for post-1973 research with mental patients bearing upon the adaptive-style theory. Theory relevance and support has required that cognitive behaviors distinguishing normal males displaying the two adaptive styles also differentiate process and reactive schizophrenics in specified ways. In addition, these differences should represent sources of vulnerability to major psychotic symptoms. Five studies into delusions and auditory hallucinations are discussed in terms of how well they support adaptive-style theory.
The management of drug-resistant, persistent and unpleasant auditory hallucinations.
This article attempts to give an overview of the main cognitive-behavioral therapeutic approaches in order to reduce persistent, unpleasant and drug-resistant auditory hallucinations. These procedures are based on operant conditioning principles and cognitive self-management techniques. A brief case history is reported to illustrate the therapeutic interventions.
Lack of motivation for treatment in emergency psychiatry patients.
BACKGROUND: A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients. METHOD: A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale. RESULTS: In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21-3.40], substance abuse (OR 1.71; CI 1.09-2.67), suspiciousness (OR 1.4; CI 1.19-1.64), grandiosity (OR 1.19; CI 1.01-1.4), anxiety (OR 0.74; CI 0.64-0.86), and GAF score (OR 0.98; CI 0.96-0.99). CONCLUSIONS: Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients.
Inpatient violence and the schizophrenic patient. A study of Brief Psychiatric Rating Scale scores and inpatient behavior.
A correlational analysis of Brief Psychiatric Rating Scale (BPRS) ratings and measures of inpatient violence in 207 schizophrenic patients is presented. Significant correlations were found between BPRS measures of schizophrenic symptomatology and several measures of inpatient violence including assault. BPRS subscales which related to paranoid symptoms were also significantly correlated with inpatient danger-related measures; however, to a lesser degree.
Psychopathology in epilepsy: prevalence, phenomenology and management.
Epilepsy is associated with interictal behavioral disturbances. The pattern of specific psychopathology differs from that of other chronic diseases because of the higher incidence of psychosis and characterological disorders. Approximately 7 percent of epileptics develop a chronic atypical psychosis with paranoid and affective features, and this may be more common in patients with a definite temporal lobe focus. Brief psychotic episodes occur and are more directly related to cerebral dysrhythmia. A subgroup of epileptics develop specific personality traits, aggressive behaviors under certain circumstances, and hyposexuality. Affective illness and suicide are also prevalent. There are special issues in the management of psychopathology in the setting of epilepsy such as the relative seizure threshold lowering effects of psychotropic drugs and the behavioral effects of altering the seizure control. This article discusses both diagnostic and management aspects of the interictal psychopathology of epilepsy.
Vicious and virtuous circles: the role of deviation amplifying feedback in the origin and perpetuation of behavior.
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Mental health and dental education.
The relationship between mental health and the educational process in dental school has rarely been explored. In the author's experience as the mental health consultant at the USC School of Dentistry, several focal points of conflict do influence academic effectiveness. These problem areas are often marked by a variety of physical or psychological symptoms such as anxiety--sometimes of panic proportions--gastrointestinal disturbances, and the like. These are frequently related to fear of failure, being exposed as being intellectually inept and fraudulent, neurotic competitive needs, real and unreal paranoid attitudes toward instructors, the student's expectations as to what his or her "silent partners" require to him or her, and the effect dental education has on marriage.
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.
Lithium treatment of mania: clinical characteristics, specificity of symptom change, and outcome.
The effects of lithium treatment and prediction of response in 18 manic patients were studied as part of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression. Patients were rated using the Mania Diagnostic and Severity Scale (MADS) and an additional battery of behavioral constructs developed for measurement of state and drug response in depressed patients. About 67% of the patients had good treatment outcome after 26 days of lithium treatment. Responders did not differ from nonresponders before treatment with respect to delusions, hallucinations, or irritable-paranoid symptoms. Nonresponders were rated as more anxious than responders before treatment and had higher scores on the Hamilton Rating Scale for Depression. Improvement on the MADS, however, did not correlate with pretreatment behavioral ratings. Patients with relatively high ratings for aspects of behavior not specific to mania tended to improve in these regardless of change in MADS score. Manic patients who were also depressed (44%) had higher mania ratings than manic patients who were not depressed. Patients with concomitant depression and mania had significantly worse overall treatment outcome, although their depression ratings improved during lithium treatment.
Effects of meta-chlorophenylpiperazine on neuroendocrine and behavioral responses in male schizophrenic patients and normal volunteers.
Functional alterations in the central serotonergic system, including presynaptic and postsynaptic function, have been reported in schizophrenia. Recently, there have been conflicting reports that the increase in plasma cortisol or prolactin concentrations induced by meta-chlorophenylpiperazine (mCPP) was significantly blunted in schizophrenic patients compared with normal volunteers. Studies of the behavioral effects of mCPP, a serotonin (5-HT) receptor partial agonist with high affinity for 5-HT1C binding sites, have also yielded conflicting results in schizophrenic patients. The purpose of this study was to examine plasma levels of prolactin and cortisol, body temperature, and behavioral responses to mCPP and placebo in a single-blind study in 25 schizophrenic and 15 normal men. No differences either between schizophrenic patients and normal volunteers or between paranoid and undifferentiated/residual subtypes of schizophrenia were found in mCPP-induced prolactin, cortisol, or temperature responses. Schizophrenic patients and normal volunteers reported significant increases in feeling calm and feeling strange of comparable magnitude following mCPP. No significant differences between normal volunteers and schizophrenic patients were found in post-mCPP behavioral ratings, such as anxiety, irritability, depression, restlessness, or arousal.
Can estradiol modulate schizophrenic symptomatology?
Using epidemiologic data, in an earlier study we formulated the hypothesis that estrogens can delay the onset of schizophrenia in females by raising the vulnerability threshold for this disease. In animal experiments, Häfner and colleagues found evidence that chronic estradiol treatment reduces the sensitivity of dopamine (D2) receptors in the brain. In the clinical study presented in this article, as a further step we examined the antipsychotic properties of estradiol in human females by testing whether schizophrenic symptomatology varies with estradiol serum levels throughout the menstrual cycle. We examined 32 acutely admitted female schizophrenia patients (Present State Examination/CATEGO diagnosis, ICD-9) with a history of regular menstrual cycles, ages 18 to 43 (mean = 30.5), during their hospital stays (3-8 weeks), analyzing hormonal parameters and applying various rating scales for psychopathology every 7 days. In all patients, estradiol serum levels were markedly reduced as compared with the normal population, and fluctuations throughout the cycle were dampened. Nevertheless, a significant association emerged between estradiol levels, on the one hand, and psychopathology scores, on the other--that is, the psychiatric symptomatology as assessed by the clinical psychiatrist (Brief Psychiatric Rating Scale, p < or = 0.01), behavior on the ward as assessed by the nursing staff (Nurses' Observation Scale for Inpatient Evaluation p < or = 0.01), paranoid tendencies and general well-being as assessed by the patients themselves (Paranoid-Depressivitäts-Skala paranoid score p < or = 0.05; Befindlichkeits-Skala p < or = 0.05). Psychopathology seems to improve when estradiol levels rise, and vice versa. These findings can be interpreted as further evidence for a protective effect of estrogens in schizophrenia, possibly due to the known anti-dopaminergic activities of these hormones.
Antisocial personality disorder with childhood- vs. adolescence-onset conduct disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.
This study, based on a nationally representative, epidemiologic sample (N = 43,093, response rate 81%), compared sociodemographic and family history correlates, antisocial personality disorder (ASPD) symptom patterns, and Axis I and Axis II comorbidity, among adults with DSM-IV ASPD who reported onset of conduct disorder (CD) in childhood ( or =age 10). Prevalence of each ASPD diagnostic criterion and comorbid lifetime disorder was estimated. Logistic regression was used to examine associations of childhood-onset CD with ASPD symptom patterns and comorbid disorders. Among the 1422 respondents with ASPD, 447 reported childhood-onset CD. Childhood-onset respondents were more likely than adolescence-onset respondents to endorse CD criteria involving aggression against persons, animals, and property before age 15, and to endorse more childhood criteria and lifetime violent behaviors. Childhood-onset respondents displayed significantly elevated odds of lifetime social phobia, generalized anxiety disorder, drug dependence, and paranoid, schizoid, and avoidant personality disorders, but significantly decreased odds for lifetime tobacco dependence. Childhood-onset CD appears to identify a more polysymptomatic and violent form of ASPD, associated with greater lifetime comorbidity for selected Axis I and Axis II disorders, in nonclinical populations.
A behavioral perspective of schizophrenia.
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