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PubMed1994

Capacity to stand trial: pitfalls of legal interpretation.

Legally, the concept of fitness to stand trial is fixed and absolute. Psychiatrists view fitness as a homeostatic functional capacity. The Ontario Court of Appeal recently set a precedent (Queen versus Taylor) for a standard of fitness to stand trial by interpreting the criteria for unfitness as defined in terms of Section 2 of the Criminal Code. They held that only a factual understanding of these criteria is required by the courts. A person suffering from acute psychotic symptoms with delusions which relate to the subject matter of the trial, who act contrary to their best interests and who are disruptive in their behaviour to the orderly flow of the trial may still fulfill the criteria for fitness to stand trial. The writer illustrates some important implications of this decision and suggests recommendations to current legal interpretations of a clinical capacity.

Adult↗
PubMed1999

Rorschach aggression variables: a study of reliability and validity.

This study investigated the extent to which 6 Rorschach variables of aggression (A1, A2, AG, MOR, AgC, AgPast) are related to one another, to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) Cluster B personality disorder criteria, and to self-report measures of anger, aggression, and antisocial behavior. Seventy-eight patients were found to meet DSM-IV criteria for an Axis II disorder, Cluster A personality disorder (paranoid, schizoid, schizotypal) = 9, Cluster B (antisocial personality disorder [ANPD] = 16, borderline personality disorder [BPD] = 23, histrionic personality disorder = 5, narcissistic personality disorder = 12) = 56, and Cluster C personality disorder (avoidant, dependent, obsessive-compulsive) = 13. The results of this study indicated that (a) these 6 Rorschach aggression variables can be scored reliably; (b) 2 factors, revealed by factor analysis, accounted for 77% of the total variance; (c) selected variables were found to be empirically related to DSM-IV diagnostic criteria for ANPD and BPD; and (d) selected variables were found to be empirically related to a self-report measure of anger and antisocial practices. The conceptual nature and clinical utility of these Rorschach aggression variables as well as implications for future research are discussed.

Adult↗
PubMed1999

O'Connor v. Donaldson: retelling a classic and finding some revisionist history.

This article discusses the 1975 Supreme Court opinion O'Connor v. Donaldson. The article first examines the due process clause of the Fourteenth Amendment, the basis for the O'Connor ruling. It then looks carefully at the Court's conclusions, with particular attention to the Court's reasoning and analysis. The article goes on to look at how the Supreme Court has interpreted O'Connor on subsequent occasions and suggests that the Court has often misconstrued its own decision. The article concludes by offering thoughts and commentary on the O'Connor opinion and its progeny.

Civil Rights↗
PubMedDate not supplied

[Cognitive inhibition and psychopathology: toward a less simplistic conceptualization].

"Cognitive inhibition" is a concept that has found a firm place in the interpretation of performance by normal subjects on tasks involving adherence to a plan and suppression of incorrect responses to distractors. The presence of "negative priming" is the classical indicator of cognitive inhibition. Negative priming occurs when, in a sequence of stimuli each of which is composed of a target and a distractor, the distractor of the first stimulus becomes the target of the second stimulus: reaction time to the second stimulus is slowed because of the inhibition applied to the distractor of the first stimulus. The concept has been extended to the interpretation of pathological behavior and symptoms. Pathological subjects have been found to show deficient negative priming. Thus, negative ideation in depression as well as intrusive paranoid associations in schizophrenia have been related to a deficit in the capacity to inhibit inappropriate representations. In this paper, we briefly review some of the experimental evidence from normal subjects that has contributed to the acceptance of cognitive inhibition as a key process in the control of normal cognition, as well as more recent evidence that has led to a revision of the concept. Negative priming in normal subjects has been found to be dependent upon characteristics of the experimental situation as perceived by the subject. In particular, priming is observed when the subject anticipates difficulty in determining the response and proceeds with caution. Thus, inhibition is not an automatic "brake" applied to irrelevant material, but rather the product of strategic considerations within the experimental situation. This revision of the cognitive inhibition hypothesis leads to a re-interpretation of the apparently deficient cognitive inhibition seen in depressed or schizophrenic subjects. According to this more recent interpretation, deficient cognitive inhibition in pathological subjects can be seen as a less adaptive strategic adjustment to the task. The pathology seems to touch higher-level executive functions rather than a deficient inhibitory "brake". In depressed subjects, abnormal performance in selective attention tasks could be related to the underlying pathology in two ways: some depressed subjects show a marked lack of energy and a psychomotor slowing: these subjects do not exhibit normal negative priming, probably because of a reduction of cognitive resources. Other depressed subjects show abnormal performance as reflected by negative priming greater than normal: this result could be related to an exaggerated tendency to verify a correct response. Schizophrenic subjects show a lack of negative priming that seems most plausibly to be related to an ineffectual integration of the experimental instructions concerning both speed and accuracy in the response. This re-interpretation of the cognitive deficiency in pathological patients provides a better fit with recent experimental results from normal subjects, and with cognitive deficits measured in pathological subjects.

Association Learning↗
PubMed2003

Amphetamine sensitization of hallucinatory-like behaviors is dependent on prefrontal cortex in nonhuman primates.

BACKGROUND: Repeated amphetamine (AMPH) exposure in nonhuman primates produces a chronic state of monoamine dysregulation and long-lasting changes in behaviors elicited by acute AMPH (including tracking, grasping "at thin air," manipulating nonapparent stimuli, and hypervigilance) in a manner that bears a marked resemblance to symptoms of both amphetamine psychosis and paranoid schizophrenia. These abnormal responses have historically been referred to as psychotomimetic or hallucinatory-like. In contrast to negative symptoms and cognitive deficits, the positive symptoms of schizophrenia including hallucinations have not traditionally been linked to prefrontal dysfunction. METHODS: The dorsomedial (9/8B), dorsolateral (46/8A), and inferior (45/12) sectors of prefrontal cortex were lesioned, singly or in combination. Lesioned and nonlesioned control monkeys were sensitized over a 6-week period using an intermittent schedule of escalating low doses of AMPH. Behavioral responses to acute AMPH after chronic exposure were compared with preexposure responses. RESULTS: Bilateral lesions of prefrontal cortex performed before subchronic AMPH suppressed the sensitization of hallucinatory-like behaviors but markedly enhanced locomotor sensitization compared with control animals. CONCLUSION: These findings indicate that the primate prefrontal cortex may be a substrate for the development of the full complement of behaviors elicited by AMPH sensitization, including hallucinatory-like behaviors.

Amphetamine↗
PubMed1998

Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior.

OBJECTIVE: Sociodemographic features, phenomenology, and psychiatric comorbidity of 30 subjects reporting pathological gambling behavior were examined. METHODS: Twenty-three men and seven women were recruited by advertisement and word-of-mouth. They all scored higher than 5 points on the South Oaks Gambling Screen, indicating problematic gambling behaviors. They completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (DIS), the Personality Diagnostic Questionnaire, Fourth Revision (PDQ-IV), and the Minnesota Impulsive Disorders Interview. RESULTS: The typical subject was a 44-year-old white married man with a mean income of $34,250 who visited a casino once or more weekly. All 30 subjects reported gambling more money than they intended to. Twenty subjects (67 percent) reported gambling as a current problem, and nine (30 percent) reported it as a past problem. Twenty-one subjects (70 percent) wanted to stop gambling but did not feel they could. According to DIS results, 18 subjects (60 percent) had a lifetime mood disorder, 19 (64 percent) a lifetime substance use disorder, and 12 (40 percent) a lifetime anxiety disorder. Based on the PDQ-IV, 26 subjects (87 percent) had a personality disorder, the most common being obsessive-compulsive, avoidant, schizotypal, and paranoid personality disorders. The sample also had a relatively high rate of antisocial personality disorder. Impulse control disorders were common, especially compulsive buying and compulsive sexual behavior. CONCLUSIONS: The results confirm that individuals with pathological gambling suffer substantial psychiatric comorbidity. They support continued inclusion of pathological gambling in the diagnostic category of impulse control disorders.

Adult↗
PubMedDate not supplied

The psychodynamics of the presidential assassin and an examination of the theme/graphic variables of his threatening correspondence.

Many document examiners recognize the importance of an individuals 'state of mind' and its effect on handwriting but historically have steered clear of working closely with psychiatrists, linguists, or psychologists in understanding the interaction of nervous impulses and motor responses on the final handwritten product. In an attempt to better understand and evaluate those fears and motivational influences which should exist within the writings of the mentally disturbed in his threatening correspondence, research was conducted to ascertain whether there are consistently reappearing delusional value systems/hostilities which characterize the writings of the paranoid schizophrenic assassin subject. The results of this preliminary investigation revealed substantial evidence to suggest that most U.S. assassins have been psychotic at the time they attempted to kill their victims and that the most frequently rendered diagnosis was 'paranoid schizophrenia'. It was also reported that many of the assassin subjects had either sent threatening correspondence to their victims prior to the assassination attempt or had recanted the justifiable nature of their 'heroic deed' in letters or personal diaries which were recovered shortly after the assault. It is also apparent that over the years, the Secret Service has investigated a number of threatening letter writers who were later diagnosed as suffering from some sort of schizophrenic reaction and characterized as 'potentially dangerous' to the President. Most of the insight to be gained from an examination of what researchers have discovered regarding those unique graphic traits found in 'schizophrenic writing' can be gleaned from those published papers contributed by graphologists/document examiners and that offered by the behavioral science/medical community in the form of psychiatrists, neurologists, psychologists and psycholinguists. The results of bonafide scientific and forensic literature research strongly suggest that the threatening writings of the paranoid schizophrenic and/or potential assassin will probably reveal distinctive graphic 'abnormalities' which are found to act in combination with certain combinations of reoccurring delusional value systems, frustrations, and hostilities.

Adolescent↗
PubMedDate not supplied

Threats to the president revisited.

Ten prisoners charged with "threatening the President of the United States" were evaluated in an effort to seek out psychiatric and sociological factors involved in this offence. Comparisons were made with known presidential assassins. A history of abandonment as a child, single or divorced state, and a diagnosis of paranoid schizophrenia were prominent in both the study group and the group of know assassins. Additionally, the apparent psychological need behind both the threats and the actual assassinations appeared remarkably similar in both groups. The primary differentiating variable related to lethality was "opportunity and happenstance". It is proposed that those threatening the President by letter are at high risk for carrying out their threat if intervention does not take place.

Adult↗
PubMed2005

Alzheimer disease subjects with psychosis have increased schizotypal symptoms before dementia onset.

BACKGROUND: Recent findings have demonstrated the familiality of psychotic symptoms occurring during Alzheimer disease (AD with psychosis, AD+P), particularly for subjects with multiple psychotic symptoms. We have proposed a model in which genes that confer a small risk for psychosis interact with neurodegenerative illness to yield manifest psychotic symptoms during AD. One prediction of this model would be that AD+P subjects would have evidence of increased degrees of subsyndromal psychosis before AD onset. METHODS: We used the psychosis (positive symptoms) and psychotic personality disorder sections (paranoid, schizoid, and schizotypal) of the Family Interview for Genetic Studies (FIGS) to interview the primary caregivers of AD subjects. Caregivers were specifically instructed to answer questions with regard to the subject's behavior before AD onset. Interviewers were blind to presence of psychosis during AD. Subjects were grouped by whether they had at least one or had multiple psychotic symptoms during AD. RESULTS: Scores on the FIGS subscales were generally low, reflecting a low frequency of endorsement of psychotic symptoms before AD. There was a trend for the schizotypal scores to be elevated in the AD+P group, which was highly significant in the AD+P group with multiple psychotic symptoms. There was no significant association of paranoid or schizoid scores with either group. CONCLUSIONS: Although limited by small sample size and retrospective design, these data are novel in that they indicate an association of subsyndromal psychotic symptoms before AD onset with psychosis in AD. Subsyndromal psychosis might be useful for classifying AD+P families for genetic mapping studies. Prospective confirmation is required.

Age of Onset↗
PubMed1985

Brain function in psychiatric disorders. III. Regional cerebral blood flow in unmedicated schizophrenics.

Regional cerebral blood flow (rCBF) was measured during resting baseline and the performance of a verbal and a spatial task in 19 unmedicated schizophrenics and 19 matched controls. Abnormalities in rCBF were evident in schizophrenics both for resting and activated measures. Resting flows were higher in the left hemisphere for schizophrenics, supporting the hypothesis of left hemispheric overactivation. This effect was stronger in the more severely disturbed patients. The pattern of rCBF changes during activation with the verbal and spatial tasks was also different in schizophrenics. Laterality of flow changes further supported the hypothesis of left hemispheric overactivation. Furthermore, whereas normals had greater increase in flow for the spatial than the verbal task, schizophrenics showed the reverse pattern. This effect also was more pronounced in the severely disturbed patients. Comparison with an earlier sample of medicated schizophrenics suggested that neuroleptics restore symmetry of resting flows before they produce symptomatic relief. Medication did not affect the abnormalities in pattern of rCBF changes during activation with cognitive tasks.

Adolescent↗
PubMed2005

Childhood conduct problems, stages of Alzheimer's disease, and physical aggression against caregivers.

OBJECTIVE: To assess the prevalence of physical aggression against caregivers by Alzheimer's patients. METHOD: One hundred and ninety-eight individuals with dementia, primarily Alzheimer's disease (AD) were evaluated with the Cohen-Mansfield Agitation Inventory, the Mini Mental Status Examination, two measures of Activities of Daily Living, portions of the Conflict Tactics Scale to measure physical aggression against partner, questions about conduct problems during childhood/adolescence of the patients, and chart records of delusion and paranoia. RESULTS: 25% of the patients engaged in physical aggression against their caregivers in the past year, and 33% of the patients engaged in some act of physical aggression against any individual in the past two weeks. Physical aggression against a caregiver was more likely in the middle (34%) than the early stage of AD (4%). Physical aggression against a partner and agitation were more likely if the patient had a history of symptoms of conduct disorder. Delusions and paranoia were both associated with general physical aggression and general verbal aggression but not physical aggression against a caretaker. CONCLUSIONS: 25% of Alzheimer's disease and Multi-Infarct dementia patients engaged in acts of physical aggression against their caregivers. The rate of aggression seen in this clinical sample was much higher than the rate of physical aggression in a community sample of the elderly.

Activities of Daily Living↗