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PubMed2003

Neuropsychiatric consequences (atypical psychosis and complex-partial seizures) of ecstasy use: possible evidence for toxicity-vulnerability predictors and implications for preventative and clinical care.

Two case reports of ecstasy abuse and its serious neuropsychiatric complications are presented. The first patient developed a florid paranoid psychosis resembling schizophrenia after repeated long-term recreational ecstasy abuse, and significant alterations with intermittent paroxysmal discharges were found in his electroencephalogram. The second patient showed an atypical paranoid psychosis with Fregoli syndrome and a series of complex-partial epileptic seizures with secondary generalization after a first single ecstasy dose. Both subjects presented considerable vulnerability; the first a minimal brain dysfunction after perinatal asphyxia and a persisting attention deficit/hyperactivity disorder, the second a long-lasting opioid addiction. In vulnerable individuals, dose-independent ecstasy abuse can lead to unpredictable and potentially dangerous neuropsychiatric sequelae which require proper initial assessment and adequate treatment.

Adult↗
PubMed2001

Pentobarbital for severe gamma-butyrolactone withdrawal.

STUDY OBJECTIVE: Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have become popular drugs of abuse. Acute overdose with either agent results in a well-recognized syndrome of central nervous system and respiratory depression. Recently, a withdrawal syndrome has been described for GHB. We report a severe form of GBL withdrawal, characterized by delirium, psychosis, autonomic instability, and resistance to benzodiazepine therapy. METHODS: We performed a chart review of consecutive admissions for GBL withdrawal in a regional toxicology treatment center. RESULTS: During a 6-month period, 5 patients presented with severe withdrawal attributed to abrupt GBL discontinuation. Patients manifested tachycardia, hypertension, paranoid delusions, hallucinations, and rapid fluctuations in sensorium. Test results for ethanol and routine drugs of abuse were negative. Initial treatment with high doses of lorazepam proved ineffective. Pentobarbital was then administered, resulting in excellent control of behavioral, autonomic, and psychiatric symptoms and in rapid reduction or avoidance of benzodiazepines. Median hospital stay was 5 days. No patient had respiratory depression or required mechanical ventilation. Patients were discharged on tapering doses of benzodiazepines or pentobarbital and were free of psychotic symptoms at follow-up. CONCLUSION: GBL discontinuation can result in severe withdrawal, necessitating ICU admission. Pentobarbital may be more effective than benzodiazepines at controlling delirium in patients with abnormal vital signs, paranoid delusions, and hallucinations as a result of GBL withdrawal.

4-Butyrolactone↗
PubMed1976

Cannabis psychosis and paranoid schizophrenia.

The initial clinical symptoms of 25 consecutive cases of cannabis psychosis of the paranoid type and 25 consecutive cases of paranoid schizophrenia were studied and compared, in order to delineate features that would enable a differentiation of the two conditions. It was observed that the patients with cannabis psychosis substantially differed in terms of behavioral manifestations. Most of these patients were violent and panicky and demonstrated bizzare behavior, but they possessed some insight into the nature of their illness. Schizophrenic patients manifested these disturbances and characteristics less frequently. Subjects with cannabis psychosis showed rapid ideation and flight of ideas, whereas the characteristic schizophrenic thought-disorder was found mostly in schizophrenic patients.

Acute Disease↗
PubMed1977

[Psychodynamic aspects of paraphrenia].

Proceeding from Kraeplin's original a brief summary is given of the literature about the extensive interpretations of the term paraphrenia. Our study is based on a catamnestic examination of schizophrenic diseases first acute in 1930-1940 after 30 respectively 40 years (H. Hinterhuber) and a second group of paraphrenics who at the time being have been under our control for five years. By a simplifying scheme our own conception of paraphrenia is then defined and differentiated from the paranoid schizophrenia and the development of paranoia with special reference to the characteristic juxaposition of schizophrenic symptomatic in otherwise intact personality without a noteworthy derangement of the evironmental relations. The intact personality stands in clear contrast to the only "intact outside personality' with schizophrenic derangement of the ego. Thus the paraphrenic has the possibility to withdraw to the core of his sound personality and erect a mostly stable barrier against the partly massive hallucinations on the periphery of his personality. This corresponds to a passive attitude of avoidance in the sense of behaviour psychology. As THEREFORE the paraphrenic, similar to the phobic, tends to confine the borders of his existence by an increasingly passive avoidance attitude, he tries by a systematic desensibilisation to keep the borders of existence just in the area between psychosis and sound personality and thus render the best possible extent of personality development avoiding secondary restrictions.

Behavior Therapy↗
PubMed1998

[How to recognize personality disorders in general medicine].

DEFINITION: The psychological traits characteristic of an individual define that person's personality. A personality disorder is considered to exist when it causes the person or his/her family or friends to suffer. Personality disorders are often associated with a state of depression, aggravating or prolonging it. FUNDAMENTAL ASPECTS: Histrionic, paranoid, obsessional and psychopathic personalities are the most well known types of personality disorders, but dependent and borderline personalities should not be overlooked. Cognitive and behavioral therapies are particularly useful in this field of health care.

Depressive Disorder↗
PubMed1989

Primitive personality organization as an interpersonally adaptive modification of cognition and affect.

I have attempted a new description of the salient clinical phenomenology of the primitive personality disorders (borderline, narcissistic, paranoid and schizoid), focusing in particular on absence of personality integration, sensori-motor-affective thinking, and an inability to recognize and to own significant emotional predispositions and institute appropriate behavioral adaptations. I conclude that these phenomena cannot adequately be comprehended either from the classical intrapsychic perspective and the cognitive and affective capabilities assumed to exist in normal and neurotic individuals, or from the perspective of self psychology. I propose an alternative model in which pathology of cognition and affect is postulated to be both the contemporary cause and the historical result of pathological adaptation. For these individuals, analysis of cognition and affect must occupy the central position that analysis of conflict and defence occupies in the treatment of the neurotic.

Affect↗
PubMed2002

The exclusion of the other. A clinical contribution to an object-relations theory of obsessional defence.

The author begins by noting that the subject of obsessions and obsessional neurosis seems to have fallen out of favour with the analytic community in spite of the important part it played in the formation of Freud's theories, and notwithstanding the significance of its mechanisms in the maturation of the ego. He then discusses some theoretical considerations regarding the development of the taboo on touching and, by extension, contact. Attention is drawn to the parallels with autistic functioning emphasised by other authors. Particular importance is attached to the distinction between internal and external reality that arises during the anal-sadistic phase and that leads to polarisation and splitting in obsessional neurosis. Following a discussion of the transference-countertransference situation with obsessional patients and of their concretistic experience in the treatment situation, as also featured in the literature, an extensive case history exemplifies the author's contentions and shows how the patient concerned developed during the course of his analysis. After pointing out the importance of the avoidance of identifications as a mechanism of obsessional defence, the author concludes the paper with a brief comparison of obsessional and hysteriform functioning and a characterisation of the obsessional defence as the excessive recourse to perverted thought functions so as to ward off paranoid anxieties.

Adult↗
PubMed1985

White House Cases: psychiatric patients and the Secret Service.

Delusional visitors to the White House or other government offices (often seeking a personal audience with the President) are interviewed by the Secret Service and then sent to Saint Elizabeths Hospital if they are considered mentally ill and potentially dangerous to themselves or others. A review of the demographic characteristics and diagnoses of 328 of these "White House Cases" treated at the hospital between 1970 and mid-1974 showed that these patients were most commonly unmarried, white, and male, and most had a diagnosis of paranoid schizophrenia. Although 22% of this group have threatened some prominent political figure, to date none of this study's patients has attempted to assassinate any such government official.

Adult↗
PubMed1977

Psychophysiologic aspects of cancer: the James Ewing lecture.

Clinicians have long been aware of the influence of the neuro-endocrine axis and the action of the hypothalmus on the humoral immune response in the origin and course of cancer. Little attention has been paid, however, to the psychophysiologic aspects of cancer. These psycho-social effects may be related to hypothalamic activity, the autonomic nervous system, and neuro-endocrine activity. More attention should be paid to the manipulation of the psyche in the prevention and management of cancer.

Behavior↗
PubMed2004

Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards.

OBJECTIVES: To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients. METHODS: 425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient. RESULTS: Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used. CONCLUSION: Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.

Acute Disease↗
PubMed1994

Delusional misidentification syndromes and dangerousness.

Dangerousness in the delusional misidentification syndromes is studied by reviewing a sample of 82 cases defined by either verbal threats or physical violence caused by misidentification delusion. Eighty cases were obtained from a review of the anglophone psychiatric literature in which the patients exhibited some degree of dangerousness, to which we added 2 previously unreported cases.

Adult↗
PubMed1980

The prediction of dangerous behavior in emergency civil committment.

The authors compared the records of 59 psychiatric patients involutarily committed to a Veterans Administration hospital on an emergency basis with those of a control group of 59 psychiatric patients with respect to the number of assaults noted during the first 45 days of hospitalization. The committed group had a .41 probability and the control group a .08 probability of committing an assault. The difference between the two groups was mainly accounted for by assaults that occurred during the first 10 days of hospitalization. The occurrence of an actual act of battery before admission did not predict assault in the hospital to a greater degree than did a verbal threat. The authors conclude that short-term clinical predictions of dangerousness predict assaultiveness in the hospital to a significant degree.

Adult↗
PubMed1991

[Judicial aspects of treatment of incompetent psychiatric patients who categorically refuse treatment].

Psychiatrists in particular face a clinical, legal and social dilemma in treating their patients who are likely to categorically oppose treatment. This article illustrates this dilemma in the context of Quebec's Bill 145, resulting in the care of psychiatric patients being increasingly referred to the courts. After presenting this legislation and a case, the authors illustrate the impact of this legislation in light of their own experience and similar legislation in the United States. The mechanisms proposed by Bill 145 have proved costly in several respects as well as cumbersome and ineffective. The authors propose the establishment of an administrative tribunal as an alternative to the current recourse to the courts.

Adult↗
PubMed1994

A cognitive model of dangerous delusional misidentification syndromes.

The hallmark of the delusional misidentification syndromes is the presence of a misidentification delusion of the self or others. Delusional misidentification may present with an increased risk for dangerous behaviors. Individuals suffering from delusional misidentification syndromes may express hostility in ways ranging from serious verbal threats to homicidal acts. The causes of dangerous misidentification delusions remain for the most part undetermined. In this article, we report a series of six cases of individuals who harbored dangerous misidentification delusions. These individuals were studied phenomenologically and forensically. They were also studied biologically, including neuropsychological testing. A cognitive hypothesis aimed at explaining dangerousness and delusional misidentification is proposed. Implications of the hypothesis for further research are briefly outlined.

Adult↗