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Unusually persistent complainants.

BACKGROUND: Querulous paranoia may have disappeared from the psychiatric literature, but is it flourishing in modern complaints organisations and the courts? AIMS: To investigate the unusually persistent complainants who lay waste to their own lives and place inordinate demands and stress on complaints organisations. METHOD: Complaints officers completed questionnaires on both unusually persistent complainants and matched controls. RESULTS: Persistent complainants (distinguished by their pursuit of vindication and retribution) consumed time and resources and resorted to both direct and veiled threats. Attempts to distinguish these people from a control group on the basis of the manner in which their claims were initially managed failed. CONCLUSIONS: Persistent complainants' pursuit of vindication and retribution fits badly with complaints systems established to deliver reparation and compensation. These complainants damaged the financial and social fabric of their own lives and frightened those dealing with their claims. The study suggests methods of early detection and alternative management strategies.

Agonistic Behavior↗

Co-occurrence of personality disorders in persons with kleptomania: a preliminary investigation.

This study was conducted to examine the co-occurrence of personality disorders in a group of persons with kleptomania. Twenty-eight subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-III-R Personality Disorders and a semistructured interview to assess demographics and clinical characteristics. Twelve subjects with kleptomania (42.9%) met criteria for at least one personality disorder. The most common were: paranoid (n = 5; 17.9%), schizoid (n = 3; 10.7%), and borderline (n = 3; 10.7%). Subjects with kleptomania combined with personality disorders had an earlier age of onset of stealing behavior (13.4 +/- 5.6 years compared with 27.4 +/- 14.2 years in those who had kleptomania only; t = 3.225; df = 26; p = .006). Severity of kleptomania symptoms did not differ among the Axis II comorbidities. Persons with kleptomania appear to have a high prevalence of personality disorders. Further studies are needed to understand the relationship of kleptomania to personality.

Adult↗

Psychiatric factors associated with dangerous misidentification delusions.

The delusional misidentification syndromes are characterized by misidentification delusions of others or of the self. Aggressive ideas or behaviors often accompany these delusions. The relationship between delusional misidentification and dangerousness remains for the most part poorly understood. In the present article, we compare a group of dangerous individuals suffering from dangerous misidentification delusions with a group of dangerous individuals suffering from other types of delusions. Individuals with dangerous misidentification delusions were more likely to experience grandiose ideation, thought disorder, generalized hostility, excitement, general psychopathology, and a previous history of violence than dangerous delusional individuals with no delusional misidentification. The group with dangerous delusional misidentification syndromes was less likely to attack others with weapons than were the dangerous delusional group with no delusional misidentification.

Adult↗

Urinary phenylethylamine correlates positively with hypomania, and negatively with depression, paranoia, and social introversion on the MMPI.

It has been suggested that phenylethylamine (PEA) may play a role in the modulation of affective behavior. The aim of the present study was to test this hypothesis. Urinary PEA excretion was determined in 32 drug-free healthy volunteers, and the MMPI was used for personality assessment. In support of this hypothesis, a significant positive correlation between PEA and hypomania (r = 0.50; P less than 0.05) and a significant negative correlation between PEA and depression (r = -0.58; P less than 0.01) was observed in the female subgroup. Furthermore, PEA correlated significantly negatively with hypochondriasis (r = -0.65; P less than 0.01), paranoia (r = 0.49; P less than 0.05), and social introversion (r = -0.60; P less than 0.05). These results are the first evidence in normal individuals either that PEA itself might play a role in the modulation of affective behavior, or alternatively that PEA could be related to mechanisms responsible for the modulation of affective behavior.

Adult↗

Benzodiazepines: tolerability in elderly patients.

Aging is a physiological process that shares many behavioral, biochemical and neuroendocrine phenomena with the pathophysiological situation of unresolved stress, as well as with a pharmacologically induced syndrome resulting from chronic benzodiazepine (BZ) consumption. Behavioral findings include symptoms such as drowsiness, ataxia, fatigue, confusion, weakness, dizziness, vertigo, syncope, reversible dementia, depression, impairment of intellectual, psychomotor and sexual function, agitation, auditory and visual hallucinations, paranoid ideation, panic, delirium, depersonalization, sleepwalking, aggressivity, orthostatic hypotension, and insomnia. Neuroendocrine findings include: central depletion of noradrenaline (NA), dopamine, adrenaline (AD), and serotonin (5-HT); reduction in the ratio of circulating NA/AD as well as platelet 5-HT and increase of AD, plasma free 5-HT and cortisol. These disturbances together with the increased platelet aggregability observed in the three groups are typical of unresolved-stress situations. Immunological findings include significant reduction of peripheral T lymphocytes (CD3, CD4, CD8) and the CD4/CD8 ratio, CD16 and gamma-delta cells. On the other hand, the three groups (elderly subjects, subjects faced with unresolved stress, and BZ consumers) show increase of the CD57 lymphocyte subset as well as natural killer cytotoxicity. Alterations of several biological markers have also been found, specifically in the oral glucose tolerance test, the intramuscular clonidine test, and the supine/orthostasis/exercise test. From a clinical point of view, the three groups appear to be more susceptible to the appearance and progression of many acute and chronic diseases (infectious and malignant diseases). As a result, chronic consumption of BZs should be avoided in both the elderly and subjects in unresolved-stress situations.

Adult↗

[Paranoid nosogenic reactions in patients with somatoform disorders].

The authors examined 16 patients with ischemic heart disease who had psychogenic disorders with ideas of rationalization of therapy. Paranoial personality disorders (paranoial psychopathy) was diagnosed in 11 patients, pseudopsychopathy in residual schizophrenia in 5 patients. The patients had either a fanatic idea of creating new methods of self-therapy and an autoaggressive behavior (performing some dangerous manipulations, usage of non-medicamentous substances, etc.). The premorbid state of such patients was characterized by inclination to paranoial reactions and a special predisposition to them combined with an egodystonic attitude to corporal manifestations. Paranoial reactions of such type were reversible and disappeared in the course of somatic state improvement.

Humans↗

Abuse and neglect in childhood: relationship to personality disorder diagnoses.

BACKGROUND: Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples. METHODS: This study evaluated self-rated indices of sustained childhood abuse and neglect in an outpatient sample of well-characterized personality disorder subjects (n=182) to determine the relative associations of childhood trauma indices to specific personality disorder diagnoses or clusters and to lifetime history of suicide attempts or gestures. Subjects met criteria for ~2.5 Axis II diagnoses and 24% reported past suicide attempts. The Childhood Trauma Questionnaire was administered to assess five dimensions of childhood trauma exposure (emotional, physical, and sexual abuse, and emotional and physical neglect). Logistic regression was employed to evaluate salient predictors among the trauma measures for each cluster, personality disorder, and history of attempted suicide and self-harm. All analyses controlled for gender distribution. RESULTS: Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men. CONCLUSION: These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder.

Adult↗

Empirical clusters of disordered behavior among older psychiatric inpatients.

Various researchers have suggested that traditional psychiatric nosologies may not be as useful in understanding and planning for persons with disordered behavior as might be categories based on empirical research. Although a number of cluster analytic studies have suggested that this approach can generate meaningful typologies of behavior among psychiatric patients, little attention has been paid to the issue of categorization of psychiatric disorders among older chronic inpatients. This paper presents results of a preliminary study targeted at developing a categorization system with such patients. A six-cluster solution was obtained using K-means clustering. The six clusters were "Paranoid Symptoms," "Motor Symptoms," "Depressive Symptoms," "Nonsymptomatic," "Positive Symptoms," and "Negative Symptoms." Results of this study of patients whose psychiatric disorders arose early in life are contrasted with studies of patients whose disorders occurred late in life.

Aged↗

Catechol-O-methyltransferase activity in psychotic children.

Catechol-O-Methyltransferase (COMT) activity was studied in three groups of institutionalized children: (1) a group of schizophrenic children; (2) a heterogeneous group of chronic psychotic children characterized by severe symptomatology and onset before 5 years of age; (3) a group of acting-out but nonpsychotic children. Erythrocyte COMT activity was found to be significantly lower among the schizophrenic subjects in contrast to the greater activity in both the other groups--the nonpsychotic and chronic psychotic children. The difference in COMT activity between psychotic groups appeared to be related to diagnosis and age of onset of disorder. Generality of findings is limited by the small sample size (N = 42) and by the difficulties inherent in the diagnosis of severe mental disorder in children. However, this preliminary study suggests that enzymatic activity may be associated with the development of schizophrenia in children.

Adolescent↗

Phantom bite.

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Adolescent↗

Impact of case formulation in cognitive behaviour therapy for psychosis.

Case formulation (CF) is the 'first principle' in cognitive behavior therapy (CBT), and the cornerstone of CT for psychosis. Experiment 1 (E1) assesses impact of CF in CBT for psychosis on perception of therapeutic relationship. Experiment 2 assesses the impact of CF on strength of delusional and self-evaluative beliefs (E2). Both E1 and E2 assess impact of CF on symptoms of anxiety and depression. CF had little or no impact on these variables. Descriptive data suggested there were other benefits for certain participants. Therapists' perception of the therapeutic relationship did improve following CF. Six clients found CF, at least in part, a negative experience.

Adult↗

Hallucinations and delusions. 2: A dual diagnosis case study.

This article, the second of two parts, describes how evidence-based psychological interventions were used to help a client suffering from treatment-resistant delusions and substance misuse, allied to a chaotic lifestyle, that had previously presented a substantial challenge to services. The first part (Vol 8(15): 998-1002) Investigated how the neurobiological, social and environmental factors involved in the course and treatment of schizophrenia have helped to establish a pathway to recovery or remission that does not involve pharmacological therapy alone.

Adaptation, Psychological↗