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PubMed1997

The selective breakdown of frontal functions in patients with obsessive-compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding.

In an our recent preliminary study, we reported the neuropsychological finding of a double dissociation in the frontal lobe functioning between 25 OCD patients and 25 schizophrenics. The first group performed normally in the Wisconsin Card Sorting Test (WCST), which is considered sensitive to Dorso-Lateral Prefrontal Cortex (DLPFC) dysfunctions and abnormally to the Object Alternation Test (OAT), which has been proposed as a tool sensitive to Orbito-Frontal Cortex (OFC); on the other hand, schizophrenics performed abnormally to the WCST and normally to the OAT. The present study, conducted on a new sample of 60 schizophrenic in-patients, 60 OCD in-patients and 30 normal subjects, matched according to age, educational level, handedness and duration of illness, confirms our preliminary data and it suggests a more selective impairment of OFC system in OCD and of DLPFC in schizophrenia. Moreover, schizophrenic patients with paranoid subtype showed worse WCST performance compared to non-paranoid subtype. Our results could open some interesting perspectives about the neuroanatomical systems involved in these two major psychiatric illnesses and so, about their pharmacological treatment, on the basis of the prominent catecholaminergic characterization of the DLPFC and, respectively, the cholinergic innervation of the OFC.

Adult↗
PubMed1994

Risk factors for suicidal behavior in borderline personality disorder.

OBJECTIVE: This study identified potential risk factors for suicidal behavior in patients with borderline personality disorder defined by the Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for patients who did and did not attempt suicide. METHOD: Histories of suicide attempts and attempt characteristics were obtained by Schedule for Affective Disorders and Schizophrenia interviews from 84 patients with borderline personality disorder and were related to severity of borderline pathology, diagnostic comorbidity, and state and trait symptoms. RESULTS: There were 61 patients with a lifetime history of suicide attempts (72.6%), with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were significantly older than nonattempters, with more impulse actions, antisocial personality disorder comorbidity, and state depression. State depression was significantly less severe in patients who had attempted suicide in the present episode (or past year) than in patients who had attempted suicide only in the past. A comorbid diagnosis of major depression, alcoholism, or drug use disorder did not distinguish attempters from nonattempters. Suicide attempt in the present episode was best predicted by the number of prior lifetime attempts. A highly serious intent to commit suicide was predicted by the number of lifetime attempts and subjective depression, while a low intent was predicted by a mixed subtype of borderline personality disorder plus schizotypal personality disorder and paranoid ideation. A high degree of medical lethality was predicted by number of lifetime attempts, older age, and hysteroid dysphoria, while low lethality attempts were associated with high degrees of anger. CONCLUSIONS: Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.

Adult↗
PubMed2002

The social anxiety spectrum.

Social anxiety disorder is well suited to the spectrum concept because it has trait-like qualities of early onset, chronicity, and no empirically derived threshold that demarcates normal from clinically significant trait social anxiety. Social anxiety disorder has been shown to respond to relatively specific pharmacologic and cognitive-behavioral therapies, which makes identification of other conditions that may lie on the social anxiety disorder spectrum important because of possible treatment implications. Biologic markers associated with social anxiety disorder also may be shared by similar but nonidentical traits, such as behavioral inhibition and detachment. Clarification of the trait spectrums associated with specific biologic systems offers an opportunity for improving the understanding of the origin of these conditions. Strong evidence exists that at least some forms of shyness, avoidant personality disorder, and selective mutism lie on a social anxiety disorder spectrum. For several other disorders that share a prominent focus on social comparison, significant subgroups of patients seem to have features of social anxiety disorder. These disorders include major depression (especially the atypical subtype), body dysmorphic disorder, and eating disorders. Several other disorders marked by social dysfunction or inhibition, including substance use disorders (especially alcoholism), paranoid disorder, bipolar disorder, autism, and Asperger's disorder, also may show some overlap with social anxiety disorder features (e.g., social anxiety as a cause or complication of substance abuse, social avoidance in paranoid disorder, social disinhibiton in bipolar disorder, and social communication deficits in autism and Asperger's disorder). Social anxiety disorder also is associated with other anxiety disorders in general and other phobias in particular. In respect to traits, a growing body of evidence links behavioral inhibition to the unfamiliar to a social anxiety disorder spectrum with some specificity. Biologic measures of dopamine system hypoactivity have been linked to social anxiety disorder, trait detachment, and general deficits in reward and incentive function. It remains to be clarified, however, whether this brain system function is best characterized by a social anxiety disorder spectrum or some variant that incorporates social reward deficits or social avoidance behavior. Social anxiety disorder, shyness, and behavioral inhibition all seem to have a genetic component, but more research is needed to attempt to identify a more specifically heritable temperament associated with these conditions. Finally, the emergent concept of a social anxiety spectrum needs maturation. Although the notion of a single social anxiety disorder spectrum currently has some clinical use, the authors believe that exclusive focus on the notion of a single continuum with two extremes--from social disinhibition in mania to the most severe form of social anxiety, avoidant personality disorder--is premature and limiting in respect to etiologic research. An alternative approach is to conceptualize multiple, probably overlapping spectra in this area of social psychopathology. Individual dimensions might be based on various core phenomenologic, cognitive, or biologic characteristics. A bottom-up biologic approach holds promise for identifying spectra with a common etiology that might respond to specific treatments. Taking a pluralistic view of the concept of spectrum at this stage may help accelerate our understanding of social anxiety and related disorders.

Brain↗
PubMed1998

Attachment style and emotion regulation in dementia patients and their relation to caregiver burden.

One hundred and sixty-eight patients with mid- to late-stage dementia and their caregivers participated in a study of the relation between patient emotional characteristics, dementia symptomatology, and caregiver burden. Measures included premorbid attachment style, premorbid emotion regulation style, and behavioral symptoms of dementia. The attachment patterns (secure, avoidant, ambivalent) of these elderly patients resembled those obtained in samples of younger individuals in terms of emotion regulation characteristics; however, the distribution of attachment styles was significantly different, with a lower proportion of ambivalently attached individuals in the present sample. In terms of the behavioral symptoms of dementia, ambivalent patients had more depression and anxiety than secure and avoidant patients; the latter patients experienced more activity disturbance than ambivalently attached individuals and were higher on paranoid symptomatology than securely attached persons. Caregivers of securely attached individuals experienced less total burden than did caregivers of both insecure groups. In regression analysis, attachment style accounted for the largest proportion of unique variance in the prediction of caregiver burden (8%); only 1 of 7 patient symptoms contributed a significant independent effect, namely depressed affect, which accounted for 4% of the variance.

Adult↗
PubMed1978

The relationships of some information-processing factors to severely disturbed behavior.

Thirty-five psychiatric inpatients with heterogeneous diagnoses were given four tasks: Mueller-Lyer Illusion, Wisconsin Card Sorting Text, Object Sorting, and Rokeach dogmatism questionnaire. Tasks were chosen to represent a broad sampling of paradigms, spanning levels of information processing, involving perceptual, conceptual and attitudinal processes. Subjects' behavior was assessed by the Inpatient Multidimensional Psychiatric Scale (IMPS). Each IMPS scale was analyzed in turn as a function of perceptual/cognitive variables, in multiple regression analysis. To provide basis for comparison, traditional clinical measures were included as independent variables (MMPI scales) and dependent variables (intelligence, chronicity, and premorbid adjustment). Results showed that different patterns of disordered behavior were predicted by different perceptual/cognitive variables. MMPI scores were predicted primarily by traditional measures. Interrelationships of all variables suggested three subject groups: chronic, process-type schizophrenics with perceptual abnormalities, paranoid patients with conceptual abnormalities, and affectively disordered patients with predominantly attitudinal abnormalities.

Affective Disorders, Psychotic↗
PubMed1987

Evaluation and treatment of paranoid syndromes in the elderly: a review.

Paranoid symptoms in the elderly patient may be a manifestation of medical, neurologic, psychiatric, or medication-induced illness. Because of the potential for multiple interacting factors between underlying organicity and psychiatric illness precise assessment of the etiology of the patient's psychotic behavior may be difficult. This article reviews the medical and neurologic illnesses often associated with paranoia in the elderly as well as the psychiatric differential diagnosis. Psychotic depression, late-onset schizophrenia, and delusional/paranoid disorders are examined, as are their treatments. Revisions in the nosology of late-onset psychosis as they are affected by revisions in DSM-III-R are also discussed.

Aged↗
PubMed1981

Psychopathologic patterns in depressed adolescents.

Depression in adolescents may be masked by symptoms not commonly found in adults. These symptoms may require, at least initially, a management approach not necessarily in the best interest of treatment of the underlying depression. Suicidal behavior in adolescents can be manipulative and unrelated to depression. Management of such adolescents must differ from the management of patients whose suicidal behavior is the direct result of depression.

Adolescent↗
PubMed2005

An unusual foreign body ingestion in a schizophrenic patient: case report.

The topic of foreign body ingestion has received extensive coverage in the areas of surgery, emergency medicine, and pediatrics. A subset of this topic, the intentional ingestion of foreign bodies, however, is much less common, and requires special evaluation and management. Here, we report a case of ingestion of a rolled, metal tuna can lid in a male prison inmate previously diagnosed with depression and paranoid schizophrenia. Following evaluation by the surgical team, the foreign body was removed by laparotomy and the patient was discharged back to the prison without complication. In many cases, ingestions of this type involve a command hallucination ordering the patient to swallow the foreign body. Interestingly, the patient in the present case reported auditory hallucinations commanding him not to swallow the can lid. On further investigation, we found that patient had a proclivity toward this swallowing behavior even prior to his incarceration. Early identification of inmates with this proclivity has important implications for treatment and prevention.

Adult↗
PubMed1977

Diagnosis and expectation for change: an inverse relationship?

The purpose of this study was a test the hypothesis that the use of psychiatric labels leads to reduced expectations for patient change and recovery. Thirty-nine staff members at a residential mental hospital were given a description of a patient and asked to indicate expected length of stay in the hospital, chance of readmission, chance of leading a normal life, and overall prognosis. A diagnosis of schizophrenia, paranoid type was included at the end of half of the descriptions and was omitted in the other half. It was found that staff working in the acute treatment areas were significantly negatively affected by the diagnosis when overall prognosis was considered. In addition, the findings of this study with respect to occupation, sex of patient, and treatment area suggested that such variables should not be overlooked when assessing staff attitudes or treatment orientation. Since an admitting diagnosis is required by most treatment facilities, the results highlighted the limitations of these preliminary labels and spoke to the necessity of individualized evaluations. Finally, further work was indicated on the development of scales which could measure expectations for change and the behavioral concomitants of such expectations.

Adult↗
PubMedDate not supplied

The cycloid type and its differentiation from core schizophrenia: a phenomenological approach.

The heterogeneity within schizophrenia or the group of schizophrenias remains a vexing and limiting problem. An alternative to the "classic" explanatory construct of a schizophrenic unitary psychosis is the current concept of a positive/negative dichotomy with or without mixed type. However, the validation by findings from brain imaging, specificity, and prognostic validity of these multiple-entity approaches are still uncertain. Psychopathology is challenged to identify discrete types as homogenous as possible, providing closer relationship to distinct disease processes. Such types are to be defined by one or more axial syndromes, syndromes in an essential, not correlative, sense. One of these types is embraced by the term cycloid psychosis, implying a good prognosis. Using an integrative phenomenological methodology, the present study is able to show the specific quality of phenomena occurring in this type to pinpoint their "inner" relationships and to demonstrate cycloid syndromes as axial syndromes in the phenomenological sense. Thus, it is shown that positive symptoms in the cycloid type are different from those in core schizophrenia. In addition to the quality and inner coherence of the constituent elements, the absence of structural deformations of (1) emotional expression and affect, (2) thought, and (3) movement impulses and sequences is the decisive specificity feature that allows differentiation of the cycloid type from poor-prognosis core schizophrenia. These syndromes of structural deformations are the axial syndromes of core schizophrenia, occurring with or without "productive" (positive) phenomena. Its conceptualization makes a contribution to the actual negative-symptom discussion shifting the perspective from a low specific level (e.g., abulia) to phenomena of higher specificity. On the basis of a precise definition of cycloid axial syndromes, previous operationalization suggestions are reviewed and evaluated, and an alternative approach is outlined. Finally, it is hypothesized that the cycloid type may be a primary neurotransmitter disease, while core schizophrenia seems closer to the pathophysiological mechanisms described in Stevens' theory.

Affective Symptoms↗