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PubMed2007

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing.

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Adaptation, Psychological↗
PubMed2006

Monozygotic twins suffering from Huntington's disease show different cognitive and behavioural symptoms.

Monozygotic male twins, carrying the same number of trinucleotide repeats in the IT 15 Huntington disease (HD) gene, showed a different clinical course. Patient 1 presented with anxiety and chorea at the age of 40. Patient 2 showed persecution paranoia and motor impersistence at the age of 42. Both patients were monitored for 30 months using currently recommended motor and behaviour scales. No differences were observed in motor scoring besides small interevaluation fluctuations. However, on the cognitive and behaviour scales, patient 1 showed a significant worsening when compared with patient 2. Our cases support the belief that the motor symptoms and signs in HD are highly dependent on the trinucleotide expansion. However, the differences in the evolution of mental status in our patients suggest that other still unknown environmental factors are important in the phenotypic expression of Huntington's disease.

Adult↗
PubMed1987

[The public health office and its clientele--on the conditions of psychiatric practice in the public health office].

The public health office is analysed as an administration of peoples health with its structure and function. By aiming at the order of health, not at the pathology of an inner world, it guarantees - paradoxically enough - for a reservation of individual disorder. This structure corresponds with the clients' coping strategies and represents the condition of a problematic coexistence. By three cases it is demonstrated how different configurations of order develop from these conditions.

Adaptation, Psychological↗
PubMed2001

[Psychopathology and outcome in first-admission schizophrenia: a 13-year follow-up study at a medical school hospital].

BACKGROUND: The course and outcome of 'dementia praecox' have attracted considerable attention since it was first described. However, studies in which schizophrenic patients have been followed for more than ten years are rare. In this study, the course and outcome of first-admission schizophrenic patients in Jichi Medical School Hospital was investigated. METHOD: The subjects were 62 schizophrenic patients, 29 females and 33 males (the mean age at first hospitalization was 25.2 +/- 7.4 years), who were consecutively discharged from the Department of Psychiatry, Jichi Medical School Hospital, between June 1983 and May 1988. The mean interval between first-admission and follow-up was thirteen years. The social outcome was measured using Eguma's Social Adjustment Scale. The subjects were divided into two groups according to Eguma's Scale: a favorable outcome group and an unfavorable outcome group. The following data were obtained from clinical records and analyzed: sex, family history of mental disorders, educational background, job experience, marital status, age at first contact to a psychiatrist, age at first hospitalization, type of onset, subtype of schizophrenia (paranoid, catatonic, hebephrenic types) and symptoms at the time of first hospitalization. Symptoms at the time of first hospitalization included delusions, hallucinations, disorders of ego consciousness, thought disorders, emotional disturbances, lack of spontaneity, catatonic symptoms, hypochondriac-cenestopathic symptoms, disorganized behavior, and suicide attempts. RESULT: Fifty-six of the 62 patients were followed-up. Six patients could not be contacted. Nine of the 56 patients follow-up were dead; two had died suddenly and seven had committed suicide. Forty-seven patients were alive, eight of which were not under psychiatric treatment, while 39 patients were receiving treatment (33 as outpatients, 6 as inpatients). The 47 patients who were still living were divided into two groups: 22 were included in the favorable outcome group, and 25 in the unfavorable outcome group. No significant differences in premorbid status were found. The unfavorable outcome group had an earlier age at first contact and age at first admission than the favorable outcome group. In the favorable outcome group, acute onset was more common than chronic onset. A comparison of psychopathological symptoms at the time of first hospitalization between the favorable and unfavorable outcome groups revealed significant differences in lack of spontaneity and hypochondriac-cenestopathic symptoms. No significant differences were found for any other symptoms. In the favorable outcome group, paranoid type was more common than hebephrenic type. DISCUSSION: Lack of spontaneity may reflect negative symptomatology, which has been suggested to be a predictor of an unfavorable outcome. While hypochondriac-cenestopathic symptoms may reflect an insufficient psychic container for the body, which has been hypothesized to work as an enabler of body image or imaginary body and an enabler of ego function as well. CONCLUSION: First-admission schizophrenic patients followed up after a mean period of thirteen years, and of this group data could be obtained on 90% of them. Two symptoms (a lack of spontaneity and hypochondriac-cenestopathic symptoms) present at the time of first hospitalization were observed more frequently in the unfavorable outcome group than in the favorable outcome group.

Adolescent↗
PubMed1992

[A case of Castleman's disease with a variable neuropsychiatric symptomatology].

A case of 44-year-old woman who had shown psychiatric symptoms before and during the course of Castlemans' disease was presented. For four years, she first suffered from a paranoid-hallucinatory state and then a depressive one episodically. In the course of the latter, severe anemia developed. She was diagnosed as Castleman's disease, because the increased serum level of gamma-globulin and interleukin-6 (IL-6), and multiple lymphomata were evidenced. A paranoid-hallucinatory state relapsed about one year later from this episode. At last, some bulbar and cerebellar symptoms, and a delirium suddenly occurred. The ischemic changes at the level of the pons and midbrain were revealed by the magnetic resonance imaging (MRI) examination. It is certainly that both neurological and psychiatric symptoms were related to the lesions. This ischemic lesions may have resulted from the anoxia secondary to the severe anemia and/or hyperviscosity syndrome in the disease. On the other hand, the increased serum level of IL-6 as well as the ischemic lesions might have caused psychiatric symptoms in this case, as the interferone which is one of the analogues of IL-6, is known to induce emotional and behavioral symptoms.

Adult↗
PubMed1983

Carbamazepine in the treatment of aggressive behavior in schizophrenic patients: a case report.

Carbamazepine has been used in the treatment of temporal lobe epilepsy since 1963. It has also been found effective in the treatment of psychiatric disorders accompanying epilepsy. Patients with nonspecific EEG abnormalities without overt epilepsy but with behavioral problems, including gross psychopathology and violent behavior, improve on carbamazepine. These findings prompted us to use it in the treatment of aggressive behavior in a schizophrenic patient. Due to the frequency and severity of aggressive behavior in this patient, maintenance ECT was given. However, when carbamazepine was instituted, ECT was discontinued and the patient has been virtually free from aggressive behavior since this medication has been instituted. The authors conclude that carbamazepine may be used in the treatment of aggressive behavior in schizophrenic patients.

Adult↗
PubMedDate not supplied

Paranoia--an unusual presentation of hydrocephalus.

Hydrocephalus commonly occurs after traumatic brain injury. Normal pressure hydrocephalus after traumatic brain injury is usually associated with a failure to progress in therapy and a plateauing or regression of functional abilities. Behavior disturbances are commonly seen as unfortunate sequelae of traumatic brain injury. However, normal pressure hydrocephalus has not been reported to cause aberrant, antisocial behavior. This case report details the course of a patient who sustained a traumatic brain injury and, subsequently, developed normal pressure hydrocephalus associated with paranoia, delusions, and violent behavior.

Accidents, Traffic↗
PubMed1995

Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia.

The relationship between adherence to group cognitive-behavioral treatment instructions and outcome was examined for 52 social phobic clients. Less symptomatic clients were no more likely to adhere to treatment instructions than more highly symptomatic clients. Clients were less likely to participate during group treatment sessions if they were higher on avoidant personality traits, and were less likely to complete self-directed exposures if they were more paranoid. Dependent clients tended to complete homework assignments more than less dependant clients. With one exception, adherence to treatment instructions for between session homework was not related to any of the outcome measures at the completion of treatment. However, at the 6-month follow-up, clients who adhered more to homework instructions reported less anxiety during the speech, and also tended to report greater decrements in anxiety and larger changes in their avoidant behavior. These data suggest that homework may be more important in the long-run, when the therapist is no longer present to prompt exposure.

Adult↗
PubMed1991

Delusional psychoses associated with unpatriotic conduct during World War II: a long-term follow-up study.

Of a large sample of patients with paranoid psychoses consecutively admitted to the Psychiatric Department, University of Oslo, during a period after World War II, 10 patients (6.3%, 9 women and 1 man) became ill through accusations of unpatriotic conduct during the war. The psychosis seemed precipitated in connection with legal procedures against the patient in 3 cases, and against close relatives in 2 patients. In 2 cases mixed precipitating events were present, while the psychosis in 3 cases had a connection with the woman being intimate with occupation soldiers. Discharge diagnosis according to DSM-III was schizophrenia (n = 2), schizophreniform disorder (n = 4), schizoaffective disorder (n = 1), major depressive disorder (n = 1), mania (n = 1), and atypical psychosis (n = 1). The patients have been followed up twice, with a mean 31 years of observation. Course and outcome varied, mostly according to the diagnosis. Most patients had a favorable global outcome, although they had a tendency to keep up their social isolation. None of the patients felt they had done anything wrong or regretted their behavior during the war.

Adult↗
PubMedDate not supplied

Cannibalism in paranoid schizophrenia: a case report.

In ancient times, cannibalism was deemed acceptable for reasons of survival when faced with extreme need or for religious or magic reasons. In today's society, these cases are extremely rare and are generally associated with severe mental illness. We present a case of cannibalism in an individual with schizophrenia. The patient who lacked insight into his illness admitted to committing acts of cannibalism and offered in-depth explanations of the procedures used to prepare the bodies. He made statements on television and to the press and was given the nickname of "the people-eater", an identity he readily accepted and integrated into his system of delusions. Cases of this nature are exceedingly unusual, but the fact that people with schizophrenia commit uncommon, unpredictable crimes attracts the media. This circumstance not only interferes with the natural course of the disease, but also affects the therapeutic behavior and how the patient is perceived by society.

Adult↗
PubMed1990

Successful behavioral treatment of polydipsia in a schizophrenic patient.

Behavioral treatment of a 35 year old female with chronic schizophrenia and water intoxication with seizures was conducted on an inpatient psychiatric unit. Treatment included frequent daily weights, restricted fluid intake, positive reinforcement for program compliance, and time-out from reinforcement following significant weight gain or other specified program violations. The final 6 months of the 30 month treatment program were a maintenance phase during which most contingencies were faded and all fluid restrictions were removed. There was no reported recurrence of polydipsia after 18 months of community placement.

Adult↗