Personality correlates of success in a methadone maintenance program.
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Adult↗
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Results for “Paranoid Behavior”
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Psychiatric hospital admissions in Bristol. II. Social and clinical aspects of compulsory admission.
Three groups of patients admitted compulsorily from populations with markedly different rates of compulsory psychiatric admissions were compared on a range of social and clinical data. Whilst West Indian and white patients from inner city areas differed in many respects, they were both more likely than other patients to be referred to the psychiatric services through police agencies, with little GP involvement and were often admitted from public places following disturbed behaviour. However, levels of violence and threatening behaviour were no higher among inner city patients, black or white, and once admitted, these groups showed similar treatment compliance to white patients who had been admitted compulsorily from suburban areas. Implications for primary care and delivery of psychiatric services are discussed.
Adult↗
[Pathogenetic model-theories of endogenous psychoses (author's transl)].
The multiplicity of frequently conflicting views in the psychiatry of today inspires the wish for a uniform way thinking about the thorough knowledge and the many hypotheses that have become almost boundlessly vast. Such ideas of models as have played a part for quite some time in the mathematical and natural sciences, and of late in the sociology, are also to be found in the field of psychiatry, without however always being called so expressis verbis. Guided by the historical development an attempt has been made to expose model-like ideas about the etiology and pathogenesis of endogenic psychoses, first of all of schizophrenia, as they have become decisive for modern psychiatry. It appears that in the abbreviation of the "model" the basis for a discussion already overdue is to be found.
Anthropology↗
[Serotonin dysfunctions in the background of the seven deadly sins].
The symbolic characters of the Seven Deadly Sins can be traced from time to time in the cultural history of human mankind, being directly specified in certain artistic products. Such are, among others, the painting entitled "The Seven Deadly Sins and the Four Lost Things" by Hieronymus Bosch and the poems Divina Commedia and The Foerie Queene by Dante Alighieri and Edmund Spenser, respectively. However, there are several paragraphs referring to these behaviours of the Seven Deadly Sins in the Bible and in the dramas of William Shakespeare. The objective of the present review is to propose that dysfunctions in the central serotonergic system might be involved in the neurobiology of these 'sinful' behaviour patterns. Evidences indicate that behaviour traits such as Accidia (Sloth), Luxuria (Lust, Lechery), Superbia (Pride), Ira (Wrath, Anger), Invidia (Envy), Avaritia (Greed, Avarice), and Gula (Gluttony) can relate to the functional alterations of serotonin in the brain. Results of biochemical and molecular genetic (polymorphism) studies on the human serotonergic system (receptor, transporter, enzyme), findings of functional imaging techniques, effects of depletion (or supplementation) of the serotonin precursor tryptophan, data of challenge probe investigations directed to testing central serotonergic functions, alterations in the peripheral serotonin measures (platelet), and the changes in the CSF 5-hydroxy-indoleacetic acid content indicate such serotonergic involvement. Furthermore, results of animal experiments on behaviour change (aggressive, dominant or submissive, appetite, alcohol preference) attributed to serotonin status modification and the clinically evidenced therapeutic efficacy of pharmacological interventions, based on the modulation and perturbation of the serotonergic system (e.g. selective serotonin reuptake inhibitors), in treating the 'sinful' behaviour forms and analogous pathological states reaching the severity of psychiatric disorders (depression, sexual disturbances, social phobia, impulsivity-aggression, obsessive-compulsive and related spectrum disorders, paranoid jealousy, eating disorders) all strongly suggest the possibility that brain serotonin dysfunctions might underlie the neurophysiology of the Seven Deadly Sins.
Behavior↗
Antiaggressive effect of adjunctive clonazepam in schizophrenia associated with seizure disorder.
A case of schizophrenia associated with complex partial seizure disorder and postictal violence, both refractory to conventional treatment, is presented. Adjunctive treatment with clonazepam resulted in the cessation of the seizures and of persistent, violent hallucinations. The theoretical implications for possible mechanisms underlying at least some types of aggressive behavior are discussed.
Adult↗
Hearing impairment and paraphrenia.
An elderly resident of a Home for the Aged, with an admission diagnosis of senile dementia, was referred for psychiatric assessment. Mental state examination revealed intact cognitive functions, but attitudes and beliefs symptomatic of paraphrenia, a late onset form of schizophrenia. Noting apparent hearing impairment, the psychiatrist suggested the patient be referred to the ENT clinic. ENT examination and audiological assessment revealed severe mixed hearing loss bilaterally, probably originating in early childhood. A hearing aid was prescribed, and the patient adjusted well to its use. On subsequent psychiatric examination, the patient demonstrated fewer disturbed behaviors and less delusional thought. It is suggested that conjoint assessment and treatment may be of benefit in diagnosis and management of behaviorally disturbed geriatric patients.
Aged↗
Schizophrenia and major affective disorder: forensic psychiatric issues.
A group of schizophrenic (S) and major affective disorder (MAD) patients assessed in a Forensic Psychiatric Department was studied in depth to test the hypothesis that these patients commit crimes during periods of serious psychiatric disturbance, even if other sociodemographic factors might be contributing to their criminal behavior. The demographic, psychiatric, psychological and legal data were analyzed. The schizophrenic group was overrepresented in this sample compared with the hospitalization pattern for S and MAD patients as a whole. Both groups showed demographic characteristics such as mean age, marital and family status and education and employment, consistent with the diagnoses. S offenders tended to be either chronically ill or paranoid type and MAD offenders the early onset, bipolar type. Both groups showed evidence of serious psychiatric disturbance at the time of assessment and at the time of the alleged offense. S offenders were considered more dangerous based on clinical criteria and showed an increased tendency to assault. About two-thirds of the total group were considered unfit to stand trial at the time of assessment and about three-quarters were considered not fully responsible for the alleged offense from psychiatric viewpoint. These findings confirm the hypothesis that criminal behavior in these seriously ill patients is at least partly due to the psychiatric disturbance itself. The need for psychiatric assessment and treatment of these mentally ill offenders is thus clearly shown.
Adult↗
Meningo-encephalitis presenting as an acute paranoid psychosis.
A twenty-seven year old women with meningo-encephalitis and paranoid symptoms is presented. The patient was admitted to a psychiatric unit where, two months previously, her brother had been under treatment for a paranoid schizophrenic episode. The diagnostic lumbar puncture was performed after several days of increasing periods of disorientation, stupor, incontinence, posturing, and perseveration. There was no fever, no signs of meningeal irritation, and no localizing neurologic deficit. The problem of recognizing organic brain disease presenting as an acute psychotic episode is discussed. In this case, the positive family history was given inappropriate emphasis, while the good pre-morbid adjustment of the patient and the symptoms of confusion and headache were inadequately considered. Viral meningo-encephalitis, particularly that due to herpes simplex, often presents with a picture of behavioral abnormalities and minimal physical signs, and is easily confused with a functional process.
Adult↗
Psychiatric manifestations of right hemisphere infarctions.
Five right-handed patients (aged 45 to 78 years) developed acute psychotic disturbances in conjunction with infarcts in the right hemisphere. Their presentation was marked by agitation, inattention, suspiciousness, paranoid delusions, hallucinations, and lack of appropriate concern. Several of these patients initially received primary psychiatric diagnoses. Although neurological findings indicative of right hemisphere involvement could also be elicited, these were generally overshadowed by the more dramatic behavioral alterations. The electroencephalogram and computerized axial tomography were positive in most cases. These cases demonstrate that the possibility of a right hemisphere lesion needs to be entertained in patients who present with an atypical psychotic episode.
Aged↗
[A case of "interval" form of acute carbon monoxide poisoning--brain MRI and therapeutic effect of hyperbaric oxygenation].
A 43-year-old female who had suffered from paranoid reaction attempted suicide with city gas. She was admitted to an emergency hospital in a comatose state, regained consciousness the next day and was discharged 12 days after. However, on the 21st day after the poisoning, behavioral anomalies and staggering appeared. She was readmitted into another emergency hospital with the diagnosis of an "interval" form of acute carbon monoxide poisoning. She was performed hyperbaric oxygen therapy 42 times until the 53rd day after the accident. Nevertheless, her symptoms did not improve and remained in a state like an apallic syndrome. With little promise of improvement, she was moved to our hospital, and hyperbaric oxygen therapy further continued for 40 times which resulted in a remarkable recovery. Repeat EEGs were performed. On the 32nd day, EEG showed an abnormality consisting of generalized delta waves. On the 56th day, the abnormal EEG improved slightly with more alpha activity. EEG was normalized 126 days after. The X-ray CT scan on the 32nd day revealed low densities in the bilateral globus pallidus and the deep white matters adjacent to the frontal horns of the lateral ventricle and in the semioval centers. On the 57th day, these low density areas were depicted more clearly by the X-ray CT scan, which became less marked on the 73rd day. MRI was performed 3 times.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Cerebrospinal fluid levels of phenylacetic acid in mental illness: behavioral associations and response to neuroleptic treatment.
Cerebrospinal fluid levels of phenylacetic acid (CSF PAA) were obtained from normal controls and from drug-free psychiatric inpatients (schizophrenia, major depression, mania, and schizoaffective disorder). Post-treatment CSF PAA levels were obtained from 16 patients after 4 weeks of neuroleptic treatment. Phenylacetic acid levels were higher in women and were significantly correlated with age. There were no differences in CSF PAA levels between the various diagnostic groups and no difference between the paranoid and the nonparanoid subtypes of schizophrenia. CSF PAA was significantly correlated with several measures of psychopathology, especially the Brief Psychiatric Rating Scale hostility/suspiciousness factor. Neuroleptic treatment did not result in significant PAA changes. These findings are discussed in light of the amphetamine-like role ascribed to phenylethylamine, the precursor of PAA.
Adult↗
The response to acoustic stimulation and the changes in brain amine levels after repeated administration of beta-phenylethylamine in rats.
Reverse tolerance to stereotyped behavior was induced after repeated administration of beta-phenylethylamine (PEA) (50 mg/kg, i.p., daily for 10 days) in rats. The reverse tolerance was maintained for at least 4 weeks after the last administration. We studied the effects of acoustic stimulation on locomotor activity 2 days and 4 weeks after withdrawal from PEA and measured the changes in brain monoamine levels 4 weeks after the withdrawal. Locomotor activity during acoustic stimulation was increased in the saline treated group, and this response was unaffected after repeated PEA treatment. Four weeks after withdrawal, significant increases in noradrenaline levels in the cerebral cortex and decreases in 5-hydroxytryptamine levels in the hypothalamus were found. The effects of acoustic stimulation on locomotor activity and the changes in brain monoamine levels were different from those of methamphetamine treatment obtained in our previous study. In conclusion, it may be suggested that the response to acoustic stimulation after repeated PEA administration in rats cannot be a model for abnormal responsiveness to environmental stimulation that is observed in chronic paranoid schizophrenics.
Acoustic Stimulation↗
The psychosis of fatherhood: a clinical study.
The psychosis of fatherhood is classified as an acute delusional disorder. It has been psychodynamically correlated with preoedipal conflicts. Common elements were identified in 6 men who were about to become fathers for the first time. Their personal histories and their clinical pictures were very similar. It is our hypothesis that up to the moment of facing the impact of becoming fathers themselves, these subjects had managed to avoid the oedipal conflict. As a consequence of this avoidance, they failed to identify with the father figure and to incorporate the paternal function into their symbolic universe. Once they accepted the concrete reality of fatherhood, these men underwent an acute psychotic crisis having inadequately interiorized paternal role models for themselves. We believe that this sort of psychopathological behavior becomes clinically manifest only when triggered by impending fatherhood.
Adult↗
Defensiveness in the criminally insane.
The MMPI and 16 PF were administered to 45 forensic patients and scores on five derived measures of defensiveness were computed. The 10 highest and 10 lowest scoring subjects were assigned to either a high or low defensiveness group and their responses analyzed with regard to the Schizophrenia, Paranoia, Psychopathic Deviate and Hostility clinical scales and sub-scales of the MMPI according to past or present items. Results confirm that high defensiveness subjects are selectively and cautiously interpreting items so as to admit to significantly less overall pathology and relatively less present pathology than low defensiveness subjects. This finding represents a consistent strategy of defensiveness rather than an artifact of false response bias. This study has implications for personality assessment in Forensic Psychology and the potential of trend analysis for the prediction of future dangerous behavior in a forensic patient population.
Adult↗
Grief, psychosis, and panic intervention with a psychotic patient: integrating psychodynamic and cognitive-behavioral approaches.
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Cognitive Behavioral Therapy↗
Cannabis psychosis following bhang ingestion.
The purpose of this preliminary investigation is to systematically characterize the signs and symptoms of cannabis psychosis in individuals who presented for psychiatric treatment in Pakistan after ingestion of bhang; a beverage containing cannabis. In order to control for the behavioral effects of cannabis alone, symptoms produced by bhang ingestion among non-patients consuming the same beverage were compared with those symptoms found among psychotic patients. Patients differed from controls in that a higher proportion of patients were found to be chronic users of bhang, and had a past history of psychotic episodes. Presenting symptoms of bhang-induced psychosis found in patients included grandiosity, excitement, hostility, uncooperativeness, disorientation, hallucinatory behavior and unusual thought content. Neuroleptic treatment successfully attenuated psychotic symptoms within five days of the initiation of the episode. The presenting symptoms of bhang-induced psychosis are consistent with a brief mania-like disorder with paranoid psychotic features, and cognitive dysfunction. Several etiologic hypotheses are proposed.
Administration, Oral↗
Curiosity: reflections on its nature and functions.
This paper attempts to clarify the nature, function and centrality of curiosity in the development of object relations and the consolidation of the self. It demonstrates how the primary relationship between the infant and the care-giver influences the development of curiosity, the ability to use it productively for thinking and for building the internal world. Curiosity, in its schizoparanoid forms, is an attempt at freezing states of primary undifferentiatedness. In its more mature forms, it serves as an integrative agent and signifies both the possibility and the need to know, as well as the boundaries of knowledge. It is an essential element in the individual's psychic fabric and counterbalances splitting and projective identification. Hence, in analysis, it is vital to be constantly attentive to all the diverse expressions of curiosity or, conversely, to its absence. In the transference, the analyst, as well as the analytic setting, often become the aims of that curiosity and its containers. By allowing curiosity and surviving it, curiosity is transformed from an expression of destructiveness and disintegrating intrusiveness to a necessary prerequisite for psychological growth, self-discovery and creativity. Several vignettes illustrate the impact of curiosity during therapy.
Adult↗
"Treating" a homeless mentally ill patient who cannot be managed in the shelter system.
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Adult↗