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Predictors of treatment dropout from a spouse abuse abatement program.

This study evaluated predictors of dropout among men who began and attended at least 1 session of a cognitive-behavioral, skills training oriented spouse abuse abatement counseling program. Based on prior research, a number of demographic, criminal justice, partner violence pattern, and personality characteristics were studied. Dropout prediction was assessed at 2 phases of program participation, during assessment (early drop) and during intervention (late drop). Overall, few of the variables studied predicted dropout. Early dropout was predicted by high rates of police contact for violent crimes, failure to self-report an alcohol problem, and paranoid personality characteristics. Late dropout was predicted by both high and moderate levels of police contact for violent crimes, and borderline personality characteristics. An Age x Violent Crime interaction suggested that young violent offenders are more likely to complete treatment. The overall model accounted for only 7.15% of the variance. Clinical and research implications are discussed.

Adult↗

Types of complaints in psychiatric and internal medical patients.

A follow-up study was made in groups of female neurotic, depressive, periodic catatonic, hypertonic, hyperthyreotic patients and normal control subjects using self-rating questionnaires to assess disposition, depressivity, neuroticism and subclinical symptoms. The subclinical symptoms scale (Sub-S) was elaborated on the basis of Huber's pure defect. We found that the experience (Sub-Exp) and behavior characteristics (Sub-Be) of the Sub-S form two separate subconstructs. The Sub-Exp belongs to the neuroticism factor and the Sub-Be can be evaluated as a subclinical appearance of manifest psychopathological behavior symptoms. The 'general disposition' construct is divided into subconstructs and shows contextual variants. It is proposed to use different methods for assessing it in the different problem areas simultaneously.

Adolescent↗

Postsurgical psychosis: case report and review of literature.

A wide range of behavioral symptoms may occur following surgery, including depression, hallucinations, true psychosis, mania, and impulsivity. Psychoses, including those that occur postoperatively, are among the most frequent indications for hospitalization in the United States and are associated with a substantially increased rate of morbidity. The exact cause of postoperative psychosis has not been identified. A 59-year-old woman who developed acute psychosis after cholecystectomy is described here. The patient was brought to Mount Vernon Hospital in New York because she exhibited acute disruptive behavior following endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy performed on 2 consecutive days. The patient was psychotic and was unable to be managed; she was disorganized, confused, and perplexed. Findings of computed tomography of the head, electroencephalography, and chemical and hematologic tests were normal. The patient was treated with lorazepam 1 mg every 6 h, olanzapine 5 mg at bedtime, and clonazepam 1 mg at bedtime. She experienced a mixture of auditory and visual hallucinations with a paranoid perspective and was then treated with haloperidol 5 mg, diphenhydramine chloride 25 mg, and divalproex sodium 500 mg. After 1 wk, the patient was described as acutely psychotic; antipsychotic medication dosages were readjusted and the patient's condition stabilized. The association between surgical procedures and psychosis is thoroughly reviewed here. Awareness, ability to diagnose, and an understanding of the cause of psychotic symptoms that emerge following surgery must be established if physicians are to provide better care and more effective treatment.

Antipsychotic Agents↗

Terminal cardiomyopathy, splitting, and borderline personality organization.

A 63-year-old married man with idiopathic terminal cardiomyopathy was admitted to the medical service for treatment of advanced heart failure. A psychiatric consultation was requested to assist the medical treatment team in dealing with the patient's abusive behavior. The case is presented and discussed within the context of understanding the borderline personality in the medical setting.

Adaptation, Psychological↗

Use of the Columbia University Scale to assess psychopathology in Alzheimer's disease.

The Columbia University Scale for Psychopathology in Alzheimer's disease (CUSPAD) was developed as a short, semistructured instrument that can be administered by a clinician or trained lay interviewer to the relatives or caregivers of patients with probable Alzheimer's disease (AD). The components of the scale focus on symptoms of psychosis, behavioral disturbance, and depression. A simple decision-tree approach is used to identify the presence of specific psychotic features and makes it possible for the instrument to be used by trained lay interviewers. Interrater reliability has been established. Use of this scale in a multicenter longitudinal study of patients with mild to moderate AD revealed that agitation was the most common and persistent symptom, depressed mood with vegetative signs was the least common and least persistent, and paranoid delusions and hallucinations showed moderate persistence over time. Besides its established psychometric properties, the strengths of the CUSPAD include its brevity, clarity in assessing psychotic symptoms, and ease of administration. These features make it useful for cross-sectional and longitudinal evaluation of the symptoms of psychopathology in AD. The main disadvantage is the lack of quantitative ratings of severity for many of the components, making it unsuitable for use in psychopharmacologic trials.

Aged↗

Nursing care of cognitively impaired, institutionalized elderly.

Findings indicate the importance of many nursing staff behaviors in relation to the behaviors of demented elderly persons, especially when asking the elder to complete a care task, such as dressing. Nonverbal as well as verbal nursing staff behaviors were related to behaviors of demented elderly persons, especially smiling, eye contact, and manipulating the environment to avoid difficult encounters. The nursing staff's ability to remain relaxed and flexible when assisting with the elder's care was strongly related to the elder's ability to remain flexible, calm, and cooperative during the care procedure. Use of verbal distraction or redirection, praise, and light-hearted, playful approaches were often found to be helpful when the demented elder became upset or paranoid.

Adult↗

Management of behavioral and psychiatric problems in Parkinson's disease.

Behavioral and psychiatric problems associated with idiopathic Parkinson's disease (PD) include cognitive dysfunction, drug-related psychosis, depression, anxiety, apathy, fatigue and sleep disturbance. These nonmotor symptoms are a significant cause of disability at all stages of illness. Cognitive dysfunction spans a continuum from circumscribed cognitive impairments to severe global dementia which can occur in up to 10-30% of advanced PD patients. Psychosis develops in 20-30% of PD patients receiving chronic antiparkinsonian therapy. Visual hallucinations and paranoid delusions are the most frequent symptoms. The gradual elimination of drugs of lesser priority that may affect cognition and/or cloud the sensorium constitutes the first step in the management of cognitive and psychotic symptoms. Atypical neuroleptic agents are an invaluable tool in those cases in which maximum drug regimen simplification is not adequate or results in unacceptable immobility. Depression and anxiety often go unrecognized although they are eminently treatable and may be important contributors to the morbidity of PD. They are present in 30-40% of PD patients and frequently occur together in association with other nonmotor symptoms such as apathy, fatigue and sleep disturbance. A combination of early recognition, counseling, antidepressant therapy, antianxiety and well-balanced antiparkinsonian therapy sets the stage for improved quality of life for patients with PD.

Journal Article↗

Psychopathology in the light of brain injury: a case study.

A case study of late onset psychopathology following brain injury is presented to illustrate the effects of cognitive and perceptual loss on personality functions. Based on Hughling Jackson's (1884/1958) notion of the duality of the symptom, we proposed a model of the development and process of psychopathology following brain injury, which views the development of the psychopathological behavior as a product of acquired cognitive and perceptual defects and ensuing compensatory strategies. For the present case study of paranoia, this involved defects in long-term memory, conceptual ability, and compensatory strategies of confabulation and self-referential orientation. Neuropsychological testing established defects in concept formation tasks including the Raven Progressive Matrices, the Leiter International Performance Scale, and the Wisconsin Card Sorting test, as well as long-term memory defects where cognitive reorganization was needed. The paranoid process was understood as a product of disordered conceptual ability in interpersonal situations, and a self-referential conceptual classification system, which took time, and changed social relations, to emerge. The implications of this model for psychotherapy with brain injury is elaborated in our case study, in which psychotherapeutic intervention included training on interpersonal hypothesis formation.

Adult↗

Neuropsychological deficits and violent behavior in incarcerated schizophrenics.

The authors studied 37 male schizophrenics in a county jail psychiatric unit. Subjects were classified as impaired or not according to Luria-Nebraska Neuropsychological Battery criteria. Twelve of the 37 patients were impaired. Violence ratings were made on inpatient behavior and adult criminal records. Impairment status was related to adult history of violence but not inpatient violence. The most violent patients (by criminal record) were from the impaired category.

Adolescent↗

Assessment of a man with a dual diagnosis.

This case assessment of a man with dual diagnosis exemplifies the use of recent psychological measures, computerized programs, and structured assessment, including the Reiss Screen for Maladaptive Behavior, the Psychopathology Inventory for Mentally Retarded Adults, the Apperceptive Personality Test, and the Residential Services Indicator. In this case, computerized scoring of two very different tests (the Reiss Screen and the Apperceptive Personality Test) yielded very similar results.

Adult↗

[Reactive depression in adolescents].

On the basis of studying the characteristic features of the clinical pattern of depression in 105 patients, the author specifies four variants of psychogenic depressive states in adolescence: (1) the basic variant characterized by the development of typical depression; (2) a variant of subclinical psychogenic depressions with behavioral disturbances; (3) a variant of recurrent depressions; (4) a variant of the so called anaclitic depressions. Specific characteristics of their clinical picture and course were ascertained and the features distinguishing them from psychogenic depressions in adults are presented.

Adjustment Disorders↗

A factor analysis of the signs and symptoms of mania.

BACKGROUND: No adequate factor analyses of signs and symptoms of mania have been reported. From limited past reports, the view has arisen that 2 main symptom clusters (euphoric-grandiose and paranoid-destructive) occur in patients with mania, along with so-called core symptoms of psychomotor pressure. In this view, dysphoric mania is associated with paranoid-destructive symptoms and with psychosis. METHODS: We rated 237 patients with DSM-III-R-defined bipolar disorder, manic (n = 204) or mixed (n = 33), on 15 classic features of mania and 5 features related to dysphoric mood. Principal components factor analysis was applied to the ratings. RESULTS: Five clearly interpretable and clinically relevant factors were identified. The first and strongest factor represented dysphoria in mania, with strong positive loadings for depressed mood, lability, guilt, anxiety, and suicidal thoughts and behaviors and a strong negative loading for euphoric mood. Factors 2 through 5 represented psychomotor acceleration, psychosis, increased hedonic function, and irritable aggression, respectively. The distribution of weighted scores on factor 1 was bimodal, whereas the corresponding distributions of factors 2 through 5 were unimodal. Contrary to all past reports, no general factor denoting overall severity of mania was found. Factors previously proposed by Beigel and Murphy were not confirmed. CONCLUSIONS: Five independent factors representing dysphoric mood, psychomotor pressure, psychosis, increased hedonic function, and irritable aggression were identified. The conventional view of symptom factors in mania was not confirmed. Dysphoric features are statistically salient in patients with mania, and the bimodal distribution of the dysphoria factor is consistent with the possibility that mixed bipolar disorder is a distinct state.

Adolescent↗

Central error-correcting behavior in schizophrenia and depression.

A previous study suggested that schizophrenic subjects exhibit an impaired ability to correct their own errors of movement without using exteroceptive signals. However, the performance of schizophrenic subjects was compared to that of only one other psychiatric group (alcoholic subjects), and a relatively small number of subjects was studied. To investigate the specificity of the postulated impairment, 9 schizophrenic, 11 depressed, and 8 normal subjects performed a tracking task designed to prevent the use of exteroceptive cues in correcting errors of movement. The depressed and normal groups did not differ significantly on any performance measure, but the schizophrenic subjects again demonstrated a gross impairment in correcting errors, yet no impairment in initiating correct responses. These findings suggest that the impaired ability to monitor ongoing motor behavior on the basis of internal, self-generated cues may be specific to schizophrenia among major psychiatric disorders.

Adult↗

Psychopathological dimensions in childhood and adolescent psychoses: a confirmatory factor analytical study.

The present study explored psychopathological dimensions in psychoses of children and adolescents and the distribution of demographic and clinical variables across different psychopathological domains. This study included 101 consecutive patients aged 6-18 years who had a DSM-IV psychotic disorder (schizophrenia and related disorders or mood disorders). Exclusion criteria included presence of organicity, substance use disorders, and any other childhood disorder. Psychopathology was assessed with Scales for Assessment of Positive and Negative Symptoms. Analysis revealed a four-factor model comprising primary negative, secondary negative, manic and paranoid factors. Patients were regrouped into one of the four factors based on their symptomatology. Patients in these four groups differed in education and age of onset and duration of illness. This study confirmed the existence of a factor structure in psychoses of children and adolescents.

Adolescent↗

[Emotional behavior in schizophrenia and one-sided brain damage. Cerebral hemispheric asymmetry. Part I].

Although, emotions play a crucial role in schizophrenia, the changes in emotional dimension in relation to brain asymmetry still remain controversial. The aim of our work was: 1) to compare the emotional behaviour between the examined groups: S--non-chronic schizophrenic patients (n = 50), CS--chronic schizophrenic patients (n = 50), N--healthy controls (n = 50), R--right brain-damaged patients (n = 30), and L--left brain-damaged patients (n = 30), 2) to assess the changes in attitude processes and in types of emotional reactions, its relation to lateralised hemisphere damage and chronicity of the schizophrenic process. All psychiatric subjects were diagnosed as paranoid schizophrenics according to DSM-IV criteria and were scored on the PANSS scale after four weeks of neuroleptic treatment. Brain-damaged patients were included if they experienced single-episode cerebrovascular accidents causing right or left hemisphere damage (confirmed in CT scan reports). The neurological patients were examined at least 3 weeks after the onset of the episode. Emotional behaviour was assessed using Observational Scale of Emotional Behaviour aimed at the evaluation of: A) attitude processes B) the emotional reactions. Our results revealed differentiated type of emotional behaviour in the examined population. Right brain-damaged patients significantly often revealed elevated mood, lack of adequacy of self-evaluation and active or negative attitude towards the environment. Left brain-damaged patients showed depressed mood, resignation, positive or seldom passive attitude to others and adequate self-evaluation. Schizophrenic patients mostly revealed indifferent mood and passive attitude to environment, their self-evaluation was rather adequate. Based on our data, the changes in emotional behaviour in schizophrenic patients might reflect frontal lobes dysfunction rather than dysfunction localised in one of cerebral hemispheres.

Adult↗

Extended suicide attempt: psychopathology, personality and risk factors.

Delinquency among depressed patients plays a minor role in criminal behavior. Among the most tragic associations between depression and criminality are cases of extended suicide or suicide attempt. We studied psychopathology, personality, and psychosocial stressors of 9 Austrian females who committed a serious extended suicide attempt. They were admitted for treatment at a special department of the Justizanstalt Wien-Josefstadt, Aussenstelle Wilhelmshöhe. Patients were diagnosed according to ICD-10 as severely depressed with (n = 6) or without (n = 3) psychotic features. After stabilization we diagnosed the following personality disorders: anxious-avoidant (n = 5), paranoid (n = 1), combined (n = 1) and borderline type (n = 1). Traits of the typus melancholicus were found in 5 patients. Seven females were pretreated before the offence by a psychiatrist or a psychologist; 4 of them had committed at least one suicide attempt in the past. Main psychosocial stressors mentioned by patients in the context of the offence were overstrain, marital and/or financial problems. One female killed her child under the influence of acoustic hallucinations. Patients with traits of the melancholic type showed an altruistic and hypernomic motive for killing as well as a psychotic identification with the victim, whereas in the other cases egocentric motives were in the forefront. Potential risk factors for an extended suicide attempt will be discussed.

Adult↗