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PubMed1979

Taijin Kyofusho: diagnostic and cultural issues in Japanese psychiatry.

Taijin Kyofusho or 'anthrophobia' is a Japanese culture-specific disgnostic label for the presenting problems of various fear reactions in interpersonal situations. The starting point of the present study was accumulating studies on Japanese cases of Taijin Kyofusho and the assertion in Japanese psychiatry that the symptom complex called Taijin kyofusho is Japanese culture-bound. In light of previous works on culture-bound disorders, the present study examines whether or not American mental health professionals could diagnose Japanese case descriptions of Taijin Kyofusho and what kinds of labels they applied to these Japanese cases. The results showed that American judges were able to diagnose Japanese cases nearly as well as American cases. However, there were considerable variability and inconsistency in their judgments of both the Japanese and American cases. The rate of disgnostic agreement dropped considerable as judges were asked to proceed from broad categories to specific categories. American judges grouped the Japanese cases of Taijin Kyofusho into a number of heterogeneous categories using labels such as paranoid schizophrenia, paranoid personality, phobic neurosis, and anxiety neurosis, among others. These results are discussed in terms of psychopathological diagnostic criteria and present conceptualization of culture-bound disorders, value judgments of mental health professionals, and the social contexts in which Taijin Kyofusho reactions occur.

Cultural Characteristics↗
PubMed2000

Long-term therapeutic drug monitoring of clozapine and metabolites in psychiatric in- and outpatients.

RATIONALE: Clozapine is a unique antipsychotic drug, outstanding for its lack of extrapyramidal side-effects and its superior efficacy in refractory schizophrenia. However, an unambiguous concentration-response relationship has not yet been established. OBJECTIVE: We investigated serum concentrations of clozapine, norclozapine and clozapine-N-oxide in psychiatric in- and outpatients to identify particular metabolic patterns in clozapine responders and non-responders and putative threshold levels for clozapine response. METHODS: Psychiatric assessments, CYP2D6 genotype, and weekly serum concentrations of clozapine, norclozapine and clozapine-N-oxide were obtained in 34 adult schizophrenic in-and outpatients (18 men, 16 women) during 10 weeks of clozapine treatment with a naturalistic dose design. RESULTS: Responders (n=21) displayed significantly lower serum concentrations of clozapine corrected for dose compared to non-responders (n=13; P<0.05), while none of the other parameters (absolute clozapine concentration, metabolite ratios, gender) were different. Smokers had significantly lower dose-corrected clozapine concentrations. A positive correlation was observed between age and average steady state clozapine concentrations. CONCLUSIONS: These findings indicate a possible link between CYP activity and response to clozapine that is not mediated through differences in serum concentrations. No clinically meaningful pattern in serum parameters could be identified that differentiates responders from non-responders. Thus, clozapine TDM seems ineffective for predicting clinical response. Smoking behavior is a major determinant of clozapine clearance while CYP2D6 genotype does not impact clozapine disposition.

Adult↗
PubMed1980

The ambivalent copulator: ejaculatory incompetence and identity diffusion.

This case report illustrates how a serious identity problem is crucial in dynamically understanding this rare sexual dysfunction. Ten retarded ejaculators treated by the author tend to be extremely compulsive and neurasthenic, with a failure to develop basic trust reflected in an obvious or concealed paranoid stance toward life. They exaggerate the destructive potential of their anger, perceive women as being invasive, possessive and controlling and lack basic sexual knowledge. Differences with the dynamics of the other male sexual dysfunctions are outlined. The successful treatment outcome in eight cases was greatly influenced by the partner's personality.

Adult↗
PubMed1975

Erotomania or de Clérambault syndrome.

De Clérambault focused attention on a syndrome in which a woman has the delusional belief that a man, usually of higher social status and considerably older, is much in love with her. If the patient's romantic ideas shaped private fantasies instead of determined public behavior, there would be little cause for concern. The situation becomes critical when the fantasies are dramatized in real life with an unsuspecting and usually unwilling man cast in the role of the lover. The woman dwells on the feelings she ascribes to her "suitor." Such delusional thinking, resulting from an ego defect and producting bizarre actions, may be shaped largely by feelings of being unloved or even unloveable; a narcissistic blow is overcome by a grandiose fantasy. Cases in which erotomania is prominent are usually diagnosed as paranoid state or paranoid schizophrenia.

Adult↗
PubMed1999

Mesolimbic activity associated with psychosis in schizophrenia. Symptom-specific PET studies.

Hallucinations and paranoid delusions are prominent among the positive symptoms of schizophrenia. Such psychotic symptoms are notable for their aberrant representations of, and relation to, the external world and for the emotional/motivational valence associated with the representations. As mesolimbic structures, including the amygdala and ventral striatum, are thought to play a significant role in imparting emotional valence to external stimuli, we here examine the mesolimbic findings of H215O PET studies designed to probe the functional neuroanatomy of psychosis. Patients with schizophrenia (including those with active hallucinations, those with active paranoid delusions, and those without active positive symptoms at the time of scanning) and healthy control subjects were studied. An event-related PET paradigm was used to identify the neural correlates of hallucinations, and a modified emotional stroop paradigm (with threat versus neutral words) was used to test the hypothesis that paranoid patients would have increased mesolimbic activity in response to threat, and even in response to neutral stimuli. The findings suggest that the positive psychotic symptoms of hallucinations and delusions share similar functional neuroanatomical features of increased mesotemporal and ventral striatal activity in the setting of decreased prefrontal activity. The pattern is evident even in a neutral context, unlike the case for normal subjects, who show such features only in response to threat. The implications of these findings for a pathophysiology of psychosis will be discussed in the context of the behavioral neuroanatomical literature in animals and humans.

Corpus Striatum↗
PubMed2001

Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders.

This study examined whether personality disorder status and beliefs that characterize personality disorders affect response to cognitive therapy. In a naturalistic study, 162 depressed outpatients with and without a personality disorder were followed over the course of cognitive therapy. As would be hypothesized by cognitive theory (A. T. Beck & A. Freeman, 1990), it was not personality disorder status but rather maladaptive avoidant and paranoid beliefs that predicted variance in outcome. However, pre- to posttherapy comparisons suggested that although patients with or without comorbidity respond comparably to "real-world" cognitive therapy, they report more severe depressive symptomatology at intake and more residual symptoms at termination.

Adolescent↗
PubMed1985

Life skill training: psychoeducational training as mental health treatment.

Fifty-four patients of a Veterans Administration Medical Center were assigned to either a life-skill training program that emphasized psychoeducational instruction and skill building or to a group counseling control condition. Subjects assigned to life-skill training were provided with 28 hours of instruction in interpersonal communication, purpose in life problem solving, and physical fitness/health maintenance. Control subjects received equal time engaged in psychiatric treatment that emphasized the analysis and exploration of personal problems, but with no direct coping skill training. Significant differences between the two groups were found on measures of interpersonal communication and meaningful purpose in life. Both groups received lower staff ratings on psychopathological behavior and demonstrated improvement on ratings of health and physical fitness upon completion of treatment. Twelve- and 24-month follow-up data that include rehospitalization rates are presented for each group.

Adaptation, Psychological↗
PubMed2006

Social anhedonia and schizotypy: the contribution of individual differences in affective traits, stress, and coping.

While social anhedonia is a promising indicator of vulnerability to schizophrenia, it remains uncertain whether anhedonia is a core feature of schizotypy or merely a secondary associated characteristic. This issue was examined by comparing dimensional scores on schizophrenia spectrum personality disorder symptoms derived from clinical interviews among three groups: a) "pure" social anhedonics with high scores on the Revised Social Anhedonia Scale (SAS; [Eckblad, M.L., Chapman, L.J., Chapman, J.P., Mishlove, M., 1982. The Revised Social Anhedonia Scale. Unpublished test, University of Wisconsin, Madison.]) and low scores on the Magical Ideation Scale (MIS, [Eckblad, M.L., Chapman, L.J., 1983. Magical ideation as an indicator of schizotypy. Journal of Consulting and Clinical Psychology, 51, 215-225.]), b) subjects with high MIS and low SAS scores, and c) controls with low scores on both scales. This study also sought to identify individual differences in stress reactivity, personality, coping style, and social support that might be related to severity of clinical symptoms among at-risk subjects. Compared to controls, the SAS group had higher levels of schizotypal, schizoid, and paranoid symptoms and the MIS group had higher schizotypal symptoms. Among social anhedonics, individual differences in perceived stress, trait negative affectivity, and coping style accounted for over 40% of the variance in schizotypal and paranoid symptoms. This cross-sectional study bolsters support for the validity of social anhedonia as a primary feature of schizotypy. Longitudinal studies are required to determine whether these individual differences potentiate clinical outcomes among social anhedonics.

Adaptation, Psychological↗
PubMed1982

Mad or bad? some clinical considerations in the misdiagnosis of schizophrenia as antisocial personality disorder.

Some clinicians tend to misdiagnose schizophrenia when there is accompanying antisocial behavior, thus depriving the patient of appropriate treatment. Four factors appear to contribute to this misdiagnosis, the most important of which is the nature of the interaction between examiner and examinee. The authors present a case illustration and discuss the implications for treatment.

Adult↗
PubMed2001

Childhood depression and adult personality disorder: alternative pathways of continuity.

BACKGROUND: This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. METHODS: Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. RESULTS: Odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, nonintact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. CONCLUSION: Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition.

Adolescent↗
PubMed1986

Dual factitious disorder.

The DSM-III classification of factitious disorders encourages artificial separation into disorders with physical and those with psychologic symptoms. Despite documented examples of similar patients who present with psychiatric complaints, Munchausen's syndrome is usually considered a form of chronic factitious physical disorder. Three patients with both factitious physical and psychologic symptoms are presented. These patients illustrate the importance of focusing on the fundamental behavior of assuming the patient role, rather than on the specific category of symptoms. We recommend that the category of symptoms be used as a modifying statement, rather than defining separate disorders.

Adult↗
PubMed2002

[Hallucinations, delusions, and nocturnal events in 152 Parkinson's patients: a regional survey].

Parkinson's disease cannot be reduced to its motor symptoms. Psychological and behavioral disorders often accompany its development. Our study was conducted in June 1999 among 36 neurologists practicing in hospital or private clinic settings in the Poitou-Charentes area. Neurologists were requested to record hallucinations, delusions and nocturnal events observed in Parkinson's patients. A total of 152 reports were collected from 17 physicians. Fifty-three percent of the patients attended hospital clinics and 47p.100; were seen at the physician's office. Hallucinations were recorded in 23.1p.100; of the patients. The risk of hallucination symptoms was higher among patients seen at hospital clinics and who had more advanced disease. Only 7.2p.100; of the patients reported delusions, most often of a persecution type. Nocturnal events affected 49.3p.100; of the patients. The appearance of such symptoms was highly related to Hoehn and Yahr stage and was more frequent in hospital patients. Hallucinations, delusions, and nocturnal events affect patients with advanced Parkinson's disease, associated with long-term L-dopa treatment. Eighty-three percent of the patients had such symptoms and most of them used L-dopa. This long-term treatment is linked to these three symptoms. Hallucinations were increasingly reported for patients with increasing long-term medication with dopaminergic agonists. Nocturnal events, for patients on L-dopa, were associated with advanced disease, long-term treatment with L-dopa, and hospitalization. Psychic and behavioral disorders appear frequently in Parkinson's disease patients and are inter-related. Physicians should be aware of the relationship with treatment to avoid aggravation.

Aged↗
PubMed1988

Cognitive disturbances in schizophrenics: what are they, and what is their origin?

Cognitive disorders are neither a unique nor a constant phenomenon in schizophrenia. Among the dysfunctions that may be observed at times, primarily during acute phases and in patients with a non-paranoid symptomatology, certain disturbances in attention-focusing and information processing seem to be most conspicuous. Some of these cognitive dysfunctions may have been transmitted from parent(s) to the patient, either genetically or through simple forms of learning. the empirical evidence for this assumption is to be found in the fact that some of the same cognitive deficits as those found in schizophrenic patients also found in their first-degree relatives, although usually in a milder form. Other forms of cognitive dysfunction may have developed as complementary strategies in response to communication deviances and cognitive behavior found in their parents. A developmental model, in which genetic, physiological and environmental factors are included is described as a way of illustrating how predisposing factors, as well as intermediating and stress factors, contribute to the debut and maintenance of cognitive disorders in schizophrenics.

Attention↗
PubMed1991

The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.

Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed2001

Dysfunctional beliefs discriminate personality disorders.

This study examines whether specific sets of dysfunctional beliefs are differentially associated with five personality disorders (PDs) as predicted by cognitive theory. Seven hundred fifty-six psychiatric outpatients completed the Personality Belief Questionnaire (PBQ) at intake and were assessed for PDs using a standardized clinical interview conducted by assessors who were blind to patients' PBQ responses. Findings showed that patients with avoidant, dependent, obsessive-compulsive, narcissistic, and paranoid PDs preferentially endorsed PBQ beliefs theoretically linked to their specific disorders. The study results support the cognitive theory of personality disorders. Suggestions are made regarding the clinical utility of the PBQ with personality-disordered patients and future research on the PBQ.

Adolescent↗
PubMed1981

Monoideism in psychiatry: theoretical and clinical implications.

The incessant repetition of disturbing monoideistic thoughts which cannot be eliminated from the patient's mind is a symptom of a variety of psychiatric conditions. The persistent monoideistic preoccupation tends to acquire the quality of a repetitive hypnotic suggestion or "inner commands" and creates an altered state of consciousness that transcends the limits of volitional control. The one-sided ideational context permeates interpersonal relations, intensifies family conflict and drains a considerable portion of available psychic energy. Disregard or an incorrect approach to this factor may result in painful therapeutic failure, since no exploratory psychotherapy or verbal intervention technique will be able to penetrate the monoideistic armour. THe continuous repetition of the dominant idea functions as a cumulative suggestion stimulus leading to disruption of spontaneous processes and self-defeating thinking, behavioral, motivational, and affective changes. The monoideistic preoccupation may be total and pervade the individual's entire life. Any comprehensive form of therapy should offer formulations and precise procedures--for the identified patient, nuclear family, and network of significant others--to block the feedback supplying system attached to the monoideistic pattern.

Adult↗
PubMedDate not supplied

Cross-ethnic evaluation of psychotic symptom content in hospitalized middle-aged and older adults.

OBJECTIVE: The objective of this study was to examine ethnic differences in the content of delusions and hallucinations among a tri-ethnic sample of adult psychiatric inpatients older than 40 years who were hospitalized with an acute psychotic episode. METHODS: A chart review of inpatient episodes for 133 middle-aged and older adult patients (31 African Americans, 50 Latinos, and 52 Euro-Americans) with a mean age of 50 years was performed at an acute behavioral medicine unit at a university hospital. All patients were diagnosed with a severe psychotic disorder. The content and frequency of psychotic symptoms were systematically reviewed using a structured checklist and comparisons across ethnic groups were made using chi(2) statistics. RESULTS: Ethnic group differences were found in the contents and subtypes of delusions and hallucinations. Significant ethnic differences were found in symptom content, consistent with findings from studies on younger samples of inpatients. Euro-Americans were nearly twice as likely as Latinos to report delusions of grandiosity. African Americans were more likely than Latinos to report general paranoid delusions of persecution. Latinos reported more culturally influenced contents than the other groups. CONCLUSION: Raising provider awareness of ethnic variation in symptom expression is a key step in the process of developing effective treatments for ethnically diverse middle-aged and older patient populations.

Adult↗