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PubMedDate not supplied

Psychological distress symptoms in women undergoing medical vs. surgical termination of pregnancy.

OBJECTIVES: The purpose of this study is to compare the baseline psychological distress and symptom profile of women undergoing either medical (with mifepristone) or surgical pregnancy termination and the psychological outcome 2 weeks after the procedure. METHODS: Women (n = 200) given free choice of pregnancy termination method, either medical or surgical, were assessed before pregnancy termination by a demographic questionnaire including questions regarding the choice of the method of pregnancy termination, the Brief Symptom Inventory (BSI), the Spielberger State Anxiety questionnaire and the Rotter Locus of Control Scale. Two weeks after the procedure, the BSI and Spielberger questionnaires were repeated. RESULTS: Women with a smaller number of past pregnancies tended to choose the medical procedure. Reasons for choosing the medical procedure were fear of surgery, anesthesia and of future fertility difficulties. Prior to the procedure, the "medical group" had significantly higher levels of obsessive-compulsive symptoms, guilt and BSI general symptom index score, and a trend for higher interpersonal sensitivity and paranoid ideation. Postprocedure, both groups showed significant decline in anxiety levels and did not differ on most symptom parameters. CONCLUSIONS: Women who chose to have a medical termination are marginally more symptomatic before the procedure than women choosing surgical termination. However, both methods of pregnancy termination resulted in significant reduction in preabortion psychological distress level.

Abortifacient Agents↗
PubMedDate not supplied

A longitudinal study relating P3 amplitude to schizophrenia spectrum disorders and to global personality functioning.

Auditory and visual event-related potentials (ERPs) were recorded from first-degree relatives (adolescent offspring) of index cases with schizophrenic disorder, affective disorder, or no psychiatric disorder (normal controls) at a mean age of 15 years. Nearly a decade later, these subjects (at a mean age of 25 years) were evaluated for Research Diagnostic Criteria Schizophrenic Disorder, Schizoaffective Disorder, Unspecified Functional Psychosis, and for DSM-III-R Axis II schizophrenia-related traits and disorders including schizotypal, schizoid, and paranoid features. It was hypothesized, based on Duncan et al (1987a, Duncan 1988), that reduction of P3 amplitude in the auditory (but not the visual) modality would predict subsequent schizophrenic-related outcomes in subjects from the schizophrenic disorder parental group. This specific expectation was not statistically supported. An unanticipated and statistically robust result linking P3 decrements (in both auditory and visual modalities) with poorer Global Personality Functioning was observed for offspring from both psychiatric parental groups and the offspring of the normal control group. These data are consistent with the results of a large number of clinical studies of the P3 component that have demonstrated reductions in P3 amplitude in individuals expressing a wide range of behavioral dysfunctions. Their importance lies in the fact that these P3 amplitude decrements were detected long before the overt behavioral symptoms were identified, and were nonspecific with respect to parental psychiatric diagnostic group.

Acoustic Stimulation↗
PubMed1985

Crisis-oriented residential treatment as an alternative to hospitalization.

The La Posada program, a short-term alternative to hospitalization for acutely disturbed chronic patients, combines crisis intervention techniques with techniques developed in halfway houses to enhance independent functioning and counteract regressive, dependent behavior. Highly structured days involving a variety of approaches including group and individual therapy, therapeutic activities, expectations of appropriate behavior, and responsibility for ongoing treatment enable most clients to leave the program within nine days and to begin outpatient and day treatment before discharge. The program has proved to be a cost-effective and readily reproducible way of reducing hospital utilization by diverting patients directly or allowing early discharge to La Posada.

Adjustment Disorders↗
PubMed2001

Latent class analysis of DSM-IV schizotypal personality disorder criteria in psychiatric patients.

The aim of the study was to evaluate the latent structure of DSM-IV schizotypal personality disorder (SPD) diagnostic criteria. The sample consisted of 564 consecutively admitted inpatients and outpatients. Exploratory latent class analysis identified a four-class model as the best fitting model for DSM-IV SPD criteria. The first of the SPD latent classes was mainly characterized by odd thinking, inappropriate affect, and interpersonal features; the second class by cognitive/perceptual difficulties; the third class by paranoid features; and the fourth class by absence of SPD features. The conditional probability pattern of the fourclass solution could be safely replicated across confounder strata. Unlike previous findings, oddness, aloofness, and social withdrawal, rather than positive symptoms, best characterized SPD even in clinical samples.

Adult↗
PubMedDate not supplied

Evaluation of insomnia and daytime napping in Iranian Alzheimer disease patients: relationship with severity of dementia and comparison with normal adults.

OBJECTIVE: Alzheimer disease (AD) is among the most common and disabling diseases in adulthood, and it has been largely neglected in traditional societies like Iran. Exacerbation of AD symptoms creates many severe problems, especially in traditional Iranian extended families. One of these problems is insomnia, which can very significantly affect patients' family members because of disturbing insomnia-related behaviors. METHODS: The authors studied 53 patients with probable AD who had been interviewed for dementia and depression in the Neurology Clinic of Roozbeh Psychiatric Hospital (Tehran University of Medical Sciences). Excluding patients with overlapping multi-infarct dementia, 35 AD patients (22 men, 13 women) and 21 adults without dementia were studied as a comparison group (11 men, 10 women). RESULTS: There was a significant relationship between duration of informant-reported symptoms and severity of dementia with daytime napping and more daytime napping among AD patients than in the comparison group. There was also a significant relationship between cognitive decline and daytime napping in the comparison group. Our study showed a relationship between insomnia and aggression, between daytime napping and paranoid delusions; and between onset of insomnia and anxiety. The comparison group showed a significant relationship between depression and daytime napping. CONCLUSIONS: Daytime napping and insomnia are very common among Iranian AD patients, much more so than in normal adults. There is also a significant relationship among psychiatric symptoms, daytime napping, and insomnia, but it seems that daytime napping and insomnia in depressed AD patients are caused more by the progress of AD than by depression.

Aged↗
PubMed2001

Is it legal to be crazy: an ethical dilemma.

The legal versus ethical rights of behavioral health patients have long complicated inpatient treatment plans and challenged the creative thinking skills of behavioral health nurses. This article examines the practical ethics of involuntary treatment with focus on the principles of respect, individual autonomy, and the right for self-determination. Through an examination of an actual case in Florida, this discussion highlights the ethical dilemma of treating an involuntary patient versus releasing a potentially dangerous individual back into society. Practical solutions to this ethical dilemma are offered.

Adult↗
PubMed1994

Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome.

OBJECTIVE: This study addressed the unique clinical properties attributed to the atypical antipsychotic clozapine, including its efficacy in patients with treatment-refractory psychosis and against negative symptoms, its lack of acute extrapyramidal side effects, and the longer time course of its therapeutic effects. METHOD: The clinical responses of 84 schizophrenic inpatients (66 with treatment-refractory illness and 18 who were intolerant of antipsychotic treatment) were examined. After all previous antipsychotic medications had been withdrawn, the patients were treated with clozapine according to a standardized titration and dosage schedule. Patients who tolerated and responded to treatment were discharged and maintained on a regimen of clozapine for up to 52 weeks. Patients were evaluated for behavioral response and side effects after weeks 3, 6, 12, 26, 39, and 52 of treatment. RESULTS: Fifty percent of the patients with treatment-refractory illness and 76% of the treatment-intolerant patients responded to clozapine in up to 52 weeks. The optimal period for a trial of clozapine appeared to be 12-24 weeks. Clozapine exhibited therapeutic effects on negative symptoms, but these were not clearly independent of its effects on positive symptoms and extrapyramidal side effects. Several variables, including early age at onset of illness and female gender, were found to be predictors of poor response to treatment. Predictors of good response included the presence of extrapyramidal side effects during previous treatment with classic neuroleptics and a diagnosis of paranoid schizophrenia. CONCLUSIONS: These findings have important implications for the use of clozapine and our understanding of the pathophysiology of treatment-resistant schizophrenia.

Adolescent↗
PubMedDate not supplied

Factors affecting smoking in schizophrenia.

There is an increased frequency of smoking among patients with schizophrenia. However, it is unknown whether the smoking behavior of the patients is similar in all schizophrenia subtypes, as well as which is the relationship between smoking initiation and disease onset. Four hundred six patients with DSM-IV schizophrenia were interviewed to determine the smoking status in relationship to gender and schizophrenic subtype, and to other factors that could affect or be affected by smoking. The frequency of smoking among patients (58%) was significantly greater than in subjects from the general population (42%) (P =.000005). Male patients smoked significantly more frequently (70%) than the corresponding control subjects (50%) (P =.000006), whereas the difference failed to reach significance between female patients (41%) and control subjects (32%). Among male patients, the number of smokers was significantly greater than in the controls in the paranoid (77%), undifferentiated (72%), and residual (78%) subtypes, whereas there was no significant difference in the disorganized (44%) and catatonic (22%) subtypes. The findings show that the frequency of smoking in schizophrenia patients increases with increasing positive symptoms and decreases with increasing negative symptoms. Male and female smoking patients consumed approximately 10 cigarettes per day more than the corresponding control subjects (P <.000001). In 86% of the patients, smoking initiation occurred before the disease onset. Among patients who smoked, smoking initiation and disease onset occurred at age 18.7 +/- 4.4 and 24.1 +/- 6.1 years, respectively (P <.000001). It appears that smoking in schizophrenia is influenced by gender and subtype. However, the nature of this association remains uncertain because in the vast majority of the patients smoking initiation occurs earlier than the disease onset.

Adolescent↗
PubMed1999

Increasing rates of hospital admission for men with major mental illnesses: data from Scottish mental health units, 1980-1995.

OBJECTIVE: We studied first admission rates for major mental illness in order to explore links with an increase in psychiatric morbidity and mortality in men. METHOD: Patient discharge data from Scottish Mental Health Units during 1980-1995 were analysed. RESULTS: Admission rates for schizophrenia remained constant in men and decreased in women. Affective disorders remained constant in men and decreased in women. Paranoid states increased in men and remained constant in women. Non-organic psychoses increased in both men and women. CONCLUSION: Further evidence is provided for an increase in the proportion of men, particularly younger age groups, admitted with major mental illness. Possible reasons include (i) comorbidity, (ii) biological variables, (iii) responses to and change in health-seeking behaviour in men and (iv) an increased prevalence of major mental illness in men.

Adolescent↗
PubMed2004

The role of attention in affect perception: an examination of Mirsky's four factor model of attention in chronic schizophrenia.

Attentional skills among people with schizophrenia may be related to deficits in affect perception. Such deficits can dramatically inhibit appropriate social functioning. We examined attention and affect perception in a sample of 65 people diagnosed with chronic schizophrenia. We used Mirsky's four factor model of attention to assess attentional functioning. To measure affect perception, we used two reliable measures of emotion recognition, the Bell-Lysaker Emotion Recognition Test and the Face Emotion Identification Test. Multiple regression analysis showed that all four attentional factors and a diagnosis of paranoid schizophrenia were significantly predictive of affect perception scores. In contrast, psychiatric symptoms, medication levels, demographic variables, verbal fluency, and face recognition scores were not predictive of affect perception scores. The four factors of attention accounted for 78 percent of the variance in affect perception scores. These results emphasize the role that attentional abilities play in affect perception for people with schizophrenia.

Adult↗
PubMed1977

[Alcohol consumption, alcohol abuse, and subjective feeling: a representative inquiry in the Federal Republic of Germany].

The investigation was carried out in a representative sample of subjects of the Federal Republic of Germany, including West Berlin (n = 1952). The subjects were 20--64 years old. The following were investigated: 1. Social and abusive drinking patterns 2. Relations between drinking behavior and sociodemographic data 3. Relations between drinking behavior and subjective feeling. Of the subjects, 47% consumed alcohol daily or several times a week, 6% called themselves teetotallers. Beer was the preferred beverage. The drinking behavior varied among income classes and vocational groups. Of the whole sample, 8% drank regularly whilst working; 25% of the skilled workers did so. Comparing alcohol consumption and subjective feeling, there was a slight association between elevated mood and frequent alcohol consumption. Of the subjects, 4% were identified as alcohol misusers (7% of the males, 1% of the females). Persons at high risk were men living alone (especially widowed and divorced subjects) and persons of medium income. Regular consumers of hard liquor were at higher risk than consumers of beer or wine. The highest percentage of misuse was found among unskilled and skilled workers and among inhabitants of large cities. There was a slight association between high alcohol misuse index and depressive states, subjective complaints, and paranoid attitudes.

Adult↗
PubMed2001

Verbal aggression in Alzheimer's disease. Clinical, functional and neuropsychological correlates.

OBJECTIVES: To determine the clinical, functional and neuropsychological correlates of verbal aggression in Alzheimer's disease in a group of consecutive first attendees to a memory clinic. METHODS: 150 people were evaluated and diagnosed as suffering with probable Alzheimer's disease. These people were tested using the Behave-AD for the presence of verbal aggression, delusions, depression and agitation. They were also assessed with cognitive, functional and neuropsychological scales. RESULTS: Twenty-eight per cent of this group of Alzheimer patients had exhibited some verbal aggression in the preceding month. Male gender (p = 0.022), the presence of paranoid and delusional ideation (p = 0.003) and agitation (p = 0.042) were significantly associated with verbal aggression in a stepwise backward logistic regression analysis. CONCLUSION: The presence of verbal aggression should prompt the clinician to search for delusional ideation, which may respond to pharmacotherapy.

Aged↗
PubMed2002

Regional brain atrophy in patients with mild Alzheimer's disease and delusions.

BACKGROUND AND OBJECTIVE: The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer's disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. METHODS: The setting of the study was the outpatient facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 +/- 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. RESULTS: AD patients without delusions had symmetrical enlargement of both temporal (8.1 +/- 3.9 vs. 8.5 +/- 4.5) and frontal horns (35.8 +/- 4.8 vs. 35.9 +/- 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 +/- 3.3 vs. 7.7 +/- 3.1, p = .06) and the frontal horn to the left (35.7 +/- 4.3 vs. 37.5 +/- 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model interaction term between asymmetry and group: F1,38 = 5.5, p = .03). DISCUSSION: AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.

Aged↗
PubMed2001

Psychotic consciousness.

ABSTRACT Congruent with recent demands for greater attention to be given to patients' actual experiences at a fine-grained level in the understanding of psychosis (e.g. Thomas 1997) the present paper first describes one day in an actual psychotic episode suffered by the author in 1979 and then subjects this narrative to analytic and normalisation interpretations. It is suggested that acute psychotic thinking of paranoid form is critically mediated by real social events and by intrapsychic deficits in attentional capacity; metacognition; thought regulation and signal discriminative ability. Cognitive processes in delusion however, are suggested to be influenced by the presence of a threatening external locus of control. This reflects the strong social and political quality to delusional suffering. The effects therefore of victimisation on cognitive processes is suggested to be an important issue in social cognitive psychology and psychiatry.

Brain↗
PubMed2005

Catatonia induced by levetiracetam.

Levetiracetam (Keppra) is a novel antiepileptic drug approved as adjunctive treatment for adults with partial onset seizures. Although the drug is generally well tolerated, behavioral side effects have been reported in variable frequency. Most behavioral problems are mild in nature (agitation, hostility, anxiety, emotional lability, apathy, depression) and quickly resolve with discontinuation of medication. However, serious psychiatric adverse events may also occur with rare cases of psychosis and suicidal behavior. We report here the case of a 43-year-old woman who developed symptoms compatible with catatonia after being exposed to levetiracetam for the treatment of epilepsy. To our knowledge, it is the first reported case of catatonia induced by levetiracetam. We review the difficulties that may be encountered in the differential diagnosis of medical catatonia.

Adult↗
PubMed1994

The role of mother-son incest in the pathogenesis of narcissistic personality disorder.

Psychoanalytic case material is presented to illustrate how mother-son incest may be involved in the pathogenesis of a particular subtype of narcissistic personality disorder. Male patients with this disorder have a grandiose view of themselves as entitled to occupy a special position with others, combined with a paranoid tendency to anticipate imminent betrayal. The enormous guilt related to perceived oedipal transgressions leads these patients to fear retaliation from an enraged, vindictive, and castrating father at any moment. In addition, these men often feel that their special role vis-à-vis mother is a precarious one contingent on doing her bidding. Hence, they also live in dread of an impending disaster involving either abandonment or humiliation by their mothers.

Adult↗
PubMed1981

Violent behaviour by psychiatric patients.

There is no substantial body of evidence to prove that psychiatric patients as a group are more violent than the general population. In determining whether violence is exhibited, the underlying personality of the individual is far more important than the psychiatric illness from which he suffers. Individuals with psychopathic personalities, those who abuse or are dependent on alcohol drugs, and those with pronounced paranoid or sadistic traits may be characterized by aggressive and violent behaviour. There is at present no reliable method of predicting if or when an individual patient will exhibit assaultive behaviour. Psychiatric hospitals, especially in the UK, are characterized more by frequent petty violence than by serious violence. Victims of assaults by patients are often related or known to them an interact with them on a personal level; they may also play a considerable role consciously or otherwise in instigating the assault.

Alcohol Drinking↗
PubMed2001

Impaired conditional discrimination learning in schizophrenia.

Learning deficits have repeatedly been found in patients with schizophrenia. Eyelid conditional discrimination learning (ECDL) is a test of discriminative aversive conditioning and places minimal demands on motivation. An ECDL task was used to examine residual and paranoid type individuals with schizophrenia and age- and gender-equivalent healthy controls. In the experiment two differently colored light stimuli were randomly presented. Only one of the stimuli (in reinforced trials) was followed by an aversive airpuff to the cornea, as opposed to unreinforced trials where the stimulus was not followed by an aversive airpuff. Conditioned responses develop to both trial types during the course of the experiment. These conditioned responses consist of reflectory eyelid closures already upon light presentation. The patients showed significantly impaired conditional discrimination learning abilities. There was no significant difference between the results in the two schizophrenia subtypes. Patients failed to increase response frequencies on reinforced trials during the course of the experiment, while controls showed appropriate conditional discrimination ability. Thus the results show an impairment of adequate behavior modification in an aversive conditioning task in individuals with schizophrenia. It is concluded that ECDL might be a trait marker for schizophrenia.

Adult↗