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PubMedDate not supplied

Pimozide in the treatment of some "social maladjustments" in "personality disorders".

Forty patients with some "social maladjustments" or disturbed interpersonal relationship under 2 mg pimozide (Orap: a 24 h long-acting neuroleptic) for six to twelve months. Concomitant but complementary medication was kept unchanged. Control was based on: long-term investigation (1/2 - 1 year), quantification, use of two scales. Statistical evaluation of the changes in "cardinal symptoms" showed a significant improvement in tension, disorders of sleep, intellectual disturbances, cardiovascular symptoms and gastrointestinal complaints. More detailed analysis of the other 27-item rating scale revealed a dramatic improvement in anxiety and paranoidism. The overall appreciation shows that: 25 patients responded well or very well to pimozide, eight did moderately, seven poorly. Neurasthenia and related states with predominant asthenia turned out to be no indication for pimozide treatment. Except for some cases of increased fatigue, tolerance was exceptionally good. The trial showed that extra patience is required from the therapist as a clinical onset of one to two months is not uncommon.

Adult↗
PubMedDate not supplied

Personality traits associated with panic disorder: change associated with treatment.

Eighty-two subjects with panic disorder completed the Personality Diagnostic Questionnaire (PDQ) before treatment and again after a period of relatively stable improvement 3 years later. At baseline, panic subjects scored higher than normal control subjects, who had been matched for age and sex, on avoidant, dependent, histrionic, and paranoid personality subscales. Improvement in panic symptoms after 3 years was associated with reductions in these same subscale scores. Examination of individual items that distinguished panic from normal subjects showed themes of dependency, lack of self-confidence, emotional instability, and sensitivity to criticism that reflected demoralization in the panic disorder subjects. To a large extent, the findings reveal nonspecific, state-dependent effects of panic and agoraphobic symptoms on the personality functioning and morale of patients with panic disorder.

Alprazolam↗
PubMed1998

Open-label olanzapine treatment in five preadolescent children.

Olanzapine is a recently introduced atypical neuroleptic agent for which little information is available on its use in children. Open clinical trials of olanzapine treatment were conducted on five hospitalized children (ages 6 to 11 years) with varying diagnoses including bipolar disorder, psychosis not otherwise specified, schizophrenia, and attention-deficit/ hyperactivity disorder. Each patient had failed previous psychotropic medication trials, with a mean of four prior trials. The mean length of olanzapine treatment was 32 days (range, 2 to 7 weeks), and mean daily dose was 7.5 mg/day (range, 2.5 to 1.0 mg/day) or 0.22 mg/kg/day (range, 0.12 to 0.29 mg/kg/day). All children experienced adverse effects, including sedation (N = 3), weight gain of up to 16 pounds (N = 3), and akathisia (N = 2). Three patients showed some clinical improvement, but olanzapine treatment was discontinued in all five children within the first 6 weeks of treatment because of adverse effects or lack of clinically significant therapeutic response, although higher (or lower) doses, slower titration of dosage, or a longer duration of treatment might have produced more favorable results. Psychotic symptoms did not respond in the two patients with evidence of overt hallucinations and paranoid ideation. Improvement was observed in sleep in all five patients and in control of aggression in three. Before controlled trials of olanzapine in children are undertaken, further exploration of dose range and increased duration of treatment on an open basis are warranted. Until more encouraging data are available, clinicians should be cautious and conservative in their predictions about the potential value of olanzapine in treating preadolescent psychiatric disorders.

Akathisia, Drug-Induced↗
PubMedDate not supplied

Psychiatric conditions in worker fitness and risk evaluation.

This chapter has reviewed the specific techniques of measuring fitness for work in individuals with psychiatric impairment. The discussion also considered the estimate of risk associated with various specific conditions and diagnoses. The use of psychiatric measures in work-fitness estimation is warranted in the following situations: 1. applicants with known or suspect history of psychiatric disorder; 2. employees returning to work after an episode of emotional illness or substance abuse; 3. employees referred to the medical department by management for evaluation of performance decrement, absence, abrupt indebtedness, unusual behavior, etc.; and 4. individuals evaluated for high stress or high risk jobs. Applicants' evaluations begin with a thorough medical history, a physical examination, a mental status examination, and basic laboratory studies. The personal history must include a complete work history, with particular attention paid to job duration and reasons for leaving employment. The mental status may be extended by specialized scales, e.g., the Griffiths work behavior rating scale. Unless an applicant has evidence of cognitive dysfunction, the usual battery of psychometric tests will not be helpful. Instruments that measure self-concept and ego strength, e.g., the Stotsky-Weinberg Sentence Completion Test and Miskimins Self-Goal-Other Test, may assist in resolving difficult questions about work fitness, especially in people with a history of schizophrenia. When an employee returns to work after an episode of psychiatric illness, the major questions for the occupational physician are: Is this person capable of returning to his current job? If not, what type of work is he capable of performing? In this instance, the fitness evaluation must add management data about the job to medical data about the patient. The patient-job fit is the crucial issue. For example, a socially-isolated, withdrawn paranoid schizophrenic functioned adequately for years as a third-shift computer operator. The scale of his operational responsibilities allowed him to work alone most of the time, a work environment unsatisfactory to most people but quite suitable for him. To aid in maintaining patient compliance with the treating physician's regimen, the patient should be asked to authorize release of medical information about the illness and to allow continued contact between the occupational physician and the treating doctor. Regularly scheduled follow-up visits are very helpful in maintaining patients on the job. They should include a brief interval history, an abbreviated mental status, relevant laboratory data (e.g., urine chromatography), and support.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed2005

Clinical, cognitive, and social characteristics of a sample of neuroleptic-naive persons with schizotypal personality disorder.

INTRODUCTION: Schizotypal personality disorder (SPD) shares with schizophrenia many biological features, yet little is known about the clinical characteristics of persons diagnosed with this disorder. This report describes the clinical, cognitive and socio-occupational characteristics of a community sample of subjects diagnosed with SPD. METHOD: Sixty-four male and 40 female neuroleptic-naive DSM-IV SPD subjects and 59 male and 51 female comparison subjects were recruited from the community for a total sample of 214 subjects. Demographic and cognitive differences between groups and, within the SPD group, the effect of gender on clinical features, such as the SPD criteria, SAPS, SANS, Schizotypal Personality Questionnaire, and co-morbidity, were examined using ANOVA and Chi-square distributions. RESULTS: SPD subjects, in contrast to comparison subjects, had significantly lower socio-economic status, poorer social relationships and skills, and lower vocabulary scores. Furthermore, SPD subjects demonstrated more impairment on Vocabulary scores than on Block Design, as measured by the WAIS-R, a pattern not seen in comparison subjects. In the SPD cohort, positive symptoms predominated and nearly half were co-morbid for major depression. With respect to gender, male SPD subjects, compared with female SPD subjects, evinced significantly more negative symptoms, fewer friends, had more odd speech, and were more likely to also suffer from paranoid and narcissistic personality disorders. In contrast to male SPD subjects, female SPD subjects perceived themselves to be more disorganized. CONCLUSIONS: SPD subjects, similar to schizophrenics, are impaired socially, occupationally, and cognitively, particularly in the area of verbal measures. Moreover, male SPD subjects may be more severely affected than female SPD subjects across multiple domains of functioning.

Adolescent↗
PubMed1976

[Hatred and change of love into hatred from the psychiatric nosological aspect (author's transl)].

Pathological hatred affects belong to the paranoic reactions, paranoic developments and paranoid psychoses. The normal hatred affect helps as a means to the end of removing the object of hatred. The passion of hatred is an affect swinging between a feeling of triumph and a feeling of impotence and the cardinal symptom of a paranoic neurotic development. Hatred becomes monomania when the affect degenerates maniacally (e. g. queruousness) or perversely (e. g. misogyny). In catathymic mania, hatred is projected on to the "pursuer". The metamorphosis of love into hatred is historically and dynamically behind all normal and pathological manifestations of hatred.

Adult↗
PubMedDate not supplied

[Long-term clinical experience with clozapine].

This study reports a clinical experience among twenty schizophrenic patients treated by clozapine during two years and eight months within a range extending from three months to seven years. These twenty patients had previously shown long-term resistance to usual neuroleptics but three out of them met the diagnosis of mental retardation or childhood disintegrative disorder (F.84.3-ICD 10). These patients were put under clozapine for their violent behavior. The methodology was retrospective, descriptive with intra-individual comparison, each patient being his own reference before and after treatment. Diagnosis met CD 10 criteria and were assessed without using standard examination. This study aimed at assessing once more clozapine efficacy and tolerance upon a long time follow up. Single therapy has been the rule and dosages have been progressively increased reaching a mean daily dosage of 350 mg per day. The efficacy, assessed by the way of BPRS, GAF (DSM III-R) and simplified form of CGIS, has been verified in approximately 30% of the patients, mainly concerning positive symptoms. Clozapine was also able to alleviate severe behavior troubles brought about by delusional states, without this latter being markedly softened when it was a long term one. Clozapine tolerance has shown it to be satisfactory, however we noticed the occurrence of a leucopenia with neutropenia after seventeen weeks of treatment, followed, some days later, by a Quincke oedema, which forced to interrupt the treatment. White blood cells came back in a normal range fifteen days later. The other side effects (transitory hypersialorrhea, tachycardia, without clinical and ECG perturbations) have been usually well tolerated and have never caused treatment interruption. No extrapyramidal side effect have been noticed among our twenty patients. The end of this paper consists in the presentation of four clinical cases: one about the efficacy of clozapine upon violent antisocial behaviour in a schizotypital disorder; one delusional chronic schizophrenic patient whose violence has been controlled despite of the delusion; one paranoid schizophrenic patient who has been able to maintain a satisfactory professional and family adaptation; and finally a childhood disintegrative disorder (F.84.3-ICD 10) in whom occurred the only leucopenia side effect of our study. These four clinical cases have seemed particularly meaningful regarding our clinical experience of clozapine which has been lasting for almost seven years now.

Adolescent↗
PubMed1990

Chronic schizophrenia-like states in methamphetamine psychosis.

In order to clarify the characteristic psychopathology of chronic methamphetamine (MAP) psychosis, the clinical symptoms of 11 chronic MAP psychotics were compared with those of the same number of chronic schizophrenics matched for sex and age. The positive symptoms were almost similar in both groups. However, the negative symptoms evaluated by the Scale for the Assessment of Negative Symptoms (SANS) differed considerably. According to the SANS, the scores of avolition-apathy, anhedonia-asociality and attentional impairment were moderately high in both groups. The scores of affective flattening or blunting and alogia were lower in the MAP group than those in the schizophrenia group. The SANS scores of negative symptoms increased in accordance with the age of onset in the MAP group, while such a correlation was not observed in the schizophrenia group. Furthermore, detailed clinical observations of the patients revealed the following differences between the two groups: 1) spontaneous affective expression during the interviews was more vivid in the MAP group compared to the schizophrenia group, and 2) affective expressions or interpersonal behaviors changed immediately depending on the situation in the MAP group. From the viewpoint of clinical psychopathology, a group of MAP psychotics whose hallucinatory-delusional state persisted for a long period of one month or more after cessation of MAP use seemed to differ from either chronic schizophrenics or patients with acute MAP psychosis. The author proposed that this group of patients should be a clinical entity and be called as "residual methamphetamine psychosis."

Adult↗
PubMedDate not supplied

[An ethological model of endogenous psychoses].

Our theory deals with the causality of the endogenous psychoses, considered as a shift of the systems of social behaviour that, in the natural history of our species, are supposed to have controlled the "Social homeostasis": territorial intolerance and dominance hierarchy. The subjective feeling of displacement beyond the boundaries of the group territory would trigger the paranoid syndrome, while the inner experience of an invasion of the own domain would lead to paranoia; hierarchical sudden ascent fits to the maniac syndromes, and the decay of dominance to depression. Intermingled emergence of territorial and ranking vectors allows us to obtain the syndrome profiles of mixed and atypical states with schizomorph and affective components. This causal model gives unity, as well as explanatory and comprehensive principles, to the clinical syndromes formed in the evolution of the endogenous psychoses.

Ethology↗
PubMed2006

[Hypochondria circumscripta (to the problem of coenesthesiopathic paranoia)].

Hypochondria circumscripta manifests in patients with paranoial personality and signs of somatopsychic accentuation. A sample included 11 patients (6 men, 5 women, mean age 54 years) who referred to dermatologists or had been admitted to gastroenterological and psychiatric units. Pathokinesis of hypochondria circumscripta comprises three stages: idiopathic algias, overmastering sensations and possession of pain. In the latter stage, delusional behavior targeted to the elimination of a part of the body, which is perceived as the source of pain, develops. Psychopathological disorders are realized in limits of coenesthesiopathic spectrum without tendency to interpretive delusion manifestation as well as transformation to systematic delusion of persecution during the disease course. As a consequence of above mentioned peculiarities of psychopathological structure, the stage of possession of pain may be designated as coenesthesiopathic paranoia. Because of the small sample, the findings can be considered as preliminary ones.

Aged↗
PubMed2006

Human clock, PER1 and PER2 polymorphisms: lack of association with cocaine dependence susceptibility and cocaine-induced paranoia.

Considerable research points to the importance of genetic mechanisms in psychostimulant addiction. Behavioral sensitization, a well-documented response to repeated stimulant exposure, may be mechanistically important in clinical features of the disorder, including escalating patterns of drug use, craving and drug-induced paranoia. Basic studies in both Drosophila melanogaster and mice have suggested the importance of circadian rhythm genes in locomotor sensitization and reward. The primary objective of the current study was to assess the potential involvement of three human orthologs (CLOCK, PER1 and PER2) in clinical phenotypes of the disorder. Allelic associations of three single nucleotide polymorphisms (SNPs) were assessed for both cocaine dependence and cocaine-induced paranoia in 186 cases and 273 controls. Potential population stratification biases were controlled for by means of within-population comparisons, and by structured association methods (using all populations). No differences in allele frequencies were found for any of the three single nucleotide polymorphisms studied between cocaine dependent and control subjects or between paranoid and nonparanoid cocaine users. These results do not support the involvement of genetic variation in these three circadian gene SNPs for influencing risks for either of these cocaine phenotypes.

Animals↗
PubMed1982

Psychological resolution of homicide after 10 years.

The projective imagery, artwork, and behavior of an artistically trained psychiatric patient are presented 10 years after having committed a murder. The case is examined to see whether the Rorschach responses and the artist's choice of subject matter demonstrate the repetition compulsion familiarly associated with trauma. Additionally, does psychotherapy in which the crime is remembered serve as a stimulus to these other forms of repetition? Our case shows evidence of a continuing psychological struggle to express or deny his involvement in the murder, with phases of limited resolution.

Adaptation, Psychological↗
PubMed1995

[Male erotomania: a type of dangerous sexual harassment].

OBJECTIVE: The purpose of our study is to examine male erotomania and its consequences for women who are victims of it. METHOD: We studied the clinical characteristics of erotomaniacal men and the physical and psychic consequences to women who were their victims. RESULTS: The men we met have a severe paranoid thought disorder which combines jealousy, projection and interpretation. Their behaviour is characterized by escalating violence in their involvement with women by whom they believe they are loved. During their contacts with the erotomaniac, the victims develop adjustment disorders and anxiety. CONCLUSION: Our study leads us to conclude that erotomaniacs and their victims have symptoms and a clinical evolution identical to those found in harassing and violent ex-spouses. The positive response of some erotomaniacs to antipsychotic medication raises a therapeutic prospect for other violent men with the same thought disorders.

Adjustment Disorders↗
PubMed1977

[Erotomania or the delusional conviction of being loved. Contribution to the psychopathology of the love life].

Identified and described 150 years ago, the delirious conviction of being loved, or erotomania, is probably more frequent (in his less spectacular forms) in the private practice, than in the psychiatric services. The critical examination of the literature permits to classify this peculiar clinical-psychological entity as paranoid psychoses, or as sensitive characteropathias of the the Kretschmer-type, finally as an exaggerated-rediculous form of the intra-specific struggle for the conquest of a sexual partner. The pathogenesis of erotomania is yet under discussion. The psycho-analytic conception invoking the rejection or denegation of a latent homosexuality is yet not demonstrated. Six personal cases (three women, two of them being married, and three single men) are related as a contribution to the study of the yet debated problem of erotomania.

Adolescent↗
PubMed2003

Moyamoya disease in a patient with schizophrenia.

We present the case of a 23-year-old Vietnamese male with a 2-year history of a psychotic illness marked by prominent negative symptoms, fatuousness and disturbed behavior. Neuroimaging revealed a prominent vascular flow void affecting the middle and anterior cerebral arteries, with associated increased collateral supply to the frontal cortex, consistent with Moyamoya disease. Neurological examination was unremarkable; however, neuropsychological assessment revealed significant executive dysfunction, including stimulus-driven behavior. Whilst the diagnosis of schizophrenia and Moyamoya disease may be coincidental, an interaction between the 2 diseases may have led to some of the atypical features of this case, including prominent executive dysfunction and marked sensitivity to psychotropic medication. We discuss the nature of possible interactions between the 2 conditions. This case also highlights the importance of re-evaluating patients with atypical or treatment-resistant psychoses for cerebral pathology.

Adult↗
PubMed1995

Confirmed clinical efficacy of Actovegin in elderly patients with organic brain syndrome.

A double-blind randomized clinical trial was performed comparing the therapeutic effects of Actovegin versus placebo in elderly patients with organic brain syndrome. In addition to the necessary basic internal medicine therapy, 40 geriatric patients received dialy intravenous infusions of 250 ml Actovegin 20% p.i., and 20 patients received 250 ml 0.9% saline solution as placebo over a period of four weeks. Of the patient sample, 58% were hospitalized for simple dementia (ICD-9: 290.0) and 42% due to senile dementia with depressive or paranoid symptoms (ICD-9: 290.2). Based on the Syndrome Short Test (SKT) and the Sandoz Clinical Assessment Geriatric Scale (SCAG) score, the patients suffered from mild to moderate dementia. The therapeutic effect on the total SCAG score and the Clinical Global Impression (CGI) were the primary study variables. The scores for the SCAG subscales and the SKT score served as secondary variables. The mean total SCAG score in the drug group decreased from 56.3 at the start of therapy to 36.3 points at the end of therapy, and in the placebo group the total score went from 61.2 to 52.0 (p < 0.01). The CGI showed that with Actovegin, 70% of the patients experienced "distinct improvement" or "improvement" compared to only 35% with such results in the placebo group. The SCAG subscales and the total SKT score also demonstrated the superior effects of Actovegin compared to placebo. Moreover, the therapy group treated with Actovegin showed greater improvements in social behavior and mental performance than did the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2007

Specific psychiatric manifestations among preclinical Huntington disease mutation carriers.

BACKGROUND: Despite the need for significant clinical intervention owing to the psychiatric manifestations of Huntington disease (HD), there has been a paucity of studies specifically designed to evaluate these symptoms prior to disease diagnosis. OBJECTIVES: To investigate whether the Symptom Checklist 90-Revised (SCL-90-R) and the Center for Epidemiological Studies Depression Scale can be used to detect psychiatric manifestations among preclinical mutation carriers with absent or minimal motor signs of HD. DESIGN, SETTING, AND PARTICIPANTS: Individuals at risk for or recently diagnosed with HD were recruited and then evaluated at Indiana University School of Medicine, Indianapolis. All of the subjects completed a uniform clinical evaluation that included the Unified Huntington's Disease Rating Scale-99, molecular testing to determine HD mutation status, the SCL-90-R, and the Center for Epidemiological Studies Depression Scale. The sample was divided into 4 study groups: 171 individuals in the nonmutation carrier group; 29 with minimal, if any, motor signs of HD in the preclinical mutation carrier group 1; 20 with motor abnormalities suggestive of HD in the preclinical mutation carrier group 2; and 34 in the manifest HD group. MAIN OUTCOME MEASURES: Scores on the SCL-90-R and Center for Epidemiological Studies Depression Scale were compared. RESULTS: Five SCL-90-R symptom dimensions (obsessive-compulsive, interpersonal sensitivity, anxiety, paranoid ideation, and psychoticism) demonstrated a significant group effect (P < or = .04). The preclinical mutation carrier group 2 and the manifest HD group scored significantly higher on all 5 dimensions as compared with the nonmutation carrier group. The preclinical mutation carrier group 2 scored significantly higher than the nonmutation carrier group for 3 of the SCL-90-R symptom dimensions (anxiety, paranoid ideation, and psychoticism). A significant group effect was found on the Center for Epidemiological Studies Depression Scale (P = .04). The frequency of depressive symptoms was significantly higher in the manifest HD group and the preclinical mutation carrier group 2 as compared with the nonmutation carrier group. CONCLUSION: This study identified specific psychiatric symptom dimensions that differentiate nonmutation carriers from individuals in the early preclinical stages of HD who are either symptom free or have minor nonspecific motor abnormalities.

Adult↗
PubMed1978

Behavioral rhythms in schizophrenia.

Daily behavioral observations were made for several years on 10 male schizophrenic patients and on three male patients with organic brain disorders. Analysis of these data showed strong cyclic components in the five schizophrenic patients with predominantly hebephrenic symptomatology. Period lengths noted were about 2 days, 5 to 6 days, 30 days, and a longer cycle of 40 to 100 days duration. Antipsychotic medications appear to have a suppressant effect, but tricyclic antidepressants may enhance pre-existing rhythms.

Adult↗