ARE PARANOIDS SCHIZOPHRENICS?
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Many authors have stressed the particular affective behavior in paranoid psychoses, mainly its dysphoric pattern. In 1983, Berner formulated the dysphoric axial syndrome as a third type of the endogenomorphous cyclothymic axial syndrome. In this paper two points are examined: (1) The interrelation between dysphoric and depressive and/or manic affective disorders in paranoid psychoses, cross-sectionally and longitudinally, in order to test the hypothesis of their independence, and (2) the relation of dysphoric mood disorders in paranoid psychoses to their course, again in comparison with other types of affective symptoms. The paper is based on an empirical study by Gabriel in 1978 on the phenomenology and the course of paranoid psychoses.
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In order to assess which of three current models is most useful in understanding paranoia, the authors applied computer speech content analysis to 55 patients--24 of whom were in four groups expressing paranoid delusions and 31 of whom were in four groups not expressing such delusions. The results delineated a semantic or verbal profile of paranoid self-presentation. This self-presentation is more identifiable than the effects of any other patient characteristic, even if the delusion is not discussed by the patient. The strength of the statistical evidence supports the model of paranoid delusions as a separate disease rather than as a subtype of schizophrenia or as a trait that exists on a spectrum from normality to pathology.
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The authors review the literature pertaining to the roles of psychopathology and personality variables in traffic accidents. They review studies of nonpsychiatric and psychiatric samples and examine the roles of suicide, life events, alcohol, and drugs. Certain personality characteristics and psychopathology--such as low tension tolerance, immaturity, personality disorder, and paranoid conditions--appear to be risk factors for traffic accidents. Although the role of alcohol is relatively well established, the roles of most other drugs are less clear. The results of further investigation of psychopathology's role in traffic accidents may have implications for prevention.
After presenting their model for the description of delusions, the authors report some results of two catamnestic studies in patients with delusional syndromes. There is evidence for the hypothesis that the usual classification of such patients as paranoid schizophrenics is frequently not justified. A reasonable number of the cases might belong to cyclothymia or at least approach it. Disappearance of delusions and complete restitution frequently occur in this group, while chronicity seems connected with persistent psychopathological signs in the accompanying symptomatology supposed to represent--in part--organic brain syndromes or congenital or acquired psychopathic personalities.
Delusional parasitosis is characterized by the unshakeable belief of being infested with tiny (microscopic) insects. Patients spend much time trying to get rid of the bugs and suffer from these symptoms. Patients prefer to go to dermatologists because they have a strong conviction over the presence of a somatic disease and do not accept any psychiatric advice for their complaints. Folie a deux or shared psychotic disorder (SPD) is a relatively rare syndrome, which has long attracted clinical attention. Delusional parasitosis is associated in 5-15% of SPD and can run within a family. We experienced delusional parasitosis as Folie a Deux between a mother and her son and successfully treated them through early psychiatric intervention. We believe that attention should be drawn to DP with SPD.
Conditioned blocking (CB) refers to a delay in learning that a new stimulus, added during learning, has the same consequences as the conditioned stimulus already present. In animals such "learned inattention" depends on monoaminergic and limbic function and, thus, CB performance should be informative on selective information processing impairments found in subgroups of psychotic patients. Attenuated CB in acute schizophrenia has been reported to normalize rapidly. This study examines in young patients the specificity of CB performance to illness, and its associations with symptoms, personality traits and monoaminergic metabolic status. CB was attenuated in psychotic patients with non-paranoid symptoms (NP: n = 12, mean age 17 years) with respect to obsessive-compulsive (OCD: n = 13, mean age 16 years) and healthy subjects (CON, n = 29, mean age 18 years), but only a transient attenuation was observed in paranoid hallucinatory patients (PH: n = 14, mean age 19 years). Outgoing personality traits in CON and OCD subjects correlated with CB. In NP patients attenuated CB was associated with increasing neurotic lability. In PH patients CB correlated positively with "manic" but negatively with psychotic or neurotic scores. The severity of negative symptoms in psychosis and specific negative/positive symptoms in the NP/PH groups was associated with reduced CB. Increased dopamine activity (24-h urine samples) correlated positively with CB, but relative increases of noradrenaline metabolism in NP and serotonin metabolism in OCD patients interfered. In summary, marked psychotic or neurotic traits and some symptom-states were associated with reduced CB. The particular selective processing problems of NP patients may reflect inappropriate NA activity.