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PubMed1996

Delusional disorder: the recognition and management of paranoia.

Delusional disorder, the contemporary conceptualization of paranoia, is an uncommon condition characterized by the presence of one or more nonbizarre delusions and the relative absence of associated psychopathology. The delusions concern experiences that can conceivably occur in real life, such as being followed (persecutory type), having a disease (somatic type), being loved at a distance (erotomanic type), having an unfaithful sexual partner (jealous type), and possessing inflated worth, power, identity, or knowledge (grandiose type). The diagnosis requires at least 1 month's duration of the delusion; impact on functioning that is consistent with the delusion or its ramifications; generally normal appearance and behavior; and the exclusion of schizophrenia, mood disorder, substance-induced toxicity, and medical disease. Typically, patients are unaware of the psychiatric nature of the condition. They may present to internists, dermatologists, plastic surgeons, lawyers, or the police rather than to psychiatrists. Although the prevalence is low, delusional disorder is not rare. Age at onset is usually middle or late adulthood, and the course is variable. Familial transmission is suspected, and comorbidity (frequently mood disorders) may exist. Successful management is difficult and may include hospitalization, pharmacotherapy, and certain forms of psychotherapy.

Adult↗
PubMedDate not supplied

[Genetic factors in the onset of schizophrenia].

The importance of inheritance in the development of schizophrenia was recorded in classic papers by Kraepelin and Bleuler. These observations have been confirmed by the contemporary research. In this paper, we summarize the results of genetic-epidemiological studies that include family, twin and adoption studies, as well as the results of segregation analysis and molecular-genetic research. Family studies indicate increased morbidity risk in the relatives of patients with schizophrenia, that augments with the degree of relation. Twin studies also suggest the importance of genetic factors demonstrating higher rates of concordance for the disorder in monozygotic (MZ) than in dizygotic (DZ) twins and consistent MZ/DZ ratios across the studies. Adoption studies provide further evidence for genetic vulnerability, showing an association between biological relatives separated at birth. The concept of "schizophrenia spectrum" is based on the observation of the familial aggregation of several hierarchically defined disorders in relatives of schizophrenic probands. Schizophrenia, schizoaffective disorder, schizotypal and paranoid personality disorder, other nonaffective psychoses and psychotic affective disease, according to this concept, represent manifestations of varying severity, of the same underlying vulnerability, which is transmitted within families. The results of segregation analyses support rather polygenic than monogenic inheritance, if schizophrenia is genetically homogeneous. However, the possibility of genetic heterogeneity augments the interest for searching for vulnerability genes with linkage. The results of linkage studies, indicating association between schizophrenia and markers on chromosomes 5, 6, 8 and 22, have not yet been replicated on independent samples of probands. Recent findings indicate that schizophrenia may be caused by unstable DNA (the expansion of trinucleotide repeated sequences at the disease locus). This could explain the departure from Mendelian inheritance, highly variable phenotype and wide ranging age of onset in schizophrenia. Further research in this field could not only clarify the mode of the transmission of the liability for schizophrenia and the relationship of genetic and environmental factors in the development of the disorder, but also determine which characteristics, behavior and physiological variables schizophrenia genes code for. This would, in addition, contribute to our understanding of the biological basis of schizophrenia.

Humans↗
PubMed2005

Psychotic symptoms in Parkinson's disease. From description to etiology.

Psychotic symptoms are common in Parkinson's disease (PD) and occur in at least 20% of medication-treated patients. Benign visual hallucinations usually appear earlier, while malignant hallucinations, confusional states, delusions, paranoid beliefs, agitation, and delirium become more frequent with disease progression. Virtually all antiparkinsonian drugs may produce psychotic symptoms. Cognitive impairment, increased age, disease duration and severity, depression, and sleep disorders have been consistently identified as independent risk factors for their development. Although the precise pathoetiologic mechanisms remain unknown, we review evidence that links ventral dopaminergic pathway dysfunction (overactivity) together with the involvement of other neurotransmitter system imbalances as likely contributors. The clinical importance of the proposed mechanism is that successful management of psychotic symptoms in PD may rely on a multitarget approach to restore neurotransmitter imbalances rather than focusing exclusively on the dopaminergic dysfunction.

Animals↗
PubMed1993

Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population.

OBJECTIVE: Youths with conduct disorder extract an inordinate amount of time and money from the U.S. judicial system and taxpayers, yet studies pertaining to this population have been few. This study was undertaken to examine the co-occurrence of personality disorders and conduct disorder in a group of incarcerated children and adolescents and to raise the issue of the possibility of antisocial personality disorder in persons under the age of 18 years. METHOD: One hundred incarcerated juvenile offenders aged 11-17 years were randomly selected and then interviewed with the Diagnostic Interview for Children and Adolescents--Revised and the Structured Clinical Interview for DSM-III-R Personality Disorders to establish their psychiatric diagnoses. RESULTS: Eighty-seven percent of the group met the criteria for conduct disorder. Among those diagnosed as having conduct disorder, the only comorbid personality disorder that was present with significant frequency was antisocial personality disorder. The other comorbid personality disorder diagnoses that appeared most frequently were the borderline, narcissistic, paranoid, passive-aggressive, and dependent types. Borderline personality disorder was observed more frequently in the females than in the males with conduct disorder. CONCLUSIONS: The findings suggest that by using DSM-III-R criteria for adult personality disorders, one finds a considerable number of personality disorders in a young population with conduct disorder. The findings also show that youths manifest signs of antisocial personality disorder before they are 18 years of age, raising the question of how age should be incorporated into the diagnosis of personality disorder as DSM-IV is being prepared.

Adolescent↗
PubMed1981

Attention and visual reaction time in schizophrenia.

Schizophrenic behavior is sometimes characterized by inefficiency and symptoms possibly attributable to difficulties in coordinating attention. In fact, breakdown in cognitive and perceptual processes may be secondary to an initial disorder in mechanisms which coordinate focused attention. These processes were therefore tested in four subgroups of 10 schizophrenics each and in a normal comparison group (N = 10). A visual reaction time task was designed to operationalize definitions of width of cue utilization (responses to number of cues and position of cues), selective attention (color of cues), and ability to develop a set (probability of cues). Perceptual deficit was most prominent among long term nonparanoid schizophrenics who reduced their observation to central position cues when faced with a large number of potentially distracting stimuli. These patients, as well as short term nonparanoid schizophrenics, often failed to differentiate color even though this stimulus information provided an alternative method for reducing the number of stimuli requiring attention. Short term nonparanoid schizophrenics showed broad but disorganized attention to visual cues and inability to develop a probability set. Paranoid schizophrenics were not deviant in coordinated attention.

Adult↗
PubMed2003

Personality traits and personality disorders in early onset versus late onset major depression.

BACKGROUND: We aimed to determine the relationship between certain personality disorders and/or personality traits and early onset major depression. METHODS: A total of 400 depressed primary care patients were assessed for personality disorders using the SCID screen and for personality traits using the Karolinska Scales of Personality (KSP) questionnaire. Early onset was defined as onset of the first episode before the age of 26. Logistic regressions were performed to reveal relationships after adjustment for sex, age and number of previous episodes. RESULTS: Both groups had a similar severity of current illness determined by the Montgomery-Asberg Depression Rating Scale. Those with an early onset presented with a more debilitating course, seen in the form of more depressive episodes and previous hospitalisations in spite of their younger age. Early onset was also an independent predictor for avoidant, borderline and paranoid personality disorders. It also predicted increased scores on the KSP scales Psychic anxiety, Psychasthenia, Muscular tension, Suspicion and Irritability, and decreased Socialisation. LIMITATIONS: The evaluation was performed as a self-assessment, subjects had a superimposed major depressive episode when assessed, and subgroups of individuals were not eligible. CONCLUSIONS: Early onset major depression is a predictor for personality pathology and deviant personality traits. A better understanding of the interplay between genetics and environment that underlies this phenomenon will help to improve the long-term course in afflicted individuals.

Adult↗
PubMed1998

Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle.

BACKGROUND: The heterogeneity of schizophrenic and delusional syndromes by age of onset has frequently been discussed. METHODS: The age distribution of symptoms and 5 year course was studied in a population-based first-episode sample admitted to 10 psychiatric hospitals before the age of 60 (N = 232) and in a clinical sample without age limit of consecutive first admissions to a single hospital (N = 1109), both samples with broadly diagnosed schizophrenia. RESULTS: Early-onset patients, particularly men, presented more non-specific symptoms and higher PSE-CATEGO total scores than late-onset patients. In men, symptom severity decreased with increasing age of onset. In women, it remained stable except for an increase of negative symptoms with late-onset. Only a few symptoms changed markedly with age: disorganization decreased, while paranoid and systematic delusions increased steeply across the whole age of onset range. Pronounced age- and sex-differences emerged in illness behaviour, socially negative behaviour and substance abuse. Within the group of late-onset psychoses there were continuous transitions in symptom profiles and no discrimination between schizophrenia and paranoid psychosis or late paraphrenia. The main determinant of social course was onset level of social development. Early-onset patients did not improve in social status, while late-onset patients, prior to retirement, suffered considerable decline in social status. CONCLUSIONS: Gender differences in age at onset and in age trends in symptom severity support the hypothesis of a mild protective effect of oestrogen. Social course results from an interplay between biological factors (age at onset and functional impairment) and development factors (level of social development at onset and illness behaviour).

Adolescent↗
PubMed2005

Suicide attempt and melancholic depression in a male with erotomania: case report.

Erotomania is a delusional disorder, which is more common among women. A case of erotomania in a 34-year-old male associated with depression and suicidal behavior is presented. At the time he attempted suicide his erotomania fulfilled the diagnostic criteria of "pure" erotomania, described by de Clérambault. A depressive picture with melancholic features emerged four months later. Antidepressant medication was given and two months later he became euthymic. The erotomanic delusion disappeared in the third month of the euthymic state. In this case primary erotomania was associated with a depressive illness, presumably unipolar depression. The patient developed delusional guilt and suicidal ideation before the unequivocal change in his mood. To the authors' knowledge this is the first reported case where the erotomanic symptomatology led to suicidal attempt.

Adult↗
PubMed1996

Dopamine transporter gene polymorphism and psychiatric symptoms seen in schizophrenic patients at their first episode.

To investigate the possible role of the dopamine transporter (DAT) gene in determining the phenotype in human subjects, allele frequencies for the 40-bp variable number of tandem repeats (VNTR) polymorphism at this site were compared between 117 Japanese normal controls and 118 schizophrenic patients, including six subgroups: early-onset, those with a family history, and those suffering from one of the following psychiatric symptoms at their first episode: delusion and hallucination; disorganization; bizarre behavior; and negative symptoms. No significant differences were observed between the group as a whole or any subgroup of schizophrenic patients and controls. The results indicate that VNTR polymorphism in the DAT gene is unlikely to be a major contributor to any of the psychiatric parameters examined in the present population of schizophrenic subjects.

Adult↗
PubMed2005

Do you see what I see? Interpretations of intentional movement in schizophrenia.

OBJECTIVE: Current literature exploring theory of mind (ToM) abilities in patients with schizophrenia has failed to take into account the dynamic nature of complex social interactions. The aim of this study was to explore symptom specific impairments in theory of mind using a novel, dynamic task. METHODS: Subjects viewed short animations displaying three types of movement; random, goal directed, and socially complex (theory of mind). Verbal descriptions of the animations were obtained from 61 patients with schizophrenia (divided into symptom sub-groups) and 22 healthy comparison subjects and were scored for accuracy, type of response and use of target terms (terms most appropriate to each animation type). RESULTS: Accuracy on all three conditions discriminated behavioural signs (BS), and (to a lesser degree) paranoid subjects, from the other schizophrenia sub-groups (those in remission and those with passivity features) and the controls. Paranoid and BS groups had difficulties with all the animations, yet all symptom sub-groups failed to use the appropriate mentalising language to describe the ToM animations. CONCLUSIONS: In this first exploration of on-line mentalising abilities in schizophrenia, it is suggested that a failure to use appropriate mentalising language may be a trait marker for the disease. The nature of the type of tasks used to assess social cognitive processing in this group needs careful consideration, and tasks tapping into the fluidity of social interactions yield results that differ from previously reported studies.

Adult↗
PubMed1998

Ethological strategies for defence in animals and humans: their role in some psychiatric disorders.

Ethological strategies for defence in animals and humans are expressed as either aggression or flight behaviour. Aggression is employed by animals during intraspecific competition for resources, mate, territory and acquiring and maintaining social status. It also disperses individuals throughout the biotope. Flight behaviour is used to avoid a source of danger or harm, has both dynamic arid static forms, is phylogenetically very old and takes precedence over all other activities including social behaviour. Animals exposed to inescapable threats or attacks exhibit a characteristic defensive strategy, arrested flight, which consists of gaze-avoidance or cut-offs, cryptic postures such as immobility and covert surveillance of their surroundings. Arrested flight also occurs in social encounters when submission fails to reduce attacks, and in prey animals when escape from a predator is hampered. Ethological studies show that during interviews, depressed patients exhibit a pattern of non-verbal behaviour having all the hallmarks of arrested flight. Cut-off behaviour, which seeks to reduce the input of flight-evoking stimuli is especially evident in these patients but takes an extreme form, i.e. eye closure, in the gaze-profiles of paranoid patients. It is proposed that cut-offs always denote the presence of incipient flight and that arrested flight is a 'last measure' defensive strategy in response to inescapable proximal threat. It can arise in humans whenever their escape routes are hampered and characterizes the behaviour of patients suffering from depression. As in animals, different pathways may lead to arrested flight in humans. In humans, defensive mechanisms also operate at the mental level through putative ego defences, the psychological function of which is to preserve self-esteem by hindering the access of disturbing emotional material into awareness. It is suggested that they function ethologically as mental cut-offs analogous to the behavioural cut-offs in animals.

Adaptation, Psychological↗
PubMed1995

Perceived consequences to the predictor: a variable in the release of psychiatric patients.

The present study examined factors hypothesized to influence mental health professionals' perceptions of dangerousness, predictions of violence, and decisions on patients' release. 120 mental health professionals employed in state mental hospitals were each given one of 12 patient profiles. The independent variables, manipulated within vignettes, were (a) violence history, (b) paranoid schizophrenia versus nonparanoid schizophrenia, and (c) perceived consequences in terms of liability and publicity. Type of schizophrenia did not affect ratings, but violence history of the predictee and perceived consequences to the predictor did significantly influence the ratings. Patients with actual violence histories were viewed by the subjects as having more potential for future violence, as being more globally dangerous, and as requiring a more secure placement than those with histories of threats of violence or no violence. Possible litigation following release led to a recommendation for more secure placement than did minimal legal consequences. Predictions of violence and decisions on hospital release were interpreted as dependent on both predictor and patient-related variables.

Adult↗
PubMed1973

Reducing delusional speech in chronic, paranoid schizophrenics.

Four schizophrenic patients with paranoid and grandiose delusions who had been hospitalized for an average of 17 yr were exposed to social reinforcement contingencies in a multiple baseline design. During the baseline period, each patient was interviewed for four 10-min sessions each day. The elapsed time from onset of conversation to onset of delusional talk was recorded. At the end of each day, the patients engaged in a 30-min informal chat with a nurse-therapist while relaxing with coffee, snacks, and cigarettes. The intervention introduced two contingencies: (1) The 10-min interviews were terminated as soon as the patient began talking delusionally; (2) The patients earned time for their evening chat by talking rationally during their daytime interviews. Increases of from 200 to 600% in the amount of rational talk exhibited during the interviews occurred as the contingencies were introduced for each patient sequentially over time. These increases were maintained in three patients when the amount of reinforcement was halved, but declined when the patients were confronted directly with their delusional ideas. A modest amount of generalization occurred from the day-time interviews to the evening chats but did not extend to the behavior of the patients on the ward.

Journal Article↗
PubMed1976

Breaking a cycle of hospitalization through the psychiatric house call.

The authors discuss a case in which family therapy administered in a home setting helped to break a cycle of psychiatric hospitalization that had continued for ten years. Their patient had adopted a persistent behavioral pattern involving protective magic rituals and consultations with spirits as a defense against other problems in her family relationships. With regular visits from the therapists and cooperation from each member of the family, the patient's symptoms were ameliorated and the family situation greatly improved after eight months. The authors believe that because they worked with the entire family as a system, were able to recognize sociocultural factors that had not been dealt with in the patient's hospitalizations, and were able to stimulate communication among family members in a home setting, they were able to see more immediate results and thus were able to break the costly cycle of repeated hospitalizations.

Family Therapy↗
PubMed1996

Posterior fossa lesions associated with neuropsychiatric symptomatology.

We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood.

Adult↗
PubMed2003

A cluster-analytic investigation of MMPI profiles of serious male and female juvenile offenders.

OBJECTIVE: To use cluster analysis to identify psychological profiles and related mental health symptoms among male and female juvenile offenders. METHOD: Juvenile offenders (N = 141) incarcerated in the California Youth Authority completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2). RESULTS: MMPI cluster analysis revealed four distinct profiles: two for male and two for female juvenile offenders. Among males, we identified one Normative cluster with no clinically elevated scores. A second male cluster, labeled Disorganized, exhibited clinical elevations on scales 8 (Schizophrenia), 6 (Paranoia), 4 (Psychopathic Deviate), and 7 (Psychasthenia). Among females, two clinically elevated profiles emerged. One Impulsive-Antisocial cluster consisted of clinical elevations on scale 4 (Psychopathic Deviate), which has been consistently associated with delinquent and antisocial behavior. The second cluster, labeled Irritable-Isolated, produced elevations on MMPI scales 4 (Psychopathic Deviate), 8 (Schizophrenia), 6 (Paranoia), and 7 (Psychasthenia). There were no significant sex, ethnicity, or offense differences across clusters, but the clusters exhibit distinct psychiatric profiles (MMPI) and mental health symptoms (MAYSI-2). CONCLUSIONS: The findings indicate that not only do female offenders have more acute mental health symptoms and psychological disturbances than male offenders, they exhibit qualitatively distinct psychiatric profiles. Results reinforce the need for assessment of mental health symptoms for male and female juvenile offenders as well as sex-appropriate treatments.

Adolescent↗
PubMed1977

Common neurologic syndromes in medical practice.

The cases presented here are intended to illustrate an approach to the patient with complaints which may be vague, evanescent, or related to emotional factors. A scheme to analyze only five factors, mood, movement, sensation, cognition, and consciousness is presented to simplify the complexity of human behavior in order to arrive at correct diagnoses. The importance of a complete medical evaluation is stressed. Psychosis and other major psychiatric illness have been alluded to, but space does not permit discussion of the very important issues of the genetics, the neurochemistry, and the differential diagnosis of schizophrenia, mood disorders, and the organic brain syndromes. Some of the many manifestations of epilepsy have been presented, and the importance of electroencephalography and computed axial tomography is stressed. The references have been chosen for their general utility to practicing clinicians, especially the works of Pincus, Glaser and Tumulty.

Adolescent↗
PubMed1981

Torque behavior in schizophrenics, elderly persons, and other special groups.

The incidence of clockwise drawing (torque) was compared for 90 schizophrenics, 57 institutionalized elderly individuals, 24 general medical patients, 50 adults functioning well in the community, 71 graduate students, and 72 undergraduate college students. In view of Blau's (Blau, T. H. Torque and schizophrenic vulnerability: As the world turns. Am. Psychol., 32: 997-1005, 1977) previous finding that torque behavior in children is substantially associated with subsequent schizophrenic pathology an attempt was made to verify the pathological significance of torque. Results indicated that for all Ss combined 38 per cent produced torque. Only the elderly as compared with undergraduate students displayed a significant difference in incidence of clockwise circling, with the elderly producing more torque. The absence of any significant differences between adult schizophrenics and any of the other comparison groups raises serious doubts about the pathological importance of torque in adults. Moreover, since groups who would be expected to be neurologically more intact performed no different from those who would be expected to be less intact, the neural integrative defect explanation proposed by Blau would seem to be unwarranted.

Adult↗