[Delusion of pregnancy revealing paraphrenia phantastica].
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To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.
Clinical signs and symptoms preceding the onset of dementia are sometimes acute, such as mood disorders often associated with hypochondriacal traits and cognitive slowing, sudden and serious suicide attempts, character and conduct disorders contrasting with the previous state, and psychotic disorders presenting as pathological mistrust, or ill-structured prejudice or persecution. Most forerunning symptoms reflect a progressive deterioration of cognitive functions over a long period, that have been masked by various coping strategies used by the patient with the spouse's help. Progressive cognitive deficits may develop over years before dementia can be diagnosed with confidence. Quantitative tools can help to detect dementia incipiens, such as the Folstein Mini Mental Test, the Mattis Dementia Scale, the five-word learning test, the clock drawing test, and the brief cognitive battery. The profile of early cognitive deterioration varies according to the type of dementia (Alzheimer's disease, fronto-temporal dementia, Lewy body dementia, and vascular dementia). The symptoms of dementia may be interlinked with symptoms of other disorders. Neuropsychological tests and brain imaging are needed to validate the diagnosis.
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A 28-year-old divorced black male intranasal cocaine abuser presented three times in seven days to the psychiatric emergency service of a general hospital with complaints of psychotic symptoms in the context of a cocaine binge. His repeated visits provided the opportunity to correlate his clinical picture with serum cocaine levels. This article describes that correlation and reviews the current literature on cocaine abuse and the cocaine abstinence syndrome.
Organic delusional disorders and secondary mania are clinical syndromes produced by neurologic diseases and toxic-metabolic disorders. Delusional disorders are associated primarily with limbic system lesions and basal ganglia dysfunction. These two groups of structures are united into a single system involved in the assessment of ongoing perception and experience, and dysfunction in these structures may explain the presence of psychosis. Lesions producing delusional disorders involve dopaminergic projections considered important in idiopathic schizophrenia, and involvement of similar anatomic and biochemical systems may explain the identity of symptoms noted in both disorders. Secondary mania is associated with deep midline lesions and with pharmacologic agents affecting monoaminergic function. Midline lesions may involve reward-system nuclei and euphoriant enkephalins to produce an elevated mood and hypothalamic nuclei to produce alterations in sleep, appetite, and libido. Mania appears to be more common with right-sided than with left-sided lesions. Lesions, metabolic disturbances, and drugs causing mania may disturb serotonergic and noradrenergic transmitters implicated in idiopathic bipolar disease. Study of the organic psychoses is providing insight into the neurophysiologic basis of idiopathic psychotic disorders. Clinically, greater awareness of the organic psychoses may lead to the discovery of additional cases of secondary mania and organic delusional disorders with potentially treatable neuromedical causes.
During an open clinical trial, 51 schizophrenic patients were treated with Penfluirdol, 34 for 1 year and 17 for a shorter time. The mean dosage of Penfluirdol was 22 up to 28 mg per week. Assessments were made on days 0, 14, 28, 56, 90, 180, 270, and 365 using the AMP system and the EPRS scale of Simpson and Angus. The symptomatology was mainly reduced during the first 3 months of treatment and remained afterwards relative unchanged. Penfluridol showed a good antipsychotic effect on productive schizophrenic symptoms (thought disorders and paranoid symptoms, autism and schizophrenic affective disorders). The dosage used showed only a slight sedative effect and was well tolerated concerning autonomic and extrapyramidal side-effects.
Working in a clinical setting the psychiatrist experiences relatives of patients in varying situations. Our study describes the relative playing the role of the accompanying person, the role of the visitor, the role of the accused and the role of a group member. The distortions of perspective being an immanent danger of psychiatric therapeutic endeavour can also deform the three-cornered-relationship between physician, patient and relative. Deformation of this triangle can be avoided by the therapist critically reflecting the possible beneficial role of the relative for the course of the psychiatric illness.
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