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PubMed2006

Analysis of delusional statements from 15 Japanese cases of 'Folie à Deux'.

BACKGROUND: Although many studies have reported folie à deux (FAD) cases, there has not yet been a study systematically examining patients' delusional statements. In the present study, we analyzed the changes in patients' delusional statements across the clinical course from the perspective of discourse analysis. SAMPLING AND METHODS: First, we presented a case of FAD in a married Japanese couple. Second, we examined 14 other cases of FAD from Japanese literature and analyzed changes in subjective pronoun (SP) use in each patient's delusional statements. RESULTS: Observed delusions of FAD were classified into the following two categories, based on the SP: (1) We-type: 'We are persecuted', and (2) Non We-type: mostly 'I am persecuted'. Interestingly, We-type was generally observed in paranoid schizophrenia, paranoid disorder, and shared psychotic disorder. In contrast, Non We-type was predominantly observed in nonparanoid schizophrenia. CONCLUSIONS: The present classification might reflect two different mechanisms of delusional association in FAD. Possible mechanisms of delusional transmission in schizophrenia were discussed. The present study has a clear limitation in the small number of cases from only Japanese literature. Furthermore, the relatively high occurrence of FAD between married couples in the Japanese literature may have introduced some bias into the present results. Further studies on FAD are needed, however, the present method of examining the SP seems to be useful in order to investigate the psychological mechanism of delusion formation between plural subjects.

Adult↗
PubMed1991

Psychiatric problems in the elderly.

Psychosocial changes and physical disabilities that occur in the elderly contribute to an increase in the prevalence of psychiatric disorders in the elderly. A comprehensive approach to diagnosis is required. Depression, dementia, delirium and paranoid disorders are common psychiatric disorders seen in the elderly. Underlying treatable causes must be excluded. Treatment requires special considerations such as adverse drug reactions, drug interactions, side effects and concomitant physical illnesses. Management of the elderly should involve the family as well as the patient.

Aged↗
PubMed1985

Psychiatric illness in first-degree relatives of patients with paranoid psychosis, schizophrenia and medical illness.

This study examines the respective morbid risk for psychiatric illness determined by the family history method in the first-degree relatives of medical controls and patients with delusional disorder (paranoid psychosis) and schizophrenia. The morbid risk for schizophrenia and schizoid-schizotypal personality disorder was significantly greater in the relatives of the schizophrenic patients than in those of the delusional disorder or medical control patients, but no difference in the risk for affective illness or alcoholism was found in the three groups of relatives. Paranoid personality disorder was significantly more common in the relatives of the delusional disorder patients than in those of the medical controls. These results support the familial independence of delusional disorder and schizophrenia.

Adult↗
PubMed1990

A comparison of two interviews for DSM-III-R personality disorders.

The study examined agreement between personality disorder diagnoses obtained using two structured interviews and the effect of depression on the diagnoses obtained. Twenty subjects were interviewed while depressed, using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorder; both interviews are designed to yield DSM-III-R personality disorder diagnoses. Eighteen subjects were reinterviewed later, 17 after recovery. Diagnostic agreement between the two instruments for any disorder was fair (kappa = 0.38). Kappas for the personality disorder clusters ranged from 0.08 to 0.83. Kappas for individual personality disorders ranged from 0.18 for paranoid disorder to 0.62 for borderline disorder. While the depressive state did not consistently affect categorical diagnoses, dimensional scores tended to be higher when patients were depressed. A dimensional profile, in which scores on each disorder are generated for subjects, may be more reliable than categorical diagnoses derived from the same instrument.

Adult↗
PubMed1992

On the descriptive validity of DSM III schizophrenia.

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.

Adult↗
PubMed1989

Delusional disorders. I. Comparative long-term outcome.

Of 301 first-admitted patients with delusional psychoses, 94 met DSM-III criteria of schizophrenia (S), 53 paranoid disorder (PD), 47 schizophreniform disorder (SFD), 35 schizoaffective disorder (SAD), 54 major affective disorder (AD), and 18 other disorders (OD). Retterstöl selected the patients and personally interviewed them after 5-18 years, and later the author interviewed them after 22-39 (mean 30) years. At last follow-up good functioning was noticed in 42%, moderate symptoms in 22%, severe defect in 20%, and very severe defect in 16%; 40% were still delusional. On average S patients did poorest, and OD patients slightly better. AD patients had superior outcome, while PD, SFD and SAD patients showed an intermediate position, but a little closer to AD than to S. However, heterogeneous course and outcome was noticed in all diagnostic groups.

Adult↗
PubMed1992

Factors predicting suicide in psychotic patients.

Death rate and causes of death during a mean period of 5.8 years were investigated in 250 male inpatients with psychotic disorders (DSM-III). Fifty patients died during the observation period. Suicide was confirmed in 11 of these patients and could not be excluded in 7 cases, where the cause of death was reported as uncertain. Clinical and neurobiological characteristics (DST-non-suppression, CSF proteins, and monoamine metabolites) were compared in patients who committed suicide and non-suicide patients of the same age, with or without suicidal behaviour. A highly increased mortality rate was seen among the patients and the rate of suicide was more than 20 times higher than that expected in a normal population of the same age. The estimated annual incidence of suicide was 2.5%, 1.3%, 1.0% and 0.4% for patients with bipolar disorder, paranoid psychosis, major depression and schizophrenic disorder, respectively. The following factors were significantly positively correlated with completed suicide: depressive mood, elated mood, paranoid ideas, and paternal age. All suicides had previously shown suicidal behaviour and the suicide occurred during or shortly after a period of hospitalisation. No correlations were found with age at onset of illness, duration of illness, substance abuse or neurobiological parameters.

Adolescent↗
PubMed1986

Classification of functional psychoses with special reference to follow-up studies.

The classification of functional psychoses is still a controversial issue, as are also diagnoses in psychiatry. The predictive validity of the diagnosis is of crucial importance. Diagnostic systems are discussed. The author presents the Scandinavian concept of reactive psychoses, schizophreniform psychoses and schizophrenia, and demonstrates from his own material on paranoid psychoses the predictive value of these concepts, with a percentage recovery of 81, 61 and 23% after long-term follow-up. The concepts are discussed in relation to ICD-9 and DSM-III. The concepts of paranoid disorders, affective disorders and borderline conditions are mentioned. The paper also introduces other papers to be presented in this volume.

Affective Disorders, Psychotic↗
PubMed1988

Somatization, paranoia, and language.

Somatization and paranoia are circumscribed distortions of reality that are impervious to the normative process of consensual validation. These distortions are often postulated as a means of bolstering lowered self-esteem. We used computerized content analysis of the free speech of patients with these disorders in order to identify and compare dimensions of self-concept reflected in their lexical choices. Interestingly, patients with these disorders differed in the themes prominent in their speech. The higher frequency categories used by the somatization disorder group conveyed an overwhelming sense of negativism, distress, and a preoccupation with an uncertain self-identity. In contrast, the categories used by the paranoid patients portrayed an artificially positive, grandiose self-image and a defensive abstractness. Our exploratory analysis suggests that circumscribed distortions of reality in somatization and paranoid disorders are not associated with the same common defensive style attempting to bolster self-esteem.

Adult↗
PubMed1990

The paranoid patient: surgeon beware!

Patients who have a paranoid disorder have a general expectation of being exploited or harmed. Assessment of personality and mental health is an important aspect of the preoperative patient evaluation. Paranoid patients can be troublesome or even physically dangerous, but may be difficult to detect preoperatively. We recount our experiences with such a patient and suggestions are made for detecting these patients and managing them. Care should be taken to avoid cosmetic facial surgery on such patients.

Adult↗
PubMed1995

[The characteristics of the cognitive defect in patients with different variants of late paranoia].

Evoked cortical activity in response to acoustic stimuli (oddball paradigm) was studied in patients with different paranoid disorders. The analysis covered the N150 negative wave and positive complex P300. In patients with paranoid schizophrenia and paranoid form of involutional psychosis cortical responses to the stimuli and cortex effects were not recorded. Such cognitive deficiency is believed to be typical for schizophrenia.

Aged↗
PubMed1991

Folie à six: a case report on induced psychotic disorder.

A case of folie à six is described in which the persecutory delusions of the central figure spread to her husband and their 2 sons, and even to her sister-in-law and a nephew. The main factor in the development of this shared paranoid disorder seems to have been the dominant personality of the inducer. In contrast to reports in the literature, there was no family history of such disorders and there were no adverse social or environmental circumstances.

Adult↗
PubMed1982

Demography of paranoid psychosis (delusional disorder): a review and comparison with schizophrenia and affective illness.

This article reviews the demographic characteristics of paranoid psychosis or delusional disorder (DD) and compares them with those found for schizophrenia and affective illness. Delusional disorder constitutes between 1% and 4% of all psychiatric admissions, with an incidence of first admissions between 1 and 3/100,000 population per year. Like affective illness, but unlike schizophrenia, DD is predominantly an illness of middle to late adult life, usually occurring in persons who have been married. Like schizophrenia, but unlike affective illness, DD occurs more frequently in low socioeconomic classes and produces a poor chance for full recovery. Delusional disorder occurs more frequently than either schizophrenia or affective illness in immigrants. From a demographic perspective, DD closely resembles neither schizophrenia not affective illness.

Adult↗
PubMedDate not supplied

Mummification and folie à deux.

Mummification is the preservation of the effects and/or corpse of a loved one. Psychiatric literature regarding this condition is reviewed and a case is presented in which a mother's paranoid psychosis is discovered following her apparent mummification of her son's corpse. In retrospect, it appears that a diagnosis of folie à deux pertained to this pair. The authors contend that mummification may represent the outcome of a shared delusional system and that failure to establish psychiatric diagnoses in those who practice mummification has been the result of inherent difficulties in diagnosing paranoid disorders.

Aged↗