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OBJECTIVE: Pathological gambling is a disabling disorder experienced by approximately 1%-2% of adults and for which there are few empirically validated treatments. The authors examined the efficacy and tolerability of the opioid antagonist nalmefene in the treatment of adults with pathological gambling. METHOD: A 16-week, randomized, dose-ranging, double-blind, placebo-controlled trial was conducted at 15 outpatient treatment centers across the United States between March 2002 and April 2003. Two hundred seven persons with DSM-IV pathological gambling were randomly assigned to receive nalmefene (25 mg/day, 50 mg/day, or 100 mg/day) or placebo. Scores on the primary outcome measure (Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling) were analyzed by using a linear mixed-effects model. RESULTS: Estimated regression coefficients showed that the 25 mg/day and 50 mg/day nalmefene groups had significantly different scores on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling, compared to the placebo group. A total of 59.2% of the subjects who received 25 mg/day of nalmefene were rated as "much improved" or "very much improved" at the last evaluation, compared to 34.0% of those who received placebo. Adverse experiences included nausea, dizziness, and insomnia. CONCLUSIONS: Subjects who received nalmefene had a statistically significant reduction in severity of pathological gambling. Low-dose nalmefene (25 mg/day) appeared efficacious and was associated with few adverse events. Higher doses (50 mg/day and 100 mg/day) resulted in intolerable side effects.
Examined the relationship between personality and psychopathology through the use of the Multivariate Personality Inventory (MPI) (N = 100). The concurrent validity study compared the factors of the MPI with those of the Lazare-Klerman Personality Inventory, which was developed for a pathological population. Factor analysis of these two inventories yielded three factors that correspond to the three predicted personality styles: Hysteric, Compulsive, and Character Disorder. In the second part of this study the construct validity of these scales was examined. Results showed significant differences among groups in the predicted directions, which indicates that the personality groups as defined by the MPI in a normal population perform as would be predicted from work with pathological groups that bear the same label. Construct validity measures did not support the predictions with regard to the performance of the personality types.
This study investigated whether normals, personality disorders, psychotics and organics could be differentiated by the Minnesota Percepto-Diagnostic Test. There were significant differences between all the groups except the psychotics and personality disorders. It appears that, in general, perceptual disturbance lies along a pathological continuum. Similar performances of psychotics and personality disorders were discussed.
44 cases of adrenal hemorrhage (AH) were analyzed. The forensic autopsy showed that AH occurred mainly in male aged from 20 to 40 years old. The traumatic AH was more often seen in young men and the pathologic AH was mostly seen in elderly persons. AH were more likely found in bilateral adrenal corticomedullary junction. The pathological grade of AH was not related to the interval time of survival. The pathologic mechanism of AH was discussed as well.
Proliferative processes were studied using radioautography with 3H-thymidine at the height of the disease and in the early convalescence of the bacterial dysentery. The mucous membrane of the sigmoid colon of healthy persons undergoing rectoromanoscopy due to the epidemic reasons served as control. No pathologic changes were found in these healthy persons; the labeled nuclei index (LNI) was 5.75 +/- 0.4%, the label intensity (LI) characterizing the rate of DNA synthesis was 14.9 +/- 0.8. During the peak of bacterial dysentery LNI increased up to 12.9 +/- 1.3% and there was a three-fold increase of LI. Activation of the proliferative processes persisted in the period of an early recovery. LNI was 9.4 +/- 1.0%, LI was 2.6 times higher as compared to control.
Some vegetovascular parameters were examined in 155 persons with late sequelae of open and closed craniocerebral injuries. A certain pathology pointing to vegetovascular dystonia and poor adaptation of the vessels was revealed, this pathology being especially marked and persistent in persons with closed cerebral injuries. These findings, when taken together with the clinical picture, are of importance for evaluating the victims' working capacity, and can serve as a criterion for placing the victim into this or that disability group, or as indications for rational working engagement.
Personality structure, defined as an enduring, consistent, and unique set of behavioral traits that differentiates one individual from another, forms the foundation of a person's response to both normal and pathologic aging. Although normal aging of the brain may not greatly influence personality, brain injury and disease often lead to personality change. Overall personality traits have been found to be stable within cohorts over time, although with several discrete changes. An older individual's responses to age-related stress will depend on the balance of personality strengths and weaknesses. Severe or multiple stresses in late life may overwhelm an individual's coping skills and lead to personality change. Personality disorders, defined as enduring and pervasive patterns of maladaptive behaviors, are challenging to diagnose in late life and have a variable course depending on the type of personality disorder or disorders. More research is needed to improve diagnosis and better understand the manifestations of late-life personality disorders.
The natural history of a personal group of eight patients with olfactory neuroblastoma is reviewed with particular reference to surgical pathology as revealed by a study of the operative specimens in seven of these patients. This reveals that spread to the cranial surface of the overlying dura must be considered to be present in all patients irrespective of the radiologic findings. Craniofacial resection is therefore considered to be an essential part of any treatment regimen.
In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Individual psychotherapy is a recommended treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , cluster B personality disorders. Due to their pathology, these patients represent a challenge in psychotherapy, and guidelines for practical handling exist. This study examined the attitudes of psychotherapists toward these challenges. Three hundred twenty-four experienced Norwegian therapists filled in a questionnaire on issues relevant to individual psychotherapy of patients with personality disorders. The attitudes toward cluster B patients were examined and compared with those of clusters A and C patients on contract issues, acting out, use of drugs, information to relatives, and contraindications. A considerable gap was found between therapists' attitudes toward cluster B patients and published guidelines. The therapists mostly handled cluster B in the same way as clusters A and C. Empirical investigations of therapists' handling provide an important feedback from everyday clinical practice on divergences in relation to guidelines derived from experts' consensus and research.
It has been proved that Adolf Hitler suffered from idiopathic Parkinson's disease. No indication for postencephalitic parkinsonism was found in the clinical symptoms or the case history. Professor Max de Crinis established his diagnosis of Parkinson's disease in Hitler early in 1945 and informed the SS leadership, who decided to initiate treatment with a specially prepared 'antiparkinsonian mixture' to be administered by a physician. However, Hitler never received the mixture, this implies that the SS intended to remove the severely diseased 'Leader'. Two different character traits can be analysed in Hitler's personality: on the one hand the typical premorbid personality of parkinsonian patients with uncorrectable mental rigidity, extreme inflexibility and insupportable pedantry. On the other an antisocial personality disorder with lack of ethical and social values, a deeply rooted tendency to betray others and to deceive himself and uncontrollable emotional reactions. This special combination in Hitler's personality resulted in the uncritical conviction of his mission and an enormous driving for recognition. The neuropsychiatric analysis of Hitler's personality could lead to a better explanation of the pathological traits of one of the most conspicuous historical personalities.
In the framework of a multiphase oncologic population screening-program performed in persons above 40 years of age according to the census in the community of Becej during 1986-1987, Hemoccult screening program, together with the fluorographic action involved 16.895 (83.80%) persons out of 20.160 predicted ones which was far less than the involvement of persons through the distribution and gathering of the screening material by a specialized nurse. In 907 (5.37%) Hemoccult positive persons out of which 121 (13.34%) persons rejected to cooperate or did not respond to the invitation for further investigation 16 malignant neoplasms in the lower part of the colon (anus 1, rectum 11, sigma 4) were detected as well as 53 polyposes of the rectum and the anus. Besides, 4 malignant neoplasms of the skin were found and 29 benign tumours (27 adenomas of the prostate gland, 1 fibrolipoma glutei and 1 cysta renis). Apart from these diseases 569 other previously not treated pathologic states were found, i.e. new pathologic states were detected in 85.37% of Hemoccult-positive persons. Previously known pathologic states were confirmed in 22.52% of Hemoccult-positive persons. Diagnostic was performed by the rigid rectoscope and in Hemoccult-positive persons with the negative rectoscopis finding radiologic and fiberoscopic investigations were carried out in the less scope due to the deficiency of financial resources. The number of detected malignant neoplasms of the colon surpassed the three-fold value of the average Vojvodina incidence of these localizations of malignant neoplasms at this age.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of this study was to determine the potential relationship among borderline personality disorder traits, specific aspects of narcissism, and different elements of eating pathology. Fifty-two nonclinical female participants completed standardized measures of narcissism, borderline personality disorder traits, and eating pathology. Data were analyzed using correlations. Specific associations were found, suggesting that different elements of narcissism are linked with different eating characteristics. Bulimic attitudes were linked with narcissistic personality disorder and borderline personality disorder traits. In contrast, restrictive eating attitudes and a low body mass index were associated with a repressed form of narcissism (which involves putting others' needs before one's own). If these findings are replicated in a clinical group, treatment of restrictive and bulimic cases might need to address different personality features.
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OBJECTIVE: Study of the concept of perfectionism and its phenomenology, etiology, and treatment. METHODS: Review of the literature, phenomenological, and-clinical analyses. RESULTS: The International Classification of Diseases introduced the notion of perfectionism into psychiatric discourse in 1977. In DSM-III, DSM-III-R, and DSM-IV, perfectionism is a diagnostic criterion of obsessive-compulsive disorder, but has never been defined in the psychiatric literature. We differentiate normal perfectionism and pathological perfectionism, which is of some psychiatric interest: normal perfectionism is manifested according to the aptness of the target and its sociocultural value, and is therefore selective and flexible, whereas pathological perfectionism is the compulsive pursuit of a performance level not required by the circumstances and idiosyncratic in nature. Its symptomatology may resemble that of obsessive-compulsive disorder, but is actually quite different: whereas obsessive-compulsive symptoms are absurd and the product of ego-dystonic compulsion, pathological perfectionism is experienced as a personal obligation, and retain an identifiable cultural objective. CONCLUSIONS: The phenomenology of the normal and abnormal manifestations of perfectionism is well defined. While pathological perfectionism and obsessive-compulsive disorder are similar and may even share a common etiology, they should be considered 2 distinct clinical entities. The therapeutic approaches to pathological perfectionism remain empirical.