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PubMed1981

[Clinical criteria for the social dangerousness of schizophrenics (syndromes with a predominance of delusional and hallucinatory disorders)].

Data obtained from epidemiological studies carried out in some large administrative regions have shown that among the causes of socially dangerous actions committed by schizophrenics the syndromes with prevalent delusional and hallucinatory-delusional disorders take the second (after psychopathy-like states), and, as regards acts of violence, the first place. Practically all the phenomena of a delusional or a hallucinatory-delusional syndrome may be the motives of the socially dangerous actions. However, the occurrence and character of those actions are different, these differences being associated with particular psychopathological features of the hallucinatory-delusional syndromes. The knowledge of those peculiarities may contribute to early recognition of such patients and to taking adequate curative and rehabilitation measures aimed at preventing the dangerous actions.

Antisocial Personality Disorder↗
PubMed1990

Dimensions of personality disorder. The DSM-III-R cluster A diagnoses.

The authors adopt a construct validity approach to examine the structural validity of diagnoses of paranoid, schizoid, and schizotypal personality disorders. Systematic descriptions of these diagnoses were developed based on features identified from the literature that were organized using the clinicians' ratings. Each diagnosis was described in terms of a series of behavioral dimensions. Sets of behavioral exemplars were developed to assess each dimension. Dimensions and diagnoses were found to exhibit satisfactory levels of internal consistency that were cross-validated in a general population sample of 274 subjects and a clinical sample of 133 patients with a diagnosis of personality disorder. Some dimensions did not correlate highly with the total diagnosis score. Diagnoses could probably be refined by eliminating these dimensions. The structural relationships between dimensions delineating each diagnosis were explored using factor analysis. Diagnoses were not unifactorial. Instead, each diagnosis was found to be composed of two factors. The factorial structure of each diagnosis was found to be similar in the general population and clinical sample. It is suggested that the results support a dimensional representation of these diagnoses using three dimensions: paranoid behaviors, social avoidance, and perceptual cognitive distortion.

Adult↗
PubMed2003

Sanctioned social violence: A psychoanalytic view--part I.

This paper is the first of a series of two that present an effort to systematize the application of psychoanalytic theory of group processes to the outbreak of massive violence. It explores the origins and social amplification of primitive aggression by means of group psychology and mass psychology, and the combined influences of the regressive pull of ideologies, the personality features of social and political leadership, and the triggering impact of historical trauma and social crises. The paper describes a spectrum of narcissistic-paranoid mechanisms that provide a common matrix for the analysis of those aspects of social psychology that co-determine socially sanctioned violence.

Aggression↗
PubMed1989

Managing the group monopolist.

This article explores, both theoretically and clinically, the behavior of the habitual group monopolist, an individual who dominates a group in a nontherapeutic manner. It examines clinical data to illustrate various ways a client can monopolize a group and how other group members react to this behavior. The article concludes with some therapist and group interventions that have a significant effect in lessening a group member's monopolistic behavior.

Art Therapy↗
PubMed1976

Personality factors in jargon aphasia.

The personality background of 20 patients with jargon aphasia was compared to that of a standard aphasia group with particular reference to features of the so called anosognosic personality; denial or marked overt fear of illness and strong work orientation. Such attitudes toward illness were found in 19 of 20 jargon subjects, and seven of the comparison group. Nineteen of the jargon patients and eleven of the non-jargon asphasics were described as highly work oriented. The premorbid personality was also significantly related to the type of denial of the speech deficit, and to related aspects of behavior. Patients with strong premorbid denial explicitly and completely denied their asphasic deficits, and were affable, bland or unconcerned. Patients with a history of overt fear of illness had implicit or mixed forms of denial, and showed disturbed, agitated, paranoid and often psychotic behavior. The type of denial is thus related not only to premorbid personality, but to observable behavior in hospital. The observations are regarded as providing additional evidence for the view that jargon may be regarded as "anosognosic aphasia," and represents not only a linguistic deficit, but an adaptation to the deficit.

Adult↗
PubMed2005

Deficit in decision making in catatonic schizophrenia: an exploratory study.

Catatonic schizophrenia can be distinguished from paranoid schizophrenia by prominent behavioral and motor anomalies. As demonstrated in recent imaging studies, behavioral symptoms may be related to dysfunction in the ventral prefrontal cortex. However, the neuropsychological correlates of ventral prefrontal cortical dysfunction remain unclear. In an exploratory study, we investigated eight patients with catatonic schizophrenia and compared them with 19 patients with paranoid schizophrenia and 26 healthy subjects. The Iowa Gambling Task (IGT) and the Object Alternation Task (OAT) served as measures of ventral prefrontal cortical function. In addition, other prefrontal cortical tests such as a visual working memory task, a Go-NoGo task, and the Wisconsin Card Sorting Test, as well as attentional tasks, were included in the test battery. Catatonic patients showed significant deficits in the IGT characterized by an inability to shift from the initial preference for high-risk cards to a more advantageous strategy with low-risk cards. Moreover, catatonic patients showed significant deficits in the OAT. In conclusion, our preliminary results suggest a specific deficit in catatonic schizophrenia in those neuropsychological measures that are associated with ventral prefrontal cortical function.

Adult↗
PubMed1983

Auditory hallucinations and schizophrenia.

Forty-five patients with auditory hallucinations were studied. Sixty per cent proved to be excellent hypnotic subjects with multiple personalities. These latter patients received 11 different diagnoses by clinicians, predominantly those related to schizophrenia or an affective illness. Because patients with multiple personalities frequently have hallucinations, delusions, paranoid ideas and bizarre behaviors, they may be misdiagnosed as some form of schizophrenia.

Auditory Perception↗
PubMed1993

Assessment of potential violence in the paranoid worker.

Violence in the workplace is sometimes a manifestation of an untreated psychiatric disorder. Paranoid personality disorder, paranoid schizophrenia, and delusional (paranoid) disorder are three psychiatric syndromes in which paranoid ideation is a prominent feature. While the vast majority of people with these conditions are not violent, paranoid workers can exhibit violent behavior as a reaction to beliefs that co-workers or supervisors are threatening or persecuting them. Three cases are described to illustrate the clinical presentation of these disorders and their management in an occupational setting.

Adult↗
PubMed1975

Evaluation of a content-analysis system for therapeutic interviews.

The Zimmer and Cowles system for content analysis was tried out on psychotherapeutic sessions and on interviews with disturbed patients. It was found that the system indeed did seem to pick up improvement in psychotherapy, and to a lesser degree, differences in speech behavior between patients with radically differing pathologies. It also was concluded that the computer program for the content analysis system is not easily portable, but a SNOBOL equivalent is made available.

Aggression↗
PubMed1975

Diagnostic criteria and five-year outcome in schizophrenia. A report from the International Pilot Study of schizophrenia.

Systematic psychiatric assessment was undertaken on 131 patients (the American cohort of the International Pilot Study of Schizophrenia). Nine areas of outcome functioning were assessed five years later at follow-up evaluation on 63% of these patients. An analysis of 66 clinical and demographic variables established that the patients sucessfully followed-up were representatives of the entire cohort. Diagnostic data from initial evaluations and follow-up outcome assessment were used to examine the relationship between diagnostic criteria and outcome in schizophrenia. Applying the criteria for schizophrenic diagnosis defined by Langfeldt, by Schneider, and Carpenter et al failed to define a poor outcome group. No difference in outcome was found when traditional schizophrenic subtypes were contrasted. Overall outcome in 61 patients with conditions diagnosed as schizophrenic was heterogeneous. However, despite overlap, the mean outcome in the schizophrenic cohort was poorer than in the 19 nonschizophrenic patients.

Activities of Daily Living↗
PubMed2003

A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease.

AIM: To document the behavioural and psychological symptoms in patients with a diagnosis of established Alzheimer's disease (AD) for at least 3 years. METHODS: Patients with a > or =3 year history of AD (NINCDS/ADRDA) were recruited from old age psychiatrist and elderly care memory clinics. Information regarding duration of symptoms and non-cognitive symptomatology was obtained during interview with a carer or next-of-kin who had contact with the patient at least 3 times a week and for at least 3 years. MMSE, FAST and NPI including caregiver distress, were used to assess cognition, function and behavioural/psychological disturbance respectively. With each non-cognitive symptom the carer was asked to estimate its onset. RESULTS: The mean age of patients was 77 years and duration of illness 87 months. Mean MMSE was 8/30 and FAST score 6d. Of the psychological symptoms occurring at any stage, depression (56%), delusions (55%) and anxiety (52%) were most common, with hallucinations, elation and disinhibition occurring less frequently. In general, behavioural changes were more common with apathy occurring in 88% of patients, motor behaviour in 70%, aggression in 66%, irritability and appetite changes in 60% and sleep disturbance in 54%. All symptoms except apathy became less common when the carer was asked if they were still present in the last month. Mean onset of psychological symptoms was 47 months. Mean onset of behavioural symptoms was 48 months. Behavioural disturbance seemed to cause more care-giver distress than psychological change. CONCLUSION: The results show behavioural and psychological symptoms in AD are common and distressing for carers. They appear to require a consistent period of neurodegeneration in order to emerge.

Aged↗
PubMed1992

Safety and effectiveness of low-dose clozapine in psychogeriatric patients: a preliminary study.

The short- and long-term treatment tolerance of low-dose clozapine was retrospectively investigated in 18 psychogeriatric patients. Discontinued use of the drug because of side effects or inefficiency was required for only four patients. In the long-term treatment group leukopenia was not observed, and disturbances of liver function appeared to be very infrequent. A second group of seven severely demented psychogeriatric inpatients who were currently being treated with low-dose clozapine underwent a withdrawal study in order to evaluate the therapeutic efficacy of the drug, measured by the NOSIE and the SCAG scales. The results indicate that for patients such as these, with paranoid or socially disturbing behavior who also tend to develop severe neurological side effects with classical neuroleptics, a low-dose administration of clozapine is an acceptable alternative treatment.

Aged↗