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PubMed1984

[Borderline--a diagnostic entity?].

In the last years, there has been considerable controversy as to whether the term "borderline" should be introduced into psychiatric diagnostic nomenclature to designate psychiatric disorders not classifiable as psychoses, neuroses or traditional forms of personality disorders. Whereas many psychiatrists, especially those who are psychodynamically oriented, have been using this term for a long time, the more phenomenologically oriented psychiatrists refuse to do so while pointing to its lack of clear-cut definitions and its confusing abundance of meanings. The definitions of the term "borderline" used in the various "borderline" -concepts are reviewed. Some authors (Knight, Kety et al.) consider "borderline schizophrenia" to be a subgroup of schizophrenic psychoses. Others (Klein, Stone) take "borderline" disorders as a heterogeneous group of psychiatric illness encompassing especially some atypical affective disorders. Thirdly the concepts of those authors who conceive "borderline" as a distinct diagnostic entity are reviewed: Kernberg's "Borderline personality organization", Grinker's "Borderline syndrome", Gunderson and Singer's "Borderline personality disorders", Spitzer and Endicott's "Borderline (unstable) personality disorder" and "Schizotypical personality". The "borderline" definitions of all concepts are examined as to whether they fulfil the requirements of a "useful" (according to Kendell) diagnostic category, i.e. whether they yield reliably defined diagnostic criteria, and whether they can be validated by genetic and biological studies, therapy response, and long-term studies. It is pointed out that attempts have been made to establish operationally defined diagnostic criteria for some of the "borderline" concepts, but that research aiming at their validation is still in an initial stage.

Affective Disorders, Psychotic↗
PubMed1997

[The forensic-psychiatric evaluation of young persons in accordance with 105 JGG between punishment and therapeutic help].

105 of the the German Jugendgerichtsgesetz (JGG, law on criminal cases involving offenders between 14 and 17 years of age) allows the use of this special law also for offenders between 18 and 21 years of age if they can be considered juveniles with regard to their personal development or the type of crime they have committed. Assessment of the "maturity" of young people in this age group has been the subject of great controversy in forensic psychiatry since the first JGG went into effect in 1953. In spite of numerous attempts to operationalize the term "Jugendlicher", for example in the Marburg guidelines, it has not yet been possible to establish clear-cut criteria defining the characteristics of those who are juveniles in the sense of the JGG. Neither child and adolescent psychiatry nor criminal law nor criminology has provided an adequate basis for such a definition. The wide range of discretionary decisions in forensic psychiatry and the associated lack of legal uniformity may, however, be a necessary prerequisite for an adequate assessment of an individual case. Although the chances of a change in criminal law governing those between 18 and 21 are small, creation of a law specifically for this age group, with a separation of the educational-therapeutic aspects from the punishment aspects, could be a great help to those preparing expert opinions in forensic psychiatry and to the juvenile courts because it would necessitate greater clarity in decisions relating to this group of offenders. Elimination of Section 105 JGG and the subsequent use of either general criminal law or that governing those under age 18 only, which has been proposed repeatedly, is not recommended.

Adolescent↗
PubMed1996

[12 patients with extended suicide--psychology, personality, motivation, previous history and psychosocial conflict environment].

12 unselected female patients of extended suicide examined for an expertise testimony (4 schizophrenics, 4 endogenous depressives, 3 personality disorders, 1 psychogenic reaction) were investigated. With the exception of one all schizophrenic patients killed their victims under the influence of hallucinations and/or delusion. In two of the melancholic patients showing personality traits in the sense of the melancholic type (Tellenbach) a duty-bound motive for killing the other, characterized as a hypernomic motive, was found. Apart from this, in these patients a psychotic identification with the victim was given, which induced them to kill the other like themselves with the motive of an unworthy existence. In all patients with a personality disorder and psychogenic reaction the motive of killing others was connected with egocentric personality traits. In all of these patients the killing of the victim or the attempt of killing was precipitated by an event. Two of the patients were addicts. The notion of extended suicide as well as the question of the altruistic motive of killing others are discussed.

Adolescent↗
PubMed1994

[Brain damage after tonsillectomy?].

We report on a 47-year old male patient who developed persistent postoperational bleeding after tonsillectomy, which made tamponading of the pharynx necessary. Even though the patient left the hospital after one week with a haemoglobin value of 10.6 g% and without any complaints, he developed personality changes and later severe neurological symptoms which led to the diagnosis of hypoxic brain damage as suggested by a variety of neurologists and psychiatrists. The diagnosis was finally disproved by a brain biopsy revealing the existence of Jakob-Creutzfeldt disease, a degenerative inflammatory disease due to a slow virus infection. By this final diagnosis the reproach of a maltreatment could be ruled out. The accidental coincidence of the tonsillectomy and the beginning of the Jakob-Creutzfeldt disease had led to the incorrect diagnosis of an operation-caused brain damage. A relation to the tonsillectomy could be ruled out by an extensive neurological examination using every possible diagnostic aid including brain biopsy.

Brain↗
PubMed1992

[Personality, motivation and affect as modulating factors in suicidal behavior of depressed women].

From a psychological point of view, we would expect that motivational rather than biological dysfunctions mediate initiation of violent and non-violent suicidal actions. To prove this assumption we classified depressed women in four groups according to their suicidal behaviour and matched them to age: suicide ideators, violent suicide attempters, non-violent suicide attempters, non-suicidal depressed controls. We then tested group differences in respect of aggression, impulsivity, introversion, affective lability, anxiety, depression and electrodermal activity (EDA). To take a closer look at motivational dysfunctions, we implemented the Action Control Scale (corresponding to Kuhls theory of action and state orientation), since we regard chronic state orientation as a risk factor for suicidal behaviour. Results show few differences in violent attempters compared with controls. In contrast to non-violent attempters, they show a greater tendency to achievement and action oriented behaviour being less introverted. Non-violent attempters, however, show most significant differences to their controls: Corresponding to a high state orientation, they are more depressed, anxious, less stable in respect of affectiveness, and more introverted, with low scores in aggression and contentedness in life. In contrast to some other studies, nonreactivity in the electrodermal system dominates in all groups. Results demonstrate that motivational dysfunctions like state orientation allow better prediction and understanding of violent or non-violent suicidal behaviour in depressed women than does electrodermal reactivity.

Adult↗
PubMedDate not supplied

[The later years of Johann Georg Heine in The Netherlands (1828-1838)].

Recent reviews of the archives with respect to the last years of life of J. G. Heine necessitate a revision of his respective image. His late bizarre personal and professional opinions can no longer be considered merely as misdevelopments due to advanced age and without scientific value. Modern research rather considers the personal development of J. G. Heine as the expression of an increasingly manifesting psychosis, dominating his life and work decisively during the concluding years of his life. His seemingly "confused work at old age" can however not be explained solely by these circumstances, but can be understood within the historic concept only, as a curing system of the romantic period characteristic for that time. In spite of all errors and mistakes resulting from this standpoint, the system contains numerous valuable approaches and advanced ideas. J. G. Heine has not yet received much credit for them, but several of them are now common concepts of modern medicine.

History, 19th Century↗
PubMed1982

[Preparation and testing of a hepatitis B vaccine (author's transl)].

Starting with 41.5 l of plasma from anti-HBe positive carriers of HBs antigen, 11,400 doses of a hepatitis B vaccine with 42 micrograms HBsAg-protein and 11,300 national units HBsAg activity per dose were obtained. After purification, HBsAg is obtained in 99% purity with a yield of more than 90% protein. A possible residual infectivity was inactivated by a diluted formalin solution. The infectivity test in chimpanzees confirmed the absence of infectious hepatitis viruses (HBV and nonA-nonB). In guinea pigs the immunogenicity of the vaccine was comparable to that of the reference preparation from the U.S. National Institute of Health. The presence of Al(OH)3 in the vaccine increased the anti-HBs titre by factors of 30-50. After vaccination with two doses 41 of 45 persons became anti-HBs positive, with three doses 42 of 45 persons developed anti-HBs. Median anti-HBs titre after the third doses: schedule I (three doses in intervals of 6 weeks) 427 mWHO-U/ml; schedule II (two doses at an interval of 4 weeks, third doses 4 months after the first doses) 1535 mWHO-U/ml. The vaccine was well tolerated. There were minor local reactions only.

Animals↗
PubMed2003

Comparison of the psychosocial typology of children with below average IQ to that of children with learning disabilities.

This study investigates the subtypal patterns of psychosocial functioning of children with below average IQ (BAIQ) using the application of both Q-factor analysis and profile-matching. The results suggest that the psychosocial dimensions of children with BAIQ are quite similar to those of children with LD in a general sense. Many of the same subtypes were derived, and the proportions of children displaying normal, mild, and severe levels of psychopathology were not significantly different from those of children with LD. There were some minor differences, however: For example, children with BAIQ exhibited a greater tendency to display psychopathology with internalizing features. Consistent with previous research involving children with LD, there were no changes in either type or severity of psychopathology with advancing years.

Adolescent↗
PubMed2003

Pathological mechanisms of acne with special emphasis on Propionibacterium acnes and related therapy.

Acne is a common disease that in cases of extreme disfiguration can have severe consequences for the personality development of young people and is associated with a relatively high prevalence of depression and suicide. Spontaneous regression is common, but acne can extend into the fourth and fifth decades of life. The pathogenesis is still not fully understood. Factors promoting the development of acne are: increased sebum production, ductal cornification, bacterial colonization of the pilosebaceus ducts and inflammation. However, there is evidence that inflammation is not a factor but rather a consequence of the interaction of the other three factors. Propionibacterium acnes releases pro-inflammatory cytokines as well as antigens and mitogen(s), with cellular and non-cellular responses to these products triggering inflammation. Treatment is often frustran. Therapeutical strategies are needed based on new understandings of the pathomechanisms involved in acne. The aim of this review is to summarize the data on aetiopathological factors in acne and their contribution to acne pathology and therapy.

Acne Vulgaris↗
PubMed1987

Type A coronary-prone behaviour pattern and pathological narcissism.

Type A coronary-prone behaviour pattern exhibits many of the features of neurotic repetition compulsion. Thus, it is often maladaptive and tends to be compulsive, inflexible, irrational and ultimately non-satisfying. There is a notable similarity between the descriptions of Type A individuals in the behavioural literature and narcissistic individuals in the psychoanalytic literature. It is postulated that Type A individuals may have a deficient self-representation. This psychodynamic formulation of Type A as a variant of pathological narcissism has implications for assessment, prevention and management. In particular, it may help discriminate a sub-group of high achievers who are neurotically motivated and have abnormally high arousal. Only this sub-group may be at increased risk of coronary pathology.

Compulsive Behavior↗
PubMed1993

Psychological maladjustment among homeless adolescents.

The prevalence of psychological maladjustment in homeless adolescents (n = 54) was compared to a control group (n = 58) in Brisbane, Australia using the Youth Self-Report Scale. Overall, 74% of the homeless group and 22.4% of the control group scored within the clinical range on one or more of the clinical subscales. There was considerable diversity of symptomatology in the homeless group. Less than half of the homeless group were within the clinical range on both the delinquent subscale and the thought disorder subscale. Depressive, Aggressive and Somatic Complaints were also prevalent. The study challenges preconceived notions of a simple relationship between adolescent homelessness and delinquency, and draws attention to the psychological needs of this group of adolescents.

Adaptation, Psychological↗
PubMed1994

Childhood depression, stressors and parental depression.

The relationship between depression and stressors and the relationship between depression in children and depression in their parents were investigated. Depressed children aged 7-11 years (n = 20) were compared with clinical non-depressed children (n = 88) and normal children (n = 55). Children, mothers and fathers in the three groups were tested. Measures included the Children's Depression Inventory, Recent Life Events Scale, Stressor Scale and Beck Depression Inventory. The findings showed that children and mothers in the depressed group reported more stressors than other children and other mothers while fathers of children in the depressed group did not report more stressors. The findings also showed that mothers of depressed children were more depressed than mothers of normal children while there were no differences between the scores of fathers in the three groups.

Adolescent↗
PubMed1991

The relationship between absorption, openness to experience, anhedonia, and susceptibility.

Examination of the absorption (Tellegen Absorption Scale [TAS] of Tellegen & Atkinson, 1974), openness to experience (OTE Inventory of Costa & McCrae, 1978), and anhedonia (ANH Scales of L. J. Chapman, J.P. Chapman, & Raulin, 1976) scales suggested that they might be conceptually related. Given the reliable relationship between TAS and hypnotic susceptibility, the authors were interested in studying OTE and ANH as possible personality correlates of hypnotic susceptibility. 2 studies, 1 involving a community sample and the other a sample of university students, were conducted to assess the relationships between the TAS, OTE, and ANH scales and hypnotic susceptibility. As predicted, in Study 1 (community sample) the TAS and OTE inventories were positively correlated with one another and both were negatively correlated with the ANH scale. This pattern of correlations was replicated in Study 2 (university sample), but only TAS correlated significantly with hypnotic susceptibility. Factor analyses further confirmed these findings. It was concluded that the conceptual relationship among the TAS and the OTE and ANH scales resides in some dimension other than hypnotic susceptibility.

Adolescent↗
PubMed1995

Fantasy proneness, reported childhood abuse, and the relevance of reported abuse onset.

This study investigated the relationship between fantasy proneness and the age at which reported childhood sexual abuse occurs. Seventeen adult females who reported having been sexually abused before the age of 7 years, 20 females who reported having been abused after the age of 7 years, and 20 females who reported having never been abused were administered two measures of imaginative involvement (Tellegen Absorption Scale [TAS] and Inventory of Childhood Memories and Imaginings [ICMI]). Participants who were reportedly abused early in childhood obtained higher scores on the TAS and ICMI than participants who were reportedly abused later in childhood, who in turn obtained higher scores than the control participants. Findings are discussed in terms of factors that mediate fantasy proneness and reports of childhood abuse.

Adolescent↗
PubMed1989

The role of the leader in managing the preoedipal patient in the group setting.

Preoedipal patients present a special problem in group treatment. This is because their difficulties arose largely before they learned to use words. Such patients are prone to act rather than talk. They do not respond well to interpretation. They must be approached and influenced through feelings. We can utilize the group to provide them with maturational experiences, helping them reach a more adult level of mental functioning so that our usual technical interventions can be brought into play. The paper discusses methods for enhancing this process, including reflection, emotional communication, using reconstruction to close developmental gaps, and immunization.

Ego↗
PubMed1989

Group psychotherapy of the characterologically difficult patient.

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.

Adult↗
PubMed1996

Group therapy as an effective treatment modality for people of color.

The unique benefits for group therapy are examined with special emphasis on the treatment of blacks and Latinos. Because of racial prejudice, economic exploitation, and negative stereotypes, group forces have been especially detrimental to the personality development of people of color. The group therapist attempts to harness these powerful group forces and use them therapeutically, thus enabling people of color to relate better to others while retaining their own autonomy. Racial differences can intensely affect diagnosis, transference, countertransference, and the "real relationship." Distinctions between cultural and functional paranoia are particularly relevant in interracial groups. Implications for training group therapists are also explored.

Black or African American↗
PubMed1989

Prevalence and sociodemographic variance of type A behavior in Finnish preadolescents, adolescents, and young adults.

The prevalence and sociodemographic variance of Type A behavior was studied among 1,721 preadolescents, adolescents, and young adults in Finland. The AFMS questionnaire (Type A behavior questionnaire for the Finnish Multicenter Study), as self-rated and assessed by mothers, and the Hunter-Wolf A-B Rating Scale (HWolf) were used. There was considerable variation between measures: On the AFMS boys scored higher, whereas on the Hwolf girls scored higher. In contrast to earlier findings, Type A behavior was more prevalent among rural subjects than among urban subjects. Economic and occupational status of the family were of no importance. The notion that the Type A behavior pattern characterizes urban, middle-to upper-class males was not validated in this group of Finnish children and young adults.

Adolescent↗