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Hypochondriasis and paranoia are common psychopathologies of aging. The former may be secondary to depression or organic brain syndrome, whereas the latter may be secondary to sensory impairment or organic brain syndrome. Paranoid schizophrenia, with delusions of grandeur, is rare in later life. The authors classified 273 institutionalized geriatric patients by means of staff ratings into categories such as lucid and alert, confused, hypochondriacal, paranoid, etc. Among confused patients there was a correlation of .45 (p less than .001) between hypochondriasis and paranoia. Even among nonconfused patients, there was a slight positive correlation. The authors concluded that geriatric paranoia and hypochrondriasis have similar structure (delusion) and functions (safeguarding self-esteem and manipulating others). An interpersonal perspective can also provide guidelines for when to treat these conditions.
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PMID:Hypochondriasis and paranoia: similar delusional systems in an institutionalized geriatric population. 43 93

An extensive survey of two communities in Western Nigeria, one urban and the other rural, was conducted to find out some characteristics of opinion and knowledge about mental illness among the Yoruba. A questionnaire containing descriptions of four different types of mental illness (simple schizophrenia, paranoid schizophrenia, anxiety neurosis/depression, and alcoholism), was administered to 771 respondents, randomly selected. The description of paranoid schizophrenia was more readily recognized as mental illness than the others. Respondents tended to typify persons who fit the other three descriptions in such terms as "shy," "hot-tempered," "queer," "flirt," and "drunkard." Compared with Asian, Australian, and North American studies, lesser proportions of Nigerian respondents viewed the descriptions as symptomatic of psychiatric disorder. The finding that most respondents are still unaware of the range of symptoms and their significance is particularly striking because the catchment area for this study has had a long exposure to modern psychiatric delivery systems. It is suggested that the heightening of awareness of psychiatric symptoms through nationwide mental health education is essential for the full utilization of mental health services.
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PMID:A comparative study of opinion and knowledge about mental illness in different societies. 71 98

The hypochondriacal patient presents numerous frustrations for the physician. The typical hypochondriac is a middle-aged person dominated by a preoccupation with bodily symptoms. Bereavement, serious life failures, and severe blows to self-esteem put patients at high risk for somatization. Hypochondrisis has been cited as a symptom of masked depression, early paranoid schizophrenia, and dementia and/or delirium. A careful diagnostic work-up with attention to any correctable psychiatric illness sets the stage for regularly scheduled, long-term supportive therapy.
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PMID:Hypochondriasis: difficulties in diagnosis and management. 76 Feb 21

An analysis of the result of administering electroconvulsive therapy (E.C.T.) to 292 patients suffering predominantly from psychosis and depression is presented. The results show that the courses of E.C.T. administered range from three to twenty-five. The most frequently administered course was six to eight. Favourable response to treatment was reported in all diagnostic groups immediately after completing the course but less so in cases of depression and paranoid schizophrenia. The reasons thought to account for this were discussed. It is concluded that there is need for careful selection of patients for E.C.T.
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PMID:Electroconvulsive therapy in Ibadan. 82 7

In subtypes of schizophrenia and unipolar depression, both increased and decreased levels of platelet serotonin were found. Hyperserotonemia was usually observed in patients with psychotic features (i.e., in paranoid schizophrenia and psychotic depression). Hyposerotonemia, although less common than hyperserotonemia, was present in nonparanoid schizophrenia and nonpsychotic depression (i.e., in patients without psychotic symptoms). A sex difference in platelet monoamine oxidase activity was observed among healthy subjects, but not among schizophrenic patients. The activity of platelet monoamine oxidase in paranoid and nonparanoid schizophrenic patients did not differ from that in healthy subjects. The findings in this study suggest that biological differences between subtypes of unipolar depression or schizophrenia might depend upon the presence of psychotic symptoms.
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PMID:Platelet serotonin in subtypes of schizophrenia and unipolar depression. 175 25

In contrast to contemporary approaches to psychopathology that establish diagnostic taxonomies derived primarily from differences in manifest symptoms, this paper, based on an integration of cognitive and psychoanalytic developmental theory, proposes a structural cognitive morphology for understanding and assessing differences among various forms of psychopathology, from schizophrenia to the neuroses. A theoretical model based on the development of cognitive schema, consistent with clinical and research data, considers schizophrenia and paranoid schizophrenia as involving fundamental disturbances in boundary articulation and recognition constancy, and considers borderline personality disorders as involving disturbances in evocative constancy. Also, a lack of integration of object and self-schema, expressed in either a distorted and exaggerated preoccupation with interpersonal relatedness or self-definition, defines two primary personality configurations that have implications for understanding the neuroses and subtypes of depression, as well as differential response to various types of psychotherapeutic intervention.
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PMID:A cognitive morphology of psychopathology. 185 7

Urinary free-cortisol levels (micrograms per day) were measured by radioimmunoassay at 2-week intervals during the course of hospitalization in the following patient groups: posttraumatic stress disorder (PTSD); major depressive disorder; bipolar I, manic; paranoid schizophrenia; and undifferentiated schizophrenia. The mean cortisol level during hospitalization was significantly lower in PTSD (33.3 +/- 3.2) than in major depressive disorder (49.6 +/- 5.9), bipolar I, manic (62.7 +/- 6.7), and undifferentiated schizophrenia (50.1 +/- 8.9), but was similar to that in paranoid schizophrenia (37.5 +/- 3.9). The same differences across groups are evident in the first sample following hospital admission. This finding of low, stable cortisol levels in PTSD patients is especially noteworthy, first because of the overt signs of anxiety and depression, which would usually be expected to accompany cortisol elevations, and second because of the concomitant chronic increase in sympathetic nervous system activity shown in prior psychophysiological studies of PTSD and reflected in marked and sustained urinary catecholamine elevations previously reported in our own PTSD sample. The findings suggest a possible role of defensive organization as a basis for the low, constricted cortisol levels in PTSD and paranoid schizophrenic patients. The data also suggest the possible usefulness of hormonal criteria as an adjunct to the clinical diagnosis of PTSD.
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PMID:Urinary free-cortisol levels in posttraumatic stress disorder patients. 395 May 96

70 psychiatric patients were treated with a depot preparation of cis (Z) clopenthixol decanoate, a new sedative and anti-psychotic neuroleptic. The mean dosage interval was two weeks, an amount of drug from 50 to 1000 mg for each I.M. injection. Significant improvements were obtained on thinking disturbance, hostile-suspiciousness and anxious-depression symptoms groups. Thus, paranoid schizophrenia seems the best indication of cis (Z) clopenthixol decanoate. Side effects (parkinsonism, weight increase) were of low intensity, and no depression was observed. This new long-acting depot neuroleptic may be used not only in hospitalized chronic schizophrenic patients, but also in outpatients as maintenance treatment: excellent results were obtained in such patients with a very low (less than 200 mg) fortnightly dosage. Advantages and indications of cis (Z) clopenthixol decanoate are discussed.
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PMID:[A new injectable delayed-action neuroleptic with sedative and antipsychotic action: cis-(Z)-clopenthixol decanoate. Clinical trials]. 638 Oct 33

Thirty-one individuals awaiting trial or sentencing for murder or undergoing an appeal process requested a neurologic examination through legal counsel. We attempted in each instance to obtain EEG, MRI or CT, and neuropsychological testing. Neurologic examination revealed evidence of "frontal" dysfunction in 20 (64.5%). There were symptoms or some other evidence of temporal lobe abnormality in nine (29%). We made a specific neurologic diagnosis in 20 individuals (64.5%), including borderline or full mental retardation (9) and cerebral palsy (2), among others. Neuropsychological testing revealed abnormalities in all subjects tested. There were EEG abnormalities in eight of the 20 subjects tested, consisting mainly of bilateral sharp waves with slowing. There were MRI or CT abnormalities in nine of the 19 subjects tested, consisting primarily of atrophy and white matter changes. Psychiatric diagnoses included paranoid schizophrenia (8), dissociative disorder (4), and depression (9). Virtually all subjects had paranoid ideas and misunderstood social situations. There was a documented history of profound, protracted physical abuse in 26 (83.8%) and of sexual abuse in 10 (32.3%). It is likely that prolonged, severe physical abuse, paranoia, and neurologic brain dysfunction interact to form the matrix of violent behavior.
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PMID:Neurologic abnormalities in murderers. 896 Jul 68

The frequency of depression is extremely high in schizophrenia, about 60%. Depression much suffering, as evidenced by out patient suicides. As early as 1920, Mayer Gross, and more recently Widroe, identified this kind of depression under the name of post-psychotic depression. This definition deserves to be interpreted in several ways: depression differentiated negative symptoms; only the mood disorder is then characteristic and the other symptoms are part of the deficiency syndrome, depression can be integrated to schizophrenia or on the contrary it can be considered as independent of it and interpreted as reactive, secondary--for example as a morning phase for delusions, the iatrogenic effect of neuroleptics and depressogenic self-medication should not be overlooked. The issue that must be raised before instituting therapy is whether the disinhibitory effect of antidepressants may lead to the resurgence of delusions. After reviewing the literature and in the light of a personal study, the authors answer in the negative. Based on a preliminary study in 10 patients with essentially paranoid schizophrenia, treated with fluoxetine 20 mg per day, the author observed an improvement in sadness, sleep, death wishes in 7 patients, without exacerbation of delusions. It is legitimate to ask, with Lindenmayer, which place depression could take as a "blind factor" alongside with negative and positive factors of schizophrenia.
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PMID:[Antidepressant treatment of schizophrenic patients]. 790 37


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