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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a sample of 412 patients with psychotic disorders, the authors examined whether comorbid substance use can be reliably diagnosed, is associated with increased rates of affective symptoms and syndromes and specific psychotic symptoms, and is associated with lowered reliability of the DSM-III-R principal diagnosis. Data from the DSM-IV Field Trial for Schizophrenia and Other Psychotic Disorders was analyzed. In this dataset, substance use was scored on a 4-point ordinal scale and reliability was determined using weighted kappa scores. The associations of significant substance use with affective syndromes and symptoms, and psychotic symptoms were analyzed. Kappa statistics were calculated for principal psychotic disorder diagnoses for patients with and without significant substance use. Weighted kappa scores for substance use ratings ranged from 0.27 to 0.96 (median = 0.85). Syndromal depression was significantly associated with current alcohol use in the entire sample and in the subgroup with schizophrenia alone. Grandiose delusions were also associated with substance use. Significant comorbid substance use was not associated with lowered reliability of diagnosing the principal psychotic disorder. These findings support the hypothesis that comorbid substance abuse can be reliably diagnosed and that alcohol abuse is associated with depressive syndromes in patients with psychotic disorders.
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PMID:Substance abuse in psychotic disorders: associations with affective syndromes. DSM-IV Field Trial Work Group. 789 24

Depressive patients often have some hypochondriacal symptoms, but their various patterns are prone to be overlooked. The author presents statistical characteristics of 24 depressive patients (based on DSM-III-R, major depression, melancholic type), who have some hypochondriacal symptoms. Taking into consideration these statistical characteristics and a detailed analysis of representative cases, the author proposes a psychopathological perspective and classification of patients, who have hypochondriacal symptoms during manic-depressive psychosis. The author presents five characteristics, namely, (1) age during depression, (2) personality trait, (3) anxiety-agitation, (4) dependency, and (5) guilt feelings, as factors that raise the hypochondriacal symptoms in depressive patients. Based on such characteristics, depressive patients with hypochondriacal symptoms can be classified into 3 subgroups; the anxiety-agitation group, the dependency group and the guilt feeling group. Among the anxiety-agitation group hypochondriacal depression is considered as a mixed state of manic-depressive psychosis with the grandiosity of hypochondriacal idea and agitation as manic expressions. In personal relations, patients in the anxiety-agitation group are ego-centric ("eigenwelt-bezogen"). On the contrary, patients in the dependency group are often conscious of others, and their hypochondriacal symptoms mean an escape from reality and also the intention of a new personal relationship. In the guilt feeling group, hypochondriacal symptoms arise due to guilt obsessiveness. A difference in the 3 groups also appears in the discourse characteristics of the hypochondriacal symptoms. The discourse of patients in the anxiety-agitation group can be called a "Circle type" or "Go-round type", since their complaints are various, but have a common structure. Discourse in guilt feeling group can be characterized as a "Tied-up type" or "Standstill type", since they repeat only a fixed complaint in a depressive state. Discourse in dependency group does not have a regular linguistic structure, and the patients make a great deal of importance in complaining to others. In addition to such considerations, the author suggests an affinity between hypochondriacal symptoms and manic elements on the grounds that some patients have hypochondriacal symptoms in their manic state, and that depressive patients with hypochondriacal symptoms, especially in the anxiety-agitation group, as well as manic patients, are strongly concerned with the present. Treatment for hypochondriacal depression requires the therapist to recognize the individuality of the disease, to safeguard against suicide and other ramifications.
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PMID:[A psychopathological study of hypochondriacal symptoms in manic-depressive psychosis]. 853 18

This study developed a Minnesota Multiphasic Personality Inventory-2 (MMPI-2) portrait of narcissism using the Narcissistic Personality Inventory and 5 narcissism scales derived from the MMPI-2 with a nonclinical sample of 283 subjects. Correlational analyses revealed a divergent pattern of relationships among the 16 narcissism measures and MMPI-2 scales, with 1 set of narcissism scales correlating positively with MMPI-2 mania (Ma) and a second set correlating positively with MMPI-2 depression (D), psychasthenia (Pt), feelings of inferiority (Sc), social introversion (Si), and other measures of distress. A principal-components analysis of the 6 narcissism scales produced 2 orthogonal factors, 1 suggesting Grandiosity and the other Depletion. High scorers on the Grandiosity factor were equally well characterized by a 98/89 or 96/69 MMPI-2 profile with an average F, whereas high scorers on the Depletion factor were best represented by an 87/78 profile with an elevated F. Profile analyses of high scorers on the narcissism scales indicated that a 98/89 MMPI-2 profile with an elevated F score is the best overall representation of the narcissistic personality in nonclinical samples. Results supported 3 alternative interpretations, including a narcissistic continuum, narcissism as a pathological defense against depression and rage, and 2 forms of narcissism, 1 grandiose and overt and the other depleted and covert.
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PMID:An MMPI-2 portrait of narcissism. 857 24

Previous studies have compared demographic and clinical-outcome features of bipolar patients with mixed or pure mania. However, little is known about the potential differences in the nature and extent of manic symptoms in mania either with or without an accompanying depression. This study examined DSM-III-R manic symptoms in a cohort of 183 bipolar I inpatients hospitalized for mixed mania (diagnosed by broad or narrow criteria) or pure manic episodes. Inpatient charts were reviewed to determine the presence of individual affective symptoms. The results indicate that clinicians were more likely to diagnose a pure mania from the beginning to end of an episode than to diagnose a mixed mania from its beginning to end. Mixed-manic patients had significantly fewer manic symptoms than pure manic patients. Grandiosity, euphoria, pressured speech, and a decreased need for sleep were more prevalent during pure versus mixed mania. Grandiosity and a diminished need for sleep were especially notable during pure mania compared with mixed mania as defined by narrow criteria for mixed states. The observed differences in manic symptom profiles between mixed and pure mania may aid in the clinical assessment of dysphoric states among bipolar patients. The data also lend support to the use of broad diagnostic criteria for defining mixed mania as an entity phenomenologically distinct from pure mania.
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PMID:Qualitative differences in manic symptoms during mixed versus pure mania. 1092 89

The effects of risperidone on affective symptoms were determined by an analysis of pooled data from six double-blind trials of risperidone versus haloperidol in 1254 patients with chronic schizophrenia. Symptoms indicating mania were assessed by the Positive and Negative Syndrome Scale (PANSS) excitement and grandiosity items and by the excited cluster (excitement, hostility, uncooperativeness, and poor impulse control); anxious / depressive symptoms were assessed by the PANSS anxious / depressive cluster (somatic concern, anxiety, guilt feelings, and depression). Mean change scores from baseline to endpoint were compared in patients receiving risperidone, haloperidol or placebo by analysis of variance with factors for trial and baseline score included in the model. In all patients, change scores on excitement and grandiosity items and excited and anxious / depressive clusters were significantly greater for risperidone than for haloperidol or placebo. Dropouts due to inefficacy were less frequent with risperidone (5 of 59; 8%) than with haloperidol (7 of 38; 18%) or placebo (8 of 10; 80%). In patients with anxious / depressive symptoms at baseline (anxiety / depression cluster score > or = the median), anxiety / depression scores decreased significantly more with risperidone than with haloperidol, and symptom reduction occurred faster with risperidone. These results are consistent with previous reports and suggest that risperidone is more efficacious than haloperidol for affective symptoms in patients with schizophrenia.
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PMID:Effects of risperidone on affective symptoms in patients with schizophrenia. 1111 10

Mental health professionals working with people with HIV disease are often confronted by the patients' feelings of shame and should be prepared to recognize and treat what can sabotage the openness crucial to the therapeutic process. Shame is unlike guilt in that instead of being a transgression against some moral code or value, it is the failure to live up to an internal ideal image of oneself; its sanction is rejection or abandonment as opposed to punishment. Shame can have many triggers, and when faced with these triggers, a strong sense of self can protect a person. However, most people with HIV find that shame does arise in some situations. In its wake, shame can cause withdrawal, substance abuse, depression, denial, rage, grandiosity, lack of entitlement, and perfectionism. Therapists can help gay men deal with shame and cope better with the indignities of HIV infection. Guidelines include building a strong patient/therapist relationship to build trust and improve self-esteem; and identifying the shame, and bringing it out for validation by the patient. Therapists must guide patients to an awareness of their true feelings, and help them trust their perceptions of these needs and feelings.
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PMID:Shame, gay men, and HIV disease. 1136 58

Is shame out of fashion? The first part of this article discusses how the concept of shame has changed in modern western culture, with a shift from collective definitions of norms towards personal experience. The second part is a phenomenological description of shame and how shame can be expressed and experienced in therapeutic relationships. Shame is something we do want, and something we do not want. It regulates both self-esteem and intimate relationships. It protects the psychological self from invasion. But too much shame is destructive. The main expression of deep shame is silence; it is shameful to speak about one's shame. But deep and pathological shame can be masked in other forms of presentation, "the voices of shame". In addition to silence the article describes "the psychopathology of normalcy", hesitation, depression, alexithymia, rage, envy, contempt, grandiosity and shamelessness. Finally, the article discusses how to escape from destructive feelings of shame.
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PMID:[Voice of shame--silence, eloquence and rage in the therapeutic relationship]. 1144 50

Classical descriptions of mania subtypes extend back to Kraepelin; however, in marked contrast to the study of depression subtypes, validation of mania subtypes by multivariate statistical methods has seldom been attempted. We applied Grade of Membership (GOM) analysis to the rated clinical features of 327 inpatients with DSM-III-R mania diagnoses. GOM is a type of latent structure multivariate analysis, which differs from others of this type in making no a priori distributional assumptions about groupings. We obtained 5 GOM Pure Types with good face validity. The major Kraepelinian forms of "hypomania," "acute mania," "delusional mania," and "depressive or anxious mania" were validated. The major new finding is of two mixed mania presentations, each with marked lability of mood. The first of these displayed a dominant mood of severe depression with labile periods of pressured, irritable hostility and paranoia, and the complete absence of euphoria or humor. The second mixed mania Pure Type displayed a true, incongruous mixture of affects: periods of classical manic symptoms with euphoria, elation, humor, grandiosity, psychosis, and psychomotor activation, switching frequently to moderately depressed mood with pressured anxiety and irritability. This multivariate analysis validated classical clinical descriptions of the major subtypes of mania. Two distinct forms of mixed manic episodes were identified. DSM-III-R criteria did not reliably identify either of these two natural groups of mixed bipolar patients. As occurs in depression, this clinical heterogeneity of mania may influence response to drug treatments.
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PMID:Subtypes of mania determined by grade of membership analysis. 1152 65

The individual diagnosed with Narcissistic Personality Disorder presents with grandiosity, extreme self-involvement, and lack of interest in and empathy for others. This paper reviews current theories concerning the development and treatment of Narcissistic Personality Disorder, and introduces the use of Ego State Therapy for its treatment. The ego state model of treatment will be described and demonstrated with case material. Initially ego states that reveal the grandiosity will be accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge. With further treatment, transformation and maturation of the ego states occur, reflecting the changes in internal structure and dynamics as well as improvement in external interpersonal relationships. Issues concerning Ego State Therapy as utilized with personality disorders will be discussed and contrasted with more traditional methods of treatment.
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PMID:A character in search of character: Narcissistic Personality Disorder and Ego State Therapy. 1257 94

For schizophrenic disorders, the clinical conception of "acute state" is widely used in clinical settings to assess the effectiveness of therapeutic programs as well as epidemiological studies. Schizophrenic-specific symptomatology modification, need for hospitalization, significant change in care, disturbances in social behavior or suicide attempts were all used to define acute schizophrenic state. The decision to hospitalize is frequently used to define acute state but refers to multiple factors such as mood disorder, suicide attempts, drug abuse or social and environmental problems. Indeed, several and distinct definitions in a criteria basis form are available but no one has reached consensus. Because recognition of acute schizophrenic state remains based on the subjective clinician's advice, epidemiological and therapeutic studies fail in validity and reliability. The aim of the study was to evaluate how a population of French psychiatrists define criteria and therapeutic targets of acute schizophrenic state in their clinical practice. Psychiatrists filled out a self administered interview. At the time the interview was given, clinicians were notified that they were participating in a clinical consensus survey about schizophrenia. Six major indicators for acute state definition based on the literature data were proposed: general schizophrenic symptomatology modification (depression, anxiety, agitation, impulsivity/aggressiveness), specific schizophrenic symptomatology modification (positive symptoms, negative symptoms, disorganization), need for hospitalization, significant change in care, disturbance in social behavior and lastly, suicidal behavior. Minimal duration (1.2 or 4 weeks) of general and specific schizophrenic symptomatology modification required to define acute state were evaluated. The booklet included the 30 PANSS symptoms listed with their definitions. Among this symptom list, clinicians were instructed to select the ten criteria which they estimated best defined the acute state, followed by the ten most important target symptoms to be treated. Out of 2,369 questionnaires, 1,584 were collected on time (66.9%). Among the six majors indicators proposed to define acute state 75% of psychiatrists considered 1 to 3 criteria. Three were more frequently rated, including core schizophrenic symptomatology disturbance (68.4%), general schizophrenic symptomatology disturbance (68.0%) and suicidal behavior (64.9%). The other criteria were rated as follows: need for hospitalization (26.8%), significant change in care (18.3%), and disturbance in social behavior (29.1%). For 53.2% of psychiatrists the definition of acute state requires the presence of specific schizophrenic symptomatology for a minimal duration of one week. Two weeks with general symptomatology was required for 45.5% of psychiatrists to define acute state. Symptoms more often rated within the four first choices for acute state definition included delusions, conceptual disorganization, hallucinatory behavior and excitement. Except for grandiosity, all the PANSS positive subscale items were chosen to be included in the definition (delusions, conceptual disorganization, hallucinatory behavior, excitement, suspiciousness/persecution and hostility). Four items, including anxiety, depression, uncontrolled hostility, inner tension from the general psychopathology subscale were chosen as part of the ten most important criteria to define acute state. On the PANSS negative subscale (blunted affect, emotional withdrawal, poor relationships, passive apathetic withdrawal, difficulty in abstract thinking, lack of spontaneity/flow of conversation and stereotyped thinking), no item was rated to be included in the acute state definition. The highest rated symptoms among the four first choices for treatment included delusions, hallucinatory behavior, excitement and anxiety. The ten most important criteria for treatment were the same as for acute state definition with differences in frequency. Excited state, depression and suspiciousness/persecution were more rated for treatment than definition whereas delusion, hostility and conceptual disorganization were less rated as treatment target than definition criteria. In clinical practice, recognition of acute schizophrenic state is underscored by the association of specific schizophrenic symptomatology (positive symptoms, negative symptoms, disorganization) and general symptomatology (impulsivity/aggressiveness, anxiety, depression, agitation) of schizophrenia. For most clinicians, acute state definition requires specific symptom for a minimum of one week and other non-specific indicators such as suicidal behaviour have to be taken into account. With regard to PANSS criteria, most positive schizophrenic symptoms and some general schizophrenic symptoms are necessary for definition and designated as treatment priorities. Negative symptoms were not taken into account. Hallucinatory behavior is the first symptom rated in definition and is considered by psychiatrists as the absolute therapeutic priority. This survey could be a first step in the construction of an operational and consensual definition. This definition is strongly needed as a valid measurement in therapeutic and epidemiological outcome studies, which remain at least partly based on clinician subjective judgment.
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PMID:[Acute schizophrenia concept and definition: investigation of a French psychiatrist population]. 1597 35


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