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 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The nature of psychiatric disorders in tropical regions is affected much more by the effect on the patient of certain environmental and cultural factors than by any specific features of tropical diseases. In places where the standards of health care and health education are not yet fully developed, abnormalities of physical development, particularly those affecting the development of the cerebral cortex, are of great importance. For example, protein-energy malnutrition may result in deficits in cerebral maturation and efficiency that reduce the capacity of the brain to manage its behavioural functions and may give rise to impaired capacities for concentration, foresight, and judgement and impairment of inhibitory control over intensely experienced emotions. In addition, certain cultural attitudes that are widespread in pre-literate societies influence the type of secondary reaction to disease: for example, acute symptoms tend to be florid and uninhibited, and violently experienced and externalized emotions such as hilarity, terror, anger, and grief are the rule rather than the exception.Certain tropical diseases are, however, the direct cause of severe disturbance of cerebral functioning, while others affect only the finer cerebral controls so that normally controlled fears, anxieties, and other personality traits emerge. These specific brain syndromes may be acute or chronic and may be triggered by an apparently trivial physical cause. Acute brain syndromes appear to be more common in tropical countries perhaps because in the adult the cerebral cortical reserve is less than it ought to be because of the prevalence of earlier minimal brain damage. Formal psychiatric reactions are, of course, also seen in tropical countries, but the expression of, for example, schizophrenia, hypomanic and manic states, and depression is coloured by the underlying personality and the cultural background of the patient. Perhaps in no other setting is the intimate relationship between behaviour and the physical body seen more clearly than in populations living in the tropics and it is important that health workers in these regions should be aware of the role played by earlier or concurrent physical disease in behavioural disturbance.
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PMID:The psychiatric aspects of tropical disorders. 31 50

In order to get information about the premorbid personality of patients with endogenous psychosis, we examined the adjective check list of von Zerssen with regard to form and content on a sample of 126 schizophrenic and 31 affective-psychotic patients. The data gathering occured through retrospective evaluation by a close relative of each patient. One aim of the study was the development of a psychometric instrument in order to construct clinically relevant scales, which would allow us to objectify characterizations of the premorbid personality of patients with psychic illness. Another aim was to test the validity of this instrument by investigating the coherence between the obtained test results and the corresponding clinical psychiatric judgments of experts in the form of diagnoses. Finally, we sought to determine if typical premorbid characteristic features give a predisposition for specific aspects of psychotic diseases, in order to be able to differentiate between diverse psychiatric groups of diagnoses. By means of factor analysis (principal component analysis) with Varimax rotation we came to five easily distinguishable clinical-psychological well interpretable factors, from which we derived five scales. These scales seem to be appropriate for the characterization of premorbid personality traits. They represent the following clinical concepts: (1) cyclothymia, (2) sthenia, (3) anancasm, (4) hostility, (5) schizothymia. Formal examination of the factor-analytical proved scales according to criteria of classic test-theory (item-test correlation, reliability, distribution, intercorrelation) showed that we were able to measure rather independent dimensions of premorbid personality by our five scales with sufficient accuracy. To get evidence for the empirical validity of our scales we compared our test results (1) with three groups of different diagnoses concerning premorbid personality and (2) with the two diagnostic groups of schizophrenia and affective psychoses. We also tried to work out differential aspects within the diagnostic group of schizophrenia for four subgroups. As criteria for validity we sued clinical judgments of psychiatrists both for the premorbid personality and for the diagnosis of the present disease. On the whole our adjective check list turned out be as useful instrument to get a discriminating description of premorbid characteristic features which is better than a global evaluation in form of a single diagnosis. First First indications of the practical importance of our scales are discussed.
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PMID:[Assessment of the premorbid personality in endogenous psychoses. A factor-analytical study of the adjective check list of von Zerssen (author's transl)]. 84 9

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.
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PMID:Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas. 202 75

The Kiddie Formal Thought Disorder Story Game and the Kiddie Formal Thought Disorder Scale were administered to schizophrenic, schizotypal, and normal children, aged 5 to 13 years. The story game elicited more elaborate speech samples than did a structural clinical interview focused on psychotic symptomatology. The sum of illogical thinking and loose associations was a reliable kappa = 0.77), sensitive (79%), and specific (90%) indicator of schizophrenia in this sample. It also demonstrated significant developmental changes in the schizophrenic and normal subjects. Incoherence and poverty of content of speech were infrequently rated in both schizophrenic and normal subjects.
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PMID:The Kiddie Formal Thought Disorder Rating Scale: clinical assessment, reliability, and validity. 273 8

Formal diagnostic systems such as the Research Diagnostic Criteria (RDC) and standardized diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia (SADS) have enhanced clinical psychiatric research over the past decade. Because of the cost and time factors, however, they are not routinely used in most clinical settings. The availability of reliable alternatives compatible with clinical practice would encourage more psychiatrists to engage in clinical research. This study describes the nature and procedural validity of two such alternatives based on the RDC. Acceptably accurate, less costly research diagnostic processes can be incorporated into clinically oriented short-term acute inpatient units.
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PMID:Procedural validity of an abbreviated version of the SADS/RDC diagnostic process. 374 94

A total of 24 never-treated (i.e. drug-naive) actively psychotic schizophrenic patients, operationalized according to DSM-III-R, were examined in a pre-post-treatment design using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and 99mTc-HMPAO-single photon emission computed tomography (SPECT) to assess regional cerebral blood flow (rCBF). The control subjects were 20 patients free of neurological and psychiatric symptoms. Before treatment there was only a slight hypofrontality, and hypoperfusion was observed in the left temporal superior region. After treatment, hypofrontality was reduced to one region and temporal hypoperfusion disappeared. Formal thought disorders were accompanied by increased rCBF in the bilateral frontal interior and left temporal superior regions. Delusions were associated with hypoperfusion in the anterior cingulate cortex. Negative symptoms showed no linkage to hypofrontality, either before or after treatment. Factor analysis showed delusions and hallucinations loading on different dimensions. The disorganized dimension correlated positively with all regions of interest, whereas these were negatively correlated with reality distortion.
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PMID:Psychopathological and SPECT findings in never-treated schizophrenia. 925 24

Eighty six in-patients suffering from puerperal psychosis within six weeks after childbirth were prospectively investigated in Muhimbili National Hospital during two years. Formal psychiatric history, mental status evaluation, research and diagnostic criteria including ICD 10 and clinical progression were employed for diagnosis. Using a structured questionnaire, the socio-demographic characteristics, concomitant physical disorders, major obstetric events, period of onset of puerperal psychosis following delivery and social support given were established. Mean age was found to be 23.6 years; the majority was primiparous women with parity of between one and three children. Main physical co-morbidities included anaemia in 51.4% of cases, infections in 44.2% and EPH-gestosis in 17.4%. Most mothers received social support from their extended families. Organic psychosis was found in four fifths of the mothers and schizophrenia in 8.1%. A high rate of early onset puerperal psychosis (3.2/1000 (births), predominantly in young primiparous women, was found.
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PMID:The nature of puerperal psychosis at Muhimbili National Hospital: its physical co-morbidity, associated main obstetric and social factors. 1247 28

The presence of formal thought disorder (FTD) in childhood is sometimes viewed as a possible precursor of psychotic symptoms or adult schizophrenia. It is possible to assess FTD in childhood in a valid and reliable manner, by using the Kiddie Formal Thought Disorder Rating Scale (K-FTDS). However, training and rating procedures are very time consuming, and may be particularly difficult during clinical assessment. The aim of this study was therefore to compare the clinician's rapid judgment of FTD to the detailed ratings of the K-FTDS. The K-FTDS was administered to 172 consecutively referred children, aged 6 to 12 years and subsequently rated by two blind raters. The same criteria, as used in the K-FTDS (illogical thinking, loose associations, incoherence, and poverty of content of speech), were rated by nine clinicians. The overall agreement between K-FTDS scores and FTD scores as rated by the clinician was low. The clinician's judgment of FTD did not correspond very highly with ratings on the K-FTDS. Thus, although detecting FTD has important clinical value, the assessment of its presence or absence seemed to depend highly on which measure was used.
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PMID:Assessment of formal thought disorder: The relation between the Kiddie Formal Thought Disorder Rating Scale and clinical judgment. 1715 54

The purpose of the present paper was to examine the psychiatric symptom dimensions related to needs of care among patients with schizophrenia in hospital and in the community. Subjects were 217 patients with F2 ICD-10 diagnoses. Hospital patients included 102 inpatients (47.0%) in psychiatric long-term care units. Community patients included 115 outpatients (53.0%) living in their homes or residential facilities. Psychiatrists used the Brief Psychiatric Rating Scale (BPRS) to assess patients' psychiatric symptoms. Formal care providers assessed needs of care using a scale developed by the Committee on Case Management Guidelines for People with Mental Disabilities in Japan. Instrumental Activities of Daily Living (IADL) self-performance and difficulty were also measured using a scale from the Minimum Data Set-Home Care (MDS-HC). Multiple regression analyses were applied, using the symptom dimensions as dependent variables and needs of care as independent variables. Patient group (hospital or community) was also used as an independent variable. Hospital patients demonstrated more severe psychiatric symptoms and greater needs of care than community patients. Multiple regression analyses showed that the total needs of care were greater among male patients (B = 0.142, P = 0.005), hospital patients (B = 0.310, P < 0.001), patients with poor IADL self-performance (B = 0.217, P = 0.047), and patients with severe negative symptoms (B = 0.240, P = 0.002; R(2) = 0.515). The present results suggested an association between negative symptoms and needs of care in schizophrenia. Hospital patients had greater needs of care, even though their psychiatric symptoms were controlled for. Further research should examine the relationships between psychiatric symptoms and needs of care in a cohort study following patients when hospitalized and when living in the community.
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PMID:Symptom dimensions and needs of care among patients with schizophrenia in hospital and the community. 1787 27

Quantitave EEG profile was recorded for 60 age and sex matched drug free/naive schizophrenia patients, divided into two groups based on the presence and absence of Formal Thought Disorder (FTD) and a group of 30 matched healthy participants. Coherence and power spectrum analysis revealed that as compared to normal controls, schizophrenia patients with FTD had decreased regional power and intra hemispheric coherence; those without FTD had increased regional power and increased intra hemispheric coherence. Inter hemispheric coherence was greater in schizophrenia patients with FTD and lesser in those without FTD, as compared to healthy participants. The data were interpreted in terms of neural dis-connection which in FTD can be attributed to the existence of both a deficit and excess of neural connections, which compensate each other.
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PMID:Electrophysiological examination of Formal Thought Disorder in schizophrenia. 2317 41


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