Delusional parasitosis (DP) is mostly described in single cases or small samples. Data on epidemiology, nosological classification, therapy and course are therefore difficult to interpret. A thorough literature review is recommended to delineate common features of the syndrome. All case reports concerning DP (except toxic forms) were collected and analyzed according to a standardized protocol. DP is a disorder which may occur in every period of life but is much more frequent in older subjects. Sex differences with a predominance of females increase with age. Mean duration of delusion was 3.0 +/- 4.6 years (median: 1 year). Social isolation seems to be more a premorbid feature than a secondary phenomenon related to the delusion. Diagnostic classification revealed a high proportion of so-called 'pure' forms ('delusional disorders' in DSM-III-R or ICD-10) but the syndrome was also reported in schizophrenia, affective or organic psychosis or even as a neurotic symptom. Frequency of induced DP can be estimated between 5 and 15%. Course of DP is not so unfavorable as commonly thought; in about half the patients a full remission was described during the observation period or at catamnesis. Short preclinical courses may indicate better outcome. Comparing the patients of the prepsychopharmacological era (before 1960) with those after, the rate of full remissions increased from 33.9 to 51.9%.
There is a growing awareness of a psychiatric construct that needs to be better defined and understood: Internet addiction (IA). Recently there has been much public concern over the relationship between Internet use and negative affect. This study explored the concept of IA and examined the relationship between addictive symptoms and depression.
An online questionnaire was used to measure participants' Internet use, the functions for which they used the Internet, and their depressive tendencies. Three scales were included: the IA Test, the Internet Function Questionnaire and the Beck Depression Inventory (BDI). 1,319 respondents completed the questionnaires, with 18 (1.2%) identified as falling in the IA category.
Correlational analyses were conducted across the whole data sample. In factorial analyses, the 18 IA respondents were compared to a matched group of non-addicted (NA) respondents in terms of their scores on the Function Test and the BDI. Across the whole data sample, there was a close relationship between IA tendencies and depression, such that IA respondents were more depressed; there were also significant differences between the sexes, with men showing more addictive tendencies than women. In addition, young people were significantly more likely to show addictive symptoms than were older people. There was a significant difference between the IA and the NA group in their levels of depressive symptoms, with the NA group firmly in the non-depressed range, and the IA group in the moderately-to-severely depressed range (F(1, 34) = 22.35; p < 0.001). In terms of the function for which they used the Internet, the IA group engaged significantly more than the NA group in sexually gratifying websites, gaming websites and online community/chat websites.
The concept of IA is emerging as a construct that must be taken seriously. Moreover, it is linked to depression, such that those who regard themselves as dependent on the Internet report high levels of depressive symptoms. Those who show symptoms of IA are likely to engage proportionately more than the normal population in sites that serve as a replacement for real-life socialising. Further work needs to be done on validating this relationship. Future research is needed to corroborate the existing evidence and address the nature of the relationship between IA and depression: there is comorbidity between these conditions that needs greater investigation.
The prevalence of hallucinations and delusions was studied in 1,715 patients with unipolar or bipolar affective disorders hospitalized at a tertiary care facility. The authors found that the presence of psychotic features was significantly associated with diagnostic subtype. Bipolar manics were more likely than primary depressives, secondary depressives, and bipolar depressives to have hallucinations and/or delusions; primary depressives were significantly more likely than secondary depressives to have psychotic features. Among psychotic patients, bipolar manics were more likely than the other diagnostic groups to have delusions only and less likely to have hallucinations only. Possible explanations for these findings are discussed.
The proposed revision of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), subsuming polymorphic, schizophrenic or predominantly delusional syndromes, would restrict their classification to acute polymorphic psychotic disorder, reminiscent of the clinical concepts of bouffée délirante and cycloid psychosis.
Sampling and methods:
We selected all subjects aged 15-64 years (n = 5,426) who were listed in the Danish Psychiatric Central Register with a first-admission diagnosis of ATPDs in 1995-2008 and estimated incidence rates, course and outcome up to 2010.
Although about half of ATPD patients tended to experience transition to another category over a mean follow-up period of 9.3 years, acute polymorphic psychotic disorder fared better in terms of cases with a single episode of psychosis and temporal stability than the subtypes featuring schizophrenic or predominantly delusional symptoms. Acute polymorphic psychotic disorder was more common in females, while cases with acute schizophrenic features predominated in younger males and evolved more often into schizophrenia and related disorders.
These findings suggest that acute polymorphic psychotic disorder exhibits distinctive features and challenge the current approach to the classification of ATPDs.
The impending revisions of DSM-IV and ICD-10 provide an excellent opportunity to improve the diagnostic accuracy of the current somatoform disorder classification. To prepare for these revisions, this study systematically investigates the validity of the current classification of somatoform disorders.
We searched Medline, Psycinfo and reference lists to investigate convergent, divergent, criterion and predictive validity of the current somatoform disorder classification.
Substantial associations of somatoform disorders with functional impairment and elevated health care costs give evidence for the clinical and societal importance of somatoform disorders and for the convergent validity of the current operationalization. The specificity of the current somatoform disorder classification, i.e. their divergent validity, is demonstrated by the fact that functional somatic syndromes and their consequences are only partially explained by association with anxiety and depression. However, the imprecision of the diagnostic criteria, which are not based on positive criteria but on the exclusion of organic disease, largely limits the criterion validity of the current classification systems. Finally, studies investigating the predictive potential of somatoform disorders are lacking, and to date predictive validity has to be considered as low.
The insufficient criterion and predictive validity of the present somatoform classification underlines the need to revise the diagnostic criteria. However, an abolishment of the whole category of somatoform disorders would ignore the substantial convergent and divergent validity of the current classification and would exclude patients with somatoform symptoms from the current health care system. A careful revision of the current somatoform disorder diagnoses, based on positive criteria of psychological, biological and social features, has the potential to substantially improve the reproducibility and clinical utility of the existing classification system.
A 14-year follow-up study was conducted on 214 patients from the diagnostic groups schizophrenia, affective psychosis, and neurosis to determine the relationships between various clinical and psychosocial variables and to assess their value as predictors of long-term course and outcome. Particular emphasis was placed on ascertaining the interrelationships between the variables within the individual diagnostic groups. The results indicate that for schizophrenia, severity of disease at discharge from index hospitalization was the principal predictor of the number and duration of further hospitalizations. Furthermore, it predicted the severity of illness and social functioning at follow-up. For affective psychosis, the Global Assessment Scale score predicted the number and duration of further hospitalizations. Severity of illness, social functioning, and age at first hospitalization were predictors of occupational development. For neurotic disorders, severity of disease and social adjustment at discharge from index hospitalization were each predictors of themselves at final follow-up. In addition, age at first hospitalization was an important predictor of most course and psychosocial variables. Among the endogenous course variables within the schizophrenic group, the number and duration of further hospitalizations had a substantial bearing on severity of illness and social functioning at follow-up. For affective psychoses, indicators of occupational development and number of hospitalizations had an impact on severity of illness and social functioning at follow-up. Our findings reveal a good overall predictive value for the clinical and psychosocial variables within each of the diagnostic categories studied.
Concerns with eating were studied in 130 Japanese boys and 125 girls aged 6-18 years using the Simplified Eating Attitudes Test (s-EAT). The s-EAT scores in girls slightly increased with age. The mean scores in girls at age 10 years or older were significantly higher than in boys of the same age, suggesting that pubertal girls have more concerns with eating. On the other hand, s-EAT scores in boys that were not overweight decreased as they grew older, contributing, at least partly, to the sexual difference in eating behavior. The mean scores in overweight boys were higher than in boys that were not overweight. The score in boys correlated significantly with weight though there was no significant correlation in girls. These results suggest that, in addition to increased concerns with eating in girls, decreased concerns with age in boys is one of the causes of the sexual difference in eating behavior, especially during puberty. Eating behaviors in girls seem to be less influenced by changes in body weight than in boys.
Despite a large scientific literature on early clinical precursors of schizophrenia, bipolar disorder and unipolar depression, few data are available on axis I disorders preceding the adult onset of these illnesses.
Disorders before the age of 18 years were retrospectively assessed with a structured interview in 3 groups of consecutive adult inpatients with DSM-IV diagnoses of schizophrenia (n = 197), major depressive disorder (n = 287) and bipolar disorder (n = 132). Only patients with adult onset of schizophrenia and of mania/hypomania were included. A sample of the general population served as control group (n = 300).
The clinical groups significantly outnumbered the control sample on the majority of early axis I diagnoses. Schizophrenia was significantly associated (1) with attention deficit hyperactivity disorder (ADHD), ADHD inattentive subtype, ADHD hyperactive subtype and primary nocturnal enuresis, compared to unipolar depression, and (2) with social phobia and ADHD inattentive subtype, compared to bipolar disorder. Oppositional defiant disorder was significantly associated with bipolar disorder, compared to the other clinical and control groups. The ADHD hyperactive subtype predicted the adult onset of bipolar disorder compared to unipolar depression. Externalizing disorders seem of special importance as regards the clinical pathways toward schizophrenia.
A representative sample of 908 hospital records covering admissions between 1920 and 1982 for depression was analyzed in order to assess the switch rate to hypomania/mania. The results are the following: (1) Over the decades of this century there has been a substantial increase in hospital admissions in Zurich for both depression and mania, but the ratio remained constant. (2) Due to this increase the clinicians can observe more spontaneous switches from depression to mania, which favors the assumption of a causal relationship when treatment is applied. (3) 64 of the 908 patients (7.0%) admitted for depression switched to hypomania or mania. Hypomania was observed in 48 cases (5.3%) and mania in 16 cases (1.7%). (4) The analysis of predisposing factors to a switch has resulted in a simple finding. Bipolar patients (including schizomanics) have an 8-fold higher switch rate (28.9%) than the unipolars (3.7%). The switchers are equally distributed over the two sexes and do not differ in the frequency of a family history of affective psychoses, schizophrenia, schizoaffective disorders, or suicide. (5) Bipolarity correlates positively with 'higher number of previous episodes', with 'readmitted' and with 'switch'. Therefore, studies selecting readmissions [Lewis and Winokur 1982] overrepresent switchers purposely. (6) A loglinear analysis together with some univariate strategies show that over the decades (from 1920 to 1982) there was no significant increase in switches of unipolar or bipolar patients. In conclusion, there is no evidence for a treatment-induced switch. This result is in line with Prien et al.  and with Lewis and Winokur .
The first purpose of the paper is to sketch the development of the concept of axial syndromes, starting with the generation of the hypotheses in Berner's monograph on 'The paranoiac syndrome' published in 1965 and leading to the last formulation of the Viennese Research Criteria in 1983. The second purpose is to draw the attention on a series of empirical studies which have been undertaken in order to evaluate the classificatory validity of the concept, studies dealing with the long-term course of paranoid psychoses (both in a retrospective and a prospective design) and secondary cases of different diagnostic classes in the families of the same patients (first-degree relatives).
A sample of 46 schizophrenic patients (26 men and 20 women) from a night clinic (N subjects) with an average age of 21.7 years at the time of first manifestation of the illness and a sample of hospital inpatients (H subjects) matched for diagnosis, sex, and age were followed up from 1971/1973 to 1983. The average age of the patients in 1983 was 40 years. The course of the illness and the pattern of hospitalization were investigated by personally questioning each patient and by scrutinizing all the case history records and other relevant documents; for each clinical cycle of illness, consisting of an overt phase followed by a quiescent interval, a case control sheet was filled out. The duration of illness was 18 years for the N subjects and 15 years for the H subjects. Longitudinal analysis of these years of illness in both patient samples showed a marked decrease in the number and duration of overt phases and stays in hospital, but a progressive aggravation of residual symptomatology during quiescent intervals and a progressively decreasing ability to work and earn a living.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of this study was to compare the evolution of psychotic patients in Algeria and in France. In 1975, 105 patients were selected in Algeria and 237 in France. Ten years later, in 1985, all these patients were interviewed. In 1985, we investigated for each subject the evolution of the following parameters: sex, age, DSM-III axis 1 and 5, marital status, social welfare work, and treatment variables. Our results indicate that the improvement of the psychosocial adaptation (DSM-III axis 5) is slightly better in Algeria than in France. Medical and social support seems to be quantitatively less important in Algeria.
Delusional misidentification syndromes (DMS) are beginning to be well described clinically but little is known about their epidemiology. To try and obtain an estimate of their prevalence, a survey was performed of all admissions to a locked psychiatric inpatient unit from April 1983 to June 1984. 26 patients satisfied clinical criteria for DMS during this time and overall 835 patients were admitted to the unit. Thus, a crude prevalence of 3.1% was found. The median age of the patients was 29 years. The overwhelming majority had a principal psychiatric diagnosis of paranoid schizophrenia and only 2 of an affective disorder. By a small margin, most patients were male. The implications and limitations of these findings are discussed.
The stressor criterion (criterion A) in the DSM-IV diagnosis of posttraumatic stress disorder (PTSD) is frequently questioned. To explore the clinical and diagnostic usefulness of criterion A, we examined its value in predicting and capturing PTSD symptom clusters (criteria B-D) in a sample of trauma survivors.
We studied 342 adult German-speaking Swiss tourists affected by the 2004 tsunami. We analyzed sensitivity and specificity, predictive value and variance explanation of criterion A for evoking PTSD criteria B-D.
Sensitivity of criterion A for PTSD criteria B-D was 93.2%, while positive predictive value was 23.1%. Criterion A made a small, yet statistically significant contribution of 7.5% for PTSD symptom clusters B-D.
The assessment of criterion A (A1 and A2) is not necessary for the identification of individuals suffering from PTSD symptoms according to DSM-IV. We suggest therefore that criterion A is a dispensable part of the diagnosis of PTSD.
This paper reproduces the executive summary of a report on values in psychiatric diagnosis commissioned by the chair of the ICD-12/DSM-VI Co-ordination Task Force, newly established in 2010 following the publication of ICD-11 and DSM-V. The report describes a programme of research on values in psychiatric diagnosis carried out in the first decade of the twenty-first century. This programme paralleled the twentieth-century programme of research on the descriptive (or factual) elements in diagnosis. The report includes concrete proposals for re-drafting key sections of DSM and corresponding sections of ICD. These proposals add values to, rather than subtracting science from, psychiatric classification. This is shown to have put psychiatry at the leading edge of twenty-first century medical science by 2010.
The ICD-8 diagnosis applicable to borderline psychosis in children is psychosis limitaris infantilis (299.02). Results from a register-based study referring to all Danish children admitted between 1970 and 1992 and diagnosed borderline psychosis are presented here. A total of 415 children (332 boys and 83 girls) were admitted with a diagnosis of psychosis limitaris infantilis. At a follow-up examination in the Psychiatric Case Register 70% of those diagnosed with psychosis limitaris infantilis were found to have been re-admitted at least once to a psychiatric hospital. Thirteen percent of the boys and 19% of the girls, admitted more than once, had a diagnosis of schizophrenia after 5 years. This share increased after a 15-year period of observation to 24% in the group of boys, whereas the number of schizophrenic girls remained unchanged. One third of the boys and 17% of the girls were diagnosed with personality disorders, following a 15-year observation period.
The full version of the Borderline Symptom List (BSL; for clarification now labeled BSL-95) is a self-rating instrument for specific assessment of borderline-typical symptomatology. The BSL-95 items are based on criteria of the DSM-IV, the revised version of the Diagnostic Interview for Borderline Personality Disorder, and the opinions of both clinical experts and borderline patients. The BSL-95 includes 95 items. In order to reduce patient burden and assessment time, a short version with 23 items (BSL-23) was developed.
The development of the BSL-23 was based on a sample of 379 borderline patients, considering the items from the BSL-95 that had the highest levels of sensitivity to change and the highest ability to discriminate borderline patients from other patient groups. In a second step, the psychometric properties of the BSL-23 were investigated and compared with the psychometric properties of the BSL-95 in 5 different samples, including a total of 659 borderline patients.
In all of the samples, a high correlation of the sum score was found between the BSL-23 and the BSL-95 (range: 0.958-0.963). The internal consistency was high for both versions (BSL-23/Cronbach's alpha: 0.935-0.969; BSL-95/Cronbach's alpha: 0.977-0.978). Both BSL-23 and BSL-95 clearly discriminated borderline personality disorder patients from patients with an axis I diagnosis (mean effect sizes were 1.13 and 0.96 for the BSL-23 and BSL-95, respectively). In addition, comparisons before and after 3 months of dialectical behavior therapy revealed a numerically larger effect size for the BSL-23 (d = 0.47) compared to the BSL-95 (d = 0.38).
The results indicate that the BSL-23 is an efficient and convenient self-rating instrument that displays good psychometric properties comparable to those of the BSL-95. The BSL-23 also demonstrated sensitivity to the effects of therapy.
The 28-item General Health Questionnaire (GHQ-28) is a scaled version of the General Health Questionnaire that has been used internationally to screen for mental disorders in nonpsychiatric populations. There is great need to validate international screening instruments in the Russian language for their use in post-Soviet countries.
200 persons were surveyed in a deprived area of Almaty, Kazakhstan using the Russian version of the GHQ-28 and socioeconomic measures (income level, employment situation and education). We calculated the median and the mean GHQ-28 scores for different socioeconomic subgroups. The internal reliability was tested using Cronbach's α coefficient and intersubscale correlations. We conducted an exploratory factor analysis using varimax rotation.
The median score of the GHQ-28 was 2 (mean = 3.56; SD = 5.09) for the total sample. Higher age, unemployment and female gender were significantly associated with high mean GHQ-28 scores. Cronbach's α coefficient was 0.92 for the total scale. Exploratory factor analysis revealed four factors explaining 50.07% of the variance. The factor Anxiety/Insomnia accounted for 14.87%, Severe Depression for 13.74%, Social Dysfunction for 13.47% and Somatic Symptoms for 8.81% of the variance.
The test showed good internal consistency. The median GHQ-28 score was relatively low compared to other countries. The subscale Severe Depression including items on suicidal ideation may have a lower acceptance than the other subscales Somatic Symptoms, Anxiety/Insomnia and Social Dysfunction.
Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition.
Sampling and methods:
Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung's self-report questionnaires for depression and anxiety.
Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78.
Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.
Although previous reports have described the association of autism, mental retardation, and schizophrenia with a missing Y chromosome, we are not aware of any case showing an association between this particular chromosomal abnormality and Asperger syndrome.
We report the case of a male patient with a combination of Asperger syndrome, obsessive-compulsive disorder and 45,X/46,XY mosaicism. During the follow-up, this individual has also developed a severe episode of major depression, which was successfully treated with electroconvulsive therapy.
To the best of our knowledge, this is the first case in which a 45,X/46,XY mosaicism was described in association with Asperger syndrome, either alone or associated with other psychiatric disorders. Diagnostic and therapeutic aspects of this unique case are presented and discussed.
Our findings suggest that a missing Y chromosome may play an etiological role in some cases of Asperger syndrome.
Musical hallucinations remain rare, are more common in women, and their onset is often related to ear pathology, particularly deafness. When brain disease is involved, pathology of the right or non-dominant hemisphere seems overrepresented. Psychosis and personality traits play a minimal role in their development. A discriminant function was constructed that correctly predicted the presence of brain disease (89%) and included the following clinical variables: being male, having acute onset musical hallucinations, and absence of deafness, psychiatric disease, and other forms of hallucination.
Sex differences with regard to age at first hospitalization and residual symptomatology were investigated in 54 long-term hospitalized chronic schizophrenics. Patients fulfilled diagnostic criteria of DSM-III, Kraepelin's dementia praecox and Leonhard's group of schizophrenias as well. The severe residual psychopathology necessitated continuous hospitalization in all the patients. The 27 women and 27 men neither differed in duration of illness or period of hospitalization nor in their social environment. We found that women were older than men at their first hospitalization and exhibited more marked positive symptomatology during the course and in the residual state than men. However, regardless of the residual symptomatology, men generally received more neuroleptics. A classification of the schizophrenic patients by means of the Leonhard criteria revealed that unsystematic schizophrenics (affect-laden paraphrenia, periodic catatonia, cataphasia) of both sexes were significantly (p less than 0.001) more often married at the time of first hospitalization than were systematic schizophrenics. Further, there was an overwhelming preponderance of women among the group of affect-laden paraphrenia and, conversely, of men in the group of periodic catatonia. Presuming different etiology in affect-laden paraphrenia and periodic catatonia, our findings suggest a significantly varied frequency in the rate in which women and men are afflicted by heterogeneous subgroups of schizophrenia.
The charts of 61 children and adolescents admitted to the Psychiatric Hospital for Children in Aarhus, Denmark, in the period 1970-1986 fulfilling the DSM-III criteria for obsessive-compulsive disorder were reviewed for obsessive/compulsive symptoms. The symptoms were divided into form and content. The most common form of compulsion was rituals seen in 39 of the patients, and the most common compulsive content was washing. The most frequent obsessive content was thoughts about dirt and contamination followed by concern about death, illness and harm. The phenomenological feature of boys and girls was very similar, and only a few significant differences between boys and girls were found. One quarter of the boys and 12.5% of the girls had only obsession, whereas 27.0% of the boys and 37.5% of the girls had only compulsion and no obsession. The number of obsessive/compulsive symptoms was not found to correlate with the time spent each day on the symptom. It is concluded that there do not seem to be any intercultural differences between Denmark, India, and Japan as to the content of obsessional thoughts and compulsive behaviour in children and adolescents.
This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.
Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.
Since few studies have focused on the diagnostic process foregoing a case record diagnosis of schizophrenia, the present study was undertaken with the aims to examine the time interval between the onset of the illness, the first admission as inpatient, and the timepoint of a case record diagnosis of schizophrenia. Further, the study aimed at analyzing the influence of demographic and clinical variables on an 'early' or 'late' diagnosis of schizophrenia. The records of 84 inpatients treated during the calendar year 1986, were retrospectively analyzed. Only 21.4% of the patients had received a case record diagnosis of schizophrenia at their first admission into hospital, and additionally 16.7% after two admissions. Those patients with 'early' diagnosis differ significantly from patients with 'late' diagnosis, being more frequently men, having longer admission latency, higher frequency of Schneiderian first-rank and negative symptoms, a longer stay at hospital at their first admission, and lower levels of working capacity at the onset of the illness. The data suggest a propensity to include course and social functioning aspects of poor outcome in the diagnostic process. Confining the diagnosis of schizophrenia to the severe cases indicates a conservative, perhaps tautological, approach to this diagnosis.
Based on pretreatment psychopathological symptoms measured with the Symptom Checklist 90 Revised (SCL-90-R), this study investigated whether stable symptom clusters exist among psychotherapy inpatients. Furthermore, it was examined whether the identified clusters would differ with respect to clinical characteristics and treatment outcome.
We collected data from a total of 3,688 psychotherapeutic inpatients involved in psychodynamic group psychotherapy from 10 hospitals. Ipsatized SCL-90-R presymptom data were used as input variables for a series of cluster analyses combining hierarchical (Ward algorithm) and non-hierarchical (k-means) procedures.
The cluster analyses revealed a 7-cluster solution with the following subgroups: (1) insecure-paranoid, (2) neutralizing, (3) phobic-anxious, (4) aggressive, (5) insecure-phobic, (6) somatizing, and (7) obsessive-depressive. Cross-validation with independent data sets, as well as alternative statistical procedures, confirmed the stability of the 7-cluster solution. Correlations with clinical diagnoses and interpersonal problems indicate the clinical relevance of the cluster differentiation. The cluster insecure-phobic proved to be less beneficial when used as a predictor of treatment outcome. Furthermore, we found moderator effects between cluster assignment and pretreatment interpersonal problems: the overall amount of interpersonal problems seemed to be detrimental to the patients from the clusters insecure-phobic and somatizing, whereas a relatively (ipsatized) heightened level of dominance was advantageous for improving psychopathological complaints of the patients from the cluster aggressive.
We could identify typical and clinically meaningful symptom clusters for the population of inpatients undergoing psychodynamic group psychotherapy in Germany. This finding could help strengthen clinical research which is led by the assumption that it is relevant to characterize patients by a specific pattern of psychopathological symptoms rather than or in addition to one (or more) distinct diagnostic categories.
The Narcissism Inventory (NI) is a frequently used German inventory for measuring narcissism in clinical settings; an additional short version (NI-90) also exists. Psychometric properties of the NI-90 scales were examined in clinical and non-clinical adolescent samples.
Two adolescent samples were assessed with the NI-90: a non-clinical sample (n = 439, mean age ± SD = 15.05 ± 1.77 years) and a clinical sample (n = 235, 18.26 ± 0.77 years). Confirmatory factor analysis and principle component analysis were used to scrutinize the structure of the scales. Multiple regression analysis was used to predict the scores on two scales (helpless self; negative body self).
This study revealed heterogeneity in the NI-90 scales, which in turn explains the wide range seen in Cronbach's α (from 0.53 to 0.93). The postulated 4-factor structure could not be replicated in both samples. Multiple regression analysis revealed that personality disorder did not significantly predict negative body self or helpless self scores, whereas eating, mood, as well as somatoform and conversion disorders did. One NI-90 scale (greedy for praise and reassurance) showed sufficient psychometric quality for the measurement of narcissism in both samples.
Based on the results, the authors recommend revising the NI-90. Items that may be useful for measuring aspects related to affective and body image complaints are presented. The greedy for praise and reassurance scale may be valuable for measuring features of 'overt' narcissism.
The factorial and discriminative validity of the Hopkins Symptom Check List SCL-90-R were examined in the light of criticism that clinical self-rating scales primarily express a general distress factor. In a population of 899 psychosomatic patients, high intercorrelations were found between the individual dimensions of the SCL-90-R. A subsequent Principal Components Analysis obtained 9 factors which were markedly less interdependent than those in the original version. The ability of the questionnaire to distinguish between patients with dysthymia, anxiety disorders and anorexia nervosa was examined. The average hit rate in the discriminant analysis was 67% using the original version and 74% with the proposed new factorial structure of the SCL-90-R, confirming the discriminative validity of the inventory. The present results as well as earlier studies suggest that the factor 'anxiety' should be included in the factor 'phobic anxiety', the factors 'paranoid ideation' and 'psychoticism' should be reformulated, and a new factor 'sleep disturbances' should be added to the original version of the SCL-90-R.
In a symptom-oriented study 17 patients suffering from chronic auditory hallucinations were investigated by means of 99mTc-HMPAO-SPECT and compared with healthy controls. The results confirm the relative frontal hypoactivity in junction with a relative hyperactivity in the basal ganglia and mesial limbic structures in both hemispheres found in a previous pilot study in auditorily hallucinating patients. Our results should fortify the symptom-oriented approach in psychiatric research.
About 30% of outpatients meet the criteria of a personality disorder (PD). When PD remains unnoticed or untreated, individuals with co-occurring PD benefit considerably less from disorder-related treatments for axis I disorders than patients without PD. The present study examines the diagnostic efficiency of the German version of the Standardized Assessment of Personality--Abbreviated Scale Self-Rating Version (SAPAS-SR).
Sampling and methods:
Based on the signal detection theory, receiver operating characteristics as well as reliability and validity indicators are determined in a heterogeneous outpatient sample (n = 230).
The values of internal consistency and the validity indicators turned out to be in the expected range. The area under the curve was low, at 0.67. Using the cutoff point of 4, sensitivity (80%) and specificity (46%) values were at a level that was only acceptable.
Since specificity was lower than in previous studies, using the SAPAS-SR results in a moderate cost efficiency only.
The aim of this study was to investigate the relationship between executive abilities and subjective basic symptoms in a group of outpatients with schizophrenia. Fifty patients underwent a neuropsychological testing battery. Basic symptoms were assessed using the Frankfurt Complaint Questionnaire. Using Pearson's product-moment correlations or partial correlations calculated by regression procedure, cognitive performance was not related to subjective experience. When patients were divided into two groups, with and without 'hypofrontality', as assessed by the neuropsychological testing, we did not find any significant difference in basic symptoms rating. Thus, it is likely that basic symptoms and neurocognitive functioning are unrelated in schizophrenic outpatients, probably because the expression of subjective experience and cognitive impairment is less pronounced than in inpatients. Also, subjective self-perceived basic symptoms and neurocognitive functioning may be unrelated, because these concepts are based on different theoretical backgrounds.
To assess insight in a large sample of patients with schizophrenia and to study its relationship with set shifting as an executive function.
The insight of a sample of 161 clinically stable, community-dwelling patients with schizophrenia was evaluated by means of the Scale to Assess Unawareness of Mental Disorder (SUMD). Set shifting was measured using the Trail-Making Test time required to complete part B minus the time required to complete part A (TMT B-A). Linear regression analyses were performed to investigate the relationships of TMT B-A with different dimensions of general insight.
Regression analyses revealed a significant association between TMT B-A and two of the SUMD general components: 'awareness of mental disorder' and 'awareness of the efficacy of treatment'. The 'awareness of social consequences' component was not significantly associated with set shifting.
Our results show a significant relation between set shifting and insight, but not in the same manner for the different components of the SUMD general score.
Many studies on the autobiographical memory and the explanation of reasons for success and failure proved that persons suffering from major depression tend to overgeneralize. This study examines the hypothesis that changes of reactions caused by a depressive disorder can be described by the affected persons but not explained.
Persons suffering from major depression and persons with posttraumatic stress disorder or disturbance of accommodation with depressive mood (= reactive form of a depressive disorder) were presented with a list of modalities (behaviour, emotional and physical reactions) characteristic for depression. They were asked to identify modalities applicable to them and to describe and explain them. Their responses were analysed using a content analysis and assigned to the categories description and explanation.
Persons with a major depression tended to use explanations or evaluations rather than descriptions for their depression-related modalities. Those persons suffering from a reactive form of depressive disorder tended to prefer evaluations.
These results support the assumption that states of depression cause general descriptions of depression-relevant behaviour. The specific characteristics that have been perceived confirm the general concepts, which however make the patient prone to the respective selective perceptions. Persons suffering from a reactive form of depressive mood cannot be assumed to have this tendency of self-affirmation. Their depressive state may be maintained by perseverating general pessimistic schemes.
It must however be conceded that it was not possible to control the physical comorbidity methodically and to take its effects into consideration, even though only persons without serious illnesses were included in the samples. This study did not verify whether other clinical groups, like patients suffering from anxiety, show the same patterns of explaining and describing their problems. It should furthermore be reviewed how other actions, e.g. positive ones, are represented by depressive persons.
A screening test for detecting abnormal illness behaviour in patients with somatic symptoms is described here along with its psychometric properties. This screening version of the Illness Behaviour Questionnaire (SIBQ) is derived from two subscales of the Illness Behaviour Questionnaire and has 11 items. The study was carried out on 78 consecutive patients with prominent somatic complaints and 22 normal volunteers. The SIBQ was administered to the subjects and the sensitivity, specificity and hits positive rates were computed for different cut-off scores. A score of 7 and above gave a sensitivity of 86%, a specificity of 83% and a hits-positive rate of 0.7537, and this seems the optimal cut-off score. The SIBQ may prove to be a sensitive screening instrument to detect probable cases of abnormal illness behaviour and especially useful for busy clinics or centres.
Studies showing interference with color naming threat-related words in patients with anxiety disorders suggest a bias towards processing threatening material in these patients. We assessed the specificity of this finding to anxiety disorders and to threatening stimuli by administering Stroop cards with a variety of types of emotional stimuli to 24 panic disorder patients with no history of major depression, 30 patients with major depression and no history of panic attacks and 25 controls with no history of an axis I disorder. Our findings suggest that the abnormal information processing seen in panic disorder may be characterized by a more general bias towards processing emotional stimuli than previously thought. They also suggest that this more general bias may illustrate differences in information processing in panic disorder and major depression.
The belief that passage of a 'whitish discharge' is associated with bodily complaints of weakness, tiredness, exhaustion, multiple aches, and multiple somatic complaints is known to be widely prevalent among Asian women. However, this aspect has not gained research attention. The case reported here illustrates how multiple somatic complaints, psychosomatic in nature, are attributed to the passage of white discharge and manifest as an abnormal illness behaviour.
Sixty schizophrenics and 40 depressives in remission from the floridly psychotic phase were given a semi-structured interview concerning their abnormal perceptual experiences at the onset of their illness. About 50% of each set of subjects had experienced an alteration in the quality of their perception. However, there was a fairly characteristic pattern in each case: emotional tainting of the world around, a sense of unreality and noise sensitivity in depression; and an indefinable, qualitative change in visual perception, particularly affecting the way colours, people, space and facial expression were viewed, in schizophrenia. Of the various theories which have been put forward to explain perceptual change in schizophrenia, a breakdown in gestalt appeared to explain these findings best.
Thirty-one habitual drinkers with a personal, familial, social complication were screened from a Taiwan aborigine community. Each was given an in-depth descriptive semistructured interview. The interview, recorded with audiotape, contained 4 aspects: (1) personal developmental history; (2) family structure and interaction; (3) developmental process and current state of drinking behavior, and (4) attitude toward drinking behavior. Based on the evolving process and current state of drinking behavior, three process patterns of alcoholism were defined: (1) social developmental type (67.7%); (2) deviant behavioral type (9.7%), and (3) special constitutional type (22.6%).
Cannabis is a possible risk factor for the onset of schizophrenia and can induce neurocognitive, behavioural and motor co-ordination alterations. The aim of this study was to evaluate the role of cannabis in the occurrence of neurological soft signs (NSS) and, considering that this drug has been related to positive symptoms, whereas NSS have been linked to negative symptoms, we also examined the role of clinical features.
The study investigated NSS in 25 male cannabis-consuming and 25 male non-consuming schizophrenic patients, using the Neurological Evaluation Scale. Clinical features were studied using SANS and SAPS.
Significant differences emerged after comparison analysis, with more NSS in non-consuming patients. The SANS subscales Alogia and Anhedonia-asociality were also statistically significant in this group of patients.
If non-consuming patients show a higher incidence of both NSS and negative symptoms, which, according to the literature, seem to be associated, then these findings suggest that NSS are relatively independent from cannabis, but not from clinical features.
The present study investigates the Millon Behavior Health Inventory basic coping styles, mental absorption (Tellegen Absorption Scale), sensation seeking (Arnett Inventory of Sensation Seeking, AISS) and affect inhibition (Marlowe-Crowne Social Desirability Scale, MC-SDS), in a group of abstainers from alcohol (n = 55) compared to an age-equivalent group of moderate drinkers (n = 176). The abstainers had significantly higher scores on one of the repressive coping styles (respectful) and significantly lower scores on sociability. There were no differences on the other basic coping styles. The abstainer group had lower AISS scores and higher MC-SDS scores. There were no significant differences between abstainers and drinkers in mental absorption. The results suggest that abstainers from alcohol may have adopted an affect-inhibiting, passive-ambivalent coping style associated with denial of hostility, rigid impulse control and social conformity.
Very few cases exist in the literature of maternal obsessional thoughts of child sexual abuse. Two such cases are described of mothers who experienced obsessional thoughts in the puerperium which concerned sexually abusing their own children. Obsessional thoughts of a sexual nature have been shown to occur commonly--in over 25% of those diagnosed with obsessive-compulsive neuroses. These obsessional thoughts concern actions which are usually identified as going against the sufferer's own value systems or involving sexual perversions. Obsessional thoughts of sexually abusing family members are rarely documented; there are no reports of obsessional thoughts experienced by a mother in the puerperium concerning sexual abuse of her own children. We report two cases of mothers suffering from obsessions of this nature at The Mother and Baby Unit (MBU), Queen Elizabeth Psychiatric Hospital, Birmingham.
Male alcoholic subjects were asked to rate their own typical dysphoric mood states soon after admission for alcohol detoxification and again following 2 weeks of recovery from alcohol abuse. Self-ratings of typical dysphoric mood decreased following 2 weeks of recovery from alcohol abuse while self-ratings of typical impulsive behaviors remained unchanged. Within subjects, the magnitude of change in ratings of typical dysphoric mood during the first 2 weeks of recovery from alcohol abuse correlated highly with the level of typical dysphoric mood measured at the onset of alcohol treatment.
Alcohol and drug abuse is frequent among performers and pop musicians. Many of them hope that alcohol and drugs will enhance their creativity. Scientific studies are scarce and conclusions limited for methodological reasons. Furthermore, extraordinary creativity can hardly be grasped by empirical-statistical methods. Thus, ideographic studies are necessary to learn from extraordinarily creative persons about the relationship of creativity with alcohol and drugs. The pop icon Jim Morrison can serve as an exemplary case to investigate the interrelation between alcohol and drug abuse and creativity.
Morrison's self-assessments in his works and letters as well as the descriptions by others are analyzed under the perspective of creativity research.
In the lyrics of Jim Morrison and in biographical descriptions, we can see how Jim Morrison tried to cope with traumatic events, depressive moods and uncontrolled impulses through creative activities. His talent, skill and motivation to write creatively were independent from taking alcohol and drugs. He used alcohol and drugs to transgress restrictive social norms, to broaden his perceptions and to reinforce his struggle for self-actualization. In short, his motivation to create something new and authentic was reinforced by alcohol and drugs. More important was the influence of a supportive group that enabled Morrison's talents to flourish. However, soon the frequent use of high doses of alcohol and drugs weakened his capacity to realize creative motivation.
Jim Morrison is an exemplary case showing that heavy drinking and the abuse of LSD, mescaline and amphetamines damages the capacity to realize creative motivation. Jim Morrison is typical of creative personalities like Amy Winehouse, Janis Joplin, Brian Jones and Jimmy Hendrix who burn their creativity in early adulthood through alcohol and drugs. We suppose that the sacrificial ritual of their decay offers some benefits for the excited spectators. One of these is the illusion that alcohol and drugs can lead to authenticity and creativity.