RESUMEN
Appropriate handling of suicidal tendencies is for certain one of the most important duties within ambulant treatment. As various examples show, occurrence of a suicidal tendency can be chronical as well as acute. Well-known risk factors including current psychopathology and psychodynamics help to identify and assess a suicidal tendency and to take necessary therapeutic options. Some of these can be applied in general, others have to be tailored specifically with respect to the mental disorder in question. Suicide often occurs in an interpersonal context. This fact underlines on one hand the importance and the therapeutic potential of the relationship between the patient and the therapist, on the other hand it results in many cases in a highly stressful situation for the therapist. Significant attention has to be paid to counter transference and its control. Development of an emergency plan and challenges of a "non-suicidal-contract" are discussed. We recommend an agreement with the patient to contact the therapist in case of not feeling able to control his/her own actions. This agreement includes our guarantee of permanent reachability.
Asunto(s)
Atención Ambulatoria/organización & administración , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Manejo de Atención al Paciente/organización & administración , Prevención del Suicidio , Suicidio/psicología , Humanos , Trastornos Mentales/diagnóstico , Ideación Suicida , SuizaRESUMEN
BACKGROUND: The relationship between borderline personality disorder (BPD), bipolar disorder (BD), and attention deficit/hyperactivity disorder (ADHD) requires further elucidation. METHODS: Seventy-four adult psychiatric in- and out-patients, each of them having received one of these diagnoses on clinical assessment, were interviewed and compared in terms of diagnostic overlap, age and sex distribution, comorbid substance, anxiety and eating disorders, and affective temperament. RESULTS: Diagnostic overlap within the three disorders was 54%. Comorbidity patterns and gender ratio did not differ. The disorders showed very similar levels of cyclothymia. LIMITATIONS: Sample size was small and only a limited number of validators were tested. CONCLUSIONS: The similar extent of cyclothymic temperament suggests mood lability as a common denominator of BPD, BD, and ADHD.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno Bipolar/psicología , Trastorno de Personalidad Limítrofe/psicología , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno Bipolar/diagnóstico , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno Ciclotímico/diagnóstico , Trastorno Ciclotímico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Temperamento , Adulto JovenRESUMEN
The survey "Datenerhebung zur Depression in der Allgemeinbevölkerung" was conducted from fall 2010 to spring 2011 on several online platforms. The results show that there is a considerable timespan between the appearance of initial symptoms of depression and the first diagnosis of a patient. Intervention at early stages of the disease can reduce a potentially long time of suffering and can lead to the successful treatment of depression. General practitioners play an important role as the link between patient and psychiatrist.
Asunto(s)
Depresión , Trastorno Depresivo , Médicos Generales , Humanos , Psiquiatría , Encuestas y CuestionariosRESUMEN
OBJECTIVE: We sought to explore the impact of sexual trauma on symptom severity, sense of coherence, and control orientation in female psychiatric inpatients diagnosed with and admitted for non-trauma-related mental disorders. METHODS: A sample of 31 female inpatients with a reported history of sexual trauma (two thirds abused in childhood, one third raped in adulthood) were compared with 31 female inpatients with similar sociodemographic backgrounds, matched for age and psychiatric diagnosis. FINDINGS: Compared with the sexually nontraumatized patients, the patients with a reported history of sexual trauma were neither more symptomatic nor did they have a more severe course of illness. No significant differences were found between the two groups with regard to sense of coherence and control orientation. Patients who had been raped in adulthood rated lower than all other patients in the Meaningfulness subscale of the Sense of Coherence Scale, indicating that their belief that there is good reason to care about what happens has been affected. CONCLUSION: Based on the dimensions assessed, female psychiatric inpatients with a reported history of sexual trauma were not found to be significantly different from female inpatients without such a history. The burden of a mental disorder ensuing from the severity of illness symptoms and illness course is probably so high that the potential impact of a sexual trauma cannot manifest.
Asunto(s)
Abuso Sexual Infantil/psicología , Trastornos Mentales/complicaciones , Violación/psicología , Autoeficacia , Estrés Psicológico/complicaciones , Violencia/psicología , Adulto , Niño , Femenino , Hospitales Psiquiátricos , Humanos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , SuizaRESUMEN
Coping/recovery styles of integration and sealing over, reflecting the patient's dealing with his or her psychotic illness, influence the treatment adherence and, perhaps, the therapy outcome. Knowledge of these styles' potential clinical and personality correlates is so far limited. A semi-structured interview and self-rating questionnaires were used to assess 64 inpatients recovering from an acute episode of a schizophrenia spectrum disorder with regard to the prevailing coping/recovery style, depressive and negative syndromes, global functioning, locus of control and personality characteristics of novelty seeking, harm avoidance, and reward dependence. A significant positive correlation was found between coping/recovery style of sealing over and both negative syndrome and external control (by powerful others) orientation; a significant negative correlation was found between sealing over and good global functioning. The final multivariate model comprised negative syndrome, global functioning and a personality characteristic of reward dependence; together these three variables explained 44% of the coping/recovery style variance. Thus, in patients with disorders in the schizophrenia spectrum, the inclination towards sealing over is positively correlated with the higher degree of the overall severity of psychiatric disturbance and it is closely associated with a negative syndrome. In contrast, both the degree of depression and personality characteristics measured do not seem to play an important role with regard to the prevailing coping/recovery style of integration and sealing over.
Asunto(s)
Adaptación Psicológica , Inventario de Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adulto , Depresión/diagnóstico , Depresión/psicología , Femenino , Hospitalización , Humanos , Control Interno-Externo , Masculino , Modelos Psicológicos , Modelos Estadísticos , Psicometría , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Two types of alcoholism with distinct clinical features and mode of inheritance have been identified in male alcoholics. The relevant studies, however, have given consistent results in men but not in women. The current study tested the hypothesis that the type I and II classification is also valid in women. A sample of 103 hospitalised alcohol-dependent women were given face-to-face structured interviews considering four different classification criteria sets devised for differentiation of alcoholism type I and II and type A and B along with SCID I and II. The two types of classification could be replicated with three of the four criteria sets, 73 women being allocated to the larger cluster C1, and 30 women to a smaller cluster C2. Comparing the patients from both clusters with each other, eight variables were identified which excellently discriminate between the groups. The two types of classification for alcoholism could also be found in a female sample. A type II of female alcohol-dependent patient was identified, characterized by parental alcoholism and paternal and patient's tendency for violent behavior. Type I lacks these characteristics. Early identification of the type II female alcoholic may be clinically important.
Asunto(s)
Alcoholismo/clasificación , Adolescente , Adulto , Anciano , Alcoholismo/genética , Alcoholismo/psicología , Alcoholismo/rehabilitación , Niño , Hijo de Padres Discapacitados/psicología , Comorbilidad , Trastorno Depresivo/clasificación , Trastorno Depresivo/genética , Trastorno Depresivo/psicología , Trastorno Depresivo/rehabilitación , Femenino , Humanos , Entrevista Psicológica , Trastornos Mentales/clasificación , Trastornos Mentales/genética , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Determinación de la Personalidad/estadística & datos numéricos , Psicometría , Factores de Riesgo , Centros de Tratamiento de Abuso de Sustancias , Violencia/psicología , Adulto JovenRESUMEN
Background: The current study explored the relationship between parenting experience in childhood as a specific aspect of the non-shared environment and the amount of psychopathology in adulthood. Sampling and Methods: 27 same-sex sibling pairs were studied. In each pair, one prob and was a psychiatric outpatient, the other prob and a non-patient. All prob ands filled in the Parental Bonding Instrument (PBI) and the Symptom Checklist-90-Revised (SCL-90-R).Results: The patients rated higher on practically all SCL-90-R scales whereas no significant differences were found with regard to the PBI ratings. With only one exception, there were no significant correlations between PBI and SCL-90-R ratings in the group of patients. In contrast, all SCL-90-R subscales correlated negatively with paternal care and half of them positively with paternal control in patients healthy siblings. Conclusions: The degree of paternal care seems to be most closely related with lack of mental symptoms in psychiatric non-patients. In contrast, parenting does not seem to playa substantial role in patients, presenting with a higher degree of psychopathology. Obviously, environmental factors become less important, the more pronounced the pathology (AU)
No disponible
Asunto(s)
Humanos , Padres/psicología , Hermanos/psicología , Psicopatología , Trastornos Mentales/psicologíaRESUMEN
BACKGROUND: The long-term evolution of neuroleptic-induced extrapyramidal syndromes (EPS) of Parkinsonism, akathisia and tardive dyskinesia (TD) is still a controversial issue worth exploring. METHOD: A total of 200 inpatients on regular typical neuroleptics (NL) and/or clozapine were assessed in 1995 with regard to the prevalence of EPS. Altogether, 83 patients could be reassessed in 2003/04 (63 had died) using the same methods. Strict definitions of EPS were used. The complete account of NL therapy the patients were prescribed between 1995 and 2003/04 (including atypical NL other than clozapine) was considered. RESULTS: The prevalences found in 1995 and 2003/04 were 17% and 29% for Parkinsonism, 14% and 14% for akathisia, and 24% and 13% for TD. There were considerable intra-individual fluctuations in EPS occurrence even when the overall prevalence rate remained the same. In intra-individual comparisons of EPS ratings on both assessments, there was a tendency for worsening of Parkinsonism to be associated with a current (2003/04) therapy with typical NL; worsening of akathisia was associated with a current therapy with atypical NL other than clozapine, amelioration of akathisia with a current therapy with clozapine; and, basically, there were no significant associations found between the changes in TD ratings and the long-term therapy with typical NL, clozapine, and other atypical NL, considering cumulative doses of all these drugs. In a multivariate analysis, there was a tendency for the long-term evolution of TD to depend on illness duration as the only variable. CONCLUSIONS: There are intra-individual fluctuations in all EPS over longer time periods. The choice of current NL therapy has an impact on Parkinsonism and akathisia. The long-term evolution of TD appears independent of NL prescriptions.
Asunto(s)
Antipsicóticos/efectos adversos , Enfermedades de los Ganglios Basales/inducido químicamente , Clozapina/efectos adversos , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Adulto , Acatisia Inducida por Medicamentos/epidemiología , Acatisia Inducida por Medicamentos/etiología , Enfermedades de los Ganglios Basales/diagnóstico , Enfermedades de los Ganglios Basales/epidemiología , Discinesias/epidemiología , Discinesias/etiología , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Examen Neurológico , Trastornos Parkinsonianos/inducido químicamente , Trastornos Parkinsonianos/epidemiología , Pacientes Desistentes del Tratamiento , Prevalencia , Trastornos Psicóticos/psicología , Psicología del EsquizofrénicoRESUMEN
Dissociation was one of the roots of the nosopoetic construct "schizophrenia", and a link seems to exist between psychotic and dissociative phenomena. We explored the relationship between dissociation and schizoidia as defined by the Dissociative Experiences Scale (DES) total score and the schizoidia subscale of the Munich Personality Test (MPT), respectively. The study comprised 43 outpatients diagnosed with schizophrenia spectrum disorders in remission, 47 outpatients with personality disorders and 42 non-patients. Besides the DES and the MPT, all participants also completed parts of the Symptom Checklist (SCL-90-R) and theTrauma Questionnaire (TQ). In the final multivariable logistic model, a set of five variables was identified as the strongest contributors to the occurrence of schizoida. The model included TQ broken home, MPT neuroticism, schizophrenia spectrum and personality disorder diagnoses, and SCL aggressivity; it did not include any dissociation variable. The purported relationship between dissociation and schizoidia could not be confirmed; the existence of schizophrenia-inherent dissociation appears questionable.
Asunto(s)
Trastornos Disociativos/epidemiología , Trastorno de Personalidad Esquizoide/epidemiología , Esquizofrenia/epidemiología , Adulto , Diagnóstico Diferencial , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Femenino , Humanos , Masculino , Determinación de la Personalidad , Trastorno de Personalidad Esquizoide/diagnóstico , Trastorno de Personalidad Esquizoide/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.
RESUMEN
BACKGROUND: The main purpose of the study was to investigate whether there are differences between dual patients with affective disorders regarding the different kinds of substances abused - a topic which has hardly been dealt with in the literature. METHODS: Clinical charts of 94 dual and 94 non-dual patients, matched for sex, age, and diagnosis, were scrutinized and the data of both groups compared with each other, with regard to the substance of abuse. RESULTS: A total of 17.4% of all patients with affective disorders were found to be dual patients and the proportion of dual patients was equal among patients with unipolar disorder, bipolar disorder, and dysthymia. Only a few significant differences were found between dual and non-dual patients; more differences were identified when the dual group was divided into patients abusing alcohol (59%), opioids/cocaine (22%), and sedatives/hypnotics (19%). In particular, the group of patients abusing illegal drugs was found to be younger and to show more behavioral pathology. All three groups of dual patients differed regarding the onset of their affective illness. LIMITATIONS: Retrospective study of clinical records. CONCLUSIONS: There are differences between dual patients with affective disorders abusing different substances. The choice of a particular substance of abuse appears to be the function of the age of onset of the disorder.
Asunto(s)
Trastornos del Humor/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Comorbilidad , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Diagnóstico Dual (Psiquiatría) , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno Distímico/diagnóstico , Trastorno Distímico/epidemiología , Trastorno Distímico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/diagnóstico , Trastornos del Humor/psicología , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Objective. To study the frequency, socio-demography and comorbidity of ICD-10 personality disorders (PD), especially of emotionally unstable PD, in psychiatric inpatients. To test the subdivision of emotionally unstable PD in impulsive and borderline subtypes. Methods. Data on all psychiatric hospital stays in the Canton of Zurich in the years 1998-2002, routinely collected at the time of each patient's hospitalization, were analysed. Results. PD was diagnosed in 10.2% of all inpatients, and the proportion of emotionally unstable PD diagnosis was 54.5%. There are considerable differences between impulsive and borderline personality disorders with respect to sex, age, employment status and comorbidity. Conclusion. Emotionally unstable PD is the most frequent PD in clinical settings. Its differentiation into impulsive and borderline subtypes is justified.
RESUMEN
Individuals' use of heroin, cocaine, and alcohol during long-term methadone maintenance treatment (MMT) was studied. Prospectively collected data from 103 heroin-addicted individuals who were consecutively admitted for MMT and remained 2 years in treatment were evaluated. The patients were assessed every 6 months with a standardized interview. Three longitudinal patterns of drug abuse were identified. A proportion of patients abstained fully from their particular drug use (26% from heroin, 39% from cocaine, and 19% from alcohol); a proportion (39%, 32%, and 47%, respectively) switched between periods of abuse and nonuse of these drugs; and chronic drug users (34%, 28%, and 33%, respectively) continued use, including periods of daily abuse throughout MMT. Different therapeutic interventions may be needed in patients with different longitudinal patterns of additional substance use during MMT.
Asunto(s)
Alcoholismo/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Dependencia de Heroína/epidemiología , Metadona/administración & dosificación , Narcóticos/administración & dosificación , Detección de Abuso de Sustancias/estadística & datos numéricos , Adulto , Alcoholismo/rehabilitación , Atención Ambulatoria/estadística & datos numéricos , Trastornos Relacionados con Cocaína/rehabilitación , Estudios Transversales , Femenino , Dependencia de Heroína/rehabilitación , Humanos , Estudios Longitudinales , Masculino , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Prevención Secundaria , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , SuizaRESUMEN
OBJECTIVE: To test the antisuicidal effect of clozapine, taking into consideration some potentially confounding variables. METHOD: A retrospective evaluation was conducted of the clinical charts of 94 inpatients treated continuously with clozapine for at least 6 weeks between 1962 and 1994. In a mirror design, a period of continuous clozapine treatment (mean duration of 15 months) was compared with a pre-clozapine period of equal length, and in 17 patients also with a post-clozapine period, with regard to suicidal behavior. The role of variables such as staying in a protective hospital milieu and receiving treatment with typical neuroleptics and antidepressants was considered. RESULTS: The rate of suicidal behavior was 28% (26/94) in the pre-clozapine period, 3% (3/94) in the clozapine period, and 18% (3/17) in the post-clozapine period, the corresponding figures for serious suicidal behavior requiring medical attention being 12% (11/94), 1% (1/94), and 12% (2/17), respectively. The odds ratios were 11.6 (95% CI = 3.4 to 39.9) and 12.3 (95% CI = 1.6 to 97.5) for suicidal and serious suicidal behavior, respectively, in favor of the clozapine period in comparison with the pre-clozapine period. Staying in the hospital was associated with reduction in suicidal behavior. The antisuicidal effect of clozapine possibly disappears at doses that are too low. CONCLUSION: Clozapine diminishes the frequency of suicidal behavior including serious suicidal acts, regardless of comedication with antidepressants. In the protective hospital milieu, this effect is less pronounced, and it disappears after clozapine discontinuation.
Asunto(s)
Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Prevención del Suicidio , Adulto , Causas de Muerte , Factores de Confusión Epidemiológicos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Hospitalización , Humanos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos , Suicidio/psicología , Suicidio/estadística & datos numéricos , Suiza/epidemiologíaRESUMEN
We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologies.
Asunto(s)
Abuso Sexual Infantil/estadística & datos numéricos , Violencia Doméstica/estadística & datos numéricos , Familia/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Adulto , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/epidemiología , Niño , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Humanos , Masculino , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y CuestionariosRESUMEN
Violent and criminal behavior in the mentally ill remains an issue of major importance and in this context the role of comorbid substance abuse must be addressed. Data on criminal behavior in 282 men with schizophrenia and 261 men with affective disorder were studied. Samples of patients with and without additional substance abuse were compared. Also, non-abusing patients from both diagnostic groups were compared with matched controls from the general population. Substance abuse was found in half of all men in both groups of major mental disorders, and substance abusers had twice as high a probability of having a criminal record. However, compared with the matched sample from the general population, violent criminality was increased in schizophrenic patients without comorbid substance abuse, and patients with affective disorders without substance abuse had a higher probability of committing crimes against property. Men with major mental disorder have an increased probability of becoming criminal even when there is no comorbid substance abuse.
Asunto(s)
Alcoholismo/epidemiología , Crimen/estadística & datos numéricos , Trastornos del Humor/epidemiología , Esquizofrenia/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Alcoholismo/psicología , Comorbilidad , Crimen/psicología , Humanos , Funciones de Verosimilitud , Masculino , Persona de Mediana Edad , Trastornos del Humor/psicología , Probabilidad , Valores de Referencia , Riesgo , Psicología del Esquizofrénico , Trastornos Relacionados con Sustancias/psicología , Violencia/psicología , Violencia/estadística & datos numéricosRESUMEN
OBJECTIVE: We tested the purported complex relationships between alexithymia and somatization, depression, borderline pathology and general health. METHODS: A total of 139 medical students and 84 members of nursing personnel completed questionnaires. RESULTS: Thirteen (6%) alexithymic participants indicated more depression and borderline pathology and worse mental health. Path analysis confirmed a significant positive effect of borderline pathology and a significant negative effect of mental health on alexithymia but did not reveal any effects of somatization and depression. CONCLUSION: Presence of borderline pathology may indicate higher probability of alexithymia.
Asunto(s)
Síntomas Afectivos/psicología , Depresión/psicología , Trastornos Somatomorfos/psicología , Adulto , Estudios Transversales , Femenino , Estado de Salud , Humanos , MasculinoRESUMEN
A dissociative taxon has been proposed by Waller et al. (1996) to help identify individuals experiencing pathological dissociation. We studied the frequency of taxon membership and tested its validity. A total of 276 students and 204 psychiatric inpatients completed the Dissociative Experiences Scale (DES). In patients with higher DES ratings, the Dissociative Disorders Interview Schedule was administered. Taxon classification applied to 2.9% of non-patients and to 12.7% of patients. No statistically significant relationship was found between taxon membership and the clinical diagnosis of a dissociative disorder. Taxon membership indicates a higher frequency of dissociative experiences but cannot be equated with the presence of a dissociative disorder.
Asunto(s)
Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Terminología como Asunto , Adulto , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The influential 1972 study by Manfred Bleuler on the long-term course of schizophrenic illness has been reconsidered. The authors tested the diagnosis of schizophrenia in all patients and investigated how the distribution of the types of illness course and outcome would change after exclusion of patients whose diagnosis of schizophrenia could not be confirmed by modern diagnostic standards. METHOD: Clinical charts and Bleuler's research notes on the original sample were assessed, and all patients were rediagnosed with the help of DSM-IV, DSM-III-R, ICD-10, the Research Diagnostic Criteria (RDC), Schneider's criteria, and an operationalized version of the criteria of Eugen Bleuler. RESULTS: The diagnosis of schizophrenia was not confirmed in about 30% of the sample; the majority of these patients were rediagnosed with schizoaffective disorder. High diagnostic agreement was found between DSM-IV, DSM-III-R, ICD-10, and RDC; there was much less agreement with Bleuler's and Schneider's criteria. After exclusion of patients whose schizophrenia diagnosis was not confirmed, the proportion of patients with undulating course and recovery slightly decreased, and the proportion of patients with severe end state slightly increased. Nevertheless, the distribution of the types of long-term course did not significantly change, and even among patients with strictly defined schizophrenia, half had an undulating course with remissions and 12%-15% recovered. CONCLUSIONS: Schizophrenic illness remains heterogeneous with regard to illness course and outcome even when narrowly diagnosed with the help of modern operationalized diagnostic criteria. Contemporary differentiation between schizophrenic and schizoaffective disorders is prognostically valid.
Asunto(s)
Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adolescente , Adulto , Anciano , Diagnóstico Diferencial , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Readmisión del Paciente , Pronóstico , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/clasificación , Trastornos Psicóticos/psicología , Trastornos Psicóticos/rehabilitación , Estudios Retrospectivos , Esquizofrenia/clasificación , Esquizofrenia/rehabilitaciónRESUMEN
Two case reports of ecstasy abuse and its serious neuropsychiatric complications are presented. The first patient developed a florid paranoid psychosis resembling schizophrenia after repeated long-term recreational ecstasy abuse, and significant alterations with intermittent paroxysmal discharges were found in his electroencephalogram. The second patient showed an atypical paranoid psychosis with Fregoli syndrome and a series of complex-partial epileptic seizures with secondary generalization after a first single ecstasy dose. Both subjects presented considerable vulnerability; the first a minimal brain dysfunction after perinatal asphyxia and a persisting attention deficit/hyperactivity disorder, the second a long-lasting opioid addiction. In vulnerable individuals, dose-independent ecstasy abuse can lead to unpredictable and potentially dangerous neuropsychiatric sequelae which require proper initial assessment and adequate treatment.