The Hillside journal of clinical psychiatry最新文献

The available data supporting a viral or immune mediated etiology of psychiatric disease is indirect and controversial, but there is a sufficient evidence to implicate such a process in a subgroup of the psychiatric population. Recent technological advances in neurovirology and neuroimmunology justify a re-assessment of this etiology in psychiatric disease. The author describes three patients with psychiatric symptomatolgy and cerebrospinal changes compatible with such a process. The evidence supporting a role for viral or immunological factors in the pathogenesis of psychiatric disease is reviewed, and guidelines for future research which could be of use in further clarifying this issue are proposed.

Because of the methodologic differences and limited data, the sensitivity and specificity of the dexamethasone suppression test in children are in question. In our study we used 0.5 mg of dexamethasone and a 4 p.m. cortisol sample to perform the DST on 32 hospitalized prepubertal children diagnosed by a structured interview (DICA) and DSM-III criteria. Cortisols differed significantly by ANOVA among principal diagnoses, with highest values in children with major depression (MDE) or separation anxiety (SAD) and lowest in those with behavior disorders (BD). Using 5.0 micrograms/dl as a cutoff value for positive DST, MDE and SAD are positively and BD negatively associated with positive DST results. Rating scales for anxiety and depression showed no significant association with cortisol level. We conclude that the DST in this sample shows excellent sensitivity but its specificity is limited to distinguishing depressed or anxious children from those with pure behavior disorder.

The role of different variables in the development of tardive dyskinesia was examined among patients in two different diagnostic categories. Age and length of hospitalization were associated with development of tardive dyskinesia in the schizophrenic subjects while parkinsonism and alcoholism were related to tardive dyskinesia in the affective disorder patients. Schizophrenic subjects constituted the largest absolute number of tardive dyskinesia patients, but in relative terms they represented the patient population least likely to develop tardive dyskinesia in comparison to affective disorder and organic mental disorder subjects. The clinical implications of these findings are discussed.

A psychotherapeutic approach to the treatment of depersonalization disorder is presented. The treatment process enables the patient to drop dissociation as a defense against overly vigorous scrutiny of a "self," which is felt to be inadequate when compared to highly demanding standards set by parents. When feelings of worthlessness and helplessness are "transferred" back to original sources of childhood trauma, the patient is then taught how to handle conflict without needing to dissociate from the stress as overpowering and literally depersonalizing the threat.

An analysis of Freud's forgetting of the name Signorelli provides a framework for an explication of some central concepts in Lacan's theory of the unconscious. The parapraxis is viewed as a symptom which is structured like a metaphor. The creation of a symptom during the process of repression produces a gap in conscious discourse. The analysis of such symptoms provides evidence for Lacan's assertion that the unconscious is structured like a language.

Alpha 2-adrenergic receptor function was measured in platelets from chronic schizophrenic patients and normal controls. The number of alpha 2-receptors was greater in patients' platelets, and the prostaglandin E1 (PGE1)-stimulated cyclic AMP (cAMP) production lower, when compared with the normal controls. The changes measured may occur only in the platelet, but if central nervous system neurons share with platelets these changes, one might speculate that an increase in the number of alpha 2-receptors and a decrease in cAMP production may relate to the psychopathology of schizophrenia.

A comprehensive investigation into the social support networks of a group of chronic psychiatric patients attending a Supportive Care Clinic was conducted. The results suggest that these patients, while exhibiting weaker support systems than the general population, do have a significant amount of personal support in addition to that received from the treatment center. Furthermore, they perceive the "support" aspect of the Clinic as the most helpful feature as compared to personal growth or medication. The results of these findings are discussed in terms of their practical utility for the ambulatory care of chronic psychiatric patients.

The authors have presented a description and review of the Capgras Syndrome along with data from a case series of 25 patients with misidentification syndromes (24 Capgras Syndrome, 1 Fregoli Syndrome). From this data, the following conclusions can be drawn: The Capgras Syndrome is not a rare condition, but an uncommon one which is probably frequently overlooked. The misidentification syndrome is not important as a diagnostic entity. It appears in a variety of psychiatric and neurologic conditions. Capgras Syndrome appears to have a possible neurological link in clinicopathological studies; it has been correlated with lesions which produce prosopagnosia. Capgras Syndrome seems to occur more frequently in women, blacks and schizophrenics. Capgras Syndrome had a high (15%) incidence in our adult inpatients diagnosed as having schizophrenia. From this figure we estimate a 0.12% prevalence of Capgras Syndrome in the general population. Capgras Syndrome is often associated with medical illness and when found should signal the alert clinician to investigate for occult organic conditions.

The relationship between early childhood events and DSM III personality disorders was examined in 82 non-psychotic psychiatric outpatients. Early loss of a parent or living in a family where there was overt marital discord was associated with having a greater chance of developing DSM III Cluster B personality disorders (narcissistic, antisocial, borderline, histrionic) as adults. It was also related to an increased number suicide attempts as adults. Those patients who suffered an early loss of a parent through death had a significantly higher percentage of antisocial personality and suicide attempts as adults. Patients who as adults had a DSM III Cluster B personality disorder were significantly less likely than comparison patients to have had an early loss of a parent. This finding of a lower chance of a personality disorder if there were a loss of a parent was also significant for histrionic personality disorder when it was analyzed separately. Some theoretical implications of these findings are discussed.