Two distinct styles of recovery from a schizophrenic episode, namely, integration and sealing over, have been described in a number of clinical reports. This investigation focused on differences in the defensive organization of the two styles; specifically, that integrators possess a less primitive constellation of defensive organizations (less dominated by denial, negation, and repression). These results are discussed in relation to psychodynamic theory and their implications for the treatment process.
{"title":"Defensive constellation and styles of recovery from schizophrenic episodes.","authors":"E J D'Angelo, H M Wolowitz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Two distinct styles of recovery from a schizophrenic episode, namely, integration and sealing over, have been described in a number of clinical reports. This investigation focused on differences in the defensive organization of the two styles; specifically, that integrators possess a less primitive constellation of defensive organizations (less dominated by denial, negation, and repression). These results are discussed in relation to psychodynamic theory and their implications for the treatment process.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14863838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Restless leg syndrome is a frequently misdiagnosed and often misunderstood condition contributing to a complaint of insomnia in geriatric patients. Various pharmacologic agents used to treat the condition are often ineffective and have not consistently provided relief for the majority of patients with this condition. Our recent experience with Xanax suggests its possible effectiveness in controlling symptoms of the restless leg syndrome. Further, more controlled double blind studies--especially comparing other benzodiazepines at appropriate dosages--are called for.
{"title":"Possible efficacy of alprazolam in restless leg syndrome.","authors":"M B Scharf, L Brown, J Hirschowitz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Restless leg syndrome is a frequently misdiagnosed and often misunderstood condition contributing to a complaint of insomnia in geriatric patients. Various pharmacologic agents used to treat the condition are often ineffective and have not consistently provided relief for the majority of patients with this condition. Our recent experience with Xanax suggests its possible effectiveness in controlling symptoms of the restless leg syndrome. Further, more controlled double blind studies--especially comparing other benzodiazepines at appropriate dosages--are called for.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14679200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members.
{"title":"Core criteria for diagnosing borderline patients.","authors":"H G Nurnberg, A Feldman, S W Hurt, R Suh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14680142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One context for understanding an adolescent's (or any other individual's) abnormal functioning is an appreciation of normal or modal functioning in the culture to which that adolescent belongs. After decades of research and clinical observation there is no consensus about what constitutes modal adolescent functioning in the United States. Much less is known about adolescent functioning in other cultures. Results were suggestive of large, cross-cultural differences in self-image among normal adolescents. In most areas American teenagers reported the best functioning while Bengali teenagers reported the worst. There were consistent gender differences in self-image across cultures, with adolescent girls showing poorer self-image than adolescent boys in many areas. Results are discussed from the point of view of difficulties in doing cross-cultural psychiatric research and the need for further research in this field.
{"title":"Cross-cultural studies of sex differences in normal adolescents' self-image.","authors":"E Ostrov, D Offer, K I Howard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One context for understanding an adolescent's (or any other individual's) abnormal functioning is an appreciation of normal or modal functioning in the culture to which that adolescent belongs. After decades of research and clinical observation there is no consensus about what constitutes modal adolescent functioning in the United States. Much less is known about adolescent functioning in other cultures. Results were suggestive of large, cross-cultural differences in self-image among normal adolescents. In most areas American teenagers reported the best functioning while Bengali teenagers reported the worst. There were consistent gender differences in self-image across cultures, with adolescent girls showing poorer self-image than adolescent boys in many areas. Results are discussed from the point of view of difficulties in doing cross-cultural psychiatric research and the need for further research in this field.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14680148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changes in hospital psychiatry: implications for the future or whatever happened to the concept of asylum?","authors":"C J Rabiner","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14862827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M B Scharf, R Kauffman, L Brown, J J Segal, J Hirschowitz
The effects of triazolam on immediate and delayed recall were evaluated in a double-blind placebo controlled study in 22 normal volunteers. Subjects were randomized to receive triazolam or a placebo as a single dose administered at bedtime. Immediate and delayed recall are tested using a modified version of the "Williams Word Memory Task" before and at .5, 8, and 14 hours after drug administration. Delayed recall was evaluated at the 14 hour time point for words recalled at the pre drug and 1/2 and 8 hour time points. No significant difference was noted between the triazolam and placebo group with regard to their immediate recall ability at any of the time points. The placebo group demonstrated no decrease in their delayed recall ability during any of the various post drug time points. However, when evaluating delayed recall in the triazolam group, a statistically significant (p less than .05) decrease compared to baseline in their recall ability of words remembered at the .5 and 8 hour time points was noted. This study suggests that triazolam's amnestic effect may extend beyond the duration of its generally accepted hypnotic efficacy. This is consistent with the hypothesis that amnestic potency among the benzodiazepines is related to benzodiazepine receptor binding affinity and lipophilicity.
{"title":"Morning amnestic effects of triazolam.","authors":"M B Scharf, R Kauffman, L Brown, J J Segal, J Hirschowitz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The effects of triazolam on immediate and delayed recall were evaluated in a double-blind placebo controlled study in 22 normal volunteers. Subjects were randomized to receive triazolam or a placebo as a single dose administered at bedtime. Immediate and delayed recall are tested using a modified version of the \"Williams Word Memory Task\" before and at .5, 8, and 14 hours after drug administration. Delayed recall was evaluated at the 14 hour time point for words recalled at the pre drug and 1/2 and 8 hour time points. No significant difference was noted between the triazolam and placebo group with regard to their immediate recall ability at any of the time points. The placebo group demonstrated no decrease in their delayed recall ability during any of the various post drug time points. However, when evaluating delayed recall in the triazolam group, a statistically significant (p less than .05) decrease compared to baseline in their recall ability of words remembered at the .5 and 8 hour time points was noted. This study suggests that triazolam's amnestic effect may extend beyond the duration of its generally accepted hypnotic efficacy. This is consistent with the hypothesis that amnestic potency among the benzodiazepines is related to benzodiazepine receptor binding affinity and lipophilicity.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14863840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Other studies have reported the use of TCA antidepressants in the treatment of depressed children (Frommer 1967; Ossofsky 1974; Stack 1972; Polvan and Cebiroglu 1972). However, these studies did not meet criteria for inclusion in this review. In studies, other medicines were given concurrently with TCAs. Several did not specify the number of subjects and/or the number who responded. Sometimes subjects who were not diagnosed as depressed were included. Also studies of childhood depression tend to include adolescents; thus many samples were a mixture of adolescents and prepubertal children with the adolescents frequently predominating. As the purpose of this review was depression in prepubertal children, only studies comprised predominantly of prepubertal children were included. Although not included in this review, many such studies reported TCAs were useful in treating depression in children. After reviewing these studies, it is obvious that their sophistication has improved dramatically in recent years. Standard diagnostic criteria such as Feighner's Research Diagnostic Criteria, the Research Diagnostic Criteria, and more recently DSM-III (all of which are similar) have permitted a more objective and standardized diagnosis of depression. Likewise, the development of the Children's Depression Inventory and the Childhood Depression Rating Scale have allowed more objective measurement of severity of depression and of improvement in depression in children. Plasma drug level monitoring has allowed for pharmacokinetic studies of TCAs, more precise dose adjustment and equivalent drug treatment of subjects involved in clinical research studies. Studies to date indicate TCAs were helpful in treating depressed prepubertal children. However, double-blind placebo/control studies of tricyclic antidepressants in depressed prepubertal school-aged children have not been published. Ideally a study of antidepressants in children should include: objective standardized diagnostic criteria for diagnosing depression; objective rating of severity of depression; explicit exclusion criteria; steady-state plasma blood level monitoring; assured compliance; adequate duration of treatment so sufficient time is allowed for response to occur; a double-blind study design. Unfortunately the ideal study has not been done. TCAs may be an effective treatment for prepubertal major depressive disorder. However, further study is necessary to clearly establish their efficacy.
其他研究报道了使用TCA抗抑郁药治疗抑郁症儿童(Frommer 1967;Ossofsky 1974;堆栈1972;Polvan and Cebiroglu 1972)。然而,这些研究不符合纳入本综述的标准。在研究中,其他药物与TCAs同时给予。有几个没有具体说明受试者的数量和/或回应的人数。有时没有被诊断为抑郁症的研究对象也被包括在内。此外,对儿童抑郁症的研究往往包括青少年;因此,许多样本是青少年和青春期前儿童的混合物,青少年往往占主导地位。由于本综述的目的是针对青春期前儿童的抑郁症,因此仅包括主要由青春期前儿童组成的研究。虽然没有包括在本综述中,但许多此类研究报道了TCAs对治疗儿童抑郁症有用。回顾这些研究后,很明显,近年来它们的复杂性有了显著提高。标准的诊断标准,如Feighner的研究诊断标准,研究诊断标准,以及最近的DSM-III(所有这些都是相似的)已经允许对抑郁症进行更客观和标准化的诊断。同样,《儿童抑郁量表》和《儿童抑郁评定量表》的发展使得对儿童抑郁的严重程度和抑郁的改善有了更客观的衡量。血浆药物水平监测使TCAs的药代动力学研究、更精确的剂量调整和临床研究受试者的等效药物治疗成为可能。迄今为止的研究表明,TCAs对治疗青春期前儿童抑郁症有帮助。然而,三环类抗抑郁药在青春期前学龄抑郁儿童中的双盲安慰剂/对照研究尚未发表。理想情况下,儿童抗抑郁药物的研究应包括:诊断抑郁症的客观标准化诊断标准;抑郁严重程度客观评定;明确的排除标准;稳态血浆血药浓度监测;保证合规;适当的治疗时间,以便有足够的时间产生反应;双盲研究设计。不幸的是,理想的研究还没有完成。TCAs可能是治疗青春期前重度抑郁症的有效方法。然而,需要进一步的研究来明确其有效性。
{"title":"Tricyclic antidepressants in prepubertal depressed children: review of the literature.","authors":"R A Weller, E B Weller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Other studies have reported the use of TCA antidepressants in the treatment of depressed children (Frommer 1967; Ossofsky 1974; Stack 1972; Polvan and Cebiroglu 1972). However, these studies did not meet criteria for inclusion in this review. In studies, other medicines were given concurrently with TCAs. Several did not specify the number of subjects and/or the number who responded. Sometimes subjects who were not diagnosed as depressed were included. Also studies of childhood depression tend to include adolescents; thus many samples were a mixture of adolescents and prepubertal children with the adolescents frequently predominating. As the purpose of this review was depression in prepubertal children, only studies comprised predominantly of prepubertal children were included. Although not included in this review, many such studies reported TCAs were useful in treating depression in children. After reviewing these studies, it is obvious that their sophistication has improved dramatically in recent years. Standard diagnostic criteria such as Feighner's Research Diagnostic Criteria, the Research Diagnostic Criteria, and more recently DSM-III (all of which are similar) have permitted a more objective and standardized diagnosis of depression. Likewise, the development of the Children's Depression Inventory and the Childhood Depression Rating Scale have allowed more objective measurement of severity of depression and of improvement in depression in children. Plasma drug level monitoring has allowed for pharmacokinetic studies of TCAs, more precise dose adjustment and equivalent drug treatment of subjects involved in clinical research studies. Studies to date indicate TCAs were helpful in treating depressed prepubertal children. However, double-blind placebo/control studies of tricyclic antidepressants in depressed prepubertal school-aged children have not been published. Ideally a study of antidepressants in children should include: objective standardized diagnostic criteria for diagnosing depression; objective rating of severity of depression; explicit exclusion criteria; steady-state plasma blood level monitoring; assured compliance; adequate duration of treatment so sufficient time is allowed for response to occur; a double-blind study design. Unfortunately the ideal study has not been done. TCAs may be an effective treatment for prepubertal major depressive disorder. However, further study is necessary to clearly establish their efficacy.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14650802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although symptoms of major depression are the same in adults and prepubertal children, diagnosing depression in children presents special problems not encountered with adults. In addition to the standard clinical interview, methods of assessing childhood depression include diagnostic interviews, self-report inventories, projective tests, peer ratings, and biological markers. Unfortunately many of these methods currently lack detailed reliability and validity studies. Despite their limitations these techniques can be helpful in making a diagnosis. However, accurate diagnosis still requires careful evaluation and individualized clinical judgement.
{"title":"Assessing depression in prepubertal children.","authors":"E B Weller, R A Weller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although symptoms of major depression are the same in adults and prepubertal children, diagnosing depression in children presents special problems not encountered with adults. In addition to the standard clinical interview, methods of assessing childhood depression include diagnostic interviews, self-report inventories, projective tests, peer ratings, and biological markers. Unfortunately many of these methods currently lack detailed reliability and validity studies. Despite their limitations these techniques can be helpful in making a diagnosis. However, accurate diagnosis still requires careful evaluation and individualized clinical judgement.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14671814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The author reports a case of factitious rape in a psychiatric inpatient. To his knowledge, this is the first case report of this syndrome in the medical literature. This case is related to the signs and symptoms commonly found in Munchausen Syndrome. The question of the relationship of factitious rape to borderline personality disorder and to disturbed sexual identity is raised. Physicians are urged to develop an index of suspicion for factitious disorder.
{"title":"Factitious rape: a case report.","authors":"H H Dohn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The author reports a case of factitious rape in a psychiatric inpatient. To his knowledge, this is the first case report of this syndrome in the medical literature. This case is related to the signs and symptoms commonly found in Munchausen Syndrome. The question of the relationship of factitious rape to borderline personality disorder and to disturbed sexual identity is raised. Physicians are urged to develop an index of suspicion for factitious disorder.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14679201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Handling of the hospitalized borderline patient's request for disability compensation reflects the therapists's success or failure in keeping a sustained focus on splitting. This focus is crucial to the subacute hospital treatment of borderline psychopathology. Overprotectiveness or withholding of appropriate support results from countertransference reactions. Splitting is reinforced rather than minimized if the therapist fails to focus both on the damaged and overwhelmed aspect of the personality (how the patient feels) and on the irresponsible and manipulative aspect (what the patient does). The therapist who fails to respond to the disparate aspects in an integrated way risks acting out key aspects of the clinical picture to the detriment of successful subacute hospital treatment. The therapist's awareness of typical patterns of splitting can be enhanced by considering the patient's developmental history; current familial and vocational relations (or lack of them); and the patient's relation to the hospital staff.
{"title":"Right on the money: disability forms and the hospitalized borderline patient.","authors":"M R Lansky, A Rudnick","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Handling of the hospitalized borderline patient's request for disability compensation reflects the therapists's success or failure in keeping a sustained focus on splitting. This focus is crucial to the subacute hospital treatment of borderline psychopathology. Overprotectiveness or withholding of appropriate support results from countertransference reactions. Splitting is reinforced rather than minimized if the therapist fails to focus both on the damaged and overwhelmed aspect of the personality (how the patient feels) and on the irresponsible and manipulative aspect (what the patient does). The therapist who fails to respond to the disparate aspects in an integrated way risks acting out key aspects of the clinical picture to the detriment of successful subacute hospital treatment. The therapist's awareness of typical patterns of splitting can be enhanced by considering the patient's developmental history; current familial and vocational relations (or lack of them); and the patient's relation to the hospital staff.</p>","PeriodicalId":77808,"journal":{"name":"The Hillside journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14680143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}