[Siblings of disabled children].
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Biomedical subjects
Publications and source records attributed to C Epelbaum.
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Since reports have underscored that panic attacks (PA) may be an identifiable state occurring in schizophrenia, we studied the symptomatology of PA in a group of schizophrenic patients. Of 40 patients (21 males and 19 females) attending a clinic for maintenance therapy of schizophrenia, 19 (36.8%) had a lifetime history of PA. Seven among those 19 patients (36.8%) had or had had spontaneous panic attacks, not related to phobic fears or delusional fears, and for the 12 remaining patients, the PA were related to paranoid ideas. Moreover, the paranoid subtype of schizophrenia tends to be more often associated with a history of panic attack than other subtypes of schizophrenia (52.6% vs 23.8%; chi2 = 3.5, P =.06). It seems that there are at least two types of PA in schizophrenic patients. The first one could be independent from the psychotic feature, with no psychopathological link. The second kind of PA could be directly related to a schizophrenic disorder, and found in patients with the paranoid subtype.
Chronic illness can severely disturb the main developmental processes of adolescence. Many adolescents with chronic illness do not enter properly into adolescence ("unconsummated", or on the contrary, too noisy adolescence) and principally give words to their body (self-destructive behaviours, risk behaviour, depressive episodes with body expression). Therapeutic attitudes in helping these adolescents are discussed.
Metaphor comprehension was studied in schizophrenics as compared to psychiatric and nonpsychiatric controls. Subjects were asked in a two-condition forced-choice response task to detect the metaphor similar or contrary to a proverb with an abstract meaning. Schizophrenic patients were impaired in both conditions. However, the paranoid patients' performances did not differ from psychiatric and nonpsychiatric controls. These results are consistent with the hypothesis that the ability of metaphorizing is preserved in some schizophrenic patients.
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Twenty schizophrenic patients and 20 normal subjects matched for age, sex and verbal level were asked to identify, from a list of alternatives, the statement that was the most contradictory to each of 8 proverbs. Schizophrenics (whether severely disturbed or not) were found to be less accurate in detecting the contradictions [F(1,18) = 29.21; p less than 0.0001]. No significant differences between undifferentiated and disorganized DSM-III subtypes were observed. The greatest tolerance of contradictory statements was interpreted in terms of violation of the 'no contradiction principle' and examined in the light of a deficit in logical abilities.
Seventy-three patients successively hospitalized in psychiatry and meeting the criteria of the DSM-III for diagnoses of major depressive episode with or without melancholia (n = 64), dysthymia (n = 5) or adjustment disorder with depressed mood (n = 2) were studied. Of these 73 patients, 50.7% also exhibited, at the time of their hospitalization, panic disorder as defined by the DSM-III criteria (53.4% having exhibited this disorder at some time in their life). Moreover, eight of the 73 patients (11%) exhibited, or had exhibited at some time in their life, a "sub-panic" state characterized by recurring rudimentary attacks, while five of the 73 patients (6.8%) exhibited "permanent panic anxiety" tending to fluctuation rather than paroxysm. These two forms of anxiety raise the question of the limits of panic disorder. The comparison of depressions with and without panic disorder shows an even distribution of endogenous and nonendogenous forms in both groups. Depressions with panic disorder, moreover, registered greater intensity (according to the HDRS score), a higher lever of anxiety (according to the AMDP-AT score), and a higher degree of nervousness (according to the EPI score) than depressions without panic disorder. The study of the chronology of the associations between depressions and panic disorder shows that in more than one-half of the cases these disorders began within one month of each other. In one-third of the cases, panic disorder preceded the depressive episode by more than one month. And finally, in just over 10% of the cases, panic disorder appeared more than one month after the beginning of the depressive episode.
This study, based on a single case experimental design, examined logical reasoning in a schizophrenic meeting the DSM-III criteria. The quantitative assessment carried out by 32 psychiatrists on a rating scale for logical thinking disorders (nine items, six points) of the retranscribed clinical interview showed 1. that the assessments varied in a statistically significant way according to items and psychiatrists, and that these variations were independent of their degree of experience--the correlations between the different items of the rating scale proved to be weak and not significantly different from zero; and 2. the study of the most contradictory statements carried out by a logician using reasoning analysis procedures concluded that there were in fact logical relationships between the subjects the schizophrenic talked about. The results are discussed in relation to the methodology of assessing formal thought in schizophrenia.
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