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J P Docherty

Publications and source records attributed to J P Docherty.

14 recordsLinked to original sources
PubMed1979

Predicting drug-free improvement in schizophrenic psychosis.

In a sample of 22 psychotic schizophrenic patients, eight improved substantially during a 30-day drug-free period. The drug-free improver group differed from the nonimprover group in demonstrating a later age of onset, briefer psychotic episodes, shorter hospitalizations, and better prognostic scores on the Phillips Scale, Strauss-Carpenter Modified Prognostic Scale, and the Vaillant Scale. After drug withdrawal, drug-free improvers frequently demonstrated further improvement when treated with doses of neuroleptic drugs that were substantially lower than the clinically recommended doses. The authors raise the question as to whether the drug-free improvers may represent a subgroup of schizophrenic patients who are being overtreated presently by standard neuroleptic practice.

Adolescent↗
PubMed1979

Subtypes of schizophrenia: descriptive models.

Descriptive approaches to subtyping schizophrenia use symptoms, signs, and functioning characteristics as diagnostic criteria. Such approaches often appear superficially to be obvious, simple, and atheoretical; in reality, however, there are many ways in which descriptive data can be selected and organized to subtype patients. This report describes these various approaches. Selection of diagnostic criteria can focus primarily either on cross-sectional or longitudinal characteristics of patients. Alternative ways of organizing descriptive data include typological and dimensional approaches and two increasingly common complex models, multiaxial and hierarchical subtyping. Examples and implications of these alternative approaches are described, and methods for choosing among them are suggested.

Cross-Sectional Studies↗
PubMed1979

Psychological factors in the prognosis of malignant melanoma: a prospective study.

Sixty-four patients with Stage I or II malignant melanoma who were apparently disease free rated the amount of adjustment needed to cope with their illness on a scale of 1 to 100. The resultant figure was called the melanoma adjustment score. Twenty-nine patients who relapsed within 1 year of surgery reported a score of 53 +/- 31 (mean +/- SD); 35 nonrelapsers reported a score of 80 +/- 20, p less than 0.001. Based upon analysis of indivual melanoma adjustment scores in the first 31 patients, we predicted that subjects scoring greater or equal to 65 would stay in remission, whereas those scoring greater than 65 would relapse. Applying this prospectively to the next 33 patients we correctly identified 25 of 33 outcomes (76%), p less than 0.03. This psychological variable was independent of known biological prognostic factors, which did not predict 1 year survival. The melanoma adjustment score was also independent of the number of positive lymph nodes, which did correlate with outcome in these patients. The results suggest a role for psychological factors in the one year prognosis of this malignancy.

Adolescent↗
PubMed1979

Intrapsychic structural effects of psychiatric research.

The authors observed that many psychotic patients on a clinical/research ward incorporated various aspects of research organization into their own evolving intrapsychic structures. This process had either beneficial or deleterious clinical effects, depending on the attributes of the research and the specific mental functions to which these attributes became attached. The observations resulted in the development of a set of recommendations for maximizing the therapeutic usefulness of this phenomenon and minimizing its countertherapeutic drawbacks.

Adaptation, Psychological↗
PubMed1978

Use of antidepressant drugs in schizophrenia.

This review surveys the therapeutic efficacy of tricyclic antidepressants and monoamine oxidase inhibitors in schizophrenic patients. In general, the use of these drugs alone was found not to be warranted in schizophrenia, except perhaps in the so-called pseudoneurotic subgroup. In most cases, combinations of antidepressants and phenothiazines were not more beneficial than phenothiazines alone. In particular, the conditions of agitated patients and patients with histories of social deviance dating back to childhood were often made worse by the addition of an antidepressant. However, when the patients who demonstrated symptoms of clinical depression other than anergia were isolated from several of these studies, it was found that they constituted a subgroup that was often benefited by use of these combinations. Favorable and unfavorable clinical response patterns are discussed, and recommendations for future research are outlined.

Adolescent↗
PubMed1978

Stages of onset of schizophrenic psychosis.

On the basis of a review of the literature describing the process of schizophrenic illness, the authors conclude that schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding consisting of the sequential appearance of hierarchically ordered, distinguishable, and recognizable psychological states. They present on illustrative case history of a patient who was able to describe her feelings during the process of decompensation to schizophrenic psychosis and two case histories of patients whose decompensations were rated according to the authors' State of Illness Rating Scale.

Acute Disease↗
PubMed1977

Psychotherapy and pharmacotherapy: conceptual lenses.

Of the many difficulties in maintaining an integration of psychotherapeutic and pharmacotherapeutic treatment, one of the most important is "the problem of bimodal relatedness", that is, the distinction between relating to the patient as a diseased organ or object of study and as a disturbed person. The authors identify the forces that act to inappropriately emphasize one mode or the other and discuss major difficulties that arise because of failure to maintain a bimodal relatedness. In a setting of combined therapy, maintaining and safeguarding the optimal relationship of collaborative subject-subject relatedness can prevent the emergence of problem destructive to effective psychiatric treatment and research.

Adult↗
PubMed1976

Integrative and sealing-over recoveries from schizophrenia: distinguishing case studies.

The types of recovery from an acute schizophrenic break are manifold: one patient "returns" to reality and walks away as if untouched; another despairs for months about "losing control" of himself; still another finds his reentrance into the world less attractive than his psychotic exit. Each "copes" with his psychosis uniquely, both during and after the acute regression. Nevertheless, from observing and treating several acutely psychotic and recovered schizophrenics on a National Institute of Mental Health clinical research unit, we have noted that individual recovery styles tend to cluster around one of two distinct types--integrative or sealing-over. Broadly defined, the sealing-over patient prefers not to think about his psychotic experience during recovery, the integrator, by contrast, is interested in the psychotic experience and desires to place it into some coherent perspective. Specific behavioral definitions and dynamic considerations of these concepts have been presented elsewhere (McGlashan et al., 1975; Levy et al., 1975). As recovery "styles," we are talking about dichotomies, such as expansion versus constriction and flexibility versus rigidity of controls over consciousness, which in turn determine the range of feelings, thoughts, and actions that a person permits himself and is reasonably comfortable with. This paper illustrates and further delineates these recovery styles with specific cases of two young women who each experienced a first psychotic break and were treated on our clinical research unit. Though but two of many acute schizophrenics admitted to our unit, these patients demonstrated clinical courses most representative of each recovery style and provided rich material for a greater understanding of the dynamics of integration and sealing-over.

Acute Disease↗
PubMed1976

A new concept and finding in morbid jealousy.

The authors describe an unexpected coincidental finding in three couples who sought therapy because the husband was pathologically jealous. In the course of treatment they found that during early adolescence each of these men had witnessed his mother engaged in extramarital sexual activity. The authors discuss the implications of this finding for further understanding of the etiology of the syndrome of pathological jealousy, its transactional dimensions, and possible psychotherapeutic approaches. They also present a typology of morbid jealousy that consists of excessive obsessional-delusional, and ego dysfunctional forms.

Adult↗
PubMed1975

A context analysis of psychological states prior to petit mal EEF paroxysms.

This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during nonparoxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally silences than during the patient's speech (for two of the three patients)--talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.

Adolescent↗