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PubMed1977

Psychological effects of mastectomy on a woman's feminine self-concept.

Previous literature on mastectomy indicates that the operation may be perceived by the patient as a threat to her feminity. Accordingly, the present study attempted to measure changes in body image, self-concept, and total self-image in mastectomy patients and two control groups (biopsy and surgical controls). Patients were given a questionnaire measuring the concepts in question three times: 1 day before surgery; 6 days after surgery; and 6 to 11 months later. There were distinctly different patterns of results for the three groups. Mastectomy patients did indeed evince a decline in body image and total self-image, but not until months after surgery. This was not unexpected in light of previous findings of massive denial in mastectomy patients. Immediately after surgery, this denial would be at its strongest, and it is feasible that it would take some months of reality testing until the denial is no longer a necessary defense. Biopsy patients showed a decline in body image and total self-image immediately after surgery, when their denial was no longer needed. Surgical control patients showed little overall change. Thus, mastectomy patients do appear to react to the operation with a decline in self-image, although this does not appear until some time after the operation.

Adult↗

PubMed1975

The concepts: Disturbed state of consciousness and psychosis.

A theoretical analysis is made of the two concepts: "disturbed state of consciousness" (DSC) and "psychosis", and these concepts are defined in ways which are consistent with actual clinical psychiatric work on the Continent. Concerning DSC's two points are emphasized: Whether we, as psychiatrists, are conscious of it or not--one of our premisses for classifying a state as a pathological DSC is an evaluation of the client's ability to change the state voluntarily. Furthermore, stating that a DSC was present in the time interval tl0tn implies stating that all experiences were abnormal in some way during the interval--when the word "experience" is taken in the broad sense, including William James' "fringe" and "embeddedness" in the stream of consciousness. Reality testing may remain the cardinal point in the definition of "psychosis"--if we make the distinction between theoretical, "fullblown", syndromes and concrete syndromes with fewer symptoms clear to ourselves.

Alcoholic Intoxication↗

PubMed1978

Diagnosis of schizophrenic borderline states.

The aim of this paper is to contribute to the clinical description of the group of schizophrenic borderline patients. In the first place important clinical features pointed out in older, basic papers will be restated. Secondly, additional observations, not used in clinical practice before, at least not explicitly, are described, data which are believed to be useful for the diagnosis of the states in question as well as for the differential diagnosis from other conditions, neuroses in particular. In the latter regard the following points are considered to be of outstanding importance: the presence or absence of a primary gain; the presence or absence of strivings to obtain an emotional secondary gain; the nature of the interpersonal relationship; the composition of the single symptoms. Pseudonormal, pseudoneurotic and pseudopsychopathic states are characterized. Micro-psychotic and overt psychotic states are described. Clinical differences from schizophrenic psychosis as observed in patients in the nuclear group of the schizophrenias are pointed out.

Adult↗

PubMed1990

The ego competency model of psychiatric nursing: theoretical overview and clinical application.

The Ego Competency Model (ECM) of Psychiatric Nursing provides a focus for the role and function of the psychiatric nurse. The ECM offers a framework for assessing the patient's level of functioning in terms of certain ego strengths and deficits. Emphasizing a balanced health/illness focus, the model identifies three major goals of psychiatric nursing. The ECM scale allows nurses to rate the client on specific ego functions in order to address patient care problems arising from deficits in ego functioning. Ego functions that are systematically assessed with the ECM include impulse control, reality testing, judgment, mood, object relations, activities of daily living, competency, self-perception, thought process, and stimulus barrier.

Ego↗

PubMed1990

On the measurement of delusions.

Garety (1985) analysed problems with existing definitions of delusions, focusing on the fixity and intensity of delusional beliefs. A quantitative method was proposed to evaluate with greater sensitivity the intensity of delusional conviction and its fixity over time. In this comment, three related points are raised about Garety's analysis and measure. None of the three challenges the fundamental usefulness or value of the measure, although potential problems are noted in the items used to check test-retest reliability and in the wording of one of the two forms described.

Awareness↗

PubMed1975

Platelet monoamine oxidase activity in acute schizophrenia.

The authors found normal monoamine oxidase (MAO) activity in 40 acute schizophrenic patients, in contrast to previous reports of a genetically linked platelet MAO deficit in chronic schizophrenia. Variations in MAO activity were not significantly associated with the 65 clinical variables analyzed, although there was a tendency for patients in the low-MAO group to have more severely impaired reality testing, more paranoid and grandiose delusions, better prognostic scores, and less restlessness.

Adult↗

PubMed1979

Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders.

In a pilot study of 150 manic or depressive patients, the authors used the Research Diagnostic Criteria (RDC) and the Schedule for Affective Disorders and schizophrenia (SADS) to perform preliminary analysis of symptom pictures of the index episode of different diagnostic groups, joint diagnostic classification of the different subtypes of major depressive disorder, and differential outcome by diagnostic groups. The results suggest that schizophrenic symptoms in affective disorders do have diagnostic and prognostic significance, that the term "psychotic depression" should be limited to impaired reality testing without reference to degree of incapacitation, that situational-nonsituational and endogenous-nonendogenous classifications are separate depressive subtypes, and that it may not be true that patients with endogenous major depressive disorder have a better prognosis than patients with nonendogenous depression.

Adjustment Disorders↗

PubMed1976

Combining activities and group psychotherapy in the treatment of chronic schizophrenics.

The author reviews literature relating to the use of activities in the treatment of chronic schizophrenia, citing several programs that combined activities and psychotherapy to produce effective modes of treatment. He also describes a program in which he used collage-making to help a group of schizophrenic women improve interpersonal relationships, reality-testing, and self-image as well as to help them express problems and develop feelings of autonomy. The author believes that such combined programs help meet the basic needs of schizophrenic patients and alleviate their tendencies to withdraw from their surroundings.

Art Therapy↗

PubMed1979

Psychodiagnosis and psychoanalytic psychotherapy.

Patients with conditions in the intermediate range of severity often show adequate capacity to test reality but poor ego integration. To many, a modified psychoanalytic method is often applied. These patients are not easily classified within the standard nomenclature. The term "borderline" has been applied, in an illdefined manner at first; more recently, Kernberg has outlined, in more precise terms, the characteristics of this group from a psychostructural viewpoint. Genetic factors are important in this group also: a family history positive for mental illness is frequently noted. Amenability to analytic therapy is also related to the characterologic subtype, which carries prognostic implications as well. A multidimensional diagnostic approach is therefore crucial in this range of patients. A triaxial model is proposed and described, stressing (a) traditional diagnosis from the standpoint of genetic predisposition, (b) psychostructural diagnosis, and (c) characterological subtype. This method may help resolve confusion about diagnosis in the borderline realm and may lead to more accurate selection of treatment strategy.

Bipolar Disorder↗

PubMed1991

Perceived risk and sources of information regarding cocaine.

A study was made of the perceptions of risk and of the sources of information about risk regarding cocaine. Subjects were adult (N = 90) and juvenile (N = 20) cocaine abusers in seven Baltimore area treatment programs. Using structured interview, it was found that 87.8% of adults and 80.0% of youth had experienced at least one negative consequence of their cocaine use, other than addiction, prior to entry into treatment. The most common negative experience reported by both groups was the loss of reality testing. Moreover, 86.6% of adults and 65.0% of youth reported becoming addicted to cocaine before entering treatment. While juveniles sampled had entered treatment within a year of first cocaine use, adults entered treatment 7.9 years after first use and reported an average of 6.6 years of cocaine use before experiencing the first negative consequences. Television received consistently high ratings as an accessible and credible source of information about cocaine. Adolescents rated schools relatively high on the amount and accuracy of cocaine-related information provided.

Adolescent↗

PubMed1976

Psychotherapeutic intervention with the addict-client.

In order for the nurse therapist to be most effective with the narcotic-addicted client, she should be aware that his behavioral style many times reflects dependence, low self-esteem, and impaired reality testing. The major defense mechanisms used by the client are denial, projection, and manipulation. An attitude of hopeful expectancy on the part of the nurse is most important therapeutically in the treatment of the addict. Some therapeutic interpersonal interventions between the nurse and client are contracting, goal-setting, limit-setting, and the sharing of the responsibility for growth between the client and the nurse. The total treatment program for the client must also be scrutinized, and more than physiologic detoxification and one-to-one therapy must be provided in order for the client to have the maximum opportunity for change.

Defense Mechanisms↗

PubMed1975

[Symptom-centered group therapy for phobias--the problem-oriented workshop in psychotherapy].

Short term psychotherapy is increasingly recognized as a socioeconomic necessity. Problem-oriented treatments, particularly if applied in problem-homogenous groups, are one means of economizing and sometimes even improving psychotherapy. They also require a re-evaluation of the nature of the patient-therapist dyad. The "task-oriented small group" as a basic field of human interaction has been studied intensively in experimental social psychology. Nevertheless, group psychotherapy and behavior therapy have largely neglected group-specific aspects of such variables as cohesion, task-orientation, modelling, mutual self-help, risk-taking, motivation and insight. This paper outlines some recent changes in this respect, and discusses in particular the "symptomoriented peer workshop" as a treatment milieu. The general therapeutic potential of the peer workshop is briefly assessed with regard to the application of the above mentioned group variables in peer self-help groups, rehabilitation programs for the chronically hospitalized, symptom or depth-treatment in short-term psychotherapy, and in re-education programs for problem-children. The main concern is with its specific application to the treatment of phobias. Phobias are comparatively easy to define, yet are often connected with other personality problems. This has made them a model-problem in the arguments about symptom-substitution between "psycho"- and "behavior" -therapists, and it has stimulated discussion as to how behavior-focused treatments affect cognition and emotion, and to what extend depth and insight-oriented therapies change behavior. The interaction between treated and non-treated problems, and the behavioral, cognitive and emotional effects of differential treatment ingredients are discussed with special reference to the first controlled study in behavior therapy, that applied behavior-focussed confrontation with reality (flooding in vivo) under the sociodynamics of the small gsoup. Problem-focussed retraining under real-life conditions (reality testing) as group-therapeutic fieldwork can be a means of treatment in its own right may open up the patient for subsequent attempts to tackle more complex problems, or may just be an adjuvant in a multi-level approach. This certainly applies for phobias and can probably be generalized to other problems.

Agoraphobia↗

PubMed1976

Transference regression and real experience in the psychoanalytic process.

At the patient's level of reality testing and integration in the transference neurosis, the analyst serves as an effective parent who halpd the 'child' master various danger situations. This results in the patients relearning and development as the analyst provides new experiences for the regressive childhood components of the patient's personality. There is also a sequential or simultaneous cognitive element which is important in the ultimate development of mastery and is particularly useful in the process of working through. This cognitive element, however, cannot be effectively used until there have been repeated new and real experiences for the fixated and/or regressive components of the patient's personality.

Affective Symptoms↗

PubMed1992

Some superego conflicts in the analyst who has suffered a catastrophic illness.

This paper, originally part of a panel (in a somewhat different form) on life stresses of the analyst, focuses on some of the superego conflicts of the analyst who has suffered a catastrophic illness. The interplay between ego and superego functioning is examined, particularly in reference to how superego conflicts cause the ego to become subordinated to drive-related aims and to superego demands from which it would ordinarily have more autonomous distance. Some of the issues which are conflictual for analysts who have suffered a catastrophic illness and which have a tendency to be played-out in the treatment include: problems of self-esteem regulation; regressive alteration of identifications; reinstinctualization of identifications and of object relations; alterations in the ego-ideal; disruptions of other narcissistic regulatory processes; and the above mentioned subordination of ego functions, especially in regard to its synthetic, reality testing, and other autonomous capacities. Examples are presented of how these conflicts may be dynamically operative in unconsciousness, how they may enter into consciousness, and how they might be expressed in the treatment.

Aggression↗

PubMed1991

The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.

Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗

PubMed1990

[Primary and secondary process thinking in normal probands, neurotic and borderline patients].

In the present paper normals, neurotics and borderline patients were compared with respect to primary and secondary process thinking. The Holtzman Inkblot Technique was used to assess the different modes of functioning. As it was expected, normals had more indicators of the most severe levels of primary process thinking than neurotics, but less than borderline patients. On the other hand it could be demonstrated that in normals the reality testing ability and synthetic functioning were not impaired compared to neurotics. In the contrary, the normals exceeded the neurotics concerning indicators of abstractive abilities. The results are discussed with regard to the hypothesis of a continuum of normal and deviant thinking and with regard to the concept of adaptive regression in the service of the ego.

Borderline Personality Disorder↗

PubMed1987

[Narcissistic disorders in the light of modern psychoanalysis].

Whereas psychoanalysis in its beginnings was based preponderantly on drive-theory, later on attention was paid essentially on ego-psychology and in the last years on self-psychology. This development is seen in the context of developments in society, especially of the fact of an increasing outer direction of man in the modern world with the danger linked with it of loss of ego and of self. The designed development may be understood as a reactive one. After an overview on the different concepts of the self it is defined as the narcissism which gives to the instances ego, id and super-ego as well as to the body the feeling and the impression, to be an individual capable for feeling and cognitive processes, forming an entity which is experienced continuously and in its continuity. Two different narcissistic disturbances are described: Narcissistic neuroses (= narcissistic personality disorders in the sense of Kohut) with a consistent ego, but a lack in self-representation because of deficiency experiences in early childhood, Borderline-conditions with a severe ego-pathology and, as a consequence of it, rigid defense-mechanisms, extreme fusion tendencies and projective identification, splitting etc. The development of normal narcissism is discussed. At the end the slightly modified psychoanalytic technique in the treatment of patients with narcissistic neuroses and the analytically oriented expressive psychotherapy of borderline-patients which is directed on reality testing is described.

Borderline Personality Disorder↗

PubMed1988

[Differential experience of anxiety conditions: a contribution to the diagnosis and pathogenesis of anxiety attacks. A case report].

By means of a case report about a depressive female patient suffering from clusters of attacks of various psychosomatic disorders associated with anxiety states of different degrees problems of diagnostic classification are discussed with regard to the DSM-III. The subjective experiences of anxiety during the various episodes of the patient's disease are described. A phenomenological difference between fear of death with preserved relation to reality on the one hand and "calamity anxiety" with a short-lasting breakdown of reality testing on the other hand is indicated. The neurobiological model of noradrenergic dysregulation is taken on trial to understand the various phenomenons of the disease.

Adult↗