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PubMedDate not supplied

Transferences as differential diagnostic tools in psychoanalysis.

A discussion of "Clinical Application of the Concept of a Cohesive Sense of Self," by Joseph Lichtenberg, M.D. Clinical phenomena, symptoms and specific "events" such as fragmentation are not reliable differential diagnostic tools in psychoanalysis and psychoanalytic psychotherapy. Rather it is suggested that this purpose can be better served by the proper diagnosis of the developing cohesive transferences in the course of the psychoanalytic treatment process. The discovery of the selfobject transferences (the various forms of mirror and the idealizing transference) has broadened the scope of analyzable conditions. The recognition of these transferences which arise in relation to the reactivation of infantile narcissistic structures (the grandiose-exhibitionistic self and the idealized parent imago), are helpful in delineating patients with primary self-pathology from the neuroses on the one end and the borderline and psychotic conditions on the other end of the broad spectrum of psychological disorders. It is important to recognize the presence of cohesive transference in order to make a clinically meaningful diagnosis. This is demonstrated with the help of the clinical vignette presented by Lichtenberg. Mr. T is described as suffering from a narcissistic personality disorder--or what we would prefer to call primary self-pathology.

Adult↗
PubMed1981

Primary non-endogenous depression and features attributed to reactive depression.

Primary non-endogenous depression was examined with respect to preceding life stress and instability of personality. A sample of 146 hospitalized patients suffering from primary endogenous depression, primary non-endogenous depression or depression secondary to a neurosis was interviewed for preceding personal loss and completed the Eysenck Personality Inventory after recovery. Presence of a preceding personal loss did not discriminate between the three types of depression. Only in personality patterns did primary non-endogenous depressives show features that have been attributed to reactive depression. The primary non-endogenous depressives were significantly more introverted and neurotic than the endogenous depressives, but had lower neuroticism scores than patients with depression secondary to neuroses. Two-thirds of all depressives were found to dissimulate on the Lie scale. Depressives secondary to neuroses showed significantly lower Lie scores than primary endogenous and non-endogenous depressives. High Lie scores were interpreted as expressions of denial or conformity.

Adjustment Disorders↗
PubMed2006

Demand for psychiatric emergency services and immigration. Findings in a Spanish hospital during the year 2003.

BACKGROUND: The aim of this study is to investigate differences among immigrants and natives regarding access and pathways to psychiatric care, psychiatric admission rates, length of stay, continuity of care, and main diagnoses. METHODS: Psychiatric emergency visits (1511) and hospitalizations (410) were registered in a Spanish Hospital with a catchment area of 280 000 people (19.3% immigrants) during the year 2003. Motives for demanding emergency psychiatric care, pathways to care, admission rates, length of stay, continuity of care, and main diagnoses were compared among natives and immigrants. RESULTS: Immigrants accounted for 13.0% of consultations to the psychiatric emergency room (15.9% of patients) and 11.0% of admissions to the psychiatric hospitalization unit (13.5% of patients). The pathways to care were different for immigrants and natives. Immigrants had a lower rate of readmission to the psychiatric emergency room. Motives for consultation and hospitalization were also different among immigrants and natives. Immigrants showed more self-aggressive behaviours and neuroses, and lower rates of affective disorders and psychoses. CONCLUSIONS: Immigrants under-used psychiatric emergency and hospitalization services in comparison with natives. They did not consult because of psychoses or affective disorders, but mainly because of reactive conditions related to the stress of migration.

Adult↗
PubMed1986

[Neurophysiologic analysis of disorders of the functional activity of projection systems of the brain in patients with neuroses].

To study the neurophysiological mechanisms of neurasthenia, hysterical neurosis and obsession neurosis with a view to the practical employment of the results, the authors examined 100 patients and 40 normal subjects using the method of evoked potentials (EP). EP changes indicated an neurasthenia-related decrease in the functional activity of the cortex, weakening of its inhibitive functions and an increase in the reactivity of the system of negative-emotional support. Patients with hysterical neurosis displayed the greatest excitability of the structures of the projective pathways and insufficiency of programme-integrating effects of the higher portions of the brain. Neurosis of obsessive states was characterized by an increase in the activity of specific cortical zones and, to a larger degree, of the centres of negative-emotional reactivity. The time-course of EP during treatment is outlined. The findings obtained may serve as additional criteria in the diagnosis and treatment of neurosis.

Adult↗
PubMed1992

[Tactile-symbiotic relationship as the earliest step of child development].

Whereas Sigmund Freud considered the orality to be the beginning of the child development, in the last two decades the tactile-symbiotic mother-child-relationship came into the center of scientific attention. The symbiotic-narcissistic basal relationship of early childhood is reactivated in each later object relation. On this basis all active ego performances are built up, as e.g. the projective identification (archaic form), the identification, the transference (in psychotherapy), the regression etc. as well as the delimination from the object. The next level of the object relation is that of the free decision for or against an object. People with narcissistic personality disorders (narcissistic neuroses), having a constituent ego, and borderline personality disorders which occur in individuals with a fragmentation-prone ego, have suffered in their early childhood under deficiency experiences or the experiences of overprotection or of an attention under conditions. The more the individuals were disturbed also in their ego functions, the more an incapacity of the infant has to be supposed to experience or to admit the attention really presented to it. In major depressions the narcissistic emptiness or depletion seems to be at least partially the consequence of a genetic predisposition.

Adult↗
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↗
PubMed1971

Symptom evaluation and treatment selection in the latency-aged child.

Most latency children referred to the non-psychiatric physician with behaviour disorders do not suffer from classical neuroses, brain syndrome, retardation or psychoses. In evaluating the significance of disturbance two questions must be answered. I. Does the child have significant symptoms? This requires assessment of parental objectivity, knowledge of normal development, familiarity with developmental tasks of the period and ability to draw conclusions from observations of the child. II. How disturbed is the child? Here the basic questions are: 1. To what extent are the difficulties reactive to current stress rather than internalized? 2. How serious are the symptoms themselves? Criteria for answering these questions are provided. Comments are made on history-taking and a guide to the clinical examination is presented, together with findings indicating whether the disturbance is mild or serious. Principles for rational intervention are discussed and various treatment options are examined. Methods relatively economical of the physician's time are indicated unless clear reasons for more intensive treatment are present. If very definite improvement has not taken place within six months, psychiatric consultation should be sought.

Child↗
PubMed1986

Sexual development and life of psychiatric female patients.

Using a structured interview and four questionnaires we examined the sexual development and life in the following groups of psychiatric female patients: 51 with schizophrenia, 50 with manic-depressive psychoses, 50 with neuroses, 30 with hysterical psychopathic personality, and 20 with anorexia nervosa. The results were compared with a control group of 101 gynecological spa patients. The sexual development of the schizophrenic patients was found to be retarded, whereas that of the patients with anorexia nervosa accelerated in the initial stages. The sexual development of patients with hysterical personality was found to be disharmonious. No differences were found between patients with manic-depressive psychoses and the control group as far as the sex life in adulthood is concerned. However, all the other groups of psychiatric patients showed decreased sexual activity and/or reactivity. Sexual dysfunctions in the female psychiatric population are frequent, especially with schizophrenic patients, females with anorexia nervosa, and with hysterical personality. The etiological factors responsible for these sex disturbances are different in the individual groups of psychiatric patients.

Adult↗
PubMed1983

[Betamed in the treatment of psychogenic disorders with a somatic component].

52 patients with acute neurotic anxious and psychosomatic syndromes or chronic anxious and vegetative neuroses were treated orally with the combination drug Betamed (1 tablet contain 60 mg bupranolol and 2.5 mg diazepam). The optimum daily dosage are 2 to 3 tablets; duration of treatment ranged from 2 to 12 weeks. The most responsive target symptoms are psychogenic disorders of the cardiovascular system, anxiety and insomnia, while no antidepressive effect was observed. Clinical improvement is often observed 2 to 3 weeks after the onset of treatment, and dosage reduction is possible frequently. Rarely observed side effects are minimal and mainly occur within one week after onset of treatment. Controls performed 2 to 4 weeks after discontinuation of treatment revealed reactivation of symptoms only in some patients with chronic anxiety and vegetative syndromes. In addition to the easy application and excellent tolerance of the combination drug emphasis is given on the minimal danger of drug dependence.

Adolescent↗
PubMedDate not supplied

[Individual features of rat behavior and limbic structures of the brain].

Bilateral ablation of the frontal parts of the neocortex and the hippocampus enhances the rats' reactivity to artificial stimuli (light and sound), and at the same time diminishes their sensitivity to signals of defensive excitation in another individual. Simultaneous bilateral ablation of the frontal neocortex, the lateral and ventromedial hypothalamus enhances in equal measure the rat reactivity to light, sound and the partner's pain cry. Comparison of the results with facts previously obtained and with published data suggests that individual correlations of the "information system" (the frontal neocortex and the hippocampus) with the "motivational system" (the amygdala and hypothalamus) underlie the extra-introversy parameter. Correlation between the "frontal neocortex--hypothalamus" and "hippocampus--amygdala" systems is manifested on the neuroticism (emotionality) scale. Activity of the "hypothalamus--hippocampus" system is of great importance for the lability versus inertia factor. The different forms of disturbance of normal interaction of the above four brain structures are likely to determine the basic varieties of neuroses.

Acoustic Stimulation↗
PubMed1982

Computerized tomography studies on schizophrenic diseases.

Earlier clinical pneumoencephalographic studies showed a subgroup of schizophrenics that have small and dysplastic cerebral ventricles as well as a subgroup with a "pure defect", i.e., a slight internal brain atrophy. In echoencephalograms of pure and mixed residual schizophrenic syndrome patients, a significantly higher average transverse diameter of the third ventricle was demonstrated compared to that in patients with complete remissions. Correlations cannot be expected between certain groups of disease, e.g., epilepsy, multiple sclerosis, or schizophrenia on the whole, and pneumoencephalographic (PEG) and CT findings. Only schizophrenics with distinct signs of pure defect that had persisted for at least 3 years revealed deviations from normal by CT and PEG, but those with irreversible fixed deformations of personality structure ("Strukturverformungen" [9,10]) did not. In patients who were 50 years of age or less with psychic reactive and psychopathic personality disorders, CT showed an average third ventricle diameter of 4.2 mm (range 2-6 mm). Of 117 schizophrenics (average age 35.5 years), only 28% revealed pathological CT changes. However, of 36 schizophrenics with pure residual syndromes 69% showed pathological CT findings that always concerned the third ventricle, rarely the lateral ventricles, and in no case the cortex. The average transverse diameter of the third ventricle in this subgroup with pure defect was 7.6 mm, as compared to 4.6 mm in the subgroup of schizophrenics with complete remission. There was no increase in size with increasing years until the 50th year in schizophrenics, as well as in the control group of variations of psychic being (neuroses and psychopathic personality disorders).

Adolescent↗
PubMedDate not supplied

[Anorexia nervosa - thoughts on psychogenesis and psychotherapy].

In this work I tried to classify Anorexia nervosa into two groups, the central group and the reactive group. The central group contains four different subgroups, the immature, the schizoid, the hysterical and the compulsive type. In the first two subgroups the lack of appetite appears primarily at the onset of the disease, and the fear of growing up plays an important role. In the latter two subgroups the lack of appetite comes later on the basis of a conscious or subconscious suppression of the appetite; here prevails a wish to be slender and the disturbance of the aesthetic value orientation. The basis of this syndrome lies in the interpersonal constellation in the family during the childhood. In tests and interviews of the parents of 20 patients was proved, that the fathers have weak and immature character structures, show little interest in the family, they are hypochondriacl, undecisive and not self-confident. On the contrary the mothers are more normative and they endeavour to accept or compensate some parts of the father-role. In the course of these excessive efforts they lose their motherhood and become secondarily dominating grumbling persons. By the lack of the normal father-daugher-relationship, the maturation of sexuality and feminity is disturbed. The method of psychotherapy of those ambivalent, unmotivated patients with ego-splitting is different from that of other neuroses in many points, such as activity, flexibility and educational control on the part of the therapist instead of the psychoanalytic neutrality. In such cases therapists should not be reluctant to act as an object of identification for these patients.

Anorexia Nervosa↗
PubMed1963

EMOTIONAL REACTIONS TO DISFIGUREMENT FROM CANCER THERAPY.

Disfigurement not only produces current anxieties but reactivates childhood conflicts. The emotional reaction depends upon the disturbance to the patient's major adaptations to life as well as the meaning of the organ to the patient. Fear of isolation and rejection by others may be more terrifying than fear of death. Emotional reactions include regression with marked dependency, anxiety, depression, hostility and, if severe, paranoid states, hypochondriasis, denial, counterphobic behaviour, obsessive-compulsive reactions and schizophrenic reactions. Management basically involves early establishment of a positive doctor-patient relationship. In such a relationship the physican should educate his patient, undercut guilt, accept transient regression and expression of anger, set limits on counterphobic behaviour, either support or gently question denial of reality, and support, without being overly sympathetic, a depressed patient. The nurse, social worker, psychiatrist and the patient's family may be valuable members of the therapy team. Disfigurements of various body areas pose individual problems of management.

Amputation, Surgical↗