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PubMed2004

Potential benefits of quetiapine in the treatment of substance dependence disorders.

OBJECTIVE: Some antipsychotic medications prescribed for the treatment of psychoses, mood disorders or post-traumatic stress disorder in patients with coexisting substance dependence disorders (SDD) have reduced substance dependence. We studied the potential benefits of quetiapine in the treatment of SDD. METHODS: We conducted a retrospective chart review of data for 9 patients who were admitted to a 28-day residential rehabilitation program designed for individuals with SDD during a 3-month period from January 2003 through March 2003 and treated with quetiapine for nonpsychotic anxiety. These patients also met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for alcohol, cocaine and/or methamphetamine dependence and substance-induced anxiety disorder. The patients were assessed using the Hamilton-D Rating Scale for Depression (Ham-D), a 10-point Likert scale to measure alcohol or drug cravings, and random Breathalyzer and urine drug screens. RESULTS: Quetiapine was generally well tolerated. Only 1 of the 9 patients stopped taking the medication because of increased anxiety. Other patients reported improvement in sleep and anxiety. The mean decrease in Ham-D score at discharge for the responders was 18.5 (p < 0.005). The biggest decreases on the Ham-D occurred on the subscales of insomnia, agitation, somatic anxiety, psychologic anxiety, hypochondriasis and obsessional symptoms. The mean decrease in the Likert 10-point craving scale was 5.9 for the responders (p < 0.005). These patients' periodic Breathalyzer and urine test results suggested that they remained abstinent from alcohol and other drug use. CONCLUSION: Quetiapine was beneficial in the treatment of SDD in patients with nonpsychotic anxiety.

Adult↗
PubMed1991

[Clinical characteristics of depression in women in forensic- psychiatric practice].

A study has been carried out of the post-delivery and involutional depressive states through an analysis of 121 case reports of women with psychogenic depressions, who had committed severe crimes and were under the stationary forensic psychiatric investigation at the Serbsky All-Union Research Institute for General and Forensic Psychiatry. The data have shown that during the post-delivery and involutional periods and under some objectively hard and subjectively valuable psychogenic traumatic conditions, women may develop depressive psychoses which are accompanied by pathologically altruistic motivations for socially dangerous actions that are usually directed towards children, grandchildren and close relatives. The neurosis-like phase in the development of such states was discovered, promoting prevention of crimes in the described population of patients.

Adult↗
PubMed1996

International health and psychiatry.

OBJECTIVE: To abstract and evaluate data on psychiatric illness and health care in Canada from a recent major World Bank/World Health Organization (WHO) publication. METHOD: A review of the publication and related material provides a picture of the level of disability produced by neuropsychiatric disorders. Changing patterns of life expectancy in developing countries, and some social factors associated with prevention are extracted. RESULTS: Psychiatric disorders account for 15% of disability and premature death in developed countries. A surprisingly small percentage is accounted for by psychoses, and more than expected by post-traumatic stress disorders. Violence against women is highlighted as a risk factor for psychiatric disorders. Objectives for health care systems - improving outcomes, reaching the disadvantaged and containing costs - are detailed. CONCLUSIONS: Although little formal attention is given to psychiatric disorders, there is a wealth of information about the extent of disability produced by neuropsychiatric disorders, and future directions of health care systems.

Adolescent↗
PubMed2006

[Post-traumatic psychosis: the contribution of an acute post-immediate trauma to a dynamic theorization].

SUMMARY: In his recent publication (2004), in which he favors the psycho-dynamic approach, M. Bertrand underlines the importance of traumatic matter at the heart of new clinical, methodological and epistemological challenges of psychopathology. TRAUMATIC PSYCHOSIS CONCEPT: Our contribution ("post-traumatic psychosis") comes within that prospect in reference to the semiology of traumas generated by extreme situations, such as the tsunami in South Asia (December 2004), the terrorist attacks in Madrid (March 2004) or the hostage taking in North Ossetia (September 2004). Four principle sets of themes lead us to suggest a traumatic psychosis when the person shows symptoms of a neurotic psychic structure: 1. There's no traumatic representation or psychic inscription of the event. Sideration (and its stupor-like confusion symptoms) or panic flight (together with hallucinations or acute delirious fits) often illustrate this first clinical aspect. 2. According to the psychodynamic frame of reference, psychic processes tend to ignore the pleasure/displeasure principle. They are governed by the "invasion" of affects of pain and compulsion to repeat. 3. The models of neurosis and psychic conflict are not efficient in the management of the "quota of affect" and the drive influence. 4. It would be necessary to add, from a psychopathological point of view, the appearance of temporary fits of mental confusion, self-destructive and autolysis behavior. CLINICAL FEATURES: The frame of reference of a DSM IV type "descriptive" psychopathology (ie acute Stress Disorder) seems to de inadequate to convey the implemented post traumatic stakes. If trying to soothe the symptoms is undeniably important, psychic disorganizations that generate a semiology that is essentially present in the symptomatology of the psychoses cannot be ignored. A first clinical approach makes it possible to specify the argumentation of our proposal: "a post-traumatic psychosis". It is supported by five main syndromic classes: 1) the symptoms are often more or less temporary delirious fits (delirious ideas or perceptions of a persecutory, cenesthetic or hypochondriac nature), mental confusion (oneiroid state, anxiety and stupor), phases of depersonalization and derealization, severe death pangs, serious physical disorders, divides close to schizophrenic-type dual personalities; 2) the adhesiveness marks the impossibility for the victims to keep away from a trauma. The objects are bound, persecuting and adhesive; 3) traumatic temporality imposes a factual and current omnipresence of the trauma. It destroys the temporal projections of the patient as well as an anamnesic reconstruction; 4) the "traumatic body" is not that of hysterical neurosis conversions. The somatic semiology marks operational-type functioning (P. Marty); 5) traumatic compliance doesn't work on the level of facilitations that lead to the formation of symptoms. The identity structure appears disorganized by the dismantling of the primary psychic envelopments. PSYCHOPATHOLOGICAL ASPECTS: A second theoretical approach makes it possible to promote this immediate psychotic-type post-traumatic psychopathology. Four considerations of fundamental psychopathology support our contribution: 1) Pictogramic inscription. The severe traumatism does not produce the polarity required for the process of "self-fathering" described by P. Aulagnier in connecting with original processes. Traumatic adhesiveness does not separate the victim from the trauma. It splits the necessary mediation spaces and distance for the emergence of representation processes. 2) Pain affect. The pain affect generated recalls the first experiences of the newborn, primitive agony and anaclitical collapse; the "narcissistic contract" is broken and the patient lives without a secure base or a sufficiently good and supporting psychic container (D.W. Winnicott). 3) Anxiety status. The anxiety is not of neurotic nature but truly annihilating. It is often similar to anxieties caused by disasters, psychoses due melancholy (H. Ey) or more "archaic" anxieties that have been observed in hebephrenic pathologies. 4) Body dismantling. The trauma results in "mute somatizations that cannot be symbolized" (M. Bertrand). They appear in sensory outward signs such as dermatosis, pruritus, diarrhea, hemorrhagic periods or persistent headaches for example. These two clinical and theoretical aspects of the severe forms of trauma confirm the unconscious traumatolytic aim of the victim's psychological destruction. The semiological forms most impervious to therapeutic processes seem to be, in reference to hostage-takings or terrorists acts, those where the patient was conformed with a trauma "that was not carried out" like mock hangings or executions. Suicidal dimension seems to be the ultimate recourse so as not to sink into insanity and to keep a subjective position when faced with barbarian figures.

Affect↗
PubMed1994

The validity of the Scandinavian concept of reactive psychoses.

The historical background of the Scandinavian concept of reactive psychoses is presented. The reactivity concept consists of several elements. There has to be a traumatic life event of psychological or somatic nature but its duration can be discussed. What is the time lag between the life event and the psychotic reaction? Some say one week, others up to one year. Is a personal disposition (vulnerability) a necessary condition for the psychotic reaction? Are emotional turmoil or non-organic confusion specific symptoms of the reactive psychotic reaction? Does the psychotic reaction have a meaning as an escape or a defense? What is the duration of the psychosis in relation to the duration of the life event? Does reactive psychoses always imply full recovery (good outcome)? The various editions of the ICD- and the DSM-classification include some of these features in their definition of reactive psychoses. Scandinavian experts also emphasize various aspects in their descriptions of these psychoses. Studies have shown that reactive psychoses can be diagnosed reliably. Work on the operatinalization of "reactivity" is under way. In the Scandinavian tradition there is a diagnostic shift from reactive psychoses to schizophrenia in later admissions. Generally, the reactive psychoses have a good outcome, and the outcome is significantly better than for schizophrenia and as good as for manic-depressive psychoses. Most cases of reactive psychoses are treated with neuroleptic drugs for some months. Electroconvulsive treatment is rarely given for reactive psychoses. Scandinavian psychiatrists think that DSM-IV and ICD-10 have not taken the concept of reactive psychoses seriously, and that research work has to be done to convince international psychiatry of the value of the concept.

Humans↗
PubMed1997

Cognitive effects of antipsychotic agents in persons with traumatic brain injury.

Over 1 million survivors of traumatic brain injury receive maintenance pharmacotherapy, of which a substantial number receive antipsychotic agents for the treatment of psychoses, agitation and aggression, and other maladaptive behaviours. In spite of the common clinical uses of antipsychotics, the cognitive risks versus benefits are unclear. The purpose of this study was to assess differences in cognitive functioning before, during, and after discontinuation of antipsychotic agents in inpatients undergoing rehabilitation for traumatic brain injury. Neuropsychiatric tests (Reys Auditory-Verbal Learning, Trail Making A&B, Digit Span Forwards and Backward) evaluating cognitive skills of verbal ability, visuomotor speed, memory, learning, attention, and spatial ability were administered to each subject at baseline (immediately prior to tapering or discontinuing antipsychotic), when taper reached 50% of baseline dose, 1 week after antipsychotic discontinuation, and 3 weeks after discontinuation. These data suggest that select areas of cognition improve after antipsychotic discontinuation in subjects with traumatic brain injury. The magnitude of improvement appeared to be greater after discontinuation with thioridazine, a low-potency agent, compared to haloperidol, a high-potency agent. Results, although very preliminary, support the hypothesis of cholinergic involvement in regulating cognitive processes, and this underscores the need for more systematic research in this area.

Adult↗
PubMed1979

[Cerebral seizures, alcoholism, and deliria (author's transl)].

The occurrence of cerebral seizures in alcoholics was investigated in case histories of 84 delirious and nondelirious male patients. Eighteen patients had seizures before they became alcoholics; the frequency of the seizures increased during abuse. Twelve had no deliria at all up to the moment of this investigation; in 66 of the patients the occurrence of seizures was assumed to be caused by alcohol abuse alone. Seventy-one patients had seizures irrespective of deliria and nearly 40% of them had no deliria at all. In 21% we observed only deliria with seizures; in 16% only deliria without seizures; and 24% had deliria both with and without seizures. The remaining 13 patients of 84 had only deliria complicated by cerebral seizures; only 3 had deliria without seizures. The seizures occurred as grand mal in 94% of the alcoholics, in all patients with genuine epilepsy, and in 60% of the patients with post-traumatic epilepsy.

Adult↗
PubMed1975

A study of genetic factors, childhood bereavement, and premorbid personality traits in patients with anancastic endogenous depression.

From a sample of 1,005 patients admitted to the State Hospital in Aarhus for the first time during the period 1950-1959 and who had been diagnosed as suffering from manic-depressive psychosis or endogenous depression (affective psychoses), a subsample of 104 manic-depressive aptients with anancastic symptoms in the history were selected. The 104 probands were individually matched with 104 non-anancastic probands with affective psychoses. The anancastic probands and the controls who were still living were seen personally at the follow-up. Information concerning the psychiatric history of 945 first degree relatives of the anancastic probands and 1,000 first degree relatives of the controls were obtained. During the search for factors which could be used to distinguish affective psychoses with anancastic symptoms from affective psychoses without these traits, a positive correlation was found between the presence of anancasma and the following factors: (a) premorbid obsessive personality traits; (b) traumatic environmental factors in childhood; (c) a tendency to monopolarity; (d) a preponderance of monopolar depressions in the family; (e) the presence of secondary cases of anancastic endogenous depression. The findings are compatible with a theory which attributes a pathoplastic effect to the obsessive personality giving rise to anancastic symptomatology in the form of affective psychoses which tend to a unipolar course.

Affective Symptoms↗