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PubMed2004

A preliminary study identifying risk factors in drop-out from a prison therapeutic community.

Three different groups of therapy leavers and current residents (total n = 80) from Dovegate Prison's Therapeutic Community (TC) were compared on various demographic, criminogenic and psychometric attributes. Statistically significant findings distinguished the leaver groups from current residents and differentiated between type of leavers. Those leavers judged as unsuitable for therapy were characterised by high scores of Psychopathy, Neuroticism, Criminality, Addiction, Venturesomeness, and Avoidant and Schizoid Personality Disorders. Those leavers who had elected to leave the TC were more likely to have a sexual index offence, significant scores on the Multiphasic Sex Inventory, and Paranoid and Depressive Personality Disorders. Logistic Regression analysis confirmed that particular personality disorders were predictive of therapy leaver group membership. Paranoid Personality Disorder was identified as a predictor of all types of drop-out. These findings provide a psychological profile of the different types of residents who have left a prison therapeutic community and can be used to support and inform selection and assessment practices.

Adult↗
PubMed2006

Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study.

BACKGROUND: The 'odd' or 'Cluster A' personality disorders (PDs) - paranoid, schizoid and schizotypal PDs - were created in DSM-III with little empirical foundation. We have examined the relationship between the genetic and environmental risk factors for dimensional representations of these three personality disorders. METHOD: These personality disorders were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV) in 1386 young adult twin pairs from the Norwegian Institute of Public Health Twin Panel. Using Mx, a single-factor independent pathway twin model was fitted to the number of endorsed criteria for the three disorders. RESULTS: The best-fit model included genetic and unique environmental common factors and genetic and unique environmental effects specific to each personality disorder. Total heritability was modest for these personality disorders and ranged from 21% to 28%. Loadings on the common genetic and unique environmental factors were substantially higher for schizotypal than for paranoid or schizoid PD. The proportion of genetic liability shared with all Cluster A disorders was estimated at 100, 43 and 26% respectively for schizotypal, paranoid and schizoid PDs. CONCLUSION: In support of the validity of the Cluster A construct, dimensional representations of schizotypal, paranoid and schizoid PD are all modestly heritable and share a portion of their genetic and environmental risk factors. No evidence was found for shared environmental or sex effects for these PDs. Schizotypal PD most closely reflects the genetic and environmental liability common to all three Cluster A disorders. These results should be interpreted in the context of the limited power of this sample.

Adult↗
PubMed1993

A fundamental dilemma of psychoanalytic technique: reflections on the analysis of a perverse paranoid patient.

The work refers to the general topic of the traumatic effects of transference in the analytic situation. The author defines the fundamental dilemma of interpretive technique as the technical difficulty, sometimes insurmountable, faced by the therapist in the treatment of severely ill patients, particularly in the case of narcissistic, self-centred disorders, where the interpretive action itself often produces negative side effects that are not countered by the curative effect of the insight achieved through interpretation. In a brief theoretical introduction, this dilemma is described as a longstanding problem in psychoanalysis that has been systematically concealed by the protracted discussion on the subject of 'analysability' and which has still not been resolved by the theory of technique. Clinical case material on a perverse patient is then presented to illustrate the dilemma described and to demonstrate some general strategies by which it may be overcome.

Adult↗
PubMed1985

Refining personality assessments by combining MCMI high point profiles and MCMI codes. Part III. MMPI code 24/42.

In this study it has been shown that the addition of MCMI high point code data to the MMPI 24/42 code type serves to clarify contradictory MMPI descriptors and produces three distinct clusters. These MMPI/MCMI clusters comprise an interpersonally acting-out group, an interpersonally acting-in group, and an emotionally acting-out group. These groups were useful in determining different roles for the MMPI 2 and 4 scales insofar as they relate to both personality (Axis II) and its clinical consequences (Axis I). The results of this study also lend support to the utility of combining objective assessment instruments both for identifying and for discriminating among relevant personality disorders and clinical syndromes.

Adult↗
PubMed1990

Personality styles of patients asserting environmental illness.

Case reports and chart reviews of patients asserting environmental illness suggest that they suffer from psychiatric difficulties, typically somatization disorder. We assert that viewing these patients solely as somatizers or hysterical characters searching for a nurturant relationship will undermine the doctor-patient relationship. Rather, many of these patients are obsessive/paranoid characters searching for a medical explanation to their physical symptoms. This distinction is highlighted by contrasting the clinical presentations of hysteric/somatizing patients with those environmental illness patients demonstrating an obsessive/paranoid style. Further illustration is provided by a case report with psychological test data. Finally, treatment recommendations based upon this distinction are delineated.

Adult↗
PubMed2001

Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence.

The aim of the catch-up follow-up study is to describe the long-term outcome of obsessive-compulsive disorder (OCD) with onset in childhood and adolescence. The psychiatric morbidity in adulthood including personality disorders was assessed and predictors in childhood for the course of obsessive-compulsive symptoms were examined. The total study group consisted of the entire patient population treated for OCD at our departments for child and adolescent psychiatry between 1980 and 1991. We reassessed 55 patients personally by way of structured interviews. The mean age of onset of OCD was 12.5 years and the mean follow-up time was 11.2 years. At the follow-up investigation 71% of the patients met the criteria for some form of psychiatric disorder, while 36% were still suffering from OCD. Of the patients with a present diagnosis of OCD 70% had at least one further clinical disorder (especially anxiety and affective disorders). The most frequent personality disorders diagnosed were obsessive-compulsive (25.5%), avoidant (21.8%), and paranoid (12.7%) personality disorders. In-patient treatment, terminating treatment against advice and tics in childhood or adolescence significantly correlated with more severe OC symptoms in adulthood.

Adolescent↗
PubMed1999

Paraphrenia redefined.

BACKGROUND: Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis," "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category. Virtually no systematic research on paraphrenia has been conducted in the past 60 years. METHOD: The authors distinguish paraphrenia from "late paraphrenia," a diagnosis used mainly in the United Kingdom, and provide a neo-Kraepelinian description of paraphrenia that would be compatible with the formats of DSM-IV and ICD-10. Using a questionnaire adapted from this description, intake cases in 2 Canadian psychiatric centres (Ottawa [Ontario] and Dartmouth [Nova Scotia]) were surveyed. Cases of paraphrenia were distinguished from those of schizophrenia and delusional disorder and were examined at the time of intake and immediately prior to discharge. RESULTS: For logistical reasons, collecting a totally consecutive series was not possible. However, during an 18-month period, investigators in both centres identified 33 cases closely fitting paraphrenia. The outstanding features of these cases are enumerated, and an outline description of paraphrenia is derived. CONCLUSION: It is possible to define and recognize paraphrenia; it is a viable diagnostic entity. Further research would benefit paraphrenia and schizophrenia patients. Cases in this study have been coded to permit follow-up investigations.

Adult↗
PubMed1993

Psychiatric illnesses in families of subjects with schizophrenia-spectrum personality disorders: high morbidity risks for unspecified functional psychoses and schizophrenia.

OBJECTIVE: The authors determined morbidity risks for psychiatric illnesses in the families of probands with schizophrenia-spectrum personality disorders. METHOD: Subjects were recruited from the community through newspaper advertisements. Subjects were identified as having schizophrenia-spectrum personality disorders (N = 30) if they met at least three, four, or three DSM-III-R criteria for schizoid (N = 14), schizotypal (N = 20), and/or paranoid (N = 15) personality disorder, respectively. The comparison subjects had no psychiatric diagnoses (N = 8) or had other personality disorders (N = 12); none of the subjects in either group had any DSM-III-R axis I diagnosis. Trained interviewers collected family history information about the relatives of the two groups; the interviewers were blind to the probands' diagnoses. RESULTS: The risks for schizophrenia, other functional psychoses, and schizophrenia-spectrum personality disorders were significantly higher in the relatives of subjects with schizophrenia-spectrum personality disorders than in the families of the comparison subjects. CONCLUSIONS: The high rate of schizophrenia in the families of probands with schizophrenia-spectrum personality disorders is consistent with the previous findings of higher than normal rates of these personality disorders in the biological relatives of schizophrenic patients. The significance of the high rate of unspecified functional psychoses is unclear. Use of the family study method, by which valid differential diagnosis of psychoses is possible, is indicated. The results from the current study do not rule out the possibility that the schizophrenia-spectrum personality disorders are related to psychoses in general rather than specifically to schizophrenia.

Adult↗
PubMedDate not supplied

Phenomenology of obsessive-compulsive disorder: a transcultural study.

Ninety patients suffering from obsessive-compulsive disorder (OCD) and diagnosed according to International Classification of Diseases (10th edition [ICD-10]) criteria attending the outpatient clinic of the Institute of Psychiatry in Cairo in 1991-1992 were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for symptomatology and severity of symptoms. Sixty-nine percent of the patients were males, and 32% were females. The mean age of the sample was 23.7 years, with a mean duration of OCD of 3.2 years. Twenty percent of patients had a positive family history for OCD. Forty percent of patients presented with a mixture of obsessions and compulsions, whereas 29% presented with obsessions and 31% with compulsions. The most commonly occurring obsessions were religious and contamination obsessions (60%) and somatic obsessions (49%), and the most commonly occurring compulsions were repeating rituals (68%), cleaning and washing compulsions (63%), and checking compulsions (58%). Seventy-one percent of patients were rated severe on the Y-BOCS, and all of them had impaired insight; 9% were insightless. The age of patients was found to correlate positively with the total compulsive score and the total Yale BOCS score, but it correlated negatively with the total obsessive score. One third of patients had a comorbid depressive disorder. Regarding premorbid personality disorders, 14% had obsessive personality disorder, 34% had paranoid, anxious, or emotionally labile personality disorder, and 52% had no premorbid personality disorder. The role of religious upbringing has been evident in the phenomenology of OCD in Egypt, which is similar to the outcomes of studies in Jerusalem and different from results in India and Britain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Personality traits in schizophrenia and related personality disorders.

We investigated whether schizophrenia spectrum disorders share common personality characteristics or traits. Participants with a diagnosis of schizophrenia or schizoaffective disorder (SZ) or with a schizophrenia spectrum personality disorder (schizophrenia spectrum PD: schizoid, paranoid, and schizotypal personality disorder) were compared with non-psychiatric control subjects on the five-factor model of personality and the psychosis-proneness scales. On the five-factor personality scales, SZ subjects showed higher levels of neuroticism, and lower levels of openness, agreeableness, extraversion, and conscientiousness than control subjects. Higher scores on openness and lower scores on neuroticism distinguished schizophrenia spectrum PD from SZ. On the psychosis-proneness scales, both PD and SZ participants scored high relative to non-psychiatric control participants on magical ideation and perceptual aberration, while PD participants scored intermediate between non-psychiatric control participants and SZ on social anhedonia. Discriminant analysis indicated that schizophrenia spectrum patients could be distinguished from PDs by more severe social withdrawal and maladjustment, while subjects with PDs could be best distinguished from control subjects on the basis of odd or novel ideation and decreased conscientiousness.

Adult↗
PubMed1998

A genome-wide search for schizophrenia susceptibility genes.

We completed a systematic genome-wide search for evidence of loci linked to schizophrenia using a collection of 70 pedigrees containing multiple affected individuals according to three phenotype classifications: schizophrenia only (48 pedigrees; 70 sib-pairs); schizophrenia plus schizoaffective disorder (70 pedigrees; 101 sib-pairs); and a broad category consisting of schizophrenia, schizoaffective disorder, paranoid or schizotypal personality disorder, psychosis not otherwise specified (NOS), delusional disorder, and brief reactive psychosis (70 pedigrees; 111 sib-pairs). All 70 families contained at least one individual affected with chronic schizophrenia according to DSM-III-R criteria. Three hundred and thirty-eight markers spanning the genome were typed in all pedigrees for an average resolution of 10.5 cM (range, 0-31 cM) and an average heterozygosity of 74.3% per marker. The data were analyzed using multipoint nonparametric allele-sharing and traditional two-point lod score analyses using dominant and recessive, affecteds-only models. Twelve chromosomes (1, 2, 4, 5, 8, 10, 11, 12, 13, 14, 16, and 22) had at least one region with a nominal P value <0.05, and two of these chromosomes had a nominal P value <0.01 (chromosomes 13 and 16), using allele-sharing tests in GENEHUNTER. Five chromosomes (1, 2, 4, 11, and 13) had at least one marker with a lod score >2.0, allowing for heterogeneity. These regions will be saturated with additional markers and investigated in a new, larger set of families to test for replication.

Chromosome Mapping↗
PubMed1979

Geriatric evaluation unit of a medical service: role of a geropsychiatrist.

Psychiatric evaluation as a part of the complete geriatric workup was done on 143 consecutive patients transferred to a Medical Geriatric Evaluation Unit. The patients' age ranged from 48 to 94 years. The findings were: free of psychiatric problems--19.1%; organic brain syndrome--58.8%; dysphoria-depression--36.8%; paranoid--3.7%; alcohol abuse--8.1%; marital maladjustment 18.3% (of marrieds). The Geropsychiatrist diagnoses, participates in psychiatric management, consults, and supervises psychiatric evaluation by other team members. He is an esential member of the Geriatric team since proper recognition and treatment of psychiatric problems is necessary to complete treatment and to make optimum disposition.

Activities of Daily Living↗