Chronic Psychotics Research Articles

Mental Health Care Bill-2016: An illusory boon; on close reading it is mostly bane.

Byline: James. Antony The recent editorial, “Mental Health Care Bill (MHCB): a Boon or Bane,” states that the “Bill”[sup][1] is progressive and rights-based in nature.[sup][2] May be, a wide definition for mental illness, along with the enumeration of many patients' - rights has kindled optimism in its authors. But, generous offers by a Law are unlikely to persuade many to admit their mental illness. The reason: the devastating effects that stigma has in our society. The editorial [sup][2] has rightly observed that “the Bill tries to be over inclusive in its approach, stretching beyond the legislative limits and despite noble intentions behind it, would be a challenge to stakeholders whether the contents of the Bill are legislation, program, policy or even a treatment guideline.” The main defect of this draft law is this style of packing it with many vague, unenforceable “policies and treatment guidelines,” much in the fashion of some propaganda material. Any practisimg psychiatrist in India would expects the editorial to comment on this lack of focus and precision, a little more forcefully. However, the editorial has not only failed to do this; it is as though its learned authors want the Bill to go further, with its propaganda-style, in more areas! They state in paragraph two of the editorial that “priorities of mental health care have to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary mental health centers.”[sup][2] The reason given is an increase in “invisible” mental problems! Indeed similar views on these matters have been expressed by some authors earlier, as well.[sup][3],[4] But, this approach, of wanting to give an emphasis to “community” in relation to “hospital” or giving attention to “invisible problems”, in a new law is quite unfortunate. These may indeed be good ideas, which could possibly be taken up, when a new mental health “policy” or “programme” is formulated. A law must always be clear, unequivocal and focussed. It is rather cruel to have a view that psychotic patients in this country are getting some “priority treatment”! And, as for mental hospitals, where is this priority when centuries old dilapidated buildings are still waiting to be pulled down and re-built? The editorial also says that “places like juvenile homes, destitutes or beggars' homes and religious places, where mental patients are housed need not have license.”[sup][2] This statement in an editorial of the official publication of the Indian Psychiatric Society is unfortunate. One expects the Journal to speak for the sake of the mentally ill, rather than for those who run mental health establishments. Maybe, they are making this suggestion, equating various “care-homes” with general hospital psychiatry units. But, sparing general hospitals, from the hassles of a license is a different matter; a bystander would be there to secure the rights of a patient, and this has been pointed out, earlier.[sup][5],[6] But allowing people to run institutions for chronic psychotics, without supervision is not acceptable. The danger of this approach has been elaborately dealt with, recently.[sup][7] Not only license, such places must also have close, on-going supervision. It is painful when senior psychiatrists are mocking at the need for surveillance of all kinds of care homes, by saying it will bring-in a “Licence Raj.”[sup][2] How could Indian psychiatrists forget that huge man-made national shame called “Erwadi tragedy?”[sup][8],[9],[10] The important thing that should worry practicing psychiatrists, with regards to MHCB-2016 is that it would repeal the existing law, the Mental Health Act-1987. …

Psychopathologies rencontrées sur l’île de Mayotte entre 1998 et 2004

Before 2001, psychiatric care on the island of Mayotte was ensured by missionaries from the Reunion Island. A mental health system has since been gradually installed, although the culture in Mayotte, mixing practicing Muslim women and traditional animists, still leaves a broad place for traditional healers. This paper presents a retrospective study of 1212 psychiatric case reports, aimed at indexing the various psychopathologies according to the CIM 10, on the island of Mayotte between 1998 and 2004. The files, before and after the opening of the mental health centre, were compared with those of the psychiatric diagnoses of the Comorians. The results show an evolution in the chronic pathologies treated in the Comorians: delirious disorders, and the organic, major, mental disorders in the first psychiatric files have given way to depressive episodes and somatoform disorders. Nevertheless, an underlying prevalence of depression and addiction persist. It is interesting to note the reduced number of suicide attempts, far lower than in western countries: one suicide attempt per annum for 375 inhabitants in metropolitan France, whereas, in this study, one suicide attempt in Mayotte was reported for 2504 inhabitants. The cultural characteristics are also taken into account in the discussion of these results. Thus, if there are more demonstrations with somatic expression in the Comorians, related to a stronger implication of the body in situations of psychological faintness: 1.75% of hysterical conversion in the Comorians versus 0.99% in Mayotte, this does not mean a more histrionic personality in this population: 1.8% of Comorians, against 1.98% in Mayotte. The results of this study consolidate the impressions felt by the experts and show the effects of the mental health policy on the island. Thus, the assumption of responsibility of chronic psychotics made it possible to improve their quality of life, and to decrease the number of medical evacuations that decreased from 17 to three, between 2001 and 2004. However, this study also underlined the possible axes of development in this field, namely the assumption of responsibility of psychiatric emergencies with a crisis centre, and the development of a specialized pedopsychiatric assumption of responsibility. Indeed, in the first six months of 2004, 35% of the patients were 0-20 year-old.

Living in a self‐organized house in the early psychosis treatment

The self‐organized house (SOH) is a resident structure with light outpatient assistance. We have had a long time experience of these structures in the rehabilitation treatment of chronic psychotics. Our more recent experience is to use these kind of structure for the early treatment, in the subacute phases. The patient is treated for several years, separated and protected from his family. Family therapy is started later. The flexibility of protection, therapies, and social committments allow a different perspective in the treatment of early psychosis. Several single cases, and study on a small sample group are presented.

Behavioral and neuroimaging studies on schizophrenia in Japan

Chronic methamphetamine psychotics became a major problem in Japan after World War II. On one hand, the clinical symptoms of chronic methamphetamine psychotics were noted to resemble those of schizophrenics quite closely but, on the other hand, their respective personality profiles appeared to differ. Recent research on exploratory eye movements has also shown such similarities and differences. In long-term remitted chronic methamphetamine psychotics, extremely small doses of drugs, or stress, can be enough to cause a recurrence of symptoms. This phenomenon resembles the recurrence of schizophrenia, and animal experiments and basic research are being actively conducted in order to elucidate the mechanism involved. Some 20 years ago, unique studies were conducted that objectively looked at the characteristic behavior of severe chronic schizophrenics in a playground situation. Exploratory eye movements can also be regarded as a kind of behavior and, in this paper, eye movement patterns made in response to a maze test are discussed. In addition, much research on brain imaging in schizophrenia is being conducted in Japan and several interesting studies have also been chosen by the authors for presentation in this paper.

Selective Abnormalities of Prefrontal Serotonergic Receptors in Schizophrenia

This study investigates serotonergic receptors in prefrontal cortex of patients with schizophrenia. We measured serotonin 2 receptors and serotonin uptake sites in prefrontal and occipital cortex of schizophrenics, patients with chronic schizoaffective disorders, nonpsychotic suicides, and controls. Diagnoses were established according to DSM-III-R criteria from medical chart reviews. In prefrontal cortex, serotonin 2 density was decreased in chronic psychotics dying of natural causes, as opposed to psychotics dying of suicide, controls, and nonpsychotic suicide victims. Serotonin uptake sites were decreased in prefrontal cortex of schizophrenics and nonpsychotic suicides, but not in patients with schizoaffective disorder. None of the observed differences were clearly related to antemortem pharmacological treatments. In the occipital pole, no differences were found among the groups. Selective prefrontal alterations of both presynaptic and postsynaptic serotonin receptor densities are present in at least some schizophrenic patients.

Chronic Schizophrenia‐Like States in Methamphetamine Psychosis

In order to clarify the characteristic psychopathology of chronic methamphetamine (MAP) psychosis, the clinical symptoms of 11 chronic MAP psychotics were compared with those of the same number of chronic schizophrenics matched for sex and age. The positive symptoms were almost similar in both groups. However, the negative symptoms evaluated by the Scale for the Assessment of Negative Symptoms (SANS) differed considerably. According to the SANS, the scores of avolition-apathy, anhedonia-asociality and attentional impairment were moderately high in both groups. The scores of affective flattening or blunting and alogia were lower in the MAP group than those in the schizophrenia group. The SANS scores of negative symptoms increased in accordance with the age of onset in the MAP group, while such a correlation was not observed in the schizophrenia group. Furthermore, detailed clinical observations of the patients revealed the following differences between the two groups: 1) spontaneous affective expression during the interviews was more vivid in the MAP group compared to the schizophrenia group, and 2) affective expressions or interpersonal behaviors changed immediately depending on the situation in the MAP group. From the viewpoint of clinical psychopathology, a group of MAP psychotics whose hallucinatory-delusional state persisted for a long period of one month or more after cessation of MAP use seemed to differ from either chronic schizophrenics or patients with acute MAP psychosis. The author proposed that this group of patients should be a clinical entity and be called as "residual methamphetamine psychosis."

A Psychodynamic Observer in a Chronic Psychiatric Ward

ABSTRACT. The everyday life of a ward for chronic psychotics was sampled in regular weekly sessions and the observations analysed to discover the unconscious interactions and shared defences that explained its social structure.Outwardly there was boredom, monotony, and an absence of interactions, emotions and events but underneath there were pervasive anxieties defensively subdued especially by the staff. Even tiny moves by patients to alter this atmosphere were instantly nullified. These anxieties had two sources:(a) a massive impotence in face both of chronicity and of identification with the patients as social rejects.(b) lurking fear of madness stagnation and cmptiness.This typical psychiatric facility for chronic patients functions as a defensive system that makes change and development safely impossible and demoralises the staff. Some remedial suggestions are offered.

Democlocycline improves hyponatremia in chronic schizophrenics

Serum sodium concentration increased significantly in eight hyponatremic schizophrenic subjects treated with demeclocycline. The incidence of severe hyponatremic episodes was significantly reduced. The authors argue that mild impairments in urinary dilution contribute to water intoxication in most chronic psychotics who develop this syndrome. Demeclocycline may help these patients.

Evaluating day-care for chronic psychotics: goal attainment versus symptom-attitude change.

Evaluating day-care for chronic psychotics: goal attainment versus symptom-attitude change.

Thought-stopping for Delusions and Hallucinations: A Pilot Study

A pilot controlled study was designed to evaluate the efficacy of the thought-stopping technique (T.S.) as a treatment for persecutory delusions and auditory hallucinations with chronic schizophrenics already treated with neuroleptics and to compare this combination with patients only treated with antipsychotic drugs. Medication was standardized for each patient and psychological measurements were recorded before and after treatment and during a 6-month follow-up. Results show significant differences in favor of the T.S. group mainly after treatment. Although T.S. was beneficial for chronic psychotics, other studies should be conducted with patients whose illness would be less severe and less chronic. The length of treatment as well as the cues that would serve to stop delusions and hallucinations also merit further investigation.

On "The Psychotic Self - An Experience with a Group of Chronic Psychotics" by Salomon Resnik, XIV/2, pp. 113-117

On "The Psychotic Self - An Experience with a Group of Chronic Psychotics" by Salomon Resnik, XIV/2, pp. 113-117

Personal Power: a Taoist Perspective

This article draws from the teachings of Taoism to provide a possible framework from within which we may consider personal relationships and especially personal power. Personal power is viewed as a mode of being, something existential, something to be lived rather than to be acquired. As Carl Rogers (1977) notes, when perceived in this manner personal power becomes the basis for a quiet revolution which has "gone to the root of many of the concepts and values of our culture." To understand the contributions of Taoism to humanistic psychology we must first understand the concept of ch'i ( ki in Japanese). Ch'i is the vital force that permeates and flows throughout the universe. The enhancement of ch'i is central to creative expression and personal power as expressed through Chinese poetry, art, medicine, and martial arts. By gaining a better understanding of ch'i, we can gain a better understanding of interpersonal relationships and personal growth. In my work with both acute and chronic psychotics I continually noticed that an increased ability to be empathic and an increased feeling of personal power were intimately related. Those people who were willing and able to enhance their abilities to be empathic were also able to improve their level of functioning so they could be discharged. Those people who were unable to become more empathic or who were unwilling to do so (which was more often the case) usually continued at the same general level of functioning. Through my practice of meditation and Chungdokwan Taekwon-do I became aware of how ch'i directly affects daily life. There are moments in the practice of a martial art when: You and your opponent will no longer be two bodies separated physically from each other but a single entity, physically, mentally, and spiritually inseparable. Therefore the motion of your opponent may be considered to be your motion [Murphy & White, 1978, p. 34]. There are moments in a counseling relationship as well as in any interpersonal relationship when this happens also. Perhaps as the Taoists suggest, the underlying principle behind this is ch'i. If this is so, present conceptions of personal power can benefit from a greater understanding of the Taoist concept of ch'i.

Effects of model warmth on acquisition and performance of modeled behavior in chronic psychotics.

Hypotheses derived from an earlier study were tested in experimental dyads with 32 adult chronic psychotic state hospital residents of both sexes. Patients either interacted with an adult model who was noncontingently warm and rewarding, or were not exposed initially to a model. In a second phase, the model displayed task responses and novel behaviors incidental to the task, and the patient's subsequent imitation of the model under minimal demand conditions was recorded. In a third phase, the model again displayed the same behaviors, whereupon half the patients in each group were subjected to moderate (explicit verbal request) or high (verbal request plus material rewards) incentives to imitate. Under strong incentive conditions, initial differences between groups on incidental imitation vanished, indicating that a previously positive relationship with a model facilitates imitative performance but not learning.

Sensitivity to Change in Symptoms of New Scales for Rating Chronic Psychotic Patients

The sensitivity of Krawiecka, Goldberg and Vaughan's scales for rating chronic psychotic patients was established by testing them under conditions comparable to those of a controlled cross-over trial. 34 chronic schizophrenics were assessed on the scales at the beginning, after 6 weeks on one form of medication and after the same period on another drug. Significant changes in ratings of symptom severity of anxiety, hallucination delusions and incoherence were observed in patients who were sympomatic at the outset. Further, patterns of intercorrelations were found to be stable over time. It was concluded that Krawiecka et al.'s scales may be sensitive to change in symptoms in chronic psychotics and that given their known reliability, they may be viable research tools.

Improving social interaction in chronic psychotic using discriminated avoidance ("nagging"): experimental analysis and generalization.

Three social-interaction behaviors of a withdrawn chronic schizophrenic were increased using a discriminated avoidance ("nagging") procedure. The three behaviors were: (a) voice volume loud enough so that two-thirds of his speech was intellibible at a distance of 3m; (b) duration of speech of at least 15 sec; (c) placement of hands and elbows on the armrests of the chair in which he was sitting. "Nagging" consisted of verbal prompts to improve performance when the behaviors did not meet their criteria. A combined withdrawal and multiple-baseline design was used to evaluate the effectiveness of the procedure, and the contingency was sequentially applied to each of the three behaviors in each of four different interactions to determine the degree of stimulus and response generalization. Results indicated that the contingency was the effective element in increasing the patient's appropriate performance, and that there was a high degree of stimulus generalization and a moderate degree of response generalization. After the patient's discharge from the hospital, the durability of improvement across time and setting was determined in followup sessions conducted at a day treatment center and at a residential care home. Volume and duration generalized well to the new settings, while arm placement extinguished immediately.

Effects of vicarious reward and punishment on social imitation in chronic psychotics

Despite considerable evidence that modeling procedures provide effective methods for the acquisition and change of behavior, there is very little research on the effects of vicarious reward, and none on the effects of vicarious punishment, on social imitation in chronic psychotics. Two studies (Goldstein et al., 1973: Gutride, Goldstein and Hunter, 1973) demonstrated the superiority of vicarious reward over no-treatment with adult psychotics. However, in neither study was a model no-consequences group included in order to control for the effects of observation per se; therefore, such findings cannot be clearly attributed to vicarious reinforcement (Thelen and Rennie, 1972). The only other study known to bear on this issue revealed no differences in initial learning between a model-rewarded and a model no-consequences group (Olson, 1971). The present study included model no-consequences control groups in an attempt to examine the effects of vicarious reward and punishment on subsequent interview behavior in chronic psychotics. Drawing on the larger body of vicarious learning research (Bandura, 1969). it was hypothesized that such patients demonstrate higher levels of socially appropriate behavior after observation of a model who is (a) rewarded for appropriate behavior or (b) punished for inappropriate responses, and lower levels of appropriate behavior after exposure to a model who is (c) rewarded for inappropriate behavior or (d) punished for appropriate responses, relative to conditions in which the same modeled behaviors elicit no contingent consequences.

Effects of model warmth on imitation learning in adult chronic psychotics.

Effects of model warmth on imitation learning in adult chronic psychotics.

Hypnotic susceptibility, amnesia, and IQ in chronic schizophrenia.

Abstract The purpose of this study was to evaluate the nature and extent of hypnotic susceptibility for a random sample of chronic psychotics (N = 56), mainly schizophrenics (N = 48), using the standardized procedure of the Stanford Hypnotic Susceptibility Scale, Form A (Weitzenhoffer & amp; Hilgard, 1959). Results are the following: (1) there is a lower frequency of high hypnotic susceptibility scores as well as a lower percentage of success on eye closure, eye catalepsy, and moving-hands items than in the standardization group; (2) there is a higher incidence of posthypnotic amnesia, as found in previous comparable studies; (3) there is strictly no reversibility of amnesia in 78% of the cases; (4) those schizophrenics who passed the amnesia item have a lower IQ than those who failed. Distinctions between genuine posthypnotic amnesia and forgetting are proposed and results on the amnesia item are tentatively related to experimental data on distractibility and disturbed attentional processes in chronic schizophrenia.

CONDITIONING AND POST‐HOSPITAL GENERALIZATION OF NONDELUSIONAL RESPONSES IN A CHRONIC PSYCHOTIC PATIENT1

An operant conditioning approach was successful in getting a chronic psychotic patient to give factual answers to direct questions that had previously elicited only delusional responses. Multiple baseline and reversal controls established that the changes were due to the experimental procedure. The subject was a female patient classified as paranoid schizophrenic who had persisted in giving bizarre responses to direct questions regarding her identity, age, and personal history during 26 yr of hospitalization. She was discharged after factual answers to these questions had been obtained, but operant conditioning trials were continued in the community to promote generalization. Two follow-up interviews were conducted 36 and 52 days after discharge to evaluate generalization. No generalization was found in the first interview, but the second gave evidence of some generalization.

Chronic Psychotics in Prison

Chronic Psychotics in Prison