Psychotic Personality Research Articles

O delírio à luz da teoria dos atos de fala

Este trabalho apresenta uma possivel solucao para problemas suscitados pelo entendimento do fenomeno delirante segundo o modelo de uma teoria restrita da referencia absoluta, na qual as palavras e, consequentemente, os juizos, corresponderiam as coisas como um alfabeto logico. Na concepcao pragmatica aqui adotada, a linguagem e tomada por um jogo regido por regras em que e mais importante a eficacia da cooperacao discursiva que o significado ideal das expressoes. A teoria dos atos de fala se mostra a mais bem acabada solucao da pragmatica filosofica nesse sentido e e usada como principio metodologico na analise dos excertos de fala de pacientes delirantes que constituem os corpus discursivos. O delirio termina por se mostrar como uma solucao inedita para questoes cruciais da historia do individuo psicotico.

P.2.001 Long term treatment of psychotic pictures and personality disorders with risperidone associated with psychotherapic-rehabilitative approaches

P.2.001 Long term treatment of psychotic pictures and personality disorders with risperidone associated with psychotherapic-rehabilitative approaches

FORENSIC PSYCHOTHERAPY WITH A POTENTIAL SERIAL KILLER

ABSTRACT Treatment with the patient described here, a 28‐year‐old man in a Regional Secure Unit on a Pre‐Discharge ward who had murdered his mother during late adolescence, was aimed at altering the intrapsychic factors through transference‐based psychoanalytical psychotherapy in order to facilitate a change of attachment to the internal mother/object and to women, whom he had devalued at part‐object level, based on his primitive perception of his mother as 'Satan's dog’and the‘devil's jackal’. There was an apparent change in the way he eventually interacted with the therapist as a whole object. Where the condition of latent murderousness exists, internal (intrapsychic) factors, or external ones, can become the reactivating agents which set into motion a sequence which ends in actual murder. The relationship of such events to a psychotic personality organization is variable and often difficult to delineate because the catastrophic deed itself greatly alters the intrapsychic as well as the external situation. More importantly, the control should be intrapsychic and not externally imposed if we are to deal adequately not only with murder but murderousness.

Proposal for a social psychiatry theory based on experiences from a programme for the homeless mentally ill

What are the paradigm, the theory and the methods of social psychiatry? This theme is discussed on the background of the evaluation of a social and psychiatric project, going out into the streets looking up and offering support and treatment to psychotic persons living on the streets. All activities in the project during one year, i.e. 120 out-reach activities and 37 different persons, were registered in a diary. The contacts resulted in interventions and treatment, even involuntary hospitalization. One out of three seems to have improved life quality due to the project. The main question is whether it is acceptable to go out into the streets and seek out persons with the purpose of intervening in their existence. The answer is that it must be a part of psychiatric work - as an ethical claim - to seek out psychiatric patients living under miserable social conditions. The project resulted in a programme dealing with this kind of psychiatric work. It is suggested that the field of interest for social psychi...

Shared Psychotic Disorder: A Critical Review of the Literature

To search the literature to reassess the concept of shared psychotic disorder (SPD) using modern nosology and current biopsychosocial formulation. Analyzing published case reports from 1942 through to 1993 that meet DSM-IV criteria for SPD according to patient age, sex, nature and duration of the relationship with the "primary", length of exposure to primary's psychosis, family psychiatric history, comorbidity, social isolation of the dyad, presence of hallucinations, delusional type, and the diagnosis of the primary. Findings revealed: 1. males and females were affected with equal frequency; 2. there was equal prevalence in younger and older patients; 3. the majority of shared psychoses (90.2%) were equally distributed among married couples, siblings, and parent-child dyads; 4. comorbid dementia, depression, and mental retardation were common; 5. hallucinations were common; 6. the majority of dyads (67.3%) were socially isolated. SPD probably occurs in premorbidly disposed individuals in the context of social isolation which is shared with a psychotic person.

Wahn und Imagination

In this study delusion is regarded from the aspect of a phenomenology of imagination. Delusion as an experience of fictitious actualities is interpreted as the attempt of a psychotic person, to find a sense of existence in view of the threat by mental illness. After explaining the philosophical fundamentals, imagination is considered to be the dynamic origin of delusion and hallucinations. The discussion of psychopathological and clinical problems is followed by a demonstration of further phenomenological and hermeneutic approaches.

Interrater Reliability of the Structural Interview

This study investigated the structural interview for its reliability. The interview was developed by Kernberg et al. and is intended to make a differential diagnosis between a neurotic, borderline, and psychotic personality organization. We studied two categories of psychiatric patients (outpatients and inpatients) by recruiting 37 subjects: 20 men and 17 women. Two assessment methods were used: observation and videotape evaluation. The three authors alternated their roles between interviewer, observer, and videotape evaluation. The results showed that it was possible to classify the patients into the categories neurosis, borderline, and psychosis. The ? values for interrater reliability ranged from moderate to substantial. Further study is indicated, and well-planned training in the structural interview would make the technique a useful tool within the psychodiagnostic process.

Schizophrenia and parental social class

Persons with psychotic disorders recieve devalued labels. Despite considerable theorizing, the proposition that these labels affect the course of psychotic illness has rarely been subjected to investigation. The lack of an adequate operational measure for the labeling construct has hampered research. The present report describes the development of the Social Response Questionnaire (SRQ), a measure of the ‘sick’ label which incorporates moralistic attitudes, fear of dangerousness and negative expectations attached to the role of the severely psychiatrically ill. This 32-item scale, a multidimensional measure of informal labeling, which may be administered in a self-report format or to significant others, permits the study of dose-response relationships. The SRQ is internally stable. It also exhibits construct validity. Schizophrenics and persons with affective psychosis label themselves and are labeled by others more harshly than persons with Crohn's disease or normals. While self-percepts and the perceptions of significant others are fairly congruent for normals and persons with a significant physical illness, there is no agreement between the self-ratings of psychotics and their significant others. Psychotic persons view themselves more negatively than Crohn's disease sufferers or normals, but not as negatively as their therapists, families and friends. Potential uses for the SRQ in longitudinal research are addressed.

Linguistic characteristics of neurotic, borderline and psychotic personality organization.

Thirty patients were subjected to a Structural Interview by means of which 10 of them received the diagnosis NPO (Neurotic Personality Organization), 10 BPO (Borderline Personality Organization) and 10 PPO (Psychotic Personality Organization). About 2500 words and groups of words were extracted from the patients' utterances for analysis. The word-frequencies thus found were analyzed by a PLS discriminant analysis which yielded two significant principal components (main dimensions) explaining 57% of the variance. This analysis showed that the three groups of patients are well separated from one another and that there is a definite correlation between personality organization and linguistic variables. The main features of the BPO-patients in this study seem to be that they refer to positions outside themselves and their language is impersonal; we see this as an example of a vacillating identity. The NPO-group is characterized by an intense and rich language, signs of a more advanced symbolizing ability, deixis and high level defenses. The language of the PPO-patients is poor and its predominant feature is a lack of words; in our interpretation this indicates foreclosure and a lack of identity.

Cohabitation and the negative therapeutic reaction

SUMMARY Borderline and psychotic patients especially, but not exclusively, show genuine motivation towards achieving insight and change and then suddenly behave as if these have never been desired. When this shift occurs after a helpful interpretation it can be thought of as a negative therapeutic reaction. Patients can feel taken over by perceptions which drive them to think and behave in ways they later disagree with. These observations have led the author, along with colleagues at the Willesden Centre for Psychological Treatment, to recognise a situation of internal cohabitation of two autonomous minds in the one body which is a development of but not identical to Bion's concepts of psychotic and non-psychotic personalities. Some of the psychoanalytic literature on the different modes of mental functioning are reviewed and problems of appropriate conceptualisations are discussed. Clinical examples are presented to illustrate that differentiating the genuine negative therapeutic reaction from reactions to poor interpretations is facilitated and leads to further understanding of the patient's psychotic personality if the psychotherapist can hold in mind both the patient's and the therapist's psychotic and non-psychotic personalities.

Defining schizophrenia: Operational criteria

The use of operational criteria to define the syndrome of schizophrenia has dramatically improved the reliability of diagnosis. However, none of the many different operational definitions for schizophrenia has proven superior validity and it is therefore suggested that a polydiagnostic appproach is adopted until the aetiology of schizophrenia is determined and consequently most valid definition known. The operational criteria checklist for psychotic illness (OPCRIT) facilitates such a polydiagnostic approach and the paper goes on to describe the use of OPCRIT on various data sets of psychotic subjects to explore three further questions. The first of these considers the relationship between different definitions. The second question relates to which other psychotic disorders and personality types might be included within a broader schizophrenia spectrum and the third question considered relates to the different sub-types of disorder found in schizophrenia and whether these are aetiologically separate or me...

Are males more likely than females to develop schizophrenia?

This study was undertaken to determine whether the incidence of schizophrenia is equivalent for males and females. An attempt was made to identify every first-episode case of psychosis in a large Canadian city over a period of 2 1/2 years. A comprehensive referral network was established that included hospital and community settings where psychotic persons might appear. More than 300 potential subjects were identified, 175 of whom underwent a structured psychiatric interview and were assigned diagnoses according to five different diagnostic systems. The incidence of schizophrenia was two to three times higher among males than among females. Even though the use of different diagnostic systems yielded slightly different risk rates, the elevated risk for males remained consistent. There were no differences between the sexes in the incidence of affective psychosis. In comparison with schizophrenia, the incidence rates for mood disorders with psychotic features were sometimes lower and sometimes higher, depending on the diagnostic system used. The findings, coupled with reports in the past 10 years from other investigators, challenge the conventional belief that the incidence of schizophrenia is the same for the two sexes.

Psychodiagnosis of personality structure: psychotic personality organization.

Recent developments in Rorschach psychology, including nomothetic approaches focused on scores, ratios, and indices and idiographic approaches focused on content emerging from psychoanalytic theory, offer the Rorschach clinician a rich and potent interpretive methodology. This article examines the structural diagnosis of personality organization with a focus on psychotic personality structure. Rorschach approaches to the differential diagnosis of psychotic personality organization are presented. The Rorschach is viewed as indispensible in the differential diagnosis of personality organization, especially in the so-called "borderline" cases.

Reactions to DMT as related to psychotic and borderline personality organization.

Thirty-one inpatients in a psychiatric clinic were assessed with DMT and the Structural Interview. In order to assemble every relevant reaction that an individual might have to a percept-genesis, 130 DMT variables were formed. The results were first subjected to a quality control of the DMT-scores and then subjected to partial least squares in latent variables (PLS) discriminant analysis. The analysis showed that it is possible to separate patients with psychotic PO (PPO) from those with borderline PO (BPO) by means of the 130 variables. The BPO group is characterized by aggressive manifestations, sensitivity to threat, identity lability and various transformations of the Hero gestalt. The PPO group, on the other hand, is characterized by high threshold values for perception, lack of identity, denial and repression of the peripheral person at a late-phase level. There are other perceptual reactions that are important predictors of PO than the defence categories of the manual. These perceptual reactions do not correspond to the traditional psychodynamic defence mechanisms. Our conclusion is that principal component analysis (PCA) and PLS are useful methods of finding discriminating patterns of perceptual reactions to the DMT for patients with different PO.

Dangerousness of the Delusional Misidentification of Children

Misidentification syndromes have been studied from a variety of perspectives, including phenomenological, biological, and nosological approaches. More recently, misidentification syndromes have been studied from a psychiatric-legal perspective, especially with regards to the problem of dangerousness. Capgras syndrome and other syndromes of misidentification can lead to hostile mood and subsequent physical violence. Little attention has so far been devoted to children as the objects of the psychotic person's misidentification delusion(s). We provide a review of cases from the anglophonic literature that have children as the misidentified objects, add three new cases, and then discuss the relationship between misidentification and potential harm to these children.

The psychotic personality: A psychoanalytic theory and its application in clinical practice

SUMMARY This paper presents and discusses aspects of Bion's theory of the psychotic personality. In particular, it focuses on the psychotic personality's attacks on the dependent and needy self. The paper considers how Bion's theory can be applied to understanding the schizophrenic patient. Examples are given to show its importance not only in analytic practice, but also within general psychiatry.

The Concept of Personality Organization: A Long-Term Comparative Follow-Up Study With Special Reference to Borderline Personality Organization

In a 5-year long-term follow-up study, index and end-point diagnoses were made on 44 psychiatric inpatients according to DSM-III, the Diagnostic Interview for Borderlines according to Gunderson, and the Structural Interview for assessment of personality organization according to Kernberg. Working capacity and psychiatric hospitalization during follow-up were registered. Analyses were made in a comparative design between the three diagnostic categories defined by Otto Kernberg: neurotic, borderline, and psychotic personality organization (NPO, BPO, and PPO). BPO turned out to be a wide concept including patients with a variety of Axis I and Axis II DSM-III disorders: 21% received a diagnosis of major affective disorder, 13% a diagnosis of schizophrenic disorder (residual type), and 46% fulfilled criteria for an Axis II diagnosis of borderline personality disorder. Long-term prognosis was severe. Patients with BPO were hospitalized, on average, during 23% of the follow-up period and only 8% managed without ...

Varieties of Pathological Self-Mutilation

Pathological self-mutilation appears as a non-specific symptom as well as a specific syndrome. Since psychotic persons may commit horrifying acts, such as enucleation of an eye or amputation of a body part, identification of high risk patients is crucial. Stereotypical self-mutilation, such as head banging and biting off of fingertips, is associated with mental retardation and with the syndromes of Lesch-Nyhan, deLange, and Tourette. This type of self-mutilation is the focus of biological research or endorphins and on dopamine receptors. Skin cutting and burning, the most common type of self-mutilation, is often associated with personality disorders, post-traumatic stress disorder, and multiple personality disorder. When cutting and burning become established as responses to disturbing psychological symptoms on environmental events, a specific Axis I impulse disorder known as Repetitive Self Mutilation may be diagnosed. Patients with this newly identified syndrome may alternate their direct acts of self-mutilation with eating disorders and episodic alcoholism.

Varieties of Pathological Self-mutilation.

Pathological self-mutilation appears as a non-specific symptom as well as a specific syndrome. Since psychotic persons may commit horrifying acts, such as enucleation of an eye or amputation of a body part, identification of high risk patients is crucial. Stereotypical self-mutilation, such as head banging and biting off of fingertips, is associated with mental retardation and with the syndromes of Lesch-Nyhan, deLange, and Tourette. This type of self-mutilation is the focus of biological research or endorphins and on dopamine receptors. Skin cutting and burning, the most common type of self-mutilation, is often associated with personality disorders, post-traumatic stress disorder, and multiple personality disorder. When cutting and burning become established as responses to disturbing psychological symptoms on environmental events, a specific Axis I impulse disorder known as Repetitive Self Mutilation may be diagnosed. Patients with this newly identified syndrome may alternate their direct acts of self-mutilation with eating disorders and episodic alcoholism.

Psychological care of heart surgery patients

In a series of previous experiments in our laboratory we have demonstrated that a disproportionate number of schizophrenics and others high in ‘psychoticism’ display an unusual psychophysiological profile, charcterized by hightened perceptual sensitivity associated with very low electrodermal activity. the same feature was observed here in a group of adult first-degree relatives of schizophrenics. Compared with a sample of neurotics' relatives, the group contained a significantly greater number of individuals with low-skin-conductance levels (SCL) and high positive slopes relating amplitude and stimulus intensity on a visual evoked potential measure of ‘augmenting-reducing’. A parallel was noted between this observation and a finding, reported earlier on the same sample, that the schizophrenics' relatives also tended significantly more often to show low SCL and high forearm EMG levels. Few relatives showed both anomalous patterns of psychophysiological response, but those who did also had somewhat higher scores on certain questionnaire measures of psychotic personality traits. The results were taken as further evidence for the view that a crucial feature of the biological basis of ‘psychoticism’ may be weakening of CNS homeostasis, possibly implicating cortical regulation of subcortical arousal mechanisms.