Diagnostic differences in psychogeriatric patients in Toronto, New York and London, England.
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National statistics on psychiatric illness in the elderly patient from Canada, the United States and the United Kingdom suggest great differences in morbidity in these three centres. The present study shows that these differences stem mainly from different diagnostic habits in the three countries, but also there were more alcoholics in the Canadian sample. In particular, the diagnostic bias of the New York psychiatrists towards diagnosing most elderly patients as senile was not shared by their Toronto colleagues. Some patients were psychiatrically well, in spite of receiving a psychiatric diagnosis, and could have been helped without hospitalization. In addition, some depressed patients were labelled senile. Recommendations include improvement of catchment and treatment facilities for the elderly alcoholic and the provision of psychogeriatric diagnostic centres. (+info)
Unusually persistent complainants.
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BACKGROUND: Querulous paranoia may have disappeared from the psychiatric literature, but is it flourishing in modern complaints organisations and the courts? AIMS: To investigate the unusually persistent complainants who lay waste to their own lives and place inordinate demands and stress on complaints organisations. METHOD: Complaints officers completed questionnaires on both unusually persistent complainants and matched controls. RESULTS: Persistent complainants (distinguished by their pursuit of vindication and retribution) consumed time and resources and resorted to both direct and veiled threats. Attempts to distinguish these people from a control group on the basis of the manner in which their claims were initially managed failed. CONCLUSIONS: Persistent complainants' pursuit of vindication and retribution fits badly with complaints systems established to deliver reparation and compensation. These complainants damaged the financial and social fabric of their own lives and frightened those dealing with their claims. The study suggests methods of early detection and alternative management strategies. (+info)
Alcoholism and personality disorders: an exploratory study.
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AIMS: To define the most frequent personality disorders related to alcohol dependence. METHODS: Using the International Personality Disorder Examination and the Millon Clinical Multiaxial Inventory-II for personality disorders, 30 consecutively recruited alcohol-dependent patients attending an outpatient clinic were compared with 30 consecutively recruited psychiatric patients with non-addictive disorders and 31 subjects from the general population chosen to match the patient samples for age, gender and socio-economic level. RESULTS: Forty percent of the alcohol-dependent patients and 16.6% of the general clinical sample (vs 6.4% of the normative sample) showed at least one personality disorder. Dependent personality disorders were most prevalent (13.3%), followed by paranoid and obsessive-compulsive personality disorders (10% each). (+info)
Dermatitis artefacta in a patient with paranoid syndrome.
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It is well recognized that psychosomatic factors play an important role in many skin diseases. Dermatitis artefacta coexists with quite an extensive number of psychopathologic conditions. In women, it is regarded as a ''cry for help'', especially when the patient is faced with psychosocial stressors. We present the case of a 40-year-old woman with long lasting self-inflicted excoriations and ulcerations of the skin located within easy reach of her hands. We discuss the reasons for such behavior and the possibilities of dermatological and general interventions. (+info)
What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation.
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Corticosteroid induced psychosis in the pain management setting.
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BACKGROUND: Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events. OBJECTIVE: We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration. DESIGN: Case Report. METHODS: We describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session. RESULTS: Approximately 7 days following the multiple injections, the patient developed psychotic episodes including racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days. DISCUSSION: Although well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization. (+info)
Defining the schizophrenia spectrum: issues for genetic linkage studies.
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Genetic linkage studies of schizophrenia depend on accurate psychiatric diagnosis of relatives within multiply affected families. Each investigator makes a series of explicit or implicit decisions to define which relatives will be assumed to share a schizophrenia-related genotype, that is, who is an "affected relative." In this article we delineate issues that we believe should be considered in such studies and review the relevant literature. Issues include criteria for selecting probands; whether broader criteria should be used to select affected relatives; approaches to including or excluding diagnoses for which family study data suggest a relationship to schizophrenia or to affective disorders or other psychiatric disorders; clarification of diagnostic hierarchy; and issues related to substance abuse and neurological disorders. Also discussed are whether relatives without spectrum diagnoses should be considered unaffected or undiagnosed in linkage analyses, how bilateral familial affectedness should be defined, and provision for independent review of study diagnoses. As an illustration, the clinical model for the authors' schizophrenia linkage study is described. (+info)
Paranoid personality has a dimensional latent structure: taxometric analyses of community and clinical samples.
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