Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time. This can cause diagnostic confusion and uncertainty about treatment. This paper examines se...Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time. This can cause diagnostic confusion and uncertainty about treatment. This paper examines seven ways in which symptoms of both conditions can co-exist. The literature on this topic consists to a large extent of case reports, so that firm conclusions cannot be drawn from their examination. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. Psychosis is not necessarily a mark of severity in the course of an eating disorder, and food refusal can occur independent of severity in psychotic illness, but it can be a cause of death. There is some genetic association and some overlap of physiologic, cognitive and brain structure deficits in the two types of disorder. The connection between the two, however, remains speculative. The area of comorbidity and overlapping symptoms in psychiatry requires more research. Clinical recommendations include attentionto the different individual ways in which these two disparate conditions often overlap.展开更多
Psychotic syndromes are divided into affective and non-affective forms.Even among the non-affective forms,substantial differences exist.The aim of this relatively brief review is to synthesize what is known about the ...Psychotic syndromes are divided into affective and non-affective forms.Even among the non-affective forms,substantial differences exist.The aim of this relatively brief review is to synthesize what is known about the differences between two non-affective psychoses,schizophrenia and delusional disorder(DD),with respect to clinical,epidemiological,sociodemographic,and treatment response characteristics.A PubMed literature search revealed the following:in schizophrenia,hallucinations,negative symptoms and cognitive symptoms are prominent.They are rare in DD.Compared to schizophrenia patients,individuals with DD maintain relatively good function,and their delusions are believable;many are beliefs that are widely held in the general population.Treatments are generally similar in these two forms of psychosis,with the exception that antidepressants are used more frequently in DD and,for acute treatment,effective antipsychotic doses are lower in DD than in schizophrenia.It is with the hope that the contrasts between these two conditions will aid in the provision of safe and effective treatment for both that this review has been conducted.展开更多
Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blur...Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature(2000-2014) on this subject(women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.展开更多
The dopamine hypothesis of how antipsychotic drugs exert their beneficial effect in psychotic illness has an interesting history that dates back to 1950.This hypothesis is not to be confused with the dopamine hypothes...The dopamine hypothesis of how antipsychotic drugs exert their beneficial effect in psychotic illness has an interesting history that dates back to 1950.This hypothesis is not to be confused with the dopamine hypothesis of schizophrenia;the aim of the latter is to explain the etiology of schizophrenia.The present review does not deal with schizophrenia but,rather,with the historical development of our current understanding of the dopamine-associated actions of the drugs that reduce the symptoms of psychosis.This historical review begins with the serendipitous discovery of chlorpromazine,a drug synthesized around a chemical core that initially served to produce man-made dyes.This molecular core subsequently contributed to the chemistry of antihistamines.It was with the aim of producing a superior antihistamine that chlorpromazine was synthesized;instead,it revolutionized the treatment of psychosis.The first hypothesis of how this drug worked was that it induced hypothermia,a cooling of the body that led to a tranquilization of the mind.The new,at the time,discoveries of the presence of chemical transmitters in the brain soon steered investigations away from a temperature-related hypothesis toward questioning how this drug,and other drugs with similar properties and effects,modulated endogenous neurotransmission.As a result,over the years,researchers from around the world have begun to progressively learn what antipsychotic drugs do in the brain.展开更多
Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attem...Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.展开更多
Many brain diseases, including schizophrenia, affect men and women unequally-either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings...Many brain diseases, including schizophrenia, affect men and women unequally-either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.展开更多
Delusional disorder(DD)has been traditionally considered a relatively rare and treatment-resistant psychotic disorder.In the last decade,increasing attention has focused on therapeutic outcomes of individuals affected...Delusional disorder(DD)has been traditionally considered a relatively rare and treatment-resistant psychotic disorder.In the last decade,increasing attention has focused on therapeutic outcomes of individuals affected by this disorder.The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research:(1)For which patients with DD do antipsychotic medications work best(the moderators of response);and(2)What variables best explain the relationship between such treatments and their effectiveness(the mediators of response).We searched PubMed and Google Scholar databases for English,German,French and Spanish language papers published since 2000.We also included a few classic earlier papers addressing this topic.Variables potentially moderating antipsychotic response in DD are gender,reproductive status,age,duration of illness,the presence of comorbidity(especially psychiatric comorbidity)and its treatment,brain structure,and genetics of neurochemical receptors and drug metabolizing enzymes.Antipsychotic and hormonal blood levels during treatment,as well as functional brain changes,are potential mediating variables.Some,but not all,patients with DD benefit from antipsychotic treatment.Understanding the circumstances under which treatment works best can serve to guide optimal management.展开更多
Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day func...Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask aboutnightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in nonschizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.展开更多
The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to...The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job(she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.展开更多
Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks a...Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks are known to be disrupted in this condition. The aim of this minireview was to scan the existing literature to determine:(1) whether individuals with schizophrenia are able to learn a second language as adults;(2) whether clinical assessment, both for the purpose of accurate diagnosis and for the prediction of treatment response, should be carried out in both languages in bilinguals with schizophrenia;(3) whether psychotherapy in schizophrenia is affected by bilingualism; and(4) whether speaking a second language improves outcome in schizophrenia. The literature to date is too sparse to make definitive statements, but:(1) individuals with schizophrenia appear to be capable of learning a new languages as adults; and(2) it is possible that teaching a foreign language may serve as a form of cognitive rehabilitation for this condition. This literature review recommends research into the effects of bilingualism on the outcome of schizophrenia. Included in this review is a retrospective pilot study conducted in Canada, which suggests that employment opportunities for patients with schizophrenia are improved when they speak more than one language. This is important to note because employment is generally problematic in the context of schizophrenia while, at the same time, the ability to obtain work contributes significantly to quality of life.展开更多
It was once impossible anywhere in the world for single adults to adopt children, and this is still the case in many jurisdictions. Elsewhere, however, single adults are now being actively recruited primarily because ...It was once impossible anywhere in the world for single adults to adopt children, and this is still the case in many jurisdictions. Elsewhere, however, single adults are now being actively recruited primarily because they are more willing than are married couples to adopt older or disabled children or to adopt across racial or other barriers. This is true for single men as well as for singlewomen, but single men seeking to adopt continue to be widely viewed with skepticism and are reportedly often judged to be inappropriate parents. This paper reviews the sparse fostering and adoption literature on single heterosexual males and addresses the evident ambivalence with which parenting by single men is held among both child and adult mental health professionals. The paper also discusses the parenting styles of mothers and fathers, the ways that the central nervous system in both sexes has been found to respond to parenthood, the similarity of outcomes between single male and single female parenting, and the availability in North America of support and training for foster and adoptive single parents. The paper concludes that, in general, single men have as much to offer an adopted child as do single women and that seeming discrimination against them by childcare agencies requires investigation.展开更多
文摘Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time. This can cause diagnostic confusion and uncertainty about treatment. This paper examines seven ways in which symptoms of both conditions can co-exist. The literature on this topic consists to a large extent of case reports, so that firm conclusions cannot be drawn from their examination. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. Psychosis is not necessarily a mark of severity in the course of an eating disorder, and food refusal can occur independent of severity in psychotic illness, but it can be a cause of death. There is some genetic association and some overlap of physiologic, cognitive and brain structure deficits in the two types of disorder. The connection between the two, however, remains speculative. The area of comorbidity and overlapping symptoms in psychiatry requires more research. Clinical recommendations include attentionto the different individual ways in which these two disparate conditions often overlap.
文摘Psychotic syndromes are divided into affective and non-affective forms.Even among the non-affective forms,substantial differences exist.The aim of this relatively brief review is to synthesize what is known about the differences between two non-affective psychoses,schizophrenia and delusional disorder(DD),with respect to clinical,epidemiological,sociodemographic,and treatment response characteristics.A PubMed literature search revealed the following:in schizophrenia,hallucinations,negative symptoms and cognitive symptoms are prominent.They are rare in DD.Compared to schizophrenia patients,individuals with DD maintain relatively good function,and their delusions are believable;many are beliefs that are widely held in the general population.Treatments are generally similar in these two forms of psychosis,with the exception that antidepressants are used more frequently in DD and,for acute treatment,effective antipsychotic doses are lower in DD than in schizophrenia.It is with the hope that the contrasts between these two conditions will aid in the provision of safe and effective treatment for both that this review has been conducted.
文摘Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature(2000-2014) on this subject(women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.
文摘The dopamine hypothesis of how antipsychotic drugs exert their beneficial effect in psychotic illness has an interesting history that dates back to 1950.This hypothesis is not to be confused with the dopamine hypothesis of schizophrenia;the aim of the latter is to explain the etiology of schizophrenia.The present review does not deal with schizophrenia but,rather,with the historical development of our current understanding of the dopamine-associated actions of the drugs that reduce the symptoms of psychosis.This historical review begins with the serendipitous discovery of chlorpromazine,a drug synthesized around a chemical core that initially served to produce man-made dyes.This molecular core subsequently contributed to the chemistry of antihistamines.It was with the aim of producing a superior antihistamine that chlorpromazine was synthesized;instead,it revolutionized the treatment of psychosis.The first hypothesis of how this drug worked was that it induced hypothermia,a cooling of the body that led to a tranquilization of the mind.The new,at the time,discoveries of the presence of chemical transmitters in the brain soon steered investigations away from a temperature-related hypothesis toward questioning how this drug,and other drugs with similar properties and effects,modulated endogenous neurotransmission.As a result,over the years,researchers from around the world have begun to progressively learn what antipsychotic drugs do in the brain.
文摘Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.
文摘Many brain diseases, including schizophrenia, affect men and women unequally-either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.
基金Supported by Intensification of the Research Activity Grant from the Health Department of the Generalitat de Catalunya,No.SLT006/17/00012 to Labad J.
文摘Delusional disorder(DD)has been traditionally considered a relatively rare and treatment-resistant psychotic disorder.In the last decade,increasing attention has focused on therapeutic outcomes of individuals affected by this disorder.The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research:(1)For which patients with DD do antipsychotic medications work best(the moderators of response);and(2)What variables best explain the relationship between such treatments and their effectiveness(the mediators of response).We searched PubMed and Google Scholar databases for English,German,French and Spanish language papers published since 2000.We also included a few classic earlier papers addressing this topic.Variables potentially moderating antipsychotic response in DD are gender,reproductive status,age,duration of illness,the presence of comorbidity(especially psychiatric comorbidity)and its treatment,brain structure,and genetics of neurochemical receptors and drug metabolizing enzymes.Antipsychotic and hormonal blood levels during treatment,as well as functional brain changes,are potential mediating variables.Some,but not all,patients with DD benefit from antipsychotic treatment.Understanding the circumstances under which treatment works best can serve to guide optimal management.
文摘Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask aboutnightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in nonschizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.
文摘The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job(she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.
文摘Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks are known to be disrupted in this condition. The aim of this minireview was to scan the existing literature to determine:(1) whether individuals with schizophrenia are able to learn a second language as adults;(2) whether clinical assessment, both for the purpose of accurate diagnosis and for the prediction of treatment response, should be carried out in both languages in bilinguals with schizophrenia;(3) whether psychotherapy in schizophrenia is affected by bilingualism; and(4) whether speaking a second language improves outcome in schizophrenia. The literature to date is too sparse to make definitive statements, but:(1) individuals with schizophrenia appear to be capable of learning a new languages as adults; and(2) it is possible that teaching a foreign language may serve as a form of cognitive rehabilitation for this condition. This literature review recommends research into the effects of bilingualism on the outcome of schizophrenia. Included in this review is a retrospective pilot study conducted in Canada, which suggests that employment opportunities for patients with schizophrenia are improved when they speak more than one language. This is important to note because employment is generally problematic in the context of schizophrenia while, at the same time, the ability to obtain work contributes significantly to quality of life.
文摘It was once impossible anywhere in the world for single adults to adopt children, and this is still the case in many jurisdictions. Elsewhere, however, single adults are now being actively recruited primarily because they are more willing than are married couples to adopt older or disabled children or to adopt across racial or other barriers. This is true for single men as well as for singlewomen, but single men seeking to adopt continue to be widely viewed with skepticism and are reportedly often judged to be inappropriate parents. This paper reviews the sparse fostering and adoption literature on single heterosexual males and addresses the evident ambivalence with which parenting by single men is held among both child and adult mental health professionals. The paper also discusses the parenting styles of mothers and fathers, the ways that the central nervous system in both sexes has been found to respond to parenthood, the similarity of outcomes between single male and single female parenting, and the availability in North America of support and training for foster and adoptive single parents. The paper concludes that, in general, single men have as much to offer an adopted child as do single women and that seeming discrimination against them by childcare agencies requires investigation.
