Vulnerability: A new view of schizophrenia.

Reviews the 6 approaches to etiology that now preempt the field—ecological, developmental, learning, genetic, internal environment, and neurophysiological models—and proposes a 2nd-order model, vulnerability, as the common denominator. Methods are suggested for finding markers of vulnerability in the hope of revitalizing the field. It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it (i.e., one's vulnerability), the crisis will either be contained homeostatically or lead to an episode of disorder. Vulnerability and episode stand in a trait–state relation, and markers for each must be provided to distinguish between them. (83 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptualization and treatment of paranoid schizophrenia: A deficit-discontinuity view.

Discusses the problems of obtaining trust and treating delusions in paranoid schizophrenia in the context of the conflict-continuity vs deficit-discontinuity debate regarding the development of the disorder. Therapeutic principles derived from a deficit-discontinuity model aimed at developing trust and attacking delusions are outlined. These principles include (1) always challenge a delusion; (2) provide simple explanations for faulty inferences, avoiding psychodynamic (genetic) interpretations; (3) teach generalization; (4) identify and encourage the avoidance of pathogenic environmental situations; (5) identify and utilize internal cues to prevent the emergence of delusional ideas; and (6) use medication when necessary. The model seeks to help patients control delusional ideas and unrealistic thoughts and to avoid situations that stimulate such thoughts. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coming alive: the psychotherapeutic treatment of patients with eating disorders

OBJECTIVE: To describe a dynamic psychotherapeutic approach specifically developed for women with eating disorders. METHOD: The developmental origins and psychological disturbances associated with eating disorders are outlined based on a review of the literature and the authors' observations. Principles from contemporary psychodynamic theories that focus on subjectivity and intersubjectivity are applied to the treatment of women with eating disorders and are illustrated with clinical vignettes. Theoretical models employed include intersubjective and relational theory, self psychology, and feminist psychodynamic theory. RESULTS: Relative unresponsiveness to a child's subjective experience and to child-initiated cues are thought to contribute to psychological disturbances among women with eating disorders. These disturbances include impairment in the sense of effectiveness, in the capacity to appreciate and tolerate emotions, and in the continuity and cohesiveness of self-experience. Self-imposed starvation, binge-purge episodes, and excessive exercise may act as psychic organizers in women with these vulnerabilities. An active psychotherapeutic approach with sustained interest in the patient's authentic subjective experience promotes the identification, organization, and integration of emotional experience and the consolidation of a more differentiated sense of self. CONCLUSION: In the psychotherapeutic treatment of women with eating disorders, a therapeutic posture of sustained empathic enquiry contributes to the patient's curiosity about her own subjective world. Feeling understood in a therapeutic relationship and feeling assisted in organizing and understanding one's subjective experience contributes to the gradual unfolding of the psychological sense of self.     

Fertility and schizophrenia: evidence for increased fertility in the relatives of schizophrenic patients

BACKGROUND AND PURPOSE: We present a rare case of desmoplastic fibroma of the skull. Desmoplastic fibroma is a distinctive and rare neoplasm of bone that histologically and biologically mimics desmoid soft tissue tumor. Only 6 cases have been reported in the skull and none of these was diagnosed by MRI. CLINICAL PRESENTATION: A 64 year-old woman, operated on in June 1991 for left mastectomy due to a ductal adenocarcinoma and again in October 1994 for a left frontal metastatic adenocarcinoma, was admitted in our Department of Neurosurgery because a control cerebral MRI had detected a diploic lesion, isointense on T1-weighted images and hyperintense on T2, with moderate enhancement, localized in a right parietal site. Neurological examination was negative. The lesion was surgically removed and a cranioplasty was performed. Histological diagnosis was desmoplastic fibroma. Twelve months after treatment she has no neurological symptoms or signs of cerebral lesions (MRI) or systemic metastasis (total body CT). CONCLUSION: In the literature the number of desmoplastic fibroma is too small and the follow-up period too short to permit any conclusions regarding the aggressiveness of the tumor.     

Serotonin function and treatment response to clozapine in schizophrenic patients

OBJECTIVE: Clozapine is the only compound proven to be effective in the 20% of schizophrenic patients refractory to treatment with conventional neuroleptics. Although its mechanism of action has not been elucidated, clozapine appears, in contrast to most conventional neuroleptics, to be a potent serotonin (5-HT) antagonist. This study hypothesized that 5-HT function is increased in patients who benefit from clozapine treatment relative to patients who fail to improve on it. METHOD: The 5-HT receptor agonist m-chlorophenylpiperazine (MCPP) was used as a probe to examine 5-HT function. MCPP (0.35 mg/kg p.o.) was administered in a placebo-controlled design after a 3-week drug-free period to 19 schizophrenic patients. ACTH, prolactin, body temperature, behavior, and MCPP blood level were measured. Patients were then treated with a conventional neuroleptic, and, having failed to respond to it, were treated with clozapine for 5 weeks (up to 600 mg/day). RESULTS: Patients who responded to clozapine had significantly higher ACTH responses to MCPP during the drug-free state than the patients who failed to benefit from clozapine. Moreover, the degree of improvement with clozapine, particularly the improvement in psychotic symptoms, was strongly correlated with the magnitude of MCPP-induced ACTH release. Other MCPP-induced responses and MCPP blood level were similar for the two groups and did not correlate with the degree of symptomatic improvement with clozapine. CONCLUSIONS: Results of this study suggest that MCPP-induced ACTH release, and by inference 5-HT receptor function, may be increased in patients who benefit from treatment with clozapine relative to patients who fail to improve on this drug.     

Childhood leukaemia: towards an integrated psychosocial intervention programme in Singapore

Presumably ribosome and transfer RNA (tRNA) evolved from a pre-existing function in the RNA stage of life and were secondarily adapted for protein synthesis. Various possible initial functions of the primitive ribosome (protoribosome) have been suggested. The initial function of the primitive ribosome and primitive genetic translation would have been quite similar. It is possible that, initially, both functions coexisted in the protoribosome. Given that the three-dimensional structure of ribosomal RNAs shows only minor variations throughout time, it is, then, most likely that present ribosomes can still recall (remember) the most important parts of the mechanism of their initial function. A process would have arisen to inactivate the initial function of the protoribosome without affecting genetic translation: the modification of some ribosome nucleosides. We suggest that the modifications of some rRNA nucleosides located in the catalytic center responsible for the initial function of primitive ribosomes, and of some of the tRNA nucleosides which interacted with the same center could have resulted in the inability of their recognition and secondary interaction. Thus, it is a known fact that the establishing of hydrogen bonds between modified nucleosides is rare and unstable. Therefore, the initial biological function of primitive ribosomes could have been inactivated without significantly affecting its three-dimensional structure. Therefore, without affecting the primitive translation. After the emergence of translation, some catalytic proteins (enzymes) which could modify the nucleosides of ribozymes could have arisen. In brief, we suggest that the catalytic proteins, through nucleoside modification, inactivated the catalytic RNA activity but RNA capacity to recognize and to bind other RNAs was not essentially altered. Only a few ribozymes were slightly affected by the modifications and they still maintain catalytic and binding activities. Therefore, we suggest that the proteins, through modification process, could have diminished the diverse functional capacities of the first RNA molecules. Auto-organization of the organic matter could be based on this type of interaction between macromolecules (protein and RNA).     

Clozapine in long-term treatment of schizophrenic patients

Clozapine has advantages over standard antipsychotics in refractory schizophrenia. Studies on the efficacy of clozapine in the maintenance treatment are sparse and suffer from methodological limitations. Despite this fact clozapine ranked second in a survey dealing with the preference of this antipsychotic in the long-term treatment of schizophrenia. Doctors report on using a mean of 130 mg/d in this indication which is considerably less than the doses used in most of the published long-term trials. The discrepancy between the popularity of clozapine and the lack of sound empirical data on its long-term efficacy is discussed.     

The acquisition of psychotherapeutic skill: an empirical study

The acquisition of psychotherapy skillfulness is an important aspect of training programs in psychiatry and clinical psychology. Psychotherapy supervision is employed to teach and monitor the development of these clinical skills. The Supervisor Report (SR) is a questionnaire designed to systematically assess therapeutic behaviors and global psychotherapeutic skillfulness of therapists conducting psychodynamic psychotherapy. SRs were employed to examine changes in trainees' skillfulness over the course of training. T-tests were applied to evaluate differences between the average scores of trainees in the first half of their training compared to the last half of their training. Comparisons of the scores for Psychotherapeutic Techniques and assessments of Global Skillfulness were in the predicted direction: Trainees in the advanced portion of their training were rated as more skillful than at the beginning. This study provides some evidence that psychotherapy skillfulness is acquired over time in training.     

Prevalence of antibodies to Toxoplasma gondii in cattle and swine in The Netherlands: towards an integrated control of livestock production

V3703 (Stomadhex) is a tablet with bioadhesive properties enabling it to remain in place for several hours after it has been placed on the oral mucosa. It continuously releases chlorhexidine and niacinamide. In a study conducted in 15 dogs, the tablets were well tolerated by the animals. The product significantly reduced (p < 0.05): dental plaque; quantitative periodontopathogen and total anaerobic bacterial counts; spirochetes; and halitosis when used daily over a 14 day period. Gingivitis was also reduced, though not significantly (p = 0.07). Stomadhex treatment can provide a carry-over effect following dental scaling by reducing oral microflora and retarding the reappearance of dental plaque.     

Prime theory: An integrated view of motivation and emotion.

Presents a theory that describes motivation and emotion as different aspects of a single process in which emotion involves the readout of motivational potential inherent in hierarchically organized primary motivational/emotional systems (primes). This theory involves an integrated way of thinking about emotion and motivation in their various physiological, expressive, and cognitive aspects. The most basic readout, Emotion I, involves adaptive-homeostatic functions. In species where communication about the state of certain primes became important, Emotion II, involving their outward expression, evolved. With cognition, a 3rd type of readout evolved, Emotion III, involving the direct experience of certain primes. A model of the interaction between primes and cognition is presented, and the unique role of language in human motivation-emotion is discussed. (4? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dependency in psychotherapy: Toward an integrated treatment approach.

Briefly reviews empirical research on the etiology and dynamics of dependency, describes extant theoretical and clinical writings on dependency in psychotherapy, and presents an integrated treatment approach to working with dependent patients in the clinical setting. This treatment approach focuses, first and foremost, on altering the dependent patient's problematic cognitions and self-statements. In addition, this treatment approach strives to alter the dependent patient's motivations, behaviors, and emotional responses, with the aim of facilitating autonomous functioning and encouraging healthy interdependence in interpersonal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of congitive-dissonance theory to an aspect of psychotherapeutic practice.

"The present paper is designed to link dissonance theory with one practical reality-oriented aspect of the process of psychotherapy with emotionally troubled individuals—namely, the charging of fees." Freud stated that "money matters are treated by civilized people in the same way as sexual matters—with the same inconsistency, prudishness, and hypocrisy. It is… avowed… that in order to accomplish any significant therapeutic work the patient must be charged a fee that is somewhat painful and discomforting." Dissonance theory "would predict that if a person paid nothing for something that he believed was worth nothing he would not experience cognitive dissonance. Rather his cognitive world would be in a state of harmony in this regard. My main purpose has been to stimulate greater clinical interest in the possibilities of employing general psychological theories, developed in the more traditional academic areas of psychology, to shed light upon seemingly complex issues in the field of clinical psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training schizophrenic patients to manage their symptoms: predictors of treatment response to the German version of the Symptom Management Module

Thermally reversible poly(N-isopropylacrylamide) (PIPAAm) was covalently grafted onto tissue culture dishes to allow detachment of cultured cells upon temperature change from physiological to room temperature. In addition the grafted polymer matrix was used to entrap biomolecules such as growth factors either to be released by diffusion early in cell cultures, or remain entrapped and be reversibly exposed to cell receptors. Experiments with model proteins trypsin and insulin show that amount loaded and released depends upon the PIPAAm grafting density. Dishes grafted with 2.5 microgram/cm2 PIPAAm released approximately four times more model protein over 4 h than dishes grafted with 1.8 microgram/cm2. This in vitro drug delivery system can be used to deliver factors to the basal side of cells early in cell culture by providing high local concentrations without high bulk concentration. Cultures of human retinal pigmented epithelium showed higher growth rate on insulin loaded dishes than on controls containing a similar bulk solution concentration. These cultures retained the ability to detach singly or as confluent sheets from the loaded surfaces.     

"The relation of congitive-dissonance theory to an aspect of psychotherapeutic practice": Comment.

Presents a comment on Anthony Davids' article (see record 1965-02097-001) which presented the hypothesis that payment of high fees will cause clients entering a psychotherapeutic relationship to experience cognitive dissonance which may be reduced through increased commitment to therapeutic gain. This thesis, beyond providing a source of rationalization for psychologists engaged in private practice, raises another interesting question. Namely, why do writers in this area continue to speculate about the influence of fee payment on the behavior of the client, but neglect to raise the question of its influence upon the clinician? The author notes that Davids' thesis may actually be pointing toward a "double-effect" hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-compliance with treatment in patients suffering from schizophrenia: a study to evaluate possible contributing factors

In the decade since the clinical arrival of laparoscopic cholecystectomy, there have been gratifying improvements in imaging technology and instrumentation, and innovative techniques have evolved. Laboratory-simulator devices are available for basic skills exercises and can at least reasonably mimic the appearance of the gallbladder and some other organs or anatomic regions. Unfortunately, there is no satisfactory method to practice dealing with certain structural abnormalities or disease processes. Because of that, some operations will be particularly difficult and the outcomes will be favorable only with careful planning and capable execution. The experiences and skill level of the surgeon can be enhanced by appropriate mental preparation. As a result, the surgeon will have the opportunity to accomplish the task, both laparoscopically and safely, under circumstances that initially were thought to be inappropriate or impossible for laparoscopy.     

A theory-based treatment of psychotic symptoms in schizophrenia: treatment successes and obstacles to implementation

This study investigated the use of the immediacy theory to explain the existence of auditory hallucinations and delusions in individuals with schizophrenia and to develop treatment strategies. In a 2-phase approach, a therapist trained 6 individuals with schizophrenia to stop responding to the immediate stimuli ostensibly evoking their symptoms and instead to respond to more remote stimuli unrelated to the problem behavior. Two other participants received nonspecific supportive psychotherapy to control for rater bias and to provide some comparison to the experimental treatment. Following 6 weeks of therapy, participants in the experimental group improved on 66% of the symptom measures. By contrast, participants in the control group improved on only 11% of the measures. The individuals in the experimental group retained some of these benefits during the follow-up period. The findings are discussed in light of several contributory factors.     

Obsessive-compulsive disorder among schizophrenic patients: an exploratory study using functional magnetic resonance imaging data

The case of a 70-year-old woman with cerebral amyloid angiopathy (CAA) is presented. MRI of the head showed widespread miliary foci of haemorrhage within the cerebrum and cerebellum, with some additional linear lesions within the cerebral cortex and patchy lesions in the white matter. This is in contrast to the more usual pattern of intracranial haemorrhage in CAA, i.e., a lobar haematoma.