Negative symptoms of schizophrenia and the dexamethasone suppression test.

The dexamethasone suppression test (DST) was administered to 30 inpatients who met the DSM-III-R criteria for chronic schizophrenia and shared similar environments. Four of them (13%) were DST nonsuppressors. The mean and maximum postdexamethasone cortisol levels were correlated with the patient's score on the scale for the Schedule for the Assessment of Negative Symptoms and with the score on the anergia subscale of the Brief Psychiatric Rating Scale. None of the correlations were statistically significant. Furthermore, the scores on the above scales were not significantly correlated with clinical variables such as duration of illness, number of admissions or length of hospitalization, nor were any significant correlations found between the postdexamethasone cortisol levels and the score on the Beck Depression Inventory. In addition, depressed and nondepressed schizophrenics did not differ regarding the rate of nonsuppression and the postdexamethasone cortisol levels. This study found that: 1) dexamethasone nonsuppression in schizophrenia was not related to the presence of negative symptoms; 2) there was no relationship between negative symptoms and illness variables; and 3) the depressed schizophrenics did not display increased nonsuppression compared with nondepressed schizophrenics.

Differential emotional precipitation of migraine and tension-type headache attacks.

The frequency of precipitation of headache attacks by individual emotional states as well as the awareness of vulnerability to particular emotional precipitants were investigated in 90 consecutive patients with tension-type headache and 50 consecutive migraine subjects at an Outpatient Headache Clinic. There was differential emotional precipitation in tension-type headache and migraine, with patients with tension-type headache reacting more selectively to negative emotional arousal (anger, anxiety) and reporting a graded frequency of attack precipitation by individual emotional states. Migraine subjects reported a more uniform distribution of attacks among different emotional precipitants. The two groups also showed a differential awareness of vulnerability to individual emotional precipitants. A cognitive process screening the emotional precipitants of tension-type headache and migraine attacks is proposed, based on different cognitive schemata functioning either over-effectively or defectively. The significance of cognitive mediation of the precipitation of attacks is further emphasized for a comprehensive management of both tension-type headache and migraine.

Psychopathology and personality characteristics of epileptic patients: epilepsy, psychopathology and personality.

The psychiatric investigation of a sample of 101 epileptic patients (65 temporal lobe epileptics (TLE) and 36 non-TLE) through various methods of evaluation, showed that only a minority of TLE with DSM-III diagnoses of Organic Brain Syndromes had severe psychopathology and manifested some personality traits. Thus, these patients seem to be differentiated from the rest of epileptics, TLE and non-TLE, who had quite "benign" psychological problems, if at all. It is quite probable that this sub-group of TLE could be the main instigators and perpetrators of the "bad image" of epileptics. The findings are discussed in relation to the pertinent literature and some hypotheses are offered for their explanation.

The Greek cancer patient's knowledge and attitudes towards his diagnosis and prognosis.

One hundred and sixteen cancer patients were interviewed in order to investigate whether the Greek cancer patient wants to be informed and whether he knows his true diagnosis and prognosis of his illness. A semistructured interview was used and also a number of psychological parameters were assessed. Though only 15.5% of the patients named their real diagnosis, according to the interviewer's assessment 53% were strongly suspicious of their real diagnosis and 55% suspected their real prognosis. Furthermore, 49% when asked directly answered that they wanted to know if they had cancer and 49% disagreed with the policy of withholding the truth from the patient. The policy of telling or not telling the truth to the cancer patient in Greece is discussed in comparison with policies and attitudes in other countries.

Evaluation of the need for prophylactic antiparkinsonian medication in psychotic patients treated with neuroleptics.

A double-blind study of 42 psychotic patients treated with neuroleptics evaluated the need for prophylactic use of antiparkinsonian medication. The patients assigned to placebo (N = 27) presented significantly more severe extrapyramidal symptomatology, particularly dystonias, than those given trihexyphenidyl (N = 15), indicating a need for the prophylactic use of antiparkinsonian medication during treatment with neuroleptics.

Coping with cancer: psychological dimensions.

Cancer has a profound psychological impact upon the patient and his family, and the psychological responses, primarily of the patient himself, the close family, physician and nursing personnel, but also of the extended family, and society in general, become a complex interrelationship. Some of the most important psychological aspects of cancer are reviewed. These include the psychological responses of the patient, such as denial, vulnerability, coping strategies, hope, depression, suicide, reaction to diagnosis, and the management of the family, and the psychological responses and attitudes of the physician and nursing personnel. Based on the above psychological analysis some guidelines are offered to help in coping with cancer.

Evaluation of psychoanalytic psychotherapy outcome.

In a public psychotherapy clinic, the outcome of psychoanalytically oriented psychotherapy was investigated in a controlled study. The patients formed a treatment and a non-treatment (with initial evaluation) group, and psychotherapy was evaluated after 4 months of therapy. MMPI, target symptoms, global evaluation and other clinical evaluations were used. A number of aspects of the results are discussed pointing both to the efficacy of psychotherapy and the relative spontaneous improvement of the untreated patient.

Sexual life, problems, and attitudes of the prospective Greek physician.

A multi-item questionnaire was administered to 82 male and 48 female senior medical students; it addressed questions pertinent to their sexual life, sexual problems, and attitudes toward sex and sexuality. The results are discussed in relation to relevant studies in other countries and indicate that the prospective Greek physician, male or female, is quite liberal and permissive in his or her sexual practices and attitudes toward sexual matters. The latter might influence positively his or her attitude toward future patients' sexual problems. However, a need for specific sexual education is emphasized.

Gradual withdrawal of antiparkinson medication in chronic schizophrenics: any better than the abrupt?

Twenty-four months after the completion of a double blind study of antiparkinson (AP) medication abrupt withdrawal in which 100 chronic schizophrenics took part, 42 patients out of that study's 75 patient placebo group were found in the ward. In a new double blind 8-week study of 3-week gradual withdrawal of AP medication, 70-6 per cent of the 34 patient placebo group (vs. none of the active) presented severe extrapyramidal symptoms (EPS) necessitating early termination, 23.5 per cent (vs. 12.5 per cent of the active) presented worsening but not to a point necessitating early termination, and only 5.9 per cent (vs. 87.5 per cent of the active) completed the 8-week period unchanged. Furthermore, 41.17 and 23.52 per cent of the placebo group (vs none of the active) presented EPS-related severe complaints and or psychotic symptomatology, respectively. These results were almost identical to those of the study of abrupt withdrawal. Thus, it seems that AP medication withdrawal in chronic schizophrenics remains problematic, even if the medication is withdrawn gradually.

The need for continuous use of antiparkinsonian medication with chronic schizophrenic patients receiving long-term neuroleptic therapy.

In this double-blind six-week study, 98 chronic schizophrenic patients receiving long-term neuroleptic treatment and trihexyphenidyl were switched to either placebo or study trihexyphenidyl. Fifty-one (68%) of the 75 patients given placebo versus 1 of the 23 patients who continued on active trihexyphenidyl developed severe worsening of extrapyramidal signs, necessitating early termination from the study. Twenty-one (28%) of the placebo patients versus 2 (8.7%) of the trihexyphenidyl patients developed less severe worsening. Furthermore, 50 (66.6%) of the placebo patients but only 2 (8.7%) of the trihexyphenidyl patients had psychotic or other severe physical symptoms related to withdrawal of prestudy antiparkinsonian medication. The authors conclude that these data support the need for continuous use of antiparkinsonian medication in the long-term neuroleptic therapy of chronic schizophrenic patients.

Discontinuing antiparkinson medication in chronic schizophrenics. At what cost to the patient?

In a double-blind study of 100 chronic schizophrenic patients, withdrawal of antiparkinson (AP) medication showed that 44% of the 75 patients who constituted the placebo group (versus none of the patients on active AP medication), complained strongly of debilitating extrapyramidal symptoms (EPS) and another 22.6% (versus 8.7% of the patients on active AP medication), displayed disturbing psychotic symptomatology related to EPS. The authors discuss their findings in relation to the widely held view that AP medication may be safely withdrawn from chronic schizophrenics.

Attitudes of cancer specialists toward their patients in Greece.

A three-part questionnaire was mailed to Greek cancer specialists practicing in the two largest cities of Greece. Part I addressed the question of telling the truth to the cancer patient, Part II the question of telling the truth to the terminal cancer patient, and Part III investigated the psychological difficulties of the above specialists in the care of their patients. Most of the Greek cancer specialists (73%) chose not to tell the diagnosis to the cancer patient and an even greater majority (95%) prefer not to inform the terminal cancer patient of his impending death. A considerable number of them, though (41%), favor a change towards telling the cancer patient his true diagnosis. Furthermore, two thirds of them admit to psychological problems in their contact with the cancer patient and subscribe to the need for specific psychiatric training to improve the care of their patients.

Maintenance antipsychotic pharmacotherapy, relapse, and length of stay out of the hospital in chronic schizophrenics in Greece.

A retrospective study of 820 rehospitalization of chronic schizophrenics in Greece showed no significant difference in the discharge-rehospitalization, discharge-relapse, and relapse-rehospitalization time intervals, between the patients who continued to receive their medication after discharge regularly, and the patients who discontinued their medication upon discharge. Furthermore, there seemed to be an increased social adaptability or tolerance of the psychotic behavior of the patients who had discontinued their medication, suggested by their longer relapse-rehospitalization time interval.