[Preventing dangerous psychotic acting out]. / Prévenir les passages à l'acte dangereux psychotiques.

Delusions of having been wronged, of persecution, of having a mission or order to execute, are frequently the causes of dangerous psychotic acting out. The regular clinical assessment of these patients and their treatment is essential for preventing this acting out, which can have dramatic consequences on the potential victims. If there is a treatment indication but refusal on the part of the patient to cooperate, it is necessary to resort to treatment without the patient's consent.

[Operationalized psychodynamic diagnostics (OPD) in patients in a prodromal state of schizophrenia--an explorative study]. / Operationalisierte Psychodynamische Diagnostik (OPD) bei Patienten im schizophrenen Prodromalstadium--Eine explorative Studie.

OBJECTIVES: To obtain data and hypotheses regarding the amelioration of risk estimation and preventive psychotherapy in patients in a prodromal state of schizophrenia by using OPD. METHODS: 20 participants with a prodromal condition--6 subjects far from psychosis and 14 close to psychosis--along with 10 patients with paranoid schizophrenia as reference group were examined using the first four OPD axes. RESULTS: Both groups differed considerably in all four axes. Compared to the schizophrenic participants, prodromal probands appear to have more favourable preconditions for therapy. Moreover, they experienced the interaction partners, including the investigator, as less aversive and induced less distanced behaviour in the investigator. Conflicts of self-esteem were prominent in both prodromal subgroups. However, patients farther from psychosis showed less conflicts of autonomy versus dependence and displayed a higher integration in structures such as "defence" and "attachment" when compared to participants closer to psychosis. CONCLUSIONS: Particularly the differences between the prodromal subgroups suggest that application of the OPD may positively complement previous approaches of early detection, prevention,and psychotherapy for prodromal conditions. The hypotheses obtained should be tested in longitudinal studies with larger sample sizes.

Morgellons in dermatology.

Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a number of alleged infectious species (usually parasites and bacteria), whose identity has varied over the decades. Since 2002 worldwide an increasing number of patients have complained of unverifiable fibers and filaments in or on the skin, associated with numerous nonspecific complaints (arthralgias, altered cognitive function and extreme fatigue). This entity has been named "Morgellons disease" by the patients themselves, although medical evidence for its existence is lacking. As an example, we discuss a 55-year-old woman who complained of Morgellons disease and was treated as if she had DP. Currently the delusional assumption of infestation with Morgellons should be considered as a new type of DP with some kind of inanimate material. We therefore recommend in case of DP including Morgellons the use of the broader term "delusional infestation".

[The neuroleptic treatment of delusional parasitosis: first experiences with aripiprazole]. / Neuroleptische Behandlung des Dermatozoenwahns: Erste Erfahrungen mit Aripiprazol.

Delusional parasitosis can occur as an isolated delusional syndrome, or it may be associated with an underlying psychiatric disorder or physical illness. The benefit of treatment with antipsychotics in the treatment of delusional parasitosis is well known. Because of their efficacy and side effects profile, atypical neuroleptics have been suggested as potential alternatives to classical neuroleptics. In the case presented, the positive experiences with the novel neuroleptic aripiprazole are described.

Síndrome de Capgras: a propósito de un caso / Capgras syndrome: considerations of a clinical case

En 1923 Jean Marie Joseph Capgras describe un caso al que denomina “La ilusión de Sosías”, en el que su principal característica es la convicción delirante del paciente, de que algunas personas de su entorno han sido sustituidas por un impostor, no son reales, sino dobles de sí mismos. Psicopatológicamente se plantea con frecuencia la controversia sobre si este fenómeno debe considerarse un síntoma aislado o un síndrome con entidad propia. En este artículo se expone un caso de síndrome de Capgras en una mujer joven

In 1923 Jean Marie Joseph Capgras described a clinical case that he called “La ilusión de Sosias” in which its main characteristic is the patient delusional conviction that some people within his/her environment have been substituted by impostors, they are not real but doubles of themselves. In psychopathology it is often set the controversy if this phenomenon must be consider as a single symptom or as a syndrome with own entity. In this article a clinical case of Capgras syndrome in a young female is presented

Schizophrenia: the quest for a minimum sense of identity to ward off delusional disorder.

OBJECTIVE: This study was designed to analyze the language of patients with schizophrenia exhibiting negative symptoms during a 3-month period. METHOD: The computer-assisted ALCESTE method was used to simultaneously analyze the subjects' oral behaviour and speech patterns at various levels. RESULTS: The tested subjects had very specific speech patterns. Most significantly, analysis of the underlying syntactic processes showed that the patients exhibited a sense of identity, however minimum, based on their own pathologies and on the surrounding world. In our previous study, no such characteristics were observed in the discourse of schizophrenia patients with delusions (exhibiting positive symptoms). This suggests that the minimum sense of identity that develops in patients with schizophrenia allows them to avoid positive symptoms. CONCLUSION: In studies of language production by subjects suffering from schizophrenia, it is necessary to distinguish between patients with positive symptoms and those with negative symptoms. The speech patterns of these 2 groups have to be analyzed separately, which has not been done previously, since the groups differ in too many respects.

[The analysis of factors prior to positive symptoms relapse in schizophrenia]. / Czynniki poprzedzajace nawrót objawów wytwórczych w schizofrenii.

Schizophrenic relapses are an important problem for the sick persons and the society. They decrease the quality of patients' and their families life and also increase treatment costs. The aim of the study was to evaluate the type and frequency of the following factors during six months prior to relapse: patient non-compliance with pharmacotherapy, substance use, doctor's mistakes in antipsychotic treatment, absence of patient and family psychoeducation, stress situations, occurrence of physical disturbances and presence of additional psychiatric diagnosis. The studied group was composed of 60 patients with the diagnosis of paranoid schizophrenia (according to DSM-IV) that fulfilled the relapse criteria and were admitted in turn to psychiatric departments. Data were collected by specially constructed Questionnaire of Factors Prior to Schizophrenic Relapse. In the studied group the most frequent "risk factor" prior to relapse was patient non-compliance with pharmacological treatment (in 51.7% of subjects).

Established chronicity of psychotic symptoms in first-admission schizophrenic patients.

The course of schizophrenia before a patient's first admission is important theoretically, prognostically, and from a preventive psychiatric perspective. However, there is little systematically collected information on this topic. In this evaluation of a representative sample of first-admission schizophrenic patients, there was a wide variation in chronicity of psychotic symptoms before admission, with 20% of the patients having been symptomatic for more than 2 years and 28% for less than 1 week. Delusions of grandeur, delusions of reference, and suspiciousness were more common in the more chronic patients than in the most acute patients; symptoms of withdrawal and retardation showed the opposite pattern. The authors discuss the implications of these findings for prognosis, prevention, and theory.