Differences in obsessive-compulsive symptom dimensions between patients with epilepsy with obsessive-compulsive symptoms and patients with OCD.

Clinical correlates of obsessive-compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive-Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive-compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group. As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS. This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD.

Left colon interposition for esophageal reconstruction after perforation by metal blades ingestion: a case report.

Esophageal reconstruction with colonic or jejunal segment is a second choice treatment when the stomach is injured or not adequate for use. These reconstructions, whether pedicled or as free jejunal graft, are technically demanding and they are associated with high rate of morbidity and mortality. Complications are mainly due to insufficient blood supply and therefore anastomotic leak or stricture and graft necrosis. We describe the case of a 51-year-old psychiatric man with diagnosis of esophageal perforation after ingestion of metallic razor blades for suicide intent. The patient was treated at an outside hospital with endoscopic removal of the blades and apposition of endoscopic clips, be cause of esophageal mucosal perforation. Nevertheless, he developed a septic status caused by mediastinitis. The patient underwent several interventions to solve the sepsis and after complete recovery he was referred to our Department for esophageal reconstruction. During surgery we found that the stomach was unavailable for reconstruction, therefore a left colonic interposition pedicled on the left colic vessels was performed through the retrosternal route. During the postoperative course the patient developed acute respiratory failure and suppuration of the cervical wound. The postoperative course was complicated because of the poor compliance of the patient due to his psychiatric disorder. He was discharged in postoperative day (POD) 42 in good clinical conditions, on oral-only diet. Colonic interposition through the retrosternal route after esophagectomy is a technically demanding procedure, associated with high morbidity and mortality, but it is a feasible option when the stomach is not available for reconstruction.

[Aripiprazole, gambling disorder and compulsive sexuality]. / Aripiprazole, jeu pathologique et sexualité compulsive.

INTRODUCTION: Aripiprazole, an atypical or second-generation antipsychotic, is usually well tolerated. It is an approved treatment for schizophrenia and mania in bipolar disorder type 1. Unlike the other antipsychotics, it has high affinity agonist properties for dopamine D2 and D3 receptors. It has also 5-HT1A partial agonist and 5-HT2A antagonist properties. Aripiprazole is a first or second line treatment frequently used because it has reduced side effects such as weight gain, sleepiness, dyslipidemia, insulin resistance, hyperprolactinemia and extrapyramidal symptoms. CASE-REPORT: We report the case of a 28-year-old male patient diagnosed with schizoid personality disorder. He was a moderate smoker with occasional social gambling habits. After several psychotic episodes, he was first treated with risperidone, but he experienced excessive sedation, decreased libido, erectile dysfunction and was switched to 15 mg aripiprazole. He developed an addiction habit for gambling at casino slot machines. Due to large gambling debts, he requested placement on a voluntary self-exclusion list. Thereafter, he turned his attention towards scratch card gambling. The patient described his experience of gambling as a "hypnotic state". He got several personal loans to obtain money to continue gambling. He was then referred to an addiction unit. Before being treated with aripiprazole, he was an exclusive heterosexual with a poor sexual activity. Under treatment, he switched to a homosexual behavior with hypersexuality, unprotected sex and sadomasochistic practices. The craving for gambling and compulsive sexual behavior ceased two weeks after aripiprazole was discontinued and he was switched to amisulpride. Thereafter, he reported a return to a heterosexual orientation. DISCUSSION: Compulsive behaviors such as gambling, hypersexuality and new sexual orientation are common in patients with Parkinson's disease treated with dopaminergic agonists. These behaviors involve the reward system, with an enhanced dopaminergic activity in the mesolimbic pathways and occur more frequently in young subjects, males with previous gambling habits and tobacco use. A few cases of aripiprazole-induced pathological gambling as well as aripiprazole-induced hypersexuality have been reported. To our knowledge, we are the first to report a case of gambling disorder associated with hypersexuality and change of sexuality orientation. Aripiprazole is the only antipsychotic with agonist properties for the D2 dopamine receptor. It may also act as an enhancer in the mesolimbic dopaminergic pathways. Aripiprazole also has 5-HT1A partial agonist and 5-HT2A antagonist properties that may promote sexual activity. CONCLUSION: Aripiprazole is an antipsychotic associated with reduced side effects compared to other antipsychotics. We report the case of a patient who experienced gambling disorder, hypersexuality and a new sexual orientation under treatment. These side effects are little known. They are usually difficult for patients to mention due to feelings of guilt. The consequences on social life, family and health may be serious. Clinicians and patients should be aware about the possible issue of these behavior disorders with aripiprazole.

Enriched environment has limited capacity for the correction of hippocampal memory-dependent schizoid behaviors in rats with early postnatal NMDAR dysfunction.

Pre- and early postnatal stress can cause dysfunction of the N-methyl-d-aspartate receptor (NMDAR) and thereby promote the development of hippocampus memory-dependent schizoid abnormalities of navigation in space, time, and knowledge. An enriched environment improves mental abilities in humans and animals. Whether an enriched environment can prevent the development of schizoid symptoms induced by neonatal NMDAR dysfunction was the central question of our paper. The experimental animals were Wistar rats. Early postnatal NMDAR dysfunction was created by systemic treatment of rat pups with the NMDAR antagonist MK-801 at PD10-20 days. During the development period (PD21-90 days), the rats were reared in cognitively and physically enriched cages. Adult age rats were tested on navigation based on pattern separation and episodic memory in the open field and on auto-hetero-associations based on episodic and semantic memory in a step-through passive avoidance task. The results showed that postnatal NMDAR antagonism caused abnormal behaviors in both tests. An enriched environment prevented deficits in the development of navigation in space based on pattern separation and hetero-associations based on semantic memory. However, an enriched environment was unable to rescue navigation in space and auto-associations based on episodic memory. These data may contribute to the understanding that an enriched environment has a limited capacity for therapeutic interventions in protecting the development of schizoid syndromes in children and adolescents.

[The first episode of psychosis in juvenile patients: personality features and cognitive functioning].

A systemic study of personality features and cognitive processes based on the conception of pathopsychological syndrome has been conducted in patients with the first episode of juvenile endogenous psychosis. The association between characteristics of a pathopsychological syndrome and clinically determined premorbid features has been identified. The highest expression of schizotypal features (reduced selectivity, social perception) and cognitive impairment (motivation, mental activity regulation, adequate self-esteem, emotional reaction to success/failure) were characteristic of a group named "deficit variant of pseudopsychopathy" which contained a large number of passive schizoids. It has been shown that premorbid personality features are most distinct in initial stages of disease ("pathos" factors). "Nosos" factors are implicit and can be only presumably regarded as predictors of disease course.

Coping flexibility in young adults: comparison between subjects with and without schizotypal personality features.

The current study examined characteristics of coping patterns adopted by college students in mainland China. In particular, it examined the coping strategies adopted by subjects with schizotypal personality (SPD) features compared to those without SPD features, and compared the relative effectiveness of their coping. Four types of coping flexibility were identified among the college sample (n=427), including active-inflexible, passive-inflexible, active-inconsistent, and passive-inconsistent styles. The passive-inconsistent style was related to the worst outcomes. When comparing subjects with SPD features with those without SPD features, subjects with SPD features endorsed significantly more emotion-focused strategies in uncontrollable situations than those without SPD features. The SPD group experienced higher levels of trait anxiety, depression, paranoid ideation and general health problems. The SPD group also generally perceived more, less controllable stress than the non-SPD group and randomly used all four categories of coping strategies.

[Personality disorders in eating disorder patients]. / Trastornos de la personalidad en pacientes con trastornos de la conducta alimentaria.

Personality disorders in eating disorder patients. A follow-up study was designed to analyze the relation between personality disorders (PD) and the course of eating disorders (ED) in 34 patients who required treatment over 4 years and half. 91% of the clinical sample met the criteria for PD at the initial assessment and 36% at the end of treatment, with a significant reduction in MCMI-II scores at follow-up. The outcome of the ED was significantly related to the PD outcome. There was a higher rate of improvement of PD in the bulimic group (61%) than in anorexic group (34%). The patients who presented schizoid and avoidant personality disorders were the most resistant and they adhered less to treatment. The prevalence of PD in the clinical sample and its relation to the course of ED from a person-centered model is discussed.

Thought disorder in Asperger syndrome and schizophrenia: issues in the differential diagnosis. A series of case reports.

The relationship between Asperger syndrome (AS) and schizophrenia is still unclear. An unanswered question is, do hallucinations or delusions per se justify a diagnosis of schizophrenia when these symptoms appear in subjects with AS? The aims of the present study were: (1) to review the characteristics of thought disorder in AS and schizophrenia; (2) to describe the clinical features of six adult patients with AS who presented psychotic symptoms without mood symptoms; (3) to observe their clinical course and response to therapy in order to speculate possible relations between AS and schizophrenia. In the presence of its specific symptoms, it seems inappropriate to omit the diagnosis of AS because the DSM-IV-TR criteria for schizophrenia are also met, whether delusions and hallucinations appear early or late in the course of the disease. Recognizing and emphasizing the diagnosis of AS is not only important for clinicians to tailor the therapeutic strategy to the features of patients, but also for the patients and their relatives.

Dual-task information processing in schizotypal personality disorder: evidence of impaired processing capacity.

Working memory theories heavily rely on the concept of processing resources and the their efficient deployment. Some recent work with schizophrenia-spectrum patients has suggested that many associated cognitive impairments may be reduced to deficits in working memory, possibly related to reductions in information-processing capacity resources. In this study, 38 patients with schizotypal personality disorder (SPD), 22 patients with other personality disorders, and 14 healthy comparison participants performed a dual-task processing assessment that was designed specifically for use in this type of study. Participants recalled lists of digits at their predetermined maximum digit span and performed box-checking tests, first alone and then in a dual-task format. Instructions included equal prioritization of both tasks. SPD patients had significantly shorter digit spans, and they also showed more deterioration on both tasks. Performance operating characteristics curves indicated that SPD patients' reduced performance was not due to abnormal resource allocation strategies leading to strategic failures. The authors discuss the implications of these processing capacity limitations for understanding both the signature of cognitive impairment within the schizophrenia spectrum and general abnormalities in working memory.

Reduction of caudate nucleus volumes in neuroleptic-naïve female subjects with schizotypal personality disorder.

BACKGROUND: The caudate nucleus might contribute to the psychopathological and cognitive deficits observed in schizotypal personality disorder (SPD), a schizophrenia spectrum disorder. Here we focused on female patients, because this group is underrepresented in studies of SPD and schizophrenia, and we might learn more about the caudate and clinical and cognitive impairments that are unique to female patients diagnosed with SPD. METHODS: Magnetic resonance imaging scans, obtained on a 1.5-T magnet with 1.5-mm contiguous slices, were used to measure the caudate in 32 neuroleptic-naïve women with SPD and in 29 female normal comparison subjects. Subjects were group-matched for age, parental socioeconomic status, and intelligence quotient. RESULTS: We found significantly reduced left and right caudate relative volume (8.3%, 7.7%) in female SPD subjects compared with normal comparison subjects. In female SPD subjects, we found significant correlations between smaller total caudate relative volume and worse performance on the Wisconsin Card Sorting test (nonperseverative errors) and on the California Verbal Learning Test (verbal memory and learning), and significant correlations between smaller total caudate relative volume and both positive and negative symptoms on the Structured Interview for Schizotypy. CONCLUSIONS: These findings demonstrate that, for female SPD subjects, smaller caudate volume is associated with poorer cognitive performance and more schizotypal symptomatology.

Anaesthesia or psychotherapy: eradicating thoughts or working them through.

The author presents two sessions from the analysis of a depressive narcissistic doctor, which are characterised by a mixture of co-operation and pseudo-co-operation. The dialogue is in parts intellectualised, complicated, lifeless and schizoid. Points at which the patient shows surprising insights are then partly denigrated by him, on the basis that change is not to be expected. Semi-lifeless contact assists the defensive claustrophobia that he experiences in meaningful contact. It becomes very clear that he is then afraid of entering into an openly aggressive conflict that entails the existential threat of object loss. However, this has so far been avoided. The secret pleasure in an anal-narcissistic, sadomasochistic addiction to doubt persists in the partial denigration. The patient's artificially maintained self-doubt and doubt of the object reinforce a genuine confusion that consists in never knowing exactly what lies behind the helpful and needed object.

Fragmented attachments: the paranoid-schizoid experience of loss and persecution.

The author discusses paranoid-schizoid patients who have yet to deal with whole-object depressive fears of harming one's object. Their paranoid-schizoid anxiety is more a combination of dread, paranoia, and fear of destroying one's object with neediness, envy, and other oral desires. In this part-self and part-object world, destruction is absolute. Ego functions and object relational capacities such as guilt and grief are not yet fully consolidated. The part-object is not only destroyed but is also equally capable of magically resurrecting itself to seek revenge. Fear of annihilation of the self and object, as well as desperate attempts at keeping each other alive, are the primary focus of this early anxiety state. These infantile fears are at the root of certain difficult treatment situations. Within the transition from paranoid-schizoid to depressive, the ego struggles with highly exaggerated and distorted fantasies of persecution, loss, and primitive guilt by resorting to crude and often self-destructive mechanisms. These include splitting, projective identification, and idealization. During the course of analytic treatment, three overlapping phases are distinguishable. Acting out is the main theme of early treatment. As this externalization of internal conflict is analyzed and contained, a second phase of intrapsychic struggle emerges. The patient exhibits a paralyzing battle between certain ego-object ties and the striving of a defensive death instinct. If the analytic relationship is able to withstand passage through these difficult phases, the patient begins to work through more core issues of persecutory loss and annihilation. Case material is used for illustration.

Serotonin transporter gene polymorphism and schizoid personality traits in the patients with psychosis and psychiatrically well subjects.

BACKGROUND AND OBJECTIVES: serotonin transporter (5-HTT) gene allelic variants were shown to be associated with Neuroticism and Harm Avoidance but the results were not replicated in other studies. The current investigation was undertaken in a further attempt to study the relationship between 5-HTT polymorphism and personality traits. SUBJECTS AND METHODS: to evaluate a spectrum of personality traits, MMPI was administered to a sample including patients with affective disorders (n=114), patients with schizophrenia spectrum illnesses (n=110) and psychiatrically well controls (n=124). All groups were genotyped for VNTR-17 and functional insertion-deletion (5-HTTLPR) polymorphisms. RESULTS: an association was found between 5-HTTLPR polymorphism and scores on three MMPI scales: Psychopathic deviance, Paranoia and Schizophrenia in patients with affective disorders and S chizophrenia in normal subjects. Both affected and control individuals with 'ss' genotype exhibited lower scores on these scales. CONCLUSION: we demonstrated that functional deletion/insertion allelic variation associated with decreased expression of serotonin transporter ('s' allele or 'ss' genotype) may restrict expression of schizoid traits in normal subjects and patients with affective disorders.

Diagnosis of personality disorders in learning disability.

BACKGROUND: Though contentious, the diagnosis of personality disorders in persons with learning disability is clinically relevant because it affects many aspects of management. AIMS: To examine published literature on the diagnosis of personality disorders in learning disability. METHOD: Selective review with computerised (Medline, Embase and PsychInfo) and manual literature searches. RESULTS: The variation in the co-occurrence of personality disorder in learning disability, with prevalence ranging from less than 1% to 91% in a community setting and 22% to 92% in hospital settings, is very great and too large to be explained by real differences. CONCLUSIONS: The diagnosis of personality disorders in learning disability is complex and difficult, particularly in those with severe disability. Developing consensus diagnostic criteria, specific for various developmental levels, is one way forward. Such criteria may need to include objective proxy measures such as behavioural observations and informant accounts.

Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment.

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of "psychopathic" personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.

Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder.

This study explored the hypothesis that body weight is reduced in male children and adolescents with schizoid personality disorder or Asperger's disorder. The body weights of 33 consecutively admitted male subjects with one of these disorders were retrospectively assessed with percentiles for the body mass index (BMI). The mean percentile (+/- SD) for the BMI was 31.6 +/- 27.6 and differed significantly from the expected value of 50 (P<0.001). Ten subjects had a BMI of < or = 10th age percentile. Post hoc comparisons revealed that BMI percentiles were (a) reduced to a similar extent in patients with schizoid personality disorder and Asperger's disorder and (b) reduced to a greater extent in patients with abnormal eating behaviour. During childhood and adolescence both diagnoses are associated with an increased risk of being underweight. Population-based BMI percentiles are useful for detecting associations between specific psychopathological syndromes and body weight.

[Anhedonia and sensation seeking]. / Anhédonie et recherche de sensations.

The relationship between anhedonia and sensation seeking has been studied in 56 normal subjects of both sexes (33 males, 23 females). Anhedonia and sensation seeking were respectively defined by two reliable rating scales: Physical Anhedonia Scale of Chapman (PAS), Zuckerman's Sensation Seeking Scale (SS form V -40 items). The results have shown a negative correlation between this scales for males but not for females. These finding suggest that lowered levels of sensation seeking could constitute for males, like anhedonia, a risk factor of schizophrenia.