Bipolarity, monopolarity and "dichotomous functional decay" as principles of differential diagnosis and "functional pathology" of endogenous psychoses

On the basis of Leonhard's Classification of the endogenous psychoses an attempt is made to trace the phenomenology of the monopolar and bipolar affective psychoses as well as Leonhard's "unsystematic schizophrenias" to three different functional anomalies. The differential diagnosis between the "cycloid psychoses" and the "unsystematic schizophrenias" as well as the problem of the so-called schizoaffective psychoses connected with them, is of particular interest. The arrangement to "functional areas" seems to be suitable.     

"Psychotherapy" versus "treatment"

Presents a comment on "Psychological treatments" by D. H. Barlow. Barlow proposed that we distinguish between the terms "treatment" and "psychotherapy." The author believes that not only is the distinction unnecessary, but that its implications could have negative consequences for the field of clinical psychology. It is the proposed distinguishing feature that treatments are "specifically tailored to the pathological process that is causing the impairment and distress" that is most problematic. Clinical psychology does not need a distinction that further exacerbates the split between researchers and practitioners.     

What catatonia can tell us about "top-down modulation": a neuropsychiatric hypothesis

Differential diagnosis of motor symptoms, for example, akinesia, may be difficult in clinical neuropsychiatry. Symptoms may be either of neurologic origin, for example, Parkinson's disease, or of psychiatric origin, for example, catatonia, leading to a so-called "conflict of paradigms." Despite their different origins, symptoms may appear more or less clinically similar. Possibility of dissociation between origin and clinical appearance may reflect functional brain organisation in general, and cortical-cortical/subcortical relations in particular. It is therefore hypothesized that similarities and differences between Parkinson's disease and catatonia may be accounted for by distinct kinds of modulation between cortico-cortical and cortico-subcortical relations. Catatonia can be characterized by concurrent motor, emotional, and behavioural symptoms. The different symptoms may be accounted for by dysfunction in orbitofrontal-prefrontal/parietal cortical connectivity reflecting "horizontal modulation" of cortico-cortical relation. Furthermore, alteration in "top-down modulation" reflecting "vertical modulation" of caudate and other basal ganglia by GABA-ergic mediated orbitofrontal cortical deficits may account for motor symptoms in catatonia. Parkinson's disease, in contrast, can be characterized by predominant motor symptoms. Motor symptoms may be accounted for by altered "bottom-up modulation" between dopaminergic mediated deficits in striatum and premotor/motor cortex. Clinical similarities between Parkinson's disease and catatonia with respect to akinesia may be related with involvement of the basal ganglia in both disorders. Clinical differences with respect to emotional and behavioural symptoms may be related with involvement of different cortical areas, that is, orbitofrontal/parietal and premotor/motor cortex implying distinct kinds of modulation--"vertical" and "horizontal" modulation, respectively.     

The inconstant "principle of constancy"

A review of the principle of constancy, as it appeared in Freud's writings, shows that it was inspired by his clinical observations, first with Breuer in the field of cathartic therapy and then through experiences in the early usage of psychoanalysis. The recognition that memories repressed in the unconscious created increasing tension, and that this was relieved with dischargelike phenomena when the unconscious was made conscious, was the basis for his claim to originality in this area. The two principles of "neuronic inertia" Freud expounded in the Project (1895), are found to offer the key to the ambiguous definition of the principle of constancy he was to offer in later years. The "original" principle, which sought the complete discharge of energy (or elimination of stimuli), became the forerunner of the death drive; the "extended" principle achieved balances that were relatively constant, but succumbed in the end to complete discharge. This was the predecessor of the life drives. The relation between the constancy and pleasure-unpleasure principles was maintained for twenty-five years largely on an empirical basis which invoked the concept of psychophysical parallelism between "quantity" and "quality." As the links between the two principles were weakened by clinical experiences attendant upon the growth of ego psychology, a revision of the principle of constancy was suggested, and it was renamed the Nirvana principle. Actually it was shifted from alignment with the "extended" principle of inertia to the original, so that "constancy" was incongruously identified with self-extinction. The former basis for the constancy principle, the extended principle of inertia, became identified with Eros. Only a few commentators seem aware of this radical transformation, which has been overlooked in the Standard Edition of Freud's writings. Physiological biases in the history and conception of the principle of constancy are noted in the Standard Edition. The historical antecedents of the principle of constancy, especially in relation to the teachings and influence of J. F. Herbart (1776-1841), do much to bridge the gap between psychological and neurophysiological aspects of Freud's ideas about constancy and its associated doctrine, psychic determinism. Freud's later teachings about the Nirvana principle and Eros suggest a continuum of "constancies" embodied in the structural and functional development of the mental apparatus as it evolves from primal unity with the environment (e.g., the mother-child unit) and differentiates in patterns that organize the inner and outer worlds in relation to each other.     

The analyst's knowledge and authority: a critique of the "new view" in psychoanalysis

A critical assessment is presented of positions recently taken by Mitchell and Renik, who are taken as representatives of a "new view" in psychoanalysis. One article by Mitchell and two by Renik are examined as paradigmatic of certain ways of construing the nature of mind, the analyst's knowledge and authority, and the analytic process that are unduly influenced by the postmodern turn in psychoanalysis. Although "new view" theorists have made valid criticisms of traditional psychoanalytic theory and practice, they wind up taking untenable positions. Specifically called into question are their views on the relation between language and interpretation, on the one hand, and the mental contents of the patient on the other. A disjunction is noted between their discussion of clinical material and their conceptual stance, and their idiosyncratic redefinitions of truth and objectivity are criticized. Finally, a "humble realism" is suggested as the most appropriate philosophical position for psychoanalysts to adopt.     

Re-reading "Little Hans": Freud's case study and the question of competing paradigms in psychoanalysis

Psychoanalysts have long recognized the complex interaction between clinical data and formal psychoanalytic theories. While clinical data are often used to provide "evidence" for psychoanalytic paradigms, the theoretical model used by the analyst also structures what can and cannot be seen in the data. This delicate interaction between theory and clinical data can be seen in the history of interpretations of Freud's "Analysis of a Phobia in a Five-Year-Old Boy" ("Little Hans"). Freud's himself revised his reading of the case in 1926, after which a number of psychoanalysts--including Melanie Klein, Jacques Lacan, and John Bowlby--reinterpreted the case in the light of their particular models of the mind. These analysts each found "evidence" for their theoretical model within this classic case study, and in doing so they illuminated aspects of the case that had previously been obscured, while also revealing a great deal about the shifting preoccupations of psychoanalysis as a field.     

"Knowledge by acquaintance" and "Knowledge-about": A psychometrical demonstration

In two studies, students were asked to rate their knowledge of a number of different topics, extracurricular as well as drawn from their textbooks of the history of psychology and philosophy. The score distributions on a scale from "unknown" to "well known" were in all cases distinctly U-formed, as if knowledge were a question of either/or, rather than one of degree. However, when knowledge was rated on a scale from "know nothing about" to "know much about", the U-pattern failed to appear, and the students tended generally to give more cautious ratings. The differences are interpreted as evidence for the philosophical and linguistic distinction between "knowledge by acquaintance" (German: "kennen", French: "connaître") and "knowledge-about" (German: "wissen", French: "savoir").     

Accuracy of Reported Community Diagnosis of Autism Spectrum Disorder

To compare community diagnoses of Autism Spectrum Disorder (ASD) reported by parents to consensus diagnoses made using standardized tools plus clinical observation. 87 participants (85% male, average age 7.4 years), with reported community diagnosis of ASD were evaluated using the Autism Diagnostic Observation Schedule) (ADOS-2), Differential Ability Scale (DAS-II), and Vineland Adaptive Behavior Scales (VABS-II). Detailed developmental and medical history was obtained from all participants. Diagnosis was based on clinical consensus of at least two expert clinicians, using test results, clinical observations, and parent report. 23% of participants with a reported community diagnosis of ASD were classified as non-spectrum based on our consensus diagnosis. ASD and non-spectrum participants did not differ on age at evaluation and age of first community diagnosis. Non-verbal IQ scores and Adaptive Behavior Composite scores were significantly higher in the non-spectrum group compared to the ASD group (104.5?±?21.7 vs. 80.1?±?21.6, p?<?.01; 71.1?±?15 versus 79.5?±?17.6, p?<?.05, respectively). Participants enrolled with community diagnosis of PDD-NOS were significantly more likely to be classified as non-spectrum on the study consensus diagnosis than Participants with Autism or Asperger (36% versus 9.5%, Odds Ratio?=?5.4, p?<?.05). This study shows suboptimal agreement between community diagnoses of ASD and consensus diagnosis using standardized instruments. These findings are based on limited data, and should be further studied, taking into consideration the influence of DSM 5 diagnostic criteria on ASD prevalence.     

Mahler's concepts of "symbiosis" and separation-individuation: revisited, reevaluated, refined

Mahler's developmental theories are reviewed in the light of subsequent clinical experience and theoretical and empirical critique. Several modifications are proposed, each tending to particularize and focus the nature and scope of developmental events. Particular attention is accorded the "symbiosis" concept, and focus placed on transmission of psychodynamic issues from mother to infant and on the progressive buildup of self-sustaining pathological systems. Overall, an argument is advanced for the continued developmental import of Mahler's "symbiotic" and "separation-individuation" phase formulations, though with recognition of significant individual differences in their role in individual lives. An argument is advanced also for the clinical utility of these ideas, and illustrations presented, though the link between clinical applications and psychoanalytic theories of early development remains problematic.     

Paul Gray's narrowing scope: a "developmental lag" in his theory and technique

A cental thesis of Paul Gray's work is that a "developmental lag" pervades modern psychoanalysis in its failure to assimilate and apply knowledge gained about the role of the unconscious ego in intrapsychic life. But Gray himself, it is proposed, has become a victim of a new "developmental lag," of his own construction. As he somewhat single-mindedly pursued the ramifications of his "developmental lag" concept, Gray may have foreclosed on some noteworthy ideas developing around him. The most important example is his claim--herein refuted--that proper interpretive technique can avoid being infused with transference. He also seems to have rejected the theoretical importance of the internalization of the analyst and the clinical usefulness of countertransference. While emphasizing defense analysis, he ignores defenses such as splitting, denial, and disavowal as substantive problems for his technique of close-process attention. Gray's "undoing" of the rapprochement between "ego analysis" and "id analysis" by viewing the matter as an either-or proposition undermines the very real value of his contribution to the field.     

Are critical items "critical" for the MMPI-A

This article examines one aspect of the potential usefulness of critical items to the: Minnesota Multiphasic Personality Inventory -Adolescent (MMPI-A). Endorsement frequency data are presented on the Koss-Butcher (1973) and the Lachar-Wrobeli (1979) critical items for Minnesota Multiphasic Personality Inventory-2 (MMPI-2) adult normative and clinical samples and for MMPI-A adolescent normative and clinical samples. Adolescents in both normal and clinical samples endorse critical items with a higher frequency than do normal adults. Further, results demonstrated that significant differences were uniformly found between the endorsement frequencies for normative versus clinical subjects for the MMPI-2 samples, whereas similar comparisons for the MMPI-A samples typically showed that adolescents in clinical setting did not endorse critical items more frequently than normal adolescents. These findings indicate that it may be difficult to construct critical item lists for adolescents based on the type of empirical methodology used with adults in which items are selected based on endorsement frequency differences found between comparison group. Beyond the issue of the technical difficulty in creating a critical item list for adolescents, several conceptual concerns are raised regarding the application of critical items to the MMPI-A. It was noted that the concept of "critical items" has not been we11 defined, and both the reliability and validity of critical items may be limited in adolescent populations.     

Interviewees' overuse of the word "like" and hesitations: effects in simulated hiring decisions

This study examined the use of hesitations and discourse markers such as "uh" and "like," sex of an interviewee, and professional or student participants on hiring decisions of job interviewees. Participants consisted of 105 students between the ages of 18 to 43 years and 71 professionals between the ages of 22 to 76 years (120 women, 56 men). Adult professionals and students were least likely to want to hire, perceived the applicant as less professional, and were less likely to recommend the interviewee for hiring if the interviewee overused the word "like" compared to "uh" or control. Professionals were less likely than students overall to want to hire interviewees across conditions. Sex of the interviewee was not found to be significant.     

Importance of "accentuation" for diagnostics in practical medicine

The report is about a study made in the USSR of 840 people (sick persons, female students, workers, intellectuals). All were given questionnaires acc. to H. Schmieschek in a Russian version, and the author (V. N. Belyayev) lists the results in tables and analyzes them. Reference is made to various aspects which are of importance for practical medicine and relate to a diagnosis of "accentuation" acc. to K. Leonhard.     

Concurrent Validity and Informant Agreement of the ADHD Module of the Anxiety Disorders Interview Schedule for <Emphasis Type="Italic">DSM-IV</Emphasis>

Examined the concurrent validity of the attention-deficit/hyperactivity disorder (ADHD) module of the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent versions (ADIS-C/P). One hundred eighty-four clinic-referred children were categorized into three ADIS-generated groups: No diagnosis of ADHD (No ADHD; n = 63), parent-only diagnosis of ADHD (Parent Only; n = 81), and parent plus child diagnosis of ADHD (Parent + Child; n = 40). The groups were compared on demographics, comorbid diagnoses, parent and child-report measures, and a computerized test of attention. Results support the concurrent validity of the ADIS ADHD module and highlight the positive relationship between internalizing symptomatology and parent-child agreement on ADHD diagnoses. The clinical implication of this study is that parent-child agreement on ADHD may serve as a marker of internalizing symptomatology. Future research on child self-perceptions is suggested in developing treatments for this internalizing ADHD group.

A contribution to "stiff man" syndrome

A patient with the clinical symptoms of the "Stiff-man"-syndrome, but an atypical course was introduced. Symptoms and course were compared with similar cases mentioned in literature. The "Stiff-man"-syndrome is probably a disease of central origin affecting the relationship between inhibitory and excitatory regulation of the muscle tonus, especially the exteroceptive reflex mechanisms. Several pathological processes of the CNS can be held responsible for the disturbance of the balance in this regulatory system.     

Comments on so-called "chronic" and "therapy refractory" depression

The problems of so-called "therapy resistant or chronic" depression has been investigated on own patients of the year 1986, but simply one chronic example could be noticed. Configurations-frequence-analytic research didn't essentially result in significant statements. It is referred to that the frequent occurrence of the so-called "therapy resistant" depressions described by some authors, could be in connection with limited diagnosis inventories and insufficient to the personality orientated therapy regime.     

Interpretation of paroxysmal slow activity--"subcortical signs"--in the electroencephalography of adults

Slow paroxysmal EEG activity, also referred to as "subcortical signs", offers an indication of impaired subcortico-cortical functional interaction that may be set off as a result of intracranial processes of a wide range of localisation. For this reason, the occurrence of this EEG pattern should not be taken to indicate a primary localisation in the range of the medical subcortical structures, nor does its absence imply any improbability of extensive lesions in the region. Taking into consideration the form and frequency of the waves during paroxysms and their local distribution, even this aspecific pattern yields more information for the clinical diagnosis. In particular, generalised paroxysms from monomorphic delta waves are usually associated with an existing primary or secondary brain illness, and would suggest the need for further diagnostic clarification. In interpreting the slow-wave groups restricted to the temporal regions, frequently counted among the "subcortical signs", the wave frequency and the patient's age must be taken into account. In the second half of life they frequently occur unaccompanied by any pathological process.     

“逆临床思维”与新型疾病发现方法的探讨

目的 初步总结发现新型疾病的方法和医学思维方式。方法 研究30余种疾病发现的过程。结果 新型疾病的发现过程和判断的思维方式似可初步总结为以下几个方面：（1）以疾病的异常特征为发现新型疾病的线索,包括流行病学、临床、实验室三个方面。（2）发现线索后从以上三个方面全面系统收集资料。（3）运用宏观思维寻找群体的共同特征,排除个体差异。（4）不仅收集与已知疾病相同的特征,而且还应注意与已知疾病不同的特征,然后综合分析判断。结论 发现新型疾病的方法与思维方式不同于经典的临床思维模式。     

Assessment of "juvenile psychopathy" and its association with violence: a critical review

Interest in the construct of psychopathy as it applies to children and adolescents has become an area of considerable research interest in the past 5-10 years, in part due to the clinical utility of psychopathy as a predictor of violence among adult offenders. Despite interest in "juvenile psychopathy" in general and its relationship to violence in particular, relatively few studies specifically have examined whether operationalizations of this construct among children and adolescents predict various forms of aggression. This article critically reviews this literature, as well as controversies regarding the assessment of adult psychopathic "traits" among juveniles. Existing evidence indicates a moderate association between measures of psychopathy and various forms of aggression, suggesting that this construct may be relevant for purposes of short-term risk appraisal and management among juveniles. However, due to the enormous developmental changes that occur during adolescence and the absence of longitudinal research on the stability of this construct (and its association with violence), we conclude that reliance on psychopathy measures to make decisions regarding long-term placements for juveniles is contraindicated at this time.