Severe psychosis and the adrenal androgens

Past literature suggests a link between certain psychotic states and adrenal androgen production, including Dehydroepiandrosterone (DHEA). A group of severely psychotic androgenized females, refractory to substantial amounts of neuroleptics, has been identified for whom endocrine testing revealed abnormaly high levels of DHEA. A similar group has been identified among the severely psychotic male population. Improvement in psychosis appears to occur as DHEA returns to its normal range using standard low dose Dexamethasone suppression.     

Prenatal androgens and gender-typed behavior: a study of girls with mild and severe forms of congenital adrenal hyperplasia

Gender-typed behaviors and interests were investigated in 26 girls, aged 2-10 years, affected with congenital adrenal hyperplasia (CAH) and in 26 unaffected girls matched for age. Girls with CAH were more interested in masculine toys and less interested in feminine toys and were more likely to report having male playmates and to wish for masculine careers. Parents of girls with CAH rated their daughters' behaviors as more boylike than did parents of unaffected girls. A relation was found between disease severity and behavior indicating that more severely affected CAH girls were more interested in masculine toys and careers. No parental influence could be demonstrated on play behavior, nor did the comparison of parents' ratings of wished for behavior versus perceived behavior in their daughters indicate an effect of parental expectations. The results are interpreted as supporting a biological contribution to differences in play behavior between girls with and without CAH.     

Hysteria and psychosis

The relationship between endogenous-psychotic and hysterical behavior is presented in this paper on the basis of typical patients' accounts. Various patterns of behavior are revealed: chronic hysterical psychotic syndromes, acute hysterical psychotic syndromes, hysterical exalted psychotic episodes, simulated hysterical psychotic syndromes, hysterical behavior in the attempt to cope with psychosis, and pseudohysterical behavior in endogenous psychoses. The specific aspects of the doctor-patient relationship in the case of these patients are described.     

Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Symbiotic psychosis and the need for fame

This paper attempts to synthesize Tartakoff's concept of the Nobel Prize complex (a constellation of personality traits found in some achievement-oriented neurotics) with the symbiotic syndrome which Mahler noted among certain psychotic patients. The performance-oriented symbiotic syndrome formulated in this paper is found in patients whose pathology ranges from the normal to the psychotic. The familial constellation involved in this performance-oriented symbiosis consists of an obessive, successful father; a depressed, hysterical, unfulfilled mother; and a child who is made to take the father's place in the household. The mother exploits the child by offering attention only when he achieves or performs in such a way as to fulfill her narcissistic strivings and bolster her self-esteem. The father is often involved in a similar symbiotic relationship with his own mother and therefore sanctions his wife and son's dyadic relationship.     

Mood theme and bizarreness of delusions in schizophrenia and mood psychosis.

Narratives of the delusions of 83 schizophrenic and 55 nonschizophrenic psychiatric subjects were categorized as of one or more of 12 types. Narratives were also independently assessed along dimensional scales of bizarreness and mood theme. Schneiderian and grandiose types were found to be more common in schizophrenics and mood psychotics, respectively. Dimensional measures showed that the delusions of schizophrenics were more unlikely and that those of mood psychotics had a stronger mood theme. Regression analysis determined that Schneiderian delusions and a dimensional estimate of mood theme best differentiated schizophrenics from mood psychotics. Assessments along dimensions of other parameters, particularly those represented by Schneiderian delusions, may further discriminate the functional psychoses.     

Social identity and psychosis: Explaining elevated rates of psychosis in migrant populations

A substantial body of literature suggests that migrants are at greater risk of developing psychotic symptoms, such as paranoia, compared to non‐migrants. To date, researchers have been unable to identify the primary cause of this effect, finding scarce support for biological, diagnostic, and economic explanations. Social determinants have received little empirical attention in this domain, which we assert is a critical gap in the literature. Here, we propose that the social identity approach offers a framework to help explain the elevated rates of psychosis among migrants, and in turn inform policies and interventions to address this important mental health issue. We propose that cultural identities play a central role in mitigating the psychological precursors of psychosis and that disidentification and social disconnection subsequent to migration could initiate or exacerbate psychosis for multiple generations. We draw together research from social and clinical psychology to detail a social identity approach to psychosis in migrant populations, and make recommendations for future research.     

Temporal processing and psychosis proneness

Two measures of temporal processing: critical stimulus duration (CSD) and visual backward masking (VBM), were examined in a group of normal subjects whose predisposition to psychosis was assessed using the psychoticism (P) scale from Eysenck's Personality Questionnaire. The current study employed the method of constant stimuli with a two-alternative forced choice responding to reduce the variability in CSD-data. Higher P scorers required a significant longer target stimulus duration in order to correctly identify the stimulus than lower P scorers. These results suggest that subjects prone to psychosis possess a relatively less sensitive temporal processing system than low P scorers. Performance in the subsequent masking phase revealed no evidence of a VBM deficit. It was not possible to explain this pattern of results in terms of task difficulty. The findings were discussed in terms of potential inadequacies in previous calculations of CSD. This possibility requires further testing before the backward masking deficit can be adopted as a trait marker for schizophrenia.     

Endogenous psychosis and human development

The attempt is made to demonstrate that the cerebral systems susceptible to affection in endogenous psychoses arose early in the stage of human development, and are thus of social origin. The biological aspects (inheritability, structures, metabolism) and the social aspects of these affections both arise out of the same human characteristics that distinguish man from animals. It thus seems within the bounds of possibility to resolve the fundamental inconsistency in the theory of endogenous psychoses.     

Chestnut Lodge and the psychoanalytic approach to psychosis

The study of psychosis has a long history in psychoanalysis, as does the debate over the suitability of psychoanalysis for treating schizophrenia. For decades, Chestnut Lodge was not only a hospital but also a clinical research and educational institution. A unique patient-staff ratio--about twenty analytic therapists for a hundred patients--made possible prolonged and intense clinical work with schizophrenic and other severely disturbed patients. Interstaff discussions were encouraged and facilitated. This quasi-academic approach to in-depth individual case studies led to clinical findings and theoretical formulations that had a significant impact on developments in psychoanalysis, both here and abroad. Many of these findings and theoretical formulations are relevant to current studies and treatments of psychotic and nonpsychotic patients.