Group therapy with selected forensic-psychiatric patients (dyssocial maldevelopment

The treatment of patients with medically relevant dissozial misdevelopment in a forensic-psychiatric clinic demands special methods corresponding to the subjective and objective conditions. The group therapy represents a possibility of activating those patients in a socially adequate way. There are being described the course and first results of this method.     

The forensic-psychiatric expert opinion on offenders under the influence of alcohol. Structure and problems

The authors recommend and comment on the following structure for forensic-psychiatric expert opinion on offenders under the influence of alcohol. (I) Statement as to the presence of psychopathological impairment apart from acute intoxication, and, if present, what impairment. (II) Assessment of the actual impairment due to intoxication at the time of the offence. (III) The interaction of the factors set out in (I) and (II). (IV) Assessment of personal responsibility for the state of intoxication.     

The pathological left-handedness syndrome

A clinical syndrome of pathological left-handedness (PLH) is proposed to identify the pattern of correlative changes in lateral development associated with early brain injury in some manifest left-handers. This syndrome is believed to be caused by a hemispheric lesion that is predominantly left-sided (or bilateral asymmetric), which onsets before Age 6, and which encroaches upon the critical speech zones of the frontotemporal/frontoparietal cortex. The pattern of changes may include any or all of the following features: shifts in manual dominance, trophic changes in the extremities, transfer of hemispheric speech, and/or intrahemispheric reorganization of visuospatial cognitive functions. Although some of these correlates of PLH have long been known, they have not been recognized as an interrelated pattern of traits that constitute a clinical syndrome. Identification of these individuals, all manifest left-handers, will be shown to have implications for diagnosis/remediation and for models of recovery of function.     

The effects of ethanol intoxication on phobic anxiety

Behavioral conceptions of alcohol abuse often include the hypothesis that drinking behavior is a negatively reinforced operant, with ethanol intoxication viewed as alleviating aversive environmental and internal states. This hypothesis has not been confirmed or refuted by previous studies which employed mild stressors and limited assessment methodology. In the present experiment, 22 patients with severe phobias approached their phobic animal under two consecutive conditions—first while sober and second after drinking either a placebo or an intoxicating dose of ethanol. The severe anxiety induced was assessed behaviorally, physiologically and by the patient's self-report of fear. The intoxicated patients did not experience decreased anxiety, tachycardia or avoidance, compared to the placebo group. These results have clinical implications and suggest the need to reconsider tension-reduction theories of alcohol abuse.     

Judging intoxication

Judgments of whether a person is intoxicated by alcohol are important in a number of civil and law enforcement settings. This paper reviews how well people are able to make such judgments, the evidence for individual signs of intoxication, several structured rating techniques, and the use of sobriety tests. It is concluded that observers relying on common-sense clues of intoxication have limited ability to assess the blood alcohol concentration (BAC) levels of strangers, particularly below .10%. This generalization holds across professions that might be expected to show greater accuracy. Structured assessment instruments based on observable signs have shown promise but are confounded by the wide variations between casual social drinkers and those that have obtained a high level of tolerance. Among sobriety tests, only NHTSA's Standardized Field Sobriety Tests (SFSTs) have substantial, but seriously flawed, research support. Assessing the sobriety of strangers in the low to moderate BAC ranges without resort to chemical tests remains a daunting task. Copyright © 2010 John Wiley & Sons, Ltd.     

The destruction of time in pathological narcissism

This paper describes the characteristics of subjective time (in contrast to objective time), with particular reference to a specific form of pathological experience and relation to the passage of time in patients with narcissistic personality undergoing psychoanalytic treatment. The clinical manifestations and technical approach to this pathology of time experience are outlined in the context of illustrative clinical vignettes.     

The psychoanalyst's normal and pathological superegos

The first section of the paper explores a number of differing views regarding the concept of the superego, essentially in terms of its formation and its functions. Two broad theories of superego development, both of which were introduced by Freud, are described. The first takes the superego to be principally oedipal in origin; the second traces the superego to an earlier period. The controversy about the usefulness of the concept of the death instinct is also implicated in the different views. It is then suggested that it is worthwhile to distinguish between a normal superego and a pathological superego and that these two distinct models of the superego are implicit in the work of both Freud and Klein. Strachey's (1934) views on the nature of the mutative effect of psychoanalytic treatment are briefly reviewed in the light of this distinction. It is suggested that Strachey was hesitant in clarifying the full implications of his views, particularly regarding the reasons for the difficulty the psychoanalyst will experience in making a transference interpretation. It is argued that the difficulty will relate to the psychoanalyst's anxiety about having sufficiently worked through the countertransference, particularly in relation to superego functioning. Two brief clinical vignettes are considered in support of this view. The last section of the paper offers some comments on the emotional development of the psychoanalyst and the ways that maturing as a psychoanalyst will involve a certain mellowing of the analyst's stance and a greater tolerance of the patient's prerogative to bring the full range of his or her personality into the treatment.     

The effect of alcoholic intoxication upon calorically induced oculogyral illusion

Ten male and 10 female subjects, half of whom were classified as “heavy” and half as “light” drinkers, ingested a 4-1 combination of tonic water and 80-proof vodka in an amount calculated to produce a state of moderate intoxication (average estimated peak blood alcohol level=.075). This resulted in an increased sensitivity (latency, magnitude, and duration) to the calorically induced “oculogyral illusion” (OGI) relative to a placebo (tonic water) condition. “Heavy” and “light” drinkers did not differ significantly on any of the measures. It was speculated that the alcoholic enhancement of the OGI was due either to a decreased ability to suppress vestibular nystagmus when attempting to fixate a visual stimulus or to the expenditure of extra-normal effort in order to maintain fixation.     

The "semiconscious" form of pathologic alcoholic intoxication, its characteristics and differences from "classical" forms of pathologic intoxication

An account of eight forensic-psychiatric reports characterises the special features of the "semiconscious" form of pathological and pathologically biased inebriation, and contrasts them with "classical" pathological forms.     

The impact of comorbidity on the management of pathological gambling

A 30-year-old woman with severe pathological gambling and cyclothymia presented to our program with no previous history of pharmacologic or psychotherapeutic treatment. Pathological gambling is an impulse -control disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in which comorbidity is common, particularly with substance abuse, obsessive-compulsive disorder and mood disorders. As described in this case, pathological gamblers with bipolar comorbidity may be effectively treated with mood stabilizers such as lithium. After receiving 10 weeks of lithium treatment, the patient showed improvement in both gambling behavior and affective instability. The identification of specific subtypes among patients with pathological gambling may be relevant to the choice of pharmacologic treatment.     

Alcohol intoxication and self-aggressive behavior

Nonexperimental field studies have demonstrated an association between alcohol intoxication and self-aggressive behaviors across the spectrum of lethality. Although these results are suggestive, it is not yet known whether alcohol intoxication is causally related to self-aggression. The authors therefore experimentally examined the effects of alcohol intoxication (mean blood alcohol concentration of .10) on a behavioral measure of self-aggression in men (N = 40). After consuming either an alcohol or a placebo drink, participants were provided the opportunity to self-administer shock during a task disguised as a reaction-time game, with self-aggression defined by the intensity of shock chosen. Half of the participants observed a self-aggressive model (a potential moderator of alcohol-related self-aggression). Independent alcohol and model effects were found, with alcohol accounting for over 30% of the self-aggression variance.     

The impact of alcohol intoxication on witness suggestibility immediately and after a delay

Intoxicated witnesses are common, making it important to understand alcohol's impact on witness accuracy and suggestibility. Participants assigned to an immediate retrieval condition encoded and recalled in one of the three intoxication conditions: sober control, placebo, or intoxicated. Participants in the delayed retrieval condition were assigned to encode in one of the three intoxication conditions, returned a week later, and were assigned to retrieve in one of the three intoxication conditions. Intoxication condition at encoding was fully crossed with intoxication condition at retrieval in the delayed condition. Participants encoded a mock crime video and retrieved via a forced‐choice test, with answers already circled (purportedly by a prior participant); half of the precircled responses were incorrect. When recalling after a delay only, intoxication at encoding increased agreement with incorrect suggested answers and decreased accuracy. Results suggest intoxicated witnesses may benefit from being interviewed immediately rather than after a sobering delay.     

The weighing of pathological and non-pathological information in clinical judgment

On the basis of the classic data of Meehl (1959), I examine how clinical psychologists use the MMPI scales to judge the degree of pathology of psychiatric patients by comparing linear models of the judgment to a linear model of the criterion (the actual diagnosis of the patients). This comparison reveals that excessively heavy weight is assigned to pathological information in comparison to non-pathological information. Additional analyses reveal that this biased weighing also influences the actual diagnosis and that it is a major determinant of the accuracy of clinical judgment. It is suggested that these effects arise from a confirmation bias associated with the hypothesis that a patient has severe, rather than mild, pathology.     

The performance of two pathological gambling screens in college students

The psychometric properties of two pathological gambling (PG) screening instruments, the South Oaks Gambling Screen (SOGS) and the Massachusetts Gambling Screen-DSM-IV subscale (MAGS), were explored in a sample of college students (N = 159). Participants completed the two screening instruments, a diagnostic interview for PG, the Gambling-Timeline Followback (G-TLFB), Gambling Self-Efficacy Questionnaire (GSEQ), and the Hopkins Symptom Checklist (HSCL). Both screening measures were found to have adequate internal consistency and were highly correlated with each other and the diagnostic interview. The screening measures demonstrated convergent and discriminant validity. Using the diagnostic interview as the criterion measure, the SOGS demonstrated better sensitivity in identifying PG college students than the MAGS. The MAGS demonstrated better specificity in identifying non-PG college students than the SOGS. The results of this study suggest that although neither measure is perfect in identifying PG college students, the SOGS is a more appropriate measure for screening purposes.     

Effect of catatoxic steroids upon lidocaine intoxication

Various steroids have been shown to influence the activity of psychotropic hormones and drugs. Among these, we distinguish “syntoxic” steroids which act by inhibiting excessive reactions to various agents and “catatoxic” steroids which actually destroy certain toxicants and hormones often through the induction of hepatic microsomal enzymes. Thus, the liver can play a decisive role in psychosomatic interrelations by regulating the blood clearance of agents affecting the nervous system. To illustrate these principles, new observations are presented which show that certain catatoxic steroids offer considerable protection against lidocaine, an anesthetic, analgesic drug. These findings may serve as an example showing how modern research techniques may help us to analyze the possible relationships between the liver and the mind, which were intuitively suspected since Hippocrates created the term “melancholia.”     

Alcoholic intoxication and memory storage dynamics

Strength retention functions were obtained for English words from 2 min to 50 min within a continuous recognition memory session and from I to 14 days subsequent to the session, with subjects being sober or moderately intoxicated. A small, but significant, decrement was obtained in memory performance under alcoholic intoxication. However, there was no difference in forgetting rate either within the continuous session or over the subsequent 1- to 14-day period. Single-trace fragility theory provided an excellent fit to the data. The entire effect of alcoholic intoxication was on degree of learning with no effect on the form of the retention function or rate of forgetting. No state-dependent retrieval effects were obtained. White noise during learning and/or retrieval had no effect on acquisition, storage, or retrrieval.