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IntroductionIn the Danish social welfare system, few people are homeless solely for economic reasons. In fact, 38% of homeless people suffer from both substance use and a psychiatric disorder, making diagnostic assessment and treatment... more
IntroductionIn the Danish social welfare system, few people are homeless solely for economic reasons. In fact, 38% of homeless people suffer from both substance use and a psychiatric disorder, making diagnostic assessment and treatment difficult. This patient group, with dual diagnoses, often fail to receive effective treatment, and the consequences are far reaching and detrimental. A more comprehensive grasp of the history and patterns of substance use in these patients may contribute to improve their treatment.ObjectivesTo identify the role and patterns of substance use in mentally ill, homeless people.Methods50 homeless, mentally ill patients are examined in comprehensive interviews, exploring the relationship between substance use, homelessness, and suffering from a mental disorder. The data are analyzed quantitatively as well as qualitatively using thematic analysis.ResultsPreliminary results indicate that substance use in mentally ill homeless patients is a complex phenomenon....
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The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to... more
The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to social cognitive deficits in schizophrenia. Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 11 “imaginary conversation (i.e., theory of mind)” items, 10 “psychological understanding” items, and 10 “practical understanding” items. Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. Healthy controls performed better than patients on all types of social cognitive tests, particularly on “psychological understanding.” However, after adjusting for intelligence and neuropsychological test performance, all group differences became nonsignificant. When intelligence and global cognitive functioning is taken into account, schizophrenia patients and healthy controls perform similarly on social cognitive tests.
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IntroductionIn the continuous work to reduce the use of coercion in the psychiatric care, attention in Denmark has especially been directed towards mechanical restraint, i.e. the use of belts to fixate patients to a bed. While the use of... more
IntroductionIn the continuous work to reduce the use of coercion in the psychiatric care, attention in Denmark has especially been directed towards mechanical restraint, i.e. the use of belts to fixate patients to a bed. While the use of mechanical restraint is currently decreasing, increases in other types of coercive acts are observed (e.g., forced medication and hourly episodes of manual restraint). The use of manual restraint refers to mental health workers immobilizing a patient to avoid harm to self or others. Manual restraint is generally considered less intrusive to a patient’s autonomy than the use of mechanical restraint. However, no study has yet explored if it is actually experienced as such by the patients.ObjectivesThis study explores patients’ perspectives on manual and mechanical restraint, respectively.MethodsWe are currently performing a qualitative interview study of 10 patients, who have been exposed to both types of coercion. The interviews will be transcribed v...
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Recent systematic reviews and meta-analyses conclude that similar social cognitive impairments are found in autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD). While methodological issues have been mentioned as a... more
Recent systematic reviews and meta-analyses conclude that similar social cognitive impairments are found in autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD). While methodological issues have been mentioned as a limitation, no study has yet explored the magnitude of methodological heterogeneity across these studies and its potential impact for their conclusion. The purpose of this study was to systematically review studies comparing social cognitive impairments in ASD and SSD with a focus on methodology. Following the PRISMA guidelines, we searched all publications on PubMed, PsycINFO, and Embase. Of the 765 studies identified in our data base searches, 21 cross-sectional studies were included in the review. We found significant methodological heterogeneity across the studies. In the 21 studies, a total of 37 different measures of social cognition were used, 25 of which were only used in 1 study. Across studies, the same measure was often said to be assessing ...
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Recent systematic reviews and meta-analyses conclude that similar social cognitive impairments are found in autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD). While methodological issues have been mentioned as a... more
Recent systematic reviews and meta-analyses conclude that similar social cognitive impairments are found in autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD). While methodological issues have been mentioned as a limitation, no study has yet explored the magnitude of methodological heterogeneity across these studies and its potential impact for their conclusion. The purpose of this study was to systematically review studies comparing social cognitive impairments in ASD and SSD with a focus on methodology. Following the PRISMA guidelines, we searched all publications on PubMed, PsycINFO, and Embase. Of the 765 studies identified in our data base searches, 21 cross-sectional studies were included in the review. We found significant methodological heterogeneity across the studies. In the 21 studies, a total of 37 different measures of social cognition were used, 25 of which were only used in 1 study. Across studies, the same measure was often said to be assessing different constructs of social cognitiona confusion that seems to reflect the ambiguous definitions of what these measures test in the studies that introduced them. Moreover, inadequate differential diagnostic assessment of ASD samples was found in 81% of the studies, and sample characteristics were markedly varied. The ASD and SSD groups were also often unmatched in terms of medication usage and substance use disorder history. Future studies must address these methodological issues before a definite conclusion can be drawn about the potential similarity of social cognitive impairments in ASD and SSD.
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Background and Hypothesis The idea that a disorder of the basic self is a central feature in schizophrenia has recently been corroborated in a meta-analysis and a systematic review. Manifestations of the self-disorder can be... more
Background and Hypothesis The idea that a disorder of the basic self is a central feature in schizophrenia has recently been corroborated in a meta-analysis and a systematic review. Manifestations of the self-disorder can be systematically explored with the Examination of Anomalous Self-Experience (EASE). In this study, we examined the factorial structure of EASE, and diagnostic efficacy of EASE. We hypothesized that EASE will have a monofactorial structure as an instability of the basic self will result in multiple deformations of self-experience which would be meaningfully interrelated as aspects of a unifying Gestalt. Design EASE data for 226 patients suffering from various mental disorders were analyzed under a confirmatory factor analysis framework (CFA). Area under the receiver operating characteristic curve (AUC) was calculated for the total EASE sums, and sensitivity and specificity values for prediction of schizophrenia spectrum disorders based on different cut-offs were ob...
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Purpose Cannabis use in the context of psychosis has been shown to have a negative impact on prognosis and yet it is difficult to treat. Recent randomized controlled trials all have negative findings and novel approaches is sought after.... more
Purpose Cannabis use in the context of psychosis has been shown to have a negative impact on prognosis and yet it is difficult to treat. Recent randomized controlled trials all have negative findings and novel approaches is sought after. This paper aims to use an embodied cognition framework to add to the understanding of cannabis use in psychosis. Design/methodology/approach The paper presents longitudinal, qualitative data on two individuals diagnosed with schizophrenia and using cannabis at least twice weekly prior to inclusion in the study. Factors influencing cannabis use were mapped in dialogue with the participants. Each participant was interviewed six times over the course of a year. The analysis was informed theoretically to describe processes maintaining or ameliorating cannabis use over time. Findings This study shows that a systems approach for understanding changes in cannabis use is meaningful; the richness of observations add to the understanding of differences in out...
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AIM The notion of a disturbed self as the core feature of schizophrenia dates back to the founding texts on the illness. Since the development of the psychometric tool for examination of anomalous self-experience (EASE), self-disorders... more
AIM The notion of a disturbed self as the core feature of schizophrenia dates back to the founding texts on the illness. Since the development of the psychometric tool for examination of anomalous self-experience (EASE), self-disorders have become accessible to empirical research. Empirical studies have shown that EASE measured self-disorders predict schizophrenia spectrum in prospective studies and consistently show a selective hyper aggregation of self-disorder in schizophrenia and schizotypal disorders. The aim of this study is to investigate the relationship between self-disorders cognitive deficits and symptoms in schizophrenia. METHODS Thirty-five non-acute first-episode patients with schizophrenia and 35 matched healthy controls were EASE, cognitive deficits, and symptoms (PANSS positive, negative and general). RESULTS The results show that self-disorders and symptoms are correlated among patients with schizophrenia, but not with cognitive deficits. Moreover, with the exception of attentional deficits, neurocognitive impairment was not significantly higher among patients with schizophrenia compared to healthy controls. CONCLUSIONS We argue that this adds support to a view of schizophrenia as being characterized by specific traits of pre-reflective self-disturbance, which are related to the severity of symptoms, whereas neurocognitive impairment reflects a separate or distinct aspect of schizophrenia.
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Evaluation of the expressive signs is an indispensable part of the psychiatric diagnostic interview. The expressive phenomena are inseparably interwoven with the subjective experiences, and none of the signs can be viewed in isolation... more
Evaluation of the expressive signs is an indispensable part of the psychiatric diagnostic interview. The expressive phenomena are inseparably interwoven with the subjective experiences, and none of the signs can be viewed in isolation from the person and context from which they originate. The patient and his presented complaints congregate in certain patterns, emerging from a conjunction of the symptoms and signs, and unfold as meaningful wholes or Gestalts.
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Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for... more
Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider’s well-known two-link model and Matussek’s lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential ...
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In 2012, Region Zealand launched the first early detection of psychosis team in Denmark. The motivation behind was the accumulating evidence of early detection of psychosis being of great importance for the outcome. This is a description... more
In 2012, Region Zealand launched the first early detection of psychosis team in Denmark. The motivation behind was the accumulating evidence of early detection of psychosis being of great importance for the outcome. This is a description of the experiences with establishing an early detection team in a Danish context and the outline of a strategy for informing the general population about psychosis. Furthermore, the first results from the research projects are presented. It is concluded, that early detection teams could be introduced throughout Denmark with great advantage.
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Tienda online donde Comprar The Psychiatric Interview For Differential Diagnosis al precio 89,76 € de Lennart Jansson | Julie Nordgaard, tienda de Libros de Medicina, Libros de Psiquiatria - Psiquiatria General
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This review provides a brief overview of key historical, conceptual and empirical aspects of the link between creativity and psychosis. The genius and his or her tendency to madness constitute the historical backbone of this link,... more
This review provides a brief overview of key historical, conceptual and empirical aspects of the link between creativity and psychosis. The genius and his or her tendency to madness constitute the historical backbone of this link, although ambiguous interpretations and substantial conceptual change characterise this mad genius hypothesis. Some empirical findings show high levels of creativity among first-degree relatives of patients with psychotic illness. For schizophrenia, this could be seen as support of a creative potential in premorbid traits, such as self-disorders and disturbed common sense.
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A 38-year-old man was referred to the psychiatric department due to auditory hallucinations, suicidal ideation and a large daily intake of 8.4 g pregabalin. The Danish National Medication Register showed that the patient had bought... more
A 38-year-old man was referred to the psychiatric department due to auditory hallucinations, suicidal ideation and a large daily intake of 8.4 g pregabalin. The Danish National Medication Register showed that the patient had bought pregabalin 21 times within the last two months, a total of 487.2 g pregabalin. Withdrawal symptoms disappeared within 48 hours, psychotic experiences and the suicidal ideations faded during the next couple of weeks. High doses of pregabalin are tolerated with surprisingly few toxicological consequences, though lethal cases have been described. Pregabalin abuse, however, can lead to dependency.
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435 Journal of Psychopathology 2014;20:435-441 Summary This paper offers an overview of a current direction of clinical and empirical research in schizophrenia, viz. the phenomenologically informed approach that regards the generative... more
435 Journal of Psychopathology 2014;20:435-441 Summary This paper offers an overview of a current direction of clinical and empirical research in schizophrenia, viz. the phenomenologically informed approach that regards the generative disturbance of schizophrenia as a specific disorder of the self. Empirical studies have recently documented that anomalous self-experiences (i.e. self-disorders) aggregate in schizophrenia spectrum disorders, but not in other mental disorders. What appears to underlie this aggregation of self-disorders is an instability of the first-person perspective, which threatens the most basic experience of being a subject of awareness and action. In this paper, we elicit the meaning of the phenomenological notion of “disordered self” in schizophrenia spectrum disorders, we offer rich clinical descriptions of self-disorders, and we provide a concise overview of results from contemporary empirical studies. Finally, we provide some suggestions for future research o...
This article explores how research in phenomenological psychopathology can be translated to quantitative data, using the “EASE: Examination of Anomalous Self-Experience” scale as an example. To appreciate the distinctiveness of... more
This article explores how research in phenomenological psychopathology can be translated to quantitative data, using the “EASE: Examination of Anomalous Self-Experience” scale as an example. To appreciate the distinctiveness of phenomenological psychopathology, we first describe key features of the philosophical discipline of phenomenology, in which phenomenological psychopathology is rooted. We then outline central characteristics of phenomenological psychopathology itself, before examining the construction of EASE scale, its psychometric properties, and the results from this direction of empirical-quantitative research. Finally, we emphasize that even though the EASE scale is rooted by phenomenology, the EASE interviews themselves must also be conducted in a phenomenologically faithful way, and we offer some insights into how these interviews must be conducted, for example, in a semi-structured, conversational manner, by keeping focus on the patients’ lived experiences, and by ide...
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Background: The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of... more
Background: The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of first-rank symptoms for schizophrenia. Yet, it seems that Schneider’s original concept of first-rank symptoms was overly simplified when it was introduced in DSM-III. Specifically, it was overlooked that first-rank symptoms, in Schneider’s understanding, fundamentally involve a disorder of the self. The aim here is to empirically test Schneider’s claim that first-rank symptoms involve self-disorders. Methods: In a modified, cross-sectional study of 98 first-admission patients, the relation between lifetime presence of first-rank symptoms and self-disorders was examined. Self-disorders were examined with the EASE (Examination of Anomalous Self-Experiences). Results: We found an odds ratio of 1.56 (95% CI 1.10–2.21) for having first-rank symptoms for each 5-point increase in the EASE (measuring self-disorder) using a generalized linear mixed model regression. We did not find first-rank symptoms in the absence of self-disorders. Conclusion: The close relation between first-rank symptoms and self-disorders seems to support Schneider’s original concept of first-rank symptoms. We suggest that first-rank symptoms occurring without the pervasively altered self-experiences might not be different from other psychotic phenomena in terms of their diagnostic significance. Awareness of self-disorders can help clinicians in assessing and detecting first-rank symptoms.
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Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal... more
Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain’s intrinsic neural timescale using the autocorrelation window (ACW) and power-law exponent (PLE). Our goal was to relate intrinsic neural timescales (ACW, PLE), as a proxy of temporal integration on the neuronal level, to temporal integration related to self-disorder on psychological (Enfacement illusion task in electroencephalography) and phenomenological (Examination of Anomalous Self-Experience [EASE]) levels. SCZ participants exhibited prolonged ACW and higher PLE during the self-referential task (Enfacement illusion), but not during the non-self-referential task (auditory oddball). The degree of ACW/PLE change during task relative to rest was significantly reduced in self-referential task in SCZ. A moderation m...
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Little is known about which factors actually motivate individuals with psychosis to seek help or how psychosis may complicate the help-seeking process. The aim of this article is to examine the steps of this process and how... more
Little is known about which factors actually motivate individuals with psychosis to seek help or how psychosis may complicate the help-seeking process. The aim of this article is to examine the steps of this process and how psychopathological experiences might affect and interfere with it. In this qualitative study we interviewed nine patients with a first episode of psychosis. The interviews were transcribed and analysed according to the principles of thematic analysis using inductive as well as deductive methods. The crucial step in help-seeking behaviour seemed to be for the patients to identify the kind of problem they were facing. None of them clearly recognized their psychotic or otherwise anomalous experiences as symptoms of a mental disorder, and most of them did not seriously question the reality status of these experiences. For most of the patients it was an untenable social situation that caused them to seek help. When they did seek help the majority did not initially contact the psychiatric services. It seems paradoxical to expect patients who experience symptoms of psychosis for the first time to be able to unambiguously identify them as being exactly that and accordingly seek out psychiatric help, as diminished insight into illness is an inherent feature of psychosis. However, the phenomenon of ‘double bookkeeping’ seemed to provide an opening for seeking help from psychiatry in spite of compromised insight. This observation should be included in everyday clinical work and in future information campaigns.
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The presence of delusions is considered a key feature of psychosis, but despite the psychopathological centrality of the concept of delusion, its definition and comprehension is a matter of continuing debate. In recent years studies... more
The presence of delusions is considered a key feature of psychosis, but despite the psychopathological centrality of the concept of delusion, its definition and comprehension is a matter of continuing debate. In recent years studies showing that delusions are common in the general population have accumulated and challenged the way we perceive psychotic illness. In this systematic review, we examine the basis of the psychosis continuum-hypothesis, by reviewing a representative section of the original literature that report measures of delusional ideation in the general population, focusing specifically on methodology. Three online databases were systematically searched for relevant studies. After applying criteria of inclusion and exclusion, 17 articles were included for comprehensive review. Estimates of the distribution of delusions in the general population vary substantially, as does the mode of assessment. The methodology relies with few exceptions exclusively on self-report and fully structured interview by lay person. We conclude that measures of delusions in the general population should be interpreted cautiously due to inherent difficulties in methodology. Hypothesizing a continuum of delusion between normality and full-blown psychosis is deemed premature based on the reviewed studies.
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In Denmark, a large proportion of individuals experiencing attenuated psychotic symptoms are diagnosed with an ICD-10 schizotypal disorder. The diagnosis of schizotypal disorder makes patients eligible for specialized early intervention... more
In Denmark, a large proportion of individuals experiencing attenuated psychotic symptoms are diagnosed with an ICD-10 schizotypal disorder. The diagnosis of schizotypal disorder makes patients eligible for specialized early intervention treatment, which in Denmark is termed the OPUS treatment. The OPUS treatment is provided to all patients with a first-time diagnosis within the schizophrenia spectrum (chapter F2, ICD 10) and comprises the treatment modalities of assertive community treatment, social skills training, and family involvement. Research on individuals with attenuated psychosis syndromes (APS) in Denmark focuses on enhancing the cognitive and functional outcome of APS individuals by use of an integrative cognitive remediation approach. The research is also directed toward identifying biological predictors of course of illness. A specific Danish contribution to the identification of APS individuals is founded on the Examination of Anomalous Self-Experiences (EASE) instrument. This assessment instrument identifies subtle anomalies in the subjective experience of self and the world as constituting early signs of psychosis risk.
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The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined... more
The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession (‘with resistance’) and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% o...
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This paper serves as an introduction to the Examination of Anomalous Fantasy and Imagination (EAFI) - a novel instrument for a semistructured, phenomenological exploration of psychopathology of imagination. We present an account of the... more
This paper serves as an introduction to the Examination of Anomalous Fantasy and Imagination (EAFI) - a novel instrument for a semistructured, phenomenological exploration of psychopathology of imagination. We present an account of the phenomenology of imagination and proceed to a presentation of the disorders of imagination that are addressed in the EAFI. Furthermore, the interrater reliability of the EAFI was examined in a diagnostically heterogeneous sample of 20 in-patients. The interrater agreement ranged from 0.6 to 1.0, with an average κ of 0.84. The internal consistency of the EAFI as measured by Cronbach's α was above 0.88. We suggest that the anomalies of imagination explored by the EAFI reflect an alteration of the structure of consciousness and belong to a fundamental, generative layer of psychopathology. These disorders may have relevance for differential diagnostic purposes, especially in first-contact, young patients.
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Genetics constitute a crucial risk factor to schizophrenia. In the last decade, molecular genetic research has produced novel findings, infusing optimism about discovering the biological roots of schizophrenia. However, the complexity of... more
Genetics constitute a crucial risk factor to schizophrenia. In the last decade, molecular genetic research has produced novel findings, infusing optimism about discovering the biological roots of schizophrenia. However, the complexity of the object of inquiry makes it almost impossible for non-specialists in genetics (e.g., many clinicians and researchers) to get a proper understanding and appreciation of the genetic findings and their limitations. This study aims at facilitating such an understanding by providing a brief overview of some of the central methods and findings in schizophrenia genetics, from its historical origins to its current status, and also by addressing some limitations and challenges that confront this field of research. In short, the genetic architecture of schizophrenia has proven to be highly complex, heterogeneous and polygenic. The disease risk is constituted by numerous common genetic variants of only very small individual effect and by rare, highly penetr...
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Self-disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia-spectrum disorders and a certain degree of temporal stability of self-disorders would therefore be expected. The aim of the study was... more
Self-disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia-spectrum disorders and a certain degree of temporal stability of self-disorders would therefore be expected. The aim of the study was to examine the persistence of self-disorders measured by the Examination of Anomalous Self Experiences over a time span of 5 years. 48 patients with schizophrenia-spectrum disorders were thoroughly assessed for psychopathology at baseline and 5 years later. Self-disorders were assessed by the Examination of Anomalous Self Experiences. The level of self-disorders was same at the two occasions for the full Examination of Anomalous Self Disorders and for four out of the five domains. For one domain, the level of self-disorders increased slightly from baseline to follow-up. The correlations between baseline and follow-up were moderate. 9 out of the 13 most-frequently rated items at baseline showed equal frequencies at follow-up. The baseline level of sel...
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BACKGROUND The concept of self-disorders in schizophrenia has gained substantial interest and it has now been established empirically that self-disorders aggregate in schizophrenia-spectrum disorders but not in other mental disorders or... more
BACKGROUND The concept of self-disorders in schizophrenia has gained substantial interest and it has now been established empirically that self-disorders aggregate in schizophrenia-spectrum disorders but not in other mental disorders or in healthy controls. Yet, the issue of temporal persistence has not been addressed. AIM The aim of this study is to examine the temporal persistence of self-disorders. METHODS 96 first admission patients were thoroughly assessed for psychopathology including SD at baseline and again 5years later. We created a 25-item self-disorder scale which was used both at baseline and follow-up to assess self-disorders. The scale was a pre-cursor of the later published EASE-scale. Additionally, we examined the development of positive and negative syndromes and of the Global Assessment of Functioning (GAF). RESULTS There was a high correlation between self-disorders at baseline and at follow-up, and the majority of the items in self-disorders scale showed equal proportions between baseline and follow-up. CONCLUSION Self-disturbances showed a high level of persistence at 5-year follow-up.
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This chapter introduces the concept of psychosis, pivotal for psychopathology and nosology. Psychosis implies a loss of rationality, but the recognition of psychosis is not just a matter of identifying explicit, “psychotic” symptoms but... more
This chapter introduces the concept of psychosis, pivotal for psychopathology and nosology. Psychosis implies a loss of rationality, but the recognition of psychosis is not just a matter of identifying explicit, “psychotic” symptoms but requires a global appraisal of rationality. Even in the absence of circumscribed, productive symptoms of psychosis, certain clinical states are characterized by a loss of implicit rationality as seen in, e.g., disorganized (hebephrenic) schizophrenia. Most space in this chapter is devoted to schizophrenia, the quintessence of psychosis, and the schizophrenia spectrum, a broad range of clinical and subclinical states, many of which escape the diagnostic criteria. What distinguishes the schizophrenia spectrum disorders from nonschizophrenic disorders is its generative disorder, autism and disordered self-awareness, which contribute the specific, fundamental structure and coloring to all its psychopathological phenomena, e.g., the autistic-solipsistic quality of delusions. Transition sequences from nonpsychotic self-disorder to first-rank symptoms have been demonstrated. Failing to identify this fundamental structure, the clinician may be tempted to make diagnoses guided by single symptoms or characteristics (e.g., anxiety or personality disorder). Changing and multiple diagnoses should raise the suspicion of underlying schizophrenia spectrum. Acute, affective, and organic psychoses are treated elsewhere in this book.
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Seeking an adequate approach to the psychiatric diagnostic interview, it is essential to examine the character of the object in question, viz., the “psychiatric object.” In this chapter, we examine the theoretical aspects—what kind of... more
Seeking an adequate approach to the psychiatric diagnostic interview, it is essential to examine the character of the object in question, viz., the “psychiatric object.” In this chapter, we examine the theoretical aspects—what kind of phenomena are symptoms and signs? And how does the psychiatrist arrive at a diagnosis? The symptoms and signs are interdependent and mutually implicative and form certain meaningful wholes based on the patient’s biography. They are interpenetrated by experiences, feelings, expressions, beliefs, and actions. A symptom is not an independent, thinglike entity that can be evaluated in isolation from the patient and context. Content, structure, and meaning relations to other experiences are all aspects of importance for “a psychic event” to become a specific symptom. Confronted with the patient, the psychiatrist perceives the patient in a certain way—resembling a certain prototype. This typification will be modulated and perhaps altered during interaction with the patient. Based on the analyses in this chapter, we conclude that the assessment of psychopathology requires an in-depth study of experience and subjectivity.
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In this chapter, we examine the interface between organic mental disorders and psychiatric disorders having resemblance with organic states. Organic brain disease can mimic any spectrum of mental disorders. But the course of illness, the... more
In this chapter, we examine the interface between organic mental disorders and psychiatric disorders having resemblance with organic states. Organic brain disease can mimic any spectrum of mental disorders. But the course of illness, the often later age of onset, the relation to a known brain affection, and qualitative differences in psychopathology are helpful for making the differential diagnosis. Organic psychoses are divided into acute delirious psychosis and (chronic) non-delirious psychosis often accompanied by focal neurological signs or cognitive impairment. Organic psychosis, as opposed to schizophrenia, is indicated by the predominance nonauditory hallucinations and delusions without self-reference or systematization. Functional mental illness may also mimic organic diseases (dementia and neurological disease), and the diagnosis is supported by the changing and inconsistent clinical findings and the absence of convincing neurological signs and of abnormal paraclinical results.
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The notion of disordered self as the core, trait-phenotypic disturbance of schizophrenia was ventilated in nearly all foundational texts on schizophrenia, and it is strongly supported by recent empirical studies. In this chapter, we... more
The notion of disordered self as the core, trait-phenotypic disturbance of schizophrenia was ventilated in nearly all foundational texts on schizophrenia, and it is strongly supported by recent empirical studies. In this chapter, we introduce the reader to a variety of clinical manifestations of self-disorders in single, comprehensive case story, which we subsequently analyze in the light of contemporary phenomenological research. We also briefly address the psychopathological core that appears to underlie the various manifestations of self-disorders. Moreover, we provide a dense overview of the results from empirical studies, and we discuss the adequate way of assessing self-disorders in the psychiatric interview. We conclude that self-disorders are crucial elements in the psychopathology of schizophrenia and that they may aid the understanding of our patients and their experiential life, play a significant role in diagnostic and differential diagnostic procedures, and offer vital resources for a more phenomenologically informed psychotherapy for schizophrenia.
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There is a broadening international consensus that the level of psychiatric clinical knowledge and skills have lowered alarmingly and to the point of threatening’s psychiatry’s future survival as an academic medical discipline. This is a... more
There is a broadening international consensus that the level of psychiatric clinical knowledge and skills have lowered alarmingly and to the point of threatening’s psychiatry’s future survival as an academic medical discipline. This is a consequence of a complete educational domination by the operational diagnostic manuals and manuals for structured interviewing as the only sources of theoretical and clinical knowledge. The purpose of this volume is to offer an alternative: to provide an exposition of psychiatric interviewing that is theoretically and clinically well founded and providing the reader with a coherent framework to perform a thorough psychiatric examination. The goal is not to come up with yet another interview scheme but to facilitate an understanding of the basic (but today, completely neglected) tenets of psychopathology and phenomenology. This exposition targets the disorders of subjectivity (consciousness), the second-person processes involved in converting subjective, first-person and observable data into a third person, diagnostically useful, format. The exposition includes the most pertinent clinical descriptions concerning the major diagnostic groups.