Evolutionary systems therapy for paranoid personality disorder: A seven cases series

Little is known about effective psychosocial treatments for paranoid personality disorder. This study explores the feasibility of a novel treatment, namely Evolutionary Systems Therapy, in supporting individuals diagnosed with paranoid personality disorder. Seven patients attended 10 months of individual therapy without receiving any psychopharmacological treatment. The primary outcome was the feasibility of the intervention, while the secondary outcomes were remission from the diagnosis and reliable changes in personality pathology and paranoid ideation. All recruited patients completed the intervention and did not report any adverse events. Six out of seven patients experienced remission from the diagnosis of paranoid personality disorder. All participants showed reliable changes in personality pathology and paranoid ideation, which were maintained at the 1-month follow-up. Further research is needed to confirm these encouraging results.

Conceptualizing a less paranoid schizophrenia

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches.

Longitudinal associations of temperament and character with paranoid ideation: A population-based study

The aim of this study was to examine (a) the associations of temperament and character dimensions with paranoid ideation over a 15-year follow-up in the general population (b) the associations of explosive temperament and organized character profiles with paranoid ideation. 2137 subjects of the Young Finns Study completed the Temperament and Character Inventory and the Paranoid Ideation Scale of the Symptom Checklist-90 Revised in 1997, 2001, and 2012. Temperament dimensions of high novelty seeking, high harm avoidance, low reward dependence and explosive temperament profile were associated with the development of higher paranoid ideation. Regarding character, high self-directedness, high cooperativeness, and low self-transcendence and organized character profile were associated with lower paranoid ideation. These associations sustained after controlling for age, gender, and socioeconomic factors. However, the associations between temperament and paranoia mostly disappeared after taking character into account. Our study supported the hypothesis that personality dimensions contribute to the development of paranoid ideation. Temperament and character might combine a variety of single previously found risk factors into a more comprehensive framework for the developmental etiology of paranoia. Our findings provide evidence for psychotherapeutic interventions that support the self-regulation of temperamental vulnerabilities by internalizing mature concepts about the self and social relationships.

The Paranoid Optimist: An Integrative Evolutionary Model of Cognitive Biases

Human cognition is often biased, from judgments of the time of impact of approaching objects all the way through to estimations of social outcomes in the future. We propose these effects and a host of others may all be understood from an evolutionary psychological perspective. In this article, we elaborate error management theory (EMT; Haselton & Buss, 2000). EMT predicts that if judgments are made under uncertainty, and the costs of false positive and false negative errors have been asymmetric over evolutionary history, selection should have favored a bias toward making the least costly error. This perspective integrates a diverse array of effects under a single explanatory umbrella, and it yields new content-specific predictions.

The Quest for Greatness in the Race to Not Be Forgotten

Details from a brief psychoanalytic treatment with a disturbed and desperate patient in acute emotional crisis are used to consider the internal dread some patients have regarding separation from the object and their phantasy of eternal damnation as a result of self-differentiation. One patient's loyalty to her object as the only way to prevent abandonment is examined in depth, but also considered as a severe psychic struggle found in other disturbed patients. The nature of this pathological loyalty has to do with the internalized and projected demand for perfection as the only currency for love and acceptance. Theoretical considerations are offered from a Kleinian perspective.

Paranoid personality disorder

Paranoid personality disorder (PPD) is currently included in DSM-IV's "odd cluster" or "cluster A." In the present article, the authors review available information pertaining to the psychometric properties of PPD, as derived from the relevant literature and from databases of personality disorder study groups. There is comparatively little published evidence for the reliability and validity of PPD, and researchers by and large have tended not to study the disorder, either because of investigators' difficulty recruiting individuals with PPD into research studies, or (as seems more likely) because the trait-paranoia from which many psychiatric patients suffer has seemed better explained by other DSM-IV disorders on Axis I and/or Axis II than by PPD. Given the scant empirical evidence on PPD, it seems reasonable to remove it as an independent diagnosis from the next edition of DSM, and instead to encourage clinicians to code trait-paranoia using a dimensional approach.

Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates

Understanding the prevalence and type of personality disorder within prison systems allows for the effective targeting of resources to implement strategies to alleviate symptoms, manage behaviour and attempt to reduce re-offending. This study aimed to determine the prevalence of personality disorder (PD) traits within a local urban high-turnover adult male prison with a remand/recently sentenced population in London, UK. The International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ) self-administered questionnaire (ICD-10 version) was completed by 283 prisoners (42% completion rate). 77% of respondents reached the threshold for one or more PDs. The most common PD types were Paranoid PD (44.5%), Anankastic PD (40.3%), Schizoid PD (35%) and Dissocial PD (25.8%). These results confirm and extend existing knowledge regarding the prevalence of PD in prison populations into a high-turnover, urban, remand population. The stark comparison with community samples indicates that a more equitable standard of service delivery within the criminal justice system, focussing on preventive and early intervention services, is now required.

Personality disorder symptoms are differentially related to divorce frequency

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55-64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM-IV personality disorders were assessed with the Structured Interview for DSM-IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains.

[Paranoid delusions and homicides inside or outside the family]

Paranoia is a mental pathology which severely complicates interpersonal relationships. Its mechanisms and its delusional themes often mean that paranoid subjects have strained, or even violent relations inside and/or outside their family. These difficuIt relationships can sometimes even lead to serious assaults without causing death or more rarely result in homicides with frequent pre-incident indicators.

What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation

BACKGROUND

In recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation.

METHOD

Two hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality.

RESULTS

The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety.

CONCLUSIONS

The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of 'things not seeming right'. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery

Body dysmorphic disorder (BDD) is a somatoform disorder characterized by an excessive concern with an imagined or slight defect in appearance. BDD has been particularly studied in cosmetic surgery settings. The object of the present study is to investigate the relationship between personality disorders and dysmorphic symptoms in a group of 66 patients seeking cosmetic surgery. Assessment instruments included the following: a semistructured interview for demographic and clinical characteristics; the Structured Clinical Interview for DSM-IV, the Hamilton Depression and Anxiety Rating Scales, and the Body Dysmorphic Disorder Yale - Brown Obsessive--Compulsive Scale (BDD - YBOCS). A multiple regression analysis was performed using the BDD - YBOCS score as a continuous dependent variable. The severity of dysmorphic symptoms (BDD - YBOCS score) was significantly related to two factors: the number of diagnostic criteria for schizotypal and paranoid personality disorders. The results suggest that the presence of a psychopathological reaction to imagined defects in appearance in subjects pursuing a surgical correction is associated with the severity of schizotypal and paranoid personality disorders. Preoperative assessment could help to define the clinical profile of patients in cosmetic surgery settings.

[Hypochondria circumscripta (to the problem of coenesthesiopathic paranoia)]

Hypochondria circumscripta manifests in patients with paranoial personality and signs of somatopsychic accentuation. A sample included 11 patients (6 men, 5 women, mean age 54 years) who referred to dermatologists or had been admitted to gastroenterological and psychiatric units. Pathokinesis of hypochondria circumscripta comprises three stages: idiopathic algias, overmastering sensations and possession of pain. In the latter stage, delusional behavior targeted to the elimination of a part of the body, which is perceived as the source of pain, develops. Psychopathological disorders are realized in limits of coenesthesiopathic spectrum without tendency to interpretive delusion manifestation as well as transformation to systematic delusion of persecution during the disease course. As a consequence of above mentioned peculiarities of psychopathological structure, the stage of possession of pain may be designated as coenesthesiopathic paranoia. Because of the small sample, the findings can be considered as preliminary ones.

[Paranoid syndrome, paranoid reaction, paranoia]

The term paranoid is derived from the Greek word paranoia meaning nadnese. It does not only mean self-reference, but there are various personality features as they are hostility, a tendency towards aggressiveness, irritability, a lack of sense of humour, feelings of overestimation of one-self and a tendency towards accusations. These features may appear also within normal psychology and they becomeclinically important after thein increase of intensity and conspicuousness (los sof hearing, long-term abuse of alcohol and psychostimulants) and organic disorders of the brain may contribute to the development of paranoidity. A mechanism of projection is considered as a decivise factor from the point of view of dynamic psychiatry. Clinically unimportant sign sof paranoidity can be observed due to unusual situations. If a paranoid reaction becomes more serious, formation of a paranoid delusion should be taken to account. In our koncept the term paranoid and paranoidity should be used only as a psychopathological term.

Impoverished Dialogical Relationship Patterns In Paranoid Personality Disorder

In the opinion of many experts, the self is made up of numerous different, independent facets interacting with each other in an ongoing inner dialogue. The meaning of events depends on the form this dialogue takes. The hypothesis we discuss in this article is that patients suffering from paranoid personality disorder (PPD) present impoverished dialogical relationship patterns. By this we mean that: a) The characters operating on their mental stage are few and repetitive. The character identified as self is insufficient-inadequate or diffident-mistrusting-hostile. The characters embodied by other persons are hostile, humiliating, and threatening. b) The inner dialogue the characters set up is stereotyped and always has the same outcome--the inadequate part of self feels under attack by a hostile other. This pattern has an influence on patients' behaviour and the course of psychotherapy. Our discussion of this hypothesis will be based on an analysis of extracts from diaries written by a patient with PPD during therapy. We shall give a number of strategies as to how a therapist may avoid patient drop-outs and provide effective treatment.

Belief, hope and faith

A case of hysteria is presented in order to create a frame of reference for the author's approach to the concepts of hope, belief and faith. A difference between hope as a 'sad passion' (which is here called regressive hope) and hope as a principle of mental functioning is established. The concept of hope will at first always be based on beliefs--either beliefs organised in the paranoid-schizoid position (called here fragmented and delusional beliefs)--or those organised from the depressive position (complex systems of beliefs, which end up being dogmatic); the latter typically occur in neurotics. It is suggested here that there is another possibility for hope, which is based on faith. The meaning of faith is considered here externally to the religious sense. The solid establishment of hope as a principle--based on faith--can be viewed as responsible for the opening up of creative potentials and as one of the main aims of analysis. Such an aim, however requires the establishment of a deep relationship, both in theory and in clinical practice, between the Kleinian question of the depressive position and the Freudian question of the Oedipus complex.

Beliefs in personality disorders: a test with the Personality Disorder Belief Questionnaire

The hypothesis that each personality disorder (PD) is characterized by a specific set of beliefs was tested in a sample of 643 subjects, including non-patient controls, axis-I and axis-II patients, diagnosed with SCID-I and -II interviews. Beliefs of six PDs (avoidant, dependent, obsessive-compulsive, paranoid, histrionic, borderline) were assessed with the Personality Disorder Belief Questionnaire (PDBQ). Factor analyses supported the existence of six hypothesized sets of beliefs. Structural equation modeling (SEM) supported the hypothesis that each PD is characterized by a specific set of beliefs. Path coefficients were however in the medium range, suggesting that PDs are not solely determined by beliefs. Nevertheless, empirically derived cutoff scores of the six belief subscales were reasonably successful in classifying subjects, percentages ranging form 51% to 83%. It appeared that there was a monotonical increase in scores on each belief subscale from non-patient controls, to patients without any PD, to patients with PDs (other than the pertinent PD), to patients with the pertinent PD. This suggests that PD-related beliefs are at least partly associated with (personality) psychopathology in general. Another explanation is that many patients' position on the underlying dimensions is not high enough to lead to a DSM PD diagnosis, but high enough to lead to an elevated belief score.

Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.

Unusually persistent complainants

BACKGROUND

Querulous paranoia may have disappeared from the psychiatric literature, but is it flourishing in modern complaints organisations and the courts?

AIMS

To investigate the unusually persistent complainants who lay waste to their own lives and place inordinate demands and stress on complaints organisations.

METHOD

Complaints officers completed questionnaires on both unusually persistent complainants and matched controls.

RESULTS

Persistent complainants (distinguished by their pursuit of vindication and retribution) consumed time and resources and resorted to both direct and veiled threats. Attempts to distinguish these people from a control group on the basis of the manner in which their claims were initially managed failed.

CONCLUSIONS

Persistent complainants' pursuit of vindication and retribution fits badly with complaints systems established to deliver reparation and compensation. These complainants damaged the financial and social fabric of their own lives and frightened those dealing with their claims. The study suggests methods of early detection and alternative management strategies.

Personality disorders and adult attachment dimensions in a mixed psychiatric sample: a multivariate study

The associations between personality disorders and adult attachment dimensions were assessed in a sample of 487 consecutively admitted psychiatric subjects. Canonical correlation analysis showed that two sets of moderately correlated canonical variates explained the correlations between personality disorders and adult attachment patterns. The first and second attachment variates closely resembled the avoidance and anxiety attachment dimensions, respectively. The first personality disorder variate was mainly characterized by avoidant, depressive, paranoid, and schizotypal personality disorders, whereas dependent, histrionic, and borderline personality disorders loaded on the second canonical variate. However, these linear combinations of personality disorders were different from those obtained from principal component analysis. The results extend previous studies linking personality disorders and attachment patterns and suggest the importance of focusing on specific constellations of symptoms associated with dimensions of insecurity.

[Microdeletion 22q11.2. A too rarely diagnosed genetic change in psychiatric illnesses]

Microdeletion 22q11.2 with an estimated incidence of 1:4000 is known to cause the DiGeorge syndrome (DGS) or the velocardiofacial syndrome (VCFS), both usually being diagnosed in the newborn period or childhood. Recent studies have shown that children suffering from VCFS frequently develop psychiatric disorders in late adolescence or adulthood. Here we report the case of a 30-year-old man presenting with slight facial dysmorphisms, hypoparathyreoidism, minor cardiac anomalies, and slight cognitive impairments who had developed a severe personality disorder which eventually led to the diagnosis of microdeletion 22q11.2 with maternal inheritance. Psychiatric patients should be thoroughly examined for typical signs associated with this chromosomal anomaly. Genetic diagnosis is necessary because of the 50% probability of inheritance with possibly severe congenital anomalies. In view of a prevalence of 2% in an unselected group of patients with schizophrenic psychosis, microdeletion 22q11.2 is likely to be underdiagnosed.

Anger and narcissism: between the void of being and the hunger for having

The borderline syndrome, a typical marginal structure, is certainly a specific, autonomous pathology, with its own distinctive characteristics: among them, acting out, cyclical repetition of events without historical progression and anaclitic depression. Kohut's concept of 'narcissistic hunger' is particularly pertinent to the borderline condition: the borderline patient hungers to have that which is missing in his being. Through the application of the related notions of 'tragic man', 'self objects', 'grandiose self', and 'damaged self', the authors further develop their theory that the borderline syndrome has much in common with paranoid personalities.

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.

Murder-suicide of the jealous paranoia type: a multicenter statistical pilot study

The authors present a pilot statistical study of murder-suicide comprising 32 cases from the years 1990-1992, collected from the offices of the medical examiners of seven counties in five of the United States. The study includes brief reviews of previous statistical surveys of murder, murder-suicide, and suicide. This present study's conclusions parallel the findings of previous research on the demographic characteristics of the perpetrators of murder-suicide, the relationship between killers and victims, the types of weapon used, locations of the incidents, and the time intervals between the murder and suicide. It also highlights the similarities between the characteristics of the perpetrator of murder-suicide and those of persons who commit only suicide, supporting the thesis that murder-suicide is an extended suicide. Suggestions for prevention of such a type of crime are offered.

A mind of one's own

The author argues that in the transference the patient unconsciously identifies the analyst with what he has projected into him, creating what Strachey called an external phantasy object. In the intimate rapport of the analytic session, the analyst tends to identify with these projections as well, which brings him into a relationship with the patient that complements the patient's narcissistic object relationship with him. The analyst's identification with the patient's projections is a type of pathology of his receptivity to the patient that is exacerbated by the patient's skill at producing states of mind in the analyst with which the analyst is supposed to identify. The analyst's ability to distance himself from the patient's projections and therefore to interpret them depends on his having links to his internal objects that survive the patient's projections and unconscious manipulations. Interpretations make the patient aware simultaneously that he and the analyst are separate and that the analyst has a link to internal objects that are not under the patient's control. The latter is a rudimentary oedipal situation. The author argues that these two 'awarenesses' are really the same, and that working through the depressive position and working through the oedipal situation are therefore fundamentally the same thing.

The MMPI Suspiciousness Scale on the MMPI-2

Information is provided to facilitate use of the Minnesota Multiphasic Personality Inventory (MMPI) Suspiciousness scale of Endicott, Jortner, and Abram-off with the MMPI-2.

Querulous paranoia in Chinese patients: a cultural paradox

OBJECTIVE

There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic.

METHOD

One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work.

RESULTS

Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported.

CONCLUSION

Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.

Covert visual attention in schizophrenia spectrum personality disordered subjects: visuospatial cuing and alerting effects

A recent study observed lateralized deficit in the disengagement of covert visual attention in schizophrenic patients. Subsequent attempts to replicate this finding have had mixed results. Differences in the neuroleptic treatment or other secondary factors associated with schizophrenia are some of the possible reasons for these inconsistent findings. In this study, we examined the ability to shift covert visual attention in neuroleptic-naive, schizophrenia spectrum personality disordered (SSPD; n = 35) subjects and normal controls (n = 34) under a variety of spatial cuing and alerting conditions. We hypothesized that SSPD subjects would have difficulty with disengagement of covert visual attention from an invalidly cued left visual field when the target appeared in the right visual field in comparison to the normal subjects. As predicted, schizophrenia spectrum personality disordered subjects had significantly longer latencies for the right visual field invalid targets than normals (p = .014). Under the remaining cue conditions, spectrum subjects performed normally. Consequently, the cost of left visual field invalid cueing for the right visual field target was significantly higher in spectrum personality subjects than in normals. The cost for the invalid right visual field cue and the benefits of valid cue in both fields were very similar in the two groups. The findings of an asymmetrical deficit in the disengagement and shift of covert visual attention in schizophrenia spectrum subjects are similar to the one's observed in patients with unilateral left hemisphere lesions.

Urinary excretion of bufotenin (N,N-dimethyl-5-hydroxytryptamine) is increased in suspicious violent offenders: a confirmatory study

We previously reported that violent offenders with paranoid symptoms or whose violent actions had been directed against family members had higher urinary levels of bufotenin than other violent offenders. In the present study, patients were evaluated with the Karolinska Scales of Personality (KSP), and urinary levels of bufotenin were determined by mass spectrometry. In drug-free patients suspiciousness was positively correlated, and socialization was negatively correlated, with urinary bufotenin excretion. These two personality variables were strongly interdependent. In drug users, bufotenin excretion was correlated positively with social desirability and negatively with irritability, but not with suspiciousness. Bufotenin excretion was not found to be associated with violence toward family members in the present study. The results are in keeping with the earlier finding that violent offenders with paranoid personality traits have higher urinary levels of bufotenin than other violent offenders.

Obsessional harassment and erotomania in a criminal court population

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.

Examining the relationship between Machiavellianism and paranoia

To investigate the relationship between Machiavellianism and paranoid tendencies we administered the Mach IV scale and Fenigstein and Vanable's Paranoia scale to 150 students enrolled in 4 sections of a course, Introduction to Psychology, at a university in the Middle South. Scores on the 2 were significantly and positively correlated (Pearson r = .50). Men had a significantly higher mean score on Machiavellianism than women. Although men obtained a higher mean on the Paranoia scale than women, the difference was not statistically significant. Implications are discussed.

Paranoid personality traits in a panic disorder population: a pilot study

To better understand the relationship between panic disorder and paranoid personality, panic disorder patients (N = 28) who were referred to an anxiety disorder clinic in a community mental health center were evaluated for paranoid personality traits on a standardized personality self-report instrument. Paranoid personality disorder was found in 54% of subjects. Paranoid subjects were found to have an earlier age of onset, longer duration of illness, and more psychopathology. Possible etiologies and implications for treatment of these findings are discussed.

A case of paranoid disorder associated with hyperthyroidism

This paper describes a patient presenting with paranoid symptoms who eventually was diagnosed as having Graves' disease. In this patient, paranoid disorder appeared to occur concurrently with hyperthyroidism in a clear state of consciousness. This case underscores the need to maintain a high index of suspicion of possible medical conditions in psychiatric patients. This is especially the case in the presence of unexplained symptoms and when there is a difficulty communicating with the patient. The importance of carrying out a careful physical examination on admission to a psychiatric unit is emphasized. Another indication for further medical investigation in a patient with psychiatric symptoms is the absence of a psychological explanation for a worsening of the psychiatric symptoms.

Delusions in schizophrenia spectrum disorders: diagnostic issues

Family studies of schizophrenia frequently include relatives of schizophrenia probands with diagnoses falling within the schizophrenia spectrum. As part of an ongoing genetic linkage study of schizophrenia, the authors examined case material from 50 relatives (of schizophrenia probands) who received a DSM-III-R diagnosis of a nonaffective psychotic disorder or schizotypal or paranoid personality disorder. Eleven exhibited episodic or chronic delusions that resulted in diagnostic dilemmas, often arising from issues pertaining to the classification of delusional phenomena. Four of these cases are presented here. Unusual beliefs were often difficult to classify as odd beliefs versus full delusions, brief/transient versus persistent delusions, bizarre versus non-bizarre delusions. It is suggested that these might be considered continuous rather than dichotomous dimensions. Several possible implications for genetic studies of schizophrenia are discussed.

Schizotypal and paranoid personality disorder in the relatives of patients with schizophrenia and affective disorders: a review

This review considers the possible familial relationship of schizotypal and paranoid personality disorders (SPD, PPD) to schizophrenia (SCZ) and affective disorders (AD). There have been few controlled studies on familial risk of SPD and PPD based on direct semi-structured interviews of relatives, blind to proband diagnosis. Three of six studies reported increased familial risk of SPD for SCZ probands, but with considerable variability in estimates of this risk. None of four studies reported a significant relationship between AD and familial SPD. There is substantial but less consistent evidence for a familial relationship between PPD and SCZ: three of six studies supported such a relationship, but one large study reported increased familial risk of PPD for AD and not for SCZ probands. There is also some evidence that negative symptoms are most characteristic of SPD in relatives of SCZ probands. Also discussed are issues concerning the adequacy of current criteria for defining schizophrenia spectrum pathology, and of diagnostic methods in this area.

[Apropos of a misdiagnosed form of paranoia: paranoia of the elderly]

The expression of elements of a paranoid symptomatology (suspicion, mistrust, hostility, etc.) is frequently seen in the elderly patients. Paranoid symptom is non-specific in geronto-psychiatric practice. The association with a cognitive disorder is frequent. The relationship between this trouble and a previous paranoid personality disorder appears, according to literature, looser than in the younger patients. The paranoid behavioral pattern often stands for the elderly as a defense against feelings of inferiority and humiliation. The expression of a paranoid symptomatology is a hamper for the subject's social autonomy, as well as an actual risk factor so far as it may involve a delay in the demands for medical care. Therapeutical attitudes, reassurant and preventing the patient from a rough awareness of his deficit, seem to be useful in the alleviation of the trouble.

A fundamental dilemma of psychoanalytic technique: reflections on the analysis of a perverse paranoid patient

The work refers to the general topic of the traumatic effects of transference in the analytic situation. The author defines the fundamental dilemma of interpretive technique as the technical difficulty, sometimes insurmountable, faced by the therapist in the treatment of severely ill patients, particularly in the case of narcissistic, self-centred disorders, where the interpretive action itself often produces negative side effects that are not countered by the curative effect of the insight achieved through interpretation. In a brief theoretical introduction, this dilemma is described as a longstanding problem in psychoanalysis that has been systematically concealed by the protracted discussion on the subject of 'analysability' and which has still not been resolved by the theory of technique. Clinical case material on a perverse patient is then presented to illustrate the dilemma described and to demonstrate some general strategies by which it may be overcome.

Assessment of potential violence in the paranoid worker

Violence in the workplace is sometimes a manifestation of an untreated psychiatric disorder. Paranoid personality disorder, paranoid schizophrenia, and delusional (paranoid) disorder are three psychiatric syndromes in which paranoid ideation is a prominent feature. While the vast majority of people with these conditions are not violent, paranoid workers can exhibit violent behavior as a reaction to beliefs that co-workers or supervisors are threatening or persecuting them. Three cases are described to illustrate the clinical presentation of these disorders and their management in an occupational setting.

Paranoia: a part of most analyses

Paranoid defenses appear during most analyses, sometimes with great intensity, but often subtly, and require specific analytic attention. Preoedipal conflicts, inner fears around passivity, narcissistic injury and rage, and subsequent masochistic and projective defenses lie at the core of these patients' pathology. In addition, specific cognitive, object-relational, and affective distortions reflecting multiple developmental levels emerge during analysis. A case vignette is provided to demonstrate the analysis of a neurotic patient without borderline features who showed prominent paranoid formation.

Covariance of personality, neurocognition, and schizophrenia spectrum traits in the community

Clinical researchers have observed in relatives of schizophrenic individuals abnormal personality traits resembling the psychopathology of schizophrenia. Further similarities have been observed in correlations between measures of brain function, including attention and executive abilities, and these personality psychopathologies. However, two methodologic factors might account for the covariation of these 'schizophrenia spectrum' personality traits and measures of brain function. Clinical selection bias (Berkson's bias) might result in subjects with overlapping conditions being more likely to be studied, and normal personality attributes could affect performance on neurobehavioral tasks. This study investigated relationships between neurobehavioral correlates of schizophrenia, clinical schizophrenia spectrum personality traits, and normal personality dimensions in the five-factor model of personality. To avoid Berkson's bias, subjects expected to have a high probability of spectrum traits were recruited from the Baltimore Epidemiologic Catchment Area Survey community sample. About 40% of the sample were found to have DSM-IIIR Schizotypal, Schizoid, or Paranoid Personality Traits or Disorders. Schizophrenia Spectrum traits showed significant associations with personality dimensions of the five factor model, particularly Openness to Experience and Neuroticism. In ordinary linear regression models, after adjustment for a number of normal personality characteristics, Schizotypal Personality Traits were still strongly associated with perseverative responses on the Wisconsin Card Sorting Test (WCST). In logistic regression models, subjects with Schizotypal, Schizoid, or Paranoid Traits differed in terms of normal personality profiles and WCST performance.

Assessment of a man with a dual diagnosis

This case assessment of a man with dual diagnosis exemplifies the use of recent psychological measures, computerized programs, and structured assessment, including the Reiss Screen for Maladaptive Behavior, the Psychopathology Inventory for Mentally Retarded Adults, the Apperceptive Personality Test, and the Residential Services Indicator. In this case, computerized scoring of two very different tests (the Reiss Screen and the Apperceptive Personality Test) yielded very similar results.

Paranoid character and the intolerance of indifference

This paper suggests that aspects of paranoid character are structured around fantasies of magical and concrete connectedness to objects; these fantasies serve to avoid the terrors of object inconstancy. The authors describe how these fantasies are expressed in the psychoanalytic situation and explore their relation to common paranoid phenomena. The paranoid person must maintain these fantasies of connectedness at all cost or risk experiencing unbearable indifference between self and object. Paradoxically, the sacrifice of self and object boundaries inherent in these fantasies makes object constancy even more difficult to achieve because of the secondary defensive use of anger mobilized to protect the boundaries of the self.