Psychosexual aspects of the panic-fear personality types in asthma

Numerous earlier studies have demonstrated the close relationship between MMPI Panic-Fear categories and various medical outcome measures in asthma. The present study relates MMPI Panic-Fear categories to psychosexual development. Specifically, High Panic-Fear patients demonstrate oral preoccupations, Low Panic-Fear patients demonstrate anal preoccupations, while Moderate Panic-Fear patients do not demonstrate pre-Oedipal preoccupations. Thus, MMPI Panic-Fear categories, useful in predicting medical outcome measures, have now been related to developmental levels, with the explanatory power of developmental concepts as well as their implications for psychological treatment.     

Inpatient treatment of multiple personality disorder

Multiple personality disorder (MPD) was once thought to be rare, but there is increasing evidence that it is relatively common. In a period of a year the author had 73 inpatient admissions under his care, of which 8 were for MPD. Three of the MPD admissions were for previously undiagnosed cases in an unselected general adult population. Thus 4.4% of the author's inpatients, once MPD patients diagnosed prior to admission are excluded, had MPD. The implications of this finding are discussed. The diagnosis and inpatient treatment of MPD are reviewed.     

Techniques in the treatment of multiple personality disorder

Multiple personality disorder, once considered to be rare, is being diagnosed with increasing frequency in the 1980s. The purpose of this paper is to present and discuss twenty techniques used in the treatment of multiple personality disorder. The primary treatment is psychotherapy but a number of adjuvant interventions are also required. The techniques discussed should be of use to therapists and represent a step towards definition of a treatment package for controlled trials, of which none have been conducted to date.     

The postunification treatment of multiple personality disorder: first findings

The treatment issues encountered in the unified multiple personality disorder (MPD) patient have received little attention in the literature to date. This study reviews the therapy records of 91 such patients and identifies seven recurrent areas of concern: (1) coping with the psychophysiologic changes associated with unification, (2) coping with the psychologic changes associated with unification, (3) working through, (4) abandoning autohypnotic evasions, (5) modifying adaptive and coping mechanisms, (6) interpersonal adjustments, (7) and major life changes. Some therapeutic approaches are indicated.     

Psychopathology and personality characteristics of epileptic patients: epilepsy, psychopathology and personality

The psychiatric investigation of a sample of 101 epileptic patients (65 temporal lobe epileptics (TLE) and 36 non-TLE) through various methods of evaluation, showed that only a minority of TLE with DSM-III diagnoses of Organic Brain Syndromes had severe psychopathology and manifested some personality traits. Thus, these patients seem to be differentiated from the rest of epileptics, TLE and non-TLE, who had quite "benign" psychological problems, if at all. It is quite probable that this sub-group of TLE could be the main instigators and perpetrators of the "bad image" of epileptics. The findings are discussed in relation to the pertinent literature and some hypotheses are offered for their explanation.     

Kynurenines, redox disturbances and neurodegeneration in multiple sclerosis

Multiple sclerosis (MS) is a chronic, demyelinating disease of unknown origin. Sophisticated analytical methods have made it possible to measure small biologically active molecules at low endogenous levels, and understand their role in the network of other biologically active compounds actively involved in inflammatory and neurodegenerative processes. Evidence is accumulating as concerns the disturbances of the kynurenine pathway and redox changes in MS. A new promising metabolite of the kynurenine pathway seems to beneficially influence experimental allergic encephalomyelitis. More clinical evidence is needed to prove the role of kynurenic acid analogues and/or enzyme inhibitors as potential medications in MS in the future. Various compounds have been shown to be important in the pathophysiological processes of the disease and are targets for pharmaceutical intervention.     

Social phobia: etiology, neurobiology, and treatment

Social phobia is a common and often disabling condition, with an etiology that is not established. There is evidence at several levels for an interplay of biological and psychological processes in social phobia. Genetic studies show that both genetic and environmental factors are important, with evidence pointing to associations with 2 genetic conditions, autism and fragile X syndrome. Behavioral inhibition has emerged as an important precursor to social phobia and possibly to other anxiety disorders. Epidemiologic and clinical studies have suggested that factors within the family environment, such as overprotection, overcontrol, modeling of anxiety, criticism, and in some cases abuse, can play a role in the development of social phobia. During childhood, complex interactions between brain system disturbances that mediate responses to negative social cues and factors in the social setting may lead to the development of a distorted set of internal "blueprints" for social behavior. The impact of severe social anxiety on brain systems that mediate behavioral change may prevent patients from learning better "blueprints." These can be taught through cognitive-behavioral therapies. The effective control of social anxiety with medications enables patients to recover; whether recovery can last after discontinuation of medications may depend on whether a new "blueprint" has been developed and whether stable changes in affected brain systems have occurred. Neuroimaging techniques are at the early stage of identifying abnormalities at the neurotransmitter and systems levels.     

Childhood-juvenile multiple sclerosis: clinical characteristics and treatment

The characteristics of multiple sclerosis with onset during childhood or adolescence are presented in this review. The clinical findings are similar to those of the adult form, but some aspects are peculiar: the high female to male ratio, occurrence of hyperacute forms, occurrence of encephalopatic symptoms and high relapse rate. The evolution is relapsing-progressive in most cases. Mild and severe disability are reached after a longer interval than in the adult form but, in spite of this, at a given age disability is higher. A high relapse rate, short interval between first and second attack and high disability after the first year are negative prognostic factors. Magnetic resonance imaging and cerebrospinal fluid data are discussed, with particular reference to differential diagnosis from acute disseminated encephalomyelitis. Currently, there are no controlled trials concerning subjects aged under 16 years. Some observations demonstrate that immunomodulatory drugs are well tolerated and have a beneficial effect, reducing the relapse rate and progression of the disease.     

Rational psychopharmacology in the treatment of multiple personality disorder

The current state of the data concerned with psychopharmacologic interventions for multiple personality disorder (MPD) is reviewed. Common sense guidelines are provided for drug treatment of MPD. An overview is given for use of medications for specific symptoms commonly found in MPD patients, such as affective, posttraumatic stress disorder, and sleep disorder symptoms.     

Systemic treatment of multiple personality: response to a chronic disorder

Multiple Personality Disorder (MPD) is a more and more frequently diagnosed disorder. In this article, MPD is considered the result of a dissociative defense in response to severe trauma during the formative period of personality formation. As the child dissociates to defend against the trauma, the fragments of personality develop as separate entities. The traditional focus of therapy is integration, or fusion of the various fragments of personality. The current article does not dispute this therapeutic goal, but does offer an alternative treatment process. Borrowing from the theoretical concepts of the family therapy literature, the person with MPD is described as a system. Therapy, then, must attempt to maintain balance within the system as a short-term goal, as well as striving for integration as a long-term goal. This article delineates the systemic approach, first from a theoretical, then a practical perspective. The concepts of coconsciousness (or awareness by all aspects of the system) and coexistence (a state of mutual cooperation between various personalities) are described, and fitted within the systemic model. Practical aspects of life with MPD, including activities of daily living and relationships, are then outlined within this model.     

Fatigue,sleep disturbances and circadian rhythm in multiple sclerosis

The aim of this study was to investigate whether fatigue and sleep disturbances in multiple sclerosis (MS) patients might be due to disrupted circadian sleep wake regulation. Actigraphy and a multiple sleep latency test (MSLT) were performed in 16 MS patients with both prominent sleep complaints and fatigue. Actigraphy scores did not differ from control values, whereas sleep onset latency values were altered in subgroups of MS patients. No evidence was found for a generalized circadian disturbance in MS patients.     

Playing for time: temporizing techniques in the treatment of multiple personality disorder

The treatment of multiple personality disorder (MPD) is often a prolonged and grueling enterprise, which imposes taxing demands upon the therapist and the patient alike. It becomes quite important to pace the therapy, lest the already beleaguered patient become both acutely and chronically overwhelmed. The majority of the extant literature on the use of hypnosis for the treatment of MPD addresses the processes of accessing the alters, abreacting traumata, arranging reconciliations among the alters, and facilitating integration. This communication discusses the necessity of titrating the amount of discomfort the patient must endure against the patient's resources and capacity to achieve mastery and self-efficacy. Several hypnotherapeutic techniques for offering respite and temporary asylum are explained and illustrated: alter substitution, the provision of sanctuary, distancing maneuvers, bypassing time, bypassing affect and/or memory, attenuating affect and/or memory retrieval, and rearranging the configuration of the alters by bartering or "shuffling the deck."     

Obsessive compulsive personality disorder and obsessive compulsive disorder: clinical characteristics, diagnostic difficulties, and treatment.

BACKGROUND: The overlap between obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD) has received increasing recognition and continues to be a source of much debate. With the advent of new research methodologies, researchers have attempted to distinguish whether OCPD and OCD are two distinct phenomena that can co-occur or whether they are similar, overlapping constructs. METHODS: MEDLINE was used to systematically review the OCPD and OCD literature published between 1991 and 2004. RESULTS: Using the more stringent DSM-IV criteria, results from OCD clinical samples suggest that the majority of individuals with OCD (75%) do not have OCPD. Similarly, results from personality disorder samples suggest that the majority of individuals with OCPD (80%) do not have OCD. CONCLUSIONS: While there is evidence that OCD and OCPD are linked, the literature does not support either one as a necessary or sufficient component of the other.     

Restraints in the treatment of a patient with multiple personality

This paper describes a technique of voluntary, intermittent use of restraints to work through a dangerous resistance during the treatment of an angry alter personality in a case of multiple personality. A safe environment for the interpretation of the angry dynamics allowed the progress of psychotherapy.     

Psychiatric disturbances after traumatic brain injury: Neurobehavioral and personality changes

Traumatic brain injuries (TBI) are frequently accompanied by psychiatric disturbances, which can include striking to relatively minor alterations in personality, behavior, and emotional regulation. The persistence of these neurobehavioral syndromes often leads to deleterious effects on recovery and rehabilitation outcomes. A recent surge of studies has emerged in the past several years to quantify the extent of psychiatric disorders in TBI and to describe differential clinical presentations. Various pre- and post-injury factors also have been hypothesized to contribute to the development and maintenance of psychiatric symptoms in survivors of brain injuries. The identi.cation of high-risk individuals with distinct neuropathophysiological and psychosocial features permits the development of multidisciplinary and tailored approaches to the assessment, prevention, and management of the negative effects of personality and behavioral changes in TBI. This article summarizes the most recent research in these areas and highlights the gaps that need to be filled in subsequent future.