Andrew Aronson

Cognitive function and biological correlates of cognitive performance in schizotypal personality disorder

There is evidence that some schizophrenic patients have deficits on tests of cognitive function, particularly tests of executive function, including the Wisconsin Card Sorting Test (WCST) and the Trail-making Test, Part B. This study was conducted to determine the generalizability of these findings across the schizophrenia spectrum to schizotypal personality disorder (SPD). Forty DSM-III SPD patients, 56 nonschizophrenia-related other personality disorder (OPD) patients, and 32 normal volunteers from two medical centers performed tests of executive function such as the WCST, Trail-making Part B, Stroop Word-Color Test, and Verbal Fluency, as well as tests of more general intellectual functioning such as the Wechsler Intelligence Scale-Revised Vocabulary and Block Design subtests, and Trail-making Part A. SPD patients performed more poorly on the WCST and on Trail-making Part B than did OPD patients or normal subjects; the groups did not differ on tests of general intellectual functioning. SPD patients may share some of the cognitive deficits observed in schizophrenia.

Panic disorder and depression: A psychodynamic exploration of comorbidity

Eight of twenty‐one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.

Oedipal Dynamics in Panic Disorder

Both research and clinical work have revealed factors that can lead to the onset and persistence of panic disorder. Preoedipal conflicts intensify the danger of oedipal longings for panic patients. Competition with the same-sex parent is linked with angry preoedipal fantasies and associated fears of disruption in attachments. Fantasied or actual successes can thus trigger panic episodes. Regression to a helpless, dependent state such as panic defends against the danger of aggressive, competitive fantasies and actual achievements. However, the regressive state can also be experienced as dangerous, and can be linked with frightening homosexual fantasies. A reactive aggressive oedipal stance can sometimes result, triggering escalating turmoil. The panic episode serves a series of compromise formations in dealing with these conflicted wishes.

Imipramine-responsive panic-like symptomatology in schizophrenia/schizoaffective disorder

A “panic-like” syndrome responsive to supplemental alprazolam has recently been described in schizophrenia (Kahn et al. 1987; Sandberg and Siris 1987). It is not known, however, if this condition might be responsive to treatment with other antipanic medications as well. Therefore, we report trials of adjunctive spine (IMI) in two such patients who met criteria for schizophrenia or schizoaffective disorder.

Commentary on “Integrating the Psychoanalytic and Neurobiological Views of Panic Disorder”

dation of relevant brain neurocircuits required to manifest a fear response, and yet further into identification of the relevant molecules and cells involved in the acquisition, maintenance, and control of fear memory. It is a model that disposes well to conceptualization of the clinical findings of the often exquisite and frequently escalating vulnerability of those affected by panic disorder, to an understanding of chronicity, and to strategies for therapeutic modification. These are ideas of powerful promise and prospect. Of this, what might be considered psychoanalytic, what might be identified as congenial to if not consonant with psychoanalytic theory, and what might considered to describe a divergent conceptualization? What are the points of correspondence and what are the points of sharper difference? Indeed, what is the psychoanalytic model of panic? One psychoanalytic model of panic as has been operationalized, manualized, and empirically evaluated is that described by Milrod (Milrod, Busch, Cooper, & Shapiro, 1997). Early findings as to the apparent clinical therapeutic efficacy of this formulation as applied in a rigorously designed treatmentoutcome study have been previously reported (Milrod et al., 2000); a report of the outcome from a full-scale, randomized controlled trial is pending. By contrast, Shear, Houck, Greeno, and Masters (2001) found that emotion-focused psychotherapy, a form of nondynamic supportive psychotherapy, has low efficacy for the treatment of panic disorder. The panic model as described by Milrod is one broadly framed in ego psychology and conflict theory and is, most fundamentally, based upon the concept of a dynamic unconscious. Conceptualization of a dynamic unconscious per se may be said to represent the prime innovation of psychoanalytic psychology. Codified in general structural theory, as well as in poststructural contemporary models, the dynamic unconscious is a concept that posits and subsumes the existence of obligatory strivings or motives (drives) expressed not only in the service of avoiding pain (unpleasure), but also and actively in the service of securing the gratification of implacable needs, both existential and pleasurable. More specifically, it posits the potential existence of an internal Andrew Aronson, M.D.: Department of Psychiatry, Mount Sinai School of Medicine, New York. OEDIPUS NOTWITHSTANDING

Comparison of 6- with 9-week trials of adjunctive imipramine in postpsychotic depression

Outcome at 6 weeks versus outcome at 9 weeks was compared in 23 patients with syndromally defined episodes of postpsychotic depression who underwent a trial of adjunctive imipramine added to their continuing treatment with fluphenazine decanoate and benztropine. The global outcome after 9 weeks was found to be superior. The implications of this finding for the treatment of secondary depressions in patients with schizophrenia and schizoaffective disorder is discussed.

Randomized trial comparing caregiver‐only family‐focused treatment to standard health education on the 6‐month outcome of bipolar disorder

Caregivers of people with bipolar disorder often have depression and health problems. This study aimed to evaluate the sustained effects of a 12‐15 week psychoeducational intervention on the health and mental health of caregivers of persons with bipolar disorder. We also evaluated the effects of the intervention on patients’ mood symptoms over 6 months post‐treatment.