Phillip R. Slavney

Predictors of psychological adjustment to genetic testing for Huntington's disease.

In the present study the authors assessed predictors of adjustment to genetic testing for Huntingtons disease. Fifty-two genetically positive and 108 genetically negative persons were studied for 1 year following testing. Adjustment, defined by hopelessness and depressive symptoms, was measured at 3, 6, 9, and 12 months after disclosure and was within normal limits for both groups. Those less well adjusted had tested positive, were married, had no children, or were closer to their estimated ages of onset. The study delineated risk factors for psychological distress that should be considered by people contemplating testing for Huntingtons disease.

Diagnosing demoralization in consultation psychiatry

Demoralization, a normal response to adversity, is commonly seen in medical and surgical patients referred for psychiatric consultation. Demoralization should be distinguished from adjustment disorders and other pathological conditions--a process that would be facilitated if demoralization, like grief, were given a V code in DSM. Although the primary responsibility for treating demoralization rests with the patients physician, the consulting psychiatrist must make an accurate diagnosis and begin the process of supportive psychotherapy.

When does Huntington's disease begin?

Recent studies have detected basal ganglia atrophy in clinically asymptomatic persons with the genetic mutation that causes Huntingtons disease (HD). Whether reductions in caudate and putamen volume on MRI scans are associated with changes in cognitive and neurologic functioning was examined in 13 healthy adults with the IT-15 mutation. Reduced striatal volume was found to correlate with greater neurologic (largely motor) impairment, slower mental processing speed, and poorer verbal learning, although none of the participants met even liberal criteria for clinical diagnosis of HD. These correlations are strikingly similar to those observed in symptomatic HD patients, possibly reflecting the earliest manifestations of disease.

Patients with medically unexplained symptoms: DSM-III diagnoses and demographic characteristics

This study reports DSM-III diagnoses and demographic characteristics of 100 patients consecutively referred to a university hospital consultation-liaison service for evaluation of medically unexplained symptoms suggesting physical disorders. Thirty-seven percent of patients received diagnoses of somatoform, dissociative, or factitious disorders, and 14% were felt to have psychologic factors affecting physical conditions. Although black and male patients were less often referred for medically unexplained symptoms, once referred they were more likely than white and female patients to receive diagnoses of somatoform, dissociative, or factitious disorders. Among patients with somatoform disorders, those with conversion disorder and somatization disorder tended to be young women, whereas those with psychogenic pain disorder were older and equally likely to be male or female.

Life Stories and Meaningful Connections: Reflections on a Clinical Method in Psychiatry and Medicine

A basic method of reasoning in psychiatry and medicine seeks to understand the patients complaints as the expressions of an individual in distress. Through knowledge of his history, personality, circum- stances, relationships, and intentions we come to appreciate why the patient is thinking, feeling, and behaving as he is. This is a most natural way of reasoning about patients, and it leads almost inevitably to an explanation of distress that is presented in terms of an individual life story. A life story is a plausible, chronological, and coherent narrative that reconstructs the development ofthe present state ofaffairs. It starts at a certain time in the patients life and draws together particular informa- tion about him into a linear perspective that makes his distress seem the logical and sometimes even the inevitable outcome of his past. As we assemble this narrative in the processofhistory taking, examination, and treatment we have a growing sense of insight about the patient and his problems. At times in this process we can have a feeling of illumination, of a linkage between the patients symptoms and life story that is im- mediate and convincing. The sense of conviction generated by the life-story method helps give us confidence in the face ofadifficult task, the psychotherapeutic taskof helping another person to change his goals, beliefs, and behaviors. Yet despite the life storys power in the organization of clinical information and despite its support to us in the process of psychotherapy, we must ask the same questions ofit that we askofother methods ofreasoning in The authors are indebted to Jerome Frank and Frank Mondimore for their critical advice.

Pseudoseizures, sexual abuse, and hermeneutic reasoning

It has been proposed that pseudoseizures are a symbolic expression of having been sexually abused. Such reasoning is hermeneutic in nature and potentially damaging if uncritically used. Sexual abuse is one of several risk factors for pseudoseizures, but it should not be deduced simply from the occurrence or form of the conversion disorder.

Hysterical and obsessional features in patients with Briquet's syndrome (somatization disorder)

Patients meeting criteria for Briquets syndrome ( N = 20) and patients diagnosed as having hysterical personality disorder ( N = 20) were assessed clinically and with personality inventories to test the hypothesis that, while in many respects patients with Briquets syndrome would resemble those with hysterical personality disorder, they would also be more obsessional. The comparison showed that both groups had highly disordered family, personal, medical and psychiatric histories, and that the Briquets patients, though manifesting similar hysterical traits, had more obsessional features than did the patients with hysterical personality disorder. The possible role of the combination of obsessional and hysterical traits of personality as a vulnerability factor in the behaviour of complaining is discussed.

The Mind-Brain Problem, Epistemology, and Psychiatric Education

The mind-brain problem is the fundamental mystery in psychiatry and the chief obstacle to a coherent curriculum for its students. Rather than acknowledge the problem as a source of ambiguity and discord, some educators have attempted to abolish, finesse, or ignore it. An alternative to these tactics is found in the epistemological approach taken by Karl Jaspers and others, which seeks to determine what we know and how we know it. Educational programs based on such an approach seem more likely than others to produce students who are broad-minded, tough-minded, and fair-minded.

Histrionic Personality and Antisocial Personality: Caricatures of stereotypes?

Abstract The proposal that the diagnoses Histrionic personality and Antisocial Personality represent sex-role caricatures of the concepts “woman” and “man”, respectively, was examined utilizing the semantic differential technique for the assessment of connotative meanings. Twenty-eight psychiatric residents and 21 academic psychiatrists rated the concepts “woman”, “man”, “histrionic personality”, and “antisocial personality” on each of 15 bipolar adjectival scales. No important differences were found between the ratings made by male or female psychiatrists or by resident and faculty psychiatrists. The subjects clearly distinguished between the connotative meanings of “woman” and “histrionic personality” and between “man” and “antisocial personality”, though there was a greater resemblance between the first pair of concepts than between the second. The linkages in meaning between women and the diagnosis Histrinic Personality are discussed, and it is proposed that the concept of sex-role caricatures be abandoned since the political overtones of the term “caricature” tend to undermine the empirical work needed to validate or reject clinical diagnoses.

In defense of pseudoseizure

There continues to be disagreement over the best term for behavior that simulates an epileptic seizure. In the authors view, pseudoseizure is the most accurate of the expressions currently in use, and fears about its potentially damaging effects are unfounded. Even pseudoseizure, however, fails to convey the behavioral nature of the phenomenon in question, for it identifies what the problem is not, rather than what it is.