IntroductionSchizophrenia is characterized by diminished insight, which fluctuates with disease progression. Insight deterioration in the prodrome of schizophrenia is poorly understood. Despite pharmacologic treatment, including early interventions, there is a high risk of relapse and need of acute care in schizophrenia patients.ObjectiveTo study if insight deterioration occurs during the prodrome and if insight preservation early in the illness might predict a better prognosis.MethodsData was collected retrospectively from the records of 24 patients initially diagnosed with schizophrenia during a 2-year period. Patients' progress was then tracked over a 3-year period. Insight was determined by a physician's subjective evaluation, patient interest and participation in treatment planning, and patient accuracy in reporting behaviors and symptoms when compared with reports from collaterals.ResultsTen patients were determined to have insight regarding the developing illness at different presentations at the hospital. Insight preservation correlated with less need for emergency visits and fewer hospitalization days (P<.005). It was also associated with more depressive and anxious mood (P<.000). Patients and family members described early, ego-dystonic perceptual disturbances followed by diminished insight. Awareness into the illness, symptoms, and attribution of symptoms to the illness fluctuated at different presentations in the insight group. In the other group, insight was nil at each presentation after the psychotic debut.ConclusionMost patients maintain insight during the perceptual disturbance phase. Insight diminishes as the early delusional phase sets in. Higher levels of preserved insight seem to correlate with less need for acute treatment. Further research in this area is warranted for determining if early insight oriented interventions in the prodromal phase can improve the prognosis of schizophrenia.
Early identification of the prodrome of schizophrenia is difficult due to the nonspecificity of the symptoms and the limitations of the available tools. In this article, the authors discuss the usefulness of phenomenological and morphoanalytic methods for identification of the prodrome of schizophrenia, and they propose the use of empathy as an additional tool to by-pass same of the difficulties encountered by the previous approaches.
My own history and the history of the Greater Kansas City Psychoanalytic Institute (GKCPI) are inextricably tied, in a history of some fifty years."Ex nihilo nihil". Nothing comes from nothing. Following Parmenides' wisdom, I searched within myself the origin of my desires to be a psychoanalyst.My first contact with the name 'Freud' occurred in my father's medical office. I should admit that my curiosity was awakened not only by the name, but by the content, as it was 'Freud on Sexuality'. Following that, I was rewarded by a lecture by Heinrich Racker.
We report a case of conversion disorder (partial aphonia) that was successfully treated with speech therapy. During the one year duration of this illness, the patient regained transiently (minutes) her normal speech on a few occasions, independently of concomitant pharmacological interventions. One year after recovery she developed aphonia for the second time, which responded again to speech therapy, although the response rate was slower. Several mechanisms of conversion disorder are reviewed as specifically applied to this case. The possible role of pertinent shame mechanisms in the conversion pathology is discussed.
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