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Assessment of the psychiatric patient
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Delusions of thought possession a number of delusional experiences are recognised in which the patient may lose the conviction that their thoughts are private experiences under their own control. These are highly suggestive of schizophrenia and include: Thought insertion: the patient believes that some of their thoughts have been put into their mind from outside.Thought withdrawal: the patient believes that some of their thoughts have been removed from their mind; this may be evident objectively by a sudden cessation in the flow of speech that is known as thought blocking (see above).Thought broadcasting: this is the belief that thoughts, although unspoken, may become known to other people by various means, such as them directly hearing the thoughts; this must be distinguished from the common feeling that others can infer thoughts from a person’s actions. ‘Do you have difficulty thinking clearly?’ … ‘Have you had the feeling that perhaps your thoughts were not your own?’
Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Thought insertion: the patient has the experience that his/her thoughts are under the control of an outside agency, he/she believes that thoughts that are not his/her own have been implanted into his/her mind by other people or forces, e.g., the subject may believe that his/her neighbor is practicing voodoo and implanting alien sexual thoughts in his/her mind.
Questions and Answers
Published in David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly, MRCPsych Paper I One-Best-Item MCQs, 2017
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly
Answer: B. Option B is a disorder of thought form. Option A is a type of auditory hallucination. The remaining options are delusions, or disorders of thought content. Thought blocking is a form of thought disorder in which the patient experiences his chain of thoughts snapping off or stopping unexpectedly. This patient interprets this experience as a delusion of thought control. He believes that his thoughts are being taken out of his head by another agency (thought withdrawal). In an additional delusion of thought control he also believes that his thoughts are being dispersed widely out of his control (thought broadcasting). Thought insertion is a third delusion of thought control, in which the patient believes that thoughts are being inserted into his head. This is a delusional interpretation of the thought disorder. Audible thoughts, in which a patient hears their own thoughts out loud, is a form of auditory hallucination. [D. pp. 140–1, 148–9]
UNITED KINGDOM NORMS FOR THE HARVARD GROUP SCALE OF HYPNOTIC SUSCEPTIBILITY, FORM A
Published in International Journal of Clinical and Experimental Hypnosis, 2020
David A. Oakley, Eamonn Walsh, Ann-Mari Lillelokken, Peter W. Halligan, Mitul A. Mehta, Quinton Deeley
The evidence to date is that administration of the scale and its translation into other languages within Western cultural settings has not substantially altered its psychometric properties. It is notable, however, that despite its involvement in both intrinsic and instrumental hypnosis research, the United Kingdom (UK) is not represented in the list of Western HGSHS:A norms. The present study remedies that omission using results drawn from samples with mixed cultural, educational, and ethnic backgrounds in a central district of South London recruited using a research-subject database of students, university staff, and members of the local population. At the more specific research level of replicability of research methods, the HGSHS:A norms reported here are drawn from the same population as that used to select participants in a series of neuroimaging studies reported over the past 10 years at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Kings College London, University of London, UK. This research includes studies on hypnotic depth and response to suggestion (Oakley, Deeley, & Halligan, 2007), the default mode network (Deeley et al., 2012), functional limb paralysis (Deeley et al., 2013), control and awareness of movement (Deeley et al., 2013), psychiatric and cultural possession phenomena (Deeley et al., 2014), automatic writing (Walsh et al., 2014), rubber hand illusion (Walsh et al., 2015), thought insertion and alien control of movement (Walsh, Oakley, Halligan, Mehta, & Deeley, 2015) and awareness of thought and movement (Walsh et al., 2017).
Do Psychiatrists Hear Their Patients' Voices? The Importance of Qualitative Research on Brain-Related Technologies
Published in AJOB Neuroscience, 2018
The lack of attentiveness to patients’ subjective experience, in the context of the clinical use of brain-related technologies, may be problematic from clinical and ethical perspectives. For example, researchers assume that electroencephalogram (EEG) studies have no potential of causing any physical harm. However, this perception, which is probably correct from an “outward” objective biological perspective with regard to normal subjects, may be mistaken for some psychiatric patients, due to “inward” subjective reasons. The data pertaining to electroconvulsive therapy (ECT)-related anxiety (Obbels et al. 2017) may suggest that undergoing a procedure that includes a direct attachment to a patient's head may provoke realistic and unrealistic fears. This may be especially disturbing with regard to subjects who suffer from psychotic disorders. It is not unrealistic to assume that for some of these patients, the utilization of an unfamiliar (especially in the case of an invasive) brain-related technology may give rise to a paranoid attitude toward the medical staff conducting the study. Theoretically, this concern is more disturbing with regard to patients with delusional content relating to thought insertion or thought broadcasting. In turn, one can expect that the patient's adherence to therapy will be reduced. In this scenario, the brain-related intervention will indirectly result in a negative effect on the patient's well-being. Indeed, subjective experiences have been found to be a contributing factor to nonadherence to antipsychotics (Moritz et al. 2014; Taira et al. 2006).
Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia
Published in Expert Review of Neurotherapeutics, 2022
Giulia Maria Giordano, Edoardo Caporusso, Pasquale Pezzella, Silvana Galderisi
An important aspect of the conceptualization of negative symptoms, too often neglected by current research and clinical practice, is the differentiation between primary and secondary negative symptoms. While primary negative symptoms are a core feature of the disorder, whose pathophysiology remains to be clearly identified, secondary negative symptoms are due to factors other than the disorder itself, such as positive symptoms, depression, iatrogenic parkinsonism or environmental hypostimulation [1,17,106–108]. This distinction has important clinical implications, both from a therapeutic and a prognostic perspective. In fact, primary negative symptoms tend to be persistent and treatment resistant [1,17,107,109], while factors underlying secondary negative symptoms can be often identified and effectively treated, leading to an improvement of the symptomatology and, consequently, of functional outcome. The identification of sources of secondary negative symptoms is sometimes difficult and may require a longitudinal observation that, especially in first-episode subjects is not always feasible. The secondary nature of observed negative symptoms might be suggested by the presence of negative symptoms during periods of psychotic exacerbation or co-occurring with depressive symptoms or following changes in pharmacotherapy. For instance, clinicians should evaluate whether negative symptoms, e.g. the social withdrawal, might be induced by persecutory delusions, mind reading, thought insertion, other psychotic symptoms, or depression. The presence of sadness, hopelessness and guilt should be evaluated since it might suggest that the negative symptomatology could be secondary to depression. Similarly, changes in antipsychotic treatment and concomitant occurrence of extrapyramidal side effects and negative symptoms strongly suggest that both are due to the antipsychotic drug treatment: an augmentation of the drug dose might induce the occurrence or increase in the severity of some extrapyramidal signs, such as hypomimia, which might be regarded as blunted affect. A standard clinical examination aimed to evaluate the presence of other extrapyramidal signs, such as tremor or rigidity to rule out or diagnose drug-induced parkinsonism may clarify the picture.