Psychodynamic Psychological Testing in the Mental Health Inpatient Setting
Meidan Turel, Michael Siglag, Alexander Grinshpoon in Clinical Psychology in the Mental Health Inpatient Setting, 2019
One particularly useful contribution of testing to these ends is its ability to detect discrete forms of thought disorder that, when present, often play a central role in patients’ struggles. Unrecognized differences between how a psychotherapist and patient perceive, make sense of, and respond to the treatment situation are often at play in the kinds of impasse that lead to treatments devolving and patients ultimately being deemed “treatment resistant.” These troubles are often difficult to detect without testing, especially for patients who are verbally gifted and able to hide their confusion beneath sophisticated verbiage. By thought disorder, we mean the processes underlying illogical thinking and reasoning (e.g., loose associations), perceptual confusion and impaired reality testing, linguistic disturbances and neologisms, and boundary disturbances. As noted earlier, we attend to the contexts in which these troubles occur, as well as to the conditions that help the patient recover. Perhaps more interpersonal structure, a less ambiguous environment, more interpersonal distance, or less affective stimulation might be helpful. Further, rather than conceptualizing disordered thinking as absolute or strictly indicative of deficit, we consider how apparent breakdowns in thinking might be breakthroughs, how lapses in organization might be on the way to reorganization that is more complex and adaptive, and how disorganization and disintegration might be serving protective functions (Leonhardt et al., 2016).
ISQ – Psyche-pathology
Bhaskar Punukollu, Michael Phelan, Anish Unadkat in MRCPsych Part 1 In a Box, 2019
Other types of thought disorder: — Metonym – An inappropriate or imprecise but related word is used in place of the correct word in a sentence.— Neologism – A new word that has no meaning is created,— Echolalia – Automatic and pointless repetition of another person’s words or phrases.— Verbigeration – Imitation of another person’s phrases in a stereotyped manner.— Palilalia – Repetition of a word from an individual’s own spoken words.— Logoclonia – Repetition of words or phrases, particularly the end syllables.— Logorrhoea: excessive flow of words or pressure of speech as occurs in mania.
Introduction
John C. Gunn, Pamela J. Taylor in Forensic Psychiatry, 2014
Before leaving concepts of illness though, the strange expression ‘formal mental illness’ which has crept into modern British psychiatry requires comment. It is difficult enough to determine what is meant by a mental illness let alone a ‘formal’ one. What could this be? One possibility is that the term derives from misguided use of the word ‘formal’. In psychiatry the term ‘formal thought disorder’ may be applied to refer to a disorder of the form of thoughts. Are clinicians trying to say that there is a disorder in the form of health? Scadding (1990) advanced a more likely explanation. He referred to a study of the use of psychiatric terms in general practice (Jenkins et al., 1988) and said (of general practitioners): Faced with a patient in whom mood changes accompanied by various social and economic stresses and recognized physical diseases, they preferred to describe the situation in informal terms, rather than commit themselves to a formal diagnosis which would imply that the changed mood should be regarded as due to a postulated ‘mental disorder’.
Professional Practice Guidelines for Personality Assessment
Published in Journal of Personality Assessment, 2022
Radhika Krishnamurthy, Giselle A. Hass, Adam P. Natoli, Bruce L. Smith, Paul A. Arbisi, Emily D. Gottfried
Like any healthcare service, the practice of personality assessment often requires prior authorization for reimbursement of the service. Generally, authorization is predicated on the medical necessity of the service. In the United States, for instance, medical necessity is defined as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine” (U.S. Centers for Medicare & Medicaid Services, n.d.). Following this definition, other third-party payers establish medical necessity guidelines to determine insurance coverage for diagnostic and treatment services. Some examples are determination of thought disorder, differential diagnosis of psychiatric conditions not resolved by interview and observation processes, and determination of treatment options for optimal clinical outcomes. From the perspective of the third-party carrier, medical necessity will be reflected in the proper coding of the assessment service. The assessor should therefore be familiar with current coding procedures.
What is the potential of neurostimulation in the treatment of motor symptoms in schizophrenia?
Published in Expert Review of Neurotherapeutics, 2020
Stephanie Lefebvre, Anastasia Pavlidou, Sebastian Walther
Schizophrenia is a neurodevelopmental disorder with adolescent onset of symptoms, which affects approximately 1% of the population worldwide. Typical features are delusions, formal thought disorder, hallucinations, and negative symptoms such as avolition, cognitive impairment, and abnormal psychomotor behavior. Peculiar movements have been part of the earliest descriptions of schizophrenia [1]. The general public readily observes these motor abnormalities in patients and frequently attributes the very obvious behavioral abnormalities to mental illness. In contrast, psychiatrists tended to oversee motor abnormalities or to reduce these symptoms to side effects of antipsychotic pharmacotherapy since the late 1960 s [2,3]. In the past two decades, however, researchers found renewed interest in studying motor abnormalities in psychotic disorders, due to the prognostic value, refined assessment methods, continued suffering of patients, and the scarcity of treatment options. Furthermore, motor abnormalities might even indicate mechanisms critically involved in the development of schizophrenia. Currently, the field is starting to unravel the pathobiology of motor abnormalities in psychoses, paving the way for novel treatment options [4].
Reducing the stigma of long acting injectable antipsychotics – current concepts and future developments
Published in Nordic Journal of Psychiatry, 2018
David M. Taylor, Sitaram Velaga, Ursula Werneke
The introduction of antipsychotics (AP) in the early 1950s heralded a start of a new era for the treatment of schizophrenia. For the first time, drugs became available that could effectively treat the positive symptoms of schizophrenia, including delusions, hallucinations and thought disorder. These first-generation antipsychotics (FGAs) significantly reduced or even eliminated harsh and ill-fated treatment attempts such as convulsive therapies or physical restraints [1]. Yet, despite the initial therapeutic success, it soon emerged that many patients only poorly adhered to these novel oral formulations [2]. This prompted the development of LAI-APs in the early 1960, first as fluphenazine and haloperidol deaconate. With the advent of second generation antipsychotics [2], LAI-FGAs use declined. But despite improved tolerability, adherence to oral SGAs did not prove any better than to oral FGAs. LAI-SGAs were developed once again to improve adherence rates [2]. Thus, the goal of LAI treatment has remained the same, to improve adherence as a means to reduce the risk of symptom exacerbation, relapse and hospitalisation [3,4].
Related Knowledge Centers
- Cognition
- Delusion
- Mania
- Mood Disorder
- Neurological Disorder
- Psychosis
- Dementia
- Schizophrenia
- Glossary of Psychiatry
- Word Salad