Search

Purpose: Despite evidence of the increased risk of psychotic disorders among ethnic minority adults, little is known about the effect of ethnic minority status to mild psychotic experiences among adolescents. This study investigated mild psychotic experiences in ethnic minority and majority adolescents in a Dutch representative general population sample, and tested the ethnic density effect in the classroom. Methods: The CAPE was used to assess mild psychotic experiences among Dutch ( n = 3,606) and non-Western ethnic minority pupils ( n = 769). Results: Ethnic minority adolescents showed higher levels of grandiosity and delusions than their ethnic majority peers, whereas no differences were found for hallucinations, paranormal beliefs and paranoia between both groups of adolescents. The ethnic density effect was partly confirmed for the ethnic majority: a decrease of ethnic majority pupils in class increased their feelings of paranoia. Conclusions: Because only some dimensions of mild psychotic experiences were affected by ethnic minority status or the interaction between ethnic minority status and ethnic class composition, our findings emphasize that mild psychotic experiences are multifactorial in origin, with different underlying processes. [ABSTRACT FROM AUTHOR]

Various conceptualizations of subtypes, levels, and dimensions of narcissism and narcissistic personality disorder (NPD) are considered with a particular focus on overt grandiose presentations and covert vulnerable presentations. Evidence supporting this distinction and clinical vignettes to illustrate it are presented as well as their implications for clinical work with NPD patients. The research and clinical evidence points to the conclusion that these broad categorical subtypes are better conceptualized as dimensions on which individual patients vary on relative levels, thus suggesting that grandiose and vulnerable presentations represent two sides of the same coin. A case example and clinical implications are provided and discussed. [ABSTRACT FROM AUTHOR]

This article introduces a special issue of the Journal of Clinical Psychology: In Session focused on the conceptualization and treatment of narcissism. Obscured by an ongoing debate about how best to define pathological narcissism, clinicians have often lost sight of the fact that narcissistic investment in the self is a normal developmental trend that can be disturbed to varying degrees by environmental stresses and failures of nurturing. Using case presentations, contributing authors demonstrate the following: the importance of understanding the closely interrelated grandiosity and vulnerability associated with narcissistic difficulties; variation in the expression of narcissistic 'types'; the role of perfectionism and sadomasochism; and the possibility that narcissistic issues are present across all types of personality psychopathology. Specific alliance-building recommendations are offered, and the greater utility of defining narcissism dimensionally rather than categorically is explored. A clinical case in the current article illustrates each of these central ideas. Together, the discussions presented in this issue invite greater insight into, and appreciation of, narcissistic phenomena, along with examples of effective and empathic treatment approaches. [ABSTRACT FROM AUTHOR]

Shone's complex is a rare and severe type of congenital left-sided obstructive lesion of multiple cardiovascular levels. This report aims to present the authors' experience diagnosing atypical Shone's complex using echocardiography. Atypical Shone's complex was diagnosed for 38 consecutive patients (18 boys and 20 girls, ages 1 day to 15 years) using echocardiography. All the diagnoses were confirmed by cardioangiography, surgery, or both. Among the congenital left-sided obstructive lesions, four levels of obstruction coexisted in 3 cases (7.9%), three levels in 10 cases (26.3%), and two levels in 25 cases (65.8%). Supra-annular mitral stenosis caused by a supravalvular mitral ring was diagnosed in 1 case. Mitral valvular stenosis was diagnosed in 24 cases including a parachute mitral valve (4 cases), a double-orifice mitral valve (1 case), and partly fused thickened mitral valvular leaflets (19 cases). Subaortic stenosis was diagnosed in 10 cases including circumferential membranous subaortic stenosis (1 case), tunnel-type subaortic narrowing (2 cases), and asymmetric obstructive fibrous ridge below the aortic valve (7 cases). Aortic stenosis was diagnosed in 25 cases including the bicuspid aortic valve (12 cases), the hypoplasia aortic annulus (3 cases), and partly fused or thickened tri-leaflet aortic valves (10 cases). Supra-aortic stenosis was diagnosed in 6 cases including the localized type (4 cases) and the diffused type (2 cases). Coarctation of the aorta was diagnosed in 26 cases. Of these, focal coarctation was described in 15 cases, long segment coarctation in 7 cases, and dysplastic isthmus and/or descending aorta in 4 cases. Secondary changes in Shone's complex manifested as left atrial dilation (26 cases), left ventricular hypertrophy (26 cases), and pulmonary hypertension (19 cases). Echocardiography plays an important role in the diagnosis of atypical Shone's complex, in comprehensive evaluation of the number, position, morphology, and severity of left-sided obstructions. [ABSTRACT FROM AUTHOR]

Objective: By comparing the co-occurring symptoms instead of co-occurring diagnoses, we will determine if there are symptoms independent of DSM diagnoses that are capable of differentiating between pathological gamblers (PG) and non-pathological gamblers. Method: This study identified past 12-month co-occurring sub-diagnostic psychiatric symptoms (i.e. shadow symptoms) among the 43,093 individuals who participated in the National Epidemiological Survey on Alcohol and Related Conditions. We compared the prevalence of these shadow symptoms among individuals with five or more DSM-IV (PG) symptoms to the prevalence among individuals who gamble with no associated problems. Factor analyses applied to 428 non-duplicated past-year symptoms compiled from 29 DSM-IV diagnostic schedules yielded 13 symptom clusters that included 212 symptoms. Results: Most (58%) PGs reported symptoms that were not directly related to gambling, but were more prevalent among gamblers without gambling-related problems. Conclusions: These findings provide evidence that people who satisfy DSM-IV diagnostic criteria (e.g. pathological gambling) are likely to report meaningful co-occurring sub-clinical symptoms that are associated with other diagnostic classes. Consequently, diagnostic classification should be complemented with an awareness of co-occurring sub-clinical symptom patterns (i.e. shadow syndromes). [ABSTRACT FROM AUTHOR]

Objective: The authors describe personality development and disorders in relation to symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders. Method: Consecutive adults referred for neuropsychiatric investigation (N=240) were assessed for current and lifetime ADHD and autism spectrum disorders and completed the Temperament and Character Inventory. In a subgroup of subjects (N=174), presence of axis II personality disorders was also assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCI D-l I). Results: Patients with ADHD reported high novelty seeking and high harm avoidance. Patients with autism spectrum disorders reported low novelty seeking, low reward dependence, and high harm avoidance. Character scores (self-directedness and cooperativeness) were extremely low among subjects with neuropsychiatric disorders, indicating a high overall prevalence of personality disorders, which was confirmed with the SCID-II. Cluster B personality disorders were more common in subjects with ADHD, while cluster A and C disorders were more common in those with autism spectrum disorders. The overlap between DSM-IV personality disorder categories was high, and they seem less clinically useful in this context. Conclusions: ADHD and autism spectrum disorders are associated with specific temperament configurations and an increased risk of personality disorders and deficits in character maturation. [ABSTRACT FROM AUTHOR]

The article discusses the clinical follow-up and pathological report on a patient with juvenile familial amaurotic idiocy or Vogt-Spielmeyer disease and with features of formes frustes of gargoylism. The author explains that the juvenile type of familial amaurotic idiocy is a rare disorder and differs from the infantile type of familial amaurotic idiocy. The stages of the disease include the visual disturbance in the form of blindness, onset of convulsions, mental deterioration and dementia. An overview of the case of a 13-year-old boy with Vogt-Spielmeyer disease is provided.

We report on a family with dominantly inherited asymptomatic Alexander''s disease due to a novel Glial fibrillary acidic protein (GFAP) mutation. The proband, a 16-month-old boy, presented with megalocephaly and brain magnetic resonance imaging (MRI) showing the typical findings of Alexander''s disease. Molecular analysis showed that he was a heterozygote of the L331P mutation of GFAP. His mother and sister, without megalocephaly or other neurological abnormalities, were also heterozygotes of the mutation and their brain magnetic resonance imaging showed mild changes in the caudates and deep frontal white matters. These results suggest the existence of a forme fruste of Alexander''s disease. The L331P mutation may be associated with the mild phenotype of Alexander''s disease. To elucidate the genotype–phenotype correlation in Alexander''s disease, molecular diagnosis and MRI examination are required for many patients and their families. [Copyright &y& Elsevier]