Ana Miruna Dragoi
Hospital for Psychiatry “Alex. Obregiaâ€, Romania
Title: The decrease of violence in a schizophrenic patient with paraphrenic tendencies
Biography
Biography: Ana Miruna Dragoi
Abstract
Background: Paranoid schizophrenia acquires a paraphrenic shade in a 60-year-old patient with chronic progression, lack of insight, and no longer compliant with medication. Progression has caused the loss of social support, dromomania and the associated homelessness, which cumulatively has accelerated the patient’s loss of self.
Objectives: Identifying the elements of semiology that dominate the clinical picture; Underlining, psychodynamic mechanisms leading to confabulatory discourse, delirium, somatic delusional ideation and pseudohallucinations.
Hypotheses: We assume that the patient's delirium is fueled by delusional perceptions centered on fundamental life events. We assume that the absence of a real psychosocial support system has contributed to the downfall of the psychiatric state of the patient as well as the paraphrenization of the delirium with the quasi-conscious maintenance of hallucinations.
Results: We highlighted the psychodynamic functioning of a schizophrenic patient with about 30 years of evolution, characterized by disorganized thinking, with a modified vocabulary which consists of the presence of neologisms and neoformation words, as well as associations by contiguity and delusional ideas based on distorted memories of non-differentiation and cloning, delusional transformation of the self, xenopathy, false relationships, memory hallucinations that create a cosmogonic world typical for paraphrenia. The attained delusions have overlapped an antisocial personality disorder leading to the decrease of violence while the imaginative world only grew stronger.
Conclusions: Over the course of time the Axis I diagnosis becomes more prominent whilst the Axis II dwindles.
During childhood the patient presented a conduct disorder that led to an antisocial personality. As the psychosis progressed and gave way to the increased loss of self the antisocial personality became less pronounced, due to disorganized thinking and to the presence of ongoing delusional phenomenology.