Symptomatic trans-sexualism

Article Abstract:

Delusions of sex change often occur in both male and female schizophrenics, but few cases have been reported of sex-change delusions accompanied by cross-dressing. A case report is presented of a Jamaican male schizophrenic who was under the delusion that he was female, and had lived as a woman for nearly two years. At age 28, he was referred to a psychiatric clinic because of this delusion; he insisted that his penis was a vagina, and claimed to be a lesbian; he had no insight into his illness. The patient's manner was effeminate, and he was dressed in a skirt, blouse, and high-heeled shoes; his speech had a 'Shakespearean flavor', revealing a schizophrenic thought disorder. Personal history included poor relationships with parents and peers; he did not graduate from high school, had no work skills, and functioned minimally. The patient had experienced two heterosexual relationships and denied any sexual attraction to men. Fluphenazine (an antipsychotic) treatment was begun on an outpatient basis, and within two months his delusions and thought disorder resolved, and he resumed life as a heterosexual male. After two years, he continued to do well on a maintenance dose of fluphenazine. While delusions of being the opposite sex are thought to be experienced by as many as one in five schizophrenics, many more cases may go undetected. Sex-change delusions are reported to be more common among unmarried schizophrenics, particularly males. There are four categories: delusions (in men) of no longer being a male; delusions of being a neuter; delusions of being both sexes simultaneously; and delusions of being the opposite sex. The importance of enquiring into the sexual beliefs of psychotic patients is stressed. Particular care is required when assessing patients who request 'sex-change operations'; it is essential to rule out psychosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexual behavior, Psychological aspects, Case studies, Causes of, Transsexuals, Schizophrenics, Sexual orientation

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Further investigation of the predictors of outcome following first schizophrenic episodes

Article Abstract:

Two hundred fifty-two adult patients hospitalized for a first schizophrenic episode were followed-up for two years so that their outcome, in terms of employment and amount of time spent in the hospital, could be evaluated. Upon discharge from the hospital, some of the patients were placed on placebo maintenance, while the remainder received maintenance doses of neuroleptic (anti-psychotic) drugs for the two-year follow-up period. For patients who had been ill for more than one year before treatment began, there was no difference between placebo and neuroleptic-drug groups in outcome, but for those who began treatment within one year, the placebo group had a significantly better outcome. No significant relationships were found between employment outcome and age, sex or ethnic origin. Factors which had a significant positive effect on employment outcome included: no relapse; fewer in-hospital days; and being treated with a placebo rather than a neuroleptic drug. Psychiatric illness in fathers of patients was associated with poor employment outcome for females, but did not seem to affect male employment outcome. Poor employment outcome was significantly related to social withdrawal, lack of close relationships, and poor social adjustment. Factors found to be significant predictors of more days spent in-hospital were social withdrawal, a tendency to speak incoherently or oddly, blunted emotions and several neurological soft signs, including abnormal hand grip, disorder of the lips and tongue, and poor performance on picture vocabulary tests. Since there was no control or comparison group in this study, relationships found between study factors and outcome cannot conclusively be attributed to schizophrenia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Prognosis, Antipsychotic drugs, Antipsychotic agents

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Suicide and related behaviour from river bridges: a clinical perspective

Article Abstract:

A survey was undertaken to evaluate the psychopathology of individuals who had committed suicide or had attempted suicide by jumping off one of eight river bridges in Australia between 1972 and 1987. Relevant clinical and demographic data was gathered from the records of coroners, police, general and psychiatric hospitals, community psychiatric services, and alcohol and drug dependency units. Ninety people were identified: 47 suicides, 16 failed suicides (those who jumped and survived), 24 attempted suicides (those who were stopped before they could jump), and 3 pranksters who jumped, but were not judged to be overtly suicidal. The male to female ratio for jumpers was about five to one. The average age of all jumpers was 35 years old. Most jumpers (46 percent) had never been married, and 40 percent were invalids living on pensions. Unemployment rates were high across all categories of suicidal behavior. Forty-six percent of the jumpers and 8 percent of the attempted suicides were schizophrenic. Six of the eight schizophrenics said that command hallucinations told them to jump. Thirteen percent of the jumpers were diagnosed with personality disorder, while 58 percent of those who attempted suicide received this diagnosis. One third of the attempted suicides were alcohol intoxicated during the incident, but only six suicides had post-mortem alcohol levels indicative of intoxication. Ninety-two percent of those who attempted suicide, and 54 percent of the jumpers, had a history of deliberate self-harm. About one third of the incidents occurred among psychiatric in-patients. Almost all of the 90 identified individuals had long histories of extensive psychiatric care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Australia, Suicide, Surveys, Self-destructive behavior, Self injurious behavior

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