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What is Amineptine?

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Introduction

Amineptine, formerly sold under the brand name Survector among others, is an atypical antidepressant of the tricyclic antidepressant (TCA) family.

It acts as a selective and mixed dopamine reuptake inhibitor and releasing agent, and to a lesser extent as a norepinephrine reuptake inhibitor.

Amineptine was developed by the French Society of Medical research in the 1960s. Introduced in France in 1978 by the pharmaceutical company Servier, amineptine soon gained a reputation for abuse due to its short-lived, but pleasant, stimulant effect experienced by some patients.

After its release into the European market, cases of hepatotoxicity emerged, some serious. This, along with the potential for abuse, led to the suspension of the French marketing authorization for Survector in 1999.

Amineptine was never approved by the US Food and Drug Administration (FDA) for marketing in the US, meaning that it is not legal to market or sell amineptine for any medical uses in the US.

Medical Uses

Amineptine was approved in France for severe clinical depression of endogenous origin in 1978.

Contraindications

  • Chorea
  • Hypersensitivity: Known hypersensitivity to amineptine, in particular antecedents of hepatitis after dosage of the product.
  • MAO inhibitors.

Precautions for Use

Warnings and precautions before taking amineptine:

  • Breast feeding.
  • Children less than 15-year of age.
  • General anaesthesia: Discontinue the drug 24 to 48 hours before anaesthesia.
  • Official sports/Olympic Games: Prohibited substance.
  • Pregnancy (first trimester).

Effects on the Foetus

  • Lacking information in humans.
  • Non-teratogenic in rodents.

Side Effects

Dermatological

Severe acne due to amineptine was first reported in 1988 by various authors – Grupper, Thioly-Bensoussan, Vexiau, Fiet, Puissant, Gourmel, Teillac, Levigne, to name a few – simultaneously in the same issue of Annales de dermatologie et de vénéréologie and in the 12 March 1988 issue of The Lancet. A year later, Dr Martin-Ortega and colleagues in Barcelona, Spain reported a case of “acneiform eruption” in a 54-year-old woman whose intake of amineptine was described as “excessive.” One year after that, Vexiau and colleagues reported six women, one of whom never admitted to using amineptine, getting severe acne concentrated in the face, back and thorax, the severity of which varied with the dosage. Most of them were treated unsuccessfully with isotretinoin (Accutane) for about 18 months; two of the three that discontinued amineptine experienced a reduction in cutaneous symptoms, with the least affected patient going into remission.

Psychiatric

Psychomotor excitation can very rarely occur with this drug.

  • Insomnia.
  • Irritability.
  • Nervousness.
  • Suicidal ideation. Seen early in the treatment, by lifting of psychomotor inhibition.

Abuse and Dependence

The risk of addiction is low, but exists nonetheless. Between 1978 and 1988, there were 186 cases of amineptine addiction reported to the French Regional Centres of Pharmacovigilance; an analysis of 155 of those cases found that they were predominantly female, and that two-thirds of cases had known risk factors for addiction. However, a 1981 study of known opiate addicts and schizophrenia patients found no drug addiction in any of the subjects. In a 1990 study of eight amineptine dependence cases, the gradual withdrawal of amineptine could be achieved without problems in six people; in two others, anxiety, psychomotor agitation, and/or bulimia appeared.

Withdrawal

Pharmacodependence is very common with amineptine compared to other antidepressants. A variety of psychological symptoms can occur during withdrawal from amineptine, such as anxiety and agitation.

Cardiovascular

Very rarely:

  • Arterial hypotension.
  • Palpitations.
  • Vasomotor episode.

Hepatic

Amineptine can rarely cause hepatitis, of the cytolytic, cholestatic varieties. Amineptine-induced hepatitis, which is sometimes preceded by a rash, is believed to be due to an immunoallergic reaction. It resolves upon discontinuation of the offending drug. The risk of getting this may or may not be genetically determined.

Additionally, amineptine is known to rarely elevate transaminases, alkaline phosphatase, and bilirubin.

Mixed hepatitis, which is very rare, generally occurs between the 15th and 30th day of treatment. Often preceded by sometimes intense abdominal pains, nausea, vomiting or a rash, the jaundice is variable. Hepatitis is either of mixed type or with cholestatic prevalence. The evolution was, in all the cases, favourable to the discontinuation of the drug. The mechanism is discussed (immunoallergic and/or toxic).

In circa 1994 Spain, there was a case associating acute pancreatitis and mixed hepatitis, after three weeks of treatment.

Lazaros and colleagues at the Western Attica General Hospital in Athens, Greece reported two cases of drug induced hepatitis 18 and 15 days of treatment.

One case of cytolytic hepatitis occurred after ingestion of only one tablet.

Gastrointestinal

Acute pancreatitis (very rare) A case associating acute pancreatitis and mixed hepatitis after three weeks of treatment.

Immunological

In 1989, Sgro and colleagues at the Centre de Pharmacovigilance in Dijon reported a case of anaphylactic shock in a woman who had been taking amineptine.

Pharmacology

Pharmacodynamics

Amineptine inhibits the reuptake of dopamine and, to a much lesser extent, of norepinephrine. In addition, it has been found to induce the release of dopamine. However, amineptine is much less efficacious as a dopamine releasing agent relative to D-amphetamine, and the drug appears to act predominantly as a dopamine reuptake inhibitor. In contrast to the case for dopamine, amineptine does not induce the release of norepinephrine, and hence acts purely as a norepinephrine reuptake inhibitor. Unlike other TCAs, amineptine interacts very weakly or not at all with the serotonin, adrenergic, dopamine, histamine, and muscarinic acetylcholine receptors. The major metabolites of amineptine have similar activity to that of the parent compound, albeit with lower potency.

No human data appear to be available for binding or inhibition of the monoamine transporters by amineptine.

Pharmacokinetics

Peak plasma levels of amineptine following a single 100 mg oral dose have been found to range between 277 and 2,215 ng/mL (818-6,544 nM), with a mean of 772 ng/mL (2,281 nM), whereas maximal plasma concentrations of its major metabolite ranged between 144 and 1,068 ng/mL (465–3,452 nM), with a mean of 471 ng/mL (1,522 nM). After a single 200 mg oral dose of amineptine, mean peak plasma levels of amineptine were around 750 to 940 ng/mL (2,216-2,777 nM), while those of its major metabolite were about 750 to 970 ng/mL (2,216-3,135 nM). The time to peak concentrations is about 1 hour for amineptine and 1.5 hours for its major metabolite. The elimination half-life of amineptine is about 0.80 to 1.0 hours and that of its major metabolite is about 1.5 to 2.5 hours. Due to their very short elimination half-lives, amineptine and its major metabolite do not accumulate significantly with repeated administration.

Society and Culture

Brand Names

Amineptine has been sold under a variety of brand names including Survector, Maneon, Directim, Neolior, Provector, and Viaspera.

Legal Status

It had been proposed that Amineptine become a Schedule I controlled substance in the United States in July 2021.

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What is the Holmes and Rahe Stress Scale?

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Introduction

The Holmes and Rahe stress scale is a list of 43 stressful life events that can contribute to illness.

The test works via a point accumulation score which then gives an assessment of risk. The American Institute of Stress for instance, regards a score of 300 or more as an “80% chance of health breakdown within the next 2 years”. While there is good evidence that chronic stress can lead to ill health, there is not much evidence to support the ranking of stressful life events in this manner.

Brief History

In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive correlation of 0.118 was found between their life events and their illnesses.

Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.

Supporting Research

Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness. The scale was given to 2,500 US sailors and they were asked to rate scores of ‘life events’ over the previous six months. Over the next six months, detailed records were kept of the sailors’ health. There was a +0.118 correlation between stress scale scores and illness, which was sufficient to support the hypothesis of a link between life events and illness.

In conjunction with the Cornell medical index assessing, the stress scale correlated with visits to medical dispensaries, and the H&R stress scale’s scores also correlated independently with individuals dropping out of stressful underwater demolitions training due to medical problems. The scale was also assessed against different populations within the United States (with African, Mexican and White American groups). The scale was also tested cross-culturally, comparing Japanese and Malaysian groups with American populations.

Scale

  • Score of 300+: At risk of illness.
  • Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).
  • Score <150: Only have a slight risk of illness.

Adults

The sum of the life change units of the applicable events in the past year of an individual’s life gives a rough estimate of how stress affects health.

Life EventLife Change Units
Death of a Spouse100
Divorce73
Marital Separation65
Imprisonment63
Death of a Close Family Member63
Personal Injury or Illness53
Marriage50
Dismissal from Work47
Marital Reconciliation45
Retirement45
Change in Health of Family Member44
Pregnancy40
Sexual Difficulties39
Gain a New Family Member39
Business Readjustment39
Change in Financial State38
Death of a Close Friend37
Change to Different Line of Work36
Change in Frequency of Arguments35
Major Mortgage32
Foreclosure of Mortgage/Loan30
Change in Responsibilities at Work29
Child Leaving Home29
Trouble with In-Laws29
Outstanding Personal Achievement28
Spouse Starts or Stops Work26
Beginning or End of School26
Change in Living Conditions25
Revision of Personal Habits24
Trouble with Boss23
Change in Working Hours or Conditions20
Change in Residence20
Change in Schools20
Change in Recreation19
Change in Church Activities19
Change in Social Activities18
Minor Mortgage/Loan17
Change in Sleeping Habits16
Change in Number of Family Reunions15
Change in Eating Habits15
Vacation13
Major Holiday12
Minor Violation of Law11

Non-Adults

A modified scale has also been developed for non-adults. Similar to the adult scale, stress points for life events in the past year are added and compared to the rough estimate of how stress affects health.

Life EventLife Change Units
Death of a Parent100
Unplanned Pregnancy/Abortion100
Getting Married95
Divorce of Parents90
Acquiring a Visible Deformity80
Fathering a Child70
Jail Sentence of Parent of Over One Year70
Marital Separation of Parents69
Death of a Brother or Sister68
Change in Acceptance by Peers67
Unplanned Pregnancy of Sister64
Discovery of Being an Adopted Child63
Marriage of Parent to Step-Parent63
Death of a Close Friend63
Having a Visible Congenital Deformity62
Serious Illness Requiring Hospitalisation58
Failure of a Grade in School56
Not Making an Extracurricular Activity55
Hospitalisation of a Parent55
Jail Sentence of Parent for over 30 Days53
Breaking Up with Boyfriend or Girlfriend53
Beginning to Date51
Suspension from School50
Becoming Involved with Drugs/Alcohol50
Birth of a Brother or Sister50
Increase in Arguments between Parents47
Loss of Job by Parent46
Outstanding Personal Achievement46
Change in Parent’s Financial Status45
Accepted at College of Choice43
Being a Senior in High School42
Hospitalisation of a Sibling41
Increased Absence of Parent from Home38
Brother or Sister Leaving Home37
Addition of Third Adult to Family34
Becoming a Full-Fledged Member of a Church31
Decrease in Arguments between Parents27
Decrease in Arguments with Parents26
Mother or Father Beginning Work26

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What is the Brief Psychiatric Rating Scale?

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Introduction

The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour.

The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.

Brief History

The BPRS was initially developed by John E. Overall and Donald R. Gorham. It was created for the purpose of being able to quickly assess the patient’s psychiatric symptoms prior, during, or following a treatment. The items of the test were generated from conducting factor analysis on the Multidimensional Scale for Rating Psychiatric Patients and the Inpatient Multidimensional Psychiatric Scale. Sixteen factors were found from the analysis, which served as the building blocks for the BPRS. Later research in 1968 added two more factors to the BPRS, which were excitement and disorientation.

Test Format

The BPRS consists of 18 items measuring the following factors:

  1. Anxiety.
  2. Emotional withdrawal.
  3. Conceptual disorganisation.
  4. Guilt feelings.
  5. Tension.
  6. Mannerisms and posturing.
  7. Grandiosity.
  8. Depressive moods.
  9. Hostility.
  10. Suspiciousness.
  11. Hallucinatory behaviour.
  12. Motor hyperactivity.
  13. Uncooperativeness.
  14. Unusual thought content.
  15. Blunted affect.
  16. Somatic concern.
  17. Excitement.
  18. Disorientation.

It uses a seven-item Likert scale with the following values:

  • 1 = “not present”.
  • 2 = “very mild”.
  • 3 = “mild”.
  • 4 = “moderate”.
  • 5 = “moderately severe”.
  • 6 = “severe”.
  • 7 = “extremely severe”.

The test is administered in tandem with a series of interviews conducted by at least two clinicians to ensure interrater reliability of the assessment.

Usage

The BPRS is intended for use on adult psychiatric patients and has been validated for use in elderly populations. A version designed for children called the Brief Psychiatric Rating Scale Children was also developed by Overall and Betty Pfeifferbaum, with different scale structures and factors.

Further Development

An expanded version of the test was created in 1993 by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Brief_Psychiatric_Rating_Scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Weathering Hypothesis?

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Introduction

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity.

It is well documented that minority groups and marginalised communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is “weathering,” and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalised communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, and telomere shortening.

Origins

The weathering hypothesis was initially formulated by Dr. Arline T. Geronimus to explain the poor maternal health and birth outcomes of African American women that she observed in correspondence with increased age. While working part-time at a school for pregnant teenagers in Trenton, New Jersey, Geronimus first noticed that the teens who came to the school tended to have far more health problems than her classmates at Princeton University. She thus began to wonder whether the health conditions of the teens at that clinic may have been caused by their environment. Subsequent research on the disparity in maternal health between African American and white women led Geronimus to propose the weathering hypothesis. She proposed that the accumulation of cultural, social and economic disadvantages may lead to earlier deterioration of health among African American women compared to their non-Hispanic, white counterparts. Geronimus specifically chose the term weathering as a metaphor for the effects she perceived that exposure to stress was having on the health of marginalised people. While the weathering hypothesis was initially proposed based on observations of patterns in maternal health, academics have expanded its application as a framework to examine other health disparities as well.

Geronimus’ Research

While conducting research in the Department of Public Health Policy and Administration as a graduate student at the University of Michigan in 1992, Geronimus noticed a trend in disparities between the fertility of African American women versus their white counterparts. She noted that while the average white woman experiences her point of highest fertility and lowest risk of pregnancy complications or neonatal mortality between her 20’s and 30’s, this generalisation did not apply to African American women. Instead, among African American women, teen mothers are most likely to have healthy pregnancies and offspring. The data indicated a widening disparity in black-white infant mortality as maternal ages increase. Subsequently, Geronimus proposed the “weathering hypothesis,” which she initially conceived as a potential explanation for the patterns of racial variation in infant mortality with increasing maternal age.

Health Disparities

In the context of the weathering hypothesis, individual health is dynamic and shaped over time by social, economic, and environmental influences. These social determinants dictate what different demographics are exposed to as they develop and age. Racism and discrimination are two specific social determinants that lay the foundation for systemic inequality in access and upward mobility. This entrenchment of social inequities disproportionately impacts minorities and communities of colour, who remain in environments of poverty that have significantly more stressors than those of wealthier, predominantly white communities. These stressors – and the associated burden of coping with them – manifest as physiological responses that have detrimental effects on individual health, often leading to a disproportionately high occurrence of chronic illness and shorter life expectancy in minority communities. Multi-ethnic studies have yielded significant data demonstrating that weathering – accumulated health risk due to social, economic and environmental stressors – is a manifestation of social stratification that systemically influences disparities in health and mortality between dominant and minority communities.

Maternal Health

Maternal mortality is three to four times higher for Black mothers than white mothers in the United States. Infant mortality is also twice as high for infants born to non-Hispanic Black mothers compared to infants born to non-Hispanic white mothers. Additionally, there are racial disparities for negative birth outcomes like low birth weight, which has been found to influence risk of infant mortality and developmental outcomes after birth, and preterm birth. Across all women, older maternal age is associated with higher rates of these negative outcomes during pregnancy, but studies have consistently found that rates rise more rapidly for Black women than white women. The weathering hypothesis proposes that the accumulation of racial stress over Black women’s lives contributes to this observed pattern of racial disparities in maternal health and birth outcomes that increase with maternal age. Research has consistently identified an association between preterm birth and low birth weight in Black women and maternal stress caused by experiences of racism, systemic bias, socioeconomic disadvantage, segregated neighbourhoods, and high rates of violent crime. There is biological evidence of weathering, including the finding that Black women have shorter telomeres, a biological indicator of age, when compared with white women of the same chronological age. Though increased socioeconomic status serves as a protective factor against negative birth outcomes for non-Hispanic white mothers, disproportionate rates of preterm birth and low birth weight for non-Hispanic Black mothers have been found at every education and income level. The weathering hypothesis has also been used to explain this trend because upward socioeconomic mobility is associated with increased exposure to discrimination for women of colour.

There is modest evidence supporting the effects of weathering on mothers from other minority groups, including for high birth weight outcomes among American Indian/Alaska Native women. Research has started to explore whether the weathering hypothesis could also explain racial disparities in the outcomes of assisted reproductive technologies, but so far the findings are inconsistent.

Mental Health

Research shows that mental health disparities among marginalized communities exist. Daily discrimination faced by marginalised groups have been found to be associated with increased depressive symptoms and feelings of loneliness. Low-income communities are more likely to have severe mental illnesses, which is frequently heightened by the inaccessibility to quality healthcare. Researchers found that persisting epigenetic changes lead to increased risk of postpartum depression as a result of adverse life events and cumulative life stress among Black, Latinx, and low-income women. In a study assessing African American men, experiences of racism were linked to a poorer mental health state.

Intersectionality of Systems of Oppression

Intersectionality is a term coined by Kimberlé Crenshaw to describe the interconnected nature of different systems of oppression, the layered effects of which can be seen in the healthcare system. Research indicates that lower class status and increased depressive symptoms are associated with higher levels of biological weathering among Black individuals in comparison to white individuals. In a study exploring disparities in mental health, researchers found that Black sexual minority women reported higher frequencies of discrimination and decreased levels of social and psychological well-being than their white sexual minority women counterparts. Black sexual minority women had decreased levels of social well-being and increased levels of depressive symptoms in comparison to Black sexual minority men. African American women are also more likely to contract COVID-19 than African American men and white women. The prevalence of medical racism and sexism (lack of quality healthcare, harmful experimentation, etc.) has led to negative relationships with healthcare systems and increased risk of negative sexual and reproductive health outcomes among African American women. Existing research show how systems of oppression work together to oppress marginalized groups within the healthcare system and, as a result, these groups disproportionately experience negative health effects.

Criticism and Related Theories

Arline Geronimus faced significant pushback for the weathering hypothesis, including from members of the medical community who believed there was a genetic or evolutionary explanation for racial differences in health outcomes. There was some early criticism regarding the quality of her data, though the evidence of weathering and health disparities has grown since. Others pushed back against the weathering hypothesis because its application to racial disparities in maternal health seemed to contradict what advocacy groups had been saying about the negative consequences of teen pregnancy on young mothers. A further criticism of this theory believes that Geronimus and others have not sufficiently demonstrated a link between weathering and racial and gender disparities in life expectancy.

The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the allostatic load model, which proposes that an individual’s exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers. Research has tended to discuss allostasis and allostatic load as the molecular mechanism behind the weathering hypothesis, and Geronimus herself went on to study racial differences in allostatic load. Another related theory is the life course approach, which emphasizes focus on cumulative life experiences rather than maternal risk factors as an explanation for birth outcome disparities. Researchers have also been interested in studying the possibility of children inheriting the epigenetic changes which result from their mother’s cumulative life stress, which could relate the weathering hypothesis with transgenerational trauma.

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What is Logorrhoea?

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Introduction

In psychology, logorrhea or logorrhoea (from Ancient Greek λόγος logos “word” and ῥέω rheo “to flow”), is a communication disorder that causes excessive wordiness and repetitiveness, which can cause incoherency.

Logorrhoea is sometimes classified as a mental illness, though it is more commonly classified as a symptom of mental illness or brain injury. This ailment is often reported as a symptom of Wernicke’s aphasia, where damage to the language processing centre of the brain creates difficulty in self-centred speech.

Refer to Tangential Speech.

Characteristics

Logorrhoea is characterised by the constant need to talk. Occasionally, patients suffering from logorrhoea may produce speech with normal prosody and a slightly fast speech rate. Other related symptoms include the use of neologisms (new words without clear derivation, e.g. hipidomateous for hippopotamus), words that bear no apparent meaning, and, in some extreme cases, the creation of new words and morphosyntactic constructions. From the “stream of unchecked nonsense often under pressure and the lack of self-correction” that the patient may exhibit, and their circumlocution (the ability to talk around missing words) we may conclude that they are unaware of the grammatical errors they are making.

Examples of Logorrhoea

When a clinician said, “Tell me what you do with a comb”, to a patient suffering from mild Wernicke’s aphasia (which produces the symptom of logorrhoea), the patient responded:

“What do I do with a comb … what I do with a comb. Well a comb is a utensil or some such thing that can be used for arranging and rearranging the hair on the head both by men and by women. One could also make music with it by putting a piece of paper behind and blowing through it. Sometimes it could be used in art – in sculpture, for example, to make a series of lines in soft clay. It’s usually made of plastic and usually black, although it comes in other colors. It is carried in the pocket or until it’s needed, when it is taken out and used, then put back in the pocket. Is that what you had in mind?”

In this case, the patient maintained proper grammar and did not exhibit any signs of neologisms. However, the patient did use an overabundance of speech in responding to the clinician, as most people would simply respond, “I use a comb to comb my hair.”

In a more extreme version of logorrhoea aphasia, a clinician asked a male patient, also with Wernicke’s aphasia, what brought him to the hospital. The patient responded:

“Is this some of the work that we work as we did before? … All right … From when wine [why] I’m here. What’s wrong with me because I … was myself until the taenz took something about the time between me and my regular time in that time and they took the time in that time here and that’s when the time took around here and saw me around in it’s started with me no time and I bekan [began] work of nothing else that’s the way the doctor find me that way…”

In this example, the patient’s aphasia was much more severe. Not only was this a case of logorrhoea, but this included neologisms (such as “taenz” for “stroke” and “regular time” for “regular bath”) and a loss of proper sentence structure.

Causes

Logorrhoea has been shown to be associated with traumatic brain injuries in the frontal lobe[7] as well as with lesions in the thalamus] and the ascending reticular inhibitory system and has been associated with aphasia. Logorrhoea can also result from a variety of psychiatric and neurological disorders including tachypsychia, mania, hyperactivity, catatonia, ADHD and schizophrenia.

Aphasias

Wernicke’s Aphasia, amongst other aphasias, are often associated with logorrhoea. Aphasia refers to the neurological disruption of language that occurs as a consequence of brain dysfunction. For a patient to truly have an aphasia, they cannot have been diagnosed with any other medical condition that may affect their cognition. Logorrhoea is a common symptom of Wernicke’s Aphasia, along with circumlocution, paraphasias, and neologisms. Often a patient with aphasia may present all of these symptoms at one time.

Treatment

Excessive talking may be a symptom of an underlying illness and should be addressed by a medical provider if combined with hyperactivity or symptoms of mental illness, such as hallucinations. Treatment of logorrhoea depends on its underlying disorder, if any. Antipsychotics are often used, and lithium is a common supplement given to manic patients. For patients with lesions of the brain, attempting to correct their errors may upset and anger the patients, since the language centre of their brain may not be able to process that what they are saying is incorrect and wordy.

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What is Tangential Speech?

Published on by Andrew Marshall1 Comment

Introduction

Tangential speech or tangentiality is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation.

It tends to occur in situations where a person is experiencing high anxiety, as a manifestation of the psychosis known as schizophrenia, in dementia or in states of delirium. It is less severe than logorrhoea and may be associated with the middle stage in dementia. It is, however, more severe than circumstantial speech in which the speaker wanders, but eventually returns to the topic.

Some adults with right hemisphere brain damage may exhibit behaviour that includes tangential speech. Those who exhibit these behaviours may also have related symptoms such as seemingly inappropriate or self-centred social responses, and a deterioration in pragmatic abilities (including appropriate eye contact as well as topic maintenance).

Brief History

The earlier phenomenological description allowed for further definition on the basis of formal characteristic rather than content, producing later practice relying upon clinical assessment. The term has undergone a re-definition to refer only to a persons speech in response to a question, and to provide the definition separation from the similar symptoms loosening of association and derailment.

Definition

The term refers simplistically to a thought disorder shown from speech with a lack of observance to the main subject of discourse, such that a person whilst speaking on a topic deviates from the topic. Further definition is of speech that deviates from an answer to a question that is relevant in the first instance but deviates from the relevancy to related subjects not involved in a direct answering of the question. In the context of a conversation or discussion the communication is a response that is ineffective in that the form is inappropriate for adequate understanding. The person’s speech seems to indicate that their attention to their own speech has perhaps in some way been overcome during the occurrence of cognition whilst speaking, causing the vocalised content to follow thought that is apparently without reference to the original idea or question; or the person’s speech is considered evasive in that the person has decided to provide an answer to a question that is an avoidance of a direct answer.

Other

According to the St. Louis system for the diagnosis of schizophrenia, tangentiality is significantly associated with a low IQ prior to diagnosis.

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On This Day … 24 April [2022]

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People (Births)

  • 1948 – Eliana Gil, Ecuadorian-American psychiatrist, therapist, and author.

People (Deaths)

  • 1924 – G. Stanley Hall, American psychologist and academic (b. 1844).
  • 1983 – Erol Güngör, Turkish sociologist, psychologist, and academic (b. 1938).

Eliana Gil

Eliana Gil (born 24 April 1948), is a lecturer, writer, and clinician of marriage, family and child. She is on the board of a number of professional counselling organisations that use play and art therapies, and she is the former president of the Association for Play Therapy (APT).

Gil is the senior partner of the Gil Institute for Trauma Recovery and Education in Fairfax, Virginia. She is also the director of Starbright Training Institute for Child and Family Play Therapy based in northern Virginia.

G. Stanley Hall

Granville Stanley Hall (01 February 1846 to 24 April 1924) was a pioneering American psychologist and educator.

His interests focused on human life span development and evolutionary theory. Hall was the first president of the American Psychological Association and the first president of Clark University. A Review of General Psychology survey, published in 2002, ranked Hall as the 72nd most cited psychologist of the 20th century, in a tie with Lewis Terman.

Erol Gungor

Erol Güngör (25 November 1938 to 24 April 1983) was a Turkish sociologist, psychologist, and writer.

After spending a period in the Faculty of Law, Güngör graduated from the Faculty of Literature and Social Sciences of Istanbul University in 1961. He received his Ph.D. in 1965 with a thesis titled “Kelâmî (Verbal) Yapılarda Estetik Organizasyon”. Kenneth Hammond invited him to visit the University of Colorado. He became an associate professor with his thesis titled “Şahıslar arası Ihtilafların Çözümünde Lisanın Rolü” in 1970. He became an academic in the Faculty of Literature and Social Sciences of Istanbul University in 1975. He eventually became the president of Selçuk University in 1982.

He mostly studied culture, personality, customs, people and religion. He focused on the identity and cultural problems which Turkish people have faced in the last 150 years.

What is Schizophrenics Anonymous?

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Introduction

Schizophrenics Anonymous is a peer support group to help people who are affected by schizophrenia and related disorders including bipolar disorder, schizoaffective disorder, psychotic depression and psychosis.

Brief History

The programme was established in Detroit in 1985. The founder was Joanne Verbanic, who was diagnosed with schizophrenia in 1970. Shortly before forming SA, Verbanic publicly disclosed her diagnosis and discussed her illness on national television in an effort to challenge the stigma associated with the condition. She was a 2006 recipient of a Lilly Reintegration Award in recognition of her lifetime contributions to the mental health community, and she continued to be active as a spokesperson for persons with schizophrenia and other mental illness until her death on 07 May 2015.

By 2007, more than 150 local SA groups operated in 31 of the 50 United States, and in Australia, Brazil, Canada, Mexico, France, India and Venezuela.

Technical support for Schizophrenics Anonymous was provided by the National Schizophrenia Foundation (NSF) until 2007 when NSF ceased operations. In response to the loss of a national sponsor, a group of consumers, family members, and mental health providers came together to form a not-for-profit organisation, Schizophrenia and Related Disorders Alliance of America (SARDAA).

SARDAA promotes recovery for persons with schizophrenia and related brain disorders including bipolar disorder, schizoaffective disorder, depression with psychosis, and experience with psychosis. They envision a future in which every person with a schizophrenia-related brain disorder has the opportunity to recover from their disorders. The name Schizophrenics Anonymous was changed to Schizophrenia Alliance in 2015 and added Psychosis Support and Acceptance in 2018. They provide an online directory of SA groups, sponsor five weekly SA conference calls, and one Family and Friends conference call. At their annual conference, the group trains individuals and groups who have started or would like to start an SA group.

Although some SA groups are organised by mental health professionals, research has suggested that peer-led SA groups are more sustainable and longer lasting. Some groups are organised in psychiatric hospitals or jails and are not open to the public.

Programme Principles

The SA programme is based on the twelve-step model, but includes just six steps. The organisation describes the programme’s purpose of helping participants to learn about schizophrenia, “restore dignity and sense of purpose,” obtain “fellowship, positive support, and companionship,” improve their attitudes about their lives and their illnesses, and take “positive steps towards recovery.”

Joanne Verbanic wrote the original “Schizophrenics Anonymous” book, better known as “The Blue Book,” which describes the six steps to recovery. The steps require members to admit they need help, take responsibility for their choices and consequences, believe they have the inner strength to help themselves and others, forgive themselves and others, understand that false beliefs contribute to their problems and change those beliefs, and decide to turn their lives over to a higher power.

Research

One study about the risks of professional partnerships centres on the partnership between Schizophrenics Anonymous (SA) and the Mental Health Association of Michigan (MHAM) over a 14-year period. The study shows that the professional partnership resulted in increased access to SA Groups across Michigan and organisation expansion and development within SA. The professional influence also lead more SA Groups to be held in more traditional mental health treatment settings and led to more professional-led SA groups.

Self-help groups are more available to people who live independently. Researchers at Michigan State University studied whether SA would be successful in group homes. The results were positive: the groups had high attendance and participation and were well liked. However, staff members controlled who could lead and who could attend the meetings, and how the meetings should be run. The programs fell apart. The same obstacle occurred in SA groups started in prisons and monitored by employees.

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On This Day … 22 Apri l[2022]

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People (Births)

  • 1884 – Otto Rank, Austrian-American psychologist and academic (d. 1939).

Otto Rank

Otto Rank (né Rosenfeld; 22 April 1884 to 31 October 1939) was an Austrian psychoanalyst, writer, and philosopher.

Born in Vienna, he was one of Sigmund Freud’s closest colleagues for 20 years, a prolific writer on psychoanalytic themes, editor of the two leading analytic journals of the era, managing director of Freud’s publishing house, and a creative theorist and therapist. In 1926, Rank left Vienna for Paris and, for the remainder of his life, led a successful career as a lecturer, writer, and therapist in France and the United States.