The Psychopathology of Delusion of Control According to Subjective Experience / La psicopatología del delirio de control según la experiencia subjetiva

ABSTRACT Background: Delusion of control, including thought insertion, occurs in 20% of patients with schizophrenia. However little is known of its psychopathology, and studies involving patients are scarce. Aims: To explore the subjective experience of patients with delusion of control and to propose a psychopathological explanation based on empirical evidence. Methods: Qualitative exploratory study of 7 patients (6 with schizophrenia and 1 with schizophreniform disorder). A phenomenologically-oriented semi-structured interview was used. Results: Delusion of control is not an isolated and pure symptom; it is always immersed in the context of a persecutory delusion and other psychiatric symptoms. The patient experiences partial control, i.e. the control is never complete. In all cases, it is possible to trace the history of the narrative formation of delusion of control from its origins in persecutory delusions and other concomitant symptoms. Conclusions: The delusion of control is a narrative resulting from the joint presence of a persecutory delusion and other psychiatric symptoms. For the patient, the delusion of control is the narrative of the elaborate expression of the meaning of the anomalous experience. Delusion of control is a narrative variety of persecutory delusion.

resumen Introducción: El delirio de control, incluida la inserción de pensamientos, se presenta en el 20% de los pacientes con esquizofrenia. Sin embargo, se conoce poco de su psicopatología y los estudios que implican a pacientes son escasos. Objetivo: A partir de una serie de casos clínicos, explorar la experiencia subjetiva de pacientes con delirio de control y proponer una explicación psicopatológica con base en elementos empíricos. Métodos: Estudio exploratorio de tipo cualitativo con 7 pacientes (6 con esquizofrenia y 1 con trastorno esquizofreniforme). Se utilizó una entrevista semi estructurada de orientación fenomenológica. Resultados: El delirio de control no se presenta como síntoma aislado y puro, siempre está inmerso en el contexto de un delirio persecutorio y otros síntomas psiquiátricos. El control vivido por el paciente es parcial, nunca total. En todos los casos fue posible rastrear la historia de la constitución narrativa del delirio de control a partir del delirio persecutorio y los otros síntomas concomitantes. El delirio de control es la narrativa que expresa de manera más elaborada el sentido que la experiencia tiene para el paciente. Conclusiones: El delirio de control es una narrativa derivada de la concomitancia de un delirio persecutorio y otros síntomas psiquiátricos. Es la narrativa que expresa de manera más elaborada el sentido que tiene la experiencia anómala para el paciente. El delirio de control es una variedad narrativa del delirio persecutorio.

Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer

PURPOSE: To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort. MATERIALS AND METHODS: We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. RESULTS: After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9 percent) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7 percent) regained EF of level 1-2 while 1 (2.9 percent) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7 percent) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively). CONCLUSIONS: Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7 percent. Further, though erectile dysfunction is common following TCAP, 25.7 percent of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.