Defense mechanisms, negative emotions, and psychopathology in adolescent inpatients.

Ego defense mechanisms were compared in adolescent psychiatric inpatients and healthy adolescents to determine their relationship to specific diagnoses and to negative emotions. Seventy-one patients with schizophrenia, 28 with major depressive disorder, and 24 with obsessive-compulsive disorder (OCD) and 87 normal adolescents were assessed for defense mechanisms by the Life Style Index (LSI) and Ego Defense Scale (EDS). The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Multidimensional Anger Inventory (MAI) were used to assess depression, anxiety, and anger. Several defenses distinguished all psychiatric patients from controls, and a few defenses characterized different patient groups, especially those with OCD. Projection (on the LSI), displacement, and regression correlated significantly with anger; displacement, reaction formation, and undoing on the EDS correlated with anxiety, and denial was negatively correlated with depression. These findings have some relevance for the evaluation of Plutchik's psychoevolutionary theory of emotions and for the further empirical study of defenses in psychopathology.

Suicidal adolescents and ego defense mechanisms.

OBJECTIVES: To identify defense mechanisms that characterize adolescents with a range of suicidal behaviors and to differentiate them from nonsuicidal adolescents. METHODS: Fifty-five suicidal adolescent inpatients admitted for a definite suicide attempt were compared with 87 adolescent inpatients who had no history of suicide attempt or ideation and 81 nonpatients. Defense mechanisms were assessed by the Ego Defense Scale (EDS) which is part of a larger semistructured interview, the Child Suicide Potential Scale (CSPS), and by a self-report questionnaire, the Life Style Index (LSI). The CSPS was also used to quantity violent and suicidal behaviors. RESULTS: On the LSI suicidal adolescent patients scored higher on denial, displacement, repression, and total defenses than the nonpatients. On the EDS they scored higher on regression, denial, projection, introjection, repression, and total defenses and lower on sublimation. LSI scores on displacement (higher) and on compensation (lower) distinguished suicidal from nonsuicidal inpatients. Denial and regression correlated positively and sublimation correlated negatively with both suicidal and violent behaviors. Introjection and repression correlated with suicidal behavior only. CONCLUSIONS: Overuse of displacement is connected with increased risk for suicidal and aggressive behaviors, while sublimation is probably a protective factor. In addition, several immature ego defenses possibly amplify aggression, which then is directed against the self by the maladaptive overuse of introjection, displacement, and repression.

Use of the Child Behavior Checklist in an Israeli adolescent psychiatric unit.

This article deals with the Hebrew version of an instrument for the diagnosis of psychopathology in young adolescents: the Child Behavior Checklist and the associated Child Behavior Profile developed by Achenbach (1978). We report on a study of the reliability and validity of the checklist and its suitability for use with severely disturbed adolescents in Israel. Parents of 130 adolescents, 89 healthy and 41 sick, participated in the research. The scales were found to be valid in that two-thirds of the items were correctly assigned by clinicians in Israel to their respective scales; it is internally consistent as measured by the Cronbach coefficient; and it is reliable in distinguishing between patient and control groups. Scores for control adolescents in Israel were found to be very similar to norms in the United States, the Netherlands and Chile. This finding may have important implications for cross-cultural research.

Penicillamine and other remittive agents in rheumatoid arthritis: comparisons and interaction.

Penicillamine treatment of rheumatoid arthritis was compared with gold and other remittive agents by reviewing the literature and studying the patients in our penicillamine clinic with respect to their previous responses to chrysotherapy. Penicillamine compares well with other remittive agents with respect to efficacy and toxicity. Prior chrysotherapy does not determine or predict the subsequent efficacy of penicillamine . Patients who reacted adversely to gold tended to react adversely to penicillamine; proteinuria and rash tended to recur.

Penicillamine compared to previous chrysotherapy in rheumatoid arthritis.

Of 331 patients in our 3 penicillamine clinics, 312 had been taking chrysotherapy previously. In 232 patients, responses to both drugs could be determined: there was no difference in the response rate to penicillamine when patients in the largest clinic with good and those with poor responses to gold were compared. Adverse reactions to penicillamine were more frequent in patients who had reacted adversely to gold in 2 of the 3 clinics. Proteinuria tended to occur more frequently in patients who had had proteinuria when taking gold than in patients who had not had gold-induced proteinuria.

Gold or penicillamine?

The recent approval of penicillamine (Cupramine) for use in rheumatoid arthritis has given the physician another remission-inducing drug for this disease. A thorough understanding of penicillamine's administration and toxicity is necessary before the physician begins to use it. Although its efficacy is similar to gold, side effects are considerably more diverse, and longterm side effects require further assessment. This article reviews the clinical use of gold and penicillamine and the factors which may influence the choice of one drug over the other in a given patient.

Adverse effects of D-penicillamine in rheumatoid arthritis.

Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the first 6 months of treatment, except for proteinuria and thrombocytopenia, which peaked in the second 6 months. Reactions were commoner at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (approximately 600 mg/d) than for the others (approximately 500 mg/d). Of 114 discontinued courses, 73 (27%) were due to adverse reactions. The remaining reactions were controlled by altering dosages and symptomatic treatment. Only obliterative bronchiolitis (two cases) was irreversible; it resulted in the only death in our series, possibly attributable to penicillamine.