Organic Personality Disorder Research Articles

The Foundations and Practice of Neuropsychological Diagnostics in the Context of Forensic Psychiatric Examination

Background: cognitive impairments are comorbid for most mental disorders and can be important in assessing the ability of a subject to understand and control their actions in legally significant situations. The aim of review: аnalysis of neurobiological correlates and cognitive impairments in individuals suffering from mental disorders — organic personality disorder, schizophrenia, borderline personality disorder, in the context of forensic psychiatric examination. Material and methods: using keywords: “cognitive impairments in schizophrenia”, “cognitive impairments in organic personality disorders”, “cognitive impairments in personality disorders”, “MRI in schizophrenia”, “MRI in organic personality disorder”, “MRI in personality disorder”, “forensic neuropsychology”, “schizophrenia and criminal actions”, “organic personality disorders and criminal actions”, “personality disorders and criminal actions” the search and analysis of scientific publications was carried out in PubMed, Scopus, and RSCI databases over the past 5 years. Conclusion: schizophrenia shows deviations in the functioning of frontal and temporal lobes characterized by cognitive impairments: executive functions, attention, auditory-verbal memory, psychomotor slowness, inconsistent behavior, and deficits in volitional efforts. Borderline personality disorder is associated with reduced volume of the anterior cingulate gyrus, hippocampus, amygdala, and prefrontal cortex, dysfunctional interaction between limbic and prefrontal areas resulting in difficulties in emotion identification and impulsivity. Individuals with a history of traumatic brain injury (TBI) and secondary personality disorders exhibit diffuse gray matter damage affecting frontal, temporal, and parietal regions, emphasizing dysfunction of limbic-reticular complex structures with cognitive impairments including decreased thinking speed, attention stability, executive functions, auditory-verbal memory, visual-spatial memory, visual-motor coordination, and decreased impulse control. Individuals with mental disorders who commit criminal acts often exhibit deficiencies in frontal lobes and associated disturbances in executive components of mental activity, particularly cognitive flexibility and planning. Neuropsychological methods for studying cognitive functions can be used to obtain additional information in forensic psychiatric examinations.

Neurocognitive deficit in organic personality disorders in persons subject to prosecution in criminal cases

Neurocognitive deficit in organic personality disorders in persons subject to prosecution in criminal cases

Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil

ObjectivesQuantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil.DesignDaily time series analysis, using quasi-Poisson combined with distributed lag non-linear...

Study of some predictors of delinquent disorders in patients with organic personality disorder

The problem of antisocial (delinquent) human behavior has existed since ancient times. According to literary sources, adolescents are the most susceptible to this form of behavior, however, this does not always reflect the reality. In psychiatry, it is customary to pay attention not only to age, gender, or nosological aspects, but also to personal characteristics when behavioral disorders occur. This article analyzes predictors of delinquent disorders in patients with organic personality disorder. The age parameters of the disorders presented in the sample are considered: behavioral deviations characteristic of childhood and adolescence, as well as of adults, are described. In addition, personal characteristics influencing the occurrence of delinquent behavior have been studied. It is proposed to introduce a new parameter — locus of control, which allows for a comprehensive assessment of the condition of subjects in different spheres of life.

Особенности полового самосознания у больных с органическим расстройством личности и множественными расстройствами сексуального предпочтения

<p style="text-align: justify;">The article analyzes the results of an empirical study aimed at assessing the dynamics of the parameters of sexual self-awareness and the tendency to aggressive behavior in interpersonal interaction in persons suffering from organic personality disorder with multiple disorders of sexual preference in the process of compulsory treatment. 30 patients were examined before and after the course of treatment (psychopharmacological effects in combination with antiandrogens and cognitive-behavioral psychotherapy). The following methods were used: “MyF”, “CTO”, “Coding”, the “Hands” test of Wagner. The changes in the psychological characteristics and parameters of sexual self-consciousness revealed in the course of the study allowed us to identify actual targets for psychotherapeutic influence and were taken into account by us when determining the assessment of the risk of relapse and the degree of social danger of patients.</p>

Clinical Case of a Combination of Endocrine, Metabolic, and Mental Pathologies: Hypopituitarism Associated with Organic Personality Disorder

Background: Psychiatric disorders are difficult to assess, diagnose, and treat in most cases. The present case describes an extremely rare psychological disorder in combination with metabolic and endocrine insufficiency. Case Presentation: The condition of a 7-year-old child with inherited psychopathology from his father was found to be aggravated by his mother's alcoholism. The child was delivered in emergency from a primigravida/primipara mother due to preeclampsia and premature membrane rupture. The examinations involved clinical signs and symptoms and instrumental and laboratory findings. All laboratory results were compared with the normal range of the local laboratory. The results of the examination showed pronounced impairment in learning and controlling behavior, and communication, as well as moderate impairment in orientation. Results: The future consequences and complications are poorly understood. Management guidelines for such complicated cases are underdeveloped. Conclusion: The child was managed by diet correction, potassium iodide and hormone replacement therapy, calcium supplement, nootropics with 2 courses per year, examination by a urologist and pediatric endocrinologist 2 times a year, and hospitalization after 6 months of treatment.

“Unspecified organic personality and behavioral disorder due to brain damage from HHV-6 encephalitis in child. case report and literature review”

IntroductionWe present a case of a 15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis.ObjectivesTo describe a case of an Unspecified Organic Personality and Behavioral Disorder secondary to brain damage from Human Herpes Virus-6 (HHV-6) Encephalitis in an 11 year-old childand to review recent literature, in order to improve clinical practice.MethodsClinical case report and brief review of literature. A bibliographic research was made in the database PubMed, using the terms “Viral Encephalitis” AND “Neuropsychiatric symptoms”; “Viral Encephalitis” AND “Behavioral Disorder”; “Long-Term Neurological Morbidity” AND “Viral Encephalitis”.Results15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis, secondary to immunosupression in the context of haematopoietic progenitor transplantation (HPT) at 11 years old. MRI showed supratentorial ventriculomegaly, atrophic changes in encephalon and right hippocampus with subcortical retraction secondary to previous encephalitis. Clinically, main changes appeared in behavior, presenting a serious frontal syndrome with high disinhibition, what implied severe social and academic difficulties. During the outpatient follow-up, the behavioural disorder is being pharmacologically treated with Risperidone 1,5mg per day with a partially favorable evolution. The patient presented intolerance to olanzapine, with an episode of low level of conciuosness after taking it.Bibliographic research results indicate that the gold standard treatment for behavioral disturbances are antipsychotics. Risperdidone is proven save for treatment in children. Results point out also the importance of an early multidisciplinar intervention, involving family training, rehabilitation resources and curricular adaptations.Image:Image 2:ConclusionsViral encephalitis may have serious neuropsychiatric consequences, especially during childhood while the brain development is not finished. When the neurological damage affects the frontal lobes of the brain, behavioural and personality disturbances are expected and an early multidisciplinar intervention should be considered. Antypsichotics are the gold standard pharmacological treatment for behavioural disturbances. During the scholar period, special curricular adaptations should be done in order to reduce study-related stress.Disclosure of InterestNone Declared

Clinical and pathogenetic prediction of the dynamics of the course of psychoses in epilepsy

Transient epileptic psychoses in 30-40% of cases turn into psychotic states with a long, paroxysmal or chronic course. The objective of this article is to conduct a systematic analysis of modern literature sources to clarify the factors, clinical and pathogenetic patterns of transformation of transient (short-term) epileptic psychosis into psychotic states with prolonged and chronic course, as well as to identify pathogenetically oriented principles of treatment of such patients. The prognostic value of clinical and neurophysiological factors regarding increasing of the psychotic process duration has been noticed, clinical patterns of transformation of short-term psychosis into long-term (changes in the dynamics and structure of psychosis, features of the relationship with organic personality disorder and dementia in epilepsy, as well as epileptic seizures) have been shown. A number of important neurophysiological pathogenetic mechanisms of increasing the psychosis duration (growing cerebral hypofrontality, temporal localization and regular spread of the epileptic process) have been identified. Pathogenetically oriented principles of treatment tactics of patients with epileptic psychoses have been described and analyzed taking into account the revealed regularities of increasing of their duration.

Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network?

Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.

Study of the role of etiological factors on the likelihood of organic personality disorder

Objective: to study the influence of etiological factors on the possibility of the formation of organic personality disorder. Materials and methods: 80 patients with organic personality disorder were examined. The control group was represented by 82 healthy volunteers. Research methods: anamnestic, clinical, and statistical. Results: it was established that heredity aggravated by mental illness, alcoholization and drug addiction of relatives of different kinship lines, perinatal pathology factors associated with the child, diseases suffered in childhood (infectious diseases, etc.), which resulted in severe outcomes in the early stages of treatment in the form of hospitalizations or other complications in the form of pneumonia, bronchitis, etc., convulsive conditions, traumatic brain injuries received in childhood, reveal a reliably significant probability for the occurrence of organic personality disorder. The effect factor of operative interventions performed under general anesthesia in childhood did not show a statistically significant effect. Conclusions: heredity, perinatal pathology, some diseases suffered in childhood, convulsive states and various types of traumatic brain injury significantly increase the likelihood of organic personality disorder.

Forensic psychiatric analysis of organic personality disorders after craniocerebral injury in Shanghai, China.

ObjectiveTo explore the incidence rate and the differences of clinical manifestations of organic personality disorders with varying degrees of craniocerebral trauma.Materials and methodsAccording to the International Classification of Diseases-10, 1,027 subjects with craniocerebral trauma caused by traffic accidents were reviewed, the degrees of craniocerebral trauma were graded and those with personality disorder after craniocerebral trauma were diagnosed. The personality characteristics of all patients were evaluated by using the simplified Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI).ResultsThe incidence rate of organic personality disorder after all kinds of craniocerebral trauma was 33.1%, while it was 38.7 and 44.2% in the patients after moderate and severe craniocerebral trauma, respectively, which was significantly higher than that in the patients after mild craniocerebral trauma (18.0%) (P < 0.05). Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences (P < 0.05) in the patients with personality disorder after craniocerebral trauma; especially the conscientiousness scores showed significant differences (P < 0.05) in the patients with personality disorder after moderate and severe craniocerebral trauma. The agreeableness and conscientiousness scores in the patients with personality disorder after moderate and severe craniocerebral trauma were significantly lower than that after mild craniocerebral trauma, and the patients with personality disorder after severe craniocerebral trauma had lower scores in extraversion than that after mild craniocerebral trauma.ConclusionThe severity and area of craniocerebral trauma is closely related to the incidence rate of organic personality disorder, and it also affects the clinical manifestations of the latter, which provides a certain significance and help for forensic psychiatric appraisal.

Association of early maladaptive schemas and psychiatric disorders between sex offenders

IntroductionSchema-therapy (ST) - one of the promising integrative models of psychotherapy, which shows its efficacy in many mental disorders. ST has main theoretical concepts: early maladaptive schemas (EMS), coping styles, modes and basic needs. EMS are self-defeating emotional and cognitive patterns established from childhood and repeated throughout life. Existing literature shows the connection between EMS and behavioral problems, which could be more significant for patients with personality disorders. The prevalence of personality disorders is relatively low in the general population, but it’s highly overrepresented in the forensic population, especially in groups of sex offenders.ObjectivesThe aim of this study is to examine if there is a prevalence of some EMS between sex offenders and their association with a diagnosed psychiatric disorder.MethodsMedical records and criminal case materials of 27 patients were reviewed, all of them were blamed for committing sex crimes and had to stay at the department for one month for forensic psychiatry examination. During their stay patients were examined several times and questioned with YSQ S3R.ResultsMost of the patients had psychiatric disorder: specific personality disorders (14), pedophilia (3), dependence syndrome (4), organic personality disorder (3). Some of them had several psychiatric diagnoses. The most prevalent EMS were abandonment, emotional deprivation, insufficient self-control and defectiveness.ConclusionsThese findings show the prevalence of personality disorder and several EMS in sex offenders, which could be useful for the full understanding of the concept of PD and improve the organization of medical care for these individuals.DisclosureNo significant relationships.

Toxoplasma gondii Infection in Patients with Psychiatric Disorders from Western Romania.

Background and Objectives: High rates of infection with Toxoplasma gondii were found in psychiatric patients globally. In this study, we assessed for the first time the prevalence of T. gondii infection in psychiatric patients and healthy individuals with no known psychiatric disorders in Western Romania. Materials and Methods: The presence of specific IgG anti-T. gondii antibodies was evaluated in 308 psychiatric patients and 296 control subjects using a chemiluminescence assay. Results: Overall, the seroprevalence of IgG antibodies was higher in psychiatric patients (67.86%; 209/308), compared with the control group (54.05%; 160/296) (p < 0.001). Our results revealed a significantly higher prevalence of T. gondii antibodies among patients with schizophrenia (69.77%), organic (personality and behaviour) disorders (76.74%), and mental disorders concerning alcohol abuse (84.62%), compared with the control group (p = 0.009, p = 0.005, p = 0.043, respectively). Conclusions: This study provides new and important information on the seroprevalence of T. gondii in Romanian psychiatric patients and may serve for further scientific research regarding the status of T. gondii infection in patients with psychiatric disorders.

Динамика клинической картины органического расстройства личности у призывников, признанных негодными или ограниченно годными к несению военной службы по призыву

Study Objective: To track the dynamics of an organic personality disorder for 5 years after call-up. Study Design: Longitudinal study. Materials and Methods. The study had two stages. Stage one was the analysis of information on conscripts who were undergoing a medical examination and were condemned as unserviceable or partially suitable for conscription. We examined 52 conscripts with an organic personality disorder with the mean age of 19.02 ± 1.01 years old. We assessed their mental status, mental disorder intensity, and degree of social adaptation; also, an experimental psychological questionnaire for anamnestic study of conscripts and Conscript Questionnaire were completed. Stage two was a clinical and follow-up (for 5 years) examination of patients. A factorial analysis of results was performed in 2, 3, 4, 5 years after the first examination. Six subjects withdrew from stage two because their place of residence changed or because they did not want to further participate in the study. Study Results. The clinical presentation of the disorder was more complicated in more than 60% cases. The factorial analysis revealed the most stable rigid link, i. e., a combination of clinical symptoms to be targeted by the therapy in order to more drastically unravel the stable pathological system of disorder manifestations. The rigid link of the system passes all first factors in examinations conducted and characterises the highest proportion of cases vs. total variance: inclination to impulsive response with poor control over behaviour, uptown tastes, decreased social adaptation and close symptoms in the form of unstable inner emotional well-being or impaired affective volitional regulation. At year four of the study, a flexible link appears: addictions, e. g., alcohol and substance abuse, and unskilled labour. At year five, further aggravation of psychopathy-like state was observed. We have identified the flexible links of the system, which can be manipulated in order to attempt to gradually negate the stable pathological condition; the quality of manipulations is worse since elimination of one relation between symptoms brings about another one, but with a lower number of observations vs total variance. Conclusion. This study highlights the need in further observation, a more drastic interference (therapeutic, psychocorrective, social and rehabilitative) with conscripts who were condemned as unserviceable or partially suitable for conscription, in order to avoid a complicated mental pathology. Keywords: organic personality disorder, conscription, rigid link, flexible link, complicated psychopathologic pattern, drastic interference.

Влияние негативного эмоционального опыта детства на криминальную активность у женщин с органическим расстройством личности

In order to study the influence of negative emotional experiences of childhood on criminal activity in women with organic personality disorder we investigated group of women, suspected or accused of crimes in criminal cases, who underwent forensic psychiatric examination (n=102) with comparison to group of women, who had not a criminal history (n=50). It is revealed that for women who have committed criminally punishable acts, negative childhood events with many psychogenic and traumatic events are of significant importance. It was revealed that the greatest importance of adverse childhood events with negative emotional experience - abuse, violence (emotional, physical, sexual) in combination with unfavorable social factors of upbringing had a significant pathoplastic and pathokinetic effect on the clinical and dynamic characteristics of the disease and to a certain extent predetermined the formation of criminal activity of this category of persons. They are more likely to have dependence on surfactants. These women were more likely to commit aggressive offenses (murder, grievous bodily harm), while the victim of these crimes was more often a partner (husband, cohabitant).

Abstract- Poster

Introduction:Personality change in post Traumatic Brain Injury occurs in 59.1% of patients.(1)It can present with symptoms of depression, emotional instability, irritability and impulsive behaviour. (2)`Personality changes might not be obvious during the initial period of injury as the sensory and motor deficits will be predominant (3).CASE HISTORY:A 26 year old male with a history of Road traffic accident in 2014 with ensuing severe traumatic brain injury with Right Temporoparietal Subdural hemorrhage and midline shift, conservatively managed.Intial year following the TBI, he had retrograde and antegrade amnesia and needed support for his activities of daily living. Gradually his behavioural changes emerged.The patient had significant social and functional impairment at the time of admission (1-08-2021)and the family sought treatment.EXAMINATION:Higher mental functions-Impairment in delayed recall, abstract and social judgement.Lobar Function tests revealed impairment in abstract, lexical fluency suggestive of frontal damage and impaired recall and verbal memory with emotional and behavioural changes and placidity suggestive of temporal damage.DIAGNOSIS:A diagnosis of F 07.0 ORGANIC PERSONALITY DISORDER according to ICD-10 was made. MRI BRAIN revealed Gliosis in frontal and temporal lobes, Chronic lacunae in posterior Periventricular region, Mild Periventricular deep white matter hyperintensities. He was managed with Haloperidol, sodium valproate and benzodiazepines.CONCLUSION:Post traumatic brain injury organic personality change is a neurobehavioural sequelae of severe TBI.It has considerable overlap with several psychiatric and neurological disorders. Serial follow-up is necessary to evaluate the evolution of deficits and prognosis.

The usefulness of cognitive training in organic amnestic syndrome (pathology associated with alcoholism - epilepsy)

We propose to present the results of a study conducted in the psychiatric clinic on a group of 30 patients diagnosed with chronic alcoholism, who in the first days of hospitalization presented epileptic seizures of grand mal type, later developing various psychiatric pathologies: delirium tremens in the following days, alcoholic psychoses with prolonged evolution, Wernicke Korsakoff type pathology, prolonged organic amnestic syndrome, organic personality disorder, organic affective disorders, mixed dementia (combined ethanolic background + epileptoid).

Foreign Body in The Scalp: A Thorn in The Flesh – Case Report

Open scalp wounds are often associated with retained foreign bodies and are poorly reported. Despite meticulous radiological evaluations, foreign bodies can still be missed. Complications such as chronic headache, scalp abscess, chronic osteomyelitis, organic personality disorder had been reported. Coupled with the potential for medicolegal concerns, retained foreign bodies in the scalp thus require critical evaluation and management. Herein we reported a case of a retained stalk of grass (foreign body) in the scalp that is complicated with scalp abscess and chronic headache and call for a high index of suspicious in the management of foreign bodies in the scalp.

Real-world experience of assessing antibodies against the N-methyl-D-aspartate receptor (NMDAR-IgG) in psychiatric patients. A retrospective single-centre study

ObjectiveTo evaluate the frequency of anti-NMDAR encephalitis in a secondary mental health service and investigate the challenges of its diagnosis in routine clinical practice. MethodsPatients whose electronic health records registered an indication for NMDAR-IgG assessment were selected and seropositive patients were reviewed. ResultsIn 1661 patients assessed for NMDAR-IgG over 12 years, the positivity rate was 3.79% (95% confidence interval [CI]: 2.87–4.70%). The working diagnosis at assessment was new onset psychosis in 38.7% and a chronic psychotic syndrome in 34.0%. Among seropositive patients, 30 (47.6%, 95%CI: 35.8–59.7%) had a final alternative diagnosis different from encephalitis after a median period of 49 months from onset. Patients with a final diagnosis of encephalitis were more frequently female (27/35 vs 13/30, p = 0.011) than other seropositive patients and had more frequently an acute (34/35 vs 11/30, p < 0.001), fluctuating (21/23 vs 4/27, p < 0.001) or agitated (32/32 vs 10/26, p < 0.001) presentation. Nine encephalitic patients received specialized follow-up for chronic neuropsychiatric problems including learning disabilities, organic personality disorder, anxiety, fatigue, obsessive–compulsive and autism-like disorder. ConclusionsIn a psychiatric setting, NMDAR-IgG seropositivity rates were low with a positive predictive value for encephalitis around 50% when screened patients had chronic presentations and absence of other diagnostic criteria for encephalitis or psychosis of autoimmune origin. Chronic neuropsychiatric problems in anti-NMDAR encephalitis are not uncommon, so better diagnostic and treatment strategies are still needed.

Foreign body in the scalp: A thorn in the flesh – case report

Open scalp wounds are often associated with retained foreign bodies and are poorly reported. Despite meticulous radiological evaluations, foreign bodies can still be missed. Complication such as chronic headache, scalp abscess, chronic osteomyelitis, organic personality disorder had been reported. Coupled with the potential for medicolegal concerns, retained foreign bodied in the scalp thus require critical evaluation and management. Herein we reported a case of a retained stalk of grass (foreign body) in the scalp that is complicated with scalp abscess and chronic headache and call for a high index of suspicious in the management of foreign bodies in the scalp.