Personality Disturbance Research Articles

FAKTOR-FAKTOR PENYEBAB KEKAMBUHAN PADA PASIEN SKIZOFRENIA DI POLIKLINIK JIWA RSUD H. ANDI SULTHAN DG. RADJA KABUPATEN BULUKUMBA

Schizophrenia is a person who has a psychiatric problem, or a disturbed personality such as thoughts, feelings, hearing, emotions, language, delusions, and behavior that is not in accordance with other normal humans. Reason If the disease is not treated it will cause adverse effects and endanger the patient, family, and society because they can behave like a tantrum, act as they please, destroying goods or patients will hurt others even themselves. Factors studied were family support, age, and adherence to taking medication. The purpose of this study was to determine the factors that cause recurrence in schizophrenic patients in the Catholic Cl
 Schizophrenia is a person who has a psychiatric problem, or a disturbed personality such as thoughts, feelings, hearing, emotions, language, delusions, and behavior that is not in accordance with other normal humans. Reason If the disease is not treated it will cause adverse effects and endanger the patient, family, and society because they can behave like a tantrum, act as they please, destroying goods or patients will hurt others even themselves. Factors studied were family support, age, and adherence to taking medication. The purpose of this study was to determine the factors that cause recurrence in schizophrenic patients in the Catholic Clinic of H.Andi Sulthan Hospital Dg. Radja Regency of Bulukumba. The research design uses analytical design with cross sectional approach. The population in the study were all schizophrenic patients who had schizophrenia accompanied by a family for 1 month at the mental clinic of H. Andi Sulthan Hospital Dg. Radja Bulukumba obtained data from January-March as many as 135 people, with sampling techniques using non-probability sampling. The number of samples in this study were 57 respondents. Data obtained through questionnaires made by researchers to respondents. Data analysis using Fisher's alternative Chis-quare test and Kolmogorov-Smirnov test, with a significance level of α = 0.05. The results of data analysis showed age variables p = 0.032, family support p = 0.005, and medication adherence variables p = 0.025. Conclusion that there is a relationship between age, family support, medication adherence to the recurrence of schizophrenia in the mental clinic of H. Andi Sulthan Hospital Dg. Radja in Bulukumba District in 2018. Suggestion expected This research can be used as additional knowledge to reduce the frequency of recurrence of schizophrenic patients.
 inic of H.Andi Sulthan Hospital Dg. Radja Regency of Bulukumba. The research design uses analytical design with cross sectional approach. The population in the study were all schizophrenic patients who had schizophrenia accompanied by a family for 1 month at the mental clinic of H. Andi Sulthan Hospital Dg. Radja Bulukumba obtained data from January-March as many as 135 people, with sampling techniques using non-probability sampling. The number of samples in this study were 57 respondents. Data obtained through questionnaires made by researchers to respondents. Data analysis using Fisher's alternative Chis-quare test and Kolmogorov-Smirnov test, with a significance level of α = 0.05. The results of data analysis showed age variables p = 0.032, family support p = 0.005, and medication adherence variables p = 0.025. Conclusion that there is a relationship between age, family support, medication adherence to the recurrence of schizophrenia in the mental clinic of H. Andi Sulthan Hospital Dg. Radja in Bulukumba District in 2018. Suggestion expected This research can be used as additional knowledge to reduce the frequency of recurrence of schizophrenic patients.

Personality traits across the psychosis spectrum: A Hierarchical Taxonomy of Psychopathology conceptualization of clinical symptomatology.

Psychotic disorders have varied clinical presentations, diagnostic stability is poor and other mental disorders often co-occur with the conditions. To improve the clinical and pathophysiological utility of classification systems for psychosis, it is necessary to consider how symptoms may reflect dimensions of psychopathology that extend beyond the boundaries of traditional diagnostic classifications. We examined personality deviation as a means for explaining symptom variation across individuals with serious mental illness. Participants (N=312) with psychosis, first-degree biological relatives and healthy controls underwent comprehensive clinical evaluations that included symptom ratings and Diagnostic Statistical Manual consensus diagnoses. They completed the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PID-5), which provides multidimensional assessment of personality disturbances and characterizes psychosis-relevant phenomena, and the Schizotypal Personality Questionnaire (SPQ), a widely accepted measure of schizotypal traits. PID-5 was comparable with SPQ in differentiating between participants with and without psychosis. Greater psychotic symptomatology and higher scores on the SPQ Cognitive-perceptual dimension were associated with higher scores on PID-5 Psychoticism. Facet-level traits showed diverse associations with existing clinical syndromes, suggesting they have utility for quantifying separable symptom dimensions that cut across existing disorders. Yet the patient groups were similar across four of the five PID-5 personality trait domains, indicating shared patterns of personality expression that challenge existing categorical delineations. © 2019 John Wiley & Sons, Ltd.

Toward an understanding of the distinctiveness of body-image constructs in persons categorized with overweight/obesity, bulimia nervosa, and binge-eating disorder

ObjectiveWe examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of weight/shape, preoccupation with weight/shape, and fear of weight gain – in three study groups of persons categorized with overweight/obesity [O/O], bulimia nervosa [BN], and binge-eating disorder [BED] and examined how each body-image construct relates to clinical measures within and between the study groups. Method1017 community volunteers completed measures of body-image, eating-disorder psychopathology, and depression. Participants were categorized into three study groups: O/O (N = 511), BN-purging type (N = 167), and BED (N = 339). ResultsGroups differed significantly on the four body-image constructs (medium-to-large effect sizes) with a consistent severity gradient with BN greater than BED greater than O/O. Both within and between groups, the four body-image constructs varied in strengths of association among themselves and with clinical measures. Analyses revealed considerable variability in variance accounted for in the clinical measures; distinctive significant patterns observed across the groups included: dissatisfaction with BMI, preoccupation and fear with eating concerns and restraint, and overvaluation with depression. ConclusionClinical manifestations of body-image disturbances are complex and show important differences across study groups defined as overweight/obesity, BN, and BED. Improved understanding of distinctions between different body-image constructs and their differential salience across different eating/weight disorders is needed to improve case conceptualization and treatment formulation.

P53-S The effect of sleep deprivation on the parameters of visual evoked potentials in healthy volunteers

Background Sleep deprivation causes a number of negative effects on cognitive functions. It disturbs the processes of attention and concentration. It reduces visual vigilance and reduces the ability to recognize complex visual information. The aim of our study was to determine the effect of 48 hours sleep deprivation on visual processes evaluated with visual evoked potentials Material and methods We examined 17 healthy volunteers aged from 21 to 24 years old, 7 men and 10 women who underwent controlled sleep deprivation for 48 hours. Basic vital parameters were monitored in all subjects. Visual evoked potentials were induced before and after 24 and 48 hours of sleep deprivation. The study was approved by the local bioethics committee. All participants gave written consent to participation in the study. Latencies and amplitudes of N75, P100 and N145 responses were analyzed. Results No significant differences in the N75 and P100 latencies and amplitudes were found. N145 response latencies were significantly longer after 24 and 48 hours of sleep deprivation. Conclusions 24 and 48 hours sleep deprivation induces prolongation of the N145 response, which may be a neurophysiological biomarker of visual perception disturbances in sleep deprivated persons.

Chronic Distal Sensory Polyneuropathy Is a Major Contributor to Balance Disturbances in Persons Living With HIV.

Medical comorbidities accumulate in older persons living with HIV (PLWH), causing disability and reduced quality of life. Sensory neuropathy and polypharmacy may contribute to balance difficulties and falls. The contribution of neuropathy is understudied. To evaluate the contribution of chronic distal sensory polyneuropathy (cDSPN) to balance disturbances among PLWH. Ambulatory PLWH and HIV- adults (N = 3379) were prospectively studied. All participants underwent a neurologic examination to document objective abnormality diagnostic of cDSPN and reported neuropathy symptoms including pain, paresthesias, and numbness. Participants provided detailed information regarding balance disturbance and falls over the previous 10 years. Balance disturbances were coded as minimal or none and mild-to-moderate. Covariates included age, HIV disease, and treatment characteristics and medications (sedatives, opioids, and antihypertensives). Eleven percent of participants reported balance disturbances at some time during the last 10 years; the rate in PLWH participants exceeding that for HIV- [odds ratio 2.59, 95% confidence interval: 1.85 to 3.64]. Fifty-two percent met criteria for cDSPN. Balance problems were more common in those with cDSPN [odds ratio = 3.3 (2.6-4.3)]. Adjusting for relevant covariates, balance disturbances attributable to cDSPN were more frequent among HIV+ than HIV- (interaction P = 0.001). Among individuals with cDSPN, older participants were much more likely to report balance disturbances than younger ones. cDSPN contributes to balance problems in PLWH. Assessments of cDSPN in older PLWH should be a clinical priority to identify those at risk and to aid in fall prevention and the ensuing consequences, including bone fractures, subdural hematoma, hospital admissions, and fatal injury.

A Network Approach to Understanding the Structure of Core Symptoms of Psychopathic Personality Disturbance in Adolescent Offenders.

A central aim of research on psychopathic personality disturbance (PPD) involves identifying core features of the construct. This has been addressed primarily through prototypicality studies and research using item-response theory. More recently, the logic of social network analysis was extended to psychopathology research to examine which symptoms were most central to PPD networks. Such studies identified affective symptoms of the disorder as especially central among adult offenders. To build upon this prior research, the current study used data on male offenders from the Incarcerated Serious and Violent Young Offender Study to examine the network structure of the Comprehensive Assessment of Psychopathic Personality - Institutional Rating Scale (CAPP-IRS; n= 224) and Psychopathy Checklist: Youth Version (PCL:YV; n= 445). Using multiple measures of PPD helped avoid equating measures with constructs. In both the CAPP-IRS and PCL:YV networks, in line with prior studies, attachment/affective features of the disorder were most central. Several recommendations are made for future research, including the need to study the longitudinal development of PPD using a network approach.

The Role of Counseling Service Center and Its Implementation in Madda Walabu University: Qualitative Research

Background: University students often face challenges to adjust to a new environment. The challenges include: - adjustment to university, peer groups, and new academic atmosphere. These challenges possibly lead students to personal crisis, emotional disturbance, stress, and academic failure. Counseling service can help mitigate adjustment problem facing university students. The main objective of this study is to identify the roles of counseling service center and its implementation in Madda Walabu University (MWU).Methods: Explorative qualitative research was conducted on Madda Walabu University (MWU) students’ counselor and concerned management bodies in March 2016. Accordingly, four management bodies; the President, the Academic Vice President, the Student Dean and Student Counselor were purposefully selected for in-depth interview. Besides, international, national and organizational documents were analyzed on thematic basis.Results: Result of study showed that the counseling center of MWU lacked intra-organization network, administrative independence and autonomy. Besides, the service providers were not counselors by profession; the center did not have network with relevant domestic and international organizations, and there was poor client data base management. In addition, MWU counseling center fell short to meet national and international standards.Conclusion: There is increased need for counseling service in university. Standardization of counseling service center, allocation of sufficient materials and human resources, collaboration with relevant bodies is needed to improve the role and practice of the center. Lastly, the importance of crisis interventions, professional development, and academic skills training are recommended to be included under the functions of the center.

EFFECT OF YOGA PERSONALITY DEVELOPMENT CAMP ON TRIDOSHAS IN CHILDREN

Background: Yoga has proven effect on personality and psychological disturbances in children. But no studies are available on short term effect of Yoga on Tridoshas, which may point to restoration of positive health.
 Objective: To understand the effect of Yoga Personality Development Camp on the tridoshas in children.
 Method: The study was pre-post design with control. 320 children (160 children in each group), aged 8-12 yrs, selected from a residential camp at Prashanti kutiram Jigani (experimental group) and Jayagopal Garodia Rasrtothana school. Experimental group children practiced Integral Yoga module including Asanas, pranayama, nadanusandhana, chanting, and games. Control group children observed were not given any intervention. Caraka Child personality inventory was administered before and after 10 days. Mann-Whitney U test and Wilcoxon Signed Ranks Test were applied.
 Results: Vata decreased significantly, while Pitta and Kapha increased significantly as compared to the control group.
 Conclusions: Yoga Personality Development camp has the significant effect on the tridoshas (Vata,Pitta and Kapha) in Children.

The relation between goal adjustment, goal disturbance, and mental well-being among persons with multiple sclerosis

Objective: This study investigated the role of goal adjustment, i.e. disengaging from blocked goals and reengaging into alternative goals, in mental well-being and goal disturbance in persons with multiple sclerosis (MS).Design: A cross-sectional design was used with self-report data from questionnaires and Personal Project Analysis (PPA).Main outcome measures: Dependent variables were mental well-being, indicated by depression/anxiety (HADS; Hospital Anxiety and Depression Scale) and mental functioning (SF-36; Short Form Health Survey), and goal disturbance, indicated by goal manageability and goal interference (PPA). Independent variables were patient-reported physical impairment (SF-36) and goal disengagement and reengagement (GAS; Goal Adjustment Scale).Results: Higher goal reengagement was associated with better mental well-being, but unrelated to goal disturbance. Goal disengagement only showed a negative association with anxiety. High disengagement was associated with lower goal interference but only for those also scoring high on reengagement. Goal adjustment did not buffer the effects of physical impairment on mental well-being and goal disturbance. Contrary to expectations, higher goal reengagement increased the association between physical impairment and goal interference.Conclusion: Although goal reengagement is associated with better mental well-being in persons with MS, it might also strengthen the perceived effect of physical impairment on goal interference.

The Assessment of Psychopathic Personality Disturbance Among Adolescent Male Offenders: Interview Strategies and Recommendations

Although it is relatively common for some practitioners to assess psychopathic personality disturbance (PPD) among adolescent offenders, little has been said about interview skills and strategies that are helpful for an accurate assessment. Thus, this article provided recommendations for improving interview protocols for the assessment of PPD among incarcerated adolescent offenders. These recommendations were based on experiences interviewing adolescents from the Incarcerated Serious and Violent Young Offender Study and related to: (1) establishing and improving rapport, (2) responding to dishonesty, (3) tailoring the interview for adolescents as opposed to adults, (4) the importance of follow-up questions, and (5) recognizing and responding to symptoms of PPD that emerge during the interview. Vignettes of interviews with incarcerated adolescent males were used to help illustrate recommendations and strategies. Future research should systematically measure what works and what does not work when implementing interview strategies, including whether such strategies generalize across gender and culture.

Personality disorders, addictions and psychopathy as predictors of criminal behaviour in a prison sample

Disturbances in personality and addictions are associated with an increased risk of committing crimes and therefore of being imprisoned. In this study, the relationship between these factors is analyzed through a sample of inmates in the Prison of Pereiro de Aguiar, Ourense. 204 inmates participated in this transversal simple blind design study. The following variables were analyzed: presence of personality disorders and psychopathy, history of addictive psychoactive substance use, criminal history and socio-demographic variables. 101 (49.5%) inmates received a diagnosis of personality disorder, the most frequent being: narcissistic, 43 (21.08%); antisocial, 38 (18.63%); and paranoid, 29 (14.22%). The presence of any personality disorder was associated with an increase in the risk of committing crimes, especially violence and crimes against property. The most frequent personality disorders were associated with higher scores in the psychopathy assessment tools. Higher scores in the Psychopathy Checklist Reviewed (PCL-R) correlated with an increased risk of committing the following crimes: violent, against public health, against property and disorderly conduct. The consumption of addictive psychoactive substances was associated with the commission of crimes against property. Methadone stood out for its protective role against the commission of violent crimes. This sample shows that inmates have a higher prevalence of personality disorders, psychopathy and consumption of addictive psychoactive substances. These three variables significantly increased the risk of committing crimes.

Animal-assisted interventions: Social work practice for older adults with dementia

Many older persons experience neurocognitive impairments as they age, experiencing cognitive and behavioral symptoms which may cause serious disruptions and lead to residential placements. As there is no cure, these care facilities strive to manage symptoms and provide comfortable and supportive care. Numerous therapeutic approaches have been used to manage cognitive and behavioral disturbances in older persons with dementia with mixed success. Animal-assisted interventions (AAI) are emerging as an innovative therapeutic modality which holds benefit for minimizing distressing behaviors experienced by older persons. Human-animal contact has been shown to positively benefit the quality of life of older adults. Specific research on the use of AAI in social work practice is limited. An exhaustive review of the literature was conducted to summarize relevant research, identify the practice of AAI, and determine implications for social work practitioners who work to enhance the lives of older adults in various settings. This unique article integrates these benefits as they relate to older people with dementia and aims to provide concrete strategies for implementation of animal-assisted interventions. Key Practitioners Message Animal-assisted interventions (AAI) shows promise as a therapeutic modality for social workers Social workers can utilize AAI to assist in addressing cognitive, social and behavioral issues with older adults AAI can be beneficial to social workers at the micro and meso levels Integration of AAI into existing treatment plans may decrease agitation, depression, and isolation among older adults with dementia

Prevalence and influence factors of subthreshold body dysmorphic disorder in undergraduates

Objective To explore the prevalence of subthreshold body dysmorphic disorder in an undergraduates sample and investigate the mediating role of self-esteem on big five personality and body image disturbance. Methods A sample of 1 166 undergraduates coming from four different colleges were recruited to complete questionnaire survey. Results The prevalence of subthreshold body dysmorphic disorder in undergraduates was 6.2%.Body image disturbance(35.2±18.4) was negatively correlated with self-esteem ((29.0±4.3), r=-0.41, P<0.01), positively correlated with neuroticism ((32.9±8.1), r=0.52, P<0.01) while negatively correlated with extraversion (39.6±6.8), openness (39.8±6.4), agreeableness (41.7±4.7) and conscientiousness ((40.1±6.4), r=-0.18, -0.14, -0.14, -0.25; all P<0.01). The mediating role of self-esteem was 19.7%. Conclusion The prevalence of subthreshold body dysmorphic disorder in undergraduates is rather high.Big five personality can directly predict body image disturbance and indirectly predict body image disturbance through the mediating role of self-esteem. Key words: Subthreshold body dysmorphic disorder; Body image disturbance; Big five personality; Self-esteem; Depression; Mediating role

Starzenie się w miejscu zamieszkania a zakłócony performance miejsca

The paper aims at marking a common ground for sociology of dwelling, sociology of ageing and social gerontology in the concept of ageing in place. Disciplines’ tangence focuses on the notion of place (and sociology of place) and how it alters when ageing is accompanied by frailty. The paper’s goal is to reveal a certain disturbance in person – place relation and its consequences. The place here is referred to older adults’ dwellings, therefore it is a narrower reference. In order to achieve the goal, I point to phenomena and tendencies creating a background for the concept of ageing in place, discuss the concept itself and analyze the very disturbance of person-place relation. It is reflected in the paper’s structure and sequence of problems’ analysis. The article composes of a scientific literature review (parts on phenomena and tendencies in the background of ageing in place concept, the concept itself and sociology of place) and of a discussion based on primary conclusions of a research initiative I participated in 2017 (the part on ageing in place disturbances).

Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study

Background: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [<xref ref-type="bibr" rid="ref1">1</xref>-<xref ref-type="bibr" rid="ref4">4</xref>] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. This exploratory study sought to develop, using established assessment methods, a dimensional measure of malignant narcissism that incorporates the key features of grandiose narcissism, paranoid propensities, psychopathic features, and proclivity for a sadistic and aggressive interpersonal style. Method and Sampling: This study examined 57 subjects, diagnosed with borderline personality disorder that were treated using 3 different empirically supported treatments in a previous study [<xref ref-type="bibr" rid="ref5">5</xref>], for possible deviance on the proposed malignant narcissism index. It also evaluated 2 important clinical domains of change in relation to malignant narcissism. To wit, it was predicted, based on Kernberg’s [<xref ref-type="bibr" rid="ref3">3</xref>, <xref ref-type="bibr" rid="ref4">4</xref>] clinical model, that elevated levels of malignant narcissism would be significantly associated with slower rates of improvement in both general psychosocial/psychological functioning and anxiety among treated individuals. Results: Higher levels of malignant narcissism were associated, as predicted, with slower rates of improvement in both global functioning and anxiety. The proposed malignant narcissism index was a more powerful predictor of slowed improvement in global functioning than simple narcissistic personality disorder features. Conclusions: The heuristic potential of the malignant narcissism construct is discussed and the utility of a dimensional approach to this construct is explored, especially in reference employing personality traits/processes to better understand pathological configurations and personality disturbance.

Personality Traits and Weight Loss Surgery Outcome.

To update the recent findings on the influence of personality features on postoperative weight loss in patients undergoing bariatric surgery. Several studies investigated the influence of pre-surgical psychological variables on the outcome of bariatric surgery, but the effective role of personality factors (i.e., both normal personality traits and personality disturbances) in shaping bariatric surgery outcome is still unclear. We analyzed nine recent papers that examined the impact of pre-operative personality traits on postoperative weight loss among individuals undergoing surgery for severe obesity. A personality pattern denoting the ability to self-regulate in spite of the urges or demands of the moment emerged as a robust predictor of good outcome across studies, independently from baseline psychiatric comorbidity and personality disorders.

Comportamiento epidemiológico de la dependencia del teléfono móvil: una perspectiva criminológica

Introducción: la prevalencia de la dependencia del celular (nomofobia) aumenta en todo el mundo, pero se desconoce hasta ahora su prevalencia y factores relacionados en América Latina. Recientemente, se ha reconocido el papel de la nomofobia en la agresión, la personalidad antisocial y las perturbaciones emocionales en los adolescentes.Metodología: se incluyeron estudiantes universitarios de Veracruz, México. Se aplicó la Escala de Uso Problemático de Teléfonos Móviles (MPPUS), que es una escala de Likert de 27 ítems. Se usaron los percentiles 15, 80 y 95 para establecer cuatro categorías: usuarios ocasionales, habituales, en riesgo y problemáticos. Los valores obtenidos se compararon con varias variables sociodemográficas. El análisis estadístico se realizó mediante la prueba U de Mann-Whitney y el ANOVA de una vía.Resultados: se incluyeron 541 estudiantes entre 18 y 25 años de edad (mediana de 20,5 años); el número de años en que se usó el teléfono móvil fue mayor que 5 en el 73% (n = 395). El número de horas de uso por día fue de al menos 3 en 75,2% (n = 407). El 16,5% se puede considerar como usuarios en riesgo y el 4,1% como usuarios problemáticos. Se encontró una asociación estadísticamente significativa entre el valor de la MPPUS y el número de horas de uso por día, así como el número de años en que se usó el teléfono móvil (p &lt; 0,05).Conclusión: la prevalencia de la dependencia del teléfono móvil es similar a la informada en otros países en desarrollo; la cantidad de horas de uso por día y la cantidad de años en que se usó el celular podrían considerarse factores predictivos en nuestra población.

Rhodiola rosea Improves Lifespan, Locomotion, and Neurodegeneration in a Drosophila melanogaster Model of Huntington's Disease.

Huntington's disease (HD) is a dominant, late-onset disease characterized by choreiform movements, cognitive decline, and personality disturbance. It is caused by a polyglutamine repeat expansion in the Huntington's disease gene encoding for the Huntingtin protein (Htt) which functions as a scaffold for selective macroautophagy. Mutant Htt (mHtt) disrupts vesicle trafficking and prevents autophagosome fusion with lysosomes, thus deregulating autophagy in neuronal cells, leading to cell death. Autophagy has been described as a therapeutic target for HD, owing to the key role Htt plays in the cellular process. Rhodiola rosea, a plant extract used in traditional medicine in Europe and Asia, has been shown to attenuate aging in the fly and other model species. It has also been shown to inhibit the mTOR pathway and induce autophagy in bladder cancer cell lines. We hypothesized that R. rosea, by inducing autophagy, may improve the phenotype of a Huntington's disease model of the fly. Flies expressing HttQ93 which exhibit decreased lifespan, impaired locomotion, and increased neurodegeneration were supplemented with R. rosea extract, and assays testing lifespan, locomotion, and pseudopupil degeneration provided quantitative measures of improvement. Based on our observations, R. rosea may be further evaluated as a potential therapy for Huntington's disease.

RESISTANT HYPERTENSION IN MOOD DISORDERS AND SLEEP DISTURBANCES

Objective: A relationship between cardiovascular diseases and psychopathological symptoms has been described in the literature. However, few studies have reported mood disorders in patients with resistant hypertension (RH). We discuss a case of RH in a young otherwise healthy woman, and analyse the diagnostic and therapeutic approach followed.Design and method: A 52-year old woman referred to our Centre for hypertension (170/104 mmHg) uncontrolled by 10 mg/day amlodipine, 10 mg/day ramipril, 25 mg/day hydrochlorothiazide and 4 mg/day doxazozin. The 24h-ABPM showed a Reverse-Dipper profile of BP values (Figure 1). She referred a new onset diabetes, a rapid weight gain and new-onset personality disturbance with generalized anxiety, panic disorder, impairment of memory and asthenia for which she had been treated with sertraline 50 mg and alprazolam 1 mg daiy. She also had insomnia and alteration of dreams which became more bizarre and vivid. Physical examination showed central obesity, supraclavicular fat pads, moon facies with easy bruising and mild hirsutism. Results: Serum cortisol levels at the morning and at the evening and 24h-urinary free cortisol levels were increased (52.7/55.8 mcg/dL and 2450 μg respectively). Hypokalemia (2.6 mEq/L) was also found. A total-body TC scan (Figure 2) revealed a left adrenal gland mass (12 × 13 × 7.5 cm on size) and many nodular focal lesions in the liver suspected as replicating forms. A total body FDG-PET/CT scan (Figure 3) showed an increased uptake of the tracer (SUVmax 5.2) in the left adrenal gland with multiple liver metastases. Despite a therapy with ketoconazole and high doses of mitotane, 45 days after the admission the patient died for a cardio-circulatory arrest but autopsy was not performed by explicit family request. The clinical picture was suggestive for a primary adrenocortical carcinoma (ACC). Conclusions: ACC is a rare and aggressive malignant neoplasm often diagnosed at an advanced stage. The combination of Cushing's syndrome is frequently found, but psychopathological symptoms are rare at the onset of ACC. We suggest not to consider as «depressed» and not to treat with antidepressant agents a young hypertensive subject with resistant HT without having ruled out an organic cause of psychiatric disease.

“Frontal lobe syndrome”? Subtypes of acquired personality disturbances in patients with focal brain damage

Conceptualizations of the nature of acquired personality disturbances after brain damage, especially to prefrontal cortex, have progressed from clinical observations of a large, disparate set of disturbances to theories concerning neuroanatomically-based subgroups with prefrontal damage. However, hypothesized subtypes have not yet been studied systematically. Based on our previous investigations of acquired personality disturbances, we hypothesized five subtypes of acquired personality disturbances: Executive Disturbances, Disturbed Social Behavior, Emotional Dysregulation, Hypo-emotionality/De-Energization, and Distress, as well as an undisturbed group. Subtypes were investigated in 194 adults with chronic, stable, focal lesions located in various aspects of prefrontal lobes and elsewhere in the brain, using two different cluster analysis techniques applied to ratings on the Iowa Scales of Personality Change. One technique was a hypothesis-driven approach; the other was a set of strictly empirical analyses to assess the robustness of clusters found in the first analysis. The hypothesis-driven analysis largely supported the hypothesized set of subtypes. However, in contrast to the hypothesis, it suggested that disturbed social behavior and emotional dysregulation are not two distinct subtypes, but two aspects of one multifaceted type of disturbance. Additionally, the so-labeled “executive disturbances” group also showed disturbances in other domains. Results from the second (empirical) set of cluster analyses were consistent with findings from the hypothesis-driven cluster analysis. Overall, findings across the two cluster analyses indicated four subtypes of acquired personality disturbances: (1) executive disturbances in association with generalized disturbance, (2) dysregulation of emotions and behavior, (3) hypo-emotionality and de-energization, and (4) distress/anxiety. These findings show strong correspondence with subtypes suggested by prominent models of prefrontal systems based on neuroanatomically-defined circuits. Clarification of distinctive subtypes of acquired personality disturbances is a step toward enhancing our ability to tailor rehabilitative interventions for patients with prefrontal brain injuries.