Psychiatric Point Of View Research Articles

Potential links between brown adipose tissue, circadian dysregulation, and suicide risk.

Circadian desynchronizations are associated with psychiatric disorders as well as with higher suicidal risk. Brown adipose tissue (BAT) is important in the regulation of body temperature and contributes to the homeostasis of the metabolic, cardiovascular, skeletal muscle or central nervous system. BAT is under neuronal, hormonal and immune control and secrets batokines: i.e., autocrine, paracrine and endocrine active substances. Moreover, BAT is involved in circadian system. Light, ambient temperature as well as exogen substances interact with BAT. Thus, a dysregulation of BAT can indirectly worsen psychiatric conditions and the risk of suicide, as one of previously suggested explanations for the seasonality of suicide rate. Furthermore, overactivation of BAT is associated with lower body weight and lower level of blood lipids. Reduced body mass index (BMI) or decrease in BMI respectively, as well as lower triglyceride concentrations were found to correlate with higher risk of suicide, however the findings are inconclusive. Hyperactivation or dysregulation of BAT in relation to the circadian system as a possible common factor is discussed. Interestingly, substances with proven efficacy in reducing suicidal risk, like clozapine or lithium, interact with BAT. The effects of clozapine on fat tissue are stronger and might differ qualitatively from other antipsychotics; however, the significance remains unclear. We suggest that BAT is involved in the brain/environment homeostasis and deserves attention from a psychiatric point of view. Better understanding of circadian disruptions and its mechanisms can contribute to personalized diagnostic and therapy as well as better assessment of suicide risk.

Behavior Contracts in Psychiatric Practice and Everyday Situations: A Psychological and Psychiatric Viewpoint

In recent years, “difficult” patients have gained attention, and behavior contracts have been introduced into clinical practice. This is because some patients behave inappropriately toward healthcare providers, and behavior contracts require patients to refrain from such behavior. However, it has been highlighted that behavior contracts have ethical problems. We present an ethical analysis of behavior contracts from the viewpoint of psychiatric practice and patient psychology. We analyze why patients become “difficult” for medical practitioners and explain why consideration must be given to the psychological aspects of the patient and the burden of mental illness. Behavior contracts are inappropriate because they do not consider individual patients’ psychological or psychiatric conditions and are applied uniformly. Moreover, the behavioral model that behavior contracts assume is not justified by today’s psychiatry. Furthermore, in this article, we show how behavior contracts promote the stigmatization of mental illness. For these reasons, we argue that the use of behavior contracts in clinical practice is not ethically justified. However, we add that physical violence against healthcare providers should not be tolerated under any circumstances.

Dermatitis Artefacta in the Patients of Obsessive Compulsive Disorder: A Case Series

Abstract Dermatitis artefacta or factitious dermatitis is a psychodermatological disorder commonly found in dermatology and psychiatric departments. Comorbid psychiatric disorders are frequently seen with this conditions and proper meticulous history and evaluation both from dermatology and psychiatric point of view is needed to make this diagnosis of exclusion. There are no definite diagnostic criteria or treatment protocols for the above conditions and a combination of psychiatric dermatological and psychological approach is needed to manage this. Lack of proper clinical knowledge and awareness regarding the condition may lead to misdiagnosed the cases frequently. Here we have reported the three cases of dermatitis artefacta with comorbid obsessive compulsive disorder.

Psychiatric Comorbidity in Dermatology Patients in a Tertiary Care Centre in Western U.P

Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the ‘skin’ and the ‘mind’ specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.

Les Aventures de Tintin, l’œuvre d’Hergé au regard de la psychiatrie

Hergé’s “Adventures of Tintin” is a renowned Belgian comic book series. The twenty-four albums are rich in psychological and psychiatric elements, intricately woven into a smartly written and complex storyline. These elements have, however, seldom been studied systematically from a psychiatric point of view. In the current paper, we propose a systematic review of the series and of the medical literature concerning the psychiatric semiology and phenomenology found in the work of Hergé. The search terms used in the Pubmed database were “Tintin”, “medicine”, “medical”, “health”, “mental”, and “psychiatry”. Upon reading the integrality of the twenty-four albums, the most recurrent themes found were delusions and psychosis, personality disorders, and alcohol and other psychoactive substance use disorders. We then conduct a chronological analysis of the evolution of the representations of asylums and psychiatric hospitals, psychiatrists and the “mad man” throughout the albums. Finally, we present the psychoanalysis of the “Adventures of Tintin”, as developed by the psychiatrist and psychoanalyst Serge Tisseron, who, upon reading Hergé’s work, suspected the existence of a family secret that the author might have concealed in his albums.

Relationship between Breast Cancer Surgical Treatment and Psychiatric Symptomatology: Which Sociodemographic and Clinical Factors Could Influence It? A Preliminary Study.

This study aimed to investigate psychiatric symptomatology in a sample of patients affected by breast cancer undergoing surgery, evaluating the potential mediators on perceived stress levels, depression and hopelessness. The study was conducted on eighty-five patients with breast cancer, admitted consecutively to the Breast Unit of the IRCCS Ospedale Policlinico San Martino, between May 2018 and December 2019. Sociodemographic (age of diagnosis, gender, marital and occupational status, educational level, having children) and clinical (type and side of surgery, previous breast surgery, neoadjuvant chemotherapy and axillary dissection) characteristics were investigated through a semi-structured interview. The following rating scales were administered: Beck Depression Inventory, Beck Hopelessness Scale, and Perceived Stress Scale. Our findings indicate that the presence of children and of a partner was associated with a lower total score on the clinical dimensions evaluated. Furthermore, we found demolitive surgery to be a mediator between perceived stress and hopelessness, while history of previous breast surgery was found to be a mediator between demolitive surgery and perceived stress. In conclusion, patients affected by breast cancer undergoing more complex and demolitive surgery or with history of previous breast surgery should be mostly monitored from a psychological and psychiatric point of view from the beginning of treatments to evaluate the first manifestations of psychiatric symptomatology.

Dissociative stupor in young adults. Challenges in differential diagnosis and treatment management

Dissociative stupor is a rare psychiatric condition, included in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among Other Specified Dissociative Disorders, as an acute dissociative reaction to a stressful event. Like other acute pathological dissociative presentations, it is primarily related to traumatic experiences. Aim. This article aims at presenting the case of dissociative stupor in a 21-year-old male who presented firstly with mixed symptoms of tonic seizures and catatonia. Method. Before the present admission, the patient had two previous emergency department presentations, upon which he presented altered consciousness, muscular rigidity, unresponsiveness to external stimuli, alternated with episodes of psychomotor agitation and visual hallucinations, symptoms partially remitted after the administration of propofol, levetiracetam and solumedrol. During the presentation, the patient’s mother revealed that the patient may have seen the dead body of his grandfather, with whom he had a previously close relationship, and found out in this manner that he passed away during the previous night. Urinary tox-screen was positive for tetrahydrocannabinol (THC). Also, complete blood count (CBD), basic metabolic panel (BMP), cerebrospinal fluid (CSF) analysis, cerebral magnetic resonance imaging (MRI), both native and angiographic sequence, and electroencephalogram (EEG) were performed, with results within normal range. The treatment with selective serotonin reuptake inhibitors (SSRI’s; sertraline) and second-generation antipsychotics (SGA; olanzapine) was initiated. Discussion. From a psychiatric point of view, the patient needs to be reevaluated periodically regarding the psychopharmacologic therapy; also, cognitive-behavioral therapy (CBT) or hypnosis may be an option in this case. Conclusions. The diagnosis and therapeutic management of dissociative stupor represents a real challenge due to the need of excluding other psychiatric or somatic conditions and the fact that there are no available data regarding the psychopharmacological treatment. However, there is much ongoing research in the neurobiology of trauma-related altered states of consciousness and the promising results of them are the basis of future psychopharmacological strategies.

Forfeiting the paradigm of victimhood

This paper is a philosophical meta-discussion of the current culture in psychiatry and psychotherapy that focuses on trauma as the source and predominant determinant of a large number of psychiatric complaints. Such a culture leads to increasing, rather the decreasing, the destructive role of traumatization and victimization throughout the life experiences of those affected, and (as culture) is exemplified by increasing calls by influential psychiatrists to expand the interpretative role of trauma to virtually all our experiences of social inadequacy and personal hurt. We argue here, from a philosophical and psychiatric point of view, that the transactions, semantics and affects that psychiatry and psychotherapy are concerned with in cases of trauma and victimhood are negatively affected by the culture of using trauma as an alibi and a kind of universal explanation of psychological dysfunctionality and suffering. We also argue that, contrary to the current culture of a sort of idolatry of trauma, more consistent and philosophically informed approaches to psychiatric and psychotherapeutic intervention, based on a different interpretation of less-than-radically adverse life experiences, might in fact reduce both the clinical occurrence of traumatization and the actual adverse impact of self-perceived victimization and traumatization on the prospects for achieving the goal of ?the good life?.

Fibromyalgia from a psychiatric point of view

Fibromyalgia is a disorder bordering on rheumatology and psychiatry, which was included in the ICD-10 (M79.7) classification in the 1990s. It is characterised by a triad of symptoms including chronic widespread pain, sleep disturbances, and mental or physical exhaustion. According to various estimates, fibromyalgia affects from 2 to 4% of the population, particularly individuals between 50 and 60 years of age. There is a lack of consistent data in the available literature on the prevalence of the disorder between sexes. Depending on the criteria used, the female/male ratio is reported to be 13.7:1, 4.8:1 or 2.3:1. Despite nearly three decades of fibromyalgia presence in the ICD classification system, the nature and treatment of the disease have not been sufficiently recognized and arouse a lively discussion among researchers of various medical specialties. The paper attempts to systematise selected issues related to fibromyalgia which seem particularly important from the point of view of psychiatry. The introduction presents the history of the debate on the concept of fibromyalgia, problems relating to the definition and classification of the condition and, finally, symptomatology. The article focuses on the psychiatric aspect of fibromyalgia and reviews reports of the association of fibromyalgia with mental disorders, as well as issues relating to pathophysiological and therapeutic concepts that may be useful to both psychiatrists and other specialists who may encounter the disorder in their practice.

ACONSELHAMENTO FILOSÓFICO COMO CONTRIBUIÇÃO NA FORMAÇÃO DA PESSOA HUMANA, SEGUNDO EDITH STEIN

O Aconselhamento filosófico nasce da tese de que a filosofia deve ultrapassar os muros das universidades e, por isso, deve ser inserida de maneira prática no nosso cotidiano. Iniciado por Gerd B. Anchenbach em 1982 na Alemanha, essa nova concepção de filosofia expandiu-se pelo mundo inteiro, assumindo diversas nomenclaturas. Seus critérios, abordagens e métodos tornaram-se cada vez mais eficaz, ao ponto de promover e oferecer o auxílio necessário para a própria formação da pessoa enquanto tal. Nem sempre podemos compreender os problemas existenciais e periféricos da vida, por isso, muitos dos problemas não podem ser tratados do ponto de vista psicológico ou psiquiátrico, mas podem ser compreendidos e resolvidos a partir do Aconselhamento filosófico, que não é uma terapia para os doentes, mas para os são. No entanto, é possível por meio dos questionamentos filosóficos universais, tratar questões básicas inerentes ao ser humano: Quem sou eu? De onde vim? Para onde vou? Segundo Edith Stein, o caminho para a formação da pessoa humana, depende de tais reflexões que, através de um processo contínuo de interiorização e busca pela verdade, permite o indivíduo despertar suas forças interiores e formadoras em vista da busca do seu núcleo central. Sendo assim, descrevendo a estrutura do ser humano e apresentando o conceito de formação a partir de seu método fenomenológico, Edith Stein afirma que, a formação humana consiste em ir em busca do núcleo pessoal, ou seja, descobrir o que temos de originalidade (ser individual, identidade) a fim de encontrar-se com eu mais verdadeiro e libertar-se dos reveres da vida, tornando-se sujeito da própria história. Contudo, o Aconselhamento filosófico com base na maiêutica socrática: “conhece-te a si mesmo” contribui de maneira qualitativa na formação da pessoa humana, permitindo que o indivíduo encontre através da reflexão, a luz para chegar a essência do seu próprio ser.

Sarcoidosis and Corticosteroid Therapy: Dilemma from a Psychiatric Point of View

Introduction and Methods: A man diagnosed with sarcoidosis developed partial retrograde amnesia followed by three months of depressive symptoms with panic attacks, which remitted with an antidepressant and a benzodiazepine. However, three months later hallucinations and overvalued persecutory ideations subsequently emerged, only to show partial response to antipsychotic treatment. Results: Sarcoidosis was treated with corticosteroids but serial thorax imaging shows minimal response. Corticosteroid was onboard throughout treatment, corresponding with non-remission of psychotic symptoms. There are persistent subjective cognitive difficulties but Mini Mental State Exam score is full. He is currently being treated with escitalopram, alprazolam and quetiapine. Conclusion: This case illustrated the dilemma between prolonging the corticosteroid therapy for sarcoidosis treatment and the psychiatric sequalae. While symptomatic antipsychotic treatment is effective, multi-disciplinary approach is imperative in determining the duration of the corticosteroid therapy.

Suicidal attempt with intracranial sewing needle in a female adult with major depressive disorder, case report

BackgroundMajor depressive disorder is one of the most common psychiatric illnesses. It is counted as an important suicide-attempting factor. Beside common and known suicide methods such as pesticide poisoning and hanging, some unusual methods (adapted by major depressive disorder patients) are reported in the literature. One of these methods is intracranial swing needle insertion.Case presentationHereby, we detail a 44-year-old woman who was admitted to our hospital due to a sewing needle in her brain tissue. The first sign suggesting the existence of a metal foreign body in her brain was the rejection of magnetic resonance imaging ordered (follow-up of a previous admission). Later, a sewing needle was observed in her skull inserted in a suicidal attempt. Her denial of the attempt has aroused the medical team attention to make further study of the patient from a psychiatric point of view. The psychiatric study expressed major depressive disorder in the patient which can justify her suicide intention in the needle insertion.ConclusionsTreating such patients should be tackled in two fronts. From neurosurgical point of view, it should be decided whether to extract the foreign body or conduct a follow-up in order to determine the necessary time for operation. On the other hand, from a psychiatric point of view, rigorous consult sessions with patient and family members are required to prevent recurrence of such attempts.

Psychiatrist Works to Bridge Gap Between Faith, MH

Psychiatrist Works to Bridge Gap Between Faith, MH

Homesickness - A Systematic Review of the Incidence and Consequences of a Phenomenon of Topical Relevance

Homesickness is a phenomenon of many cultures. International research deals with this topic, not so in Germany. The aim of this work is to bring the phenomenon of homesickness closer to the reader from a scientific and psychiatric point of view, to provide evidence and to create an awareness of its actuality. Systematic literature research in the databases "Psyndex", "Pubmed" and "google scholar". Data on the incidence in different populations vary from 20 to 90 %, which is mainly due to inconsistent definitions of homesickness and the different measuring instruments. The clinical consequences range from sleep disorders to depression and social anomalies. Migration movements, increasing prevalence of mental illness and impairments resulting from homesickness make clear how important a modern understanding of homesickness is.

Smoke and Mirrors: The Recreational Marijuana Debate.

With the increasing number of states that have legalized the use of recreational marijuana, concerns regarding its negative effects are necessary. There is growing scientific evidence that the use of marijuana for recreational purposes has a wide variety of negative health effects, both physical and psychiatric.

Guidelines in psychiatry: clinical and forensic issues

Treatment guidelines (GL) in psychiatry represent a useful and functional tool to be explored and enhanced in terms of the contribution of patient care and the promotion of scientific improvement. However, they show some limitations, both clinical and forensic. The objective of this paper is to examine the objectives, the clinical limitations and the applicability of the GL on professional liability (forensic aspects). From a clinical point of view, the GL have objectives that are functional to the promotion of physical and mental health, among which the constitutional observance of the right to health, the improvement of public health, the implementation of best clinical practices, the promotion of scientific research, the professional training of operators in the field of physical and mental health. However, GL cannot replace a contextualized clinical judgment. GL must be applied, in the single clinical case, in light of their multiple criticalities, including the limits of the methodology used for their formulation, the differences between the GL' recommendations, the difficulty of their application in daily clinical practice, the lack of specific treatment interventions. From a forensic psychiatric point of view, GL, as currently conceived, cannot be used in terms of professional liability without their interpretation on a legal basis with forensic psychiatric methodology, similarly to any other clinical and scientific information, with its qualifications and criticalities.

Assessing the ability to recognize facial emotions in schizophrenia spectrum disorders

Objectives: The deficiency in social functionality represents a characteristic of the patients with schizophrenia spectrum disorders. At this time, there are several options for defining the concept of social functionality, all based on a multidimensional construction based on two main elements: social skills and social cognition. Social functionality involves summarizing multiple areas of daily life, such as occupation, interpersonal relationships, the ability to live independently and last but not least, the quality of life. The perception of facial emotions represents the individual's ability to recognize and use emotions, ensuring the necessary behavior in the development of interpersonal interactions. Methods: Given the heterogeneity of studies evaluating the main prognostic factors associated with poor ability to recognize facial emotions, this paper is a non-systematic literature review that aims to answer a series of questions such as: Do patients with schizophrenia have a real deficit in facial recognition or is it due to a deficit in higher cognitive function? Are these deficits specific to a particular group of patients? Are these deficits specific to physiognomy or is it a general deficit, which involves the recognition of objects? Results: In this study, several scientific papers that aim at the deficit in facial recognition from a behavioral, neuroimaging and psychiatric point of view were reviewed, these deficits being widely reported in patients with schizophrenia spectrum disorders. The results of the analyzed studies suggest that the deficit in facial emotions recognition is secondary to deficiencies in visual perception, followed by deficits in the attention and memory field. Moreover, there is research indicating a deficit in the perception of the stimulus. Similarly, abnormalities in eye movement during facial recognition tasks suggest a general impairment of visual exploration. Conclusions: People diagnosed with schizophrenia spectrum disorders face multiple deficits in social functionality. The medical literature presents scientific evidence on facial recognition deficits as well as the process of recognizing facial emotions among schizophrenia spectrum disorders.

A Study of Literature about Correlation between Chakra Awakening and Autonomic Nervous Immune System

The chakra, meaning wheel or discus in Sanskrit, is a core concept of the Indian asceticism tradition. In the yoga tradition, the chakra is understood as the center of life energy or spirit, which can not be accurately identified from an anatomical or psychiatric point of view. The chakra is located in the central nervous system, which is the brain and spinal cord, and linked to the autonomic nervous system. The autonomic nervous system is a nervous system that autonomously regulates the function of the body without being directly affected by the cerebrum, and is an important nervous system connected to most of the vital organs of the human body. The stresses and pressures we experience directly affect the autonomic nervous system, which causes the balance between sympathetic and parasympathetic nerves in the autonomic nervous system. Therefore, the balance of sympathetic and parasympathetic nervous system in the autonomic nervous system is highly important to raise and maintain immunity. The purpose of this research is the study of literature about correlation between the chakra and autonomic nervous system. For this purpose, the correlation between the organs related to the chakra and the autonomic nervous system was examined, and the effects of awakening or activation of the seven chakras on the psychoneuroimmunology(PNI) were examined. Since the chakra theory of yoga tradition is usually based on intuitive experience, there is little clarification of the effects of the chakra arousal on the autonomic nervous system. Therefore, this study intends to investigate the effect of the chakra awakening on the autonomic nervous system by reinterpreting the chakra theory of yoga tradition from the viewpoint of autonomic immunity today.

Cultural Tradition of School Excursion and Collective Trauma of the Motor Vessel Sewol Accident.

The Motor Vessel Sewol accident was a horrible accident, and it had complex ripple effects in various areas such as politics, economy, and culture. In particular, the psychological impact of each individual in Korean society was great, and various explanations for the causes of such psychological mass trauma would be possible. One of these important causes is the historical memory about common cultural custom. Therefore, the historical and cultural memory of the school trips shared by members of Korean society may be one of the causes of the psychological trauma. This paper aims to explain the cultural and social functions of school trips in East Asian societies from a historical point of view. In addition, we will also analyse the reasons why shared cultural memories contributed to the formation of collective trauma of the accident from a cultural, anthropological and psychiatric point of view.

Work capacity seen from a psychiatric viewpoint

Work capacity seen from a psychiatric viewpoint