Psychopathological Phenomena Research Articles

The phenomenon of “emptiness” in modern psychiatry

The article analyses a new psychopathological phenomenon of “emptiness” for classical psychiatry, which is compared with clinical manifestations of emptiness, boredom, apathy, and melancholy. A conclusion is made about the uniqueness of this symptom is drawn. The relationship between the phenomenon of “emptiness” and other diagnostically significant symptoms of borderline personality disorder (BPD) is examined, as is its influence on suicidal and self-harming behavior. It is argued that “emptiness” reflects the mechanism of dissociative depersonalization, and that the wide representation of dissociative symptoms within BPD in conjunction with the “emptiness” phenomenon makes it promising to consider BPD and its individual symptoms a “new hysteria”.

Sexuality in the digital world: Treatment of a case of dating app addiction

This article explores internet addiction, with a focus on digital devices and dating apps. Using the psychoanalytical conceptualization, we present a clinical case study of a young man struggling with both his sexuality and his addiction to online interactions. The addictive nature of internet use, particularly in relation to sexuality and pornography, is explored, highlighting its pervasive characteristics in contemporary society. Drawing on psychoanalytic theories, we explore the concept of “symptom” as the expression of discontents in civilization, from a Freudian approach, and therefore the impact of symbolic and cultural factors on psychopathological phenomena. The study offers insights into the psychodynamics of various forms of addiction, particularly sexual addiction. The treatment of a case of addiction to dating apps will show how this relationship to sexuality is shaped by social practices disseminated through the internet and social networks. Finally, the psychodynamic underpinnings of internet addiction and its impact, particularly on vulnerable young people, underline the importance of recognising the addictive nature of digital devices in contemporary society. In fact, the patient’s addictive style of enjoyment could be considered as typical of a generalised style of enjoyment in contemporary society. Addiction thus becomes a typical symptomatic trait that excludes the existential lack of the subject.

Natural language processing in at-risk mental states: enhancing the assessment of thought disorders and psychotic traits with semantic dynamics and graph theory.

Verbal communication has key information for mental health evaluation. Researchers have linked psychopathology phenomena to some of their counterparts in natural-language-processing (NLP). We study the characterization of subtle impairments presented in early stages of psychosis, developing new analysis techniques and a comprehensive map associating NLP features with the full range of clinical presentation. We used NLP to assess elicited and free-speech of 60 individuals in at-risk-mental-states (ARMS) and 73 controls, screened from 4,500 quota-sampled Portuguese speaking citizens in Sao Paulo, Brazil. Psychotic symptoms were independently assessed with Structured-Interview-for-Psychosis-Risk-Syndromes (SIPS). Speech features (e.g.sentiments, semantic coherence), including novel ones, were correlated with psychotic traits (Spearman's-ρ) and ARMS status (general linear models and machine-learning ensembles). NLP features were informative inputs for classification, which presented 86% balanced accuracy. The NLP features brought forth (e.g. Semantic laminarity as 'perseveration', Semantic recurrence time as 'circumstantiality', average centrality in word repetition graphs) carried most information and also presented direct correlations with psychotic symptoms. Out of the standard measures, grammatical tagging (e.g. use of adjectives) was the most relevant. Subtle speech impairments can be grasped by sensitive methods and used for ARMS screening. We sketch a blueprint for speech-based evaluation, pairing features to standard thought disorder psychometric items.

Phenomenology of Somatization in Immigrants: An Idealtypical Approach

Introduction: Somatization in immigrants is frequent but standard studies do not differentiate between various forms of somatization. In this qualitative study, we used an idealtypical approach with the aim of phenomenologically differentiating between different forms of somatization in immigrants. Methods: The clinical description of the ideal types was based on seven levels: medical examination; description of somatization symptoms; the patients’ own interpretation of their somatic experience; concomitant psychopathological phenomena; genetic understanding; clinician’s interpretation; and course and treatment. Results: Five different ideal typologies of patients emerged: anxious hypochondriasis, somatization with cultural features playing a pathogenetic role, culturally shaped somatization (through pathoplastic effects), somatization as part of adjustment reactions due to migratory living difficulties, and somatization as post-traumatic reaction. Conclusion: These differences are useful to highlight the complex interrelationship between socioeconomic, migratory, cultural, and value factors in the construction of somatization among immigrants. Implications for research methodology, nosology, clinical management, and organization of medical facilities are also discussed.

Validation of the German long and short versions of the UPPS-P Impulsive Behavior Scale.

The UPPS-P Impulsive Behavior Scale is a widely used self-report measure of impulsivity, but there is currently no validated German version that includes the Positive Urgency scale. We combined existing German translations of UPPS scales and included the Positive Urgency dimension to validate the UPPS-P in a sample of 399 participants. In addition, we developed a revised short version of the UPPS-P (SUPPS-P) with 20 items and conducted a confirmatory factor analysis (CFA) to verify the structure in an independent validation sample with 349 participants. To determine evidence of convergent and discriminant validity, we used measures of impulsivity, depression, anxiety, stress, problematic alcohol and substance use. CFA of the five factorial structure of the UPPS-P demonstrated acceptable fits and evidence of validity and reliability for the subscales. Psychometric characteristics of the SUPPS-P using the original item configuration were not satisfactory. As a result, we developed a revised German version of the SUPPS-P and confirmed the five-factor structure using a CFA in the validation sample. For the revised version, model fits and evidence of validity and internal consistencies were good. Associations with other constructs were as expected. For example, whereas Sensation Seeking was associated moderately with problematic alcohol use, lacking associations of Lack of Premeditation to internalizing symptoms showed evidence of discriminant validity. The German translations of both UPPS-P and SUPPS-P are valid tools for measuring impulsive behaviors. They are well-suited for exploring the associations between different facets of impulsivity and psychopathological phenomena.

Neurocognitive Targets for Psychological Assistance in Patients with the Anhedonia Phenomenon within the Framework of Affective Pathology

IntroductionAnhedonia is a transdiagnostic psychopathological phenomenon that is considered a key feature for several disorders, primarily affective spectrum disorders. It exhibits a significant association with social and occupational maladjustment, reduced quality of life, and increased suicidal risk among psychiatric patients.ObjectivesThe aim of this study is to identify recommendations for psychotherapeutic assistance for patients with affective spectrum disorders.MethodsA total of 26 patients with affective spectrum disorders (ICD-10 code - F33, F31) and the phenomenon of anhedonia were examined. We utilized neuropsychological methods aimed at investigating a wide range of cognitive functions (Dynamic praxis; Color interference test; Arithmetic Tasks; Number of skips and impulsive errors; Reverse and straight rows; Verbal fluency; Design fluency; Rey-Osterritz figure) and psychometric methods designed to diagnose various types of anhedonia (consummatory (TEPS), anticipatory (TEPS), social (RSAS), and physical (PAS)).Results Among patients with depression, the consummatory type of anhedonia was the most pronounced. A relationship was found between anticipatory anhedonia and phonetic verbal fluency (r = 0.487; p < 0.01). Additionally, there were correlations between immediate (consummatory) pleasure experience and Rey figure errors (r = -0.349; p < 0.05). Social anhedonia was associated with phonetic verbal fluency productivity (r = -0.509; p < 0.01) and performance in visual fluency productivity (r = -0.473; p < 0.01).ConclusionsThe obtained results allow us to hypothesize that anhedonia is associated with difficulties both in evaluating and imagining possible positive stimuli, which leads to a lack of emotional response to the current stimulus. Thus, the availability of current pleasure may be linked to memory accessibility and regulatory function. When these domains are weakened, the respondent loses the ability to associate the current stimulus with positive past experiences, making it challenging to generate an emotional response in the current stimulus situation and disrupting the anticipation of pleasure. Based on the results, we propose the effective use of behavioral activation and work on the actualization of past experiences. Behavioral activation can be implemented by gradually introducing behaviors associated with past pleasures into the patient’s life, followed by cognitive restructuring aimed at focusing the emotional response on past and current stimuli. In addition to this, from a neurocognitive perspective, an additional element of therapy could involve training various types of cognitive functions, with an emphasis on the auditory modality.Disclosure of InterestNone Declared

On the natural incompleteness of terms, euphemisms and psychiatric nomenclature

The article examines the classification of terms denoting psychopathological phenomena in diagnostic criteria of the operational ICD from the perspectives of epistemology and general terminology. The conclusion is that the terms featured in the diagnostic criteria are not scientific terminology, but rather nomenclature lists. Using the example of substituting traditional psychiatric terminology with euphemisms, this study demonstrates the manipulative impact of classifications on the consciousness of both professionals and society as a whole, resulting in the “psychologization” of psychiatry. The psychiatric symptom was found to be a diminished semiotic system, reduced to the simplistic idea of “object — label”. The diagnostic work of the physician has lost its meaning.

Tinnitus and Psychiatric Disorders (a Clinical Psychopathological Study of Patients without Otorhinolaryngological Pathology)

Background: tinnitus is the perception of acoustic, phantom sounds in the ear and/or head in the absence of an external source. The prevalence of tinnitus is 5–15 % in the population. The occurrence of subjective noise may have a number of possible causes, but the causal relationship between psychiatric disorders and tinnitus remains insufficiently proven, according to previous studies. The aim was to study an acoustic phenomenon of the “ear/head noise” type, comparable with tinnitus symptomatology, in the absence of otorhinolaryngological, neurological, somatic pathologies. Patients and methods: the sample consisted of 12 patients (11 men, 1 woman, mean age 38 ± 8.5 years) who underwent complex psychopathological, pathopsychological, psychometric, otorhinolaryngological, neurological, and instrumental examinations, statistical. The patients met the diagnostic criteria of subjective tinnitus according to ICD-10 classification (code H93.1). Results: the psychopathological qualification of tinnitus in our observations corresponds to psychosensory disorders of the synesthesia type. In the most cases, the ear noise occurred against the background of already long-standing neurotic or overvalued hypochondria. Depending on clinical picture of ear noise, and features of the course of hypochondriacal disorder, the acoustic phenomenon of the “ear / head noises” type was revealed within four nosologies: hypochondriacal schizophrenia, schizotypal disorder, cluster B personality disorder with the phenomenon of hypochondriacal diathesis, paranoid personality disorder with the phenomenon of overvalued hypochondria. Conclusion: the results of the present study, in spite of a limited number of observations, allow us (as a working hypothesis) to propose the following statement: the acoustic phenomenon of the “ear / head noise” type can manifest in psychiatric disorders (psychopathological phenomena of the hypochondriacal circle) duplicating the symptoms of tinnitus at clinical level which, are formed within otolaryngological, neurologicl and somatic pathology. Taking into account these clinical data, hypochondriacal formations appearing in the considered casuistic of the present study, having no base of otorhinolaryngology-related pathology, or internal organ pathology, can be qualified in accordance with the criteria presented in publication A. B. Smulevich et al. (2023) as a part of somatic paranoia. Further comprehensive study of this phenomenon is necessary for more accurate verification of the clinical criteria for differential diagnosis, increasing the efficiency of identifying the pathology under discussion, and determining rational methods of complex treatment, including psychopharmacotherapy and psychotherapeutic modalities.

Mental health crisis situations: the nurse's work in Primary Health Care.

to analyze the nurses' work in Primary Health Care in the face of mental health crisis situations. this is a descriptive-exploratory study with a qualitative approach, supported by the theoretical-interpretive frameworks of behavior analysis and historical-dialectical materialism. The data was collected through a semi-structured interview with twelve Primary Health Care nurses and analyzed using the deductive technique proposed by the Theorical Domains Framework, the methodological reference adopted. the data analyzed made it possible to draw up two themes: "Nurses' work: material and social determinants" and "Nurses' subjective conditions in the face of mental health crisis situations". Nurses' work was guided by the protocol execution of "technical" steps related to clinical psychiatry, with an understanding of the crisis as a "psychiatric outbreak". the study made it possible to analyze the nurse's work in crisis situations, describing the objective and subjective contradictions, their understanding of the crisis phenomenon and the emotional repercussions of this work on the professionals. This situation raises the need for action, organization and political-social mobilization of the nursing category in the fight against the asylum model of care and the consolidation of the Psychiatric Reform perspective. (1) Manicomial protocol action to identify and reduce crisis symptoms. (2) Reducing the experience of crisis as a psychopathological phenomenon. (3) Use of theoretical-critical references aligned with the proposals of psychosocial care. (4) Internationally validated methodological and analytical framework. (5) The need for political and social action on the nursing profession's part.

Disocijativna amnezija s obilježjima fuge kod bolesnika s Huntingtonovom bolešću

Huntington's disease is a severe, incurable neurological disease characterised by motor, cognitive, andpsychological symptoms. This paper presents the case of a Huntington's disease patient with dissociativesymptoms. Clinical characteristics, genetic background, diagnostics, and guidelines for treatingHuntington's disease are shown in the paper. We emphasised the importance of knowing the genetic basisand testing the descendants of the patients. We highlighted the difference between behaviouralperseveration as a common psychomotor disorder in these patients and symptoms of obsessive-compulsivedisorders.Dissociative disorders may occur under extreme mental stress and exhaustion, such as when dealingwith a severe incurable illness. These disorders are not typical psychopathological phenomena forHuntington's disease, but conditions of hopelessness and despair after facing a severe diagnosis may leadto dissociative symptoms. Dissociative disorders as indicators of exhaustion of mental functioning requirecaution, especially given their high frequency of occurrence with suicidality as extreme exhaustion ofmental functioning.So far, treatment of Huntington's disease is only symptomatic, emphasising the relaxation of motorchoreatic movements and heterogeneous mental disorders. Antipsychotics that reduce choreatic movementsbut also affect psychotic symptoms, behavioural perseverations and mood stabilisation are used primarilyto relieve symptoms.As it is a progressive disease that ends in severe motor deficit, dementia and death, treating these patientswith a multidisciplinary team that includes neurological, psychiatric and palliative care, physical therapy,nursing, and social care is necessary. Psychotherapeutic and sociotherapeutic approaches make it easier forpatients and their families to cope with this severe disease. Genetic testing of the offspring is desirable todetermine the potential carrying of the mutated gene and its transmission to subsequent generations inwhich the disease appears earlier.

DIAGNOSTIC MARKERS CONTINUUM OF THE SOCIALLY-DISADAPTATIVE POST-COMBAT SYNDROME

Abstract. Background. The increased need for the diagnosis of mental disorders associated with hostilities has arisen in Ukraine since 2014 in connection with Russia's unprovoked invasion. During the Anti-Terrorist Operation, and later – the Operation of the United Forces, the combatants of Ukraine encountered a wide range of the newest methods of war, which are capable of leaving an imprint on the human psyche. For more than 7 years, we have been able to observe a number of specific continuums of psychopathological phenomena, one of them being Socially-Disadaptive Post-Combat syndrome. Aim: to investigate the diagnostic continuum of markers of Socially-Disadaptive Post-Combat syndrome in combatants of Ukraine. Material and methods. 382 combatants who were involved in the Anti-Terrorist Operation / Combined Forces Operation were examined at the Zaporizhzhia Military Hospital and Zaporizhzhia State Medical University between 2015 and 2021. We compared the identified markers of Socially-Disadaptive Post-Combat syndrome (SDPS) with ICD-10 markers of similar mental disorders: enduring personality change after catastrophic experience (F62.0), PTSD (F43.1), and adjustment disorders (F43.2). Results. We established a continuum of symptoms and identified 23 markers of Socially-Disadaptive Post-Combat syndrome, of which 9 are significant in the context of differential diagnosis. The provoking factors and features of the debut of Socially- Disadaptive Post-Combat syndrome, as well as its consequences, were also described by us. We determined the differences between post-combat social maladjustment syndrome and similar disorders that combatants suffer from in order to improve timely diagnosis, prognosis and development of treatment methods. Conclusions. Today, we report on the identification in combatants of Ukraine Socially-Disadaptive Post-Combat syndrome. This syndrome has clear differential differences from a related group of disorders and requires further clarification of the tactics of its treatment.

Logics of Discovery II: Lessons from Poetry-Parataxis as a Method That Can Complement the Narrative Compulsion in Vogue in Contemporary Mental Health Care.

This paper highlights the limitations of narrative logic in mental health care, and in particular of "narrative vigilance"-the tendency to watch over experience via narrativisation, and to tether the concrete particulars of experience to the hypothetical structure of a narrative signification. Narrative logic is grounded in hypotaxis-the syntactic structuring whereby a discourse is characterised by different levels of subordination using linking words that connect, especially in terms of temporal and explanatory consequentiality. I offer an alternative approach based on parataxis-the practice of placing phrases or parts of speech next to each other without subordinating conjunctions. Sentences are juxtaposed without a clear connection; the contrast may generate novel and unexpected combinations between these dissimilar fragments. After distinguishing between parataxis and psychopathological phenomena like disturbances of association, I take inspiration from the work and life of a poet, Johann Christian Friedrich Hölderlin (1770-1843), considered among the greatest. He suffered for half his life from a severe form of mental illness that would perhaps, today, be diagnosed as schizophrenia. In the poems written during his illness, hypotaxis and narrative vigilance seem to blur, and parataxis takes centre stage. The fading of narrative structure in no way coincides with the absence of meaningfulness. Rather, meaningfulness is left to parataxis itself, that is, to the recombining power of words, sentences, and images. Parataxis itself can provide meaningfulness or, at least, provide the soil in which it can germinate. The void of narration opens the door for the fullness of "emergent" connections. In the final part of the paper, with the help of Freud's ideas on the relationship between "analysis" and "synthesis" in psychoanalytic treatment, some implications are derived about the relevance of parataxis to the logics of discovery in psychotherapeutic care, especially that of persons with severe mental conditions.

Structural-dynamic features of states of mental exhaustion in medical students

The analysis of relevant literary sources makes it possible to form the idea that, despite the significant representation of states of mental exhaustion, there is a lack of representative evidence-based information about the structural and dynamic features of the studied phenomena in the contingent of medical students. Purpose. By means of clinical-psychopathological analysis of the manifestations of mental exhaustion in medical students, to establish the structural and dynamic features of these conditions. Methods that were used: clinical-psychopathological, psychodiagnostics and clinical-statistical. According to the results of the study, it was found that the phenomena of mental exhaustion in the formed contingent were characterized by: a wide prevalence, reaching 54.0 %, clinical polymorphism and intragroup heterogeneity, a significant representation of interpersonal sensitivity disorders (61 (34.8 %) students) and psychotism (73 (41.7 %) students), manifestations of obsessive-compulsive (47 (26.8 %) students) and depressive (49 (28.0 %) students) spectra. Five variants of the most common compilations of psychopathological phenomena of various spectra were established: depressive and obsessive-compulsive (46 (26.3 %) students), hostility and psychotism (41 (23.4 %) students), psychotism and manifestations of interpersonal sensitivity (30 (17.1 %) of students), manifestations of interpersonal sensitivity and anxiety (29 (16.6 %) students), somatic anxiety and phobic manifestations (21 (12.0 %) students). The representation and structural-dynamic features of states of mental exhaustion in medical students have been established, which gives a better understanding of the pathogenesis of these conditions and forms the basis for their systematization. Key words: mental exhaustion, emotional burnout, maladaptation, students, psychotherapy

Порушення сну внаслідок дистресу війни

Topicality. With the start of the full-scale invasion of russia in Ukraine, sleeping disorders are becoming more and more widespread among the civil population – frequent air alarms at night, shelling of the civil areas, everyday loud sounds that are now perceived in a different way - these all cause sleeping disorders. Studies of the US researchers [1] prove that sleeping disorders, such as insomnia, short-term sleep, and nightmares in particular, are common at the time of military actions. This has an impact on people’s health and well-being by reducing muscular strength and impairing the nervous and cardiovascular systems. For many people involved in armed conflicts (servicemen, civilians living within the area of active combat actions, people under constant threat of air attacks, etc.) sleeping disorders last for many more years after and can have a considerable impact on their ability to reintegrate in society and have a normal life after war. As of today, there is little research in Ukraine which would describe sleeping disorders and sleep quality deterioration in the civilian population in wartime, features of sleep in wartime, and their correlation with psychopathological phenomena, such as anxiety and depression. Also, there is insufficient research of projected functional changes in the population emerging as a result of sleep-wake cycle disorders. All these define the topicality of this research. Aim of the research. The research aims to explore sleep quality deterioration in the civilian population living in Ukraine in wartime and identify correlation between sleep quality deterioration and symptoms of anxiety and depression. Methodology of the research. The clinical objects of the research are 103 respondents. In addition to the social demography method of study, the research made use of the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Quality of Life Scale (© by O. Chaban), as well as the methods of statistical data processing using the CORREL function in Excel tables. Results. In the course of the research it has been discovered that ⅔ of the respondents living in Ukraine in wartime show sleeping disorders of different severity. Positive direct medium-degree correlation has been established between sleep quality deterioration and elevated anxiety levels. The given research contains optimized recommendations for medical and psychological consultations aimed at improving sleep quality at the time of crisis and dealing with negative consequences of sleeping disorders.

Сognitive Functioning in Patients with the Phenomenon of Anhedonia in the Framework of Affective Pathology and Schizophrenia Spectrum Disorders

Background: anhedonia is a transdiagnostic psychopathological phenomenon, which is assessed as “core” for several diseases at once — first of all schizophrenic and affective spectrum disorders. The problem of clinical features differentiation and identification of anhedonia’s neurobiological mechanisms in the structure of the affective and schizophrenic spectrum disorders is still topical and far from being resolved.The aim of the study: to compare the relationship between the features of neurocognitive functioning and the manifestations of anhedonia among patients with disorders of the schizophrenic and affective spectra.Patients: the sample consisted of 40 patients including 17 patients with schizophrenic spectrum disorders (ICD-10 diagnosis codes F20.01, F20.02, F21.3, F21.4, F25.0, F25.1) and 23 patients with affective disorders (ICD-10 diagnosis code F33, F31).Methods: clinical, psychometric, experimental psychological and statistical.Results: patients with schizophrenia spectrum disorders show lower scores on pleasure anticipation ability and ability to experience pleasure in the social sphere. The affective spectrum group showed a correlation between anticipatory anhedonia and phonetic verbal fluency (r = –0.487; p < 0.01). There was also a correlation between immediate pleasure experience and errors in the Rey figure test (r = –0.349; p < 0.05). Social anhedonia in these patients was associated with phonetic verbal fluency productivity (r = –0.509; p < 0.01) and performance in visual fluency productivity (r = –0.473; p < 0.01). Patients with schizophrenia spectrum disorders had a correlation between anticipatory anhedonia and the Color-Word Interference Test (r = –0.329; p < 0.05) and the Rey Complex Figure Test (r = –0.307; p < 0.05). Consummatory anhedonia was correlated with verbal fluency test (r = –0.511; p < 0.01) and the Rey Complex Figure Test (r = –0.417; p < 0.01). Social anhedonia was correlated with Color-Word Interference Test (r = –0.656; p < 0.01), verbal fluency (r = –0.523; p < 0.01), and story description (r = –0.421; p < 0.01).Conclusion: manifestations of different parameters of anhedonia demonstrate the differences in schizophrenia and affective spectrum disorders. Patients with schizophrenia spectrum disorders have greater difficulties in anticipating pleasure and experiencing pleasure in the social sphere. The ability to anticipate pleasure may be associated with executive function, while the ability to experience pleasure immediately may be associated with memory function. Social anhedonia affects a wide range of cognitive functions.

Specific interpretation biases as a function of social anxiety and callous-unemotional traits in a community and a clinical adolescent sample

BackgroundThreatening and hostile interpretation biases are seen as causal and maintaining mechanisms of childhood anxiety and aggression, respectively. However, it is unclear whether these interpretation biases are specific to distinct problems or whether they are general psychopathological phenomena. The specificity versus pervasiveness of interpretation biases could also differ depending on mental health status. Therefore, in the current study, we investigated whether social anxiety and callous-unemotional (CU) traits were uniquely related to threatening and hostile interpretation biases, respectively, in both a community and a clinical sample of adolescents.MethodsA total of 161 adolescents between 10 to 15 years of age participated. The community sample consisted of 88 participants and the clinical sample consisted of 73 inpatients with a variety of psychological disorders. Social anxiety and CU-traits were assessed with self-report questionnaires. The Ambiguous Social Scenario Task was used to measure both threatening and hostile interpretations in response to written vignettes.ResultsResults showed that social anxiety was uniquely related to more threatening interpretations, while CU-traits were uniquely related to more hostile interpretations. These relationships were replicated for the community sample. For the clinical sample, only the link between social anxiety and threatening interpretations was significant. Explorative analyses showed that adolescents with externalizing disorders scored higher on hostile interpretations than adolescents with internalizing disorders.ConclusionsOverall, these results support the content-specificity of threatening interpretation biases in social anxiety and of hostile interpretation biases in CU-traits. Better understanding the roles of interpretation biases in different psychopathologies might open avenues for tailored prevention and intervention paradigms.

A very musical psychopathology – from intrusive musical imagery, to musical obsessions and hallucinations

IntroductionThe semiological spectrum that encompasses musical imagery is a very confusing field, as it is often difficult to understand the nature of the underlying psychopathological phenomenon from the patient’s description.ObjectivesThe purpose of the authors is to explore reviewing, distinguishing and organizing the concepts such as Intrusive musical imagery, musical obsessions, musical hallucinations, pseudohallucinations and musical palinacousis.MethodsA brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.ResultsIntrusive musical imagery (earworms, ohrwurms, or involuntary musical imagery) occur in more than 85% of general population, without pathology or ear disease. It involves the involuntary repetition of 15-30 seconds of a fragment of music/tune, persisting like a looping soundtrack, not being aversive.Musical obsessions are a rare form of intrusive imagery, occurring either with other symptoms of Obsessive Compulsive Disorder or isolated (“The stuck song syndrome”). It is recurrent, persistent, intrusive, unintentional, time consuming and causes distress or functional impairment (although not as ego-dystonic and aversive as usually intrusive visual imagery are); preserved insight.Musical hallucinations occur only in 0,16% in a general hospital; they can be linked to psychiatric diseases, but they are more common in neurological diseases (cerebral lesions, Parkinson’s disease, delirium, drug induced…). They are reported to with less controllability, less lyrical content, and lower familiarity, than other forms of inner music; are perceived to arise from an external source and are interpreted as veridical.Musical Pseudohallucinations can arise after severe hearing loss, in hallucinogen intoxication and in psychotic or non-psychotic disorders (as dissociative states or in borderline personality disorder). They occur in inner/subjective space, but insight can fluctuate.Musical palinacousis is associated with electroencephalogram and neuroimaging abnormalities, linked to structural brain pathology. There is perseveration (echoing) of an external auditory stimulus occurs after cessation of the stimulus.ConclusionsA rash classification can lead to misdiagnosis (for e.g. interpreting obsessive symptoms as hallucinatory phenomena or rendering an organic pathology undiagnosed) and the institution of inappropriate therapy. It is important to carefully explore these musical imagery phenomena when patients present these complaints, taking some time to characterize them.Disclosure of InterestNone Declared

Depression and Suicide in Regards to Sex

Psychiatric disorders represent one of the leading problems of the public health community in the modern world today, especially because their incidence is steadily increasing and they are one of the main reasons for the overall disease burden in Europe. One of the most frequently diagnosed, yet under recognized diseases, is depression. Depression, whether a symptom, part of a syndrome or an independent diagnosis, is characterized by feelings of sadness, loss of interest and pleasure in activities that normally bring joy to a person, and can affect how a person feels, thinks and behaves. It affects all age and social groups, as well as both sexes, it is often comorbid with other physical diseases, and increases the risk of developing other physical diseases. There are certain differences between the sexes in the prevalence, the way a certain sex group deals with problems caused by depression, and the possible causes of these differences, which we present in more detail in this paper. Differences are observed in all cultures, environments and across different age groups. Patients suffering from depression have a particularly high risk of committing suicide. Suicide is a psychopathological phenomenon of multifactorial aetiology that is most often associated with psychiatry and mental disorders and is not a diagnosis in itself, but a complication of many psychiatric disorders. here are many differences in the rate of suicide by age and sex, as well as in the method of suicide, which we also present in more detail in this paper.

Psychopathological intersection of OCD and PTSD: scoping review of similitudes and differences.

Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded. Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension. The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.

The Power of Images and the Logics of Discovery in Psychiatric Care.

This paper, aligned with contemporary thinking in terms of patient-centered care and co-creation of patient care, highlights the limitations of the reductionist approaches to psychiatry, offering an alternative, "emergent" perspective and approach. Assuming that psychopathological phenomena are essentially relational, what kind of epistemological framework and 'logic of discovery' should be adopted? I review two standard methods I call 'ticking boxes' and 'drafting arrows'. Within the ticking boxes framework, the clinician's main goal is to discover whether a patient showing psychopathological phenomena meets pre-given diagnostic criteria. The process of discovery can be compared to two people assembling a puzzle where the patient has the pieces and the interviewer has the image of the completed design. Drafting arrows consists in constructing pathogenetic diagrams that display linear causative relationships between variables connected by an arrow to other nodes. These explanatory narratives include psychodynamic (motivational) and biological (causal) diagrams. I argue for a third approach called 'linking dots', a method of discovery based on the emergent properties of psychopathological phenomena. I build on and develop the approach to images and discovery devised by art historian Aby Warburg in his atlas of images Bilderatlas Mnemosyne. The visual constellations created by Warburg in the panels of the Bilderatlas can be understood as a method to reveal the layers of memory and the web of relationships manifested in them, inviting the viewer to participate in the production of meanings, forging ever new connections between the images. It is the viewer's acts of perception that draw relationships between singularities. I suggest that this method is of enormous significance in the context of today's socio-cultural transformation processes and related forms of psychopathological conditions, which can no longer be comprehended using the categories of existing knowledge systems.