Psychotic Anxiety Research Articles

Targeting calcium dependant/cAMP/PKA/CREB pathway and GABAergic transmission by drotaverine and hesperidin for amelioration of tardive dyskinesia

Antipsychotics, commonly used for anxiety and psychosis, are linked to severe side effects like fatal ventricular arrhythmias, sudden cardiac death, and movement disorders, limiting their therapeutic use. This research aimed to explore novel mechanisms to treat psychotic anxiety while minimizing these risks. Drotaverine activates the cAMP/PKA/CREB pathway, while Hesperidin inhibits dopaminergic hyperactivity. Using a reserpine-induced orofacial dyskinesia model, which mimics tardive dyskinesia linked to oxidative stress, reserpine (1 mg/kg, s.c) was administered for three days. Rats were pre-treated with drotaverine (8 mg/kg, p.o) and hesperidin (50 mg/kg, p.o) for five days. Statistical analysis via one-way ANOVA and Dunnett’s test showed that reserpine significantly increased vacuous chewing movements (VCMs), tongue protrusions (TPs), and reduced locomotion and exploration. Pre-treatment with drotaverine and hesperidin reduced VCMs and TPs. Reserpine-treated rats had lower catalase and higher lipid peroxidation (LPO) levels, indicators of oxidative stress, which were reversed by the drugs. Additionally, drotaverine improved cognition by modulating the cAMP/PKA/CREB pathway, and Hesperidin offered neuroprotection through GABAergic transmission. Both drugs, alone or in combination, demonstrate potential as alternative therapies for psychotic anxiety with neuroprotective benefits.

Psychosis as a sacrifice of sovereignty

ABSTRACT In this work, I explore psychosis as an intersubjective state. Positing the importance of an early traumatic loss of a significant figure, I describe a situation in which a caregiver is not able to achieve separateness and unconsciously relates to their child as a replacement for the beloved lost object. The child unconsciously interprets this complicated state as a plea to abandon separateness and exist as a part of the caregiver’s inner world. This act of surrender is unconsciously phantasised by the child as a means of preserving the aliveness of the caregiver’s central internal object, which holds the caregiver’s subjectivity together. In unconsciously fulfilling the role of protector of his caregiver’s sanity, the child becomes bound by the psychotic anxiety that demonstrating autonomy will destroy this state of merger causing the caregiver’s mind to disintegrate. The child thus feels that he cannot develop himself without risking the caregiver’s collapse and must therefore become ‘nobody’ or ‘no-thing’, often psychotic and sometimes suicidal. I describe a continuum of pathology dependent on the caregiver’s ability to differentiate their child from their forsaken object. I present a clinical example of psychoanalytic psychotherapy with a five-year-old boy who suffered from psychotic anxiety about bodily fragmentation, and the accompanying work with his mother, who was neglected in her childhood. I discuss the essential elements of playing, which were crucial in reaching this boy in his psychotic, near-death state. The implications of this theoretical view illustrate the repercussions of self-sacrifice on a child’s ability to accept help.

Neutropenia in a patient with Very-Late-Onset-Schizophrenia-Like-Psychosis under Risperidone treatment – Case report

This case report describes the clinical evolution of a 75-year-old man with no psychiatric history, hospitalized for psychotic anxiety, commentary and imperative auditory hallucinations, and multimodal delusions in the absence of an affective disorder or neurocognitive decline. He was diagnosed with very-late-onset-schizophrenia-like-psychosis after a complex differential diagnosis, including Alzheimer’s dementia with psychotic symptoms, delirium, Lewy-body dementia, and other psychiatric or general medical conditions. The patient received antipsychotic treatment (Risperidone up to 3 mg/day) with favorable clinical outcomes. However, the laboratory tests showed a low neutrophil count three weeks into treatment. The thorough interdisciplinary evaluation concluded that another cause of neutropenia other than the pharmacologic treatment was improbable. Risperidone was then progressively switched to Olanzapine up to 10 mg/day. Neutrophils returned to base levels after a few days. Unfortunately, the clinical course was unfavorable, and since the reoccurrence of psychotic symptoms was debilitating for our patient, the decision to rechallenge Risperidone was made, starting with low doses of 0.5 mg/day and slowly increasing to 2 mg/day. Despite normal neutrophil count and positive clinical results after seven days, neutropenia was noticed again after two weeks. Therefore, because of the patient’s vulnerability and the uncertainty of periodic outpatient assessment of complete blood count, he was discharged on Haloperidol with resolution of psychotic symptoms and without any side effects. This report’s primary purpose is to highlight a challenging differential in an elderly patient while presenting a rare but potentially harmful adverse effect of Risperidone treatment.

An Analysis on Adultery in Hawthorne’s The Scarlet Letter

Abstract. The main feature of the research discusses the adultery on Hester Prynne and Arthur Dimmesdale in Hawthorne’s The Scarlet Letter. Adultery is caused by several things and has impact to the doers. The research purposed is to find out the factors cause adultery done by the two main characters and the impacts on the doers. The research is qualitative research. Therefore, it applies descriptive method since the writer describes the analysis based on the data and the theories. The research uses psychological approach that just focuses on the psychological condition of adultery’s doers. The data are collected from the original text of The Scarlet Letter, then analyzed in terms of factors and impacts of adultery. The result of the research was clearly found and explained that the act of adultery is caused by several things, namely need of safety, need of affection, need of love and belongingness, and need of sex. while its impacts make the doers experience certain psychological conditions, these are esteem need, psychotic anxiety, safety need, develop superego, neurotic anxiety, mental disorder, and psychosomatic illness . The act of adultery makes the doers have different conflicts because they have different ways in facing the impacts of adultery. Hester has external conflict such as conflict with the society, magistrates, her husband, and her child. While Dimmesadle has internal conflict such as double avoidance conflict, double approach conflict, and approach avoidance conflict.

Bipolar disorder in megalencephalic leukoencephalopathy with subcortical cysts: a case report

BackgroundMegalencephalic leukoencephalopathy with subcortical cysts (MLC), or Van der Knaap disease, is a rare spongiform leukodystrophy that is characterized by macrocephaly, progressive motor dysfunction, and mild mental retardation. It is very rare for mental illness such as psychotic disorders, affective disorders and anxiety disorders to occur in MLC.Case presentationA 17-year-old boy was admitted to our hospital after he developed symptoms of depressive state with catatonia after being diagnosed as having MLC with confirmed MLC1 mutation. His catatonic symptoms were improved with administration of olanzapine and sertraline and he was discharged after 4 months. Several months later, he became hypomanic. He was diagnosed with bipolar II disorder. Mood swings were controlled with the administration of carbamazepine.ConclusionsThis case is the first report of bipolar disorder during the clinical course of MLC. This case indicate the possibility that MLC influences the development of bipolar disorder in MLC, however, further studies involving more patients are required to clarify this.

Mindfulness and compassion for youth with psychotic symptoms: A description of a group program and a consumer’s experience

ABSTRACTAn 8-week mindfulness and compassion program was developed for youth at risk for, or already experiencing, psychosis, based on UK national guidelines for developing interventions. The aim of this paper is to provide a program description and first hand account of a participant’s experience.First, mindfulness skills are taught. Next an emotional regulation model is introduced, to help participants understand how psychotic experiences, anxiety and depression contribute to a heightened threat system, and how compassion can help them. The program contains meditations (e.g. breath practice, compassionate friend) and practices for use in daily life (e.g. STOP practice).The second author found mindfulness allowed her to feel and acknowledge her experience and give her emotions the recognition they needed. Being self-compassionate was a new concept, which at times was challenging but helped her realize her emotions were normal and she could manage difficult emotions using soothing practices. Furthermore, being part of a group helped her realize she was not alone.Mindfulness and compassion skills can be helpful for youth with psychotic experiences. A group program can provide a safe place to share experiences and reduce isolation. An evaluation of the program will be the focus of future papers.

Intervention of auricular point sticking on perioperative psychological stress in patients with anorectal diseases

To explore and quantify the intervention effect of auricular point sticking on perioperative psychological stress in patients with anorectal diseases. Eighty patients who underwent anorectal surgery were randomly divided into an observation group (40 cases) and a control group (40 cases). The routine preoperative guidance, preoperative visits, and informed of the postoperative condition were received in the control group. On the basis of the treatment in the control group, auricular point sticking was immediately applied at Shenmen (TF4), Shen (CO10), Wei (CO4), Gan (CO12), Pi (CO13), Pizhixia (AT4), E (AT1), Nie (AT2) and Zhen (AT3) in the observation group.The patients were pressed by themselves, 3 to 5 min per point each time, 5 times a day, and the contralateral auricular points were replaced every 2 or 3 days until 1 week after surgery. The Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), and Pittsburgh sleep quality index (PSQI) scores were compared between the two groups before and 7 days after surgery. There was no significant difference in the total HAMA scores between after and before surgery in the observation group (P>0.05). The total HAMA score in the control group was higher than that before surgery (P<0.05). The total HAMA score in the observation group after surgery was lower than that in the control group (P<0.05). There was no significant difference in the total HAMD scores between the two groups before and after surgery (P<0.05). There was no significant difference in the total HAMD scores between the two groups after the surgery (P>0.05). The scores of somatic anxiety factor in the two groups were higher than those before surgery (P<0.05). The scores of somatic anxiety factor in the observation group were lower than those in the control group (P<0.05). The scores of psychotic anxiety factors in the two groups were lower than those before surgery (P<0.05). There was no significant difference in the score of psychotic anxiety factors between the two groups (P>0.05). The total score of PSQI in the two groups was lower than that before surgery (P<0.05), and the total score of PSQI in the observation group was lower than that in the control group (P<0.05). Auricular point sticking can effectively improve some psychological stress problems during perioperative period in patients with anorectal diseases.

Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis

BackgroundMany people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions.MethodsOur search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis.DiscussionThe identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life.Systematic review registrationPROSPERO CRD42016033869

An analysis of the evolution of delusion in a Chinese case of paraphrenia

ABSTRACTThis article proposes a psychoanalytic approach to interpret the work of Song Shipeng, especially starting from an interrogation on the function of the nomination in the evolution of his delusion. Song was an author suffering from paraphrenia; he published some books writing about his conversations with extraterrestrials and their theory of the Universe. Furthermore, in the last years of his life, he practised a pseudo-medicine, as part of his practice of cosmic energy. His works are full of traces of his personal experience, which open the door to the understanding of the evolution of his delusion. The unifying factor of this examination will be the following hypothesis: Song attempted to compensate for his psychotic crisis, which he regarded as a way to install his “Pseudo-Ego Ideal,” to invent all the delusion by the mnemic traces and to rebuild an identity. Within this perspective, writing could be viewed as enabling the patient to fight against psychotic anxiety, which could take the form of delusion of imagination, of naming oneself, of making a link between his psychotic enigmatic experience, his writing and his thought, and finally, of compensating his ego defect.

Electro-acupuncture improves psychiatric symptoms, anxiety and depression in methamphetamine addicts during abstinence: A randomized controlled trial.

Background:It aimed to observe the effect of electro-acupuncture on the improvement of psychiatric symptoms, as well as anxiety and depression in methamphetamine (MA) addicts during abstinence using randomized controlled trials.Methods:All patients in the present study received compulsory drug detoxification in Shanghai Drug Rehabilitation Center. All patients were enrolled consecutively from June 2014 to February 2015; data collection was completed in March 2015. According to the randomized, single-blind and control principle, 68 men MA addicts were randomly divided into 2 groups: electro-acupuncture (EA) and sham electro-acupuncture (sham-EA) groups. Patients were given 20 minutes EA or sham-EA treatment every Monday, Wednesday, and Friday, with a total of 4 weeks. Positive and Negative Syndrome Scale (PANSS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) were used to evaluate the patients’ psychotic symptoms, anxiety and depression before treatment and after receiving treatment with 1 to 4 weeks, respectively.Results:EA could effectively improve the symptoms of psychosis, anxiety, and depression during abstinence in patients with MA addiction. In terms of PANSS score, the scores for positive symptoms and general psychopathological symptoms in patients after receiving 1 to 4 weeks of treatment were significantly decreased compared with the control group, while the score for negative symptoms was significantly decreased after receiving 2 and 4 weeks of treatment. For the HAMA score, the psychotic anxiety scores in patients receiving 1 to 4 weeks of treatment were significant lower than the control group. In terms of HAMD score, there was a significant reduction in anxiety/somatization and sleep disturbance scores after the 4 weeks of EA treatment.Conclusion:Electroacupuncture helps to improve psychiatric symptoms and anxiety and depression in MA addicts during abstinence, and promote rehabilitation of patients.

Association between psychological and self-assessed health status and smartphone overuse among Korean college students

Background: Several studies suggest that subjective health status is closely related to various behavioral addictions, but there are few studies on smartphone overuse.Aim: This study investigated the associations between psychological and subjective health conditions and smartphone overuse in Korean college students.Method: A total of 608 college students participated in this study. We investigated the perceived psychological factors, such as stress, depression symptoms and suicidal ideation. Overall health status was evaluated with self-assessed items, including usual health condition and EuroQol-visual analog scales (EQ-VAS) score. Smartphone overuse was evaluated as the Korean Smartphone Addiction Proneness Scale.Results: Students with psychotic anxiety (i.e. stress, depression and suicidal ideation) showed significant associations with smartphone overuse, indicating an approximately twofold increased risk compared to those without psychological anxiety (all p < 0.05). Students who reported feeling that their usual health is not good were more likely to overuse smartphones than those who are in good health (OR = 1.98; 95% CI = 1.22–3.21). The EQ-VAS score, which indicates current self-assessed health status, also showed a similar result with general health status (OR = 2.14; 95% CI = 1.14–4.02).Conclusion: Negative conditions in self-perceived emotional or overall health condition are associated with the increased likelihood of smartphone overuse in Korean college students.

Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial

BackgroundYoung people who have social disability associated with severe and complex mental health problems are an important group in need of early intervention. Their problems often date back to childhood and become chronic at an early age. Without intervention, the long-term prognosis is often poor and the economic costs very large. There is a major gap in the provision of evidence-based interventions for this group, and therefore new approaches to detection and intervention are needed. This trial provides a definitive evaluation of a new approach to early intervention with young people with social disability and severe and complex mental health problems using social recovery therapy (SRT) over a period of 9 months to improve mental health and social recovery outcomes.MethodsThis is a pragmatic, multi-centre, single blind, superiority randomised controlled trial. It is conducted in three sites in the UK: Sussex, Manchester and East Anglia. Participants are aged 16 to 25 and have both persistent and severe social disability (defined as engaged in less than 30 hours per week of structured activity) and severe and complex mental health problems. The target sample size is 270 participants, providing 135 participants in each trial arm. Participants are randomised 1:1 using a web-based randomisation system and allocated to either SRT plus optimised treatment as usual (enhanced standard care) or enhanced standard care alone. The primary outcome is time use, namely hours spent in structured activity per week at 15 months post-randomisation. Secondary outcomes assess typical mental health problems of the group, including subthreshold psychotic symptoms, negative symptoms, depression and anxiety. Time use, secondary outcomes and health economic measures are assessed at 9, 15 and 24 months post-randomisation.DiscussionThis definitive trial will be the first to evaluate a novel psychological treatment for social disability and mental health problems in young people presenting with social disability and severe and complex non-psychotic mental health problems. The results will have important implications for policy and practice in the detection and early intervention for this group in mental health services.Trial registrationTrial Registry: International Standard Randomised Controlled Trial Number (ISRCTN) Registry.Trial Registration Number: ISRCTN47998710 (registered 29/11/2012).

Films and fiction leading to onset of psycho-phenomenology: Case reports from a tertiary mental health center, India

Mind is influenced by socio-cultural religious belief systems, experiences and attributions in the development of psychophenomenology. Film viewing is a common entertainment among young adults.ObjectivesInfluence of repetitive watching of films of fiction and horror genres on onset phenomenology in young adults.MethodTwo case reports on onset of psychotic features and mixed anxiety depressive phenomenology were seen in two patients aged 16 and 20 years respectively and based on the fantastic imagination created by films. The 28-year-old female patient diagnosed with schizoaffective disorder had onset at 16 years of age and the course of phenomenology was influenced by the fiction movie ‘Jumanji’ with partial response to medications over 10 years. The depressive and anxiety symptoms of less than 6 months duration of a 20-year-old male patient was influenced by film ‘Hannibal’ and responded to antidepressant and cognitive behavior therapy.ConclusionsHorror and fiction films can influence the thinking patterns and attribution styles of a young adult by stimulating fantasy thinking which if unrestrained can lead to phenomenology. Viewing films compulsively, obsessive ruminations on horror and fictional themes can lead to onset of psychopathology of both psychosis and neurotic spectrum. Further research on neurobiological, psychological correlates is needed. Parental guidance and restricted viewing of horror genre films with avoidance of repeated stimulatory viewing of same genre movies in children, adolescents, young adults and vulnerable individuals is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic Depression and Suicidal Behavior

Objective: This study investigated how severely depressed individuals experienced the relationship between psychotic symptoms and suicidal ideation and behavior. Method: Semi-structured qualitative interviews were conducted with a purposive sample of nine inpatients from a psychiatric university hospital between September 2012 and May 2013 fulfilling diagnostic criteria for a psychotic depressive episode as part of a unipolar or bipolar disorder. Analysis was conducted using systematic text condensation. Results: Participants experienced (1) being directed to perform impulsive potentially fatal actions, (2) feeling hounded to death, (3) becoming trapped in an inescapable darkness, and (4) being left bereft of mental control. They described how impulsivity directed by delusions and hallucinations resulted in unpredictable actions with only moments from decision to conduct. Suicide was seen as an escape not only from life problems but also from psychotic experiences and intense anxiety. Participants reported being in a chaotic state, unable to think rationally or anticipate the consequences of their actions. Their ability to identify and communicate psychotic symptoms and suicidal ideation and behavior was compromised, leaving them to struggle alone with these terrifying experiences. Conclusions: Suicide risk assessments based on verbal reports from individuals with psychotic depression may not always be valid due to potential impulsivity and underreporting of suicidal ideation. It may be important for clinicians to explore the delusional content of such patients’ experiences to assess the possibility of suicide as a result of shame, guilt, remorse, or altruistic intentions to save others from harm.

Key indicators for mental disorders in officers of the Armed Forces of Russia (2003–2015)

Relevance. There have been made some reorganizations in the Armed Forces of Russia lately (changes in the staff structure, enhancing the image of the officers, increasing officer’s salaries and military pension), which could affected the mental health of military personnel. Intention. The aim of our study was to determine the medical-statistical characteristics of mental health in officers of the Armed Forces of Russia as the most combat-capable unit. Methods. The research presents the stastical analysis of mental disorders in officers of the Armed Forces of Russia during the last 13 years (2003–2015). Results and Discussion. The annual average general morbidity (negotiability) of officers with mental disorders was (8.21 ± 0.86) ‰, the primary morbidity rate – (2.73 ± 0.13) ‰, the dynamic level of dispensary observation – (1.29 ± 0.14) ‰, the hospitalization rate – (2.37 ± 0.12) ‰, the inactivity rate measured in days – (51 ± 3) ‰, the dismissal rate – (0.55 ± 0.06) ‰, the mortality ratio – (0.4 ± 0.2) deaths per 100,000 officers in a year. The polynomial trends at low coefficients of determination of almost all indicators predicted their decrease. With a small contribution of mental disorders (1–6 %) to the structure of general morbidity, hospitalization and inactivity, the dismissal rate of officers with mental disorders remained at a high level and ranks 6th among all diseases. In 97.3 % of cases the structure of the generated complex indicator of the mental health status in officers was determined by 6 groups of disorders from Chapter V of ICD-10: mental disorders due to known physiological conditions (F00–F09), mental and behavioral disorders due to psychoactive substance use (F10–F19), schizophrenia, schizotypal, delusional and other non-mood psychotic disorders (F20–F29), mood (affective) disorders (F30– F39), anxiety, dissociative, stress-related and somatoform disorders (F40–F48). The major contribution to the structure of mental pathology is made by the neurotic, stress-related and somatoform disorders, as well as addiction disorders. In addition it is the chemical forms of addiction and neurotic disorders that often lead to the dismissal of officers from the Armed Forces of Russia. It is shown, that some isolated socio-economic factors have influence on the mental health of officers. It is determined, that the «unpopular» reforms carried out until 2011 had negative influence, on the other hand, there is the reduction of the prevalence rate of mental disorders among the officers since the reforms of 2012. Conclusions. It is assumed, that the system of the psychoprophylactic measures existing at present needs to be further improved and primarily focused on the early diagnosis of the addiction and neurotic disorders.

Particularités de l’accompagnement en soins palliatifs d’un patient atteint de schizophrénie en secteur psychiatrique

ObjectivesThe studies of comorbidities, risk factors of organic pathologies, or declining life expectancy of patients with mental disorders, particularly psychotic disorders, are the subject of many publications. The cares, including palliative care, for these patients, but also the patients and caregivers experience in these situations are rarely described in the literature. From the story of Peter, we evoke the palliative support and the management of these patients in a psychiatric hospital. PatientPierre was monitored for paranoid schizophrenia. He was hospitalized in a psychiatric hospital after a suicidal attempt. Before that event, he spent a large part of his life in the psychiatric hospital, with more than 50 hospitalisations. After 1 month of hospitalisation, a diagnosis of a lung cancer with lethal prognosis was done. Pierre was very anxious, especially about the medical exams, and also the chemotherapy. He did not eat and sleep anymore. He told every doctor and nurse that he did not want any treatment, especially not chemotherapy. After discussions with Pierre, his family, specialized doctors in pneumology and palliative care, we decided to respect his will, and Pierre was informed about that decision. After that, he felt relieved, ate and slept again, and kept his normal activities in the hospital. Pierre died 4 months after the diagnosis was done. ResultsWe present a brief introduction on palliative care history in France, and discuss the specificities of this kind of monitoring, especially about the management of the medical teams, but also the assessments of the behavior or the pain. It is sometime really difficult to assess behavior and pain for patients suffering from schizophrenia. These patients cannot talk about their pain as well as other patients because of the language impairment and lack of capacity of expressing their feelings. Also, it seems, in recent research, that schizophrenic patients do not feel the pain as other patients. These specificities increasingly complex the evaluation, at the limit of normal and pathologic event. Beyond these practical aspects, we initiate a reflection on the challenges of this unusual support. In fact, we discuss the end of life and the specific follow-up of this patient, and the legal aspects in this situation of patients suffering from severe psychiatric illness. We also talk about the impact of this kind of management on the patient and the medical team. We question and discuss the possibility of patients suffering from severe schizophrenia to take some decisions about their health. Finally, we question ethical aspects in this specific context, dealing with unreasonable obstinacy, refusal of treatment. In fact, it is an ethical question to know if we have to consider the will of a patient suffering from judgment trouble because of his psychiatric disease if he do not want a medical treatment. Do we have to respect that choice? Do we have to try to convince him, even if he will have some psychotic anxiety? ConclusionsWe discuss in this publication the care for patient suffering from psychosis disorders, concerning the patient's right, but also our responsibility as doctors in medical decision. In the situation described, limiting curative care was adapted to the gravity of the disease, and did not compromised the patient's integrity. The patient's right and responsibility needs to be treated for each situation, without any theorical previous rules, except the Leonetti law. We argue that caregivers in psychiatric hospital have to accompany these patients, also at the end of their lives. Some teams in psychiatric hospital works for the prevention and treatment for the physical pain, and we probably need to extend their abilities to healthcare at the end of life, promoting medical education.

Resistant psychosis in a patient with coexisting beta-thalassemia and latent toxoplasmosis

We present the case of a 44 year-old Caucasian male (V.B) with a known psychiatric history of paranoid schizophrenia, admitted to “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry during the months of May-July 2015 (67 days of hospitalization) for: compound and complex auditory and visual hallucinations, paranoid delusions, hallucinatory behavior, psychotic anxiety and sleep disturbances, symptoms which had intensified in the several months preceding admission despite following adequate antipsychotic treatment. We present the difficulties we encountered in treating his resistant psychosis, the process of diagnosing his co-morbidities (beta-thalassemia and latent Toxoplasma gondii infection), a differential diagnosis of the intense positive symptoms the patient presented and the implications of toxoplasmosis in the evolution and treatment of a paranoid schizophrenic patient. Conclusion. The scope of this paper was to show the importance of performing a differential diagnosis and a thorough workup however certain we are of the patient's initial presentation. We also wanted to emphasize the need for studies that present more effective treatments of resistant psychosis with fewer adverse reactions. The etiology of schizophrenia presents a tremendous challenge for both researchers and physicians, the latent toxoplasmosis infection observed in high prevalence among schizophrenic patients representing only a small part of what remains to be discovered. Ultimately we must draw attention to the importance of a multidisciplinary approach to every case encountered.

Substituted cyclopentanes, tetrahydrofurans and pyrrolidines as orexin-1-receptor antagonists for treatment of various CNS disorders (WO2015/055994; WO2015/124932; WO2015/124934)

ABSTRACTThe three patent applications WO2015/055994, WO2015/124932 and WO2015/124934 from Takeda Pharmaceuticals describe antagonists for the orexin-1 receptor, based on saturated substituted five-membered carbo- or heterocycles. According to the patent applications, the compounds have utility in therapeutic areas such as schizophrenia and other psychotic disorders, anxiety or addiction disorders, among others. The patent applications together describe almost 300 examples, and for most of them activity data, determined by Fluorescence Imaging Plate Reader (FLIPR) technology on the orexin-1 as well as the orexin-2 receptor, are disclosed. Structurally, the building blocks used to prepare the compounds are reminiscent of other orexin antagonist programs recently disclosed in the literature. However, the templates used are novel in the orexin antagonist field and are probably the key feature for the selectivity of the derivatives towards the orexin-1 receptor.

The serum levels of superoxide dismutase, malondialdehyde and nitric oxide in first episode generalized anxiety disorder patients: a control study

Objective To investigate the serum superoxide dismutase(SOD), malondialdehyde (MDA), and nitric oxide(NO)level in generalized anxiety disorder (GAD) patients for exploring the importance of oxidative stress in etiology of GAD. Methods 42 cases of first episode patients with GAD (GAD group) and 42 cases of health (control group) matched with age and gender were included . Serum levels of SOD, MDA , and NO were tested to analyze for a control study. Results GAD patients had significantly higher levels of SOD, MAD and NO than health controls ((858.09±137.32)×102 U/L vs (745.40±119.19) ×102 U/L; (10.92±3.42)mmol/L vs(7.52±2.32)mmol/L; (74.32±12.34) μmol/L vs(65.22±14.29) μmol/L), t=4.036, 5.368, 3.297; P=0.000, 0.000, 0.003). A positive relationship between SOD and total score of Hamilton Anxiety Scale(HAMA ), psychotic anxiety factor of HAMA, or somatic anxiety factor of HAMA was found in GAD group (r=0.331, 0.370, 0.318; P=0.029, 0.016, 0.040). The level of MAD correlated with total score or psychotic anxiety factor of HAMA(r=0.311, 0.320; P=0.042, 0.039). Conclusion It is suggested that the dysfunction of oxidative stress may play a role in pathogenesis of generalized anxiety disorder. Key words: Generalized anxiety disorder; Superoxide dismutase; Malondialdehyde; Nitric oxide

When the Outside World Changes: A Group's Attempts to Emerge from Apartheid

This was a plenary presentation at the 18th International Congress of IAGP ‘Between Worlds and Cultures: Social Transformation’ Cartagena de Indias, Colombia in 2012. The demise of the apartheid system in South Africa brought about a change in the external world so profound that all who lived through it sensed its unique, oncein- a-lifetime quality. Yet, alongside the palpable and widespread relief that a hated system had finally passed, there was also considerable anxiety as to possible threats that racism internalised into the mind during the apartheid years, working especially at an unconscious level, might pose for the future. This was not easy to address - it was often said that in the new South Africa one could not find anyone who had ever supported apartheid, which made it difficult to have a proper dialogue, at the personal level, about how that system had become so central to white thinking. It also led to concerns about what was being denied. This paper describes work in a small group setting that tried to investigate that anxiety. Early on, mention of an incident involving hidden racist dynamics led to a deadening paralysis. Paralysis of such intensity usually gives expression to psychotic anxiety but is also characteristic, I have found, of the deployment of internal racist defences. These comprise an organised us-them defensive system, constituted around a split between self and ‘racial’ other, which is a universal feature of the mind that can be mobilised to deal with anxiety - in the group’s case, underlying anxiety about change itself. It was not this anxiety that paralysed the group. Instead, it stemmed from an unconscious belief that the racialised defence was necessary for protection, which generates unbearable guilt and a fear of retribution. The intensity of these emotions and the paralysis they engendered stem from the racialised defence being located at a primitive level of functioning in the mind. Despite the intensity, the theoretical understanding that it occurs within a normal rather than psychotic mind made it possible to address the paralysis in a direct and ordinary way. This approach provided an opportunity to engage directly the defensive system in which the racist object relationship is located. Splitting became the group’s dominant defence, recreating an apartheid mindset in the here-and-now but the facilitator’s capacity to contain, by verbalising accurately what was being projected, enabled the group to work with the projections. I bring forward moving material that shows unconscious recognition of the fact that the group had traversed this apartheid terrain in its own short history, as well as its pain at losing such a containing space, seen as precious in a changing world that generates considerable anxiety and in which the regressive pull to a racialised defence is ever-present. Would its members, as individuals, be able to take forward into the world the learning from the group, or would they succumb to the unconscious pull of the radicalised defence?