bluuebunny/crossref_metadata_2025 huggingface dataset:
Central nervous system vasculitis presenting as acute psychotic disorder
Authors: Fontes H. , Nzwalo H. , Mendes S. , Fernandes S. , Ponte G. , Pereira M.
Published: May 2011

Introduction

Acute psychosis can represent a diagnosis challenge. Several disorders can be implicated, and some representing a life threatening condition. We report a rare case of acute psychosis with persistent soft neurological signs as a primary presentation of a central nervous system vasculitis.

Results

A 23 year old man, with antecedent of depression, previous history of cocaine and marijuana abuse, admitted to an acute psychiatric ward with three days evolution of disturbed behavior, mainly isolation and immobility. On the psychiatric ward he appeared vague, with negativism, inattentiveness, and elementary and incoherent speech. He had unsystematised delusions. His neurological examination revealed a slight ataxic gait and discoordination, and signs of frontal lobe release. Initial extensive complementary study, including brain CT, EEG, and urine toxicology were negative. He began treatment with risperidone and clomipramine, with improvement of his mental condition, and by the second week he was able maintain a coherent speech. The neurological signs did not improve, and frequent falls appeared. We performed a brain MRI who revealed lesions compatible with vasculitis. The extensive liquor study was negative, with exception of proteins levels (56 md/dl). He was transferred to an internal medicine ward, treated with corticoesteroid. His condition improved in the following weeks and on discharge from Hospital he had recovered his mental status and was autonomous.

Conclusions

Psychosis is an uncommon presentation of central nervous system vasculitis. In cases of persistence or progression of the soft neurological signs, further complementary study is essential to exclude organic pathology.
Psychiatric intensive care units - designed for the patient ….designed for the environment
Authors: Kandasamy S. , Dooldeniya D. , Beezhold J. , Prabhu A. , Heffernan C.
Published: May 2011

Aims

This poster explores how Psychiatric Intensive Care Units can be designed using “green” technology in order to be environment-friendly whilst also meeting patient needs.

Method

Analysis of the new PICU at Hellesdon Hospital, Norfolk and Waveney Mental Health NHS Foundation Trust, United Kingdom. We describe how the architecture has been adapted from the standard mental health unit model to facilitate more intensive supervision. We will also examine the building design features that have been incorporated to ensure the lowest possible carbon footprint.

Results

Rollesby Ward (PICU) at Hellesdon Hospital won the Broadland design award 2009. It is a new, purpose built, building that provides a safe, user-friendly unit with en-suite accommodation; and rooms for seclusion, therapeutic activities and one to one sessions. The use of key cards and the layout of the bedrooms and lounge areas maintain patient privacy and dignity. A number of technologies have been used to minimise the building's carbon footprint. These include maximising usage of natural light and ventilation, underground rainwater tanks for flushing toilets, photovoltaic roof panels, and ground source heat pumps. Since the PICU has opened, 62.63 mwh of energy (35.57 tons of carbon) has been saved.

Conclusion

New build psychiatric units can successfully incorporate design features that deliver a better patient and therapeutic environment whilst also minimising the consumption of energy and the size of the carbon footprint.
Psychiatric advance directives: A stakeholders’ analysis on a multistage scenario
Authors: Lorant V.
Published: May 2011

Introduction

Involuntary admissions for the treatment of mental disorders affect 10% of mental health services users. Psychiatric Advance Directives (PADs) are documents that allow users notifying treatment preferences for crisis relapses. PADs have been experienced in several countries to improve users’ empowerment and reduce involuntary treatment. However, PADs take-up rate remains low and its effectiveness inconsistently evaluated. A hypothesis is that PADs should be considered as a process including its completion, registration, and honouring.

Aim

A Multi-Criteria Stakeholders’ Survey was carried out to understand what an optimal PAD process should be, and what the main hurdles are in implementing it.

Method

102 Belgian stakeholders were selected among users and non-users groups, and face-to-face interviewed. Each interviewee scored 20 different options in designing, completing, registering and honouring a PAD. Four criteria were assessed: patient's autonomy, therapeutic relationship, mental care continuity and feasibility.

Results

Overall, the PAD options aiming at improving access to the document and honouring statements received lower scores than options aiming its design or completion. Therapeutic relationship was a more important criterion than autonomy for the non-users than for the users group (p = 0.03). Options with the highest scores emphasized that PADs should be requested by the user, drafted in an outpatient setting, include de-escalating methods, justify treatment preferences, allow appointing a surrogate decision-maker, and need health providers training or a case-coordinator to be honoured.

Conclusion

PAD access and honouring are problematic steps of the process and should be developed to improve the use of PADs and its possible effectiveness
An audit of medical and nursing records of 100 emergency short-term (< 7 dys) psychiatric admissions to acute adult wards in Dumfries
Authors: Muir A. , Paul S.
Published: May 2011

Introduction

The study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.

Objectives

To evaluate the recorded admission and discharge processes in the medical and nursing notes.

To record relevant clinical characteristics of the admission and the patient.

Aims

To assess recorded admission and discharge processes against standards defined in the protocol.

Methods

A random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.

Results

51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.

Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.

Conclusions

The recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.
Emergency pshychiatric treatment in a multy-type hospital
Authors: Pyrkov P.P.
Published: May 2011

Objectives

We have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 beds

Methods

Clinicopshycopathologic, clinicotherapeutic, and statistical.

Results

1982 patients, 18–92 years of age, 64% of them males, have been examined.All the patients have been primary admitted with acute somatic disorders:insult - 18%,skull injury - 21%,myocardial infarction - 23%,exogenic poisoning - 31%,parasuicides -4%,operations on the thoracic organs - 3%.The mental disorders diagnosed were following:amnesic syndrome, organic - F04 - 29%,depression - F43.20 - 5%,organic hallucinosis - F06.0 - 12%,organic delirium - F05 - 33%,psychotic disorder - or drug induced - F1 - 21%.

Conclusion

After psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery. No one patient has been moved to the mental hospital.
The mental health assessment unit; A novel method for assessing new inpatients
Authors: Ulhaq S. , Ratnayake T. , Agius M.
Published: May 2011

Introduction

The Mental Health Assessment Unit (MHAU) isa gateway between community services and in-patient services. It aims to provide an acute setting in which to assess patients within 72 hours, with the view to reducing in-patient hospital admissions. We aimed to ascertain the number of referrals made to the MHAU and admissions over a one month period. The presentation and length of stay was investigated and the diagnosis and follow up plans made were explored.

Method

Data was collated from a one month period. Crisis and home treatment team (CRHT) notes were reviewed.

Results

100 referrals were made to the MHAU; 48 patients were admitted. 25 patients had care coordinators. In the majority of cases the source of referral was through the Emergency Department. There was a range of presenting complaints.Diagnoses included a wide variety of nature and severity. Average length of stay was 2 nights. Patients deemed to require in-patient management had shorter length of stay with swift transfer to treatment units. Shorter stays were also associated with milder degrees of illness. Longer length of stay was associated with more complex illness.

37 patients were discharged home, 11 were transferred to in-patient treatment units. Most patients discharged home were followed up by the CRHT.

5 patients were admitted to the MHAU more than once. This may represent a subgroup of more complex patients.

Conclusion

We recommend study into patients’ experiences with care coordinators at times of need. We also plan to re-audit for a longer time frame.
Hypokalemia, psychomotor agitation and prolonging the QTc
Authors: Vega M. , Riaza C. , Chinchilla A. , Gobernado I.
Published: May 2011

Introduction

There is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.

Aims

Evaluate the presence of hypokalemia in agitated psychiatric patients.

Methods

We chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).

Conclusions

These data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.
Relational ethics and psychiatry
Authors: Barbosa A.
Published: May 2011

In relationship centred medicine perspective it is essential to take into account an ethical principle model for our actions, in a meta-analytical foundational perspective, facing concrete and at the same time complex problems in health care, we have to frame them not in terms of strictly defined principles, either formulate them by general acontextual interpretations or resolve them through abstract procedures.

Clinical ethics has been enriched by several contributions that deepen a strict principalist perspective. It is from the observation that the clinic relationship creates, in a space and a time, conditions for the emergence of experiential values of the patient and of the professionals through which you can build a relationship of trust (and not through a process merely procedural), that other ethical questionings emerged in this problematization area (ethics of care, hermeneutics, narrative ethics, responsibility ethics).

We describe the way this theoretical and deliberative relational ethical model can be easily applied to different ethical issues in psychiatry practice and research.

Relational ethics integrates three basic polarities: creating conditions of personhood authenticity, developing a process of reciprocal mutuality and generating an opportunity of growth, development and enhancement. The hermeneutic helical deliberative process takes always in consideration the context relativity and contingency, the other's perspectives and, by creative co-authorship cooperation, allows the emergence of new possibilities of transformative developmental issues.
Trust and psychosis services: Bridging the gap between managing risk and meeting need
Authors: Brown P. , Calnan M.
Published: May 2011

Introduction

Research suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness - not least psychosis. There currently exists a paucity of research into trust and mental health services.

Aims and objectives

To develop an understanding of trust as it relates to psychosis services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice.

Method

Semi-structured interviews were carried out with 21 stakeholders - service-users, professionals, managers, carers - across 3 different types of service working with people experiencing psychosis: early intervention; assertive outreach; and a more standard community mental health team.

Findings

Trust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk.

Conclusions

Through an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes.
Attitudes and experiences to the implementation of the Mental Health Act 2001
Authors: Doherty A.M. , Jabbar F. , Kelly B.D.
Published: May 2011

Introduction

The Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.

Objectives

To examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.

Aims

To propose amendments to the legislation, based on the experiences elicited.

Methods

This cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.

Results

317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.

Conclusion

Nursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.
The informed consent not to be informed - a cross sectional survey on the use of placebo in clinical practice
Authors: Nitzan U. , Feffer K. , Lichtenberg P. , Lev-Ran S. , Becker G. , Fennig S.
Published: May 2011

Introduction

Current clinical practice excludes placebo usage on ethical grounds. No attempt was made to clarify the viewpoint of the general population regarding the matter.

Objective

To evaluate the opinion of young-adults towards the use of Placebo in clinical practice.

Aim

1)

Investigate the willingness of our study population to receive placebo for the treatment of depression or other general medical conditions, and

2)

assess whether prescribing placebo would affect the study population's view regarding doctor-patient relationship or patient's autonomy.

Method

We enrolled 344 students from five academic institutes in Israel, and briefed them thoroughly about the effects of placebo, its efficacy and limitations in treating depression. Understanding was verified and only then did the subjects complete a 32 item self-report questionnaire (include sociodemographic, health related data, past experience in medical encounters and willingness of subjects to be treated with Placebo medication).

Results

In contrast to our main hypothesis 70% (N = 243) of the subjects expressed consent to be treated with placebo as a first line treatment had they suffered from depression, and 73% (N = 248) agreed to receive placebo for other general medical conditions. Eighty-eight percent of the subjects (N = 297) did not perceive a physician using placebo as a deceiver or the act of prescribing it a deceit.

Conclusions

The majority of our study population was willing to use placebo medication in general, and in particular, as first line treatment for depression. This study results should promote physicians to rethink and discuss the legitimacy of using placebo in clinical practice.
Research and psychiatric disease
Authors: Friedrich O. , Heinrichs J.-H.
Published: May 2011

Research with psychiatric patients raises frequently discussed, ethical questions, one of which is: Can psychiatric patients give consent to participation in research at all? To answer this and similar questions adequately, it is - according to our thesis - necessary to analyze first, which theoretical assumptions are made in established practice.

To solve the question after the possibility of consent, compatible understandings of ‘disease’, ‘illness’ and ‘autonomy’ are crucial, but there is no consensual use of these terms in philosophy. Therefore we first are going to explain different concepts of ‘autonomy’ and ‘disease’. Subsequent to this we will test how the different conceptualizations of ‘autonomy’ and ‘disease’ can be related to each other and how the reasonable combinations shape possible answers to the opening question. It will become apparent that an adequate analysis of ‘autonomy’ and ‘disease’ raises ethical dilemma in psychiatry, for which we shall suggest possible solutions.
An alert in the psycho-social-health intervention. A graphic testimony of a real case with autism spectrum disorder
Authors: García J.A. , Raya A.S. , del Arco E.S.
Published: May 2011

The graphic papers of Pablo, 14 years, diagnosed of autism of high functioning, serve as a sign of alert when facing what underlies after the specializing professional intervention.

A few letters, a few drawings, and a few words that show the powerlessness, the suffering and the absence of contextual specific adequacy.

In this work we study, from the analysis of a real case, some excellent aspects in the psychosociosanitary attention, such as:

-

The need for compilation of pertinent information

-

The need for elimination of prejudices

-

The need for respect to the family

-

The need for specialized formation

-

The need for search of a shared communicative code

-

The need for search of strategies of social interaction

-

The need for empathy

-

The need for search of contextual specific adequacy

-

The need for rigorous rules in the physical containment.

-

The need of a turned over of adapted information

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The need to respect the psychoevolutive situation of the patient

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The need to give priority to the person on the illness.

A testimony that should serve as a warning for those institutions, administrations and professionals who are thinking of having put all the resources to its scope.

A testimony that should serve to contribute information and new challenges to those other professionals who do not stop their determination of conceptual and/or clinical anxious research.
Ethical implications of team approach in art therapy in lithuania
Authors: Gostautaite Midttun N. , Survilaite D.
Published: May 2011

In 2004 Art Therapy Lab was created to investigate viability of team approach in art therapy in psychiatry. Five projects were carried out between 2004–2010. These projects were based on cooperation between medical professionals, professional artists and members of user organization. During these projects adherance to ethical regulations was assesed, ethical difficulties and dillemas were noted and discussed. This paper will discuss main ethical problems that were relevant in those projects and provide recomendations on how to solve and prevent them.
Impact of disease concepts on attitudes towards alcohol dependent patients
Authors: Heberlein A. , Schuster R. , Frieling H. , Glahn A. , Bleich S. , Hillemacher T.
Published: May 2011

Introduction

Stigmatizing attitudes regarding mentally ill people are common (Rusch et al., 2010). Study result suggest that the degree of stigmatization may depend on concepts of psychiatric diseases (Crisafulli et al., 2008).

Aims

We aimed to investigate the impact of a sole neurobiological vs. a sole sociodynamic disease concept on the attitudes of students towards the alcohol dependent patients (Crisafulli et al., 2008).

Methods

200 students were randomly assigned to read information explaining alcohol dependence sole neurobiologically/sociodynamically. Subsequently, the students completed a series of questionnaires (adapted from Crisafulli et al. (2008)) regarding their attitudes towards the alcohol dependent patients. Attitudes were compared to attitudes of students not exposed to any disease concept.

Results

Consistent with former study results we found increased blaming and decreased willingness to finance therapy in those students exposed to the sociodynamic explanation. Attitudes regarding blaming and harmfulness of the alcohol dependent patients were increased in the neurobiological and sociodynamic group compared to the un-exposed control group.

Conclusions

Information regarding possible causalities regarding the development of alcohol dependence is associated with more negative attitudes towards alcohol dependent patients in the questioned students compared to unexposed controls. This may be reasoned by the recognition of alcohol dependence as a manifestation of mental illness and the subsequent inclusion of the alcohol dependent patients in the prejudices and acts of discrimination commonly leveled against the mentally ill. Therefore, multimodal interventions rather than medicinal information seem to be necessary in order to decrease stigmatization of the alcohol dependent patients.
Psychiatry, politics and national socialism
Authors: Pereira S.M. , Bohun J. , Guimarães S.
Published: May 2011

Introduction

The misuse of psychiatry by politics during dictatorships has mainly happened in the first half of the last century during the Third Reich and Stalinist period in Soviet Union. Even today the psychiatric diagnoses may be changed in an abusive way for politic purposes as they were in the past. This may undermine the credibility of psychiatry. The psychiatric professional organizations only recently start to discuss and investigate this issue.

Methods

The authors made a literature review in historic and psychiatric books. They also visited some memorial sites were psychiatry and dictatorship were sadly connected in history. Using as main example the abuse made by psychiatrists as a politic instrument in the Third Reich period, the authors aim to make a historic review about the relationship between psychiatry and politics.

Conclusion

Abuse and misuse in psychiatry may also easily be done nowadays. Psychiatry is a science with not so clear boundaries, what is normal or abnormal may be sometimes unclear mainly if not seen in a serious and ethic perspective. Because of this psychiatrists should be very clear about their position in ethics, science and society.

The psychiatric professional organizations should face the facts of the tragic relationship between psychiatry and politics in history, discussing this issue more openly for an appropriate understanding of the past and for preventing new errors in the future.
“I am gaining weight- get me out of here.” what happens to body mass index (BMI) following admission to a medium secure unit?
Authors: Abbasi Y. , Bowlie S. , Bloye D.
Published: May 2011

Introduction

A diagnosis of mental illness has been associated with weight gain, particularly among patients suffering from schizophrenia1.

Aims & objectives

This study aims to establish trends in weight gain among inpatients and the effects of several public health interventions between 2006 and 2009.

Methods

A body mass index (BMI) was calculated on admission and one of the authors has routinely measured the BMI of all inpatients on an annual basis since 2005 as part of a regular audit cycle.

Results

Admission BMIs are comparable to the male general population2. The vast majority of patients are prescribed antipsychotic medication, approximately 50% receiving clozapine or olanzapine at any given time. There is a wide range of weight change from admission to discharge (−8.5 kg to +60 kg) but the average BMI of each sample exceeds the general population such that a majority of patients in each sample are clinically obese (BMI ≥30).In response to the audit findings the unit promoted public health and individual care plans (2006–09) aimed at addressing the high rates of obesity. Despite these initiatives there was a substantial rise in mean BMI between July 2007 and February 2008.

Conclusions

Admission to a medium secure unit results in substantial weight gain for the majority of patients. The causes of weight gain in a relatively closed institution are probably multi-factorial in origin.
Development of nurse's attitude towards forensic psychiatric patients scale
Authors: Baysan Arabacı L.
Published: May 2011

Aims

The research was applied in a methodological type in order to develop a scale for the purpose of determining the nurses’ attitudes related to forensic psychiatry patients and to determine the availability and reliability of the scale developed.

Methods

The research was carried out with 650 nurses accepted to participate the research.Evaluation of the data was carried out over 536 questionnaires.In the research, Information Form, Belief Towards Mental Illness Scale(BMIS) and Nurse's Attitude Towards Forensic Psychiatric Patients Scale(NAFPPS) were used. NAFPPS was developed in two processes as qualitative and quantitative. In theoretical process, “focus group discussion” and “composition forms” and various attitude scales developed in psychiatry field in literature were used.In experimental process, validity and reliability analysis was built up.

Results

Content validity index(CVI) was found .69, concurrent validity with BMI was found as .44, Cronbach Alpha coefficient determining the internal consistency was found as .86 and cluster correlation coefficient was found as .86, ön-test ile son-test arasındaki tutarlılığı belirleyen stability factor determining the consistency between pre-test and post-test was found as .69. It was determined that NAFPPS consisted of four lower dimensions.The highest point that can be acquired from the scale is “125”, the lowest point is “25”.High point shows the positive attitude towards the forensic psychiatry patient.

Conclusions

In the direction of these data, it was determined that Nurse's Attitude Towards Forensic Psychiatric Patients Scale was a valid and reliable scale.
Judicialized treatment in severe mental disorder
Authors: Campos Mangas M.C. , Ruiz Feliu M.A.
Published: May 2011

Introduction

Involuntary outpatient treatment (IOT) is a form of involuntary treatment applied in the community, which seeks to ensure adherence to treatment in patients suffering from severe mental illness, unaware of disease and in which abandonment of treatment poses a high risk of relapse, with the development of disruptive and violent behavior, and repeated hospitalizations (usually involuntary) and frequent emergencies.

In 1997 was the first time was implemented in the province of Guipúzcoa, Spain.

Objectives

Perform an analysis of IOT in two mental health centers of San Sebastian.

Methods

Retrospective descriptive study. The sample comprised all patients who are on involuntary outpatient treatment in two mental health centers in San Sebastian, from 2009 until June 2010.

The collection of information is conducted through a review of the patient’s medical history, analyzing the following demographic and clinical data: age, sex, psychiatric diagnosis, evolution of the disease, number of hospital admissions and care in emergencies

Results

A sample population of 42 patients. 58% are male and 42% female. The average patient age is 48 years. The youngest person is 18 years and 81 years older.

The years of evolution of the illness range from 2 to 25 years, with an average of 12 years. The average hospital admissions per patient is 4.

For diagnosis, schizophrenia is the most common mental disorder. In second place: delusional disorder, bipolar disorder and schizoaffective disorder.

Conclusions

IOT is most often applied to people with schizophrenia which have severe relapses with violent behavior or noncompliance.
Capgras’ syndrome: A case report
Authors: Cimino L. , Atti A. , Moretti F. , Morini V. , Attili T. , Forlani M. , Biondini A. , De Rochi D.
Published: May 2011

Introduction

The delusional misidentification syndromes (syndromes of Frégoli, Intermetamorphosis, Subjective Doubles and Capgras) are characterized by delusions of misidentification of other persons or of one-self. Aggressive ideas or behaviours often go with these delusions, but the problem received relatively little attention. Capgras’ Syndrome is characterized by the delusional belief that a well-known person has been replaced by a double. The delusion frequently involves significant others and takes place in a paranoid atmosphere with feelings of strangeness and unreality. We stress the importance of considering the potential dangerousness and homicidal acts directed towards family members of patients with Capgras’ Syndrome.

Methods

We report a case with histories of paranoid schizophrenia and alcohol and cannabis intoxications who developed a Capgras’ Syndrome associated with homicidal behaviours toward his wife.

Results

Our case met DSM IV-TR diagnostic criteria for paranoid schizophrenia, according to previous studies which show that paranoid schizophrenia is the most frequent mental disorder associated with delusional misidentification. The psychopathological analysis show that homicidal acts are connected to anguish of the ego disintegration and failure of defense mechanisms.

Conclusions

According to the most recent literature, our findings suggest that Capgras’ Syndrome may be linked to a genesis of aggressive behaviours; alcohol and substance intoxications facilitates impulsivity and dissociation. The patients’ acting out directed toward family members occurs during a psychotic breakdown. Capgras’ Syndrome should always be evaluated in order to prevent violent acts.
Psychometric correlations between MMPI-2 and aggressivity
Authors: Cimino L. , De Ronchi D. , Atti A.
Published: May 2011

Introduction

The use of standardized and objective instruments constitutes a support to the clinical observation in order to evaluate particular and general aspects of an individual's psychic life, and it can represent a valid aid in the evaluation and prediction of aggressivity. Our aim is the assessment of the MMPI-2 ‘s predictive capacity, a self-report personality test, constituted of 567 items, evaluating possible aggressive acts.

Method

20 subjects with a history of aggressivity, in the absence of major psychiatric disorders, were examined. The MMPI-2 test was administered to them, so as to assess their profile with reference to the aggressivity's indicators. It was also administered to a control group of subjects without a history of aggressivity.

Results

In all the examined offenders, unlike the control group, were observed low T values in the K scale (< 40), an increase in the Pd base scale (>65) and supplemental scale O-H (>65); with respect to the derivative indexes, it was noticed a scarce adaptive capacity (Hy< Pa), a low tendency to the tolerance of frustrations and a negative value at T points in the PAI (Hy+100)-(Pd+2Pa).

Conclusion

In concordance with the literature data, the MMPI-2 can be a useful support in evaluating the risk of aggressivity. Subjects at risk of acting out show low values in the K scale (< 40), high values in the Pd scale (>65). Other particularly important risk indicators are: code types 4/6, 4/8, 468, a scarce adaptive capacity (Hy< Pa) and a scarce tolerance to frustrations.
Posthumous forensic psychiatric examinations in litigations about capacity to contract
Authors: Daskevicius K. , Marcinkeviciene J. , Kazeniene Z.
Published: May 2011

The particular difference of testamentary capacity is that unlike common civil capacity it cannot be limited. The authors’ objectives were to estimate the trends of diagnostics and conclusions in post mortem forensic examinations about capacity to contract, to establish the main diagnostic groups and to evaluate the factors of influence on experts’ choice.

Data base and methodology

All of the 147 statements on capacity to contract drawn by forensic psychiatrists in Lithuania during the period of five years. The data were sorted by a special questionnaire worked out by the authors. Statistical analysis was done by Pearson correlation method, using SAS, SPSS program packages for statistical processing.

Results and conclusions

Posthumous examinations made up only 2.7 per cent among all accomplished in 5 years. Witnesses testimonies in 51.7 cases were so contradictory that half odf them had been discarded from considering. Medical files made the major material, however 16.5 per cent of them were psychiatrically irrelevant. 46.2 per cent contained descriptions of mental disorders, the subjects had not been consulted by psychiatrists. From all registered mental pictures 86.6 per cent had a background of somatoneurological disorder, and 13.4 per cent of mental syndrome had no association to physical condition. Mental disorder or severe somatic pathology alone do not always determine patient's incapacity. Due to experts’ 45 per cent contracts were nullified.
Profile of involuntary hospitalized patients
Authors: Djokic N.S. , Vukic D.V.
Published: May 2011

The involuntary hospital treatment is presented as one of the most current problems in psychiatry at all, but not enough explored in Serbia. Because of extremely high percentage of involuntary hospitalized mentally ill people in Serbia, it’s particularly important to study all aspects of involuntary hospitalization. The aim of this paper is to determine recognizable profile of involuntary hospitalized patients, based on a detailed analysis of the social-demographic characteristics. This study included 8762 patients, hospitalized in Special Hospital for Psychiatric Disorders Gornja Toponica nearby Nis, during the period of five calendar years. There were 2812 voluntary hospitalized patients (32.1%) and 5950 involuntary hospitalized patients (67.9%). Comparative analysis of the involuntary hospitalized, showed statistically significantly greater number of male patients, not of the Serbian national or ethnic origin, who were not married, unemployed, who reside in southeastern Serbia outside the place where the hospital is located. Given the fact that 1298 patients or 21.8% of total involuntary hospitalized were hospitalized because of F10 (Disordines mentales et disordines morum propter usum alcholis), the paper discusses details of the validity for the involuntary hospitalization in these and other diagnostic categories. This data is a valuable contribution to the forthcoming reform of psychiatric services in the Republic of Serbia and practical contribution to the changing criteria for involuntary hospitalization to its reduction.
Paternal filicide in arab culture: A study of 5 men
Authors: Eid S.A.
Published: May 2011

Introduction and objectives

Paternal filicide is the killing of a child by his or her father. These offences are rare but when happened they are traumatic to the community and people. Most of published studies focused on child homicide in Westernized developed societies. The aim of this study is to shed light on this rare phenomenon in Kuwait.

Methodology

The psychiatric, socio-demographic profiles and the religious background of 5 filicidal men hospitalized at Kuwait Psychological Medicine Hospital forensic unit between 2001 and 2005 were reviewed. Information was obtained from a number of sources including:

1- hospital files

2- Police reports,

3-newspaper reports.

Data including psychiatric, psychological as well as criminological assessment of these cases were analyzed in detail.

Results

The average age of those men was 35.6 years (SD ± 4.3 years) with a range of 30 to 42 years. Two men have been diagnosed as schizophrenia; one substance related psychotic disorder (they have active psychotic symptoms at the time of offence and committed their offence under these symptoms), another one depression, and the fifth one has no psychiatric disorder. Religious beliefs and conventions colored the offence in two incidents. Eight of the victims (total number 10) were girls. One filicide man killed his spouse during the act.

Conclusions

Paternal filicide, while unthinkable crime by most people, is seen in developing as well as in developed societies. The impact of cultural and religious background of the filicidal on the act was discussed.
Acquired brain injury and violent offending: prevalence and risk factors
Authors: Faruqui R.
Published: May 2011

Introduction

Acquired brain injury has been reported to be associated with violence.

Objectives

To determine whether an association exists between acquired brain injury and violent offending

Aims

Study an association between brain injury and crime and identify associated risk factors.

Methods

Systematic search of Medline, Embase, PsychInfo, CINAHL, TRIP, using terms, Acquired brain injury, traumatic brain injury (TBI), head injury, frontal lobe, crime, offending, violent offending, sexual offending, prison.

Results

A:

Multiple studies reported higher life time history of head injury in prison or offender populations in comparison to control groups. Sampling bias and case definition problems have influenced reported prevalence of head injury in offender population ranging from 3.3% to 82%. Reports from secure psychiatric services identify that patients with history of head injury may be more difficult to discharge. Community based studies report cognitive damage as significant risk factor for domestic violence.

B:

Large scale population and military cohorts have reported a higher relative risk for criminal conviction in mild traumatic brain injury (TBI) group. TBI increases the risk of mental disorder by two-folds but also that TBI is significantly related to mental disorder with co-existing criminality.

C:

Childhood conduct problems, loss of a parent, substance misuse, maternal drug use in pregnancy, impaired executive cognitive functioning, structural damage to orbito-frontal and ventromedial areas, amygdala, and hippocampus are reported as risk factors for violent offending in this population group.

Conclusions

The review provides evidence for an association between brain injury and violent offending and also identifies associated risk factors.
PTSD and ICD-10: clinico-social conсeption
Authors: Fastovtsov G. , Oskolkova S.
Published: May 2011

The aim of the investigation

To determine clinical-dynamic characteristics of combat-related PTSD for best understanding etiologocal and pathogenesis bases in mentioned category.

Subjects

478 male combatants aged 22–43 y.o., observed in 1993–2008 years.

Methods of investigation

Clinico-psychopathological; quality of life self-evaluating scales, IES-R and statistical.

According to ICD-10, only one diagnostical category - “reaction to hard stress and adaptation disturbance”- is identified as having explicit etiological connection with psycho-traumatic extraordinary impact. Negative mental symptomatology in combatants is reflected there as “chronical personality changes after catastrophe”.

Contrary to “classical” position personality change may be its chronical outcome and the diagnosis should be stated not only after 2 years. That's why the period of urgent adaptation is characterized by regressive, ontogenetically more early forms of reacting; conscience disintegration.

Appearance of more prolonged and more specifical PTSD symptomatology reflects pathoplastic later development.

PTSD can be understood as a transforming reactive process, fixating in memory traces new behavioral stereotypes. Specifical adaptation in military conditions happens because of cortical behavior control's depression and deep-undercortical philogenetically old vital affects releasing (as the biological base). Positive PTSD symptomatology in combatants are repeated memories about psychotrauma, often transform into obsessive-phobic complexes. In case of increased cortex inhibition impulsive behavior's motives are formed. Initial war stress is complicated by the necessity to adapt to usual conditions and it often becomes a basis for behavioral deviations. That's why we should consider the treatment and rehabilitation of such persons one of the priority medical and social tasks in XXI century.
Essessment of criminal aggression at combatants with posttraumatic stress disorder by horowitz scale
Authors: Fastovtsov G. , Sokolova E.
Published: May 2011

As an observation object for this research were taken veterans of local wars with posttraumatic stress disorder. Research materials were based at analysis of representative group, contains of 478 man, who were doing their military service at the areas of local armed conflicts with clinics of posttraumatic stress disorder. The main group contains of 344 man who committed an aggressive crime and passed an examining in Serbsky National Research Center for Social and Forensic psychiatry, Moscow. For the contrast group were taken 134 man, who were under the treatment in military hospitals.

To educate specialty and estimate severity of posttraumatic stress disorder was used the Impact of Event Scale-Revised, IES-R. Reliable difference were received. Clinics of this disorder includes not only intrusion, avoidance and hyperarousal, but organic mental disorders also.

This scale was officially accepted in Russian science academy. Intrusion scale contains of such factors as obsessive flashbacks at the influence of stress factors and nightmares. Avoidance scale includes attempts to avoid experience, connected with stress event and reactivity reduce. Symptoms of third scale includes irritability, tension, emotion instability, difficulties of attention concentration. For patients who committed crimes the level of intrusion and hyperarousal was reliably higher. No difference was found at the avoidance. For assessment of aggression risk were created special models, based on subscale IES-R. The results of regression analysis showed the predictors of criminal aggression. The research permits to make prognosis for criminal aggression as a complicated form of posttraumatic stress disorder.
Clinical criteria stability for involuntary psychiatric admission: comparison of two samples of portuguese patients compulsorily admitted ten years apart
Authors: Gracias M.J. , Talina M.
Published: May 2011

Introduction

Since 1999 the Portuguese law envisages compulsory admission as a Court decision based on major psychiatric criteria: dangerousness and need for treatment. The rate of compulsory versus total admissions in Portugal has increased since then, maintaining, however, one of the lowest reported rate in Europe. This trend is also noted in other European countries and there is a current debate concerning the underlying reasons.

Objectives

To examine whether the decision criteria for compulsory admissions has changed over time in a general hospital in Lisbon.

Methods

We conducted a retrospective study in two non-probabilistic samples of compulsorily admitted patients with no prior involuntarily admissions in a general hospital in Lisbon: the first one hundred patients admitted in 1999 and the last one hundred admitted in 2009 were selected. Data was collected from patient files using a standardized questionnaire.

Results

There were no significant differences between samples concerning age, gender, employment, living alone, duration of illness, duration of hospital stay, drugs use or mandatory outpatient treatment. The diagnostic of affective disorders, the overt violent behaviour and depot medication at hospital discharge increased significantly (p < 0.05) in the 2009 sample.

Conclusions

There seems to be no changing in the decision criteria of compulsory admission envolving sociodemographic variables. The increasing rate of compulsory admissions may be due to the increasing admission of patients presenting affective disorders and overt aggressive behaviour, and hence, this may be caused by the application of criteria of dangerousness and of need for treatment.
Forensic aspects of schizotypal patients
Authors: Klembovskaya E. , Fastovtsov G.
Published: May 2011

Schizotypal disorder comprises a wide spectrum of schizophrenic disorders from personality to sub-psychotic disorders. As a result, psychiatric evaluation of this psychopathology is ambiguous and a challenge to forensic psychiatry. The other important side of the problem is the prevention of social aggression of these patients.

For the aim of investigation of these aspects a cohort of 82 patients was studied. All of them committed crimes and had been diagnosed “schizotypal personality disorder”(12), or “schizotypal disorder” (pseudopsychopatic (38), pseudoneurotic schizophrenia (13), schizophrenia with bare symptoms (16), schizophrenic reaction (3).

We found that the main criteria for the forensic psychiatric evaluation of schizotypal disorders include personal, social and clinical aspects. The patients with schizoptypal personality disorder can demonstrate mostly integrity of cognitive sphere and singularity of emotions, also rather high level of social adjustment. The patients with mild forms of schizophrenia show pathology in sphere of thinking and emotions, social problems, so the psychiatric forensic conclusion can be different from irresponsibility.The main factors of criminal aggressive behavior of patients were pseudopsychopatic syndrome with disability of critical functions and brutish behavior pathology.