Sadistic sexual assault, perversion and schizophrenia: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S594-S594
Author(s):  
M. Zghal ◽  
F. Fekih Romdhane ◽  
G. Jmii ◽  
F. El Ghali ◽  
A. Belkhiria ◽  
...  
Keyword(s):  
Case Report ◽  
Criminal Responsibility ◽  
Clinical History ◽  
Review Literature ◽  
Psychotic Symptoms ◽  
Sexual Perversion ◽  
Sexual Impotence ◽  
Forensic Psychiatric ◽  
Competing Interest ◽  
Psychiatric Department

IntroductionIn some forms of sexual perversion, sexual satisfaction is achieved only by treating one's partner violently (sadism) or conversely, by suffering pain (masochism).Objective and methodThe objectives of our study were to understand the complex relationship between psychotic and perverse structures, and discuss the importance of some criminal risk factors for psychotics who have sexually perverse behaviors, through clinical observation and review literature.Case reportMr AB was 35-year-old, single and unemployed. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of emasculation on a child aged 5 years without sexual abuse. In his biography we have objectified cruelty to animals, charged judicial history (imprisonment for theft, murder and escape from prison, hetero aggressive acts) and substance use.The patient explained with indifference that he heard voices making fun of his “sexual impotence and loss of his manhood”. The day of the forensic act, he got an uncontrollable urge to emasculate the first man he met on his way at the behest of this hearing hallucinatory activity. Psychiatric experts retained the diagnosis of psychosis with perverse arrangements. Under neuroleptic treatment, psychotic symptoms disappeared but the patient's sadistic problems remained present and active throughout his hospitalization.ConclusionThe following case illustrates the issue of dangerousness and responsibility in a perverse psychotic author assault of a sexual nature. Given their clinical history, the path between perversion and psychosis shows that perverse manifestations are prior to the first psychotic symptoms and the perverse constitution is developed parallel to the psychotic illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Incest in the Schizophrenic patient: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S588-S588
Author(s):  
M. Mezghani ◽  
F. Fekih-Romdhane ◽  
F. El Ghali ◽  
M. Zghal ◽  
G. Jmii ◽  
...  
Keyword(s):  
Case Report ◽  
Sexuality Education ◽  
Clinical Observation ◽  
Criminal Responsibility ◽  
Patient Case ◽  
Annihilation Anxiety ◽  
Psychiatric Expertise ◽  
Competing Interest ◽  
The Individual ◽  
The Relationship

IntroductionIncest may be defined as sexual relations between close blood relatives. Legally, incest and sexual aggression toward minors are classified as a criminal behaviour. Tunisia is among the countries from which incest cases are rarely reported.Objectives and methodThe aim of this study is to investigate the relationship between the psychotic structure and incest, and to describe the individual, clinical, and criminal traits of the incestuous father through clinical observation.Case reportMr T.G is 46 years old. He is married and has six daughters. His wife appears to be passive, and largely dependent on her husband. Mr T.G has had incestuous relationships, initially, with his two eldest daughters. The acts were followed by the mother's complicit silence and the non-denunciation of the daughters. Two years later, he starts an incestuous behavior with his third daughter. Incest took place in the context of delusion. The patient was convinced that he is responsible of his daughters’ sexuality education. He develops an incoherent theory of purification with a tendency towards morbid rationalism. It is only after four years of insufferable paternal incestuous relationships that the third daughter filed a complaint to the police. A psychiatric expertise concluded that the accused is exempt from criminal responsibility.ConclusionIncest is a multi-faceted phenomenon, which makes its approach, comprehension, and treatment quite complex. For a psychotic patient incest is a means to deny alterity by crushing other. It also allows him to find, in this complete power, control over his annihilation anxiety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Culture and mental disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S517-S517
Author(s):  
A. Adrián ◽  
C. Noval Canga ◽  
H. Rebeca ◽  
S. Isabel ◽  
G. Sofía ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Mental Disorders ◽  
Psychiatric Diagnosis ◽  
Emergency Service ◽  
Psychotic Symptoms ◽  
Sociocultural Factors ◽  
Psychiatric History ◽  
Sexual Content ◽  
Competing Interest

ObjectivesShow with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.Methods and materialsSeventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.ConclusionWhenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cycloid Psychosis: A Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S532-S532
Author(s):  
G. Martinez-Ales ◽  
I. Louzao ◽  
A. Irimia ◽  
M.F. Bravo ◽  
J. Marin
Keyword(s):  
Case Report ◽  
Psychotic Disorders ◽  
Clinical History ◽  
Diagnostic Systems ◽  
Cycloid Psychosis ◽  
History Of ◽  
Competing Interest ◽  
High Index Of Suspicion ◽  
Clinical Pictures ◽  
Restitutio Ad Integrum

IntroductionEpisodes of time-limited acute psychosis, with full recovery in between, are categorized as acute polymorphic psychotic or brief psychotic disorders. Leonhard described the three forms of cycloid psychosis (CP). Perry considers it a separate entity.Case reportWe report the case of a 54-year-old male, with a 9-year history of brief psychotic disorders. He was admitted to an inpatient unit after a 4-day episode of persecutory delusion, leading to high emotional repercussions and isolation at home. Euthymia was present. Previous admissions, 9 and 5 years before, presented similar clinical pictures. Treatment with low dose paliperidone during 6-month periods had led to the complete resolution of the episodes (restitutio ad integrum: no psychotic manifestations and the ability to run his business). In this episode, 8 days after the reintroduction of 12 mg of paliperidone per day, cessation of the symptoms took place. Careful reconstruction of the clinical history showed no stressors or drug consumption. And immediately previous 5-day phase of insomnia, hyperactivity and expenditure was described by the patient's wife.DiscussionThree inpatient admissions, a careful clinical history and a thorough review of the evidence regarding Perris criteria led to a diagnosis of CP.ConclusionCP, a classical nosological approach, is helpful in a clinical setting, as it might imply different prognosis and treatment. Recognition of CP, not included as an entity by the major diagnostic systems, requires a high index of suspicion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

2016 ◽  
Vol 33 (S1) ◽  
pp. S546-S546 ◽  
Author(s):  
H. Maatallah ◽  
H. Ben Ammar ◽  
M. Said ◽  
A. Aissa
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Symptoms ◽  
Review Of Literature ◽  
Blood Cell Count ◽  
Life Threatening ◽  
Dsm Iv ◽  
Competing Interest

IntroductionAntipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.Objective and methodsDefine epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.Case reportPatient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.ConclusionThis case report shows the importance of hematological monitoring during the course of typical or atypical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Obsessive symptoms in schizophrenia: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S573-S574 ◽  
Author(s):  
S. Benavente López ◽  
N. Salgado Borrego ◽  
M.I. de la Hera Cabero ◽  
I. Oñoro Carrascal ◽  
L. Flores ◽  
...  
Keyword(s):  
Case Report ◽  
Effective Dose ◽  
Mood State ◽  
Physical Restraint ◽  
Psychotic Symptoms ◽  
Minimum Effective Dose ◽  
Obsessive Compulsive ◽  
Behavioral Disturbances ◽  
Compulsive Disorder ◽  
Competing Interest

IntroductionSchizophrenia could be presented with obsessive thoughts or an obsessive-compulsive disorder. It is known that some antipsychotics like clozapine could cause obsessive symptoms or worsen them.Case ReportWe report the case of a 53-year-old male who was diagnosed of schizophrenia. The patient was admitted into a long-stay psychiatric unit due to the impossibility of outpatient treatment. He presented a chronic psychosis consisted in delusions of reference, grandiose religious delusions, and auditory pseudohallucinations. He often presented behavioral disturbances consisted in auto and heteroaggressive behavior, being needed the physical restraint. Various treatments were used, including clozapine, but obsessive and ruminative thoughts went worse. Because of that, clozapine dose was lowed, and it was prescribed sertraline and clomipramine. With this treatment the patient presented a considerable improvement of his symptoms, ceasing the auto and heteroaggressive behavior, presenting a better mood state, and being possible the coexistence with other patients. Psychotic symptoms did not disappeared, but the emotional and behavioral impact caused by them was lower.DiscussionThis case report shows how a patient with schizophrenia could present severe behavioral disturbances due to obsessive symptoms. If obsessive symptoms are presented, clozapine must be at the minimum effective dose and antidepressants with a good antiobsessive profile.ConclusionsObsessive symptoms could be presented as a part of schizophrenia. Clozapine could worsen this symptoms and it is necessary to adjust its dose to the minimum effective dose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differential diagnosis and therapy of cycloid psychoses: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s843-s843
Author(s):  
A.M. Uminska-Albert ◽  
G. Eikmeier
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Clinical Course ◽  
Complete Recovery ◽  
Psychotic Symptoms ◽  
Cycloid Psychosis ◽  
Cycloid Psychoses ◽  
Endogenous Psychoses ◽  
Icd 10 ◽  
Competing Interest

Kraepelin already challenged his dichotomy of psychoses, because in clinical practice too many cases were not in line with his pattern. Different terms for these disorders were coined. Leonhard separated cycloid psychoses from other forms of endogenous psychoses. The idealized subtypes (anxiety-beatific, hyperkinetic-akinetic-motility and confusional exited-inhibited) are characterized by a bipolar course with complete recovery. Operationalised criteria were developed by Perris. We report on a 60 year old woman diagnosed as schizophrenic in 1984/1985 and 2006. In August 2015 she was admitted with stupor and mutism and therefore was treated with fluphenazine and lorazepame. Six days later the clinical picture changed, she became confused and very agitated. After change of treatment to benperidole her clinical condition improved within 12 days. After 3 further days she became confused, agitated and euphoric again. The symptoms persisted in spite of a change of treatment to haloperidole. After diagnostic revision therapy was augmented with lithiumcarbonate. Six days later the psychotic symptoms began to improve and were completely remitted after 10 further days. The case report points out that a differential-diagnostic revision of an apparently therapy-resistant schizophrenia should not only be carried out according to ICD 10 criteria but a cycloid psychosis should be taken into account, too. Perris-criteria are contrasted with ICD 10-criteria for schizophrenia and mania with psychotic symptoms. Symptomatology and clinical course in our patient fulfilled exactly the Perris-criteria. We recommend an augmentation trial with lithium in acute phases of cycloid psychoses by all means before ECT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hyperthyroidism and Psychotic Symptoms: a Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S440-S441
Author(s):  
S. Benavente López ◽  
N. Salgado Borrego ◽  
L. arroyave Villa ◽  
C. Hernández Durán ◽  
E. Muro Fernández de Pinedo ◽  
...  
Keyword(s):  
Case Report ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Psychiatric Symptoms ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Generalized Anxiety ◽  
Thyroid Function Tests ◽  
Competing Interest ◽  
Thyroid Profile

IntroductionHyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia. in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.Case reportwe report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms. an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.Discussionin this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.ConclusionsHyperthyroidism is very common in general population, being infradiagnosed most of times. in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder. in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

2017 ◽  
Vol 41 (S1) ◽  
pp. S591-S591
Author(s):  
S. Khouadja ◽  
S. Younes ◽  
S. Chatti ◽  
R. Ben Soussia ◽  
L. Zarrouk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mentally Ill ◽  
University Hospital ◽  
Acting Out ◽  
Psychiatric Assessment ◽  
Schizophrenic Patients ◽  
Forensic Psychiatric ◽  
Competing Interest ◽  
Psychiatric Department ◽  
Forensic Psychiatric Assessment

IntroductionMany studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.Aims of the studyDescribe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.MethodologyA retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.ResultsAge average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.ConclusionThe knowledge of risk factors improves the management and allows us better prevention of violence among our patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Recurrent Depression Over An Schizoid Personality. Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S504-S504
Author(s):  
M.C. Cancino Botello ◽  
F. Molina López ◽  
J.M. Hernández Sánchez ◽  
A. Peña Serrano ◽  
M.D.L.A. Canseco Navarro
Keyword(s):  
Personality Disorder ◽  
Personality Traits ◽  
Clinical History ◽  
Psychotic Symptoms ◽  
Recurrent Depression ◽  
Schizoid Personality ◽  
Schizoid Personality Disorder ◽  
Competing Interest ◽  
Depressive Episodes ◽  
Depression Disorder

IntroductionAccording to Millon, personality is a “complex pattern of psychological factors, which are mostly unconscious and express themselves automatically in almost every functional dimension of the subject”. It has been described how personality traits can modify the expression of other mental diseases, leading to confusion in diagnosis and treatment of the patient.MethodSystematic review of the literature in English (PubMed) and clinical history of the patient. Keywords: “recurrent depression disorder”; “schizoid personality”.ObjectiveTo highlight the importance of making an accurate and detailed diagnostic formulation, in patients with both mental and personality disorders.CaseSixty-seven-year-old woman, with many psychiatric hospitalizations, secondary to a recurrent depression disorder with psychotic symptoms and schizoid personality disorder. Both psychiatric monitoring and pharmacological treatment have been erratic. Initially, depressive episodes were considered as symptoms of her personality disorder. However, over the years, it was possible to make a more accurate diagnosis and a better treatment adjustment. In this case, lack of adherence is probably due to multiple factors, but no awareness of illness and personality disorder itself are the most important ones. This fact makes the patient less concerned about her personal care, leading to irregular treatment.ConclusionsPeople with schizoid, schizotypal or paranoid personality traits usually have a worse outcome, and they interfere with the functionality of the patient. This explains the importance of making an accurate and detailed diagnostic formulation, in order to benefit the course of the underlying mental disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis-related polydipsia and chronic hyponatremia – A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S578-S578
Author(s):  
F. Gonçalves Godinho ◽  
A.L. Melo ◽  
S. Marques ◽  
D. Barrocas
Keyword(s):  
Case Report ◽  
Water Intake ◽  
High Water ◽  
Psychotic Symptoms ◽  
Water Restriction ◽  
Psychogenic Polydipsia ◽  
Behavioral Measures ◽  
Severe Hyponatremia ◽  
High Water Intake ◽  
Competing Interest

IntroductionPsychogenic polydipsia has an estimated prevalence of 6–20% in psychiatric population. Although first described in the 1930s, there are few studies addressing this problem and its management. The high water intake can lead to severe hyponatremia with a mortality rate high enough to merit clinical concern.AimsReport a case of a schizophrenic patient with psychogenic polydipsia and hyponatremia.MethodsRetrospective review of the clinical file and literature research on this topic.ResultsA 41-year-old man with a long-term schizophrenia presented to the emergency room (ER) with exacerbation of psychotic symptoms. In the prior 24 months, he had stopped medication and began excessive water intake (5 to 10 L/day). He presented with auditory hallucinations, passivity phenomena and persecutory and other delusional thoughts that justified this behavior – “The water will end; I have to stock it, like camels do”. Presently he had an asymptomatic hyponatremia (128 mg/dL), but 6 months before he had been admitted in the ER with vomiting, altered state of consciousness and convulsions secondary to severe hyponatremia (108 mg/dL). During the present hospitalization, organic causes of hyponatremia were excluded and he was started on behavioral measures and antipsychotics. The psychotic symptoms improved and there was no need for water restriction after the first week, with restored natremia values on discharge.ConclusionsWith this case report we intended to raise awareness on this potentially fatal condition that despite its prevalence has no defined diagnostic criteria, nor established controlled trials concerning the effectiveness of treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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