A case of catatonia in the aftermath of the COVID-19 pandemic: does autism spectrum matter?

Background There is growing concern about the psychopathological consequences of the COVID-19 pandemic. The prolonged stress due to the spreading fear of the contagion and to the enforced containment measures are deemed to trigger recurrences of preexisting mental disorders as well as the onset of new ones. From such perspective, clinical cases may be of primary ground to identify individual features and pandemic-related factors predisposing to the development of serious psychiatric symptoms. Case presentation Mr. R. is a 64-year-old, married, unemployed man, whose premorbid personality was characterized by relevant autistic traits. The patient developed catatonia in the context of the COVID-19 pandemic. We aimed at discussing the role of both preexisting and precipitating factors. Conclusions Autism spectrum could represent a predisposing factor for severe psychopathological outcome and catatonia. Furthermore, the present clinical case highlights the role of COVID-19 pandemic in influencing physical and mental health.

Predictors of Behavioral and Psychological Symptoms in Community-Dwelling Older Adults With Dementia

Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, the current understanding is limited as it considers BPSD as a homogenous construct, not accounting for its heterogeneity. Therefore, this study explored the predictors of BPSD subsyndromes, and built prediction models for these subsyndromes in community-dwelling older adults with dementia in Korea. This prospective study consisted of a two-wave dataset. We fit the generalized linear mixed models using Wave 1 data (N = 145) and then validated them using Wave 2 data (N = 59). BPSD and their proximal factors were assessed on a daily basis using diaries written by family caregivers. Sleep and activity levels were objectively measured using actigraphy. The amount of nighttime sleep hours was significantly associated with next-day sleep and nighttime behaviors (OR = 0.87; p = 0.005), with the amounts of energy expenditure showing significant association with euphoria/elation (OR = 0.02; p = 0.019). All subsyndromes except euphoria/elation were found to be significantly associated with either hunger, thirst, urination, or bowl movement; with all BPSD showing a significant association with environmental changes. We also found several background factors, including premorbid personality and taking sedatives as predictors for specific subsyndromes. The area under the receiver operating characteristic curve scores for the data were greater than 0.9 and 0.8 in Waves 1 and 2, respectively, across all subsyndromes. Prediction models for BPSD will help in the development of symptom-targeted, individualized interventions.

On the learning of addictive behavior: Sensation-seeking propensity predicts dopamine turnover in dorsal striatum

We asked if sensation-seeking is linked to premorbid personality characteristics in patients with addictive disorders, or the characteristics follow the sensation-seeking activity. We interpreted the former as a state associated with normal rates of dopamine synthesis, and the latter as a trait of individuals with abnormally high rates of synthesis. We previously determined dopaminergic receptor density in striatum, and we now tested the hypothesis that an elevated dopaminergic condition with increased extracellular dopamine and receptor density follows increased dopamine synthesis capacity in highly sensation-seeking individuals, as measured by positron emission tomography of 18 men with tracer fluorodopa (FDOPA). We detected a site in left caudate nucleus where the volume of distribution of FDOPA-derived metabolites correlated negatively with FDOPA metabolite turnover, consistent with decreased metabolite breakdown in highly sensation-seeking subjects. High rates of sensation-seeking attenuated the dopamine turnover in association with a low rate of dopamine recycling, low dopamine oxidation, and elevated extracellular dopamine and receptors in caudate nucleus. In contrast, low rates of sensation-seeking were associated with rapid dopamine recycling, rapid dopamine oxidation, low extracellular dopamine, and low receptor density. We conclude that the modulation of dopaminergic neurotransmission associated with sensation-seeking is a state of sensation-seeking, rather than a trait of personality following abnormal regulation of dopaminergic neurotransmission.

The Frontal Behavioral Battery: A Measure of Frontal Lobe Symptoms in Brain Aging and Neurodegenerative Disease

Background: Approximately 90%of persons living with dementia experience behavioral symptoms, including frontal lobe features involving motivation, planning, social behavior, language, personality, mood, swallowing, and gait. Objective: We conducted a two-stage study with a development sample (n = 586) and validation sample (n = 274) to evaluate a brief informant-rated measure of non-cognitive features of frontal lobe dysfunction: the Frontal Behavioral Battery (FBB). Methods: In the development sample, internal consistency, principal factor analysis, and correlations between the FBB and outcomes were evaluated. In the validation sample, we examined (a) FBB scores by diagnosis, (b) known-group validity by demographics, subjective complaints, and dementia staging, and (c) correlation between FBB and MRI volumes. Receiver operator characteristic curves assessed the ability of the FBB to discriminate individuals with frontal lobe features due to a neurodegenerative disease. Results: The FBB characterized 11 distinct frontal lobe features. Individuals with dementia with Lewy bodies and frontotemporal degeneration had the greatest number of frontal lobe features. Premorbid personality traits of extroversion, agreeableness, and openness were associated with fewer frontal lobe behavioral symptoms, while subjective cognitive complaints were associated with greater symptoms. The FBB provided very good discrimination between individuals with and without cognitive impairment (diagnostic odds ratio: 13.1) and between individuals with and without prominent frontal lobe symptoms (diagnostic odds ratio: 84.8). Conclusion: The FBB may serve as an effective and efficient method to assess the presence of non-cognitive symptoms associated with frontal lobe dysfunction, but in a brief fashion that could facilitate its use in clinical care and research.

A closed loop audit of clerking psychiatric histories in an acute psychiatric inpatient unit

AimsAn accurate and complete history is a key component of a medical consultation. Evidence suggests that up to 80% of diagnosis may be made entirely off the patient history. The aim of this closed loop audit was to examine the effects of a clerking pro forma on the quality of doctors clerking histories of new patients admitted to an acute psychiatric inpatient unit, against standards suggested in the New Oxford Textbook of Psychiatry.MethodData for this audit were gathered by finding the initial clerking history for inpatients at The Orchard on ECR and RIO. The clerking histories of the 18 inpatients present on 12.10.20 were initially audited. These standards recommend in the in the New Oxford Textbook of Psychiatry include; Patient Identification (ID), Presenting Complaint (PC), History of Presenting Complaint (HPC), Psychiatric history, Medical history, Family history, Forensic history, Social history, Personal history, Premorbid personality, Mental state exam (MSE). After analysis of the results of the first loop, a clerking pro forma was created and distributed to junior doctors to implement. The clerking histories for the subsequent 18 patients to be admitted were then audited and compared.ResultThe results of the first audit cycle were poor. Only patient identification and presenting complaint were present in 100% of clerked histories. Concerningly, only 72% of the histories included the patients’ medical histories, forensic histories were included 44% of the time, and social history just 39% of the time.The implementation of a clerking history proforma showed improvements in all areas of clerking. Patient ID, PC, HPC, psychiatric history and MSE were now present in 100% of clerked histories. Forensic history showed a statistically significant improvement from 44% to 73% [X2(1) = 5.9; p = 0.015]. Social history showed a statistically significant improvement from 39% to 78% [X2(1) = 5.6; p = 0.018]. Premorbid personality showed a statistically significant improvement from 44% to 89% [X2(1) = 8.0; p = 0.005]. Personal history showed a non-statistically significant improvement from 39% to 56%, as did medical history from 72% to 94%, and family history from 39% to 61%.ConclusionIn conclusion, the implementation of a clerking history pro-forma has significantly improved the quality and completeness of clerking histories gathered by doctors at The Orchard. This is hopefully increase diagnostic accuracy and improve the quality of care of patients in the hospital.

HISTRIONIC IMMATURE PERSONALITY DISORDER

Background: We aim at presenting a clinical case of a 37-year-old patient, who has been a nun for several years and at the moment can no longer adapt to the environment in which she lives and to the requirements of everyday life. The perspective of this analysis is both a psychiatric one, explaining the diagnosis of Axis II of Histrionic Immature Personality Disorder, but also the overlap with dissociative conversion disorder, and explanatory from a psychodynamic perspective, by addressing the regression issues and the presence of the Oedipus Complex. Histrionic Immature Personality Disorder and its overlap with Dissociative/Conversion Disorder are conditions with negative effects in terms of adaptation to the social environment and assuming professional responsibilities. Also, the particularities in the sphere of immaturity make it difficult to relate to those around. Method: Hospitalization, psychiatric interview, psychodynamic interview, psychological tests - CAQ Personality Questionnaire and the Szondi Test, psychodynamic interpretations. Results: The results highlight aspects of an immature premorbid personality, characterized by a high degree of sensitivity. Currently, the patient's ego is fragile and cannot adapt to the emotional meanings in the environment in which she lives, which leads to functional crises and manifestations such as dissociative fugue. Conclusions: Dissociative manifestations are associated with immaturity and reduced ability to adapt to professional requirements. On a personal level, the same immaturity leads to the denial of one's sexuality and projection.

THE ROLE OF PSYCHOLOGICAL REHABILITATION IN THE TREATMENT OF PATIENTS WITH LUNG TUBERCULOSIS

The article is devoted to current issues of psychological rehabilitation of patients with pulmonary tuberculosis. The article focuses on the specifics of psychological assistance. Itsubstantiates the need to organize special psychocorrectional programs aimed at overcoming premorbid elements of the relationship system, which are considered as psychological risk factors for the occurrence of the tuberculous process and its relapses.Keywords:pulmonary tuberculosis, psychological rehabilitation, premorbid personality characteristics, relationship system, therapeutic targets