Case Report: Catatonia Associated With Post-traumatic Stress Disorder

We report here about a 12-year-old female patient who had two life-threatening accidents that led to post-traumatic stress disorder associated with catatonia. She had closed eyes, had urinary and fecal incontinence, and had been in an abnormal position for one and half month. Moreover, she had complications such as dehydration, malunion of the fractured arm, and deformities in hand and foot. After detailed psychiatric examination, neurological assessment, and laboratory investigation, the patient received successful treatment in the form of benzodiazepine injections, intravenous fluid, oral antidepressants, and six sessions of electroconvulsive therapy (ECT). We discuss the pathophysiology of catatonia, which remains elusive, and recommend evaluating catatonic children for any possible trauma during psychiatry assessment.

PROVISION OF QUALIFIED LEGAL ASSISTANCE TO VICTIMS AND WITNESSES WITH DEVIANT BEHAVIOR: POSING A PROBLEM

Ensuring the protection of the rights of the individual is the purpose of criminal proceedings, regardless of the procedural status of its participant. The most vulnerable individuals with different psychophysiological differences are subjected to various types of criminal attacks, while protecting themselves and their interests is quite problematic due to intellectual development or physical condition, which raises the question of ensuring the possibility of their participation and protection of rights in the adversarial process. A difficult situation exists in protecting the rights of a witness who, whether he or she is an accidental eyewitness to the event or a witness to the event by the victim or the accused, is exposed to the representatives of the parties concerned, which raises the question of ensuring the protection of the rights of witnesses. Often, persons with deviant deviations, both social and psychobiological, act as witnesses and victims, but the possibility of establishing the circumstances of the case depends on the truthful and objective testimony of victims and witnesses. The need to provide victims with deviant deviations with qualified legal assistance, providing for the participation of a representative lawyer, was justified, and the grounds for the mandatory participation of a representative lawyer of the victim were determined. When a witness manifests deviant behavior, he should consult a psychiatrist, with pronounced mental abnormalities, prescribe a forensic psychiatric examination. Given the peculiarities of deviant behavior, it is proposed to decide on the use of a representative lawyer to provide him with qualified assistance.

Depression and anxiety in patients with suspected renal artery stenosis

Objective: To investigate the occurrence of depressive and anxiety disorders in patients remitted for endovascular treatment of renal artery stenosis (RAS), and whether symptoms of depression and anxiety can be reduced after the treatment of RAS with percutaneous transluminal renal angioplasty (PTRA). Methods Patients: Selected for renal angiography with pressure measurement in the renal arteries due to suspected RAS were invited to participate in the study. 37 patients agreed to answer a questionnaire. Eighteen patients also agreed to a clinical psychiatric examination including the International Neuropsychiatric Interview (M.I.N.I. 6.0) to be diagnosed according to the DSM-IV. Results: Twenty-one of the 37 patients completing the questionnaire were found to have a pressure gradient of ≥ 10 mmHg at angiography, indicating significant stenosis. Ten of the 18 examined patients met the criteria for current DSM-IV anxiety diagnosis and two patients had a current depression. Three of the 18 examined patients had previously made a suicide attempt. Conclusion: The results of this study suggest that patients with suspected RAS have a high psychiatric comorbidity, as 56% of the patients undergoing psychiatric examination met the DSM-IV criteria for a current anxiety disorder.

A new approach regarding to the recognition of an individual incapable

The article is devoted to the analysis of the procedural order of consideration and resolution of cases related to the change of an individual’s legal status, namely - recognition of an individual incompetent. The article analyzes the updated procedure for declaring an individual incompetent. The author of the article draws attention to the fact that the legislator has expanded the range of litigants in this type of proceedings; has provided for the possibility of direct participation of the person in respect of whom the proceedings for recognition of his/ her incompetence were initiated, both in-person and his/ her participation in the case through a videoconference from the medical institution where such person is at that moment; has set the terms of the court decision on declaring an individual incompetent, for not more than two years; has granted the right to certain entities to apply for an extension of the decision declaring an individual incompetent, which may be filed no later than fifteen days before the end of two years; has granted a person who was declared incompetent the right to apply to the court with a request to cancel the court decision, etc.It is noted that the validity of a court decision declaring an individual incompetent, which is provided by law, requires certain clarifications. It is substantiated that the obligatory appointment of a forensic psychiatric examination during the consideration of the case and to confirm the request for extension of the decision validity also requires some clarification, depending on the individual’s state of disease. The author considers the views of scholars and practitioners regarding mandatory participation in the consideration of an individual’s incompetence cases and the cancellation of a court decision on such cases - a lawyer who will provide adequate judicial protection and effective civil proceedings. It is concluded that it is expedient to expand the range of entities authorized to initiate the issue of revoking a court decision declaring an individual incompetent, supplementing them with such a participant as a prosecutor, which in turn will guarantee access to court, promote fair judicial protection of rights, freedoms, and interests of the persons, making a lawful and reasonable decision.

Undisclosed probing into decision-making capacity: a dilemma in secondary care

Background The assessment of patients’ decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions. Main text Decision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception. Conclusion The necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems.

The Collective Mental State Examination as Predictive Tool for Assessing Unfavourable Political Outcomes

The purpose of this article is to establish that the mental state examination, a fundamentally important part of individual psychiatric examination, also has a role to play in the diagnosis of situations that could have potentially harmful political outcomes for whole societies. This is because societies operate through a collective mental state which is in a state of constant variability and at times can present a situation of extreme vulnerability. Political leaders of an infinite range of intentions can work through the collective mental state to mine the bedrock of collective consciousness, where national identity resides, to produce outcomes that can hugely range from beneficial to disastrous.

ABOUT THE DELIRIUM OF CORONAVIRUS SELF-CONTEMPT

Based on observations from forensic psychiatric practice and the review of the literature, we describe for the first time the delirium of the "coronavirus (self)contempt". An elderly patient after coming through COVID-19 infection began to consider himself and his wife a distributor of the coronavirus infection, constituting himself a danger to the public. Against the background of feeling of impending doom, he felt the sense of disgrace, shame and self-contempt for himself and expected a negative attitude from others, including discrimination, so he was ready to commit suicide. Under the influence of these delusional ideas, he tried to kill his wife and himself, but by a lucky chance all the defendants in the case remained alive. The forensic psychiatric examination recognized him insane. Delirium of the coronavirus (self)contempt is a sensual delusion that develops against the background of a severe stress (or depression), by the conditions of formation (character, experience, environment) it resembles sensitive reference delusion. The paper discusses the involvement of self-stigmatization (stigma and discrimination) phenomena, the influence of COVID-19 on the development and pathoplasty of delusional (super-valuable) ideas in this psychopathological phenomenon.

Sports psychiatric examination in competitive sports

Pre-Participation Examination (PPE) is recommended in many countries prior to or during the practice of competitive sports. The dedicated exploration of psychological complaints and illnesses in the sense of a psychiatric basic assessment within the PPE is not yet the rule. The implementation of a Psychiatric Basic Assessment (PBA) in the PPE is proposed and presented in terms of content. Abnormal findings in the PBA, crises, emergencies as well as conspicuous changes in behaviour should lead to further sports psychiatric evaluation (SPE) by child, adolescent and adult psychiatrists and psychotherapists qualified for this purpose. The goal is to use diagnostic and procedural standards to identify risks to mental health, stress, and already manifest illnesses in a timely manner and to provide qualified, specialized medical or psychiatric treatment. The diagnostic standards are intended to promote research and the benefits are to be verified by studies. Key Words: Psychiatric Basic Assessment (PBA), Sports Psychiatric Evaluation (SPE), Mental Health, Mental Disorders, Pre-Participation Examination (PPE)

Indices of Victimization in Minor Victims of Sexual Violence and Abuse

The article presents the results of a comprehensive psychological and psychiatric examination of 117 minor victims of sexual violence and abuse. A qualitative and quantitative analysis of cases of sexual violence and abuse against minors was used, depending on the degree of the victims ' ability to understand the nature and significance of the illegal sexual acts committed with them and to resist them. The comparison criteria are identified: the type of violence and abuse, the age of the victim, the presence of a mental disorder in the victim, and the features of interaction in the "victim – assailant" dyad. 4 groups of victims are described, which differ in the degree of understanding of the criminal situation and the ability to resist, and indicators of victimization and victim behavior of children and adolescents are highlighted. The prospects for future research are outlined, which can improve the effectiveness of expert conclusions and preventive measures.