Functional neurologic disorders in an adult with propionic acidemia: a case report

Background Inborn errors of metabolism are often characterized by various psychiatric syndromes. Previous studies tend to classify psychiatric manifestations into clinical entities. Among inborn errors of metabolism, propionic acidemia (PA) is a rare inherited organic aciduria that leads to neurologic disabilities. Several studies in children with PA demonstrated that psychiatric disorders are associated to neurological symptoms. To our knowledge, no psychopathological description in adult with propionic acidemia is available. Case presentation We aimed to compare the case of a 53-year-old woman with PA, to the previous psychiatric descriptions in children with PA and in adults with other inborn errors of metabolism. Our patient presented a large variety of signs: functional neurologic disorders, borderline personality traits (emotional dyregulation, dissociative and alexithymic trends, obsessive-compulsive disorders), occurring in a context of neurodevelopmental disorder. Conclusion Clinical and paraclinical examinations are in favor of a mild mental retardation since childhood and disorders of behavior and personality without any definite psychiatric syndrome, as already described in other metabolic diseases (group 3). Nonetheless, further studies are needed to clarify the psychiatric alterations within adult patients with PA.

Gender differences in attachment anxiety and avoidance and their association with psychotherapy use – Examining students from a German university

Background: Attachment anxiety and avoidance have been insufficiently studied in relation to psychotherapy use. Attachment theory, specifically attachment anxiety and avoidance, might explain gender differences in psychotherapy use, which is generally lower in those identifying as male. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal.Methods: A total of 44,299 students from a German university were invited to participate in an online survey on the topic of "studying with mental stress", and 4,894 completed the survey (adjusted response rate of 11.04%). The students answered questions regarding psychotherapy use, and they completed the Patient Health Questionnaire (PHQ-D) identifying syndromes of depression, anxiety, alcohol use, somatoform and eating disorders. In addition, the Experiences in Close Relationships – Revised (ECR-RD12) questionnaire, was used to measure attachment anxiety and avoidance.Results: Significant gender differences for attachment anxiety and avoidance emerged showing higher attachment anxiety in female students and higher attachment avoidance in male students. In addition, male students used psychotherapy significantly less than female students, and they also intended less to use psychotherapy in the near future. Male students did not differ from female students with regard to mental distress. When exploring regressions to predict psychotherapy use, male students’ attachment anxiety and avoidance predicted use. For female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety further emerged as a significant moderator of the association between suffering from a depressive or somatoform syndrome and current psychotherapy use. In essence, students not presenting a psychiatric syndrome and exhibiting higher attachment anxiety were more likely to use psychotherapy.Conclusion: Attachment anxiety and avoidance are positively associated with psychotherapy use; however, gender differences in attachment anxiety and avoidance may partially explain lower psychotherapy use in male university students. Lower attachment anxiety in male students emerges as a relevant factor explaining lower psychotherapy use in males, which is not balanced by higher attachment avoidance in males.

Homoeopathic Management of Conduct Disorder: A Case Series

Conduct disorder is a psychiatric syndrome occurring in childhood and adolescence, and is characterised by a long-standing pattern of violations of rules and antisocial behaviour. The aetiology of conduct disorder involves an interaction of genetic/constitutional, familial and social factors. Conduct disorder increases the risk of several public health problems, including violence, weapon use, substance abuse and dropping out of school. Thus, it is important to identify conduct disorder and begin intervention as early as possible.Three cases of conduct disorder are presented here, which have been treated exclusively with homoeopathic medicines without any supportive therapies. The diagnosis and severity were assessed by Conduct Disorder Diagnostic Tool and the symptomatic assessment was done by using Conduct Disorder Rating Scale-Parent Version. Possible causal attribution of changes was explicitly depicted by Naranjo Criteria.The initial outcome of homoeopathic treatment shows a positive role of homoeopathy as the cases are exclusively managed by homoeopathic medicine.

The association of oxytocin with major depressive disorder: role of confounding effects of antidepressants

Major depressive disorder is a genetic susceptible disease, and a psychiatric syndrome with a high rate of incidence and recurrence. Because of its complexity concerning etiology and pathogenesis, the cure rate of first-line antidepressants is low. In recent years, accumulative evidences revealed that oxytocin act as a physiological or pathological participant in a variety of complex neuropsychological activities, including major depressive disorder. Six electronic databases (Web of Science, PubMed, Scopus, Google Scholar, CNKI, and Wanfang) were employed for researching relevant publications. At last, 226 articles were extracted. The current review addresses the correlation of the oxytocin system and major depressive disorder. Besides, we summarize the mechanisms by which the oxytocin system exerts potential antidepressant effects, including regulating neuronal activity, influencing neuroplasticity and regeneration, altering neurotransmitter release, down regulating hypothalamic–pituitary–adrenal axis, anti-inflammatory, antioxidation, and genetic effects. Increasing evidence shows that oxytocin and its receptor gene may play a potential role in major depressive disorder. Future research should focus on the predictive ability of the oxytocin system as a biomarker, as well as its role in targeted prevention and early intervention of major depressive disorder.

Wearing the wolf skin: psychiatry and the phenomenon of the berserker in medieval Scandinavia

This paper examines the berserker, a frenzied warrior attested to in both the written and material sources of medieval Scandinavia, and elucidates the characteristics that define him. It critiques explanations for the phenomenon offered in the existing historiography and whether this can be explained as a psychiatric diagnosis. It concludes that the berserker cannot be simply defined as a culturally bound or other psychiatric syndrome, or accounted for by psychogenic drugs alone. Instead, it proposes that berserk frenzy constituted a transitory dissociative state shared among a small warband steeped in religious/spiritual ideology. In entering this state, the psyche of the berserker was reconstituted in an almost archetypal pattern. Further research is required into this phenomenon in other contexts, including modern conflicts.

Feeling the world as being here

A vast array of experimental results has recently shown that there is something specific in the way we perceive the space immediately surrounding the body, also known as ‘peripersonal space’, by contrast with the perception of what lies farther away. However, we seem to have no conscious awareness of peripersonal space as being ‘special’ in any sense. Instead, we are presented with a continuous visual field without a phenomenological boundary between what is close and what is far. The computational peculiarities of peripersonal perception thus seem to have no phenomenological consequences. Here I will argue that, when you see an object in the immediate surroundings of your body, not only do you have a visual experience of the object (comparable to the experience you can have of further objects), but you also experience what you see as being here. This sense of here-ness can be conceived of as a specific type of sense of presence. To better understand it, I shall turn to illusions in virtual reality and to the feeling of disconnection in the psychiatric syndrome of depersonalization.

Immunotherapy in Autoantibody-Associated Psychiatric Syndromes in Adults

Background: Autoantibody-associated psychiatric syndromes are often distinct from, but might also be part of autoimmune encephalitis. Our article focuses on potential immunotherapy in these patients with a probable autoimmune origin of their psychiatric syndrome.Methods: We searched through PubMed for appropriate articles on immunotherapy in autoantibody-associated psychiatric syndromes between 2010 and 2020 for this narrative review.Results: In line with prior recommendations for autoimmune encephalitis and autoimmune psychosis, we suggest that in patients with a probable autoimmune-based psychiatric syndrome should be given early corticosteroids, intravenous immunoglobulins, or plasmapheresis as first line immunotherapy. If these therapeutic options fail, second-line immunotherapy should be applied within 1 month consisting of rituximab or cyclophosphamide. Maintenance therapy is best for those patients responding to steroids including mycofenolate mofetil or azathioprine. So far, there is evidence from a few retrospective cohort studies supporting the usage of first- and second-line, and maintenance immunotherapies for autoantibody-associated psychiatric syndromes. Some immunological agents are discussed that might exert an effect in autoimmune-based psychiatric syndromes, but the latest evidence is low and derived from case reports or series with autoimmune encephalitis patients.Conclusions: Taken together, the immunotherapeutic landscape for patients with autoantibody-associated psychiatric syndromes is delineated. Our suggestions rely on observational studies in autoantibody-associated psychiatric syndromes and a few placebo-controlled, randomized trials for patients with autoimmune encephalitis and psychosis. Thus, adequate powered, prospective as well as placebo-controlled clinical trials in patients with autoantibody-associated psychiatric syndromes are warranted in order to enlighten efficacy and safety aspects of current and novel therapy strategies.

Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

Background: Delirium is a psychiatric syndrome observed among patients with critical psychiatric disorders. Haloperidol is now one of the first-line drugs for the treatment of delirium. However, quetiapine can be considered as an appropriate substitute in patients with a high risk of extrapyramidal symptoms or long QT syndrome. Objectives: This study aimed to compare the effectiveness of intramuscular haloperidol and oral quetiapine to control delirium in patients in the emergency department and intensive care unit. Methods: This randomized clinical trial was performed during 2017-2018 on patients with delirium who were referred to the emergency department and intensive care unit of Imam Reza Hospital (referral center), Mashhad, Iran. Patients were divided into two groups of 100 patients per group through a random allocation technique . In this study, 5 mg of intramuscular haloperidol every 12 hours and 25 mg of oral quetiapine were prescribed daily for the patients in the control and intervention groups, respectively. The delirium severity score of each patient was evaluated before and three days after the intervention through Delirium Rating Scale-Revised-98. Results: In this study, the mean±SD age of participants was 60.2±14.1 years. The findings indicated that no significant difference was observed between haloperidol (22.7±1.9) and quetiapine (22.7±2.2) groups in terms of the baseline delirium severity score (P=0.95). The mean delirium severity scores of patients in haloperidol and quetiapine groups were 25.6±2.1 and 25.2±2.5, respectively. Based on the obtained results, the difference between the delirium severity scores of both groups was not statistically significant (P=0.24). Conclusion: Based on the results, oral quetiapine has a similar effect as intramuscular haloperidol and can be used as a substitute to this medicine for controlling the symptoms of patients with delirium.

Psychopharmacology in Cancer Care

Clinicians who care for adult cancer patients have many tools to manage symptoms of depression, anxiety, cognitive changes, insomnia, and fatigue. Non-prescribing clinicians, such as psychologists, nurses, social workers, and occupational and physical therapists, provide frontline psychosocial interventions and physical support for cancer patients. Psychotropic treatments are sometimes required to resolve complex syndromes that mingle both medical and psychiatric features. Psychiatric medications are most frequently prescribed to cancer patients by oncologists, general medical practitioners, general psychiatrists, and psychiatric advanced practice providers such as nurse practitioners and physician assistants, as few oncology practices have dedicated psycho-oncologists. Non-prescribing practitioners who care for people with cancer are often the first to identify a psychiatric syndrome that requires a referral for psychopharmacologic intervention. They can also play an important role in educating patients about how psychopharmacologic agents can augment their cancer care. After psychotropic medications are started, non-prescribers can observe for improvement and detect problematic side effects if they arise, thus improving adherence with medication regimens. Practitioners who read this book will benefit from the highlighted clinical pearls to follow, and the potholes to avoid, regarding the tricky diagnostics and pharmacologic treatment of psychiatric syndromes. All clinicians will learn communication strategies that bridge distances of professional specialty and geography so that treatment by multiple providers may be more seamless, which it is hoped will enrich outcomes, both medical and emotional.