Dream-Reality confusion: differential psychiatric diagnosis in narcoleptic subjects / Confusão sonho-realidade: diagnóstico psiquiátrico diferencial em narcolépticos

Dream-reality confusion (DRC) is the consequence of hypnagogic content confusion with real events and memories. Narcoleptic subjects eventually have DRC and can be misdiagnosed as schizophrenic or with another disorder with delusional or hallucinatory symptoms. Although dream-related experiences and hallucinatory perception share neurophysiological pathways, they are phenomenologically distinct. The lack of phenomenological intentionality in Dreamrelated perceptions, the different cognitive pathways for delusion generation, and other differences between mental disorders psychopathology, and DRC-related phenomena are here discussed. The lived world and awake experience interpretation, and dream neurobiology in narcoleptic subjects related to DRC, might indicate some hints for the mind-brain gap issue that still exists in neurology and psychiatry.

A confusão entre realidade e sonho (CRS) é a consequência da confusão do conteúdo hipnagógico com eventos e memórias reais. Sujeitos narcolépticos eventualmente têm CRS e podem ser diagnosticados erroneamente como esquizofrênicos ou com outro transtorno com sintomas delirantes ou alucinatórios. Embora as experiências relacionadas ao sonho e à percepção alucinatória compartilhem vias neurofisiológicas, elas são fenomenologicamente distintas. A falta de intencionalidade fenomenológica nas percepções relacionadas ao sonho, as diferentes vias cognitivas para a geração do delírio e outras diferenças entre a psicopatologia dos transtornos mentais e os fenômenos relacionados à CRS são discutidos aqui. A interpretação do mundo vivido e da experiência de vigília, e a neurobiologia dos sonhos em sujeitos narcolépticos relacionados à CRS, podem indicar algumas dicas para a questão do gap mente-cérebro que ainda existe na neurologia e na psiquiatria.

Impregnated with delusion: A case of pseudocyesis

Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. It is the conviction of a non-pregnant woman that she is pregnant. Here, we present a case of pseudocyesis in a 45-year-old woman Para 2 Living 2 currently in her second marriage of 15 years. The management of pseudocyesis is multidisciplinary, including psychiatrists, gynecologists, and psychologists. The goal of treatment is to help patients perceive the meaning of their symptoms and to help resolve the associated stressors.

Estructura factorial del Síndrome de Cotard: revisión sistemática de reportes de caso / Factor Structure of Cotard's Syndrome: Systematic Review of Case Reports

RESUMEN Introducción: El síndrome de Cotard es de rara aparición en la clínica psiquiátrica. Debido a esto, la información actual se basa principalmente en reportes y series de casos. Objetivo: Analizar las características psicopatológicas y la agrupación de los síntomas de los casos de síndrome de Cotard reportados en la literatura médica. Métodos: Se realizó en la base de datos MEDLINE/PubMed una búsqueda sistemática de la literatura de todos los casos de síndrome de Cotard reportados desde 2005 hasta enero de 2018. Se recolectaron variables demográficas y las características clínicas de cada caso. Se realizó un análisis factorial exploratorio de los síntomas. Resultados: La búsqueda identificó 86 artículos, de los cuales 69 eran potencialmente relevantes. Luego de la revisión de los textos completos, se seleccionaron 55 artículos para la revisión sistemática, entre los cuales se hallaron 69 casos. En el grupo de más edad con síndrome de Cotard fueron más frecuentes los diagnósticos de depresión mayor (p < 0,001) y trastorno mental orgánico (p = 0,004). El análisis factorial exploratorio arrojó 3 factores: depresión psicótica, en la que se incluye a los pacientes con delirios de culpa (0,721), ideas suicidas (0,685), delirios de condena (0,662), delirio nihilista del cuerpo (0,642), depresión (0,522) y delirios hipocondriacos (0,535); delirante-alucinatorio, con pacientes que sufrían delirio de inmortalidad (0,566), alucinaciones visuales (0,545) y delirio nihilista de la existencia (0,451), y mixto, con pacientes que sufrían delirio nihilista de los conceptos (0,702), ansiedad (0,573) y alucinaciones auditivas (0,560). Conclusiones: La psicopatología del síndrome de Cotard es más compleja que la simple asociación con el delirio de estar muerto, ya que abarca una estructura factorial organizada en 3 factores.

ABSTRACT Introduction: Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series. Objective: To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature. Methods: A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed. Results: The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P < 0.001) and organic mental disorder (P =0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560). Conclusions: The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.

Psychosis associated with anti-N-methyl-d-aspartate receptor encephalitis

Aim: Anti-N-methyl D-aspartate (NMDA) receptor encephalitis is commonly seen in women with various neuropsychiatric symptoms. Here we report a case of psychosis associated with anti-NMDA receptor encephalitis. Case description: A 22-year-old woman was admitted with acute onset fever, generalised tonic-clonic seizures, reduced speech output, and delusion of persecution for one week. She was found positive for anti-NMDA receptor antibodies and anti-thyroid peroxidase antibodies. Her psychotic symptoms improved with antipsychotics, immuno-modulators, and steroids within two months. Conclusion: A possibility of anti-NMDA receptor encephalitis should be kept in mind in young women presenting with psychotic symptoms. It is ideal to liaise with neurologist to screen all such cases with suspicion of autoimmune encephalitis visiting a psychiatry clinic.

Ekbom Syndrome associated with Lewy Body Dementia: A case report / Síndrome de ekbom associada à demência com corpos de lewy: um relato de caso

ABSTRACT Ekbom Syndrome, also known as parasitosis delusion or psychogenic parasitosis, is a rare condition in which patients present with a fixed belief of being infested by parasites, vermin or small insects, along with tactile hallucinations (such as pruritus or sensations of the parasites crawling over or under the skin). The syndrome may occur idiopathically or be associated with other medical conditions and drug use. This case report describes the occurrence of Ekbom syndrome in a patient diagnosed with Lewy Body Dementia (LBD), a neurodegenerative disease that commonly presents with sensory perception and thought disorders and other neuropsychiatric symptoms. Although visual hallucination is considered a core diagnostic criterion, other modalities of psychiatric symptoms can also occur posing a further challenge for correct diagnosis. Proper recognition allows early diagnosis and adequate treatment, preventing hazardous antipsychotic use in these patients.

RESUMO A síndrome de Ekbom, também conhecida como delírio parasitário ou parasitose psicogênica, é uma condição rara na qual os pacientes apresentam crença fixa de estarem infestados por parasitas, vermes ou insetos, acompanhada de alucinações táteis (como prurido ou sensação dos parasitas andando sobre ou sob a pele). A síndrome pode ocorrer de forma idiopática ou associada a outras condições médicas ou uso de drogas. Este relato de caso descreve a ocorrência da síndrome de Ekbom em um paciente diagnosticado com Demência com corpos de Lewy (DCL), uma doença degenerativa que comumente se apresenta com desordens de sensopercepção e pensamento, e outros sintomas neuropsiquiátricos. A alucinação visual é considerada um dos critérios diagnósticos nucleares, entretanto outras modalidades de sintomas psiquiátricos podem ocorrer criando desafios adicionais ao diagnóstico correto. O reconhecimento apropriado permite o diagnóstico precoce e tratamento adequado, prevenindo o uso arriscado de antipsicóticos nesses pacientes.

Prevalence of Capgras syndrome in Alzheimer's patients: A systematic review and meta-analysis / Prevalência da síndrome de capgras em pacientes com doença de alzheimer: uma revisão sistemática e metanálise

ABSTRACT The association between Capgras syndrome and Alzheimer's disease has been reported in several studies, but its prevalence varies considerably in the literature, making it difficult to measure and manage this condition. Objective: This study aims to estimate the prevalence of Capgras syndrome in patients with Alzheimer's disease through a systematic review, and to review etiological and pathophysiological aspects related to the syndrome. Methods: A systematic review was conducted using the Medline, ISI, Cochrane, Scielo, Lilacs, and Embase databases. Two independent researchers carried out study selection, data extraction, and qualitative analysis by strictly following the same methodology. Disagreements were resolved by consensus. The meta-analysis was performed using the random effect model. Results: 40 studies were identified, 8 of which were included in the present review. Overall, a total of 1,977 patients with Alzheimer's disease were analyzed, and the prevalence of Capgras syndrome in this group was 6% (CI: 95% I² 54% 4.0-8.0). Conclusion: The study found a significant prevalence of Capgras syndrome in patients with Alzheimer's disease. These findings point to the need for more studies on the topic to improve the management of these patients.

RESUMO A associação da síndrome de Capgras com a doença de Alzheimer é relatada em diversos estudos, porém a sua prevalência varia consideravelmente entre bibliografias, dificultando a real mensuração e manejo desta patologia. Objetivo: O objetivo deste estudo foi estimar, através de uma revisão sistemática, a prevalência da síndrome de Capgras em pacientes com a doença de Alzheimer, bem como revisar os aspectos etiológicos e fisiopatológicos relacionados à síndrome. Métodos: Uma revisão sistemática foi realizada utilizando-se as seguintes bases de dados: Medline, ISI, Cochrane, Scielo, Lilacs e Embase. A seleção dos estudos, extração de dados e análise qualitativa foi feita por dois pesquisadores de forma independente e seguindo rigorosamente a mesma metodologia, sendo as discordâncias resolvidas por consenso. A metanálise foi calculada utilizando-se modelo de efeito randômico. Resultados: Foram recuperados 40 estudos, dos quais 8 foram incluídos na presente revisão. Considerando todos os estudos incluídos, 1977 pacientes com doença de Alzheimer foram analisados, sendo encontrada a prevalência da síndrome de Capgras dentre esses pacientes de 6% (IC: 95% I² 54% 4,0-8,0). Conclusão: A presente revisão encontrou uma prevalência significativa da síndrome de Capgras nos pacientes com doença de Alzheimer. Tal achado implica na necessidade de mais estudos visando melhorar o manejo desses pacientes.

Síndrome de Capgras: una revision de la literatura / Capgras syndrome: a review of the literature

Los síndromes de falsa identificación delirante (DMS, por su sigla en inglés) son trastornos neuropsiquiátricos poco frecuentes que se caracterizan por tener ideas delirantes respecto a la propia identidad y la de otras personas, animales o lugares conocidos por el paciente. Los principales DMS son el Síndrome de Capgras (SC), el de Fregoli, el de doble subjetivo y el de intermetamorfosis. Se presentan en contexto tanto de enfermedades psiquiátricas como en cuadros orgánicos. Distintos modelos han tratado de encontrar una explicación a los DMS, con aportes tanto desde la psicología como de las neurociencias. Entre las causas están enfermedades neurodegenerativas, cuadros psiquiátricos, alteraciones estructurales, efecto de drogas, y alteraciones metabólicas. El manejo depende de la patología de base y las características clínicas específicas. Esta revisión se centra específicamente en el SC, ya que dentro de los DMS, es el más frecuente y estudiado

Delusional misidentification syndromes (DMS) are rare neuropsychiatric disorders that are characterized by having delirious ideas regarding one's and other people, animals or places identity known by the patient. The main DMS are the Capgras syndrome, the Fregoli syndrome, the subjective double syndrome and the intermetamorphosis syndrome. They appear in context of both psychiatric illnesses and organic disorders. Different models have tried to find an explanation to the DMS, with contributions from both psychology and neurosciences. Among the causes are neurodegenerative diseases, psychiatric symptoms, structural alterations, drug effects, and metabolic alterations. Management depends on the underlying pathology and the specific clinical characteristics. This review focuses specifically on the SC, since within the DMS, it is the most frequent and studied.

Máquinas de escrever verdades e mentiras / Machines to write truths and lies / Máquinas de escribir verdades y mentiras

Examinando friamente, a capacidade de mentir é uma aquisição positiva da criança, que assim toma consciência da relativa autonomia de sua capacidade de pensar. O proton pseudos histérico, tal qual descrito por Freud no Projeto em 1895, insere-se nesta linha: mentira que, constituindo-se como sintoma, diz ao mesmo tempo a verdade do impacto do outro originário. O sujeito psicótico não dispõe desse luxo; seu delírio tenta, sem verdadeiro sucesso, dizer a verdade nua de sua experiência da alteridade. Por falta de uma mediação pela fantasia, o discurso assim exposto se torna delirante. A novela de Kafka Na colônia penal é citada para ilustrar que o corpo não pode ser traduzido, sem resíduo, em linguagem e que tentar inscrever a verdade no corpo não faz senão destruí-lo. É impossível pensar sem corpo, mas também não se pode pensar e dizer o corpo integralmente sem desnaturalizá-lo. O corpo impõe o recurso à analogia, que, sem ser uma mentira, também não é a pura verdade

Examining coldly, the ability to lie is a positive acquisition of the child, who thus becomes aware of the relative autonomy of its ability to think. The hysterical proton pseudos, as described by Freud in the Project in 1895, is inserted in this line: lies as symptom, at the same time tell the truth of the impact of the originary other. The psychotic subject does not have this luxury; his delusion tries, without real success, to tell the naked truth of the experience of otherness. Lacking mediation by phantasy, the discourse becomes delirious. Kafka's short story In the Penal Colony is quoted to illustrate that the body cannot be translated into language without residue, and that trying to inscribe the truth on to body does nothing but destroy it. It is impossible to think without body, however one also cannot think and say the body as a whole without denaturalizing it. The body imposes the use of analogy, which, although not being a lie, is not the truth either

Examinando fríamente, la capacidad de mentir es una adquisición positiva del niño, que así toma conciencia de la relativa autonomía de su capacidad de pensar. El proton pseudos histérico, como descrito por Freud en el Proyecto en 1895, se inserta en esta línea: mentira que, constituyéndose como síntoma, dice al mismo tiempo la verdad del impacto del otro originario. El sujeto psicótico no dispone de ese lujo; su delirio intenta, sin verdadero éxito, decir la verdad desnuda de su experiencia de la alteridad. Por falta de una mediación por la fantasía, el discurso así expuesto se vuelve delirante. El relato de Kafka En la colonia penal es citado para ilustrar que el cuerpo no puede ser traducido en lenguaje sin sobras; que intentar inscribir la verdad en el cuerpo no hace más que destruirlo. Es imposible pensar sin cuerpo, pero tampoco se puede pensar y decir el cuerpo integralmente sin desnaturalizarlo. El cuerpo impone el recurso a la analogía, que, sin ser una mentira, tampoco es la pura verdad

The Psychopathology of Delusion of Control According to Subjective Experience / La psicopatología del delirio de control según la experiencia subjetiva

ABSTRACT Background: Delusion of control, including thought insertion, occurs in 20% of patients with schizophrenia. However little is known of its psychopathology, and studies involving patients are scarce. Aims: To explore the subjective experience of patients with delusion of control and to propose a psychopathological explanation based on empirical evidence. Methods: Qualitative exploratory study of 7 patients (6 with schizophrenia and 1 with schizophreniform disorder). A phenomenologically-oriented semi-structured interview was used. Results: Delusion of control is not an isolated and pure symptom; it is always immersed in the context of a persecutory delusion and other psychiatric symptoms. The patient experiences partial control, i.e. the control is never complete. In all cases, it is possible to trace the history of the narrative formation of delusion of control from its origins in persecutory delusions and other concomitant symptoms. Conclusions: The delusion of control is a narrative resulting from the joint presence of a persecutory delusion and other psychiatric symptoms. For the patient, the delusion of control is the narrative of the elaborate expression of the meaning of the anomalous experience. Delusion of control is a narrative variety of persecutory delusion.

resumen Introducción: El delirio de control, incluida la inserción de pensamientos, se presenta en el 20% de los pacientes con esquizofrenia. Sin embargo, se conoce poco de su psicopatología y los estudios que implican a pacientes son escasos. Objetivo: A partir de una serie de casos clínicos, explorar la experiencia subjetiva de pacientes con delirio de control y proponer una explicación psicopatológica con base en elementos empíricos. Métodos: Estudio exploratorio de tipo cualitativo con 7 pacientes (6 con esquizofrenia y 1 con trastorno esquizofreniforme). Se utilizó una entrevista semi estructurada de orientación fenomenológica. Resultados: El delirio de control no se presenta como síntoma aislado y puro, siempre está inmerso en el contexto de un delirio persecutorio y otros síntomas psiquiátricos. El control vivido por el paciente es parcial, nunca total. En todos los casos fue posible rastrear la historia de la constitución narrativa del delirio de control a partir del delirio persecutorio y los otros síntomas concomitantes. El delirio de control es la narrativa que expresa de manera más elaborada el sentido que la experiencia tiene para el paciente. Conclusiones: El delirio de control es una narrativa derivada de la concomitancia de un delirio persecutorio y otros síntomas psiquiátricos. Es la narrativa que expresa de manera más elaborada el sentido que tiene la experiencia anómala para el paciente. El delirio de control es una variedad narrativa del delirio persecutorio.

Shared Psychotic Disorder: A case of “Folie a deux” with a delusion of pregnancy

Shared psychotic disorder (Folie a deux), is a rarely seen and poorly understood psychiatric disorder. It ischaracterized by the transfer of delusional belief from one primary patient, who already suffering from apsychotic disorder, to another, the secondary patient. Here we present a case, of daughter of schizophrenicmother who has shared psychotic disorder with belief delusion of pregnancy. It was easily diagnosed but abigger challenge for management purpose.

Relationship between Delusion of Theft and Cognitive Functions in Patients with Mild Alzheimer's Disease

Although delusion of theft (DT) is the most frequent type of delusion in Alzheimer's disease (AD), its relationship to cognitive functions remains unclear. The aim of this study was to demonstrate the relationship between DT and cognitive functions in mild AD. Two hundred eighty-nine mild AD patients were enrolled in this study. These subjects were classified into three groups: patients with no delusions (ND, n=82), patients with paranoid delusions (PD, n=114) and patients with DT (n=93). Cognitive functions and their associations with the degree of delusion were compared among the three groups. The results showed that verbal Fluency scores were significantly lower in the PD group than in the DT and ND groups. Word List Recall scores were significantly lower in the DT group than in the PD and ND groups. Interestingly, delusion severity measured with the Neuropsychiatric Inventory delusion subscale correlated negatively with the Word List Recall scores in the DT group. In this study, we demonstrated that episodic memory functions in mild AD patients were associated with DT, but not with PD. Further studies might be needed to clarify the pathophysiology of delusions associated with AD.

A case of Huntington disease first presenting with psychotic symptoms / 中国心理卫生杂志

This was a case of 32-year-old HAN woman admitted to psychiatric hospital presenting for social withdraw,deluded ideas,unexplained runaways and suicide behaviors.She was diagnosed as schizophrenia and brought to the psychiatrist for unbearable behavior problems by her family.When admitted to hospital the patient showed significant depressive symptoms and delusions with influent speech,hypotonia,involuntary movements of distal limb and ataxia.Cognitive tests revealed multiple deficits.Consulted with the neurologist,a diagnosis of organic mental disorder was suggested.Magnetic resonance imaging showed slight widen of lateral ventricles and mild atrophy of caudate nucleus and cortex of frontal lobe.The family history was re-collected and found three family members shared the influent speech and ataxia.Then the clinical diagnose of Huntingdon Disease was made and validated with gene tests.

Folie à deux / Case report: Folie à deux

JMCD, Sexo masculino, 19 años, soltero, sin hijos. Vive en Casas Compartidas de la Fundación Don Bosco. Examen Mental: Refiere que conversa con Dios en su corazón, y ahí siente el "fuego", pero no lo ve ni lo escucha. Dice tener la misión de predicar (sin mayor elaboración), y que no le gusta ninguna Iglesia. Discurso sin alteración del curso formal. Afecto de "templanza" forzada y superioridad. Al ingreso se agita y presenta postura antieconómica (también en el hogar: crucificado). Pone los ojos en blanco y parpadea rápidamente. Sin consciencia de enfermedad. Juicio de realidad alterado. Diagnósticos: Síndrome delirante lúcido. Folie à deux. Discusión: El trastorno de ideas delirantes inducidas, también conocido como Trastorno psicótico compartido o folie à deux es una condición poco común, caracterizada por síntomas psicóticos en 2 o más individuos que mantienen una relación cercana.

JMCD, male, 19 years old, single, childless. Live in shared houses of the Don Bosco Foundation. Mental examination: Refers conversing with God in his heart, and there he feels the "fire", but neither sees nor hears God. He claims to have the mission of preaching (without further processing), and he does not like any church. Speech without altering the formal course. Forced "temperance" affection and superiority. Agitation at Income and presents uneconomical posture (also at home: crucified). He rolls his eyes and blinks rapidly. Without awareness of disease. Reality trial actually altered. Diagnosis: Lucid delusional syndrome. Folie à deux. Discussion: The disorder of induced delusional thoughts, also known as shared psychotic disorder or folie à deux is a rare condition characterized by psychotic symptoms in 2 or more individuals who maintain a close relationship.

Quando a pena é um mal necessário na psicose melancólica / When punishmet is a necessary evil within melancholic psychosis / La peine comme mal nécessaire dans la psychose mélancolique / Cuando la pena es un mal necesario en la psicosis melancólica

O presente artigo questiona a lógica autoterapêutica do delírio melancólico. Os casos clínicos propostos como contribuição ensinam que o psicótico melancólico pode tentar tratar sua culpabilidade delirante a partir da violência que ele se inflige, mas também a partir de condutas heteroagressivas, de delitos e de crimes. Em cada um dos casos, a dupla "autoacusação-autopunição" é operante. Ela permite um equilíbrio do gozo. A tal ponto que podemos defender que a pena, na ambivalência (dor moral e sanção aplicada), é um mal necessário na melancolia.

This paper questions self-therapeutic logic within melancholic delusion. The clinical cases presented here as a contribution teach us that melancholic psychotics can try to treat their delusional blame through self-inflicted violence, and also through hetero- aggressive behavior and crime. In each of these cases, the "self-accusation-self-punishment" relationship is at work. This balances out pleasure — to the extent that we can state that punishment, within ambivalence (moral suffering and inflicted punishment), is a necessary evil in melancholia.

Cet article interroge la logique auto-thérapeutique du délire mélancolique. Les cas cliniques mis ici à contribution enseignent que le psychotique mélancolique peut tenter de traiter sa culpabilité délirante à partir de la violence qu'il s'inflige mais aussi à partir de conduites hétéro-agressives, de délits et de crimes. En chaque cas, le couple «autoaccusation-autopunition¼ est à l'œuvre. Il permet l'équilibration de la jouissance et on peut donc affirmer que la peine, dans son double sens (douleur morale et sanction appliquée) est un mal nécessaire dans la mélancolie.

Este artículo cuestiona la lógica autoterapéutica del delirio melancólico. Los casos clínicos presentados aquí, demuestran que el psicótico melancólico puede intentar tratar su culpabilidad delirante a partir de la violencia que se aplica a sí mismo, pero también a partir de conductas heteroagresivas, de delitos y de crímenes. En cada caso, el dúo — autoacusación y autocastigo — está activo y permite equilibrar el goce. Por lo tanto, se puede postular que el dolor, en la ambivalencia (dolor moral y pena impuesta) es un mal necesario en la melancolía.

Dieser Artikel stellt die autotherapeutische Logik des melancholischen Wahnes in Frage. Die angeführten klinischen Beobachtungen lehren, dass der melancholische Psychotiker mit der Gewalt, die er sich selbst antut, aber auch mit seinem aggressiven Verhalten gegenüber anderen, mit Straftaten und Verbrechen versuchen kann, seine wahnsinnigen Schuldgefühle zu behandeln. In allen analysierten Fällen ist das Paar„Selbstbeschuldigung-Selbstbestrafung" am Werk, welches eine Regulierung des Genusses erlaubt. Man könnte also behaupten, dass das moralische Leiden und die angewandte Strafe ein notwendiges Übel der Melancholie sind.

Parasitosis ilusoria intestinal y dermatológica: casos clínicos / Delusional parasitosis intestinal and dermatological: clinical cases

Illusory parasitosis, better known as delusional parasitosis, is a neuropsychiatric syndrome in which patients have the belief of suffering a parasitic disease, that can not be demonstrated after an exhaustive medical study. These patients are characterized by being polyconsultants in different medical specialties and, many of them, have antecedents of psychiatric disorders, some of them undiagnosed. Knowing the existence of the clinical picture, diagnosing early and empathizing with the patient, could give to clinician some clues for a timely and assertive psychiatric referral, and improve patient adherence to the proposed treatment.

La parasitosis ilusoria, más conocida como delusión parasitaria, es un síndrome neuropsiquiátrico donde los pacientes tienen el convencimiento de padecer una infestación parasitaria, que no puede ser demostrada tras un exhaustivo estudio médico. Estos pacientes se caracterizan por ser policonsultantes en distintas especialidades médicas y, muchos de ellos, poseen antecedentes de trastornos psiquiátricos, algunos de ellos no diagnosticados. Conocer la existencia del cuadro, diagnosticar precozmente y empatizar con el paciente, pueden dar al médico clínico algunas claves para una derivación psiquiátrica oportuna y asertiva, y mejorar la adherencia del paciente al tratamiento propuesto. Se presentan cuatro casos clínicos que consultaron por esta extraña condición.

A Case Of Psychotic Disorder Due To Dengue Fever

This case reported highlighted psychotic disorder due to dengue fever is rare. Hence we describe a case which clearly presented with psychotic symptoms during the illness. Methods: We reported a case of psychotic disorder due to dengue fever who presented with psychotic symptoms of auditory and visual hallucination, and persecutory delusion, which had significant temporal correlation with dengue fever symptoms. There were no neurological deficits noted, no altered sensorium and cognitive impairment during the episode. He has no past and family history of mental illness and there was no evidence of encephalitis and metabolic disturbances. Results: Our case suggests that prominent psychotic symptoms can occur during an episode of dengue fever, which remitted when one recovering from dengue fever. Conclusion: We demonstrated that patients who presented with the acute onset of psychosis accompanied by symptoms of viral fever should be screened for dengue fever, particularly if the person lived in or visited the area where dengue fever is endemic. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Morte do sujeito: representação e limite real na clínica das psicoses / Death of the subject: representation and real limit in the clinic of psychosis

Aborda-se a formulação lacaniana de que, em Schreber, houve um momento de 'morte do sujeito' que permitiu a construção do delírio estabilizador. Se o advento do sujeito é tributário da 'morte da coisa' perpetrada pelo significante, Lacan fala aqui da psicose, constituída pela não simbolização da castração. Discute-se a noção de 'segunda morte', forjada a propósito de Sócrates, de Antígona e do Cotard, e a Bejahung como afirmação primordial que inclui a negatividade. Conclui-se que a 'morte do sujeito' pode ser uma abertura para a representação ou um limite real para o psicótico, expondo às passagens ao ato e evoluções demenciais.

The paper discusses Lacan's proposal that Schreber's stabilization was made possible by a moment of 'death of the subject.' The advent of the subject is related with the 'death' of the thing itself perpetrated by the signifier. Here, Lacan mentions its relation to psychosis, in which there's a non-symbolization of castration. We discuss the notion of 'second death', related to Socrates, Antigone and Cotard, and the Bejahung as an original affirmation which includes the negativeness. We conclude that the 'death of the subject' can be an opening to the representation or a 'real' limit to the psychotic, presenting the risk of passages to the act and 'dementia-like' evolutions.

A linguistic analysis of transitivity in delusional speech: a case study / Uma análise linguística da transitividade em discurso delirante: um estudo de caso

This article presents results of a research that investigated some syntactic and semantic aspects of the expression of delusional events in the discourse of a person with schizophrenia. Based on Cognitive Linguistics (CL), we analyzed 1104 clause units taken from her speech. The case analyzed shows a specific linguistic syntactic pattern related to the expression of delusional events. Results indicate a highly significant relation between the transitive construction and the clause units involving delusional entities (χ²(1, N=98) = 45.097, p<.0001) and also a significantdifference in the mean of transitivity rate in these clause units (t(80)=2.71, p=.008). These results were interpreted as evidence of a schematic conceptual core, i.e., a prototypical schematic cognitive structure associated to delusion. These findings suggest, albeit in a preliminary way, the possibility of describing delusion also on a linguistic basis

Este artigo apresenta os resultados de uma pesquisa que investigou alguns aspectos sintáticos e semânticos ligados às estruturas que compõem o discurso delirante de uma paciente com esquizofrenia. Com base no quadro teórico da Linguística Cognitiva, foram analisadas 1104 unidades oracionais que compõem o discurso dessa paciente. O caso analisado mostra um padrão sintático específico relacionado a essas estruturas. Os resultados indicam uma relação altamente significativa entre a construção transitiva e as unidades oracionais que envolvem entidades delirantes(χ²(1, N=98) = 45.097, p<.0001), assim como uma diferença significativa na transitividade média dessas unidades oracionais (t(80)=2.71, p=.008). Esses resultados foram interpretados como uma evidência de um núcleo conceptual esquemático, i.e, uma estrutura cognitiva esquemática e prototípica associada ao delírio. Esses achados sugerem, ainda que de maneira preliminar, a possibilidade dese descrever o discurso delirante em uma base linguística

The classification, definition, and ontology of delusion / A classificação, definição e ontologia do delírio / Classification, définition et ontologie du délire / La clasificación, definición y ontología del delirio / Klassifizierung, Definition und Ontologie des Wahns / 谵妄症的分类，定义及其存在

Although delusion is one of the central concepts of psychopathology, it stills eludes precise conceptualization. In this paper, I present certain basic issues concerning the classification and definition of delusion, as well as its ontological status. By examining these issues, I aim to shed light on the ambiguity of the clinical term ‘delusion’ and its extension, as well as provide clues as to why philosophers are increasingly joining the ranks of psychiatrists, psychologists, and neuroscientists in the effort to come to a comprehensive understanding of delusion.

Apesar de o delírio ser um dos conceitos centrais da psicopatologia, ainda escapa à conceptualização precisa. Neste artigo, apresento alguns problemas fundamentais a respeito da classificação e definição do delírio, bem como sobre seu estatuto ontológico. Por meio do exame desses problemas, tenho como objetivo esclarecer a ambiguidade do termo clínico “delírio” e sua extensão, bem como fornecer pistas sobre o motivo de filósofos cada vez mais se juntarem a psiquiatras, psicólogos e neurocientistas na tarefa de chegar a uma compreensão global do delírio.

Bien que le délire soit l'un des concepts centraux de la psychopathologie, il échappe encore à la conceptualisation précise. Dans cet article, je présente quelques problèmes fondamentaux concernant la classification et la définition du délire, ainsi que son statut ontologique. Par le biais de l'examen de ces problèmes, je cherche à faire la lumière sur l'ambiguïté du terme clinique « délire ¼ et son ampleur, ainsi qu’à fournir des indices sur la raison pour laquelle les philosophes se joignent de plus en plus aux efforts des psychiatres, psychologues et chercheurs en neurosciences pour parvenir à une compréhension globale du délire.

Aunque el delirio sea uno de los conceptos centrales de la psicopatología, este aún se escapa de la conceptualización precisa. En este artículo, presento cuestiones fundamentales relacionadas a la clasificación y definición del delirio, así como también acerca de su estado ontológico. A través del examen de estas cuestiones, mi objetivo es dilucidar la ambigüedad del término clínico ‘delirio’ y su extensión, así como proporcionar pistas sobre por qué los filósofos se unen cada vez más a los psiquiatras, psicólogos y neurocientíficos en el esfuerzo por llegar a una comprensión global del delirio.

Obwohl der Wahn eines der zentralen Konzepte der Psychopathologie ist, konnte ein genauer Begriff bisher nicht erstellt werden. In dieser Arbeit stellen wir grundlegende Probleme bezüglich der Klassifizierung und Definition des Wahns, sowie seinen ontologischen Status dar. Unsere Problemuntersuchung hat zum Ziel, die Mehrdeutigkeit des medizinischen Begriffs „Wahn“ und seine Erweiterungen zu erläutern, sowie mögliche Antworten auf die Frage zu finden, warum Philosophen sich zunehmend Psychiatern, Psychologen und Neurowissenschaftlern anschließen, um ein umfassendes Verständnis des Wahns zu erlangen.

虽然谵妄症是精神病症的主要概念，但是它的概念依然不是很清楚。本论文对谵妄症的分类和定义方面的一些基本问题进行探讨，并且分析了它的本体论的一些问题。通过调查分析这些问题，作者尝试澄清谵妄症这个临床术语的模糊性和它的外延，了解驱使精神分析学，心理学，神经科学，众多学科的学者联合起来，试图对谵妄症进行一个全面的理解的哲学背景。.

An Intriguing Case Of Heroin Induced Delusion Of Parasitosis

Objective: The objective of this case report is to highlight a rare case of delusion of parasitosis induced by heroin abuse. Methods: We report a case of a 44-yearold heroin addict who had the false and unshakeable belief of being infested by the African botfly. As a result of his belief, he resorted to various methods to rid himself of the insect such as picking his skin with a knife and burning his skin with a lighter. Result: He was diagnosed to be suffering from heroin induced psychotic disorder and was successfully treated with the atypical antipsychotic olanzapine. Conclusions: Heroin; an opiate which is not commonly known to cause psychosis was seen to have been the cause of the delusion of parasitosis suffered by our patient.