Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

Enfermedad psicógena masiva. Reporte de tres episodios no recientes / Massive Psychogenic Disease. A report of three not recent episodes

Episodios de enfermedad psicógena masiva han ocurrido en entornos sociales diferentes, en todo el mundo, a lo largo de la historia de la humanidad. Cada vez los profesionales de la salud participan más en su atención y solución. Este trabajo presenta tres "casos" catalogados como tales, que el autor tuvo la oportunidad de asistir. Se realizan comentarios en cada uno de ellos y se actualizan conceptos sobre esta condición, que se expresa por los más variados síntomas en un grupo de personas ante un estrés intenso por supuestas amenazas, aunque no exista una razón física o ambiental para que se enfermen. Genera marcada tensión tanto en pacientes como en facultativos y en el público. Los médicos, y el personal sanitario en general, deben estar preparados para su adecuado diagnóstico y conducta a seguir.

Episodes of massive psychogenic disease have occurred in different social contexts, worldwide, throughout history. Every time health professionals participate more in their attention and solution. This work presents three ¨cases¨ classified as such, which the author had the opportunity to attend. There are, in this work comments, about each of them and concepts about this condition are updated; which is expressed by the most varied symptoms in a group of people facing intense stress due to supposed threatening even though there is no physical or environmental reason to get sick. It generates a marked tension in patients and doctors so as in the general public. Doctors and sanitary personnel should be prepared for its adequate diagnosis and conduct to follow.

Parte III: las locuras histéricas / Part III: the hysterical follies

Caso Clínico Paciente María R.A., 28 años, Escolaridad básica en programa diferencial, dueña de casa, Casada, 9 años de matrimonio. Su pareja tiene 62 años. Actualmente vive con esposo e hijo de 2 años, en Maipú. Durante 2016, María consultó en distintos servicios de urgencia, recibiendo distintos diagnósticos: Conversión, Síndrome conversivo. Se ingresa en Urgencia con diagnóstico: Síndrome Psicótico lúcido. Paciente en cama, sin movimientos espontáneos, con rigidez, mirada fija, deshidratada, no acepta alimentarse, negativista, no establece contacto visual, no responde preguntas simples, sin embargo, en forma espontánea puede permanecer hablando, dando cuenta de contenidos delirantes. El día de su ingreso a sector se inició terapia Electro convulsiva, y completó 5 sesiones. Tras la primera sesión paciente evoluciona favorablemente, se levanta de la cama, solicita agua, es capaz de comer. Síntomas psicóticos ceden tras la tercera sesión, señalando además no recordar nada de lo ocurrido. En entrevista de evolución paciente vigil, orientada TE, actitud parcialmente cooperadora. En cuanto a las psicosis histéricas en sí, es una psicosis aguda, de rápida curación cuando se las trata adecuadamente y Bleuler habla de los llamados estados crepusculares histéricos. La duda diagnóstica es entre un trastorno disociativo tipo psicosis histérica o bien un trastorno psicótico agudo, refiriéndose a trastornos de presunto origen disociativo con sintomatología que podríamos denominar pseudopsicótica. La CIE-10 clasifica las psicosis agudas no afectivas, como Trastornos psicóticos agudos y transitorios (TPAT), (Acute and Transient Psychotic Disorders (ATPD) en inglés), comparten las características comunes de inicio agudo dentro de dos semanas, y la presencia de síntomas psicóticos típicos. La descripción de TPAT fue influenciada por los conceptos de psicosis cicloide, bouffée délirante y psicosis reactiva. No es sorprendente, por lo tanto, que los ATPD de la CIE-10 (al menos diagnósticamente) sean un heterogéneo grupo de trastornos. Tanto los sistemas CIE como DSM se basan en síntomas, y descuentan los aspectos "no empíricos" del diagnóstico, que pueden constituir el «fenómeno" esencia de un trastorno psicótico. Actualmente, no existe una categoría de diagnóstico para definir individuos que están experimentando tal psicopatología y tienen un riesgo significativamente mayor de desarrollar esquizofrenia u otro desorden psicótico. Trastorno histriónico de la personalidad (HPD), como argumento aquí, no es una patología mental real; más bien, "histriónico" se refiere a un rasgo o grupo de rasgos de personalidad que podría conducir a algún otro trastorno mental.

Clinical case. Patient María R.A., 28 years old, Basic schooling in differential program, housewife, Married, 9 years of marriage. His partner is 62 years old. Currently lives with husband and 2 year old son in Maipú. During 2016, Maria consulted in different emergency services, receiving different diagnoses: Conversion and conversion syndrome. Urgency is entered with diagnosis: Syndrome Psychotic lucid. Patient in bed, without spontaneous movements, with rigidity, stare, dehydrated, does not accept to feed, negativist, does not establish visual contact, does not answer simple questions, however, spontaneously can remain talking, giving account of delusional contents. On the day of his admission to the sector, Electro Convulsive therapy was started, and he completed 5 sessions. After the first patient session he progresses favorably, gets up from bed, requests water, is able to eat. Psychotic symptoms give way after the third session, noting also not remember anything of what happened. In an evolution interview, vigil patient , oriented TE, partially cooperative attitude. As for hysterical psychoses per se, it is an acute, rapidly healing psychosis when properly treated and Bleuler speaks of so-called hysterical crepuscular states. The diagnostic doubt is between a dissociative disorder type hysterical psychosis or an acute psychotic disorder. referring to disorders of presumed dissociative origin with symptomatology that we could call pseudopsychotic. The ICD-10 classifies acute non-affective psychoses, as Acute and Transient Psychotic Disorders (ATPD), share the common characteristics of acute onset within two weeks, and the presence of typical psychotic symptoms. The description of ATPD was influenced by the concepts of cycloid psychosis, bouffée délirante and reactive psychosis. It is not surprising, therefore, that the ATPD of the ICD-10 (at least diagnostically) is a heterogeneous group of disorders. Both CIE and DSM systems are based on symptoms and discount the "non-empirical" aspects of diagnosis, which may constitute the "phenomenon" essence of a psychotic disorder. Currently, there is no diagnostic category to define individuals who are experiencing such psychopathology and have a significantly increased risk of developing schizophrenia or other psychotic disorder. Histrionic Personality Disorder (HPD), as an argument here, is not a real mental pathology; rather, "histrionic" refers to a trait or group of personality traits that could lead to some other mental disorder.

Dimensions of youth psychopathy differentially predict concurrent pro- and antisocial behavior

Objective: To investigate the unique contribution of narcissism and impulsivity, in addition to callous-unemotional (CU) traits, in explaining concurrent prosocial and antisocial behavior. Method: Two hundred and forty-nine schoolchildren (53% female; age 9-12 years) completed the self-report Strengths and Difficulties Questionnaire (SDQ) and the Antisocial Process Screening Device (APSD). Two statistical models were tested, predicting conduct problems (CP) and prosocial behavior (PB). In the first one, CU traits and gender were entered into the equation. The second model added narcissism and impulsivity. Results: Gender, narcissism and impulsivity, but not CU, were statistically significant predictors of CP in the second model (F3,226 = 45.07, p < 0.001, R2 = 43.7%; betas: gender = -0.20, narcissism = 0.29, impulsivity = 0.36, CU = 0.06). PB was significantly predicted by all domains except gender (F3,226 = 42.57, p < 0.001, R2 = 42.4%; betas: gender = 0.08, narcissism = -0.16, impulsivity = -0.23, CU = -0.41). Conclusion: Our results confirmed that CU traits refer to a distinct manifestation of psychopathy in youth, but we also found that narcissism and impulsivity are equally important when predicting CP. Previous reports of sex differences on APSD and SDQ domains were also corroborated.

Personality assessment in chronic pain patients / Avaliação da personalidade em pacientes com dor crônica

Abstract In Brazil, studies investigating the personality characteristics of chronic pain patients are scarce. The present study aimed to evaluate the personality characteristics of patients with chronic pain and to compare them with those of patients without this condition. To this end, the Personality Disorders Dimensional Inventory and the Hypochondriasis scale of the Brazilian version of the Minnesota Multiphasic Personality Inventory were administered. Two different statistical analyses were carried out: the t - test to determine the differences between the scores for the two groups and the logistic regression analysis to examine the predictive power of the scales for the diagnosis of chronic pain. The results revealed significant differences (p < 0.05) among the Histrionic, Hypochondriasis, and Sadistic scales as predictors for the groups studied, with larger effect sizes on the Histrionic and Hypochondriasis scales. The authors suggest that the use of these scales in a clinical context may provide important information for health professionals.

Resumo No Brasil, estudos investigando as características da personalidade em pacientes com dor crônica são escassos. O objetivo da presente pesquisa foi avaliar as características da personalidade em pacientes com dor crônica e compará-las com as de pessoas sem esse diagnóstico. Para tanto, foram aplicados o Inventário Dimensional de Transtornos da Personalidade e a Escala de Hipocondria da versão brasileira do Minnesota Multiphasic Personality Inventory. Duas análises estatísticas distintas foram empregadas, sendo elas o teste t, para verificar diferenças entre as pontuações dos dois grupos, e a análise de regressão logística, para investigar a capacidade preditiva das escalas para o diagnóstico de dor crônica. Os resultados indicaram diferenças significativas (p < 0,05) nas escalas Histriônico, Hipocondria e Sádico como preditores dos grupos estabelecidos, com maiores magnitudes as escalas Histriônico e Hipocondria. Os autores sugerem que o uso das escalas para o contexto clínico pode agregar informações relevantes para o profissional.

Caracterización de las creencias irracionales del trastorno histriónico de la personalidad / Characterization of irrational beliefs related to histrionic personality disorder

This research paper shows the results of a case and control study which aims to characterize a repertoire of based beleliefs, values and prototypical irrational concepts in the recorded clinical histories of 30 patients afflicted with histrionic personality disorder and whom were diagnosed as such in the region of Bucaramanga (Colombia). Through the MCMI-III and SCID II, individual structured interviews and self-reported beliefs, concepts and irrational values of histrionic disorder were applied to patients being classified in two groups (diagnosed and control group), ratifying the results as follows: 5 values, 12 concepts and 15 irrational beliefs that were characteristic of patient groups with the disorder, with X²=43.642, with a p<0.001 and gl=29 was lower than expected (X²=58.302). There were also no differences by gender, because we found that X²=28.765, which was a p<0.001 and gl=14, lower than expected as well: X²=36.123.

El presente artículo de investigación presenta los resultados de un estudio de tipo casos y controles con el cual se buscó caracterizar un repertorio de creencias, valores y conceptos irracionales prototípicos del trastorno histriónico de la personalidad en 30 pacientes diagnosticados en Bucaramanga (Colombia). Se clasificaron dos grupos (grupo diagnosticado y grupo control), mediante el MCMI-III y la SCID II, a cuyos integrantes se les practicaron entrevistas individuales estructuradas con el Autoinforme de creencias, conceptos y valores irracionales del trastorno histriónico, ratificándose 5 valores, 12 conceptos y 15 creencias irracionales, característicos del trastorno en el grupo con X²=43.642, que con una p <0.001 y gl=29 fue inferior al esperado (X²=58.302). Tampoco hubo diferencias por género, pues, se halló que X²=28.765, lo cual, con una p<0.001 y gl=14, también resultó inferior al esperado: X²=36.123.