Síndrome de Cotard y retraso mental: reporte de un caso / Cotard syndrome and intellectual disability: a case report

Resumen El síndrome de Cotard, descrito en la historia por presentar diferentes tipos de delirios siendo el principal el nihilista o de negación, ha sido reportado en diversos trastornos neuropsiquiátricos; sin embargo, existe poca literatura que lo refiera en el contexto de retraso mental, por lo que el objetivo del trabajo es examinar las características del Síndrome de Cotard a propósito de un reporte de caso. Presentamos a un paciente de 19 años que cumple con los criterios para Retraso mental y Síndrome de Cortad. Se revisó la literatura, hallando sucinta data en que se presente cuadros similares. Sería muy recomendable continuar evaluando con mayor profundidad la asociación entre retraso mental y síndrome de Cotard e investigar la respuesta al tratamiento, dado que no existen protocolos en nuestra región.

Cotard syndrome, described in the history for presenting different types of delusions being the principal as the nihilistic delusion or delusion of negation, was reported on neuropsychiatric disorders. However, there is little literature that refers to it in the context of mental retardation. The aim of this report case is to explore the characteristics of Cotard syndrome. We present a 19 year-old boy who complete criteria for intellectual disability and Cotard syndorme. The literature was reviewed, finding succinct data associated to cases like this. We recommend to evaluate deeply the association between intellectual disability and Cotard syndrome and to research the treatment, given that there are no protocols in our region.

Síndrome De Cotard Y Catatonía: Reporte De Un Caso / Cotard's Syndrome And Catatonia: A Case Report

Resumen El Síndrome de Cotard es una condición neuropsiquiátrica poco frecuente, descrito inicialmente por Jules Cotard como un delirio hipocondríaco y luego como Delirio de negación, en que el paciente niega la existencia de partes de su cuerpo, la propia existencia y/o del mundo entero. La aparición de un Síndrome Catatónico junto al Síndrome de Cotard es aún más infrecuente. Se presenta el caso de una paciente de 72 años con una Depresión psicótica, que desarrolla un Síndrome de Cotard y posteriormente Catatonía. Logra buena respuesta tras la adición de Lorazepam y Venlafaxina al esquema farmacológico en curso, por lo que se desestima el uso de Terapia Electroconvulsiva. Se constata remisión total de síntomas y posterior recuperación funcional ad integrum, siendo evaluada a través de entrevista clínica, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale e Índice de Barthel. Además, se revisan otros reportes de caso sobre esta comorbilidad, y a diferencia de la mayoría de éstos, se destaca la favorable evolución de la paciente sin necesidad de Terapia Electroconvulsiva. Aún no se ha dilucidado la relación entre ambos síndromes, aunque algunos autores han planteado la hipótesis de vías neurobiológicas compartidas y otros han postulado la aparición de síntomas catatónicos como la progresión del Síndrome de Cotard. Para aclarar estas interrogantes, son necesarios más estudios al respecto que permitan conocer la etiopatogenia de esta inusual combinación.

Cotard's Syndrome is a rare neuropsychiatric condition, initially described by Jules Cotard as a hypochondriacal delusion and then as Delusion of negation, in which the patient denies the existence of parts of his body, his own existence and / or the entire world. The appearance of a Catatonic Syndrome together with Cotard Syndrome is even more infrequent. We present the case of a 72-year-old patient with a psychotic depression, who developed Cotard's Syndrome and later Catatonia. She achieves good response after the addition of Lorazepam and Venlafaxine to the current pharmacological treatment, so the use of Electroconvulsive Therapy is dismissed. Total remission of symptoms and subsequent functional recovery ad integrum was observed, being evaluated through clinical interview, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale and Barthel Index. In addition, other case reports on this comorbidity are reviewed, and unlike most of these, the favorable evolution of the patient stands out without the need for Electroconvulsive Therapy. The relationship between the two syndromes has not been elucidated, although some authors have proposed the hypothesis of shared neurobiological pathways and others have postulated the appearance of catatonic symptoms such as the progression of Cotard's Syndrome. To clarify these questions, more studies are needed in order to know the etiopathogenesis of this unusual combination.

Reliability and Validity of the Korean Version of Health Anxiety Questionnaire

OBJECTIVE: Health anxiety can be defined by concern about health in the absence of a pathology. The Health Anxiety Questionnaire (HAQ) based on the cognitive-behavioral model can be useful for evaluating the severity and the structure of health anxiety. This study aims to verify the reliability and validity of Korean version of HAQ (K-HAQ). METHODS: For reliability, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Receiver Operating Characteristic (ROC) analysis was performed to identify the optimal cut-off score. RESULTS: Cronbach’s alpha was 0.92, and r value of test-retest reliability was 0.84. In the EFA, 4- and 5-factor model showed cumulative percentile of variance of 60% or more. In the CFA, the 4-factor model was found to be the most appropriate and simplest (χ²=397.33, df=187, CFI=0.909, TLI=0.888, RMSEA=0.077). In the ROC analysis, the cut-off score was 20 points. CONCLUSION: It is expected that K-HAQ can be helpful to evaluate the severity of health anxiety and make therapeutic plans because K-HAQ can help explore the cognitive, emotional, and behavioral structure of health anxiety by each factor.

Comparative Study on Personality Assessment Inventory and MMPI-2 Profiles of Groups with High and Low Depression and Suicide Ideation in Psychiatry Patients and Discriminant Variables of Depression and Suicide Ideation / 신경정신의학

OBJECTIVES: The purpose of this study was to compare psychological test profiles of psychiatric outpatients with high and low depression/suicide ideation and to identify predictor variables for depression/suicide ideation. METHODS: Component scores of the Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were compared using t-tests. Discriminant analysis was conducted for predictor variables of depression/suicide ideation. RESULTS: Regarding PAI profiles, somatic complaints (SOM), anxiety (ANX), anxiety-related disorder (ARD), depression (DEP), paranoia (PAR), borderline features (BOR), antisocial features (ANT), mania (MAN) drug problems (DRG) scores were significantly elevated in high depression and high suicide ideation groups. Concerning MMPI-2 profiles, the scores of hypochondriasis (Hs), depression (D), hysteria (Hy), psychopathic deviate (Pd), paranoia (Pa), psychasthenia (Pt), schizophrenia (Sc), social introversion (Si) were significantly elevated in these same groups. The PAI and MMPI-2 profile shapes were remarkably similar between high depression and high suicide ideation groups. Therefore, in terms of psychological profile, depression and suicidal ideation seemed to reflect the same construct. However, in discriminant analysis, significant predictors for depression were found to be Pt and D Sc from MMPI-2, while those for suicide ideation were found to be Pa and Sc, suggest subtle differences. CONCLUSION: The superficial characteristics of depression and suicide ideation groups reflected by the psychological test profiles seemed similar, but the determining factors may differ. Thus, the psychological interventions for these two groups may have to follow different routes considering these subtle differences.

Angústia hipocondríaca e o eterno retorno do presente: considerações a partir do filme Sinédoque, New York / L'angoisse hypocondriaque et l'éternel retour du présent: considérations à partir du film Synecdoque, New York / La angustia hipocondríaca y el eterno retorno de lo presente: consideraciones a partir de la película Synecdoche, New York / Hypochondriacal anxiety and the eternal recurrence of the present: considerations about the film Synecdoche, New York

A partir de questionamentos levantados pelo filme Sinédoque, New York (2008), pretende-se discutir a articulação da angústia hipocondríaca com a temporalidade. Observa-se que no filme o recurso do flashback não é utilizado; a temporalidade, que se instaura diante da angústia relacionada a sintomas hipocondríacos do personagem, calca-se em um presente absoluto. A hipocondria foi considerada por Freud uma neurose atual e a angústia a ela articulada opera como a contrapartida afetiva do encontro com o desamparo gerado pelo desfacelamento da imagem corporal. Estamos, portanto, diante da face traumática desse afeto que torna a ser discutido no contexto das neuroses traumáticas e mediante o conceito de angústia automática em 1926. A partir de então, a questão da atualidade dos sintomas, já indicada nas neuroses atuais, ganha um novo sentido: trata-se de uma problemática que não pôde ser representada e, por isso, insiste, instaurando eterno retorno do presente.

À partir des questions soulevées par le film Synecdoque, New York (2008), nous prétendons discuter l'articulation de l'angoisse hypocondriaque avec la temporalité. On observe que dans le film la fonction flashback n'est pas utilisée ; la temporalité, qui est établie sur l'angoisse liée à des symptômes hypocondriaques du personnage, installe un présent absolu. L'hypocondrie a été considérée par Freud une névrose actuelle et l'angoisse qu'elle articule fonctionne comme une contrepartie affective de la rencontre avec la détresse générée par la fragmentation de l'image corporelle. Nous sommes donc devant la face traumatique de cette affection qui est reprise comme objet de discussion dans le contexte des névroses traumatiques et à travers le concept d'angoisse automatique en 1926. Depuis lors, la question de l'actualité des symptômes, déjà soulignée quant aux névroses actuelles, obtient une nouvelle signification : il s'agit d'une problématique qui n'a pas pu être représentée et qui, de ce fait, insiste, tout en instaurant l'éternel retour du présente.

A partir de cuestiones surgidas de la película Synecdoche, New York (2008), en este texto se pretende discutir la articulación de la angustia hipocondríaca con la temporalidad. Se observa que en la película no se utiliza el mecanismo de flashback; la temporalidad que se establece relacionada con los síntomas hipocondríacos del personaje se articula a un presente absoluto. La hipocondría fue considerada por Freud una neurosis actual y la angustia articulada a ella una contrapartida afectiva del encuentro con la impotencia generada por la fragmentación de la imagen corporal. Estamos, por consiguiente, frente a la faceta traumática de este afecto que vuelve a ser discutido en el contexto de las neurosis traumáticas y a través del concepto de angustia automática en 1926. Desde entonces, el tema de la actualidad de los síntomas, como señalan en las neurosis actuales, logra un nuevo significado: es un problema que no puede ser representado, por lo tanto, insiste, estableciendo un eterno retorno al presente.

It's the intention of this article, based on questions raised by the film Synecdoche, New York (2008), to discuss the articulation of hypochondriacal anxiety with temporality. It is noteworthy that the flashback feature is not used in the film; temporality, presented in light of the anxiety related to the hypochondriacal symptoms of the character, is fixed in an absolute present. Freud considered Hypochondria to be an actual neurosis and the anxiety articulated with it operates as an affective counterpart to the encounter with helplessness generated by the fragmentation of body image. We are, therefore, before the traumatic face of this affection that would once again be discussed, in the context of traumatic neurosis and through the concept of automatic anxiety, in 1926. Since then, the issue of the actuality of the symptoms, as indicated in the actual neurosis, gains a new meaning: it is a problem that could not be represented and therefore persists, establishing an eternal recurrence of the present.

Minnesota Multiphasic Personality Inventory Characteristics of Parricide Offenders with Schizophrenia in Korea

OBJECTIVE: This study aims to examine the personality characteristics in parricide offenders, by using the Minnesota Multiphasic Personality Inventory (MMPI) test, which is commonly used in clinical medicine. METHODS: A total of 73 parricide offenders with schizophrenia who were admitted to National Forensic Hospital in Gongju city between September 2014 and February 2015, and 104 comparison schizophrenia patients who had been admitted to Dankook University Hospital in Cheonan city the same hospital, completed the Korean version of the MMPI. RESULTS: The parricide offender group showed significantly higher on L, F, Hs, Hy and Pd than the comparison group. The result of the regression analysis indicated that Pd and Si significantly increased the odd ratio of the sexual offender group by 2.77 times and 0.32 times, respectively (p=0.029 and p=0.023). The offenders of parricide may have developed the following characteristics: hypochondriasis, hysteria and psychopathic deviate. CONCLUSION: These results suggested that the psychopatholgy in the offenders of parricide might be different, compared to the control group.

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.

Memória corporal e hipocondria: um vivido arcaico sempre presente? / Mémoire corporelle et l’hypocondrie: un vécu archaïque toujours présent? / Memoria corporal e hipocondría: ¿Un arcaico vivido siempre presente? / Body memory and hypochondria: an ever present archaic experience?

O objetivo deste artigo é analisar a singularidade da dimensão de memória na hipocondria. A angústia corporal que lhe é característica constitui um dos modos mais arcaicos de vivência da experiência de morte, projetando-se na concretude e no imediato do corpo. Na hipocondria, o caráter persecutório que incide sobre o corpo do sujeito implica uma “atualização” no sentido de um retorno demoníaco do mesmo, de um vivido traumático primordial. O perigo iminente de morte, apresentado pela doença grave da qual esses sujeitos estão convencidos de terem sido acometidos, expressa a contínua percepção que eles têm dos estados do corpo. Isso resulta da permanência na vida psíquica de um tempo presentificado, tempo do arcaico, mais próximo do registro da percepção. Desse modo, o ego atualiza seu modo de existência mais elementar e primordial, protegendo-se, paradoxalmente, dos efeitos do traumático.

L’objectif de cet article est d’analyser le caractère unique de la dimension de la mémoire dans l’hypocondrie. La détresse corporelle caractéristique est l’un des modes les plus archaïques du vécu de l’expérience de la mort, qui se reflète dans la matérialité et l’immédiateté du corps. Dans l’ hypocondrie, le caractère de persécution qui se concentre sur le corps du sujet implique une ® mise à jour ¼ dans le sens d’un retour démoniaque du même, un vécu traumatique primaire. Le danger imminent de mort, présenté par la maladie grave dont ces sujets sont convaincus qu’ils ont été touchés exprime la percepcion continué qu’ils ont de ses états de corps. Ceci résulte de la permanence dans la vie psychique d’un temps présentifié, temps de l’archaïque, plus proche du champs de la perception. Ainsi, le moi met à jour son mode d’existance le plus primordial et fondamental, tout en se protégeant, paradoxalement, des effets traumatisants.

El objetivo de este trabajo fue analizar la singularidad de la dimensión de la memoria en la hipocondría. La angustia corporal que es su característica es uno de los modos más arcaicos de la experiencia demuerte, que se proyecta en la concretud y en el inmediato del cuerpo. En la hipocondría, el carácter persecutorio que incide en el cuerpo del sujeto implica una “actualización”, en el sentido de un retorno demoníaco de lo mismo, un vivido traumático primario. El riesgo inminente de muerte, presentado por la enfermedad grave que estos sujetos están convencidos de que les afectan, expresa la continua percepción que tienen de sus estados corporales. Esto resulta la permanencia en la vida psíquica de un tiempo presentificado, tiempo del arcaico, más cerca del registro de la percepción. Así, el ego actualiza su modo de vida más básico y primordial, mientras paradójicamente protege a sí mismo de los efectos del trauma.

The aim of this article is to analyze the uniqueness of the dimension of memory in hypochondria. Its characteristic body distress is one of the most archaic modes of death experience, projecting itself into the concrete and into the immediate of the body. In hypochondria, the persecutory character that affects the subject’s body implies an “updating” in the sense of a devilish return of the same, a primary traumatic experience. The imminent danger of death, presented by the serious illness these subjects are convinced to have been affected by, expresses the continuing perception they have of body states. This comes from how long the time made present, an archaic time, stayed in the psychic life, closer to the level of perception. Thus, the ego updates its most basic and primordial mode of existing, paradoxically protecting itself from the effects of trauma.

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese / Tradução e adaptação transcultural da Cyberchondria Severity Scale para o português brasileiro

Abstract Introduction: The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. Objective: To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. Methods: This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. Results: Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. Conclusion: This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

Resumo Introdução: A internet tem se revelado um recurso valioso para o autocuidado, permitindo o acesso a informações e promovendo a interação entre profissionais, cuidadores, usuários de serviços de saúde e pessoas interessadas em informações sobre saúde. No entanto, pesquisas recorrentes na internet estão frequentemente relacionadas a ansiedade excessiva com saúde, e um fenômeno conhecido como cybercondria pode ocasionar danos à saúde física e mental do indivíduo. Nesse contexto, a Cyberchondria Severity Scale foi desenvolvida para diferenciar o comportamento saudável do não saudável no que diz respeito a pesquisas na internet sobre informações de saúde, com base nos seguintes critérios: compulsão, aflição, excessos e confiança/desconfiança nos profissionais de saúde. Objetivo: Realizar a adaptação transcultural da Cyberchondria Severity Scale para o português brasileiro, em razão da falta de um instrumento adequado para uso no Brasil. Métodos: Este estudo foi autorizado pelo autor original da escala. O processo foi dividido em quatro etapas: 1) tradução inicial, 2) retrotradução, 3) desenvolvimento de uma versão sintética, e 4) aplicação experimental. Resultados: A adaptação para o português do Brasil exigiu algumas correções em expressões idiomáticas. Em alguns casos, as palavras não foram literalmente traduzidas do inglês para o português. Apenas os itens 7, 8, 12, 23 e 27 foram alterados, com o objetivo de seguir as normas gramaticais e favorecer a compreensão. Os itens foram reescritos sem que houvesse perda do conteúdo original. Conclusões: Este trabalho apresenta uma versão traduzida da Cyberchondria Severity Scale que foi adaptada semanticamente para a população brasileira, proporcionando uma base para futuros estudos na área, o que deverá, por sua vez, contribuir para uma melhor compreensão do fenômeno cybercondria nessa população.

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

BACKGROUND AND OBJECTIVES: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. SUBJECTS AND METHODS: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. RESULTS: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). CONCLUSION: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Comparison of MMPI Profile Patterns between Patients with Epileptic Seizures and Psychogenic Non-Epileptic Seizures

BACKGROUND: Psychogenic non epileptic seizures (PNES) are characterized by repeated seizures that are typically caused by stress and psychologic problems such as anxiety and depression. This contrasts with epileptic seizures (ES), which are transient and caused by irregular excitement of nerve cells. PNES can be found in patients with ES, but due to their differing etiologies, it is important to determine the psychologic characteristics that differentiate PNES from ES. METHODS: This study identified psychopathologic and personality traits in 137 patients with PNES (n=7, 49.3% female) or ES (n=0, 35.7% female) using MMPI. The diagnosis was based on a medical history of seizures and the clinical examination in patients who visited the epilepsy clinic. Statistical analyses for comparing MMPI differences between the two groups were conducted using the t-test, chi-square test, and analysis of covariance. RESULTS: We analyzed the frequency of individuals who exhibited a T score of ≥5 on the MMPI, and the results indicated that there were significantly more patients in the PNES group than in the ES group who had elevated scores on the hypochondriasis (Hs) scale and hysteria (Hy) scale. The mean scores of Hs, Hy, paranoia scale and schizophrenia scale were significantly higher in the PNES group than in the ES group. CONCLUSIONS: These results suggest that patients with PNES have greater psychologic problems than ES patients. Differences in MMPI profile patterns between patients with PNES and ES may be helpful in tailoring appropriate therapeutic interventions for the two groups.

A Study on the Anxiety of the Chronic Viral Hepatitis Patients Receiving Pegylated Interferon Therapy / 신경정신의학

OBJECTIVES: The aim of this study was to clarify anxiety symptoms associated with the pegylated interferon (PEG-IFN) treatment and to determine which factors are associated with these anxiety symptoms. METHODS: The subjects were 30 patients with hepatitis B and C viral infections who were waiting to receive PEG-IFN treatment. For assessment of depressive and anxiety symptoms, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used. Patients were examined before treatment and then prospectively during the 2 weeks, 4 weeks and 1 years of therapy. We analyzed the changes in anxiety and depression symptoms, and applied multiple regression analysis to identify factors that significantly affect the anxiety symptoms. RESULTS: Compared to pre-treatment baseline, anxiety symptoms increased 2 weeks after treatment, and gradually decreased 4 weeks, and 1 year after treatment. And, we analyzed the sub-factors of depressive symptoms that affect the anxiety symptoms. After 2 weeks of treatment, cognitive-affective factors and hypochondriasis factors of depressive symptoms had an effect on anxiety symptoms. Furthermore after 4 weeks of treatment, the cognitive-affective factors had an effect on anxiety symptoms. CONCLUSION: In this study, we found a significant increase in anxiety symptoms after PEG-IFN treatment, and cognitive-affective depressive factors significantly affect anxiety symptoms.

The negative psychology for the public in Zhejiang province during the epidemic of human H7N9 avian influenza / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the cognition and emotional response of the public in Zhejiang province during the epidemic of human H7N9 avian influenza and provide scientific support for group psychological intervention under public health emergency.</p><p><b>METHODS</b>57 communities in 19 counties from Hangzhou, Jiaxing and Lishui district of Zhejiang province were selected as survey sites using stratified clustered sampling method from March, 2013 to April, 2014. 2 319 ordinary civilians were chosen using convenience sampling method and 390 individuals who had close contact history with H7N9 avian influenza patients, 109 family members of patients and 281 medical workers, were selected using census method. The inclusion criteria for subjects were: subjects aged over 10 years; could complete the questionnaire independently or with the help of the investigators. A total of 2 709 subjects were surveyed by avian influenza risk perception and response questionnaire, negative emotion questionnaire was also used to see their cognition and negative emotion related to the disease. Spearman correlation analysis was used to analyze the interrelationship between public risk perception, response and negative emotions.</p><p><b>RESULTS</b>95.10% (2 576)of the subjects have sensed the risk of epidemic and 91.00% (2 465) of the subjects have taken preventive measures in 2 709 subjects. The positive rate for depression, neurasthenia, fear, anxiety and hypochondriasis were 36.40% (986) , 37.21% (1 008) , 79.70% (2 159) , 33.41% (905) , 27.69% (750) respectively (χ(2)=1 935.89, P<0.001) ;the P(50)(P(25)-P(75)) of the depression scores of patients' family members, medical workers and the general public were 0.50 (0.00-0.83), 0.17 (0.00-0.67), 0.17 (0.00-0.50) (H= 7.27, P=0.03) ; the neurasthenia scores were 0.20 (0.00-0.60), 0.2 (0.00-0.40), 0.00 (0.00-0.20) (H= 64.74, P<0.001) ; fear scores were 0.83 (0.33-1.17), 0.33 (0.17-0.67), 0.33 (0.17-0.83) (H=30.03, P< 0.001) ; anxiety scores were 0.17(0.00-0.50), 0.00(0.00-0.33), 0.00(0.00-0.17) (H=51.82, P<0.001). The neurasthenia, fear, anxiety scores (P(50)(P(25)-P(75))) for females among the public were 0.00(0.00-0.20), 0.50(0.17-0.83), 0.00(0.00-0.17), which were higher than those of male's (0.00(0.00-0.20), 0.33(0.00-0.67), 0.00(0.00-0.17)) (χ(2) values were 5.26, 27.52, 8.29, P<0.05); Among medical staff, the depression, neurasthenia, fear, anxiety and hypochondriasis scores for females were 0.33(0.00-0.67), 0.20(0.00-0.40), 0.50(0.17-0.83), 0.00(0.00-0.33), 0.00(0.00-0.50) respectively, which were higher than those of males'(0.00(0.00-0.50), 0.00(0.00-0.40), 0.33(0.17-0.50), 0.00(0.00-0.17), 0.00(0.00-0.00))(χ(2) values were 7.22, 7.97, 14.46, 4.93, 5.22, P<0.05); for the family members of the patients who were in poor mental conditions when doing self-assessment, their depression and neurasthenia scores were 0.50(0.08-0.96), 0.30(0.00-0.55), which were higher than those of people in good mental conditions (0.17(0.00-0.83), 0.20(0.00-0.60)) (χ(2) values were 12.95, 11.20, P<0.05). Spearman correlation analysis showed that the subjects' risk perception level was positively correlated with depression, neurasthenia, fear, and hypochondriasis, with the correlation coefficients 0.07, 0.07, 0.08, 0.04, respectively (P<0.05) ; the subjects' risk response level was also positively related with depression, neurasthenia, fear, anxiety and hypochondriasis, and the correlation coefficients were 0.09, 0.09, 0.12, 0.05, 0.04, respectively (P<0.05).</p><p><b>CONCLUSION</b>The general public was highly concerned about the epidemic of H7N9 avian influenza and developed certain levels of negative emotions. The female, equal or over 60 years old, those with poor educational level, agricultural related occupation and poor physical and psychology health were risk factors of disease related negative emotions. The subject's risk perception and response level was positively related with depression, neurasthenia, fear and hypochondriasis.</p>

Comparisons of Depressive Symptoms of the Hamilton Depression Rating Scale between Elderly and Non-Elderly Outpatients with Major Depressive Disorder / 신경정신의학

OBJECTIVES: Previous studies have reported that symptoms of patients with major depressive disorder (MDD) are different according to age groups, and the Hamilton Depression Rating Scale (HDRS) is the most widely used measure to evaluate the symptoms of MDD. However, few previous studies have compared the symptoms of HDRS between the elderly and non-elderly groups. METHODS: The study population consisted of 574 subjects with MDD who were > or =18 years old, evaluated using the Mini International Neuropsychiatric Interview and 17 items of HDRS. Differences between two groups were analyzed using independent t-test. A multivariate logistic regression model was used to evaluate associations between age and 17 items from HDRS after controlling for gender, years of education, marital status, and employment status. RESULTS: Among 574 patients with MDD, there were 80 elderly patients (age> or =65) and 494 non-elderly patients (age between 18 and 64). Elderly patients had higher scores on item 5 (middle insomnia) (t=-2.271, p=0.024) and item 6 (late insomnia) (t=-2.280, p=0.023), whereas they had lower scores on item 1 (depressed mood) (t=2.860, p=0.004), item 3 (suicide) (t=2.258, p=0.024), and item 9 (agitation) (t=2.031, p=0.043), although no significant difference in the total HDRS scores was observed between elderly and non-elderly. Multivariate logistic regression showed significant association of elderly with hypochondriasis [adjusted odds ratio (AOR)=1.894, 95% confidence interval (CI) 1.01-3.56] and agitation (AOR=0.50, 95% CI 0.29-0.87). CONCLUSION: Elderly MDD patients showed more insomnia and hypochondriasis and less depressed mood, suicidal ideation, and agitation than non-elderly.

Characteristics of Emotion and Personality in Obstructive Sleep Apnea Patients with Insomnia Symptoms: Analysis of Minnesota Multiphasic Personality Inventory

OBJECTIVES: Obstructive sleep apnea-hypopnea syndrome (OSAHS) and insomnia are two of the most common sleep disorders in the general population. Because OSAHS patients with insomnia may have difficulty in adapting to the sleep breathing medical equipment, it is necessary to pay special attention to the diagnosis and treatment of comorbid insomnia. This study is to investigate the emotion and personality in OSAHS patients with insomnia complaints by using Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHODS: We reviewed the results of the standardized questionnaires assessing sleep-related variables, MMPI, and polysomnographic findings of the patients diagnosed as OSAHS. RESULTS: 145 subjects were 49.05+/-11.83 years of age. The mean Respiratory Disturbance Index was 33.57+/-19.91 and the mean score of Insomnia Severity Index (ISI) was 11.52+/-6.49. The mean scores of the Beck Depression Inventory (BDI) and MMPI-2 were within normal ranges. We divided the patients into two groups based on the scores of the ISI, OSAHS with insomnia (n=109) and OSAHS without insomnia (n=36). OSAHS patients with insomnia symptoms had significantly higher scores of hypochondriasis, hysteria, psychasthenia, schizophrenia, paranoia and psychopathic deviate scales and BDI than those without insomnia. CONCLUSIONS: Our results suggest that insomnia complaints are very common in OSAHS patients and the psychological problems are more frequently found in OSAHS patients with insomnia symptom than those without it.

Schreber, um estudo sobre a paranoia e a violência / Schreber, a study on paranoia and violence

O presente trabalho visa a uma recapitulação de pontos essenciais da autobiografia de Schreber, baseada principalmente em suas memórias e relacionada com obras de vários autores como Freud, CastoriadesAulagnier, Lacan, Santner, Arendt, Carone, Zizek e outros. O assunto relaciona-se com a paranoia e a origem da violência, vista tanto do ponto de vista da ontogênese como da filogênese. Examinam-se, com certa atenção, as consequências do abuso em um sentido amplo e do trauma e suas impossibilidades de elaboração, com o retorno do forcluido e a cisão do eu.

This study reviews essential points of Schreber’s autobiography, mainly based upon his memories, and correlated to the works of many authors such as Freud, Castoriades-Aulagnier, Lacan, Santner, Arendt, Carone, Zizek and others. The topic deals with paranoia and the origin of violence, from the standpoint of ontogenesis as well as phylogenesis. The consequences of abuse are carefully examined, in a broad sense, as well as the consequences of trauma and its impossibilities of working-through with the return of the forcluded and the split of the ego.

El presente trabajo visa a una recapitulación de puntos esenciales de la autobiografía de Schreber, basada principalmente en sus memorias y relacionada con obras de varios autores como Freud, Castoriades-Aulagnier, Lacan, Santner, Arendt, Carone, Zizek y otros. El tema se relaciona con la paranoia y el origen de la violencia, vista tanto desde la mirada de la ontogénesis como de la filogénesis. Se examinan con cierta atención las consecuencias del abuso en un sentido amplio y del trauma y sus imposibilidades de elaboración con el retorno del forcluido y la escisión del yo.

Hypochondriasis: considerations for ICD-11

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

Psychological profile of patients with central serous retinopathy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the psychological profile of Filipino patients diagnosed with central serous retinopathy (CSR).<br /><strong>METHODOLOGY:</strong> Patients seen at the Philippine General Hospital and diagnosed with CSR were included in the study after undergoing an eye evaluation. They completed a data collection form and the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire that was administered by a psychologist. The results of the MMPI were analyzed against an available normative scale. The socio-demographic data and patients' psychological profile were determined.<br /><strong>RESULTS:</strong> The study population (N=12) included 10 males (83%) and 2 females (17%), with a mean age of 38 ± 8.58 years. Eighty three percent (83%) of the patients lived at home with their families. All (100%) had some formal education; 58% attended or completed high school. The majority (75%) worked in non-professional roles (cooks, drivers, seaman, salesman) and 25% were not working. Most (67%) had no other medical illnesses. In the MMPI, the CSR patients showed tendencies to schizophrenia (84%), hysteria (83%), depression (75%), psychopathic deviate (67%), and hypochondriasis (58%).<br /><strong>CONCLUSION:</strong> The socio-demographic data confirmed that CSR is an ailment largely affecting middle-aged men. The sample population of Filipino CSR patients have the tendency to demonstrate schizophrenia (84%), hysteria (83%), depression (75%), and psychopathic deviate (67%), and 33% showed type A personality.</p>