Antisocial and borderline Personality disorder, violent behavior and covid-19

The combination of severe personality disorders and violence poses a challenge for mental health services, including forensic services and community mental health services. In the context of COVID-19 pandemic, after observing the alarming number of cases of coronavirus and deaths in Brazil, we aimed to discuss the potential increase in hostile behavior, violence and crime in individuals with personality disorders. A literature review was conducted on antisocial and borderline personality disorders and the possible implications on violent behavior of these personality disorders, during the Covid-19 pandemic. We reviewed Medline database articles on these topics between the years 2000 and 2020. During the pandemic it is important that these services be attentive and prepared for new demands and worsening of previously stabilized individuals of borderline personality disorder and antissocial personality disorder.(AU)

A combinação de transtornos de personalidade grave e violência representa um desafio para os serviços de saúde mental, incluindo os serviços forenses e os serviços comunitários de saúde mental. No contexto da pandemia do COVID-19, após observar o número alarmante de casos de coronavírus e mortes no Brasil, objetivamos discutir o potencial aumento do comportamento hostil, da violência e da criminalidade em indivíduos com transtornos de personalidade. Foi realizada uma revisão da literatura sobre os transtornos borderline e antisocial e as possíveis implicações no comportamento violento desses transtornos de personalidade durante a pandemia do Covid-19. Revisamos artigos da base de dados Medline sobre esses temas, entre os anos 2000 e 2020. Durante a pandemia é importante que esses serviços fiquem atentos e estejam preparados para novas demandas e agravamento de indivíduos previamente estabilizados de transtorno borderline de personalidade e transtorno de personalidade antissocial.(AU)

La combinación de trastornos graves de personalidad y violencia plantea un desafío para los servicios de salud mental, incluidos los servicios forenses y los servicios comunitarios de salud mental. En el contexto de la pandemia COVID-19, después de observar el alarmante número de casos y muertes de coronavirus en Brasil, nos propusimos discutir el posible aumento de la conducta hostil, la violencia y la delincuencia en individuos con trastornos de personalidad. Se realizó una revisión de la literatura sobre trastornos limítrofes y antisociales y las posibles implicaciones en el comportamiento violento de estos trastornos de la personalidad durante la pandemia de Covid-19. Se revisaron artículos de la base de datos Medline sobre estos temas entre los años 2000 y 2020. Durante la pandemia es importante que estos servicios estén atentos y preparados para nuevas demandas y el empeoramiento de individuos previamente estabilizados de trastorno límite de la personalidad y trastorno antisocial de la personalidad.(AU)

Countertransference, Defense Mechanisms, and Vicarious Trauma in Work With Sexual Offenders.

This study aimed to examine the associations between countertransference induced by sex offenders, defense mechanisms, and manifestations of vicarious trauma in forensic psychiatrists and psychologists. A cross-sectional study using a mixed-methods design was performed with 56 Brazilian forensic psychiatrists and psychologists from October 2016 to May 2017. Countertransference, defense mechanisms, and vicarious trauma were assessed with the Assessment of Countertransference Scale, the Defense Style Questionnaire-40, and the Trauma and Attachment Belief Scale (TABS), respectively. Qualitative data analysis based on grounded theory was also performed to explore the influence of sex-offender assessments on the experts' personal and professional lives. Positive and moderate correlations were found between feelings of indifference and the Other-Safety TABS subscale (rho .43, P < .01) and between immature defense mechanisms and TABS total score (rho .45, P < .01). Qualitative data revealed changes in the professionals' identity, worldview, and beliefs related to safety and trust. Specific maladaptive coping strategies, such as feelings of indifference and immature defenses, during the assessment of sex offenders were associated with manifestations of vicarious trauma in forensic psychiatrists and psychologists. These findings indicate the need for awareness and care about the forensic expert's mental health.

Mood disorder as a manifestation of primary hypoparathyroidism: a case report.

INTRODUCTION: Primary hypoparathyroidism is a rare condition caused by parathyroid hormone deficiency and characterized by hypocalcemia. The clinical manifestations of primary hypoparathyroidism include tetany, seizures, paresthesias, dementia, and parkinsonism. Psychiatric manifestations such as mood disorders are unusual and may constitute a major diagnostic challenge, especially if the typical manifestations caused by hypocalcemia are absent. CASE PRESENTATION: The patient was a 22-year-old Caucasian man with a history of chronic omeprazole use and periodic seizures, who presented to the emergency department of a secondary hospital in Southern Brazil with symptoms of major depression (sadness, anhedonia, loss of appetite, insomnia, and fatigue) associated with paresthesias affecting his toes. The initial electrocardiogram revealed a prolonged QTc interval. A computed tomography scan of his brain revealed bilateral, nonenhancing hyperdense calcifications involving the putamen and caudate nucleus. An electroencephalogram showed generalized bursts of slow spikes. Blood laboratory study results indicated serum hypocalcemia, hypomagnesemia, and hyperphosphatemia associated with a low parathyroid hormone level. His serum levels of albumin, 25-hydroxyvitamin D, thyroid-stimulating hormone, T3 and T4 thyroid hormones, as well as the results of kidney function tests, were normal. The definitive diagnosis was primary hypoparathyroidism with psychiatric manifestations due to chronic hypomagnesemia induced by proton pump inhibitor use. CONCLUSIONS: In some cases, to differentiate between a primary psychiatric disorder and primary hypoparathyroidism with neuropsychiatric symptoms may represent a challenge given that the classical manifestations of hypocalcemia, especially tetany, may be absent in the setting of chronic hypoparathyroidism. Clinicians and psychiatrists should consider primary hypoparathyroidism part of the differential diagnosis during the evaluation of patients with mood symptoms, especially in the context of atypical presentations associated with hypocalcemia.