A transient personality disorder induced by football matches.

BACKGROUND: Personality disorders are a class of mental diseases characterized by inflexible and maladaptive patterns of behavior, cognition, and inner experience, involving several areas of functioning, such as affectivity, impulse control, ways of perceiving and thinking and reaction to stress factors. In the literature, personality disorders have always been described as stable patterns of long duration, and their onset can be found during adolescence or early adulthood. These patterns are associated with significant distress or impairment in a patient's life in which a main element affects every aspect of living, and in which no biological or other pathologies exist to assist in its identification. Therefore, they often lead to comorbidities such as dysfunctional anxiety, drug abuse, major depression and suicide. SUBJECTS AND METHODS: We present a case of a 37-year-old man, who came to the outpatient department needing support to quit smoking. During the follow up, he described some transitory changes in his personality while watching football (soccer) games. These episodes were characterized by inappropriate anger crises, rapid and dramatic shifts in emotional tone, dysphoria and superstitious and magical beliefs with paranoid elements; connecting himself, his family and friends to players in the match and to the unfolding of the game. Every manifestation was induced by the football match, and there were no signs of difficulty in handling impulses and in managing relationships, or any superstitious beliefs, outside of it. RESULTS: The combination of all the symptoms led us to think about a diagnosis of the borderline personality disorder. There was a lack of managing impulsivity, intense uncontrollable emotional reactions, and episodes of psychotic decompensation with unreal and paranoid connections made between the patient's entourage and the results of the match. CONCLUSIONS: With this case, we propose to consider the personality disorder, not just as a stable and inflexible pattern, but also as a transitory dysfunction induced by stress factors, as in this case, a football match, introducing therefore a new entity: transient personality disorder.

Admitting or Discharging Patients with Opiate or Alcohol Related Problems? Psychiatrist Uncertainty and Welfare Losses.

BACKGROUND: Much attention has focused on variations in therapeutic strategies across catchment areas and the related question of whether the differences in attitudes are due to socio-economic variables in the studied population or to physician uncertainty about making a specific therapeutic recommendation. SUBJECTS AND METHOD: We monitored the emergency admission rate for patients with alcohol or opiate related problems of 9 resident psychiatrists for a year. To rule out differences in population characteristics, the study took place in only one hospital: Brugmann University Hospital, whose catchment area is the north of Brussels. RESULTS: Our results show 3 distinctive practice styles. We suggest that variation in urgent admission rates for patients with alcohol and opiate related problems can be due not only to the socio-economic variables of the population, but also to medical uncertainty about the effectiveness of admission for the treatment of these disorders. CONCLUSION: The extent of uncertainty about appropriate standards of care and the plausible related inappropriate care and welfare losses are discussed.

Bipolar Disorder and Early Affective Trauma.

BACKGROUND: Bipolar disorder is a chronic psychiatric disease with a high prevalence and is a major psychosocial and medical burden. The exact etiological pathways of bipolar disorder are not fully understood. Genetic factors are known to play an important role in the etiology of bipolar disorder. However, high rates of discordance among identical twins and a growing body of evidence that environmental factors such as early stress can influence the onset and course of psychiatric diseases underline the importance of additional etiological mechanisms of bipolar disorders. There has been little investigation about early trauma in bipolar disorder. The aim of this study was to review the literature on the association between early traumatic interactions like child neglect, mistreatment, abuse or early parental separation and the occurrence of bipolar disorder in adulthood or impact on the course of the disease. METHODS: Studies investigating associations between child neglect, mistreatment, abuse or early parental separation and occurrence of bipolar disorder in adulthood or impact on the course of the disease were searched in the Pubmed database. More than 700 articles were sorted independently by two of the authors using predefined criteria. Only research articles, reviews and meta-analyses were selected for this review. RESULTS: 53 articles met the inclusion criteria. To date, four systematic reviews partially addressed our research question. Early trauma is more frequently found in the past of bipolar patients than in the general population. Studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a worse prognosis. CONCLUSIONS: Early trauma is more often found in the past of bipolar adult patients than the general population and studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a worse prognosis. In further studies attention should be paid to the age of trauma occurrence and the definition of trauma. The findings also support the importance of additional psychoanalytic oriented psychotherapy for the treatment of bipolar disorder.

Megadose bromazepam dependence.

BACKGROUND: Benzodiazepines (BZDs) are among the most widely prescribed drugs in developed countries. Since BZDs can produce tolerance and dependence even in a short time, their use is recommended for a very limited time. However, these recommendations have been largely disregarded. The chronic use of BZDs causes a number of serious side effects, i.e. cognitive impairment, falls, traffic accidents, dependence and tolerance. METHODS: We present the case of a 37 years old woman taking daily doses of 220 mg of bromazepam. The patient's anxiety, depression and cognitive status were evaluated with a battery of questionnaires. A sleep laboratory test was performed in search of sleep apneas and sleepiness during the day. A Cerebral PET SCAN was executed in search of altered cerebral metabolism. RESULTS: Blood concentrations of bromazepam reached 7800 µg/L. Questionnaire evaluations showed significant depression and anxiety but only moderate cognitive impairment. Oxygen saturation was normal throughout the Sleep lab test, respiratory events were very few and sleepiness was moderate with an average latency of 9 minutes. Brain cortical glucose consumption was homogeneously slightly reduced. CONCLUSIONS: With doses of bromazepan reaching 15 times the toxic dose, anxiety remained high. Cognition, sleepiness, respiratory sleep events and brain metabolism remained remarkably close to normal.

An economic analysis of different cannabis decriminalization scenarios.

BACKGROUND: Cannabis is the most widely used illegal drug in European countries. In countries with repressive cannabis policies, prevalence is not lower than in those with tolerant laws. Repressive policies not only have uncertain benefits but they are also expensive. Economists tend to believe that good public policies minimize social costs; that is, they help to improve collective wellbeing at a lower cost. METHOD: The paper draws on a review of international literature on cannabis legislative models around the world. After a description of some of the fundamental concepts of a market economy, several existing policy scenarios will be presented and analyzed from an economic perspective. Strength and weaknesses will be summarized for each alternative. RESULTS: In addition to consumption tolerance in countries such as the Netherlands, recent decriminalization of domestic markets in the Unites States and Uruguay present alternatives to reduce the negative impact of cannabis on society. Earlier initiation age and rise in consumption are unintended potential consequences of decriminalization that need to be addressed by public authorities when designing a liberalized cannabis policy environment. Price is a key variable that needs to be addressed to prevent a rise in consumption. CONCLUSION: Repressive cannabis policies are expensive and have limited impact on consumption. Consumption legalization significantly reduces expenses for repression and law enforcement, allowing for the allocation of more resources to other targets such as education and prevention. With legalization of supply along with consumption, repression and law enforcement costs are reduced even further. Moreover, a legal market would create employment and generate tax revenues that could be allocated to the prevention of increased consumption. Legalizing cannabis would not lead to a sudden rise in consumption, providing the duty imposed by the state kept the product at its current price.

The myth of virginity: the case of a Franco-Belgian serial killer.

This article provides an in-depth description of the case of Michel Fourniret (MF), a French serial killer who, with his wife Monique Olivier (MO), confessed to kidnapping, raping, and murdering at least nine girls during the 1980s and 1990s. Using information from writers, witnesses, trial experts, and regarding current forensic literature, we utilize this case to discuss sexual homicide from both the forensic and neuropsychiatric perspectives. Interview, psychometric, and forensic data from the trial were used to explain and shed light on MF's and MO's personalities and psychosexual proclivities. In the final section, we propose and discuss several theories and specific areas of potential exploration that, in light of the murder couple case story, may prove fruitful in the study of violent attachment and murder pacts.