A. Douzenis

Female perpetrators of sexual abuse of minors: what are the consequences for the victims?

INTRODUCTION The definition of sexual abuse changes according to the moral values and culture of each era. In the past the perpetrators of sexual abuse were perceived to be exclusively male. However, contemporary literature is placing increasing emphasis on the role of female sexual abusers. The aim of the current literature review is to focus on the consequences of sexual abuse in minors when the perpetrator is female. METHODS A literature search of the main databases for studies was conducted. Restriction was placed on European and North American literature due to perceived culture differences. RESULTS Victims of sexual abuse by female perpetrators are usually friends or relatives of the abuser and find themselves sometimes under persuasion and psychological coercion to participate in sexual acts. The percentage of male victims is growing. There are severe and longstanding psychological consequences for the victims which are further analyzed. CONCLUSION Contemporary studies offer limited information about this issue and the consequences it has on the victims. The majority of such cases are not reported. Sometimes sexual abuse by female perpetrators is considered more acceptable than sexual abuse by males. Psychological interventions could be a powerful tool in reduction of female sexual abuse and its consequences on the victims.

Tardive dyskinesia in a patient treated with quetiapine

Quetiapine is an atypical antipsychotic that is believed to have a low D2 binding affinity in striatal and extrastriatal regions. We report the case of a female patient with the diagnosis of schizoaffective disorder (using DSM-IV-TR criteria) who initially received amisulpride for 3 months, discontinued gradually because of persistent and distressing extra-pyramidal symptoms, and who developed tardive dyskinesia 3 months later after the initiation of quetiapine. A trial with ziprasidone resulted in a further worsening of tardive dyskinesia symptoms. A further trial with aripiprazole, improved her tardive dyskinesia symptoms. Although, it is under consideration the possibility that the improvement could have been due to the discontinuation of quetiapine, we conclude that aripiprazole improved the TD symptoms.

Minor psychiatric disorders and syncope: the role of psychopathology in the expression of vasovagal reflex.

Background: A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. Methods: In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. Results: A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p < 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 ± 0.5 from 2.5 ± 1.4, p < 0.01, and 0.7 ± 0.5 from 2.7 ± 1.3, p < 0.01, respectively). Conclusion: A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

Medical comorbidity of cluster B personality disorders.

Purpose of review Cluster B personality disorders are associated with behaviour and lifestyle that cause significant problems not only for the personality disordered individual but for society as well. Despite the fact that cluster B personality disorders have attracted a lot of research interest recently, their association with medical (physical health) problems is less studied, though it is anticipated that personality is clinically important and influences the outcome of somatic disease illnesses. Recent findings Cluster B personality disorders are associated with Axis I psychiatric disorders such as addiction that have serious and life-threatening physical comorbidity. Lifestyle and health behaviours associated with cluster B personality disorders lead to medical problems and enhance preexisting physical problems. Furthermore, personality traits associated with cluster B personality disorders disrupt both medical treatment and follow-up, influencing negatively life expectancy and quality of life. Summary It is imperative that clinicians of all medical specialties are aware of the influence personality disorders and certain personality traits such as impulsivity can have on the outcome of the illness. Further research on the interaction between personality disorders and medical illness is needed.

Isolated delusional syndrome in Parkinson’s Disease

Psychotic features in patients with Parkinsons Disease usually present as visual hallucinations against a background of cognitive deterioration and dopaminomimetic therapy. Isolated delusions are rare. We report here 4 patients with Parkinsons Disease who developed a delusional syndrome resembling schizophreniform psychosis in the absence of changes in alertness, visual hallucinations or dementia. We suggest that this syndrome may be more common than previously recognized, and that it may be related to the use of dopaminergic medications and environmental triggers on a background of a susceptible individual. This syndrome suggests interesting parallels with the pathophysiology of amphetamine-induced psychosis and schizophrenia.

Porencephaly and psychosis: a case report and review of the literature

BackgroundMalformations of the cerebral cortex are often associated with developmental delay and psychoses. Porencephaly is a rare congenital disorder of central nervous system involving a cyst or a cavity filled with cerebrospinal fluid, in brains parenchyma.Case presentationWe present a 25 years old woman with her first psychotic episode. She also suffers from porencephaly in the frontotemporal lobes region. It is emphasized that the two consistently abnormal brain regions in schizophrenia research had significant damage in this patient since birth. There is a total of only five cases of schizencephaly or porencephaly associated with psychosis in the scientific literature. Their clinical characteristics as well as the imaging results are described.ConclusionIt is unclear if porencephaly and psychosis concur by chance or are causally related. The area where the porencephalic cysts appear seems to be of relevance. This case highlights the need for further research.

Obsessive-compulsive disorder associated with parietal white matter multiple sclerosis plaques.

We report the case of a patient who developed obsessive-compulsive symptoms after being diagnosed with multiple sclerosis. In this patient, obsessive-compulsive symptoms deteriorated with the emergence of a right parietal white matter multiple sclerosis plaque. The involvement of parietal white matter abnormalities in the pathophysiology of obsessive-compulsive disorder remains largely unexplored. Our case report raises the possibility that parietal lobe white matter microstructure plays a role in mediating obsessions and compulsions through disruptions of the functional connectivity between cortical–cortical and/or cortical–subcortical brain regions implicated in the pathophysiology of obsessive-compulsive disorder.

Signs of striatal dopamine transporter density increase in association with improvement of tardive dyskinesia in a patient with schizophrenia, as demonstrated by a DAT scan.

The imaging of the dopamine transporter could demonstrate the implication of dopaminergic pathway in the appearance of tardive dyskinesia. We report a case with psychotic and tardive dyskinesia symptoms. A DAT scan showed decreased dopamine transporter uptake in the area of brains basal gaglia. A trial with quetiapine improved both psychotic and TD symptoms while a second DAT scan showed improvement status. We conclude that increased dopamine transporter uptake seemed to associate with the improvement of TD.

Differences Between Suicide Victims Who Leave Notes and Those Who Do Not

BACKGROUND Whether differences exist between those who do leave a suicide note and those who do not has not yet been comprehensively answered. Leaving a suicide note is not a random phenomenon: A minority, varying between 3-42%, of all suicide victims leave a note. AIMS To compare the group of suicide victims who leave notes with the ones who do not, using data from the Athens Department of Forensic Medicine, the largest in Greece. METHODS We examined sex, age, nationality, religious beliefs, marital and residential status, history of prior psychiatric disorder and psychiatric attempt(s), suicide method, physical disease, recent hospitalization, and existence of suicide notes. We completed psychological autopsy questionnaires after phone interviews with relatives of the suicide victims of a 2-year period (November 2007-October 2009). RESULTS Note writers, 26.1% of our sample, differed in the following: they died by hanging or shooting (p=.007), had no history of psychiatric illness (p<.001) or recent (i.e., within 12 months of the suicide) psychiatric hospitalization (p=.005). CONCLUSIONS Our study showed that there are indeed differences between suicide victims who leave a note and those who do not. We also suggest some explanations for these differences, which could represent a valuable starting point for future research on this topic.

Psychotic (delusional) depression and suicidal attempts: A systematic review and meta-analysis

It still remains unclear whether psychotic features increase the risk of suicidal attempts in major depressive disorder. Thus, we attempted, through a systematic review coupled with a meta‐analysis, to elucidate further whether unipolar psychotic depression (PMD) compared to non‐PMD presents higher levels of suicidal attempts.