Florence Hellen

Attention and CERAD test performances in cognitively impaired elderly subjects

Attention plays a fundamental role in cognitive performance and is closely interrelated with all major cognitive domains. In this retrospective study, we correlated different measures of attention with standard cognitive parameters in 85 cognitively impaired elderly individuals presenting with cognitive complaints to a memory clinic.

Der „erweiterte Suizid“

ZusammenfassungHintergrundDer Homizid-Suizid ist ein seltenes schwerwiegendes Phänomen, welches vor allem in Intimbeziehungen oder Familien auftritt.Material und MethodenFür den Zeitraum von 2006 bis 2011 konnten im Einzugsgebiet der Rechtsmedizin Düsseldorf insgesamt 10 solcher Ereignisse identifiziert werden, die durch Einsichtnahme in die rechtsmedizinischen und staatsanwaltschaftlichen Unterlagen untersucht wurden.ErgebnisseDie Täter waren ausschließlich männlich. Als Risikofaktoren konnten im Konsens mit der Literatur männliches Geschlecht, höheres Lebensalter, intime Täter-Opfer-Beziehung, Zugang zu Schusswaffen sowie narzisstische und/oder emotional instabile Persönlichkeitsmerkmale und Impulsivität herausgearbeitet werden. In allen gefunden Fällen lagen je mindestens drei Risikofaktoren vor. Mutmaßliche Hauptmotive waren Trennungswunsch der Partnerin und drohender sozialer Abstieg. Die meisten Opfer verstarben an den Folgen einer Schussverletzung, am nächst häufigsten war Tod durch scharfe Gewalt.SchlussfolgerungDie Homizid-Suizide scheinen sich phänomenologisch von Homiziden und Suiziden zu unterscheiden. Insbesondere die Darstellung der Risikofaktoren soll dazu dienen, behandelnde Ärzte, Ermittlungsbehörden oder andere öffentliche Institutionen hinsichtlich der Gefahr eines Homizid-Suizids zu sensibilisieren.SummaryBackgroundHomicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families.Materials and methodsIn this study ten cases of murder-suicide during the period 2006–2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files.ResultsAll perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force.ConclusionsCompared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.BACKGROUND Homicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families. MATERIALS AND METHODS In this study ten cases of murder-suicide during the period 2006-2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files. RESULTS All perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force. CONCLUSIONS Compared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.

Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease.

Anosognosia is common in patients with Alzheimer disease (AD) even in early stages. Although neural correlates and the impact of cognitive dysfunctions have been described, possible psychodynamic processes such as a repressive coping style as described in other illnesses, have not been examined. Our study aimed to examine possible psychological influence factors on illness perception embracing a repressive coping style and cognitive functions in AD patients in the diagnostic process. Fifty-four subjects with mild AD diagnosed in our memory clinic were enrolled. Anosognosia was evaluated using a patient-caregiver discrepancy rating. All patients underwent comprehensive neuropsychological testing. In addition, characteristics of a repressive coping style were assessed. In total, 79.6% of our patients showed a lack of awareness at least to some degree. 33.3% of the patients were classified as repressors. Repressors and nonrepressors did not differ in cognition, or the unawareness score. Multivariate regression analysis showed that repressive coping style did not significantly contribute to anosognosia, but that verbal memory and naming ability had a strong influence. Although our data indicate that a high proportion of patients with mild AD show characteristics of repressive coping, this possible defense mechanism had no influence on the awareness of illness-related deficits measured by caregiver patient discrepancy.

Extended suicide : Homicide-suicide under psychopathological and criminological aspects

ZusammenfassungHintergrundDer Homizid-Suizid ist ein seltenes schwerwiegendes Phänomen, welches vor allem in Intimbeziehungen oder Familien auftritt.Material und MethodenFür den Zeitraum von 2006 bis 2011 konnten im Einzugsgebiet der Rechtsmedizin Düsseldorf insgesamt 10 solcher Ereignisse identifiziert werden, die durch Einsichtnahme in die rechtsmedizinischen und staatsanwaltschaftlichen Unterlagen untersucht wurden.ErgebnisseDie Täter waren ausschließlich männlich. Als Risikofaktoren konnten im Konsens mit der Literatur männliches Geschlecht, höheres Lebensalter, intime Täter-Opfer-Beziehung, Zugang zu Schusswaffen sowie narzisstische und/oder emotional instabile Persönlichkeitsmerkmale und Impulsivität herausgearbeitet werden. In allen gefunden Fällen lagen je mindestens drei Risikofaktoren vor. Mutmaßliche Hauptmotive waren Trennungswunsch der Partnerin und drohender sozialer Abstieg. Die meisten Opfer verstarben an den Folgen einer Schussverletzung, am nächst häufigsten war Tod durch scharfe Gewalt.SchlussfolgerungDie Homizid-Suizide scheinen sich phänomenologisch von Homiziden und Suiziden zu unterscheiden. Insbesondere die Darstellung der Risikofaktoren soll dazu dienen, behandelnde Ärzte, Ermittlungsbehörden oder andere öffentliche Institutionen hinsichtlich der Gefahr eines Homizid-Suizids zu sensibilisieren.SummaryBackgroundHomicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families.Materials and methodsIn this study ten cases of murder-suicide during the period 2006–2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files.ResultsAll perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force.ConclusionsCompared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.BACKGROUND Homicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families. MATERIALS AND METHODS In this study ten cases of murder-suicide during the period 2006-2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files. RESULTS All perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force. CONCLUSIONS Compared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.

Der „erweiterte Suizid“@@@“Extended suicide”: Vollendete Homizid-Suizide unter psychopathologischen und kriminologischen Aspekten@@@Homicide-suicide under psychopathological and criminological aspects

ZusammenfassungHintergrundDer Homizid-Suizid ist ein seltenes schwerwiegendes Phänomen, welches vor allem in Intimbeziehungen oder Familien auftritt.Material und MethodenFür den Zeitraum von 2006 bis 2011 konnten im Einzugsgebiet der Rechtsmedizin Düsseldorf insgesamt 10 solcher Ereignisse identifiziert werden, die durch Einsichtnahme in die rechtsmedizinischen und staatsanwaltschaftlichen Unterlagen untersucht wurden.ErgebnisseDie Täter waren ausschließlich männlich. Als Risikofaktoren konnten im Konsens mit der Literatur männliches Geschlecht, höheres Lebensalter, intime Täter-Opfer-Beziehung, Zugang zu Schusswaffen sowie narzisstische und/oder emotional instabile Persönlichkeitsmerkmale und Impulsivität herausgearbeitet werden. In allen gefunden Fällen lagen je mindestens drei Risikofaktoren vor. Mutmaßliche Hauptmotive waren Trennungswunsch der Partnerin und drohender sozialer Abstieg. Die meisten Opfer verstarben an den Folgen einer Schussverletzung, am nächst häufigsten war Tod durch scharfe Gewalt.SchlussfolgerungDie Homizid-Suizide scheinen sich phänomenologisch von Homiziden und Suiziden zu unterscheiden. Insbesondere die Darstellung der Risikofaktoren soll dazu dienen, behandelnde Ärzte, Ermittlungsbehörden oder andere öffentliche Institutionen hinsichtlich der Gefahr eines Homizid-Suizids zu sensibilisieren.SummaryBackgroundHomicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families.Materials and methodsIn this study ten cases of murder-suicide during the period 2006–2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files.ResultsAll perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force.ConclusionsCompared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.BACKGROUND Homicide-suicide is a rare and serious phenomenon which mainly occurs in intimate relationships and families. MATERIALS AND METHODS In this study ten cases of murder-suicide during the period 2006-2011 in the greater area of Düsseldorf were investigated. Data were obtained from coroner and prosecution files. RESULTS All perpetrators were male. In accordance with the literature the results of the analysis revealed male sex, higher age, intimate partnership, access to firearms and special personality traits, mainly emotionally unstable, narcissistic traits and aggressiveness as the main risk factors. In all cases, at least three risk factors were identified. Breakdown of the marital relationship and social descent emerged as probable leading motives. Shooting was the most frequent method of killing followed by sharp force. CONCLUSIONS Compared with homicide and suicide, homicide-suicide appears to be a distinct phenomenon. The knowledge and understanding of relevant risk factors could help mental health professionals, police and public authorities to intervene in time.

Bilddokumente hautnah: Opfer oder Täterin?

— Ein 16-jähriges Mädchen erschien bei der Polizei und erklärte, dass sie in einem Park von einem maskierten Mann gewaltsam festgehalten und an einem Baum gebunden worden sei. Der Mann habe ihr mit einem 20 cm langen Küchenmesser diese Schnittwunden zugefügt. Die vorliegenden Verletzungen weisen nahezu alle wesentlichen Charakteristika einer Selbstbeschädigung auf. Es handelt sich um zahlreiche, durchweg oberflächliche, annähernd parallel angeordnete Schnitte. Die Verletzungen liegen in einem Bereich, der einer Selbstbeibringung leicht zugänglich ist und mit der Rechtshändigkeit des Mädchens gut vereinbar ist. Die Kleidung war unversehrt, die übrige Untersuchung zeigte keine Abwehrverletzungen oder andere Spuren einer äußerlichen Gewaltanwendung, was dem geschilderten dramatischen Ablauf widersprach. Nach Konfrontation mit den Hinweisen auf selbstschädigendes Verhalten, gab das Mädchen an, dass sie vor längerer Zeit sexuell missbraucht worden war und auf ihre seelische Notlage aufmerksam machen wollte.

Resumption of food and fluid intake in Alzheimer's disease with severe apathy following intravenous citalopram

A 61-YEAR-OLD WOMAN with Alzheimer’s dementia (AD) was admitted semi-mutistic having ceased eating, drinking, and taking oral medications over 2 weeks before. DSMIV-TR criteria for major depression were not met. Hostile/ aggressive features as well as any signs of emotional distress were unapparent. Thus, upon admission, apathy syndrome was diagnosed with indolence, requirement of prompts to initiate physical and mental activity and a complete lack of goaldirected behavior. Medical and neurological examination revealed tachycardia and clinical signs of dehydration but she was otherwise normal. Laboratory work-up was normal. A computed tomography scan showed no acute pathological findings. Intravenous fluid and electrolyte replacement was installed. Treatment with intramuscular lorazepam (1 mg b.i.d.) and haloperidol (5 mg q.d.) had no effect and was discontinued after 5 days. Intravenous administration of citalopram 20 mg q.d. was started after 5 drug-free days. Three days later, responsiveness increased, and spontaneous speech and emotional reactions occurred. After 8 days, the patient ate and drank. She was switched successfully to oral citalopram 40 mg q.d. after 14 days. Although emotional blunting persisted, she became accessible and cooperative. Her Mini Mental State Examination score was 15/30, consistent with moderate dementia. After 30 days of oral citalopram, she was referred to a nursing home with sufficient daily food and fluid intake, having gained 1.9 kg of bodyweight. Apathy is one of the most common behavioral symptoms in AD representing a significant burden to patients and caregivers. Severe forms, such as the reported case, with distinct key symptoms as highlighted above are well separable from other AD-related behavioral disturbances, above all, depression. Treatment options include psychostimulants and dopaminergics which, however, are not available for parenteral administration and bear the risk of other behavioral complications. Selective serotonin reuptake inhibitors (SSRI), such as citalopram or sertraline, are well tolerated in geriatric populations. However, most likely due to differentially impaired neural pathways, they appear not to be effective in depression in AD. Nevertheless, SSRI have shown efficacy for treating irritability and psychotic symptoms in AD. Furthermore, cholinergic and glutamatergic disturbances, a profound alteration of serotonergic (5-HT) activity, for example via 5-HT1A receptor and/or 5-HT transporter reduction in AD, has been demonstrated and linked to the aforementioned neurobehavioral symptoms. Thus, and given the possibility of parenteral administration, SSRI should be considered as an alternative treatment option for such conditions over less well-tolerated drug classes. Our case suggests that intravenous citalopram may be a treatment option in severe AD-related apathy.