Search

The management of patients diagnosed with personality disorders represents a challenge for any clinician, regardless of experience, especially when they have other comorbid psychiatric disorders. The major depression - borderline personality disorder - bulimia nervosa comorbidity constitutes a complex clinical presentation, with heterogeneous psychiatric manifestations, which require immediate therapeutic intervention, in order to prevent the risk of suicide or other complications. This paper presents the case of an 18-year-old patient, who was admitted to our unit for depressive symptoms with severe intensity, alongside suicidal ideation, behavioral difficulties, self-harm and an eating disorder. [ABSTRACT FROM AUTHOR]

Judicial psychological expertise is an important element for establishing the importance of juridical objective circumstances whith the purpose of determining a correct qualification of the juridical event or situation. The use of psychological knowledge enhances the possibility of determining several important facts and circumstances in order to solve a case rightly and fairly, and ensures the multi-aspect examination of circumstances contributing to avoiding false accusations. Thus, the present paper aims to present a case of judicial psychological expertise of a minor, a victim of sexual, physical and psychological abuse. [ABSTRACT FROM AUTHOR]

This paper aims to review the generally accepted benchmarks (evidence) of suicide in major depressive disorder and the controversies surrounding them. Resuming the discussion of concepts that appear to be axiomatic may open new opportunities for the development of pragmatic interventions aimed at reducing the suicidal phenomenon in general and at the level of particular populations, such as those of Harghita and Covasna counties, where the suicide rate continues to be very large, despite the measures already taken. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUD) are some of the greatest challenges in clinical practice, because of their tendency to become chronic, to associate various complications, to decompensate underlying psychiatric or somatic disorders, to increase the hospitalization costs for any comorbid conditions etc. In this context, the case manager should be aware of the necessity for a multidisciplinary team that has to approach psychological, organic and social aspects of the SUD. A narrative review of the most evidence-based treatments for SUD is considered important as a reference for clinicians faced with SUD patients. The main dimensions of the therapeutic management suggested by this paper are: combined pharmacological and psychotherapeutic treatment is necessary; organic diseases should be evaluated and treated concomitantly with SUD; using psychological instruments is important for an objective monitoring of the clinical evolution; the involvement of a caregiver in the patient monitoring is strongly recommended, both on short and long term; particular care to pharmacokinetic and pharmacodynamic interactions of the recommended treatment is required; also, special consideration should be paid to the risk of overdose, adverse events and discontinuation risk for all the recommended drugs. [ABSTRACT FROM AUTHOR]

Depression is an important public health problem at the moment. There are data that can influence the spiritual spirit and resilience on major depression, can be studied imposingly and to cope with a Romanian population. The study will evaluate the spirituality, resilience, symptoms and severity of depression and suicide risk on a sample of adult patients diagnosed with major depression. The control group will consist of participants without psychiatric background, comparable as age and sex with the first group. Patients will undergo a structured psychiatric interview (M.I.N.I. - International Neuropsychiatric Interview), will complete a demographic questionnaire and will assessed with a depression scale, suicide risk scale, resilience and spirituality scale. Spirituality and religiosity become an area of interest for the study of depression protective factors. The present paper may propose to demonstrate the beneficial influence of the spirituality on the symptoms of major depression and the reduction of suicide risk in major depressive disorder. If the study will find a statistically significant correlation between spirituality and suicide risk reduction, it will emphasize the importance of spirituality in the evolution of psychiatric patients and it may change their approach and management. [ABSTRACT FROM AUTHOR]

The evolution of temporal lobe epilepsy often implies complex psychiatric manifestations, as the elements can be part of an aura, as well as of a psychiatric pathology of its own. This paper presents the case of a patient diagnosed with focal epilepsy of the right mesial temporal lobe, who subsequently developed psychotic disorder due to a general medical condition with medicolegal implications, treatment noncompliance and difficulties in controlling epileptic seizures. [ABSTRACT FROM AUTHOR]

Post-stroke depression is a very challenging condition because it involves the existence of a frail biological and psychological background. The clinician must therefore observe carefully the clinical context before the initiation of a treatment, in order to prevent severe adverse events for this group of age and negative pharmacokinetic and pharmacodynamic interactions, and to monitor the concomittant treatment of multiple comorbidities within an interdisciplinary team. More difficulties arise from the psychiatric evaluation of these patients which may be very hard-to-do - e.g., in a patient with aphasia, or with a preexistent neurocognitive disorder. The first step of this paper was to review the existing clinical studies dedicated to the evaluation of the efficacy and tolerability of antidepressants in post-stroke depression, in order to provide the clinician with a few orientation points.The use of structured psychological instruments for measurement of depression severity is encouraged, in order to monitor as objectively as possible the patients' evolution under treatment. Post-stroke depression is correlated with negative functional prognosis and a poorer quality of life, therefore its treatment is necessary even for the physical recovery of these patients. The treatment of post-stroke depression may decrease the risk of a new cerebrovascular incident, an argument to further support the necessity of an early and efficient therapeutic intervention in patients diagnosed with this disorder. [ABSTRACT FROM AUTHOR]

This paper was written from the p o in t o f view o f a real crisis worker belonging to a Crisis Intervention Program in Canada. My main goal was to transfer these specific and sensitive knowledge and protocols about assessment and intervention o f a suicidal individual to the hypothetic crisis services from Romania. The paper reproduced the real steps o f an algorithm followed by a crisis worker having to respond to a suicidai crisis: (i) contact, (ii) communication, (Hi) assessment protocol and instruments, (iv) risk and protective factors, (v) general and particular issues o f the interviewing with a suicidal individual, and (vi) intervention methods. The suicidal subject is taken specifically into account in various situations: unsuccessful suicidal attempt, presence o f a suicidal ideation, formulation o f a suicidal plan, and possession o f the resources to fu lfill a suicidal plan. Intervention protocol fo r a suicidal individual is portrayed as a 25- step logical program ended up with the formulation o f a suicidal safety plan, follow-up contacts, referral to other services, and documentation. A ll these crisis worker's activities are highly standardized and structured so th a t h e/ she w ill stand up accountable for the jo b done. Drawing up this paper, the author has creatively incorporated his personal experience w orking in the crisis programs and the review o f a large body o f international references. [ABSTRACT FROM AUTHOR]

This paper was written from the point o f view o f a real crisis worker belong to a Crisis Intervention Program in Canada. My main goal was to transfer these specific and sensitive knowledge and protocols about assessment and intervention o f a suicidal individual to the hypothetic crisis services from Romania. The paper reproduced the real steps o f an algorithm followed by a crisis worker having to respond to a suicidal crisis: (i) contact, (ii) communication, (Hi) assessment protocol and instruments, (iv) risk and protective factors, (v) general and particular issues o f the interviewing with a suicidal individual, and (vi) intervention methods. The suicidal subject is taken specifically into account in various situations: unsuccessful suicidal attempt, presence o f a suicidal ideation, formulation o f a suicidal plan, and possession o f the resources to fulfill a suicidal plan. Intervention protocol for a suicidal individual is portrayed as a 25-step logically program ended up with the formulation o f a suicidal safety plan, follow-up contacts, referral to other services, and documentation. All these crisis worker's activities are highly standardized and structured so that he/ she w ill stand up accountable for the job done. Drawing up this paper, the author has creatively incorporated his personal experience working in the crisis programs and the review o f a large body o f international references. [ABSTRACT FROM AUTHOR]

Objectives: The recent evaluatior of the relationship between psychological and medical interventions in ADHD reveals the level of the reductionist approach o f just initiating drug therapy in order to treat the disease. The objective ofthis paper is to assess the main factors that led to the imbalance between drug and psychological intervention in ADHD and to identify possible communication dysfunction that could be corrected. Results: The variable prevalence of ADHD rates argue for the existence of a communication deficit in agreeing common diagnostic criteria and stresses the significant influences of Socio Economic Status and cultural environment. The modern technology does not communicate much in order to bring more specificity to ADHD diagnosis so searching for more objective tests continues to remain a challenge. Despite the high level of unspecificity, ADHD diagnosis often comes for families as a relief, a quick and unbinding intervention contrary to long-term commitement required by psychotherapy. The fact that less than a quarter ofchildren diagnosed with ADHD have received psychotherapy in the year they received medication, does not suggest that parents are informed enough about aspects of treatment effectiveness, possible side effects or abuse. Also, psychologists have some responsibility for the current situation. Although psychotherapy has acquired sufficient clinical evidence, the results should be expressed in a more convincing manner in order to improve the communication with psychiatrists, family practitioners and insurers. Healthcare authorities could have their role in improving communication about ADHD treatment options by asking for direct comparisons between non-pharmacological and pharmacological treatments for ADHD. The requestto conduct direct comparative studies could lead to the conclusion that it would be useful to reimburse psychological interventions in the firstphase oftreatment, increasing both long-term satisfaction o f families who have a member suffering from this problem and cost-effectiveness in public spending. Conclusions: Although there are no studies to show what percentage of ADHD patients in Romania benefit from psychotherapy, we can assume that the percentage is significantly below the US figures. It is thus assumed that the warning made by American experts about the underusage of psychotherapy benefits in ADHD can be considered also by the Romanian healthcare authorities. It is the role of psychologists to better communicate psychotherapy benefits in ADHD but in the same time it is the role o f doctors and health authorities to try to correct the other communication disfunctions highlighted by this paper. [ABSTRACT FROM AUTHOR]

Introduction. Depression and suicidal behaviour represent major public health issuss. Although they are intensely studied, few literature works focus on a common endophenotype, composed of genetic and psychological aspects of these disorders. Materials and method. One hundred sixty-seven patients were recruited for this transversal study, out of which 125 had a clinical diagnosis of unipolar or bipolar depression, with or without suicide attempt, and 42 were healthy subjects. The participants were applied psyhological scales (BIS-11, MADRS, Paykel, TCI), cognitive tests (Cog Test), and biological samples were obtained for genetic determinations. Genetic tests comprise determinations realised using PCR method - for 5-HTTLPR polimorphism (L/S variant), COMT (Val/Met), BDNF (Val/Met), and rtPCR for ApoE, GPHN and GRID2 genes, respectively. Discussions and conclusions. Although researchers suppose that a suicide phenotype exists, which includes the ideation, the plan and the suicide attempt, there are few studies that highlight these traits. The goal of the present paper is to elaborate a model of quantification for the suicide risk, based on personality traits, and genetic and clinical markers. Another goal is to identify the genes responsible for depression vulnerability in a Romanian population, in subjects diagnosed with uni- or bipolar depression, with or without previous suicidal attempts. [ABSTRACT FROM AUTHOR]

Although multiple clinical scales for dementia assessment have been designed, only some of these are commonly used in clinical practice or in clinical trials. The scales built for the multidimensional assessment of Alzheimer's dementia have proved to be useful over the years for the evaluation of other forms of dementia. In addition to the evaluation of cognitive deficits, core symptoms of dementia, clinical scales target also non-cognitive associated symptoms, the level of functioning and the quality of life of patients with dementia. There are clinical scales that aim to make a global assessment of the disease. The most known assessment scales that are used in clinical practice and in most clinical trials are: Alzheimer's Disease Assessment Scale - cognitive section (ADAS-cog) for cognitive impairment, Neuropsychiatric Inventory (NPI) for non-cognitive symptoms, Interview for Deterioration in Activities of Daily Living in Dementia (IDDD) for functional assessment and the Clinical Dementia Rating (CDR) for the global assessment of dementia. Several of the dementia assessment scales have proven useful as screening tools in primary care. These are the Abbreviated Mental Score Test (AMST), the Mini Mental State Examination (MMSE), and the Clock Design Test. Almost all clinical scales are hetero-evaluation scales, some of which are applied by the clinician and others are scored by the caregiver. The purpose of this paper is to review the clinical scales designed and used in the extensive assessment of dementia. [ABSTRACT FROM AUTHOR]

Psychogeriatrics is defined as a branch of psychiatry which handles with diagnosis, treatment and care of the mental disorders occurring in the elderly population. Its recognition in many European countries has allowed the development of institutions and diagnosis and care structures which have a community structure. Moreover, in the last 5- 10 years, a special attention is given to specific emergency psychiatric pathology among which the states of delirium, which recorded a high rate of mortality, psychotic disorders and behavioral and psychiatric disorders in dementia (BPSD), pathology which is the main cause for the quality of life deterioration in suffering people and their family. The paper describes in detail the structures and diagnostic and care services for BPSD, according to European recommendations, as concluded the Alzheimer Cooperative Valuation in Europe study (ALCOVE), conducted in 19 ELI member states including Romania, during 2011-2013. This European project had as objective to inform and guide policy makers, health professionals, carers of people with dementia and other European citizens through converged operational recommendations in terms of health policies. [ABSTRACT FROM AUTHOR]

The field o f neuroscience has known a vast expanse o f its areas o f study and the methods used. A high number o f other various disciplines (from mathematics and physics to philosophy and linguistic to psychology and medicine) currently study diverse aspects o f neurosciences. Even the domain o f neuroscience is, at this point, very diverse by including numerous sub domains which often present similar areas o f interest or use the same techniques. In this paper we will present the main fields o f study which use neurosciences in their research, such as medicine, genetics, psychology, engineering, philosophy, linguistics, ethics and law and we will focus on the main techniques used in neurosciences (brain imaging, electrophysiology, microscopy, biochemistry and genetics). [ABSTRACT FROM AUTHOR]

Increase in conduct disorder occurrence and severity among children and adolescents motivates the diversity o f interdisciplinary efforts to identify the triggers, the predisposing factors, the facilitators and maintenance factors o f psychopathoiogicai features within this disorder, in the present paper we investigate which o f the psycho-sociai aspects we studied in relation to conduct disorder are the most important predictors o f adolescents' maladaptive behaviors. The broad perception o f problem solving (trust in one's ability to solve problems, the approach style - avoidance and personal control), irrational values/beliefs and self esteem are significant predictors for development o f conduct disorder. The resulting predictors can be useful in identifying the adolescents with conduct disorder as well as in applied studies of psychological intervention. [ABSTRACT FROM AUTHOR]

First Psychotic Episode With Murder -- Category Perspective This paper is a case presentation whose topic is more rarely encountered in psychiatric practice because the onset of the first psychotic episode was through a murder, to which had been retraced a particular prodrome, an acute psychotic schizophrenia -- like disorder and then observing a particular evolution in the context of an imposed treatment and a course of medical services consumption according to the law. [ABSTRACT FROM AUTHOR]

This paper is a case presentation whose topic is more rarely encountered in psychiatric practice because the onset of the first psychotic episode was through a murder, to which had been retraced a particular prodrome, an acute psychotic schizophrenia - like disorder and then observing a particular evolution in the context of an imposed treatment and a course of medical services consumption according to the law. [ABSTRACT FROM AUTHOR]

In my experience over time, I often encountered anxious subjects, anxiety being close to an adjuvant for different types of mental and psychosomatic disorders. The present paper presents a model for the cognitive approach, focusing on anticipatory anxiety. This approach requires calculation, systematization and rationalization, using the method of probability, not possibilities. The conclusion towards which I tend to guide the readers of this paper consists in a terminological and psychological clarification, to decrease the anxiety that comes in this process, and I present a chart for a curative proportional practice for the anticipatory anxiety. [ABSTRACT FROM AUTHOR]

Retrogenesis has been defined as the process by which the progression of Alzheimer's disease (AD) deterioration proceeds inversely to human ontogenic acquisition patterns. The present paper gives an overview of the functional, cognitive, neurologic, neuropathologic, neurometabolic and electrophysiological evidence that support the concept of retrogenesis. It also emphasizes a retrogenic model for detecting abuse of institutionalized people with AD. Moreover, the paper provides expert opinion on the possible ethical and forensic implications of retrogenesis. [ABSTRACT FROM AUTHOR]

In my experience over time, I often encountered anxious subjects, anxiety being close to an adjuvant for different types of mental and psychosomatic disorders. The present paper presents a model for the cognitive approach, focusing on anticipatory anxiety. This approach requires calculation, systematization and rationalization, using the method of probability, not possibilities. The conclusion towards which I tend to guide the readers of this paper consists in a terminological and psychological clarification, to decrease the anxiety that comes in this process, and I present a chart for a curative proportional practice for the anticipatory anxiety. [ABSTRACT FROM AUTHOR]