Here it is good that they tell you their antecedents (we all have antecedents because we all have a life) and that they rule out organic pathology. That is fundamental. Let us not forget that also the hypochondriacs have body. We first eliminate the most striking "acute" personality disorder. Personality accompanies us all our lives. There are no "acute" characteristics in our personality. Depressive disorder? There is a time criterion that is not met, it may be sad, but sad is not depression (1). agoraphobia? if it was something like that we would have been told the context post-traumatic stress reaction? That's a good one.  The correct term would be post-traumatic stress disorder or acute stress reaction, and according to ICD 10: "The stressor may be a devastating traumatic experience involving a serious threat to the safety or physical integrity of the patient or loved one(s) (e.g., natural catastrophes, accidents, battles, muggings, rapes) or an abrupt and threatening change in the individual's rank or social environment (e.g., loss of several loved ones, house fire, etc.). )" or more briefly: "exceptionally threatening or catastrophic nature" Breaking up with a partner I understand is hard, but not exceptional. So by elimination 5. Crisis of distress. This is a useful question, common in daily practice, and so we see that we must avoid giving a diagnosis of long evolution for a natural reaction. Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins. Useful and realistic question.

Here it is good that they tell you their antecedents (we all have antecedents because we all have a life) and that they rule out organic pathology. That is fundamental. Let us not forget that also the hypochondriacs have body. We first eliminate the most striking "acute" personality disorder. Personality accompanies us all our lives. There are no "acute" characteristics in our personality. Depressive disorder? There is a time criterion that is not met, it may be sad, but sad is not depression [HIDDEN]. agoraphobia? if it was something like that we would have been told [HIDDEN] post-traumatic stress reaction? [HIDDEN] The correct term would be post-traumatic stress disorder or acute stress reaction, and according to ICD 10: "The stressor may be a devastating traumatic experience involving a serious threat to the safety or physical integrity of the patient or loved one(s) (e.g., natural catastrophes, accidents, battles, muggings, rapes) or an abrupt and threatening change in the individual's rank or social environment (e.g., loss of several loved ones, house fire, etc.). )" or more briefly: "exceptionally threatening or catastrophic nature" Breaking up with a partner I understand is hard, but not exceptional. [HIDDEN] Crisis of distress. This is a useful question, common in daily practice, and so we see that we must avoid giving a diagnosis of long evolution for a natural reaction. Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins. Useful and realistic question.

A 31-year-old man with no psychiatric history comes to the emergency room complaining...¨ symptoms of anxiety. Two days ago he experienced another episode of the same symptoms... .... 1 week ago he broke up with his partner... ruled out any organic pathology....:

[Depressive symptoms in pathomimia: comorbidity or psychiatric factitious disorder?].

The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders. The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement. These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.

Psichiatry_DSM-5

Anxiety disorders and obsessive-compulsive disorder. In OCD, there are recurrent intrusive thoughts, but these meet the definition of an obsession. In addition, the intrusive thoughts are not related to an experienced traumatic event, compulsions are usually pres- ent, and other symptoms of PTSD or acute stress disorder are typically absent. Neither the arousal and dissociative symptoms of panic disorder nor the avoidance, irritability, and anxiety of generalized anxiety disorder are associated with a specific traumatic event. The symptoms of separation anxiety disorder are clearly related to separation from home or family, rather than to a traumatic event. Major depressive disorder. Major depression may or may not be preceded by a trau- matic event and should be diagnosed if other PTSD symptoms are absent. Specifically, ma- jor depressive disorder does not include any PTSD Criterion B or C symptoms. Nor does it include a number of symptoms from PTSD Criterion D or E.

[Cerebral hydatic cyst and psychiatric disorders. Two cases].

The hydatidosis is an endemic illness in regions of the Middle Orient, Mediterranean, south of America, north Africa and the Australia. The preferential localization of cyst hydatic is the liver (48%), the lung (36%) and in 6% of cases it localizes in unaccustomed place as the brain. Intracerebral localization is relatively rare, its impact is 1 to 5% of all cases of hydatidose. This localization is the child's appendage with a masculine predominance. The cyst hydatic intracranien is often lone, of localization usually supratentorielle, sometimes infratentorielle. Symptoms are especially the diffuse headache associated to various neurological signs in relation with sits of the tumor. The psychiatrics symptoms depends on its localization, sides, intracranial hypertension, and the previous personality. In 15 to 20% of cases these tumors can appear in the beginning of their evolution by the isolated psychiatric symptoms. We report the case of two patients that have been hospitalized first in the Academic Psychiatric Unit of Marrakech for isolates psychiatric disorders and whose scanning revealed the presence of cerebral hydatic cyst and that required a surgical intervention in neurosurgery. Case 1 - Patient 29 years old, bachelor, uneducated, leaving in country outside, fermar, in permanent contact with dogs. No particular medical history. The patient has been brought by his family to the psychiatric emergencies after behavior disorders. The beginning of his symptomatology was one year ago by behavior disorders: instability, violence, isolation, and a corporo-sartorial carelessness. His symptomatology worsened and the patient became very aggressive. In psychiatric unit, he was disregarded, sad, anguished, indifferent to his state, very dissonant, completely detached, depersonalized. He brought back some visual and auditory hallucinations with attitude of monitoring. He was raving with delirium of persecution, of ideas of reference and delirium of bewithment. He was unconscious of his disorders. The patient has first been put under classical neuroleptic 9 mg/day of Haloperidol and 200 mg/day of chlorpromazine. The diagnosis of schizophrenia has been kept according to criteria of DSM IV. The PANSS (Positive and Negative Syndrome Scale) was to 137 (score on a positive scale was to 34, score on a negative scale was to 35 and the general psychopathologie scale was to 58). One week after his hospitalization, he developed headache with subconfusion, a cerebral scanning has been made in emergency and showed a voluminous cyst in oval foramen compressing the mesencephalon strongly. The cyst was well limited, hypodense, not taking the contrast, and without intracerebral oedema, the diagnosis of cerebral hydatic cyst has been made. The complementary exploration didn't show any other localizations, and biologic exam results didn't show any particular anomalies. The patient has been operated in neurosurgery. The immediate evolution was favorable with disappearance of confusion and absence of complications. The patient was lost of view. Six months after, the patient has been readmitted to the psychiatric emergency. He dropped his neuroleptic treatment. He was aggressive, raving, hallucinated and depersonalized. The global score to the PANSS was 63. He has been put back under neuroleptics. Three weeks after improvement and passage of the PANSS to 30, the patient went out. We couldn't have a cerebral scanner of control because the patient had no medical assurance and no money for cerebral scanner. Case 2 - Patient aged of 53 years, father of four children, uneducated, native and resident of Marrakech, confectioner as profession. He is in contact with dogs since 12 years. He has been brought to the psychiatric emergencies by his family after an agitation. The history of his illness seemed to go back at eight months ago, by the progressive apparition of an instability, sleep disorders, hostility, associated with an emotional lability. To the interview he was agitated and had a delirium of persecution. He was convinced that his wife and his children plotted against him. He had sad mood. He was anguished and had auditory and visual hallucinations. The patient was not confused but it had a hypoproxie, an fixing amnesia, a disorders of judgment and a light left hemiparesia. Cerebral scanner revealed three cerebral cyst. The first measuring 42 x 40 mm, sitting at the level parietal right, to the contact of the occipital horn, dragging his/her/its amputation and an effect of mass on ventricle homolateral, the median line and ventricle controlateral. The two other, at the level of the center semi oval, behind the first, measuring 23 mm and 15 mm on the big axis. The patient has been addressed in neurosurgery. He had a completeray exploration to search other localizations. The thoracic x-ray showed 2 pulmonary cyts. The abdominal scan and imagery by magnetic resonance showed liver cyst, peri-heart cyst and mediastinal cyst. The patient has been operated for these three cysts with good recuperation on the psychiatric and neurological symptoms. He has been addressed in heart surgery for the heart localization. The hydatidose is an endemic illness in Morocco and constitute a public health problem. The cerebral localization is rare and appear by signs of cerebral hypertension and signs of focusing. The psychiatric demonstrations are rare but preserve a major interest, by the therapeutic measure specificity that they impose. Of course, the surgical ablation of the tumor can be sufficient to attenuate the psychiatric symptoms but the recourse to a specific treatment can prove to be necessary to act on the precise targets. We are conscious of the methodological difficulties that present these 2 cases but there are unfortunately due to the financial difficulties of our patients.

Female same gender stalking: a brief review of the literature and case report.

The authors analyze a rare case of female same gender stalking that came to their observation as forensic psychiatry experts. Despite previously only heterosexual experiences, the woman, who was 30 in 2002, had three intimate same gender relationships in succession from 2002 to 2009: she broke off with each woman in order to take up with another. When she separated from the third woman she began violent persecutory behavior against her, in the form of harassment coming under the heading of stalking, and was reported to the authorities. In treatment with SSRI since 2003 for an anxiety disorder with panic episodes, she had been taking the drugs irregularly during the stalking period. At the end of the third relationship, after she had violently attacked her girlfriend she was advised by her family to present to a Hospital center in Northern Italy. There, she was diagnosed with a "Narcissistic Paranoid Personality Disorder", and it was hypothesized that the SSRI she was taking could have induced hypo/manic episodes and disinhibition in the woman, who had previously been heterosexual. At this hospital, mood stabilizers were prescribed. The defending lawyer therefore applied for a forensic psychiatry assessment, claiming that the persecutory behavior against the third girlfriend was induced by taking SSRI. In Italy the penal code specifies the recognition of abolished or diminished liability for crimes if a correlation between the mental disease and the crime can be demonstrated, if the disease was in course at the time of the crime, and if the motives behind the crime and the disease can be shown to be linked. In short, if the crime can be shown to be a symptom of the disease. But the forensic psychiatry assessment demonstrated that despite the presence of some factors of a psychopathological nature, the motives underlying the harassment were attributable to the woman's existential history and personality structure rather than to psychopathological causes. She was therefore judged guilty of the crime of stalking and a plea for a reduced sentence was granted. In this case, the gender of the stalker and victim seemed to be irrelevant.

Acute stress disorder

History The term "acute stress disorder" was first used to describe the symptoms of soldiers during World War I and II, and it was therefore also termed "combat stress reaction" (CSR). Approximately 20% of U.S. troops displayed symptoms of CSR during WWII. It was assumed to be a temporary response of healthy individuals to witnessing or experiencing traumatic events. Symptoms include depression, anxiety, withdrawal, confusion, paranoia, and sympathetic hyperactivity. The APA officially included the term ASD in the DSM-IV in 1994. Before that, symptomatic individuals within the first month of trauma were diagnosed with adjustment disorder. According to the DSM-IV, acute stress reaction refers to the symptoms experienced immediately to 48 hours after exposure to a traumatic event. In contrast, acute stress disorder is defined by symptoms experienced 48 hours to one month following the event. Symptoms experienced for longer than one month are consistent with a diagnosis of PTSD.

Jenny Jones (presenter)

Controversy On an episode called "Same-Sex Secret Crushes" taped on March 6, 1995, a gay man named Scott Amedure confessed his love for an acquaintance, Jonathan Schmitz. While on the show, Schmitz reacted with laughter; three days after the show's taping, he killed Amedure. He was later convicted of second degree murder and received a sentence of 25–50 years in prison. Amedure's family then sued the producers of The Jenny Jones Show, saying they should have known about Schmitz's history of mental illness. In interviews, Jones said the producers told Schmitz that his admirer could be a man, but Schmitz thought that the admirer was a woman. Jones also said that the show didn't want Schmitz to know the outcome of his secret crush. Amedure's family won the initial ruling, and the show was ordered to pay them $25 million. The verdict was later overturned by the Michigan appellate court.

[Mood disorder after malaria prophylaxis with mefloquine (two case reports)].

Mefloquine (Lariam) is the drug of choice as malaria prophylaxis for travel to chloroquine-resistant areas. Severe neuropsychiatric side effects are rare. We report two clinical cases of mood disorders: mania and a major depressive episode with psychotic characteristics in two patients with mefloquine antimalarial prophylaxis. FIRST CLINICAL CASE: A 31-year-old man had taken mefloquine at a rate of 250mg/week as malaria prophylaxis for his mission in Democratic Republic of Congo. He developed mania with psychotic symptoms after taking five tablets of 250mg of mefloquine. He exhibited an elevated mood and also developed delusions of grandeur, reference and persecution, with auditory hallucinations. The physical examination and the blood laboratory tests were normal. The patient was treated with an atypical neuroleptic (olanzapine 20mg/d) leading to a complete resolution of symptomatology at the end of 3 weeks. SECOND CLINICAL CASE: A 27-year-old man presented a major depressive episode with psychotic symptoms after 1 week on his return from a stay in Democratic Republic of Congo, where he had taken mefloquine during 6 months as malaria prophylaxis (250mg/week). His physical examination and investigations (full blood test, serology and MRN) were normal. The patient was treated with clomipramine (150mg/d) and olanzapine (20mg/d). The outcome was favorable after 4 weeks. Mefloquine is widely accepted as a safe and effective treatment and a prophylactic agent for chlorquine-resistant malaria. Common neuropsychiatric adverse effects of mefloquine can occur in up to 40% of patients, such as dizziness, sleep disturbances, anorexia, ataxia, and fatigue. Other more serious adverse reactions are rare. They are represented primarily by panic attacks, convulsions, acute psychosis, paranoid delusions, suicidal ideation, disorders of mood: major depressive episode and the manic excitation. The incidence of such neuropsychiatric effects is 1/10,000 to 1/15,000 during the prophylactic treatment. The causal mechanism for the side effects is not known. Several risk factors increasing the neurotoxicity of mefloquine can be identified, the patient with personal or family history of psychiatric disorders are more frequently concerned. Alcohol and the association with other drugs (like quinine) are two other risk factors. It is relevant for medical practitioners to be aware of the severe neuropsychiatric side effects of mefloquine as malaria prophylaxis. It requires investigation of the risk factors such as personal or family history of psychiatric disorders.

History of mental disorders

16th to 18th centuries

Self-embedding

The majority of people who engage in self-embedding are white teenage females with psychiatric diagnoses. Self-embedding has a high comorbidity with other psychological disorders such as post-traumatic stress disorder, dissociative disorder, and borderline personality disorder. Additionally, deliberate self-harm is associated with externalizing pathology such as oppositional defiant disorder and conduct disorder. Adolescents who self-injure have higher mean depression scores and report more depressive symptoms than adolescents who do not self-injure. They also report more symptoms of anxiety. Life stressors such as sexual abuse, witnessing family violence or experiencing a traumatic event have also been found to be associated with deliberate self-harm. The frequency and the presence of deliberate self-harm are correlated with the number of stressful life events adolescents report. Adolescents with a history of deliberate self-harm report more stressful life events and those with

Psychiatric history

Source and method of presentation The next step is to determine why the patient is there. How did they get to be in the interview? Were they referred by someone (such as another clinician, a relative or friend, or by the police or the courts) or did they come looking for help? If they were referred by someone then what was that person's reason for the referral. Often such information is provided in a referral letter or by an earlier phone call. The main (chief) complaints The clinician next tries to clarify what are the main problems that have brought the patient to be there. Some of this may have already been achieved in the previous section. The patient may have more than one problem and these may be related, such as posttraumatic stress disorder and alcohol abuse or seemingly unrelated, such as panic disorder and premature ejaculation. The patient is unlikely to present a diagnosis and is more likely to describe the nature of their problems in common language.

[Pseudo-dementia conversion and post-traumatic stress disorder].

Post-traumatic stress disorder (PTSD) is often associated with other psychiatric syndromes. However, studies exploring conversion and PTSD comorbidity are scarce. This paper reports the case of a 45 year-old patient without medical or psychiatric history. In 2003, he suddenly started suffering from amnesia and symptoms of delirium: he was at his office with a cup of coffee but he did not remember why. Aphasia, trembling, behavioural disorders appeared over the next hours and days. Numerous neurological examinations and laboratory tests (including cerebral imagery) were performed without evidence of any physical disease. Three psychiatric examinations were also negative, even if a possible psychogenic origin was hypothesized. Neurological or psychiatric diagnoses were discussed but without definitive conclusion. One year later, the symptoms were unchanged until the patient watched a movie ("Mystic River") that described the story of a man with sexual abuse in childhood. He suddenly remembered that he lived the same experience when he was 8 years old. At the end of the movie, his wife surprisingly noticed that he was walking and speaking normally. All the neurological symptoms disappeared. Unfortunately, symptoms of a severe PTSD appeared, as well as a major depressive disorder. The patient and his parents remembered that he had been more irritable, depressed and anxious at school and during the night, between 8 and 13 years of age, with a possible PTSD during this period. He always refused to talk with his parents about the traumatic event. When he was 13, the family moved house, the patient seemed to forget everything and the symptoms disappeared. About thirty years later, the symptoms were similar with the reexperien of the traumatic event through unwanted recollections, distressing images, nightmares, or flashbacks. He had also symptoms of hyperarousal with physiological manifestations, such as irritability, insomnia, impaired concentration, hypervigilance, and increased startle reactions. Hospitalisation became necessary because of a severe depressive disorder with suicidal ideation and suicidal attempt by hanging. After two failed treatments with SSRI antidepressants, the administration of clomipramine (200 mg/d) and a combined therapy with Eyes Movement Desensitization and Reprocessing (EMDR) led to a significant improvement of PTSD and depression symptoms. Even if PTSD and conversion may share common dissociative mechanisms, the links between both syndromes have not yet been sufficiently explored. Our clinical case raises specifically the question of the initial manifestations of pseudo-dementia (why this type of symptoms, and why at this particular moment of his life, without any targeting events). Moreover, the case of this patient is particularly interesting because of the very long amnesia period between the traumatic event and the onset of PTSD. The different phases of this case warrant more precise exploration of the links between PTSD and conversion, with clinical, epidemiological and cerebral imagery perspectives.

Dookie

The hit single "Basket Case", which appeared on many singles charts worldwide, was also inspired by Armstrong's personal experiences. The song deals with Armstrong's anxiety attacks and feelings of "going crazy" prior to being diagnosed with a panic disorder. In the third verse, "Basket Case" references soliciting a male prostitute; Armstrong noted that "I wanted to challenge myself and whoever the listener might be. It's also looking at the world and saying, 'It's not as black and white as you think. This isn't your grandfather's prostitute – or maybe it was.' " The music video was filmed in an abandoned mental institution. It is one of the band's most popular songs.

[A rare and little-known method of elaborating the loss of the object in melancholia].

The author presents a fully detailed report of the observation of two economically secure young women who were caught shop-lifting in a large department store; one woman was apprehended while suffering from depression, the other was caught just prior to the onset of a depressive episode. It is hoped that the details referred here may contribute to the insufficient data published on this subject up to the present. It is important to note that the thefts committed by these patients show the typical characteristics of "impulsive behavior". Furthermore, the impulse to steal may appear in various psychiatric conditions. Therefore, the author first considered the hypothesis that these thefts may have been computed during an acute dysthymic psychosis. Epilepsy was ruled out in both cases based on anamnestic data, electroencephalographic findings and, even after the administration of a pharmacological trigger, no epileptic symptoms appeared. These negative results prompted the author to propose a psychosemeiogenetic rapport between the depressive conditions and the thefts. Considering basic information regarding the psychodynamic of impulsive behavior in general, and that manifested in the course of melancholia in particular, the author confronts the problem of the psychosemeiogenesis of the impulsive to steal in the depressed patient. In order to understand this problem, the author proposes several interpretative hypotheses (equivalence of suicide or "parasuicide" according to Deshaies; attempt to give a concrete reason for the "feeling of guilt"; conduct to symbolically compensate the loss of the "object"). Following an in-depth, critical discussion, the author concludes that the "parasuicide" hypothesis is most accurate in the case of the first patient, whereas "compensation" more adequately explains the second. In conclusion, the interest that these cases present in the forensic medical sphere is also brought to light.

Combat stress reaction

Combat stress reaction is an acute reaction that includes a range of behaviors resulting from the stress of battle that decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and the inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction. The US Army uses the term/acronym COSR (Combat Stress Reaction) in official medical reports. This term can be applied to any stress reaction in the military unit environment. Many reactions look like symptoms of mental illness (such as panic, extreme anxiety, depression, and hallucinations), but they are only transient reactions to the traumatic stress of combat and the cumulative stresses of military operations.

[The concept of anniversary reaction - an explanation for the onset of depression].

In this contribution, the concept of anniversary reaction is explained and elucidated by a paradigmatic case-report. The influence of a certain date, e.g. birthday, on mortality is epidemiologically well proven. The psychoanalytical comprehension of anniversary reaction emphasizes the significant coherence to a biographical trauma. An anniversary reaction emerges on a specific date or age of life that reminds and actualises the conflict attached to the trauma. The anniversary reaction may appear in the shape of a psychic or an organic disease. In the case described, the anniversary reaction emerged on the anniversary of the death of the partner of life that had initially been followed by pathological mourning.

Stress-related disorders

These defenses prevent person from knowing what is wrong, but they do not prevent us from feeling bad. Stress as in clinical medicine Acute stress disorder Acute stress disorder occurs in individuals without any other apparent psychiatric disorder, in response to exceptional physical or psychological stress. While severe, such reactions usually subside within hours or days. The stress may be an overwhelming traumatic experience (e.g. accident, battle, physical assault, rape) or unusually sudden change in social circumstances of the individual, such as multiple bereavement. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions, as evidenced by the fact that not all people exposed to exceptional stress develop symptoms. However, an acute stress disorder falls under the class of an anxiety disorder.

Hilde Purwin

Someone who did commit suicide at the end of April 1945 was Adolf Hitler. A couple of weeks earlier he gave orders that all the Ciano papers should be destroyed. However, Hilde Beetz had somehow got hold of two volumes of Ciano diaries that had been left by Edda while a patient at the "La Ramiola" clinic at Parma shortly before her husband was executed. These covered the important pre-war period from 1937 till 1939. It is not clear whether Beetz had the originals or merely micro-fiched copies of them. In the summer of 1944, by now back in Weimar living with her mother in the house where she had grown up, she was instructed to produce translations of them all. These, it turns out, are the papers (or possibly only some of the papers) identified in the US intelligence report produced by Lt. Col. Andrew H. Berding in June 1945. Beetz had sorted them and hid them in her parents' garden during the early months of 1945. They were buried in a tin under a bed of roses which has led to them

Adjustment disorder

Common characteristics of Adjustment disorder include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to the DSM-5, there are six types of Adjustment disorder, which are characterized by the following predominant symptoms: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. However, the criteria for these symptoms are not specified in greater detail. Adjustment disorder may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-5, if the Adjustment disorder lasts less than six months, then it may be considered acute. If it lasts more than six months, it may be considered chronic. Moreover, the symptoms cannot last longer than six months after the stressor(s), or its consequences, have terminated. However, the stress-related disturbance does not only exist as an exacerbation of a

List of Mad Men characters

Arnold Wayne Dr. Arnold Wayne (Andy Umberger) is Betty's psychiatrist during the first season, who she began seeing because of her problem with her hands going numb unexpectedly in the wake of her mother's death. While she is seeing him, Dr. Wayne is secretly in contact with Don to discuss her sessions, which Betty finds out about in the Season 1 finale. She uses that to her advantage by confiding in Dr. Wayne her anger at Don's infidelity, knowing that the doctor will report the session to Don. Abigail Whitman Abigail Whitman is the stepmother of Dick Whitman and the mother of Adam Whitman. She was married to Archie Whitman and had recently miscarried when a midwife gave her Dick, the child of Archie and the prostitute Evangeline, to raise. However, Abigail resented Dick and regularly referred to him as a "whore's son." Don greatly hated Abigail in return; in Season 1's "5G", when Adam tells Don that Abigail has died, Don's response is, "Good."

Post-traumatic psychiatric disorders: PTSD is not the only diagnosis.

Traumatic events and their consequences are often hidden or minimised by patients for reasons linked to the post-traumatic stress disorder itself (inexpressibility, shame, depressive thoughts, fear of stigmatisation, etc.). Although post-traumatic stress disorder (PTSD) remains the most widely known disorder, chronic post-traumatic psychiatric disorders are many and varied. After a trauma, the practitioner has to check for the different clinical forms of post-traumatic psychological consequences: PTSD is not the only diagnosis. Based on our own clinical experience compared to the international literature, we think necessary to build a didactic classification describing chronic post-traumatic symptoms and syndromes. Post traumatic depressions and bereavement lead to high risk of suicidal crisis and self-harm behaviours. Re-experiencing are felt with anxiety, hyper arousal increases anxious reactivity, and avoidance strategies increase anticipatory anxiety, indicating post-traumatic anxiety disorders (agoraphobia, specific phobia, obsessive compulsive disorder, separation anxiety, social phobia). Characterising an often-severe clinical picture, the co-occurrence of post-traumatic and chronic psychotic symptoms is not unusual (post-traumatic schizophrenia, post-traumatic depression with mood-congruent psychotic features, non-schizophrenic post-traumatic psychotic disorder, and bipolar reaction to trauma). A physical injury occurring at the same time as a traumatic exposure increases the risk of developing post-traumatic stress disorder later which, in turn, afflicts the subjective perception of the physical health (development of somatoform and psychosomatic disorders, comorbidity with a post-concussion syndrome). The trauma may cause a rupture in the biography of a person, also in his/her internal physiological functioning as in his/her social activities (impacts of instinctive functions and behaviours, personality changes, and adjustment difficulties on professional and personal life). Although a nomenclature is necessary for semiological descriptions, a thorough analysis of the patient's general psychological functioning must also be conducted.

[Drop-out from a mental health centre after the first contact].

Many patients drop-out from treatment after a single contact; however, characteristics have only rarely been investigated. We aimed at estimating the frequency of early drop-out and identifying possible risk factors. The study was performed at the Palestrina Mental Health Centre, located near Rome, Italy. The clinical charts of all first-time attenders who did not come back during a 7-year index period (2000-2006) were reviewed and information was collected on sociodemographic factors, psychiatric history, clinical presentation, and process of care. During the index period, 97 of 1.001 first-time attenders dropped out after the first contact. We excluded patients with symptoms of organic (N = 9) or severe mental disorders (N = 3). Of the remaining 85 patients, 49 presented with symptoms related to life events or situations ("reactive symptoms", RS), while 36 had "non-reactive symptoms" (NRS). Eighty-five randomly selected patients with comparable conditions (psychogenic reaction; anxiety, dysthymic or somatoform disorder; ICD-9 code 300.x, 308.x, 309.x) who came back to visit were included as controls. First-only contact patients tended to present with RS more often (58% vs. 43%) than controls. Therefore, the analyses were stratified for reactivity of symptoms. Among patients with NRS, first-only contact patients tended to be younger than controls. Among patients with RS, time until the next appointment tended to be longer in first-only contact patients than in controls. No other differences were observed between first-only contact patients and controls on sociodemographic variables, source of referral, and previous treatment history. The occurrence of early drop-out was relatively low. The higher prevalence of RS among first-only contact patients may suggest a greater disposition towards conflict or ambivalence in interpersonal situations. Patient-perceived service availability, in the form of shorter appointment delay, seems to promote maintenance of contact. Younger patients who tend to be at higher risk of early drop-out deserve increased clinical attention.

Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student.

Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change.He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation.His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family.Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 mg daily, guanfacine 1 mg 3 times daily, sustained release bupropion 100 mg twice daily, levothyroxine, vitamin D, and a weekly somatropin injection. He has not been able to tolerate psychostimulants or nonstimulant agents because of treatment-emergent SI.Now in the ninth grade, he continues to be easily distracted by peers, with impulsive behaviors and reduced self-regulation. Despite receiving special education services since the fifth grade, his academic performance has been poor, and he has limited motivation. Previous testing indicated average in an intelligence quotient test, with relative deficits in working memory compared with above average strength in fluid reasoning. He dislikes school and has few friends. He has always been noted to be "immature." He displays temper tantrums at home and school around transitions and behavioral expectations and has complained of feeling "different" and misunderstood by peers in addition to having difficulty reading social cues. His interests include acting and playing Fortnite and other video/computer games. His screen time is limited to 1 to 2 hr/d by the family.As the new clinician, you raise the possibility of undiagnosed autism spectrum disorder as a unifying/underlying diagnosis with his mother, who disagrees and does not consent to additional workup despite your recommendations. How would you proceed with next steps to best support your patient and his family in obtaining further clarifying evaluation?

[On trigger experience of a group of anxiety neurotics--its psychopathology and therapeutic utilization].

There is a group of anxiety neurotics, characterized by trigger experience (specific experience that triggers the anxiety attack at the initial phase of the illness). These are the patients, whose chief clinical manifestation is anxiety attack and anticipatory anxiety, with the additional feature of the recognizable trigger experience. Because of this additional feature, psychotherapeutic approach is often made in these cases. In this article, we present 7 such cases, in which we attempted psychotherapeutic approach with the special emphasis on the reconstruction of their trigger experience. Then we discuss the characteristics of the trigger experience and the therapeutic utilization of its reconstruction. The basic structure of their trigger experience is as follows. 'The experience of being taken by surprise, and shaken off something, which they believed to be, or tried to believe to be, firm and secure to them'. This 'something' is mainly concerned with their self-image. The self-image of 'the person who is healthy and has nothing to do with death, disease and madness' is common to all cases. But they also get different features, and can be divided into 3 subtypes, according to the difference in their self-images. 1. Compulsive-phobic type (case 1, 2, 3); 'the harmless person without impulsiveness and aggression'. 2. Hysterical type (case 4, 5, 6); 'the good mother, doing their best for their children, suppressing their own desire'. 3. Narcissistic type (case 7); 'the manly, energetic and ambitious person'. Symbolically speaking, in the contrast of 'ordinariness and extraordinariness', 'something familiar and something unfamiliar and uncanny', they exclude 'extraordinariness, something unfamiliar and uncanny', and rely only on 'ordinariness, something familiar'. They are clinging to the world of 'ordinariness', and thrown into confusion and anxiety when they catch a glimpse of the world of 'extraordinariness', which they have tried desperately to exclude from their life until then. Therapeutic efficacy of the reconstruction of the trigger experience is summarized in 3 factors as follows. 1. Explanation of their pathogenesis. It is a grave shock to them that the anxiety attack has occurred 'out of the blue' and 'with no reason'. In addition to the general explanation of the pathogenesis of anxiety neurosis, it is a relief to them that the explanation for each individual is possible. 2. Reinforcement of the transference cure ('faith care'). By putting into words what they did not make explicit until then, their belief in the therapist is intensified, and the function of the therapist of endowing them with the basis of security is reinforced.(ABSTRACT TRUNCATED AT 400 WORDS)

[Reactive anxiety crisis and chronic adjustment disorder: a unique case of work injury and suspected occupational disease].

The present study aims to describe a case of work injury and occupational disease which is unique for the type of disease diagnosed, conditions of onset and mode of management by INAIL (Italian National Institute of Insurance for Injuries at Work and Occupational Diseases). A worker, after a verbal animated dispute with some collegues and superiors, had an acute psychiatric agitation attack and went to the nearest emergency room, where he was subjected to clinical exams. No neuropsychiatric alteration was found, but the physicians diagnosed an anxiety crisis reactive to the work environment. Consequently, the medical certificate for work injury was edited and sent to INAIL. The worker has been off work for 110 days because of a anxious and depressive syndrome, due to the verbal conflict. In a later assessment, INAIL recognized only the first 30 days of the employee's time off as injury at work, while judging the following period off work as related to affectivity disturbance due to common disease, not related to work environment. The following year, "anxious-depressive syndrome" is worsened and attributed by the same worker to the recurrence of acts of persecution and discrimination against him at work. For this reason he applied for recognition of occupational disease diagnosed as "Chronic Adjustment Disorder with prolonged depressive reaction and somatic anxiety, which developed into a protracted conflict marked the employment situation". INAIL rejected that request, but in the same year the employee has submitted the complaint for "mobbing". Even this request was rejected. Literature shows many examples of traumatic events during working activities which cause psychiatric disturbances. These events include industrial disasters, explosions, transport and mining accidents, accidents in psychiatric units with high risks of assaults, armed conflicts, war, assault and sexual assault, natural disasters. Victims show symptoms of acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). Cases of acute stress disorder resulting only from verbal conflict recognised as work injury aren't currently described. This case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to put more attention to psychiatric health of workers.

Psychiatric history

This article mainly covers the initial assessment history taking of a patient presenting for the first time with a new complaint. Background In the field of medicine a patient history is an account of the significant events in the patient's life that have a relevance to the issue being addressed. The clinician taking the history guides the process in an attempt to achieve a succinct summary of these relevant details. Much of the history is obtained by asking questions. Some of these questions are quite specific, such as, "How old are you?" and others are more open, such as, "How have you been feeling lately?" Although the structure of the interview may appear disjointed, the end result is usually under a set of headings which have a worldwide similarity.

Agoraphobia

Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. In the DSM-5 agoraphobia is classified as a phobia along with specific phobias and social phobia. Other conditions that can produce similar symptoms include separation anxiety, post-traumatic stress disorder, and major depressive disorder. The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicide ideation.

History of mental disorders

19th century

Psychiatric reaction of an intensive care unit survivor in the context of coronavirus disease 2019: a case report.

The coronavirus disease 2019 pandemic has had a serious impact on global mental health, particularly in intensive care unit survivors. Given the lethal potential and unpredictability of coronavirus disease 2019, a high risk of posttraumatic stress disorder was identified in the beginning of the crisis. There are insufficient details in current literature and no official guidelines available for the treatment and follow-up of acute stress disorder and the prevention of posttraumatic stress disorder for intensive care unit survivors in the context of coronavirus disease 2019. We hereby describe a 67-year-old Swiss patient presenting a psychiatric reaction in the context of coronavirus disease 2019. He was admitted to the intensive care unit due to severe acute respiratory distress syndrome from severe acute respiratory syndrome coronavirus 2 and intubated for 13 days. Afterwards, there was a severe worsening of acute renal failure prompting hemodialysis, and he developed delirium. Psychiatric liaison was requested 4 days post-intubation because the patient presented residual symptoms of delirium, false memories about the real context of his medical care, and ideas of persecution toward medical caregivers. He suffered from a very strong peritraumatic reaction, then developed an acute stress disorder linked with his care on the intensive care unit. We looked for strategies to prevent progression from acute stress disorder to posttraumatic stress disorder. We proceeded to the following therapeutic interventions: intensive psychiatric follow-up, intensive care unit diary, and low-dose antipsychotic treatment. The aim of our psychotherapeutic approach was to allow him to increase his feeling of security and to cope with the reality of his traumatic experience. He showed clinical improvement in his mental state after 3 months, despite several predictive factors of evolution to post-intensive care unit posttraumatic stress disorder. This case report illustrates how a delusional clinical presentation after intensive care in the context of coronavirus disease 2019 can hide psychotraumatic symptoms. It is important to highlight that the intensive care unit diary completed by the intensive care team and the follow-up by the psychiatric liaison team helped the patient reconstruct an appropriate and coherent account. Further studies are needed to determine the psychiatric effects of coronavirus disease 2019 and to assess early and appropriate psychiatric intervention for patients hospitalized for coronavirus disease 2019 to prevent posttraumatic stress disorder.

[The Psychiatric Archives: An Opportunity to Grasp the Patient's Experience (in Belgium during the inter-war years)].

This paper presents an exploratory reflection on the question of individual experience by patients in psychiatric institutions, in its historical dimension. Are such experiences comprehensible through an analysis of the archives originating in the hospital? This reflection forms part of a study concerning the circumstances in which women were placed in psychiatric institutions, in Belgium during interwar period (1918-1940); its ultimate objective is to come to an understanding of the social, individual and familial situations that lead to a decision to intern a woman in a closed psychiatric institution. Here, the concept of experience is used to ascertain whether a different understanding of psychiatry is viable, that is to say, to understand it as a personal life-story and as a social fact. Could we, by dint of the psychiatric archives produced by medical institutions, go beyond institutional and medical issues, so as to understand how those placed in a psychiatric institution lived through their mental illness? The objective of this article is also to prepare several methodological markers with respect to issues of interpretation, of individual experience and of emotion. This article is not so much a summing-up of the results of research conducted in psychiatric archives, but rather a deliberation on the historian's approach and appropriate course of action on the question of first-hand experience in psychiatry.

Brief psychotic disorder associated with quarantine and mild COVID-19.

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

The Diary of the Rose

Commentary The concept of "political psychosis" can be compared with Orwellian "thoughtcrimes". The whole setup of the story is reminiscent of the punitive psychiatry in the Soviet Union. Some critics link the novelette with the Orsinian cycle, however in the introduction to the collection Where on Earth Ursula Le Guin remarked that while the protagonist has an Orsinian name, she would rather think that the events took place in South America rather than in Orsinia. When asked in an interview about her Orwellian-type stories, "The New Atlantis", "SQ", and "The Diary of the Rose", Ursula Le Guin commented: Those three stories arose out of rage and fear at the institutionalised cruelty and stupidity of national governments-abroad and at home. None of them is more than slightly exaggerated. It is hard for a story to come close to the terrible reality of government-directed punishment of dissent and government-directed torture.

Long-Term Retrograde Global Amnesia Following Minor Trauma.

BACKGROUND Retrograde amnesia has several causes and may be the core concern in several conditions. When acute, somatic, and neurologic causes are excluded, along with substance use, a consideration of psychiatric disease is imminent. Here, we present a case with amnesia, where diagnostics and treatment were challenging due to severe psychiatric symptoms and course of the disease. CASE REPORT After a minor trauma while driving an electric scooter, a 41-year-old man lost all memories of the past 20 years. The patient was raised in a refugee camp, where he experienced traumatic events, and later came to Denmark and established family and work life. He had 1 prior contact with the psychiatric ward. After the incident, the patient was brought to the emergency room. The patient could not recognize his wife or children and believed he was 21 years old and living with his mother in the refugee camp. A full somatic and neurological workup was performed and no somatic or organic cause could explain the retrograde amnesia. He developed post-traumatic stress disorder (PTSD) and psychotic symptoms. Treatment consisted of a combination of psychoeducation, cognitive remediation, and medical treatment for psychotic symptoms and PTSD. CONCLUSIONS The diagnosis "prolonged delirium", "PTSD", and "dissociative amnesia" were considered. Psychiatric comorbidity and previous traumatic experiences might have contributed to the development of long-term amnesia, which eventually was considered to be dissociative. During 8 months, the patient slowly regained his memory. It is impossible to conclude with certainty whether the successful outcome was the result of psychological treatment, pharmacological treatment, the passing of time, or a mixture of these.