The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misunderstood... maybe she is right... The issue is that she cannot stand rejection and has self-injurious gestures. The diagnosis is 1. 3, 4 and 5 are not even close, there is no clinical picture described in the question. Then in real life exploring well almost certainly there would be dissociative and depersonalization symptoms, as well as depressive symptoms... but symptom is not disorder. Why not 2? It could also be very punctilious and spinning very fine... here the discussion is served. I put the criteria of each one and we talk about it,... but the intention of the examiner was the 1 and I see it well defended. It cannot be challenged. - The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items: 1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviors covered in Criterion 5. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: marked and persistently unstable self-image or sense of self. Impulsivity in at least two areas, which is potentially self-harming (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviors listed in Criterion 5. 5. Recurrent suicidal behaviors, attempts or threats, or self-mutilating behavior. Affective instability due to marked mood reactivity (e.g., episodes of intense dysphoria, irritability, or anxiety, usually lasting a few hours and rarely a few days). 7. Chronic feelings of emptiness. 8. Inappropriate and intense anger or difficulties in controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient stress-related paranoid ideation or severe dissociative symptoms. - The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items: 1. Not comfortable in situations where he/she is not the center of attention. Interaction with others is often characterized by sexually seductive or provocative behavior. 3. 3. Displays a superficial and rapidly changing emotional expression. 4. Constantly uses physical appearance to draw attention to him/herself. 5. Has a way of speaking that is excessively subjective and lacking in nuance. 6. Shows self-dramatization, theatricality and exaggerated emotional expression. 7. Is suggestible, e.g., easily influenced by others or by circumstances. 8. considers his relationships more intimate than they really are.

[HIDDEN] The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misunderstood... maybe she is right... The issue is that she cannot stand rejection and has self-injurious gestures. The diagnosis is 1. [HIDDEN] there is no clinical picture described in the question. Then in real life exploring well almost certainly there would be dissociative and depersonalization symptoms, as well as depressive symptoms... but symptom is not disorder. Why not 2? It could also be very punctilious and spinning very fine... here the discussion is served. I put the criteria of each one and we talk about it,... but [HIDDEN]. [HIDDEN] - The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items: 1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviors covered in Criterion 5. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: marked and persistently unstable self-image or sense of self. Impulsivity in at least two areas, which is potentially self-harming (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviors listed in Criterion 5. 5. Recurrent suicidal behaviors, attempts or threats, or self-mutilating behavior. Affective instability due to marked mood reactivity (e.g., episodes of intense dysphoria, irritability, or anxiety, usually lasting a few hours and rarely a few days). 7. Chronic feelings of emptiness. 8. Inappropriate and intense anger or difficulties in controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient stress-related paranoid ideation or severe dissociative symptoms. - The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items: 1. Not comfortable in situations where he/she is not the center of attention. Interaction with others is often characterized by sexually seductive or provocative behavior. 3. Displays a superficial and rapidly changing emotional expression. 4. Constantly uses physical appearance to draw attention to him/herself. 5. Has a way of speaking that is excessively subjective and lacking in nuance. 6. Shows self-dramatization, theatricality and exaggerated emotional expression. 7. Is suggestible, e.g., easily influenced by others or by circumstances. 8. considers his relationships more intimate than they really are.

A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner. Her medical history shows several similar complaints in the previous year, two of them after a self-injurious gesture. Frequent conflicts in the couple's relationship, job changes and family arguments are also noted. She says she feels misunderstood by everyone, including the psychiatrists attending her. The diagnosis is:

[A case of depression whose symptoms cured by setting her psychological base on the transcendent level].

We report the case of a female in her 40s diagnosed with depression. She was raised by an eccentric father, suspected of having pervasive developmental disorder, and a dominant mother. After graduating from high school, she worked as a clerk in a company for twenty years or so; however, a change in her work environment made her fall into a depressive state. Her worsening depression caused her impulsive resignation and disappearance for about four months. She spent the duration of her disappearance traveling the country, with no dissociative episodes. After returning, she received treatment for depression as an inpatient for about four months. During the first month of hospitalization, she mainly complained of a depressive mood and anxiety over the prognosis of her disorder, while she made scarcely any progress in introspection. In the second month, she gradually advanced with introspective work, but, as her introspection progressed, her depressive mood became aggravated. The therapist avoided intervention to modify her cognition, and told her the following: "it is better not to persist in managing your depressive mood itself because curing depression does not mean resolving the superficial depressive mood, but to achieve a condition not directly influenced by mood." Then, at the beginning of the third month, she became aware of "the presence of God" and, at the same time, her depressive mood greatly improved. She extended her sympathy to her mother with her unfortunate life history, and expected her mother to change as she herself had experienced, but, disappointed by her mother, she experienced anxiety attacks and came to realize her own internal rage against significant persons in her life including her mother. After "the Great being" experience, she, who had formerly attended Christian church for a short time, started to read the Bible, but she still hesitated about committing herself to "religious following." One day during the last month of hospitalization, as she prayed to God for healing when she read a part in the Bible about a woman suffering from a hemorrhage for twelve years who touched the hem of Jesus' garment and was healed immediately (Matthew 9:20-22 and Luke 8:43-48), the patient suddenly experienced "the salvation of God" and realized what trust really meant. Through the experience, her clinical problems became totally cured, and the therapy concluded with her discharge from hospital. Several months later, she sent the therapist a letter including the following message: "I am grateful to the Lord for salvation from anxiety and irritation, but to the therapist for helping me realize it." This clinical course can be understood based on the patient's clinical problems (e.g., despair, anxiety, and depression), arising from the breakdown of her efforts to maintain stability by founding her psychological base on her feelings of omnipotence, avoiding facing her internal negative psychological factors (e.g., rage), and these were automatically resolved when her psychological base was switched to the transcendent level through "the Great being" experience and "the salvation of God." Such a sudden, marked improvement resembles what Miller and C'de Baca reported as "quantum change," of which the characteristics are vividness, surprise, benevolence, and permanence. The therapist paid attention to maintain a constant psychological distance from the patient, not persisting in modifying her cognition, with the transcendent level being the basis for the entire therapy. This stance of the therapist itself was considered to prompt her transcendence and bring about her eventual cure. This clinical course seemed to be highly suggestive of a psychotherapeutic mechanism, indicating the close relationship between the transcendent level and basic trust.

[Foreign accent syndrome in a case of dissociative (conversion) disorder].

Psychiatric symptoms are often manifested in verbal expression. Generally, the contents of such expression are pathological. The formal abnormalities of speech are also observed in various mental disorders, as far as quantitative abnormalities are concerned. However, disturbance of intonation, namely disprosody, is more commonly observed in organic disorders of the brain. When the accent of words and the intonation of sentences changes from that of a native speaker, the speech sounds like the broken language of untrained foreigners. Such foreign accent syndrome is usually an issue of neuropsychology. In this paper, the authors report a case of foreign accent syndrome without organic brain syndrome. The patient was a 44-year-old woman, who developed panic disorder about year after her father's death. Then she developed aphonia. After aphonia was resolved, she began to speak haltingly as if a Chinese woman was trying to speak Japanese. Organic brain diseases were subsequently excluded. She had complicated familial conflicts, including a divorce from a violent and faithless husband, interpersonal difficulties with her husband's parents, and her pubertal daughter. We diagnosed her with dissociative (conversion) disorder of ICD-10. Our patient is clinically interesting, because case reports of dysprosody are unusual and often involve organic brain diseases. We suppose that foreign accent syndrome in our patient is a variant of aphonia, and the patient unconsciously assigned the symptom two ambivalent rolls: to snow that she cannot speak well, and to express her meaning. In addition, she had a Chinese-speaking aunt-in-law who was her ideal role model. We surmise that her symptom signifies identification with her aunt-in-law.

Edmund Kemper

Kemper had a close relationship with his father and was devastated when his parents separated in 1957, causing him to be raised by Clarnell in Helena, Montana. He had a severely dysfunctional relationship with his mother, a neurotic, domineering alcoholic who frequently belittled, humiliated, and abused him. Clarnell often made her son sleep in a locked basement because she feared that he would harm his sisters, regularly mocked him for his large size—he stood by the age of 15—and derided him as "a real weirdo." She also refused to show him affection out of fear that she would "turn him gay" and told the young Kemper that he reminded her of his father and that no woman would ever love him. Kemper later described her as a "sick angry woman," and it has been postulated that she suffered from borderline personality disorder.

[A case report of factitious disorder with hallucinations].

Although factitious disorder has been known for a long time, its diagnosis and treatment continue to be a problem. It is an uncommon condition associated with considerable morbidity and health care expenditure. We present a case of factitious disorder with hallucinations. A 37 year-old single woman has had auditory and olfactory hallucinations for six years. She had been diagnosed with schizophrenia, hospitalized for a short term, taking classical antipsychotic drugs for years. She has been performing her job as a teacher and living with her family. A suitable dose of atypical antipsychotic drugs was administered at a convenient time for her illness (Psychotic Disorder NOS) in psychiatric outpatient clinic of Kocaeli University. She was admitted to inpatient clinic twice in order to allow a clear diagnosis to be made. Psychotic disorder and temporal lobe epilepsy were ruled out. Borderline and histrionic personality traits were determined. Her complaints were unchanged over the course of treatment taking three years. She later started to come into the emergency department with anxiety symptoms, conversion like fits and suicide attempts; hospitalized for these complaints in another hospital. She was diagnosed with factitious disorder because of her unchanged complaints, her adding new complaints to the old ones, her complaints unrelated to psychosocial stressors, her ambitions to come to hospital, her increasing hospital dependence and having no prominent secondary gain. This case emphasizes the need for the careful observation of patients to prevent unnecessary investigations at the diagnosis and treatment stage and to establish a specific management strategy for the patients.

Michael Shepherd (psychiatrist)

Clinician Shepherd's noted clinical study on the symptom of morbid jealousy early in his career led him to the conclusion that a medical opinion is of most value when the inter-personal and social aspects of a case are as closely understood as the narrower issue of diagnosis. He went on to apply these precepts to the full range of psychiatric disorders. Despite the value he gained from this study, Shepherd immediately became less concerned with the minutiae of clinical or experimental research and left the spadework to his team of research workers. As a clinician, Shepherd's style has been described as "unusual". He continued to be involved in clinical work until his retirement, although day-to-day management of his patients was delegated. His detachment was described as "Olympian" and was captured by a former patient in the lines of her book thus:

Foreign bodies in the abdomen: self-harm and personality disorders.

A 52-year-old woman presented to the accident and emergency department 5 h after deliberately stabbing herself with two pens through her midline laparotomy scar. Her medical history included an emotionally unstable (borderline) personality disorder and she was currently an inpatient in a psychiatric hospital. She had multiple accident and emergency attendances with previous episodes of self-harm. Clinical examination revealed evidence of trauma to her midline laparotomy scar with congealed blood covering the puncture site. Her abdomen was soft and non-tender on palpation. A chest radiograph revealed no air beneath her diaphragm and her abdominal radiograph identified a radiopacity in her upper right abdomen and dilated loops of small bowel. CT of the abdomen and pelvis confirmed two pens, with the lower pen tip reaching the pancreas. A midline laparotomy was performed and both foreign bodies were extricated unremarkably. The patient's postoperative recovery was uneventful. The second case involves a 22-year-old woman, a psychiatric hospital resident, presenting to the accident and emergency department 5 h after deliberately inserting the metal nib and inner plastic ink containing tube of a pen through her umbilicus. Her medical history included an emotionally unstable (borderline) personality disorder and paranoid schizophrenia. She had multiple accident and emergency department attendances with previous episodes of self-harm. Clinical examination revealed a soft, non-tender abdomen. Her chest radiograph was unremarkable and her abdominal radiograph identified a radiopaque foreign body at the right upper quadrant of the abdomen. CT of the abdomen and pelvis confirmed a metallic foreign body in the small bowel mesentery. An exploratory laparotomy converted to a midline laparotomy was performed and the foreign body was extricated. The patient's postoperative recovery was uneventful.

Documentaries and minor subjects of the Thanhouser Company

The next quarter-reel comedy was A Husband's Jealous Wife and it was split with The Convict. Released on September 23, 1910, the film is also known by the alternative title, The Hero's Jealous Wife. The synopsis of the film was published in The Moving Picture World and it states, "John Boden, a young businessman, has a very jealous wife. If he pays the slightest attention to any other woman it arouses her anger. Boden, while not at all gay, is gallant, and finds that his life is rapidly becoming a burden. He is particularly upset when his wife discharges his British stenographer and hires a woman who is principally remarkable for her homeliness. On several occasions, Boden proves that he is of the stuff of which heroes are made, but each time his jealous wife spoils things for him. Much to his surprise he discovers that the homely Susie is his friend, and believes that he is ill-treated. Finally Boden decides that life at home is impossible, and he elopes with Susie, much to the

Letter to the Editor: Depression As The First Symptom Of Frontal Lobe Grade 2 Malignant Glioma.

Dear Editor, Next to focal neurological symptoms, epileptic seizures and head aches, brain tumors can less frequently bring about cognitive changes, slowed speech, difficulty sustaining mental functioning and psychiatric symptoms of personality changes and. loss of interest in daily activities, these symptoms may be evaluated as anxiety or depression. Depression is known to be a complication of brain tumours and may sometimes be seen after the presentation of neurological symptoms linked to brain tumours, and sometimes after tumor treatment (Oğuz et al. 2005, Litofsky et al. 2004, Moise and Madhusoodanan 2006, Oreskovic M et al. 2007, Rooney A et al. 2010). The dorsolateral prefrontal, orbitofrontal and medial frontal circuits constitute the three subcortical neuronal circuits in the frontal cortex. The dorsolateral prefrontal circuit is associated with planning and operational functions and lesions on it may give rise to apathy, abulia, perseveration, personality changes and planning disorder. Lesions involving the orbitofrontal circuit, which is associated with response suppression and disinhibition, may involve emotional lability and memory problems. Whereas lesions affecting the right orbitofrontal circuit give rise to elevated mood, lesions on the left orbitofrontal circuit lead to depressed mood. In cases with medial frontal circuit involvement, akinetic mutism may result from lesions in the superior medial region and anteroretrograde amnesia and confabulation are observed with lesions in the inferior medial region (Tosun et al. 2016, Chirchiglia 2018). A diagnosis of psychiatric disorder may be given during the first examination of patieants with primary brain tumours, especially if localized in the frontal lobe. Thorough history taking and physical examination are necessary for early diagnosis. The case reported here concerns a 29-year-old university graduate female patient, living with her partner and children, who consulted the clinic with complaints of tendency to frequent crying, anhedonia, having difficulty with speech fluency, forgetfulness and distractedness that had presented suddenly, 2 months previously, without any causative stressor. In her mental status examination, she appeared having normal self-care with appearance at her actual age. She was fully conscious and oriented, not willing to cooperate with the interview, had distinct difficulty in maintaining attention and with fluency of speech. Her mood was depressive. She described loss of appetite, fatigue and energy loss. Her difficulty in paying attention was pronounced. She did not have a history of psychotropic medication use or family history of psychiatric disease. She did not smoke or use alcohol or substance. After evaluating the clinical interview, a preliminary diagnosis of major depressive disorder was considered on the basis of the DSM-5 criteria. Routine blood tests were requested. Given the continuation of her complaints, the difficulty with fluent speech and the increase in tendency to sleep at the first week follow up, cranial MRI was planned. The MRI results showed on the right, in the frontal lobe a multilocular mass with precallosal extension, undiscernable margins with the right lateral aspect of the corpus callosum genu and dispersed cystic-necrotic areas with T2 signal series. The dimensions of the mass were nearly 5 x 3 cm causing a 1-cm right-to-left shift of the midline (Figure 1) DEPRESSION AS THE FIRST SYMPTOM OF FRONTAL LOBE GRADE 2 MALIGNANT GLIOMA 2 Türk Psikiyatri Dergisi 2 Turkish Journal of Psychiatry Letter to the Editor 143 144 The patient was referred for surgery with the preliminary diagnosis of high-grade glial tumour. Pathology results identified a grade 2 glioma. It was learned that radiotherapy sessions were begun after surgery. The patient did not have any symptoms of psychopathology during the 2 monthly psychiatric interviews made after surgery. Brain tumours generally indicate their presence with headache, seizures and other neurological symptoms and very rarely with depression as seen in the case of our patient. It should be kept in mind that atypical psychiatric symptoms may have an underlying organic lesion and subtle neurological symptoms should be investigated in detail. A recent meta-analysis on 37 observational studies determined a 21.7% prevalence of depression in a total of 4518 patients with intracranial tumours. Comorbidity of depression with brain tumor was demonstrated to worsen the quality of life, increase suicidal risk and lower the chance of survival (Huang et al. 2017). The possibility of psychiatric symptoms being the clinical clues for brain cancer was noted and the necessity of neuroimaging tests in cases of recent-onset psychosis or mood disorder symptoms, atypical personality changes and anorexia without body dysmorphic disorder was emphasized (Madhusoodanan et al. 2015). Loss of interest, tendency to frequent weeping, introversion and anhedonia were the sole complaints in the case discussed here. The increase in psychomotor retardation and slowing down of movements at the very first weekly control follow up necessitated neuroimaging. Despite the reports in the literature on the frequent association of unpreventable excessive behavior, disinhibition and irritability with right frontal injury and lesions (Okumuş and Hocaoğlu 2018), depression was the dominant symptom in the case presented here. There are differences between primary major depression and depression presenting with underlying somatic diseases which is known to occur at later ages (Rouchell et al. 2002). However, our patient was aged 29 years. Also, cases of depression due to somatic disease are less associated with family history of depression and suicidal ideation and attempts, while cognitive symptoms come to the foreground during mental status examination. (Sertöz and Mete 2004, Rouchell et al. 2002). Our patient did not have suicidal ideation or attempts, or a family history of depression. In apathy, which may be explained as emotional blunting, indifference or detachment from the external world, targeted behavior is also reduced next to the lack of emotional expression. The individual discussed here was learned not to sit at the table or change the television channel unless reminded to do so. When the reason was asked, she could not think of one. The reduction in emotional expression accompanies reduced insight, abulia and lack of empathy (Sözeri Varma et al. 2019). In depression, apathy is defined as 'sorrowless depression'. Our patient cried but had very blunted mimics and gestures. She explained that she could not help weeping even at times when she did not feel internally distressed. The seriousness of apathy, as a symptom difficult to differentiate from depression, is still not understood. Neuroimaging Figure 1- Cranial MRI of the patient 145 Received: 16.08.2020, Accepted: 04.12.2020, Available Online Date: 05.10.2021 1MD., Antalya Kepez State Hospital, Department of Psychiatry, Antalya, 2MD., Ordu University Training and Research Hospital, Department of Psychiatry, Ordu, Turkey e-mail: bosbora@yahoo.com https://doi.org/10.5080/u25957 studies indicate apathy to be a reflect of impaired frontal-subcortical circuits and the functional disorder of the connections between the ventromedial prefrontal cortex and the basal ganglia (Chase 2011). Comparison of 45 individuals with depression due to aging and 43 healthy individuals showed apathy to be associated with fronto-limbic gray and white matter abnormalities which continued after antidepressant treatment. The structural anomalies of the posterior subgenual cingulate gyrus and the uncinate fasciculus were discussed (Yuen 2014). The case discussed here is presented to emphasize the importance of brain imaging methods and detailed investigation of atypical symptoms for diagnostic approaches to psychiatric disorders. Especially, complaints at young age of depression with psychomotor retardation, reduced fluency of speech and sudden onset withdrawal without stressors should be a warning of secondary depression. Yours sincerely... Şerif Bora Nazlı1 , Muhammet Sevindik2 REFERENCES Chase TN (2011) Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment. Neurotox Res 19:266-78. Chirchiglia D (2018) Pseudodepression as an Anticipatory Symptom of Frontal Lobe Brain Tumors. Int J Depress Anxiety 1:007. Huang J, Zeng C, Xiao J et al (2017) Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget 8:94932-43. Litofsky NS, Farace E, Anderson F et al (2004) Depression in patients with high-grade glioma: Results of the glioma outcomes project. Neurosurgery 54:358-67. Madhusoodanan S, Ting MB, Farah T et al (2015) Pyschiatric aspects of brain tumors: A review. World J Psychiatry 5:273-85. Moise D, Madhusoodanan S (2006) Psychiatric symptoms associated with brain tumors: a clinical enigma. CNS Spectr 2006;11:28-31. Oğuz N, Ilnem C, Yener F (2005) Psychiatric symptoms in brain tumors: Case reports. Bulletin of Clinical Psychopharmacology 15:18-21. Hocaoğlu Ç, Okumuş B (2018) Psychiatric manifestations and brain tumor: A case report and brief review. The Medical Journal of Mustafa Kemal University 9:42-9. Oreskovic NM, Strother CG, Zibners LM (2007) An unusual case of a central nervous system tumor presenting as a chief complaint of depression. Pediatric Emergency Care 23:486-8. Rooney A, Carson A, Grant R (2011) Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst103:61-76. Rouchell AM, Pounds R, Tierney JG (2002) Depression Textbook of Consultation-Liaison Psychiatry, 2nd Edition, Volume 1. MG Wise, JR Rundell (Ed), Washington DC American Psychiatric Publishing, Inc, p.307-38. Özen SÖ, Hayriye ME (2004) Bedensel Hastalıklarda Depresyon. Klinik Psikiyatri Ek 2:63-9. Sözeri Varma G , Bingöl C , Topak O et al (2019) Relationship of apathy with depressive symptom severity and cognitive functions in geriatric depression. Arch Neuropsychiatry 56:133-8. Yuen GS, Gunning FM, Woods E et al (2014) Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response. J Affect Disord 166:179-86.

[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.

Case Report: Anomalous Experience in a Dissociative Identity and Borderline Personality Disorder.

Dissociative identity disorder, formerly called multiple personality disorder, is a rupture of identity characterized by the presence of two or more distinct personality states, described in some cultures as an experience of possession. The case of a 30-year-old woman with dissociative identity disorder and borderline personality disorder associated with a previous history of anomalous experience was reported. A 30-year-old woman who fulfilled the DSM-5 criteria for dissociative identity disorder and borderline personality disorder reported the presence of unusual sensory experiences (clairvoyance, premonitory dreams, clairaudience) since she was 5 years old. The patient told that for 12 months she presented episodes in which a "second self" took charge of her actions: she would then speak with a male voice, become aggressive, and require several people to contain her desire for destruction. After 3 months of religious follow-up, and accepting her unusual experiences and trance possessions as normal and natural, she had significant improvement. When approaching DID and BPD patients, it is necessary to observe the anomalous phenomena (in the light of) closer to their cultural and religious contexts, to promote better results in the treatment of their disorders, which has not been explored in the treatment guide.

I've Been Killing Slimes for 300 Years and Maxed Out My Level

An over 400-year-old blue dragon girl who first meets Azusa and her extended family while she and her flock attempt to disrupt the wedding of Laika's older sister, out of simple jealousy that her blunt demeanor drove away her own fiance. After Azusa single-handedly thrashes the aggressors, and a final act of aggression is stalled by Beelzebub, she is forced to sign a peace treaty between the red and blue dragons. Afterwards, as part of her peace obligations, she also (much to Laika's disgust) joins Azusa's troupe - the only alternative being to commit suicide due to her inbred discipline.

On the psychology of the aging woman. Depression in late mid-life: change or repetition? Another chance for working through.

A woman of 58 came for psychotherapy for the first time suffering from a depressive reaction precipitated by two mid-life events: the marriage of her daughter and the realization that her own cherished marital dream would never be fulfilled. She had postponed coming to terms with the disappointments of her marriage as long as she had had other objects. When these objects were lost, and the distance she had maintained to handle her feelings was threatened, she sought help. There was suggestive evidence that a collusive marital system had sustained an unsatisfactory relationship for 35 years. Her husband was described as an obsessive-compulsive character. His traits were both needed, feared, and resented by the patient, representing the rejected part of herself and aspects of her hated grandmother. Mrs. A. had character traits and a developmental history which supported a diagnosis of primitive hysterical personality. (This type has been described by Zetzel (1968) as "the so-called good hysteric.") The paucity of object relationships in her life, her poor work habits, her inability to tolerate affects were striking. The patient had identified with a pathological mother in a family dominated by rejecting and depreciating attitudes. The patient's use of the defense mechanisms of splitting, projection, and withdrawal as ways of dealing with ambivalence significantly interfered with her self-object differentiation and her capacity for intense emotional or physical intimacy. She could only love men whom she rescued or protected, a pattern consistent with the fact that she could not relate to equals or superiors. Yet she was unable to draw on a good identification with a nuturing mother, so as to really be able to give. There was too much hurt and uncontrolled anger when she was in the superior position with the kind of man who could not meet her dependency needs. Feeling unprotected, she had married a "strong" man, who she expected would meet her narcissistic and dependency demands. He was inhibited and controlled and could neither need nor be needed by her during his active work life. This led to immediate disappointment of her conflicting conscious and unconscious expectations. She wanted him to be strong and ideal, yet to need her and never oppose her. Hence, there was a failure to establish a mature or satisfying marital relationship. She turned to her children for comfort, particularly her daughter, becoming depressed when her daughter married. She found gratification by staying busy tutoring and teaching underprivileged children. In the course of treatment her depressive symptoms disappeared. She felt hopeful, capable of being believed in, and able to cope as a result of the therapist's functioning as her uncritical ally. After she resumed living with her husband she began to acknowledge an ambivalence toward her cherished, confidante daughter and in some ways reversed her previous splitting of husband and daughter. The mean husband became a kindly saint and the darling daughter became a critical, spiteful queen...

Importance of Trauma-Informed Practice in Evaluation of Children Diagnosed with Autism Spectrum Disorder.

As part of a multidisciplinary adoption support clinic, Erin, a 5-year-old girl, adopted approximately 6 months before the clinic visit, presents for postadoption evaluation. Erin was born at full term. Her birth history was significant for reported maternal treatment for liver failure during pregnancy. Her previous medical history included hospitalization for a viral illness at age 2 months, recurrent ear infections, and a fractured forearm. Family history was significant for a maternal history of bipolar disorder, depression, anxiety, borderline personality disorder, and concern for substance abuse; a paternal history of attention-deficit/hyperactivity disorder (ADHD) and depression; and full biological brother with a history of ADHD and oppositional defiant disorder. Erin and her brother lived with their parents until she was approximately 3 years old. At that time, there were concerns for poor hygiene, inconsistent medical care, poor school attendance for her brother, financial instability, and significant neglect. Erin was reportedly confined to her crib for hours at a time. She and her older brother were removed from the home because of concerns for significant neglect and placed into foster care. Approximately 3 months after foster placement, Erin underwent testing because of concerns for abnormal behaviors and possible developmental delays. Symptoms included poor sleep, repetitive behaviors such as head banging, delayed speech that primarily involved grunting, and lack of toilet training. She was hyperactive and aggressive and had poor caregiver attachment. On evaluation, she was small for age, poorly groomed, and easily distracted with poor eye contact and did not tolerate interactions with examiners. Neuropsychological testing consisted of symptom checklists and caregiver interview only because she did not tolerate diagnostic testing. She was diagnosed with autism spectrum disorder and global developmental delay with intellectual and language impairments. Over the following year, Erin was transitioned to a second foster family and was subsequently adopted. She received speech, occupational, and physical therapy, along with trauma-informed therapy. She made significant gains in multiple domains and was able to graduate from trauma-informed therapy after 1 year. On examination, Erin greets you with appropriate eye contact and reports that she is feeling "good." She is verbal and interactive with her brother and parents. She looks to parents for support when asked to participate in the physical examination. She does not display any significant repetitive behaviors. Erin's parents are concerned that her initial diagnoses of autism spectrum disorder and global developmental delay do not accurately reflect her current level of functioning and are afraid she may have been misdiagnosed. How would you proceed with next steps to address these diagnoses?

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.

Trichotillomania: Bizzare Patern of Hair Loss at 11-Year-old Girl.

Trichotillomania (TTM) is defined by the Diagnostics and Statistic Manual of Mental Disorders, 4th edition (DMS-IV) as hair loss from a patient`s repetitive self-pulling of hair. The disorder is included under anxiety disorders because it shares some obsessive-compulsive features. Patients have the tendency towards feelings of unattractiveness, body dissatisfaction, and low self-esteem (1,2). It is a major psychiatric problem, but many patients with this disorder first present to a dermatologist. An 11-year-old girl came to our department with a 2-month history of diffuse hair loss on the frontoparietal and parietotemporal area (Figure 1). She had originally been examined by a pediatrician with the diagnosis of alopecia areata. The patient`s personal history included hay fever and shortsightedness, and she suffered from varicella and mononucleosis. Nobody in the family history suffered from alopecia areata, but her father has male androgenetic alopecia (Norwood/Hamilton MAGA C3F3). The mother noticed that the child had had changeable mood for about 2 months and did not want to communicate with other persons in the family. The family did not have any pet at home. At school, her favorite subjects were Math and Computer Studies. She did not like Physical Education and did not participate in any sport activities during her free time. This was very strange because she was obese (body-mass index (BMI) 24.69). She was sometimes angry with her 13-year-old sister who had better results at school. The girl had suddenly started to wear a blue scarf. The parents did not notice that she pulled out her hair at home. Dermatological examination of the capillitium found a zone of incomplete alopecia in the frontoparietal and parietotemporal area, without inflammation, desquamation, and scaring. Hairs were of variable length (Figure 1). There was a patch of incomplete alopecia above the forehead between two stripes of hair of variable length (Figure 2). The hair pull test was negative along the edges of the alopecia. Mycological examination from the skin capillitium was negative. The trichoscopy and skin biopsy of the parietotemporal region of the capillitium (Figure 3) confirmed trichotillomania. Laboratory tests (blood count, iron, ferritin, transferrin, selenium, zinc, vitamin B12, folic acid, serology and hormones of thyroid gland) were negative. We referred the girl for ophthalmologic and psychological examination. Ophthalmologic examination proved that there was no need to add any more diopters. The psychological examination provided us with a picture in which she drew her family (Figure 4). The strongest authority in the family was the mother because she looked after the girls for most of the day. She was in the first place in the picture. The father had longer working hours and spent more time outside the home. He worked as a long vehicle driver. He was in the second place in the picture. There was sibling rivalry between the girls, but the parents did not notice this problem and preferred the older daughter. She was successful at school and was prettier (slim, higher, curly brown hair, without spectacles). Our 11-years-old patient noticed all these differences between them, but at her level of mental development was not able to cope with this problem. She wanted to be her sister's equal. The sister is drawn in the picture in the third place next to father, while the patient's own figure was drawn larger and slim even though she was obese. Notably, all three female figures had very nice long brown hair. It seemed that the mother and our patient had better quality of hair and more intense color than the sister in the drawing. The only hairless person in the picture was the father. The girl did not want to talk about her problems and feelings at home. Then it was confirmed that our patient was very sensitive, anxious, willful, and withdrawn. She was interested in her body and very perceptive of her physical appearance. From the psychological point of view, the parents started to pay more interest to their younger daughter and tried to understand and help her. After consultation with the psychiatrist, we did not start psychopharmacologic therapy for trichotillomania; instead, we started treatment with cognitive behavioral therapy, mild shampoo, mild topical steroids (e.g. hydrocortisone butyrate 0.1%) in solution and methionine in capsules. With parents' cooperation, the treatment was successful. The name trichotillomania was first employed by the French dermatologist Francois Henri Hallopeau in 1889, who described a young man pulling his hair out in tufts (3-5). The word is derived from the Greek thrix (hair), tillein (to pull), and mania (madness) (5). The prevalence of TTM in the general adult population ranges from 0.6% to 4%, and 2-4% of the general psychiatric outpatient population meet the criteria for TTM (2-5). The prevalence among children and adolescents has been estimated at less than 1% (5). The disease can occur at any age and in any sex. The age of onset of hair pulling is significantly later for men than for women (3). There are three subsets of age: preschool children, preadolescents to young adults, and adults. The mean age of onset is pre-pubertal. It ranges from 8 to 13 years (on average 11.3 years) (2-5). The occurrence of hair-pulling in the first year of life is a rare event, probably comprising <1% of cases (5). The etiology of TTM is complex and may be triggered by a psychosocial stressor within the family, such as separation from an attachment figure, hospitalization of the child or parent, birth of a younger sibling, sibling rivalry, moving to a new house, or problems with school performance. It has been hypothesized that the habit may begin with "playing" with the hair, with later chronic pulling resulting in obvious hair loss (2). Environment is a factor because children usually pull their hair when alone and in relaxed surroundings. The bedroom, bathroom, or family room are "high-risk" situations for hair-pulling (5). Men and women also differed in terms of the hair pulling site (men pull hair from the stomach/back and the moustache/beard areas, while women pull from the scalp) (3). Pulling hair from siblings, pets, dolls, and stuffed animals has also been documented, often occurring in the same pattern as in the patient (5). Genetic factors contributing to the development of TTM are mutations of the SLITRK1 gene, which plays a role in cortex development and neuronal growth. The protein SAPAP3 has been present in 4.2% of TTM cases and patients with obsessive-compulsive disorder (OCD). It may be involved in the development of the spectrum of OCD. A significantly different concordance rate for TTM was found in monozygotic (38.1%) compared with dizygotic (0%) twins in 34 pairs (3). The core diagnostic feature is the repetitive pulling of hairs from one`s own body, resulting in hair loss. The targeted hair is mostly on the scalp (75%), but may also be from the eyebrows (42%), eyelashes (53%), beard (10%), and pubic area (17%) (3,5). There are three subtypes of hair pulling - early onset, automatic, and focused. Diagnostic criteria for TTM according to DSM-IV criteria are (2,3,5): 1) recurrent pulling of one`s hair resulting in noticeable hair loss; 2) an increasing sense of tension immediately prior to pulling out the hair or when attempting to resist the behavior; 3) pleasure, gratification, or relief when pulling out the hair; 4) the disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatologic condition); 5) the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The differential diagnosis includes alopecia areata (Table 1) (6), tinea capitis, telogen effluvium, secondary syphilis, traction alopecia, loose anagen syndrome, lichen planopilaris, alopecia mucinosa, and scleroderma (2-5). Biopsy of an involved area (ideally from a recent site of hair loss) can help to confirm the diagnosis (5). On histologic examination, there are typically increased numbers of catagen and telogen hairs without evidence of inflammation. Chronic hair pulling induces a catagen phase, and more hairs will be telogen hairs. Pigment casts and empty anagen follicles are often seen. Perifollicular hemorrhage near the hair bulb is an indicator of TTM (2). Complications of TTM are rare, but they comprise secondary bacterial infections with regional lymphadenopathy as a result of picking and scratching at the scalp. Many patients play with and ingest the pulled hairs (e.g. touching the hair to lips, biting, and chewing). Trichophagia (ingestion of the hair) can lead to a rare complication named trichobezoar (a "hair ball" in stomach). This habit is present in approximately 5% to 30% of adult patients, but it is less frequent in children. Patient with trichophagia present with pallor, nausea, vomiting, anorexia, and weight loss. Radiologic examination and gastroscopy should not be delayed (2,4,5). The management of the disease is difficult and requires strong cooperation between the physician, patient, and parents. The dermatologist cannot take part in the therapy, strictly speaking, but without the psychological, psychopharmacologic, and topic dermatologic treatment a vicious circle will be perpetuated.

List of Person of Interest characters

Shaw witnessed her father's death in an automobile accident at a young age but did not exhibit typical emotional reactions to it. In her first appearance, she claims that she has an Axis II (psychology)Personality disorder and alexithymia, making her unable to feel and/or express common human emotions like fear or sadness. Shaw attended Med School and once trained as a surgeon; although very technically capable, she was criticized by her superiors for her indifference and lack of sensitivity to her patients and it is implied that she was removed from the program before she could complete her surgical training because of the lack of these emotional characteristics. She is capable of deducing emotionally correct actions, such as rescuing Fusco's son rather than Fusco (S3 Ep9, "The Crossing") and taking on Genrika as her unofficial ward (S3 Ep5, "Razgovor"). She unexpectedly reveals a hint of emotion by passionately kissing Root before sacrificing herself to save the team (S4 Ep11,

Cases from the Osler Medical Service at Johns Hopkins University.

A 50-year-old African American woman presented with bilateral lower extremity pain, a history of falls during the past several months, and personality and behavior changes. She had been in good health until approximately 5 months before admission, when she began to fall with increasing frequency, often while going down a flight of stairs. She described these falls as her "legs giving out" and feeling very heavy and unsteady. There was no head trauma or loss of consciousness. Her daughter noticed that her gait had become somewhat unsteady during the last several months. Her family also noted a change in her personality at this time. Previously, she had been a very tidy person who took great care with her appearance, who was working as a customer service representative. However, she had become less social and very withdrawn. She had been observed putting on dirty clothes after showering, as well as eating constantly. The patient denied any fevers, chills, night sweats, headaches, vision changes, or tinnitus. She also denied any rashes, muscle pain, or intolerance to heat or cold. There was no history of seizure disorder or depression. Her past medical history was notable only for hypertension and being a passenger in a motor vehicle crash 1 year before admission. She denied any alcohol, tobacco, or illicit drug use, and had no travel history other than coming to the United States, as she was originally from Trinidad. On physical examination, she was a moderately obese African American woman with a flat affect, psychomotor slowing, and alopecia of the scalp. She was alert and oriented to person, place, and time, but had a score of 26 out of 30 on the Mini-Mental State Examination. She lost points only for recall; she had no difficulty with serial 7s. Her cranial nerves were intact and her speech was fluent, although sparse, and she did not make any paraphasic errors. Her muscle strength was 5/5 in both the upper and lower extremities. Reflexes were 2+ in the upper extremities and 1+ in the lower extremities, and toes were downgoing bilaterally. She had intact sensation to light touch and pinprick, but markedly diminished proprioception of her lower extremities bilaterally. She had a wide-based gait with a positive Romberg sign and was markedly ataxic. Rectal examination yielded a positive guaiac test with brown stool, normal tone, and no masses. The remainder of the physical examination was normal. Laboratory studies revealed pancytopenia with a hematocrit of 22.7% and a mean corpuscular volume of 118.2 fL. A peripheral smear that was performed on admission, prior to transfusion, revealed macrocytic red cells and hypersegmented neutrophils.

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."

[Alterations of symptoms with borderline personality disorder after fronto-temporal traumatic brain injury. A case study].

We report a case of borderline personality disorder in which severe self-mutilation, sense of futility and tendency to manipulate others disappeared after fronto (orbital cortex and dorso-lateral surface) temporal traumatic brain injury. The patient, a right-handed 34 year-old woman began having severe depressive moods, irritability, and performed recurrent self-mutilation by wrist cutting after her marriage at age 20. She was diagnosed as having borderline personality disorder. At the age of 30, she attempted to kill herself by leaping from a building, and sustained a frontotemporal traumatic brain injury. After 5 years of follow-up, she recovered from Wernicke's-like aphasia, but could not understand anything complex. She also showed disturbances of writing, calculating, attention, working memory, recent and remote memories, motivation, and sense of self. The results of tests of higher brain function were as follows: Wisconsin card sorting test (Keio version), C = 1, D = 2, P = 23; FAB (Frontal Assessment Battery) = 7/18; Trail making test B = impossible. Brain MRI demonstrated left frontal lobe (orbital cortex and dorso-lateral surface) contusions, severe atrophy in the left temporal cortex including the hippocampus and amygdala, and diffuse axonal injury in the left frontal white matter. Although her recurrent self-mutilation had disappeared after brain injury, a certain type of anxiety, which occasionally induced irritability, unstable moods and devaluation of others, occurred without any trigger once or twice a month. This anxiety continued two or three days and faded away within a week. Because of its frequency and duration, this anxiety can be considered to originate not from the traumatic brain injury, but from her intrinsic nature, and seems to be parallel to annihilation anxiety (Reich A, Klein M) and abandonment anxiety (DSM-IV). Because she showed this anxiety after a severe higher brain dysfunction including disturbances of language, attention, working memory, recent and remote memories, motivation, and sense of self, we considered this anxiety to be an unarticulated form of annihilation anxiety and abandonment anxiety.

Darvon dependence: three case studies.

Several shared symptoms are evident among the subjects described here. First of all, each subject complained of feelings of depression, consistently and frequently. In other words, in each case, the subject described him/herself as "being depressed." The detailed examination of the case notes kept by the counselors who treated these individuals indicates a more specific symptomology associated with their depression. On a more specific level, each of the subjects expressed feelings of worthlessness, hopelessness, despair, and self-destruction. In at least two of the cases, self-destructive feelings were translated into potentially suicidal actions. In addition, each of the three subjects experienced pronounced mood swings. Alternating between periods of deep depression (associated with stagnant or regressive behavior) and periods of relative optimism when at least temporary progress in therapy was evident. During these apparent periods of improvement, the subjects often related major plans of action intended to improve their lot, including new jobs, furthering their education, withdrawing entirely from drug use, patching up marital and family disorder, etc. In each case before these major improvements could be initiated, the subjects would relapse into depressed states and their plans would dissolve like so many fantasies. These cyclical mood swings and their accompanying polar manifestations would seem, superficially, indicative of a type of manic-depressive illness. It should be noted, however, that at no time did any of the subjects undergo thorough psychological testing. Such testing is planned for Subject B, who remains in treatment at this time. Each subject complained of experiencing acute anxiety attacks during his periods of depression.(ABSTRACT TRUNCATED AT 250 WORDS)

[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing].

By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.

Sally Beauchamp's career: a psychoarchaeological key to Morton Prince's classic case of multiple personality.

By the methods of psychoarchaeology, the identity of Sally Beauchamp, Morton Prince's classic case of multiple personality, has been established. The reconstructed life history has for the first time revealed the roots of the dissociative process. This goal was actually obscured by the tangled web of Prince's rambling 1906 book and his other publications on the case. The determinative events included two instances of sudden infant death during the childhood period of the patient, the earlier of which was apparently never even known to Dr. Prince. Though not mentioned in the patient's autobiography, it probably induced the initial dissociation to defend the integration of the personality. The relevance of the new concept of SIDS (since 1969) is considered. Other disturbing influences were the constant rejection of the patient by her mother, who died at an early age, and probable severe abuse by the widowed father which led her to run away from home (permanently) at age 16. Nine years afterward, therapy with Dr. Prince began and lasted seven years. It is suggested that this case and the parallel one of Breuer and Freud (Anna O.) be comparatively reexamined from the standpoint of modern feminism. The role of the conventional 19th-century woman was not acceptable to either of them, and both probably had an unusually large innate, bisexual endowment. Endogenous conflict, intensified by social demands, produced dissociation as a pseudo-solution until, through opportune therapy and other environmental opportunities, each was able to achieve a productive modus vivendi. The relation of bisexuality to the etiology of personality dissociation in general is considered. An incidental but instructive discovery made in the course of the Prince research was an unknown letter from William James to Morton Prince about The Dissociation of a Personality. This find points up the fact that James's final metaphysic was a form of pluralistic panpsychism derived from both psychical research and the contemporary knowledge about dissociated personality. James postulated a cosmic multiple personality.

[Behavior disturbances in emergency psychiatry or fronto-temporal dementia diagnosis? A challenge for psychiatrists].

The diagnosis of fronto-temporal dementia (FTD) represents a challenge for the psychiatrist, especially since this insidious pathology partly mimics other psychiatric diseases. We present a clinical case that illustrates the difficulty of FTD diagnosis particularly well. A 32 year-old woman without previous medical history presented with psychomotor agitation, logorrhea and flight of ideas. The criteria for bipolar disorder according to DSM IV were met and the patient was referred to an outpatient clinic where a mood stabilizer was initiated (lithium, 400 mg/day). An in-depth interview with her husband revealed mild but progressive modification of her personality and behavior over the course of two years. She showed signs of mild fatigue and irritability that evolved into a loss of interest for both leisure and domestic activities. In addition, she showed increasing erratic behavior and emergence of frequent episodes of verbal abuse. After the birth of her second child, the patient's clinical state worsened with the appearance of uninhibited behavior, loss of personal hygiene, sleep disturbances and nightmares. The patient was forced to stop her work as a cleaner, a steady employment that she had maintained for 10 years. The hypomanic state worsened and psychotic symptoms such as delusions and echolalia appeared within a few weeks. These events culminated in a first hospitalization in a psychiatric unit. We evoked both diagnoses of schizoaffective disorder and psychotic disorder not otherwise specified. In the following months, we conducted neurological examinations on account of the progressive deterioration of her cognitive functions. Neuroradiological results (CT scan with contrast agents, MRI, cerebral scintigraphy) coupled with her clinical evolution (neurological examination and neuropsychological testing) permitted diagnosis of fronto-temporal dementia. Fronto-temporal dementia usually presents itself as an autosomal dominant disease in 89% of reported cases, with an insidious onset associated with thymic symptoms and behavioral disturbances. The first consultation often concludes with a suspicion of a psychiatric disorder in 33% of the cases (unipolar and bipolar depressive disorders, psychotic disorders, alcohol dependence). The clinical description of such a heterogenic and neuro-psychiatric disorder should be widely disseminated, so that psychiatrists can distinguish early symptoms and diminish the risk of misdiagnosis of FDT. Such case reports emphasize the importance for psychiatrists to be aware of the clinical prodromal FDT symptoms, particularly since the neuro-imaging data of dementia are often delayed.

Dear Doctor

Billingsley also enjoyed the romantic subplot with Kellie Waymire as Elizabeth Cutler, however he was concerned that Waymire's working schedule wouldn't allow her to return to the show easily and so he wasn't anticipating the romance being followed up upon in future episodes. She had previously appeared as Cutler in the episode "Strange New World", and was pleased for her character to be involved with Phlox rather than one of the more obvious possibilities, and was interested to see if the romantic plot would be brought back by writers in a future episode. Waymire made one final appearance as Cutler in "Two Days and Two Nights", before her sudden death on November 13, 2003. Amongst other guest stars in this episode was Karl Wiedergott, who previously appeared in the Star Trek: Voyager episode "Warlord" and is better known for his voice work on The Simpsons.

[Patient with a long history of disease in whom service dog contributed to recovery].

We describe a patient who reached recovery, after purchasing a dog and training it into an assistance dog. The patient has a long lasting (over 30 years) history in mental health care and was diagnosed with autism spectrum disorder, posttraumatic stress disorder and borderline personality disorder. All these years the patient did not reach symptomatic improvement or personal or social recovery. The patient suffered from severe emotional instability, feeling misunderstood, sleeping disorder because of nightmares and traumatic re-experiences, feeling unsafe and externalisation. There were repeated conflicts and periodical rejection of caregivers. A range of interventions and support options were offered. Medication intake was considerable aiming for sedation and numbness. After a second opinion an assistance dog was suggested. Two years after the purchase of the dog, her mood had improved, anxiety decreased, she slept better and stopped all medication. She feeled safe. Conflicts with others were reduced, she had some social contacts and the intensity of care had been reduced considerably.

The role of mother-son incest in the pathogenesis of narcissistic personality disorder.

Psychoanalytic case material is presented to illustrate how mother-son incest may be involved in the pathogenesis of a particular subtype of narcissistic personality disorder. Male patients with this disorder have a grandiose view of themselves as entitled to occupy a special position with others, combined with a paranoid tendency to anticipate imminent betrayal. The enormous guilt related to perceived oedipal transgressions leads these patients to fear retaliation from an enraged, vindictive, and castrating father at any moment. In addition, these men often feel that their special role vis-à-vis mother is a precarious one contingent on doing her bidding. Hence, they also live in dread of an impending disaster involving either abandonment or humiliation by their mothers.

Caring for the Transgender Adolescent: It Takes a Village.

Christa is a 15-year-old male-to-female (MTF) transgender patient who comes to your Developmental-Behavioral Pediatrics office for consultation on attention deficit/hyperactivity disorder (ADHD) management and concerns about worsening anxiety. Review of medical history included mild persistent asthma managed with steroid inhaler and leukotriene antagonist. She was diagnosed with ADHD at 12 years and has been placed on methylphenidate and clonidine over the years with little improvement. She struggles in school, with barely passing grades, and feels that she cannot focus on her assignments.She was diagnosed with MTF transition gender dysphoria, social anxiety disorder, and depressive disorder at 13 years by a psychiatrist and was treated with sertraline with some mood improvement. More recently, she reports having thoughts of wanting to hurt people and "wanting to watch them wither away." She expressed being terrified by these thoughts, which lasted for a couple of days but have since resolved. She denied any suicidal thoughts recently and gives credit to her "best girlfriend" for her overall improved mood, improved sleep pattern, and increased energy level. She expressed having deepening feelings for this girlfriend but admitted to not having acted on these feelings as she is afraid of the consequences. She currently uses the pronouns she/her/hers.Family history is pertinent for paternal bipolar disorder. There is considerable psychosocial stress as Christa is estranged from her father, who is not supportive of her transition, although mother is. Unfortunately, she is dependent on her father for medical insurance coverage, and he is refusing to give authorization to proceed with the evaluations and diagnostic workup for the transformation. Christa has been repeatedly encouraged to seek counseling but has declined because of previous poor experiences with counselors. Her primary care clinician in Family Medicine has been administering hormonal replacement therapy because she cannot access the regional center of excellence because of above-mentioned insurance issues. She presents to you now with her mother for management suggestions and diagnostic clarification. What is your next step?

List of Everybody Loves Raymond characters

She is also depressed about her parents when they argue, and she is distraught when she finds out they are divorcing. Even though she grew up in a traditional conservative family, she was a free-spirited and a popular teen in her early years. Ray once noted that, during college, she went to Mardi Gras and flashed her breasts to many people who gave her beads and also ended up topless in the newspaper. She often calls Ray an idiot. When Ray is acting suspiciously nice towards her, she usually will say in an ominous voice, "What do you want, Ray?" The character has also appeared in the King of Queens episode "Dire Strayts".

[Mental disorders associated with multiple sclerosis].

Findings are reported in 4 patients with multiple sclerosis (MS) and various mental disorders which were directly associated with the underlying disease, with disease-related increased vulnerability, were a reactive response or had occurred independently of the MS. CASE 1: A 53-year-old woman with MS for 24 years developed cognitive disorders with markedly impaired quality of life. CASE 2: A 44-year-old man with MS for 8 years had depression and felt suicidal. CASE 3: A 58-year-old woman with MS for 35 years suffered from both depression and symptoms of a compulsive-obsessive disorder. CASE 4: A 19-year-old woman with MS for 2 years was treated by a psychiatrist for the first time when she developed acoustic hallucinations and suicidal ideation during cortisone treatment. CASE 1: The progressive mental disorder was classified as manifestation of the chronic progressive MS: it was treatment-refractory. CASE 2: The patient underwent psychotherapy as both an in- and out-patient. His depression was thought to be reactive and improved well under this treatment, despite the deterioration of the MS, requiring him to use a wheel-chair. CASE 3: The compulsive-obsessive symptoms persisted during medication for depression, for which she then received behavioral treatment. CASE 4: The initial symptoms of hallucination and suicidal ideation ceased when cortisone was stopped. A diagnosis of borderline personality was made, based on her continuing symptoms of impaired impulse control, abnormal affect, distorted self-image, a feeling of inner emptiness, agitation with suicidal tendency and factitious injuries. The renewed occurrence of acoustic hallucinations and suicidal tendency occurred independently of cortisone treatment and was interpreted as expression of inflammatory disease activity, but differential diagnosis had to consider the patient s personality disorder, too. Mental disorders in patients with MS are manifold and their causes are complex. It is important to recognize these associated diseases and initiate individualized treatment, because they considerably impair the patients quality of life.

Stree (1968 film)

Synopsis One day Anuaradha and her brother, a medical doctor, find a young man, Debabrata, unconsciousness in the tides by the sea shore and bring him home. With treatment by her brother and her care, Debabrata gets well. Anuradha and Debabrata fall in love. Her brother, Prasanna, gets them married and sees off the couple to Debarata's home. Upo arriving Anuradha discovers Debabrata is actually a widower and has a son. She feels betrayed but as a devoted loving wife overcomes the feeling and gets along with all of Debabrata's family members in the big house. Gradually she gets close to Debrabrata too and takes care of his son as her own. Debabrata's sister Bhanu can't accept Anuradha and creates misunderstanding between wife and husband. At last biased Debabrata leaves the house with his son leaving his wife Anuradha behind. But Anuradha doesn't lose hope. With her determination, sacrifice and devotion, they reunite in the end.

[Factitious disorders in dermatology: Value of the dissociative state concept].

Factitious disorders in dermatology consist of intentionally self-inflicted skin lesions that vary in morphology and distribution and occur on surfaces readily accessible to the patient's hands. They tend to be a chronic condition that waxes and wanes according to the circumstances of the patient's life. Patient management poses a particular challenge to the clinician and the prognosis is considered poor. The aetiopathogenesis of factitious disorders in dermatology is not completely understood. We present a case in which we suggested the occurrence of factitious behaviour during a dissociative state, and we briefly describe our diagnostic and therapeutic approach. A 48-year-old unemployed woman was referred to our department of psychiatry by her dermatologist for suspected factitious disorder. The patient was diagnosed with diabetes mellitus type 1 and had been hospitalized repeatedly for confirmed diabetic ketoacidosis. The onset of the disease was related to marital discord with her spouse. Numerous skin lesions had appeared on her face, arms, legs, neck and back. These lesions resulted in multiple hospital admissions and in amputation of her left leg. The condition had worsened considerably after her separation from her husband. During the initial conversation, the patient was unable to provide a clear history of the disease. She denied any knowledge of the circumstances in which these skin lesions appeared, and she did not admit self-infliction. Her mood was depressed and her speech was slow. We suspected that our patient was herself causing her skin lesions while in a dissociative state. Several arguments militate in favour of our hypothesis, particularly her history of childhood maltreatment and the association of traumatic life events with simultaneous deterioration of the skin. The explanation of the dissociative mechanism helped us to strengthen the therapeutic relationship. Within a few days, we noted a slow regression of the lesions, but the patient was still unable to explain how the lesions had occurred. The pathophysiology of factitious disorders in dermatology is poorly understood. It has strong ties with other psychiatric disorders, and according to several authors, skin lesions occur in dissociative states, after which patients do not remember how the skin change started. Management of this disease is challenging. An improved understanding of its mechanisms may enhance the prognosis for this particular group of patients.

Harok family murder

A psychiatrist's testimony followed. While Dahlgren remained silent when questioned by police, he had cooperated with the psychiatrist who commented that she had examined Dahlgren several times longer than any other person before. According to her, Dahlgren suffered from mixed personality disorder, but not to such an extent he could be declared mentally ill during the murders. He had had a sexual relationship with a male classmate during his time in high school, and sexual relationships with women afterwards. Dahlgren had claimed to like animals more than people. Before going to Brno, Dahlgren was contemplating going to Africa instead in order to kill poachers there. In Brno, he first felt fine: however, later Mr. Harok Sr. started asking him to find a meaningful occupation, which meant that he was in the same position as back in the US. During repeated interviews with the psychiatrist, Dahlgren had spoken about his "internal voice" that told him what to do "in order to become a