RESUMO
This longitudinal study aimed at determining predicting variables for middle and long-term psychological disturbance due pre-symptomatic testing (PST) for two late-onset neurological diseases, Huntington disease (HD) and TTR (transthyretin protein) familial amyloid polyneuropathy (FAP) Val30Met (now classified as Val50Met). 196 clinical records of persons who performed PST at least three years ago and answered to the two stages of evaluation (before PST and least 3 years after disclosure of results) were analysed. For this purpose, regression analysis was performed, showing that the Positive Symptom Distress Index (PSDI), psychoticism, somatization and paranoid ideation dimensions assume predictive value in the middle and long-term impact for total anxiety and PSDI. The result of PST was not a relevant predictor. The application of an evaluation instrument of various psychopathological dimensions played a fundamental role in the detection of clinical situations that may arise several years later after PST. Attention should be paid to providing psychological support to persons at-risk who, at the pre-test phase, present some psychopathology indices before pursuing with genetic testing.
Assuntos
Neuropatias Amiloides Familiares/diagnóstico , Ansiedade/prevenção & controle , Transtornos Autoinduzidos/prevenção & controle , Aconselhamento Genético/psicologia , Testes Genéticos , Doença de Huntington/diagnóstico , Adulto , Idoso , Neuropatias Amiloides Familiares/genética , Doenças Assintomáticas , Feminino , Humanos , Doença de Huntington/genética , Masculino , Pessoa de Meia-IdadeRESUMO
Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented.
Assuntos
Transtornos Autoinduzidos/diagnóstico , Traumatismos da Mão/cirurgia , Mãos/cirurgia , Síndrome de Munchausen/diagnóstico , Síndrome de Munchausen/cirurgia , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias/diagnóstico , Distrofia Simpática Reflexa/diagnóstico , Distrofia Simpática Reflexa/cirurgia , Automutilação/diagnóstico , Automutilação/cirurgia , Adulto , Diagnóstico Diferencial , Transtornos Autoinduzidos/prevenção & controle , Transtornos Autoinduzidos/psicologia , Feminino , Traumatismos da Mão/psicologia , Humanos , Síndrome de Munchausen/prevenção & controle , Síndrome de Munchausen/psicologia , Síndrome de Munchausen Causada por Terceiro , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/psicologia , Distrofia Simpática Reflexa/psicologia , Automutilação/prevenção & controle , Automutilação/psicologia , Adulto JovemRESUMO
A 34-year-old man with a history of autism developed a deep gingival cleft. During clinical evaluation, the patient repeatedly scraped the affected area with his fingernail. The lesion's clinical features were consistent with focal inflammatory hyperplasia, periodontal disease and factitious stomatitis. This article describes the case and discusses diagnostic and behavioral issues important in treating any patient whose mental age is impaired.