The murder of the surgeon Antonio Parrozzani and the relationship between sexual disorders and paranoid thinking.

In this study we aimed to describe the relationship between sexual disorders and paranoid thinking describing the historical case of murder of the famous surgeon Antonio Parrozzani and the pathological personality of his murderer. Parrozzani was killed by Francesco Mancini, his patient in the past. Mancini was obsessed by his sexual problems due to hypothetical injuries after an inguinal hernia surgery, made by Parrozzani. Following treatment, the murderer likely lived his surgery as a traumatic event and developed a paranoid thinking against the surgeon, breaking out with the dramatic homicide. Parrozzani's case highlights the strong relationship between paranoia and sexuality, and likewise this relationship can be considered as a prodromic factor for a psychotic onset. Moreover, this case, supported by two psychiatric assessments of murderer, remembers once again the association between violence and paranoia. Therefore, clinicians should take into account the danger of the possible presence of paranoid obsession together with sexual problems, to prevent psychosis onset or violent acts related to paranoid delusions.

Cómo utilizar los sueños en el psicoanálisis con psicóticos / Como utilizar os sonhos na psicanálise com psicóticos / Using dreams in psychoanalysis with psychotic patients / Utilisation des rêves en psychanalyse avec les psychotiques

Resumen Este artículo apunta a ofrecer soluciones prácticas a los atolladeros más comunes que suelen presentarse al momento de utilizar los sueños en el psicoanálisis con psicóticos, como la indiferenciación entre sueño, realidad y delirio, la dificultad de algunos psicóticos para asociar y el avance de las pesadillas. Se toma posición a favor de la posibilidad de utilizar los sueños en la clínica de las psicosis y se describen los modos en que estos pueden colaborar en la dirección de la cura: poniendo en discurso experiencias inefables, permitiendo la historización y sustituyendo la asociación libre por el encadenamiento entre sueños. Se concluye que la vía onírica puede constituir un remedio eficaz contra el retorno en lo real y que es preferible interrogar los sueños con preguntas no muy amplias, orientadas a vincularlos con la vida del soñante y su posición subjetiva.

Resumo Este artigo tem como objetivo apontar soluções práticas aos impasses mais comuns que costumam aparecer quando se aborda os sonhos na psicanálise com psicóticos, como a indiferenciação entre sonho, realidade e delírio, a dificuldade de alguns psicóticos com a associação livre e o avanço dos pesadelos. Toma-se posição a favor da possibilidade de utilizar os sonhos na clínica das psicoses e se descrevem os modos em que estes podem colaborar com o tratamento, colocando em discurso experiências inefáveis, permitindo a historização e substituindo a associação livre pelo encadeamento dos sonhos. Conclui-se que a vida onírica pode constituir um remédio eficaz contra o retorno no real e que é preferível interrogar os sonhos com perguntas não muito amplas, orientadas a vinculá-los com a vida do sonhante e com a sua posição subjetiva.

Abstract This paper offers some practical solutions to the most usual predicaments that usually arises when exploring dreams in psychoanalysis with psychotic patients, such as the non-distinction between dream, reality and delirium, the difficulty with free association and the invasion of nightmares. It advocates for using dreams in psychosis clinic and describes how dreams can contribute to treatment, by turning ineffable experiences into discourse, allowing historization and replacing association with dream chaining. Dream life can be an effective remedy against the return to the real, being preferable to interrogate dreams with precise questions aimed to link them to the dreamer's life and their subjective position.

Résumé Cet article propose quelques solutions pratiques aux problèmes les plus courants qui se posent lors de l'exploration des rêves en psychanalyse avec les psychotiques, tels que la non-distinction entre rêve, réalité et délire, la difficulté de l'association libre et l'invasion des cauchemars. On plaide pour l'utilisation des rêves dans la clinique des psychoses et décrit comment ceux-ci peuvent contribuer au traitement, en mettant en discours les expériences ineffables, permettant l'historisation et remplaçant l'association par l'enchaînement des rêves. La vie onirique peut être un remède efficace contre le retour au réel, étant préférable d'interroger les rêves avec des questions plus précises visant à les relier à la vie du rêveur et à sa position subjective.

Factor mixture analysis of paranoia in young people.

BACKGROUND: Paranoid thoughts are relatively common in the general population and can increase the risk of developing mental health conditions. In this study, we investigate the latent structure of paranoia in a sample of young people. METHODS: Cross-sectional survey; 243 undergraduate students (males: 44.9%) aged 24.3 years (SD 3.5). The participants completed the Green et al. Paranoid Thought Scales GPTS, a 32-item scale assessing ideas of social reference and persecution; the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Confirmatory factor analysis (CFA) was used to confirm the two-factor structure of the GPTS. Factor mixture modeling analysis (FMMA) was applied to map the best combination of factors and latent classes of paranoia. RESULTS: The GPTS showed excellent internal reliability and test-retest stability. Convergent validity was good, with stronger links with measures of ideas of reference and of suspiciousness than with other measures of psychosis-proneness. CFA showed excellent fit for the two-factor solution. FMMA retrieved a three-class solution with 176 subjects (72.5%) assigned to a baseline class, 54 (22.2%) to a "suspicious and mistrustful" class, and 13 (5.3%) to a "paranoid thinking" class. Compared to the baseline class, the other two classes had a higher risk of psychological distress and psychosis-proneness. CONCLUSIONS: The latent structure of paranoid thinking in young people appears dimensional. Although caution is advised when generalizing from studies on college students, screening for paranoid ideation in young people who complain about psychological distress might prove useful to prevent the development of severe and potentially debilitating conditions.

Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up.

OBJECTIVE: To assess prospectively the prevalence of impulse control disorders (ICD), psychiatric symptoms, and their clinical correlates in patients with prolactinoma receiving dopamine agonists (DA) in comparison to those with non-functioning pituitary adenomas (NFA) and healthy controls (HC). METHODS: A total of 25 patients with prolactinoma, 31 with NFA, and 32 HCs were included in the study. All patients and controls were screened for the presence of ICDs and other psychiatric disorders using revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Barratt Impulsiveness Scale (BIS-11), Symptom Check List (SCL-90-R) questionnaire and Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: We detected two new cases (8%) of ICD associated with DAs. Both cases presented with hypersexuality, which reversed totally or decreased upon discontinuation of the drug. The re-challenge of the DA in a smaller dose has led to either no symptoms or weaker symptoms than before. There was an increase in the number of patients who screened positive on obsession, interpersonal sensitivity, paranoid ideation, and additional items subscales of SCL-90-R in comparison to HCs at the end of the study period (p < 0.05 for all). Likewise, cumulative DA dose was positively correlated to obsession, interpersonal sensitivity, paranoid ideation, hostility, phobic anxiety subscales, and GSI scores of SCL-90-R (p < 0.05 for all). CONCLUSIONS: DAs are associated with a small but substantial short-term risk of ICD development and a broad range of psychiatric symptoms in patients with prolactinoma receiving DAs.

Psychological Features of Smokers.

BACKGROUND: Smoking tobacco is believed to be common among patients with psychiatric disorders like anxiety, depression, schizophrenia, and affective disorders. The aim of this study was to investigate the psychological symptoms of people without known psychiatric diseases who have freely decided to quit smoking. METHODS: A cross-sectional study was designed, and 124 healthy active-smokers (66 female) and 127 healthy non-smokers (61 female) were recruited. The symptom check list and Fagerström Test for Nicotine Dependence (FTND) were used to assess psychological symptoms and nicotine addiction level. Smokers were divided into 3 groups: light smokers (0-9 cigarettes/d), moderate smokers (10-19 cigarettes/d), and heavy smokers (> 20 cigarettes/d). RESULTS: When subjects were compared by daily levels of cigarette consumption, somatic findings were more prominent in the mild smoker group (1.61 ± 0.72 vs 0.77 ± 0.56, P < .001), while depression and hostility were similar across all groups. When subjects were compared by nicotine addiction ratio, the general symptom index of the group with high-grade nicotine addiction was found to be significantly higher than that of the control group (1.34 ± 0.72 vs 0.79 ± 0.49, P < .001). In addition, the high-grade nicotine addiction group had higher scores than the other groups for somatization, anxiety, depression, paranoid symptoms, hostility, and other symptoms. CONCLUSION: This study examined the association between psychological symptoms and smokers' daily cigarette consumption and nicotine addiction levels. Psychiatric symptoms (ie, somatization, anxiety, depression, hostility, and paranoia) were observed more frequently in people with high-grade nicotine addiction (FTND score 7-10 points).

Inclusão da loucura no pensar: um diálogo possível entre Lacan e a fenomenologia husserliana / L'inclusion de la folie dans la pensée: un dialogue possible de Lacan avec la phénoménologie de Husserl / Inclusión de la locura en el pensar: un posible diálogo entre Lacan y la fenomenología husserliana / Inclusion of madness into thinking: the possible dialogue between Lacan and Husserlian phenomenology

Por que pensar a loucura teria algum sentido na filosofia? A tese de Jacques Lacan de 1932 nos dá uma dica. Pois o autor se volta a um caso de paranoia e esboça algumas críticas à fenomenologia husserliana. A aposta desse texto é tentar mostrar que a reflexão sobre o que é dito enquanto anormal pode abrir um espaço para repensar a fenomenologia husserliana

Pourquoi penser que la folie peut être intéressant à la philosophie? La thèse de Jacques Lacan de 1932 nous donne des pistes, parce que Lacan travaille dans un cas de paranoïa et essaye quelques critiques sur la phénoménologie husserlienne. Ce texte veux montrer que ce qu'est dit anormal peux ouvrir un espace à repenser la phénoménologie husserlienne

¿Por qué pensar la locura tendría algún sentido en la filosofía? La tesis de Jacques Lacan, del año 1932, nos ofrece una indicación. Ya que el autor se vuelca en un caso de paranoia y esboza algunas críticas a la fenomenología husserliana. La apuesta de este texto consiste en tratar de mostrar que la reflexión acerca de lo que se entiende como anormal puede abrir un espacio para repensar la fenomenología husserliana

Why think madness would have some sense in philosophy? Jacques Lacan's thesis from 1932 gives us a hint. This is because Lacan turns to a case of paranoia and outlines some criticism of Husserl's phenomenology. The objective of this paper is to show that the reflection of what is said as abnormal could open room to rethink Husserl's phenomenology

Electroconvulsive Therapy as a Powerful Treatment for Delirium: A Case Report.

OBJECTIVE: The aim of the study was to describe the successful treatment of delirium with electroconvulsive therapy (ECT). METHODS: The method of the study was a case report. RESULTS: A 75-year-old man, with a recently diagnosed carcinoma of the parotid gland, was admitted with a fluctuating psychiatric syndrome. Delirium was diagnosed, although an acute underlying somatic cause could not be readily established. Antipsychotics and benzodiazepines were not effective. After 7 sessions of ECT, all symptoms ceased. This enabled him to receive radiotherapy for his tumor and enjoy a good quality of life for the remaining 8 months of his life. CONCLUSIONS: Electroconvulsive therapy is not only a powerful treatment for catatonia, neuroleptic malignant syndrome, and delirious mania but also for the most commonly occurring fluctuating psychiatric syndrome--delirium.

Da paranoia do conhecimento à psicose: uma travessia teórica no texto de lacan / The paranoia of knowledge to psychosis: a theoretical crossing in the text lacan

Analisamos aqui as bases teóricas que fundamentaram a tese lacaniana do conhecimento paranoico. Ela surgiu como uma torção da tese de doutorado de Lacan de 1932, na qual ele propõe a paranoia como fenômeno de conhecimento; nos trabalhos subsequentes, acaba por estender ao conhecimento humano em geral a pré-condição paranoica. Verificamos que a "paranoia" passa a designar a estrutura mais universal do eu, permitindo a Lacan atribuir a pré-condição paranoica ao conhecimento humano, e, como psicose, uma estrutura clínica. Através de uma análise do esquema ótico, propusemos uma forma de interpretar como conciliáveis as duas noções citadas acima.

From the paranoia of knowledge to psychosis: a theoretical crossing in the text of Lacan. In this work we analyze the theoretical bases that underlied the Lacanian thesis of paranoiac knowledge. It appeared as a twist of Lacan's doctorate thesis in 1932, where he considers paranoia as a knowledge phenomenon; in his subsequent works he extends the paranoiac precondition to the human knowledge in general. We note that "paranoia" is to designate the most universal structure of the self, allowing Lacan to attribute the paranoiac precondition to the human knowledge, and as psychosis, a clinical structure. Through an analysis of the optic project, we considered one way of interpreting how to conciliate the two concepts mentioned above.

A originalidade e a origem do estádio do espelho em Lacan / The originality and the origin of the mirror stage in Lacan / La originalidad y el origen del estadio del espejo de Lacan

Este artigo traz um estudo da obra inicial de Lacan, na qual se rompe com o estudo das psicoses pela psiquiatria tradicional, e nos interessa no ponto em que tal ruptura nos mostra a originalidade dos caminhos iniciais de Lacan com o esquema do estádio do espelho. Inicialmente, a teorização lacaniana desenvolve-se agregando o campo da personalidade aos estudos da psicose, definindo os fenômenos paranoicos em suas relações de compreensão. Essa perspectiva só se torna possível na medida em que Lacan opera um avanço teórico, ao fazer uma distinção entre a ordem genética e a gnosiológica no homem...

This paper presents a study of the early works of Lacan, in which he breaks with the study of psychosis by traditional psychiatry, which interests us at the point where such a rupture shows the originality of the initial paths of Lacan. Initially, the Lacanian theory is developed by adding the field of personality studies to psychosis, defining the paranoid phenomena in their understanding of relationships. This perspective becomes possible only insofar as Lacan operates a theoretical advance, in making a distinction between the genesis and gnoseological orders in men...

En este artículo se presenta un estudio de la obra lacaniana inicial, que rompe con el estudio de la psicosis por la psiquiatría tradicional, y que nos interesa en el punto donde esta ruptura muestra la originalidad de los caminhos iniciales con el esquema estadio del espejo de Lacan. Inicialmente, la teoría lacaniana se desarrolla con la agregación del campo de la personalidade en los estudios de la psicoses, definiendo así los fenómenos paranoicos en sus relaciones de entendimiento. Esta perspectiva sólo es posible en la medida que Lacan opera un avance teórico, haciendo una distinción entre la orden de la génesis y la orden gnoseológica en el hombre...

Dois paradigmas da psicose no ensino de Lacan / Two paradigms of psychosis in the theory of Lacan / Dos paradigmas de la psicosis en Lacan / Deux paradigmes de la psychose dans l'enseignement de Lacan

Neste artigo, trata-se de situar o conceito de psicose a partir de dois paradigmas: o paradigma Schreber, no Seminário 3 (1955-1956) e no texto De uma questão preliminar (1958) - no qual temos uma psicose francamente desencadeada; e o paradigma Joyce, no Seminário 23 (1975-1976) - no qual Lacan deduz uma estrutura psicótica, sem desencadeamento. Podemos dizer que há uma primeira clínica no começo do ensino de Lacan que se pauta nas estruturas: neurose, psicose e perversão. O primeiro Lacan formalizou o inconsciente baseado no conceito saussuriano do signo e elaborou os conceitos de Nome-do-Pai e metáfora paterna enunciando seu axioma fundamental: o inconsciente é estruturado como linguagem. A segunda fase do ensino de Lacan é considerada por Jacques-Alain Miller como uma fase de transição, pois ele subverte o Nome-do-Pai por uma pluralização e considera a operação de recalcamento não mais como atribuída à interdição paterna, mas à ação da linguagem. Lacan, na conclusão do Seminário 10 (1962-1963), destaca então o fim do Nome-do-Pai, substituindo-o por sua pluralização, os Nomes-do-Pai. A partir do paradigma Joyce, temos uma outra perspectiva da psicose, abordada sob o viés do sinthoma. A partir daí, podemos pensar em múltiplas soluções encontradas pelo sujeito para lidar com sua psicose. A teoria lacaniana dos nós nos permite abordar a singularidade das soluções inventadas pelos sujeitos através da amarração única que cada um faz dos três registros: o real, o simbólico e o imaginário.

This article is about the concept of psychosis through the view of two paradigms: The Schreber paradigm, in Seminar 3 (1955-1956) and the text On a question preliminary (1958) - In which we have a truly triggered psychosis; and the Joyce paradigm, of Seminar 23 (1975-1976) - in which Lacan deduces a psychotic structure without the triggering. Is possible to say that there is a first clinic in the beginning of Lacan's study, based on the structures: neurosis, psychosis and perversion. The first Lacan formalized the unconscious based on the saussurian concept of sign and elaborated the concepts Name-of-the-Father and Paternal Metaphor, announcing his fundamental axiom: the unconscious structured as language. The second stage of Lacan's study is considered by Jacques-Alain Miller as a transition stage, cause it subverts the Name-of-the-Father by its pluralization and considers that the repression operation can no more be attributed to the paternal interdiction, but to the action of the language. Lacan in his conclusion of Seminar 10 (1962-1963), highlights the end of the Name-of-the-Father, and substitutes by its pluralization, the Names-of-the-Father. From the Joyce paradigm, we have another perspective of psychosis, approached through the sinthome. From this start, is possible to think in multiple solutions founded by the subject to deal with his psychosis. The lacanian knots theory, allow us to approach the singularity of the invented solutions of the subjects through the unique lashing that each one does, of the three components of the reality: the real, the symbolic and the imaginary.

Este artículo sitúa el concepto de psicosis a partir de dos paradigmas: el paradigma de Schreber, en el Seminario 3 (1955-1956) y el texto de una cuestión previa (1958) - en los que tenemos una psicosis activa, francamente, el paradigma Joyce, en el Seminario 23 (1975-1976) - en la que Lacan plantea una estructura psicótica sin activar. Podemos decir que hay una primera clínica en el inicio de la enseñanza de Lacan que se guía en las estructuras: neurosis, psicosis y perversión. El primer Lacan formalizó el inconsciente basado en el concepto del signo de Saussure y elaboró los conceptos del Nombre del Padre, y la metáfora paterna indicando su axioma fundamental: el inconsciente está estructurado como lenguaje. La segunda fase de la enseñanza de Lacan es considerado por Jacques-Alain Miller como una fase de transición, ya que subvierte el Nombre del Padre por una pluralización y considera que la operación de la represión ya no lo atribuye a prohibición paterna, pero la acción de la lengua. Lacan en la conclusión del Seminario 10 (1962-1963), entonces el final del Nombre del padre, sustituyéndolo por su pluralización, los Nombres del Padre. Desde el paradigma Joyce, abre otra perspectiva de la psicosis. A partir de ahí, podemos pensar en varias soluciones encontradas por objeto hacer frente a la psicosis. Una teoría lacaniana de nudos nos permite abordar la singularidad de las soluciones inventadas por el sujeto a través del amarre sólo lo que hace cada uno de los tres registros: lo real, lo simbólico y lo imaginario.

Dans cet article, il s'agit de situer le concept de la psychose a partir de deux paradigmes: le paradigme Schreber, dans le Séminaire 3 (1955-1956) et dans le texte D'une question préliminaire (1958) - dans lequel nous avons une psychose déclenché; et le paradigme Joyce, dans le Séminaire 23 (1975-1976) - dans lequel Lacan déduit une structure psychotique, sans déclenchement. Nous pouvons dire qu'il y a une première clinique dans l`enseigment de Lacan qui se fonde dans les structures: la névrose, la psychose et la perversion. Le premier Lacan a abordé l'inconscient a partir du concept saussurien du signe et a élaboré les concepts du Nom du Père et de la Métaphore Paternelle. Son axiome fondamental est: l'inconscient est structuré comme un language. Le deuxième période de l`enseignement de Lacan est considéré par Jacques-Alain Miller comme une phase de transition, dans la mesure où il subvertit le Nom du Père par sa pluralisation et considère le refoulement plutôt dû à l'action du langage qu'à l'interdiction paternelle. Lacan, dans la conclusion du Séminaire 10 (1962-1963), souligne la fin du Nom du Père, le remplaçant par sa pluralisation, les Noms du Père. A partir du paradigme Joyce, nous avons une outre perspective de la psychose, abordée par le versant du sinthome. A partir de là, nous pouvons penser à des multiples issues rencontrées par le sujet pour y faire avec sa psychose. La théorie lacanienne des noeuds nos permet d'aborder la singularité des solutions inventées par les sujets a travers le nouage unique que chaqu'un fait des trois registres: le réel, le symbolique et l'imaginaire.

La especificidad de la operación toxicómana en la psicosis: diferencias entre Paranoia y esquizofrenia a partir de un abordaje nodal / The specific use of toxic substances in psychosis: differences between paranoia and schzofrenia in a knot theory approach

El trabajo se propone interrogar la modalidad del consumo de tóxicos en sujetos psicóticos para determinar si existen diferencias entre el polo paranoico y el polo esquizofrénico en relación a este consumo de modo de poder cernir cierta especificidad de la operación toxicómana en la psicosis. El marco teórico del trabajo es psicoanálisis de orientación lacaniana y el abordaje es a partir de la teoría de nudos.

La responsabilidad del sujeto por el pasaje al acto en L. Althusser / Subject responsibility related to the passage to the act in L. Althusser

En 1980, Althusser asesina a su mujer, bajo lo que los peritos designaron como estado de demencia. Este dictamen posibilitó el sobreseimiento de su responsabilidad jurídica por el crimen cometido, en base a la aplicación del artículo 64 del Código Francés vigente en ese momento. En 1985, Althusser redacta "El porvenir es largo", a fin de dar cuenta de las consecuencias de haber sido juzgado no responsable de sus actos. Aunque Lacan nunca se refirió explícitamente a este crimen, el mismo ha llamado la atención del psicoanálisis en tanto permite confrontar muchas de las concepciones tempranas de este autor en relación a la responsabilidad, tanto aquellas ligadas a la elaboración de la paranoia de autopunición, como a sus consideraciones sobre los aportes del psicoanálisis en criminología. El presente artículo tiene por objetivo realizar una lectura de "El porvenir es largo" de Althusser en base a dos escritos de Lacan, a saber, "Introducción teórica a las funciones del psicoanálisis en criminología" y "Premisas para todo desarrollo posible de la criminología" con el fin de confrontar el crimen del filósofo con las conceptualizaciones contenidas en dichos textos, en relación a las cuales este asesinato podría adquirir estatuto de paradigma.

Polymorphisms in AKR1C4 and HSD3B2 and differences in serum DHEAS and progesterone are associated with paranoid ideation during mania or hypomania in bipolar disorder.

Paranoia is commonly a mood-incongruent psychotic symptom of mania which may be related to dopamine dysregulation. Progesterone and its metabolite allopregnanolone (ALLO) have been found in animals to antagonize the effects of dopamine. We therefore examined serum progesterone, its endogenous antagonist DHEAS and polymorphisms of the genes coding for certain steroidogenetic enzymes (AKR1C4, HSD3B2, and SRD5A1) in 64 males and 96 females with bipolar 1 or 2 disorder with or without paranoid ideation during mood elevation. Euthymic morning serum progesterone, DHEAS and cortisol concentrations were measured in males and in premenopausal women who were in follicular phase and not taking oral contraceptives. In women only, SNPs in AKR1C4 reduced the likelihood of having exhibited paranoid ideation by circa 60%. The haplotype of all 4 SNPs in the AKR1C4 gene reduced the risk of exhibiting paranoia by 80% (OR 0.19, 95% CI 0.06-0.61, p=0.05). A history of paranoid ideation was not, however, related to progesterone or DHEAS concentration. Serum DHEAS and progesterone concentrations were lower in men who had shown paranoid ideation during mania/hypomania compared with those who had not (F=7.30, p=0.006) however this was not coupled to polymorphisms in the selected genes. The ancestral G in rs4659174 in HSD3B2 was in men associated with a lower risk of paranoid ideation (likelihood ratio χ(2) 3.97, p=0.046, OR 0.31 (95% CI 0.10-0.96)) but did not correlate with hormone concentrations. Hence, gene variants in the steroidogenetic pathway and steroids concentration differences may be involved in the susceptibility to paranoia during mood elevation.

The safety of studies with intravenous Δ9-tetrahydrocannabinol in humans, with case histories.

RATIONALE: Delta-9-tetrahydrocannabinol (THC) is one of the few cannabinoid receptor ligands that can be used to probe the cannabinoid system in humans. Despite increasing interest in the cannabinoid receptor system, use of intravenous THC as a research tool has been limited by concerns about its abuse liability and psychoactive effects. OBJECTIVES: This study aims to evaluate the safety of all intravenous THC studies conducted at this center for the past 13 years. METHODS: Included were 11 studies with 266 subjects (14 schizophrenia patients and 252 healthy subjects, of whom 76 were frequent cannabis users), 351 active THC infusions, and 226 placebo infusions. Subjects were monitored for subjective and physical adverse events and followed up to 12 months beyond study participation. RESULTS: There was one serious and 70 minor adverse events in 9.7% of subjects and 7.4% of infusions, with 8.5% occurring after the end of the test day. Nausea and dizziness were the most frequent side effects. Adverse events were more likely to be associated with faster infusion rates (2-5 min) and higher doses (>2.1 mg/70 kg). Of 149 subjects on whom long-term follow-up data were gathered, 94% reported either no change or a reduction in their desire to use cannabis in the post-study period, 18% stated that their cannabis use decreased, and 3% stated that it increased in the post-study period. CONCLUSIONS: With careful subject selection and screening, risk to subjects is relatively low. Safeguards are generally sufficient and effective, reducing both the duration and severity of adverse events.

The association between social phobia, social anxiety cognitions and paranoid symptoms.

OBJECTIVE: Previous research suggests high levels of comorbidity between social phobia and paranoid symptoms, although the nature of this association remains unclear. METHOD: Data were derived from the Early Developmental Stages of Psychopathology study, a 10-year longitudinal study in a representative German community sample of 3021 participants aged 14-24 years at baseline. The Munich-Composite International Diagnostic Interview was used to assess social phobia and paranoid symptoms, along with data on social phobia features. Cross-sectional and longitudinal analyses were conducted. Differential associations with environmental risk factors and temperamental traits were investigated. RESULTS: Lifetime social phobia and paranoid symptoms were associated with each other cross-sectionally (OR = 1.80, 95% CI = 1.31-2.47). Lifetime paranoid symptoms were associated specifically with social anxiety cognitions. Lifetime cognitions of negative evaluation predicted later onset of paranoid symptoms, whereas onset of social phobia was predicted by cognitions of loss of control and fear/avoidance of social situations. Lifetime social phobia and paranoid symptoms shared temperamental traits of behavioural inhibition, but differed in environmental risks. CONCLUSIONS: The present study showed that paranoid symptoms and social phobia share similarities in cognitive profile and inhibited temperament. Avoidance appears to be important in the development of social phobia, whereas cannabis use and traumatic experiences may drive paranoid thinking in vulnerable individuals.

Mental health symptoms and their relationship to cannabis use in adolescents attending residential treatment.

The present study examined mental health symptoms and their relationship to cannabis use and treatment outcomes in a sample of adolescents who received treatment for cannabis dependence through a residential substance use program. The sample included 132 adolescents who nominated cannabis as their primary drug of concern upon admission and who completed at least 30 days of treatment. This study found that mental health symptoms of young cannabis users reduced significantly from admission to three-month follow-up. Further, pretreatment symptoms of anxiety were associated with greater pretreatment cannabis use, while symptoms of phobic anxiety were associated with less pretreatment cannabis use. Pretreatment obsessive-compulsive and somatization symptoms were associated with greater follow-up cannabis use, whereas pretreatment paranoid ideation symptoms were associated with less follow-up cannabis use. Further, follow-up somatization, obsessive-compulsive symptoms, hostility, and phobic anxiety were associated with greater follow-up cannabis use while follow-up symptoms of interpersonal sensitivity were associated with less follow-up cannabis use. These findings highlight a variety of areas for further investigation in order to enhance current treatment for cannabis use.

[Neuropsychiatric symptoms revealing pseudohypoparathyroidism with Fahr's syndrome]. / Manifestations neuropsychiatriques révélant une pseudohypoparathyroïdie avec un syndrome de Fahr.

UNLABELLED: Fahr's syndrome is characterized by the presence of intracerebral, bilateral and symmetrical non-arteriosclerotic calcifications, located in the central grey nuclei. One of its main etiologies is pseudohypoparathyroidism (PHP), due to a resistance to the action of parathormone (PTH) with essentially hypocalcaemia and a normal or a high rate of PTH. CASE REPORT: Mr B.A. is a 36-year-old man, admitted to hospital because of refractory psychotic symptoms associated with alcohol abuse and fits of convulsion, for diagnostic and therapeutic update. Mr B.A. had presented convulsions since the age of 10, without regular medical treatment. He showed a decrease in his school performances and started using alcohol. Since the age of 17, he began expressing delusions of persecution and of enchantment fed by the persistence of the convulsions. He was administered phenobarbital, and classic antipsychotics (haloperidol and levomepromazine) and developed serious extrapyramidal side effects, treated with an anticholinergic (trihexyphenidyl). Evolution was rather disadvantageous: more epileptic fits, exaggeration of tremors; abuse of alcohol and persistence of psychotic symptoms. On admission, psychiatric examination objectified paranoid delusions of being possessed and persecuted by others. Neurological examination revealed the presence of limb tremors, with a positive Froment's sign on the right, and dysarthria. Other than this, the patient was shorter in comparison with his siblings and exhibited bad dentition. A CT brain scan found bilateral, symmetric basal ganglia calcifications, confirmed by MRI, in favour of Fahr's syndrome. Phosphocalcic investigations revealed a low concentration of serum calcium (65 mg/l) and a hyperphosphataemia (60.1mg/l). The blood level of parathyroid hormone was in the upper limit of normal (66 ng/l), and levels of thyroid hormones and thyroid-stimulating hormone were normal. The diagnosis of Fahr's syndrome, revealing a pseudohypoparathyroidism was posed, and the patient was orientated to endocrinology after readjustment in his therapy (sodium valproate and olanzapine). DISCUSSION: About 40% of the patients with Fahr's syndrome are seen with primarily cognitive and other psychiatric findings. For this patient, hypocalcaemia was at the origin of his convulsions, and the use of phenobarbital, known for its hypocalcemiant action, provoked the inverse result. Alcohol drinking also aggravated hypocalcaemia, and maintained the fits. The use of classic antipsychotics and anticholinergic agents, amplified the extrapyramidal signs caused by Fahr's syndrome. Recognizing the origin of the symptoms allowed rethinking the therapeutic strategy according to all these elements. CONCLUSION: Psychiatrists should consider Fahr's syndrome as a differential diagnosis in the evaluation of psychosis associated with convulsions. This case, along with others in the literature, further emphasizes the importance of the role of neuro-imaging and the search for disrupted phosphocalcic metabolism in patients with atypical or refractory psychotic symptoms.

Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy.

Seventeen refractory partial epilepsy patients were enrolled in an open-label study to evaluate the antiepileptic effect of low-frequency repetitive transcranial magnetic stimulation (rTMS). Seven of the patients had not obtained seizure-free status after epileptogenic focus resection surgery before they were enrolled in the study. All patients were treated with low-frequency rTMS which included 3 sessions per day (0.5 Hz, 90% RMT and 500 pulses each session) and lasted for 2 weeks. Seizure frequency, seizure days and epileptic discharges in the EEG obtained before, during and after stimulation were compared. The psychological conditions of all individual patients were evaluated with Symptom Checklist-90 (SCL-90) before and after rTMS treatment. Mean seizure frequencies per week significantly decreased in the following 4-week rTMS treatment period compared with the pretreatment period (14.09 vs. 5.63, p < 0.05, mean reduction of 60.02% in seizure frequency). Mean seizure days per week during the treatment period and the post-treatment period were lower than that of the pretreatment period (5.18 vs. 2.99 p < 0.05, mean reduction of 42.5% in seizure days). Mean epileptic discharges in the EEG decreased significantly during the treatment period compared to that of the pre-treatment period (78.60 vs. 66.09, p < 0.05, mean reduction of 15.9% in epileptic spikes discharges) in all 17 patients. Fourteen patients completed the test of Symptom Checklist-90 effectively. The scales of Global Severity Index, Depression, Anxiety, Phobic anxiety, Paranoid ideation, Psychoticism, Somatization, Obsession-compulsion, Interpersonal sensitivity, Hostility in patients decreased respectively at the post-treatment periods compared with those of the pre-treatment periods (P < 0.05). Low-frequency rTMS may have a significant antiepileptic effect in patients with refractory partial epilepsy. Additionally, our results indicate rTMS treatment can improve the psychological condition of these patients.

Malignant Narcissism: from fairy tales to harsh reality.

INTRODUCTION: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism. METHODS: We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment. RESULTS: Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment. CONCLUSIONS: Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.