Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates.

BACKGROUND: Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants. OBJECTIVE: The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates. MATERIALS AND METHODS: This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16). RESULTS: A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021). CONCLUSIONS: According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prevalence of Axis II disorders in a sample of clients undertaking psychiatric evaluation for sex reassignment surgery.

The aim of the present study is to assess the prevalence of Axis II disorders (DSM-IV-TR) in a sample of clients requesting sex reassignment surgery (SRS), consecutively admitted to a Gender Identity Disorder (GID) psychiatric unit. Fifty clients self-referred as transsexuals (34 biological males and 16 biological females; mean age = 31.74 +/- 7.06 years) were assessed through the SCID-II after a preliminary evaluation to exclude current major psychiatric disorders. Prevalence of any Axis II disorder was 52% (N = 26), with no significant differences related to biological sex. The most frequent personality disorders were Cluster B PDs (22% of total sample), followed by Cluster C (12%) and Cluster A PDs (2%). A significant prevalence of NOS PD (16%) was also found. Our data offers prevalence estimates slightly higher than those found in previous studies and does not provide evidence for any differences in the psychopathological profile and severity between MtF and FtM transsexuals.

A comparative controlled study of personality in severe obesity: a 2-y follow-up after intervention.

OBJECTIVE: The primary purpose was to examine 2-y effects of weight change on personality traits in severely obese subjects treated conventionally or surgically. We also assessed differences between the severely obese patients and a primarily normal-weight reference group. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychasthenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. A total of 1380 surgical candidates, 1241 conventionally treated patients and 1135 subjects from the SOS (Swedish Obese Subjects) reference study, representing the general population, completed the KSP. Data presented in this study were gathered twice from the patients (prior to treatment and after 2 y) and once from the reference subjects. Significance tests and effect sizes (ES) were calculated. RESULTS: At baseline, the obese were characterised as more anxiety prone, impulsive, irritable and less monotony avoiding than the reference group; surgery patients more so than the conventionally treated. At follow-up, it was found that anxiety proneness decreased and Monotony Avoidance increased with increasing weight loss. The conventionally treated were, on average, weight stable and, hence, only a small decrease was noted regarding Somatic Anxiety. The surgery group lost on average 28 kg, and differences between surgically treated and the reference group decreased on all scales except Impulsiveness, which remained unchanged. The largest improvement was in relation to Psychasthenia. CONCLUSIONS: Weight reduction maintained for 2 y was associated with changes on practically all personality traits in proportion to the magnitude of weight loss. In particular, Psychasthenia seemed to be alleviated, while Impulsiveness was unaffected.

[Late results of operations in patients with epilepsy with marked mental disorders]. / Otdalennye rezul'taty operatsii u bol'nykh épilepsiei s vyrazhennymi narusheniiami psikhiki.

The article reports data concerning 260 patients with epilepsy who were treated by different variants of operations on the open brain. The duration of the catamnesis ranged from 3 to 17 years. It is shown that the results of the treatment are determined by some initial data, in particular, the features of the psychopathological and neuropsychological disorders and their degree. Criteria of the selection of patients with epilepsy and mental disorders for surgical management are formulated.

Psychosurgery and personality--some legal considerations.

The practice of psychosurgery is subjected to different rules, sometimes written, often unwritten, in the different jurisdictions. No commonly accepted definition on what psychosurgery exactly is has been given by the national legislatures. Some legislatures have simply outlawed psychosurgery; some have no specific rules; others have provided a stable legal basis to it, while protecting the patient (informed consent; review committees; second opinions).

Psychosurgery and personality disorders.

Defining personality and its pathological variants is a hazardous enterprise. The personality concept refers to the global coherence of functioning of a person as a whole and can be divided into two components, temperament and character. Personality disorders will be discussed according to the DSM III-R (1987) (The Diagnostic and Statistical Manual of Mental Disorders) the most recent psychiatric taxonomy of the American Psychiatric Association. The interaction between psychosurgery and personality is multiple. It will be stated that the mere presence of a personality disorder in a patient should never be an indication for psychosurgery. It may sometimes even act as a contraindication. Psychosurgery can produce changes in some basic psychic dysfunctions and although there is no universally accepted understanding of how it works, some hypothetical neurobiological foundations will be discussed.

Posteromedial hypothalamotomy in the treatment of violent, aggressive behaviour.

Although emotion in the human is largely modified by the frontal association areas (software) and may better be called affect, it is still very much influenced by the balance of the ergotropic and the trophotropic circuits in the prosencephalon (hardware) especially in patients with organic brain lesions. Violent, aggressive, restless behaviours or rage can be regarded as an unbalanced state of these two circuits with dominance of the ergotropic circuit. In order to restore the balance of these two circuits, small stereotactic lesions were made in the ergotropic portion of the posterior hypothalamus (posteromedial hypothalamotomy) with good results in the follow-up of 10-25 years. Postoperatively there was no disturbance in endocrine activities and growth.

Treatment of psychiatric illness by stereotactic cingulotomy.

The treatment of 198 psychiatrically disabled patients with stereotactic cingulotomy was evaluated prospectively for a mean follow-up of 8.6 years. Patients with major affective disorders and anxiety disorders fared the best, with a return to normal functioning in the majority. Patients with obsessive-compulsive disorders, schizophrenia, and personality disorders improved less predictably, with an uneven improvement in functioning that required active ongoing psychiatric treatment. Low mortality and morbidity, a reduction of violent behavior, a possible reduction of suicidal risk, and a lessening of the intractable suffering of chronic psychiatric illness all indicate that cingulotomy can be an effective, safe treatment for patients with affective disorders that are unresponsive to all other forms of therapy.

[Psychosurgery in behavior disorders]. / Psicocirurgia nos distúrbios do comportamento.

The results obtained in a casuistic of 170 patients with mental diseases and behavior disturbances treated by neurosurgical procedures are reported. The authors call attention to the advantages of the atraumatic stereotaxic psychosurgery over the major surgical procedures on the frontal lobes for the treatment of psychoses and intractable psychoneurosis.

Stereotactic amygdaloidotomy for aggressive behaviour.

Amygdaloidotomy was performed bilaterally on 15 and unilaterally on three patients exhibiting severe aggressive or self-mutilating behaviour. Nine subjects (50%) were improved a year after operation; improvement was maintained in seven (39%) for periods ranging from 27 months to nearly six years. Four non-epileptic cases had convulsions during the period of review; one of them has a persistent mild hemiparesis dating from the postoperative period. There was a tendency for epileptics to respond better than non-epileptics and for mentally retarded patients to respond poorly, but none of the differences was statistically significant.

A new look at bimedial prefrontal leukotomy.

Forty-four selected patients with "hard core" functional psychiatric illness were treated by bimedial prefrontal leukotomy, in which only the medial half of the prefrontal white matter of both frontal lobes was divided. This operation differs from the conventional or "standard" leukotomy which divides the entire prefrontal white matter. There were six patients with personality disorders, 25 psychoneurotics, 12 schizophrenics, and one with involutional melancholia. Forty-two of the 44 patients had thorough psychiatric follow-up, ranging from one to seven years postoperatively. They were assessed clinically and also on a point-rating scale of assessment.Seventy-six per cent of these patients had excellent or satisfactory outcomes. The most striking benefit was decrease in anxiety and tension.Modified leukotomy is a safe and effective method of reducing the symptoms of excessive tension, anxiety, fear or depression in patients with a variety of illnesses, including anxiety neurosis, phobic psychoneurosis, obsessional neurosis, neurotic or psychotic depressive reactions and schizophrenia. The operation should be considered in such neurotic, personality and psychotic illnesses when medical treatment has failed.