Coping With Pandemics: A Historical Perspective About Society's Tools to Deal With Global Infectious Diseases.

ABSTRACT: Throughout history, society has dealt with several devastating pandemics. Our objective is to analyze society's coping mechanisms to deal with pandemic-related stress in history congruent with the values of the time. For that purpose, we have carefully selected some of the most significant pandemics based on their impact and the available psychosocial literature. After a brief introduction, society's coping tools are reviewed and analyzed for the Antonine Plague, the second bubonic plague, the third cholera pandemic, the Spanish flu, the HIV pandemic, and the COVID-19 pandemic. Despite occurring at different times in history, parallels can be established in the study of society's psychological reactions among different pandemics. Magical thinking, political skepticism, fake accusations, and discrimination of minorities are recurrent reactions in society among different pandemics in history.

Catatonia in the medically ill: Differences and parallels in etiology, phenomenology and management.

OBJECTIVE: Catatonia is a disorder characterized by psychomotor symptoms. The etiology, symptomatology, response and outcome of catatonia in the medically ill has not been vigorously studied. Those who have catatonia associated with another mental disorder versus. catatonic disorder due to another medical condition may differ. The aim of this study is to study the causes, phenomenology and outcomes of medically ill patients with catatonia and explore differences among those who have catatonia associated with psychiatric illness vs. systemic medical illness. METHOD: We studied the incidence of catatonic symptoms in medically hospitalized patients to identify any apparent differences in clinical manifestations due to distinctive etiologies. Specifically, we assessed if there are differences between those who had catatonia associated with another mental disorder versus those with catatonic disorder due to another medical condition in their phenomenology, management and likelihood of response to treatment. RESULTS: Of our 40 patients, 18 patients (45%) had catatonia associated with another mental disorder, 17 (42.5%) had catatonic disorder due to another medical condition, and in 5 patients (12.5%) the cause of catatonia was not identified. The most common catatonic symptoms regardless of etiology in our medically ill were mutism, followed by rigidity, and immobility. Bipolar disorder, schizophrenia, major depressive disorder, metabolic abnormalities, anti NMDAR encephalitis were the most frequent causes of catatonia in our medically ill patients. Compared to subjects with catatonic disorder due to another medical condition, those with catatonia associated with another mental disorder had more frequent mannerisms (Chi-square = 4.27; p = 0.039), waxy flexibility (Chi-square = 11.0; p < 0.01), and impulsivity (Chi-square = 4.12, p = 0.042). Nonsignificant trends were noted for posturing (Chi-square = 3.74, p = 0.053), perseveration (Chi-square = 3.37, p = 0.067), and stereotypy (Chi-square = 2.91, p = 0.088) also being more frequent in catatonia associated with a psychiatric cause. DISCUSSION: Our data supports phenomenological differences between medical and psychiatric causes of catatonia in the medically ill.

Hercules and Cancer: A Metaphorical Attempt to Beat Mortality.

Art offers a visual document of ancestral suffering, as such mythological images in the arts can provide cathartic relief in our patients with existential anxiety. The image of Hercules fighting Hydra and Cancer may serve as an example on how art can help attaining that goal. One example of such an attempt is reflected in the story of Hercules who had to defeat Hydra and Cancer as part of his twelve labors to become immortal. The same way Hercules fought against Cancer to become immortal, humans fight against cancer to defeat death. Cancer is a constant threat to mankind; oftentimes feeling as if it belongs to an alternate reality; a different reality we cannot comprehend, but that will unavoidably reach and impact us all.

Showtime's The Affair: the Rashomon effect, eyewitness testimony, and lack of reliability in homicide.

OBJECTIVE: The Rashomon effect explores point of view in storytelling, and the subjectivity of even honest narratives is based on point of view. In 1950, Rashomon was the first film to explore this. Currently, The Affair explores the differences in story based on point of view. Both clinical and forensic psychiatrists must consider point of view when hearing narratives from patients or defendants. CONCLUSION: The Affair provides an excellent contemporary example through which to explore the Rashomon effect in conceptualization of eyewitness testimony and reliability of reporting.

Casas de Locos: The Treatment of the Mentally Ill in the Hispanic World Before the Enlightenment.

Before the Enlightenment, the mentally ill in the Hispanic world received standard medical care. After the foundation of the first hospital for specific treatment for mentally ill in Valencia in 1409, a number of hospitals opened their doors to patients with mental illness across the Iberian Peninsula during the 15th century. This model of medical care for people with mental illness was carried to America and the Philippines soon after the arrival of the Spaniards. The treatment for the mentally ill in the Hispanic World influenced the development of Pinel's moral treatment and the care of the mentally ill during the Enlightenment. This article will explain the circumstances leading to the foundation of a number of specific hospitals for the mentally ill in the Hispanic territories as well as the kind of care that these patients received at the so-called casas de locos.

Antidepressants appear safe in patients with carcinoid tumor: Results of a retrospective review.

INTRODUCTION: Patients living with neuroendocrine tumors have high rates of depression, often necessitating antidepressants, including selective serotonin reuptake inhibitors (SSRI). Neuroendocrine tumors (NETs) secrete vasoactive substances, including serotonin, which contribute to the cluster of symptoms known as carcinoid syndrome (flushing and diarrhea). Controversy exists over whether or not antidepressants are safe in NET. We aimed to study the safety of antidepressant use in NET patients. METHODS: We conducted a retrospective chart review of patients with well differentiated NET who were also prescribed antidepressants from January 2008 through April 2015. The study took place at Memorial Sloan Kettering Cancer Center and was approved by the hospital's institutional review board. RESULTS: Ninety-two patients were included. There were 16 (17.4%) patients with carcinoid syndrome (10 ileum, 1 duodenum, 1 jejunum and 4 unknown primary); and 76 (82.6%) patients without (41 lung, 9 pancreas, 8 ileal, 5 duodenum, 5 appendix, 2 unknown primary, 1 jejunum and 5 other). Median duration of antidepressant prescription was 11.6 months (range, 0-121) among those with carcinoid syndrome (N = 16) and 14.3 months (range, 0-172) among those without carcinoid syndrome (n = 76). Antidepressants were stopped in 31 cases (33.7%), though the reason was not specified in the majority of cases (n = 18; 58%). None of the patients developed carcinoid syndrome while being prescribed antidepressants. No patients developed carcinoid crisis. CONCLUSION: Our findings do not support previous authors' recommendations that SSRIs must be avoided in NET patients. Several classes of antidepressants appeared safe in NET patients with and without carcinoid syndrome.

Ars Moriendi: Coping with death in the Late Middle Ages.

OBJECTIVE: The Ars moriendi was a book written in the early 15th century with the goal of assisting friars in their work of helping the dying. The aim of our study was to review the current literature on the Ars Moriendi concerning the field of medicine, to analyze the psychological mechanisms for coping with death anxiety within Ars Moriendi, and to explore parallels between the strategies used in the medieval book and in contemporary literature about death and dying. METHOD: A review of literature using Pubmed, EMBASE, JSTOR, Project MUSE, and the New York Public Library was undertaken first. The primary source was then interpreted from a medical/psychological point of view. RESULTS: Seven articles were selected by literature review. These works comment on the importance of the Ars Moriendi in its historical context and explore the possibility of retrieving the principles of the text in contemporary society. The original text of Ars Moriendi, the primary source, presents death as a relief from the sufferings of earthly life and a gateway to eternal glory. According to the author, a good death implied the triumph over five demonic temptations in agonizing people: a lack of faith, despair, impatience, pride and greed. SIGNIFICANCE OF RESULTS: Analyzed from a modern psychiatric perspective, the Ars Moriendi offers descriptions of behavioral manifestations compatible with delirium, mood and anxiety disorders that characterize people with terminal illnesses. Moreover, we also explored parallels between the strategies used to cope with death anxiety in the Late Middle Ages and in contemporary society.

The Practice of Holy Fasting in the Late Middle Ages: A Psychiatric Approach.

During the Late Middle Ages, the practice of fasting among religious women in an attempt to follow a pious and ascetic life was common. In this paper, three cases of medieval religious women are described with a particular attention to the figure of St. Catherine of Siena, her life, popularity, and iconography. In the Middle Ages, holy fasting was characterized by a refusal to eat that could involve binging and purging, lack of menstruation, an interest in cooking for others, and in some cases death due to inanition. In the Medieval narratives of fasting holy women, we can see patterns that are compatible with symptoms of anorexia nervosa. From a psychiatric perspective, it is possible to elucidate and understand the practice of fasting among religious people in the Late Middle Ages.

Demonic possessions and mental illness: discussion of selected cases in late medieval hagiographical literature.

During the Middle Ages, demonic possession constituted an explanation for an erratic behavior in society. Exorcism was the treatment generally applied to demoniacs and seems to have caused some alleviation in the suffering of mentally distressed people. We have selected and analyzed some cases of demonic possession from thirteenth-century hagiographical literature. In the description of demoniacs we have been able to find traits of psychotic, mood, neurotic, personality disorders and epilepsy. The exorcisms analyzed in our article are the result of literary invention more than the description of a contemporary event. Nevertheless, the writers were witnesses of their time, transferred their knowledge about exorcism and possession in their narrative and presumably incorporated their actual experience with demoniacs.

Biperiden dependence: case report and literature review.

Anticholinergic drugs are frequently used in psychiatry for the prophylaxis and treatment of extrapiramidal symptoms caused by neuroleptics. Abuse of anticholinergic agents has been reported in patients with psychotic disorders, on treatment with neuroleptics, and polysubstance use disorders. We are reporting the case of a patient who presented with hypoactive delirium as a consequence of biperiden dependence. The clinician must pay special attention to detect anticholinergic misuse in patients presenting with delirium of unknown cause.