The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in ... more The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. 7.3% reported at least one episode of SH: rates were three times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.
ABSTRACT The concept of Self has brought about major interdisciplinary interaction as Neuroscient... more ABSTRACT The concept of Self has brought about major interdisciplinary interaction as Neuroscientific, Philosophic and psychological paradigms clash. The psychiatric epistemic paradigm of insight, depersonalization, dissociation, passivity experience and even schizophrenia reveals clear links to some important concepts that depend on this one. First we aim to present in a clear flowchart a short conceptual history of the Self from Aristotle’ till today. We’ll present Stoics, Descartes, Locke and Hume contributions to the clarification of this concept. As will be shown, this vast theoretical background was ground not only to its pervasiveness in psychopathology and psychiatric nosology but also to conceptual blur. Also we’ll present which different terms in psychiatry were influenced by the foundation and development of different theories of Self. Some concepts have weakened and were dropped (e.g. Multiple Personality) while others have received a greater prominence (e.g. insight). A special focus will be given to the intersection of the neuro-scientific and philosophical paradigm. It seems rather than destroying and weaken each other they can support each ones. We believe a clearer understanding of the Self will offer psychiatrists a clearer understanding in their clinical practice.
Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. ... more Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.
Acute and unexpected neuropsychiatric disturbances can herald subarachnoid haemorrhage (SAH). We ... more Acute and unexpected neuropsychiatric disturbances can herald subarachnoid haemorrhage (SAH). We investigated the risk factors for neuropsychiatric disturbances in acute SAH and analysed the relation between neuropsychiatric disturbances and location and amount of haematic densities and hydrocephalus. We assessed a sample of 108 consecutive patients with an acute (≤ 4 days) SAH (61 aneurysmal, 47 non-aneurysmal SAH), before aneurysmal treatment, using DSM-IV-TR criteria and the Montgomery Åsberg Depression Rating Scale and Mania Rating Scale, the Denial of Illness Scale, the Catastrophic Reaction Scale and the Apathy Evaluation Scale, excluding patients with severe consciousness or language disturbance. Performance on each scale was related to (i) the total amount of haematic densities in 10 basal cisterns/fissures and in the four ventricles, using the Hijdra et al. rating scale, (ii) the haematic densities in the prepontine cistern and the convexity of the brain and (iii) hydrocephalus. Depression (45%), apathy (42%), denial (21%) and catastrophic reaction (17%) were frequent in acute SAH patients. Mania was present in two patients. Denial was associated with higher haematic densities in the left and right basal sylvian fissure and in the 4th ventricle (P < 0.01) and with hydrocephalus (P = 0.05). Catastrophic reaction and depression were associated with previous mood disorder (P < 0.007). Apathy was associated with blood in the left or right lateral ventricles (P < 0.03). In the first 4 days of SAH, depression, apathy, catastrophic reaction and denial were rather frequent. SAH haematic densities were associated with denial and apathy, but not with depression, mania or catastrophic reaction.
Background and purpose: Apathy is a frequent disturbance in stroke patients. The aim of this cas... more Background and purpose: Apathy is a frequent disturbance in stroke patients. The aim of this case–control study was to elucidate whether apathy: (i) was secondary to stroke or related to hospitalization, (ii) was related to thalamic and striatocapsular stroke lesions, (iii) was independent from cognitive impairment and depression in the acute phase of stroke, (iv) was associated with clinical and demographical variables and (v) was associated with a worse functional outcome at discharge.Methods: We assessed a sample of 94 consecutive patients with an acute (≤4 days) stroke (22 intracerebral haemorrhages, 72 cerebral infarcts), and a control group of 50 patients with acute coronary syndrome, with the 10‐item Apathy Evaluation Scale‐Clinical. We related apathy with cognition (MMSE), depression (Montgomery Åsberg Depression Rating Scale) and with outcome (modified Rankin Scale).Results: Apathy was present in 36 (38.3%) acute stroke patients but was also frequent in patients with acute coronary syndrome (24%). Stroke patients were more inaccurate in understanding their problems than patients with acute coronary syndrome (P = 0.005). Logistic regression identified cerebral haemorrhage (OR = 3.5), low educational level (OR = 4.7) and a trend of right hemispherical lesion (OR = 3.0) as independent predictors for apathy (R2 = 32.3%). Cognitive impairment and depression were not associated to apathy. Apathy was associated with a worse outcome (P = 0.03).Conclusion: Apathy was frequent in acute stroke patients, and it was predicted by acute intracerebral haemorrhage and right hemispherical acute stroke lesion.
Anomalous self-experiences (ASEs), presumably involving alterations in &a... more Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840). PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.
The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in ... more The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. 7.3% reported at least one episode of SH: rates were three times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.
ABSTRACT The concept of Self has brought about major interdisciplinary interaction as Neuroscient... more ABSTRACT The concept of Self has brought about major interdisciplinary interaction as Neuroscientific, Philosophic and psychological paradigms clash. The psychiatric epistemic paradigm of insight, depersonalization, dissociation, passivity experience and even schizophrenia reveals clear links to some important concepts that depend on this one. First we aim to present in a clear flowchart a short conceptual history of the Self from Aristotle’ till today. We’ll present Stoics, Descartes, Locke and Hume contributions to the clarification of this concept. As will be shown, this vast theoretical background was ground not only to its pervasiveness in psychopathology and psychiatric nosology but also to conceptual blur. Also we’ll present which different terms in psychiatry were influenced by the foundation and development of different theories of Self. Some concepts have weakened and were dropped (e.g. Multiple Personality) while others have received a greater prominence (e.g. insight). A special focus will be given to the intersection of the neuro-scientific and philosophical paradigm. It seems rather than destroying and weaken each other they can support each ones. We believe a clearer understanding of the Self will offer psychiatrists a clearer understanding in their clinical practice.
Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. ... more Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.
Acute and unexpected neuropsychiatric disturbances can herald subarachnoid haemorrhage (SAH). We ... more Acute and unexpected neuropsychiatric disturbances can herald subarachnoid haemorrhage (SAH). We investigated the risk factors for neuropsychiatric disturbances in acute SAH and analysed the relation between neuropsychiatric disturbances and location and amount of haematic densities and hydrocephalus. We assessed a sample of 108 consecutive patients with an acute (≤ 4 days) SAH (61 aneurysmal, 47 non-aneurysmal SAH), before aneurysmal treatment, using DSM-IV-TR criteria and the Montgomery Åsberg Depression Rating Scale and Mania Rating Scale, the Denial of Illness Scale, the Catastrophic Reaction Scale and the Apathy Evaluation Scale, excluding patients with severe consciousness or language disturbance. Performance on each scale was related to (i) the total amount of haematic densities in 10 basal cisterns/fissures and in the four ventricles, using the Hijdra et al. rating scale, (ii) the haematic densities in the prepontine cistern and the convexity of the brain and (iii) hydrocephalus. Depression (45%), apathy (42%), denial (21%) and catastrophic reaction (17%) were frequent in acute SAH patients. Mania was present in two patients. Denial was associated with higher haematic densities in the left and right basal sylvian fissure and in the 4th ventricle (P < 0.01) and with hydrocephalus (P = 0.05). Catastrophic reaction and depression were associated with previous mood disorder (P < 0.007). Apathy was associated with blood in the left or right lateral ventricles (P < 0.03). In the first 4 days of SAH, depression, apathy, catastrophic reaction and denial were rather frequent. SAH haematic densities were associated with denial and apathy, but not with depression, mania or catastrophic reaction.
Background and purpose: Apathy is a frequent disturbance in stroke patients. The aim of this cas... more Background and purpose: Apathy is a frequent disturbance in stroke patients. The aim of this case–control study was to elucidate whether apathy: (i) was secondary to stroke or related to hospitalization, (ii) was related to thalamic and striatocapsular stroke lesions, (iii) was independent from cognitive impairment and depression in the acute phase of stroke, (iv) was associated with clinical and demographical variables and (v) was associated with a worse functional outcome at discharge.Methods: We assessed a sample of 94 consecutive patients with an acute (≤4 days) stroke (22 intracerebral haemorrhages, 72 cerebral infarcts), and a control group of 50 patients with acute coronary syndrome, with the 10‐item Apathy Evaluation Scale‐Clinical. We related apathy with cognition (MMSE), depression (Montgomery Åsberg Depression Rating Scale) and with outcome (modified Rankin Scale).Results: Apathy was present in 36 (38.3%) acute stroke patients but was also frequent in patients with acute coronary syndrome (24%). Stroke patients were more inaccurate in understanding their problems than patients with acute coronary syndrome (P = 0.005). Logistic regression identified cerebral haemorrhage (OR = 3.5), low educational level (OR = 4.7) and a trend of right hemispherical lesion (OR = 3.0) as independent predictors for apathy (R2 = 32.3%). Cognitive impairment and depression were not associated to apathy. Apathy was associated with a worse outcome (P = 0.03).Conclusion: Apathy was frequent in acute stroke patients, and it was predicted by acute intracerebral haemorrhage and right hemispherical acute stroke lesion.
Anomalous self-experiences (ASEs), presumably involving alterations in &a... more Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840). PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.
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