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Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5–15% of cases, and is known as shared psychotic disorder–delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.

I said to my soul, be still, and wait without hope For hope would be hope for the wrong thing; wait without love For love would be love of the wrong thing; there is yet faith But the faith and the ...

Objective To establish the features of the manifestations of psychovegetative disorders in children and adolescents throughout a long follow-up period. Material and methods In the pediatric hospital, 102 patients with functional somatic/vegetative disorders with the follow-up from 3 to 17 years were examined. The study used clinical-psychopathological, clinical-follow-up, cohort-dynamic methods. Results and conclusion Functional vegetative-somatic pathology in children and adolescents proceeds in the form of a psycho-vegetative syndrome. At the manifestation stage in preschool childhood, the psychopathological component is «masked» in nature and later becomes more complex in the clinical picture. In adolescence, the vegetative-somatic symptoms are smoothed out, while the psychopathological component determines the clinical picture with the subsequent possible «normalization» of the condition. The use of psychopharmacological therapy allows treatment of psychopathological disorders and control of vegetative-somatic symptoms.

Many schizophrenia patients seek hypnosis when they have not improved with psychopharmacological therapy. However, there has been controversy regarding the use and effectiveness of hypnosis in schizophrenia. Hypnotherapeutic methods such as direct and indirect suggestions, psycho-strengthening suggestions and imagery, hypnoprojective restructuring, guidance, and neutralization of affect associated with delusions have been effective in selected highly hypnotizable patients. Details of the hypnotherapeutic structure and strategy used for managing delusions in schizophrenia are presented with representative cases.

Os autores descrevem o caso clínico de um doente com 69 anos com depressão psicótica e sintomas físicos exuberantes. Dados os sintomas físicos significativos e o escalão etário foi efetuada avaliação médica que permitiu excluir doença orgânica. Apesar da terapêutica psicofarmacológica realizada, o doente não apresentou melhoria clínica significativa. Foi efetuada terapêutica eletroconvulsiva ainda na fase aguda, e por recidiva sob terapêutica antidepressiva, também de continuação e de manutenção. Atingiu-se assim uma remissão total do quadro clínico e de funcionamento, tendo o doente retomado a sua atividade profissional. O relato deste caso justifica-se pela sua apresentação peculiar e pelo benefício alcançado com a realização da eletroconvulsivoterapia (aguda e de continuação/manutenção), associado a terapêutica psicofarmacológica que garantiu uma remissão clínica significativa.

Drug-induced seizures are in view of a constantly ageing population and increasingly frequent polypharmacotherapy an increasing problem in daily routine praxis. Identification of potentially seizure-inducing drugs may help generating risk profiles for individual patients. Drug-induced seizures have often been seen as a complication of psychopharmacological therapy, but its occurrence has also been described in response to a great diversity of compounds such as antibiotics, sympathomimetics and anaesthetics. The present article outlines a synopsis of the most prevalent seizure-inducing drugs as well as strategies how to deal with a patient suffering from a drug-induced seizure.

OBJECTIVE About psychopharmacological long-term care in individuals with mental retardation there are only a few data. The objective of this investigation was to analyze psychopharmacotherapy over a period of 15 years. METHODS For the year 1991 291 data sets and for the year 2005 288 data sets of all residents of a home for people with mental retardation were analysed. RESULTS The number of psychiatric disorders has not changed. But the frequency of medication with neuroleptics and antidepressive compounds has increased. Atypical and typical neuroleptics did not differ significantly in side effects. But the number of side effects in SSRI's is compared with tricyclic antidepressive compounds significantly reduced. CONCLUSIONS The present study is one of the few, which gives an overview of long-term course of psychiatric disorders in people with mental retardation, the psychopharmacological therapy und side effects of used medication.

Among elderly patients with depressive disorders, restrictions of the ability to function socially apparently linger long after the depressive symptoms abate. In a 16-week long, prospective, controlled study on 30 elderly, depressed patients who were still living at home (response rate, 93.3%), we wanted to find out whether recovering the ability to function socially takes a different course through integrative treatment than it does subsequent to purely psychopharmacological therapy. We used the Beck Depression Inventory (BDI) and the Social Adaptation Self-Evaluation Scale (SASS) to measure our results. Both forms of therapy did afford a relatively rapid reduction of depressive symptoms, however, the integrative treatment not only led to a more expeditious reduction of the BDI score [in the fourth week (P < 0.05) and starting with the eighth week (P < 0.01)] but was also the only one that led to a significant improvement in the ability to function socially [in the 12th week, P < 0.05; in the 16th week, P < 0.01]. These findings could contribute to improved treatment and rehabilitation of elderly patients, thereby prolonging the periods in their lives in which they can live independently.

Controlled trials in clinical psychopharmacology may fail to provide reliable information about the benefit of treatment for the patient when considered in a real-life setting rather than as a part of a well-defined sampling procedure. Previously, we applied the mathematical model of an artificial neural network (ANN) to a pool of clinical information gathered through case descriptions provided by senior psychiatrists in clinical charts of patients receiving their first exposure to sertraline. In the present study, we applied the same mathematical model to a larger sample. The performance of the ANN model in forecasting successful and unsuccessful treatment showed an overall accuracy of classification of 97.12%. This result supports our previous finding about the potential application of this method as a reliable predictor of a given psychiatric patient's outcome during a specific psychopharmacological therapy.

Zusammenfassung: In diesem Fallbericht wird die teilstationäre Therapie zweier sieben und acht Jahre alten Geschwister mit einem elektiven Mutismus dargestellt. Bei der Behandlung handelt es sich um eine psychopharmakologische und intensive behaviorale Kombinationstherapie. Dargestellt werden die multimodale therapeutische Vorgehensweise sowie weiterführende psychosoziale Maßnahmen. Die Schwerpunkte des verhaltenstherapeutischen Vorgehens mit einem Aufbau sprachlicher Ausdrucksmöglichkeiten, dem Abbau der Sprechangst in sozialen Situationen sowie der Generalisierung auf nicht-therapeutische Situationen wird detailliert dargestellt. Die Kasuistik wird in den aktuellen Stand der Literatur zum elektiven Mutismus eingeordnet.

Therapy decision is one of the most important tasks clinicians have to perform in their clinical practice. The decision process requires taking into account many different factors. The Authors have proposed a neural computing approach for supporting clinical decision analysis. The mathematical model of artificial neural network (ANN) has been applied on a pool of clinical information gathered through case description freely filled by senior psychiatrists into 416 clinical charts. Sertraline, as drug for treatment, has been chosen since its clinical uses range from treatment of depression to that of many other psychiatric clinical conditions so that it has been thought to be a good candidate to this type of study. The ANN performance in forecasting successful and unsuccessful treatment cases showed an overall accuracy of classification of 97.35%. This result suggests a possible future application of this method to obtain a reliable prediction of a given psychiatric patient outcome during a specific psychopharmacological therapy, optimising the decisional making process. (C) 2001 Elsevier Science B.V. All rights reserved. Z8 0 ZR 0 ZS 0

This report focuses on the successful treatment of a most acute case of confusion psychosis according to the concept of Karl Leonhard. The 18-year-old patient was hospitalized three times before the current episode and his case has been characterized as pharmacologically treatment-resistant psychosis since he failed to respond to any psychopharmacological therapy including sufficient clozapine medication. In the patient's history, typical and atypical antipsychotic as well as mood-stabilizing and sedating pharmacological treatments have been conducted. However, only adverse effects could be observed. When receiving electroconvulsive monotherapy (ECT), the patient showed a marked reduction of symptoms while experiencing no adverse effects. The implications of this finding are discussed with regard to Leonhard's diagnostic system.

Problems with diagnosis in psychiatry in general and more specifically in borderline personality disorder (BPD) are discussed. On the basis of the best researched and most used diagnostic descriptions of BPD, a list of distinctive borderline symptoms is made. These distinctive symptoms are compared with the Positive and Negative Syndrome Scale (PANSS), and it is stated that the distinctive borderline symptoms will score on both the positive and the negative syndrome scales. The implications of this in connection with dynamic theories and the outcome of psychopharmacological therapy are discussed.

Objective: Little is known about depressed individuals' illness attributions and how these influence treatment assignment in clinical practice. The aim of the present study was to examine whether illness attribution across the domains of intraindividual, interpersonal and biological reasons was associated with treatment assignment in a naturalistic treatment setting.Method: Illness attribution was assessed with the Reasons for Depression Questionnaire in 221 depressed individuals. Participants were assigned to either cognitive-behavioural therapy (CBT), interpersonal therapy (IPT) or psychopharmacological treatment (PHT).Results: Depressed individuals who strongly attributed their illness to intraindividual factors were more likely to be assigned to CBT, and depressed individuals attributing their depression to biological reasons were more likely to receive in PHT. In contrast, interpersonal illness attribution was not associated with treatment assignment.Conclusions: Illness attribution influences treatment assignment to CBT and PHT. However, factors other than illness attribution for depression affect a treatment choice of IPT. Copyright (C) 2009 John Wiley & Sons, Ltd.Key Practitioner Message:Intraindividual and biological illness attributions affected depressed individuals' treatment assignment, making these individuals more likely to receive CBT and PHT, respectively.Interpersonal illness attribution was not found to be associated with treatment assignment.There were significant gender differences in illness attribution. Men were more likely to endorse in achievement-related causes, and women attributed their depressive illnesses to more interpersonal reasons (i.e., relationship, childhood and intimacy).

We report on the successful use of continuation electroconvulsive therapy (ECT) as prophylactic treatment of relapse in a case of confusion psychosis. The 20-year-old patient exacerbated in an almost annual rhythm and had been characterized as pharmacologically treatment-resistant since he failed to respond to any psychopharmacological therapy including sufficient clozapine as well as mood-stabilizing and sedating pharmacological treatments. After the diagnosis of confusion psychosis, the patient received ECT as monotherapy and showed a marked reduction of symptoms. Continuation ECT was then conducted for 7 months after the patient was discharged from hospital. Two years later, our patient is still in remission while continuation ECT has been tapered; no prophylactic psychotropic medication was prescribed in the last 2 years. Implications of this case on the therapy of confusion psychosis as well as on the diagnostic classification of confusion psychosis within our current systems are discussed.

Recurrent pyoderma is a relapsing bacterial infection of the skin. Evaluation of the primary predisposing factors is essential, but they are not always easy to determine. We reported that psychogenic factors should be considered as one cause of canine dermatoses featuring pruritic behavior such as grooming and scratching, and predicted that it could be added as a cause of recurrent pyoderma. The purpose of this study was to evaluate the roles of psychogenic factors in canine recurrent pyoderma. This study examined 21 dogs with recurrent pyoderma, which showed relapsing but antibiotic-responsive skin lesions. Predisposing factors, especially allergy, infection, endocrine disorders, congenital factors and improper treatments, were carefully ruled out with standard diagnostic procedures. Diagnosis of psychogenic factors was based on fulfillment of the following features: (1) distinctive area of broken hairs or asymmetric erythema, (2) incidental pruritic behavior related to emotionally unstable situation or physiological intervention, (3) existence of environmental antecedent triggers or concurrent psychiatric symptoms, and (4) requirement for psychogenic treatment, consisting of behavior modification and psychopharmacological therapy in some. The incidence of psychogenic factors and the efficacy of the treatment in recurrent pyoderma were evaluated. In these 21 dogs, 10 cases (47.6%) were compatible with the presence of psychogenic factors, and seven cases (33.3%) were improved with behavioral treatment. Psychogenic factors should be considered in the aetiology of so-called idiopathic canine recurrent pyoderma. Further investigation is needed to understand the relationship between skin barrier dysfunction and psychogenic factors. Funding: Self-funded.

The advent of improved diagnostic criteria, coupled with a refined psychotropic armamentarium, can now produce rapid clinical improvements in clinical psychiatric conditions for which both patients and therapist may be unprepared. The following case report illustrates this problem which will become increasingly important in the practice of psychiatry as further improvements in psychopharmacological therapy occurs.

De Maio, Domenico: Notes on Human Behavioural Pharmacotoxicology. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1988, 12 : 33–40. 1. 1. After 30 years of psychopharmacological therapy we are able to identify some aspects which can be referred to a “collateral behavioural effect”. The apparent rarity of this depends on the facility of confusing behavioural modifications (often sine materia ), with patological ones (normaly of a physical nature). 2. 2. Memory, learning, the ability of evoking, problems regarding reality, paradoxical reactions, “makefobic” behaviour, passivity and social and behavioural withdrawal, form part of the Human Behavioural Pharmacotoxicology. 3. 3. This ought to deserve greater attention on the part both of research workers and health authorities.

This article describes how psychopharmacological therapy is applied in Yugoslavia and other countries in Central Europe. The first part of the article summarizes experience and customary use of psychopharmacological substances in relation to clinical syndromes, course of disease, and dominant symptoms. In the second part of the article, the experience obtained in treatment with combinations of drugs and in prolonged pharmacotherapy of schizophrenia is described. Finally, the last section of the article addresses the social implications of psychopharmacological treatment and presents some of the problems and disadvantages that accompany this form of treatment.

Eight patients with intracranial cysts presenting with primary psychiatric diagnoses were studied. The cysts were visible on computed tomography (CT) and magnetic resonance imaging (MRI), and they produced neurologic, electroencephalographic (EEG), and neuropsychologic abnormalities. Descriptions of psychiatric manifestations associated with intracranial cysts are rare, and their potential neuropsychiatric significance has been minimized. This study demonstrates that intracranial cysts can cause neuropsychiatric symptoms, that surgical intervention may resolve the psychiatric manifestations in selected cases, and, in cases not warranting surgery, that psychopharmacological therapy to treat the behavioral manifestations is indicated. These cases mandate consideration of intracranial cysts in the diagnostic and therapeutic formulation of atypical neuropsychiatric disorders.