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Capgras and Fregoli syndromes revisited through six different psychiatric clinical cases
- L. Santa Marinha, P. Felgueiras, A. Miguel, O. Nombora, A. Horta
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S447-S448
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Introduction
Capgras and Fregoli syndromes are delusional misidentification syndromes, characterized by a belief in duplicates and replacements. Capgras delusion was first described by Capgras in 1923, reporting a belief that a person (usually a close relative) has been replaced by an exact double (imposter). On the other hand, Fregoli Syndrome was first described by Courbon and Fail in 1927, and holds a delusion that a familiar person is disguised as a strange person. Several explanatory models have been hypothesized, through myths, psychoanalytical and psychological interpretations, as well as neurobiological explanations.
ObjectivesThrough six different clinical cases and a narrative review, we aim to revisit the concepts of Capgras and Fregoli syndromes, emphasizing their complexity and heterogenicity.
MethodsWe conducted a non-systematic review of recent evidence on Capgras and Fregoli syndromes and expose exemplary clinical cases.
ResultsCapgras and Fregoli syndromes are complex psychotic experiences involving a great number of brain areas, with many heterogeneous clinical manifestations and comorbidities. Even though they were initially encompassed in pure psychotic disorders, today they are mainly understood as neurological disorders, in which the delusion primarily results from organic brain lesions or degeneration. Nevertheless, we present several distinct clinical cases with psychiatric diagnoses that include these curious phenomena: a 39-year-old man with schizophrenia; a 67-year-old woman with late-onset schizophrenia; a 24-year-old woman with schizoaffective disorder; a 48-year-old woman with first episode of acute and transient psychotic disorder; a 76-year-old woman with psychotic depression; and a 25-year-old woman with psychosis and intellectual development disorder.
ConclusionsOur review highlights the complexity of the delusional misidentification syndromes. We expose different patients with different psychiatric diagnosis, showing the diversity of pathologies in which these syndromes can fit. Although they seem to be very common in non-psychiatric disorders, little is known about the prognosis and response to treatment or whether there are systematic differences between delusional misidentification syndromes associated with “functional” and “organic” disorders, which should encourage further studies in order to address this gap and provide appropriate care.
Disclosure of InterestNone Declared
Euthanasia and assisted suicide (EAS) in psychiatric patients
- P. Pedro Felgueiras, R. Silva
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S166
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Introduction
A legal definition for EAS describes this procedure as “intentionally terminating life by someone other than the person concerned, at the latter’s request”. The number of requests for EAS has been progressively increasing in countries where this procedure is allowed, including concerning psychiatric patients (2% of all requests). EAS for reasons of unbearable suffering raises ethical concerns due to lack of criteria for psychiatric patients.
ObjectivesTo discuss the avaliable data about EAS and its controversial value in psychiatric patients.
MethodsNon-systematic review of literature on current knowledge about EAS, particularly in patients with mental disorder.
ResultsIn terms of sociodemographic and clinical characteristics, these patients were mostly women, with at least two psychiatric conditions; the main diagnosis is a (treatment-resistant) mood disorder, with some medical comorbidity. Psychological suffering was the main motivation, in patients with severe symptomatology associated with psychiatric and physical conditions (26% reported both psychological and physical suffering). These patients tend to be empowered and value self-determination. There is to highlight a high percentage of patients still alive after a not granted pEAS request (69%) and a high rate of pEAS requests withdrawals (37%).
ConclusionsSuicide prevention remains a priority in terms of public health. Thus, there is a need to ensure that EAS isn`t a way to increase suicide mortality by giving access to lethal methods to suicidal patients. In some cases, EAS request has a paradoxical value to regain control of life and it`s related to the transient nature of unbearable mental suffering.
The actual process provides a continued recovery-oriented care in parallel with the EAS evaluation, and a thorough evaluation which requires a multi-expert panel with the envolvement of mental health professionals. Ethical concerns remains about its paradox: unbearable psychological suffering is a target for suicide prevention and also a required criterion for EAS.
Disclosure of InterestNone Declared
Sexuality among elderly patients with dementia: Are we aware of their needs?
- L. Santa Marinha, O. Nombora, M. Basto, P. Felgueiras, A. Horta
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S806-S807
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Introduction
Sexuality is one of the basic needs in human life and its positive effects for the wellbeing are undeniable. People with dementia, despite cognition and functioning impairments, still pursue intimacy as part of their expression of basic human instincts.
ObjectivesWe aim to address the subject of sexuality among patients with dementia, emphasizing the physiological, environmental and legal barriers.
MethodsWe conduct a non-systematic review of recent evidence on dementia and sexuality, using PubMed/Medline database.
ResultsPeople with dementia face several difficulties expressing their sexuality. First, they struggle with physiological barriers to enjoyment of sexuality, such as ageism, apathy and limited free mobility. Secondly, either at home or in long-term care facilities, privacy is usually abolished. For care facilities, the Sexuality Assessment Tool supports the normalization of sexuality and self-audit policies that promote resident rights for privacy and assistance. Moreover, expression of sexuality in elderly can be misinterpreted as disinhibition, leading to unnecessary use of psychotropics to cease these behaviors. Additionally, legal barriers regarding consent arise when a partner loses the ability to consent sexual activity, questioning agreement and mutual desire. The Lichtenberg and Strzepek Decision Tree for Capacity to Participate in Intimate Relationships can be helpful to address this issue.
ConclusionsSexuality in older people remains neglected in clinical intervention. Besides the urgent need to deconstruct stereotypes, families and staff must be sensitized to understand the changes in expression and perception of sexuality among people with dementia, rather than being indifferent or medicate what can be perceived as disinhibited/distorted expressions of normal needs.
DisclosureNo significant relationships.
Psychotic disorders in migrant population
- P. Felgueiras, P. Barbosa
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S732-S733
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Introduction
One of the defining features of the modern world is a large scale migration that occurs due to a range of factors, from political conflicts to personal and voluntary reasons. This process can cause a severe disruption in individuals’ biography and can be followed by a large period of adaptation and a phenomenon of acculturation. Surprisingly, there is little research on the impact of migration and settlement on risk of psychosis.
ObjectivesRegarding a clinical case, we aim to enphasize the current evidence about the risk of psychotic disorders in migrants.
MethodsWe present a qualitative review of this topic using the Pubmed database.
Results27 years old portuguese female, with hyperthymic temperament and history of depressive episode. Her process of migration in 2016 was motivated by an academic purpose. In context of stressful life events she developed psychotic symptoms - messianic and persecutory delusions, with visual and auditory hallucinations.
ConclusionsThere is an increased risk of psychosis among migrant population that is well documented. This is even the main risk factor with the exception of a family history of psychosis. The risk can be explained by socio-demographic and psychological features, factors involving the migration process, and socio-occupational environment in the host country. A socio-developmental-cognitive model theorize how exposure to a stressful environment and social defeat interacts with underlying genetic risk to create an enduring liability to psychosis. These findings can help in important decisions about mental health resources and accessibility, including protocols to identify and treat migrants at higher risk of mental diseases.
DisclosureNo significant relationships.
Vascular depression – regarding a case report
- P. Felgueiras, A. Martins, A. Miguel, N. Almeida
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S429-S430
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Introduction
Age-related vascular changes have long been documented as an etiopathogenic factor of some geriatric depressive syndromes. More recently, it has emerged the concept of “Vascular Depression” recognizing that cardiovascular disease may predispose, precipitate or perpetuate late life depression. This condition was defined by an episode of major depressive disorder within the preceding 12 months in elderly with cardiovascular/cerebrovascular disease, or major cardiovascular risk factors. Vascular Depression isn`t described in DSM-V, and that difficults clinical recognition and affects clinically informed systematic studies.
ObjectivesRegarding a clinical case, we enphasize the clinical impact of Vascular Depression`s hypothesis.
MethodsWe present a qualitative review of this topic using the Pubmed Central database.
Results74 years old male patient, with major depressive disorder about ten years. Depressive and cognitive symptoms didn`t respond to antidepressive treatment and his functional state has gradually declined.
ConclusionsVascular depression develops after the 60 – 65 years in the absence of personal and family history of affective disorder. The key symptoms are low energy, anhedonia, deficits in selfinitiation, psychomotor retardation, reduced processing speed and lack of insight into mood symptoms. Clinical assessment includes a review of history of vascular risk factors or/and disease, but also an imagiological evidence demonstrating subcortical white matter abnormalities. Insidious and chronic course tends to delay its recognition and management. This becomes critical because Vascular Depression is associated with poor response to antidepressant treatment and persistent depressive symptoms. It`s also associated with poor selfmanagement of comorbidities and impairment in daily function. Increased mortality from all causes is widely documented.
Munchausen syndrome - diagnostic challenge
- B. Coutinho, P. Felgueiras, M. Torres, A. Fonte
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- Journal:
- European Psychiatry / Volume 26 / Issue S2 / March 2011
- Published online by Cambridge University Press:
- 16 April 2020, p. 870
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Introduction
The Munchausen syndrome describes patients with a particular form of factitious disorders: symptoms of illness or injury intentionally produced, for psychological reasons, in order to be hospitalized and even to be submitted to invasive interventions.
Clinical caseA 38 years-old woman, firefighter, was admitted, in Medicine Department for a transverse myelitis, (spinal thrombosis D5-D7 secondary to sepsis caused by a central venous catheter infection). Healthy up to 24 years of age, she is diagnosed Webber Syndrome-Christian and treated. Some years after appeared hypochromic microcytic anemia, whose initial cause was considered to be a rectal ulcer, with complete hematologic recovery after surgery. But some time after, there was recurrence of anemia, plenty diagnostic exams were performed and all inconclusive. Since one-year ago, she had the need to blood transfused weekly. Because of poor peripheral vessels, central venous catheter (CVC) was placed, then she developed serial infections by S. aureus with sepsis and is noticed that she got hematological recovered whenever hospitalized, leading the suspicion the catheter was being auto-manipulated. Currently she is paraplegic from D7 and when it was told her, that there was no neurological recovery, paradoxically she happily said “I already knew.” Against her will, the CVC was removed and peripheral accesses reestablished. So, for all of this, it was hypothesized Munchausen Syndrome.
DiscussionTreatment of Munchausen syndrome primarily consists in treating the self-induced illness before psychiatric help can be given. Unfortunately most patients refuse psychiatric help and leave hospital even before correct diagnosis is made.