We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet. The present study aims to assess alexithymia, hypochondriasis and obsessive-compulsive symptoms in patients with chronic prostatitis.
Methods
Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated for the presence of alexithymia, hypochondriasis and obsessive compulsive symptoms using respectively the following psychometric tools: Toronto Alexithymia Scale (TAS), Whiteley Index (WI) and Leyton Obsessional Inventory (LOI). Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.
Results
57 patients (median age 40 yrs old; IQR 32-51.5 yrs) have been evaluated so far. Median CPSI score was 18 (IQR: 13-24). Median TAS score was 44 (39-57), median LOI score was 13 (10-15) and median WI score was 28 (22-38). An abnormal LOI score indicative of obsessive-compulsive features was noted in 58% of patients and an abnormal WI score indicative of hypochondriacal beliefs in 45%. CPSI strongly correlated with TAS score (r=0.57, p=0.007).
Conclusion
High rates of alexithymia, obsessive compulsive symptoms and hypochondriasis are present in chronic prostatitis patients. Alexithymic features were strongly correlated with quality of life measures such as the CPSI. These findings necessitate further elucidation and suggest that patients with chronic prostatitis may need psychiatric counseling and therapy.
The issue whether the clinical characteristics of unipolar psychotic major depression (PMD) vary according to the age of onset remains still unclear. In this study we assess comparatively the clinical characteristics of young early-onset (n=30), elderly early-onset (n=34) and elderly late-onset (n=35) psychotic depressives.
Methods
Ninety-nine inpatients suffering from DSM IV unipolar PMD were assessed on the basis of SCID IV, HRSD and a physical impairment rating scale.
Results
The elderly late-onset patients suffered from overall more severe depression compared to both categories of early-onset ones, more gastrointestinal symptoms compared to young early-onset patients and more psychic anxiety compared to elderly early-onset patients. Moreover, they expressed significantly more frequently delusions of somatic content and had higher scores on the HRSD item of hypochondriasis than their young early-onset counterparts. The group of elderly early-onset PMD patients was found to hold an intermediate position between the young early-onset and elderly late-onset PMD patients with regard to hypochondriacal ideation, gastrointestinal symptoms and delusions of somatic, guilt and paranoid content.
Conclusions
The findings of the present study suggest considerable differences between young, elderly early-onset and elderly late-onset PMD patients with respect to their clinical features.
Primary polydipsia is a clinical disorder characterized by excessive fluid intake (polydipsia) and consequent excessive fluid excretion (polyuria). The underlying pathophysiology of Primary polydipsia is still unclear. We present a case of a 26 year-old man without any previous psychiatric or neurological history who was thoroughly investigated for severe symptoms of polydipsia and polyuria. The only finding consisted of a probable micro-adenoma on the left side of the sella turcica.
Methods
The patient was thoroughly assessed by psychiatrists and psychologists through clinical and diagnostic interviews and was administered a wide range of psychometric tools including MMPI-2, SCID, YBOCS, BDI, HAM-17 and SCL-90. Moreover, he underwent a comprehensive physical and neurological examination, blood tests, renal function tests, endocrinological assessment including hormone assays, water deprivation test and desmopressin trial and brain Magnetic Resonance Imaging (MRI).
Results
No major psychiatric disorder was detected apart from the presence of mild depressive symptoms. A brain MRI revealed a 4-5 mm diameter lesion on the left side of the sella turcica with lower contrast enhancement than the rest of the gland, which was suggestive of pituitary micro-adenoma.
Conclusion
We considered the patient's depressive symptomatology as secondary to his condition. There is no other report of pituitary microadenoma in patients with symptoms of polydipsia and polyuria. We hypothesize that the location of the lesion may be related to the hypothalamic centre of thirst.
Chronic prostatitis has been long considered a psychosomatic illness. We have previously studied alexithymic and obsessive-compulsive features in chronic prostatitis patients.
Aims
To evaluate introverted, extroverted and total hostility in patients with chronic prostatitis.
Methods
Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated with the Hostility and Direction of Hostility Questionnaire (HDHQ), a questionnaire with 5 subscales designed to assess total hostility or punitiveness and direction of hostility. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.
Results
82 patients (median age 37.5 yrs old; IQR 30-45.5 yrs) were evaluated. According to the NIH Prostatitis Classification patients were categorized as type II: 45.1%, IIIa: 9.7%, IIIb: 39%, IV: 2.4%. Median CPSI score was 19.5 (IQR: 14.5-24.3). Median introverted, extroverted and total hostility scores were 3 (IQR: 2-6), 9 (IQR: 7-13) and 13 (IQR: 9-18) respectively. Results from the Extroverted Hostility HDHQ subscale correlated (r squared = −0.25, p = 0.024) with subscales of the TAS (Toronto Alexithymia Scale). These results were independent of CPSI scores.
Conclusions
Chronic prostatitis patients’ total hostility scores are similar to those of the general population reported by other studies. However, chronic prostatiitis patients show more outward directed hostility. The relationship between TAS subscale scores and measures of extroverted hostility needs further elucidation. Patients with chronic prostatitis are potentially at risk for psychiatric disturbances and thus may need psychiatric counseling and therapy.
Self-mutilation is a heterogeneous phenomenon. The more severe cases are usually associated with psychiatric disorders or with nervous system lesions.
Objectives
Systematic research is missing, though there are cases that could be life-threatening.
Aim
Report of a rare case of a man who was mutilating his hands by biting.
Methods
The patient was a 66-year old male who had been mutilating his fingers for six years. This behaviour started as serious nail biting and continued as severe finger mutilation (by biting), resulting in loss of the terminal phalanges of all fingers in both hands. On admission, he complained only about insomnia.
Results
The electromyography showed severe peripheral nerve damage in both hands and feet due to severe diabetic neuropathy. Cognitive decline was not established. The CT scan revealed serious brain atrophy. His behaviour was not associated with any major psychopathology or traits of personality disorder. He was diagnosed as suffering from impulse control disorder not otherwise specified. His impulsive biting improved markedly when low doses of haloperidol (1.5 mg/day) were added to fluoxetine (80 mg/day). The encouragement of his social life and the use of a mouth guard, in addition to his drug regimen, helped the patient in stabilizing the therapeutic effect.
Conclusions
In our patient's case, self-mutilating behaviour was associated with severe diabetic neuropathy, impulsivity and social isolation. The administration of an antipsychotic plus an antidepressant proved to be beneficial, only when it was combined with psychosocial interventions.
There is a continuing debate about the differences and similarities between bipolar disorder (BD) and borderline personality disorder (BPD).
Objectives
Only few studies have focused on the neuropsychological profile of these two disorders.
Aims
We studied the differences on memory, executive function and inhibitory control between BD and BPD patients.
Methods
Twenty-nine patients with BD in euthymia, 27 patients with BPD and 22 healthy controls matched for age and education were included in the study. All of them were female. BD patients who could also be diagnosed with BPD were excluded from the study. Participants were administered a series of tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB), accessing memory, executive function and inhibitory control.
Results
BD and BPD patients performed worse than controls in general. Significant differences were found in the PAL test; BD patients had 46.71, BPD patients had 36.56 and controls had 15.77 errors (P = 0.004). BPD patients performed worse in the IE/ED set-shifting test; they made 48.16 errors while BD patients made 23.64 and controls 16.14 (P = 0.001). BPD patients performed better in the problem-solving task (SOC), they solved 10.0, BD patients 6.32 and controls 8.32 problems (P < 0.001).
BD and BPD patients had similar performance in the SST inhibition task but worse than controls (P = 0.03).
Conclusions
BD and BPD seem to have differences in neuropsychological performance. BD patients show more deficits in memory learning and problem solving while BPD patients show more deficits in set shifting.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Bipolar disorder (BD) is frequently associated with cognitive deficits in attention, verbal memory and executive functions that have been related to various clinical characteristics of the disorder.
Objectives
However, few studies have examined the effect of gender on cognition despite its clinical relevance.
Aims
The aim of our study was to investigate potential diagnosis-specific gender effects on visual memory/learning and executive functions in BD.
Methods
Cognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated by using CANTAB battery tasks targeting spatial memory (SRM), paired associative learning (PAL), executive functions (ID/ED, SOC). A multivariate analysis of covariance (MANCOVA) of neuropsychological parameters was performed with gender and diagnosis as fixed effects and age and education as covariates. Following univariate analyses of covariance (ANCOVA) were undertaken to examine the effect of gender on each neuropsychological task.
Results
Bipolar patients showed significantly poorer performance in paired associative learning (PAL), set shifting (ID/ED) and planning (SOC). Moreover, a diagnosis specific gender effect was observed for cognitive functioning in BD (gender × diagnosis interaction P = 0.029). Specifically, male healthy controls outperformed healthy females in tasks of visual memory/learning but this pattern was not sustained (SRM) or was even reversed (PAL) in BD patients.
Conclusions
The present study is one of the few studies that have examined the effect of gender on neurocognitive function in BD. Our findings indicate that the gender-related variation observed in healthy subjects is disrupted in BD. Moreover, they suggest that gender may modulate the degree of frontotemporal dysregulation observed in BD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.