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The expression of sexuality in the adult with mental disorders depends on the early incorporation of factors for promoting social inclusion. It is fundamental that sexual educators and advisors, in addition to working with the clients, also work with close family members. Intervention programs should establish objectives for developing a positive attitude towards sexuality in people with mental disorders and improving self-esteem (Katz G,Salud Publica Mex. 2008;50 Suppl 2:s239-54).
Challenge
Achieving support for people with mental health problems and/or substance use disorder admitted to the Social Rehabilitation Process of a psychiatric hospital so that they develop their sexuality satisfactorily. The right to privacy must be taken into account.
Objectives
Promoting a healthy and satisfactory development of sexuality in people with severe mental disorders. Raising awareness among healthcare teams, families and legal representatives regarding the need and suitability for support. Introducing the concept of sexuality as a dignifying perspective. Promoting sexual education that avoids disadvantages and situations of abuse in the target group. Coordinating the continuity of the project with non-health social services after discharge.
Hypothesis
Possibility of receiving support in the development of sexuality through training, information and improvement in the management of emotions/feelings in people who express the need or willingness to receive it, will contribute to overcoming limitations or difficulties.
Methods
Detecting people who during 2021 wish to work on the objectives through the care team. Searching for community resources aimed at attending sexuality issues in people with mental health problems. Proposing the hospital a collaboration with a non-profit entity that develops a specialized program for attention to sexuality in disability. Coordination between Treatment team and Entity. Quantitative and qualitative assessment of one year of experience according to the parameters of the entity.
Results
2022
People included
Percentage of people admittedto the Income Unit (65)
Detection concern sex-affectivity
5
7,69%
Verbalized concern
3
4,61%
Referral to the entity program
2
3,07%
Conclusions
All patients included have a diagnosis of psychosis. Experience was very positive for the participants. Community intervention projects that lead to an education in healthy and respectful relationships in the field of sexuality and affectivity are necessary. This would allow to prevent behaviours and situations at risk of abuse as well as social and emotional instability.
Peripartum mental disorders (PPMD) are characterized by heterogeneous psychopathological symptoms related to specific personality traits, which are only taken into account by a few preventive and therapeutic strategies. Traumatic experiences during childhood could predispose to develop those disorders during adulthood, especially in more stressful conditions, such as pregnancy and postpartum.
Objectives
Our study aims to evaluate the correlation between mother’s childhood trauma and the development of certain psychopathological dimensions during peripartum and which of these dimensions could be indicative of mother’s childhood trauma.
Methods
The sample included 74 women, recruited from Sant’Andrea Hospital in Rome between 2011 and 2022, diagnosed with a psychiatric disorder during peripartum, according to criteria of DSM-5. All recruited women were administered the Childhood Trauma Questionnaire – Short Form (CTQ-SF) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). We performed a linear regression using the total CTQ score as a dependent variable and the MMPI-2 scale’s scores as independent variables.
Results
The linear regression used showed two significant models, of which the most inclusive explained 60% of the variance (R2 = 0.597), resulting significant (F = 31.141; p < 0.001). This model showed that a greater expression of childhood traumatic aspects was associated with greater expression of Pa (paranoia) (t = 4.04; p < 0.001) and Ma (hypomania) (t = 3.873; p < 0.001) in the clinical scales of the MMPI-2, which were indicative of childhood trauma.
Conclusions
Our study shows that paranoiac and hypomanic symptoms in PPMD, assumed by the MMPI-2 scale, are indicative of previous traumatic dimension. Thus, in the presence of a positive history of trauma, clinicians should pay attention especially to these aspects, in order to optimally set both pharmacological and psychotherapeutic treatment.
Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p <0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p<0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p<0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.
Addiction Liaison Pychiatric Units are frequently requested by other medical services due to the high prevalence of medical pathologies in substance use disorders. We intend to know patient’s characteristics in order to improve the approach.
Objectives
To describe patient characteristics of all medical request to the Addiction Liaison Pyshicatric Unit from January 2010 to December 2022.
Methods
Study data will be obtained from all patients that were referred to the Addiction Liaison Psychiatric Unit to assess addictive disorders and withdrawal symptoms related to drugs during 12 years in Hospital del Mar (Barcelona, Spain). Demographics and clinical data (substance use, medical comorbidity and dual diagnosis) were obtained.
Results
The results will be presented as soon as all data is obtained. We will explore COVID-19 pandemic implications.
Only a few studies analyse the clinical and psychopathological characteristics of first-admitted inpatients regardless of diagnosis.
Objectives
Describing the psychopathological, demographic, and clinical characteristics of inpatients with acute symptomatology identifying groups with common features using factors extracted from the Brief Psychiatric Rating Scale (BPRS).
Methods
We selected 103 (48 F) inpatients from the psychiatric ward of the Sant’Andrea Hospital in Rome from January 2019 to December 2021. We assessed psychopathological characteristics and suicide risk with BPRS, Global Assessment of Functioning, and Columbia-Suicide Severity Rating Scale and gathered the anamnestic and demographic data. We conducted descriptive analyses and factor analysis on BPRS items. Then we used the BPRS factors as variables to perform a cluster analysis.
Results
Major Depressive Disorder (MDD) was the most frequent diagnosis. We obtained five factors: “Psychotic dimensions” (FI); “Anxiety” (FII); “Hostility and lack of cooperation” (FIII); “Depression” (FIV); “Flattening of affectivity” (FV). We identified two clusters (cluster 1 n=31; cluster 2 n=72). Patients in cluster 1 reported higher average scores in FI and FIII while the average scores of cluster 2 patients in FII and FIV were higher than patients in cluster 1. We called cluster 1 “psychotic and hostile patients compulsory admitted with a low risk of suicide”. Cluster 2 patients are “affective patients with a high risk of suicide”. The two clusters share an average age of 38-39 yo and an average GAF score indicating severe impairment and inability to function in almost all areas. They differ in the psychiatric diagnosis represented: respectively, Schizophrenia Spectrum Disorder and Bipolar Disorder with low suicidal risk, MDD, and Personality Disorders with a high suicidal risk. 39% of patients in cluster 1 were involuntarily admitted.
Conclusions
The results of our study show that patients admitted for the first time usually are admitted for psychotic symptoms and a high risk of suicide. Psychotic patients more often show hostility and lack of cooperativeness which can explain the higher rate of involuntary admissions. Patients with predominant affective symptoms show a higher risk of suicide. Our analyses do not consider categorical diagnosis highlighting that exist transdiagnostic groups of patients with specific needs.
Forced medication is one of the most frequently used coercive measures in acute mental health units. It is a practice that can lead to physical, psychological and psychopathological consequences. Therefore, it is necessary to implement measures to reduce its use. In this sense, it is interesting to study the variables that can be associated with its use, and thus take measures accordingly.
Objectives
This study attempts to identify the number of forced medication episodes between July 2017 and December 2018 treated in the catchment area of the Mental Health Service at Jerez Hospital. As a secondary objective, it pursues to identify the factors that conducted to the use of forced medication with the intention of being able to reduce the use of these measures.
Methods
A descriptive and retrospective study has been developed reviewing the total number of episodes of forced medication. Patients admitted and discharged from hospital between July 2017 and December 2018 treated in the Mental Health Service at Jerez Hospital. Data were extracted from medical records.
Results
The total number of episodes of forced medication identified was 330. In these episodes, the average age was 41 years, with a predominance of 74% of the male gender. The most used route in the episodes was intramuscular (94.8%), in addition, more than 50% needed the association of two drugs, the most used were haloperidol and olanzapine. The 32.7% of the episodes also required the use of mechanical restraint and 44.2% required the presence of security service.
Image:
Conclusions
We present the descriptive analysis of a further study currently been conducted in hour hospital which means to stablish predictive factors for the use of forced medication. We therefore intend to create patient profile, as well as new measures specifically directed to these factors with which to diminish the use of forced medication.
Pregnancy is an important life event, involving body and mind transformation as well as brain reorganization. ADHD dimension is an additional aggravating factor, albeit poorly studied in the literature, in patients with mental health disorders in the peripartum.
Objectives
The purpose of this study was to evaluate the correlation among ADHD dimension, trauma in childhood, and anxiety-depressive symptomatology to assess whether the ADHD dimension may affect the quality of life of peripartum patients, and to identify vulnerability factors and self-harm risk.
Methods
The sample included 74 women aged 21-46 years, recruited from Sant’Andrea Hospital in Rome between 2015 and 2019. All recruited women were administered the following scales: Adult ADHD Self Report Scale (ASRS), Edinburgh Postnatal Depression Scale (EPDS); Childhood Trauma Questionnaire (CTQ), Perceived Stress Scale (PSS); Minnesota Multiphasic Personality Inventory (MMPI). Statistical analysis was performed by Pearson’s correlation with SPSS software to verify the presence of linear relationships (p<0.05) among theADHD dimension, assessed by the ASRS scale, and the other psychopathological dimensions.
Results
The sample was divided into two groups depending on the results of ASRS: 26 patients were positive for at least one of the ASRS scale items, while 48 patients were negative. The groups did not statistically differ in socio-demographic variables examined. The medium score at EPDS was 15,11 (± 8,43). It was found that the severity of ADHD dimension directly correlated with the duration of mental symptoms in peripartum (r=0.324;p=0.013), with the total CTQ scale score (r=0.342; p=0.004), with emotional abuse detected by CTQ (r=0.415; p<0.001), with emotional neglect detected by CTQ (r=0.291; p=0.014) and with perceived stress detected by PSS scale (r=0.456; p<0.001). Furthermore, we identified a correlation between self-injurious ideation and ADHD symptomatology (r=0.269; p =0.049) evaluating the item 10 of EPDS.
Conclusions
The severity of ADHD traits directly correlates with the symptomatology and duration of mental disorder in peripartum. Specifically, ADHD patients who develop anxious-depressive symptoms are more likely to have experienced emotional abuse and emotional neglect in childhood.
Following the surge of the COVID-19 pandemic, some people have been experiencing severe mental health consequences related to pandemic stress, fear of contagion, lockdown, and measures to avoid contagion and virus spread. These aspects contributed to an increase in anxious-depressive symptoms in the general population (Asmundson et al. J Anx Dis 2020; 70 102196).
Objectives
The study aims at verifying the hypothesis that Italian patients with a diagnosis of a mental disorder showed more severe depressive, anxiety and stress-related symptoms compared to the general Italian population in the context of the current pandemic.
Methods
Nine hundred sixty-one volunteer subjects (542 females, 415 males; mean age 39.42, SD = 14.5) completed the Covid-Stress-Scale (CSS) (Taylor et al. J Anx Dis 2020; 72 102232) and the Depression-Anxiety-Stress Scales-21 (DASS-21) (Bottesi et al. Compr Psych 2015; 60 170-81) through a self-report survey. Participants have been assessed for between-group differences through the chi-square test for categoric variables and one-way ANOVA for continuous variables.
Results
One hundred and thirty subjects (13.53% of the whole sample) reported a diagnosis of a mental disorder for which they received medications. Among these subjects, 47.8% reported a diagnosis of anxiety disorder, 29% major depressive disorder, 2.7% bipolar disorder, and 20.4% other mental disorders. Among patients, there was a prevalence of females (chi-square = 15.84; p < 0.001), more severe depressive (F = 34.25; p < 0.001), anxiety (F = 46.15; p < 0.001), and stress-related symptoms (F = 39.38; p < 0.001) at the DASS-21 scale. The patient group also showed a tendency to more severe traumatic stress related to the pandemic (F = 3.64; p = 0.057) at factor IV of the CSS, without significant differences in the other factors of the CSS.
Conclusions
The hypothesis is partially confirmed, considering that patients showed more severe depressive, anxiety and stress-related symptoms and a tendency to more severe pandemic traumatic stress. Nevertheless, in all other pandemic-related symptoms we analyzed (i.e., xenophobia, increase of medical assessments, fear of contagion), there were no differences between the group of patients and the general population. In this sense, in the current scenario in Italy, symptoms directly related to pandemic stress are almost the same in both the general population and patients with mental disorders.
Research shows the benefits of music therapy for various mental health conditions, including depression, trauma, and schizophrenia. Music acts as a medium for processing emotions, trauma, and grief.
Playing instruments can encourage emotional expression, socialization and exploration of various therapeutic themes (i.e. conflict, communication, grief, etc.).
Group music therapy, measured by questionnaires and described in qualitative interviews, improved quality of life and self-esteem for people with severe mental illness (SMI).Group singing and song writing provide creative options for social connections. Music therapy should be considered as a component of holistic care for people with SMI. Jungup Lee, Thyer BA. May 2013Journal of Human Behaviour in the Social Environment 23(5):597-609
Objectives
Music therapy sessions are held in our hospital for people admitted to short-term hospitalization units and to psychosocial rehabilitation units. The goal of the sessions is to create a connection space, promote people’s confidence in their own resources for their recovery, and evoke valuable experiences and memories. Sometimes musicians from the community have been present in the sessions, contributing to overcoming the stigma towards mental illness.
Methods
We describe self-assessment of people admitted to psychiatric units after attending music therapy sessions. People from brief hospitalization unit filled out a survey, after each session, voluntarily, about their emotional state at the beginning of the session and after it. People from rehabilitation units, voluntarily filled the SRS V.3.0. 2002-Miller. Duncan & Johnson escale.The SRS was designed for use by clinicians to assess the therapeutic alliance during therapy (Duncan BL et al. The Session Rating Scale: Preliminary Psychometric Properties of a “Working” Alliance Measure JBT 3(1) 3-12 12/14/04 3:53 PM Page 3).
Results
23 sessions took place for each unit. 39 patients from brief hospitalization, 22 women and 17 men, attended the sessions. 15 had a diagnosis of schizophrenia and related disorders, 13 were affective disorders, and 11 others diagnosis. All of them liked the participation either fully or partially. 76% men and 77% women felt better after, none of them reported to feel worse. 82% men and 86% women replied they would repeat the session.
Patients from rehabilitation units were 7 women and 10 men. 14 had a schizophrenia related disorder and 3 had bipolar disorder. All items on the scale were scored above 9 over 10, (I felt heard, understood, and respected/ We worked on and talked about what I wanted to work on and talk about/ The therapist’s approach is a good fit for me) with an overall score of 9,62 over 10 (Overall, today’s session was right for me).
Conclusions
Music therapy sessions achieve benefits on an emotional level in any of the diagnoses, improving alliance with care teams, who value sessions as normalizing spaces, helping to overcome stigma.
Substance Use Disorders are frequently associated to other medical problems. The temporal evolution of the main drug requests is related to drug and drug users’ facts. COVID-19 pandemic is worthy of investigation.
Objectives
To analyze temporal trends in the characteristics of all medical requests to the Addiction Liaison Psychiatric Unit from January 2010 to December 2022.
Methods
Study data will be obtained from all patients that were referred to the Addiction Liaision Psychiatric Unit during 12 years in Hospital del Mar (Barcelona). Demographics and clinical data (substance use, medical diagnosis, dual diagnosis) will be obtained and analyzed by semesters.
Results
The results will be presented as soon as all data is obtained. We will explore COVID-19 pandemic implications.
For 147 hospital-onset bloodstream infections, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the National Healthcare Safety Network surveillance definitions of central-line–associated bloodstream infections against the gold standard of physician review, examining the drivers of discrepancies and related implications for reporting and infection prevention.
It has long been assumed that lead glazing technology preceded glassmaking in the Western world and that the technological transfer was from glazes to glass. Here, we present new evidence for the reverse, the indigenous innovation of glassmaking and its transfer to glazes in early Islamic al-Andalus (Spain). Compositional analyses show that Islamic lead glazes from Córdoba are intimately related to a distinct type of high-lead glass, suggesting a connection between the two technologies. The archaeological remains from a pottery workshop indicate that the glazing process initially involved the production of a lead glass and is not linked to earlier Roman or other contemporary glazing technologies. The data also demonstrate that the potters not only used the same materials and techniques but borrowed stylistic and decorative models from glassmaking.
Although several authors have investigated the relationship between demoralization, insight, and suicide risk, the role of these factors in determining suicide risk in patients with psychiatric disorders is still unclear [Berardelli et al., 2019; Costanza et al., 2020].
Objectives
The main aim of this study was therefore to determine whether suicide risk was associated with better insight and worse demoralization in a sample of 100 adult psychiatric inpatients.
Methods
The study was performed on 100 psychiatric hospitalized adult patients consecutively enrolled between January 2019 and April 2020 at psychiatric units of Sant’Andrea Medical Center, Sapienza University of Rome. The Columbia Suicide Severity Rating Scale (C-SSRS) was used to assess suicide risk, Demoralization was assessed using the Demoralization Scale (DS) [Kissane et al., 2004] and for the assessment of insight we used the The Insight Scale (IS).
Results
Only age was significantly associated with higher suicide risk (χ2=9.07, p<0.01). The variable mood disorder was significantly associated with higher suicide risk (χ22=7.50, p<0.05). Non-suicidal self-harm behaviors in the last 3 months (χ2=5.89, p<0.05) and lifetime suicide attempts (χ2=21.80, p<0.001) were significantly associated with higher suicide risk. Only the insight-high dimension (χ2=8.01, p<0.01) and lifetime suicide attempts (χ2=12.33, p<0.001) were significantly associated with higher suicide risk.
Conclusions
Our results don’t confirm the role of demoralization in suicide risk. In our sample of patients, only high insigth of illness and other psychological variables are involved in suicide risk.
Horticultural therapy is a professional practice that is increasingly used in a lot of mental health rehabilitation programs. This therapy was introduced in the Comunitary Rehabilitation Service of INAD, considering its beneficial results in patients with severe mental disorder in combination with the usual rehabilitation program.
Objectives
We would like to study the benefits of this therapy compared to the usual in our patients.
Methods
This is an explanatory study for the purpose of establishing the association between the application of a Therapeutic Horticulture Program and the Clinical Symptomatology of Schizophrenia. A research with an experimental design Pre and Post-Test was carried out, by applying a Horticulture Program and evaluating with PANSS after 6 months its effects on the Clinical Symptomatology. The participants of the experimental group were selectively chosen. The only selection criteria were to attend the orchard at least once a week and be diagnosed with a schizophrenic disorder. The control group was chosen according to the number of members that made up the other group, with the criterion that they did not perform any outdoor activities and also had a diagnosis of schizophrenia.
Results
The comparison of the Pre and Post-Test measures in the case of the experimental group reports the presence of statistically significant differences in the scale of positive symptomatology composite scale and general scale.
Conclusions
This psychopathological improvement of those participants open a door to possible applications of this therapy as a psychosocial treatment.
Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media.
Method
A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted.
Results
From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application.
Conclusion
Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.
Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Suicide is a serious public health problem. In the international literature there is evidence to support the notion that certain temperaments and personality traits are often associated with suicidal behavior. In this study, 150 psychiatric inpatients were investigated using the TEMPS-A, the MMPI-2 and the Beck Hopelessness Scale (BHS) and evaluated for suicide risk through the critical items of the Mini International Neuropsychiatric Interview (MINI). Statistical analysis, including linear regression analysis and multiple regression analysis, showed that suicide risk contributed to the prediction of hopelessness. Among the temperaments, only the Hyperthymic temperament, as a protective factor, and the Dys/Cyc/Anx temperament contributed significantly to the prediction of hopelessness. Irritable temperament and Social Introversion were protective factors for suicidal risk. Hopelessness and depression were associated with higher suicidal behavior and ideation, but, unexpectedly, depression as measured by the MMPI did not contribute significant to the multiple regression.. The present study indicated that, although suicidal psychiatric patients have MMPI-2’s profiles in the pathologic range, they exhibit several differences from nonsuicidal patients. Patients at risk of suicide have specific temperaments as well as personality and defense mechanism profiles. They are more social introverted, depressed and psychasthenic, and use hysterical and schizoid mechanisms more often. Generalizability of the findings was limited by the small sample size, mix of BPD-I, BPD-II, MDD and psychotic disorder patients.
Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.
Method:
We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).
Results:
115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.
61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.
Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).
Conclusions:
Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.
Auditory and musical hallucinations have been reported in patients as an adverse effect of the use of opioids. Hearing loss, old age, and female gender are considered risk factors in the development of musical hallucinations. The aim of this report is to describe a case of a patient with auditory and musical hallucinations and to discuss the role of an opioid –tramadol- in the origin of those.
Methods:
An 80 years old woman experiencing auditory hallucinations was referred to our hospital from an emergency room. The patient had bilateral mild hearing loss and was receiving tramadol 112.5 mg/daily during the last year for cervical pain. In the last ten months, she had been gradually noticing the voice of her dead husband coming from under her pillow, as well as intermittently hearing popular songs being played inside her head. The patient had good insight on both types of abnormal perceptions, which were reported as increasingly unpleasant through time.
Results:
Tramadol was discontinued and pimocide (range 1-4 mg/day) and loracepam (2.5 mg/day) were introduced, achieving the improvement of the hallucinations and the anxiety associated with them.
Conclusions:
The outcome of this case supports the hypotheses that Opioids could induce musical hallucinations. Hearing impairment, old age, and gender could be underlying risk factors on the development of musical hallucinations.