HYPERSEXUALITY IN NEUROCOGNITIVE DISORDERS IN ELDERLY PEOPLE – A COMPREHENSIVE REVIEW OF THE LITERATURE AND CASE STUDY

Background: Hypersexuality is defined as an increase in libido. It is often confounded with sexual disinhibition and inappropriate sexual behavior directed against oneself or against others. It is described in 2.9 to 8% of patients living at home and in 3.8 to 7% of patients in institutions. The pathophysiology of hypersexuality is complex. Several brain areas are involved. The psychological factors are also important. We found it useful to present a clinical case of a patient who presented with symptoms of hypersexuality and to discuss the diagnosis and the management. Methods: Data collection was based on the case of a patient hospitalized in the Department of Psychosomatic medicine in CHU Mont-Godinne - Yvoir - Belgium in February 2013. For the literature review, we used the database PubMed with the following keywords: hypersexuality, dementia. A total of 40 articles were selected for this study. Results: The patient had symptoms of hypersexuality, and hyperorality in the context of delirium induced by benzodiazepine withdrawal. A blood test and brain imaging were normal. She was put under risperidone 2 mg with complete resolution of symptoms within a few days. Conclusion: The diagnosis of Kluver-Bucy syndrome in the context of a minor neurocognitive disorder was retained. Management is mainly non-pharmacological using behavioral techniques. The education of the patient, his partner and caregivers are essential. Pharmacotherapy is sometimes necessary. It is reserved as a last resort because of the serious side effects of the drugs used

COULD BIPOLARITY BE INFLUENCED BY STRESSFUL LIFE EVENTS? A REFLECTION BASED ON A CASE REPORT

Introduction: Bipolar disorder (BPD) has over the last fifteen years been considered as a biological disease with genetic bases, possibly triggered by stress factors. On the basis of a clinical case, we will question this theory. Subject and methods: Mrs. X, a patient with a history of domestic violence, has two manic episodes that corresponded with conjugal difficulties. This would lead us to believe that stressful life events may have triggered the onset and the relapse of the illness of our patient. To confirm this , we made a literature review with the keywords bipolar disorder, stress, family functioning and domestic violence on three databases: PubMed, PsycInfo and PsycArticles. Results: Studies show that BPD has likely genetic and biological origins. It is also established in the literature that stressful life events influence the course of the disease, with for example the “Kindling” effect. However, there is very few data regarding the precise nature of these events. It is also established that the family interactions are affected by the BPD. Nonetheless, little is known about the influence of the family’s interactions on the onset of the disease. Conclusions: Our clinical case raises the question of the stress factors that may influence the onset and the course of BPD. It also raises the question of the possible link between BPD and domestic violence and the question of theeffect of stressors on the genetic and biological factors, introducing a more psychodynamic view of BPD. Further research on this subject should allow us to expand the treatment to more comprehensive care

WAYS OF COPING AND MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL IN HOSPITALIZED DEPRESSED PATIENTS ADMITTED THROUGH THE EMERGENCY DEPARTMENT OR CONSULTATIONS

Background: In a previous study, we compared the family relationships of patients hospitalized in a psychiatry unit from either psychiatric consultations or after passing emergency room (E.R.). The intensity of depression was statistically comparable in both groups. What distinguishes patients transiting emergencies is that their families and couples are more cohesive and adaptable. In this study, we compare both groups in terms of coping mechanisms and multidimensional health locus of control (MHLC). Subjects and methods: All patients (N=2172) with a major depressive disorder admitted to our department between 01/01/2010 and 31/12/2012 are included in an open study. They completed the Beck’s Depression Inventory, the Olson’s Family Adaptability and Cohesion Scale, visual analogue scales of stress, the ways of coping checklist, and the MHLC scale. Results: Patients admitted through emergencies are found to have less belief in chance (CHLC) (t=2.488; p=0.014), distance themselves more from their problems (t=-2.187; p=0.03), but reappropriate them less positively (t=2.355; p=0.019) than those admitted through consultations. A logistic regression model including variables identified in the previous study (adaptability in the original family and the couple\u27s lived stress) gives a risk factor (odds ratio) of 14.7 which means that a patient who would combine the different risk factors would be 14.7 times more likely to go through emergency. Conclusions: How to explain that depressive patients with more favorable factors considered: to believe less in chance, distancing from their problems, and having a better family support, are more likely to go to the E.R.? We make the suggestion that those factors exactly slowed down patients in their care application at first, allowing the depression to worsen. It is only once they would have depleted their reserves that they would reach the emergency room on their own initiative or encouraged by their families, themselves overwhelmed by the situation. Further study should take into account the duration of the episode before arrival at the hospital

LIAISON PSYCHIATRY AND BARIATRIC SURGERY: DOUBLE STANDARDS What are the possibilities for the systematization of the pre-operative psychiatric assessment in Belgium?

Background: In the context of health care in Belgium, the psychological or psychiatric opinion of a multidisciplinary team is required in the assessment of bariatric surgery candidates. In clinical practice, a wide variety of liaison psychiatry assessment methods exist. Subjects and methods: On the basis of a post-operative psychiatric comorbidity case report and a literature review on "liaison psychiatry and bariatric surgery" we aim to identify opportunities for the systematization of bariatric pre-surgery psychiatric evaluation. Results: The bariatric pre-surgery evaluation must be rigorous and founded on evidence-based medicine. On this basis, specific psychiatric criteria may be defined and researched in assessments. The issue remains for psychiatric comorbidities that develop after surgery and for which a preventive framework should be sustained in the liaison psychiatry approach. Conclusions: The aim of the research is to support an improved systematization of the psychological assessments of preoperative bariatric surgery candidates. We believe that systematic evaluation tools should be defined for the identification of possible absolute or relative contra-indications and that a preventive approach to post-operative psychiatric disorders should be included in this assessmen

THE PSYCHO-IMMUNOLOGICAL MODEL AS A PSYCHOSOMATIC ENTITY: A LITERATURE REVIEW OF INTERACTIONS BETWEEN DEPRESSION AND IMMUNITY

Background: A large amount of evidence has already shown associations between depression and immunity, a bi-directional relationship seems to be increasingly evident. We showed in several precedent studies that family dynamics (Dubois et al. 2016, Zdanowicz et al. 2015), some coping skills (Manceaux et al. 2016) or gender (Fagniart et al. 2016) are correlated with depression and/or immunity and change the way depression and immunity interact together. Method: The objective of this review is to study the literature in search of older and recent evidence about how immunity and depression interact and which determinants influence this relationship. We searched on PubMed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity and depression and with coping, gender and family. Results and discussions: Surprisingly we observed in the literature that depression is mostly correlated with both inflammatory and impaired immunity mainly for cell-mediated immunity. Recent studies showed that gender differences in immunity seems to explain in part some variabilities concerning depression and acute/chronic stress among men and women. There is evidence for a sexual dimorphism of the immune system. Coping style, perceived control or personality impact the immune system. There is evidence that childhood maltreatment or stress occurring early in life can exert persistent effects over a long period of time like a «biological scar». Conclusions: There seems to be an individual and biological heterogeneity behind the label of major depressive disorder. We demonstrated the role of several modulators on immunity and depression such as gender, coping, personality, early-life stress or relationships. Many other modulators could exist and should be considered for further investigations

RELAXATION AND IMPACT ON THE MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL: INTEREST OF GROUP PSYCHOEDUCATION FOR STRESS MANAGEMENT IN THE CONTEXT OF LIAISON PSYCHIATRY WITHIN A GENERAL HOSPITAL

Background: In this article we propose a model for caring for a group focusing on psychoeducation for stress management and learning relaxation designed for patients experiencing somatization and who were recruited during organic medicine consultations. We are developing an interest for this kind of group from a clinical and practical point of view and have sought to demonstrate the impact that this kind of care can have on health representations among these patients through using the MHLC (Multidimensional Health Locus of Control) questionnaire. Subject and methods: Participants in the stress management and relaxation groups completed the questionnaire at the beginning of the first session and at the end of the second and last session. We collected 94 usable questionnaires between January 2008 and December 2014 and processed the data using Student’s t-test on paired samples. Results: The results tend to demonstrate that psychoeducation for stress management and relaxation reduces internality scores in patients with high scores and the opposite for patients whose internality scores are low. Discussion: Our research protocol does not enable us to distinguish between the respective influences of the psychoeducation group and the relaxation group. Conclusion: The psychoeducation groups for stress management and relaxation have an impact on health representations in patients experiencing somatization who would not have spontaneously sought out psychiatric consultations

CAN DENIAL OF PREGNANCY BE A DENIAL OF FERTILITY? A CASE DISCUSSION

Background: For many years, several cases of neonaticide resulting from a denial of pregnancy were reported in the press. Recently, a case of neonaticide made headlines in Belgium: a woman realised that she was pregnant during childbirth. A few minutes after the delivery, the baby was asphyxiated to death. In the obstetric history of the patient, we note six pregnancies, of which three births were given to anonymous adoption. Mrs D. was not able to explain why she was not using any method of contraception despite all of her pregnancies. Many questions need to be asked in order to further understand denial of pregnancy. Do these women understand the link between sexual intercourse and the potential of pregnancy? Which women are more at risk of denying their pregnancy? Is there a certain personality profile at risk? Methods: In the following article, we report the case of Mrs D. who presented to the consultation of the clinic of CHU Mont- Godinne (Belgium). We will also discuss the literature available on the online databases (PubMed, PsycArticles, PsycInfo and Cairn.info) using the following keywords: denial of pregnancy, neonaticide, contraception. Results: In the results of retrospective studies, we notice that indeed most women who have had a denial of pregnancy were not using any method of contraception. This observation suggests the hypothesis of a denial of fertility in these women. In addition, it appears that a specific personality profile is very difficult to establish, due to the lack of sufficient data and due to the discrepancy of the results concerning these women, especially in the matters of age and socio-economic status. However we can note that some psychological characteristics are similar. Conclusions: The denial of pregnancy is a complex mechanism, which still raises many questions in the clinical setting and in matters of etiopathogenesis. In these patients, we note that denial is a defense mechanism regularly used, even in other aspects of their lives. Moreover, the frequent non-use of contraceptive method might therefore be more in favor of a denial of fertility than of a denial of pregnancy