From Moral Insanity to Psychopathy

Psychopathy is currently a condition that arouses great interest among psychiatrists because of its significant involvement in the forensic field. The authors illustrate the course over time of the concept of psychopathy, starting from the definition of “moral insanity” of Prichard. The historical journey allows to illustrate the different positions that the various European schools of psychiatry have had toward psychopathy, until modern nosographic classification systems such as Diagnostic and Statistical Manual of Mental Disorders (DSM). Special attention is paid to the “core” of psychopathy: the alteration of the moral sense, and through the illustration of moral development is provided a reading of morality in the psychopath and the reasons for its impairment. A clinical and critical examination of psychopathy assessment scales is proposed, with the aim to broaden the horizons of assessment, also to individuals who do not show violent behavior, but with compromised moral sense. Lastly, authors propose an interpretation of the social aspects of psychopathy that goes beyond the assessment of the psychopath confined in jails, with several highlighted aspects of psychopathy that contribute to social success in work, relationships, and career and that can contribute to the success of the psychopath

Disturbi di personalità e temperamenti affettivi nei disturbi dell'umore

Introduction. Personality disorders (PD) and Affective temperaments (AT) have been considered vulnerability factors for the development of mood disorder (MD). Objective. To study the simultaneous presence of PD and AT in patients with DU and differences between unipolar depression (DD) and bipolar disorder BD. Methods. An observational study was conducted. Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A) for AT and the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) for PD. The interrelationships of the different PD and AT were studied by factor analysis (principal component analysis, PCA) (orthogonal rotation, Varimax). Results. Participants were 156 adult patients with MD, 37,1% with DD and 62,9% with BD. DD patients presented with significantly more paranoid PD (p=0.009), depressive (p=0.029), anxious (p=0.009) and hirritable temperament (p=0.006) compared to BD. PCA results showed four significant factors, explaining the 63,1% of total variance, corresponding to four potential groups of patients with specific PD and AT associations. Conclusion. The comorbidity between MD and PD and AT may differentiate DD from BD. Specific patterns of comorbidity may be useful as they may substantially influence the course of the mood disorders and how patients respond to treatment

Colloquio psichiatrico e credulità terapeutica nelle istituzioni penitenziarie

The purpose of the present study is demonstrating - through the description of twelve clinical cases - that patients in prison may lie to their therapists and give them false information. A psychiatrist working in a penitentiary institute should remember that a patient may give false information for different reasons: defence of his/her own life, protection of his/her physical integrity, desire to hide a crime committed in jail or to avoid or shorten a condemnation, personal advantage, recreational purpose, masked desire for violence, need to be accepted, need of a physical contact, malingering, deception, social visibility and acceptance. Therefore, it is important to examine the information given by patients and the anthropologic, sociologic and psychologic patterns of penitentiary life in a critical way, in order to achieve a better contextualization of clinical observation.Oggetto del presente studio è di illustrare, attraverso la descrizione di dodici casi clinici esemplificativi, la possibilità che lo psichiatra, nel suo colloquio clinico con pazienti in istituzione carceraria, riceva da questi errate informazioni. È importante, per lo psichiatra che opera in un’istituzione penitenziaria, sapere che il paziente può fornire informazioni di interesse psichiatrico, che non corrispondono al vero per vari motivi, tra cui: la difesa della propria vita, la protezione della sua integrità fisica, il desiderio di nascondere un reato commesso in carcere, uno stratagemma per evitare od abbreviare la durata della pena, l’ottenimento di un beneficio personale, un’opportunità ludica da sfruttare, la verbalizzazione mascherata di desideri di violenza, il bisogno di essere accettato, la ricerca del contatto fisico rassicurante, la simulazione consapevole ed inconsapevole, la dissimulazione per evitare conflitti, la presentazione del proprio doppio. È importante, quindi, che lo psichiatra che opera in carcere esamini ed approfondisca sempre con critica le informazioni che vengono fornite dal paziente e che conosca gli aspetti antropo-socio-psicologici della vita penitenziaria, per meglio contestualizzare le sue osservazioni psichiatriche

Mixed states: Still a modern psychopathological syndrome?

The aim of this review is to evaluate whether the DSM-5 concept of mixed features \u201cspecifier\u201d provides a definition that reflects the richness and multiplicity of this psychopathological picture pointing out the historical development, clinical concepualisation and proposed therapeutic approach to mixed states. We review and discuss the recent evidence on the presence of mixed features during mania and depression and summarise findings on the conceptualisation of mixed states. Electronic searches of all English-language papers were performed in the MEDLINE and PUBMED database using and cross-listing key words: mixed state, mixed features, bipolar disorder, major depressive disorder, mania, hypomania, depression. The mixed categorical-dimensional concept used in the DSM- 5 broadens the concept of mixed episodes, introducing substantial changes to the diagnosis of mixed states. This definition appears more appropriate for less severe forms of mixed states presenting clear and detectable mood symptoms with evident improvement compared to the DSM-IV, as the possibility of classifying depression \u201cwith mixed features\u201d. The transition from the classical definition of mixed states to the one reported in the DSM-5 has determined a complex modification of the concept of mixed state. The DSM-IV-TR description, based on the co-presence of symptoms of opposite polarity, was extremely reductive and did not capture the sub-syndromal symptoms of the opposite pole experienced in bipolar and major depressive disorders. The DSM-5 definition of mixed features \u201cspecifier\u201d represents a valid tool to improve the recognition and proper treatment of bipolar mixed patients, reducing misdiagnosis and mistreatment associated with chronic and repetitive exposure to antidepressants and sedatives, although the mixed categorical-dimensional concept does not adequately reflect some overlapping mood criteria, such as mood lability, irritability and psychomotor agitation

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries.

BACKGROUND: Scientific literature has provided clear evidence of the profound impact of sexual violence on women's health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia. METHODS: We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview. RESULTS: Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India. CONCLUSIONS: Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy