[Typus melancholicus and melancholia: Theoretical synthesis using a clinical case]

COVID-19 related lockdown: a trigger from the pre-melancholic phase to catatonia and depression, a case report of a 59 year-old man

BACKGROUND

The pre-melancholic model described by Tellenbach may provide a common model for understanding the psychological implications of the lockdown. In this case report, we describe a rare catatonic status as a psychological implication linked to the COVID-19 pandemic, a really unique global situation.

CASE PRESENTATION

B is a 59 year-old man with mute psychiatric anamnesis whose mother suffered from a major depressive disorder. As the lockdown began, he started to develop concerns about his family's economic condition. According to his wife, he could see no end to the epidemic and no future at all. Moving from this, he started to show a severe and rapidly progressive depression and to develop mood congruent delusions. In addition, he had increasing anhedonia, apathy, starvation and insomnia. This turned in the end into a catatonic-like state, along with a deep desire to die. Admitted to the psychiatry ward in a state of mutism, he was discharged after 15 days with a diagnosis of "Major depressive disorder, single severe episode with no psychotic behavior". He was treated with Sertraline, Olanzapine and Lorazepam.

CONCLUSIONS

Our aim is to draw attention to the effect of the lockdown upon a Tellenbach-like personality structure. Identifying this type of pre-morbid personality structure could help clinicians understand and treat some cases of patients with severe major depressive disorders elicited by the COVID-19 pandemic.

Phenomenological contribution to understanding of vocally disruptive behaviour: A clinical case study in a patient with dementia

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) cause great suffering in patients and their families. Phenomenology can help clarify the diagnosis and propose some new therapeutic responses using Daseinsanalyse. Separation issues understood using the phenomenological description of the melancholic type (MT) by Tellenbach may further shed light on our understanding of depression in dementia.

SUBJECT AND METHODS

In a 90-year-old woman presenting with advanced (Clinical Dementia Rating 3) mixed dementia and BPSD in the form of vocally disruptive behaviour (VDB), we discuss separation anxiety as the aetiopathogenic hypothesis. Depression and BPSD were assessed using the Neuropsychiatric Inventory, Cornell scale, and Montgomery-Åsberg Depression Rating Scale to confirm our second phenomenological diagnostic hypothesis, ie, melancholy. The Big Five Inventory scale filled in by a proxy was also used to evaluate the patient's premorbid personality. We then propose an explanatory frame of VDB and depression through the standard phenomenological assessment of its relation to time, space, self, and other.

RESULTS

Confirming MT, we found an inhibited temperament and low openness to experience in the patient, as well as a symbiotic relationship with a close relative (the other).

CONCLUSION

Separation anxiety may well explain the patient's MT expressed by VDB. Melancholic type and her symbiotic relationship led to a situation unbearable to the patient and her close relative unable to delegate care to a specialized team.

RUNNING HEAD

Phenomenology in vocally disruptive behaviour in dementia. We have found new explanations in similar clinical cases in dementia as follows. A patient presenting with vocally disruptive behaviour has a melancholic type, a behavioural-inhibited temperament, and marital violence in the past. Phenomenology may help explain this profile with neurobiological disorders. The life trajectory, from childhood into older age, must be taken into account to understand behavioural and psychological symptoms of dementia.

A New Understanding of Psychopathy: The Contribution of Phenomenological Psychopathology

The objective of this study is to present a theoretical paper about a clinical issue. Our aim is to propose some clinical and semiological considerations for a psychopathological conception of psychopathy. We will discuss several major theoretical works dedicated to this nosographic entity (mainly those of Schneider [Psychopathic Personalities (1923). London, Cassell, 1950], Cleckley [The Mask of Sanity. St. Louis, Mosby, 1941] and Hare [The Hare Psychopathy Checklist - Revised Manual, ed 2. Toronto, Multi-Health Systems, 2003]). We will also examine a significant issue raised by Cooke et al. [Psychol Assess 2001;13:171-188; J Person Disord 2004;18:337-357; Br J Psychiatry Suppl 2007;49:s39-s50; Int J Forensic Ment Health 2012;11:242-252], namely whether psychopathic functioning is consistently related to antisocial behavior. This theoretical essay is informed by clinical situations (involving psychopaths who were interviewed in prison or in forensic centers). The method applied a phenomenological psychopathology analysis to the clinical material. We first compare Binswanger's conception of mania with psychopathic functioning. Patient behavior is similar, but there is a difference related to the dialectic between the ego and the alter ego. A patient with mania has a fundamental crisis of the ego, which a psychopath does not have. A second finding of our investigations concerns emotions and the adaptive dimension of the psychopathic disorder. An epistemological discussion of the concept of emotions reveals that psychopaths are competent in the management of emotional stimuli, which confers a psychological advantage upon them.