The concept of Evil in Psychiatry: Philosophy, neurobiology and clinical implications

Introduction

Although difficult to define, the concept of evil is widely used and implicitly influences psychiatric judgements and diagnosis. Most definitions of evil rely on classical philosophical concepts, but it remains controversial if evil is a concept by itself or rather a dysfunction on the ability to experience goodness. Also, it is unclear if there is a neurobiological basis for evil or if it is entirely dependent on socio-cultural beliefs.

Objectives

In this work, we intend to systematize evidence on the philosophical definitions and neurobiological correlates of evil, and reflect on its implications in clinical psychiatry.

Methods

Literature review.

Results

The concept of evil has been a theme of debate since the ancient Greek, where Plato argued that evil was a result of ignorance and Aristoteles saw morality as a guide for education and politics. Nietzsche claimed that evil was a dangerous concept that was created by the church, while Hannah Arendt underlined the banality of evil by highlighting “thoughtlessness” that frequently justify evil acts. From a neurobiological perspective, studies assessing individuals with neuro-psychiatric conditions associated with evil-related behavioral abnormalities have been suggesting a potential role of frontal and limbic structures, as well as of the serotonergic system. However, several of these studies assessed presumed correlates of evil, such as antisocial personality disorder or impulsive-aggressive behavior.

Conclusions

Despite the polemic frontier between neurosciences and morality, a conceptual insight over the definition of evil is vital to guide comprehensiveness and clinical approach when dealing with deviant evil-like behaviors.

Disclosure

No significant relationships.

The importance of mental and sexual health in addressing people with hiv - the double stigma

Introduction

Having a mental disorder is associated with increased vulnerability to the transmission of the Human Immunodeficiency Virus (HIV) and the prevalence of HIV is higher in people with a severe mental disorder. People with psychiatric comorbidities such as bipolar affective disorder and depressive disorder, post-traumatic stress disorder (physical or sexual abuse) and/or psychoactive substance use have a higher risk of HIV infection.

Objectives

This work is intended to expose the importance of integrating mental health care with the care of HIV patients.

Methods

The authors conducted a non-systematic review of the literature, conducting research through Pubmed and Medscape using the keywords ‘Preexposure prophylaxis’, ‘HIV’, ‘Mental health problems’.

Results

Several factors may contribute to the high comorbidity between HIV and Mental Disorders, including socio-demographic factors, weak social and environmental structures, as well as internalized stigma, social and experienced discrimination. Mental health problems may interfere with the care needed for prevention, including regular HIV testing and/or adherence to Preexposure Prophylaxis (PrEP); and influence access to and adherence to antiretroviral treatment.

Conclusions

This compelling evidence makes the necessary contribution of integrating mental health into an assessment and continuous treatment of the HIV patient, on the other hand, the assessment and treatment of mental disorders should address sexual health.

Temporality, lived time and psychopathology of everyday life

Introduction

Since Ancient Times, Man has tried to analyze the passage of time, looking for repetitions, relating them to space to build a notion of a mechanical and chronological time. The idea and problem of time play a central role in both modern philosophy and psychiatry. Many authors contributed to the notion of “lived time” and placed the focus on how time is lived and perceived by the individual. Even though the notion of “time assimilated in space” has an important role in psychiatric nosology, the “lived time” has a psychopathological impact and is a field of study and debate.

Objectives

This work aims to acknowledge the relevance of the experience of temporal structures (past, present and future) and how they relate to psychopathology.

Methods

We did a non-systematic literature revision in the main databases.

Results

Phenomenological psychopathology has been profoundly interested in the philosophical discussions on the nature of time and its relation with the subject’s experience and condition. For instance, the melancholic experience, the maniac experience and the schizophrenic experience constitute changes in how time structures are perceived and lived by the individual.

Conclusions

Temporality has drawn attention to researchers from many different areas of study, having as of this day many approaches possible. It is important to know those contributions and conceptualizations in order to improve as a clinician.

Disclosure

No significant relationships.

Ekbom syndrome - a case report

Introduction

Delusional parasitosis/infestation or Ekbom syndrome is an uncommon psychotic disorder characterized by a false belief that there is a parasitic infestation of the skin - the delusion that insects are crawling underneath the skin.

Objectives

This work aims to summarize and evaluate the currently available evidence regarding Delusional parasitosis, and for this purpose, we will illustrate a case report of a patient admitted in the emergency room.

Methods

The authors have conducted online research in PubMed with the words “Delusional parasitosis” “delusional infestation”, “Ekbom syndrome”, from the outcome, the articles considered to be relevant were collected and analyzed.

Results

Delusional parasitosis can be classified into primary delusional parasitosis without other psychiatric or organic disorders present, secondary – functional (secondary to several mental disorders such as schizophrenia, depression, dementia, anxiety, and phobia), and organic forms (associated with hypothyroidism, anaemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse. It is most commonly seen in middle-aged women. The patients became frequently socially isolated, prone to the development of depression symptoms.

Conclusions

This syndrome often presents a high level of psychosocial morbidity. Patients often seek dermatologists help in the first place, although there is no medical evidence. Psychiatrists play a major role in the diagnosis and treatment of these patients. Psychopharmacological therapy is quite challenging because of the patient’s belief that they have a parasitic infestation and not a psychiatric condition.

No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches

BACKGROUND

to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF).

METHODS

spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m.

RESULTS

All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800.

CONCLUSIONS

as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

Fungal Planet description sheets: 868-950

Novel species of fungi described in this study include those from various countries as follows: Australia, Chaetomella pseudocircinoseta and Coniella pseudodiospyri on Eucalyptus microcorys leaves, Cladophialophora eucalypti, Teratosphaeria dunnii and Vermiculariopsiella dunnii on Eucalyptus dunnii leaves, Cylindrium grande and Hypsotheca eucalyptorum on Eucalyptus grandis leaves, Elsinoe salignae on Eucalyptus saligna leaves, Marasmius lebeliae on litter of regenerating subtropical rainforest, Phialoseptomonium eucalypti (incl. Phialoseptomonium gen. nov.) on Eucalyptus grandis × camaldulensis leaves, Phlogicylindrium pawpawense on Eucalyptus tereticornis leaves, Phyllosticta longicauda as an endophyte from healthy Eustrephus latifolius leaves, Pseudosydowia eucalyptorum on Eucalyptus sp. leaves, Saitozyma wallum on Banksia aemula leaves, Teratosphaeria henryi on Corymbia henryi leaves. Brazil, Aspergillus bezerrae, Backusella azygospora, Mariannaea terricola and Talaromyces pernambucoensis from soil, Calonectria matogrossensis on Eucalyptus urophylla leaves, Calvatia brasiliensis on soil, Carcinomyces nordestinensis on Bromelia antiacantha leaves, Dendryphiella stromaticola on small branches of an unidentified plant, Nigrospora brasiliensis on Nopalea cochenillifera leaves, Penicillium alagoense as a leaf endophyte on a Miconia sp., Podosordaria nigrobrunnea on dung, Spegazzinia bromeliacearum as a leaf endophyte on Tilandsia catimbauensis, Xylobolus brasiliensis on decaying wood. Bulgaria, Kazachstania molopis from the gut of the beetle Molops piceus. Croatia, Mollisia endocrystallina from a fallen decorticated Picea abies tree trunk. Ecuador, Hygrocybe rodomaculata on soil. Hungary, Alfoldia vorosii (incl. Alfoldia gen. nov.) from Juniperus communis roots, Kiskunsagia ubrizsyi (incl. Kiskunsagia gen. nov.) from Fumana procumbens roots. India, Aureobasidium tremulum as laboratory contaminant, Leucosporidium himalayensis and Naganishia indica from windblown dust on glaciers. Italy, Neodevriesia cycadicola on Cycas sp. leaves, Pseudocercospora pseudomyrticola on Myrtus communis leaves, Ramularia pistaciae on Pistacia lentiscus leaves, Neognomoniopsis quercina (incl. Neognomoniopsis gen. nov.) on Quercus ilex leaves. Japan, Diaporthe fructicola on Passiflora edulis × P. edulis f. flavicarpa fruit, Entoloma nipponicum on leaf litter in a mixed Cryptomeria japonica and Acer spp. forest. Macedonia, Astraeus macedonicus on soil. Malaysia, Fusicladium eucalyptigenum on Eucalyptus sp. twigs, Neoacrodontiella eucalypti (incl. Neoacrodontiella gen. nov.) on Eucalyptus urophylla leaves. Mozambique, Meliola gorongosensis on dead Philenoptera violacea leaflets. Nepal, Coniochaeta dendrobiicola from Dendriobium lognicornu roots. New Zealand, Neodevriesia sexualis and Thozetella neonivea on Archontophoenix cunninghamiana leaves. Norway, Calophoma sandfjordenica from a piece of board on a rocky shoreline, Clavaria parvispora on soil, Didymella finnmarkica from a piece of Pinus sylvestris driftwood. Poland, Sugiyamaella trypani from soil. Portugal, Colletotrichum feijoicola from Acca sellowiana. Russia, Crepidotus tobolensis on Populus tremula debris, Entoloma ekaterinae, Entoloma erhardii and Suillus gastroflavus on soil, Nakazawaea ambrosiae from the galleries of Ips typographus under the bark of Picea abies. Slovenia, Pluteus ludwigii on twigs of broadleaved trees. South Africa, Anungitiomyces stellenboschiensis (incl. Anungitiomyces gen. nov.) and Niesslia stellenboschiana on Eucalyptus sp. leaves, Beltraniella pseudoportoricensis on Podocarpus falcatus leaf litter, Corynespora encephalarti on Encephalartos sp. leaves, Cytospora pavettae on Pavetta revoluta leaves, Helminthosporium erythrinicola on Erythrina humeana leaves, Helminthosporium syzygii on a Syzygium sp. bark canker, Libertasomyces aloeticus on Aloe sp. leaves, Penicillium lunae from Musa sp. fruit, Phyllosticta lauridiae on Lauridia tetragona leaves, Pseudotruncatella bolusanthi (incl. Pseudotruncatellaceae fam. nov.) and Dactylella bolusanthi on Bolusanthus speciosus leaves. Spain, Apenidiella foetida on submerged plant debris, Inocybe grammatoides on Quercus ilex subsp. ilex forest humus, Ossicaulis salomii on soil, Phialemonium guarroi from soil. Thailand, Pantospora chromolaenae on Chromolaena odorata leaves. Ukraine, Cadophora helianthi from Helianthus annuus stems. USA, Boletus pseudopinophilus on soil under slash pine, Botryotrichum foricae, Penicillium americanum and Penicillium minnesotense from air. Vietnam, Lycoperdon vietnamense on soil. Morphological and culture characteristics are supported by DNA barcodes.

Neuropsychiatric adverse effects of HIV antiviral medication

Introduction

HIV (human immunodeficiency virus) infection is related to several neuropsychiatric complications, such as dementia, encephalopathy, psychosis, as well as, opportunistic infections of the central nervous system (CNS). The discovery of antiretroviral therapy (ART) has limited these conditions and extended the life span of infected patients into a chronic illness, but it is also associated with neuropsychiatric adverse effects.

Objectives

To review the literature on the most common neuropsychiatric complications of the ART, since it can be difficult to distinguish drugs toxicity, the effects of the virus, immune system and psycho-social events.

Methods

The authors have conducted an online search in PubMed with the terms: “Psychiatry”, “HIV”, “adverse effects” and “antiretroviral drugs” from 2011 until 2016. From the outcome were collected, analyzed and summarized the articles considered to be relevant.

Results

The antiretroviral therapy (ART) are associated with a numerous adverse effects on the central and peripheral nervous systems, as well as, metabolic, gastrointestinal, cardiac, and other toxicities. The neuropsychiatric effects are common and highly variable, including depression, cognitive impairment and sleep disturbance. The nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors are one of the two classes of antiviral drugs most frequently associated with neuropsychiatric complications.

Conclusions

The occurrence of new-onset conditions related to ART makes it difficult to determine the association between psychiatric disorders and ART adverse effects, and given the fact that patients commit to lifelong therapy, as well as, they can diminish quality of life; it makes these assessment important in treating these conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treating bipolar disorder in pregnancy

Introduction

Bipolar disorder is a chronic psychiatric illnesses characterized by alternating episodes of mania/hypomania and major depression, or with mixed features. Acute exacerbations and maintenance treatment with appropriate pharmacotherapy are mandatory. Long-term treatment with mood-stabilizing medications is typically required. The incidence of bipolar disorders in women during the primary reproductive years is very high, and the episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.

Objectives

Provide a clinically focused review of the available information on the effectiveness and safety of the different pharmacotherapies in the treatment of bipolar disorder during pregnancy.

Methods

A bibliographic review is made of the pregnancy in bipolar disorder, based on the data published in PubMed.

Results

Clinical decision making about the use of mood stabilizers and atypical anti-psychotics by pregnant women can be conceptualized as balancing the competing risks imposed by withholding or stopping pharmacotherapeutic treatment against that of continuing or initiating pharmacotherapy during pregnancy. Some of the most effective pharmacotherapies have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. There is few information about the safety profile and clinical effectiveness of atypical anti-psychotic drugs when used to treat bipolar disorder during pregnancy.

Conclusions

Treating women with bipolar disorders during pregnancy is a challenge. There are no uniformly effective or risk-free treatment options. Fully informed decision-making requires the review of the risks of both untreated maternal bipolar disorder and risks associated with potentials interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Intraspecific and interspecific polyploidy of Brazilian species of the genus Inga (Leguminosae: Mimosoideae)

We investigated the karyotypes of 13 species of six sections of the genus Inga (Leguminosae-Mimosoideae) from Brazil. We used conventional Giemsa staining to identify numerical chromosomal variations and looked for karyotypic evolutionary patterns. The karyotypes generally had small chromosomes, varying from metacentric to submetacentric, with a basic number x=13. Nine of the species showed 2n=2x=26 (I. thibaudiana, I. cayennensis, I. ingoides, I. edulis, I. vera, I. subnuda, I. striata, I. bollandii, and Inga sp), while 2n=4x=52 was seen in a population of Inga cylindrical and of I. capitata, and in five populations of I. laurina. Additionally, 2n=8x=104 was observed in a population of I. cayennensis. Eight of these counts were new, while the counts of 2n=52 for I. laurina and 2n=26 for I. marginata, I. vera, I. subnuda, and I. edulis confirmed previous studies. We did not find cytological stability among the sections studied, with occurrence of significant intra- and inter-specific numerical variations. We conclude that polyploidy has played a significant role in karyotypic evolution in this group and that it occurred independently in several sections of the genus.

[Public figures on trial: an assessment of the use of the "jury court" technique for city officials in Santa Catarina, Brazil]

This study describes the 'Law Court' technique as applied to City Health Departments in the State of Santa Catarina, in dealing with the issue of obligations on the part of public officials. The project was the first part of a training course for public administrators held in 1997. The article presents the technique's components and results. Some 98% of the 156 participants had a positive opinion of the training course, considering it dynamic/participatory (31%), educational/stimulating reflection (27%), and realistic (24%). The technique fostered the discussion of the main subjects pertaining to the country's Unified Health System (SUS). Although all five juries acquitted the defendants, the issue of ethics was reported by 58% of the participants as the main prerequisite for a public administrator.

Computed tomography intravenous cholangiography

Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or CT scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required.

Parinaud syndrome caused by Bartonella henselae: case report

The authors report a case of Parinaud syndrome (conjunctivitis with pre-auricular satellite adenitis) caused by Bartonella henselae, the etiologic agent of Cat Scratch Disease. The etiologic assessment of this case was performed by serum indirect immunofluorescence reaction and allowed for a better therapeutics and follow up, avoiding ineffective antibiotics and surgical interventions.