Diagnosing Institutional Violence

Chapter 2 examines the resistance of women prisoners and their supporters’ opposition to the use of medicalized behavior-modification regimes in prisons during the 1970s. The Coalition to Stop Institutional Violence, a broad-based, feminist-led alliance in Massachusetts that included advocates for the rights of prisoners and mental patients, blocked the construction of a locked treatment center for dissident and gender-nonconforming women prisoners who were labeled “deviant” and “violent.” Activists criticized the “prison/psychiatric state” for perpetrating violence against women while advocating alternative approaches to safety, accountability, and healing.

Ancient of Days The Vocal Pattern as Primordial Big Bang of Communication

Familiar voice recognition appeared on the earth 250 million years ago with the advent of frogs. Interestingly, air breathing and vocalization coemerged in the amphibian, as they do as first gesture in the human newborn, suggesting that the larynx was designed to serve these two functions with equal commitment. Establishing a repertory of familiar voices plays a crucial role across biological species, enabling identification of family, friend, and foe in the distance and at night. All voices, familiar and unfamiliar, transmit a cornucopia of data about the speaker, a capability which began simply and has flourished prodigiously in the human to include gender, age, size, sexual preference, socioeconomic and geographical background, mood, emotion, linguistic meanings, pragmatic communication, attitude, and psychiatric state. Considering that vocal information draws on an immense range of human behaviour, one can conclude that it takes a whole brain to produce and perceive a voice pattern.

Periodic Catatonia Marked by Hypercortisolemia and Exacerbated by the Menses: A Case Report and Literature Review

Kahlbaum first described catatonia; later Kraepelin, Gjessing, and Leonhard each defined periodic catatonia differently. A 48-year-old female with catatonia, whose grandmother probably died from it, was prospectively followed for >4 years in a US psychiatric state hospital. Through 4 catatonic episodes (one lasting 17 months) there were menstrual exacerbations of catatonia and increases in 4 biological variables: (1) creatine kinase (CK) up to 4,920 U/L, (2) lactate dehydrogenase (LDH) up to 424 U/L, (3) late afternoon cortisol levels up to 28.0 mcg/dL, and (4) white blood cell (WBC) counts up to 24,200/mm3 with neutrophilia without infections. Records from 17 prior admissions documented elevations of WBC and LDH and included an abnormal dexamethasone suppression test (DST) which normalized with electroconvulsive therapy. Two later admissions showed CK and WBC elevations. We propose that these abnormalities reflect different aspects of catatonic biology: (1) the serum CK, the severity of muscle damage probably exacerbated by the menses; (2) the hypercortisolemia, the associated fear; (3) the leukocytosis with neutrophilia, the hypercortisolemia; and (4) the LDH elevations, which appear to be influenced by other biological abnormalities. Twentieth-century literature was reviewed for (1) menstrual exacerbations of catatonia, (2) biological abnormalities related to periodic catatonia, and (3) familial periodic catatonia.

Evaluation of psychological interview before prominent ear reconstruction: Three cases report

Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of cosmetic surgery. By time to time researchers began to incorporate standardized psychometric tests and psychiatric evaluation into their studies. Psychiatrists have studied the personality characteristics and psychological state of these patients with the hope of identifying patients who may be psychologically inappropriate for surgery or those who are likely to be dissatisfied with a technically successful surgical outcome. There were some degree of congruence in the factors that appeared to be associated with poor outcome, demographic factors like being male, younger age, psychological/psychiatric factors such as history of depression or anxiety, dysmorphophobia, personality disorder as narcissistic or borderline, previous surgical procedure with which the patient was dissatisfied and minimal deformity. As a cosmetic surgery, prominent ear deformity is the most common abnormality of the external ear. We have used both clinical interview and psychometric assessments in three cases who want to go surgery because of their prominent ear. Two of the cases have used cyanoacrylate adhesive to their postauricular skin for camouflage of their prominent ear deformity. We have evaluated the patients’ psychiatric state with psychosocial viewpoint of the deformity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Referrals of patients with schizophrenia to a consultation-liaison psychiatry service

BackgroundThere are few studies specifically investigating the acute treatment procedures of patients with schizophrenia in the context of Consultation-liaison psychiatry (CLP).PurposeDescribe the main clinical features of the referrals of patients with schizophrenia, attended by a general hospital CLP service.MethodsLongitudinal observational and descriptive study, assessing adult inpatients with schizophrenia (DSM-IV-TR criteria) admitted to non-psychiatric units of Hospital Clínic of Barcelona (Spain), who were consecutively referred to our CLP service over a 10-year period (from January 1, 2005, through December 31, 2014).ResultsDuring that period, 9.808 psychiatric consultations were requested. 163 of them (1.8%) concerned patients with schizophrenia. These groups of patients were aged 50.9 ± 15.3 years and 65% were male. A 25.9% of patients had history of suicide attempts and 45.6% presented current psychosocial stressors.Characteristics of referrals Referral sources according to medical specialties are shown in Table 1.The major medical conditions for referral according to ICD-10 categories were: external causes of morbidity (21.5%), infectious diseases (13.5%) and diseases of the digestive system (10.4%).The two most frequent reasons for referral were the assessment of psychopharmacological treatment and/or psychopathological state examination (62%) and suicidal risk/attempt assessment (8.6%).ConclusionsIn our sample, only a 1.8% of all patients for whom psychiatric consultation was requested had a diagnosis of schizophrenia. The most common profile of them was: male, 50 years old, coming from general medicine department due external causes of morbidity and referred to the CLP service because of psychiatric state and/or medication review.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A rare presentation of genital self-mutilation in a patient of schizophrenia

Genital self-mutilation (GSM) is an uncommon self-inflicted injury. GSM is not a single clinical entity, and it can occur in any psychiatric state or condition. The instruments that are used for self-mutilation can vary, and treatment of these injuries requires a detailed clinical evaluation and multi-disciplinary approach. We report here a case report of a 28-year-old psychotic man who came to our emergency with complaint of self-hammered nails in his both scrotum with fear of not able to reproduce child after marriage. He underwent surgical removal of nail under local anaesthesia and was promptly reviewed by the psychiatrists who managed appropriately. To our knowledge this is the first case reported in literature and the rarest type of injury presented as a bilateral scrotal self-mutilation as should be managed wisely.