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Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet. The present study aims to assess alexithymia, hypochondriasis and obsessive-compulsive symptoms in patients with chronic prostatitis.
Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated for the presence of alexithymia, hypochondriasis and obsessive compulsive symptoms using respectively the following psychometric tools: Toronto Alexithymia Scale (TAS), Whiteley Index (WI) and Leyton Obsessional Inventory (LOI). Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.
57 patients (median age 40 yrs old; IQR 32-51.5 yrs) have been evaluated so far. Median CPSI score was 18 (IQR: 13-24). Median TAS score was 44 (39-57), median LOI score was 13 (10-15) and median WI score was 28 (22-38). An abnormal LOI score indicative of obsessive-compulsive features was noted in 58% of patients and an abnormal WI score indicative of hypochondriacal beliefs in 45%. CPSI strongly correlated with TAS score (r=0.57, p=0.007).
High rates of alexithymia, obsessive compulsive symptoms and hypochondriasis are present in chronic prostatitis patients. Alexithymic features were strongly correlated with quality of life measures such as the CPSI. These findings necessitate further elucidation and suggest that patients with chronic prostatitis may need psychiatric counseling and therapy.
Suicide notes are considered very sensitive markers of suicide attempt severity providing a lot of information about the mental state of the victim. An interesting question is whether note writers differ from suicide victims who don’t leave suicide notes.
Objective and Method
To present and discuss the differences between these two subgroups. We collected psychological autopsy data from one year's suicide deaths (November 2007 -October 2008), at the Athens’ Department of Forensic Medicine (covering 35% of the total Greek population).
Note writers represented 21.7% of our sample (30 out of 138), had no history of psychiatric disorders (p = 0.003) or recent (psychiatric) hospitalization (p = 0.026), were mostly men (p = 0.001), and died by hanging or shooting (p = 0.04). We believe that the powerful stigma associated with psychiatric disorders in our Country could provide a possible explanation for our results. A lot of people suffer in silence. For many of the deceased's relatives the suicide note provided, for the first time, an insight into their loved one's mental problems. It is also believed that psychiatric symptoms are indicating character weakness, incompatible with the sense of power that, particularly men, should display. Finally, it is well-known that men commit suicide more often than women, choosing more violent methods (hanging or shooting) compared to them.
More efforts against mental illness stigma and towards improving detection of psychiatric disorders are needed in our Country. Unfortunately, suicide notes seem to represent the first and only means of communication of mental suffering for a lot of people.
Poor decision-making is a prominent feature of Bipolar Disorder (BD) suggesting that patients may be impaired in affective aspects of complex problem solving. We examined the neural correlates of emotional learning (EL) in remitted BD patients and healthy controls (HC).
Subjects comprised three groups: (a) 11 remitted BD patients with EL (b) 11 remitted BD patients who failed to show EL and, (c) 11 HC with EL. All groups were demographically matched. Patients were also matched on clinical variables. Participants underwent functional magnetic resonance imaging (fMRI) while performing the Iowa Gambling Task. In the active condition participants relied upon EL to weigh up short-term rewards against long-term losses, in order to achieve an optimal gambling strategy. The control condition was identical to the gambling condition except for the reward/loss component. Behavioural and neural responses associated with the overall task performance were assessed.
Regardless of their performance in EL, BD patients, compared to HC, showed increased task-related activation in the insula and ventral anterior cingulate gyrus. BD patients with EL showed increased activation in left frontopolar and ventrolateral prefrontal cortices while reduced activation was noted in the same regions in BD patients who failed to show EL.
BD patients showed evidence of increased limbic activation associated with affective decision-making. Their ability to attain emotional learning was associated with increased recruitment of frontopolar and ventral prefrontal cortex regions. This finding may reflect a successful compensatory response to limbic overactivation during affective decision-making.
Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet.
Patients diagnosed with chronic prostatitis at a tertiary care ID clinic are evaluated for the presence of alexithymia, with the use of the Toronto Alexithymia Scale, as part of a prospective cohort. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category. Association of psychiatric symptoms with prostatitis category was performed.
Preliminary results are reported for 30 patients (median age 43 years old; IQR= 36-52). According to the NIH Prostatitis Classification System patients were categorized as type II : 48.2%, type IIIa: 6.9 %, type IIIb: 38%, type IV: 6.9%. Median CPSI score was 16 (IQR: 11-25). Abnormal TAS score was noted in 72% of the population. Specifically, 90% had high scores in external orientation of emotions, 25% in identification of emotions and 38% showed reduced expression of emotions. It is of notice, that mean TAS scores were significantly higher in type IIIa prostatitis cases (p=0.002, ANOVA).
High rates of alexithymia were noted in prostatitis subjects especially in type IIIa cases. These findings need further prospective evaluation.
The cases of two borderline patients are presented, dexamethasone suppression test (DST) positive and refractory to many therapeutic interventions and treated successfully with high doses of amitriptyline (225 and 200 mg/day, respectively). During the therapeutic intervention, the psychopathological condition of the patients was evaluated using Hamilton's rating scale for depression and a constructed scale based on items 11, 12 and 13 (dysphoria, anger, sense of emptiness, boredom, anhedonia) of the diagnostic interview for borderline patients.
Chronic prostatitis has been long considered a psychosomatic illness. We have previously studied alexithymic and obsessive-compulsive features in chronic prostatitis patients.
To evaluate introverted, extroverted and total hostility in patients with chronic prostatitis.
Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated with the Hostility and Direction of Hostility Questionnaire (HDHQ), a questionnaire with 5 subscales designed to assess total hostility or punitiveness and direction of hostility. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.
82 patients (median age 37.5 yrs old; IQR 30-45.5 yrs) were evaluated. According to the NIH Prostatitis Classification patients were categorized as type II: 45.1%, IIIa: 9.7%, IIIb: 39%, IV: 2.4%. Median CPSI score was 19.5 (IQR: 14.5-24.3). Median introverted, extroverted and total hostility scores were 3 (IQR: 2-6), 9 (IQR: 7-13) and 13 (IQR: 9-18) respectively. Results from the Extroverted Hostility HDHQ subscale correlated (r squared = −0.25, p = 0.024) with subscales of the TAS (Toronto Alexithymia Scale). These results were independent of CPSI scores.
Chronic prostatitis patients’ total hostility scores are similar to those of the general population reported by other studies. However, chronic prostatiitis patients show more outward directed hostility. The relationship between TAS subscale scores and measures of extroverted hostility needs further elucidation. Patients with chronic prostatitis are potentially at risk for psychiatric disturbances and thus may need psychiatric counseling and therapy.
Europe can hardly be considered as homogeneous. There are gross historical, climatological, cultural, developmental, religious, political and economic differences that render generalizations inappropriate and European “globalization” a mission impossible (and, by and large, undesirable).
Psychiatry is no exception to the above and in the historical evolution of our discipline, psychiatric practice has varied. Because this evolution has followed a different course and has occurred at a different pace in the various parts of Europe, the present situation reflects all these developmental stages, thus rendering homogeneity questionable.
In spite of these differences, however, there is a degree of consensus regarding the basic requirements for the practice of our discipline and the desired competencies of its practitioners. The development of a common language through the modern classification systems, the organizations of specialist psychiatrists (e.g. the UEMS) the WPA and the European Psychiatric Associations have played a useful role in the harmonization of psychiatric practices and are expected to play a more useful role in the future.
In conclusion, what is required (and what can be realistically achieved) is consensus on some basic clinical, research, administrative and teaching requirements, in association with agreement on the basic ethical principles of our profession and, basically, the beneficence and non maleficence principles. European Psychiatry Guidance should involve these basic requirements that can be achieved by all European countries.