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To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique.
A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent).
Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009).
Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.
“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.
Study the elements of a rite of passage present in Psychiatric Trainning.
• Field study (observational, descriptive, non-experimental).
• Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.
• “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.
• Summary and analysis of the answers. Review of the literature.
- Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” concept
- Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.
- The collective behaved as a communitas(10/10)
- No spiritual elements(0/10): liminoid process
- Resemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).
- Trainees felt that they grew spiritual and mentally(7/10) during the trainning years
Results suggest that Psychiatric Trainning has stable phenomena that:
• are compatible with the Rite of Passage schema
• Are considered exclusive of Psychiatry by trainees
• Have not been systematically studied as a whole, which could help to improve the training.
Describe Attention Deficit Hyperactive Disorder's (ADHD) prevalence in Bipolar Disorders (BD) and relatives.
78 admissions for Bipolar Disorder (DSM-IV) in Impatient Psychiatric Unit, in Hospital Clínico Universitario of Valladolid (Spain). Only 36/78 patients participate in study. Demographic, social and clinical information were registered. ADHD symptomatology was evaluated from patient and descendant (Conners short version).
ADHD symptomatology suggestive in childhood/adolescence were detected in 13,9% (5/36). Conners score were negative (below 15) in all case.
ADHD symptomatology suggestive in their children were detected in 6,25% (n=3). Conner score were positive in 2,1%. Family psychiatry history in 72,2% (n=26), affective disorder in 60,52% (n=23). No family history with ADHD diagnosis. Only one case (2,8%) with symptomatology suggestive of ADHD in relatives.
The ADHD prevalence in our sample of BD and relatives weren’t higher than general population.
- Frontiers Between Attention Deficit Hyperactivity Disorder and Bipolar Disorder. Cathryn A. Galanter, MDa, Ellen Leibenluft, MD. Child Adolesc Psychiatric Clin N Am 17 (2008) 325-346.
- Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
Most of the studies about Eating Disorders in adolescents have been typically focused on females, only to conclude that the approach should be similar in males. It has been stimated that 5-10% of patients with Anorexia Nervosa are males. Later age of onset and higher prevalence of premorbid overweight are considered among the main differences with female patients.
Analysis of the anthropometric variables of a sample of males with diagnosis of Restrictive Eating Disorder.
Naturalistic, Descriptive and Retrospective study
- Sample: 22 male adolescents
- Inclusion criteria: males with Restrictive Eating Disorder diagnosis (according to DSM-IV criteria) admitted to an Eating Disorder ward during 2007 and 2008
- “ad hoc” questionnaire (15 items)
- Analysis: PASW statistics 18
Age range: 7-14years (medium age=14,79±2,50years).11 patients (50%) were older than 16 years-old
- Medium BMI (Body Mass Index) at the beginning of the admission was 17,79kg/m2.
medium weight loss: 13,5±7,02kg/m2 (corresponding to a reduction of 22,24±7,52% of the previous weight)
- Medium speed of weight loss: 0,92±1,1kg/54
- BMI at discharge: 18,69 ±3,43 kg/m2
- 19/22 patients (86%) had a premorbid history of overweight
- Binge eating: 8 patients (36,4%)
- Purgative behaviour: 10 patients (45%)
- Laxatives use: 4 patients (18%)
- Intense physical exercise: 21 patients (95,5%)
- Average duration of current restrictive episode: 13,7 months
In the studied sample we observed:
- High prevalence of premobid overweight
- Very high frequency of compulsive exercise
- Drastic weight loss and loss of a very high percentage of the previous weight, in short periods of time, reaching very low BMI.
Suicide is one of the most frequent causes of death. In 1993, Bleuler emphasized its importance in his “Suicidal behavior is the most serious symptom of schizophrenia”. Since then, various studies have confirmed importance of suicide in schizophrenia, and today it's clear that his research and knowledge is one of the great challenges of psychiatry.
- Establish clinical-socio-demographic profile and risk factors for psychotic people with autolytic behaviors.
- Determine frequency of suicides in psychotic disorders in our area of care.
Material and methods
Retrospective study(3 years evolution) that includes psychotic patients(diagnosed according DSM IV-TR) admitted to the HCU of Valladolid. With data provided by hospital medical records, analyzed socio-demographic variables and clinics. Study consists of two groups:group of cases(those patients who have suicidal behavior) and control group (those that haven't autolytic gesture during the study period). Statistical evaluation was performed with SPSS.
- The sample includes 191 patients:41(21%) have attempted suicide.
- Of them:73% are males;88% singles;51% have basic studies;61% we re unemployed;37% were 31-40 aged;54% started disease 21-30 aged and 63.5% are schizophrenic.
- Considering statistical study we find that suicidal patient profile is male(p = 0.039),diagnosed with schizophrenia(p = 0.033),with previous suicide attempts(p = 0.009)and lack of social support(p = 0.007).
- 21% of hospitalized psychotic patients have presented some autolytic attempt.
- Profile of suicidal psychotic patient is a male, single, 21-40 aged, primary education, unemployed, with a primary diagnosis of schizophrenia, particularly paranoid, with ten years evolution,without acceptable social support, number of revenues higher than non-suicidal psychotic and a personal history of previous autolytic attempts.
Present study shows the socio-demographic and clinical profile of patients with severe mental illness in Mancha Centro health area. Furthermore, it is a descriptive approach to the current state of clinical assistance in the area.
Socio-demographic and clinical variables were collected in a sample of 55 patients, 37 men and 18 women with severe mental illness, treated at the Mancha Centro Mental Health Centre. Using SPSS.15, analysis of qualitative and quantitative variables was made.
Average age was 39, 25 years +/− 8, 82; 72, 7% lived with their families and 85, 5% had the support of relatives. Main diagnosis were: psychotic disorder (81,2%) with high proportion of schizoaffective disorder; mood disorders (9,1%), personality disorders (5,5%) and OCD (3,6%). In the last two years, 25, 5% was admitted in a medium-stay psychiatric unit, 15% in a short- time stay psychiatric unit and, in the last six months, 4% came to emergency service. Patients with higher number of admissions and emergency consultations were those with schizophrenia and schizoaffective disorder. The average time of follow up was 10 years (+/− 6, 84), every 49, 45 days (+/− 19,1). 80% receive group therapy, 85,5% family intervention and 54,5% cognitive rehabilitation.
We found a profile of young man with significant family support, low number of admissions and emergency consultations. Results could be in relation to: geographical dispersion, emergency access difficulties and protective socio-cultural factors. Better knowledge about needs would allow a better assistance in the future.
UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.
Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.
Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.
Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.
47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.
19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.
Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.
10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.
Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.
Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.
Alexithymia is a term to describe a state of deficiency in understanding, processing, or describing emotions. It expresses the cognitive-emotional state of vulnerable subjects who prone to suffer from psychosomatic illnesses. It’s characterized by difficulties in relationship and emptiness of feelings. It has been incriminated in genesis and maintenance of various psychosomatic pathologies, included psoriasis. Psychological stress is important in onset and exacerbation of psoriasis. We assume hypothesis that emotions that cannot be expressed through the appropriate symbolic language will be expressed through a symbolic somatic symptom.
A case study of psoriasis in a woman of 27 years without a previous psychiatric history. She was treated jointly by the service of psychiatry and dermatology. Methodology: We performed a detailed history in the course of the disease, summarizing vital changes and outstanding events of her lifetime in the different vital areas (family, work, school and sex life).
From the comprehensive revision of the ailments and pathobiography we can establish a clear relationship between physical-psychological symptoms.
Skin is an envelope that represents the boundary line between body-psyche. Skin and psyche interact in many ways. The skin reacts to feelings and perceptions. Psychosomatic patients feel extreme anxiety when they have to cope with separation and merger situations. They experience these situations as if they were to lose their physical limit. Broadly speaking, because of their alexithymia, they cannot process a painful emotion properly, and though they will express it through somatisation disorders and the development of diseases. In the case of our patient, the skin verbalizes her emotional silence.
Patients with schizophrenia and bipolar disorder appear to have more difficulties with smoking cessation than the general population. Moreover, gender and unsuccessful smoking cessation are associated with depression and negative emotional experience. Less attention has been given to the association of cigarette smoking in women and the use of other substances.
To determine the influence of gender and substance abuse on smoking cessation in a long-term follow up after a first psychotic episode.
Patients were evaluated at years 1, 3, and 5 obtaining information about functional outcome, positive and negative symptoms and substance use. At 8th year, functional outcome and use of substance were recorded. Patients were classified in two groups: those who stopped smoking during follow-up, and those who did not stop.
At baseline, rates of tobacco smoking were high with no differences between genders. Difficulty with smoking cessation was associated with female (p = 0.017) and typical antipsychotics (p = 0.032). Those who used alcohol continuously were less likely to stop smoking (p = 0.050) controlling for typical antipsychotics. The interaction with gender was not significant. Continuous cannabis use was not associated with smoking cessation, but women who use cannabis continuously were less able to stop smoking than men (adjusted p = 0.036).
Women are less prone to quit smoking than men during long-term follow-up after the development of psychosis. Different treatments should be considered for men and women in relation to tobacco dependence in patients with psychotic disorder. Treatment for women smokers should probably be more supportive and intensive.
To evaluate the efficacy, safety, and tolerability of fixed-dose agomelatine 25 and 50 mg/d in the treatment of outpatients with obsesive-compulsive disorder (OCD) compared to placebo.
In this 8-week, multicenter, double-blind, parallel-group trial, patients with DSM-IV-defined OCD were randomly assigned (1:1:1) to receive a once-daily dose of agomelatine 25 mg, agomelatine 50 mg, or placebo. The primary efficacy measure was the change from baseline to week 8 in the clinician-rated 17-item Hamilton Depression Rating Scale (HDRS(17)); other efficacy measures were The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale. The study was conducted between December 2009 and January 2010.
Agomelatine 25 mg/d was more efficacious based on the HDRS(17) total score (P = .01) compared to placebo throughout the treatment period, whereas for agomelatine 50 mg/d, statistically significant reduction in HDRS(17) total score could be observed from weeks 2 to 6 but not at week 8 (P = .144). A higher proportion of patients receiving agomelatine 25 mg/d showed clinical response (P = .013), clinical remission (P = .07), and improvement according to the Clinical Global Impressions-Improvement scale (P = .065) compared to those receiving placebo. No statistically significant difference between patients receiving agomelatine 50 mg/d compared to placebo on clinical response. Both agomelatine doses were safe and well tolerated, although clinically notable aminotransferase elevations were observed transiently in the agomelatine 50 mg/d group.
Agomelatine 50 mg/d provided evidence for its antidepressant efficacy until week 6 and was also safe and well tolerated.
Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”
20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:
- SCIP (schizophrenia cognitive screening)
- Scale GEOPTE (social cognition in schizophrenia)
- Social Functioning Scale (SOFAS, PSP)
- Scale of disease awareness
- IPDE (TP)
- Hamilton Scale (anxiety-depression)
The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:
1. 60 item-Scale, specific on each chapter, evaluating:
Hooliganism has become recognised by governments and the media as a serious problem since the 1960s. Scientists have been offering explanations of football hooliganism mainly from a psychosocial approach.
The primary objective of this study was to collect measurable data of violence risk in football hooligans.
We used the Plutchik and van Praag's Past Feelings and Acts of Violence (PFAV) Scale to measure the risk of violent acts in three samples: hooligans from a professional football team, standard football supporters, and a control sample.
We found an increased risk of violent behaviour in all the individuals from the hooligan sample, but not in the standard supporters' sample.
Football hooligans have extremely high risk of committing violent acts. Standard football supporters are not more violent than general population.
Our study aimed to compare the mental illness awareness in institutionalized schizophrenics when compared to non institutionalized schizophrenics.
Diagnoses of Schizophrenia was done following the ICD-10 dignosis criteria. We chose a convenience sample of our patients: 74 patients, 69.9% of institutionalized inpatients and a 31.1% of outpatients.
Specific survey applied by the group of investigators aiming to collect socio-demographical data and clinical data, using the following psychometric scales: Scale to Assess Unawareness of Mental Disorder (SUMD), Global Assessment Scale (GAS), and Clinical Global Impression (CGI).
Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis.
Differences found among awareness of response to medication and the awareness of social consequences of mental disorders are statistically significant, being higher in the institutionalized group of schizophrenics.
Numerous organic pathologies may appear as single or first psychiatric symptomatology manifestations. That is why we must perform a detailed exploration in these type of patients; anamnesis, a physical examination and supplementary tests.
This poster describes the case of a 24 year old woman who unexpectedly manifests behavioural disorders(psychomotor disinhibition, myoclonus, opsoclonus), speech disturbances (inconsistent content) and a decreased level of consciousness.
We highlight the importance of a sequentially well arranged full assessment and conclude with an accurate diagnosis. Additionaly, we emphasize on differential diagnosis something we ought to take into account in these patients.
Bibliographic review of a clinical case of limbic encephalitis Review.
This poster describes the case of a 24 year old woman who unexpectedly manifests behavioural disturbances (psychomotor deshibición, myoclonus, opsoclonus), speech disturbances (Inconsistent content) and a decreased level of consciousness.
These symptom characteristics are consistent with those we found in our literature review on this pathology (PubMed) and in addition it highlights the important of bearing in mind the organic pathology while examining psychiatric patients.
Organic mental disorders are conditions that we should keep in mind while making an initial psychiatric assessment.
Paraneoplastic limbic encephalitis is a neurological condition that can present psychiatric symptoms, and that requires a complete organic diagnosis (biochemistry, blood count, urinary toxic, EEG, cranial CT and thoraco-abominopelvic, cranial MRI, CSF antibodies).
In order to perform a correct diagnostic it is crucial that we consider a couple of differential diagnosis.
It is established the presence of seasonal variations in decompensation of patients with bipolar disorder. The purpose of this study is to assess whether other environmental factors such as Moon lighting or the distance between the Moon and Earth are associated with decompensation of this group of disorders.
Material and Methods:
We collected all the attention made ??to the Emergency Department of the Hospital de León for one year (July 2012 to June 2013). We identified patients diagnosed with Bipolar Disorder (F31.x). Consultations were correlated with the following astronomical data: Moon lighting, Moon Phase, Earth-Moon distance and growing or waning moon. Main variables to study were number of emergency consultations and income in hospitalization. It was used for analysis SPSS v20.
From a total of 1405 emergency consultations 96 patients were diagnosed with Bipolar Disorder, of whom 60 required hospitalization. The mean ratio of total number of consultations / total days in a particular moon phase was 0.2858 (95% CI: 0.2313 to 0.3403) with significant variations in the different phases. The mean ratio of total hospitalizations / total days in a particular moon phase was 0.1728 (95% CI: 0.1095 to 0.2361). The comparison of the mean lunar illumination between patients who required admission (mean = 56.7 + / -32.08) and those who were discharged (mean = 43.69 + / -32.39) was found near statistical significance (p = 0.058). There were no significant differences in the Earth-Moon distance or the waxing or waning state of the Moon.
No association was found between the Earth-Moon distance and the number of visits or hospitalizations in bipolar patients. The lunar illumination is higher in cases that required hospitalization and it is necessary conduct a study with a greater potency to establish or definitely reject this finding.
It is hypothesized that in the etiology of schizophrenia genetic and environmental factors are involved. Between the environmental events linked to the causation of this condition an inmune dysfunction has been described. First degree biological relatives of people with schizophrenia also have an incrased incidence of autoimmune diseases.
The aim of this work was to examine the serum levels of proinflammatory cytokines (IL-1β, sIL-2R IL-6, IL-12p70, TNF-α and IFN-γ) as well as of anti-inflammatory cytokines (IL-4 and IL-10) in male patients with schizophrenia and in their first degree-biological relatives.
Blood samples were obtained from patients with a diagnosis of schizophrenia in a stable psychophatological condition (n = 36), first degree biological relatives of those patients and a healthy control group (n = 26). Serum interleukins were analyzed using a commercial ELISA preparation (Bender MedSystems). We used non-parametric test for statistical analysis.
Patients with schizophrenia showed significantly higher serum levels of proinflammatory cytokines (sIL-2R, IL-6, TNF-α, IFN-γ and IL12-p70) and lower serum levels of the anti-inflammatory cytokine IL-4 than in the healthy control group. The unaffected first-degree relatives showed changes in proinflammatory cytokines (sIL-2R, IL-6 and TNF-α,) in the same way as the corresponding schizophrenia patients, but at a lower level than the healthy control group.
Ours findings suggest that sIL-2R, IL-6 and TNF-a may be biologic vulnerability markers for psychiatric disorders and also these alterations might have an hereditably pattern.
Because of the interest about the physical health in psychiatric patients was made this study, to analyze, in a sample of patients with schizophrenia, the possible occurrence of metabolic disorders, their relationship with treatment, and the interventions need in this regard.
Check if patients with schizophrenia treated with antipsychotics have metabolic disorders
Check if the introduction of information about metabolic disorders influences the habits of life.
A 6 months prospective study with patients followed up in the Day Hospital with an atypical antipsychotic.
The results describe a young population with 59% of males, without adequate dietary habits and with a low activity level. Most patients showed overweight or obesity.
On the other hand the presence of metabolic syndrome was higher in patients with olanzapine and risperidone long-acting injectable, although it was not statistically significant.
In the sample has been found the influence of certain doses of these antipsychotics and their influence on weight. Of note is the decrease in weight with olanzapine, usually associated with antipsychotic drug weight gain and that this study gives an opposite result that may be related to psycho-educational interventions on healthy lifestyles and the consequent change in the behavior in this regard and that received the most study patients.
There are metabolic disorders and overweight problems that are need to investigate into the possible mechanisms of control and early detection. This problems also be likely to be influenced of a healthy lifestyle, which could be the subject of a psycho-educational treatment.
Lately is increasingly frequent the use of depot antipsychotic treatment for schizophrenia at any stage of the disease. This issue is still being discussed, since the opinions of experts are occasionally contradictory without reaching a general consensus of the indications for use of depot treatment.
Description of discharge treatment at a short term Hospitalization Unit of 160 psychotic patients, analyzing the use of oral or depot therapy for 9 months in 2014.
A pool of 160 patients discharged from January 2014 up to September 2014 with a diagnosis of Schizophrenia and other psychotic disorders according to DSM-IV and DSM-5. A descriptive analysis of the number of patients on antipsychotic treatment is performed oral versus depot, making a brief description of the characteristics of patients in those groups.
Pending a more thorough analysis of the data, most of the discharged patients discharged were treated with oral antipsychotics and only a minority was discharged with depot treatment.
The use of depot treatment in the referred unit is still restricted to poorly compliant patients and poor awareness of disease abandoning the oral treatment, despite the fact that in the current scientific literature is becoming more frequent its use in early stages of disease.
In an effort to avoid the progression to a psychosis, there is a tendency nowadays to bend psychotherapeutic interventions on the prodomic period . However, there is no unanimity in what the treatment should consist of.
OBJECTIVES: To describe an appealing case, in which Systemic Therapy is used to work from a familiar perspective of a problem identified in only one member of the family.
This clinical case is about a 12 year old male, he was brought to the Child and Adolescent Unit of Mental Health by behavioral alterations that express the rejection to his father. The family reports that the onset of these behaviors occurred insidiously, presenting regressive attitudes, strange behaviors and social isolation. The patient was admitted to the Children and Youth Hospital Day and received multidisciplinary treatment: pharmacological and Systemic Family Therapy.
Through the nine Systemic Family Therapy sessions that the family has attended, the conflict in the marital subsystem has become evident, showing a triangulation of both parents with the patient.
Even though it cannot be stated, the child’s pathology is supported by a prodromal state of psychosis. Professionals are still working through therapy with the family and the patient, awaiting for the progression of other symptoms.