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One of the usual indications for Electroconvulsive Therapy (ECT) is Paranoid Schizophrenia (PS), being performed usually in cases resistant to antipsychotics.
To present a clinical case of a patient with antipsychotic-resistant PS, including Clozapine, who received ECT.
We present the case of a 47-year-old patient with an 8-years diagnosis of PS. He presented visual, auditory, and kinesthetic hallucinations, delusions, and thought insertion and diffusion phenomena that impeded concentration. He had received treatment with different antipsychotics (including Clozapine), without achieving remission of symptoms. He also presented significant adverse effects such as hypersalivation and extrapyramidal symptoms. Due to the poor response and the adverse effects that limited the dose increase, it was decided to start ECT.
The patient received a total of 9 sessions, presenting a significant reduction in symptoms since the 5th session (disappearance of the sensory-perceptual alterations and thought disturbances). As side effects, the patient presented amnesia of the moments prior to applying the therapy, which subsequently resolved. The patient continued to present concentration difficulties, although after ECT he denied the presence of thought insertion or diffusion phenomena to which he previously attributed the cause of these difficulties.
Although less responsive than in other indications, ECT combined with antipsychotic drugs has been proven to be more effective than monotherapy (regardless of whether it’s Clozapine or another). This lower response could be due to the use of ECT in the most resistant cases, since it has been demostrated that in more acute cases a faster improvement occurs when the two treatments are combined.
Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls.
We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments.
Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology.
Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.
Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.
We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.
This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.
A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.
Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.
In Chile, two quinoa ecotypes are grown: salares, also present in the highlands of Bolivia, and coastal, in central and southern areas of the country, at sea level. Genotypes from the coastal ecotype have characteristics that differentiate them from the most popular quinoa genotypes grown in the Andean Region of South America. The objectives of this study were: (1) to determine the cardinal temperatures for seed germination in quinoa genotypes from coastal and salares ecotypes cultivated in Chile, and (2) to study the presence of physiological dormancy (PD) in these genotypes. Seed germination from nine quinoa genotypes, two from salares and seven from coastal ecotypes, was evaluated in a gradient of temperatures between 11 and 42°C. Germination was also evaluated at 20°C at 0, 7 and 15 months from harvest. Results showed that seed from the nine genotypes germinated at their maximum percentage between 11 and 35°C. However, their faster germination occurred between 25 and 35°C. There was a significant difference between optimum temperature for germination between genotypes from coastal (28°C) and salares (30°C). An increase in germination rates after 7 months of storage suggested the presence of a non-deep PD in seeds from coastal ecotype, which may be useful to improve pre-harvest sprouting resistance in quinoa breeding programmes.
One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.
Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.
During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.
This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.
Previously, we showed the usefulness of the REF scale to assess referential thinking (Rodríguez-Testal et al., 2001; 2009) although it isn’t specific for patients with psychotic disorders (Rodríguez-Testal et al., 2008).
This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.
Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.
The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).
It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
Previously (Rodríguez-Testal et al., 2001) we analysed the multidimensionality of Referential Thinking Scale, obtaining similar results to original research of Lenzenweger et al. (1997) but warning about the construction of subscales.
In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).
Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.
Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.
Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.
In previous works we demonstrated the utility of the REF scale for the assessment referential thinking (Rodríguez-Testal et al., 2001) although it wasn't specific for patients with psychotic disorder (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We analyzed the psychometric properties of reliability and validity of the REF scale. We compared the differences in referential thinking between subjects with and without psychopathology. In the patient group we will not obtain differences in referential-thinking between diagnosis types of Axis I, Axis II, or patients with diagnoses on both axes.
Participants: 120 subjects, 70 patients attending a private center of clinic psychology, 64.3 % women, mean age = 35.21 (SD = 10.5) and 50 controls selected from the normal population, 54 % women, mean age = 33.48 (SD = 10.83).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
We reached adequate internal consistency (Cronbach's alpha= .90, split-half reliability= .83 and .82). The test-restest reliability was significant (mean interval of 44 days). There are significant differences in referential thinking between subjects with and without psychopathology (t=3.8; p=.001). There are significant differences in referential thinking between types of diagnoses (F=3.99; p=.001).
The REF scale has adequate psychometric properties (reliability and validity). It discriminated between patients and no-patients, and between the different types of diagnoses, especially for those who suffer psychotic disorders.
In previous works we used the REF scale of referential thinking as criterion of therapeutic evolution (Benítez-Hernández et al., 2006; Rodríguez-Testal et al., 2009).
Objectives and hypotheses
We designed a group therapy of social skills for monitoring and modification of the referential thinking. We predict a decrease of referential thinking (frequency and intensity) both in pretest and posttest measures for each session, as in the progress of the all sessions as a whole.
Participants: 5 women from 24 to 38 years old with the diagnoses: Panic Disorder with Agoraphobia and history of Sexual Abuse; generalized Social Phobia; Avoidance Personality Disorder; Bipolar I Disorder; Obsessive-Compulsive Disorder and Avoidance Personality Disorder. It's employed a longitudinal design (brief time-series) of REF measurement (frequency and intensity) at a weekly interval. C Young (p < 0.01) was used for the statistical analysis of the data, t (paired samples) and the method of least squares to obtain the trend line.
#1: frequency-posttest (p=.01).
#2: intensity-pretest (p =.01); intensity-posttest, C =.663 (p< .01).
#3: intensity-pretest, C =.772 (p< .01), intensity-posttest, C =.681 (p< .01).
#4: frequency-pretest, C =.695 (p< .01), frequency- posttest, C =.74 (p< .01).
#5: frequency-pretest and frequency-posttest (p>.01).
Preliminary analysis indicates an improvement of referential thinking in the frequency and intensity both intra and inter-sessions. More therapy sessions are needed to reflect a change statistically significant.
In previous works we found that REF scale (Lenzenweger et al., 1997) is a stable and reliable measure (Rodríguez-Testal et al., 2009).
In this study we assess the sensitivity of REF scale to detect the disorganization of patient's mental state longitudinally.
Participants: It's a 35-year-old man diagnosed with Schizotypal Personality Disorder. He had a psychotic breakdown and he is being treated with haloperidol. The psychological intervention is cognitive type.
Design, materials and procedure: We used an experimental adaptation of the REF-scale. This self-applied scale consists of 34 items that evaluate the referential thinking in Likert format. We employed a longitudinal design (brief time-series). C Young (p < 0.01) was used for the statistical analysis of the data and the method of least squares to obtain the trend line. We included 103 measures registered at an interval of 3 days.
It's observed a significant declining trend in the whole of the measures both intensity and frequency from the beginning of therapy. However, we observed a significant declining trend in intensity but not in frequency when we analyzed the data from the 50th measurement, which was the period during which the patient got worse.
It's confirmed again that the REF-scale is a stable and reliable measure. It's able to detect changes in the patient's evolution of the referential thinking from the beginning of therapy. In addition, the REF-scale is sensitive detecting decompensations in patients. Therefore, we conclude REF scale is a useful measure for the subsequent decision-making therapeutic.
We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.
Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).
The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.
In previous works, referential thinking was predicted by clinical and dispositional variables such as social anxiety or vulnerability to depression (Rodríguez-Testal, Senín-Calderón & Fernández-Jiménez, submitted to revision).
Objectives and hypotheses
We propose to find personality variables to characterize the emergence of referential thinking. We predict a greater referential thinking in subjects with a high sensitivity to punishment and higher scores on social anxiety.
Participants: 366 subjects selected from the general population, 66.6% women, mean age = 33.18 (SD = 12.79).
We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, GHQ-28 (Goldberg, 1996), SPSRQ (Torrubia et al., 2001) and The Revised Self-Consciousness Scale (Scheier & Carver, 1985).
It was applied a cross-sectional design and a correlation method. All the analysis were accepted at p < .05.
The multiple linear regression analysis showed the importance of the clinical variable of depression, public self-consciousness, and sensitivity to reward and punishment as predictors of referential thinking (34% of the variance explained). The discriminant analysis according to scores in referential thinking was significant (Lambda = .87, p = .001). The combination of the above variables correctly classified 85.1% of cases.
Subjects more concerned about how they are perceived by others tend to a greater presence of self-references, although they don’t show a high score in social anxiety. Susceptibility to reward and high vulnerable to punishment are the personality variables that best predicted referential thinking.
In a previous study (Senín-Calderón et al., 2010) we observed that the REF scale of referential thinking (Lenzenweger et al., 1997) didn’t discriminate among different mental disorders.
Objectives and hypotheses
We try to verify if self-references in various disorders are related to the severity of psychopathology (patients from public hospital and a private clinical). We predict that there will be differences between patients and controls, but not between the clinical samples. Psychotic disorders will be characterized by a significantly greater presence of self-references.
Participants: 287 subjects, 47 patients from a private clinical center, 57.4% women (mean age = 35.02, SD = 12.69), 30 patients from a public hospital, 53.3% women (38.36 years, SD = 9.53), and 210 controls selected from the general population, 50.5% women (33.80 years, SD = 11.79). Cross-sectional design, correlation method. All analysis were accepted at p < .05.
There are significant differences in self-references between patients and controls in frequency (t (285) = 2.33, p = . 021) and intensity (t (83.98) = 3.59, p = . 001). No significant differences between patients groups (p>.05) (REF-intensity without homogeneity, p < .05). No significant differences in self-references between types of diagnoses except psychotic patients versus adjustment disorder (frequency and intensity).
Self-references are highlighted in psychosis but, with the exception of adjustment disorders, doesn’t discriminate between personality, mood or anxiety disorders. Differences are more related to the clinical severity (BPRS) than with referential thinking.
Antisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation.
To determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour.
A random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files.
Past antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits.
While the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.
Brain derived neurotrophic factor (BDNF) is the most widely distributed and highly expressed neurotrophin in the CNS. BDNF gene have been associated with increased risk psychiatric disorders. It has been described interaction between BDNF and serotonin system at a neural and genetic level. Neuroticism as a personality trait relevant in borderline personality disorder (BPD) has genetic inheritance and is associated with serotonergic dysfunction. Has been reported that BDNF Val66Met variant is associated with neuroticism in general population. The aim of this study is to test the association between Val66Met and neuroticism and evaluate if the presence of Val66Met allele interacts with polymorphism in promoter region of serotonin transporter gene (5-HTTLPR) for develop neuroticism in BPD. We evaluate personality with NEO PI R in 104 BPD subjects that did not meet criteria for axis I diagnoses and other personality disorders. Genetic analysis of BDNF was performed determining the presence of Val/Val Val/Met and Met/Met BDNF variants. 5-HTTLPR was performed determining the presence of L and S 5-HTTLPR alleles. Statistical analysis were tested with parametric and correlation method with Stata10. We did not found differences in neuroticism between BDNF variants, but when controlled by BDNF alleles we found that Met/Met modulate the expression of 5-HTTLPR, with S-carriers (LS+SS) having higher neuroticism than LL (F = 6.36, p = 0.0031). We found no differences in expression of 5-HTTLPR in other BDNF variants. We conclude that BDNF have a differential modulating effect of 5-HTTLPR in neuroticism in BPD.
To evaluate the efficacy and safety of amisulpride in medical inpatients who present with delirium.
Open label prospective study with 7-day follow-up. Forty hospital inpatients with delirium were recruited, seven of whom died and two of whom refused medication. The average dose of amisulpride for delirium treatment was 200–300 mg/day. Daily assessments were performed with Delirium Rating Scale (DRS), Positive Subscale of the Positive and Negative Syndrome Scale (PANSS-P), Mini Mental State Examination (MMSE), Neurological Subscale of the UKU side effect rating scale. Variance analysis was performed through repeated measurements, with the general linear model with paired comparisons and Bonferroni correction for each measured variable.
Patients showed significant improvement on the DRS from the first day of treatment DRS = 17.55 until day 7 DRS = 7.26 (F = 92.485; p < 0.001), psychotic symptoms improved from first day PANSS-P = 18.26 to last day PANSS-P = 9.35 (F = 144.83; p < 0.001). Cognitive status showed a significant improvement from day 2 MMSE = 18.71 until day 7 MMSE = 24.06 (F = 96.56; p < 0.001), and the neurological subscale of the UKU side effect rating scale showed a significant improvement the last day with respect to baseline pretreatment level (F = 7.539; p = 0.01).
These results suggest a good response to amisulpride in the acute phase of delirium, although further randomized controlled studies must be performed.
Neuroticism is characterized by emotional instability and the tendency to experience negative emotions such as anger, anxiety and depressed mood. Subjects with borderline personality disorder (BPD) present this personality dimension as a temperamental core trait. There has been proposed that neuroticism can appropriately describe the most important characteristics of BPD. The polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been implicated in depression, anxiety and suicide. It is estimated that 5-HTTLPR polymorphism account to 7 to 9% of inherited variance of neuroticism in personality. The aim of this study is to evaluate the association between neuroticism and 5-HTTLPR polymorphism in BPD. We evaluate personality with NEO PI R inventory in 104 BPD subjects (76 female/28 male) that did not meet criteria for axis I diagnoses and other personality disorders. The genetic analysis of 5-HTTLPR were performed determining the presence of long and short alleles, subjects were grouped in long/long (LL) and S-carriers (LS+SS). Statistical analysis were tested with parametric and correlation method with Stata10. We found significant difference in neuroticism between the genotype groups (F = 8.57, p = 0.0004) and lower levels of neuroticism in LL than S-carriers. Female have higher neuroticism than male. 5-HTTLPR polymorphism explains 18.02% of inherited variance in neuroticism. The S-carriers had 11.9 times higher risk of presenting elevated neuroticism compared with LL. We conclude that there are relation between 5-HTTLPR polymorphism and neuroticism in BPD. These results should contribute to the genetic study of BPD.
There is general consensus that social cognition is a key cognitive dysfunction in schizophrenia. At the same time, the hypothesis that social cognition is an aspect of cognition that determines social functioning has been receiving more and more empirical support since it was first proposed a few years ago.
However, the actual definition of “social cognition” can be a confounding factor in this framework. The definition has been a matter of debate in literature and only recently has some consensus emerged about the aspects that constitute “social cognition” (emotion perception, theory of mind, social perception, attributional style, social scheme). As a consequence, most of the time research in this area only considers some of these aspects, probably because the instruments available to measure social cognition measure these aspects individually and not social cognition globally.
The SCS (social cognition scale) is an instrument under development with the goal of measuring together some of the components of social cognition, specifically: identification of stimuli, emotion perception, and social perception. Results show that the social perception of the patients who participated in the social perception program has improved. Patients that have received training in social perception learn to gather more information from an image, and to make more adequate interpretations.
Despite the high prevalence of obsessive-compulsive symptoms located around 2-3% of the population, there continue to be cases where the characteristics of the patient or the circumstances of their environment, they fall short queries mental health or when they do not for the disorder itself, but for another reason obsessional symptoms worsen.
Expose using clinical case, the existence of patients with obsessive pathology whose characteristics do not seek mental health consultation, until this is associated with a new disease that interferes significantly in vital organization.
We report the case of a man of 88 years old, married at 60, was admitted to the psychiatric consultation at the request of his wife 29 years his junior, for behavioral disorders several years of evolution and history of obsessive symptoms compulsive, which did not interfere with their daily lives by the lack of insight and poor social environment
OCD is included in anxiety disorders.
It is characterized by the presence of obsessions and compulsions that interfere with personal, work and / or patient's social.
There are cases that own personality traits of the patient, this disorder is not diagnosed early and choose to go only when associated with worsening cognitive impairment rituals and interfere with family life.