Academic literature on the topic 'Psychology, Pathological – Case studies'

AbstractObjectives:Features of gambling, particularly among young people have changed over the past decade and, while there are no data from Ireland, there are suggestions from those working in the field that pathological gambling is increasing among adolescents. Relatively little is known about the effective treatment of pathological gambling in adolescents. This paper aims to review research in cognitive behavioural treatments with a view to their application in adolescents. Research among adolescence is given prominence when this is available.Methods:The methodology comprised a literature search of Medline, Psycinfo, and EMBASE databases, using the search terms: ‘cognitive behavioural therapy’; ‘gambling; ‘psychology’; ‘epidemiology’; ‘adolescent’; ‘motivation’; ‘effectiveness’; ‘outcome’; ‘relapse’; and ‘internet’. In addition, a hand search ofClinical Psychological Reviews, Journal of Gambling Studies, Addiction, Psychology of Addictive Behaviors, and International Gambling Studies(1997-2007) was performed.Results:A total of 23 studies comprising various cognitive and behavioural approaches were identified, all but three of them confined to adult subjects. Study methodology and quality varied greatly, with many case studies or small case series, and only three randomised control trials. None used an intention-to-treat analysis, and there was little long-term follow-up. Almost ail indicated, with more or less evidence, that cognitive behavioural strategies might be beneficial.Conclusions:Many varieties and modifications of cognitive behavioural therapy have been applied to pathological gambling, though there are few studies of any psychological treatments for adolescent gamblers. Methodological problems surround much of the research. Notwithstanding these reservations cognitive behavioural approaches seem to offer promise in managing this serious problem.

SynopsisCase studies of patients with familial schizophrenia may help to define the pathophysiology of this illness and indicate potential candidate genes for genetic linkage studies. In this regard, the clinical, radiological and pathological assessments of a 39-year-old affected man from a pedigree with familial schizophrenia are presented. Brain imaging with CT indicated moderate cortical atrophy, particularly of the temporal lobes. Neuropathological examination revealed granular ependymitis, indicating possible past ventricular pathology. Granular ependymitis was reported to occur in genetic developmental disorders with neuronal migration abnormalities. In the present case, heterotopic clusters of neurons were visualized in the entorhinal cortex, suggesting that temporal lobe development was not entirely normal. This case study suggests that genetic factors could be investigated further as one possible aetiology of certain neurodevelopmental abnormalities observed in schizophrenia.

Signet-ring cell carcinomas are malignant tumors that may affect the stomach and the colon, but extrahepatic bile duct localization is rare. Here we present a case (a 56-year-old Moroccan woman), without either pancreato-biliary mal-junction or liver disease. The patient had obstructive jaundice. Morphological studies by MRI and ERCP revealed a bile duct tumor obstructing the common bile duct and invading gallbladder and hepatic hilum. Pathological examination revealed a carcinoma containing signet-ring cells. The evolution was characterized by rapid disease progression; the patient died in about five months. The case of our patient is among the rare cases described in the mainly Asian literature, and the first case reported in North Africa.

Abstract Background India has a highest incidence of gallbladder cancer (GBC) and contributes 10% of global GBC burden. The risk of GBC increases with age. The first peak of GBC occurs at 50 to 60 years and second peak at 70 to 80 years. In this article, the authors have presented a suspected case of GBC in a male patient of 65 years. Radiological reports also show presence of gallstones in this case. Studies show that four out of five persons with GBC have gallstones when they are diagnosed. The patient had pain in right upper abdomen, weight loss for few months, liver function test was highly altered and a space-occupying lesion was found in the gallbladder on radiological investigation. Patient was receiving treatment in a private medical college and hospital where computed tomography (CT) scan and magnetic resonance cholangiopancreatography detected gallbladder mass . Age of the patient, significant weight loss, presence of gallstones, abnormal liver function test and gallbladder mass have raised a suspicion of gallbladder cancer. Patient was advised for CT-guided biopsy by doctors of private hospital, but patient did not go for biopsy because of his belief that biopsy may worsen malignancy. Patient came to National Institute Homoeopathy for homoeopathic treatment to avoid biopsy and surgery. Method After proper case taking and repertorisation, a constitutional medicine Carcinosin was prescribed in Q-potency. Patient was kept under follow-up for more than a year and the patient is still under treatment. During treatment different potency of Carcinosin was prescribed in ascending scale. Results During the course of treatment, significant clinical, radiological and biochemical and pathological improvement has occurred. Conclusion Homoeopathy is among the commonly used alternative approaches in cancer. It is being widely used as palliative and curative care in patients suffering from cancer. Though studies on the use of homoeopathy in cancer after surgery, radiotherapy and chemotherapy have been reported, clinical trials on effects of homoeopathy in cancer are rare. In this case report, a suspected case of GBC was treated by higher homoeopathic dilution with significant improvement.

Infant pain is a non-stationary made by infants in response to certain situations. This infant facial expression can be used to identify physical or psychology status of infant. The aim of this work is to compare the performance of features in infant pain classification. Fast Fourier Transform (FFT), and Singular value Decomposition (SVD) features are computed at different classifier. Two different case studies such as normal and pain are performed. Two different types of radial basis artificial neural networks namely, Probabilistic Neural Network (PNN) and General Regression Neural Network (GRNN) are used to classify the infant pain. The results emphasized that the proposed features and classification algorithms can be used to aid the medical professionals for diagnosing pathological status of infant pain.

Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.

By embedding the "theory of sadness" phrase in the novel's title (Mileva Einstein, a theory of sadness), Slavenka Drakulić suggests that she sees her heroine's life as a paradigm of melancholy and depression. By diving into the psychology of a woman who has been portrayed during the two decades as wilingless and gloomy, always lacking the sense of self-fulfillment, the author is trying to reveal the key drivers which are responsible for Mileva's humiliating life circumstances-non-assertiveness, suppression, adjustment, feeling of inferiority, inability to tolerate separation and addiction, as well as a tendency to deny the facts. The protagonist illuminates her own feelings of inferiority due to her birth physical defects which pushed her into the science. She compensates her low self-esteem by school achievements and by nurturing the love relationship towards the symbiosis and removal of self-boundaries. Therefore, the love loss is a personal impoverishment and an identity issue. The novel is told by the omniscient narrator influenced by the influx of Mileva's stream of consciousness (still unreliable, since it is a testimony of "melancholy effect" and distortion of reality). The heroine faces the deepest truth about herself and at the same time turns away from it. Intertwined contradictions and ambivalences are revealing that the main cause of Mileva's tragedy is her pathological sadness. Using the psychoanalytical repertoire of object relations, we point out that, following the loss of the object, the heroine transferred her libido to herself and became self-obsessed in a destructive manner. By suggesting to the reader why Mileva Marić Einstein's response to the circumstances was depression (amidst all other psychological possibilities), Slavenka Drakulić's work is breaking the journalistic boundaries and emerges as a psychological novel.

ABSTRACTBackground: The clinical presentations in dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD) overlap considerably with that of Alzheimer's disease (AD) despite different pathological processes. Autopsy studies have also shown that multiple brain pathology occurs frequently, even in cases with a single clinical diagnosis. We aimed to determine the frequency of clinical diagnosis of FTD and DLB and the underlying pathology in a well-characterized cohort of patients with a clinical diagnosis of probable or possible AD.Methods: We conducted a retrospective analysis of 170 AD patients (probable AD = 83; possible AD = 87) originally enrolled in a case-control study, 27 with postmortem examination, to establish the number of cases meeting probable diagnosis for FTD and DLB, using a checklist of features compiled from their consensus criteria.Results: 23/83 probable AD cases and 32/87 possible AD cases met probable criteria for another dementia, more commonly DLB than FTD. AD pathology was present in 8/15 probable AD and 8/12 possible AD cases coming to autopsy. DLB pathology was seen in four cases and FTD pathology in eight cases. In the AD cases reaching clinical diagnosis for a second dementia syndrome and coming to autopsy, a minority showed non-AD pathology only.Conclusions: Presence of core clinical features of non-AD dementia syndromes is common in AD. Concordance between clinical and pathological diagnoses of dementia remains variable. We propose that repeat clinical examinations and structural neuroimaging will improve diagnostic accuracy. In addition, clinical diagnostic criteria for the main dementia syndromes require refinement.

Student participants ( N = 316) viewed a videotaped simulated case involving a woman who had entered a self-defense plea in the shooting death of her abusive husband. As successful claims of self-defense rest on the portrayal of a defendant who has responded reasonably to his/her situation, the implications of various forms of expert testimony in constructing this narrative were examined. Jurors were presented with either expert testimony regarding the battered woman syndrome (BWS), the BWS framed within post-traumatic stress disorder (PTSD) nomenclature, or a no-expert control condition. As the BWS classification may support a stereotypical victim, the degree to which the defendant fit the stereotype in terms of her access to a social support network (family, friends, employment outside of the home) was varied within the expert testimony conditions to reflect either a high or low degree of stereotype fit. Although jury verdicts failed to differ across expert testimony and stereotype fit conditions, perceptions of her credibility and mental stability did. Although affording jurors a framework from which the defendant's experiences as a battered woman may be acknowledged, this portrayal, as advanced within PTSD nomenclature, endorsed a pathological characterization of the defendant. Implications of this discourse for battered women within the context of self-defense are discussed.

Background:Cerebral Amyloid Angiopathy related inflammatory process (CAA-ri), a rare condition caused by an inflammatory reaction occurring within essential cerebral blood vessels against beta-amyloid deposits, leads to subclinical cognitive decline. Often misdiagnosed as dementia, this process can be treated through aggressive immunosuppression, thereby reversing much of the cognitive impairment.Case Report:We report a 69 year old female who came to the clinic for a second opinion and had received a previous diagnosis of Alzheimer’s Dementia (AD) from an outside hospital two years prior. She presented with her husband who provided some key aspects of the history. The husband reported two years of worsening of memory, while the patient denied her symptoms. Per husband and patient, she was able to perform activities of daily living (ADLs), including bathing, dressing and toileting, but had difficulties with many instrumental ADLs (IADLs). The clinical course was somewhat fluctuating with progressive cognitive symptoms and significant word-finding difficulties. Patient had been started on Donepezil 5 mg daily by her primary provider.Results:On examination, the patient did exhibit significant word-finding difficulties and scored 12/30 on the Montreal Cognitive Assessment (MoCA), indicating moderate cognitive impairment. The Patient was as well confused and disoriented to time and place. Neurological examination was otherwise unremarkable. Magnetic Resonance Imaging (MRI) studies were ordered and showed patchy and diffuse T2/FLAIR hyper intensities and particularly concentrated in the posterior cerebral artery and inferior division of the middle cerebral artery. These findings were consistent with cerebral amyloid angiopathy related inflammation (CAA-ri). Besides susceptibility weighted image (SWI) was showing multiple widely distributed microhemorrhages typical for CAA.To address the acute inflammatory reaction the patient was hospitalized and received high dose, 3 day course of intravenous steroids, followed by an oral steroid taper. The treatment had to be monitored due to an unrelated hypertensive emergency and WPW syndrome (both newly diagnosed and treated emergently) thus the Patient was hospitalized for a 3 days and discharged on oral steroids tapper in improved condition.Additionally, imaging showed that the patient’s hippocampal volumes were within normal range so this particular imaging biomarker didn’t support the diagnosis of AD. CSF biomarkers analysis didn’t support the diagnosis of AD either since had p-Tau levels were found to be within normal limits. Patient was found to be homozygous for the APOE e4 gene. Follow-up evaluation (including a repeat MRI study) was performed 2 months later showed clinical recovery and near complete resolution of diffuse hyperintensities, suggesting inflammation had resolved. Both the patient and the husband reported significant improvement in orientation and other aspects of cognition including working memory. The Patient scored 26/30 on MoCA.Discussion:Cerebral amyloid angiopathy (CAA) has been commonly associated with brain hemorrhages in the elderly, but the inflammatory subtype CAA-I occur much less frequently and may be often misdiagnosed as a cancerous process (Ronsin et al. 2016). In a recent systematic review by Caldas A et al. 2015, of the 155 patients with documented CAA-I, almost half displayed some form of cognitive impairment and 86% received corticosteroids. Nearly half of the cases improved following treatment.Conclusion:We present a case of a patient previously diagnosed with AD, upon further investigation, likely CAA-I, treated aggressively with intravenous steroids to good effect. Although rare, CAA-I is a reversible disorder that may be masked by a dementia or/and delirious process and should be considered in patients showing relatively rapid and fluctuating cognitive decline.

This thesis sets out to critically examine Guidano's model of psychopathology in eating-disordered individuals . The literature review highlights the diverse etiological approaches that have been taken in understanding eating disorders. Guidano's model is presented as an alternative to traditional approaches . It is a developmental, unitary model of psychopathology, conceptualised within a systems/process-oriented approach to organised complexity. Within a qualitative framework, case study methodology is utilised to test the viability and limitations of Guidano's model. Four in-depth case histories are presented which offer appropriate material for the testing of the model. The data is analysed using the reading guide method and presented in terms of the four features of Guidano's model: (1) dysfunctional patterns of attachment; (2) sense of self; (3) major themes on systemic coherence; (4) common coping strategies. The findings of the research support Guidano's model of psychopathology in eating-disordered individuals. The findings are: (1) attachment styles are ambiguous, "intrusive, and enmeshed; participants experience a disappointment in the preferential attachment relationship; (2) that participants' sense of self is blurred and wavering; (3) the major theme on systemic coherence is the oscillation between seeking and avoiding intimacy; (4) common coping strategies are: the seeking of supportive intimacy with minimal self-exposure; withdrawal into the self; perfectionism; the development of an eating disorder; continuous thoughts about food, eating, and weight which prevents participants from becoming aware of the real issues confronting them. An evaluation of Guidano's model in terms of its specific contribution to knowledge and research on the role of father in child and adolescent psychopathology, as well as how father effects evidence in eating disorders, demonstrates the model's value as an explanatory tool and raises implications for future treatment, theory, and research practices of eating-disordered individuals.

This study represented an examination of the social issue of increasing female aggression in the State of Connecticut and has clarified a predictive relationship among internal locus of control, pathological narcissism to include contingent self-esteem, self-sacrificing self-enhancement, hiding the self, devaluing, grandiose fantasy, entitlement rage, and the four manifestations of female aggression that included physical and verbal aggression, anger, and hostility.

Aggression perpetrated by young adult females has been problematic in terms of the direct cost to society through injuries or damage sustained, increased displacement, or negatively affected social circumstances of children as collateral damage created by sanctioning of the female parent. As a learned response, children emulate the aggressive values and behaviors of those adults both as a defensive coping strategy, as well as the multi-generational perpetuation of aggressive behavior as a learned behavioral choice. This study was conducted in Connecticut with a selective participant group of 174 self-reported adult females, aged 18–35, with histories of having been legally sanctioned for aggressive behavior. Participants were solicited through a receptive social service agency, The Connection, Incorporated and the social media network, Facebook. The data generated in this quantitative study were analyzed utilizing multiple and stepwise linear regression analyses; statistically significant, predictive relationships among the variables, internal locus of control, pathological narcissism, and female aggression were identified and measured independently, as well as in different groupings. The various combinations of internal locus of control and components of pathological narcissism were each more predictive of each of the specific forms of female aggression.

Dissertation (DSc)-- Stellenbosch University, 2008.
ENGLISH ABSTRACT: The overall aim of these studies was to investigate selected aspects of psychopathology, neurobiological abnormalities and treatment in schizophrenia. The following topics were researched: 1. Psychopathology: We explored the symptom structure of schizophrenia by means of principal components and factor analysis in two separate samples. a. The first study investigated the nature of symptoms in patients with a first-episode of schizophrenia, in a large cohort of patients who were participating in a multinational clinical trial. We compared our findings with similar analyses previously conducted in multi-episode schizophrenia patients. b. We then assessed the influence of culture on the symptom structure of schizophrenia by conducting a principal components and factor analysis of the symptom ratings in a large sample of South African Xhosa patients with schizophrenia, and comparing the results with those in other parts of the world. c. We investigated the occurrence of co-morbid depressive and anxiety symptoms, and their demographic and clinical correlates. The sample for this study comprised acutely psychotic patients who were participants in clinical drug trials conducted at our centre. d. To explore the relationships between obsessive-compulsive disorder and schizophrenia, we conducted a review of the relevant literature. 2. Neurobiological abnormalities: a. We performed a series of studies to investigate disorders of water homeostasis and vasopressin secretion in schizophrenia. To test the hypothesis that acutely psychotic patients have disordered regulation of water homeostasis, we applied a dynamic suppression test - a water loading test, with assessment of excretory capacity (including arginine vasopressin assay) in acutely psychotic patients. To evaluate whether a subset of patients with schizophrenia and co-morbid disordered water homeostasis sustained cerebral damage as a consequence of water intoxication we did the following experiment: We identified a cohort of subjects with schizophrenia and disordered water homeostasis and compared them with patients with schizophrenia without disordered water homeostasis in terms of cerebral ventricular size and cognitive function. To assess the prevalence of disordered water homeostasis in a long-term inpatient sample of psychiatric patients we conducted serum sodium screening tests. Those subjects with dilutional hyponatraemia were then further investigated for dysregulation of water homeostatic mechanisms. b. We studied neurological soft signs in a sample of subjects with first-episode schizophrenia followed up over a two year period. We investigated their occurrence, relationships to psychiatric symptoms and medication effects, their temporal stability and their outcome correlates. We also investigated their potential to predict outcome in schizophrenia 3. Treatment aspects A great deal of our work has focussed on the pharmacological treatment of schizophrenia. The following aspects of treatment are included in this thesis: a. Treatment effects on psychiatric symptoms: i. To assess the effects of ethnicity on treatment outcome in schizophrenia we compared the acute response to antipsychotic treatment in 3 ethnic groups, namely blacks, coloureds and whites. We included patients in this analysis who had participated in clinical trials in our department as well as the Department of Psychiatry in the University of the Free Sate. Patients had been treated under blinded conditions over a 6-week period. ii. After discussions with the late Dr David Horrobin, who had pioneered possible applications of the omega-3 fatty acids in the treatment of various psychiatric disorders, we became interested in further investigating the potential of this group of compounds as an affordable adjunct to treating schizophrenia. We assessed the antipsychotic potential of the omega-3 fatty acid, ethyl-eicosapentaenoic-acid (e-EPA) supplementation versus placebo supplementation in a small sample of subjects with schizophrenia who had been only partially responsive to antipsychotic treatment previously. We also conducted a review of the literature to evaluate the evidence for efficacy for the omega-3 fatty acids in schizophrenia according to published studies. b. Treatment effects on neurological abnormalities: i. In a single-blinded controlled study we compared a new generation antipsychotic to a conventional antipsychotic in the treatment of tardive dyskinesia (TD). This was a long-term (1 yr) study in patients with chronic schizophrenia and established tardive dyskinesia. ii. We also assessed the effect of omega-3 fatty acid (e-EPA) supplementation in treating TD. This was conducted in a larger sample (n=84) of patients with chronic schizophrenia and established TD. The blinded, placebo-controlled phase was 12 weeks. This was followed by an open-label extension for 40 weeks. c. Conventional versus new generation antipsychotic agents. Several evidence-based literature reviews of the efficacy and tolerability of the new generation of antipsychotics compared to the conventional agents were conducted. Some multinational, randomised, controlled clinical trials in which the author was principal investigator, are included in this thesis. Also, studies addressing patients with partial treatment refractoriness are included, as well as studies of the effects of antipsychotics on depressive symptoms, body mass and glycaemic control. Finally, we have included a pharmacoeconomic study comparing a conventional antipsychotic (haloperidol) with a new generation antipsychotic (quetiapine) in partially refractory patients in a South African setting. Findings and conclusions: 1. Psychopathology: Our studies demonstrated that the factor structure for the symptoms of schizophrenia is replicable across samples, and is not greatly influenced by ethnic and cultural factors. However, changes in the factor structures do occur over time. There are symptom domains that are present in first-episode schizophrenia but disappear as a distinct entity as the illness becomes chronic. Particularly, a motor component is evident in untreated patients, but disappears after initiation of treatment. We found that depression and anxiety are common co-morbid symptoms in schizophrenia, and have important clinical and outcome correlates. Depressive symptoms in the acute psychotic phase of schizophrenia are associated with a favourable prognosis and diminish as the symptoms of psychosis improve in response to antipsychotic treatment. However, persistent depressive symptoms are associated with a poorer prognosis, and require additional therapeutic intervention. 2. Neurobiological abnormalities: We investigated the occurrence of disordered water regulation in a population of psychiatric inpatients, and conducted further investigations on those identified, in order to establish mechanisms involved. Polydipsia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) were found to occur in a subset of patients with schizophrenia, and are associated with acute psychosis, as well as with some psychotropic medications. These patients are characterised by more severe cognitive impairment and evidence of cerebral atrophy. The condition can become life-threatening in the presence of other factors impeding water excretion, particularly thiazide diuretics. Neurological soft signs were investigated in a sample of patients with a first-episode of schizophrenia. These soft signs appear to be trait-like (present early in the illness, and stable over time), except for a motor sequencing factor. Patients performing poorly on this latter group of tests have a longer duration of untreated psychosis, and are at significant risk for developing TD. 3. Treatment aspects: Our studies suggest that there are important ethnic differences in antipsychotic treatment response, but that these differences could be explained by a number of environmental and biological factors. As was found with many studies worldwide, we found that the new generation antipsychotics have important efficacy and safety advantages over their predecessors. Risperidone was as effective as haloperidol in first-episode psychosis, but with a more favourable side-effect profile in terms of reduced extrapyramidal symptoms. Quetiapine treatment in partially refractory patients resulted in more responders compared to haloperidol, and fewer extrapyramidal symptoms. However, evidence of a different side-effect profile is emerging. Of particular concern is the finding that some of the new antispychotics cause weight gain, glucose intolerance and dyslipidaemias. We found that one novel antipsychotic, quetiapine, was not associated with significantly more weight gain or disordered glucose metabolism that a conventional agent, haloperidol. The omega-3 fatty acids, particularly EPA may have a role in the treatment of various psychiatric disorders. Our studies provided mixed results – the first found a significant beneficial effect on psychotic symptoms and dyskinesia scores for EPA supplementation, while the second failed to demonstrate a beneficial effect on TD or psychotic symptoms. We explored the early treatment response in first-episode psychosis and found, unlike that reported in multi-episode patients, some patients took a long time to respond. We also found that early treatment response was a significant predictor of later remission, as was duration of untreated psychosis, educational level and baseline excitement factor scores. Finally, our pharmacoeconomic study conducted for South African circumstances in patients with a partial response to conventional antipsychotic treatment showed cost-neutrality or cost-benefits for quetiapine compared with haloperidol treatment for direct costs.
AFRIKAANSE OPSOMMING: Die oorkoepelende doel van hierdie studies was om geselekteerde aspekte van psigopatologie, neurobiologiese abnormaliteite en behandeling in skisofrenie te ondersoek. Die volgende onderwerpe is nagevors: 4. Psigopatologie: Ons het die simptoomstruktuur van skisofrenie ondersoek deur middel van hoofkomponent- en faktoranalise in twee aparte steekproewe. a. Die eerste studie het die aard van simptome in pasiënte, met ʼn eerste-episode van skisofrenie, ondersoek in ʼn groot kohort van pasiënte wat deelgeneem het aan ʼn multi-nasionale kliniese proefneming. Ons het ons bevindinge vergelyk met soortgelyke analises wat voorheen gedoen is in multi-eposode skisofrenie pasiënte. b. Hierna het ons die invloed van kultuur op die simptoom struktuur van skisofrenie geassesseer deur ʼn hoofkomponent- en faktoranalise van die simptoomtellings uit te voer in ʼn groot steekproef van Suid-Afrikaanse Xhosa pasiënte met skisofrenie en die resultate te vergelyk met bevindinge in ander dele van die wêreld. c. Ons het die voorkoms van ko-morbiede depressiewe en angssimptome ondersoek, asook hul demografiese en kliniese korrelate. Die steekproef vir hierdie studie het bestaan uit akute psigotiese pasiënte wat deelnemers was in ʼn kliniese geneesmiddel proef wat uitgevoer is by ons sentrum. d. Om die verband tussen obsessief-kompulsiewe steurnis en skisofrenie te verken, het ons ʼn oorsig van die relevante literatuur gedoen. 5. Neurobiologiese abnormaliteite: a. Ons het ʼn reeks studies uitgevoer om steurnisse in water homeostase en vasopressien sekresie in skisofrenie te ondersoek. Om die hipotese dat akute psigotiese pasiënte versteurde regulering van water homeostase het te ondersoek, het ons ʼn dinamiese onderdrukkingstoets toegepas – ʼn water ladingstoets, met assessering van ekskresiekapasiteit (insluitend arginien vasopressien essai) in akute psigotiese pasiënte. Om te evalueer of ʼn onderafdeling van skisofrenie pasiënte met ko-morbiede versteurde water homeostase serebrale skade opgedoen het as gevolg van water intoksikasie, het ons die volgende eksperiment uitgevoer: Ons het ʼn kohort deelnemers met skisofrenie en versteurde water homeostase geïdentifiseer en hulle vergelyk met skisofrenie pasiënte sonder versteurde water homeostase in terme van serebrale ventrikulêre grootte en kognitiewe funksionering. Om die voorkoms van versteurde water homeostase in ʼn langtermyn binne-pasiënt steekproef van psigiatriese pasiënte te bepaal, het ons serum natrium siftingstoetse uitgevoer. Deelnemers met hiponatremie is hierna verder ondersoek vir disregulering van water homeostatiese meganismes. b. Ons het neurologiese sagte tekens in ʼn steekproef van deelnemers met eersteepisode skisofrenie bestudeer en opgevolg oor ʼn twee jaar tydperk. Ons het hulle voorkoms, verwantskappe met psigiatriese simptome en medikasie effekte, hulle temporale stabiliteit en hul uitkoms korrelate ondersoek. Ons het ook hulle potensiaal om die uitkoms in skisofrenie te voorspel, ondersoek. 6. Behandelings aspekte ʼn Groot meerderheid van ons werk het gefokus op die farmakologiese behandeling van skisofrenie. Die volgende aspekte van behandeling is ingesluit in hierdie tesis: a. Behandelingseffekte op psigiatriese simptome: i. Om die effek van etnisiteit op behandelingsuitkoms in skisofrenie te assesseer, het ons die akute respons op anti-psigotiese behandeling in 3 etniese groepe vergelyk, naamlik swart, gekleurd, en wit. Ons het pasiënte wat deelgeneem het aan kliniese proefnemings in ons departement sowel as die Departement Psigiatrie van die Universiteit van die Vrystaan ingesluit in hierdie analise. Pasiënte is behadel onder geblinde toestande oor ʼn tydperk van 6 weke. ii. Na besprekings met wyle Dr David Horrobin, wie die moontlike toepassings van omega-3 vetsure in die behandeling van verskeie psigiatreise steurnisse gepionier het, het ons begin belangstel in verdere ondersoek na die potensiaal van hierdie groep samestellings as ʼn bekostigbare toevoeging in die behandeling van skisofrenie. Ons het die anti-psigotiese potensiaal van die omega-3 vetsuur, etieleikosapentanoësuur (e-EPA) supplementasie versus plasebo supplementasie ondersoek in ʼn klein steekproef van deelnemers met skisofrenie wat slegs gedeeltelik responsief was op anti-psigotiese behandeling in die verlede. Ons het ook ʼn literatuuroorsig gedoen om die bewyse vir die effektiwiteit vir die omega-3 vetsure in skisofrenie te evalueer volgens gepubliseerde studies. b. Behandelingseffekte op neurologiese abnormaliteite: i. In ʼn enkelblinde kontrole studie het ons ʼn nuwe generasie anti-psigotiese medikasie vergelyk met ʼn konvensionele anti-psigotiese medikasie in die behandeling van tardiewe diskinesie (TD). Hierdie was ʼn langtermyn (1- jaar) studie in pasiënte met chroniese skisofrenie en vasgestelde TD. ii. Ons het ook die effek van omega-3 vetsuur (e-EPA) suplementasie geassesseer in die behandeling van TD. Dit was gedoen in ʼn groter steekproef (n=84) van pasiënte met chroniese skisofrenie en vasgestelde TD. Die blinde, placebo kontrole fase was 12 weke. Dit is gevolg deur ʼn nie-geblinde ekstensie vir 40 weke. c. Konvensionele versus nuwe generasie anti-psigotiese agente. Verskeie bewys-gebaseerde literatuuroorsigte oor die effektiwiteit en toleransie van die nuwe generasie anti-psigotiese agente in vergelyking met die konvensionele agente, is gedoen. Sommige multi-nasionale, ewekansige, kontole kliniese proefnemings waarin die outeur die hoofnavorser was, is ingesluit in hierdie tesis. Verder, studies wat die pasiënte met gedeeltelike behandelingsweerstandigheid aanspreek, is ingesluit, sowel as studies oor die effekte van anti-psigotiese agente op depressiewe simptome, liggaamsmassa en glisemiese kontrole. Laastens, het ons a farmakoekonomiese studie ingesluit wat die konvensionele anti-psigotiese behandeling (haloperidol) met ʼn nuwe generasie anti-psigotiese behandeling (quetiapien) in gedeeltelik weerstandige pasiënte in ʼn Suid-Afrikaanse ligging vergelyk. Bevindinge en gevolgtrekkings: 4. Psigopatologie: Ons studies het gedemonstreer dat die faktor struktuur vir die simptome van skisofrenie herhaalbaar is oor steekproewe, en dat dit nie grootliks beïnvloed word deur etnisiteit en kulturele faktore nie. Veranderinge vind egter in die faktor strukture wel plaas met verloop van tyd. Daar is simptoom domeine wat teenwoordig is in eerste-episode skisofrenie, maar verdwyn as ʼn afsonderlike entiteit soos wat die toestand chronies word. Spesifiek, ʼn motoriese komponent is duidelik in onbehandelde pasiënte, maar verdwyn na die aanvang van behandeling. Ons het gevind dat depressie en angs algemene ko-morbiede simptome in skisofrenie is en het belangrike kliniese en uitkoms korrelate. Depressiewe simptome in die akute psigotiese fase van skisofrenie word geassosieer met ʼn gunstige prognose en verminder soos wat die simptome van psigose verbeter in repons op anti-psigotiese behandeling. Egter, volgehoue depressiewe simptome word geassosieer met ʼn swakker prognose en benodig addisionele terepeutiese intervensie. 5. Neurobiologiese abnormaliteite: Ons het die voorkoms van versteurde water regulering ondersoek in ʼn populasie van psigiatriese binne-pasiënte en verdere ondersoek ingestel op dié wie geïdentifiseer is, om die betrokke meganismes vas te stel. Polidipsie en en die sindroom van onvoldoende antidiuretiese hormoon sekresie (SIADH) is gevind om voor te kom in ʼn onderafdeling van pasiënte met skisofrenie, en word geassosieer met akute psigose sowel as met somige psigotropiese medikasie. Hierdie pasiënte word gekenmerk deur meer ernstige kognitiewe beperking en bewyse van serebrale atrofie. Die toestand kan lewensbedreigend raak in die teenwoordigheid van ander faktore wat water ekskresie hinder, veral tiasied diuretikums. Neurologiese sagte tekens is ondersoek in ʼn steekproef van pasiënte met eerste-episode skisofrenie. Hierdie sagte tekens blyk om kenmerkend (teenwoordig vroeg in die siekte, en stabiel oor tyd) te wees, behalwe vir ʼn motoriese volgorde faktor. Pasiënte wat swak vaar op die laasgenoemde groep toetse, het ʼn langer durasie van onbehandelde psigose, en het ʼn beduidende risko om TD te ontwikkel. 6. Behandeling aspekte: Ons studies stel voor dat daar ʼn belangrigke etniese verskil is in anti-psigotiese behandelingsrespons, maar dat hierdie verskille verduidelik kan word deur ʼn aantal omgewings- en biologiese faktore. Soos wat gevind was vir verskeie studies wêreldwyd, het ons gevind dat die nuwe generasie anti-psigotiese agente belangrike effektiwiteit- en veiligheidsvoordele het bo hulle voorgangers. Risperidoon was net so effektief as haloperidol in eerste-episode psigose, maar met ʼn meer gunstige newe-effkte profiel in terme van verminderde ekstrapirimidale simptome. Quetiapien behandeling in veral refraktêre pasiënte het gelei tot meer respondeerders vergeleke met haloperidol, en minder ekstra pirimidale simptome. Alhoewel, bewyse van ʼn verskillende newe-effekte profiel is besig om na vore te kom. Van spesifieke belang is die bevinding dat sommige van die nuwe anti-psigotiese agente gewigstoename, glukose intoleransie en dyslipidemie veroorsaak. Ons het gevind dat een nuwe anti-psigotiese agent, quetiapien, nie geassosieer was met enige beduidende meer gewigstoename of versteurde glukose metabolisme as ʼn konvensionele agent, haloperidol, nie. Die omega-3 vetsure, spesifiek EPA mag moontlik ʼn rol in die behandeling van verskeie psigiatriese versteurings hê. Ons studies het gemengde resultate voorsien – die eerste het ʼn beduidende voordelige effek op psigotiese simptome en diskinesie tellings vir EPA supplementasie gevind, terwyl die tweede nie ʼn voordelige effek op TD of psigotiese simptome gevind het nie. Ons het die vroeë behandelingsrespons ondersoek in eersteepisode pasiënte en het gevind, in teenstelling met dit wat gerapporteer word in multi-episode pasiënte, dat sommige pasiënte ʼn lang tyd geneem het om te reaggeer. Ons het ook gevind dat vroeë behandelingsrespons ʼn beduidende voorspeller was van latere remissie, so ook die durasie van onbehandelde psigose, opvoedingspeil, en basisvlak opwindings-faktor tellings. Laastens het ons farma-ekonomiese studie, wat uitgevoer is vir Suid-Afrikaanse omstandighede in pasiënte met ʼn gedeeltelike repons op konvensionele anti-psigotiese behandeling, koste-neutraliteit of koste-voordele aangetoon vir quetiapien vergeleke met haloperidol behandeling vir direkte onkostes.

This work present the salient features of existential psychoanalysis across a chronological selection of Sartre's works. It looks at the background in psychology and phenomenology which informed Sartre's concept and presents key aspects of the theory itself, in comparison with Freudian psychoanalysis. A study of Sartre's three existential biographies, on Baudelaire, Genet and Flaubert, shows how the theory and its progressive-regressive method are applied to concrete cases, while also tracing the evolution of Sartre's approach up to his late writings on the topic. The final assessment concerns the possibility of using Sartre's theory as a basis for existential psychotherapy. Sartre's account is shown to provide a consistent framework for analysing individuals in existential terms and through which to understand subjectivity.

The Ironman Triathlon is an epic endurance event consisting of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run. There is paucity in the literature relating to how athletes learn how to negotiate this event. This qualitative study was conducted over a 9 month period, to align with the 2013 Ironman training and racing season. Seven athletes were selected for participation in the study. Utilizing a case study approach, the Ironman athletes' learning pathways were examined through in-depth interviews and audio and video content personally captured by the participants.

The learning pathways revealed the athletes initially learned through cognitive means, i.e. social interaction, reading, Internet sources, and the observation of others. As athletes traversed the learning pathway, they subsequently operationalized the knowledge they learned and constructively made it meaningful to their respective personal training and racing situations. At the terminal end of the learning pathway, the athletes operationalized the learned content in an experiential learning cycle. During the entire learning pathway, the athletes practiced the learned content, which is best characterized as behavioral learning. The audio and video content provided by the athletes empirically validated the interviews.

The interviews with the athletes were coded. Some unifying themes emerged from the data independent of cognitive, constructivist, behavioral, or experiential learning theories; e.g. the importance of mental toughness, the understanding of pain during the training and racing process, how success is measured, the importance of training with a power meter, and motivating factors.

This research was based on the premise that psychological research on risk-taking behaviour has emphasized a one-dimensional model of instrumentality and cognitive functioning derived from male experience. The central research question "How do women experience risk-taking?" was investigated by analyzing definitions and examples of personal risk described by 44 women, and by comparing relationships between subgroups assigned by occupation and by sex-role orientation. The findings indicated that women experienced risk-taking that spanned both dimensions of affiliation (connection to others) and instrumentality (attainment of personal goals). A new definition of risk-taking was proposed that incorporated elements of uncertainty, emotional involvement, loss, and a process of change. Women in traditional occupations described a similar number of affiliative and instrumental risks, while women in non-traditional occupations emphasized instrumental risks. It was observed that the opportunity and demand for risk-taking appeared related to social context and work activity. Significant differences were also found between women in traditional and non-traditional occupations with respect to sex-role orientation (from the Bern Sex-Role Inventory), employment status, income level, and number of children. No differences were found between sub-groups designated by occupation and by sex-role orientation with respect to estimates of risk-taking tendency from a self-estimate scale and the Choice Dilemmas Questionnaire. The results supported a critique of the Choice Dilemmas Questionnaire, citing an emphasis on instrumental and hypothetical risk-taking. Participants also reported that the CDQ was not relevant to their lives. The feminist approach encouraged active participation and evaluation by the women in the study. As a result, participants reported an increased understanding of themselves and of the process of risk-taking.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

The article describes a case of intrauterine death of twin fetuses in a multiple pregnancy in a mare, presents the results of postmortal diagnostics with the establishment of the causes of miscarriage, studies the picture of changes in organs and tissues, reveals cause-and-effect relationships between pathological processes and the mechanism of death.

Male breast cancer (MMC) corresponds to 0.5% of cases of malignant neoplasms in men. Among the associated risk factors are black ethnicity, age over 60 years, family history, BRCA1 and BRCA2 gene mutations, Klinefelter syndrome, the use of exogenous estrogen, gynecomastia, obesity, and a history of chest radiation. Regarding diagnosis and treatment, the standard trend for female breast cancer is still followed, with few studies in men. We report the case of an 81-yearold black patient with few risk factors exposed in the literature. On physical examination at entry, he presented an exophytic lesion in the right breast and palpable and hardened lymph nodes in the right axillary region. With an established diagnosis of nonspecial type invasive carcinoma and invasive ductal carcinoma without other specifications by previous biopsy, a modified right radical mastectomy was performed with right axillary dissection and according to the pathological examination with pT4b pN1 pMx staging. Thus, as a result of the good evolution of the condition, the patient was discharged 2 days after the surgery to the oncology clinic, in order to monitor the condition.

The World Health Organization (WHO) states on its website, the one dedicated to the regional office of the Middle East, that there are more than 1000 million disabled people across the globe, which represents approximately 15% of the entire world population i.e. nearly 1 in every 7 people is disabled. It also indicates that the number of the people who suffer from a handicap is on a continuous rise, mainly because of the aging population as well as the exacerbation of chronic illnesses. Moreover, the same organization informs that although this matter is of an extreme seriousness, there is in fact a severe lack of awareness and an unavailability of the necessary scientific information related to this topic. As a matter of fact, there is only a small number of documents that display collections of studies about the policies and responses that the countries have put in place in order to meet the needs of people with disabilities. The data related to disabilities and disabled people points out to an evident lack of concern, on a global scale, when it comes to this particular group that happens to include millions of people all throughout the world. However, and despite the efforts and resources dedicated to accommodate and rehabilitate handicapped people, we still, unfortunately, have a long way to go before we can reach this desired goal. So, does it mean that all these efforts were in vain? In this communication, we will attempt to answer this question through a presentation of the historical evolution of opinions about the meaning of disability and special needs in light of the recent scientific advancements and its impact on the social perception, by shedding the light on the symbolism of the phenomenon of abuse and bullying targeting individuals with special needs. This historical examination shows a clear quantum leap when it comes to the treatment and attitude towards people with special needs, a leap that coincides with the advancement that the scientific research and the pathological classification in the psychology have witnessed in the beginning of the twentieth century. Following these classifications, a number of legal renewals took place, which provided disabled people with several rights that guarantee their protection. Therefore, we can determine that there is indeed a tangible change, albeit the fact that there is definitely and undoubtedly more room for improvement in this regard. Consequently, the denunciations we witness today regarding the abuse and mistreatment of people with disabilities is in fact a product of the collective awareness and the public acknowledgment of the radical shift regarding the conceptual and practical notion of disability. Which in turn, predicts a better and a more prosperous future for a group of people who are in dire need of change.

Context: The Broca’s (BA) and Wernicke’s Area (WA) are fundamental for the language function. Surgical interventions in proximal areas can cause functional deficits. The left brain (LB) contains BA and WA in 92.5-97% of the right-handed individuals and 2/3 of the left-handed. The mapping of these functional areas is done with functional magnetic resonance (fMRI), which identifies which cerebral hemisphere is responsible for to the language function. In slow-growing tumor lesions, there might be plasticity in these areas, which allows tumor resection with functional recovery. In high-grade tumors, growth is fast and there is usually no significant plasticity. This article aims to demonstrate that even in high-grade tumors, brain plasticity in language areas can occur. Case report: T.R.P., male, 20 years old, right-handed, with type-2 neurofibromatosis. Evaluated due to the epileptic seizure with a lesion suggestive of high-grade glioma (IV-WHO) affecting the lower frontal gyrus in magnetic resonance imaging. Results: Undergoing surgical resection with awake craniotomy for functional language mapping. Functional studies have shown that the anatomical area corresponding to BA had no function and was surgically removed. T.R.P. evolved without functional deficits and fMRI showed complete resection of the Broca’s area and the anatomo-pathological exam confirmed that the tumor was a high-grade Glioma (IV-WHO). Conclusions: Even in the presence of a fast-growing lesion, the possibility of brain plasticity in the language areas should be considered. When plasticity is found, complete resection of the tumor is possible using invasive brain mapping, which has a direct impact on prognosis and survival.

Introduction: The triple-negative breast cancer (TNBC) is one of the most aggressive types of breast cancer, corresponding to about 15% to 20% of invasive breast tumors. They are those tumors that in immunohistochemistry do not express homone receptors and epidermal growth factor type 2 (cerbB2). This tumor phenotype does not yield many treatment options, beyond standard chemotherapy, and within this context, the evidence of some markers of this type of tumor may contribute to the discovery of more effective types of treatment. Case report and Objectives: The aim of this study was to define predictive and prognostic factors in TNBC that could be related with a pathologic complete response after neoadjuvant chemotherapy treatment. Methods: A descriptive and retrospective study, a case series type, in women with TNBC who had underwent neoadjuvant chemotherapy and surgery at the Mastology Service of Maternidade Escola Assis Chateaubriand – Brazil - from May 2015 to June 2020. A statistical analysis was performed considering the 5% significance level. Results: From 108 women, only 47 were included in the study, with median age of 49 years (+14 years); about 30 (42.6%) had a family history of breast cancer in first or seconddegree relatives. About 44 (93.6%) cases were classified as invasive ductal tumor and grade II or III; the value of Ki67 greater than 14% was evidenced in 46 (97.9%) women and 26 (55.3%) had clinical stage III. Pathologic complete response to chemotherapy was evidenced in 16 (34%) cases, partial response in 13 (27.7%) and no response in 18 (38.3%) cases. The latter cases correspondeded to those who had stable or progression of disease. There was recurrence in 13 (27.7%) women, about 8 distant metastases, with the lungs as the most frequent site of metastasis followed by the brain. Eleven patients, about 23.4%, died. In the survival analysis of the studied population, the overall survival was 5.6 months and disease-free survival was 19.4 months. No association was observed in the study between the outcome of pathologic complete response to neoadjuvant chemotherapy and anatomopathological characteristics of the tumor. Conclusion: The results of this study did not show statistical significance to determine the possible predictive and prognostic factors for obtaining a complete clinical response to TNBC in a public reference service for the treatment of breast cancer, where there is no genetic signature, PDL1 status or access to differentiated treatment for such a heterogeneous tumor profil. This shows a need for further studies in order to understand this disease and for greater accessibility to high-cost exams and more effective treatments.

Psychological explanation of consumer behaviour is mostly focused on the research of individual behaviour. In this case, psychology studies internal (interpersonal) variables related to the mental state and personality characteristics of individuals. Since it is impossible to directly analyse processes that take place in man, psychology uses the methods and techniques of direct reasoning. Psychology has made a significant contribution in the explanation of the motives and behaviour of tourists as consumers. This is especially true for motivational research which has provided the most complete answer to the question of why consumers behave the way they do when buying products and services. Personality characteristics are the subject of psychological research of consumer behaviour; attitudes, evaluations and emotions of individuals represent an essential component of the thought structure of individuals. The paper will consider various psychological determinants from the aspect of their influence on the present tourist demand as well as on the tourist demand in some future period.

This study aims to describe the clinical and pathological characteristics in women with breast cancer with three or four ipsilateral and contralateral malignant tumors. The second primary malignant neoplasm of the breast is a condition in which the frequency of occurrence is around 50%, mainly in young women. The occurrence of the third and fourth neoplasms is rare, between 0.73% and 11.7%. This is a retrospective cohort study of women with breast cancer from 2000 to 2015. We identified 375 women with second primary breast tumor, of which 6 (1.6%) had three and four new primary breast cancer. Of the six cases with three and four neoplasms, three cases occurred in the QIE (lower left quadrant), overlapping lesion in two cases, and two cases in the QSE (upper left quadrant). Zero clinical and pathological staging was observed in two cases, I in two cases, IIA in two cases, and IA in one case, invasive lobular carcinoma in four cases, and invasive ductal carcinoma in three cases. The molecular subtype luminal occurred in four cases, HER2 overexpressed in three cases, estrogen receptor and HER2 were negative in three cases, and progesterone positive in three cases. The time of diagnosis between the first, third, and fourth tumor ranges from 2 to 72 months. Therefore, more studies are needed on the third and fourth malignant breast tumors as it is a rare entity in patients whose genetic and molecular characteristics are poorly known.

Rapid Prototyping (RP) has been considered, over the last decades, as a highly promising technology for reducing product development time and cost, as well as for addressing the need for customization and faster response to the market needs. Nowadays this technology is also used widely in medical applications (Medical Rapid Prototyping – MRP), supporting diagnosis and treatment in Neurosurgery, Orthopedic and Dental-Cranio-Maxillo-Facial surgery as well as in Tissue Engineering. The scan data that are usually obtained by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) are used to build a 3D CAD model of the patient’s pathological region. The 3D model is used to construct the real size prototype using one of the existing RP processes. This assists surgeons in gaining a detailed insight of the problem, making the diagnosis and treatment easier and more reliable. This study presents the current benefits and barriers of Rapid Prototyping and Manufacturing methods and applications in the field of medicine. Most of the recent state-of-art developments and case studies of MRP are presented. Their limitations are discussed along with the challenges to be addressed in the future.

Intracranial aneurysms are pathological dilations of the arteries in the brain, whose rupture is often fatal. Surgery and endovascular embolization are the two most common methods of treatment. Surgery involves opening a portion of the skull and placing metallic clips at the aneurysm neck thereby preventing blood flow into the aneurysm. In the case of embolization, a catheter is used to pack platinum coils in the aneurysm reducing the inflow and promoting thrombus formation. Due to its less invasive approach endovascular embolization is preferred over surgery. Nevertheless this approach also has some serious aftereffects. Coil compaction followed by the re-growth or the formation of the secondary aneurysm is the most common problem. The endovascular embolization approach also has a serious shortcoming that the coils alone cannot be used to block every type of aneurysm. Wide neck or fusiform aneurysms are coiled with the help of stents. Recent studies show that stent, which is a hollow cylindrical mesh, can be successfully used to limit the flow of blood into the aneurysm. However these studies have been conducted using idealized in-vitro and numerical models. Studies conducted using patient-specific models generated from medical images will provide a more realistic approach to computationally investigate the effects of stents on intra-aneurysmal flow patterns. However generation of computational grids inside the parent vessel and around these stents is a challenging task. In this paper an algorithm to map the stent to a patient-specific vascular model and an adaptive unstructured embedded gridding technique to model flow around stents are presented. Finally these techniques are demonstrated on patient-specific cases to prove their feasibility.