Cet article décrit le cas d’une jeune fille de 10 ans qui a développé un syndrome qui ressemble à celui du stress post-traumatique (SSPT) après avoir regardé un film d’horreur. Six ans plus tard, la patiente présentait toujours les symptômes du SSPT correspondants aux critères du DSM-IV. La littérature scientifique a été examinée à la recherche de cas semblables et treize cas semblables ont été recensés. La présence des critères DSM-IV a été confirmée uniquement dans deux cas. Nous concluons que l’exposition à des films d’horreur peut déclencher un syndrome du type SSPT chez les personnes vulnérables.

We reported a case of a 10-year-old girl who developed a PTSD-like syndrome after watching a horror movie. After 6 years, the now 16-year-old patient still fulfilled the DSM-IV criteria for PTSD, except for the trauma itself. We reviewed the scientific literature for case reports of PTSD-like syndrome induced by horror movies and found 13 cases. In only two was the presence of the DSM criteria confirmed. Watching horror movies may thus trigger PTSD-like syndromes in vulnerable viewers

Dieser Artikel beschreibt den Fall eines 10-jährigen Mädchens, das ein PTBS-ähnliches Syndrom entwickelte, nachdem sie einen Horrorfilm angeschaut hatte. Sechs Jahre später zeigte die nun 16 Jahre alte Patientin nach wie vor PTBS Symptome auf, die den Kriterien des DSM-IV entsprachen. Wir forschten in der wissenschaftlichen Literatur nach Fallberichten des PTBS-ähnlichen Syndroms, die durch Horrorfilme induziert wurden und fanden 13 Fälle. In nur zwei Fällen wurden die DSM-IV-Kriterien bestätigt. Wir kommen zum Schluss, dass bei anfälligen Personen, die sich Horrorfilmen aussetzen, es zu PTBS-ähnlichen Syndromen kommen kann.

O caso de uma menina de 10 anos de idade que desenvolveu síndrome do tipo transtorno de estresse pós-traumático (TEPT) após assistir a filme de terror é relatado. Após seis anos, a paciente ainda preenchia os critérios do DSM-IV para TEPT. Em revisão da literatura, identificamos 13 casos de síndrome TEPT-símile induzida por filmes de terror, mas o diagnóstico baseado em critérios DSM foi feito em dois casos apenas. Filmes de terror podem desencadear síndromes TEPT-símile em pessoas vulneráveis.

Presentamos el caso de una niña de 10 años que desarrolló un síndrome tipo trastorno de estrés postraumático (TEPT) después de ver una película de terror. Al cabo de seis años, la paciente aún cumplía con los criterios del DSM-IV para el TEPT. Durante la revisión de la literatura, identificamos 13 casos de síndromes similares al TEPT, inducidos por películas de terror, pero el diagnóstico basado en los criterios DSM fue hecho solo en dos casos. Películas de terror pueden desencadenar síndromes similares al TEPT en espectadores vulnerables.

Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

Objective: Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). Methods: Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. Results: Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). Conclusions: Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.

OBJETIVO: Atualizar os clínicos sobre a existência de um possível subtipo do transtorno obsessivo-compulsivo caracterizado por pouco insight. MÉTODO: Revisão opinativa baseada em estudos indexados na base de dados PubMed e PsychINFO, identificados por meio dos unitermos "obsessive-compulsive disorder" e "insight" ou "ego-dystonic" e publicados entre 1966 e outubro de 2009. Os resultados foram examinados de acordo com a estratégia utilizada para abordar o insight, i.e. categórica vs. dimensional. RESULTADOS: Análise dos estudos nos permitiu identificar pontos que colocam em dúvida a existência de um subtipo do transtorno obsessivo-compulsivo bem delimitado caracterizado por pouco insight. Estes pontos incluem 1) prevalência extremamente variável do transtorno obsessivo-compulsivo com insight reduzido encontrada em estudos categóricos, 2) homogeneidade dos achados fenotípicos (i.e. maior gravidade) associados a baixo insight em estudos categóricos e dimensionais e 3) ausência de estudos que investigam "zonas de raridade" entre as formas de transtorno obsessivo-compulsivo com pouco e bom insight. CONCLUSÃO: Embora uma abordagem categórica do insight no transtorno obsessivo-compulsivo seja importante em ambientes clínicos, uma vez que neles existem demandas prementes para tomada de decisões, a abordagem dimensional do insight parece refletir de forma mais fidedigna o fenômeno apresentado pelos pacientes em tela.

OBJECTIVE: To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight. METHOD: Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords "obsessive-compulsive disorder" AND "insight" OR "ego-syntonic", and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder. RESULTS: The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder. CONCLUSION: Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.

INTRODUÇÃO: Os déficits cognitivos em pacientes com esquizofrenia tardia têm sido relatados como estáveis, embora alguns estudos prospectivos demonstrem que um sub-grupo evolui com declínio cognitivo significativo. Os dados sobre esquizofrenia de início tardio são escassos nos países em desenvolvimento. OBJETIVO: Avaliar o desempenho cognitivo de pacientes brasileiros com esquizofrenia de início tardio ao longo de um ano. MÉTODO: Os pacientes com esquizofrenia de início tardio (n=13) foram avaliados inicialmente e após um ano com o Mini-Exame do Estado Mental (MMSE), o CAMCOG, a Escala de Sintomas Positivos e Negativos, a Escala de Atividades de Vida Diária de Pfeffer (ADL) e o Inventário Neuropsiquiátrico (NPI). RESULTADOS: A cognição e as atividades de vida diária permaneceram estáveis ao longo de um ano [inicial MMSE= 21,31 (4.87) e CAMCOG=80,31 (16,68); final MMSE=20,77 (3,86) e CAMCOG=82,92 (14,42) (Z=-0,831; p=0,40); inicial ADL=4,31 (5,65); final ADL=5,92 (3,86) (Z=-0,831; p=0,40); inicial NPI=13,92 (16,87); final NPI=10,54 (10,69) (Z=-0,737; p=0,46)]. CONCLUSÃO: Assim como os pacientes de países desenvolvidos, esquizofrênicos de início tardio no Brasil não evoluem para demência, ao menos ao longo de um ano.

BACKGROUND: Cognitive deficits of late-onset schizophrenia (LOS) patients have been reported as stable, although some prospective studies show that a sub-group develop a significant cognitive decline. Data on LOS from developing countries are scarce. OBJECTIVE: To evaluate the cognitive performance of Brazilian patients with LOS over the course of one year. METHOD: Thirteen LOS patients were evaluated at baseline and after one year with the Mini-Mental State Examination (MMSE), the CAMCOG, the Positive and Negative Symptoms Scale, the Pfeffer’s Activities of Daily Living (ADL), and the Neuropsychiatric Inventory (NPI). RESULTS: Cognition and activities of daily living remained stable over the course of one year [baseline MMSE= 21.31 (4.87) and CAMCOG=80.31 (16.68); end-point MMSE=20.77 (3.86) and CAMCOG=82.92 (14.42) (Z=-0.831; p=0.40); baseline ADL=4.31 (5.65); end-point ADL= 5.92 (3.86) (Z=-0.831; p=0.40)]; end-point NPI=10.54 (10.69) (Z=-0.737; p=0.46]. CONCLUSION: Like patients from developed countries, Brazilian patients with LOS do not seem develop dementia, at least over the course of one year.

A síndrome de Kleine-Levin é caracterizada por hipersônia periódica, hiperfagia, desinibição sexual e outras alterações do comportamento. O prognóstico é geralmente benigno, com funções cognitivas e sociais normais após os episódios. Descrevemos um caso típico de síndrome de Kleine-Levin associada com declínio acadêmico, sequela neuropsicológica e alterações da personalidade após o segundo episódio da síndrome. Estudos adicionais sobre a história natural da doença são necessários para, por exemplo, determinar se a intervenção terapêutica precoce melhoraria o prognóstico a longo prazo.

Kleine-Levin syndrome is characterized by periodic hypersomnia, hyperphagia, sexual disinhibitions and behavioral disturbances. The prognosis is generally benign, with normal cognitive and social functions after the episodes. We describe a typical case of Kleine-Levin syndrome associated with apparent academic decline, neuropsychological sequelae and personality alterations after the second episode of the illness. Further research in the natural history of Kleine-Levin syndrome is needed, for example, to determine whether early intervention would improve long-term prognosis.