RESUMEN
AIM: To examine possible risk factors for the doctor to be killed by the patient in the clinical practice by examining a series of murders that involved physicians. METHODS: This aim has been achieved through a retrospective review on clinical cases of doctors killed by patients within the period between 1988 and 2013, in Italy. RESULTS: In this period 18 Italian doctors have been killed in the workplace, with a rate of 0.3/100,000. In 7 cases, the murder resulted in the context of doctor-dissatisfaction; in 7 cases the murder was committed by a psychiatric patient; 1 case in the context of a stalking; 3 cases occurred in a workplace which was not safe enough. Four categories of at-risk contexts have been identified. One category includes a murder in the context of a doctor-dissatisfaction, perceived by patient. The second category concerns murders committed by patients suffering from mental illness. A third category includes homicides in a workplace which is not safe. The last category comprises the murder in the context of stalking. CONCLUSIONS: These categories identify specific dangerous situations for physicians, in which are highlighted elements that have played a crucial role in the murder and for which special precautions are suggested preventive.
Asunto(s)
Homicidio/prevención & control , Homicidio/psicología , Relaciones Médico-Paciente , Homicidio/estadística & datos numéricos , Humanos , Italia/epidemiología , Trastornos Mentales/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Acecho/epidemiología , Violencia Laboral/estadística & datos numéricosRESUMEN
The purpose of the present study is to point out suicidal contagion and suicidal collusion describing clinical cases, to improve professional skills in suicidal risk evaluation and management. In suicide contagion we described three typologies of contagion between therapist and patient: 1) suicide contagion of the environment on the therapist and on the patient; 2) suicide contagion of the therapist on the patient; 3) suicide contagion of the patient on the therapist. We described also four typologies of suicidal collusion with specific kind of patients: 1) with patient suffering of physical illness; 2) with patient suffering of a serious mental illness; 3) with manipulative patients; 4) with patient who is aggressive toward himself and toward other people. In conclusion we pointed out the importance of an adequate recognizement and management of suicidal contagion and collusion to decrease patient suicidal risk.
Asunto(s)
Competencia Profesional , Relaciones Profesional-Paciente , Suicidio/psicología , Adulto , Enfermedad Crónica/psicología , Contratransferencia , Femenino , Humanos , Maquiavelismo , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Grupo Paritario , Influencia de los Compañeros , Psicoterapia/métodos , Medición de Riesgo , Factores de Riesgo , Conducta Autodestructiva/psicología , Intento de Suicidio/psicología , Prevención del SuicidioRESUMEN
AIM OF THE STUDY: This study tried to identify risk factors of aggressive behavior in a population of schizophrenic inpatients. We tested the association between aggressive behavior and socio-demographic characteristics, addictive disorders, history of suicide attempt, and sexual violence, impulsivity, and sensation seeking. METHODS: All consecutive schizophrenic inpatients (100) were assessed during 6 months. Aggressive behavior was quantified with a standardized scale, the Overt Aggression Scale (OAS). We studied socio-demographic characteristics and the history of suicide attempt and sexual violence with a specific standardized questionnaire. Addictive disorders were identified with the Fagerström and CAGE questionnaires and with the DSM-IV-R diagnostic criteria for nicotine, alcohol, cannabis opiates, and cocaine abuse and dependence disorders. Lastly, we studied sensation seeking with the Zuckerman scale and impulsivity with the Barratt scale. RESULTS: Linear regression identified four factors associated with aggressive behavior: male gender (odd ratio = 12.8), history of sexual violence (odd ratio = 3.6), Fagerström score (odd ratio = 1.3), number of cigarettes smoked each day (odd ratio = 1.16). Patients with nicotine use or dependence had significantly higher levels of OAS scores. This difference was not observed between patients with or without alcohol dependence. OAS scores were correlated to the number of cigarettes smoked each day and to Fagerström scores. Patients with a higher level of sensation seeking and impulsivity also had higher OAS scores. CONCLUSION: A typical schizophrenic patient at risk of showing aggressive behavior is a man, who smokes and presents a history of sexual violence.
RESUMEN
We describe, thirteen psychopathologic dynamics based on defense mechanism and primary process thinking, that could determined an homicide committed by a patient with schizophrenia. The purpose of this study is to allow: a) to improve diagnosis of the homicidal act; b) to emphasize psychopathological elements which can be treated by specific forensic psychotherapy; c) to prevent an homicidal recidivism through evaluation of risk passing to the homicidal act.
Asunto(s)
Homicidio , Trastornos Mentales/psicología , Psicología del Esquizofrénico , Adulto , Humanos , Masculino , Factores de Riesgo , Adulto JovenRESUMEN
In the present study, we describe fourteen therapists' reactions (Avoidance, Rejection, Suicidal collusion, Over-involvement, Overprotection, Loss of patients' responsibilities, Loss of therapists' responsibilities, Reaction to the feeling of being exploited, Creation of dependency, Manipolatory acting out, Feeling of undergoing an iniquity, Patients psychopathology inflation, Therapists' psychopathology inflation, Suicidal Burnout Syndrome), based on emotions, behaviors and cognitivity, toward patients with suicidal risk. These responses can interfere with a correct assessment and management of suicidal risk in psychiatric patients. The purpose of the present clinical study was to improve therapist's professional skills through the recognition and management of his own responses to suicidal patients.
Asunto(s)
Contratransferencia , Psicoterapia , Prevención del Suicidio , HumanosRESUMEN
We described thirteen typologies of the therapist countertransference toward the patient with mental disorder and violent behavior. The purpose of this study is to improve: a) the ability of the therapist to mentalize emotions without any passing to the act; b) the recognition of the patient transference; c) the recognition of the countertransference related to mental disorder and violent behavior.
Asunto(s)
Contratransferencia , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Psicoterapia/normas , Reconocimiento en Psicología , Violencia/prevención & control , Adulto , Emociones , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Psicoterapia/métodos , Violencia/psicologíaRESUMEN
AIM OF THE STUDY: Exercise dependence is an inadequate pattern of exercise leading to clinically significant negative consequences. Subjects present loss of control of their physical activity, tolerance, and withdrawal symptoms when they do not practice sport. We studied the prevalence of exercise dependence among clients of a Parisian fitness room. We also assessed alcohol and nicotine use disorders, 2 other "socially tolerated" behavioral addictions (compulsive buying and Internet addiction), and 2 disorders related to anxiety focused on the body (bulimia and hypochondria). METHOD: All clients of the fitness room 18 years and older were invited to participate in the study. Three hundred subjects were included; 125 (42%) presented diagnostic criteria of exercise dependence. Unsurprisingly, exercise dependents spent more hours each day in the fitness center practicing (2.1 vs 1.5 hours per day). They went to the fitness center more often each week (3.5 vs 2.9 days per week). Exercise addicts smoked less; alcohol consumption was equivalent in both groups. Compulsive buying was significantly more frequent in exercise dependents (63% vs 38%), which means they scored higher in the compulsive buying scale (5.4 vs 4.1). Prevalence of hypochondria was equivalent in both groups, but scores in the Whiteley Index of Hypochondria were higher (4.1 vs 3) in the exercise-dependent group. Bulimia was significantly more frequent among exercise dependents (70% vs 47%), who also presented a higher number of bulimic episodes each week (2.5 vs 1.3). Subjects with exercise dependence spent more time on their computer each day (3.9 vs 2.4 hours per day). We found no difference regarding time spent using Internet, the number of e-mails sent or received, and their time at speaking on a cellular phone. CONCLUSION: Our results lead to systematically study the addictive relation to exercise among regular clients of the fitness rooms. Exercise addicts are exposed to negative consequences for their excess of physical activity. Exercise addiction is also associated to compulsive buying, bulimia, and, in a lesser extent, hypochondria.