[Rocuronium and sugammadex use for the management of neuromuscular blockade in urgent abdominal surgery in a patient with Landouzy-Dejerine myopathy]

In patients with neuromuscular diseases, the use of rocuronium in the general anesthesia rapid sequence induction provides safety intubation conditions, but induces a deep and prolonged neuromuscular blockade. We report dose reduction to 0.8mg/kg for a 47-year-old female with Landouzy-Dejerine myopathy. Therefore, less dose of sugammadex was given to reverse the neuromuscular block.

Capgras’ syndrome: A case report

Introduction

The delusional misidentification syndromes (syndromes of Frégoli, Intermetamorphosis, Subjective Doubles and Capgras) are characterized by delusions of misidentification of other persons or of one-self. Aggressive ideas or behaviours often go with these delusions, but the problem received relatively little attention. Capgras’ Syndrome is characterized by the delusional belief that a well-known person has been replaced by a double. The delusion frequently involves significant others and takes place in a paranoid atmosphere with feelings of strangeness and unreality. We stress the importance of considering the potential dangerousness and homicidal acts directed towards family members of patients with Capgras’ Syndrome.

Methods

We report a case with histories of paranoid schizophrenia and alcohol and cannabis intoxications who developed a Capgras’ Syndrome associated with homicidal behaviours toward his wife.

Results

Our case met DSM IV-TR diagnostic criteria for paranoid schizophrenia, according to previous studies which show that paranoid schizophrenia is the most frequent mental disorder associated with delusional misidentification. The psychopathological analysis show that homicidal acts are connected to anguish of the ego disintegration and failure of defense mechanisms.

Conclusions

According to the most recent literature, our findings suggest that Capgras’ Syndrome may be linked to a genesis of aggressive behaviours; alcohol and substance intoxications facilitates impulsivity and dissociation. The patients’ acting out directed toward family members occurs during a psychotic breakdown. Capgras’ Syndrome should always be evaluated in order to prevent violent acts.

Psychometric correlations between MMPI-2 and aggressivity

Introduction

The use of standardized and objective instruments constitutes a support to the clinical observation in order to evaluate particular and general aspects of an individual's psychic life, and it can represent a valid aid in the evaluation and prediction of aggressivity. Our aim is the assessment of the MMPI-2 ‘s predictive capacity, a self-report personality test, constituted of 567 items, evaluating possible aggressive acts.

Method

20 subjects with a history of aggressivity, in the absence of major psychiatric disorders, were examined. The MMPI-2 test was administered to them, so as to assess their profile with reference to the aggressivity's indicators. It was also administered to a control group of subjects without a history of aggressivity.

Results

In all the examined offenders, unlike the control group, were observed low T values in the K scale (< 40), an increase in the Pd base scale (>65) and supplemental scale O-H (>65); with respect to the derivative indexes, it was noticed a scarce adaptive capacity (Hy< Pa), a low tendency to the tolerance of frustrations and a negative value at T points in the PAI (Hy+100)-(Pd+2Pa).

Conclusion

In concordance with the literature data, the MMPI-2 can be a useful support in evaluating the risk of aggressivity. Subjects at risk of acting out show low values in the K scale (< 40), high values in the Pd scale (>65). Other particularly important risk indicators are: code types 4/6, 4/8, 468, a scarce adaptive capacity (Hy< Pa) and a scarce tolerance to frustrations.