BackgroundPersons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics.MethodsLatent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3–70) years.ResultsFive distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability.ConclusionsThe identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1426-8) contains supplementary material, which is available to authorized users.

Background There has been substantial increase in the number of people with mild intellectual disability (MID) or borderline intellectual functioning referred to long-term care. Insight into the specific characteristics and needs of these people is essential to provide appropriate support and gain insight into the increase in referrals. Method This retrospective descriptive study was based on a structured case analysis of a sample of 250 participants.Results Mental health problems and exposure to social and familial disadvantages were common. Care provided before referral tended to be suboptimal. Individuals with borderline intellectual functioning had more personal and contextual problems than people with MID. Conclusion People with MID or borderline intellectual functioning are confronted with a wide range of complex problems; even after years of professional support they may still need intensive support. Differences in the characteristics and contexts between individuals with MID or borderline intellectual functioning require further exploration.

Starting from atypical psychosis as a model of a psychotic entity typically associated with states of altered consciousness, and having as organic and physiological comparative models epileptic psychosis and dream, respectively, the authors seek to establish a fundamental condition for these phenomena. Then, assuming a phenomenological perspective, we analyze the latest neuroscientific findings in the field of psychosis, including schizophrenia, trying to extrapolate the findings obtained in atypical psychoses to all forms of psychosis, achieving a defining principle of psychosis. We conclude that psychosis consists in a disturbance of consciousness, namely, of a pre-reflective consciousness. This will be dependent on a complex neural system which, starting from a primordial feeling of Self, differentiates and branches out through higher brain structures along the ontogenetic development. A significant interference on the connectivity of this system leads to a commitment of effective intentionality in the psychotic individual, with a discontinuity in the search for meaning, and interaction of individuals in the world, where the regulation of primitive emotional tendencies for higher cognitive components is lost.

Children with Gender Identity Disorder (GID) show a strong preference for sex-typed behaviors more characteristic of the opposite sex and a rejection or avoidance of sex-typed behaviors more characteristic of one's own sex. There are also signs of distress and discomfort about one's status as a boy or a girl, including verbal expressions of dislike or disgust about one's genital anatomy. The behaviors that characterize GID in children occur in concert, not in isolation. It is this behavioral patterning that is of clinical significance, and recognition of the patterning is extremely important in conducting a diagnostic assessment. The authors describe the case of a 6-year-old boy with GID. The clinical referral occurred 3 years after the onset of the condition, at the age of 6, when his parents begin to feel that the pattern of behavior was no longer a "phase" and worried about the implications of his symptoms in his academic and social life. This case illustrates some of the problems of the diagnosis, assessment, associated psychopathologies, developmental trajectories and therapeutic strategies for childhood GID, including parental considerations.

Narcolepsy is a disabling sleep disorder affecting 0.02% of adults worldwide. It is characterized by irresistible daytime sleepiness, catalepsy and can be associated with sleep paralysis, and hipnagogic hallucinations. The treatment is essentially symptomatic with stimulant drugs (mostly dopaminergic) for daytime sleepiness and sleep attacks, antidepressants (mostly noradrenergic) for catalepsy and hypnotics for disturbed night-time sleep. Special care must be taken, with close blood monitoring for toxicity, in the prescription of these drugs to patients with concurrent renal or hepatic disease. The authors present a case of a 72 year-old female patient with the diagnoses of narcolepsy and conjoint severe chronic renal and hepatic insufficiency, with intolerance for most of the recommended treatments for her sleep disorder. The patient is observed in a psychiatric consultation after several bone fractures due to cataleptic phenomena. We describe a successful therapeutical approach with reboxetine, with a significant improvement in daytime sleepiness, reflected by a decrease of 52% on the Epworth Sleepiness Scale. Furthermore, a significant reduction in the cataplexy subscore of the Ullanlinna Narcolepsy Scale was also found. Consequently, this treatment led to a decrease in the frequency of catalepsy attacks and secondary traumatic injuries and an increase in the Global Assessment of Functioning scale.

The imprecise status of Psychiatry may be due to Cartesian dualism and the mind / body assumption. We can clarify this status resorting to an alternative ontology. Popper's Worlds 1, 2 and 3, and the corresponding concepts of matter, energy and information, from Von Bertalanffy and his General Systems Theory, are candidates for a new ontology. Applying them to the history and present structure of Western Medicine, we can assume that General Surgery is the branch of medicine which deals with bodily matter, Internal Medicine deals with energy and Psychiatry is the branch which deals with information. The respective basic disciplines are Anatomy, Physiology and Psychology. None of them is a medical specialty, because specialties, such as Neurology, Urology and Cardiology, deal with a sub-system of the organism and may have a surgical, medical or even psychiatric emphasis. In the same way that the body / mind problem seemed important for Cartesian dualism, this triadic structure of Medicine may also inform a new ontology. The recent history of Philosophy may be interpreted as an attempt of looking for it.

The case of a 72-year-old male patient with initial depressive symptoms and visual hallucinations, added to a progressive motor and cognitive neurological impairment, is presented. The patient died of pneumonia 7 weeks after the onset of the symptoms; the necropsy confirmed the diagnosis of Creutzfeldt-Jacob disease (CJD) suggested previously by complementary diagnostic tests (brain magnetic resonance imaging, electroencephalogram, 14-3-3 protein determination in the cerebrospinal fluid and study of the prionic protein gene). Discussion: CJD is a rare dementia characterized by a rapidly progressive course. Psychiatric symptoms, including depression and personality change, occur early in the clinical course in about a third of patients, being estimated in some studies that 10% of patients are first admitted to psychiatric wards. Psychiatric symptoms associated with CJD have often lead to erroneous initial diagnoses of functional psychosis, depressive pseudodementia, or hysteria. Analysis of the psychiatric symptoms does not suggest specific features that rapidly allow the differentiation from more common psychiatric disorders, although the occurrence of associated persistent sensory symptoms may raise the possibility of this diagnosis. Later, the characteristic rapidly progressive neurological impairment is decisive in the affirmation of the diagnosis of CJD.

After the original description of the Ganser syndrome (GS), in 1898, there has been a great debate over the etiological primacy of either hysteria or psychosis (including organic states). Even now, despite the DSM-IV classification of GS as a dissociative disorder, this condition remains an extensively misunderstood condition. Not only has it been reported in association with various functional psychiatric disorders but also as organic states, most often in patients with head injury and stroke, especially those involving the frontal lobes. A case of GS in a 47-year-old male patient admitted in the psychiatry ward due to a reactive depressive syndrome along with a personality disorder is presented. Throughout his stay in the inpatient unit, the patient developed a full blown GS after defenestration-in a paranoid contextwith consequent head-trauma and internal hemorrhage in the fronto-temporal region of the dominant hemisphere. The case illustrates some of the problems of nosology, clinical presentation, and psychopathology that this syndrome raises. The authors discuss the etiological dilemma and the complexities of the diagnosis of GS in the presence of an organic lesion accompanied by an overwhelming emotional component.