Self-mutilation is understood as any willful gesture or alteration of the body tissue without a suicidal intent. The most common self-mutilating gestures are, to a great extent, those that are superficial or moderate, such as cuts, burns, or bites. The most severe, as is the case of genital self-mutilation (GSM), are extremely rare and, in most cases, observed in patients suffering from psychosis. Furthermore, they are mostly reported from a surgical standpoint. Here, we report the case of a 20-year-old female patient who resorted to the emergency department after having amputated her clitoris with surgical scissors. This dramatic gesture, coupled with the patient's narrative, prompted for differential diagnosis between a psychotic syndrome and a severe personality disorder. We propose that, despite the magnitude of the self-harm, it is possible to conceptualize this GSM within a disturbed personality with significant sexuality issues and, therefore, this case report aims to broaden the limits that have been associated with the self-mutilating gestures in borderline personality disorder.

IntroductionJealousy is a complex emotional state and some degree is considered normal in mature love, but when does it become destructive in a relationship? There's a thin line between what is normal and what is pathologic. Pathological jealousy differs from normal by its intensity and irrationality. Obsessive and delusional jealousies are different types of pathological jealousy, difficult to distinguish, which is important, since they have different treatment. Despite the differences, both result in significant distress and carry the risk of homicide/suicide, so it's a matter deserving the psychiatrists’ attention.ObjectiveExplore the psychopathological differences between obsessive and delusional jealousy and list the characteristics and difficulties in the approach to pathological jealousy.MethodsThe results were obtained searching literature included on the PubMed and Google Scholar platforms.ResultsDelusional jealousy is characterized by strong and false beliefs that the partner is unfaithful. Individuals with obsessive jealousy suffer from unpleasant and irrational jealous ruminations that the partner could be unfaithful, accompanied by compulsive checking of partners’ behavior. This jealousy resembles obsessive-compulsive phenomenology and should be treated with SSRIs and cognitive-behavioral therapy. Delusional jealousy is a psychotic disorder and should be treated with antipsychotics.ConclusionThe common issue in pathological jealousy is the problem of adherence to treatment and bad prognosis. In order to achieve better treatment outcomes, we should follow-up the patient regularly. One key factor is to explore the psychopathology and motivate the sufferer for the proper pharmacological and psychotherapeutic interventions, trying to reduce the suffering caused by ideas of unfaithfulness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe patient readmission is commonly associated with the failure of the previous hospitalization/admission and is an important psychiatric and economic issue. Furthermore, it is still source of frustration to patients, their families and the teams treating them.MethodsThe authors propose a retrospective study investigating all the readmissions within 28 days of the last discharge in the general adult psychiatry ward of a portuguese hospital (Aveiro Hospital) from 2011 to 2013 in order to characterize the reasons and factors (social, demographic and clinical) involved.ResultsOver the total 1994 discharges, 88 were readmited, yielding a readmission rate of 4.4%. The main diagnose was Schizophrenia, schizotypal and delusional disorders, according to icd 10, and the main reasons for readmission were suicide and psychosis. Most previous hospitalizations have lasted less than the average length of stay during the considered period of time.ConclusionsEvaluating the characteristics of readmissions promotes a better understanding of the whole process in order to devise a strategy for prevention and improvement of mental health services.

Background Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common hereditary subcortical vascular dementia, and it is caused by a broad spectrum of mutations in the NOTCH3 gene on chromosome 19. Aims The authors intend to review the clinical patterns of the condition and expose the variability of its radiological and genetic data. Furthermore, its diagnostic strategies and available treatments are also clarified. Methods Brief description of a clinical case and review of literature collected from online medical databases under the keywords 'CADASIL', 'dementia" and 'genetic". Results (including clinical vignette) The authors report a case of a 67-year-old woman with history of late onset migraine and polymorphic psychiatric and neurologic symptoms, which further evaluation confirmed the CADASIL diagnosis. The involutive course of her condition is also emphasized as well as its devastating social and familiar consequences. Literature on CADASIL is vast and confirm that its phenotype is variable between and within affected families, with new clinic features continually arising. Nevertheless, main pattern consists in migraine with aura (often atypical or isolated), strokes, cognitive decline/dementia and psychiatric symptoms. Diagnosis is confirmed either by identifying a pathogenic NOTCH3 mutation or by the demonstration of specific granular osmiophilic material in skin biopsies. So far, only symptomatic treatment is available. Conclusion CADASIL is notably underrecognized and underdiagnosed. Authors consider it deserves greater awareness from psychiatrists, since it brings great suffering for the patients and their families, as well as high demand for non-psychiatric care.

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