Posttraumatic stress disorder and somatic complaints: Contrasting Vietnam and OIF/OEF Veterans' experiences

ObjectiveTo replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans.MethodData were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n = 185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms.ResultsThere were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p < .05), fainting (p < .01), and shortness of breath (p < .001), whereas OIF/OEF Veterans were more likely to complain of headaches (p < .001). A significant interaction effect occurred between service era and dizziness (p < .05) and chest pain (p < .01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD.ConclusionFindings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.     

The association between number and type of traumatic life experiences and physical conditions in a nationally representative sample

Objective

Posttraumatic stress disorder (PTSD) is significantly and positively associated with several physical conditions. We aimed to examine whether the nature and number of trauma(s) experienced may be related to physical conditions using a population-based sample.

Methods

Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N= 34,653; age 20 years and older). Participants indicated lifetime trauma experiences and physical conditions experienced over the past year. Multiple logistic regressions examined the association between type and number of trauma(s) and physical conditions.

Results

After adjusting for sociodemographics, Axis I and II mental disorders, and all other trauma, injurious and witnessing trauma were significantly associated with all the assessed physical conditions. Psychological trauma was associated with cardiovascular and gastrointestinal diseases, diabetes and arthritis. Natural disaster/terrorism was associated with cardiovascular disease, gastrointestinal disease and arthritis only. Finally, combat-related trauma and other trauma were not positively associated with any physical condition. Our results also suggested a dose–response relationship between number of traumatic events and physical conditions.

Conclusion

These data suggest that the impact of certain types and number of traumas may differ with respect to their relationship with physical health problems independent of PTSD.     

Trauma type as a conditional risk factor for posttraumatic stress disorder in a referred clinic sample of adolescents

IntroductionTraumatic experiences that are varied in type and severity may lead to the development of Posttraumatic Stress Disorder (PTSD). Some trauma types present a higher conditional risk for PTSD owing to their nature and impact on growth and functioning. Few studies have investigated the conditional risk of PTSD in clinic referred adolescents in low- and middle-income countries. The aim of the study was to determine the conditional risk for PTSD based on various trauma types (car accidents, other serious accidents, fires, witnessing a natural disaster, witnessing a violent crime, being confronted with traumatic news, witnessing domestic violence, physical abuse and sexual abuse) and to stratify risk by gender.MethodAdolescents exposed to at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) qualifying trauma were referred to a research clinic in Cape Town, South Africa (n = 216). PTSD status was assessed using a clinician administered interview. Conditional risk was determined using backwards stepwise multiple logistic regression analysis for 1) the whole sample, 2) females only and 3) males only. Gender differences in exposure to trauma types were determined using chi-square tests and cross-tabulation.ResultsThe prevalence of PTSD was 48.1% in the whole sample. Age (β = .16, p = .048, OR 1.17), fire exposure (β = 2.32, p = .036, OR 10.12) and sexual abuse (β = .93, p = .001, OR 2.54) were significant predictors of PTSD in the whole sample with the model explaining 12.4% of the variance in PTSD status. Age (β = .22, p = .041, OR 1.24) and sexual abuse (β = .87, p = .018, OR 2.39) were significant predictors of PTSD in female participants and explained 9.8% of the variance in PTSD status. Being a victim of a violent crime (β = .78 p = .100, OR 2.19) was the only remaining predictor of PTSD in male participants and showed a trend towards significance. The model explained 7% of the variance in PTSD status.ConclusionsThe findings underscore the importance of timely identification of trauma, particularly, sexual abuse and violence. Longitudinal tracking of adolescents exposed to different trauma types may identify those in need of treatment and enhance our understanding of the lasting impact of trauma.     

Development of Exposure to Combat Severity Scale of the Combat Experiences Questionnaire (CEQ)

Combat exposure is detrimental to physical and mental health, and is an important risk factor for Post-traumatic Stress Disorder (PTSD). The current study aimed to develop the first section of a self-report measure (Combat Experiences Questionnaire – CEQ), and to explore its psychometric properties on Portuguese Overseas War Veterans. The Exposure to Combat Severity Scale (CEQ A), assesses the exposure severity to objective scenarios related to military combat, common to contemporary and older theaters of operations. Studies included structural analysis through Rash Model, internal consistency, convergent validity (n = 708), temporal reliability (n = 112) and sensibility to differentiate war Veterans with and without war-related PTSD (N = 40 and N = 47, respectively). The scale's structure presented adequate fit to the data, adequate psychometric properties, and discriminant validity. Thus, the CEQ A is a valid and reliable tool presenting diverse combat scenarios to assess severity of combat exposure in war Veterans.     

Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard Soldiers deployed to Iraq and Afghanistan

ObjectiveAlthough women in the military are exposed to combat and its aftermath, little is known about whether combat as well as pre-deployment risk/protective factors differentially predict post-deployment PTSD symptoms among women compared to men. The current study assesses the influence of combat-related stressors and pre-deployment risk/protective factors on women's risk of developing PTSD symptoms following deployment relative to men's risk.MethodParticipants were 801 US National Guard Soldiers (712 men, 89 women) deployed to Iraq or Afghanistan who completed measures of potential risk/protective factors and PTSD symptoms one month before deployment (Time 1) and measures of deployment-related stressors and PTSD symptoms about 2–3 months after returning from deployment (Time 2).ResultsMen reported greater exposure to combat situations than women, while women reported greater sexual stressors during deployment than men. Exposure to the aftermath of combat (e.g., witnessing injured/dying people) did not differ by gender. At Time 2, women reported more severe PTSD symptoms and higher rates of probable PTSD than did men. Gender remained a predictor of higher PTSD symptoms after accounting for pre-deployment symptoms, prior interpersonal victimization, and combat related stressors. Gender moderated the association between several risk factors (combat-related stressors, prior interpersonal victimization, lack of unit support and pre-deployment concerns about life/family disruptions) and post-deployment PTSD symptoms.ConclusionsElevated PTSD symptoms among female service members were not explained simply by gender differences in pre-deployment or deployment-related risk factors. Combat related stressors, prior interpersonal victimization, and pre-deployment concerns about life and family disruptions during deployment were differentially associated with greater post-deployment PTSD symptoms for women than men.     

Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample

Background

Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD.

Methods

Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis.

Results

PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01).

Conclusion

The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.     

Posttraumatic stress disorder in OEF/OIF veterans with and without traumatic brain injury

Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are presenting with high rates of co-occurring posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to compare the clinical presentations of combat-veterans with PTSD and TBI (N = 40) to those with PTSD only (N = 56). Results suggest that the groups present two distinct clinical profiles, with the PTSD + TBI group endorsing significantly higher PTSD scores, higher overall anxiety, and more functional limitations. The higher PTSD scores found for the PTSD + TBI group appeared to be due to higher symptom intensity, but not higher frequency, across PTSD clusters and symptoms. Groups did not differ on additional psychopathology or self-report of PTSD symptoms or executive functioning. Further analysis indicated PTSD severity, and not TBI, was responsible for group differences, suggesting that treatments implicated for PTSD would likely be effective for this population.     

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence,Characteristics, and Psychiatric and Functional Burden

ObjectiveTo characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.Design and SettingA nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020.ParticipantsU.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60–99).MeasurementsPTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD.ResultsThe vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%–10.9%) and 68 (1.9%, 95% CI: 1.3%–2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning.ConclusionSubthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.     

Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans

OBJECTIVE: Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. METHOD: The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. RESULTS: Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. CONCLUSIONS: The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.     

Longing for existential recognition: A qualitative study of everyday concerns for people with somatoform disorders

Objective

Patients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life.

Methods

A cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory.

Results

A major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) “existential misrecognition” covered the experience of being met with distrust and disrespect, 2) “uncertain existential recognition” covered experiences of unclear communication and a perception of not being totally recognized, and 3) “successful existential recognition” covered experiences of total respect and understanding. “Misrecognition” and “uncertain recognition” related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas “successful recognition” related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal.

Conclusion

Different modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.     

Que changent les « entendeurs de voix » à l’écoute des hallucinations ? II. Recherches sur l’entente de voix

Objectives

Several studies have shown the high prevalence of experiences of acoustic-verbal hallucinations (so-called “voices”) in non-psychiatric individuals. From the 1980s was constituted an international movement – the “voice hearers” – who relativize but also fertilize the clinical knowledge on the listening of hallucinations. This paper proposes to question some of aspects of the debate on “voice hearers” when integrating it within the broader contemporary models attempting to account for “psychotic-like experiences” or “exceptional experiences”.

Materials

A brief review of scientific literature on these experiences help to compare psychiatric, psychoanalytic and more specialized researches on “voice-hearing”. We also compare classical clinical positions with new ones.

Results

It appears that “voice-hearers” introduce a reversal of some classical prejudices, in moving towards a treatment of psychotic-like experiences as if they were neurotic expressions. Paranormal and spiritual interpretations of voices are ubiquitous in many studies of voice hearing, and even are outstanding examples of salutogenic appraisals of psychotic-like experiences. The research on the type of appraisal along the axes of internal/external or personal/impersonal provides direct guidance on clinical intervention strategies.

Conclusions

No longer focusing on the “what” but rather on the “how” of hallucinations experiences helps to avoid some biases relative to the assessment of beliefs – especially unusual beliefs – in the clinical setting. As the figurehead of the broader movement of “recovery”, the Hearing Voices Movement offers a competitive clinical practice, but failed to provide a true differential clinical practice starting from a neutral name referring to several psychopathological pathways that need to be distinguished.     

Proinflammatory milieu in combat-related PTSD is independent of depression and early life stress

BackgroundChronic inflammation may be involved in combat-related post-traumatic stress disorder (PTSD) and may help explain comorbid physical diseases. However, the extent to which combat exposure per se, depression, or early life trauma, all of which are associated with combat PTSD, may confound the relationship between PTSD and inflammation is unclear.MethodsWe quantified interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP) in 51 combat-exposed males with PTSD and 51 combat-exposed males without PTSD, and assessed PTSD and depression severity as well as history of early life trauma. To decrease the possibility of Type I errors, we summed standardized scores of IL-1β, IL-6, TNFα, IFNγ and CRP into a total “pro-inflammatory score”. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale (CAPS) rating scale.ResultsSubjects with PTSD had significantly higher pro-inflammatory scores compared to combat-exposed subjects without PTSD (p = 0.006), and even after controlling for early life trauma, depression diagnosis and severity, body mass index, ethnicity, education, asthma/allergies, time since combat and the use of possibly confounding medications (p = 0.002). Within the PTSD group, the pro-inflammatory score was not significantly correlated with depressive symptom severity, CAPS total score, or with the number of early life traumas.ConclusionsCombat-related PTSD in males is associated with higher levels of pro-inflammatory cytokines, even after accounting for depression and early life trauma. These results, from one of the largest studies of inflammatory cytokines in PTSD to date, suggest that immune activation may be a core element of PTSD pathophysiology more so than a signature of combat exposure alone.     

Natural killer cell cytotoxicity and lymphocyte perforin expression in veterans with posttraumatic stress disorder

Objective

To examine the effect of posttraumatic stress disorder (PTSD) on the measures of immune function and the hypothalamic–pituitary–adrenal axis components, and to determine whether additional life stressors affect measured variables.

Methods

We simultaneously examined the natural killer cell cytotoxicity (NKCC), perforin and glucocorticoid receptor (GCR) expression in natural killer (NK) and cytotoxic T (CD8) cells, as well as serum cortisol concentration in a group of Croatian war veterans with chronic, combat-related PTSD (n = 29) and a group of healthy, age-matched men (n = 13). PTSD patients were divided into two subgroups: compensation-seeking (n = 15) and retired or compensation non-seeking (n = 14) subjects. The former includes those involved in the process of getting disability-based army retirement as an additional life stressor.

Results

NKCC was decreased in both PTSD groups when compared to controls. Impairment of NKCC could not be attributed to the perforin expression as perforin was not decreased in comparison to controls. Moreover, the increased level of perforin was recorded in NK cells of retired PTSD subjects. Both PTSD groups shared an increased relative quantity of GCR in lymphocytes, whereas no difference between the groups in the baseline levels of serum cortisol was observed.

Conclusions

Diminished NKCC was not accompanied by perforin insufficiency in PTSD subjects, and other causes should be examined. An additional life stressor does not contribute considerably to either immune or endocrine system related changes.     

Time, before, and after time: temporal self and social appraisals in posttraumatic stress disorder

Background and objectives

In the aftermath of a traumatic event, individuals may engage in a series of comparisons in which they appraise their current functioning in relation to how they functioned prior to the traumatic event, as well as how they anticipate functioning in the future. In addition, trauma-exposed individuals may also appraise their functioning in relation to other individuals exposed to the same or similar types of traumatic events. We examine whether PTSD and non-PTSD classified individuals differ in temporal self and social appraisals.

Methods

Operation Enduring/Iraqi Freedom (OEF/OIF) combat-veterans with and without PTSD appraised their own past, current, and anticipated future functioning, as well as hypothetical other OEF/OIF veterans functioning across the same three temporal points.

Results

Individuals without PTSD appraised their own functioning as progressively improving across time. In contrast, individuals with PTSD viewed their current pre-trauma current self more favorably than their current or anticipated future self. Both groups appraised hypothetical other OEF/OIF veterans improving with time, yet individuals with PTSD evaluated other OEF/OIF veterans more favorably than those without PTSD.

Limitations

Limitations of the study include a cross-sectional design, precluding causality; the lack of a non-trauma exposed group, relatively small sample, and all-male gender of participants limit the generalizability to other populations.

Conclusions

PTSD and non-PTSD individuals differ in self and social appraisals when asked to evaluate past, present, and future functioning. Further research needs to better understand the extent to which these differences are associated with resilience to or maintenance of PTSD symptoms.     

Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results

Background

Facilitating neural activity using non-invasive brain stimulation may improve extinction-based treatments for posttraumatic stress disorder (PTSD).

War exposure,posttraumatic stress disorder,and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war

Background

High rates of posttraumatic stress disorder (PTSD) have been documented in war-affected populations. The prevalence of Complex PTSD (CPTSD) has never been assessed in an active war zone. Here, we provide initial data on war-related experiences, and prevalence rates of ICD-11 PTSD and CPTSD in a large sample of adults in Ukraine during the Russian war. We also examined how war-related stressors, PTSD, and CPTSD were associated with age, sex, and living location in Ukraine.

Method

Self-report data were gathered from a nationwide sample of 2004 adult parents of children under 18 from the general population of Ukraine approximately 6 months after Russia's invasion.

Results

All participants were exposed to at least one war-related stressor, and the mean number of exposures was 9.07 (range = 1–26). Additionally, 25.9% (95% CI = 23.9%, 27.8%) met diagnostic requirements for PTSD and 14.6% (95% CI = 12.9%, 16.0%) met requirements for CPTSD. There was evidence of a strong dose–response relationship between war-related stressors and meeting criteria for PTSD and CPTSD. Participants who had the highest exposure to war-related stressors were significantly more likely to meet the requirements for PTSD (OR = 4.20; 95% CI = 2.96–5.95) and CPTSD (OR = 8.12; 95% CI = 5.11–12.91) compared to the least exposed.

Conclusions

Humanitarian responses to the mental health needs of the Ukrainian population will need to take account of posttraumatic stress reactions. Education in diagnosing and treating PTSD/CPTSD, especially in the situation of a significant lack of human resources and continuing displacement of the population, is necessary.     

Enseignements de l’approche organo-dynamique de l’acouphène

Objective

In this article, we make a critical analysis of the Traité des Hallucinations by the French psychiatrist Henri Ey (1900–1977) and his organo-dynamic theory, that is focused on the functional pathology in contrast to the delirious hallucination. The analysis is dedicated in particular to the phenomenology of tinnitus (i.e. ringing in the ear[s]) that is currently labelled a “phantom auditory perception” by contemporary neurosciences.

Method

The analysis was conducted from a thorough reading of the psychiatric work of Henri Ey, mainly his important “Traité des Hallucinations” (2006), “Études psychiatriques” (2006) and “Neurologie et Psychiatrie” (1998). Following his warning regarding a pathological reality (hallucination) that cannot be seized “by draft and outlines”, in this report we address the understanding of the patient's discourse beyond its convergence with the experimental facts.

Results

Because he wanted to include in the pathogeny of his treatise the “most elementary one” – e.g. tinnitus in the auditory sense – Henri Ey felt in the conception he did not support himself, that is to compare hallucination to a “kind of” perception. Having distinguished the delirious from the functional hallucinations (that correlate with sensory deprivation), he could not avoid reifying them within the sensory deficit, leading again to the concept of perception. This remark can be applied to the contemporary neurophysiological model of the “phantom auditory perception”, which also casts the patient's discourse on a frame with its relativity and proportions that belong to the field of perception (“elementary” vs. “complex” phenomena).

Discussion

The paradox of drafting functional hallucination as an elementary perception supports a new perspective on suffering from tinnitus, that is not restricted to an understanding of the convergence between the subjective discourse and a sensory deficit. Beyond a reification of the subjective indication arising inside the body (i.e. tinnitus), the study of the individual enunciation of the suffering appears on the horizon of the organo-dynamic theory. A psychodynamic approach of this new issue on tinnitus has been supported by the author and a colleague.

Conclusions

Whilst today the magnetic resonance imaging seems to nullify the intersubjective reality, by showing visual correlates of this intangible phenomenon, Henri Ey allows us to recognize a surprisingly modern requirement: a psychotherapeutic listening to tinnitus patients has to be iconoclastic. If the aim is to set-up an individual dialogue with the tinnitus sufferer, the clinician must remove in his mind the images he created about it.     

Mélancolie délirante et paranoïa : diagnostic différentiel

Objectives

In this paper, the author proposes to separate delirious melancholy and paranoia, locating in these two psychoses the common points and points which are able to distinguish them clearly.

Methodology

We present the delirious melancholy according to the psychiatrist H. Ey's theory, then – with psychoanalytical approach, according notably to Lacan – we will underline three important points of reference: relationships with “fault”, with the “object”, and finally with the “Other” (Lacan).

Results

These three points will lead us to the melancholic self-accusation and to the paranoiac accusation, to the position of “exception”, and to delirious common themes.

Discussion and conclusion

Finally, we attempt to ascertain – as Freud formulated about paranoiac delirium – whether melancholic delirium could also be a “tentative of (self) cure”.