Biomedical subjects
Publications and source records attributed to G Cygielman.
Hallucinations are a well-recognized phenomenon in a dissociative state. In reference to conversion states, sensations may be distorted or inhibited but overstimulation to the extent of hallucination has not yet been recognized. We wish to offer a hypothesis of conversion hallucinations based on two detailed case reports, with a possible mode of action and in combination with the cognitive and dissociative models.
Urinary MHPG (3-methoxy-4-hydroxyphenylglycol) amounts increased threefold during a toxic delirious state in a 57-year-old bipolar patient 3 days after phenelzine treatment was stopped. This norepinephrine metabolite was not expected to rise as monoamine oxidase (MAO) was completely blocked. In addition, the delirious state appeared as a rebound phenomenon and not an acute toxic state during drug administration. It seems that phenelzine acts more through catecholamine release phenomenon than by inhibition of MAO.
Plasma cortisol levels of 41 patients suffering from major depressive episodes were measured at 4 p.m. and 10 p.m. one day after administration of 1 mg dexamethasone at 10 p.m. Comparison of cortisol results to clinical improvement measured by the Beck Depression Inventory before and after 5 weeks of treatment with either ECT, chlorimipramine, amitriptyline, or phenelzine showed no difference between nonsuppressors and suppressors in relation to clinical improvement. Clinical prediction of the outcome of acute response to these treatments using an initial DST does not seem feasible.
The term 'masked depression' is not accepted in current psychiatric classification for three basic reasons: (1) It is not a unique type of a disease or a syndrome, but a state or a stage which is a part of the depressive syndromes. (2) No special list of symptoms which has enough specificity, reliability and validity can be drawn in order to describe this state. (3) The term 'masked' is vague, and is in contradiction to the basic necessity to describe what is observed in contrast to what is unobservable and masked. However, precise and scientific criteria may be unsuitable for diagnostic purposes in these cases which are quite common; thus an entity which has a deep meaning and begs recognition among general physicians may be ignored. In addition, diagnosis of such depression is very important to allow for suitable and adequate treatment procedures. Diagnostic problems, clarification of the term 'masked' and the procedures of diagnosis are discussed in the article.
Reports of conversive hallucinations are rare in the literature. A case is presented describing the psychogenesis and phenomenology of hallucinations experienced by a female patient.
A 55-year-old man suffered from compulsive sleep episodes as a manifestation of masked depression. Although the overt symptoms were conversive in nature, the treatment which finally focused on the depression was followed by disappearance of the patient's recurring sleeping spells for the first time in 4 years. Three methods were used: a) supportive psychotherapy, b) behavior therapy, and c) antidepressive medication. We conclude that the behavior treatment indirectly revealed the masked depression previously concealed by rigid defense mechanisms.