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PubMed1993

[On compulsive hand-washing--psychopathology of "touching"].

Compulsive hand-washing has been well known to the psychiatrists, since Legrand du Saulle described this disorder by the name of "délire du toucher" (1866), which refers to mysophobia or contact-phobia. But its clinical significance seems to have been not fully examined, except from the psychoanalytical point of view, that has observed the repression of sexuality in its pathology. This report presents four cases of compulsive hand-washing, and explores why they exclusively wash their hands. In order to elucidate the reason for their hand-washing and its significance, this report aims to study the relation of following three elements; "Sexuality", "hand" and "touching". As the idioms using "hand" often represent the various modes of sexual life in Japanese language as well as in English, so the "touching by hand" is reasonably considered to evoke the sexual impulsions, which the hand-washers fear and wish to avoid. On the other hand, "touching" is, necessarily in nature, to be touched by the touched object. For example, one who touches the lover's hand is inevitably to be touched by hers. That is; one is forced to be an object of one's object, which becomes to be a subject. In this sense, the act of "touching" means to lose one's "being subject" and to melt oneself into the situation where the structural distinction of subject and object can disappear. So one's act of "touching" or vivid contact with the other can cause anxiety by means of losing one's ego, which may be also a critical point to introduce to create something new. A compulsive hand-washer fears and avoids this critical moment that can make him lose his "being subject", so he "washes his hands of (cuts off relation with)" the situation that can undermine his ego. This avoidance of having contact can be compared to "the lose of vivid contact with the reality (la perte du contact avec la réalité (Minkowski)" observed in schizophrenia. In their ways of life, many hand-washers are not less autistic than the schizophrenics.om

Adult↗
PubMedDate not supplied

[Methods and transference in short term psychoanalytic therapy].

The therapist's emotional reactions and attitudes in time-limited short-term therapy are presented. Limitations of time and scope this kind of therapy must be dealt with emotionally by the therapist; emotional reactions and attitudes can be expected to vary according to the therapist's personality structure; schizoid, depressive, compulsive or hysterical. Transference in time-limited short term therapy can be very intense but is easier to indendify. This has implications for countertransference reactions caused by the patient's transference.

Adjustment Disorders↗
PubMed1996

Physicians say government-approved love affair with gambling sure bet to cause problems.

There has been an abrupt change in Canadians' attitudes toward gambling. Almost all forms of gambling used to be illegal, but cash-strapped governments have recognized this new and healthy source of revenue and have become the biggest bookies in the country. Gil Kezwer sought responses from physicians and gambling experts about the implications of Canada's love affair with all types of gambling.

Attitude of Health Personnel↗
PubMed1977

[Potomania: re-evaluation of the diagnostic tests and unusual presentation with hydronephrosis and megabladder].

Three cases of compulsive polydipsia previously diagnosed as diabetes insipidus are presented. Abnormally dilated bladder and pyelocalyceal systems were accompanying features, as previously described for diabetes insipidus, particularly of renal orign. Results of the hypertonic saline (Hickey-Hare) test were positive in only one case. Results of restriction of liquids followed by intravenous injection of vasopressin (Miller test) favoured a diagnosis of complete diabetes insipidus. These two tests cannot, therefore, exclude compulsive polydipsia. The features suggesting a diagnosis of compulsive water drinking are low plasma osmolality, a decrease in 24-hour urine output following water restriction, and abnormal behaviour. The diagnosis is confirmed by an 18-hour dehydration test done after gradual fluid restriction, which favours partial restoration of the papillary osmotic gradient.

Adolescent↗
PubMed1995

[Monoamine metabolism in different forms of paraphilias].

42 persons which commited crime sexual actions were examined in terms of clinical and neurochemical investigations. The sexual behaviours of 31 patients from this group were associated with sexual inclination pathology--with paraphilia. The patients were divided into 2 groups namely with compulsive form of paraphilia (13 individuals) and without compulsive disturbances (18 patients). Both free and conjugated forms of norepinephrine (NA), dopamine (DA), dihyroxyphenylalanine (DOPA) and dihyroxyphenylacetic acid (DOPAC) were measured in serum and daily urine as well as serotonin concentration was estimated in blood plasma and platelets. The rate of 3H-serotonin uptake into platelets (Vmax) was also investigated. It was determined that Vmax, free and especially conjugated forms of NA, DA, DOPAC levels were significantly higher in patients with compulsive forms of paraphilia. It was supposed that monoamine mechanisms may be operated in psychopathological variations of the crime sexual behaviour.

Biogenic Monoamines↗
PubMed1977

Work compulsion--a psychoanalytic study.

There are no published reports of a case of work compulsion. Such a case is described. The patient's history, the course of his analysis, and metapsychological formulations concerning the unconscious and complex meaning of work for this patient are presented. The case is discussed in relation to the relevant literature.

Adult↗
PubMed1977

[Refining the indications for atropine-coma therapy].

Atropine-comatose therapy was performed in 18 patients with schizophrenia and disorders in the framework of an obsessive-syndrome. Improvement was seen in 11 of the 18 patients. A psychopathological analysis of obsessive disorders in this group of patients demonstrated that they were characterized by manifold traits, instability, abstract content of obsessions, a tendency towards their complication and expansion of obsessional disturbances. The absence of any effect was seen in 7 of the cases. They were characterized by montony, monomorphism, everday content and by their structure were near to constitutionally conditioned psychasthenic doubtfulness.

Atropine↗
PubMed1977

On Kibarashi-gui (binge eating).

The authors presented 16 cases that displayed episodes of pathological over-eating, i.e. kibarashi-gui (binge eating). The cases were divided into three groups, and symptomatology of the eating bouts and associated psychiatric symptoms were described. Constellations of symptoms differed from group to group. The first group, Group A, was concluded as the pure kibarashi-gui (binge eaters), and Group B can be regarded as a variant of anorexia nervosa. Discussion was focused on the similarities and differences between kibarashi-gui and anorexia nervosa. Kibarashi-gui is explained as a defeat of self-control or competition. Discussions on the origin of the sex difference of eating disorder were done. And, the concept of slimness or beauty in women was assumed as the most important factor in eating disorders.

Adolescent↗
PubMed1977

Obsessional phenomena and the concept of intentionality.

Obsessional phenomena exist in a variety of character types. The particular phenomena may be of limited value in total personality assessment. Some speculative links are made between obsessional phenomena and preanal developmental steps. It is suggested that the concept of intentionality of thought and action be examined in these patients to distinguish obsessionals with core conflicts that are primarily neurotic and triadic, from those with more significant, earlier difficulty in the oral period. The concept of intentionality is related to self-object distinction, the use of projections, the sense of self, pathologic ego-superego condensation, and the existence of the ability to tolerate and recognize aggressiveness within. More accurate and rapid diagnostic distinction among obsessionals has implications for different treatment approaches.

Adult↗
PubMed1977

Compulsive water drinking: a review with report of an additional case.

Symptomatic compulsive water drinking is uncommon. The pathophysiology of compulsive water drinking is essentially that of an acute organic brain syndrome from cerebral edema. The syndrome does not occur clinically unless there is an impairment of water excretion, since normal renal function allows up to 20 liters per day excess intake without accumulation. It has been reported that about 80 percent of cases are neurotic middleaged females. In almost all cases there is at least a history of neurotic symptoms or maladaptive symptoms if the history is probed. In most reported cases the patients were psychotic. When symptoms and laboratory aberration are mild, the sole treatment is water restriction. In moderate but very symptomatic cases, treatment includes both intravenous saline and water restriction. In severe cases treatment includes water restriction, intravenous hypertonic saline, diuretics, and anticonvulsants. After the acute phase, patient education may suffice as in the above case, but if psychosis is present, appropriate therapy is indicated accompanined by frequent checks of serum electrolytes to detect early aberration.

Aged↗
PubMed1997

[Late form with psychiatric presentation of Wilson's disease, with pseudo-compulsive stereotyped movements. Neuro-radiological correlations].

Wilson's disease rarely starts after the third decade and may present with misleading psychiatric signs. We observed a 39-year-old white male who developed hysterical behaviour followed by frank delusional psychosis. Secondary neurological symptoms like astasia and dyarthria were misinterpreted as drug-induced. Despite a treatment with D-penicillamine and zinc sulfate there was further deterioration with anarthria and pseudo-compulsive stereotypies. These latter signs cleared after five months, whereas astasia and abasia remained the same and MRI imaging showed further deterioration characterized by marked bilateral putaminal cavitation. SPECT imaging could not predict the clinical evolution. Our case emphasizes that Wilson's disease can have variable initial presentations, and confirms the relationship between pseudo-compulsive stereotypies and bilateral lenticular lesions, as already described in other diseases of the basal ganglia.

Adult↗
PubMed1997

Hoarding symptoms in patients on a geriatric psychiatry inpatient unit.

BACKGROUND: While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised. METHODS: The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored. RESULTS: Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients. CONCLUSIONS: A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.

Aged↗

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