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PubMed1983

Traumatic neurosis and other injuries.

This article examines the dynamics involved in traumatic events, providing a historical perspective and presenting symptoms and treatment of such clinical syndromes as post-traumatic stress disorder, conversion disorder, somatization disorder, and others.

Accidents↗
PubMed1984

Somatoform disorders: before and after DSM-III.

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.

Adaptation, Psychological↗
PubMed1986

Functional somatic disorders. Key diagnostic features.

In diagnosis of functional somatic disorders, it is important to remember that the patient has no control over symptoms in somatization disorder, conversion disorder, psychogenic pain, and hypochondriasis. In addition, the environmental goals are recognizable only with careful history taking. Although voluntary symptom production is involved in both factitious disorder and malingering, environmental goals in the latter disorder are much more obvious. Depression can be an accompanying feature of all of these disorders; however, it is most closely linked with psychogenic pain. Atypical or masked depression should be included in differential diagnosis in elderly patients with somatic complaints. Referral to a consultation-liaison psychiatrist can help in evaluation and diagnosis of a somatic disorder. Joint consultation is the most effective way to plan treatment for this difficult group of patients.

Adult↗
PubMed2005

Are there two qualitatively distinct forms of dissociation? A review and some clinical implications.

This review aims to clarify the use of the term 'dissociation' in theory, research and clinical practice. Current psychiatric definitions of dissociation are contrasted with recent conceptualizations that have converged on a dichotomy between two qualitatively different phenomena: 'detachment' and 'compartmentalization'. We review some evidence for this distinction within the domains of phenomenology, factor analysis of self-report scales and experimental research. Available evidence supports the distinction but more controlled evaluations are needed. We conclude with recommendations for future research and clinical practice, proposing that using this dichotomy can lead to clearer case formulation and an improved choice of treatment strategy. Examples are provided within Depersonalization Disorder, Conversion Disorder and Posttraumatic Stress Disorder (PTSD).

Consciousness↗
PubMed2001

Somatization Disorder.

There are many new developments regarding somatization disorder, which is among the most difficult and cumbersome of the psychiatric disorders encountered in neurology practice. Diagnostic criteria have been revised to facilitate clinical care and research. The differential diagnosis includes neurologic disorders (eg, multiple sclerosis, epilepsy), systemic medical disorders, and other psychiatric disorders (eg, mood and anxiety disorders, conversion disorder, malingering, and factitious disorder). Many patients have one or more of these illnesses comorbid with somatization disorder. Finally, somatization disorder demands creative biopsychosocial treatment planning by the neurologist, psychiatrist, and other health professionals.

Journal Article↗
PubMed2003

Psychogenic intractable sneezing: case reports and a review of treatment options.

OBJECTIVE: To report 2 cases of the uncommonly seen diagnosis of psychogenic intractable sneezing, to review the clinical presentation, workup, and various previous treatment modalities, and to present a unique method of treatment. DATA SOURCES: The literature was reviewed using a MEDLINE search of the following keywords: psychogenic intractable sneezing, paroxysmal sneezing, factitious sneezing, respiratory disorders, conversion disorders, habit cough, and psychogenic cough. The search was restricted to articles published from 1966 onward, although older references were cross-referenced from more recent articles. RESULTS: Sneezing alone can be caused by foreign substances, odors, chemical irritants, allergies, and other less common factors. Psychogenic intractable sneezing, although not a particularly common disease, occurs mainly in adolescent girls for which a cause may not be found. Patients are usually refractory to various medications and have an otherwise unremarkable extensive workup. Treatments have included corticosteroids, antihistamines, hydroxyzine hydrochloride, and decongestants among other pharmacologic agents, as well as psychotherapy. Based on the presented case reports, a trial of isotonic sodium chloride solution with suggestion therapy was able to rid the patients of their intractable sneezing. CONCLUSIONS: Psychogenic intractable sneezing is a real disease. Although other diseases may be considered, the workup may merely include an extensive history and physical examination. Many treatments have been tried with varying success, including those that incorporate psychotherapy. A variation of suggestiontherapy is offered as a unique treatment modality.

Child↗
PubMed2002

[Masked depression: the rise and fall of a diagnosis].

OBJECTIVE: The diagnosis of "masked depression" was very common in the 70'es and 80'es for patients with somatic complaints without an organic counterpart, when a psychic illness was assumed. Today this diagnosis does not play an important role any more - neither clinically nor scientifically. This article examines the background of the enormous initial importance of this diagnostic concept and of its final abandonment. METHODS: Critical reflection of the literature. RESULTS: The main reason for the immense success of that diagnosis was the tempting possibility of subsuming patients with a multitude of only unsatisfactorily explicable and treatable somatic symptoms under one single concept. In addition, this concept allowed to derive a uniform treatment, i.e. pharmacotherapy with antidepressants. Several problems inherent in the diagnosis of masked depression finally led to the dropping of that concept: the expansion of that diagnosis onto a vast number of disorders, the continuing lack of clarity of the concept (disorder of recognition vs. disorder of communication; the positive proof of psychic symptoms as a prerequisite vs. the positive proof of psychic symptoms as an exclusion criterion for that diagnosis). Last but not least, the introduction of DSM-III and ICD-10 as operationalized, purely descriptive and rather theory-free systems of diagnostic classification supported that development. CONCLUSIONS: The present diagnoses for those patients re-emphasize the somatic symptomatology. Formerly "masked depressed" patients are now diagnosed as suffering from somatization disorder, somatoform disorder, psychosomatic disorder, conversion disorder, neurasthenia or hypochondriasis.

Antidepressive Agents↗
PubMedDate not supplied

[Psychosomatic aspects in orthopedic legal assessment].

AIM: Complaints in orthopaedics that are not sufficiently explainable can be caused (partly) by psychosomatic disorders. A manual psychosomatic disorders for legal assessment in orthopaedics will be supplied. METHOD: Diagnoses essential for orthopaedics are classified by DSM-IV and ICD-10 in consideration of the current literature; evaluation was performed under legal assessment criterions. RESULTS: The most important complaints that are often poorly explainable results in musculoskeletal pain. Since a sensorial perception of pain is combined with emotions, emotions and psychic disorders can be perceived as pain. The most important diagnoses for assessing not sufficiently explainable complaints by somatic cause are "somatoform pain disorder", "somatization disorder", "undifferentiated somatoform disorder", "conversion disorder", "hypochondriasis", "body dysmorphic disorder", "maior depression", "dysthymic disorder", "posttraumatic stress disorder", and "adjustment disorder". The relevance of psychosomatic comorbidity in legal assessment is possible in all affairs of civil and social law. Private accident insurances exclude psychic and psychosomatic diseases from all insurance benefits. CONCLUSION: When composing legal assessments in orthopaedics, especially on pain, the knowledge of psychosomatic (co)morbidity is necessary for meeting the different causes of the complaints. Under awareness of possible psychosomatic disorders, additional psychosomatic legal assessments can be recommended and understood as well.

Diagnosis, Differential↗
PubMed2000

The Kleine-Levin syndrome as a neuropsychiatric disorder: a case report.

The Kleine-Levin syndrome (KLS) is characterized by periodic, sudden-onset episodes of hypersomnia, compulsive hyperphagia, and behavioral-emotional disorders (typically indiscriminate hypersexuality, irritability, impulsive behaviors), lasting from a few days to a few weeks, with almost complete remission in the intercritical periods. Depression, confusion, and thought disorders are frequently associated with the critical symptomatology, and they may suggest other psychiatric diagnoses (schizophrenia, mood disorder, conversion disorder) or a substance abuse. A diencephalic-hypothalamic dysfunction is suspected, even if this composite symptomatology cannot easily be linked to a simple mechanism. The aim of this article is to illustrate problems in differential diagnosis, using a case approach. History, course, and therapeutic intervention in a 21-year-old patient with KLS, associated with a clear psychiatric symptomatology and a critical affective pattern, is reported. Psychiatric correlates of KLS are discussed, including the relationship with affective disorders and the possible emotional impact of the attacks. Implications regarding a combined psychological and pharmacological treatment are also discussed.

Adult↗
PubMedDate not supplied

The use of the dexamethasone suppression test in the differential diagnosis of catatonic stupor.

Catatonic stupor is a cluster of symptoms and not necessarily a disease entity. It may be seen not only in schizophrenia, but in major affective disorders, conversion disorders, organic brain syndromes, and atypical psychoses. The dexamethasone suppression test is a valuable tool in the diagnosis of major affective disorders, differentiating them from other types of psychopathology. In a twelve month retrospective study, five patients admitted to Psychiatric Institute of Atlanta were identified as meeting the criteria for catatonic schizophrenia. A dexamethasone suppression test was performed shortly after admission. Four of the five had patterns of inadequate suppression, indicative of a major affective disorder rather than a schizophrenic disorder. The dexamethasone suppression test is simple to administer, relatively painless, free from hazards, easy to interpret, readily available, and reliable. Not only can the dexamethasone suppression test be used in diagnosis, but also as a valuable aid in following the therapeutic progress in resolution of a major affective disorder.

Adult↗
PubMed1993

Defrocking the fraud: the detection of malingering.

The purpose of this paper is to provide psychiatrists with practical advice on how to detect malingered mental illness. Various types of malingering are defined and the five major purposes of malingering are specified. The research literature on malingering is reviewed. Clinicians must be thoroughly grounded in the phenomenology of true mental disease to detect malingering. Detailed information about hallucinations is reviewed so that faked hallucinations that do not follow typical patterns can be more easily identified. Strategies for approaching persons suspected of malingering are suggested. Features of malingered mutism, mania, depression and mental retardation are described. The differential diagnosis of malingering, post-traumatic stress disorder, conversion disorder, and post-concussion syndromes after trauma is discussed. Clues to malingered psychoses and post-traumatic stress disorders are delineated. Finally, specific indicators of malingered insanity defenses are identified.

Depressive Disorder↗