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At least 433 records · Page 24Linked to original sources
PubMed2006

Behavior therapy in dissociative convulsions disorder.

OBJECTIVE: To compare the remission in symptoms achieved with behavior therapy and routine clinical care to that with routine clinical care given alone to patients having dissociative disorder. DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Psychiatry Unit, Lady Reading Hospital, Peshawar from April 2004 to September 2004. SUBJECTS AND METHODS: A total sample of 100 patients was recruited through Psychiatric OPD and Emergency unit. Patients were randomly allocated to the intervention or control group. The number of fits were recorded each day during admission. The patients were followed-up for four weeks after discharge. Hospital anxiety and depression scale and clinical global impression scales were applied. The two-sample Kolmogorov-Smirnov test was used to show the differences in relative frequencies of fits between the two groups. RESULTS: There were no statistically significant differences in sociodemographic and clinical variables in the intervention and control groups at baseline. There was a highly significant difference between the two groups in frequency of fits at discharge, on the first follow-up and on the fourth follow-up (p=0.000). Similarly, patients in the intervention group showed more improvement on hospital anxiety and depression scale compared to the control group, (p=0.000) at the end of four weeks. CONCLUSION: Behavioral intervention in the management of conversion disorder is more effective than the methods applied in our daily practice.

Adolescent↗
PubMed2003

Differential brain activations during intentionally simulated and subjectively experienced paralysis.

INTRODUCTION: Distinguishing conversion disorder from malingering presents a significant challenge as the diagnosis ultimately depends on the patient's subjective report and the clinician's suspicion of an intention to deceive. Using hypnosis to manipulate the intentionality of movement inhibition in the same subjects, we used positron emission tomography (PET) to determine whether failure to move during intentionally simulated and subjectively experienced paralysis is mediated by different neural structures. METHODS: Using a within-subject design, 12 normal, hypnotised subjects were tested under two paralysis conditions during the same scanning session. Half of the scans were performed with the suggestion that the left leg was paralysed (subjectively experienced paralysis condition) and half with the leg normal but with the instruction that paralysis should be feigned (intentionally simulated paralysis condition). RESULTS: Relative increases in brain activation were seen in the right orbitofrontal cortex, right cerebellum, left thalamus, and left putamen during subjectively experienced paralysis compared to intentionally simulated paralysis, although a previously reported activation of the right anterior cingulate cortex was not seen. During intentionally simulated paralysis compared to subjectively experienced paralysis relative increases in brain activation were seen in the left ventrolateral prefrontal cortex, and a number of right posterior cortical structures. CONCLUSIONS: Our results suggest that subjectively experienced paralysis has a different neural basis to intentionally simulated paralysis. These findings have theoretical and clinical implications for malingering and related attempts to unravel the neuropsychological basis for conversion hysteria.

Journal Article↗
PubMed1995

The clenched fist syndrome. A psychiatric syndrome mimicking reflex sympathetic dystrophy.

We describe a patient with swelling and pain in his right hand, which persisted for 1 year after minimal trauma. We think this represents a case of "clenched fist syndrome," a conversion disorder with unique somatic features that is easily mistaken for reflex sympathetic dystrophy syndrome. Included is a comparison of other psychological illnesses in which unusual physical findings involve the hand.

Diagnosis, Differential↗
PubMed2005

Camptocormia in a patient with multiple system atrophy.

The term "camptocormia" describes a severe forward-flexed posture. Although initially used to describe a conversion disorder, early authors also recognized organic camptocormia occurring in old age, or "camptocormie senile," as well as traumatic and arthritic camptocormia. More recently, camptocormia has been described in patients with Parkinson's disease and in an individual with parkinsonism. We describe a case of progressive camptocormia as part of the initial presentation of a patient with multiple system atrophy.

Antiparkinson Agents↗
PubMedDate not supplied

Chest pain in children referred to a cardiology clinic.

One hundred consecutive patients (54 girls, 46 boys) referred to a pediatric cardiology department with the primary complaint of chest pain were evaluated. The age distribution was 2.5-16.0 years (mean 11.3 years for girls and 9.9 years for boys). The history showed 17% of patients with chest pain, 22% with heart disease, and 19% with recent death in the family. The time course of the pain was longer than 1 week in 92 patients. Localization was on the left precordium in 60 patients, and there was no radiation from the original site in 66 cases. Ninety-two percent of cases were idiopathic in origin. Of the 74 patients who had a psychiatric interview, 55 (74%) had psychiatric symptoms and 5 required psychiatric care. Anxiety, conversion disorder, and depression were the main psychiatric symptoms.

Adolescent↗
PubMed2005

Combining proteasome inhibition with TNF-related apoptosis-inducing ligand (Apo2L/TRAIL) for cancer therapy.

Apoptosis has an essential role in embryogenesis, adult tissue homeostasis and cellular responses to stressful stimuli. Therefore, increased apoptosis is involved in the pathogenesis of various ischaemic, degenerative and immune disorders. Conversely, genetic aberration that results in a reduction or abolition of apoptosis can promote tumorigenesis and underlie the resistance of cancer cells to various genotoxic anticancer agents. Therefore, a detailed knowledge of the control of apoptotic pathways could aid in the rational design of effective therapeutics for a variety of human diseases including cancer. One major way to promote apoptosis involves signaling through members of the tumor necrosis factor (TNF) superfamily. On binding to their appropriate receptors, some TNF family members can promote caspase activation and apoptosis. Early studies on TNF indicated that a limited number of tumor cell lines could be induced to undergo apoptosis on exposure to TNF. Another member of the TNF family Fas ligand (FasL) is also known to induce apoptosis in a variety of tumor cells. Although TNF and FasL can efficiently induce apoptosis in a limited number of tumor cells, administration of either of these agents is associated with extreme toxicity. This toxicity has precluded further development of either TNF or FasL for cancer therapy. However, within the last 8 years another member of the TNF family, TNF-related apoptosis-inducing ligand (Apo2L/TRAIL) has been characterized, which induces apoptosis of a wider range of cancer cells than either TNF or FasL. Surprisingly, most normal non-transformed cells are quite resistant to the apoptotic effects of Apo2L/TRAIL. This selective toxicity for cancer cells is the basis for the current enthusiasm for Apo2L/TRAIL as a potential novel anticancer therapy. In this symposium report, we provide a brief overview of Apo2L/TRAIL, its receptors and their signaling pathways. We discuss findings on the antitumor effects of Apo2L/TRAIL alone or in combination with radiotherapy or chemotherapy. In addition, we present recent information from our groups concerning the possible therapeutic benefits of combining Apo2L/TRAIL with the proteasome inhibitor bortezomib.

Apoptosis↗
PubMed2005

Hydrocephalus in craniosynostosis: a review.

INTRODUCTION: Ventricular dilatation in the presence of primary craniosynostosis is a unique condition with respect to pathogenesis, clinical significance, and morphological appearance. It is rarely observed in nonsyndromic craniosynostosis, and in these cases usually attributable to coincidental disorders. Conversely, it is a common feature of syndromic craniosynostosis, affecting at least 40% of patients with Crouzon's, Pfeiffer's or the Apert syndrome. Shunt-dependent hydrocephalus is predominantly associated with Crouzon or Pfeiffer syndrome while in the Apert syndrome the usual finding is nonprogressive ventriculomegaly which, however, may also occur in some cases of Crouzon syndrome. PATHOGENESIS: The pathogenesis of progressive hydrocephalus remains somewhat obscure, a hypoplastic posterior fossa and a venous outlet occlusion at the skull base being the main causative factors discussed in literature. Ventriculomegaly may reflect primary brain maldevelopment or in some cases even a compensated state of increased cerebrospinal fluid (CSF) outflow resistance. CLINICAL EVALUATION: Clinical evaluation is mainly aimed at identifying progressive hydrocephalus, but diagnosis is hampered by the fact that classical clinical signs may be absent, and that ventricular dilatation will often become evident only after decompressive cranial surgery. Moreover, mild ventriculomegaly may in some cases coexist with intracranial hypertension from craniostenosis. Therefore, careful monitoring of intracranial pressure and ventricular size in the pre- and postoperative period is a diagnostic mainstay. CONCLUSION: In true hydrocephalus ventriculo-peritoneal shunting is currently the single promising mode of treatment.

Cranial Sutures↗
PubMed2005

Maternal lineages and Alzheimer disease risk in the Old Order Amish.

Old Order Amish, founded by a small number of Swiss immigrants, exist in culturally isolated communities across rural North America. The consequences of genetic isolation and inbreeding within this group are evident by increased frequencies of many monogenic diseases and several complex disorders. Conversely, the prevalence of Alzheimer disease (AD), the most common form of dementia, is lower in the Amish than in the general American population. Since mitochondrial dysfunction has been proposed as an underlying cause of AD and a specific haplogroup was found to affect AD susceptibility in Caucasians, we investigated whether inherited mitochondrial haplogroups affect risk of developing AD dementia in Ohio and Indiana Amish communities. Ninety-five independent matrilines were observed across six large pedigrees and three small pedigrees then classified into seven major European haplogroups. Haplogroup T is the most frequent haplogroup represented overall in these maternal lines (35.4%) while observed in only 10.6% in outbred American and European populations. Furthermore, haplogroups J and K are less frequent (1.0%) than in the outbred data set (9.4-11.2%). Affected case matrilines and unaffected control lines were chosen from pedigrees to test whether specific haplogroups and their defining SNPs confer risk of AD. We did not observe frequency differences between AD cases compared to controls overall or when stratified by sex. Therefore, we suggest that the genetic effect responsible for AD dementia in the affected Amish pedigrees is unlikely to be of mitochondrial origin and may be caused by nuclear genetic factors.

Alzheimer Disease↗
PubMed1990

Significance of coronary circulation in hypertensive heart disease for development and prevention of heart failure.

Coronary hemodynamics (coronary blood flow, coronary reserve, myocardial oxygen consumption) were analyzed in both experimental and clinical essential hypertension. Significant reduced coronary reserve was found in hypertensive patients with left ventricular hypertrophy. Extracoronary reasons for these phenomena were ruled out. Considerable thickening of the coronary resistance vessels (medial hypertrophy) in hypertensive hypertrophy associated with a marked increase in the wall thickness/radius ratio was considered sufficient to explain the impairment of coronary flow. After long-term pharmacotherapy there was normalization of both medial hypertrophy and coronary reserve. This small-vessel abnormality correlates well with clinical findings in hypertensive heart disease (angina and electrocardiographic changes despite normal coronary arteriogram). Moreover, this structural adaptation of the small vessels may carry the inherent risk of an impaired oxygen supply to the hypertrophied myocardium. Thus, late cardiac failure of the hypertrophied heart in hypertension may be attributed, in part, to this microcirculation disorder. Conversely, reversal of left ventricular hypertrophy and of hypertrophy of vascular smooth muscle by specific pharmacotherapy can be considered a possible approach to the rational prevention of cardiac failure in hypertensive patients. For future investigations, controlled clinical trials are needed to confirm these findings with regard to prevention of heart failure, and pharmacotherapeutic studies are necessary to define the optimal drug regimen for reversal of vascular smooth muscle hypertrophy.

Adult↗
PubMedDate not supplied

Pseudoseizures, sexual abuse, and hermeneutic reasoning.

It has been proposed that pseudoseizures are a symbolic expression of having been sexually abused. Such reasoning is hermeneutic in nature and potentially damaging if uncritically used. Sexual abuse is one of several risk factors for pseudoseizures, but it should not be deduced simply from the occurrence or form of the conversion disorder.

Adolescent↗
PubMed2006

Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs.

CNS Vital Signs (CNSVS) is a computerized neurocognitive test battery that was developed as a routine clinical screening instrument. It is comprised of seven tests: verbal and visual memory, finger tapping, symbol digit coding, the Stroop Test, a test of shifting attention and the continuous performance test. Because CNSVS is a battery of well-known neuropsychological tests, one should expect its psychometric properties to resemble those of the conventional tests upon which it is based. 1069 subjects age 7-90 participated in the normative database for CNSVS. Test-retest reliability (TRT) was evaluated in 99 Ss who took the battery on two separate occasions, separated, on the average, by 62 days; the results were comparable to those achieved by equivalent conventional and computerized tests. Concurrent validity studies in 180 subjects, normals and neuropsychiatric patients, indicate correlations that are comparable to the concurrent validity of similar tests. Discriminant validity is supported by studies of patients with mild cognitive impairment and dementia, post-concussion syndrome and severe traumatic brain injury, ADHD (treated and untreated) and depression (treated and untreated). The tests in CNSVS are also sensitive to malingerers and patients with conversion disorders. The psychometric characteristics of the tests in the CNSVS battery are very similar to the characteristics of the conventional neuropsychological tests upon which they are based. CNSVS is suitable for use as a screening instrument, or as a serial assessment measure. But it is not a substitute for formal neuropsychological testing, it is not diagnostic, and it will have only a limited role in the medical setting, absent the active participation of consulting neuropsychologists.

Adolescent↗
PubMed2003

Behavioral activity associated with onset in chronic tic and habit disorder.

Seventy-six people (aged 18-62 years) diagnosed with either a chronic tic disorder or a habit disorder, entering a treatment study, kept a baseline daily diary for at least ten days, noting tic frequency and activity at time of onset. Together with an evaluator, participants completed a form ranking three high-risk activities where the tic or habit was likely to appear, and three low-risk activities where the tic was absent or barely present. Subjective appraisals distinguishing the two types of activities were also elicited and their relevance to the tic was measured on a seven-point scale using an adaptation of Kelly's repertory grid technique. Overall, the most frequent high-risk and low-risk activities were, respectively, passive attendance and physical activity. There were, however, significant differences in types of high-risk activities amongst the tic and habit disorders. Conversely, appraisals of the high-risk activities seemed to center on negative evaluations of tenseness, boredom, dissatisfaction, and disinterest.

Adolescent↗
PubMed2004

Hearts, guts and minds: somatisation in the military from 1900.

OBJECTIVES: To identify patterns of somatisation in army personnel diagnosed with postcombat syndromes from the Boer War to the Gulf conflict. METHODS: Using random samples of UK servicemen awarded war pensions, patterns of symptoms were compared and related to contemporary accounts. RESULTS: Somatic symptoms continued to be common during and after World War II, suggesting that their decline was not great as claimed. Although psychological presentations increased, they did not supplant conversion disorders. CONCLUSION: Somatoform disorders did not disappear from the military in a smooth progression as society's understanding of psychological issues advanced. Rather there was a change in physical focus from the heart to the gut as new medical priorities arose.

History, 19th Century↗
PubMedDate not supplied

Ganser's syndrome.

Explore the source record for details and available documents.

Cognition Disorders↗
PubMed2003

Misdiagnosis of stroke in tissue plasminogen activator-treated patients: characteristics and outcomes.

STUDY OBJECTIVE: Misdiagnosis of acute ischemic stroke is a risk inherent in treating patients with acute deficits, yet few data exist on the problem. We report an evaluation of emergency department misdiagnoses in patients treated with tissue plasminogen activator for acute ischemic stroke. METHODS: We conducted an observational study of 151 consecutive patients treated without an acute stroke team. Initial diagnosis was compared with interim and hospital discharge diagnoses. Separate analyses were performed for patients without a final diagnosis of acute ischemic stroke and for those without a final diagnosis of either acute ischemic stroke or transient ischemic attack, combined. RESULTS: Ten of 151 patients (7%; 95% confidence interval [CI] 3% to 12%) had final diagnoses that did not include acute ischemic stroke. Six of 151 (4%; 95% CI 1% to 8%) had a final diagnosis other than acute ischemic stroke or transient ischemic attack (conversion disorder [4], complex migraine [1], and Todd's paralysis [1]). These "stroke mimics" had no intracranial hemorrhage (0%; 95% CI 0% to 31%), had less disability at discharge (modified Rankin Scale score mean+/-SD, 2.2+/-1.3 versus 3.2+/-1.8), and were younger (mean age+/-SD, 47+/-21 years versus 68+/-15 years) than patients with acute ischemic stroke or transient ischemic attack. An additional 4 (3%) patients had interim diagnoses other than acute ischemic stroke, all subsequently changed to acute ischemic stroke after magnetic resonance imaging or computed tomography. CONCLUSION: These data show that in a 4-hospital system without an acute stroke team, thrombolytic treatment of patients with diagnoses mimicking stroke was infrequent, and hemorrhagic complications did not occur in any patients without an acute ischemic stroke. However, because the number of mimics was small, safety cannot be ensured with statistical confidence.

Academic Medical Centers↗
PubMed2000

Persisting aphasia as the sole manifestation of partial status epilepticus.

OBJECTIVES: Persisting aphasia presenting as an isolated inability to vocalize is an uncommon presentation of simple partial status epilepticus and only eight such cases have been reported over the past 40 years. METHODS: We studied a patient with a 5-year history of recurrent episodes of inability to talk, without any other motor or cognitive impairments. Episodes lasted as long as 24 h, interictal EEGs were normal and she was diagnosed as a conversion disorder. RESULTS: EEG recordings during one of the episodes showed continuous discharges in the right frontal and parasagital areas demonstrating the ictal nature of the deficits. During the episode the patient had no deficits of strength, or in her ability to perform skilled movements to command, imitation or manipulation of objects. Comprehension of complex verbal commands was preserved and she would make attempts to articulate words and correctly answered questions with head nodding or monosyllables, yes or no. She could hum but had no other vocalizations. CONCLUSIONS: This is the first case of aphasic status epilepticus secondary to epileptogenic discharges of the right hemisphere. The case is also unique for the isolated involvement of production of language during the seizure.

Aged↗