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PubMed1975

Multiple personality. A single case study with a 15 year follow-up.

A review of the literature relating to multiple personality is presented together with a study of a single case of hysterical aetiology that demonstrates the development of multiple personality from a fugue amnesic state. A re-examination of this case after 15 years without significant psychotherapeutic intervention demonstrates a tendency towards remission. The view that multiple personality is a form of fugue, not necessarily hysterical, in which an alternative personality is adopted and that this behaviour is reinforced by the attention that it receives, is discussed.

Adolescent↗
PubMed2001

Psychogenic paraplegia in a patient with normal electrophysiologic findings.

STUDY DESIGN: A case report of psychogenic paraplegia following a motor vehicle accident was clinically diagnosed using median (MN) and posterior tibial nerves (PTN) somatosensory evoked potentials (SSEPs). OBJECTIVE: To report an unusual case of paraplegia in spite of normal electrophysiological and non-compromising radiographic spine findings. SUMMARY OF BACKGROUND DATA: Conversion disorder with motor system symptoms or deficit is a subtype which includes symptoms such as impaired motor coordination or balance, paraplegia, muscle weakness, difficulty in swallowing, and urinary retention. METHODS: The SSEPs were performed by each PTN at the ankle region behind the medial malleolus or the MN at the wrist using square wave pulses in 15 mA intensity. The SSEPs revealed well-developed somatosensory peaks for all extremities. RESULTS: Well-resolved MN-SSEPs were seen with stimulation of either arm. The principal peaks of N20 and P22 were 17 and 21 ms for both upper extremities. The principal peaks of P37 and N45 were 35 and 46 ms for both lower extremities. No side-to-side latency difference was noted. The MRI scan finding was a non-displaced L1 fracture without spinal canal compromise. CONCLUSIONS: In spite of an apparent paraplegia, contradictory clinical findings, normal neurophysiologic tests, and normal neuroradiologic findings are positive criteria for paraplegia/quadriplegia with psychogenic etiology.

Accidents, Traffic↗
PubMed2002

Differential diagnosis and management of spinal nerve root-related pain.

Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Distinctions in the patho-anatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of root-related pain. Root-related pain can emerge from the tension events in the dura mater and nerve tissue associated with primary disc related disorders. Conversely, secondary disc-related degeneration can produce compression on the nerve roots. This compression can result in chemical and mechanical consequences imposed on the nervous tissue within the spinal canal, lateral recess, intervertebral foramina, and extraforminal regions. Differences in root-related pathology can be observed between lumbar, thoracic, and cervical spinal levels, meriting the implementation of different diagnostic tools and management strategies.

Journal Article↗
PubMed2002

[Laparoscopic splenectomy by the "Essen-manoeuvre" for treatment of benign and malignant haematological diseases].

Despite its early description, laparoscopic splenectomy has not yet reached the level of a standard operation as a therapeutic option for haematological disease, especially for malignant disorders. We performed laparoscopic splenectomies in a modified 4 port technique and dissection of the splenic vessels by the "Essen-Manoeuvre" and report on 68 attempted laparoscopic splenectomies for benign (n = 42) and malignant (n = 26) haematological disorders. Conversion rate was 9 %, 30-days-mortality was 1.4 %, perioperative morbidity was 11 %, respectively. Accessory spleens were found and resected in 17 % of our patients. Laparoscopic splenectomy is a new minimally invasive option for patients with benign and malignant haematological disease fraught with a special risk of intraoperative bleeding.

Adolescent↗
PubMed2002

Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy.

The assumption is frequently made that women with severe nausea and vomiting during pregnancy are transforming psychological distress into physical symptoms. Psychoanalytic theory supporting this assumption is reviewed, along with the few methodologically flawed empirical studies that have been conducted. Little support can be found for the hypothesis that nausea and vomiting during pregnancy is such a conversion disorder, but there are suggestions that psychological responses to the physiologic condition(s) underlying this problem may become entrenched, or conditioned. This possibility is supported by findings that psychological treatments, such as hypnosis, can be effective. This implies that psychological responses can interact with the physiology of nausea and vomiting during pregnancy to exacerbate the condition. As such, psychological treatments for the symptoms of this disorder need to be further explored.

Female↗
PubMed1999

Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research.

Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behavioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunction, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed.

Cognition Disorders↗
PubMed1999

Hypnosis and conversion hysteria: a unifying model.

There are many similarities between the symptoms of conversion hysteria and phenomena produced in hypnotic contexts. This paper reviews some of those similarities and considers more general features associated with both hypnotic phenomena and conversion hysteria symptoms such as lack of concern, perceived involuntariness, the display of ''implicit knowledge'' and their apparently compliant nature. Neurophysiological and brain-imaging studies of hypnotically produced effects and conversion symptoms are described, which implicate frontal cortical structures in moderating the respective changes elsewhere in the brain, particularly in cingulate cortex. A recurrent theme is the apparent paradox which exists between, on the one hand, the subjective reality and involuntariness of both hypnotic phenomena and the symptoms of conversion hysteria and, on the other, the fact that objectively they appear to be role-congruent enactments responsive to the manipulation of motivational factors, expectancy, and social influence. A model of consciousness and self-awareness is presented which attempts to resolve that paradox whilst describing similar mechanisms underlying hypnotic phenomena and conversion hysteria symptoms. The model develops the idea of a central executive structure, similar to the notion of a supervisory attentional system, acting outside self-awareness but at a late stage of information processing which can be directly influenced from both internal and external sources to produce the relevant phenomena. The paper ends by proposing that as conversion disorder, pain disorder, and the dissociation disorders appear to be linked by a common mechanism they should be classified together under the heading of auto-suggestive disorder.

Journal Article↗
PubMed2005

Short stature, type E brachydactyly, exostoses, gynecomastia, and cryptorchidism in a patient with 47,XYY/45,X/46,XY mosaicism.

We report a 72-year-old male patient with a 47,XYY/45,X/46,XY mosaicism associated with short stature, exostoses, type E brachydactyly, gynecomastia, cryptorchidism, mild mental retardation, and a paranoid personality and conversion disorder. Since his prevalent cell line was 47,XYY (about 75%), our patient could be karyotypically classified as a case of 47,XYY syndrome. In view of the striking similarity of the clinical features of this case and those of a XYY case previously reported by Ikegawa et al (1992), it seems reasonable to suggest that these patients are representatives of a novel syndrome with a XYY karyotype.

Aged↗
PubMed2002

Bilateral multiple cervical root avulsions without skeletal or ligamentous damage resulting from blast injury: case report.

OBJECTIVE AND IMPORTANCE: We describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident. CLINICAL PRESENTATION: A 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder. INTERVENTION: Cervical computed tomographic myelography revealed multiple bilateral nerve root injuries. CONCLUSION: This case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.

Adult↗
PubMedDate not supplied

Psychogenic purpura in a man.

A 53-year-old man with chronic back and leg pain developed recurrent painful ecchymoses after lumbar laminectomy. No hematologic abnormality could be detected, but an ecchymosis developed after subcutaneous injection of his blood into the region of pain. A detailed study of the psychological setting of the illness and his personality revealed this to be an example of psychogenic purpura. This is the third report of the syndrome in a male.

Accident Proneness↗
PubMedDate not supplied

Sacral neuromodulation for urinary retention caused by sexual abuse.

OBJECTIVE: This case report describes the use of sacral neuromodulation to treat urinary retention after sexual abuse. METHODS: Sacral neuromodulation was added to therapeutic regimen of a 38-year-old woman in whom chronic, complete urinary retention developed after psychological and sexual abuse during childhood. RESULTS: The combination of psychotherapy and neuromodulation restored the patient's ability to void, whereas psychotherapy alone had not. CONCLUSIONS: Although a multifactorial etiology of retention cannot be ruled out in this patient, neuromodulation might effectively treat urinary retention in cases of a conversion disorder after sexual abuse.

Adult↗
PubMed1985

Briquet's syndrome in adolescence.

Briquet's syndrome, originally described more than 100 years ago, has recently become a subject of concern for physicians who work with adolescents. It is a chronic disorder that primarily affects women, is characterized by many symptoms involving a number of organ systems, and usually has a frustrating clinical course. It typically begins in the second or third decades, and only rarely subsides with time. Multiple diagnostic procedures, medications, and surgical operations are common, usually without evidence of significant disease. Complications can include substance abuse, depression, and suicide. Management centers upon viewing the symptoms as the patient's attempts to communicate difficulties in coping with stress.

Adolescent↗
PubMed1986

Pseudoseizures: an overview.

Pseudoseizures, formerly called hysterical seizures, have become an acknowledged clinical entity in their own right. Diagnosis of pseudoseizures is a complex process, depending primarily on clinical neurologic observation of the spell pattern and negative response to anticonvulsant therapy. Diagnosis is aided by psychiatric evidence of psychopathology, and in difficult cases, by video/EEG observation of actual spells, either spontaneous or induced by saline infusion or hypnosis. Exposure to some model of spell behavior is considered important in the development of most cases of pseudoseizures. Pseudoseizures are difficult to treat successfully, and exploratory attempts at treatment have included hypnosis and behavior therapy. Pseudoseizures may represent either conversion disorder or dissociative disorder.

Anticonvulsants↗
PubMed1989

Multimodal evoked potentials in neuro-Behçet: a longitudinal study of two cases.

Two neuro-Behçet patients have been studied, over a period of several months, by means of peroneal and median somatosensory- (SEP), brainstem auditory- (BAEP), and visual- (VEP) evoked potentials. In both patients, peroneal SEP showed evidence of a pathological reduction in the central conduction velocity without a related deep sensation impairment, while VEP changes were consistent with the visual disorders. Conversely, BAEP and median SEP findings did not show disease-related abnormalities. The observed anomalies were detectable irrespective of the clinical phase of the disease. Thus, evoked potential assessment is useful in providing objective evidence for evaluating and monitoring CNS damage in neuro-Behçet's syndrome.

Adult↗