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PubMed2006

Recent developments in the theory of dissociation.

Although the construct of dissociation was introduced into psychiatry at the end of the 19th century by Pierre Janet, the term still lacks a coherent conceptualization, which is partially reflected by differences in the classification of dissociative and conversion disorders in ICD-10 and DSM-IV. Given the clinical significance of dissociative psychopathology in numerous clinical conditions, it is very valuable that various efforts have been made to refine and to specify current conceptualizations in recent years. The most promising and convincing approaches converge in subdividing dissociation into qualitatively different types, i.e. pathological versus non-pathological dissociation, and "detachment" versus "compartmentalization". We review these concepts and discuss their scientific and clinical potential as well as their limitations.

Journal Article↗
PubMed1991

Coronary vascular changes in the progression and regression of hypertensive heart disease.

Coronary hemodynamics (blood flow, coronary reserve, myocardial oxygen consumption) were analyzed in both experimental and clinical hypertension. Significantly reduced coronary reserve was found in hypertensive patients with left ventricular hypertrophy. Medial hypertrophy of small coronary vessels associated with a marked increase in the wall thickness/radius ratio was considered sufficient to explain the impaired coronary flow in hypertensive left ventricular hypertrophy. 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 rational approach to the prevention of cardiac failure in hypertensive patients. 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↗
PubMed1991

Deafness after bilateral midbrain contusion: a correlation of magnetic resonance imaging with auditory brain stem evoked responses.

A 46-year-old woman became deaf after a closed head injury. When a computed tomographic scan failed to disclose the cause, conversion disorder was suspected. Magnetic resonance imaging, however, showed bilateral contusions of the inferior colliculi, providing objective evidence for an organic cause of hearing loss. Auditory brain stem evoked responses and stapedial reflexes also provided objective evidence of brain stem injury. This case illustrates the phenomenon of dorsal midbrain injury after head trauma. It indicates the sensitivity of magnetic resonance imaging for small focal lesions after head trauma, and it demonstrates some difficulties in the diagnosis of "hysterical" deafness.

Brain Concussion↗
PubMed1990

[Psychosomatic aspects of neurologic diseases. Experiences with clinical neurology from the viewpoint of the psychoanalyst].

The great relevance of psychoanalytic-psychosomatic aspects for a more profound understanding of neurological diseases is the topic of this article. In terms of medical history, the development of the discipline of neurology especially in Germany is outlined, whereby neurology and psychosomatic medicine share the fate of a handicapped individuation. On the background of this delayed establishment as branches of their own, the mutual denial of neurology and psychosomatic medicine up to the present is discussed. By means of a survey of literature and case examples of several neurological disorders (hysterical conversion symptoms, selected diseases of the extrapyramidal motor system, lumbago, sciatica, cephalgia, epilepsy) the great importance of psychosomatic medicine and psychoanalysis for neurology is pointed out.

Conversion Disorder↗
PubMed1989

[Clinical aspects of paroxysmal states in children with depression].

In 81 depressed children aged 3 to 14 years the nonepileptic attacks could manifest the different psychopathological phenomena: 1, headaches before and after spells, non-systemic++ vertigo with imbalance and oculovestibular events with or without loss of consciousness; 2, orthostatic symptoms, syncope, cataleptoid seizures, Kloos seizures; 3, depersonalization and derealization episodes, deja vu and jamais vu states; 4, attacks with pain in the stomach and other organs, various other autonomic signs; 5, unsteady neurological signs: pareses, sensory, visual and speech disorders; 6, nightmares, oneiroid states, sleep-walking; 7, convulsive states, hyperkinesis; 8, psychomotor excitation and inhibition states; 9, behavioral spells with aggression. These states are differentiated from epileptic and hysterical attacks.

Adolescent↗
PubMed1988

Doctors have feelings too.

The medical encounter, like all human interaction, is unavoidably emotion laden. Rather than viewing them as something to be overcome, the emotional responses of the physician can be analyzed for information about the patient or about the physician. The emotional states of patients arouse complementary reactions in the clinician that are diagnostic clues to important clinical syndromes such as depression or character disorders. Conversely, the physician can have idiosyncratic responses to patients that can lead to inappropriate diagnostic and therapeutic choices or to avoidance of particular problems or patients. Self-awareness is the key to utilizing these reactions to improve the patient-physician relationship.

Affect↗
PubMed1987

[Mental disorders in children with neurodermatitis and psoriasis].

The results of examination of 213 children with neurodermatitis and psoriasis (157 and 56 patients respectively) have led the authors to conclude that borderline psychopathologic symptomatology in patients with neurodermatitis shows greater polymorphism as compared to psoriasis patients. The form, severity and time-course of borderline psychic disorders were presented by asthenic obsessive phobic, subdepressive and hysterical symptomatology and the syndrome of malbehaviour in the neurodermatitis patients and astheno-subdepressive symptomatology in those with psoriasis.

Child↗
PubMed1986

Pseudoseizures.

The history of hysteria, with special reference to pseudoseizures, is reviewed. The distinguishing features between nonepileptic and epileptic convulsions are then considered, prior to discussion of management and prognosis. The various psychopathologies associated with the diagnosis are noted, as are psychiatric conditions that may be confused with epilepsy. It is concluded that pseudoseizures represent a complex clinical problem, often requiring multidisciplinary evaluation, that can be rewarding to diagnose and treat.

Anxiety Disorders↗