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PubMed1992

[Emotional-psychiatric disorder and the illness concept].

Who is abnormal--who is sick? Illness is an abnormal state. Abnormal psychological states are manyfold and rich in variations. Therefore it is necessary to define what is insanity and what is personal problem, personal disorder, personal decompensation or only any form of suffering. The problem is important with regard to therapeutical and legal decisions.

Affective Symptoms↗
PubMed2004

[Symptom Validity Testing (SVT) in the suspicion of a simulation or exaggeration of neurocognitive symptoms--a case report].

The significance of malingering or symptom exaggeration and its appropriate assessment have become increasingly recognised on an international scale. In the field of neurocognitive disorders, not only medicolegal cases, but also a number of clinical conditions are considered especially pertinent for assessment. This case report deals with a 22-year old patient who had suffered a moderately severe brain injury in a car accident almost three years before. In the context of seeking financial compensation from an insurance company, he claimed complete retrograde amnesia for all events and information prior to the accident. Moreover, he presented a Ganser-like response pattern (subsequent near misses) when trying to solve mathematical problems. Therefore, forced-choice symptom validity testing was performed with simple maths tasks. His response pattern was clearly less than random, indicating controlled incorrect responses and, thus, negative response behaviour. When confronted with this interpretation, he relinquished symptom exaggeration and was able to solve these tasks appropriately. While symptom validity techniques belong to the repertory of neuropsychologists in a number of countries, this is not yet true for Germany. However, their application will increasingly be encouraged to meet quality standards of medicolegal assessment.

Adult↗
PubMed2004

[Psychopathology in medically refractory partial seizures].

Today, psychopathology in medically refractory partial seizures is well-known. Descriptive (syndromic) classifications of both epileptic syndromes and psychiatric disturbances associated with prospective psychiatric status evaluations in resective epilepsy surgery centers in order to prevent poor post surgical outcome have increased our knowledge of the mental status of these patients. Three major categories of psychiatric comorbidities are observed. 1. Specific post ictal syndromes related to seizures (post ictal psychoses and post ictal depressive disorders). 2. Interictal psychiatric disorders: depression appears to be the most prevalent psychiatric condition in medically refractory seizures followed by anxiety and psychotic states. 3. Psychiatric adverse events of antiepileptic drugs according to the numerous new available drugs. There are no published guidelines. We are challenged both as clinicians and as an academic community. We need to improve identification, better utilize existing therapies and promote the development of prospective trials devoted to the study of psychiatric status in presurgical evaluation. A psychiatrist must be included in presurgical teams.

Anticonvulsants↗
PubMed2005

[Memory and attention in children with brain dysfunction].

INTRODUCTION: For conscious behaviours to continue, attention and working memory must be brought into play in order to match the data from the current reality with those in the long-term memory and to the sequential plans for adaptive action. PATIENTS AND METHODS: We present the preliminary findings of our study of 50 patients between 7 and 16 years of age, who were divided into three groups according to their dominant neurocognitive disorder: a 'pure' ADHD group, an ADHD/LD group (with comorbid learning disorder) and an RMEM (risk of memory disorder due to bilateral temporomesial damage) group. All of them were administered a battery of tests designed to evaluate attentional control and short and long-term memory. RESULTS: Verbal IQ was above 80 in all the participants, with no differences among the three groups. The ADHD/LD group had a manipulative IQ and level of sustained attention below those of the ADHD group, but no long-term memory deficit was observed in either of these two groups. In contrast, the RMEM group's performance was poorer in verbal memory tasks, although their behaviour is more attentive and stable compared to that of the other two groups. CONCLUSIONS: Neuropsychological analysis of these dissociations allows adjustments to be made in the strategies for therapeutic interventions. Performance in long-term learning in children with ADHD and ADHD/LD can be improved with psychostimulants owing to the activating effect they have on working memory.

Humans↗
PubMed1992

[Psychiatric evaluation in civil law].

Aspects of civil law of importance for the psychiatrist as expert witness are those dealing with disability pensions accident insurance, compensation in civil law and rights of the seriously disabled. The legal basis of each is briefly outlined, and some guidelines given for psychiatric court reports. Some outstanding theoretical and practical problems are mentioned.

Disability Evaluation↗
PubMed1992

Acute confusional migraine: case series and review of literature.

Acute confusional state (ACS) as a manifestation of migraine in the pediatric age group was initially described by Gascon and Barlow. The characteristics and natural history of acute confusional migraine (ACM) have been elaborated on by other authors. The diagnosis of ACM is, however, easily overlooked in clinical practice, due to its peculiar presentation. We describe three children who had acute onset of confusion. The differential diagnosis of acute confusional state and the clinical features and management of ACM are discussed.

Acute Disease↗
PubMed1991

[Affective disorders during pregnancy in patients with epilepsy and their relation to neurohumoral changes].

The relation of affective disorders to neurohumoral (neuromediator) changes in homeostasis was discovered on a representative clinical material on the basis of a combination of a clinical approach and biochemistry. A new concept was worded that the development of the gestation "determinant" in the brain of epileptic patients enhances the pathological process and its generalization with the involvement of the structures of the temporal lobes of the brain, namely of the basomedial ones. The involvement of those structures determines the appearance and growth of the psychopathological symptomatology and dramatically pronounced disorders in the content of the blood neuromediators, especially serotonin and noradrenaline. The presence of the temporal pathology on the EEG, the appearance and growth of affective disorders and dramatically pronounced changes in the blood serotonin and noradrenaline content++ may serve one of the prognostic indicators of epilepsy aggravation in patients in the gestation and postnatal period.

Adult↗
PubMed1991

[Problems of classification, clinical course and pathogenetic treatment of circulatory encephalopathy].

Based on the experience gained with psychoneurological examinations of 436 patients suffering from circulatory encephalopathy, the author reviews problems of its efficient classification and distinguishes the type of its clinical course (slow-progressing, rapid-progressing, galloping and remitting) and the clinical variety of the neuropsychic defect (mnemonic, affective, paranoiac). Describes methods of differentiated treatment of circulatory encephalopathy, carried out with regard to the patients' age, individual response to the drugs and selective influence of the latter ones on the structure of the neuropsychic defect.

Adult↗