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PubMed1982

The differential diagnosis of functional symptoms in adolescence.

Functional complaints constitute the major reason why adolescents visit the physician's office. These complaints may co-exist with organic illness of minor or major significance. Distinguishing between the organic and functional component is the physician's first task. But, just as each organic condition requires a different medical workup and treatment plan, each functional disorder also requires a variety of approaches. The physician therefore must be aware of the need for a further differential diagnosis among functional symptoms in adolescence. This article proposes a definition of functional disorders, sets forth a classification of the differential diagnosis of these disorders and suggests techniques for their management.

Adolescent↗
PubMed1996

Dysfunctional postures of the hand as part of a conversion reaction.

A dysfunctional posture of the hand could be due to an anatomical disorder or a conversion reaction. A conversion reaction implies that an unconscious intrapsychic conflict is expressed in a physical dysfunction. Treatment of dysfunctional postures due to conversion reactions is often difficult, and case reports are used to outline management. The need for a multidisciplinary approach is stressed.

Adult↗
PubMedDate not supplied

[Psychiatric disorders, personality and traumatic experiences in conversive non-epileptic seizures patients].

AIM: To study the clinical characteristics in patients with conversion non-epileptic seizures, and the influence that traumatic childhood experiences could have in their psychopathologic status and personality. METHODS: Seventeen patients with non-epileptic seizures confirmed through video-EEG were included. A structured clinical interview (SCID-DSM-III-R), a measure of personality variables (MMPI), and an interview designed for collecting data on personal history of childhood traumas were administered. Descriptive and comparative statistical methods were used. RESULTS: More than 70% of the sample fulfilled the criteria for two or more simultaneous diagnoses in Axis I, and for at least one personality disorder. The subgroup experiencing childhood traumatic experiences showed more clinically significant MMPI scales, a younger age at correct diagnosis, and higher scores on the MMPI psychastenia and psychopathic deviation scales than the non experiencing childhood traumatics events. CONCLUSIONS: Our sample of patients with conversion non-epileptic seizures shows a significant level of psychopathology, and the absence of a unique character substrate. Under the generic term of pseudoseizures, a number of subgroups according to childhood traumatic experiences, with different levels of severity and different clinical and personality properties, may be defined.

Adult↗
PubMed1985

The discourse of thought-disordered schizophrenic children.

The conversations of two thought-disordered schizophrenic children and two age- and sex-matched normal children were studied in three different contexts. Cohesive relations and retrieval categories were analyzed. The thought-disordered schizophrenic and normal children demonstrated divergent patterns of discourse. These patterns closely paralleled those previously reported for adults by S. Rochester and J. R. Martin (1979, Crazy talk: A study of the discourse of schizophrenic speakers, New York: Plenum) for schizophrenic and normal adults, although some discrepancies were also observed. Recommendations for future research are offered.

Child↗
PubMedDate not supplied

Is the diagnosis of hysterical psychosis justified?: Clinical study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia.

Using the method of a "blind" retrospective evaluation of clinical charts, 21 female patients with hysterical psychosis were compared with 21 patients diagnosed as suffering from nonhysterical reactive/psychogenic psychosis and 42 patients diagnosed as schizophrenic according to the Ninth Revision of the International Classification of Diseases (ICD-9). All three groups were restricted to first admissions and matched with regard to sex, age, and year of admission. Many significant differences were found between hysterical psychosis and schizophrenia; the only significant differences between hysterical and nonhysterical reactive/psychogenic psychosis were the presence of histrionic personality and the frequent shift in symptomatology in the former. Thus, both disorders seem to be identical.

Adolescent↗
PubMed1978

Dental anxiety--etiologic considerations.

Dental disease is frequently accompanied by anxiety and fear of the treatment and of dentists. The etiology of any anxiety is sought in early conditioning life experiences; here it may be related to infants' responses to first teething. The universality of dental anxiety makes it a paradigm of psychosomatic disorders. These are conceptualized as pathologic exaggerated reactions to early traumatizing events, a causality not unlike that of conversive-hysteric symptoms or "normal" bodily characteristics. Psychiatric-etiologic considerations of dental anxiety are not to be found in the literature. Recalling the cheerful manner in which children's loss of their first tooth is greeted, one gathers that repressed ambivalence is involved. A clarification of the etiology is here attempted and the dynamics compared with those of other psychosomatic diseases.

Anxiety↗
PubMed1997

[Globus pharyngis and gastroesophageal equivalents].

BACKGROUND: Globus sensation is a phenomenon of largely unknown etiology. Dyskinesia of the upper esophageal sphincter is quite often evident without pathological ENT findings elsewhere. PATIENTS AND METHODS: One hundred ten patients were examined in a interdisciplinary approach. The investigation included videofluoroscopy, esophagogastroduodenoscopy with biopsy, pharyngoesophageal computer manometry, and esophageal pH monitoring. One hundred five cases were evaluated. RESULTS: In 13 cases (12.4%) there was no evidence for any organic or functional disorder. In 92 cases (87.6%) abnormal findings were seen with two constellations being predominant. These are primarily inflammatory lesions in the stomach or the duodenum in 69.5% of all patients (73/105) associated with helicobacter pylori colonization in 58% (42/73) as well as ulcera and/or erosions in 8.2% (6/73). Concurrent disorders of the lower esophageal sphincter play the second role. Sixty-one point nine percent of all patients (65/105) had an hiatal hernia, with gastroesophageal reflux in 36.9% (24/65). In 21.5% (14/65) a reflux esophagitis was evident. A cardiac sphincter insufficiency was found in 6.7% (7/105). CONCLUSIONS: Based on these findings a gastroenterologic diagnosis is recommended in all patients with globus sensation as the symptom may be associated with corresponding disorders.

Adolescent↗
PubMed2001

Ganser syndrome after solitary confinement in prison: a short review and a case report.

A short review of the Ganser syndrome is given. The condition is a rare, probably dissociative, disorder with transient Vorbeireden as the central symptom. The case of a middle-aged man developing a transient Ganser syndrome after long-term solitary confinement in a remand prison is presented. Systematic investigation of 268 remand prisoners confirms the rarity of the syndrome, as only the case subject had this disorder.

Attention↗
PubMed1987

Somatoform disorders.

Somatoform disorders are characterized by physical complaints which have no organic basis and are commonly seen by both generalists and specialists. A case report and clinical descriptions of the major somatoform disorders are presented and recommendations for clinical management made.

Adult↗
PubMed1995

Nonepileptic seizures.

The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.

Adult↗
PubMed1989

Conversational characteristics of children with semantic-pragmatic disorder. I: Exchange structure, turntaking, repairs and cohesion.

Conversational samples were obtained from 57 children aged from 8 to 12 years with specific language impairment, and 67 control children aged from 4 to 12 years. Fourteen of the language-impaired children fitted the clinical description of semantic-pragmatic disorder. It was found that exchange structure, turntaking, conversational repair and use of cohesive devices could be assessed with adequate inter-rater and test-retest reliability. Children with semantic-pragmatic disorder produced more initiations than other children. Some of these children also violated turntaking rules by interrupting the conversational partner to an unusual degree. Use of cohesion was normal for children with semantic-pragmatic disorder, but limited in other language-impaired children. Analysis of conversations may be more useful than conventional language tests for identifying linguistic abnormalities in children with semantic-pragmatic disorder.

Child↗
PubMed1986

Somatization disorder in a US southern community: use of a new procedure for analysis of medical classification.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membership analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. The analysis indicates that seven 'pure' types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Adolescent↗
PubMed1995

Neuroendocrine disorders of the gut.

The regulation of gastrointestinal function is known to involve elements of the enteric nervous system. Processes such as secretion, motility, blood flow, and immune function are all influenced by a complex network of neurons whose cell bodies lie in the gut. These neurons use a wide spectrum of substances as neurotransmitters, although the majority use peptides once thought to function only as gut hormones. It has been increasingly recognized that abnormalities of this neuroendocrine regulatory system underlie many gastrointestinal disorders. The most obvious are states of peptide excess found in patients with gut endocrine tumors such as carcinoid, gastrinoma, and somatostatinoma. Conversely, other disorders appear to be related to deficiency states. Examples include both achalasia and Hirschsprung's disease (congenital megacolon), where the loss of inhibitory neural action leads to abnormalities of peristalsis and sphincter function. Evidence for abnormal neuroendocrine regulation leading to disease states is increasing for many other gastrointestinal disorders.

Digestive System↗