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Hysterical neurosis, though infrequently diagnosed in the West, is still one of the commonest mental disorders in India. In this study, 38 women with an index diagnosis of hysterical neurosis were evaluated after a period of 5 years; 63% of the patients remained totally asymptomatic. The premorbid hysterical personality alone showed significant relationship with the outcome.
The development of child neuroses must have certain rerequisites, in particular disposition (temperamental characteristic), an adverse situation in early childhood and a provoking conflict proper or a traumatic situation. To hysterical neuroses apply similar findings as to these disorders in adults; a hysterical neuroses is not always evidence of a hysterical nature. Psychogenic disorders in children may differ, the character of these complaints is not always typical. The complexity of the diagnostic process is demonstrated on two case--histories from which it is apparent that long--term treatment and examinations in somatic departments do not rule out the detection of the psychogenic aetiology of the somatic disorder. The first case--history is that of a twelve-year-old girl treated from the age of two years with antiepileptic drugs, in recent years the condition is compensated without treatment. After a conflict with a girl friend she developed pain in the hip joint which eventually resulted in the inability of spontaneous movement. After several months hospitalization at the orthopaedic department she was transferred to the psychiatric department where after hypnotherapy the conversion syndrome receded but the patient developed another psychopathological syndrome, impaired sexual identification. The second case--history is that of a twelve-year-old boy a re-trained left-handed with manifestations of balbuties. On account of sudden manifestations of torticollis leading to prolonged absence at school he repeated the class, for another three years he was treated by neurologists without effect. After admission to the psychiatric department he was treated by psychotherapy and placebo with a marked effect.(ABSTRACT TRUNCATED AT 250 WORDS)
The common psychiatric disorder Briquet syndrome (hysteria) has no specific treatment, but it can be managed effectively. Careful diagnosis and differentiation from other psychiatric and medical disorders is the important first step. Surgical intervention should be kept to a minimum; medicines are given cautiously and controlled carefully. The treatment of choice is supportive psychotherapy which ignores physical symptoms and encourages the patient to change the method she uses of coping with her environment.
The feeling of having a lump in the throat is a common complaint of ENT outpatients. The symptom is associated with a multitude of pharyngoesophageal abnormalities. Our study compares the diagnostic yield of videofluoroscopy to that of static radiography in patients suffering from globus pharnygis. A total of 150 consecutive patients complaining of a lump in the throat, but without evidence of dysphagia, were studied in a standardized fashion with both methods. Videofluoroscopy combined with static radiography revealed morphological or functional abnormalities in 75% of our patients. The combination of the two methods yielded significantly more abnormalities in the pharynx and esophagus than videofluoroscopy (P < 0.0001) or static radiography alone (P < 0.0001). Esophageal motor disorders, pharyngoesophageal sphincter dysfunction and pharyngeal residue of contrast material proved to be the most common abnormalities. In conclusion, videofluoroscopy combined with static radiography is mandatory in the radiological assessment of patients suffering from the globus sensation.
Reports of functional dysphonia in children and adolescents under 16 years of age are few. Approximately a dozen cases have been reported in the English literature over the past 35 years. Most of the articles appear in journals related to the fields of speech, hearing and communication with a few in the Otorhinolaryngologic journals. Published papers in psychiatric journals dealing with voice or speech disorders are virtually nonexistent. In children and adolescents the two most common varieties are the Whispering Syndrome, which occurs predominantly in girls, and the Hysterical High Pitched Voice seen mostly in boys. This paper discusses these two varieties of functional dysphonia and presents a case example of each.
Thirty probands with the diagnosis of hysterical psychopathy were studied using clinical and genealogic techniques. An analysis of the obtained data made with the help of modern geneticomathematical methods identified a significant correlation between the type of psychopathy in probands and the corresponding type of personality disorders in the first-kin relatives of the probands. The calculated rate of heredity in relation to the risk of hysterical pathology manifestation (in the framework of quasi-permanent multifactor model) (79.9%) suggests that the formation of hysterical psychopathy is to a considerable degree determined by genetic mechanisms.
Nine children presented with disturbances of gait that were not caused by organic disease. They all fulfilled at least four out of eight diagnostic criteria. Diagnosis in all had been delayed while organic causes were excluded. Unnecessary and sometimes potentially harmful procedures were performed or proposed for each child. Identification of such children earlier may avoid morbidity and facilitate management.
The term "psychosomatic" is defined by means of the "globe" sign in its clinical use. Psychosomatic anamnesis is introduced as a mode to establish the somatic and psychic status. In this diagnostic therapeutic process the psychosomatically oriented ENT specialist assesses the pattern of these frequent psychophysical disturbances. The therapy of psychosomatic disorders is based on the multiplex aetiology of these diseases; therefore, psychosocial factors of distress must be considered with the same attention as the somatic signs and symptoms. To meet this challenge the specialist has to consider the therapeutic dialogue, psychodynamics and distress coping, effective relaxation techniques and the use of psychotropic drugs.
An interdisciplinary team, which included a physiatrist, psychologist, physical therapist, occupational therapist, social worker, and nursing staff, undertook the treatment of a 33-year-old woman with a 16-year history of gait problems and multiple somatic complaints. Previously, she had been followed by a number of physicians and had undergone both invasive and noninvasive diagnostic procedures as well as several surgical procedures. After limited response to such treatment, she was referred to the outpatient PM&R clinic for evaluation. Physical and psychologic study led to a primary diagnosis of somatization disorder, leading to inpatient treatment which combined a systematic gait-training program, withdrawal of reinforcement for maladaptive disability-related behavior, and reinforcement of increases in normal activities. The patient attained all of the goals in her program in 11 weeks.
OBJECTIVE: To investigate psychiatric and neurological morbidity, diagnostic stability, and indicators of prognosis in patients previously identified as having medically unexplained motor symptoms. DESIGN: Follow up study. SETTING: National Hospital for Neurology and Neurosurgery, London--a secondary and tertiary referral hospital for neurological disorders. SUBJECTS: 73 patients with medically unexplained motor symptoms admitted consecutively in 1989-91. 35 (48%) patients had absence of motor function (for example, hemiplegia) and 38 (52%) had abnormal motor activity (for example, tremor, dystonia, or ataxia). MAIN OUTCOME MEASURES: Neurological clinical diagnosis at face to face reassessment by a neurologist and a psychiatric diagnosis after a standardised assessment interview--the schedule for affective disorders and schizophrenia--conducted by a psychiatrist. RESULTS: Good follow up data were available for 64 subjects (88%). Only three subjects had new organic neurological disorders at follow up that fully or partly explained their previous symptoms. 44/59 (75%) subjects had had psychiatric disorders; in 33 (75%) patients, the psychiatric diagnosis coincided with their unexplained motor symptoms. 31/59 (45%) patients had a personality disorder. Three subjects had developed new psychiatric illnesses at follow up, but in only one did the diagnosis account for the previous motor symptoms. Resolution of physical symptoms was associated with short length of symptoms, comorbid psychiatric disorder, and a change in marital status during follow up. CONCLUSIONS: Unlike Slater's study of 1965, a low incidence of physical or psychiatric diagnoses which explained these patients' symptoms or disability was found. However, a high level of psychiatric comorbidity existed.
Globus hystericus means the "hysterical ball or lump in the throat," and is generally assumed to be of psychic origin. True dysphagia is usually absent. Twelve patients with the globus syndrome were studied at the Esophageal Motility Laboratory of the Saint Luke's Hospital of Cleveland. An organic cause for their symptomatology was ruled out by physical examination, laryngoscopy, esophagoscopy and cineesophagograms. Ten patients showed significant elevations in esophageal resting pressures and nine had evidence of disordered motor activity in the body of the esophagus. Knowing from previous investigations that a suprasternal discomfort may be elicited from stimulation of the esophagus at different levels, we propose that the globus sensation is a referred one coming from the hypertonic and frequently incoordinated body of the esophagus.
Patients with somatization disorders are frequently unrecognized and misdiagnosed. The diagnosis depends on recognizing a long-standing pattern of seeking medical intervention for vague, multisystemic symptoms, often without clear physical cause. These patients use symptoms as a way to communicate, express emotion, and be taken care of. Instead of recognizing the disorder and exploring psychosocial contributors to illness, nonpsychiatric physicians tend to repeatedly pursue organic possibilities through multiple tests, procedures, medications, and operations. In patients with somatization disorders, the dollar costs of this strategy are only exceeded by its potential for iatrogenic harm. More productive treatment strategies are presented, emphasizing the need for a long-term relationship with a primary care provider who will treat the patient and his symptoms seriously and respectfully but who is not compelled to invasively evaluate all symptoms.
The observation of a young north african afflicted with a tic disorder suggests an underlying meaning in the apparently confused motoric discharges, thanks to psychodrama and to ethnopsychoanalytic consultations with the family. Thus, at a time when the Gilles de La Tourette syndrome is described as a neurological disorder, while recognizing the limited utility of chemotherapy, we believe that neurobiological studies, whatever their merit, do not exempt us from thinking about the specific psychopathology of tics and their evolving relationship with neurotic symptoms. That is, to go from motor discharge to the elaboration of conflicts.
Primary progressive aphasia is a recently described, uncommon language disorder with unclear etiological and clinical boundaries. The infrequency and ambiguity of the syndrome may prompt psychiatric consultation. The authors review the pertinent features of one such referral, including a brief literature review of the salient aspects of the differential diagnosis, and note the implications for appropriate treatment.
Differentiation of pseudoseizures from epileptic seizures and hysterical stridor from asthma is key to the treatment of patients. Both pseudoseizures and hysterical stridor are associated commonly with sexual abuse, eating disorders, depression, substance abuse, anxiety disorders, and personality disorders. Failure to reach an appropriate diagnosis results in inappropriate medical care including recurrent intubations, antiepileptic drugs, and excessive hospitalizations. This case represents the first instance of reported pseudoseizures in a patient with hysterical stridor secondary to childhood sexual abuse.
INTRODUCTION: Normolipidemic dislipoproteinemias include various disorders of different lipoproteins, of their subfractions or some apolipo-proteins, of primary or secondary origin, which are widespread among general population and, like hyperlipoproteinemias, they are associated with the risk for premature atherosclerosis. DECREASED LEVEL OF HDL CHOLESTEROL: It is a primary, familial hypoalphalipoproteinemia, which is commonly associated with obesity, diet rich in carbohydrates, decreased physical activity and excessive use of coffee and some drugs. HYPERAPOBETALIPOPROTEINEMIA: It is characterized by increase of apo B-100 in LDL particles, most probably as a consequence of increased hepatic synthesis. Apolipoprotein E isoforms ApoE4 isoform is associated with elevated LDL-cholesterol concentration due to rapid IDL to LDL conversion. ELECTROPHORETIC DISORDERS: The most important is the latent type IV (pre-beta) or IVb (pre-beta1) with decreased VLDL clearance. PROLONGED POSTPRANDIAL LIPEMIA: It is common in obesity, NIDDM and coronary heart disease, as an independent risk factor for premature atherosclerosis. INCREASED OXIDATIVE MODIFICATION OF THE LDL AND HDL PARTICLES: Oxidatively modified LDL may have a key role in the pathogenesis of atherosclerosis and oxidative modification of HDL reduces its transport capacity and its inhibition of LDL oxidation. INCREASED LEVEL OF LP(A) Lp(a) is an independent risk factor for premature atherosclerosis, primarily in young and middle-aged men, in persons with elevated global cardiovascular risk factor profile, decreased HDL-cholesterol, and hypertension. The risk is smaller in persons taking hypocholesterolemic drugs. Also, it is elevated in NIDDM, hypothyroidism and kidney disease.
Two patients, referred following lengthy, extensive and frequent medical evaluations, were diagnosed as suffering from chronic factitious disorder with physical symptoms (DSM III). A treatment plan to eliminate the positive reinforcements apparently operating in the hospital and home environment, while preventing "loss of face" of the patient, was formulated and successfully carried out. Two detailed case histories to provide evidence for the diagnosis, the "faradic massage" treatment, patient response, and follow-up are documented.
Ice VI is a hydrogen bond disordered crystal over its known region of stability. In this work, we predict that ice VI will transform into a hydrogen bond ordered phase near 108 K, and have identified the likely low-temperature phase as ferroelectric (space group Cc) with an antiferroelectric structure (space group P2(1)2(1)2(1)) close by in energy. Electronic density functional theory calculations provide input to our calculations, which are extended to cells large enough for statistical simulations by using graph invariants. A significant decrease in the configurational entropy is predicted as hydrogen bonds exhibit partial order above the transition, provided that the hydrogen bonds can equilibrate on an experimental time scale. Conversely, partial disorder is predicted at temperatures below the transition. Although some evidence for ordering of ice VI has been observed in experiments, a low-temperature proton ordered phase has not been identified experimentally.