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PubMedDate not supplied

A clinical picture of child and adolescent narcolepsy.

Although narcolepsy is rarely diagnosed before adulthood, symptoms often begin much earlier and can easily mimic psychiatric disorders in children and adolescents. Clinical experience from a pediatric sleep center is reviewed in 16 consecutive cases of polysomnographically proven narcolepsy with onset of symptoms by age 13 years. Only 1 of the 16 patients presented with the classic clinical tetrad of symptoms (sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis). Behavioral and emotional disturbances were present in 12 of 16 cases, with four patients appearing to have been misdiagnosed with a psychiatric disorder before recognition of the narcolepsy. Obesity appeared as an unexpected association in this case series, with 11 of the 16 narcoleptic patients found to be overweight at the time of diagnosis. The varied clinical presentations, polysomnographic findings, family history, and associated psychiatric symptoms are described. The importance of considering narcolepsy in the differential diagnosis of any child or adolescent with excessive sleepiness is emphasized.

Adolescent↗

PubMed1994

Problems in treating globus pharyngis.

Twenty-four out-patients with globus were assessed for current and past psychiatric illness with the 'Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety' version. Patients then received amitriptyline or placebo in a double-blind fashion. Treatment outcome was assessed using an inventory of throat symptoms, Beck Depression Inventory, Spielberger State Anxiety Scale, Crown-Crisp Experimental Index and General Health Questionnaire. Nine patients met the DMS-III criteria for psychiatric disorder in the past; six had suffered from panic disorder. Two further patients had been troubled by classic panic attacks. Nine of the 12 patients treated with amitriptyline and two of the placebo group discontinued treatment. In conclusion, clinical and psychometric associations were found between pathological anxiety and globus, and it appears that the recommendation that globus be treated 'aggressively' with tricyclic antidepressants is likely to lead to a high proportion of treatment failures.

Adult↗

PubMed1996

[Use of high frequency cinematography in diagnosis of globus sensation].

BACKGROUND: Globus pharyngis is a frequent symptom in patients who consult an otolaryngologist. In many cases, routine diagnostic work-up including history, clinical examination, and barium swallow fail to revealing the underlying pathogenesis. PATIENTS AND METHOD: In a retrospective study, we present 51 selected patients suffering from globus pharyngis of unknown origin who were investigated by high-speed cineradiography in a standardized manner. RESULTS: Twenty-four of the patients enrolled in the study (47.1%) showed functional and/or structural swallowing disorders. In 13 cases (25.5%) dyskinesias of the superior esophagus sphincter muscle were found. Five of these patients (9.8%) also had an inconstant hypopharyngeal diverticulum. Six cases (11.8%) showed laryngeal penetration or tracheal aspiration. In four cases (7.8%) functional disorders of pharyngeal, and in three cases (5.9%) functional disorders of oral bolus transport were found. Furthermore one hypopharyngeal web (1.9%) and two benign tumors (3.9%) were detected. In many cases, varying combinations of these findings occurred. CONCLUSION: Using high-speed cineradiography for evaluation of globus pharyngis results in an increased incidence of pathologic findings, and thus is an important method for interdisciplinary diagnostic work up of patients suffering from this symptom.

Adult↗

PubMed1995

Somatoform and related disorders: delivery of diagnosis as first step.

The care of patients with diagnoses on the somatoform spectrum represents a challenge to all primary care physicians and is a matter of frustration to some. These patients tend to "doctor shop," and studies indicate that they generate health care costs that are at least six to 14 times higher than health care costs generated by control subjects. For all disorders on the somatoform spectrum, the most effective management is regular follow-up with the primary care physician. To accomplish this goal, a therapeutic delivery of the diagnosis to the patient is essential to firmly establish the therapeutic alliance. An approach is suggested for "administering" the diagnosis as the first step in treatment for patients with several types of somatoform and related disorders. These techniques allow the patient's emotional needs to be met, enable the patient to save face when necessary and solidify the doctor-patient relationship. A good relationship allows the physician to provide long-term management with empathetic, safe and cost-effective medical care. Physicians may at times dread somatic patients, and these useful techniques can help them begin a more satisfying relationship with their very challenging patients.

Conversion Disorder↗

PubMed1977

Evaluation of a screening interview for Briquet syndrome (hysteria) by the study of medically ill women.

A screening interview for Briquet syndrome consisting of 14 symptom questions was administered to a group of 50 medically ill women. No patient was found eligible for a diagnosis of Briquet syndrome, a frequency less than the estimated general population prevalence of 1% to 2%. When symptoms explainable by known organic disorder were considered positive, 14% of patients became eligible for the diagnosis. We consider this a low enough rate to allow screening by lay interviewers. A frequency distribution of symptoms comparing the medically ill women and a group of psychiatric clinic women with Briquet syndrome shows that the Briquet group had both more symptoms and distinctive patterns of symptoms.

Age Factors↗

PubMed1992

Provocation of pseudoseizures by psychiatric interview during EEG and video monitoring.

OBJECTIVE: This paper discusses a new technique for diagnosing pseudoseizures. The technique consists of an intensive psychiatric interview designed to provoke a pseudoseizure during EEG and video monitoring. We wished to determine the overall efficacy of the technique and learn how our patients felt about having undergone the procedure. We were also interested in whether their seizures persisted approximately three years later. METHOD: We reviewed medical records and conducted telephone interviews with thirty of thirty-two patients who had previously undergone the procedure as part of an evaluation for unusual or intractable seizures. All evaluations had been performed on a university hospital neurology service. The patients were consecutive referrals to the consultative psychiatry service for suspicion of pseudoseizures. RESULTS: Nineteen of the thirty-two patients interviewed had a pseudoseizure under EEG and video monitoring. Of the thirty reached by telephone for follow-up, twenty-two recalled the procedure as helpful or benign. None regarded the overall psychiatric consultation negatively. Among the patients who had exhibited pseudoseizures there was a variety of psychiatric diagnoses with a preponderance of personality disorders. Two thirds of those patients without coexisting epilepsy stopped having seizures or rarely had seizures following their evaluations. CONCLUSIONS: The diagnostic technique described here is useful in patients with possible pseudoseizures. It does not appear to be harmful when employed as part of a comprehensive psychiatric consultation. How it may compare with other methods of pseudoseizure diagnosis will have to be determined by further study.

Adolescent↗

PubMed1982

[Psychosomatic correlations in pediatric ophthalmology].

Somatopsychic disturbances encompassing both ophthalmologic as well as child-psychiatric phenomena mainly occur in ADD: Central disorders of eye motoricity (strabismus) and disorders of visual perception are encountered. Dyslexia or dysorthography often occur as secondary phenomena. The psychosomatic or psychogenic disturbances affect not only the lid mechanism but also visualization. In the lid region, nictation tics and trichotillomania of the eyebrows and eyelashes occur. Psychic impairment of vision may range from a slight amblyopia, often associated with limitation of the field of vision, to complete amaurosis. The symptomatology is described and illustrated with examples.

Adolescent↗

PubMed1983

Vocal-cord dysfunction presenting as asthma.

We identified five patients with a functional disorder of the vocal cords that mimicked attacks of bronchial asthma. Paroxysms of wheezing and dyspnea were refractory to standard therapy for asthma. During episodes of wheezing, the maximal expiratory and inspiratory flow-volume relationship was consistent with a variable extrathoracic obstruction. Laryngoscopy confirmed that wheezing was due to adduction of the true and false vocal cords throughout the respiratory cycle. During asymptomatic periods the maximal flow-volume relationship and laryngoscopic examination were normal. Provocation tests for bronchial asthma were negative. A variety of personality styles and psychiatric diagnoses were represented; patients were not aware of the vocal-cord dysfunction, which uniformly and dramatically responded to speech therapy and psychotherapy. This syndrome may be a form of conversion reaction.

Adolescent↗

PubMed1989

Clinical studies in psychogenic stuttering of adult onset.

Twelve patients (6 men and 6 women), ages 21-79 years, who, as far as it could be determined from their case histories, began to stutter for the first time in adulthood were classified by examining physicians and speech-language pathologists as having psychogenic stuttering. The case histories of these patients were examined to determine the details of their speech and allied complaints, the course and duration of stuttering, and if any psychologically stressful events surrounded the onset and development of the disorder. Minnesota Multiphasic Personality Inventory (MMPI) data on 10 of the 12 patients were analyzed independently. The main findings were (a) stuttering was the chief complaint of 11 patients; (b) all 12 patients had additional neurologic-like complaints that turned out to be nonorganic; (c) duration of stuttering from onset to examination ranged from 4 hr to 1.5 years; (d) the stuttering of most patients was variable in severity and returned to normal either spontaneously or as a result of speech therapy or psychotherapy; (e) psychologic stress was associated with the onset in 10 patients: the stress was chronic in 4 patients and acute in 6; (f) MMPI profiles of 9 of 10 patients were abnormal, with four profiles reflective of a conversion reaction; (g) differentiating neurologic from psychogenic stuttering and the need for interdisciplinary collaboration were essential in all 12 cases; and (h) speech therapy and psychotherapy are justified when psychogenic stuttering is diagnosed.

Adult↗

PubMed1997

A classification scheme for paradoxical vocal cord motion.

Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1. brainstem compression; 2. cortical or upper motor neuron injury; 3. nuclear or lower motor neuron injury; 4. movement disorder; 5. gastroesophageal reflux; 6. factitious or malingering disorder; 7. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well-directed diagnostic evaluation and treatment.

Adolescent↗

PubMed1985

Saline activation of pseudoepileptic seizures: clinical EEG and neuropsychiatric observations.

Twenty patients with suspected pseudoseizures underwent saline infusion during prolonged sleep deprived EEG with video monitoring and nasopharyngeal electrodes. No patients had definite clinical evidence of epilepsy, but 35% had abnormal EEGs, 10% with epileptiform activity. Patients with epileptiform discharges did not experience pseudoseizures with saline infusion. Patients with generalized EEG slowing responded to saline infusion with characteristic seizures. Three groups of patients were differentiated. Eight patients had characteristic attacks with saline infusion, and in these patients females predominated, mean age was lower, and somatoform disorder was common. Six patients each either failed to respond to saline or had episodes different from their characteristic spells. These patients were more often male and more often had diagnoses of personality disorders. The findings suggest that, although saline infusion may identify pseudoseizures and confirm their non-epileptic nature, some patients may not be sufficiently suggestible to respond to saline infusion, while others may have non-epileptic attacks which are different from the spells under evaluation. Psychiatric and neuropsychological features suggestive of pseudoseizures may be more readily identified by psychiatric interview or psychometric testing. Ethical issues regarding saline infusion in the guise of a potent convulsant should also be considered.

Adult↗

PubMed2002

Are functional motor and sensory symptoms really more frequent on the left? A systematic review.

OBJECTIVES: To test the hypothesis that unilateral motor and sensory symptoms unexplained by identifiable disease are more common on the left side of the body than the right. METHODS: Systematic review of the literature published since 1965. RESULTS: 121 eligible studies, involving 1139 patients, were analysed. The pooled proportion of functional left sided weakness and sensory symptoms in adults was 58% (95% confidence interval (CI) 55 to 61%). A much higher proportion of left sided symptoms (66%, 95% CI 61 to 71%) was found in studies where laterality featured in the title of the paper. However, when laterality was not mentioned in the title, no significant difference between left and right was observed (53% on the left, 95% CI 48 to 57%). This difference could not be explained on the basis of sex differences between the groups or the date of the study. Functional or "psychogenic" movement disorder was right sided in 68% (95% CI 61 to 75%). Handedness did not influence symptom lateralisation. CONCLUSIONS: The findings of this systematic review question whether functional weakness and sensory symptoms do in fact occur more commonly on the left side of the body. A type of outcome variable reporting bias in combination with non-blinding of investigators may be responsible for this long held but erroneous belief.

Aged↗

PubMedDate not supplied

A case of psychogenic tremor associated with blepharospasm and myoclonus: an analysis with surface electromyogram.

We report a 25-year-old woman with an unusual complex psychogenic movement disorders consisting of blepharospasm, tremor, and myoclonus. The tremor appeared in both arms and legs with resting, kinetic, and postural tremor of a variable amplitude, direction, and frequency. The analysis of the arm tremor with surface electromyogram revealed that it consisted of reciprocal and alternating contraction of the wrist flexor and extensor. No apparent co-activation of agonist-antagonist muscles could be seen at the onset of the tremor at rest or at its appearance while performing diadochokinesis.

Adult↗

PubMed1976

Hysteria in India: clinical aspects.

Two hundred fifteen cases (38 males, 177 females) of hysteria were studied, while the investigators kept in view the cultural factors affecting clinical presentations and influencing etiological aspects of emotional disorders. India hysterics of either sex presented with multiple symptoms, usually combinations of physical and psychogenic manifestations. There was no significant difference between clinical presentations as observed in the two sexes. Sensory disturbances, paraplegias, monoplegias were in low frequency. Although a wide range of premorbid personality patterns could be identified in the present study, the most frequently occurring personality in females was hysterical and in males antisocial. Family history and parental deprivation did not appear to offer any relationship towards the occurrence of hysteria.

Conversion Disorder↗

PubMed1975

Psychogenesis and somatogenesis of common symptoms.

There are situations in clinical practice in which the physican should keep in mind the influence of emotional factors in the elaboration of symptoms and yet should not conclude hastily that "all is in the patient's mind". Symptoms are often the result of complex etiologic factors including life-threatening illnesses presenting psychologic symptoms as an early manifestation. Psychologic disorders and physical illnesses with similar symptoms may coexist in the same patient. There are also cases in which the symptoms are the result of the constant interaction of psychologic and physical factors. Some suggestions to help to clarify the diagnosis are given and a classification of the different clinical situations involved is presented. Becuase physicians should be constantly aware of the complexity of the factors involved in the elaboration of obscure symptoms, some recommendations are given in regard to undergraduate and graduate medical education.

Affective Symptoms↗

PubMed1984

[Psychogenic vision disorders: a case report with psychosomatic findings].

The diagnosis of psychogenic visual disturbances, a phenomenon not so very rarely to be observed, is often made by an ophthalmologist, whereas the patients concerned will seldom consult a psychotherapist. We describe somatic, psychiatric and psychological data in 8 observed cases. Results of psychodynamic interviews point to underlying, especially oedipal conflicts. Slight confidence in one's own possibilities on the one hand and incomplete defence of urge on the other may here, too, lead to functional symptoms in special conflict situations. Need for and possibilities of careful diagnostic are discussed, as well as special courses of psychogenic visual disturbances and therapeutic changes.

Adolescent↗

PubMed1984

[Pediatric psychosomatic medicine. Liminal proposals].

Psychosomatic disorders are part of the pediatrician's everyday practice. However, they have only lately become a field for systematic investigations, based on diverse methods and concepts. The viewpoints supported by the authors originate in studies carried out in the pediatric department of a hospital which deals only with psychosomatics. The following points are considered successively: 1) definition and peculiarities of psychosomatic disorders in children; 2) susceptible emotional organizations, which carry a high risk of psychosomatic disease; 3) depression, which is a key mental mechanism in psychosomatic disruption. One of the main purposes of research is description of a specific semiology of childhood psychosomatic disease. Its ambition is to be both open to medical practice and acknowledged in its specificity, so as to be used in psychological disciplines, i.e., sufficiently clear but without oversimplification. Further developments can be found in "L'enfant du désordre psychosomatique" (Privat 1981) and "La psychosomatique de l'enfant" (PUF 1983).

Child↗

PubMed1983

The general hospital psychiatrist as "compleat" therapist.

Four case histories have been presented to illustrate the range of therapeutic modalities which the liaison and consultation psychiatrist may be called upon to employ in the routine treatment of patients in the general hospital. These include analytically oriented insight and supportive psychotherapy, intervention with the family, collaboration with the medical and nursing staff, resolution of staff countertransference difficulties, pharmacotherapy, the turning of hospital and community resources to therapeutic account, and follow-up treatment and referral. Other more specialized modalities such as hypnosis (Frankel, 1978), amytal interview (Naples and Hackett, 1978) electroconvulsive therapy (Glaser, 1953), biofeedback and behavior therapy (Fordyce, 1978), and group therapy (Rahe, O'Neil, Hagan, and Ransom, 1975) have also proven useful. The synthesis of these skills into an individualized, coherent treatment approach is the challenge posed to the consultant by the 20 to 60 percent (Lipowski, 1967) of patients admitted to the general hospital with treatable emotional disorders. Because the vast majority of these disorders relate directly to the illness for which the patient was admitted and to the treatment rendered (Torem, Saravay, and Steinberg, 1979) they comprise a unique spectrum of psychiatric illnesses which often demand timely intervention (Solomon, Saravay, and Steinberg, 1980) before complete information is available. To effectively meet these challenges, the general hospital psychiatrist strives toward the ideal of the "compleat" therapist--creatively synthesizing an individualized approach from a varied therapeutic repertoire for each of the patients he is called upon to treat.

Adult↗