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PubMed1980

The emergency amobarbital interview.

Patients infrequently present to the general emergency department with what appears to be a severe psychiatric condition needing rapid differentiation from urgent and emergency medical problems for proper initial disposition and treatment. These include patients with both acute conversion reactions and those in acute catatonic or pseudocatatonic states. Fifteen consecutive patients (11 women and four men ranging in age from 17 to 62) with these symptoms underwent interviews under intravenous amobarbital in the emergency department. Five of these patients presented with acute paralysis of extremities. Ten presented in a state of vigilant awareness similar to, or identical with, catatonia. Using this technique, all 15 patients had the presumptive psychiatric nature of their underlying condition quickly confirmed. The five patients with conversion reactions have no recurrence to date. Four of the 10 catatonia-type patients had resolution of their symptoms without recurrence. All 15 patients responded to 500 mg or less of amobarbital. There were no complications. Two cases are discussed.

Adult↗
PubMed1997

Paradoxical vocal cord motion presenting as acute stridor.

We report the cases of two patients who presented with acute-onset stridor that did not respond to standard medical therapy. Both were eventually found to have paradoxical vocal cord motion (PVCM). The ED management of these patients is reviewed.

Acute Disease↗
PubMed1983

Pseudocyesis in adolescent females.

Three adolescent patients were diagnosed as having pseudocyesis based on an assessment including pelvic examination, pregnancy tests, and pelvic ultrasound scanning. Their psychosocial evaluation demonstrate a conversion reaction in already deprived and depressed adolescents. They responded to psychotherapeutic counseling. Pseudocyesis merits consideration in the differential diagnosis of secondary amenorrhea. It occurs psychologically in vulnerable adolescents who exhibit rather primitive defense mechanisms. Once a patient acknowledges that she is not pregnant, severe depression is a possible complication. A review is presented of the current medical literature on this subject.

Adolescent↗
PubMed2002

Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum.

Women's somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for women's health care and HG, in particular, are presented.

Adult↗
PubMed2002

Psychogenic sensory loss: magnetic source imaging reveals normal tactile evoked activity of the human primary and secondary somatosensory cortex.

We investigated the activation of the secondary somatosensory cortex (SII) in three patients with unilateral psychogenic sensory loss in the hand. Somatosensory evoked magnetic fields were recorded in response to tactile stimulation of the index finger of the affected and the unaffected hand. Brain sources were estimated by magnetic source imaging. In all subjects, responses in both the contralateral primary somatosensory (SI) and bilateral SII areas were normal as compared with a healthy control group, irrespective of the stimulated side. The results extend previous findings of normal evoked activity in SI.

Adult↗
PubMed1980

The clenched fist syndrome.

The clenched fist syndrome is an entity in which the patient keeps one or both hands tightly clenched. It is seen in all groups; hand dominance or compensation is not a factor. It usually follows a minor inciting incident and is associated with swelling, pain, and paradoxical stiffness. No organic disease can be found and extension of the fingers is always possible under anesthesia. Psychiatrically the patient is classified as having severe anger and poor defense. The prognosis is poor.

Adolescent↗
PubMed1985

The upper extremity and psychiatric illness.

Thirty-three patients who had various conversion reactions manifested by signs and symptoms involving the upper extremities were seen over a 13-year period. Factitious lymphedema, factitious ulcers, clenched fists, as well as other dysfunctional postures of the hand and upper extremity, were the most frequently recognized patterns of illness. Denial of knowledge of the cause of the physical problem and a lack of insight into the illness are major parts of the disease process. Twenty-nine of the 33 patients in this study had work-related and therefore compensable injuries. The physical signs and symptoms resolved in four of the patients when compensation was withdrawn. The average follow-up in this study was 4 1/2 years. Unfortunately, the long-term follow-up of these patients revealed that this disease process was chronic and most frequently failed to resolve. Various efforts at treatment have been unsuccessful, including extensive psychotherapy. Confrontation with the patient is contraindicated.

Adolescent↗
PubMed1994

Seizure suggestibility may not be an exclusive differential indicator between psychogenic and partial complex seizures: the presence of a third factor.

Differential diagnosis between psychogenic or ('hysterical') pseudoseizures and clinical partial complex seizures has often employed an index or inference of suggestibility. However, recent research indicates a moderate association between complex partial epileptic-like signs and hypnotic capacity in the normal population as well as for complex partial epileptic patients. Consequently, the precipitation of overt, non-stereotyped seizures by instruction may not be a reliable diagnostic method when an insidious process is slowly elevating temporal/limbic lobe lability. Implications for treatment and contra-indication of antipsychotic (D2 antagonist) drugs are discussed.

Anticonvulsants↗
PubMed1995

Pseudo-epileptic seizures: hypnosis as a diagnostic tool.

In this pilot study hypnosis was used in an attempt to provide evidence of a psychogenic component of pseudo-epileptic seizures. The criterion for psychogenesis was the reversal of the amnesia, which is often present in epileptic- and pseudo-epileptic seizures. The technique has been validated by a semi-blind referral of cases for analysis after the clinician had been able to make a firm diagnosis based on electro-encephalic corroboration of the nature of the seizure. In eight out of nine patients (of the original 13 patients, three patients dropped out and one patient was not evaluable), the experimental diagnosis corresponded with the clinical diagnosis. As pseudo-epileptic seizures can be characterized by their dissociative nature, a reasonable hypothesis is that patients with pseudo-epileptic seizures are more responsive to hypnosis than patients with epileptic seizures. Measurements of hypnotizability among seven patients with epileptic seizures and six patients with pseudo-epileptic seizures supported this supposition.

Adolescent↗
PubMed1997

Personality profiles of patients with pseudoseizures.

Minnesota Multiphasic Personality Inventory profiles were analysed in 55 patients with pseudoseizures (40 patients with pseudoseizures only-pure group, and 15 patients with both pseudoseizures and epilepsy-mixed group). For each of the 10 clinical scales, there were no significant differences between the groups in mean T-score values or the incidence of pathological scores (T-score of 70 or above). In 87.3% of cases in the entire sample (groups combined), at least one clinical scale was elevated in the pathological range. For the combined groups, scales having the highest mean values as well as highest incidence of pathological scores were Schizophrenia, Hysteria and Depression. The mean profile of the entire sample (n = 55) had a two-point code of 8-3 with Schizophrenia and Hysteria as profile peaks. Application of three sets of published criteria for hysteria or conversion yielded markedly different results. This finding underscores the difficulty in evaluating the role of hysteria in pseudoseizures in the absence of a single standard. Mean values and the overall profile of this patient sample were remarkably similar to those found in two previous studies.

Adult↗
PubMed1976

Globus hystericus-a psychosomatic disease?

Twenty patients with a chief complaint of a lump in the throat, were examined otolacyngologically, radiographically, and psychiatrically with special attention directed to psychosomatic aspects. The control material consisted of matched sample persons of the general population, and of the total patient material treated at a general hospital.

Adult↗
PubMed1983

The relationship of the 'inferior constrictor swallow' and 'globus hystericus' or the hypopharyngeal syndrome.

The term 'Globus Hystericus' is considered to be a very bad term for such a common condition and it is recommended that it be replaced by the 'Hypopharyngeal Syndrome'. The normal modified swallow initiated from the lingual tonsil--epiglottis area, called the Inferior Constrictor Swallow, can cause all the symptoms. The epiglottis does not bend. There are two groups of symptoms: the first due to sensation from local irritation of the lingual tonsil; and the second due to vicious circles causing increased muscle tension and strain swallowing. If there is pain or dysphagia or impairment in swallowing, then it is not the Hypopharyngeal Syndrome. The key-note of treatment is the logical explanation of these symptoms and that the vicious circles must be broken.

Adolescent↗