Practical psychiatry in medicine. Part 13: conversion disorders and hypochondriasis.
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Adult↗
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Dividing "hysteria": a preliminary investigation of conversion disorder and psychalgia.
The longstanding diagnostic controversy over the concept of "hysteria" has taken on new significance with the advent and development of the third edition of the Diagnostic and Statistical Manual (DSM-III). The problem of defining hysteria is therefore discussed and re-examined. A retrospective study of cases diagnosed as conversion reaction or hysterical neurosis, conversion type was then completed and analyzed. These cases were redefined using DSM-III criteria and were analyzed using a number of demographic and clinical variables. In a comparison of those patients classified as having conversion and those classified as having psychalgia, no significant differences were found. Those patients under the diagnosis of conversion and those carrying the diagnosis psychalgia differed significantly from a control group of patients with random "neurotic" diagnosis on five variables: a) symptoms are defensive; b) symptoms are expressive; c) secondary gain; d) previous physical trauma; and e) previous conversion symptoms.
Conversion Disorder↗
Causal Relationship of Polyunsaturated Fatty Acids With Mental Disorders: A Systematic Review and Meta-analysis.
CONTEXT: Mental disorders (MDs) pose a important global health challenge, with a complex pathogenesis complicating treatment development. Nutritional interventions, particularly polyunsaturated fatty acids (PUFAs), have gained attention as potential therapeutic options. OBJECTIVE: This Mendelian randomization (MR) meta-analysis aimed to evaluate the potential causal relationship between PUFAs and MDs. DATA SOURCES: Genome-wide association study data were utilized to analyze the association between PUFAs (including omega-3, omega-3 percentage [omega-3%], omega-6, omega-6 percentage [omega-6%], and omega-6 to omega-3 ratio) and 12 major MDs. DATA EXTRACTION: Two-sample MR technology was used to assess the role of PUFAs in MDs. DATA ANALYSIS: The MR analysis revealed that genetically predicted omega-3 was causally linked to MDs, such as obsessive-compulsive disorder, bipolar disorder, schizophrenia, and major depressive disorder. Omega-3% exhibited protective effects against emotional personality disorder. Conversely, omega-6 was inversely correlated with attention-deficit/hyperactivity disorder risk, while a high omega-6 to omega-3 ratio was associated with an increased risk of depression and other mood disorders. CONCLUSION: High omega-3 levels and omega-3% may reduce the risk of MDs, whereas a high omega-6:omega-3 ratio may elevate the risk. These findings highlight the potential of PUFAs, particularly omega-3, in MD prevention and treatment, while underscoring the need for further research into the complex interactions between omega-3 and omega-6. The study provides a scientific foundation for future clinical trials and dietary intervention strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no. CRD42024598472.
Humans↗
New aspects of preleukemic disorders.
Preleukemic disorders are a controversial group of panmyelopathic disturbances that often precede the emergence of acute myeloblastic or myelomonocytic leukemia. In most instances, these preleukemic disorders are characterized by slowly developing myeloblastosis of the bone marrow. They include preleukemia, primary acquired panmyelopathy with myeloblastosis or smouldering acute leukemia, erythroleukemia, and subacute myelomonocytic leukemia. Sometimes, transitions between these various preleukemic disorders may be observed in a single individual. Abnormalities in cellular differentiation are expressed in cytochemical aberrations and in elaboration of colony forming units by marrow cells of patients with preleukemic disorders. Cytogenic and cellular kinetic abnormalities link preleukemic disorders closely to acute myeloblastic or myelomonocytic leukemia, although in many patients with preleukemic disorders, conversion to acute leukemia is not observed or perhaps not recognized. Understanding pathogenetic and pathophysiological aspects of preleukemic disorders may shed light on aspects of cellular proliferation and cellular differentiation in the acute leukemias.
Acute Disease↗
Multiple personality. A single case study with a 15 year follow-up.
A review of the literature relating to multiple personality is presented together with a study of a single case of hysterical aetiology that demonstrates the development of multiple personality from a fugue amnesic state. A re-examination of this case after 15 years without significant psychotherapeutic intervention demonstrates a tendency towards remission. The view that multiple personality is a form of fugue, not necessarily hysterical, in which an alternative personality is adopted and that this behaviour is reinforced by the attention that it receives, is discussed.
Adolescent↗
Psychogenic purpura in a man.
A 53-year-old man with chronic back and leg pain developed recurrent painful ecchymoses after lumbar laminectomy. No hematologic abnormality could be detected, but an ecchymosis developed after subcutaneous injection of his blood into the region of pain. A detailed study of the psychological setting of the illness and his personality revealed this to be an example of psychogenic purpura. This is the third report of the syndrome in a male.
Accident Proneness↗
Neurosis and psychosomatic disorders: aspects of differentiation.
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Adult↗
[The pronated thumb].
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Anxiety Disorders↗
Adolescent psychiatric emergencies.
The adolescent in a psychiatric crisis is best seen alone first, to preclude observer bias. Emotionally charged areas of discussion must not be avoided. Suicidal and homicidal threats or attempts are challenging emergencies. Working with parents is essential for effective management. Is the fire-setter retarded or psychotic? Family therapy is often the treatment of choice in sexual "emergencies." Bizarre behavior should suggest drugs, severe anxiety or psychosis. School phobia is a particularly complex problem.
Adolescent↗
Depressive disorders and religious conversions.
The sparse psychiatric literature concerning religious conversions is reviewed. Four case histories of diagnosed depressive illness followed by religious conversion are presented. In two obsessive-compulsive patients, the religious experience failed to resolve the depression, and both ended in suicide. Two hysterical personalities had a resolution of depressive symptoms following the religious experience. The authors suggest that religious conversion dynamically strengthens repression in hysterical persons, but in some cases fails to resolve obsessive isolation of affect and ambivalence.
Adult↗
[Disorders in the conversion of fibrinogen to fibrin in patients with multiple myeloma].
A prolonged thrombin clotting time was found in 15 of 85 patients with multiple myeloma. Among those with abnormal clotting time in 9 cases (60.0%) the M protein was classified as IgG-lambda, in 1 (6.6%) as IgA-lambda, in 2 (13.3%) as IgG-kappa, and in 3 (20.3%) as IgA-kappa. There was no correlation between the prolongation of thrombin time and occurrence of bleeding. The reptilase clotting time was parallel to the thrombin time. The addition of calcium chloride partially corrected both clotting times. The isolated M proteins IgG-lambda and IgG-kappa from patients with prolonged thrombin time at the concentration of 25-50 mg/ml inhibited the polymerization of fibrin monomers but had no effect on the amidolytic and proteolytic action of thrombin.
Fibrin↗
The validity and significance of the clinical diagnosis of hysteria (Briquet's syndrome).
The author states that a valid diagnostic classification based on the medical model is a sine qua non for progress in psychiatric research and treatment and that such classification requires follow-up and family studies. To illustrate this point he reports on studies showing that hysteria, or Briquet's syndrome, is a valid clinical entity that follows a predictable course and clusters in certain families. He also reports that an association between hysteria and sociopathy has been demonstrated, suggesting that the two conditions may arise from sililar etiologic and pathogenetic factors.
Antisocial Personality Disorder↗
Symptoms in veterans considering compensation claims.
The symptomatology of 56 male veterans considering compensation claims was compared to the symptomatology seen in 163 veterans not considering such claims. Antisocial behaviors, somatic/neurotic complaints, and persecutory ideas were all positively correlated with consideration of a claim. Although the symptom profile is consistent with diagnosis of antisocial personality, a correlation with this diagnosis was not established. Nonetheless, the clinical profile does suggest a link between noncompensable disorders and consideration of a claim. The implications of this finding for military and Veterans Administration psychiatry are discussed.
Adult↗
Case studies in neuropsychiaatry. II: Conversion pseudodementia.
A patient is described who experienced pseudodementia as a conversion reaction. The patient was considered to be demented originally because of the evidence for profound cognitive impairment elicited on mental state examination. Careful analysis of the patient's verbal production in unstructured situations and of her behavior inthe hospital permitted a clinical diagnosis of pseudodementia to be made, a diagnosis confirmed by response to treatment and long term follow-up. Evidence is presented to support the interpretation of her pseudodementia as a conversion reaction.
Adult↗
Some guidelines for uses of hypnotherapy in pediatrics.
Hypnotherapy has many uses in pediatrics, and its value, not only as a adjunct but also as a primary therapy for certain conditions, justifies its inclusion in pediatric training programs. Suggestion and expectation have long been related to therapeutic outcomes in medicine, but not all physicians know how to apply them constructively and systematically in communication with patients. In pediatrics there is a tendency to overlook opportunities in which hypnosis might be the treatment of choice. Because children engage in imagination and fantasy easily without the cognitive inhibitions of adults, they are able to use hypnosis more readily than adults. More research into the imaginative skills of children may facilitate understanding of learning mechanisms and make it possible for professionals to prevent the loss of the natural imaginative capacities in children and, therefore, enhance the ability of mature members of society to use these skills. In addition to reduction of specific symptoms through hypnotherapy, children benefit by the sense of mastery which they acquire, a sense which is surely needed to overcome the feelings of hopelessness, loss of control, and depression induced by many diagnostic and therapeutic procedures in medicine.
Adolescent↗
Dystonia: a disorder often misdiagnosed as a conversion reaction.
The authors studied the records of 84 patients who had idiopathic torsion dystonia. Thirty-seven cases had originally been misdiagnosed as primarily psychiatric illness. Only 1 patient presented with dystonic movements that were clearly part of a more general psychiatric disorder. The authors believe her to be the first reported patient whose dystonia is undeniably of psychogenic origin.
Adolescent↗