Biomedical subjects
Publications and source records attributed to C V Ford.
The authors report a case in which pathological lying is associated with right hemithalamic dysfunction as shown by [99mTc]HMPAO SPECT brain scanning. This association has not been demonstrated previously and is noteworthy because it supports the hypothesized roles of the thalamus and associated brain regions in the modulation of behavior and cognition.
Persons with psychological problems who translate their distress into somatic symptoms (somatize) are frequent users of medical care. These patients often have underlying depression, anxiety, obsessive--compulsive symptoms, or personality disorders. Descriptions of the somatizing syndromes are provided in association with recommendations as how to recognize and manage the patient with somatization.
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Pseudologia fantastica has not been reviewed in the English literature in over 50 years, but the term is still used, for example, among the diagnostic criteria for the Munchausen syndrome. Based upon a review of 72 cases of pseudologia fantastica collected from 26 reports since its initial description in 1891, pseudologia is distinguished from other types of lying. Pseudologia fantastica is typified by these characteristics: (1) the stories are not entirely improbable and are often built upon a matrix of truth; (2) the stories are enduring; (3) the stories are not told for personal profit per se and have a self-aggrandizing quality; and (4) they are distinct from delusions in that the person when confronted with facts can acknowledge these falsehoods. The authors compile phenomenological data about "the pseudolouge", who is represented equally males and females. Intelligence varies, but at least 40% have evidence of central nervous system dysfunction. The authors suggest that disease simulation, peregrination, and imposture are secondary behavioral manifestations of pseudologia, which is deserving of additional study.
The authors discuss the phenomenon of lying, a common psychic process that has received remarkably little scrutiny. The ubiquity of lying and others forms of deception suggests that they have "normal" aspects, but lying which is persistent or destructive to the quality of a person's life becomes pathological. Lying has many determinants, including developmental, biological, social, and psychodynamic. Antisocial, histrionic, narcissistic, borderline, and compulsive personalities have been associated with lying. The treatment of lying needs to be individualized according to the overall symptom complex in which it is embedded.
The authors present recommendations for educating medical students and psychiatric residents in geropsychiatry. They are primarily concerned with the objectives and methods rather than the content of training. Proposals are structured in terms of training objectives and educational settings in which such training takes place. The proposals are intended to be specific enough to be truly useful and at the same time sufficiently generalizable to adapt to geropsychiatric training in a variety of institutions. Priority is given to integrating knowledge of normal and abnormal aging with the clinical skills and empathy necessary to approach patients with competence and understanding.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Aexithymia is a clinical concept referring to the difficulty some people have in verbalizing their feeling states. It is prevalent in patients suffering from a variety of psychosomatic illnesses. The authors conduced a controlled study to investigate the presence of this trait among patients attending a psychosomatic clinic and those attending a traditional outpatient psychiatric clinic in a county general hospital. The results indicate that, in this lower socioeconomic population, alexithymia is equally present in both clinics. The discrepancy between these results and those previously reported are discussed, as are the ramifications of the findings.
A 67-year-old woman, previously self-sufficient, became housebound by phobic symptoms. During the patient's hospitalization for treatment of these disabling symptoms, a multidisciplinary case conference served to identify the underlying psychodynamic issues, which were related to separation anxiety. Treatment included helping the patient understand her relationships with her daughter and her own mother, and behavior modification to reduce the secondary gains of her symptoms. After treatment, the patient successfully returned to self-care.
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Screening chest x-rays are routinely obtained for psychiatric as well as other patients. The authors present data that suggest that this practice no longer has a sound medical basis and should be eliminated or modified. It is unlikely that routine radiography of the chest is of practical benefit to adult psychiatric patients who are clinically healthy and are under age 40.
Bipolar affective illness may be a relatively common missed diagnosis in the elderly. Inaccurate historical data, atypical course of illness and atypical clinical presentation are all sources of diagnostic error. Lithium and tricyclic antidepressants are effective agents in this age group but require close monitoring, with particular attention to their interaction with illness and other medications. A high index of suspicion for bipolar illness is suggested when elderly patients present with depression.
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