PubMed · 14925586
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J QUIVY. 1951. [Phantom pregnancy].. https://pubmed.ncbi.nlm.nih.gov/14925586/
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INTRODUCTION: Sexual medicine healthcare professionals, who do not normally examine men and women with psychiatric disorders, need to be aware that those with psychiatric disorders can and do present with sexual medicine problems. In particular, psychiatric individuals may present with a variety of delusions including those that have sexual content or sexual implications. The rare disorder of reverse delusional misidentification syndrome may be encountered in schizophrenic patients and may be best managed by the combined team effort of a sexual medicine specialist and psychiatrist. AIM: To report a case study that reiterates the assessment and sexual medicine management of a female with sexual dysfunction who believed she was transforming into a male. METHODS: Case report of a woman who attended an outpatient clinic in an academic medical center. RESULTS: A 60-year-old woman with a history of paranoid schizophrenia presented to a gynecologist for ovarian cancer screening. Evaluation revealed complaints that the patient's ovaries were testes that produced sperm and her clitoris was a penis capable of erection and ejaculation. Gynecological examination revealed only atrophic vaginitis. The patient was treated with local minimally absorbed vaginal estrogens and referred for psychological assessment and counseling. Psychotropic medication compliance was encouraged, weekly psychotherapy was continued, and delusional symptoms were minimized. CONCLUSION: Sexual medicine healthcare providers should be prepared to manage sex health concerns of men and women with psychiatric disorders, including delusional misidentification syndrome, in conjunction with a psychiatrist.
In 1912, Karl Jaspers published an article entitled "The Phenomenological Approach to Psychopathology." This and his subsequent text, General Psychopathology, was to exert a profound influence on the development of psychiatry in general and psychiatric nosology in particular. The current Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases both reflect, at least in part, that legacy. This article will argue that the descriptive psychopathology of Jaspers has been gradually transformed into a caricature which has substituted authority for enquiry and simplification for subtlety. We have been left with classificatory systems which impose reified categories increasingly at variance with clinical reality and increasingly divorced from the data generated by scientific enquiry. Returning to the phenomenological method, despite its contradictions, may open the way to clinical and research approaches which free us from the current straight jacket of orthodoxy which is impending our progress.
This is an explorative study on the values of persons with schizophrenia based on transcripts of individual therapy sessions conducted for 40 persons with chart diagnoses of schizophrenia or schizotypal disorder. Values are action-guiding attitudes that subject human activities to be worthy of praise or blame. The schizophrenic value system conveys an overall crisis of common sense. The outcome of this has been designated as antagonomia and idionomia. Antagonomia reflects the choice to take an eccentric stand in the face of commonly shared assumptions and the here and now "other." Idionomia reflects the feeling of the radical uniqueness and exceptionality of one's being with respect to common sense and the other human beings. This sentiment of radical exceptionality is felt as a "gift," often in view of an eschatological mission or a vocation to a superior, novel, metaphysical understanding of the world. The aim of this study is neither establishing new diagnostic criteria nor suggesting that values play an etio-pathogenetical role in the development of schizophrenia but improving our understanding of the "meaning" of schizophrenic experiences and beliefs, and by doing so reducing stigmatization, and enhancing the specificity and validity of "psychotic symptoms" (especially bizarre delusions) and of "social and occupational dysfunction" through a detailed description of the anthropological and existential matrix they arise from.