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PubMed2007

Gait abnormalities in psychogenic movement disorders.

An abnormal gait is not uncommon in patients with medically unexplained neurological symptoms, including those with other psychogenic movement disorders (PMDs). Previous studies have not evaluated the gait characteristics of patients with a variety of PMDs and there are no reports comparing PMDs with and without gait disturbances. We were interested in determining how those with and without additional involvement of gait differed and how PMD patients differed from those with a pure psychogenic gait disorder (PGD) in the absence of another PMD. We investigated gait features in a large series of patients with PMD (n = 279), dividing them into two groups (Group I with a normal gait and Group II with an abnormal gait). Group I included those with PMD with a normal gait and no change in the PMD while walking (I-1), and those with a change in PMD while walking, but not affecting gait (I-2). Group II was divided into those with PMD with additional abnormal gait (II-1) and those with pure psychogenic gait disorder without other abnormal movements (II-2). Excessive slowing of movement was more common in PMD patients with an abnormal gait (Group II) compared to those without (Group I). Slowness of gait was the most common feature in patients with PMD combined with a PGD (II-1) and buckling of the knee pattern was the most common type of pure PGD (II-2), followed by astasia-abasia.

Adolescent↗
PubMed1984

Issues in the diagnosis and treatment of insomnia.

Most people attribute a restorative function to sleep. This is because experimental or clinical sleep disturbance is usually followed by annoying symptoms of fatigue and sleepiness the following day. Can these daytime changes be documented objectively? In the past several years, the Multiple Sleep Latency Test (MSLT) has been developed and validated as an objective quantitative measure of sleepiness. Multiple assessments of sleep latency yield a profile of sleepiness across the day. This profile changes in the predicted direction with acute total and partial sleep deprivation, chronic sleep deprivation, sleep satiation, and in comparisons between hypersomnia patients and controls. Sleep and wakefulness are complementary phases in the daily cycle of human existence. Adequacy of sleep and energetic wakefulness next day are interacting phases in this cycle. Insomnia can be seen as a perception of disturbed sleep with daytime consequences, but is essentially also a symptom. This paper reviews a number of issues in the diagnosis and treatment of insomnia. The dimensions, daytime consequences and longitudinal aspects of insomnia are considered. Most investigations to date have been geared towards the problem of chronic insomnia and yet we are all likely to suffer from transient insomnia at some point. Psychiatric and psychophysiological disorders have been shown to be the most frequent causes of disorders of initiating and maintaining sleep. Moreover, there is an apparent disparity between subjective and objective sleep parameters with, for example, objectively disturbed sleep in noncomplaining subjects. The criteria of hypnotic efficacy and the effects of triazolam and flurazepam on sleep and daytime alertness have been investigated in normals, chronic insomniacs and the elderly. In general, chronic insomniacs showed all degrees of daytime alertness regardless of nocturnal sleep parameters. About one-third could be classified as fully alert all day long in spite of their complaints. The effect of flurazepam and triazolam on sleep (improvement) was essentially the same. Daytime effects were most closely related to half-life. The long-acting benzodiazepine, flurazepam, impaired daytime alertness although nocturnal sleep was improved. Triazolam improved not only nighttime sleep but also daytime alertness.

Chronic Disease↗
PubMed1980

Menopausal syndrome: illness or social role--a transcultural analysis.

In recent years the medical diagnosis and treatment of "menopausal syndrome" has come under a barrage of criticism. Critics of the conventional clinical approach claim that menopausal syndrome is largely a social role foisted on middle-aged women in this society. The physician plays a very active part (albeit an inadvertent one) in recruiting women into this role. This paper examines the evidence for this thesis, including cross-cultural and intracultural variation. The evidence examined suggests that the more psychological and psychosomatic symptoms do seem to vary with cultural role expectations. Research paradigms for further testing of this thesis are adapted from the study of mental disorders and described. In contrast, those organic changes directly associated with estrogen insufficiency do lead in some women to definite pathologies, e.g., osteoporosis and an increased rate of bone fractures. Whether these organic concomitants of aging in women should be viewed and treated medically is a moot question, and one which involves values and politics more than medical facts.

Climacteric↗
PubMed1985

Symptomatic differences between the sexes in rural Mexico.

This paper addresses the problem of the differential presentation of illness by women and men in two Spiritualist temples and a physician's office situated in rural Mexico. Women's morbidity raises the broader anthropological questions of the interplay between symptomatic expression and women's unequal status in the social structure, their cognitive evaluation of specific life experiences, cultural etiological explanations and Western models of dysphoria. Symptoms presented by patients in different health care delivery sites are compared and case vignettes of patients' illnesses and attributions are presented to demonstrate the ways in which culturally constructed illness attributions and illness expressions comprise a somatic grammar for the articulation of experimental distress. The sick population is compared with a control group of healthy women to highlight the socio-cultural and psychosocial variables that promote illness in women from the same sociocultural strata of rural Mexico. Collective understandings of the role of life events and emotional expression in illness attributions legitimize somatization as a coping style under adverse existential conditions.

Adult↗
PubMed1985

The interrelationship of tropical disease and mental disorder: conceptual framework and literature review (Part I--Malaria).

Substantial interactions between tropical diseases and psychiatric illness have long been recognized, but the impact of biological factors in the field of cross-cultural psychiatry has been less well studied than psychosocial factors. In reviewing the literature at the intersection of tropical medicine and psychiatry in order to summarize the existing data base in this field, a generalized interactive model informed by the theoretical contributions of George Engel, the WHO Scientific Working Group on Social and Economic Research, Arthur Kleinman, P. M. Yap, Edward Sapir and others has been developed to serve as a conceptual framework for this analysis of the literature and to guide further research. The clinical literature of tropical medicine and psychiatry which recognizes the significance of concurrent tropical disease and mental disorders is reviewed along with the more specific literature on malaria and concomitant psychiatric illness. Many authors have focused on the role of organic mental disorders, especially in connection with cerebral malaria, but several have also addressed psychosocial parameters through which the interrelationship between malaria and a full range of mental disorders is also mediated. The effects of malaria may serve as biological, psychological or social stressors operating in a cultural context which precipitate or shape features of psychiatric symptomatology. Psychiatric illness may likewise precipitate an episode of malaria with typical symptoms in a patient with a previously subclinical infection. Implications of the literature and this generalized interactive model are considered as they apply to clinical practice, public health and the application of social science theory in medicine.

Cross-Cultural Comparison↗
PubMed1990

Psychiatric morbidity in general practice in Italy. A point-prevalence survey in a defined geographical area.

Psychiatric morbidity among 505 attenders on a single day at 32 general practices in South Verona was assessed using the General Health Questionnaire (GHQ-30) and recordings of practitioners' evaluations. The usual GHQ scoring system with a cut-off point of 5/6 resulted in 52% of high-scorers while the scoring system for longstanding psychological distress conditions (C-GHQ) yielded 37% of high-scorers (cut-off point 11/12). General practitioners identified 28% of attenders as cases. One-day population based prevalence estimates for the GHQ-30 and practitioners' assessment gave values of 6.6 and 4.5 per 1000 at risk. Among several possible risk factors, only presence of previous psychiatric illness increased significantly the relative risk of being a case in terms of GHQ, C-GHQ scores and practitioners' assessments. These findings are discussed in relation to the results of other surveys in the same area and other general practice studies.

Adult↗
PubMed1977

Distribution of DSM-II diagnoses in a child psychiatric setting.

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.

Adolescent↗
PubMed1977

Helen Flanders Dunbar (1902-1959) and a holistic approach to psychosomatic problems. I. The rise and fall of a medical philosophy.

Despite Dunbar's central in the American psychosomatic movement, few successors seem to have grasped the nature and context of her work. This is partially because most histories of psychosomatic theory and research overlook the holistic, organismic point of view shared by Dunbar and other psychoanalysts of the psychobiologic persuasion. The medical-philosophical context of Dunbar's work is here reviewed.

Attitude of Health Personnel↗