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PubMed2002

Paroxysmal nonepileptic events in children and adolescents.

OBJECTIVE: Paroxysmal nonepileptic events (PNEs) are frequently encountered in children and adolescents; however, there is little information concerning the relative frequency of various types of these disorders. We report our experience with PNEs in a group of children and adolescents who underwent prolonged video-electroencephalographic monitoring. METHODS: During a 6-year period, 883 patients were monitored in the Pediatric Epilepsy Monitoring Unit and 134 patients (15.2%) were documented to have PNEs on the basis of a typical spell recorded during monitoring. Their hospital charts were reviewed and videotapes of these events were analyzed. RESULTS: Patients were divided into 3 age groups: 1) the Infant, Toddler, and Preschool Group (2 months-5 years) that comprised 26 patients. The most common diagnoses were stereotyped movements, hypnic jerks, parasomnias, and Sandifer syndrome. Concomitant epilepsy was present in 12 patients (46%). 2) The School-Age Group (5-12 years) consisted of 61 patients. The most frequent diagnoses were conversion disorder (psychogenic seizures), inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders. Fifteen patients (25%) had concomitant epilepsy. 3) The Adolescent Group (12-18 years) consisted of 48 patients, of whom 40 patients (83%) were diagnosed with conversion disorder. Nine patients (19%) had concomitant epilepsy. CONCLUSIONS: In our patients with PNEs, conversion disorder was seen in children >5 years old and its frequency increased with age, becoming the most common type of PNEs among adolescents. In adolescents, conversion disorder was more common in females, whereas males predominated in the school-aged group. Concomitant epilepsy with nonepileptic events occurred in all 3 age groups to a varying extent.

Adolescent↗
PubMed1992

[Rehabilitation and psychotherapy].

Especially the chronically ill and disabled deserve to benefit from "socially integrated psychotherapy" in view of their specific situation of distress, which has often arisen without warning and unexpectedly. Dealing with bodily impairments, there are the so-called "organismic" methods using the hypnoid state as major component that have proven to be highly efficient. Dealt with are autogenic training, guided affective imagery, respiratory feedback and hypnosis. Hypnoid states can be regarded as a third basic state of consciousness in humans (besides waking and sleep). They play a major role in many forms of psychotherapy. The knowledge and selective use of underlying mechanisms enhance the potentialities of psychotherapy. The psychotherapeutic basic dialogue stays in constant accompanying function. We are opposed to a widespread misconception that psychotherapy is a method for the treatment of psychogenic disorders only. We obtained good results in the treatment of palsied patients of extrapyramidal and pyramidal type with hypnosis or autohypnosis as well as with our own model of group psychotherapy (autogenic training with concomitant analytic discussion, over a period of up to nine months). In this set-up we successfully mix patients with psychogenic and with somatogenic disorders. Although not a primarily psychotherapeutic method, respiratory feedback also makes use of the hypnoid state. Good results have been achieved with patients in rehabilitation and chronic pain sufferers. Occasional experience with guided affective imagery have been encouraging. We can conclude that psychotherapy with organically ill patients is indicated and promising. We need more appropriate training, supervision and concomitant scientific research.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1986

Functional somatic disorders. Key diagnostic features.

In diagnosis of functional somatic disorders, it is important to remember that the patient has no control over symptoms in somatization disorder, conversion disorder, psychogenic pain, and hypochondriasis. In addition, the environmental goals are recognizable only with careful history taking. Although voluntary symptom production is involved in both factitious disorder and malingering, environmental goals in the latter disorder are much more obvious. Depression can be an accompanying feature of all of these disorders; however, it is most closely linked with psychogenic pain. Atypical or masked depression should be included in differential diagnosis in elderly patients with somatic complaints. Referral to a consultation-liaison psychiatrist can help in evaluation and diagnosis of a somatic disorder. Joint consultation is the most effective way to plan treatment for this difficult group of patients.

Adult↗
PubMed1990

Delusional halitosis. Review of the literature and analysis of 32 cases.

Halitosis, or bad breath, is a feature of some oral and systemic diseases. However, there are apparently healthy individuals who complain of having bad breath which no one else can smell and for which no local or systemic condition can be found. This condition, referred to in this article as delusional halitosis, has identical features with a psychiatric disorder, monosymptomatic hypochondriacal psychosis. This paper reviews the literature on halitosis and oral psychogenic disorders and presents an analysis of 32 cases of delusional halitosis that presented at the University of Benin Dental Hospital, Nigeria, in the period 1984-1986.

Adolescent↗
PubMed1976

[Suicide attempts in the involutional and aged periods].

The authors studied 76 patients from 51-87 years who attempted to commit suicide. The main diagnostic categories were involutional, senile and reactive psychoses, alcoholism, and schizophrenia. The main syndromes during which such acts were attempted were anxious-depressive, depressive-hypochondriacal and depressive-delusional. The formation of suicidal tendency was precipitated by age involution, somatical disorders, psychogenic traumas. In most of the patients following the suicidal attempt, there were mental disorders, conditioned both by the main psychic disturbance and by the personality reaction to the suicidal act, due to which special psychiatric treatment was necessary.

Aged↗
PubMed1997

[Mood disorders. Prevalence and course of unspecified functional disorders from the epidemiologic and psychosomatic viewpoint].

Subjective complaints or somatoform symptoms beyond the case threshold (ICD-diagnoses) occur in 12% of the normal population. In recent studies prevalence is at least 17% in primary care. Somatoform complaints (e.g. headache with 38.7%) or non-specific common symptoms (e.g. feeling of inner restlessness with 41.3%) are much more widespread. Mostly, several symptoms together are forming a multiple somatoform syndrome. As well known from other psychogenic disorders, spontaneous long-term course of somatoform symptoms is variable due to the psychic co-morbidity (in particular anxiety and depression) and a strong tendency to symptomatic shift. The long-term course of total impairment by additional psychogenic symptoms is rather bad in somatoform disorders. Clinically significant personality traits and traumatic influences during early childhood development are correlated with somatoform disorders. Within the traditional role patterns of the relation between physician and patient, somatoform complaints often communicate or indicate a psychodynamic conflict. In this case, a psychosomatic/psychotherapeutic approach in primary care or a specialized psychotherapy is indicated.

Anxiety↗
PubMed2003

[Depression and schizophrenia].

Affective disorders in schizophrenia overlap with positive symptoms and are co-morbid with negative changes. At schizophrenia onset, depression may emerge in the form of psychogenic disorders (posttraumatic stress disorder, juvenile asthenic failure, etc.). Depression, developing during the disease, determines clinical picture of attacks provoked psychogenically (hysterical depression, anxious depression)--reactive schizophrenia. In post-attack stages of schizophrenia, two types may be singled out--post-psychotic depression and post-schizophrenic one. The post-psychotic depressions us includes neuroleptic depression with features of anesthetic melancholia, persevering depression, akinetic depression, neuroleptic dysphoria. Its induced by antipsychotics and combine with extrapyramidal disorders.

Affective Disorders, Psychotic↗
PubMed1993

[Prognostic indicators of psychogenic diseases in adulthood based on childhood variables].

Using the data of the Mannheim Cohort Projekt (Schepank, 1987, 1990), the authors investigate possible correlations between psychic symptoms in childhood, risk and protective factors with regard to psychogenic disorders in adulthood. For this, the number of symptoms and the "Impairment-Score" as the degree of psychogenic complaints were related to each other by determining Spearmen's rank correlation coefficient. Additionally, the predictive power of these three variables were investigated by means of discriminance analysis. It could be shown, that the severity of psychogenic illness in adulthood increases with the number of childhood symptoms. There was no evidence for the hypothesis of an increasing predictive power for the assembled variables (number of symptoms, risk factors, and protective factors) in comparison with the single variables. The results found are, however, comparable to the data of two prospective longitudinal studies.

Adaptation, Psychological↗
PubMed2002

Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami-shoyo-san and Hange-koboku-to.

Kampo medicines have been used to treat patients with psychogenic disorders from ancient times. In the present report the cases are described of four patients with panic disorder successfully treated with Kampo medicines. These four patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for panic disorder with agoraphobia. The Kampo medicine Kami-shoyo-san (TJ-24) relieved panic attacks, anticipatory anxiety and agoraphobia in two patients, and Hange-koboku-to (TJ-16) relieved these symptoms in the other two patients. The patients in whom Kami-shoyo-san was effective were older and complained of more symptoms than those in whom Hange-koboku-to was effective. These Kampo medicines may be useful as additional or alternative treatments for panic disorder.

Adult↗
PubMed1984

[Alternative therapy concept for the treatment of psychosomatic disorders. Controlled double-blind evaluation of fluspirilene versus bromazepam].

Today, Fluspirilene 1.5 mg i.m. (Imap 1,5 mg), is used to treat psychosomatic conditions, anxiety states and psychogenic disorders. The present article reports on clinical studies involving these indications. The efficacy of Fluspirilene 1.5 mg i.m. was demonstrated in patients with functional organic complaints, autonomic emotional symptom complexes, patients with anxiety, patients with functional heart complaints, and patients with functional gynaecological disorders. The results of a controlled study of 1.5 mg Fluspirilene i.m. and 6 mg Bromazepam are discussed. Forty-five patients from a neurologist's practice participated, all of whom had been classified as treatment-requiring patients with neurotic anxiety, on the basis of the physician's diagnosis and psychometric examination. Treatment lasted 42 days. The clinical assessment by the physician revealed that 1.5 mg Fluspirilene i.m. is significantly more effective than Bromazepam. The psychometric findings showed that patients with marked somatic anxiety treated with Fluspirilene showed greater improvement as expressed in a reduction in anxiety, lightening of mood, and increased activity, as compared with Bromazepam.

Adult↗
PubMed1999

[The Dusseldorf short-term dynamic psychotherapy project (DKZP)].

Time-limited psychodynamic therapies in the outpatient setting are offered for a broad spectrum of psychogenic disorders. Meta-analyses prove their effectiveness mainly for neurotic disorders. We are interested in the suitability of the here applied CMP/SASB model (Tress et al. 1996) of psychodynamic short-term therapy for patients with psychosomatic and severe personality disorders. We extensively present the concept of Cyclic Mal-adaptive Pattern (CMP) in its clinically relevant parts as the core of psychogenic pathological developments. Particularly the introject, as the patient's attitude towards him- or herself, is of great importance for therapeutic change and its follow-up development. Within the DKZP (Duesseldorf Short-Term Psychotherapy Project), 36 male and female therapists, mostly interns at the local university clinic, treated 82 patients (m: 23/f: 59) with personality disorders (n = 26) and psychosomatic disorders (n = 31) as research groups and, in comparison, neurotic patients (n = 25) in a naturalistic design. 68 treatments have been completed so far, 11 patients have dropped out, the remaining 3 are still in therapy. Relevant research instruments are the Beeinträchtigungsschwere Score (BSS, an impairment score), Global Assessment of Functioning Scale (GAF), Cyclic Maladaptive Pattern (CMP), Symptom Check List (SCL-90-R), and Structural Analysis of Social Behavior (SASB) including process and content ratings, as well as the Intrex questionnaire. The treatments last 25 sessions. We carried out follow-up examinations after 6 months, 1 year, 2, and 5 years. Effect sizes for the whole sample by BSS and GAF are remarkably high, with further increase at follow-up interviews. Psychosomatic patients came off best, but personality disorders in comparison to neurotic patients profited surprisingly well. Effect sizes in self-rating (SCL and Intrex) were less high. However, in self-rating the changes of social functions are not sufficiently addressed. As a result, our form of focal therapy is well suited not only for neuroses, but also for psychosomatic disorders and personality disorders. An enlargement of the indication spectrum for this form of psychodynamic therapy to include these disorders is well founded and promising.

Adult↗
PubMedDate not supplied

[Depressive disorders in children and adolescents].

The author presents the results of a 5-7-year research in 99 children and 74 adolescents suffering from depressive disorders. It was found that the etiology of depressive disorders, even at the same group of syndrome-associated diagnosis (DSM-III) was various. In this group very often psychogenic disorders, were present, and endogenous affective disorders were rare. An existence of atypical pictures of some depressive disorders (cyclic anxiety disorders and/or cyclic aggressive disorders was shown in the examined patients.

Adolescent↗
PubMed2006

Burning mouth syndrome (BMS): evaluation of thyroid and taste.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic, intraoral burning sensation seen mainly in middle-aged and post-menopausal females, without identifiable oral lesions or abnormal laboratory findings, but often associated with psychogenic disorders such as depression. The latter can have a range of causes, including hormonal. OBJECTIVE: Since there may be connections between BMS, psychogenic changes, hormonal changes and taste abnormalities, we have examined aspects of taste and thyroid function. PATIENTS AND METHODS: We selected 50 patients with BMS (study group) and 50 healthy subjects (control group) and analysed their ability to taste bitter, acid and spicy substances and analysed their thyroid function and Undertook thyroid echography. RESULTS: Taste sensation was normal in all controls. However, 30 of the patients with BMS reported ageusia for bitter taste and 2 had ageusia for acid. The use of pepper sauce (Tabasco) (spicy substance) produced a strong burning to the tongue in 28 patients of the BMS group but only in 10 controls. No control patients showed abnormality of thyroid function or echograpic abnormality. Five patients in the BMS group had biochemical evidence of hypothyroidism, 4 patients had raised levels of thyroid auto-antibodies and, of the 41 remaining BMS patients, most (34) had thyroid echographic changes indicative of nodularity. CONCLUSIONS: Hypothyroidism may be responsible for a negative influence on taste and consequent increase in trigeminal sensorial sensation (tactile, thermal and painful sensation).

Burning Mouth Syndrome↗
PubMedDate not supplied

[Correlation of the organic psychosyndrome in the aged with technical findings--value of EEG and CCT in psychiatric diseases in the aged].

The Psychogeriatric Department of the Bezirkskrankenhaus Regensburg is an open ward of acute cases with intensive care facilities; it exists since 2 years. There are 39 beds, admission rate is about 20-25 patients per month; patients both male and female suffer from neuropsychiatric disorders and concomitant internal diseases. There is a technical examination of all patients by EEG, CCT, cranial x-ray, and in most cases also by Doppler-sonography. The statistical evaluation aims at an attribution of neurological and psychiatric disorders resp. to technical findings. The study comprises 207 in-patients with organic brain syndromes or functional psychiatric-endogenous or psychogenic disorders. There is a better concordance in the differential diagnosis between organic brain syndrome and functional psychiatric disorders resp. and EEG than CCT, it is a statistically significant difference. Most of the psychogeriatric patients demonstrate a marked atrophy of the brain in CCT, and relation to clinical diagnosis is rare, while--apart from some exceptional cases--there is a good concordance between EEG and the clinical diagnosis "organically disturbed" or "organically normal". Though CCT being the appropriate technical method of diagnosis in cerebrovascular stroke, EEG sometimes demonstrates the localisation of an infarction at an earlier stage. EEG and CCT are indispensible in the psychogeriatric diagnostics, EEG has shown to be superior to CCT in the differential diagnosis "organic brain syndrome" vs. "functional psychiatric disorder".

Aged↗
PubMed1984

[Variants of movement disorders within the psychopathologic structure of borderline neuropsychiatric diseases in young children].

On the basis of the examination covering 30 young children (aged 2 months to 3.5 years), three variants of motor psychogenic disorders were specified. Group I included elementary, stereotypic motor phenomena expressed as special poses, rocking, jack-knifing, finger sucking and other stereotypes of motor acts. Group II was characterized by more complicated motor and psychomotor disorders in the form of various manifestations of motor infantilism. Group III comprised children with neurotic motor monosymptomatic and ritual-behavioural obsessive actions. The above disorders are assessed from the evolutional-dynamic point of view.

Borderline Personality Disorder↗
PubMed1994

[Psychoautonomic disorders in painful vertebrogenic syndromes].

Compression spectral analysis of EEG and electropolygraphic registration (EMG, SGR, ECG), psychological and clinical investigations were used to examine patients with right and left vertebrogenic pain syndrome, patients with psychogenic neurotic syndrome and control group of healthy subjects. It was found that vertebrogenic syndrome frequently combined with psychogenic disorders. The latter were more evident in the left-side syndromes, occurred in more severe EEG abnormality. The role of the right hemisphere in the genesis of the above disorders in the patients and the problem of the center-periphery relations in pain vertebrogenic syndromes are discussed.

Autonomic Nervous System Diseases↗
PubMed2006

Somatoform disorders in neurological practice.

PURPOSE OF REVIEW: Patients with medically unexplained symptoms continue to intrigue, fascinate and frustrate clinicians. They are common in general medicine and often present with apparent neurological disorder. This review aims to provide insight into the recent literature that has sought to clarify epidemiology, diagnostic issues, aetiologic understanding and treatment of patients with psychogenic disorders who usually first present to neurologists. RECENT FINDINGS: Somatoform disorders are common in neurological practice. A number of papers have addressed issues of epidemiology and identified that medically unexplained symptoms in neurological populations are higher than originally thought. A number of recent review papers have served to summarize areas of considerable information (e.g. treatments) and areas of rapid growth in knowledge (e.g. neuroimaging). Studies investigating the role of psychological factors are well represented and clarify our psychopathological understanding of somatoform disorders in patients presenting to neurologists. Treatment studies are few and continue to be limited by population sizes and study designs. SUMMARY: Somatoform disorders are common in neurological populations. Comorbidity related to somatoform disorders with known organic neurological conditions requires further study. On account of the limitations of treatment studies, evidence-based clinical management of these patients is awaited.

Conversion Disorder↗
PubMed1983

Psychiatry and Chinese culture.

When we examine the cultural characteristics that influence mental disorders and related behavior among the Chinese, no major differences are found between Chinese and other groups in the range of disorders or in overall prevalence. Several cultural factors influence the recognition and treatment of mental illness, among which are attitudes toward emotional display, somatic as opposed to psychogenic disorders and features of the traditional medical belief system in Chinese culture. The Chinese have a relatively favorable prognosis of schizophrenia, low rates of depressive illness, a strong tendency towards somatization and the presence of several unique culture-bound syndromes. From studying Chinese in Vancouver, it was found that they have a characteristic way of dealing with mental illness in the family, in that there is first a protracted period of intrafamilial coping with serious psychiatric illness, followed by recourse to friends, elders and neighbors in the community; third, consultation with traditional specialists, religious healers or general physicians; fourth, outpatient or inpatient treatment from specialists, and, finally, a process of rejection and scapegoating of the patient. The efficacy of Western psychiatric treatment of Chinese patients has yet to be objectively assessed.

Alcoholism↗