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PubMed2005

Psychosomatics and psychopathology: looking up and down from the brain.

The autonomic nervous system (ANS) plays a role in a wide range of somatic and mental diseases. Using a model of neurovisceral integration, this article describes how autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative affective states and conditions to ill health. The central nervous system (CNS) network that regulates autonomic balance (central autonomic network, CAN) is closely related and partially overlaps with networks serving executive, social, affective, attentional, and motivated behavior (anterior executive region, AER; and Damasio's [Damasio, A.R., 1998. Emotion in the perspective of an integrated nervous system. Brain Res. Rev. 26, 83-86.] 'emotion circuit'). A common reciprocal inhibitory cortico-subcortical neural circuit serves to regulate defensive behavior, including autonomic, emotional and cognitive features. This inhibitory cortico-subcortical circuit may structurally, as well as functionally, link psychological processes with health-related physiology. When the prefrontal cortex is taken 'offline' for whatever reason, parasympathetic inhibitory action is withdrawn and a relative sympathetic dominance associated with disinhibited defensive circuits is released, which can be pathogenic when sustained for long periods. This state is indicated by low heart rate variability (HRV), which is a marker for low parasympathetic activation and prefrontal hypoactivity. Consistent with this, HRV is associated with a range of psychological and somatic pathological conditions, including immune dysfunction. Finally, we discuss supportive evidence from recent studies of the reflexive startle blink, attention and working memory, which shows that low HRV predicts hypervigilance and inefficient allocation of attentional and cognitive resources.

Animals↗
PubMed2006

Psychiatric disorders in patients with psychogenic non-epileptic seizures, with and without comorbid epilepsy.

PURPOSE: The aim of this study is to describe similarities and differences in epidemiological, psychiatric and semiologic variables between patients with psychogenic none epileptic seizures (PNES) and comorbid epilepsy (mixed PNES), and patients with PNES without comorbid epilepsy (pure PNES). RESULTS: Forty-three patients with PNES diagnosed by Video-EEG were included. Twenty-four had pure PNES, and ninteen mixed PNES. Female population, age, duration of PNES, psychiatric institutionalization, psychopharmacotherapy, dissociative disorders and posttraumatic stress disorder (PTSD), were significantly higher in the pure PNES patients. Suicide attempts, antiepileptic therapy, conversive, affective and personality disorders were frequent in both groups. In the analysis of seizure semiology, the total lack of responsiveness was significantly higher in the mixed PNES group. CONCLUSIONS: Pure PNES patients showed similarities and differences in the psychiatric profile, with a greater prevalence of dissociative disorders and PTSD, factors related to psychiatric severity.

Adult↗
PubMed2006

Late-onset psychogenic nonepileptic seizures.

Psychogenic non-epileptic seizures (PNES) are common, but have not been well studied in older patients. We retrospectively reviewed patients with PNES who were 60 years of age and above at the time of "seizure" onset. Over a 27-month period, nine (9.6%) of 94 patients diagnosed with PNES had onset at age 60 or above. None had evidence for coexisting epilepsy. Eight were women. Characteristics of the group were comparable to younger patients with PNES. We conclude that PNES should be considered as a diagnostic possibility in older patients.

Age of Onset↗
PubMed1997

Behavioral management of conversion disorder in children.

OBJECTIVE: To describe the behavioral management of conversion disorder in children and to preliminarily assess its effectiveness. DESIGN: Retrospective case series. SETTING: Inpatient pediatric rehabilitation unit. PATIENTS: The first eight patients with conversion disorder treated on our pediatric rehabilitation unit, between 9 and 18 years of age. Six were girls. Three cases are described in detail. INTERVENTIONS: All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a reward system was established for good attainment. Some patients had a "level" system instituted, with increasing privileges for goal achievement. All patients and their families had psychological assessment and instruction in pain and stress management strategies. MAIN OUTCOME MEASURES: Restoration of normal gait and function, independence in activities of daily living (ADL), and symptom recurrence after discharge. RESULTS: All patients attained normal gait and ADL function before discharge. CONCLUSIONS: (1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at times a behavioral reward or "level" system may be necessary for adequate reinforcement. (2) Instruction of the patient and family in appropriate stress and pain management appears key to maintaining treatment effect over time.

Adolescent↗
PubMed1984

The psychosomatic component in prosthodontics.

A classification of psychosomatic symptoms proposed by Whitehead et al. has been discussed. It has been suggested that TMJ dysfunction, the gag reflex, and denture intolerance are representative of the etiologic categories of psychosomatic symptoms, which most often arise from environmental stressors, classic conditioning, or operant conditioning. Operant conditioning is broadly based and the hysteric response may be superimposed on classically conditioned responses such as the gag reflex or the stress-induced muscle tension of TMJ dysfunction.

Conditioning, Classical↗
PubMedDate not supplied

Psychological factors affecting a medical condition: ischemic coronary heart disease.

The criteria for scientific validation of the entities currently subsumed under the DSM-IV category of "Psychological Factors Affecting a Medical Condition" have never been clearly enumerated. Historically, its precursor category ("Psychophysiological Disorder") was rarely used, and predicated upon clinical observation of personality styles among patients with specific physical illnesses, or clinical observations relating psychosocial events and symptom exacerbation. Because of logical flaws with either of these methods, clarification of the most rigorous criteria for demonstrating a cause-effect relationship is necessary. With the increase in well-designed and carefully executed epidemiological and treatment studies, this diagnostic category has evolved into an arena where cutting-edge insights and therapies are becoming available for a growing variety of medical conditions, especially ischemic coronary heart disease. The present article reviews the nature of the scientific evidence necessary to accept an etiological or aggravating role for psychological events.

Anger↗
PubMed2003

Psychiatric morbidity in the chronic fatigue syndrome: are patients with personality disorder more physically impaired?

OBJECTIVE: The long-term consequences of chronic fatigue syndrome (CFS) include substantial impairment in physical functioning and high levels of work disability. In the absence of a medical explanation for this impairment, some have speculated that it may be due to comorbid psychiatric illness or personality disorder. We addressed this possibility by comparing the functional status of three CFS groups: no psychiatric diagnosis, psychiatric illness only, psychiatric illness and personality disorder. A second aim of the study was to determine whether a continuous measure of psychological distress could provide a better account of impairment than psychiatric diagnosis. METHOD: The study sample consisted of 84 consecutive female referrals with CFS. All participants satisfied the case definition and completed an assessment protocol consisting of: physical examination, psychiatric interview and self-report questionnaires. RESULTS: Psychiatric illness, either alone or in combination with a comorbid personality disorder, was not associated with physical impairment or disability in female participants. A regression model of physical functioning found that psychological distress accounted for 6% and symptom severity for 41% of the variance (P=.06 and <.01, respectively). In the case of disability, the corresponding percentages were 2% and 18% (NS and P<.01, respectively). The modest effects of psychological distress could not be attributed to symptom severity. CONCLUSIONS: Although psychiatric illness and personality disorder was prevalent, neither could explain the effects of CFS on physical functioning and disability. As yet, there is no psychological or medical explanation for the behavioral consequences of CFS.

Adult↗
PubMed1977

Common neurologic syndromes in medical practice.

The cases presented here are intended to illustrate an approach to the patient with complaints which may be vague, evanescent, or related to emotional factors. A scheme to analyze only five factors, mood, movement, sensation, cognition, and consciousness is presented to simplify the complexity of human behavior in order to arrive at correct diagnoses. The importance of a complete medical evaluation is stressed. Psychosis and other major psychiatric illness have been alluded to, but space does not permit discussion of the very important issues of the genetics, the neurochemistry, and the differential diagnosis of schizophrenia, mood disorders, and the organic brain syndromes. Some of the many manifestations of epilepsy have been presented, and the importance of electroencephalography and computed axial tomography is stressed. The references have been chosen for their general utility to practicing clinicians, especially the works of Pincus, Glaser and Tumulty.

Adolescent↗
PubMed1984

Limb pain in childhood.

As the presenting complaint in 7 per cent of pediatrician visits, pain in the limbs is a common problem in childhood. It is important that the diagnosis be made expeditiously. The authors review the possible organic cause of limb pain, as well as limb pain from conversion reactions and from growing pains, giving special attention to the differential diagnosis so that appropriate treatment for the pain can be initiated.

Arthritis, Infectious↗