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PubMed2004

[The development of utilisation of psychoneurotic in-patients in hospitals for psychiatry and psychotherapy of the so-called "new" Federal States of Germany].

OBJECTIVE: Up to now psychotherapeutic treatment naturally is part of treatment strategies of mental hospitals and departments of psychiatry at general hospitals. Actually there is a controversial debate in this issue. The aim of this study was to evaluate the development of the utilization of these hospitals by patients with "psychogenic disorders" in the new federal states of eastern Germany. METHOD: We studied the changes in the utilization in hospitals of psychiatry and psychotherapy in Thuringia 1993 up to 1999 by patients with ICD-9-diagnoses 300 - 1 and 306 - 9 and compared these data with these of other clinics in East und West Germany. RESULT: The utilization of psychotherapy patients increased in all hospitals. The increase in Thuringia was highest, in the other eastern German it was higher as in western clinics. Reasons of admissions for in-patient psychotherapeutic treatment were suicide ideations and attempts, aggression against others and prepsychotic agitation. CONCLUSIONS: These results can be seen as a sign of a similar necessity of this care in the eastern as in western population under similar psychosocial conditions.

Acute Disease↗
PubMed1992

Pruritus. What to do when the itching won't stop.

Pruritus is a common problem that can result from many conditions. Some, such as fungal or parasitic infection, may be fairly obvious. However, others, such as iron deficiency and psychogenic disorder, are more difficult to diagnose. Evaluation must include a thorough inspection of the skin, history taking for drug intake and chemical exposure, and appropriate laboratory testing. The location on the body and characteristics of the itching may point to a cause. In some cases, attention to exacerbating factors (eg, dry skin, coarse fabrics against the skin, dry environmental conditions) and application of topical preparations may be sufficient. Antihistamines are the foundation of oral treatment, and with the advent of second-generation agents, they can be taken with fewer concerns about their sedative effects. Specific conditions of which pruritus is one feature may require specific treatment. For example, in patients undergoing dialysis, activated charcoal, UV light treatment, or heparin therapy may be useful.

Administration, Oral↗
PubMed1975

A new variant of intra-abdominal hernia.

A new variant of intra-abdominal hernia is presented. Available evidence suggests that this type of intra-abdominal hernia may be more prevalent than previously reported. Patients suffering from crampy, intermittent abdominal pain whose routine radiographic gastrointestinal studies are unrevealing often are labeled as having psychogenic disorders. Three cases are present giving similar histories and routine findings in which mesenteric arteriography coupled with careful small bowel series has revealed a surgically curable lesion. Such patients should have judicious mesenteric angiography coupled with routine radiographic gastrointestinal studies in search of small intramesenteric herniae which are readily correctible.

Adult↗
PubMed1990

Occult somatic pathology in women with chronic pelvic pain.

Recent investigations have documented the importance of ruling out occult nongynecologic diagnoses such as myofascial syndrome, IBS, urethral syndrome, and psychogenic disorders in women with CPP and normal laparoscopy. In light of current data regarding the prevalence of nonsomatic and nongynecologic somatic pathology among patients with pelvalgia, it seems clear that "definitive" surgical therapy consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy is neither definitive nor indicated in the large majority of these cases.

Adult↗
PubMed1990

Comorbidity of anxiety and depression.

Many factors obscure the diagnosis of psychogenic disorders, especially anxiety and depression. The factors involved include an overlap of symptoms, discrepancies in diagnostic criteria, and the unreliability of self- and observer-reporting. Differentiation among the various personality disorders is, however, extremely important, both for identifying the most appropriate treatment plan for a given patient and for evaluating the therapeutic activity of newly developed pharmacologic agents. Emerging factors that may have an impact on differential diagnoses of anxiety and depression include age at onset, family history, and personality traits associated with different types of psychopathology.

Anxiety Disorders↗
PubMed1995

General health factors and denture function in patients with burning mouth syndrome and matched control subjects.

A total of 30 denture-wearing patients with burning mouth syndrome (BMS) referred to a Pain Clinic Unit and 26 age- and sex-matched control subjects were examined and compared with respect to general health factors and denture function. The study demonstrated a significantly higher frequency of multiple chronic diseases, psychosocial stress factors, and tenderness/pain in masticatory, neck, shoulder, and suprahyoid muscles in patients with BMS. Denture function differed also between the two groups as patients with BMS had significantly less daily use of dentures, reduced tongue space, incorrect placement of occlusal table and increased vertical dimension. Pain interview with the use of the McGill Pain Questionnaire demonstrated that pain in parts of the body other than the oral cavity were reported more frequently and that the intensity of past pain experiences was not rated higher except for pain in the head in patients with BMS. The results suggested a complex interaction between several general health factors, psychosocial stressors and denture dysfunction in order to explain an idiopathic burning pain in the anterior part of the oral cavity. The existence of demonstrable load factors does not seem to support the suggestion that BMS is primarily a psychogenic disorder.

Aged↗
PubMed1997

Pathophysiology and impact of nocturnal enuresis.

Nocturnal enuresis in children is not a psychogenic disorder. It is caused by a hereditary delay in maturation of the somatic mechanisms (reduction of nocturnal urine production and a normal arousal to a full bladder) which prevent the child from wetting the bed. Traditionally, doctors treating bedwetting children have used an expectant attitude, because nocturnal enuresis has been looked upon as self-limiting and harmless. According to recent research this is not true. More than 5% of children and 0.5% of the adult population report nocturnal enuresis, meaning that 10% of enuretic children will remain bedwetters for life if left untreated, and nocturnal enuresis is perceived as a shameful condition, giving a significant impairment of self-esteem at an age when an intact self-image is extremely important for an optimal development of the child's personality. Treatment should be given when the enuretic child wants to sleep dry.

Adolescent↗
PubMed1984

Querulent paranoia: a follow-up.

This study deals with all querulent paranoias admitted to Gaustad Hospital during 1938-1972. As querulent paranoia is a rare clinical condition, a plea is made for a multicenter study. We had only 22 cases, but most of them have a follow-up over several years, so that we are able to know fairly well the long-term course of illness. The family background has very little to do with schizophrenia and manic-depressive psychoses. It seems that querulent paranoia is a psychogenic disorder, based on deviant personality structures and unlucky personal experiences. Somatic treatments with ECT and drugs have no effects.

Aged↗
PubMed1987

Follow-up results from a psychosomatic outpatient clinic.

On the background of the German situation of psychosomatic medicine as an independent department beside the psychiatric clinic, we describe the theoretical issues, organizational structure and functioning of a psychosomatic outpatient clinic. 186 consecutive referrals were analyzed. The ratio of man to woman was 1:2, mean age was 32 years (range 17-58). About half of the patients suffered from psychogenic disorders (according DSM-III criteria subsumed to the category of 'psychological factors affecting physical condition'), 21% had anxiety disturbances, and of the remaining patients 15% had affective illnesses and 13% somatoform disorders. There were three treatment conditions: inpatient psychotherapy, outpatient individual or group psychotherapy and family therapy. Follow-up results (2 years after the first contact) give some hints on the effectiveness of the different treatment procedures. The results show that the psychosomatic outpatient clinic may offer treatment for a specific patient population whose characteristics differ significantly from those of patients treated in consultation liaison services as well as by practicing psychotherapists.

Adult↗
PubMed1992

Impotence due to corporeal veno-occlusive dysfunction: long-term follow-up of venous surgery.

Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.

Erectile Dysfunction↗
PubMed2006

Effect of high-dose cortisol on memory functions.

Although research indicates that hightened glucocorticoid levels impair long-term memory functions and may inhibit traumatic memory retrieval in humans, the impact of acutely elevated glucocorticoid levels on learning and attentional functions is still unclear. Furthermore, the effect of glucocorticoids on executive functions as well as the recovery from long-term memory deficits is insufficiently studied. The present study examined memory functions in patients with acute exacerbation of neurological diseases (multiple sclerosis, acute optic neuritis), who were treated with a high dose of glucocorticoids. All patients demonstrated a reversible impairment of long-term memory functions, whereas measures of short-term memory, attentional functions, and alertness remained unaffected. These findings indicate a selective cognitive disturbance, providing further evidence that the memory deficits reflect a receptor-mediated effect of glucocorticoids on hippocampal function thereby supporting a potential association of stress-induced elevated cortisol levels and memory disturbances in trauma-related psychiatric disorders (psychogenic amnesia, PTSD).

Adult↗
PubMed2005

Camptocormia: pathogenesis, classification, and response to therapy.

Originally considered a psychogenic disorder, camptocormia, an abnormal posture with marked flexion of thoracolumbar spine that abates in the recumbent position, is becoming an increasingly recognized feature of parkinsonian and dystonic disorders. Prior reports were limited by sample size, short follow-up, and paucity of data on response to therapy. The authors reviewed 16 patients evaluated in their PD Center and Movement Disorders Clinic diagnosed with camptocormia. In addition to detailed neurologic assessment all patients were videotaped. The mean age was 64.9 +/- 17.4 years, mean age at onset of neurologic symptoms was 51.5 +/- 19.9 years, duration from onset of neurologic symptoms to development of camptocormia was 6.7 +/- 7.6 years, and the mean duration of camptocormia was 4.5 +/- 3.9 years. Of the 16 patients, 11 (68.8%) had Parkinson disease (PD); others had dystonia (n = 4) and Tourette syndrome (n = 1). Twelve patients received levodopa, with minimal or no improvement in the camptocormia. Nine patients received botulinum toxin type A injections into the rectus abdominus, with notable improvement in their camptocormia in four. One patient underwent bilateral subthalamic nucleus deep brain stimulation for PD, but there was no improvement in camptocormia. Based on this series and a thorough review of the literature of camptocormia, head drop, and bent spine syndrome, the authors propose etiologic classification of camptocormia and conclude that this heterogeneous disorder has multiple etiologies and variable response to systemic and local therapies.

Abdominal Muscles↗
PubMed1995

Transient cerebellar mutism after posterior fossa surgery in children.

Cerebellar mutism has been reported after surgery for posterior fossa tumors in children and, rarely, in adults. The pathogenesis of this syndrome remains unclear, and controversy exists regarding whether it is a purely psychogenic disorder or an organic syndrome. The anatomical substrate for the mutism also remains unknown. We encountered five cases of postoperative transient cerebellar mutism in a consecutive series of 63 children with posterior fossa tumors. These cases were analyzed and compared with the patients without mutism to find predictive factors for the occurrence of mutism, with the hope of elucidating further the pathophysiological mechanism. The most significant finding was the presence in all cases of a period of cerebellar dysarthria after resolution of the muteness. We, therefore, believe that cerebellar mutism is an extreme form of dysarthria, rather than a real cognitive deficit or a psychological disturbance.

Adolescent↗
PubMedDate not supplied

The RSI syndrome in historical perspective.

The pain syndrome repetition strain injury (RSI) has been variously interpreted as a psychogenic disorder, an overuse injury of upper limb musculature, and a state of peripheral neural irritability. A review of the history of work-related upper limb disorders was undertaken to ascertain whether RSI is a new medical phenomenon or an older syndrome in a new guise. In the mid-nineteenth century these disorders were known as either craft palsies or writer's and other occupational cramps. Not withstanding clinical evidence suggesting that most were associated with peripheral neural or muscular dysfunction, a body of influential medical opinion considered them all to be disorders of the central nervous system, appropriately termed the occupation(al) neuroses. During the twentieth century, as discrete occupational upper limb nerve lesions were delineated and the spasmodic form of writer's cramp was recognized as a torsion dystonia, a unifying concept of aetiology for the occupational neuroses of the nineteenth century became untenable. The RSI syndrome of the 1980s can be identified from early case descriptions of both scrivener's palsy and the neuralgic variety of writer's cramp. Contemporary hypotheses proposed to explain RSI are remarkably similar to those proposed for the occupation(al) neuroses.

Causality↗
PubMed1997

Antinuclear antibodies in children with chronic nonspecific complaints.

Children who are chronically complaining nonspecific symptoms such as headache, fatigue, abdominal pain, and low grade fever are commonly seen in daily pediatric outpatient clinics. Some of them are unable to go to school and are diagnosed as school refusal by physicians or educational staff. On the other hand, there are children who do not fulfill any criteria of collagen diseases and whose anti-nuclear antibodies (ANA) are found to be positive. Some of these children have chronic nonspecific complaints. We prospectively studied the prevalence of ANA in children who visited a pediatric outpatient clinic because of chronic nonspecific complaints. Surprisingly, 74 out of 140 symptomatic children (52.4%) were positive for ANA, while only 5 out of 82 healthy control children (6.1%) were positive (p < 0.0001). 39 of 74 ANA positive patients (52.1%) have low ANA titers < or = 1:80, nevertheless 36 patients (47.9%) have high ANA titers > or = 1:160. ANA fluorescent patterns were homogeneous and speckled in 75.3%, speckled in 17.6% and others in 6.8%. ANA positive patients tended to have general fatigue and low grade fever, while gastrointestinal problems such as abdominal pain and diarrhea and orthostatic dysregulation symptoms were commonly seen in ANA negative patients. Children who were unable to go to school more than 1 day a week were seen significantly more in ANA positive patients than in negative patients. Autoantibody analysis using Western immunoblot revealed that 26 out of 63 ANA positive sera (41.3%) had antibodies to the 62 kD protein which had not been previously noticed. These data suggest that autoimmune mechanism may play a role in childhood chronic nonspecific symptoms. We therefore propose a new disease entity of the autoimmune fatigue syndrome in children. When chronically complaining children visit a pediatric out-patient clinic, immunological approaches should be considered before they are discriminated as school refusal or having psychogenic disorders.

Abdominal Pain↗
PubMed2003

[Exploring the nature of "Hwa-Byung" using pragmatics].

PURPOSE: While most psychiatrists diagnose Hwa-Byung as a chronic psychogenic disorder associated with familial, financial and personality, the purpose of study was to shed light on the nature of Hwa-Byung through pragmatics. Hwa-Byung is characterized as 'Hwa' which means fire 'Byung' which means disease. This condition cannot be empirically experienced, rather it is represented by suffering internally (in the mind). It also could find an aspect of somatization, and self-diagnosing. METHOD: As patients themselves diagnose Hwa-Byung, pragmatical approach was taken to analyze the context of the learning through their communication with others. The case examples resulted from in-depth telephone counseling with a client who is housewife with Hwa-Byung over a period of time at the Women's Hot Line. RESULT: The study showed that the client experienced continuous improper attacks by her husband. She expressed improperness by applying her personal emotions to social-justice reasoning. CONCLUSION: 'Hwa' means lack of mutual intimacy in this research. By expressing this 'Hwa', the client would like to recover mutual intimacy with her husband.

English Abstract↗
PubMed1984

Unexplained vomiting: a diagnostic challenge.

When vomiting is not related to preventing the entry of physically or chemically unsuitable substances into the absorbing gut, it may be regarded as pathologic. The commonest causes of chronic vomiting are structural lesions affecting the mucosa of the upper gastrointestinal tract (often with luminal obstruction) and psychogenic disorders. Diseases affecting extrinsic and intrinsic neural control of gut motility and visceral smooth muscle may also cause unexplained vomiting. A stratified management approach to patients with vomiting is suggested. The first assessment is aimed at exclusion of mucosal lesions of the upper gut and systemic or psychiatric disease that may affect it. Second is a therapeutic trial, usually with a prokinetic agent. The final phase, reserved for recalcitrant undiagnosed patients, is evaluation at special centers with gastric emptying studies, gastrointestinal manometry, other electrophysiologic studies, and, in a few patients, laparotomy with examination of full-thickness biopsy specimens of the small intestine.

Autonomic Nervous System Diseases↗
PubMedDate not supplied

[Paroxysmal disorders and episodic non-epileptic symptoms].

INTRODUCTION: Non epileptic paroxysmal events (NEPE) are clinical disorders of usually sudden appearance, brief and originated by a cerebral disfunction of diverse causes with a common character to be no epileptic. DEVELOPMENT: The non epileptic paroxysmal events are more frequent than epileptic events. The 10% of the children have NEPE. The NEPE can to be confounded with epileptic fits. Careful and detailed history and wise valuation of the circumstances of occurrence and the characteristics and duration of the seizures are determined. The history include developmental milestones and search for possible causes of seizure disorders. A complete clinical examination and EEG are essentials in the differential diagnosis. More sophisticated techniques--polygraphy and video EEG monitoring--are of great value in selected and difficult cases. CONCLUSIONS: The NEPE are categorized: anoxic/hypoxia paroxysmal disorders, psychogenic paroxysmal events, paroxysmal events occurring during sleep, paroxysmal events of movements and other episodic symptoms.

Adolescent↗