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PubMed1981

[Hysterical psychoneurosis and its psychopathological and clinical limits].

The author's purpose in this paper is to delimit the clinical and psychopathological features of the hysterical psychoneurosis, correlating its symptoms (as characteristic of this neurosis) with the psychodynamic speculations of psychoanalysis. To achieve, this, the author starts by placing this disorder among the psychoneurosis as opposed to the actual neurosis and, within that group, among the transference neurosis, separating it, in that way, from the narcissistic and impulsive neurosis. The hysterical psychoneurosis is also distinguished from the fobic and the obsessive neurosis. The clinical picture of the hysterical psychoneurosis is then defined taking into account personality on one side and symptoms on the other. Dependence, sexual behavior disturbances, agressivity, effects of identification and repression are considered characteristics of this personality. Paroxistic symptoms, corporal and lasting symptoms and psychic syndromes are part of the hysterical symptoms. The author makes a clinical characterization of these phenomena as they are actually found. On this basis the author intends to distinguish hysteria from normality, from fobic and obsessive neurosis, from schizophrenic, manic-depressive and paranoic psychosis; from traumatic and actual neurosis and from psychosomatic diseases and epilepsy. He critically examines the validity of diagnostic-differential criteria and points to the overlapping with other pathologies, discussing in brief the theoretical and practical problems that those questions pose.

Diagnosis, Differential↗
PubMed1993

Evaluating chest pain. The patient's presentation style alters the physician's diagnostic approach.

BACKGROUND: Clinical prediction rules rely largely on objective data to estimate coronary artery disease (CAD) likelihood. However, characterization of chest pain, which is central to such prediction rules, depends in part on a physician's subjective judgments. We performed a clinical trial to assess the influence of the patient's presentation style on the physician's approach to evaluating chest pain. METHODS: Forty-four internists were randomized to one of three treatment groups. Two groups viewed videotapes of the same actress performing the role of a patient in a scripted physician-patient interview in two distinct styles: one group saw a "histrionic" characterization, the other a "businesslike" portrayal. The interviewer was not seen or heard by the subjects; they saw only words on the screen. The third group read a verbatim transcript of the interview. After their initial CAD-likelihood estimates and impressions of probable cause for the patient's symptoms, which were based on history only, the participants in all three groups were given the same laboratory data and a second CAD-likelihood estimate was made. Finally, recommendations for further workup were elicited. RESULTS: Initial diagnostic impressions differed dramatically: a cardiac cause was suspected by 50% of physicians viewing the businesslike portrayal but by only 13% of those viewing the histrionic portrayal. Likewise, those viewing the histrionic and businesslike videos provided different CAD-likelihood estimates initially (10% vs 20%). However, after the patient's laboratory data were revealed, the difference in CAD-likelihood estimates was no longer significant. Despite their making a similar risk appraisal after receiving all of the data, internists viewing the histrionic portrayal were far less likely to pursue a cardiac workup (53% vs 93%). CONCLUSIONS: Although physicians may evaluate patients who have the same history word for word and the same laboratory data and whom they regard as having nearly identical likelihoods of CAD, the physician's ultimate diagnostic approach can be profoundly affected by the patient's presentation style.

Adult↗
PubMed1975

The hysterical personality. An attempt at validation with the MMPI.

We attempted to validate the DSM-II diagnosis of hysterical personality and the depression often experienced by such patients by comparing mean Minnesota Multiphasic Personality inventory (MMP) scores of hysterical personality patients with those of paranoid schizophrenic patients and a group with mixed psychiatric diagnoses. Index patients had significantly higher scores than either control group and could be distinguished on individual scales from the paranoid schizophrenics. However, the mean MMPl profile of hysterical personalities was similar to that of depressed controls. Therefore, the MMPl alone could not differentiate these two groups nor could it confirm or refute the validity of the diagnostic concept of hysterical personality, but it did support the clinical observation that depression is a major risk for individuals given this diagnosis and that the experience of depression by these patients is genuine.

Adolescent↗
PubMed1979

Centerfold. An essay on excitement.

A woman who poses for soft-core pornography reports that she has never felt she belonged to her body, that she is and wants only to be an erotic product manufactured by a team of specialists for the use of a viewing audience of males, that since age 5 she has been a nude dancer, and that she has no other material existence except in this form. She is, then, a fetish. Her success illustrates the hypothesis that erotic daydreams in pronography represent fantasies of revenge in which the consumer imagines he is degrading--dehumanizing--women.

Adult↗
PubMed1979

An investigation of apparent mass psychogenic illness in an electronics plant.

An investigation of a case of apparent mass psychogenic illness was undertaken in a midwestern electronics assembly plant. The plant employed 500 workers, of whom 80% were female. The illness outbreak involved a total of 90 female first shift workers who reported a variety of nonspecific symptoms such as headache, dizziness, and lightheadedness in response to a strange odor in the workplace. Although environmental testing revealed some localized concentrations of a few airbone contaminants, no environmental toxins were discovered that could account for the continuing outbreaks of illness. An ad hoc sample of affected and nonaffected workers was surveyed to assess the influence of psychological, sociological, and work environment factors in the outbreak. Analysis of the data revealed that affected workers reported more physical discomfort (temperature variations, poor lighting) in the workplace as well as psychological job stress (increase in workload, conflicts with supervisors) than did nonaffected workers. Moreover, affected workers scored significantly higher than nonaffected workers on personality tests measuring extraversion and hysteria traits.

Electronics↗