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PubMed2006

Evaluation and diagnosis of psychogenic disorders in neurological patients.

Patients with psychogenic neurological symptoms present a diagnostic challenge. There are certain elements in a history that are indicative of a psychogenic condition. These include sudden onset of symptoms, highly emotional events at the time of symptom onset, paroxysmal nature of symptoms, and migrating or changing complaints. Likewise, some findings on examination are more often seen in psychogenic cases than in organic disorders. Multiple symptoms that do not correspond to any identifiable neuroanatomical abnormality, distractibility, entrainment, and false weakness or sensory complaints, are all possible clues that a condition is emotional rather than organic. However, none of these features is an absolute indication of psychogenicity and each must be taken in the context of the complete clinical picture.

Female↗
PubMed1979

[Bromazepam in the treatment of somatized psychogenic disorders (author's transl)].

The clinical effects are reported of the benzodiazepine derivative, bromazepam (Lexotanil) in the treatment of psychosomatic disorders in the course of neurotic, psychovegetative, and masked depressive syndromes. The drug was administered orally in 301 patients (178 males, and 123 females). Target symptoms were anxiety, tension, and varied organic dysfunction of psychogenic origin. The optimum daily dosage was three times 3 mg; the duration of treatment ranged from 1 week to 34 months. The effect of treatment was considered excellent in 51.5%, good in 42.5%, moderate in 2%, and absent in 4%. The most responsive target symptoms were psychogenic disorders of the cardiovascular system and of the gastrointestinal tract, as well as anxiety, while no true antidepressive effect was observed. Drug tolerance is excellent. Slight fatigue, vertigo or a mild reduction in psychomotor activity were complained of by about 10% of the patients and usually occurred with daily doses of 18 mg or more, whereas no other side effects were observed. There was no obvious tendency to drug dependence even after after long-term treatment of up to 34 months. Bromazepam appears to be a superior compound to other anxiolytic and psychovegetatively active minor tranquillisers on account of its mild hypnotic action. Its anxiolytic effect causes additional indirect sleep induction in the above-mentioned conditions.

Adult↗
PubMed1983

[Betamed in the treatment of psychogenic disorders with a somatic component].

52 patients with acute neurotic anxious and psychosomatic syndromes or chronic anxious and vegetative neuroses were treated orally with the combination drug Betamed (1 tablet contain 60 mg bupranolol and 2.5 mg diazepam). The optimum daily dosage are 2 to 3 tablets; duration of treatment ranged from 2 to 12 weeks. The most responsive target symptoms are psychogenic disorders of the cardiovascular system, anxiety and insomnia, while no antidepressive effect was observed. Clinical improvement is often observed 2 to 3 weeks after the onset of treatment, and dosage reduction is possible frequently. Rarely observed side effects are minimal and mainly occur within one week after onset of treatment. Controls performed 2 to 4 weeks after discontinuation of treatment revealed reactivation of symptoms only in some patients with chronic anxiety and vegetative syndromes. In addition to the easy application and excellent tolerance of the combination drug emphasis is given on the minimal danger of drug dependence.

Adolescent↗
PubMed1986

[Clinico-biochemical approach to the problem of psychogenic disorders and background].

total of 270 patients with psychogenic disturbances were studied. Three levels of the interaction between the background and psychogenesis were specified. In accordance with these levels psychogenic disturbances were presented in the form of continuous changes from the typical to the atypical, from the predominance of the psychogenic to the predominance of the endogenic. Study of the metabolism of catecholamines in 45 patients with a nuclear form of psychopathy has shown that the biological factor plays an important role in the understanding of correlation between psychogenesis and the background.

Adolescent↗
PubMed1976

[Juvenile psychogenic hearing disorders].

Psychogenic hearing problems exist even in childhood. They must be differentiated from the stimulated or aggravated hearing losses. A characteristic is the discrepancy between the understanding during conversation and the bad results of the hearing tests. The psychical case history of the patient shows his conflict-situation and personal problems. If the psychogenic hearing problems do not improve on their own or by means of oto-rhinolaryngical placebo-therapy, psycho-therapy will be needed. Taking the example of 2 children, where the suspected primary diagnosis was sudden deafness, the problems of diagnosis was shown.

Adolescent↗
PubMed1990

Secondary amenorrhea: two kinds of psychogenic disorder--a case report.

A brief review of the limited sources in the literature on secondary amenorrhea indicates that this symptom may, in many cases, be psychogenic in origin. The disorder in such instances is often short term, spontaneously reversible, and occurs as a reaction to stress or a traumatic event. Most of these women are basically healthy, psychologically speaking. In some cases, however, this menstrual disturbance may continue for months or longer. In such instances, one may expect to find a neurotic conflict related to feminine identity as the cause. The therapeutic approach in these two alternative forms of secondary psychogenic amenorrhea (SPA) will differ; hence, it is essential that the gynecologist and psychiatrist distinguish between them. A case illustration is presented, describing in detail the treatment of a women with longstanding SPA which resolved with dynamically-oriented psychotherapy.

Adult↗
PubMed1990

Psychogenic disorders in neurology: frequency and clinical spectrum.

Among 4470 consecutive neurological inpatients presenting "with typical neurological symptoms" 405 (9%) were found to have psychogenic rather than neurological dysfunction of the nervous system as the primary cause of admission. This probably represents a conservative figure, since secondary and minor pseudoneurological symptoms were not included. Retrospective analysis of these cases showed that pain was the most common psychogenic symptom, followed by motor symptoms (in particular stance and gait disturbances), dizziness, psychogenic seizures, sensory symptoms, and visual dysfunction. Unilateral motor and sensory symptoms were equally distributed to the left and right side of the body. Psychiatric abnormalities in these patients were heterogenous. Depressive syndromes were most common (38%), whereas hysterical features were less frequent than expected (9%). On discharge, improvement was significantly better for patients with recent onset of symptoms (2 weeks or less) than for those with longstanding disturbances. Short-term outcome was best for motor symptoms and worst for pain. Improvement was independent of psychiatric findings, coexistence of a neurological disease, age, and sex.

Adult↗
PubMed1984

[Acute psychogenic disorders in lepers].

The authors carried out clinical follow-up and psychological examinations of 40 patients suffering from leprosy and treated at the Astrakhan Institute for Leprosy Research. Under study there were acute psychogenic reactions arising in the patients on diagnosing the disease and putting them to the leprosery. Clinical variants of adequate situational reactions (21 patients) and anomalous neurotic and psychopathic ones (19 patients) are described. These reactions were found to depend on the premorbid characteristics of the patient's personality and influence the subsequent course of the underlying disease.

Adaptation, Psychological↗
PubMed1983

Recurrent abdominal pain: a psychogenic disorder?

A controlled study of 30 children with recurrent abdominal pain and 30 pain free children failed to show any statistically significant differences between the groups on a variety of psychological variables thought to be associated with psychogenicity. A psychogenic basis has often been assumed as the cause in diagnosis of recurrent abdominal pain when clinical examination and laboratory tests show no organic or medical reason. We emphasise that establishing a psychogenic cause is only indicated where there is positive evidence for psychological factors such as family or school stress, extreme personality characteristics, or modelling of family pain behaviour.

Abdomen↗
PubMed1980

[Clinico-statistical data on psychologically traumatic experiences in various forms of psychogenic disorders].

On the basis of clinico-psychopathological studies of patients with different forms of neurosis and the use of the level of mental development concept a special technique was elaborated to detect by questionnaires the predilective "key" psychotraumatizing experiences in the main forms of neurosis (neurasthenia, obsessional neurosis, hysterical neurosis and a special clinical form--explosive reactions). It is assumed that these forms of psychogenic reactions, as well as their respective "key" experiences (exhaustion-overstress, a disturbance of a habitual stereotype, infringement of egocentrism, a negation of concession) form a certain hierarchic system. The "key" character of some types of pathogenic experiences for clinical forms of psychogenic reactions was confirmed statistically. The data indicate a different degree of clinico-nosological delineation of some forms of the reactive states.

Depressive Disorder↗
PubMed1986

[Structuro-dynamic features of situational and psychogenic disorders in the late period of craniocerebral injuries (in relation to the task of patient rehabilitation)].

The author describes the results of clinico-psychopathological study of 68 patients with neurotic states (hysterical, anxiety-phobic) and a psychopath-like syndrome (affective-explosive, hystero-hypochondriac and litigious-quarrelsome) observed long after occupational craniocerebral traumas. Attention is drawn to a heterogenous nature of relationships of cerebral-organic and psychogenic-situational mechanisms in the origin of these symptom complexes. Different types of "an insight into the disease" (harmonic, nosocentrical-aggravational, pretentions and hypochondriac) reflecting a degree of disorganization of the motivational-value system of patients were identified on the basis of a comprehensive study of the personality. The mechanisms of psychological compensation were found to play an important role in the genesis of analyzed disturbances and the adaptive activity of patients. Guidelines of rehabilitative tactics with a special emphasis on the conduction of psycho- and socio-therapeutic measures are proposed.

Adult↗
PubMed1989

The epidemiology of psychogenic disorders and consequences for prevention.

After discussing social issues of epidemiologic research on neurotic, character and psychosomatic disorders, we outline the main results of a field cohort study on 600 representative adults of Mannheim, a West German industrial city. According to ICD 300-307 (WHO 8th revision) and to a quantitative case definition clinically based on the severity of the symptoms we find an overall case rate of 26% in which females prevail over men by a ratio of approximately 2:1 and the rate of lower social class members over that of higher ones. We then turned to conclusions of our research for matters of primary and secondary prevention. Concerning primary prevention of psychogenic diseases life circumstances during childhood proved to be relevant as predisposing variables and risk factors often indicating poor emotional relationships between the child and its caretakers. Furthermore, we deal with protective factors preserving mental and physical health in spite of heavy burdens during childhood. Turning to secondary prevention we examine risk factors in present life, the importance of the lay system, and the influence of life events as well as the true demand for psychotherapy.

Adult↗
PubMed2004

[Visual cortex in the Tolosa-Hunt syndrome. Functional imaging for the detection of a psychogenic disorder--a case report].

Besides painful ophthalmoplegia, patients suffering from Tolosa-Hunt syndrome often present increasing loss of visual perception. The impairment of the optic nerve leads to a delay of the VEP (visual evoked potentials) responses. Using the method of magnetic resonance imaging (MRI), some patients present unspecific alterations in the vicinity of the optic nerve. However, both methods (VEP and MRI) are unsuitable to assess the effect of an impaired optic nerve function on neuronal processing in the visual cortex. We report one patient suffering from Tolosa-Hunt syndrome affecting the optic nerve. We used fMRI (functional magnetic resonance imaging) to show how this impairment of the optic nerve alters cortical processing of visual information. The activity of the unaffected visual cortex was bilaterally reduced when compared to healthy volunteers but greater that obtained from patients suffering from bilateral occipital infarction. Our results offer new opportunities to assess the efficiency of therapy in patients with increasing loss of visual perception due to the Tolosa-Hunt syndrome. Further studies are necessary to investigate, whether fMRI also provides the possibility to assess the efficiency of drug therapy on optic nerve function.

Humans↗
PubMed1979

Restricted lees screen fields in patients with asthenopia, with and without psychogenic disorders.

Lees screen restrictions of non-specific origin, including apparent restrictions of the SR, IR, and LR muscles, were reported last year by Labow et al. In this complementary study, the authors examined eight apparently healthy subjects who had no history of ocular or psychiatric problems, eight psychiatric patients, and eight who had had a CNS disorder or had suffered cerebral trauma. Comparison of the Lees screen findings, visual fields, and accommodative defects of these patients revealed significant restriction of the Lees screen fields in only those patients who had symptoms of asthenopia (including all in the third group). Thus, such restriction does not depend on emotional state.

Adolescent↗