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PubMedDate not supplied

[On the problem of depressive pseudodementia].

The term "depressive pseudodementia" introduced 20 to 30 years ago by Madden and coworkers and by Kiloh is critically evaluated. This originally descriptive term is not unequivocal due to its diagnostic and therapeutic connotations. Even by omitting the negative prefix "pseudo" it cannot be distinguished whether a psychopathological description of symptoms or a clinical diagnosis is meant. Therefore, on the present state of knowledge of dementia research and in view of the necessary distinction between syndromal and nosological classification level, the authors favour the abandoning of the term "depressive dementia". At the syndromal level it is suggested to use the term "dementia syndrome" according to Folstein and McHugh or to use the term "cognitive impairment" according to Caine. At the diagnostic-nosological level this procedure should include the information as to whether the "cognitive impairment" of an elderly patient coincides with a depression, a certain type of dementia or a combination of both. Such a positive terminology may promote the qualitative differentiation and quantification of the "cognitive impairment" which are scientifically necessary.

Aged↗
PubMed1983

[Pseudodementias. Clinical and pathogenic problems].

Since the initial description by Ganser and Wernicke at the beginning of the century, two types of problems have appeared in the history of the concept of pseudo-dementia. The clinical ones have been at the root of careful descriptions of the pseudodemential syndrome by the Anglo-Saxon authors of the sixties, and have emphasized the psychiatric etiology and the reversible aspect of the disorders. The others are concerned with the pathogenic problems coming from pseudodementia and take in consideration -- on the basis of bringing together the clinical and neuropsychological sides with subcortical dementia -- the mechanisms that could be common to the physiopathology of the degenerating, demential and psychoneurotic disorders. This article analyses the concept of pseudementia in this double view, dwelling on the clinical and diagnostic problems.

Alzheimer Disease↗
PubMed1982

Recognition and management of depression in the elderly.

Depression is probably the most common psychiatric disorder of the elderly. Societal stereotypes and atypical clinical features are contributing factors to inadequate diagnosis and treatment. Somatic complaints without an obvious mood defect and a syndrome of pseudodementia are commonly encountered. Treatment strategies rest firmly on a comprehensive evaluation that considers the biological, psychologic, and social factors involved. Psychotherapy is a valuable tool in some elderly persons. When antidepressant agents are used, it should be recognized that lower than usual dosage may be effective and that the elderly person is particularly sensitive to the autonomic side effects of these chemical agents. Electroconvulsive therapy remains a helpful and sometimes lifesaving resource when other methods have failed.

Aged↗
PubMed1995

Somatoform and related disorders: delivery of diagnosis as first step.

The care of patients with diagnoses on the somatoform spectrum represents a challenge to all primary care physicians and is a matter of frustration to some. These patients tend to "doctor shop," and studies indicate that they generate health care costs that are at least six to 14 times higher than health care costs generated by control subjects. For all disorders on the somatoform spectrum, the most effective management is regular follow-up with the primary care physician. To accomplish this goal, a therapeutic delivery of the diagnosis to the patient is essential to firmly establish the therapeutic alliance. An approach is suggested for "administering" the diagnosis as the first step in treatment for patients with several types of somatoform and related disorders. These techniques allow the patient's emotional needs to be met, enable the patient to save face when necessary and solidify the doctor-patient relationship. A good relationship allows the physician to provide long-term management with empathetic, safe and cost-effective medical care. Physicians may at times dread somatic patients, and these useful techniques can help them begin a more satisfying relationship with their very challenging patients.

Conversion Disorder↗
PubMedDate not supplied

[Use of psychopathometric procedures in diagnosis of dementia exemplified by a comparison between the Mini-Mental State and the MWT/KAI (Multiple-Choice Vocabulary/General Intelligence Test Short-Form) test system].

Different definitions of dementia have resulted in various psychopathometric diagnostic instruments. For that reason, the validity of the test or test battery is related to the originating definition of dementia. There are short tests which can be easily handled (e.g., Mini-Mental State or the test battery Multiple-Choice-Vocabulary-Intelligence Test/Short Test for General Intelligence). These tests can be used for the verification of a severe intellectual and mnemonic deterioration or a relative decrease of the mental capacity. For their objectivity, reliability and validity they are suitable for diagnostic routine. However, two aspects should be taken into consideration: Before using psychopathometric tests which aim at objectifying a decrease of mental capacity and indicating the degree of severity, it is necessary to make a differential diagnosis for particularly excluding so-called pseudodementia. It is also a fact that a single test is not sufficient for registering each degree of severity. The Mini-Mental State test can be used for documenting moderate to severe cases of dementia. The test battery Multiple-Choice-Vocabulary-Intelligence Test (MWT)/Short Test for General Intelligence (KAI) is suitable for the diagnosis and follow-up of mild to moderate cases.

Aged↗
PubMedDate not supplied

An unusual case of factitious onychodystrophy.

Nail disorders are a common dermatologic problem, and when such disorders are self-induced, the diagnosis and treatment can be challenging. We present an unusual instance of factitious onychodystrophy with associated erythronychia of the nail bed.

Child↗
PubMedDate not supplied

A case report: recognizing factitious injuries secondary to multiple eating disorders.

This report describes the uncommon problem of a female patient diagnosed with an eating disorder, bulimia nervosa, who reported self-mutilating dental factitious behavior. The case presents a serious diagnostic and management problem. Notwithstanding the clinical appearance of the dentition, a thorough medical-dental history was essential for this uncommon diagnosis.

Adolescent↗
PubMed2003

Fatality caused by self-bloodletting in a patient with factitious anemia.

Death by bloodletting among patients with factitious anemia has never been reported to our knowledge. We report the first known case. A 25-year-old woman with severe iron deficiency anemia confessed her habit of bloodletting at her first visit to our hospital, in March 1998. We prescribed oral iron and referred her to a psychiatrist. The diagnosis was borderline personality disorder. The psychiatrist began counseling the patient and prescribed a major tranquilizer. The patient's method of bloodletting was to insert an 18-gauge needle without syringe into her vein after inducing congestion in her arm. This method was considered to involve risk of death, because once the patient fell into a faint caused by blood loss, the bloodletting could not be stopped. Although we attempted to persuade the patient to stop bloodletting by this method, she died after self-bloodletting in September 1999. It is not known whether the death was intentional suicide or an accident.

Adult↗
PubMed2006

Periocular dermatitis artefacta in a child.

Dermatitis artifacta is a factitious dermatological disorder with many forms of presentation in any part of the body. It is commonly documented in dermatological cases but rarely presented as an ophthalmic condition. The diagnosis of dermatitis artifacta is often concluded after rigorous and repeated investigation. Histological sampling of skin lesions is usually required in these cases to exclude masquerading skin lesions such as basal cell carcinoma, vasculitis, or herpetic skin lesions.

Child↗
PubMed1985

The upper extremity and psychiatric illness.

Thirty-three patients who had various conversion reactions manifested by signs and symptoms involving the upper extremities were seen over a 13-year period. Factitious lymphedema, factitious ulcers, clenched fists, as well as other dysfunctional postures of the hand and upper extremity, were the most frequently recognized patterns of illness. Denial of knowledge of the cause of the physical problem and a lack of insight into the illness are major parts of the disease process. Twenty-nine of the 33 patients in this study had work-related and therefore compensable injuries. The physical signs and symptoms resolved in four of the patients when compensation was withdrawn. The average follow-up in this study was 4 1/2 years. Unfortunately, the long-term follow-up of these patients revealed that this disease process was chronic and most frequently failed to resolve. Various efforts at treatment have been unsuccessful, including extensive psychotherapy. Confrontation with the patient is contraindicated.

Adolescent↗