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PubMed1986

Falsifications in the psychiatric history: a differential diagnosis.

Several types of falsification may be encountered in the clinical setting, including lies, pseudologia fantastica, delusions and confabulations. I will review these phenomena in the psychopathology literature and propose five criteria to facilitate classification of a falsification. I will then present case histories that illustrate the relationship between the type of falsification and the clinical psychiatric diagnosis.

Adult↗
PubMed1985

"I don't know" responses in elderly depressives and in dementia.

"I don't know" responses were recorded during administration of the Mini-Mental State Examination in elderly patients with primary degenerative dementia and primary major depression. More "I don't know" responses were given by patients with degenerative dementia; however, demented patients did not differ overall from depressives in the proportion of Not Correct responses consisting of "I don't know" responses. These responses were positively correlated with age and with Hollingshead education and social class scores in depressives but not in demented patients. A higher proportion of Not Correct responses consisting of "I don't know" responses needs to be demonstrated in depressive pseudomentia than in degenerative dementia if this clinical sign is to be used in helping to differentiate the two disorders.

Aged↗
PubMed1982

Severe depressive pseudodementia with and without dementia.

Recent work has documented the existence of the syndrome of pseudodementia. The authors present four cases of depressive pseudodementia, two without associated dementing illnesses and two that occurred in the context of dementing illnesses. These cases emphasize the difficult nature of differential diagnosis and the profound cognitive impairment that can occur in depressive illness. They also document the coexistence of pseudodementia with "true" dementia. The authors discuss diagnostic and management issues for clinicians treating patients with pseudodementia and depressive illness.

Aged↗
PubMed1989

Neuropsychological and biomedical assessment of depression-dementia syndromes.

Evaluating the clinical significance of cognitive dysfunction in patients who exhibit signs of both depression and dementia is one of the more formidable challenges in psychiatry. This article reviews cognitive dysfunction associated with depression, the concept of "pseudodementia," and the syndromal phenomenology of coexisting depression and Alzheimer's-type dementia. The state of the art in neuropsychologic, electroencephalographic, metabolic, and neuroradiographic techniques for evaluating dementia and depression syndromes will be discussed, as will implications for the treatment of such patients.

Aged↗
PubMed1985

Self-inflicted injuries in childhood. A review and diagnostic approach.

Eleven clinical and behavioral syndromes that can result in self-inflicted injury in childhood and adolescence are reviewed and classified. The causes and remedies of such injuries vary both among and within these 11 classes. Pediatricians should be alert to the possible presence and meaning of self-injury.

Adolescent↗
PubMed1988

Intractable depression and pseudodementia: a report of two cases.

Two cases are presented to illustrate some of the issues that arise in the management of patients diagnosed as suffering from the dementia syndrome of depression (Pseudodementia). Case 1 illustrates the dilemma of relatively normal autopsy findings in the brain in a patient presenting with a history of depression and dementia. Case 2 deals with a patient successfully treated for depression 14 years after the diagnosis of presenile dementia. Issues raised include the problem of labelling and the Rip Van Winkle situation of unanticipated recovery 14 years after this diagnosis was made. A planned approach to the treatment of pseudodementia systematically exploring available treatment options is recommended.

Aged↗
PubMed2004

Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders.

BACKGROUND: Repeated case series have documented the effectiveness of multidisciplinary in-patient behavioural treatment for conversion disorders. However, in the absence of controlled research, treatment success could be attributed to providing patients with a face-saving opportunity to get better. AIMS: The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation of this population. METHOD: Thirty-nine patients underwent a standard behavioural programme. Using a crossover design, patients who did not improve underwent a strategic-behavioural treatment in which they and their families were told that full recovery constituted proof of an organic aetiology whereas failure to recover was definitive proof of a psychiatric aetiology. RESULTS: Chart review indicated that the standard behavioural treatment was effective for 8/9 'acute' patients but only for 1/28 'chronic' patients. Of the 21 patients with chronic motor disorder who then under went the strategic-behavioural intervention, 13 were symptom-free at discharge. CONCLUSIONS: The strategic intervention was superior to standard behavioural treatment for patients with chronic motor disorder. Treatment components previously deemed critical for the effectiveness of behavioural treatment may be unnecessary.

Acute Disease↗
PubMed1988

Differential diagnosis of pseudodementia in the elderly.

When depression occurs in the elderly, it may mimic dementia. The identification of depressive pseudodementia is important because this syndrome, unlike true dementia, often responds to antidepressant treatment. In this paper, the authors present strategies for differentiating pseudodementia, dementia, and coexisting depression and dementia. The treatment of depression in the elderly is also discussed.

Aged↗
PubMed1984

Affective illness, dementia, and pseudodementia.

The differential diagnosis and treatment of pseudodementia, dementia, and depressive illness are receiving increased attention. The literature on this subject is reviewed, and four "ideal types" of patients spanning the spectrum of these illnesses are proposed for use when their distinction or association is at issue. Attempts by investigators to distinguish those groups are summarized, ad the importance of diagnostic clarity and patient selection for future research is emphasized.

Aged↗
PubMed1982

Pseudodementia and ECT.

The author presents six cases of pseudodementia of varying degrees of severity that illustrate the difficulty in making purely clinical diagnoses of pseudodementia and demonstrate the usefulness of ECT in this condition in treatment-resistant patients. In addition, issues of cerebral laterality are raised by one case in which the patient paradoxically regressed to a preference for an acquired language (English) while pseudodemented and reverted to her native tongue (Spanish) after remission, with preservation of her ability to speak English.

Adult↗
PubMed1995

Nonepileptic seizures.

The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.

Adult↗
PubMedDate not supplied

[Dementia-depression: how are they related? From depressive pseudodementia to pseudodepression in dementia].

Dementia and depression are among the most frequent and disabling conditions in the elderly. The prognosis of depression is similar in young and elderly patients; however, treatment can be more risky in the latter. Incorrect diagnosis of dementia as well as therapeutic relentlessness should be avoided. An attempt is made to clarify the ways dementia and depression can combine. The reality of pure depressive pseudodementia seems doubtful. Depression can worsen a dementia. Cognitive dysfunction can be observed in depression, though it is difficult to estimate the extent and the meaning of this association. Patients with very mild dementia are often referred for a depression, which is ruled out by careful examination. There is no simple mean to differentiate dementia from depression. The proper way remains to perform a strict clinical, neuropsychological and psychiatric examination.

Aged↗
PubMed1994

[Significance of "abnormal reaction susceptibility" of adolescents in Munchausen by proxy syndrome. Simulation, folie à deux, induced artefact disease or what else?].

There are very few publications about the induction of emotional disturbances in Munchausen by proxy syndrome, although we see these children in our clinical work. While the pathology of the inducing mothers has been described quite well, the equally important question of pathological reactions of the child, which is a major factor at least in adolescents, has not yet been discussed. We present an unusual case of induced borderline psychosis and discuss the above mentioned aspect in relation to several psychopathological concepts, particularly Erikson's identity diffusion and folie à deux. We conclude that the concept of a simple induction of the disturbance in adolescents, which has been used so far, is insufficient. According to the authors the importance of the reactions discussed in this paper reaches far beyond Munchausen by proxy syndrome. The same reactions can for example be seen also in cases of sexual abuse. A bigger sample of patients needs to be investigated to confirm our considerations.

Adolescent↗