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At least 523 records · Page 29Linked to original sources
PubMed1984

Dermatological pathomimicry: a form of patient maladjustment.

Thirteen patients (eleven female, two male; aged 19-72 years) who mimicked their original dermatological disease by reproducing the original mechanisms of disease or by interfering with therapy were seen over a period of 5 years. Six patients had exacerbations of eczema, four drug reactions, and three non-healing leg ulcers. Exacerbations of dermatological disease were related to the patient's need for a sickness role. This maladjustment responded to positive directive psychotherapy rather than a superficial sympathetic approach which tended to reinforce the maladjustment. Eleven patients admitted their part in actively producing their disease, and the outcome was good. This clinical syndrome appears to be predominantly an opportunist reaction although one patient was depressed and one had early dementia. The syndrome should not be confused with dermatitis artefacta.

Adjustment Disorders↗
PubMed2001

Generalized dissociative amnesia: episodic, semantic and procedural memories lost and found.

OBJECTIVE: This review tests Ribot's classic twofold categorization of generalized amnesia (GA) into Type I, total loss of episodic memory, and Type II, additional more or less extensive loss of semantic and/or procedural memory. It also explores his law of regression, according to which, cast in modern terms, recovery of lost procedural and semantic memories precedes recovery of episodic memory, as well as reported aetiological factors. METHOD: Clinically and formally assessed cases of GA, published since 1845, were surveyed and further analysed. RESULTS: Over and above authentic episodic memory loss, cases differed widely in the extent of impairment of semantic and procedural memory. Recovery of semantic and procedural memory often preceded recovery of episodic memory. This particularly applied to authenticated trauma memories. To an extent, lost memories affected current functioning, and in some cases were associated with alternating dissociative personalities. Severe memory distortions upon memory recovery were not reported. Most cases were trauma or stress related, while in some cases the aetiology remained unknown. CONCLUSIONS: Contrary to the view expressed in DSM-IV, which states that dissociative amnesia pertains to an inability to recall personal information, GA may also involve loss and recovery of semantic and procedural memories. Since the loss of various memory types in GA is dimensional rather than categorical, Ribot's typological distinction does not hold. Some of the reviewed cases suggest a trauma-related aetiology. Generalized amnesia of varying degrees of severity can involve delayed retrieval of trauma memories, as well as the loss and delayed retrieval of the premorbid personality.

Amnesia↗
PubMed1984

Pharmacotherapy of geriatric depression.

Dysthymic disorders and major depressions both occur in the elderly. Aggressive but carefully chosen and monitored pharmacologic treatment is indicated in elderly patients with even modest symptoms of depression. Careful attention must be given to the presence of other medical disorders and treatments, physiologic changes of aging, decreased dosage requirements, and side effects. The available antidepressants are compared in terms of their effects on neurotransmitter reuptake mechanisms and the likelihood of producing sedation, anticholinergic effects, and cardiotoxicity. The low anticholinergic potential of desipramine makes it a useful drug in the treatment of geriatric depression.

Aged↗
PubMed1983

Depressive pseudodementia: a suggested diagnostic profile.

Severe cognitive and memory impairments often occur during episodes of depression, making it difficult to differentiate true dementia from depressive pseudodementia. The dexamethasone suppression test (DST) and the computerized tomography of the brain (CT scan) may aid in this problem. Eleven patients were assessed with the Hamilton Depression Rating Scale (HDRS), a Dementia Scale (DS), the overnight DST, and CT scans. Clinicians and raters were blind to DST results. All patients initially had high DS scores. These changed in most patients following antidepressant treatments. This study suggests a profile for the diagnosis of pseudodementia. Patients with cognitive impairment, dysphoric mood, abnormal response to the DST, and normal CT scan tend to have depressive pseudodementia. Patients with the first three features but with an abnormal CT scan likely have depression and structural brain pathology. Both groups respond to antidepressant treatments, although the latter continued to have some cognitive dysfunction during euthymia. A third group, the "true" dementia patients, may have abnormal CT scans and a normal DST response but larger samples are needed for confirmation.

Aged↗
PubMed1996

A case of Ganser's state presenting as a dementia syndrome.

We report an atypical case of Ganser's syndrome in a 54-year-old male patient. The following symptoms which include approximate answers perceptual disturbances and dissociative mechanisms were observed over 7 years, improved during hospitalization, but reappeared just before the patient's discharge. The extremely long presence and bizarre manifestation of symptoms, the course of the disorder and the patient's premorbid high intelligence level point to an unusual presentation of this case. Following the concept of hysteria and dissociation, we discuss its diagnosis within the scope of the DSM-III-R, DSM-IV and ICD-10 classification of Dissociative Disorders. Problems in the differential diagnosis which result from an increasing awareness of Dissociative Disorders are outlined.

Factitious Disorders↗
PubMedDate not supplied

[SPECT and depressive pseudo-dementia. A case report].

The SPECT (Single Photon Emission Computed Tomography), a new advance in medical imagery, allows the measure of cerebral blood flow and could be of interest in studying mental disorders. We report here a case of pseudo-dementia for which a SPECT has been performed before and after treatment. Mrs V., a 49 years old female, has been suffering from a dementia-like syndrome for several months. She is divorced, has two children, lives with a boy-friend, and has been working in a factory for 25 years. The first psychiatric disorders began three years ago with a gradual apragmatism and muteness. A neuroleptic treatment gave no result. One year later, without any reason, Mrs V. recovered a normal way of life. Nevertheless, from time to time, she had some periods of subexcitation. Few months later, she relapsed in her previous state of apragmatism and muteness. During a new hospitalization, neuroleptic treatment is tried again without any success. Mrs V. is then referred to us for medical screening of a dementia syndrome. In the Unit, it is difficult to communicate with her; she looks sad or amimic and has motor stereotypies (like rubbing her feet continuously against the floor). She has polidypsia and glutonny. Neurologic examination is normal, as well as EEG, X Scan, Nuclear Magnetic Resonance. The Folstein Mini Mental State score is 9/30.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗
PubMed1993

[Somatic symptoms and complaints of somatizing patients].

The purpose of the study was to describe the physical complaints and symptoms of persistently somatizing patients. Individuals in the general population (age 17-49 years) with at least ten general admissions during an eight-year period were studied. Persistent somatizers (i.e. patients with more than six medically unexplained general admissions) were compared with patients whose admissions could be ascribed to well-defined somatic disorders. Somatizers were characterized by multiple symptoms from many organ systems, and their physical complaints simulated most types of somatic disorders. Although some symptoms were more common than others, none were infrequent, so neither "classic" conversion symptoms nor pain symptoms were found to be especially characteristic of the persistent somatizer. These findings question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. One fifth of the persistent somatizers had been admitted at least once for factitious illness, but apart from the fact that they had more symptoms and admissions, they did not differ from the other persistent somatizers.

Adolescent↗
PubMed1994

Diagnosis of narcissistic self-esteem regulation in patients with factitious illness (Munchausen syndrome).

A quantitative taxonomy for the identification of patients with narcissistic pathology and with borderline personality disorders based on test results is presented. The quantitative identification of these subgroups was produced using a Q-factor analysis. Based on the correlation of the subjects by means of the 241 questions from the narcissistic inventory of Deneke and Müller [27], three subgroups could be defined. Two of these groups exhibited a pathology of the self-system which corresponded to the pathology described by Kernberg [24] for narcissistic and borderline personality disorders. The third group is characterized by reduced observable self-pathology traits from the narcissistic inventory. By means of the reclassification of these three taxonomical groups with the discriminant analysis, two discriminant functions could be calculated, using the weighting of the single test scales for a classification of new patients. These classification functions were used to examine 18 patients suffering from factitious disorders. The evaluation of test profiles with the reduced narcissistic inventory of Deneke and Müller [11] in order to identify the three taxonomical groups showed that 9 patients (50%) had a borderline personality disorder and 6 patients (33%) a narcissistic personality disorder, while 3 patients (17%) could be assigned to the subgroup without self-pathology. In summary, 83% of the examined patients with factitious disorders exhibited a disorder in self-regulation. The previous clinical observations of self-regulation for patients with factitious disorders could thus be confirmed. It becomes clear that different high levels of disorder in self-regulation (position in the sphere of the discriminant function) correspond to varying degrees of prognostic significance.

Adult↗