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PubMedDate not supplied

Use of the dexamethasone suppression test on a combined medicine-psychiatry inpatient unit.

The dexamethasone suppression test (DST) appears to be a sensitive and specific biological marker for endogenous depression that can have important diagnostic and treatment implications. The authors present three case studies of patients treated on a combined medicine-psychiatric inpatient unit, and who presented with complex psychobiological illnesses. They discuss the usefulness of the DST in the hospital management of these patients from a diagnostic and treatment perspective.

Adult↗
PubMed1991

Psychological aspects of diabetes.

Diabetes mellitus is treatable but not curable. Management is complex and involves dietary restrictions and sometimes daily injections. There is also a significant risk of serious complications which, at their worst, may include blindness, gangrene and renal failure. It is not surprising that a combination such as this may have significant psychological implications.

Adaptation, Psychological↗
PubMed1991

Neuropsychological presentation of Ganser symptoms.

We describe a patient with memory complaints whose history of head injury, polysubstance abuse and positive neurological findings suggested the presence of dementia. Neuropsychological testing revealed inconsistent performance plus multiple verbal and visuospatial approximate answers leading to the diagnosis of a Ganser episode. This case illustrates the importance of neuropsychological assessment in diagnosing Ganser symptoms and in differentiating this disorder from organic conditions and malingering.

Factitious Disorders↗
PubMed1993

Psychiatric and psychometric issues in acné excoriée.

Psychiatric and psychometric issues were assessed in 12 acné excoriée patients. Two patients exhibited a DSM-III-R dysthymia and 2 patients a DSM-III-R personality disorder, which were considered as associated comorbidities. Most patients reported concern for being unattractive and a compulsive urge to manipulate their skin. However, 8 out 12 patients did not fulfill criteria for any DSM-III-R disorder. In particular, we could not find evidence for the assumption of underlying obsessive-compulsive disorders or body image disorders in acné excoriée.

Acne Vulgaris↗
PubMedDate not supplied

Patients who (need to) tell stories.

There are no objective means of verifying a psychiatric diagnosis. Some patients appear to exploit this inherent uncertainty by claiming to be mentally ill when they are not. Occasional exaggeration or feigning of illness may be normal, but persistent, severe or recurrent simulation is rare, is associated with major character disorder and has a poor prognosis.

Adult↗
PubMed1998

Psychiatric diseases presenting as infectious diseases.

Although many psychiatric diseases have somatic manifestations, some focus on fears or delusions of infection. When a patient with a psychiatric basis for an apparent infection presents to an infectious disease physician, the physician may find the problem confusing, amusing, and ultimately frustrating until the psychiatric basis for disease is recognized. Some of these psychiatric disorders can be treated and controlled with medication and psychotherapy, although patients may resist psychiatric referral. This article reviews examples of psychiatric disorders in patients who present to the infectious disease physician, including factitious infection, malingering, obsessive compulsive disorder, phobias, veneroneuroses, somatization disorders, and delusional infection. The role that physicians play in amplifying these disorders is reviewed. Strategies for referral to psychiatric services are also discussed. Patients with a psychiatric disease are seen in infectious disease practices more commonly than physicians realize.

Adult↗
PubMed1992

Efficacy of MMPI-2 validity scales and MCMI-II modifier scales for detecting spurious PTSD claims: F, F-K, Fake Bad Scale, ego strength, subtle-obvious subscales, DIS, and DEB.

This study compared 119 personal injury claimants' scores on MMPI-2 and MCMI-II malingering scales. Data from 55 pseudo-PTSD patients and 64 controls confirm the utility of the scales examined. The following cut-offs were most effective for identifying spurious PTSD: F greater than 62, F-K = greater than -4, Es = greater than 30, FBS = greater than 24 (men), FBS = greater than 26 (women), total obvious minus subtle = greater than 90, DIS = greater than 60, and DEB = greater than 60. Pseudo-PTSD patients were those who (1) claimed to be suffering a psychological injury (2) that was so severe that it was disabling (3) due to an experience that was entirely implausible as a candidate for PTSD criterion A in DSM-III-R and (4) scored T = 65 or higher on both PK and PS, the post-traumatic stress disorder subscales of the MMPI-2.

Adult↗
PubMed1999

Stalking: false claims of victimisation.

BACKGROUND: False allegations of victimisation although uncommon are important to recognise. This paper examines those who falsely claim to have been the victims of stalking. AIMS: To highlight the phenomenon of false victims of stalking. METHOD: Twelve individuals who falsely claimed to be victims of stalking were compared with a group of 100 true stalking victims. RESULTS: False stalking victims presented for help earlier than real victims and were less likely to claim harassment via letters. They reported equivalent levels of violence directed at themselves but seldom claimed others were attacked. Five types of false claimants were recognisable. False victims consumed more medical services than genuine stalking victims and they were more likely to be embroiled in legal action. They reported similar levels of distress with suicidal ruminations in over 40%. CONCLUSIONS: The current interest in stalking is promoting false claims of being stalked. Early identification of these cases and appropriate intervention are essential to both minimising abuses of resources available to true victims and equally to ensure appropriate care for those who express their own disordered state in false claims of victimisation.

Adult↗
PubMed1987

The self-inflicted dermatoses: a critical review.

The self-inflicted dermatoses, namely dermatitis artefacta, neurotic excoriations, and trichotillomania, have been reported to be associated with various degrees of psychopathology in the dermatologic literature, but have received surprisingly little emphasis in the psychiatric literature. This probably reflects, firstly the fact that most of these patients initially deny any psychologic problems and hence may not receive psychiatric interventions, and secondly a lack of adequate collaboration between the psychiatrist and dermatologist. These disorders may be associated with serious sequelae, such as suicide and repeated major surgical procedures. Their treatment is also primarily psychiatric. This article critically reviews the literature and comments upon the salient clinical features and treatments for these disorders, which are relevant for the psychiatrist doing consultation-liaison work. Knowledge of these disorders is important in the evaluation of any psychiatric patient, as these disorders are essentially a cutaneous sign of psychopathology.

Dermatitis↗
PubMed2001

Instrumental psychosis: the Good Soldier Svejk syndrome.

The possession of severe mental illness, mainly schizophrenia and affective psychosis, may be perceived in positive terms. We have identified a group of patients, most of them with a history of previous psychotic disorder, who present with deliberately created symptoms and behaviour, and who are defined as having instrumental psychosis. Because most such patients have had a psychotic disorder in the past the symptoms are very like those of a real psychosis. A parallel is drawn with the fictional anti-hero of the Czech nation, the Good Soldier Svejk, who demonstrated both real and instrumental psychosis. A rating scale, the 'pseudopsychosis inventory', was devised to identify the main components of this disorder and was applied in 15 consecutive patients presenting with putative psychotic disorders in whom assessment could be made by two raters within five days. The inter-rater reliability of the items of the scale was good (intra-class correlation coefficient 0.68). An epidemiological study with this scale in 45 patients with a putative psychotic disorder suggested the presence of instrumental psychosis in 2.

Adult↗
PubMed1989

Early differentiation of senile dementias.

Neurologic causes of dementia include cortical and subcortical pathology, as well as intracranial space-occupying lesions. The elderly are particularly prone to metabolic and toxic encephalopathies with associated delirium, dementia, or both. Many of these disorders are potentially reversible, but appropriate management requires comprehensive assessment.

Aged↗
PubMed1992

Faking specific disorders: a study of the Structured Interview of Reported Symptoms (SIRS).

An untested assumption of malingering research is that persons who feign mental illness will not attempt to fake a particular disorder, but will be content to fabricate non-specific and possibly global psychiatric impairment. We tested the effectiveness of the Structured Interview of Reported Symptoms (SIRS) to detect feigning of three diagnostic groupings: schizophrenia, mood disorders, and PTSD on 45 psychologically knowledgeable correctional residents. We found that the SIRS maintained its powers of discrimination with respect to clinical samples. Similar research on faking specific disorders is needed on the MMPI-2 and other psychological measures.

Adult↗
PubMed1978

Munchausen's disorder: a case of a factitious neurological emergency.

Few signs are more ominous than the dilated pupil which is unreactive to light. The deliberate use of this fact and the simulation of other neurologic signs to enhance the aura of a serious illness will often expose a patient to hazardous procedures. A patient with Munchausen's Disorder who made unsuccessful attempts to simulate a neurological emergency is presented. A thorough knowledge of the pathophysiology of neurologic disease will enable the physician to detect the possibility of malingering when confronted with this problem. A strong cholinergic solution will produce pupillary constriction in normals and neurologic disorders but often will not alter the pupil in cases of pharmacologic pupillary paralysis.

Adult↗
PubMed1989

Psychiatry and chronic pain.

Pain and chronic pain have been defined by the International Association for the Study of Pain. Psychological mechanisms are recognized in the production of pain, but their importance has probably been overstated. Selection factors have not been attended to sufficiently, and traditional methods which have been relied upon for the diagnosis of hysterical pain have been misleading. Much emotional change seen with pain is a consequence of the physical disorder. Types of illness, seen by psychiatrists working with patients in pain, are described, and brief comments offered on their management.

Chronic Disease↗
PubMed2005

Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy.

BACKGROUND: The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal. SAMPLING AND METHODS: A case history is presented of a 35-year-old man who was referred because of his desire for amputation of his left leg, without sexual connotations. The course of a combined cognitive behavioural psychotherapy with SSRI treatment is described. RESULTS: Symptoms showed considerable similarity with obsessive-compulsive disorder, and some similarity with body dysmorphic disorder according to DSM-IV, but the core symptom seemed to be strongly connected with a sense of identity. Treatment with a selective serotonin re-uptake inhibitor decreased levels of distress only. The effects of cognitive restructuring of the psychotherapy were limited, whereas the behavioural elements substantially reduced the behaviour of pretending to be an amputee. CONCLUSIONS: The rare syndrome of apotemnophilia raises unresolved questions of classification. Psychotic disorders should be ruled out carefully. The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.

Adult↗
PubMed1992

Physical complaints and symptoms of somatizing patients.

The purpose of the study was to describe the physical complaints and symptoms of persistent somatization patients. Individuals in the general population (age 17-49 yr) with at least 10 general admissions during an 8-yr 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 disorder. 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. Gender had no influence on number of registered symptoms, whereas the number increases with age. The finding question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. The major part of the somatizers present a different illness picture when admitted with medically unexplained disorders compared with admission for which no adequate medical explanation could be found. However, one fifth had, when admitted with a medically explained diagnosis, also been admitted with the diagnosis medically unexplained at another admission. 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↗
PubMed1996

Neurotic excoriations and dermatitis artefacta.

Patients with different psychiatric disorders produce artefacts on the skin, each requiring a different therapeutic approach. These different disorders are outlined briefly. The clinical picture, pathology, psychopathology, differential diagnosis, treatment, course, and prognosis of dermatitis artefacta and neurotic excoriations are reviewed in greater detail.

Dermatitis↗