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PubMed1996

Pseudopsychodermatologic disease.

Just as psychodermatologic disorders can mimic real dermatologic conditions, real dermatologic or other bona fide physical problems such as neurologic disorders can also mimic psychodermatologic disorders. This article illustrates several cases of pseudopsychodermatologic disorders. When faced with a difficult patient or baffling case, sometimes there is a tendency to "jump to conclusions" with regard to the psychogenic origins of the case. It is important to be cognizant of the possibility that one may be missing a real organic disorder if one does not keep an open mind with regard to diagnosis of the patient's skin condition.

Adult↗
PubMed1994

Children with fever of unknown origin in Argentina: an analysis of 113 cases.

The aim of this study was to determine the causes of fever of unknown origin, to evaluate new diagnostic tests and to elucidate risk factors for chronic or life-threatening disorders. The medical records of 113 children who had undiagnosed fever for at least 3 weeks were reviewed. Infection (N = 41) was the most frequent cause of fever of unknown origin. Respiratory tract infections were the most common causes in infants and endocarditis and tuberculosis were more frequent in older children. Neoplastic disorders (N = 11) occurred in children older than one year. Juvenile rheumatoid arthritis (N = 9) was the most common collagen-vascular disorder (N = 15). Miscellaneous disorders and factitious fever occurred in 21 and 4 cases, respectively. Twenty-two patients remained undiagnosed. History and physical examination led to a final diagnosis in 81% of cases. Abdominal ultrasonography was performed in 71 patients (61%) and was helpful for diagnosis in 15%. Children with life-threatening or chronic disorders (N = 58) were older than those with self-limiting conditions (N = 55; P = 0.017). Cardiovascular and articular signs and symptoms were more frequent in the former group (P = 0.01).

Adolescent↗
PubMed2004

Meningeal derived cerebrospinal fluid proteins in different forms of dementia: is a meningopathy involved in normal pressure hydrocephalus?

OBJECTIVES: In animal models and in vitro studies leptomeninges have been shown to be the origin of neurotrophic substances that support the survival and growth of neuronal cells. Because dementia is associated with neuronal loss, we investigated whether leptomeningeal dysfunction may be involved in the pathogenesis of dementia disorders. METHODS: We analysed the cerebrospinal fluid (CSF) concentrations of the leptomeningeal derived beta trace protein, beta2 microglobulin, and cystatin C. RESULTS: There was a statistically significant difference of the CSF beta trace protein levels among different groups. Patients with idiopathic normal pressure hydrocephalus (NPH) (17.5 (SD 4.3) mg/l) showed significantly lower CSF beta trace protein levels than patients with Alzheimer's disease (23.8 (6.2) mg/l), depression (24.2 (7.3) mg/l), and normal controls (25.3 (4.9) mg/l). To patients with vascular dementia (20.1 (5.6) mg/l) and frontotemporal dementia (21.9 (7.0) mg/l), the difference was not significant. There was no significant difference regarding the CSF and serum concentrations of beta2 microglobulin or cystatin C among the different groups. CONCLUSIONS: We conclude that leptomeningeal dysfunction may be involved in certain types of dementia such as NPH and that reduced CSF beta trace protein levels in patients with NPH may aid in differentiating this difficult to diagnose disorder from other syndromes such as Alzheimer's disease.

Aged↗
PubMed1995

The clenched fist syndrome. A psychiatric syndrome mimicking reflex sympathetic dystrophy.

We describe a patient with swelling and pain in his right hand, which persisted for 1 year after minimal trauma. We think this represents a case of "clenched fist syndrome," a conversion disorder with unique somatic features that is easily mistaken for reflex sympathetic dystrophy syndrome. Included is a comparison of other psychological illnesses in which unusual physical findings involve the hand.

Diagnosis, Differential↗
PubMed1996

Multiple Health Issues in a Homeless Adolescent.

A 19-year-old homeless youth presented to the emergency department with right arm pain at the site of previous intravenous line and abdominal pain following a fight. Several days previously he had been treated for an unwitnessed grand mal seizure. The patient stated his history of seizure disorder, cardiac arrhythmia, reactive airway disease, and HIV infection (he reported CD4 count of 350 cells/mm(3)), and physical and sexual abuse. Upon admission, his CD4 count and percent were normal and HIV antibody test was negative. He refused to accept those results and kept none of his follow-up appointments. The case was consistent with factitious HIV disorder in adolescents.

Journal Article↗
PubMed1988

Neuropsychology of late-life psychoses.

The number of published neuropsychological studies of older psychiatric patients have been few. Moreover, almost nothing is known about the neuropsychological status of older individuals who develop psychotic symptoms for the first time later in life. Because of the spectrum of possible diagnostic considerations, careful diagnostic evaluations are of critical importance. Such evaluations should include comprehensive history-taking (using several sources), in addition to medical, psychiatric, neurologic, neuroimaging, and neuropsychological assessments. As the number of older individuals in our population grows, we will be increasingly faced with neuropsychiatric disorders that may arise de novo in the elderly. Multimodal and longitudinal investigations of older patients who develop psychotic or depressive symptoms are needed.

Aged↗
PubMed1982

A psychoanalyst-liaison psychiatrist's overview of DSM III.

There has been a groundswell of reaction, mostly favorable, to the most recent edition of the Diagnostic and Statistical Manual. In this paper the author attempts to evaluate the Manual, which purports to provide an atheoretical and descriptive diagnostic model on its own ground, as well as from a psychodynamic and ego-psychological point of view. More specifically, the Manual is evaluated in terms of its usefulness in the diagnosis and management of the Somatoform Disorders, as well as other typical general hospital problems. This assessment raises many questions about the basic tenets of DSM III in general. Concomitantly, suggestions are made to enhance the reliability, validity, and clinical relevance of the Manual.

Diagnosis, Differential↗
PubMed2004

Psychogenic movement disorders: diagnosis and management.

Psychogenic movement disorders (PMDs) are best defined as hyper- or hypo-kinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in most cases from psychological or psychiatric causes. There are a variety of PMDs including tremor, dystonia, parkinsonism, gait disorders and, even, unusual forms including paroxysmal dyskinesias. As has been recognised in the recent literature, PMDs cannot be strictly classified into clearly defined psychiatric disorders such as somatoform, dissociative or conversion disorders. In this review, we discuss the diagnosis of various PMDs (including hyper- and hypo-kinetic disorders; and current evidence for underlying comorbid disorders) and the current therapeutic approach to them. The therapy of PMDs is not well established, is very challenging to the clinician, and a better outcome can be achieved in the setting of a team approach involving movement disorders specialists, psychiatrists and therapists who specialise in cognitive-behavioural techniques. Current pharmacological and non-pharmacological approaches to treatment focus on therapy of underlying comorbid psychiatric and psychological issues, although compliance is a major concern.

Anxiety↗
PubMed1996

[Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis].

We describe a 39 years old patient with a history of chronic symptomatic hypokalemia. She denied taking any drugs. She satisfied the clinical criteria for Bartter's syndrome and more precisely for Gitelman's syndrome: hypokalemia in the presence of inappropriately high potassium excretion, metabolic alkalosis, hyperreninemic hyperaldosteronism, hypomagnesemia with inappropriately high magnesium excretion, normocalcemia, hypocalciuria and normal blood pressure. A HPLC analysis detected the presence of furosemide in urine and chlorthalidone in urine and plasma samples. After the self administration of diuretics was stopped, the above alterations came back to normality. Prior to the verification of a self administration of diuretics, the patient showed clinical and biochemical parameters that oriented to surreptitious diuretic ingestion (Pseudo-Bartter's syndrome) not to Bartter's syndrome or Gitelman's syndrome, particularly the plasma potassium readily restored to normal by the administration of potassium chloride supplements, the increased plasma uric acid with low uric acid fractional clearance, the widely different urine and plasma electrolyte levels and the presence psychiatric disorders. The literature is reviewed and differential diagnosis, among this three syndromes, is made.

Adult↗
PubMed1993

The Ganser syndrome in two adolescent brothers.

The Ganser syndrome is rare in children and adolescents. Two cases of Ganser syndrome in adolescent brothers, both of whom developed the syndrome while in jail and awaiting trial, are presented. Both brothers subsequently developed signs and symptoms indicative of affective disorder. The differential diagnosis and the management of these two patients are discussed in the light of the nosological controversies surrounding this clinical entity.

Adolescent↗
PubMed1993

Reversible dementias.

With so many conditions that can manifest in dementia, the question arises as to how extensive an evaluation need be done on the individual patient presenting with dementia. Thorough physical, neurologic, and psychiatric examinations are the cornerstones of the work-up, with special attention paid to the history, use of medications, and mental status of the patient. Laboratory tests recommended by the National Institutes of Health Consensus Conference on Differential Diagnosis of Dementing Diseases include a complete blood count, electrolyte and metabolic screen, thyroid panel, vitamin B12 and folate levels, syphilis serology, urinalysis, chest radiograph and electrocardiogram, and head CT scan. These evaluations are sufficient to diagnose the majority of treatable dementias. Other evaluations including magnetic resonance imaging, electroencephalography, cerebrospinal fluid examination, cerebral blood flow and metabolism measures (rate of cerebral blood flow, single photon emission computed tomography, and positron-emission tomography), and brain biopsy all can be of additional assistance in diagnosing the cause of the dementia when justified by the clinical setting. When the appropriate diagnosis is made, therapy is directed at the primary disorder. Successful treatment of the primary condition may result in stabilization or partial or complete reversal of the cognitive disturbance. In some instances, judicious pharmacologic management of the accompanying behavioral disturbance may be required.

Avitaminosis↗
PubMed1983

Diagnosis of Alzheimer's disease.

Alzheimer's disease is one of a number of conditions that can cause the syndrome of dementia. In the absence of a specific and simple test for Alzheimer's disease, the diagnosis is one of exclusion. There are several pitfalls in the diagnostic process, including failure to recognize depressive pseudodementia, focal brain disorders, and acute organomental syndromes. With an increasing proportion of elderly persons in the population, it is even more imperative to pursue accurate diagnosis with vigor, since several of the causes of dementia are treatable, whereas Alzheimer's disease is not.

Acute Disease↗
PubMed1990

Failure to detect fabricated posttraumatic stress disorder with the use of the MMPI in a clinical population.

The authors attempted to replicate previous studies that used the Frequency (F) scale and the posttraumatic stress disorder (PTSD) subscale of the MMPI to discriminate Vietnam veterans with PTSD from well-adjusted veterans and mental health professionals who feigned symptoms of PTSD. Profiles of veterans with PTSD were compared to those of veterans with non-PTSD psychiatric disorders and veterans with fabricated PTSD symptoms who sought treatment. Discriminant analysis of F scale and PTSD subscale scores correctly identified only 43.59% of the subjects, thus failing to support use of the MMPI in detecting fabricated symptoms of PTSD in a clinical population.

Adult↗
PubMed1997

[Self-induced injuries--surgical aspects].

So far, psychiatric-psychoanalytic theories have been able to explain the phenomenon "self-injury" only unsatisfactorily. Moreover, the patients do not turn to a psychiatrist in the first place, but to surgeons, dermatologists, gynecologists or general practitioners. This is therefore an interdisciplinary problem. Since general medical knowledge is relatively unhelpful in diagnosing self-inflicted disease and its treatment, these patients often do not receive adequate psychiatric co-management or further care or indeed often get the chance to delegate the act of self-injury to the physician. In view of the sustained tendency for the disorder to chronify, this frequently results in severe, partly irreversible and sometimes iatrogenically co-induced physical impairments. In the final analysis, it also leads to enormous financial burdens for the agencies which bear the costs.

Adult↗
PubMed1981

Dermatopsychosomatics: classification, physiology, and therapeutic approaches.

Psychosomatic dermatology is practiced in some manner by every dermatologist. In spite of this, there has been a virtual void in the literature from the middle 1950s until the present time. The relationship to physiologic phenomena, as well as a classification of psychosomatic dermatology, is reviewed. Dermatologic patients are divided into three groups: the primary group in which the emotional disorder is the primary disease and the cutaneous disorder merely part of its expression; the secondary group in which the basic cause is organic but does not affect the person emotionally in various degrees; and the collaborative group in which the organic causes and emotional disorders combine in different degrees to cause the skin disorder. This paper discusses anxiety and depression along with methods of dermatologic psychosomatic therapy consisting of antianxiety drugs, especially the benzodiazepines, antidepressants, hypnosis, behavior therapy, and the doctor/patient rapport. We conclude that one of the objectives for every dermatologist is to treat the entire patient-the psyche along with the soma.

Anxiety↗
PubMed1986

[The simulation of mental disorders. 2. Other psychopathological and psychosociodynamic aspects].

The output and presentation of unauthentic symptoms, or more or less roughly exaggerated, effected intentionally, can only create conceptual and semantic difficulties to the observer when, well informed by the context, he suspects a utilitarian objective from the individual person. The problem of malingering, seed of pathology, refers to questions on the expert's role and his way of collaboration with the petitioning authority.

Communication↗
PubMed1987

Pseudodementia in the mentally retarded. A case report and review.

Intellectual and behavioral deterioration in an individual who is mentally retarded presents a diagnostic challenge to the clinician, since the deterioration may be the result of the primary disorder or a new process. The mentally retarded individual's limitations in communication make the diagnostic assessment more difficult. The authors report the case of pseudodementia in a mentally retarded teenager presumed to have been caused by impacted otic cerumen and corrected by removal of the cerumen. The discussion includes a review of medical, neurologic, psychiatric, and environmental causes of intellectual and behavioral deterioration.

Adolescent↗