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PubMed2006

[Standardized diagnosing: computer-assisted (CIDI) diagnoses compared to clinically-judged diagnoses in a psychosomatic setting].

BACKGROUND: Within the past two decades, there has been an increasing trend towards the use of empirically-based, standardized instruments to diagnose mental disorders. The purpose of this study was to investigate the congruence between clinically-derived and standardized computerized diagnoses using the Composite International Diagnostic Interview (CIDI) in a psychosomatic setting. PATIENTS AND METHODS: N = 230 inpatients treated at the Department of Psychosomatic Medicine, Charité Berlin, were diagnosed for mental disorders by experienced clinicians and by the CIDI according to the diagnostic criteria of ICD-10 and DSM-IV. RESULTS: Congruence between computerized and clinically-derived diagnoses for all mental disorders was fair to poor (kappa = 0.0 - 0.33). The diagnostic congruence of somatoform (F45), anxiety (F40 - 41), depressive (F32 - 34), eating (F50) and dissociative disorders (F44) and disorders due to psychoactive substance use (F10 - 19) was fairly low (kappa = 0.19 - 0.33). Diagnostic congruence of diagnoses of reactions to severe stress (F43) and obsessive compulsive disorders (F42) was particularly poor (kappa = 0.0 - 0.01). CONCLUSION: Overall diagnostic congruence between computerized and clinical diagnostics was unsatisfactory. Thus, the validity of computer-assisted standardized interviews - like the CIDI - is questionable in a psychosomatic setting.

Adult↗
PubMed1990

The diagnosis of multiple personality disorder based on subtle dissociative signs.

Patients with multiple personality disorder (MPD) often present with subtle dissociative signs and symptoms rather than with the clear-cut, overt dissociative signs and symptoms usually associated with MPD. Because most MPD patients usually conceal their condition, there are only limited periods in their lives when they show florid, overt symptoms that can be easily diagnosed. During these other times, MPD patients often show subtle dissociative signs in their affects, thoughts, memories, behaviors, object relations, and transferences. These indirect manifestations of MPD are evidence of the patient's dissociative pathology and occur when their alters influence each other, partly emerge, or subtly shift. A familiarity with these subtle dissociative signs would allow the therapist to be aware of what MPD looks like when it is camouflaged and expressed indirectly. A recognition of these indirect manifestations would enable the clinician to suspect the diagnosis, explore the possible alters, and diagnose the patient's underlying dissociative pathology when present.

Adult↗
PubMed2001

The association between mild traumatic brain injury and psychiatric conditions.

The majority of patients with mild traumatic brain injury (TBI) recover fairly quickly and are usually restored to their previous level of functioning. However, a significant minority have prolonged, complicated, or incomplete recoveries and have outcomes disproportionately worse than would have been predicted by the objective facts of the injury. This failure to recover as expected was the focus of this study. The participants were 80 adults with actual or suspected mild TBI who were referred to an outpatient mild TBI clinic. Most were characterized by problematic recoveries. The results indicated that those individuals who only had brain injuries made good recoveries, but that those with psychiatric comorbidity did not (chi(2) = 19.65, p = 0.0002). Most of the new psychiatric conditions responsible for poor recovery consisted of depression, anxiety disorders or conversion disorder. Dissociative phenomena appeared common after mild TBI and scores on the Dissociative Experiences Scale predicted brain injury outcome with 77% accuracy.

Adult↗
PubMed1997

Paroxysmal limbic disorders in neuropsychiatry.

Patients who experience episodes with a transient disturbance in perception, memory, mood, and level of anxiety are frequently encountered by neurologists, psychiatrists, and psychologists. The possibilities for differential diagnosis of these episodes include partial complex epilepsy, psychogenic seizures, panic disorder, dissociative states, migraine, and transient global amnesia, among others. The clinical history may be vague and confusing, making it difficult to determine definitively the etiology of the events. This article describes a spectrum of paroxysmal disorders involving limbic structures, highlighting the clinical features and assessment techniques that aid in diagnosis and treatment. Clinical-anatomic correlations are provided whenever possible.

Adult↗
PubMed2004

[Factitious disorder and factitious disorder by proxy].

Similar to the adult patient, a child or adolescent may actively feign or produce artificial symptoms (synonymous: Munchausen syndrome). The more frequent case is that the child suffers from being an object of symptom fabrication induced by a close person caring for the child, regularly the mother (Munchausen syndrome by proxy). This review focuses on psychopathological aspects of the clinically more relevant factitious disorder by proxy. Typical behaviour and personality characteristics are presented that can be taken as clinical warning signs. Doctor-mother-interaction is affectively challenging due to conflicting tasks imposed on the physician. Complementary to pediatric exclusion of genuine disease, psychopathological assessment is required to exclude other sources of deviant illness behaviour. Factious disorder shares particular features (active violation of the child, false report of history, aggravated symptom presentation and increased doctor-hopping, difficulties in conforming maternal report in biomedical data) with other psychopathological entities (child abuse, simulation, dissociative disorders, somatoform disorders including hypochondria, variants of maternal overprotection and infantilization, psychosis or delusion in the mother). Criteria for differentiation are presented. Three concepts on the psychopathological etiology of factitious disorder by proxy are relevant: In some cases, it may be conceived as secondary manifestation of a primary psychopathological entity or personality disorder. Learning theory emphasises operant rewards received from vicarious sick role. Attachment theory provides possible explanations concerning the traumatic impact on the child, early sources of psychopathology in the fabricating mother and risks for intergenerational transmission of factitious disorders.

Adolescent↗
PubMed1999

History of childhood sexual or physical abuse in Japanese patients with eating disorders: relationship with dissociation and impulsive behaviours.

BACKGROUND: Empirical data regarding prevalence of sexual and physical abuse histories in Japanese patients with eating disorders is lacking, in contrast to Western countries. This study investigated the prevalence of traumatic events in Japanese patients with eating disorders, and examined the relationship between such traumatic events and clinical features. METHODS: Subjects consisted of 33 patients with anorexia nervosa restricting type (RAN), 40 patients with anorexia nervosa binge eating/purging type (AN-BP), 63 patients with bulimia nervosa purging type (BN) and 99 healthy controls. All were female and diagnoses were based on DSM-IV. The Physical and Sexual Abuse Questionnaire (PSA), Eating Disorder Inventory (EDI) and Dissociation Experience Scale (DES) were administered to all of the subjects. RESULTS: Paradoxically, victims of minor sexual abuse committed by Chikan (a Japanese word indicating a person who commits minor sexual crimes) were more prevalent among controls than among patients with RAN, AN-BP or BN. However, physical punishment histories tended to be more prevalent among patients with AN-BP or BN than among RAN or controls. Only AN-BP and BN patients with physical punishment histories had twofold higher scores for DES and significantly more frequent histories of self-mutilation (67% v. 33%) compared with patients without such histories. CONCLUSION: An abuse history is not essential or a prerequisite to developing an eating disorder in Japan.

Adolescent↗
PubMed2005

State dissociation in bulimic eating disorders: an experimental study.

BACKGROUND: Dissociation and binge eating appear to have equivalent functions, lowering awareness of generalized threat and negative self-esteem. Dissociation can be a general characteristic of the individual, present in all situations (i.e., a trait), or it can be a time-limited reaction to a specific situation (i.e., a state). Previous studies have shown that the subliminal presentation of threat cues leads to increased bulimic behaviors. This experimental study examines whether dissociation is activated under similar conditions, thus testing whether dissociation is a reactive state in bulimic women, as well as a trait. METHOD: The participants were 24 bulimic and 26 nonclinical women, each of whom completed the Eating Disorders Inventory and the Dissociative Experiences Scale. Each woman was exposed to subliminal neutral and threat cues, before completing the subjective component of the Clinician-Administered Dissociation Scale and a measure of anxiety and mood (the Hospital Anxiety and Depression Scale). RESULTS: The subliminal threat cue significantly increased state dissociation (particularly derealization levels) in the bulimic women but had no effect on the nonclinical group. There was no impact on mood. DISCUSSION: State dissociation appears to play an integral role in the bulimic process, but further studies are needed to determine the causal structure in that relationship and whether it applies in other disorders. Future clinical practice should be directed towards the identification and treatment of state dissociation in therapy.

Adult↗
PubMed1987

Attention, autonomic arousal, and personality in behaviorally disordered children.

This study assessed the construct validity of the Revised Behavior Problem Checklist (RBPC) by measuring attention, autonomic arousal, and personality in 40 behaviorally disordered children aged 7 to 15 years. Conduct Disorder and Socialized Aggression subscales were characterized by high Psychoticism, Impulsivity, and Lie personality scores, by lower heart rate levels, and by more errors on a continuous performance reaction-time task. Conversely, Attention Problems, Anxiety Withdrawal, and Motor Excess were characterized by greater variability in reaction times. Conduct Disorder alone was related to an external locus of control, while only Attention Problems was characterized by low scores on the WISC Freedom from Distraction factor. These differential relationships suggest (a) support for the construct validity of the RBPC, (b) that antisocial behavior and hyperactivity/attention deficits are dissociated disorders, and (c) that hyperactivity/attention deficits may be characterized by fluctuations in the allocation of attentional resources rather than a core structural deficit in attention.

Adolescent↗
PubMed2004

The prevalence of somatoform disorders among internal medical inpatients.

OBJECTIVE: To find the prevalence of somatoform disorders (SDs) among internal medical inpatients and to study the comorbidity with other psychiatric disorders. METHODS: Of 392 eligible consecutive medical inpatients, 294 (75%) accepted to participate and, using a two-phase design, were assessed for ICD and DSM-IV somatoform diagnoses and for ICD-10 psychiatric diagnoses. RESULTS: A total of 18.1% (95% CI: 12.8-24.9%) of the patients fulfilled the diagnostic criteria for an ICD-10 disorder, and 20.2% (95% CI:14.7-27.2% ) for a DSM-IV SD. The prevalence of specified disorders revealed marked differences between the two diagnostic systems, e.g., concerning somatisation disorder (SD), which was more prevalent in the ICD-10 (5%) than in the DSM-IV (1.5%) equivalent. Quite the contrary was found in undifferentiated SD (0.7% in ICD-10 and 10% in DSM-IV). According to ICD-10 criteria, 3.5% had hypochondriasis, 2.6% a dissociative disorder, 3.2% a somatoform autonomic dysfunction, 1.5% had neurasthenia or persistent somatoform pain disorder, and 5% had an SD, unspecified. SDs were more prevalent among younger females. Thirty-six percent of the patients with SDs also had another psychiatric disorder, 11% a depression, and 25% an anxiety disorder. The physicians detected about 1/3 of the cases. CONCLUSION: Somatoform disorders were prevalent among internal medical inpatients especially among younger women.

Adult↗
PubMed2006

[Neuropsychiatric aspects of diagnostics of nonepileptic seizures].

The outcome of nonepileptic seizures (NES) is usually poor. The early recognition suggests better prognosis. This study is undertaken to examine the value of neuropsychiatric method for making accurate diagnosis of the psychiatric disorder that underlies psychogenic NES. Multidisciplinary approach to clinical assessment of such patients with chronic or resistant course of seizure disorder was used. Out of 6 patients, who went through the neuropsychiatric evaluation, two were admitted with a diagnosis of status epilepticus, three--with acute episodes of repetitive seizures and one--with diagnoses of bettolepsy. The results demonstrated that in four cases seizures were the manifestation of dissociative disorder (F 44), in one--of somatic form autonomic dysfunction (F 45.3) and the last patient had delirium due to epilepsy. All of the four patients with the past history of epilepsy were treated with antiepileptic drugs (AED). In two cases diagnosis of epilepsy and AED therapy were withdrawn. In the remaining cases we supposed the coexistence of epilepsy and NES. Our data suggests that incorporating of neuropsychiatric methods into the diagnostic battery for people with suspected and/or intractable epilepsy help in distinguishing NES and epilepsy as well as in revealing the underlying psychic disorder, which leads to formulation specific treatment program.

Adolescent↗
PubMed1991

Multiple personality disorder. A psychoanalytic perspective.

This article links multiple personality disorder (MPD) and dissociation to related theories of defense, resistance, and development in treatment. Trauma, conflict, and deficiency all play contributing roles in the genesis of MPD; the blend of each ingredient may be decisive in each patient. Internal conflict and deficiency tend to be overlooked, whereas trauma is emphasized. Other psychoanalytic concepts, such as transitional phenomena, identity, aggression, repetition, and the seeking after quiescence, are applied to MPD. In the discussion of working through, emphasis is placed on the process nature of MPD and on strategic integration.

Adaptation, Psychological↗
PubMed2006

Trauma and dissociation in China.

OBJECTIVE: In order to determine whether pathological dissociation occurs in China, the authors conducted a survey among psychiatric inpatients, outpatients, and the general population in Shanghai, China. There is virtually no popular or professional knowledge of dissociative identity disorder in China, and therefore professional and popular contamination cannot exist. METHOD: Chinese versions of the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule were administered to 423 inpatients, 304 outpatients, and 618 factory workers in Shanghai by Chinese psychiatrists working at the Shanghai Mental Health Center. RESULTS: Dissociative disorders were diagnosed in 24 respondents by structured interview, and 15 respondents fell into the dissociative taxon on the Dissociative Experiences Scale. The outpatients reported the highest rates of childhood physical and/or sexual abuse and of pathological dissociation. CONCLUSIONS: Pathological dissociation can be detected readily among psychiatric outpatients in China but is much less common in the general population. Pathological dissociation is more frequent in more traumatized subsamples of the Chinese population. The findings are not consistent with the sociocognitive, contamination, or iatrogenic models of dissociative identity disorder.

Adult↗
PubMed2004

Mental illness among Bhutanese shamans in Nepal.

Despite efforts to promote traditional medicine, allopathic practitioners often look with distrust at traditional practices. Shamans in particular are often regarded with ambivalence and have been considered mentally ill people. We tested the hypothesis that shamanism is an expression of psychopathology. In the Bhutanese refugee community in Nepal, a community with a high number of shamans, we surveyed a representative community sample of 810 adults and assessed ICD-10 mental disorders through structured diagnostic interviews. Approximately 7% of male refugees and 0.5% of female refugees reported being shamans. After controlling for demographic differences, the shamans did not differ from the comparison group in terms of 12-month and lifetime ICD-10 severe depressive episode, specific phobia, persistent somatoform pain, posttraumatic stress, generalized anxiety, or dissociative disorders. This first-ever, community-based, psychiatric epidemiological survey among shamans indicated no evidence that shamanism is an expression of psychopathology. The study's finding may assist in rectifying shamans' reputation, which has been tainted by past speculation of psychopathology.

Bhutan↗
PubMed2006

Consequences of domestic violence on women's mental health in Bosnia and Herzegovina.

AIM: To assess psychological consequences of domestic violence, and determine the frequency and forms of domestic violence against women in Bosnia and Herzegovina. METHODS: The study was carried out in the Tuzla Canton region in the period from 2000 to 2002, and included 283 women aged 43+/-9.6 years. Out of 283 women, 104 received psychiatric treatment at the Department for Psychiatry of the University Clinical Center Tuzla, 50 women were refugees; and 129 were domicile inhabitants of the Tuzla Canton. Domestic Violence Inventory, Cornell Index, Symptom Checklist-90-Revised, PTSD Checklist Version for Civilians, and Beck Depression Inventory were used for data collection. Basic sociodemographic data and information from the medical documentation of the Department for Psychiatry of the University Clinical Center Tuzla was also collected. RESULTS: Out of 283 women, 215 (75.9%) were physically, psychologically, and sexually abused by their husbands. Among the abused, 107 (50.7%) experienced a combination of various forms of domestic violence. The frequency of domestic violence was high among psychiatric patients (78.3%). Victims of domestic violence had a significantly higher rate of general neuroticism, depression, somatization, sensitivity, obsessive-compulsive symptoms, anxiety, and paranoid tendency than women who were not abused. The prevalence of posttraumatic stress disorder (PTSD) symptoms according to the type of trauma was higher in women with the history of childhood abuse (8/11) and domestic violence (53/67) than in women who experienced war trauma (26/57) and the loss of loved ones (24/83). The majority of 104 psychiatric patients suffered from PTSD in comorbidity with depression (n=45), followed by depression (n=17), dissociative disorder (n=13), psychotic disorder (n=7), and borderline personality disorder with depression (n=7). The intensity of psychological symptoms, depression, and Global Severity Index for Psychological Symptoms (GSI) were in significant positive correlation with the frequency of psychological (r=0.45, P<0.001), physical (r=0.43, P<0.001), and sexual abuse (r=0.37, P<0.001). CONCLUSION: Domestic violence in various forms had long-term consequences on mental health of women. This should be taken into account when treating women with war-related trauma.

Adolescent↗
PubMed1999

Major mental disorders in Butajira, southern Ethiopia.

Previous studies conducted in Ethiopia lack information on the prevalence of specific mental disorders in rural communities. The lifetime and one-month prevalence of specific ICD-10 mental disorders and their associated socio-demographic factors were determined using the translated Amharic version of the Composite International Diagnostic Interview (CIDI) in a rural population. A total of 501 community subjects selected from a predominantly rural district by stratified random sampling were interviewed by non-clinician interviewers. The weighted aggregate lifetime prevalence of psychiatric morbidity was 31.8% (26.7% when substance dependence was not included). The most frequent specific diagnoses were: dissociative disorders (6.3%), mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%). After adjustment in a multivariate logistic model, female sex was shown to have a statistically significant association with mood disorders (Odds Ratio, OR = 3.84, 95% CI: 1.90, 7.73) and somatoform disorders (OR = 2.30, 95% CI: 1.13, 4.60). Severe cognitive and mood disorders were significantly associated with being elderly, i.e. 60 or more years of age (OR = 7.71, 95% CI: 1.58, 7.53; and OR = 3.68, 95% CI = 1.36, 9.95, respectively). Khat dependence was associated with being Muslim and with earning a low income. (OR = 3.5, 95% CI: 1.02, 11.98; and OR = 0.32, 95% CI: 0.10, 0.96, respectively). It is concluded that psychiatric morbidity is a major public health problem in the rural community.

Adolescent↗
PubMed1997

Rape-related psychotraumatic syndromes.

OBJECTIVE: This study took place in a forensic center for rape victims. Our aims were: first, to explore the longitudinal course of post-traumatic stress disorder (PTSD) and prevalence of disorders over the 6-month period following rape, then second, to group these disorders into syndromes related to chronic PTSD whilst remaining distinct from it, and third, to establish some predictive factors for chronic PTSD. STUDY DESIGN: 92 rape victims consecutively admitted to the center were regularly interviewed over a 6-month period by a psychiatrist. RESULTS: The paper confirms that rape leads to a high proportion of PTSD. Generally speaking, the psychopathology following rape is severe. PTSD at 6 months is associated with phobic and dissociative disorders. It is further associated with a cluster of symptoms arising after rape that we term borderline-like. Incestuous rape is a predictive factor for PTSD at 6 months. CONCLUSION: In the aftermath of rape several semiologically distinct psychotraumatic syndromes exist.

Adolescent↗
PubMed1995

[Psychological trauma and mental disorders].

Fifty-eight female impatients consecutively hospitalized in the University Hospital Department of Psychiatry in Tours were interviewed with a clinician battery of instruments (among them, the SI-PTSD by Davidson). The diagnoses leading to hospitalization were: severe disorders of psychotic type (schizophrenic, schizophreniform, schizo-affective, schizoid and paranoid delusional disorders as well as bipolar disorder), borderline and narcissistic personalities for 7%, and other disorders for 53%. Among the results, we observed that 59% of these patients had experienced at least one major stressful event (rape 26%, other sexual assault 29%, physical assault 31%, seeing somebody dying in a violent way 8%, war scene 2%, injured in an accident 2%). As a consequence, 61% of the victims have suffered from PTSD and the diagnosis of PTSD was still present in 21%. In addition, in the victims, somatoform and dissociative disorders were significantly more frequent.

Adult↗