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PubMed1992

DSM-III-R and religion.

The interpretation of religion in DSM-III-R contains considerable negative bias and contributes to unfair stereotypes of religious persons. Particularly new religious movements and religious conversion are unfairly interpreted under the DSM-III-R heading, 'Dissociative Disorder Not Otherwise Specified'. It is suggested that a more balanced and respectful interpretation of religion is needed in DSM-III-R, since psychiatry through its official nomenclature should not contribute to social intolerance of religious nonconformity.

Attitude of Health Personnel↗
PubMed1992

Epileptic seizures induced by sexual abuse. Pathogenic and pathoplastic factors.

Previous sexual abuse is now thought to be a common cause of non-epileptic seizures (pseudoseizures). However, since sexual abuse is common, a previous history of sexual abuse may also occur in people with actual epilepsy. We present six patients in all of whom sexual abuse may, by acting as a stressor in the already predisposed, have precipitated epilepsy and in some of whom the abuse may have affected the actual experiences of the epilepsy itself: all but one of the patients had partial seizures.

Abreaction↗
PubMed2005

Semantic priming after ketamine acutely in healthy volunteers and following chronic self-administration in substance users.

BACKGROUND: Ketamine is used acutely as a model of schizophrenia. It has been suggested that chronic ketamine may also mimic aspects of this disorder, in particular impaired cognitive function. As semantic processing deficits are considered central to cognitive impairments in schizophrenia, this study aimed to characterize semantic impairments following both acute and chronic ketamine. METHODS: We examined the acute effects of two doses of ketamine (Experiment 1) using a double-blind, placebo-controlled, independent group design with 48 volunteers. Ketamine's chronic effects (Experiment 2) were explored in 16 ketamine users and 16 poly-drug controls. A semantic priming task with a frequency (high and low) and stimulus onset asynchrony (SOA: short-200 msec, long-750 msec) manipulation was used. RESULTS: In Experiment 1, acute ketamine produced inverse priming at the long SOA. In Experiment 2, ketamine users showed inverse priming for low-frequency words at the long SOA compared to poly-drug controls. CONCLUSIONS: The inverse priming effect at the long SOA induced by acute ketamine was indicative of controlled processing impairments. In ketamine users, there was also an indication of controlled processing impairments. Decreased priming for low-frequency words suggested that long-term ketamine abuse results in damage to the semantic store.

Adult↗
PubMed2006

Trauma-related and neutral false memories in war-induced Posttraumatic Stress Disorder.

Recent models of cognition in Posttraumatic Stress Disorder (PTSD) predict that trauma-related, but not neutral, processing should be differentially affected in these patients, compared to trauma-exposed controls. This study compared a group of 50 patients with PTSD related to the war in Bosnia and a group of 50 controls without PTSD but exposed to trauma from the war, using the DRM method to induce false memories for war-related and neutral critical lures. While the groups were equally susceptible to neutral critical lures, the PTSD group mistakenly recalled more war-related lures. Both false and correct recall were related more to depression than to self-rated trauma. Implications for accounts of false memories in terms of source-monitoring are discussed.

Adult↗
PubMed2006

PTSD: a problematic diagnostic category.

Since the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, posttraumatic stress disorder (PTSD) has become a remarkably dominant theme in mental health discourse and diagnostic practice. This development has been encouraged by the diagnosis being officially presumed to exist in acute, chronic, delayed, complex, subdromal, and even "masked" forms. Here, we present an historical and clinical review that indicates how, since 1980, the term PTSD (along with its dubious embellishments) replaced established views on mental responses to trauma to the detriment of patient care and psychiatric investigation. From this historical perspective, we review and evaluate the natural course of emotional and behavioral reactions to traumatic experiences, and as well their assessment, formulation, and therapeutic management in both civilian and military situations. From this we conclude that the concept of PTSD has moved the mental health field away from, rather than towards a better understanding of the natural psychological responses to trauma. A return to prior standards of diagnostic practice and therapeutic planning would greatly benefit patient care, rehabilitative services to veterans, and epidemiologic research.

Diagnosis, Differential↗
PubMedDate not supplied

Transition to alcohol dependence: clinical and neurobiological considerations.

The transition to alcohol dependence is supposed to occur during a critical period that begins with increased drinking and ends with a loss of control. This process may last about 3 to 4 years, and is modified by gender and accelerated by premorbid traits (e.g., novelty-seeking) and comorbid disorders (e.g., dissocial personality disorders according to ICD-10). Genetic disposition, environmental influences (e.g., stress), and sensitization by exposure are factors implicated in dependence that alter brain functions, some possibly in an irreversible way. Underlying neurobiological mechanisms that may have different time patterns are beginning to be characterized on a systemic, cellular, and molecular level. Repeated free choices of the rewarding compound seem to be necessary for the transition to dependence.

Adult↗
PubMed1997

Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory.

Signal detection theory measures of thermal responsivity were examined to determine whether differences in reported pain experienced during self-injurious behavior in female patients with borderline personality disorder (BPD) are explained by neurosensory factors and/or attitudinal factors (response bias). Female patients with BPD who do not experience pain during self-injury (BPD-NP group) were found to discriminate more poorly between noxious thermal stimuli of similar intensity, low P(A), than female patients with BPD who experience pain during self-injury (BPD-P group), female patients with BPD who do not have a history of self-injury (BPD-C group), and age-matched normal women. The BPD-NP group also had a higher response criterion, B (more stoical) than the BPD-C group. These findings suggest that 'analgesia' during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.

Adolescent↗
PubMed2002

Rationale for a posttraumatic stress spectrum disorder.

An understanding of PTSD and stress-related conditions is in its infancy. This is not surprising given the fact PTSD was not recognized as a distinct diagnostic entity until 1980. Since that time, the diagnostic classification has undergone continuous change as our understanding of PTSD is refined. The authors believe that PTSD can be best understood through a dimensional conceptualization viewed along at least three spectra: (1) symptom severity, (2) the nature of the stressor, and (3) responses to trauma. Along the severity spectrum, studies that review diagnostic thresholds reveal significant prevalence of PTSD symptoms and impairment that results from subthreshold conditions. Comorbidity patterns suggest that when PTSD is associated with other psychiatric illness, diagnosis is more difficult and the overall severity of PTSD is considerably greater. With regard to a stressor criteria spectrum, the diagnostic nomenclature initially only recognized severe forms of trauma personally experienced. More recently, however, the person's subjective response and events occurring to loved ones were included. This has greatly broadened the stressor criteria by leading to an appreciation of the range of precipitating stressors and the potential impact of "low-magnitude" events. Given that responses to trauma vary considerably, another possible spectrum includes trauma-related conditions. Traumatic grief, somatization, acute stress disorder and dissociation, personality disorders, depressive disorders, and other anxiety disorders all have significant associations with PTSD. Further research is needed to clarify and expand the current understanding of PTSD and other trauma-related conditions. Consideration of the severity of symptoms and the range of stressors coupled with the various disorders precipitated by trauma should greatly influence scientific research. The future undoubtedly will bring a refinement of the current understanding of PTSD and improved treatments.

Humans↗
PubMed2001

Attenuation of ketamine effects by nimodipine pretreatment in recovering ethanol dependent men: psychopharmacologic implications of the interaction of NMDA and L-type calcium channel antagonists.

Ketamine blocks the calcium channel associated with N-methyl-D-aspartate (NMDA) glutamate receptors. It has transient behavioral effects in healthy humans that resemble aspects of schizophrenia, dissociative disorders, and ethanol intoxication. Ethanol is an antagonist of both NMDA receptors and L-type voltage-sensitive calcium channels (VSCC) and it has minimal psychotogenic activity in humans. A double-blind placebo-controlled study was conducted that evaluated whether pretreatment with the L-type VSCC antagonist, nimodipine, 90 mg D, modulated ketamine response (bolus 0.26 mg/kg, infusion of 0.65 mg/kg/hr) in 26 ethanol-dependent inpatients who were sober for at least one month prior to testing. This study found that nimodipine reduced the capacity of ketamine to induce psychosis, negative symptoms, altered perception, dysphoria, verbal fluency impairment, and learning deficits. Nimodipine improved memory function, but had no other intrinsic behavioral activity in this patient group. Nimodipine pretreatment attenuated the perceived similarity of ketamine effects to ethanol as well as ketamine-induced euphoria and sedation. However, nimodipine did not reduce the stimulant effects of ketamine. These data suggest that antagonism of L-type VSCCs attenuates the behavioral effects of NMDA antagonists in humans. They support the continued evaluation of nimodipine in the treatment of neuropsychiatric disorders. They also suggest that drugs, such as ethanol, that combine NMDA and L-type VSCC antagonism may have enhanced tolerability without attenuation of their stimulant effects.

Adult↗
PubMed1995

"Hysteria" in clinical neurology.

Hysteria is an ancient word for a common clinical condition. Although it no longer appears in official diagnostic classifications, "hysteria" is used here as a generic term to cover both "somatoform" and "dissociative" disorders as these are related psychopathological states. This paper reviews the clinical features of four hysterical syndromes known to occur in a neurologist's practice, viz conversion, somatization and pain disorders, and psychogenic amnesia. The presence in the clinical history of a multiplicity of symptoms, prodromal stress, a "model" for the symptom(s), and secondary reinforcement all suggest the diagnosis, and minimise the need for extensive investigations to rule out organic disease. Psychodynamic, behavioral, psychophysiologic and genetic factors have been proffered to explain etiology. Appropriate treatment involves psychotherapeutic, behavioral and pharmacological techniques. A basic requirement is to avoid errors of commission such as multiple specialist referrals and invasive diagnostic and treatment procedures. Hysteria is a remediable condition if identified early and managed appropriately.

Amnesia↗
PubMed1997

Electroencephalography as a diagnostic instrument in Alzheimer's disease: reviews and perspectives.

Electroencephalography is the only diagnostic instrument directly reflecting cortical neuronal functioning, and it remains an important clinical tool in the diagnosis and differential diagnosis of Alzheimer's disease (AD). Although a normal EEG is found in many patients with mild AD, a pathological EEG is an important finding, because such a result is not in line with differential diagnoses such as depression or pseudodementia within a dissociative disorder. The vast majority of patients with moderate to severe AD have a pathological EEG. A normal EEG in this patient group is more in line with subcortical dementia or frontal lobe degeneration than with AD. Compared to SPECT or routine structural brain imaging (cCT, MRT), EEG has a comparable diagnosis sensitivity and a higher specificity. For monitoring changes of brain function by serial recordings (e.g., during therapy with antidementia drugs), EEG is the best available method.

Aged↗
PubMed2004

Posttraumatic seizures in survivors of torture: manifestations, diagnosis, and treatment.

Survivors of torture are very likely to have been beaten repeatedly around the head. Apparent brief losses of consciousness are not uncommon following torture, and they may be associated with signs that suggest temporal lobe epilepsy (TLE). The relative risk of developing posttraumatic seizures (PTS) is increased by about 50% after a single head injury involving a brief loss of consciousness. It is 2.9 if that loss of consciousness lasts for more than about 30 min. Thus, patients who have been tortured are at increased risk of seizures. TLE is difficult to diagnose and needs specialist investigations, and other conditions that are not uncommon in survivors of torture, such as panic attacks, posttraumatic stress disorder, dissociation, and syncope can all present with similar pictures. This paper addresses the differential diagnosis of posttraumatic epilepsy in survivors of torture.

Brain Injuries↗
PubMed1996

Unacknowledged versus acknowledged rape victims: situational factors and posttraumatic stress.

Investigators of sexual assault have found that a substantial number of women who have been raped do not conceptualize their experiences as such. The present investigation examined differences between 40 unacknowledged rape victims and 20 women who acknowledged their experience as rape in a sample of college women, as well as a control group of 23 nonvictims. Groups were compared in terms of situational factors, postassault symptomatology, defense mechanisms, dissociative disorders, and sexual revictimization. In comparison to unacknowledged victims, acknowledged victims reported more forceful assaults and indicated more resistance and clearer refusal. Acknowledged victims exhibited more posttraumatic stress disorder symptoms than unacknowledged victims, who exhibited more symptoms than nonvictims, as measured by clinical interview. Implications of these findings are discussed.

Adolescent↗
PubMed1993

Childhood sexual abuse and parental alcoholism: interactive effects in adult women.

Symptoms associated with histories of childhood sexual abuse and parental alcoholism were investigated in a sample of 364 university women. A significant association was found in occurrence between the two stressors, and a substantially higher level of symptoms was revealed in women who had experienced both during childhood.

Adolescent↗
PubMed2004

[Psychological impact of the new digital media].

This review article starts from the hypothesis that the new digital media's impact on people's mental health, which in professional and private everyday life has become increasingly frequent and intense, is widely underestimated. The disturbances associated with media exposure, which have been already described and examined, are presented and discussed, while classifying them in three groups of disorders, namely dissocial, dissociative and impulse control disorders. In a second step, psychotherapeutic and psychiatric applications of the digital media are presented, especially, psychometric and neuropsychological testing, distribution of information and behavioral therapeutic tools. The positive and negative effects of the internet and cyberspace are applied to the multicausal understanding of the genesis and therapy of mental disturbances. Against this background, the opinion is held, that the paradigmatic medialization of the world has to be taken seriously and actively approached as a psycho-ecological factor with psychosocial, psychopathogenic and also neuroplastic effects. Therefore, also a psychiatric approach is needed to establish both research on media-associated disorders including their therapy and the development of quality standards in the therapeutic use of the Internet and Cyberspace.

Antisocial Personality Disorder↗
PubMed2004

[Hospitalization of non-stroke patients in a Stroke Unit].

BACKGROUND AND OBJECTIVE: Stroke care in Germany has substantially improved during the last decade. One column of modern stroke care is the institution of stroke unit which allows rapid diagnosis and treatment. The aspect of admission of nonstroke patients to a stroke unit is poorly evaluated. The aim of this study is to evaluate the number of patients who are admitted to a national stroke unit but do not suffer from stroke. Furthermore, we related the proportion of nonstroke referrals to the different referral modes. PATIENT AND METHODS: Observational study recording all suspected stroke referrals with regard to final diagnosis and type of referral during a 12-month period (1.8.2002-31.7.2003). RESULTS: 462 patients were admitted by 4 routes: 74 by paramedics or by self-presentation, 138 by emergency physicians, 144 by primary care doctors, and 106 were transferred from other hospitals. 88 patients (19 %) finally revealed no acute stroke. The most common nonstroke diagnoses were seizure (20 %), dissociative disorders (14 %), cranial nerve disorders (11 %), hypoglycaemia (8 %) and transient global amnesia (7 %). There was no significant difference among the proportion of nonstroke patients referred by ambulance paramedics and self-presentation (15 %), emergency physicians (21 %), primary care doctors (15 %) and interhospital transfer (24 %) [p = 0.222, X (2)-test according to Pearson]. CONCLUSION: Due to the fact that a number of clinical neurological conditions mimic acute stroke, misdiagnosis of stroke is common. We advocate that all stroke patients are seen early in the course of the disease by a neurologist. An alternative could be that in stroke units of internal medicine hospitals patients are seen by a consulting neurologist. Alternatively, telemedicine might be used and the neurologist on duty of a neurological stroke unit could be consulted.

Adolescent↗
PubMed2006

[Perspectives].

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Accidents, Traffic↗
PubMed2002

Clinical use of electrogustometry: strengths and limitations.

Electrogustometry (EGM) has a number of strengths and a few limitations in clinical use. The strengths of EGM are: (i) the range of measurements can be kept constant; (ii) quantitative control of the intensity of the stimulation is possible; (iii) only a short period of time is required for testing; (iv) it is possible to detect even slight taste disorders for which the patient has no subjective symptoms; (v) it is useful for topognosis of lesions of taste pathways and for determining prognosis; and (vi) it is the only quantitative method for diagnosing disorders of the glosssopharyngeal nerve. The limitations of EGM are: (i) it is not useful for determining or diagnosing some of the symptoms often complained of by patients with taste disorder, namely dissociated taste disorder, heterogeusia and spontaneous dysgeusia; and (ii) it is not useful for following the progress of taste disorder. The many strengths and few limitations of EGM make it the first choice among taste examinations. This paper describes the clinical use of EGM as well as discussing other taste examinations used in our taste clinic and, in particular, the advantages and disadvantages of filter paper disk testing with taste solutions.

Ageusia↗