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PubMed1989

[Symptomatic psychoses].

Acute exogenous reactive types (AERT), exogenous, somatogenic, organic and symptomatic psychoses have essentially identical or very similar symptoms. The terms can thus be used promiscue. The concept of symptomatic psychosis is according to the common convention superior to other psychoses it appears, however to be superfluous. It must involve direct or indirect brain damage. It seems therefore more useful to use for AERT the term organic psychosis. There is no reason why to derive all forms of AERT from impaired consciousness, as lucid consciousness being a global psychic function makes their diagnosis possible and episodic interpolated qualitative disorders of consciousness could not occur. The organic psychosyndrome is characterized by a reduction of psychic functions, the majority with an irreversible course. In case of a marked lesion of certain brain structures the topical characteristics may be reflected in psychic symptoms, more frequently, however, the premorbid structure of the personality and its compensating mechanisms play a part. Therefore it is justified to separate the local psychosyndrome which from the external aspect is identical with psychoendocrine psychosyndrome. For the diagnosis of symptomatic psychic disorders K. Schneider's and Weitbrechts preprequisites are essential. AERT may end by cure, death or development into organic psychosyndrome.

Humans↗
PubMed2005

Locked-in syndrome.

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Cerebrovascular Disorders↗
PubMed1980

[Proskynesis and servility as an expression of psychotic behaviour (author's transl)].

Proskynesis as an expression of submission, reverence and awe is deeply rooted in the religious and sociocultural history of man. It may be traced to the old phylogenetic submissive posture in animals, which is a pattern of behavior belonging to the group of survival instincts. Different forms of proskyneses and servility may emerge as an expression of psychotic behavior in man, reflecting a special stage of "archetypical" (C.G. Jung) consciousness. Archetypical conciousness is understood as a special step in the emergence of the human mind, thought and self-consciousness. The freedom of thinking--as the highest function of the human mind--is lost in every psychotic disorder. Archetypical consciousness with its lower stages of thinking may be typical for one kind of psychotic thinking disorder. Diagnostic problems may arise, if one does not recognize the drive of instinctive behaviour which lies behind the mere forms of human costums and religious rites.

Adult↗
PubMed1999

Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia.

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921-928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

Adult↗
PubMed1975

[Medical opinions on fatal auto-erotic accidents for insurance purposes (author's transl)].

The problematic nature of medico-legal opinions on fatal auto-erotic accidents made for private accident insurance companies is outlined in a survey based on our own records. Taking the "General Insuranc Terms for Accident Insurance" (AUB) into consideration, guidelines for the forming of such opinions are given. One is warned not to form summary opinions. Decisive is the insured's state of conciousness when the accident was triggered. Only in exceptional cases can an insurance covered accident be rejected because of a body injury inflicted by the insured on himself (see article). These actions do not usually result in external injury to the body. Experience proves that "ideal conditions" for forming an opinion are rarely given. Also, the nature of the death situation is such that often the corpse is discovered only days after death. From the outset, forming a medical opinion is beset with varying degrees of difficulty depending upon which category of auto-erotic activities the accident falls into: 1. direct stimulation of the erotic regions, 2. stimulation of sexual centers in the central nervous system, 3. the creation of fear and anguish in the context of masochistic perversion. According the presently valid insurance terms (AUB), cases of auto-erotic electrocution are to be regarded as covered. A disturbance of consciousness--with the exception of such disturbances following the influence of alcohol, medicines or narcotics--cannot be assumed for the moment in which the accident was triggered. At this moment body "integrity" was also intact. Accidents through strangulation, respectively asphyxiation (plastic bags etc.), usually occur during a disturbance of consciousness of the victim. This disturbance is the result of cerebral hypoxia, that is a result of strangulation, respectively external respiratory obstruction. The forming of a medical opinion for insurance purposes on auto-erotic accidents with clearly recognizable masochistic tendency is particularly difficult. A medical decision is only possible when an exact examination and description of the scene of the accident are available. In these instances, mechanical devices rigged by the victim often do not permit with sufficient probability to exclude the possibility of an accident without disturbance of consciousness on the part of the insured.

Asphyxia↗
PubMed2004

Assessment of cognitive functions in severely paralysed and severely brain-damaged patients: neuropsychological and electrophysiological methods.

A systematic neuropsychological assessment technique is described for use with severely physically disabled individuals, possibly with combined motor and cognitive disorders. Target neurological conditions may be, e.g., an incomplete locked-in state, a minimally conscious state, or severe combinations of paralysis, agnosia, and apraxia. Neuropsychological assessment in these patients is difficult, because standard neuropsychological tests require fast motor responses, which can be manual, verbal, or both. To assess the cognitive status of patients with residual motor function, tests have been applied that can be answered by a binary (yes/no) signal and whose outcomes were not based on reaction times. Further, a battery of neurophysiological examination procedures based on event-related brain potentials has been developed. These procedures can be performed directly at a patient's bedside (at home or in a hospital) and applied for assessment of cognitive functions even in patients without residual motor function.

Brain Injuries↗
PubMed1977

[Classification of psychopathological disorders after open-heart surgery (author's transl)].

A better discrimination of phenomenology and severeness of psychopathological disorders after open-heart surgery has been obtained: a) There is no equal distribution of degrees of severeness, a high correlation of severeness with duration of the disorders, a low correlation with age and no dependance of sex. b) Disorientation, clouding of consciousness and disorders of awareness arise earlier, delusions, hallucinations and paranoid ideas tentatively later after surgery. c) Three psychopathological syndromes have been identified. They appear in different frequency, intensity and can be combined.

Age Factors↗
PubMed1987

[The current understanding of so-called exceptional states in the forensic psychiatry clinic].

Exceptional conditions distinguished in forensic psychiatry represent a clinically heterogeneous group which is predominantly composed of brief psychic disorders associated with impaired consciousness which are presented by the conventionally distinguished variants of exceptional states (pathological intoxication, pathological affect, a short-circuit reaction) and are expressed clinically in the same psychopathological syndrome (twilight loss of consciousness). Two forms of this syndrome have been identified on the basis of etiopathological mechanisms of the syndrome, namely organic twilight states and psychogenic or affectogenic twilight states. Clinical descriptions of various types of twilight loss of consciousness is presented.

Cognition Disorders↗
PubMed1997

[40-Hz auditory steady state response (40-Hz SSR) in patients with intracranial lesions--with reference to consciousness level and sites of lesions].

OBJECTIVE: The issue of whether the 40-Hz SSR could become a useful neurophysiological monitoring tool in the patients with intracranial lesions was investigated. SUBJECTS AND METHODS: 40-Hz SSR was recorded in 50 normal persons and 63 patients with intracranial lesions, and correlation among differences in consciousness level, lesion site and 40-Hz SSR was determined. RESULTS: (1) Consciousness level and lesion site were both statistically significantly correlated with the pattern of wave forms at a single variable (alpha < 0.0001). (2) Using the multivariate's analysis, an equation to predict the level of consciousness from the SSR waveform and the site of lesion was made. The coefficient of determination between the calculated value and the actual value was 0.822. (3) In the group with intracranial lesions, the P1-N1 amplitude was confirmed to have significantly decreased (alpha < 0.0001) despite a apparently alert level. DISCUSSION AND CONCLUSION: This study revealed that the pattern of 40-Hz SSR waveforms varies with changes in consciousness and lesion site. Moreover, the amplitude of individual waves of SSR waveform is distinctly reduced prior to change the waveform pattern in the alert group. These findings mean that subtle changes of intracranial status could be detected by the continuous monitoring of 40-Hz SSR even at earlier stage of second insult. Consequently, the 40-Hz SSR is a probable objective means of monitoring the consciousness level.

Adult↗
PubMed2006

Ifosfamide neurotoxicity: an atypical presentation with psychiatric manifestations.

Ifosfamide can be responsible for acute central neurotoxicity in children and adolescents treated for cancer. The signs of acute encephalopathy most frequently observed are: alteration of consciousness, cerebellar syndrome, asthenia, urinary incontinence, cranial nerve palsy, and seizures. Various combinations of these signs may occur, but disorders of consciousness and drowsiness are common. We describe the case of a young man presenting with reversible acute hypomanic disorder during ifosfamide-based chemotherapy and discuss the possible mechanisms of this toxicity.

Acute Disease↗