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Brittle diabetes in a drug and alcohol abuser.
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Parental health attitudes, illnesses and supports and the referral of children to medical specialists.
Parental illness and maternal health beliefs in the parents of a group of 40 children referred to a paediatric neurology service because of headaches were compared with illness histories and health beliefs in the parents of a matched group of 40 children presenting to the same service with recognized structural pathology, mainly epilepsy. The study focused on the mother's perceptions of her own health (current and past), on life events, social supports and on her beliefs about her own health and the validity of medical reassurance. Significant differences between the two groups were found in relation to: (a) the greater amount of illness experienced by both parents in the index group (i.e. parents of children with headaches), particularly the mothers, both as children and as adults; (b) the greater amount of illness present in the families of the index group in the 3 years prior to being seen by the neurologist; (c) the greater number of index mothers who had experienced the loss of their own mothers caused by death; (d) the greater tendency of the index mothers to express feelings of loneliness; (e) the greater proportion of index mothers who, in response to the Whiteley Attitudes to Health Questionnaire, expressed both (i) concern about serious disease in themselves, and (ii) reluctance to accept medical reassurance; (f) on the other hand, significantly more 'comparison mothers' complained of currently suffering 'many different symptoms'.
Factitious purpura.
Factitious purpura may present as a perplexing problem for the dermatologist and can mimic serious disease. This form of mechanical purpura, often caused by suction may be deliberately or unknowingly induced by the patient. Some cases may go unrecognized for a considerable length of time and undergo unnecessary investigation before the diagnosis is realized. Three cases of purpura are reported in which the causative agents were very different.
Learning the cost of dermatitis artefacta.
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Dermatitis artefacta in a teenager after awareness of his HIV-positive diagnosis.
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A hand in the diagnosis of persistent facial ulceration.
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Factitious purpura.
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Periodic painful purpura: fact or factitious?
A 60-year-old woman with multiple psychosocial issues presented with a history of spontaneous painful bruising on her left upper arm. Extensive investigations did not reveal any abnormality apart from an elevated activated partial thromboplastin time as a result of factor XII deficiency. An autoerythrocyte sensitization test reproduced the tender bruises on her back. Our patient reported relief of pain with promethazine injections. She was subsequently referred to the psychiatric team for ongoing assessment and management. Having an awareness of this rare condition will assist in the prevention of unnecessary investigation of such cases and will allow the early referral of patients for appropriate psychological counselling.
Detecting malingering of Ganser-like symptoms with tests: a case study.
A middle-aged man presented with Ganser symptoms. He had been involved in a car crash and was seeking disability insurance benefits. Extensive testing with malinger instruments revealed that he performed below chance on simple memory tests and endorsed a variety of nonexistent symptoms. With this in mind, the authors collected collateral information which showed that the patient was involved in high level sports activities that were difficult to reconcile with the severe cognitive dysfunctions that he claimed to suffer from. The case demonstrates that Ganser-like symptoms deserve close scrutiny, preferably with malinger tests.
Factitious acquired immunodeficiency syndrome (AIDS)
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A case of factitious breast cancer in order to receive chemotherapy.
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Factitious diabetic instability.
Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.
Factitious hypoglycaemia documented by a modified assay for the measurement of plasma sulphonylurea.
Two cases of factitious hypoglycaemia due to intentional or inadvertent intake of glipizide by non-diabetic subjects were identified through the measurement of this sulphonylurea in plasma by a modified assay procedure.
Differential diagnosis in pseudoepileptic seizures.
With increasing use of intensive video-EEG monitoring, publications concerning pseudoepileptic seizures have burgeoned, but without clarification concerning differing psychopathologic mechanisms and without distinction of different syndromic varieties. The frequent concurrence of pseudoepileptic and epileptic seizures has not been sufficiently recognized, and an undue reliance on clinical experience on the one hand and individual tests such as EEG on the other has proven equally misleading in this group of cases.
An overview of neuropsychiatric disturbances in the elderly.
In no other period of life than old age do neurophysiologic alterations seem to affect behavior and cognition so significantly. Consequently, the relationship between neurology and psychiatry remains substantial when attempts are made to understand and deal with the many problems of aging. This study concerns improvement in the organization of such an approach to the neurologic and psychiatric problems of the elderly and to various interdisciplinary factors. Special consideration is given to changes in the central nervous system with aging, and to the differential diagnosis of dementia and pseudodementia.
Arguments for abandoning the term pseudodementia.
The term pseudodementia should be avoided in clinical practice. Its importance lies in the fact that it has alerted clinicians to the existence of potentially reversible, or at least treatable, cases of intellectual dysfunction. However, two major problems are associated with its use. First, it implies that the patient has either an organic or a functional illness, whereas many patients have elements of both, especially when depression is superimposed on a true dementia. Second, the term is often mistakenly used diagnostically, whereas it is only descriptive. The term cognitive impairment is preferable to pseudodementia.