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PubMed1983

Panic disorder.

Panic disorder is a subtype of anxiety manifested by discrete periods of apprehension or fear and at least four of the following somatic symptoms: dyspnea, palpitations, chest pain, choking, dizziness, depersonalization or derealization experience, paresthesias, hot and cold flashes, sweating, faintness, trembling, and fear of dying, going crazy, or doing something uncontrolled during an attack. Because the patient with panic disorder often selectively focuses on one of these somatic symptoms and may minimize or deny psychosocial distress, panic disorder is frequently misdiagnosed. As a result of the frightening nature of the symptoms, a pattern of overutilization of medical care systems frequently ensues. Panic disorder is usually precipitated by stressful life events, most commonly separation or loss, in a patient with a genetic or acquired vulnerability. As with other psychophysiologic illness (depression, duodenal ulcer) resolution of the acute stressful life event may not lead to resolutions of the physiologic changes. Two specific tricyclic antidepressants, imipramine and desipramine, have been shown to be effective therapeutic agents in treating panic disorder.

Adolescent↗

PubMed1983

[Age and infectious psychoses in children and adolescents].

Infectious psychoses were studied clinically in 60 children divided into three age groups: 3-7 years, 7-12 years and 12-17 years. Acute respiratory diseases, influenza, tonsillitis, otitis were the etiologic factors of psychoses. Short-term delirium states characterized by visual and tactile hallucinations prevailed in the first group. Affective-asthenic syndromes prevailed in the second group children. Their psychoses were characterized by both visual and acoustic illusions. Protracted or periodical disorders of the consciousness including psychosensory, senestopathic and depersonalization ones prevailed in the third group.

Adolescent↗

PubMed1980

[Independence of the slowly progressive form of schizophrenia].

The development stereotype of slowly progressive schizophrenia is determined by a long subclinical course (latent period), a protracted stage of florid psychopathological signs (active period) and an eventual stabilization seen in the late phases of the process. The clinical picture of the active period and the defect structure is characterized by axial symptoms, the typology of which is considered as a basis of the following systematics of slowly progressive schizophrenia: 1) latent schizophrenia; 2) slowly progressive schizophrenia with obsessions; 3) slowly progressive schizophrenia with hysterical symptoms; 4)slowly progressive schizophrenia with depersonalization; 5) hypochondriacal schizophrenia (non-delusional hypochondria); 6) slowly progressive delusional schizophrenia; 7) slowly progressive schizophrenia with a prevalence of affective disturbances; 8) schizophrenia with poor symptoms.

Affective Symptoms↗

PubMed1981

Effects of amoxapine, a new antidepressant, on pseudoneurotic schizophrenia.

During a four-week open study, amoxapine (AX), a new antidepressant agent, was administered to seven patients with pseudoneurotic schizophrenia, seven with neurosis and another seven with schizophrenia, all having similar symptoms. The improvement ratio was 71.4% in the pseudoneurotic schizophrenia group, 57.1% in the neurosis group and 42.8% in the schizophrenia group. Through the application of rating instruments, improvements were observed in the pseudoneurotic schizophrenia group in such items as psychotic and psychoneurotic symptoms in the assessment through the Springfield Outpatient Symptom and Adjustment Index, somatic concern and blunted affect through the Brief Psychiatric Rating Scale, and depression and depersonalization through the Clinical Rating Scale. On the other hand, overall improvements were less seen in the items of the neurosis group and the schizophrenia group. Effective doses of AX were 30 to 75 mg/day in the three groups. Side effects were observed in four cases which included insomnia, tachycardia, palpitation and hypomanic state. There were no cases in which AX was discontinued because of the side effects as these symptoms were slight. AX is remarkable and characteristically efficacious in the pseudoneurotic schizophrenia, and this effectiveness is presumed due to its antidepressant and antipsychotic actions.

Adult↗

PubMed1982

Agoraphobia following amphetamine withdrawal.

Agoraphobia, now a clinically accepted entity (DSM-III) was first described more than 100 years ago in the psychiatric literature. Recently, it has been considered a syndrome, with phobia, anxiety and depersonalization being the prominent symptoms. Its etiology is not clear and different schools of thought have given different explanations for its causation. Few reports of recent origin have have described a close association between the intake and/or discontinuation of pharmacologic agents and the onset of the syndrome. The agents implicated were the tricyclic group. Our report describes another "antidepressant," d-amphetamine, which when discontinued by our patient, was followed by the full syndrome of agoraphobia.

Adult↗

PubMed1980

[Visual perception disorders in depressive syndromes].

A wide range of psychopathological visual phenomena, part of which are traditionally considered as derealizational disturbances, are described in the structure of depressive states. Five main types of disordered visual perception are singled out, which differ by their structure and degree of correlation with the depressive affect and symptoms of depersonalization in a wide sense. The results point to certain dynamics in the described phenomena, their sensory basis. Electrooculographic studies of eye movements indicating a peculiar formation of a visual image in different forms of depressions are demonstrated.

Adolescent↗

PubMed1980

Enuresis: a functional equivalent of a fetish.

The split in the ego between consciousness and unconsciousness which sometimes eventuates in fetishism can also be clinically manifested in sleep disturbances, depersonalization, dejà vu and a variety of alterations in the sense of reality. It is suggested that this same split comprises the central dynamic mechanism in enuresis. The sleep disturbance which accompanies enuresis involves a confusion between waking and sleeping, sometimes taking the form of a dream that one is awake. Three patients(adult males) revealed in the course of their analyses that they suffered from childhood enuresis accompanied by a sleep disturbance. Milder forms of sleep disturbances persisted into adult life. In these analyses, certain perceptual distortions, difficulties in the sense of reality, and between fantasy and reality, confusions between waking and sleeping, could all be linked to the functional split between consciousness and unconsciousness and eventually to disavowal of the female genitals. The enuresis represented a functional equivalent of the fetish (and it may be that the urinary stream itself actually served as a fetish). Psychological test data from nine enuretic boys were examined as well. This material clearly demonstrated that these boys wished to deny the differences between males and females, that they suffered from sleep disturbances and that they confused reality and fantasy, sleeping and waking. The combined data suggest the existence of a functional split in the ego used in the service of defence, the product of a regressive fixation and a reinstatement of an archaic mode of thought.

Adolescent↗

PubMed1995

The effects of bifemelane hydrochloride on depressive illness of the elderly.

The therapeutic efficacy, utility and safety of bifemelane hydrochloride were studied in 52 elderly depressive patients. The drug was administered as a tablet containing 50 mg orally three times daily for 8 consecutive weeks. The final global improvement rating and global utility rating were respectively 80.8 and 73.1 percent for all patients. The improvement rates on the Hamilton depression rating scale (HAM-D) were more than 60% for depressed mood, guilt, suicide, middle insomnia, delayed insomnia, psychotic anxiety, gastro-intestinal symptom, hypochondriasis, depersonalization and derealization. The rates regarding global symptoms evaluated by the Psychoneurotic rating scale for doctor's use were more than 60% for tension, agitation, irritability and excitement, phobia, depression, hypochondria and nocturnal delirium in psychotic symptoms, and insomnia in addition to palpitation in somatic symptoms. A significant decrease was also observed in the symptoms covered by the Self-rating depression scale of Zung after treatment with this drug. There were no instances of side-effects, nor any abnormalities in laboratory tests, encountered throughout the trial. Therefore, bifemelane hydrochloride is of value for the treatment of geriatric depression.

Aged↗

PubMed1978

[Symptomatology of inhibition].

This essentially descriptive paper deals with inhibition as a symptom or as a behavior pattern and studies the different areas of; inhibition of the intellect (i.e. a decrease in though production witnessed by disorders of language flow), reduced attention span (distractability, inability to concentrate), inhibition of volition (abulia, indecisiveness), memory inhibition (in the sense of selective amnesias, post-crisis amnesias, cyclical amnesias), restriction of the basic drives (which can touch the life principle, the need for sleep, hunger, sexual drive), emotional inhibition including a feeling of inferiority and self-doubt which affects interpersonal relations: in this sense inhibition can also manifest itself in experiences of estrangement and depersonalization. A dynamic study of inhibition should first deal with the presumed relationship between the symptom and a specific pathological process and analysis of the underlying inconscious mecanisms.

Affective Symptoms↗

PubMed1995

Investigation of burnout in a sample of British general practitioners.

BACKGROUND: Recent changes in the general practitioner contract have produced increased workload and stress, poorer mental health and reduced job satisfaction. These factors might combine to increase the level of 'burnout' among general practitioners. AIM: This study set out to examine the extent of burnout among general practitioners. METHOD: A questionnaire was sent to all 295 Northamptonshire general practitioners seeking demographic details and including the Maslach burnout inventory. The results for the inventory were compared with the results from a sample of physicians and nurses in North America. RESULTS: There was a significantly higher level of burnout among the Northamptonshire doctors compared with the North American sample. There was virtually no association between age and the level of burnout, although a small negative correlation was found between age and the depersonalization of others subscale. Part-time general practitioners showed lower levels of burnout than full-time general practitioners. CONCLUSION: This study highlights the need to look both at the extent of burnout in young doctors during their training and at those characteristics of part-time general practitioners which might prevent burnout.

Burnout, Professional↗

PubMed1993

Recent developments in alcoholism:substance and symbol.

Alcohol is discussed as a core symbol of American culture. The language associated with alcohol, other "substances," and their widely shared folklore are shown to underlie the official "disease" model of alcoholism and treatment. The cultural psychology that gives the disease model its plausibility and experimental validity is discussed. Similar to "possession" theories in other societies, in American alcoholism the "not-me" is seen as overtaking the normal, social "me," inducing states of drunkenness if not chronic disease. This depersonalizing creates a paradox: requiring control from one held to be out of control by virtue of the disease process. It is argued that the disease model inadvertently helps perpetuate the very problems its proponents aim to treat. The author argues that conventional theories of alcohol, alcoholism, and alcoholics provide a standardizing, homogenizing, stereotypic story of far more complex accounts of alcohol use. Alternatives to the current metaphor are suggested.

Alcohol Drinking↗

PubMed1994

[The psychophysiological characteristics and correction of extreme states of an informational-semantic origin].

The article deals with the general characteristics of extreme states influence. The authors systematize the factors which may be considered as extreme ones. The article shows that the development of different extreme states frequently is predetermined by informative-semantic nature. The following types of extreme states of informative-semantic genesis were studied: emotional tension, anxiety, fear, affective excitement, inhibition, depersonalization. There are psychophysiological characteristics of these states and basic methods of its correction.

Aerospace Medicine↗

PubMed1994

[Psychasthenia: history and evolution of the P. Janet concept].

Description of psychasthenia by P. Janet (1903) sets up at the end of a double reflection, with on the one hand a theorization of asthenia, the notion of which already occupied the medical concepts of the 18th and 19th centuries, and on the other hand a progressive attribution of neurosis to the psychiatric field. Its clinical characteristics (feelings of non-fulfillment in action and emotion, experiences of oddness and depersonalization, obsessions, phobias...) makes psychasthenia a fully-fledged illness, the psychopathological organization of which results from a decrease of psychological tension and from a loss of reality function. Since P. Janet, the term of psychasthenia has not ceased to be used, although its etiopathological references blurred behind the psychoanalytic work, and it is usually synonymous with obsessional neurosis, even with obsessional personality. Description of psychasthenia appears in these rubrics of the DSM III, even though the term itself is ignored.

France↗

PubMedDate not supplied

[New challenges for humanism in medical practice].

This work is a review of the philosophical analysis surrounding the concept of "humanism" and what it means to be a human being, in relationship to daily life, education and medicine. The authors establish a direct relationship between humanism and bioethics as they relate to the new trends acquired through the development of institutional medicine and the increasing application of technological innovations in the health field. Both of these conditions tend to depersonalize the practice of medicine, and transform an ill person into a clinical file. Reflections are made about current topics, such as the knowledge and manipulation of human genome, assisted reproduction, abortion, survival of premature infants, organ transplants, technological innovation, euthanasia and disthanasia. Concepts and ideas are reviewed in relation to medical institutions and the sick, the physician and the community, and the physician and the government.

Government↗

PubMedDate not supplied

[Dependence on benzodiazepines. Clinical and biological aspects].

The high rate of benzodiazepines (BZD) consumption has been repeatedly confirmed by epidemiological surveys in most major western world countries. In a recent french survey 7% of chronic users of BZD (use in 5/7 days for the last 12 months) were found the general population (17% in the population aged above 65). It has been suggested that the high BZD consumption rate could be related to dependence. The existence of BZD dependence was described in the early sixties with very high dose of chlordiazepoxide but it has become a real concern for the medical community since the late seventies with increasing number of reports of withdrawal symptoms. The extend of the actual rate of withdrawal symptoms at BZD tapering is still very controversial and according to the different studies it varies from 39 to 90%. The between studies difference in parameters such as: the patient populations (psychopathology, treatment duration), the type of tapering employed (duration, nature of the medical and psychological support) and the used operational criteria for withdrawal definition most likely explain this wide variation in the rate of occurrence of withdrawal manifestations. According to the American Psychiatric Association Task Force on Benzodiazepine Dependence, Toxicity and Abuse three type of pathological events can happen after treatment discontinuation: rebound, withdrawal syndrome and recurrence. The rebound consists in the early and transitory reappearance of the anxiety symptoms pre-existing to the treatment but in an exacerbated from; the withdrawal syndrome associates the resurgence of the pre-existing anxiety symptoms and new symptoms as sensory disturbances (metallic taste, hyperosmia, cutaneous exacerbated sensitivity, photophobia...) nausea, headache, motor disturbance in some rare cases depersonalization, paranoid reaction, confusion, convulsion. Rebound or withdrawal syndrome appearance delay varies from hours to few days according mostly to compounds elimination half-life. The relapse develops later with a progressive reapparance of pre-treatment symptoms. In practice recurrence and rebound are often difficult to isolate: recurrence can follow rebound. Different operational criteria of definition for this different entities have been proposed but there is a need for a consensual position. The treatment length, a high daily dose, an alcohol abuse history, a dependent personality and the severity of the psychopathology of the patients have been found to be predictive for the occurrence of withdrawal symptoms. Behavioural therapies (individual or in group) have been proposed with some success for the treatment of benzodiazepine dependence; drug treatment with carbamazepine or imipramine have demonstrated some efficacy. Other drug as buspirone clonidine having anxiolytic properties have not demonstrated efficacy.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Anxiety Agents↗

PubMed1994

Transforming information use in preventive medicine: learning to balance technology with the art of caring.

CompuHx* is an Interactive Health Appraisal System (IHAPS) used in the examining room to record patient information, assist in diagnosis, and provide a legible summary of findings. This paper describes Phase I of a longitudinal study in which 22 examiners (five system users and 17 non-users) responded to detailed surveys and interviews about the system. Findings indicated that both users and non-users had mixed feelings about the system's ease of use and impact on their jobs, but agreed that it would have value for their practice. Underlying their acceptance of the system was a common concern for maintaining a caring relationship with patients and not allowing computer technology to depersonalize the examining room. Examiners also expressed concerns about the implementation process.

Artificial Intelligence↗

PubMed1994

[Study of the influence of labor and sociodemographic factors on the development of professional burnout syndrome in the area of specialized medicine of INSALUD in Avila].

BACKGROUND: The burnout syndrome is characterized by emotional exhaustion (basis of the decrease of self-esteem), depersonalization and decrease of the feeling of personal accomplishment, above all, in the field of professional achievements. It appears to be frequent in the helping professions and the human services workers, and in its origin labour factors seem to intervene. The authors intend to determine the degree of burnout among physicians and to assess the influence of labour and sociodemographic factors on the emotional state of physicians. METHODS: One hundred fifty-six physicians of the Avila Health Service Area participated. A general questionnaire and the Spanish version of the Maslach Burnout Inventory were used. The statistical analysis includes the analysis of variance, the Pearson's correlation coefficient and the Student's t test. RESULTS: The profile of the studies professional is a 37 year old male, married, who has been working for 13 years in his profession and who has had his current job for eight with a professional category of consultant. In general, they are not satisfied with their work, they do not value highly the personal policy of their managers and they hardly identify themselves with the enterprise, if at all. These negative labour aspects were correlated with the burnout syndrome, whose values indicated high levels of professional exhaustion. CONCLUSIONS: Improvements in the work conditions are suggested and in its organization such as the physicians' participations in management, definition of positions and assessment of individual situations.

Age Factors↗

PubMed1993

[The clinico-psychopathological characteristics of patients with panic disorders and the efficacy of clomipramine therapy].

The patients with panic affections (PA) treated with clomipramine hydrochloride (anafranil) were examined clinically and psychopathologically in relation to the drug response. PA diagnostic category was not uniform and may be subdivided into at least two subgroups, responders and non-responders to clomipramine hydrochloride. The responders had minor symptoms of PA, less severe vegetative impairment, though they were more seriously affected by depersonalization, maniophobia and agoraphobia. In this group the drug induced improvement and reduction of the attack frequency and severity within treatment month 1. Nonresponders had distinct vegetative symptomatology in the absence of agoraphobia. They failed clomipramine hydrochloride treatment as the panic attacks resumed, occasionally even with greater frequency.

Adult↗