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Weeping during psychogenic nonepileptic seizures.

Ictal weeping may help distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures. However, the prevalence of weeping during PNES or epileptic seizures is unknown. We reviewed videotapes of recorded events in 84 consecutive patients with PNES or epilepsy. Weeping was observed during 14% of PNES in 31% of patients with PNES. Ictal weeping was not observed in any epileptic seizures occurring in 48 patients. The differences were highly significant. One patient with epileptic seizures originating in the right temporal lobe wept soon after the end of a seizure. Depression was not more common in PNES patients with than without ictal weeping. Weeping during an apparent seizure strongly argues that the event is not epileptic.

Adult↗

Hysterical neurosis--a follow-up study.

Hysterical neurosis, though infrequently diagnosed in the West, is still one of the commonest mental disorders in India. In this study, 38 women with an index diagnosis of hysterical neurosis were evaluated after a period of 5 years; 63% of the patients remained totally asymptomatic. The premorbid hysterical personality alone showed significant relationship with the outcome.

Adolescent↗

Overview: clinical applications of the Amytal interview in psychiatric emergency settings.

The authors review the evidence for the efficacy of the sodium amytal interview with particular reference to psychiatric emergencies and rapid assessment and treatment. Amytal interviews have a valid role in the assessment and initial management of catatonia, hysterical stupor, and unexplained muteness as well as in distinguishing between depressive, schizophrenic, and organic stuporous states. Valid therapeutic indications include the abreaction of traumatic neurosis, recovery of memory in amnesic and fugue states, and recovery of function in conversion disorders. The authors offer a protocol for application of the amytal interview in emergency settings.

Adult↗

Treating the hospitalized borderline patient: reworking trauma of toddlerhood.

Frequently borderline patients are found to have suffered specific traumata during the separation-individuation phase. These traumata seem to have been experienced by them as punishment for their attempts at autonomy or for their early masturbatory explorations. Psychoanalytically oriented hospital-based treatment can allow for reexperiencing and resolving these difficulties, as illustrated in a case presentation.

Adolescent↗

Comorbidity of psychiatric disorders and posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obtained. The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD. It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes.

Anxiety Disorders↗

Personality factors in selection and flight proficiency.

Personality development is a dynamic process involving life forces, instinct drives, growth processes, life stresses, reactions to significant persons, both in and out of the family, and reactions to the environment in general, along with the mastery of methods and techniques for coping in solving problems and in providing for the satisfaction of one's needs. The love and fear of flying and the motivation and conflicts in flying involve many personality factors which deserve careful evaluation in selection of pilot and other flight personnel. These personality factors, variations, and traits also require close surveillance of pilot personnel by flight surgeons, aviation medical and operational personnel in predicting and preventing potential breakdown or difficulties and, more importantly, in the interest of maintaining optimum personnel effectiveness, proficiency, and safety in aviation.

Aerospace Medicine↗

The symptom as stigma or communication in hysteria.

Certain aspects of the history of hysteria from 1882 to the present day are discussed. Freud's discoveries about hysteria are contrasted with those of Janet, and it is shown how Freud, by treating the hysteric in a new setting, was able to reformulate his conception of the hysterical symptom so that it might be seen as a communication rather than as a stigma. This contrast between the views of Freud and Janet about the nature of the hysterical symptom is shown to be reflected in the current confusion about the concept of hysteria, and is also illustrated by means of two case histories, in both of which a change in the therapeutic setting led to a corresponding change in the understanding of the illness involved. The implications of these observations for the understanding of the history of hysteria are discussed.

Adult↗

[Hysteria: problems of definition and evolution of the symptomatology].

What is the evolution of hysteria, now that the spectacular crises of previous times tend to occur less frequently? Are hysterical manifestations disappearing or do they take other forms? This question raises semantic and phenomenological problems concerning hysteria. A review of the literature shows the complexity and precariousness of some definitions, the question raised by associated organic disorders and the compounding influences of other nosological entities, such as depression and psychosomatic disorders. Clinical histories from the records of a psychiatric hospital for the period 1910-1929 were compared with those for the period 1970-1980. The results of the study were surprising with respect to the similarity of epidemiological profiles. If it can be concluded that hysterical manifestations are not disappearing, then the study confirms the evolution of symptomatology which, especially in women, takes atypical forms of depressive, neurovegetative or psychosomatic disorders. In males, hysterical symptoms are of a more acute nature and frequently occur in dependent, immature or infantile personalities, whilst in the past they were more chronic and frequently associated with more serious personality disorders.

Adult↗

[Trance states--a case report].

For the first time, trance states have been included in the International Classification (ICD-10) as a separate identity. The case of a 13-year-old boy is presented and the diagnostic process discussed especially the differentiation between trance states and epilepsy. Psychotherapy and the in-patient treatment course are described including the factors facilitating a positive outcome.

Adolescent↗