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PubMed2006

Update in neuropsychiatry: cognition, sleep and sleep-related disorders.

The 17th Annual Meeting of American Neuropsychiatric Association was held in La Jolla Torrey Pines, San Diego, California, U.S.A., on February 18-21, 2006. The meeting was jointly sponsored by the Center for Continuing Medical Education (CME), the Ohio State University Medical Center and the American Neuropsychiatric Association. The primary objectives of the meeting were to define and describe contributions of cognitive neuroscience, the relevance of sleep disorders to neuropsychiatry and assessment of malingering in clinical evaluation. The report provides a comprehensive outlook and addresses several aspects of neuropsychiatry such as behavioral neurology, amnesia, cognitive correlates of functional status, emotions, neuropsychiatry of sleep and related disorders, insomnia, narcolepsy and other disorders, all strongly linked with other areas of science. The conference was made up of the familiar mix of symposia, poster presentations, workshop and sociocultural programs.

Cognition↗

PubMed1991

The somatic patient.

A significant proportion of patients seen in the Emergency Department will present with somatic complaints for which there is no apparent physiologic cause. Such patients may be divided into two broad categories: (1) those with symptoms and signs consciously synthesized by the patient, either for obvious secondary gain (malingering) or as a result of more subtle and complex motivations (factitious disorders); and (2) those patients with symptoms that are the unconscious expression of psychological stress (somatoform disorders). The somatoform disorders include (1) somatization disorder (characterized by a chronic history of numerous and widely divergent somatic complaints), (2) psychogenic pain disorder (somatization expressed in terms of persistent pain), (3) hypochondriasis (a conviction that one is diseased and disabled in conjunction with a well-focused constellation of supporting symptoms), and (4) conversion disorder (a single, usually nonpainful neurologic symptom, often with identifiable coping value for the patient). The first three disorders have been aggregately termed the "common somatization syndrome." Management of the somatically focused patient includes the communication of a caring attitude to the patient in conjunction with a cautious and diligent search for treatable medical or psychiatric illness. Resocialization and development of patient links with ongoing, nurturing nonmedical as well as medical support systems is of benefit.

Emergency Service, Hospital↗

PubMed1990

An unusual case of orbital cellulitis.

Munchausen's syndrome, an unusual disorder related to malingering and hysteria, is occasionally seen by the ophthalmologist. Munchausen patients deliberately deceive and attempt to manipulate physicians 'through factitious signs and symptoms. They know they are acting, yet appear unable to control their actions. Unnecessary medical workups and inappropriate surgical interventions are common with this perplexing syndrome. An unusual case of orbital cellulitis that illustrates a number of these features is illustrated and the syndrome is reviewed.

Adult↗

PubMed1990

[Mental health and war in Lebanon].

This paper studies the effects of the war on the civilian and military lebanese populations from 1975 to 1987. A review of the literature on war psychiatry is presented as an introduction in order to estimate its applicability to Lebanon, and it seems that all the morbid conditions described in the different wars are to be found in Lebanon. A study on the military population was undertaken, focusing on the comparison of the morbid conditions before and during the war. It shows that war has led to a decrease of malingering and generalized anxiety disorders but to an increase of neurotic and psychotic reactions. A comparison of these conditions with those found in Vietnam shows a greater proportion of generalized anxiety and post-traumatic stress disorders among Marines in Vietnam. The milicians of the Lebanese Forces differ from the Lebanese Army soldiers by a higher proportion of antisocial personality disorders and anxiety neuroses. Among the civilian population war does not seem to have significantly modified in-patient morbidity in the main psychotic, affective and neurotic diagnostic categories. Drug abuse whose frequency has considerably increased during the war is studied in detail. In conclusion, the author analyzes the factors having contributed to the relative psychological resistance of the Lebanese population.

Humans↗

PubMed1990

[A case of Munchausen syndrome].

A case is described of the Munchhausen's syndrome in a 35-year-old female patient. The patient was hospitalised 17 times and had six laparotomies for suspected peritonitis. Besides that venesection and lymphography were done. The patient malingered also insulin-dependent diabetes, fever, and haematuria. Since she worked as a housemaid for a doctor she had access to textbooks and professional literature. In the paper more modern aspects of the Munchhausen's syndrome are also discussed e.g. the Munchhausen's syndrome "by proxy".

Adult↗

PubMed1975

Glomus tumour of the fingers.

Clinical and therapeutic aspects of glomus tumour of the fingers have been considered by analyzing the records of 15 patients with glomus tumours. The tumour was found in the pulp in 5 patients and in the subungual region in 10. The diagnosis may be difficult to make and patients are often believed to be malingering. Complete surgical excision under magnification is curative.

Female↗

PubMed1989

[Pupillographic perimetry using the "Octopus"].

The Octopus 2000 computerized perimeter (Interzeag, Schlieren, Switzerland) is combined with an infrared videopupillograph (Demel, Haan, FRG) which at the same time records the direct pupil light response and controls fixation. Digital processing of the pupil video image is performed at a rate of 25 cps. A transient oscilloscope display of the pupil surface after each light stimulus covers the subsequent 1000 ms, so that either pupillary light reflexes or the lack of a response can immediately be identified. An additional continuous penwriter printout shows light stimuli, pupil responses and the subject's responses. Thus, potential discrepancies between the pupil response and the subject's response are clearly revealed. The examination conditions slightly deviate from the standard ones used with the Octopus. Stimulus size is analogous to the target Goldmann/V, the stimulus duration 100 ms and the adaptive illumination 1 cd/m2. Pupil fatigue considerably exceeds visual fatigue. Therefore standard Octopus perimetric programs are inconvenient for pupilloperimetric purposes. A Sargon-based pupilloperimetric program determines pupillomotor increment thresholds at 12 stimulus locations throughout the visual field (20 degrees nasal, 0 degrees, 20 degrees and 40 degrees temporal/15 degrees above the 0 degrees meridian, 0 degrees meridian and 15 degrees below the 0 degrees meridian) while applying the normal Octopus strategy of threshold calculation. Instead of the patient's subjective responses, the examiner's assessment of pupil responses provides the basis for threshold determination by the Octopus program. The subjects are unaware of the mode of examination. Their rating of "seen" or "not seen" ist displayed together with the pupil responses, thus providing a hard copy as proof of malingering or of appropriate cooperation.

Computer Systems↗

PubMed1989

Could it be Ganser's syndrome?

The term, "Ganser's syndrome," was identified by Sigbert J. Ganser, a German psychiatrist, near the turn of the century. Ganser's syndrome, defined as an hysterical reaction, was often used to describe prisoners who appeared to be trying to escape prosecution. Today, Ganser's syndrome is debated by both psychiatric and judicial systems. This paper addresses these issues by identifying guidelines for assessment and recognition of common malingering behaviors displayed by Ganser's syndrome patients. Psychiatric nurses who practice in both psychiatric and legal systems need an understanding of Ganser's syndrome to adequately assess the patient, plan effective treatment, and complete an evaluation of care. This understanding will enable the nurse to answer the important question, "Could it be Ganser's syndrome?" With the increase of crime and the prison population, the use of "Insufficient Comprehension to Stand Trial" may be a legal option for defendants. If they are exhibiting inappropriate behavior and are a danger to themselves or others, a psychiatric evaluation may be ordered by the court. It is then the responsibility of a psychiatric facility to assess, treat, and evaluate Ganser's syndrome patients in an attempt to return them to competency. The patients may return to court following the psychiatric evaluation if they are found competent to stand trial.

Diagnosis, Differential↗

PubMed1987

Neuro-ophthalmic presentation of cone dysfunction syndromes in the adult.

Cone dysfunction syndromes are probably part of the spectrum of cone-rod degenerations and can present with widely varying clinical pictures. Thus, although the age of onset is usually before the third decade, patients can present at any age, and, although family history is usually positive, in typical cases it may be quite negative. Patients can have initially very subtle, bizarre, or poorly described visual complaints so that numerous examiners may label them "functional" or "malingering." They can present with the classic symptoms of hemeralopia, poor acuity, and reduced color vision, but these complaints may be absent. Visual acuity and color vision can be normal or severely reduced and the fundi may show classic changes such as bulls-eye maculopathy, macular choroidal atrophy, pigment clumping in the maculae, mild peripheral pigmentary changes, or a fundus flavimaculata-like change. The patients here reported were considered as having normal fundi by several competent ophthalmologists as a rule, however. Visual fields can vary from normal to ring scotomas, central scotomas, and other interesting types of defects, even simulating a hemianopia. Although involvement is usually symmetrical between the two eyes, this is not always the case, and one of our patients had a strictly uniocular cone dystrophy. Cone dysfunction can be considered in a patient of any age even with normal acuity, good color vision, and a normal ophthalmoscopic examination. A high index of suspicion should prompt specific questioning about hemeralopia, or reduced visual function in brightly illuminated situations, and better vision in twilight or under dim illumination. Patients may falsely describe hemeralopia as "glare" or "photophobia." Careful testing of color vision, a meticulous tangent screen examination, and specifically looking for diffuse narrowing of retinal arterioles in a patient with an otherwise normal fundus appearance will usually suffice to prompt the clinician to order electroretinography, which is the definitive diagnostic criterion for the cone dystrophies. It is important to consider this diagnosis before embarking on an otherwise fruitless and expensive neuroimaging investigation.

Adult↗

PubMed1986

A consultant's survey of the patients in a maximum security hospital.

The patients at a state maximum security forensic facility were interviewed by a psychiatrist and their files reviewed. Only 43 of the 203 patients were judged to be suitable for the facility. Nearly 60% of the pretrial defendants were judged to be capable of proceeding to trial. Of the patients, 18% were judged to be malingering or avoiding trial or prison. The implications of these findings are discussed.

Adult↗

PubMed1985

Stereoacuity degradation by experimental and real monocular and binocular amblyopia.

Fourteen normal adult volunteers with normal binocular single vision and normal stereoacuity submitted to monocular and binocular degradation of their stereoacuity by cycloplegia and fogging with spherical lenses. Stereoacuity (SA) was reduced as soon as visual acuity (VA), both monocular and binocular, was reduced. There was a marked similarity in the degree of SA reduction produced by monocular and binocular amblyopia. The degree of SA reduction was slightly more marked with monocular decrements than with binocular at VAs between 20/25 and 20/50. Significant intersubject variation was noted. The majority of subjects maintained gross SA at 20/200 monocular or binocular. One subject was reduced to gross stereopsis at 20/30 monocular and 20/50 binocular VAs. Two subjects were able to retain 40 sec of SA until vision was degraded to 20/50. Conversely, 40 sec of SA was not achieved by any subject at monocular or binocular vision less than 20/40 (test for malingering). Thirteen patients with real monocular and binocular organic or functional amblyopia were then compared with the experimental group. On the whole, patients scored somewhat better than normals but their scores fell within the range of responses found in the normal group.

Adult↗

PubMedDate not supplied

[Several cases of non-phlebologic pigmentation of the lower extremities].

Hyperpigmentation of the lower limbs does not always reflect a phlebological abnormality. The authors briefly recall other pathological circumstances which result in cutaneous hyperpigmentation : cutaneous porphyria (hyperpigmentation of the exposed parts), malignant melanoma, Recklinghausen's neurofibromatosis (café-au-lait spots and naevo-cellular naevi), pigmented dermatoses (lichen planus), fixed pigmented toxidermias, drug induced hyperpigmentations (minocyne, synthetic anti-malarials which can provoke the development of large areas of greyish coloured s in), reticular "hot water bottle" dermatitis and malingering syndromes.

Drug Eruptions↗

PubMed1982

[Hearing disorders in industrial workers: clinical analysis of the cases observed in the audiological laboratory of the Lódź Institute of Occupational Medicine during the years 1976-1980].

The documentation of 697 cases with suspected, as suggested by regional health service units, occupational aetiology, was analysed. Within consultation those cases underwent complex audiological evaluation at the Laboratory of Audiology, using following examinations: pure tone threshold and suprathreshold audiometry, malingering tests, speech audiometry and electronystagmographic tests. The findings revealed that only 30% of subjects confirmed noise-induced hearing loss. 65.2% of those subjects exhibited cochlear localization, whereas in the remaining 34.8% the results of audiological tests showed retrocochlear impairment. The calculated mean hearing losses were characterized by symmetrical changes both in the right and left ear, as well as by directly proportional dependence on subjects' duration and exposure and age, men having more advanced hearing loss than women, despite identical mean parameters of age and exposure of both sexes. In 70% cases hearing losses were not regarded as occupational diseases, which resulted from: functional disturbances found in form of aggravation and simulation (15.3%), the presence of hearing loss lesser than the one specified by the certification rule (15.1%), post--inflammatory and adhesional changes in the middle ear (12.3%) and lack of significant exposure to noise (8.3%). It has been settled that the major causes of the diagnostic errors that we had detected were: deficient audiometric apparatus, erroneous technics of hearing measurements (among others--without masking), lack of the determination of hearing thresholds for bone conduction, drawing conclusions from single examinations, giving up simulating tests, improper evaluation of the data on occupational exposure. The considerations summing up the results of analysis include an optimum methodology of audiological studies, required standard conditions of audiometry and principles of differential diagnostics as indispensable elements of proper certification procedures in setting up the hearing impairments etiology in industrial workers.

Adult↗

PubMed1982

[Animal experiments on predilection of the superficial femoral artery of the adductor canal for arteriosclerosis].

The premature manifestation of the arteriosclerosis in the adductor canal makes this vascular region to a first-class site of predilection. These localised mechanical morphological factors were malingered by means of polyvinylchloride splinting in animal experiment. All degrees of severity of the arteriosclerotic vascular wall changes were shown histologically. The changes of the arteries were developed essentially slighter under medication of pyridinolcarbamat, however, they could not be prevented.

Animals↗

PubMed1980

Holmes, Watson and neurology.

Numerous neurological problems appear in the Sherlock Holmes stories. These include dementia, delirium, seizures, toxic-metabolic encephalopathies, syncope, movement disorders, cerebrovascular disease, and alocholism. Several problems of a neuropsychiatric nature, such as malingering and brain fever, are also reviewed. In addition, Holmes' knowledge of electroencephalography is revealed.

Crime↗

PubMed1980

DSM-III differential diagnosis of Munchausen's syndrome.

Patients who have the wish to be admitted and treated repeatedly in hospitals are a fascinating although still poorly understood group. Those who have no apparent organic basis for their complaints are especially interesting and challenging, since they often demand and sometimes receive potentially dangerous somatic treatments such as operations and medications. Such patients receive a wide range of psychiatric diagnoses, such as hysteria, Briquet's syndrome, factitious illness, Munchausen's syndrome, malingering, and schizophrenia. We recently treated a young woman who had been given most of these diagnoses, whose case history presented us with an opportunity to review problems in differential psychiatric diagnosis as applied to this frequently confused and confusing problem area.

Adult↗

PubMed1980

[Comments on the preceding article by M. Földi and L. Clodius].

In clinical symptoms inexplicable by scientific rules of pathology we should think of malingering. The case history by the authors is typical of the "Syndrome of Münchhausen". In such cases the consultation of a psychiatrist is mandatory before any operation is taken into consideration.

Adult↗

PubMed1995

[A new method for objective vision assessment using infrared nystagmography].

Objective assessment of visual acuity (VA) is necessary in cases of malingering or poor cooperation in subjective VA evaluation. Based on Ohm's idea of the suppression of experimentally evoked optokinetic nystagmus (OKN), a new objective visual acuity test is presented. A commercially available system for monitoring eye movement (OBER2) allows the test to be performed on a standard PC with a minimum amount of time. A grating pattern moving horizontally on the screen evokes OKN, which is recorded by infrared nystagmography. Superimposed black optotypes of increasing size (brake marks) suppress OKN as soon as they are recognized. Eighty-two normal eyes with VA artificially reduced by different Bangerter dispersion foils (VA 0.04-1.6) and 152 eyes with visual disturbances (VA 0.04-1.0) of various etiologies were examined. The test allowed estimation of the least VA in steps of > or = 1.0, > or = 0.25, > or = 0.1, > or = 0.05. None of the eyes examined had a VA below these values when the OKN was suppressed by the referring brake mark.

Electronystagmography↗