Might a psychosocial approach improve our understanding of itching and scratching?
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OBJECTIVE: Olfactory reference syndrome (ORS) in the Western literature is characterized as preoccupation with the idea that the body emits a foul odor. Japanese patients with a feature similar to ORS have long been recognized as jiko-shu-kyofu, which is believed to be a culture-bound syndrome and specific to Japan. The aim of the study was to clarify the relationship between the two separate syndromes that had independently been recognized in culturally different settings. METHOD: The phenomenology and treatment of seven patients with jiko-shu-kyofu were described. A feature of jiko-shu-kyofu was then compared with that of ORS. RESULTS: In our cases, clinical characteristics of jiko-shu-kyofu such as symptomatology, insight, and pharmacotherapy response were found identical to those of ORS except for the onset at relatively younger ages. CONCLUSION: Jiko-shu-kyofu and ORS may share a common clinical entity, hence the former is not a culturally distinctive disorder.
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OBJECTIVE: This study assesses neuropsychological and psychosocial determinants of judgements of personality change (PC) after traumatic brain injury (TBI). DESIGN: Cross-sectional data from 87 participants with TBI analysed using hierarchical binary regression. METHODS: Interview of participants assessed, injury severity (post-traumatic amnesia), degree of cognitive impairment (IQ and memory), presence of orbitofrontal and/or medial temporal damage (olfaction) and emotional reactions (anger, depression and anxiety questionnaires). Separate interview of relatives assessed their own response to the injury (emotional reactions and critical comments from the Expressed Emotion index) and their judgements of participants' behavioural change. RESULTS: As expected, memory loss and impaired olfaction predicted relatives' PC judgements. However, the most striking and novel result was that social-emotional factors (participants' and relatives' reactions) predicted PC judgements best. CONCLUSIONS: This study emphasizes the need (a) for future studies measuring social behaviours (e.g. impulsivity and emotional perception) (b) to explore the differing determinants of relatives' and participants' PC judgements and (c) to develop and to tailor clinical responses to the various psychosocial determinants of PC.
This study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow-up assessment. However, at the follow-up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.
One hundred children with temporal lobe epilepsy were followed into adult life. 85 per cent had had psychiatric problems in childhood. The occurrence of overt psychiatric disorder in adult life was low: of those survivors who were not gravely mentally retarded, 70 per cent were regarded as psychiatrically healthy. Overt schizophreniform psychosis has developed in 10 per cent of survivors. Males with continuing epilepsy and left-sided foci were at special risk: 30 per cent of such patients had become psychotic. No patient coded as having a right-sided focus in 1964 had become psychotic by 1977. Though 26 patients had had grossly disordered childhood homes, this factor had no significant relation to adult psychiatric disorder. Antisocial conduct marked the adult life of 12 patients. Their childhood codes showed that male sex, a focus contralateral to the preferred hand, and unremittent epilepsy marked this group. Low intelligence and childhood rages were also prominent. Treated neurotic and depressive illness was quite uncommon. Only five survivors have fallen into this category. Those patients escaping psychiatric ill-health are often notably extraverted and successful.
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This study explores the psychosocial problems and treatment needs of a sample of 50 children who remained in foster care for a period of five years. An attempt was made to rate the quality of treatment received in relation to judgments of treatment needed. The results raise questions about the appropriateness and adequacy of foster care and residential placement for this vulnerable group of children.
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Four children are described with a potentially life threatening condition manifested by profound and pervasive refusal to eat, drink, walk, talk, or care for themselves in any way over a period of several months. The multiplicity and severity of the symptoms in these children do not fit comfortably into any existing diagnostic category. Long term and highly skilled nursing and psychiatric care is required to help these children to recover. The possible causes of this syndrome are discussed.
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