[Simulated diseases in malingerens (observed in military hospitals)].
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Five patients developed recurrent episodes of psychogenic respiratory difficulty that were superimposed on psychogenic neurologic symptoms. Misdiagnosis resulted in long hospital stays, code blue alerts, intubation, mechanical ventilation, and, in one case, tracheostomy. Patients "learned" psychogenic respiratory distress because their breathing symptoms evoked distinct evidence of anxiety in physicians and staff. In these patients, gain was not incidental but exerted primary control over symptom selection. The behavioral mechanisms involved in the pathogenesis of psychogenic respiratory distress have significant implications for its diagnosis, treatment, and prevention.
Acuity profile perimetry is a technique that allows visual acuity properties to be rapidly measured at any location in the visual field. This report describes our initial clinical trials with acuity profile perimetry, as performed in combination with standard static perimetry. Preliminary results from patients with cataracts, amblyopia, and central serous retinopathy show, in general, a much greater deficit for acuity profiles than for static sensitivity profiles. In contrast, patients with optic neuritis or other optic neuropathies display approximately equivalent losses for static and acuity profiles. The recovery process in optic neuritis is also about equal for the two functions. Our initial findings suggest that acuity profile perimetry may be a valuable differential diagnostic test, particularly for cases in which optic nerve disease is suspected.
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Rosenhan's 1973 article, "On Being Sane in Insane Places," was pseudoscience presented as science. Just as his pseudopatients were diagnosed at discharge as having "schizophrenia in remission", so a careful examination of this study's methods, results, and conclusions leads to a diagnosis of "logic in remission." Rosenhan's study proves that pseudopatients are not detected by psychiatrists as having simulated signs of mental illness and that the implementation of certain invalid research designs can make psychiatrists appear foolish. These rather unremarkable findings are irrelevant to the real problems of the reliability and validity of psychiatric diagnosis and only serve to obscure them. A correct interpretation of his own data contradicts his conclusions. There are purposes to psychiatric diagnosis that Rosenhan's article ignores. His more recent suggestion that certain requirements be met prior to the adoption of a new psychiatric classification system is unrealistic.
As part of each evaluation, the clinician must decide whether or not a psychiatric treatment is indicated. It is unfortunate that there is little available research to aid in this decision, and it has not received much attention in the clinical literature. In actual practice, therapists tend to recommend treatment almost automatically and without a careful consideration of its necessity or possible harmful effects. The research methodology and problems is defining those patients who are better off without psychiatric treatment is discussed. This group is categorized into negative responders and nonresponders and spontaneous improvers. A set of preliminary criteria for no treatment and clinical examples are provided.