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PubMed2000

[Phenomenological study on the process to onset and the structure of symptoms in eating disorders].

Psychogenic experiences occurring prior to the onset of eating disorders had previously been ignored as not corresponding to the symptoms. Recently, we have been considering these experiences as outbreak conditions, and have done phenomenological analysis of the experiences themselves with the following results. We found that patients have experienced 1.) "shame", and following that, and from the phenomenological consideration of the experience of "shame", we have observed 2.) "alienation" occurring in each patients, leading to "isolation." In "isolation", the patient is driven to despair due to existential anxiety, and as the ultimate in despair, the patient shows the attitude of 3.) "One wishing to be oneself in despair." (Kierkegaard, S.), or "haughtiness" which is the attitude of "a person who understands himself or herself to be a free design, and considers others as 'existence-others' reached through this design." (Sartre, J. P.) Here, the patient shows "consumption" as a symptom in either of the forms of surfeit (bulimia) or the consumption of one's own body (anorexia): wasting. 4.) These are defined as "conspicuous consumption" (Veblen, T. B.). 5.) Conspicuous consumption has been analyzed as a primitive form of exchange by Mauss, M., and has been mentioned repeatedly in the intellectual lineage of Bataille, G., Baudrillard, J., et al. This action is concerned with the acquisition of social status in order to save one's own face, and shows what forms the depth-psychological base stratum in the "class system" of human beings, as well as illuminating the "social functions of dignity and class distribution." We have discovered a continuous course from the psychogenic experiences occurring at the onset and previously considered trifling and therefore ignored, proceeding to the symptoms and to the structure of the symptoms. In particular, by using a phenomenological analysis of shame and symptom structure, we show a new hypothesis about the structure of symptoms which is completely different from those created according to various previous opinions. Such understanding throws new light on this disease.

Adult↗
PubMedDate not supplied

[Dynamic psychopathology for a unified approach to psychogenic eating disorders].

The paper focuses on psychopathological problems relating to psychogenic dietary disorders. Using a psychodynamic approach, the Authors hypothesise the existence of a structural "continuum" which links these diseases to the contexts of either exaggerated food consumption or reduced or insufficient food intake. The discussion in centered on the dynamic-genetic aspect, also taking into account intermediate psychopathological morphologies, which underlies this branch of clinical psychiatry. The failure to overcome "infantile dependence" is identified as the most important genetic factor. The type and efficacy of strategy used to neutralise the persistent anxiety caused by this unresolved "separation/identification" of the Ego shape the individual symptomatology of each dietary disorder described in the study.

Anxiety, Separation↗
PubMed1995

Psychogenic movement disorders: frequency, clinical profile, and characteristics.

Of 842 consecutive patients with movement disorders seen over a 71 month period, 28 (3.3%) were diagnosed as having a documented or clinically established psychogenic movement disorder. Tremor was most common (50%) followed by dystonia, myoclonus, and parkinsonism. Clinical descriptions of various types are reviewed. Clinical characteristics common in these patients included distractability (86%), abrupt onset (54%), and selective disabilities (39%). Distractability seems to be most important in tremor and least important in dystonia. Other diagnostic clues included entrainment of tremor to the frequency of repetitive movements of another limb, fatigue of tremor, stimulus sensitivity, and previous history of psychogenic illness. On examination, 71% had other psychogenic features. Over 60% had a clear history of a precipitating event and secondary gain and 50% had a psychiatric diagnosis (usually depression). Twenty five per cent of patients presented with combined psychogenic movement disorder and organic movement disorder; 35% resolved and this subgroup had a shorter duration of disease than those who are unresolved. Psychogenic movement disorder represents an uncommon diagnosis among patients with movement disorders. The ability to make a diagnosis rests on the presence of a multitude of clinical clues and therapeutic action should be taken as early as possible.

Adolescent↗
PubMed2005

"Fear of falling" gait: a potentially reversible psychogenic gait disorder.

OBJECTIVE: To describe "fear of falling" gait. BACKGROUND: "Fear of falling" gait is a largely psychogenic gait disorder of the elderly that is often unrecognized. METHODS: Report of a representative case and clinical experience. RESULTS: "Fear of falling" gait usually begins after a fall and is characterized by a shuffling or sliding stride and an intense need to hold on for support. It appears to be most common in elderly women, can be reversed by education, suggestion, and physical therapy, and is often mistaken for Parkinson disease. CONCLUSIONS: "Fear of falling" gait is a potentially reversible, largely psychogenic gait disorder that occurs mostly in women and must be distinguished from other gait disorders in the elderly.

Aged↗
PubMed2003

Psychogenic movement disorders in two children.

Two schoolboys with diagnostic criteria for psychogenic movement disorder (PMD) are described: one with bizarre tremor of the right hand and a very slow and cautious gait, another with exaggerated trunk sway and collapses during standing and walking.

Child↗
PubMed2004

Mistaken diagnosis of psychogenic gait disorder in a man with status cataplecticus ("limp man syndrome").

We report on a 45-year-old man with a history of multiple psychiatric admissions for a gait disorder and episodic weakness thought to be psychogenic who was subsequently diagnosed with status cataplecticus due to narcolepsy. The gait difficulties resolved with venlafaxine. This case demonstrates that status cataplecticus can be misdiagnosed as a psychogenic gait disorder.

Carrier Proteins↗
PubMed1979

[Features of psychopathologic disorders in schizophrenia complicated by psychogenic reactions].

In order to reveal psychopathological disturbances in schizophrenia appearing under the influence of psychogenic factors, 145 schizophrenic patients with attack-like progressive and continuous forms of development, accompanied by psychogenic reactions were examined. The significant changes in the clinical picture of such conditions expressed in atypical and fragmentary psychopathological signs indicate a deep influence of psychogenic reactions on the pathogenesis of the schizophrenic process. The study demonstrated as well a certain dependence of the psychogenic modification in the clinical picture of schizophrenia on the form of development and character of psychogenic disorders. The results of the study may help to overcome difficulties in differential diagnosis of schizophrenia complicated by psychogenic reactions.

Diagnosis, Differential↗
PubMed1997

[Traffic accidents from the social medicine viewpoint--a medical history connection with present time].

A historically excursus seems sometimes useful to overlook actually problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918 Horn published monographs regarding this problem. Apart of real impairments very often complaints had no organic reason. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. In present times the problem of the whiplash injuries takes the place of the railway accidents. Here also are either organic reasons discussed or psychogenic reactions presumed. The modern techniques in neuroimaging and neuropsychology are inconsistent and the results not generally accepted. In the individual case they are often little helpful. The medicolegal problems are still important and often reason for prolonged forensic confrontations. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.

Accidents↗
PubMed2002

Psychogenic voice disorders--heroes or hysterics? A brief overview with questions and discussion.

A brief overview of the field in relation to psychogenic voice disorders is given with reference to past and present terminology used, the common presentations seen, followed by the more subtle or ambiguous examples which may challenge our notions of psychogenic or clear-cut functional versus organic dichotomies. Issues related to aetiology, personality and psychological correlates are discussed, and a number of questions regarding the phenomenology of psychogenic dysphonia and its therapeutic resolution are raised. Since prevalence continues to be significantly in favour of women, it is suggested psychogenic voice disorder as a feminist issue might be worthy of our further consideration.

Female↗
PubMed1999

[Megaloblastic anemia in a psychogenic eating disorder].

HISTORY AND ADMISSION FINDINGS: A 68-year-old woman had progressively lost strength over the past 5 years and become bed-ridden. She reported gradually reducing her diet during the last few years, for the last two years restricting herself to oatmeal, biscuits and water. Acute exacerbation of dyspnoea, dizziness, tachycardia and cardiac arrhythmias for the last 3 month necessitated her emergency admission when she was found to have oedema of the limbs and definite jaundice, as well as predominantly distal sensory deficits in the legs, a slightly ataxic gait and poor reflexes in the limbs. INVESTIGATIONS: She was found to have pancytopenia with marked megaloblastic anaemia (haemoglobin 4.8 mg/dl, mean red cell volume 141.8 fl, leukocytopenia 41/nl), marked haemolysis (lactate dehydrogenase 1629 U/l, haptohaemoglobin < 0.1 g/l, total bilirubin concentration 4.5 mg/dl). Pernicious anaemia was excluded: no antibodies against parietal cells and intrinsic factor, and no atrophic gastritis in a gastric biopsy. DIAGNOSIS, TREATMENT AND COURSE: Megaloblastic anaemia due to dietary deficiencies with early funicular myelosis was suspected. After infusion of four erythrocyte concentrates and vitamin B12 administration the symptoms and blood picture improved within days. CONCLUSION: Although dietary causes of megaloblastic anaemia are rare in Central Europe, they must be considered in the differential diagnosis, especially in the elderly and those with psychogenic disorders.

Aged↗
PubMed2000

Controversies surrounding reflex sympathetic dystrophy: a review article.

The topic of reflex sympathetic dystrophy (RSD) has generated an increasingly significant volume of medical literature and controversy over the last decade. A search of PubMed, the online site of the National Library of Medicine, for papers on RSD reveals nearly 2200 articles on the topic (using algodystrophy as the search word, wherein RSD references are also included, and more older and European articles are also listed). From 1991 through 1998 inclusive there is an average of nearly 100 articles per year on the topic, which represents more than a third of all the articles referenced since 1965. In the decade of the 1980s, there is an average of 64 articles per year, 74 per year in the last half of the decade and 54 per year in the first half. Prior to the decade of the 1980s, one finds an average of 40 articles per year back to the mid-1960s. The controversy surrounding the disorder centers around the nature of the problem and whether it is a primary organic disorder or a primary psychogenic disorder associated with the accomplishment of some secondary gain. If it is the former, then clearly research should continue to determine the nature and etiology of the malfunctioning organ(s). If, on the other hand, RSD is a psychogenic disorder, then the medical community does well to focus mainly on the peripheral manifestations of the problem. In that instance, therapy should be primarily psychological and cognitive with regard to the secondary gain, and persistent organic treatments are unlikely to improve the condition in general and worsen individual cases.

Adolescent↗
PubMed1995

Psychogenic dystonia: a review of 18 cases.

OBJECTIVE: To review the clinical characteristics and associated features found in patients with psychogenic dystonia. METHODS: A 10 year retrospective chart review of all patients diagnosed by the author as having psychogenic dystonia. RESULTS: Eighteen patients fulfilled diagnostic criteria for "Documented" or "Clinically Established" psychogenic dystonia. Clinical characteristics of the dystonia were inconsistent or incongruous with established forms of organic dystonia. Fourteen of the 18 patients had a known precipitant. In most, the onset was abrupt and progression occurred rapidly, often to fixed dystonic postures. In contrast to idiopathic dystonia, involvement of the legs was common (12 patients), despite onset in adult life. Although cases of isolated paroxysmal dystonia were excluded in the review, 10 patients had paroxysmal worsening of dystonia or other abnormal movements. Pain was a prominent feature in 14 of 16 patients with the complaint and 1 patient with documented psychogenic dystonia also had well established reflex sympathetic dystrophy (RSD). Other psychogenic movement disorders, psychogenic neurological signs and multiple somatizations were common. Long-term follow up was available for less than one-half of the patients. Outcome varied considerably; some patients had complete resolution of symptoms (including 1 who had undergone 2 previous thalamotomies) and others remained disabled by persistent dystonia. CONCLUSIONS: Dystonia is uncommonly due to primary psychological factors. At times this is an extremely difficult diagnosis to make and even when the diagnosis is confirmed, management remains very challenging. Future studies are required in hopes of providing more efficient means of distinguishing psychogenic dystonia from other dystonic syndromes especially those which rarely follow peripheral injury or accompany RSD/causalgia syndromes.

Adolescent↗
PubMed1993

Unspecific neurologic symptoms as possible psychogenic complaints.

Prevalence and course of psychogenically influenced symptoms in neurology and their dependence on age and gender are reported. The epidemiological basis of the data is a long-term follow-up investigation of a high-risk population for about 10 years (n = 240): the Mannheim Cohort Study on Epidemiology of Psychogenic Disorders. Seven psychogenic symptoms of neurologic relevance (headache, lumbar and cervical vertebral complaints, functional vertigo, hyperkinesias, pareses, sleep and concentration disturbances) are characterized in regard to frequency, course and diagnostic significance.

Adult↗
PubMed2006

Effects of biofeedback in phonatory disorders and phonatory performance: a systematic literature review.

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

Acoustic Stimulation↗
PubMed1992

Expert performance in low-back disorder recognition using patient pain drawings.

Eight low-back-pain experts who regularly include pain drawings in their clinical workup were asked to classify 25 drawings. The experts used only the drawings to place cases into one of five broadly defined diagnostic categories: benign disorder, herniated disc, spinal stenosis, underlying disorder, or psychogenic disturbance. The physicians demonstrated adequate accuracy--51% correct--when compared with change (20% correct). Classification accuracy was greatest for psychogenic disorders (85%), followed by spinal stenosis (58%), herniated discs (52%), and benign disorders (50%). Predictions were comparatively poor for the underlying disorder category (10%). The individual physician accuracies varied from 44 to 60%. "Classic" pain patterns for each disorder group were identified by determining which drawings were correctly classified by most physicians. Physicians may wish to impart greater significance to pain drawings close to one of our "classic" patterns than to others.

Back Pain↗
PubMed1984

Somatoform disorders: before and after DSM-III.

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.

Adaptation, Psychological↗
PubMed1994

Demography of a regional pediatric rheumatology patient population. Affiliated Children's Arthritis Centers of New England.

OBJECTIVE: To examine the descriptive epidemiology of a regional cohort of children with rheumatic disease, and to document the variety and frequency of diseases encountered among pediatric rheumatology centers. METHODS: Pediatric rheumatology centers in southern New England participated in a prospective multicenter patient registry. All outpatients attending clinics at 8 pediatric rheumatology centers were enrolled as subjects during the 8-year period of study (n = 4585). Diagnostic criteria defined the rheumatic disease cases which were determined by clinical examination by a pediatric rheumatologist, and record linkage was achieved to avoid duplication of subjects. RESULTS: Rheumatic conditions were diagnosed in 1742 subjects. Juvenile rheumatoid arthritis (JRA) was the most frequently encountered rheumatic condition (53%), followed by spondyloarthropathy syndromes (13%), vasculitis (10%), systemic lupus erythematosus (SLE) (6%), isolated Raynaud's phenomenon (5%), dermatomyositis/polymyositis (DM/PM) (5%), and scleroderma (2%). The mean annual incidence of JRA, spondyloarthropathy syndromes, SLE and DM/PM among children referred to pediatric rheumatology centers in Massachusetts was 4.0, 2.0, 0.4 and 0.4 per 100,000 children at risk, respectively. Nonrheumatic conditions were diagnosed in 2843 subjects, among which musculoskeletal conditions were most frequent (56%) followed by infectious disorders (18%), psychogenic disorders (3%), fever of unknown origin (2%), and abnormal immune serology without a specific diagnosis (2%). CONCLUSION: The use of a multicenter patient registry was successful in allowing the collection of descriptive epidemiologic data on a large and well defined sample of children with rare disorders.

Adolescent↗
PubMed1996

[Expert assessment of railroad accidents at the beginning of the industrial age--a medical historical excursion with reference to current circumstances].

A historical excursus seems sometimes useful to overlook actual problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918. Horn published monographs regarding this problems. Apart of real impairments very often complaints had no organic reasons. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.

Accidents↗