Psychosocial effects of a catastrophic botulism outbreak.
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The following article attempts to introduce a coupled analytical method simultaneously based on "Daseinsanalyse" and "Schicksalsanalyse" that we call "phemenological analysis of fate." One instance of its use is presented here concerning a young French woman who has been hospitalized for a month in a private Japanese hospital before being repatriated to France. During her hospitalization she went through three different phases that we analyse, first according to Schicksalsanalyse, then to Daseinsanalyse and finally from the point of view of the combined approach. Before doing so we present the foundaments of the "phenomenological analysis of fate" showing how it can complement the above methods used separately. We conclude the article by pointing out that this analytical method is mainly descriptive and that its insight can allow a more specifically adapted therapeutic help.
The history of hysteria, with special reference to pseudoseizures, is reviewed. The distinguishing features between nonepileptic and epileptic convulsions are then considered, prior to discussion of management and prognosis. The various psychopathologies associated with the diagnosis are noted, as are psychiatric conditions that may be confused with epilepsy. It is concluded that pseudoseizures represent a complex clinical problem, often requiring multidisciplinary evaluation, that can be rewarding to diagnose and treat.
For P. Janet, there exists a progressive evolution in behaviours. Reflex at the start, with immediate response, they become delayed with secondary behaviours appearing grafted upon primary behaviours. They are the feelings which allow a more and more precise adaptation to physical and social reality. Having started, as did Freud, from psychical traumatism P. Janet is not interested in subconscious but particularly studies the psychological deficiencies which traumatism causes or brings to the foreground. He makes an exhaustive study of those deficiencies under the name of feeling of lack and void. Neurotics, unable to assimilate or master their traumatisms, lose their sense of the present, of reality, and of Action. They only live in day-dreams and abstract ideas. This deviation of behaviour reaches its, pitch with the melancholic. The melancholic, riveted to his past can no longer change as is the case with the patients of Minkowski. It is every day the same old story. Any idea having to do with the future is received as abominable and catastrophic. Consequently, everything appears to them as deadly and they have such a fright of action that it results in systematical reversal of action. Instead of living, they only long for death. As in Suzan Urban's theatre, as described by Bingwanger, the melancholic has the behaviour of a trapped animal. He desperately looks for a way out and turns from side to side, but finds himself systematically trapped back once more. He looks passive and inhibited, but here we have to deal with an active inhibition. The melancholic is not resigned. He would like to come out of his mental situation, but is unable to react.
The English and French literature on Capgras' syndrome yielded 315 patients, 212 of whom provided the basis for review. Forty-six percent presented with an affective disturbance. Seven variant forms of a unified delusion of substitution are described: Capgras; subjective doubles, Capgras type; Fregoli; intermetamorphosis; subjective doubles, autoscopic type; "reverse" subjective doubles; and "reverse" Fregoli. Classes of single and multiple forms of the delusion with either functional or organic etiology were compared. Multiple form classes had a greater diversity of variant forms.
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In koro, the sensation of penile retraction is coupled with an intense fear that death will occur once the retraction is complete. Koro has been reported mainly in Southeast Asia, and it occurs in both epidemic and sporadic forms. Two cases, the first each in natives of Haiti and Ethiopia, are presented. Similarities between them and computed tomography and brain electrical activity mapping data are used to support the concept that sporadic koro may be a form of right temporoparietal or bitemporoparietal dysfunction similar to sexual epilepsy. The hypothesis is advanced that epidemic koro occurs in permissive cultures when groups of individuals imitate sporadic koro.
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A clinico-epidemiological study was devoted to psychopathies and neuroses in students. Students from different institutes showed significantly different borderline psychotic disorders. Initial disturbances, as well as the underlying causes of neuroses and psychopathy were analyzed.
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Forty-six patients with various forms of endogenous depression were treated by night sleep deprivation (NSD) which was used as the cardinal method of treatment. A single session of NSD induced a considerable clinical improvement lasting 2-3 days in the majority of patients. Repetition of the procedure (3-6 times with a 2-3 day interval) led to a significant and stable clinical improvement in 32 of the 46 patients. The highest effect of treatment was observed in such symptoms as depression and suicidal tendencies, whereas in patients with vital anxiety, the efficacy of NSD was considerably lower. Individuals with the duration of the phase under one month and the greatest reduction of the symptomatology after the recovery night showed the greatest response to the treatment. Favourable prognostic signs included such symptoms as psychomotor inhibition, lassitude and apathy, although the tempo of their reduction in the process of treatment considerably lagged behind improvement in the general mood, sleep and regress of autonomous disorders. Activation of the noradrenergic system is assumed to be one of the main mechanisms of NSD action.
The clinical fate of 73 schizophrenic patients collected from a rural general practice in England was followed for 38 years. The incidence of schizophrenia appears to have fallen since the introduction of phenothiazine drugs, and a more liberal attitude has developed toward these patients. Of these patients, 35% were permanently scarred and disabled by the disease; 28% of those who were traced had made a complete recovery. The outlook for victims of schizophrenia is better than it was in 1946. Some of the reasons for this improvement are explained.
The author studied 346 patients with different forms of epilepsy among whom 200 were subjected to different operations in relation to an extraction of the epileptogenic foci. The data are concerned with clinico-psychopahtological variants of focal cortical epilepsy with a focus in the temporal, parietal, frontal, occipital lobes and the central zone, a description of relatively characteristic prevalent lesions in the dominant and subdominant hemisphere. In 146 nonoperated patients the author describes some traits of epilepsy in bilateral lesions of the temporal and parietal lobes. It is considered that the most significant conclusion concerning the localization, subordination and lateralization of epileptogenic foci may be made on the basis of a manifold examination of the mental state of the patient. However, the most important are signs which definitely correspond to the specificity of the lateralization of the gnostical functions.