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PubMed1996

A difficult diagnosis of gliomatosis cerebri.

Gliomatosis cerebri, a rare condition, requires clinical, radiological and pathological correlation for diagnosis. Mental and personality changes are the most common presenting symptoms with or without focal neurological signs. The widespread nature of the disease is revealed by CT or MRI. The shape of the brain may be maintained and pathological gross examination may be unremarkable or show hypertrophy without evident tumour. Microscopic examination reveals infiltration of the brain by variably differentiated neoplastic glial cells. We present a patient with gliomatosis cerebri in whom we experienced difficulties with diagnosis. The literature is reviewed and the diagnostic features summarised.

Brain↗
PubMed1986

Problem patients in a psychiatric inpatient setting. An explorative study.

A total of 26 psychiatric inpatients (5.8% of all admissions) in an intensive treatment unit were identified as problem patients by nursing personnel. Reasons for such identification were behavioral pathology of the patient, difficulties of the staff in the relationship with the patient, and insufficient therapeutic progress, and the use of inappropriate therapeutic methods. Compared with a control group, the problem patients were psychotics or personality disorders. They presented more behavioral pathology, were prescribed more medication, and experienced decisively longer hospitalizations, although they profited less from their hospitalization. Follow-up investigation revealed that the majority did not earn their own living, otherwise they were no more poorly socially adapted than the discharged controls. The suicide proneness of problem patients was high. In the treatment of these patients the necessity of adapting the therapeutic standards and expectations is of the utmost importance.

Adult↗
PubMed1993

Personality traits and disorders among transsexuals.

A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.

Adult↗
PubMedDate not supplied

A developmental model of addictions, and its relationship to the twelve step program of alcoholics anonymous.

A shift in the psychoanalytic literature is seen to have taken place in the 1960s, when psychoanalysts abandoned the psychoanalysis of patients suffering from addictions. This was due to poor outcomes, and assertions such as Kohut's, that addiction was not analyzable. The author asserts that there is a similarity in the psychological part of all addictions, and that this is seen in his work with addicted patients, including psychoanalysis of addicted patients. Addiction is presented as a pathological solution to a fixation during separation-individuation. This conceptualization helps to explain why such varying previous psychoanalytic formulations have been offered. The addictive solution to a fixation during separation-individuation is compared and contrasted to a similar fixation seen in patients suffering from borderline personality disorder and patients suffering from pathological narcissism. The developmental model presented clarifies how denial of addiction can be an interpersonal expression of an intrapsychic defense.

Adult↗
PubMed1987

Personality trends in keratoconus. An analysis.

Patients with keratoconus frequently are described as having peculiar personality characteristics, despite the lack of controlled studies in the ophthalmologic or psychiatric literature. We studied 109 subjects, using a standardized personality inventory (the Millon Clinical Multiaxial Inventory) that measures 20 personality scales-both normal and pathologic. Subjects were divided into three age-matched groups: (1) patients with keratoconus, (2) patients with other chronic eye diseases, and (3) normal controls. Results indicated that although chronic eye disease, including keratoconus, did have an impact on personality functioning in young and middle-aged adults, no specific complex of personality characteristics attributable to keratoconus could be identified. Patients with keratoconus differed from normal controls in much the same way as did patients with other chronic eye diseases, being less conforming and more passive-aggressive, paranoid, and hypomanic. They tended to more disorganized patterns of thinking and scored higher on substance abuse indicators. The influence of keratoconus on personality may be a function of the timing and nature of its onset in the context of the patient's psychosocial development.

Adolescent↗
PubMed1978

[Use of the cytological method in benign pathological processes of the stomach (based on data from the prophylactic examination of persons with a high risk of cancer morbidity)].

The author examined the cytographs of gastritis, polyps and ulcers according to the materials of the prophylactic examination of a dispensary group, comprising 265 patients at high risk for gastric cancer. The differential features of the cytographs were examined in the cases in which the complex gastrogical investigation showed the concidence in the results of gastrofiberscopy, gastrobiopsy and cytological tests. The differential cytologic diagnosis of polyps and gastric ulcer is found to be possible in the presence of papillary structures in the first case, and in the second--a great variety of stromal infiltrate cell structure with the obligatory presence of lymphocytes, plasmatic cells, histiocytic elements, eosinophilous and neutrophilous leucoctyes. The differential cytological diagnosis between different histological forms of gastritis needs further studies.

Cytodiagnosis↗
PubMed2002

Comparison of radionuclide imaging and ultrasonography in the differentiation of acute testicular torsion and inflammatory testicular disease.

PURPOSE: Torsion of the testis is a urologic emergency that requires early diagnosis and prompt surgical treatment for testicular survival. However, the early differential diagnosis of acute testicular torsion from epididymitis or orchitis is often difficult. The aim of this retrospective study was to evaluate and compare the value of Tc-99m pertechnetate radionuclide imaging and ultrasonography in the differentiation of acute testicular torsion and inflammatory testicular diseases. METHODS: Twenty patients (age range, 5 to 38 years) with possible acute testicular torsion from July 2000 to July 2001 were enrolled in this study. Ultrasonography was performed in all patients in the emergency room. Within 3 hours of ultrasonography, radionuclide imaging was also performed after intravenous injection of 5 to 15 mCi Tc-99m pertechnetate in the forearms. All of the patients with clinically suspected acute testicular torsion underwent surgery. The surgical findings and pathologic reports of these patients were reviewed and definite diagnoses were established. None of the other patients had surgery and were followed clinically for at least 1 month after ultrasonography and radionuclide imaging. RESULTS: Four patients with testicular torsion, 13 patients with inflammatory testicular disease, and three healthy persons had a final surgical and pathologic diagnosis or clinical follow-up, and all were accurately diagnosed by Tc-99m pertechnetate radionuclide imaging. In contrast, ultrasonography was less accurate in the diagnosis and differentiation of acute testicular torsion from inflammation. Only 1 of 4 patients with testicular torsion, 5 of 13 patients with inflammatory testicular disease, and 2 of 3 healthy persons were diagnosed by ultrasonography. CONCLUSIONS: The results indicate that Tc-99m pertechnetate radionuclide imaging is a more useful and accurate imaging method than ultrasonography in the detection and differentiation of acute testicular torsion from inflammatory testicular disease in patients with acute scrotal pain.

Acute Disease↗
PubMed2004

Personality characteristics of women before and after recovery from an eating disorder.

BACKGROUND: Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology. METHOD: Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN + BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology. RESULTS: Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women. CONCLUSIONS: Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.

Adult↗
PubMed2005

Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. METHOD: Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria. RESULTS: The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05). CONCLUSION: Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.

Adolescent↗
PubMed1998

Personality characteristics of temporomandibular disorder patients using M.M.P.I.

It is generally recognized that psychological factors play an important role in chronic orofacial pain patients. This study analysed psychological profiles of chronic pain patients affected with temporomandibular disorders (TMD), by means of the Minnesota Multiphasic Personality Inventory (MMPI) test. Fifty consecutive TMD patients were examined and were then divided into two subgroups: 1. myofascial pain and 2. temporomandibular joint articular disorders. Sixty-two percent of the whole sample presented pathological MMPI scores. Both subgroups presented similar profiles with alteration of the neurotic triad (hypochondriasis, depression, hysteria), and pathological values of hypochondriasis and hysteria ("V" configuration). Since the personality profile did not differ between the two subgroups investigated, it was not dependent on the dysfunctional origin of the pathology (myalgia or primary TMJ pathology). Chronic TMD patients presented personality characteristics similar to those of other chronic pain patients according to the MMPI.

Adolescent↗
PubMed1986

Psychosocial issues in chronic obstructive pulmonary disease.

Chronic illnesses such as COPD require both comprehensive evaluations and multisystem treatment approaches with integration of biological, behavioral, psychological, and social systems. People function as biopsychosocial units, with complex interplay between themselves and their environments determining the degree of their illness. Illness, as distinct from disease, is a person's subjective response to the state of disease or organ pathology. Recognition and identification of the psychosocial components of a person's illness allows for far more effective therapeutic intervention. Treatment objectives include better acceptance of life changes and the development of new attitudes and goals through an increase in self-confidence and control over emotional, physical, and respiratory functioning. These rehabilitation goals can be fulfilled by the use of supportive therapies (individual, family, or marital and group) and educational behavioral techniques based upon a solid working alliance with the patient.

Adaptation, Psychological↗
PubMed1986

Pseudologia fantastica in the borderline patient.

An infrequently described clinical feature sometimes associated with borderline personality disorder is pseudologia fantastica, or pathological lying. The author describes four cases of pseudologia fantastica in borderline patients. Clinical, forensic, and treatment implications of this disorder are discussed.

Adolescent↗
PubMed1983

Identifying and preventing family-mediated abuse and neglect of elderly persons.

Unexplained trauma, neglected medical problems, failure to thrive, malnutrition, and misuse of medications may be manifestations of family-mediated abuse and neglect of the non-institutionalized elderly person. Physicians frequently overlook or misdiagnose this form of family violence. Access to these persons, assessment, and intervention are facilitated by focusing on the unmet care needs of the elderly person and by moving to meet those needs. Issues of intervention can be clarified by categorizing abuse or neglect as occurring in situations in which the dependency and care needs of the elderly person are paramount or in which the pathologic behavior of the abuser is most evident. The provision of specific support services or legally mandated separation of the elderly person and the abuser can be attempted but the elderly person's right to refuse any intervention must be recognized.

Aged↗
PubMedDate not supplied

[Occurrence of the metabolic syndrome in the population of the town of Novi Sad].

INTRODUCTION: Inadequate nutrition and physical inactivity are dominant health problems in general population resulting in high incidence and prevalence of noncommunicable diseases. Obesity (especially with central fat distribution), insulin resistance, hyperinsulinemia, hyperlipoproteinemia, dyslipoproteinemia and cardiovascular diseases are the main components of metabolic syndrome--Syndrome X. MATERIAL AND METHODS: Frequency of metabolic disorders characteristic for syndrome X are determined in a representative sample of Novi Sad town (1600 persons of both sexes, aged 25-64, of all professional levels). The response was 79.37%, so the sample included 1270 persons, in whom the following examinations were performed: history data, anthropometric measurements (height, weight, body mass index, weist to hips ratio), physical examination, blood pressure, biochemical analysis (fasting glycemia, oral glucose tolerance test (OGTT), total serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides). THE AIM: The aim of this research was to establish the frequency of obesity, types of obesity, glycemic status, disorders of glucose metabolism, disorders of lipid metabolism, frequency and type of hypertension, measurement of insulinemia and finally frequency of metabolic syndrome. RESULTS: The sample included 1270 persons. Among them 45.41% males and 32.64% females are obese. Extremely obese are 19.70% males and 27.12% females. W/H index > 1.0 was determined in 9.18% males while 48.82% females have W/H index 0.8-1.0. Fasting hyperglycaemia is present in 30.22% males and 20.86% females. Serum cholesterol > 5.20 mmol/l is determined in 74.96% males and 72.24% females. Arterial hypertension is diagnosed in 29.88% males and 23.40% females. In 82.75% persons of both sexes, aged 25-64, pathologic values among some of the followed-up characteristics are detected. In our sample syndrome X was suspected in 13.62% persons of both sexes (probability 50%) while 86.38% persons of both sexes are without risk for syndrome X (probability 70%). The best characteristic for dividing these two groups is W/H index (discriminatory coefficient 0.39). DISCUSSION AND CONCLUSION: In obese persons, especially in central obese persons, an active search for metabolic disorders which are present in syndrome X should be performed, because in that case measures of primary prevention can be applied.

Adult↗
PubMed2002

[Non-psychotic mental disorders in opioid abusers].

The purpose of the study was to estimate the structure and prognostic value of mental disorders in opioid addiction. 173 males and 34 females aged 16-58 years with opioid addiction duration from 6 months to 14 years were studied. Mental disorders were mostly expressed at the peak of withdrawal state and in the early post-withdrawal period but they occurred at other stages of the illness. Anxiety was leading in the picture of psychic disturbances, representing some kind of "a psychopathologic background", on which other disorders (phobias, hypochondriac, psychopath-like and others) developed or intensified. Marked mental and physical discomfort intolerance dominates in personality change spectrum of the opioid users. The anxiety intensity did not correlate with withdrawal symptom-complex severity. But anxiety state plays an essential role in nonpsychotic disturbance formation and addictive disorders proper. Stable and progredient anxiety hypochondriac disorders determine a pathological development of the patient's personality and unfavourable disease prognosis.

Adolescent↗
PubMed2006

Neuropathology of older persons without cognitive impairment from two community-based studies.

OBJECTIVE: To examine the relation of National Institute on Aging-Reagan (NIA-Reagan) neuropathologic criteria of Alzheimer disease (AD) to level of cognitive function in persons without dementia or mild cognitive impairment (MCI). METHODS: More than 2,000 persons without dementia participating in the Religious Orders Study or the Memory and Aging Project agreed to annual detailed clinical evaluation and brain donation. The studies had 19 neuropsychological performance tests in common that assessed five cognitive domains, including episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability. A total of 134 persons without cognitive impairment died and underwent brain autopsy and postmortem assessment for AD pathology using NIA-Reagan neuropathologic criteria for AD, cerebral infarctions, and Lewy bodies. Linear regression was used to examine the relation of AD pathology to level of cognitive function proximate to death. RESULTS: Two (1.5%) persons met NIA-Reagan criteria for high likelihood AD, and 48 (35.8%) met criteria for intermediate likelihood; 29 (21.6%) had cerebral infarctions, and 18 (13.4%) had Lewy bodies. The mean Mini-Mental State Examination score proximate to death was 28.2 for those meeting high or intermediate likelihood AD by NIA-Reagan criteria and 28.4 for those not meeting criteria. In linear regression models adjusted for age, sex, and education, persons meeting criteria for intermediate or high likelihood AD scored about a quarter standard unit lower on tests of episodic memory (p = 0.01). There were no significant differences in any other cognitive domain. CONCLUSIONS: Alzheimer disease pathology can be found in the brains of older persons without dementia or mild cognitive impairment and is related to subtle changes in episodic memory.

Age Factors↗