[Psychogenic respiration disorders, psychogenic bronchial asthma, and psychoallergic asthma].
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Asthma↗
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Accuracy of the clinical diagnosis of 'psychogenic disorders' in the presence of physical symptoms suggesting a general medical condition: a 5-year follow-up in 162 patients.
OBJECTIVE: The range of unnoticed physical disorders in patients diagnosed with a psychogenic disorder varies widely. We investigated the accuracy of the clinical diagnosis of 'psychogenic disorder' where physical symptoms suggesting a somatic condition (PDPS) are present. METHOD: All 162 cases of PDPS diagnosed between 01.01.1986 and 31.12.1987 in a medical clinic specializing in psychosomatic medicine were reviewed after 5 years. 148 follow-ups were complete. Initial diagnoses had been established using positive criteria for psychogenic diagnosis in a semistructured interview and a comprehensive clinical workup by trained clinicians. RESULTS: In 2 (1.35%) foreign-language patients of 148 an orthopedic diagnosis had been missed. In 6 patients, the family physician gave formerly known findings a different interpretation. Half of these patients were foreigners; 5 were men; none improved; 5 had back pain. CONCLUSION: A semistructured interview and positive criteria for psychogenic diagnosis permitted high diagnostic accuracy with an error of 1.35% in 148 cases.
Adult↗
Psychogenic gait disorders.
Psychogenic disorders of posture and gait are common and are the major manifestation in 8 to 10% of patients with psychogenic movement disorders. The colorful history of these disorders is reviewed. Anxiety and depression are the commonest psychological accompaniments of functional gait disorder in contemporary practice. The particular case of the cautious gait and its flip side, "fear of falling," are considered in more detail. Common presentations for somatoform disorders and malingering are also described. It is often possible to make this diagnosis based on recognition features and gait observation. Incongruous neurologic signs are commonly found, and several features are so typical as to be nearly diagnostic. Caveats and pitfalls in diagnosis based on observational features are noted. In particular, the cautious gait is often the presenting feature of an older patient with an organic balance impairment. An approach to the patient with psychogenic gait disorder is described. Although the nature of the problem is often quickly apparent in such patients, the optimal management is a challenge. Dramatic cures still occur, and some patients respond quickly to psychological management and rehabilitation therapies, but persistence for more than 6 to 12 months is frequently associated with an unfavorable prognosis and long-term disability. The outcome studies are reviewed.
Anxiety↗
[Psychogenic disorders: concepts, terminology and classification].
The neurological interest on functional or psychogenic disorders (mental or physical disturbances with no organic basis, generally unleashed by stressful situations) has been receiving increasingly more interest over the last few years. In this article we review concepts, terms and classifications of these disorders, very different over time and among different authors. Psychogenic disorders are divided into: a) dissociation (with memory, consciousness and self-identity impairment), and b) disturbances with somatizations, divided into somatoform (unconscious), factitious (voluntary search for patient's role) and malingering (searching for material gain). Special emphasis is placed on conversion or hysteria, included in somatoform disorders. New findings in functional neuroimaging are analyzed. These new data suggest an important role of unconscious and involuntary inhibition in loss of volition (similar to hypnosis and different from malingering). Normal activity in certain brain areas (motor or sensory cortex) is blocked by other areas related to emotional integration (anterior cingular and orbitofrontal cortex). The neurologist's role is important to achieve an early diagnosis of psychogenic disturbances, particularly conversive ones. This means the use of fewer economic resources and better prognosis for the patient.
Dissociative Disorders↗
[Clinical problems of sex. 9. Diagnosis and treatment of sex disorders: with special reference to psychogenic disorders].
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Female↗
How to identify psychogenic disorders of stance and gait. A video study in 37 patients.
Thirty-seven patients with psychogenic disorders of stance and gait were clinically evaluated, recorded on video, and analysed with regard to clinical phenomenology. Characteristic, suggestive and unspecific features were identified. Six characteristic features proved most valuable for diagnosis of psychogenesis, as they occurred alone or in combination in 97% of patients: (1) momentary fluctuations of stance and gait, often in response to suggestion; (2) excessive slowness or hesitation of locomotion incompatible with neurological disease; (3) "psychogenic" Romberg test with a build-up of sway amplitudes after a silent latency or with improvement by distraction; (4) uneconomic postures with wastage of muscular energy; (5) the "walking on ice" gait pattern, which is characterized by small cautious steps with fixed ankle joints; (6) sudden buckling of the knees, usually without falls. Seventy-three percent of patients had additional suggestive features. Classification into characteristic subtypes was not found useful because predominant features varied from patient to patient and occurred in various combinations. Factitious impairment of stance and gait was studied in 13 healthy drama students. Simulated gait dysfunction appeared less conspicuous and more difficult to diagnose than the clinical psychogenic disorders.
Adult↗
Psychogenic disorders of vision in childhood ("visual conversion reactions"): perspectives from adolescence: a research note.
Fifteen adolescents who had exhibited psychogenic disorders of vision in childhood were compared with a control group of adolescents who had experienced childhood visual dysfunction of organic origin. The principal modes of assessment were clinical interviews, the Parental Bonding Instrument (PBI), and self-report measures concerning specific personality traits. Adolescents who had previously presented with psychogenic disorder were more likely to (1) report having experienced school difficulties and the loss of a significant figure at the time of presentation, (2) rate their mothers as over-involved on the PBI and (3) report adjustment difficulties and obsessional personality traits in adolescence.
Adolescent↗
[Psychogenic disorders of stance and gait as seen in videotaping].
Psychogenic disorders of stance and gait were studied in 24 hysterical patients by video review analysis. In 30% of the cases, gait disorders were represented by pseudoataxia (gait with crossed legs or ataxia with sudden sidesteps); gait with dragging leg (sometimes with twisted foot and equino-varus posture); gait with flexed and/or buckling knees. Ancle and hip excess mobility, or hypermobility, proved to be rather typical, as well. The disorder types detected might be constant or first manifested themselves only during complicated gait (closed eyes, tandem walking, running). Fallings were the most frequent posture disturbances. An attention was drawn to phenomena indicative of involving environment of patient in symptom (pushing of furniture, falling on the physician) and to involving the means of nonverbal communications (space-touching hands, flailing arms, suffering facial expression etc). Phenomena revealed as a result of our investigation could be used in diagnostics of psychogenic gait and stance disorders.
Adult↗
Psychogenic disorders: a pragmatic approach for formulation and treatment.
Four perspectives can provide a comprehensive yet flexible approach to the evaluation of a patient in distress with a psychogenic disorder. Each individual patient will have a different combination of the four perspectives that formulate the patient's problems. The perspectives identify the patient with a psychogenic disorder as a patient who is a composite of personal vulnerabilities and strengths but afflicted with diseases, struggling through life events, and motivated to behave for various reasons. Each individual perspective has its own logical process for evaluation and subsequently directed treatment. Although the perspectives are complementary, they each remain distinct and essential to the formulation of a patient's disability. This comprehensive and integrated formulation of a patient supports an approach to complex psychogenic cases that defy a simple list of diagnoses and nonspecific treatments. The patient does not have to fit into one theoretical approach to receive an available treatment. The treatments prescribed are now designed from the individual formulation and relevant perspectives.
Adult↗
[Clinical evaluation of amitriptyline in the treatment of psychogenic disorders].
Clinical evaluation of amytyptiline in the treatment of psychogenic disorders was performed, using one or more 25 mg doses daily per os. Of the patients, 19 were male and 11 female; ages were between 18 and 55. Treatment for each lasted 12 weeks, and clinical improvement was observed from the second to the fifth week, with mild side effects that did not require treatment. Psychotherapy was instituted during treatment. ;inal results were: 23 good improvement, 4 some improvement and 3, no change.
Adolescent↗
[Prevention of psychogenic disorders of eating].
The author draws attention to the necessity to prevent psychogenic disorders of food intake with regard to their increasing incidence, factors conditioning their genesis and development, the serious character of their sequelae and the chronic character of the disorder. In addition to health educational programmes focused in particular on problems of nutrition, lifestyle, overweight and reasonable ways of its reduction, the author emphasizes also the necessity of early intervention.
Anorexia Nervosa↗
[The occurrence of less common psychogenic disorders in children].
The development of child neuroses must have certain rerequisites, in particular disposition (temperamental characteristic), an adverse situation in early childhood and a provoking conflict proper or a traumatic situation. To hysterical neuroses apply similar findings as to these disorders in adults; a hysterical neuroses is not always evidence of a hysterical nature. Psychogenic disorders in children may differ, the character of these complaints is not always typical. The complexity of the diagnostic process is demonstrated on two case--histories from which it is apparent that long--term treatment and examinations in somatic departments do not rule out the detection of the psychogenic aetiology of the somatic disorder. The first case--history is that of a twelve-year-old girl treated from the age of two years with antiepileptic drugs, in recent years the condition is compensated without treatment. After a conflict with a girl friend she developed pain in the hip joint which eventually resulted in the inability of spontaneous movement. After several months hospitalization at the orthopaedic department she was transferred to the psychiatric department where after hypnotherapy the conversion syndrome receded but the patient developed another psychopathological syndrome, impaired sexual identification. The second case--history is that of a twelve-year-old boy a re-trained left-handed with manifestations of balbuties. On account of sudden manifestations of torticollis leading to prolonged absence at school he repeated the class, for another three years he was treated by neurologists without effect. After admission to the psychiatric department he was treated by psychotherapy and placebo with a marked effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Child↗
[The age peculiarities of nonpsychotic forms of psychogenic disorders caused by everyday stressors].
Three groups of patients were examined in the period of 1994-1999: adolescent (aged 15-18 years), middle-aged (25-59 years) and elderly (60 years and older) with non-psychotic mental disorders developing under the influence of everyday stressors. The highest tolerability to stressors was detected in the middle-aged group. The dominating stressors in the groups were: social situations in the adolescences; interfamily conflicts--in the middle-aged patients and a presence of disease--in the elderly. Stressogenic affective disorders occurred most often in all the groups; anxious-phobic states prevailed in adolescents; neurotic pictures with hysteri-form symptoms, converse type--in the middle age and anxious phobic disorders with primary psychoorganic appearances--in the elderly. Risk factors for psychogenic disorders are: male sex, "organic predisposition", accentuation of the personality, "destructive" types of family bringing up in the adolescences; female sex, signs of endogenic diathesis and reactive lability for the middle-aged patients and female sex, aging factor and related changes of personality as well as somatic diseases in the elderly.
Adolescent↗
[Development of psychogenic disorders: an integrative model].
On the basis of clinical experience and empirically based data an integrative model of how psychogenic disorders develop is described in this article. The development-psychological steps of maturation from the uterine period to adolescence are examined with regard to the respective basic conflict to be derived from the step, and the disorder forms neurotization, structural disorder, and traumatisation are differentiated. Especially the process character of the respective development from the basic conflicts over the different coping strategies up to the symptom outbreak is emphasized.
Adaptation, Psychological↗
[Psychogenic Disorders in German soldiers during World War I and II].
In the First and Second World War German soldiers frequently suffered from psychogenic disorders. By comparison a change in the prevalences can be noted: in the First World War dissociative disorders dominated the clinical impression ("shell shock"), in the Second World War they could rarely be seen but were replaced by somatoform and psychosomatic diseases. The discussion about numerous reasons for this development has not been completed yet and is still not free from political attitudes. To achieve a more scientific point of view, the perspective of psychotraumatology might be helpful. According to psychotraumatic research, dissociative and somatoform disorders can emerge in a close relation to a Posttraumatic Stress Disorder. The choice of symptoms depends on personality traits of the victim, but also on specific factors that characterise the situation in which the trauma appears. The mixture of pathogenetic and protective influences includes e. g. the possibility of flight- or fight reactions, feelings of trauma-associated guilt and group cohesion in the military unit. These factors can be useful to help explain the change of symptoms between both wars. In addition the analysis of situational conditions in former wars can give hints to actual planning and prophylaxis strategies in modern military psychiatry, that has to adjust to very different military operation fields.
Culture↗
Psychogenic Movement Disorders.
Psychogenic movement disorders are one of the most challenging conditions encountered by clinicians. Patients with these disorders represent the overlap of psychiatry and neurology and need care from these specialties. Issues within the patient's family, questions about secondary gain, and prejudices among other clinicians often complicate evaluation and treatment. Diagnosis is further complicated by lack of laboratory and other tests to reliably diagnose movement disorders; most movement disorders are diagnosed based on history and clinical phenomena. Treatment is best conducted within the context of a multidisciplinary team experienced in working with these patients and with one another. Identification and treatment of underlying psychopathology, such as major depression or anxiety disorders, is also of great importance.
Journal Article↗
Long-term prognosis of patients with psychogenic movement disorders.
Psychogenic movement disorders (PMD) are hyper- or hypokinetic movement disorders associated with underlying psychological or psychiatric disorders. Structured telephone interview was administered to 228 patients with PMD seen in our clinic between 1990 and 2003. The mean age of the subjects was 42.3+/-14.3 years (range 14-70 years), mean duration of symptoms was 4.7+/-8.1 years (range 2-14 years), and mean duration of follow-up was 3.4+/-2.8 years (6 months-12 years). Improvement of symptoms was noted in 56.6% patients; while 22.1% were worse, and 21.3% remained the same at the time of follow-up. In this longitudinal study of patients with PMD we found that indices of strong physical health, positive social life perceptions, patient's perception of effective treatment by the physician, elimination of stressors, and treatment with a specific medication contributed to a favorable outcome.
Adolescent↗
Psychogenic movement disorders.
Psychogenic movement disorders (PMD) are challenging to diagnose and to treat. Since the nineteenth century, PMDs were recognized and described in painstaking detail. In the modern neurology clinic, PMDs may comprise 2-25% of the patient population. Recognition of the various types of PMDs, differentiation from organic illness and an approach to PMDs are described in this article.
Diagnosis, Differential↗