Pain-patient MMPI subgroups: the psychological dimensions of pain

Two-hundred-forty male pain patients were given the MMPI and an extensive pain history questionnaire. A hierarchical clustering procedure was used, and three distinct profiles emerged. One profile was essentially "normal," while a second profile revealed the "hypochondriasis" configuration, and a third was highly elevated on scales which reflect a "psychopathological" type of profile. A discriminant analysis yielded functions correctly classifying over 90% of the subjects in each group. Although the three groups did not significantly differ on age, education, income, IQ, assertiveness, type of pain, or years of pain duration, they did differ on the pain history questions relating to pain severity and pain impact on their lives. The psychopathological group reported significantly more distress than the hypochondriasis group, and the hypochondriasis group reported significantly more distress than the normal group. The implications for pain treatment are discussed.

Depression in older persons: diagnosis and management

Depression is a common psychiatric disturbance of late life that is frequently not recognized by nonpsychiatric physicians. Confusion in psychiatric nosology, variability in clinical presentation, increased frequency of medical disease and medication use and cultural biases toward older persons complicate the diagnosis. Detection of depression is important because often this disorder can be successfully treated.

Hypochondriacal complaints among Hong Kong children: a mental health hazard?

The incidence of hypochondriacal complaints among clinic attenders at a general outpatients clinic is in the region of 51/thousand (51 per 1,000). A series of 33 children were studied in detail. It was found that their age range from 1 1/2-14 with a mode of 8-10 years, females having a slight predominance (1.33:1). They usually came from lower social-economic backgrounds but a substantial portion also came from social class 2. Among his latter group, psychological complaints predominate. Pain remained the most frequent complaint. There was also a predominance of complaints confined to the respiratory tract, a tendency which could be explained on a cultural and public-health basis. It was also found that only very few of the children in the study had previous hypochondriacal traits, a fact which contrasted sharply to those of their parents in whom hypochondriacal traits predominate. Hypochondriacal children, when treated, had good prognostic outcomes. Two areas of special significance in future researches are: 1. The importance of parental influence on the health attitudes of children. 2. Whether hypochondriacal children contribute significantly towards adult jupochondriasis (Primary or Secondary).

Case conference from Cornell. Case 6: depression and hypochondriasis in a patient with peptic ulcer disease

We are going to present a patient who was admitted to the hospital with a major depressive disorder. Somatic complaints and hypochondriasis were prominent in her symptomatology and occurred in a setting of known ulcer disease. Dr. Richard Breslow will present the case and a discussion of psychological aspects of ulcer disease. I will discuss the treatment of patients with hypochondriacal depressions.

Depression in the elderly. I. Relationship between depression, psychologic defense mechanisms and physical illness

Diagnosis of depression in the elderly is sometimes difficult owing to the presence of ego defensive mechanisms or somatic symptoms that can disguise the affect. Depression also may precede, or be associated with a variety of medical illnesses which are common among older persons. Specific ego defenses and representative medical illnesses are discussed. The concepts of a depressive equivalent and pseudodementia, which particularly act to disguise the depression, are reviewed in detail.

[Investigation in patients with central serous retinopathy with the MMPI Saarbrücken (author's transl)]

Patients with angiographically proven C.S.R. were investigated with the MMPI. They showed significantly higher scores on the hypochondria and hysteria-scale. The idea, that C.S.R. is an ocular psychosomatic disease is supported by the profile pattern, which shows an elevation of the "Neurotic Triad" with the characteristically depressed "Psychosomatic Valley".

Depression in the aged: dynamics and treatment

Depression is one of the common threats to the mental health of the aged. The chief cause is the interiorization of the personality and the growth of inferiority feelings due to poor adjustment to retirement, widowhood, and/or chronic physical conditions. Psychotherapy for geriatric depression can be done by a primary care physician. Specific guidelines are given for the use of psychotherapy, psychotropics, and electroconvulsive therapy (ECT) with aged patients suffering from depression in conjunction with various complications (suicidal risk, chronic brain syndrome, hypochondriasis, and paranoia).

Psychological effects of symptoms associated with labyrinthitis. a case study

The psychological effects of postviral labyrinthitis in a patient who had been undergoing intensive psychotherapy are reported. The mildness of the physiological symptome was in contrast to the magnitude of the psychological consequences. The general psychological effects of illness on the patient are differentiated from the specific psychological correlates of vertiginous symptoms. The factors that contributed to the psychological effects and the psychological impact of these symptoms are discussed. There is a special potency to the cited effects in patients with specific personality characteristics.

A study of agoraphobic housewives

Thirty married agoraphobic women referred to out-patient clinics in Edinburgh were compared with 'normal' controls (selected from GP records and screened for the absence of psychiatric symptoms) matched on age, sex social class and marital status. The agoraphobics' husbands were similarly compared with the husbands of the controls. On most measures of attitudes, behaviour, domestic organization and marital interaction, the 2 groups were strikingly similar.

Dream mirrors

The mirror is not so rare a dream element as has been thought; and its appearance may mark a critical point in an analysis. Intact mirrors with clear images are reported when the dreamer has made a creative integration of previously threatening material, while mirrors that are shattered or multiplied or without reflection are accompanied by evidence of terror and a lower level of psychological organization. Study of mirror dreams can further clarify the nature of the dream screen and the role of illusion in early interactions and development.

A depressive syndrome responsive to lithium. An analysis of 20 cases

The authors analyze a series of 20 patients seen over the past 4 years who have shown a dramatic improvement following the introduction of lithium carbonate to their therapy. The results indicate that these patients showed a consistent syndrome with the following features: a) anergic endogenous depression; b) positive family history in first degree probands; c) obsessional personality traits and symptoms; d) hypochondriasis and somatic symptoms; e) failure to respond to previous antidepressant therapy with tricyclic and MAOI compounds as well as ECT. A previous study by Gittleson showed that one third of a series of psychotic depressives admitted to the Maudsley Hospital, London, also displayed obsessional symptoms and hypochondriasis. These patients, however, seemed to do as well with standard antidepressant treatment as a control group of psychotic depressives without obsessional features. However, in this series, there was a 7 per cent residue whose obsessional symptoms worsened, even after recovery from their depression. The authors' group of patients represented approximately 3 per cent of all psychotic depressives seen over the 4-year period and could, therefore, coincide with Gittleson's residue. The mean age of onset of illness in the authors' depressive group was 45.5 years, and this finding, coupled with the high incidence of psychotic depression in first degree relatives, indicates that these patients were suffering from a psychotic depression modified by personality traits, rather than an atypical obsessional neurosis. The consistency of clinical features and specificity of response to lithium therapy appear to indicate that this is a clearly definable clinical syndrome worthy of further investigation.

Personality patterns in insomnia. Theoretical implications

Subjects with a primary complaint of insomnia (N = 124) were evaluated with Minnesota Multiphasic Personality Inventories (MMPIs). A high percentage of subjects (85%) had one or more MMPI scales elevated to a pathological degree. The scales most elevated were, in order. 2 (depression), 7 (psychasthenia), and 3 (conversion hysteria). A striking finding was the preponderance of depression. This was indicated by the frequency in which scale 2 was elevated above 70, the frequency in which this this scale had the highest elevation, and the frequency of MMPI code types that included scale 2. Four common MMPI code types representing various types of depression were noted, indicating considerable homogeneity for code types in this sample. The predominant personality styles in this sample were characterized by the internalization of psychological distrubances rather than by acting out or aggression. We propose that this internalization produces a state of constant emotional arousal and resultant physiological activation and that this process is a psychophysiological mechansim underlyling insomnia.

The nature of bodily symptoms

Psychiatric descriptions of bodily symptoms have usually been derived from narrowly restricted clinical experience. It is argued that it is more useful to review evidence from all medical settings and occurrence, nature, disability and presentation are here discussed. Syndromes of hypochondriacal reactions appear to be extreme and uncommon manifestations of a universal potential.

Psychiatric morbidity and the menopause: clinical features

A sample of 114 women from the general population aged 40-55 years were identified as possible psychiatric cases and subjected to a standardised psychiatric interview. Mean ratings for reported symptoms and observed abnormalities were assessed in relation to menopausal status. There was no evidence of any specific combination of symptoms and signs associated with the cessation of menstrual periods, though after the menopause insomnia and hypochondriacal preoccupations were more common. In comparison with matched normal controls have been previous psychiatric illness, and contact with general practitioners was more frequent. Many women developing psychiatric symptoms at the time of the menopause appear to belong to a vulnerable population who are likely to develop symptoms in relation to stress.

[Investigation with the MMPI saarbrücken in patients with ulcerative colitis (author's transl)]

The aim of our investigation was to establish whether certain personality traits of patients with ulcerative colitis could be subjected to verification by means of a controlled psychological test. 30 patients with ulcerative colitis and 30 "healthy" control persons were tested with the MMPI Saarbrücken. The colitis patients differed from the control persons in respect of their significantly higher scores on the hypochondria scale, the depression scale, the paranoia scale and the scale measuring social introversion. These higher scores proved to be independent of duration of illness. On the other scales there were no significant differences.

Monosymptomatic hypochondriasis, abnormal illness behaviour and suicide

Two cases of chronic monosymptomatic psychogenic eye pain with abnormal illness behaviour are presented. Both failed to respond to a wide variety of treatments, and despite the accepted low suicidal risk in hypochondriasis both killed themselves. The origin, prognosis and therapy of such behaviour are discussed in this context.