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Igovskaia AS. [A case of successful psychotherapy of schizoid personality disorder with hypochondria using the method of creative self-expression]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:74-78. [PMID: 21898950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Zalutskiĭ IV, Makhnach LM, Zhukovets AG, Shishkovskaia OA. [Influence of psychological and psychopathological features of cancer patient personality on their attitudes towards the disease]. Vopr Onkol 2010; 56:687-691. [PMID: 21395125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Our paper deals with psychological and psychopathological features of cancer patient personality. Our data deals with on influence of such characteristics on attitudes of cancer patients towards the disease. The impact of pre-morbid features of patients on their attitudes was established. It was shown that maladapted patients with both intra- (neurasthenia, anxiety, hypochondria, ascetism) and inter-psychic (sensitivity) features Our results may contribute to development of efficient methods of copying strategy connection which in turn may alleviate dysadaptation of cancer patients.
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Rebok F, Pérez Roldán ML, Daray FM. [Hypochondriacal delusions in paraphrenias: a historiographical and clinical review]. Vertex 2009; 20:213-220. [PMID: 19652777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hypochondriacal delusions may eventually appear in chronic psychosis. Some authors have proposed the existence of a chronic delusional disease named Hypochondriacal Paraphrenia in which these delusions constitute its main feature. In the present article we discuss the nosological validity of the Hypochondriacal Paraphrenia and its independence from other subtypes of Paraphrenias. With this aim, an historical review of the position of the hypochondriacal symptomatology was performed form the original definitions of Lasègue and Griesinger to the description of the Hypochondriacal Paraphrenia by Karl Leonhard. Then, three cases of patients with the diagnosis of Hypochondriacal Paraphrenia are presented. We conclude that the Hypochondriacal Paraphrenia is a valid and useful nosological construct.
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Affiliation(s)
- Federico Rebok
- III Cátedra de Farmacología, Facultad de Medicina, UBA. Hospital "Braulio A. Moyano".
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Thomas P, Hazif-Thomas C, Pareaud M. [Hypochondriasis and somatisation in elderly]. Rev Prat 2008; 58:1977-1981. [PMID: 19143266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Anxiety or masked depression are often associated with somatisation in elderly. Hypochondriasis is an excessive preoccupation or worry about having a serious illness. The DSM-IV defines it as a somatoform disorder. It affects about 3% of the population but has a heavy health care cost. Depression, obsessive-compulsive disorder generalized anxiety and somatization disorder are common in elderly and are the most common accompanying conditions in people with hypochondriasis. Old persons' unexplained medical symptoms in generalized anxiety and their relationship to the somatoform disorders are presented. Supportive care and psychotherapy are as necessary as antidepressant to help patients.
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Affiliation(s)
- Philippe Thomas
- Service hospitalo-universitaire de psychogériatrie et Centre mémoire de ressources et de recherches, 87025 Limoges Cedex, France.
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Abstract
Pamela Harrington developed obsessive compulsive disorder with associated hypochondriasis 24 years ago. Eventually, a sympathetic and patient general practitioner enabled her to manage her condition
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Burno ME, Igovskaia AS. [Psychotherapy of patients with personality disorders with predominance of hypochondria]. Zh Nevrol Psikhiatr Im S S Korsakova 2008; 108:27-31. [PMID: 19156123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A standard of psychotherapeutic help to patients with hypochondriac disorder developed in paranoid, schizoid, anxiety and dependent personality disorders is worked out. In this case, hypochondria is inseparable from the personality structure. Patients of investigated group (61 people) received traditional medical treatment, individual differential symptomatic psychotherapy and a short group course with a variant of the therapy by means of creative sell-expression (TCSEB) worked out by M. Burno. This course aimed at preventing new hypochondriac symptoms and acquiring spiritual creative ways to overcome themselves. The control group (70 people) differed from the index-group by not receiving CSEB. A statistical analysis revealed a significant therapeutic efficacy of the mentioned new clinical psychotherapeutic standard compared to the psychotherapeutic tactics without TCSEB.
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Griffith NM, Szaflarski JP, Schefft BK, Isaradisaikul D, Meckler JM, McNally KA, Privitera MD. Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile. Epilepsy Behav 2007; 11:105-11. [PMID: 17602880 DOI: 10.1016/j.yebeh.2007.04.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 03/27/2007] [Accepted: 04/02/2007] [Indexed: 11/16/2022]
Abstract
Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.
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Abstract
Hypochondriasis (HC) involves preoccupation with fears of having a serious medical illness based on the misinterpretation of benign bodily perturbations. Individuals with HC also perform behaviors such as checking and reassurance-seeking presumably to reduce health-related fears. Experimental behavioral analyses of HC symptoms, however, are lacking. In the present study, 27 patients with HC were exposed to personally relevant health-related stimuli under one of two conditions: (a) subsequently performing safety-seeking behaviors (e.g., checking) (n=14) or (b) subsequently being instructed not to perform such behaviors (n=13). In both groups, subjective anxiety and urges to perform safety behaviors were monitored for 1h. Results indicated that exposure to the personally relevant health trigger provoked anxiety and urges to perform safety behaviors. For patients who performed such behaviors, these feelings were reduced. For patients who did not, a more gradual reduction of anxiety and urges was observed. Findings are discussed in terms of the conceptualization and treatment of HC behavior, and are relevant to HC's possible relationship to panic and obsessive-compulsive disorder.
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Affiliation(s)
- Jonathan S Abramowitz
- Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall CB 3270 Chapel Hill, NC 27599, USA.
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Atilganoğlu U, Uğurad I, Arikan M, Ergün SS. Monosymptomatic hypochondriacal psychosis presenting with recurrent oral mucosal ulcers and multiple skin lesions responding to olanzapine treatment. Int J Dermatol 2006; 45:1189-92. [PMID: 17040437 DOI: 10.1111/j.1365-4632.2006.02615.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Monosymptomatic hypochondriacal psychosis (MHP) is a form of psychosis characterized by the delusional idea that there is a serious problem in the skin or other body parts. Because MHP patients believe that their complaint is dermatological, not psychiatric, they often admit to several other medical disciplines before coming to a psychiatry clinic. This leads to a series of time-consuming examinations and treatment interventions. In this case report, we emphasize the importance of diagnosing the illness correctly and referring the patient to a psychiatrist. The patient presented in this report has been treated with a new generation neuroleptic, olanzapine. This treatment has led to complete resolution of delusional symptoms. Therefore, we conclude that knowing that MHP is a psychiatric illness allows early establishment of diagnosis and successful treatment.
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Jinsheng H. Acupuncture treatment of hypochondriac pain. J TRADIT CHIN MED 2006; 26:228-9. [PMID: 17078459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Hu Jinsheng
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Latas M, Starcević V, Trajković G. Relationship of psychiatric comorbidity and treatment of panic disorder and agoraphobia. SRP ARK CELOK LEK 2006; 134:267-72. [PMID: 17009602 DOI: 10.2298/sarh0608267l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Besides numerous studies that examined various aspects of comorbidity in patients with panic disorder and agoraphobia and numerous studies that examined efficacy of different treatment modalities in these patients, there was no study that examined relationship of overall psychiatric comorbidity and treatment of patients with panic disorder and agoraphobia. Objective. The objective of the study was to establish the effect of psychiatric comorbidity on treatment efficiency of patients with panic disorder and agoraphobia. Method. The sample of the study consisted of 119 patients with primary diagnosis of panic disorder and agoraphobia. The therapy of patients was based on the use of individual integrative model of treatment, which incorporated psycho-pharmaceuticals (benzodiazepines and antidepressants) and cognitive- behavior therapy. Symptom severity was estimated by Panic and Agoraphobia Scale before and after the completion of treatment. Patients with comorbidity and patients without any comorbidity were compared by MANOVA and ANOVA with repeated measures. Results. The results of the study showed that 91% of patients met diagnostic criteria of comorbid psychiatric disorder and these patients had more severe clinical picture than patients without any comorbid disorder before the treatment. The results also showed that, after the completion of treatment, there was a significant reduction of all analyzed symptoms, that the effects of treatment were significantly better in patients with psychiatric comorbidity and that comorbid psychiatric disorders had no negative effect on the main goals of the treatment. Conclusion. Based on these results, it may be concluded that: in patients with panic disorder and agoraphobia and comorbid psychiatric disorders, the pharmacotherapy must be based on simultaneous use of antidepressants and benzodiazepines, while standard cognitive-behavior therapy of patients with panic disorder and agoraphobia must be modified in case of the existing comorbid psychiatric disorders.
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Abstract
Psychological factors are believed to play a role in gastroesophageal reflux disease. It has previously been shown that preoperative illness behavior influences the outcome after laparoscopic Nissen fundoplication. Between August 2001 and June 2004 we considered a partly subjective assessment of illness behavior when selecting patients with gastroesophageal reflux disease for laparoscopic anterior partial (n = 77) or total fundoplication (n = 90). A prospective questionnaire study of illness behavior was also undertaken and the results were correlated with clinical follow up after 12 months. There was a statistically significant difference in age (P < 0.001), primary esophageal peristalsis on manometry (P = 0.037) and two illness behavior category scores related to hypochondriasis (P = 0.041 and P = 0.025) between laparoscopic anterior partial fundoplication and Nissen total fundoplication groups. Despite these differences, there was no significant correlation between preoperative illness behavior score and patient satisfaction in either group. There was a statistically significant negative correlation between the ability to express personal feelings and postoperative heartburn score in those who had a laparoscopic anterior partial fundoplication (P = 0.048). The clinical outcome in both groups was good to excellent in terms of postoperative heartburn and satisfaction scores. A tailored approach in the choice of wrap, taking into account psychological factors preoperatively, is an appropriate strategy for laparoscopic fundoplication.
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Affiliation(s)
- J D Hayden
- Department of Surgery, University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, Australia 5000
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Vossler DG, Haltiner AM, Schepp SK, Friel PA, Caylor LM, Morgan JD, Doherty MJ. Ictal stuttering: a sign suggestive of psychogenic nonepileptic seizures. Neurology 2005; 63:516-9. [PMID: 15304584 DOI: 10.1212/01.wnl.0000133208.57562.cb] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine if ictal stuttering (IS) is more common among patients with psychogenic nonepileptic seizures (PNES) than patients with epileptic seizures (ES). METHODS The authors prospectively reviewed the medical records, EEG-video recordings, and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scores of consecutive adults of normal intelligence diagnosed with either PNES or ES. RESULTS A total of 230 (117 PNES and 113 ES) patients were studied. PNES patients were older (p = 0.029), more likely to be female (p < 0.001), and had a shorter duration of seizure disorder (p < 0.001) than ES cases. Ten (8.5%) PNES subjects and no ES cases demonstrated IS. The proportion of patients with IS in these two groups was significantly different (p = 0.004). PNES patients with IS were of similar age as but had an even shorter (p = 0.010) duration of seizure disorder (mean = 3.0 years) than those without IS. Scores on the hypochondriasis, depression (D), and hysteria scales of the MMPI-2 were significantly higher among PNES subjects than in ES patients (p < or = 0.002). However, seven PNES patients with IS had a lower mean score on the D scale than did 98 PNES cases without stuttering (p = 0.005). This produced a more sharply defined "conversion V" appearance on the MMPI-2 graph in the stutterers. CONCLUSIONS Ictal stuttering was present in 8.5% of 117 consecutive patients with psychogenic nonepileptic seizures, but was not observed in a consecutive series of 113 adults with epileptic seizures. Patients with psychogenic nonepileptic seizures with ictal stuttering had a shorter duration of seizure disorder and a more prominent conversion profile on the Minnesota Multiphasic Personality Inventory than either patients with psychogenic nonepileptic seizures without stuttering or subjects with epileptic seizures.
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Affiliation(s)
- D G Vossler
- Epilepsy Center and Clinical Neurophysiology Laboratories, Swedish Neuroscience Institute, 801 Broadway #901, Seattle, WA 98122, USA.
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Pashkovskiĭ VE. [Clinical aspects of witchcraft delusions]. Zh Nevrol Psikhiatr Im S S Korsakova 2005; 105:7-11. [PMID: 15825225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.
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Ikenouchi A, Terao T, Nakamura J. A male case of monosymptomatic hypochondriacal psychosis responding to olanzapine: a case report. Pharmacopsychiatry 2004; 37:240-1. [PMID: 15470804 DOI: 10.1055/s-2004-832601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 62-year-old man with monosymptomatic hypochondriacal psychosis who failed to respond to paroxetine treatment. Olanzapine addition brought about dramatic improvement in the patient's condition and thereafter paroxetine withdrawal further eliminated his psychosis. These findings suggest that olanzapine itself may be effective for the treatment of monosymptomatic hypochondriacal psychosis. Further controlled studies are required, but this is the first report describing an olanzapine effect in a male patient with monosymptomatic hypochondriacal psychosis.
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Talbot M. Monosymptomatic hypochondriacal psychosis. Br J Vener Dis 2003; 79:425-6. [PMID: 14573846 PMCID: PMC1744736 DOI: 10.1136/sti.79.5.425-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Psychopathological investigation was conducted on the basis of the clinical observation of 23 subjects whose cenesthopathic symptoms began before 30 years of age. This illness is called 'adolescent cenesthopathy' based on the specificity of this mental condition to the adolescent period. Adolescent cenesthopathy is compared to schizophrenia, depersonalization, sensitive delusion of reference and other symptoms. Outstanding features of adolescent cenesthopathy are shown from the perspective of its difference from schizophrenia in terms of the specific characteristics of the symptoms in this disease.
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Affiliation(s)
- Hisashi Watanabe
- Department of Psychosomatic Medicine, Shiga Prefecture Adult Medical Center, Moriyama-city, Shiga, Japan.
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Kohira I, Ujike H, Katsu T, Ninomiya Y, Ohashi K. [A case of spinocerebellar ataxia type 6 with hypochondriasis and severe parkinsonism]. No To Shinkei 2001; 53:1119-22. [PMID: 11806119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report a case of 68-year-old woman who was diagnosed spinocerebellar ataxia type 6 (SCA 6) by genomic testing. She presented hypochondriasis, parkinsonism, and ataxia. Since the age of 60, she noted difficulty in walking due to dizziness, and MRI showed minimal cerebellar atrophy. She became unable to walk without assistance at the age 67. She was referred to us when she was 68 years old. She had no family history of cerebellar ataxia, and her general physical examination was normal. Her speech was fluent, with neither slurring nor scanning, and she complained of much anxiety regarding her physical condition and was diagnosed as having hypochondriasis. Neurological examination revealed parkinsonism consisting of small steppage gait, mask-like face, akinesia, rigidity of neck and limbs, and postural instability. She also showed cerebellar signs such as saccadic smooth pursuit, ataxia of upper and lower limbs, and increased tendon reflexes. Her parkinsonism had developed slowly and symmetrically yet she showed a lack of response to levodopa. Our results suggest that the genomic testing is useful for differential diagnosis for the diseases presenting ataxia and parkinsonism, even if the family history is negative.
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Affiliation(s)
- I Kohira
- Department of Neurology, Kochi Municipal Central Hospital, 2-7-33 Sakurai-cho, Kochi 780-0821, Japan
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Kitami K. [Interrelation between physical disease and chronic pain--importance of understanding myofascial pain syndrome]. Nihon Rinsho 2001; 59:1768-72. [PMID: 11554050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Myofascial pain syndrome(MPS) is characterized by its unique pathology on developing the intramuscular trigger points. The author performed the psychological tests(Cornell Medical Index, Tokyo University Egogram, Minnesota Multiphasic Personality Inventory) on 46 MPS patients to clarify the psychological background. Results revealed that the MPS patients had remarkable hypochondriacal tendency with irrational way of thinking. The author concluded that it is necessary to be hypochondriacal and irrational for the formation of apparent MPS with outstanding TPs. This fact suggests that TPs in MPS are the result of deteriorated central pain control mechanism that should actually suppress the mechanical constriction of damaged muscles.
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Affiliation(s)
- K Kitami
- Section of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
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Abstract
Hypochondriasis is frequently defined as a chronic condition distinct from anxiety and depressive disorders. Consecutive primary care attenders (n=25,916) were screened using the General Health Questionnaire and a stratified random sample (n=5447) completed a baseline diagnostic assessment. All patients with significant psychiatric symptoms and a random sample of remaining patients (n=3201) were asked to complete a follow-up diagnostic assessment 12 months later. Of patients meeting an abridged definition of hypochondriasis at baseline, 18% continued to do so at follow-up and an additional 16% continued to report hypochondriacal worries. 45% of those with hypochondriasis at follow-up also met criteria for DSM-IV anxiety or depressive disorder. Follow-up anxiety or depressive disorder was significantly associated with both onset and persistence of hypochondriasis. Hypochondriasis is moderately stable over time. The clear distinction between hypochondriasis and anxiety/depressive disorders suggested by ICD-10 and DSM-IV may be difficult to accomplish in practice.
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Affiliation(s)
- G E Simon
- Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA.
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Owczarek K. [Psychological profile of patients with psychogenic pseudoepileptic seizures]. Neurol Neurochir Pol 2000; 34:1155-63. [PMID: 11317492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Depending on the accepted definition of the nature of psychogenic pseudoepileptic seizures various values of their prevalence are reported in the literature from 5% to over 33% of cases referred to epilepsy treatment centres. According to our knowledge, in Poland these seizures occur in several thousand young individuals (mean age 25 years). The psychological determinants of these psychogenic seizures remain not clear. The purpose of the reported study was a psychological analysis of personality profiles of patients with psychogenic pseudoepileptic seizures and epileptic seizures using the results of Minnesota Multiphasic Personality Inventory test for the assessment of conversion as a possible mechanism of the occurrence of psychogenic pseudoepileptic seizures. Using long-term video-EEG monitoring the studied subjects were divided into two groups: group I of 30 subjects (25 women and 5 men) with exclusively psychogenic pseudoepileptic seizures, and group II of 27 subjects (23 women and 4 men) with exclusively epileptic seizures. Both groups were subjected to MMPI test. The averaged profiles of these groups differed in the level of hypochondria (Hs--p < or = 0.001) and hysteria (Hy--p < or = 0.005) statistically significantly, and were much higher in patients with psychogenic pseudoepileptic seizures than the depression parameter (D) statistically significantly (p < or = 0.001). Patients with epilepsy had the highest values of depression parameter (D), while Hs and Hy were statistically significantly lower (p 0.01). The analysis in subscales additionally confirmed the role of conversion in pseudoepileptic seizures.
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Affiliation(s)
- K Owczarek
- Kliniki Neurologii i Epileptologii Centrum Medycznego Kształcenia Podyplomowego w Warszawie
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Bennett EJ, Evans P, Scott AM, Badcock CA, Shuter B, Höschl R, Tennant CC, Kellow JE. Psychological and sex features of delayed gut transit in functional gastrointestinal disorders. Gut 2000; 46:83-7. [PMID: 10601060 PMCID: PMC1727796 DOI: 10.1136/gut.46.1.83] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relation of demographic and psychological factors to the presence and extent of gut transit impairment in the functional gastrointestinal disorders has received little attention. AIMS To compare the psychosocial and demographic features of patients with functional gastrointestinal disorders and delayed transit in one region of the gastrointestinal tract with those displaying more widespread delayed transit (that is, delay in two or three regions), and those with normal transit in all three regions. PATIENTS Of 110 outpatient participants who satisfied standardised criteria for functional gastrointestinal disorders, 46 had delayed transit in one region, 32 had delay in two or three regions, and 17 exhibited normal transit in all regions. METHODS Transit in the stomach, the small intestine, and the large intestine was assessed concurrently using a wholly scintigraphic technique; psychological status was assessed using established psychometric measures. RESULTS Patients with delayed transit displayed demographic and psychological features that contrasted with patients with normal transit in all regions. In particular, widespread delayed transit featured female sex, a highly depressed mood state, increased age, frequent control of anger, and more severe gastric stasis, while the features distinguishing normal transit were male sex and high levels of hypochondriasis. CONCLUSION These data suggest the existence of a distinct psychophysiological subgroup, defined by the presence of delayed transit, in patients with functional gastrointestinal disorders.
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Affiliation(s)
- E J Bennett
- Department of Psychological Medicine, University of Sydney, Australia
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Abstract
Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early stages of evaluation. Little is known about the treatment preferences and opinions of individuals seeking help for this problem. In this exploratory study, 23 volunteers from the community with a DSM-IV diagnosis of hypochondriasis were recruited through a newspaper advertisement. Participants were presented with a survey which included balanced descriptions of both a medication and a cognitive-behavioral treatment for intense illness concerns (hypochondriasis). The brief descriptions of the treatments discussed the time commitment required as well as the major advantages and disadvantages of each. Results showed that, relative to medication treatment, cognitive-behavioral treatment was predicted to be more effective in both the short and long terms and was rated as more acceptable. Psychological treatment was indicated as the first choice by 74% of respondents, medication by 4%, and 22% indicated an equal preference. Forty-eight percent of respondents would only accept the psychological treatment.
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Affiliation(s)
- J Walker
- Department of Clinical Health Psychology, University of Manitoba, Canada.
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Abstract
The course of panic disorder (PD) is often prolonged, but factors that affect the social outcome have not yet been made clear. The aim of this study was to find predictors of outcome for patients with PD. The subjects were 65 outpatients (28 men and 37 women) with PD (DSM-III-R) who were treated at our hospital for more than 1 year. The factors affecting 1-year outcome were evaluated by multiple regression analysis. We found that the following were predictors of poor social outcome in PD: (1) severe agoraphobia at the first psychiatric examination and (2) long duration of illness before the first psychiatric consultation. Furthermore, the complication of hypochondriacal symptoms predicted a poor outcome for PD. Early attention to agoraphobia and hypochondriasis is essential for the treatment of PD, and early introduction to psychiatric treatment is recommended.
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Affiliation(s)
- N Shinoda
- Department of Neuropsychiatry, Chiba University School of Medicine, Japan
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Otto MW, Demopulos CM, McLean NE, Pollack MH, Fava M. Additional findings on the association between anxiety sensitivity and hypochondriacal concerns: examination of patients with major depression. J Anxiety Disord 1998; 12:225-32. [PMID: 9653681 DOI: 10.1016/s0887-6185(98)00011-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hypochondriacal concerns ranging from disease phobias to bodily preoccupations are common among patients with panic disorder. In a previous study of patients with panic disorder, we found that, of a number of symptom dimensions examined, anxiety sensitivity was the strongest predictor of hypochondriacal concerns. This finding has been the topic of subsequent debate in the anxiety literature, with concerns raised whether true hypochondriacal concerns were confounded with typical panic-related concerns. To clarify this issue, we now report on the association between anxiety sensitivity and hypochondriacal concerns in 100 patients with major depression and no history of panic disorder. Consistent with our previous study, we found that of the symptoms examined--anxiety sensitivity, depressed mood, anxious mood, somatic symptoms, and anger/hostility--anxiety sensitivity was the strongest predictor of hypochondriacal concerns. Findings are discussed in relation to the role of catastrophic interpretations of somatic symptoms in depression, panic disorder, and hypochondriasis.
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Affiliation(s)
- M W Otto
- Cognitive-Behavior Therapy Program, Massachusetts General Hospital, Boston 02114, USA.
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Abstract
OBJECTIVE This study investigates psychological and psychobiological processes in patients with somatization syndrome. METHOD We compared physiological measures (heart rate, finger pulse volume, electrodermal activity, electromyography), cortisol levels, and subjective well-being during rest and during a mental stress task as well as selective attention and memory for illness-related words in 58 patients with somatization syndrome and 21 healthy controls. RESULTS The somatization group had higher morning salivary cortisol concentrations, higher heart rates, and lower levels of finger pulse volume. During the mental stress task, patients with somatization syndrome felt more distressed and had higher heart rates, whereas controls showed habituation to the experimental situation. We were unable to demonstrate an attention or memory bias specific for somatization. CONCLUSIONS The results point to several psychological, psychophysiological, and psychobiological mechanisms that might be involved in the maintenance of somatization syndrome. These results are discussed from a cognitive-psychobiological perspective.
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Affiliation(s)
- W Rief
- Center for Behavioural Medicine, Clinic Roseneck, Prien am Chiemsee, Germany
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30
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Chetta A, Gerra G, Foresi A, Zaimovic A, Del Donno M, Chittolini B, Malorgio R, Castagnaro A, Olivieri D. Personality profiles and breathlessness perception in outpatients with different gradings of asthma. Am J Respir Crit Care Med 1998; 157:116-22. [PMID: 9445288 DOI: 10.1164/ajrccm.157.1.9702093] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We studied the relationship between personality profiles, breathlessness perception and clinical and functional features in 36 outpatient asthmatics (12 females; age range: 18-52 yr). Each patient underwent psychometric evaluation with Minnesota Multiphasic Personality Inventory (MMPI). Breathlessness perception was evaluated by Borg's scale during methacholine (M) challenge, and PS20 (the perception score obtained when FEV1 fell by 20%) was recorded. Baseline FEV1 values ranged from 70.0 to 126%. PC20 M values ranged from 0.05 to 31.7 mg/ml. According to a symptoms score system (0 to 12 points), 12 asthmatics were classified as mild, 12 as moderate, and 12 as moderate/severe. We did not find any specific personality profile in asthmatic patients. Sixteen asthmatics had at least one MMPI subscale score indicative of psychological disturbances. We found a significant trend from mild to moderate and moderate/severe asthmatics (p < 0.015), when the number of asthmatics with subscale scores indicative of psychological disturbances was compared to that of asthmatics with normal scores. Moreover, we found that the asthmatics with scores indicative of hypochondriasis showed a significant trend from mild to moderate and moderate/severe asthma (p < 0.015). Furthermore, in all asthmatic patients, hypochondriasis scores were positively correlated to asthma severity score (p < 0.02). PS20 values ranged from 0.1 to 8.1. Twelve asthmatics were hypoperceivers (PS20 < or = 1) and four were hyperperceivers (PS20 > or = 5). We observed a significant trend from mild to moderate and moderate/severe asthmatics (p < 0.025) when we compared the number of hypoperceivers to that of normoperceivers. In conclusion, we found that in outpatients with different grading of asthma, severity of disease is linked to psychological disturbances and poor perception of breathlessness, additionally, hypochondriasis was related to disease severity in all patients.
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Affiliation(s)
- A Chetta
- Department of Respiratory Diseases, University of Parma, and Drug Addiction Research Center, Italy.
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31
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Abstract
Self-inflicted dermatoses are associated with personality disorders and psychoses, including monosymptomatic hypochondriacal psychosis (MHP), which is characterized by a delusion involving a particular hypochondriacal concern. We report an unusual case of MHP with severe mutilation of the skin complicated by a skull defect and brain abscess. The patient was a 66-year-old uneducated man who damaged his forehead repeatedly because he believed that a 'toxic root' in the forehead was the source of his general ailment. He admitted that the lesions were self-inflicted. There was no other evidence of psychosis or primary skin disease and MHP was diagnosed. Despite initial favourable response to pimozide, the patient was lost to follow-up for 4 years, during which he continued to damage his forehead and applied corrosive agents. He was then referred with a personality change and a 6 x 4 cm bony defect in the skull, complicated by herniation and abscess of the left frontal lobe. This case represents one of the most severe examples of self-mutilation ever reported. The differential diagnosis of dermatitis artefacta and the principles of treating MHP are discussed.
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Affiliation(s)
- C K Wang
- Department of Dermatology, National Cheng-Kung University Hospital, Tainan, Taiwan, ROC
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32
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Abstract
In a sample of 131 patients with panic disorder, we explored both the presence of DSM-III-R criteria for hypochondriasis and the occurrence of illness phobia before the onset of panic disorder. To explore further the possible relationship between hypochondriacal features and panic-agoraphobic syndrome, we compared patients both with and without current hypochondriasis and then patients both with and without illness phobia before the onset of panic disorder. Finally, we investigated the relationship between premorbid phobic-anxious traits and hypochondriasis during panic disorder. No differences were found between patients with and without hypochondriasis, either in terms of clinical features or in the course of panic disorder. Patients with illness phobia before the onset of panic disorder reported higher levels of anticipatory anxiety in nonagoraphobic situations and more depersonalization and derealization during panic attacks, and they met our definition of phobic-anxious temperament more frequently than the rest of the sample. This would suggest that illness phobia before the onset of panic disorder may be viewed either as a separate disorder, a prodrome, or a mild, early-onset form of panic disorder without full-blown attacks. Although patients with premorbid illness phobia are more likely to develop hypochondriasis after the onset of panic disorder, approximately 40% of them do not; therefore, illness phobia should not be considered the only factor that influences the development of hypochondriasis during panic disorder.
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Affiliation(s)
- A Benedetti
- Psychiatric Clinic, University of Pisa, Italy
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33
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Abstract
In this article, the epidemiology and differential diagnosis of monosymptomatic hypochondriacal psychosis are discussed in detail. The use of pimozide is also discussed and illustrated with case reports. Delusional patients are some of the most challenging cases based in dermatologic practice. This challenge is so much easier to meet if one knows how to approach these patients and feels comfortable in the use of pimozide.
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Affiliation(s)
- J Koo
- UCSF Psonasis Treatment Center, University of California, San Francisco Medical Center, USA
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34
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Abstract
A case report of a male patient with moderate degree of learning disabilities and monosymptomatic hypochondriacal psychosis is described, along with its pathogenic features and response to treatment.
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Affiliation(s)
- S Brooke
- Frith Hospital, Leicester, England
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35
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Abstract
This study describes a 2-part approach to the hypochondriacal patient: 1) a strategy for medical management, and 2) a specific psychiatric therapy. Medical management rests on the physician's recognition that patients have psychological and interpersonal reasons for feeling symptomatic and seeking medical attention. After gaining this appreciation, the physician can stop trying to cure the patient's symptoms, and the goal of management then shifts to assisting the patient in coping with the symptoms. A specific psychotherapy is then presented. Group discussions and cognitive and behavioral exercises are used to teach patients to moderate four factors that amplify somatic distress and hypochondriacal health concerns: the attention they pay to their symptoms, their thoughts about them, the context in which they experience their symptoms, and their moods.
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Affiliation(s)
- A J Barsky
- Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA
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36
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Abstract
OBJECTIVE This study examines the effects of two medical contexts on the relationship of hypochondriacal traits and their potential correlates. METHOD Correlates of hypochondriacal traits were compared from a matched sample of fifty-five general medical inpatients with a sample of fifty-five medical inpatients referred for psychiatric evaluation. Patients completed questionnaires assessing emotional distress and health attitudes, beliefs, and behaviors, and their attending physician completed ratings of the patient's illness and illness behavior. RESULTS Patients referred for psychiatric consultation exhibited significantly higher levels of hypochondriacal illness presentation than the matched nonreferred sample. Moderated regression analyses revealed three trends regarding the interactive effects of group status on the relationship of hypochondriacal traits to their potential correlates: 1) presence of angry feelings and interpersonal friction was positively associated with hypochondriacal concerns for the psychiatric referred patients only, 2) the tendency to deny life stresses and attribute all problems to the effects of illness was positively associated with a misinterpretation of the severity of their illness and hypochondriacal illness presentation for the psychiatric referred patients, whereas this association was negative for the nonreferred medical patients, and 3) the association of reports of emotional distress symptoms with hypochondriacal illness preparation was negative for the psychiatric referred patients and positive for the nonreferred medical patients. CONCLUSIONS Study results suggest that hypochondriasis may not represent a uniform nosological disorder and that the context of its study can significantly influence etiologic findings.
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Affiliation(s)
- P A Mabe
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta 30912-3800, USA
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37
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Shoda H. Obsessive-compulsive phenomenon in a so-called 'symptomarme schizophrenie': from the viewpoint of structural dynamics in defense mechanisms. Psychopathology 1996; 29:109-25. [PMID: 8861515 DOI: 10.1159/000284979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
(1)'Antieidos' is a formlessness that results from the reverse intentionality of the life formation and is considered to be a principle of obsessive psychosis. 'Internal emptiness' is supposed to exist in the nucleus of schizophrenia. 'Antieidos' and 'internal emptiness' are in close proximity, partly overlapping each other. Obsessive psychosis and some types of simple schizophrenia are considered to have a common intentionality for the obsessive-compulsive phenomenon from the viewpoint of defensive structural dynamics. (2) The obsessive-compulsive phenomenon and the hypochondriacal phenomenon that coexist in simple schizophrenia are considered to be a 'noema' (something in which a meaning is given to the intended experience) that results from 'noesis' (action of consciousness seen in the intended experience) which has a defensive intentionality and as a result masks the basic disturbance in schizophrenia. Complementarity between the obsessive-compulsive phenomenon and the hypochondriacal phenomenon structured in this way can form one type of disease in the nonself-introspective category of simple schizophrenia.
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Affiliation(s)
- H Shoda
- Department of Psychiatry, School of Medicine, Shinshu University, Matsumoto, Nagano, Japan
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Fukuda H, Saitoh K, Hirabayashi Y, Mitsuhata H, Kasuda H, Akazawa S, Shimizu R. [Spinal anesthesia for oophorectomy in a patient with pulmonary lymphangiomyomatosis accompanied by hypochondriasis]. Masui 1995; 44:563-565. [PMID: 7776523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 41-year-old woman with pulmonary lymphangiomyomatosis had been scheduled for bilateral oophorectomy which led to amelioration of the pulmonary pathology. The discrepancy between her dyspnea on exertion and lung function tests suggested that she had a marked tendency toward hypochondria. Therefore, we chose spinal anesthesia because of its technical simplicity, rapid onset, and effectiveness of some sedatives used perioperatively. Surgery was performed uneventfully. The anesthetic method mentioned above did not worsen respiratory function perioperatively. Spinal anesthesia is thought to be appropriate anesthesia for patients with pulmonary lymphangiomyomatosis, if feasible.
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Affiliation(s)
- H Fukuda
- Department of Anesthesiology, Jichi Medical School, Tochigi
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39
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Abstract
To examine the diagnostic stability and outcome of hypochondriasis, the authors followed 50 patients with this disorder and 50 age- and sex-matched control subjects after 1 year. After 1 year, two-thirds of the subjects continued to meet criteria for hypochondriasis, and the remaining third had persisting hypochondriacal symptoms. The hypochondriacal subjects were improved on most measures but still differed from the control subjects with regard to attitudes, perceptions, and behaviors that had distinguished them initially. More severe symptoms, longer duration of illness, and coexisting psychiatric illness were predictive of a worse outcome. The data indicate that the diagnosis of hypochondriasis is stable over time, and that, although symptoms wax and wane, characteristic features persist. The findings underscore the importance of diagnosing and treating hypochondriasis in medical outpatients.
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Affiliation(s)
- R Noyes
- Department of Psychiatry, University of Iowa College of Medicine, Iowa City
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40
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Hamon JM, Ginestet D. [Delusions of negation: 4 case reports]. Ann Med Psychol (Paris) 1994; 152:425-43. [PMID: 7978775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
After explaining Cotard's syndrome and its different developments from 1880 to 1992 by recelling the relations of nihilistic delusions with melancholia and pointing out the topicality of the research (more particularly in the last ten years), we'll give an account of four clinical cases: two cases involving two women aged 69 and 82, undergoing a plain melancholic episode; a case of post-melancholia paraphrenia, and a case of systemized nihilistic delusions during a post-partum melancholia. In the four cases, recovery was achieved thanks to electroconvulsive therapy. The third stage of this work considers the phenomenological and descriptive, as well as physiological and psychoanalytical assumptions adopted by the authors. Lastly, a psychopathological explanation is suggested both from a nosographical point of view, in which nihilism is both a mechanism and a delirious theme, and from a "modelization" point of view distinguishing two stages in Cotard's syndrome: nihilism, and delirious reconstruction strictly speaking. Here will use the concept of negative hallucination which we think underlies this delirium, and from this idea, we'll eventually try to demonstrate how relevant the Freudian theory is in this field.
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Affiliation(s)
- J M Hamon
- Centre Hospitalo-Universitaire P., Brousse, Villejuif
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41
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Luque Luque R, Valls Blanco JM. [Cotard's syndrome: historical and conceptual aspects]. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1994; 22:178-88. [PMID: 7810374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The history of the concept of Cotard's syndrome is traced from its inception in 1880 to the present day. Nihilistic delusions were described by Cotard to refer to a special type of hypochondriacal delusion associated to melancholia. Although Cotard himself and other XIX and XX centuries' psychiatrists have considered it from different approaches a specific clinical entity, most of the authors estimate that nihilistic delusion is either a syndrome or a symptom which can appear in different psychiatric disorders.
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Hänninen T, Reinikainen KJ, Helkala EL, Koivisto K, Mykkänen L, Laakso M, Pyörälä K, Riekkinen PJ. Subjective memory complaints and personality traits in normal elderly subjects. J Am Geriatr Soc 1994; 42:1-4. [PMID: 8277103 DOI: 10.1111/j.1532-5415.1994.tb06064.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states. DESIGN Cross-sectional two-group comparison. SETTING The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland. PARTICIPANTS Originally 403 subjects aged 67-78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis. MEASUREMENTS Screening and follow-up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired-associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale. RESULTS Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging. CONCLUSIONS The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.
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Affiliation(s)
- T Hänninen
- Department of Neurology, University of Kuopio, Finland
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43
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Abstract
A 45-year-old man was admitted with a hair growth delusion and depressive symptoms. The delusion persisted for three years and disappeared after a manic episode. This odd delusion has some similarities with lycanthropy.
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Abstract
This prospective study was undertaken to assess personality differences among patients with chronic pelvic floor disorders. Sixty patients (43 females and 17 males) of a mean age of 58 (range, 33-87) years with fecal incontinence (n = 19), constipation (n = 30), or levator spasm (n = 11) had a mean duration of symptoms of 35 (range, 2-50) years. The Minnesota Multiphasic Personality Inventory (MMPI) was utilized for psychologic assessment for all patients prior to treatment. Mean scores for scales 1 (hypochondriasis), 2 (depression), and 3 (hysteria) were significantly elevated for the levator spasm group (71, 75, and 73, respectively). A similar pattern was seen for the constipation group, where the mean scores for scales 1 and 2 were significantly elevated (70 and 74, respectively) with a moderate elevation on scale 3 (68). The hypochondriasis (1), depression (2), and hysteria (3) scales are referred to as the "neurotic triad," and profile patterns such as these indicate that these subjects may manifest their psychologic distress as physical symptoms. By contrast, the fecal incontinence patients were within the normal range on all scales. The information from these MMPI profiles can be used to understand the personality and emotional composition of these patients to assist in their evaluation and treatment.
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Affiliation(s)
- S Heymen
- Department of Psychiatry, Cleveland Clinic Florida, Fort Lauderdale 33309
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45
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Abstract
OBJECTIVE This review will focus on aspects of the postconcussion syndrome (PCS), including accompanying symptomatology, neuropsychological changes, brain imaging studies and treatment. METHOD In each topic area, those research studies resulting in the most interpretable data are reported. Since there is little research in some aspects of the PCS, some studies of limited merit are described, with their limitations outlined, in lieu of not reporting any study. The section on psychopharmacology largely consists of opinions of recognized clinicians, since there is almost no research on the psychopharmacology of PCS. RESULTS Mild traumatic brain injury is a relatively frequent occurrence which often results in the postconcussion syndrome (PCS), consisting of complaints of irritability, fatigue, headache, difficulty concentrating, dizziness, and memory problems. Anxiety and depression are also frequently present, especially later in its course. Although the PCS has often been thought to reflect a psychological response to injury, there is considerable recent evidence to suggest that it is primarily a physiologic disturbance. For most individuals, treatment consists primarily of education of the patient and his/her family, along with supportive counseling regarding emerging problems at work or at home. A subgroup of patients, however, may require psychopharmacologic intervention. CONCLUSION More research is needed in all aspects of PCS, especially its neurophysiology and pharmacologic treatment. Relationships between neurophysiological changes and behavioral and neuropsychological changes are unknown. New imaging techniques, such as single-photon emission tomography, and positron emission tomography will likely play an important role in understanding the physiology of this disorder.
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Fallon BA, Javitch JA, Hollander E, Liebowitz MR. Hypochondriasis and obsessive compulsive disorder: overlaps in diagnosis and treatment. J Clin Psychiatry 1991; 52:457-60. [PMID: 1744062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hypochondriasis is a disorder for which there are no established effective treatments. Hypochondriacs, in their obsessions about illness, compulsions to check with others, and failure to be reassured, share many features in common with those who have obsessive compulsive disorder (OCD). METHOD The authors present a case series of six patients with DSM-III-R hypochondriasis, five of whom also had a history of OCD. Two of the six agreed to be treated with doses of fluoxetine typically used to treat OCD. RESULTS Both patients, one of whom had no past history of OCD, showed a marked improvement in hypochondriacal symptoms. CONCLUSION These findings suggest that a subgroup of patients with hypochondriasis may be particularly responsive to serotonin reuptake blockers.
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Affiliation(s)
- B A Fallon
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University
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47
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Abstract
OBJECTIVE This study examined the relation between hypochondriasis and age while controlling for the possible confounding influences of medical morbidity, social isolation, and other psychiatric disorder. METHOD Consecutive patients attending a general medical clinic on randomly selected days were screened with a hypochondriasis self-report questionnaire. Those whose scores exceeded a preestablished cutoff level and a random sample of those who scored below it completed a research battery consisting of self-report questionnaires and structured interviews for DSM-III-R diagnoses of hypochondriasis and other axis I disorders. The patients' medical records were audited, and their physicians completed questionnaires about them. The 60 patients who met the DSM-III-R criteria for hypochondriasis at interview constituted the study group, and 100 patients randomly chosen from among those who scored below the cutoff for hypochondriasis constituted the comparison group. RESULTS The hypochondriacal group was not older than the comparison group. Hypochondriacal patients aged 65 years and over did not differ significantly from younger hypochondriacal patients in hypochondriacal attitudes, somatization, tendency to amplify bodily sensation, or global assessment of their overall health, even though their aggregate medical morbidity was greater. The elderly hypochondriacal patients had higher levels of disability, but this appeared to be attributable to their medical status rather than to any increase in hypochondriasis. Within the comparison sample, subjects aged 65 years and over were not more hypochondriacal than those under 65 years of age. CONCLUSIONS Hypochondriasis is found to some degree in all patients and appears to be unrelated to age.
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Affiliation(s)
- A J Barsky
- Department of Psychiatry, Harvard Medical School, Boston, MA
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49
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Langer D. [A case of fear of AIDS]. Psychiatr Pol 1991; 25:75-7. [PMID: 1780379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- D Langer
- III Kliniki Psychiatrycznej Instytutu Psychiatrii i Neurologii
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50
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Bulbena A, Martín-Santos R, Mateo A, Gelabert A. [Koro syndrome: 1st case in Spain]. Med Clin (Barc) 1990; 94:36. [PMID: 2335975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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