Conversion Disorder
Freudian Theory
Abreaction
Hysteria
Malingering
Neurology
Dissociative Disorders
Dyskinesias
MR line scan diffusion imaging of the brain in children. (1/88)
BACKGROUND AND PURPOSE: MR imaging of the self-diffusion of water has become increasingly popular for the early detection of cerebral infarction in adults. The purpose of this study was to evaluate MR line scan diffusion imaging (LSDI) of the brain in children. METHODS: LSDI was performed in four volunteers and 12 patients by using an effective TR/TE of 2736/89.4 and a maximum b value of 450 to 600 s/mm2 applied in the x, y, and z directions. In the volunteers, single-shot echo planar imaging of diffusion (EPID) was also performed. The patients (10 boys and two girls) ranged in age from 2 days to 16 years (average age, 6.6 years). Diagnoses included acute cerebral infarction, seizure disorder, posttraumatic confusion syndrome, complicated migraine, residual astrocytoma, encephalitis, hypoxia without cerebral infarction, cerebral contusion, and conversion disorder. In all patients, routine spin-echo images were also acquired. Trace images and apparent diffusion coefficient maps were produced for each location scanned with LSDI. RESULTS: In the volunteers, LSDI showed less chemical-shift and magnetic-susceptibility artifact and less geometric distortion than did EPID. LSDI was of diagnostic quality in all studies. Diffusion abnormalities were present in five patients. Restricted diffusion was present in the lesions of the three patients with acute cerebral infarction. Mildly increased diffusion was present in the lesions of encephalitis and residual cerebellar astrocytoma. No diffusion abnormalities were seen in the remaining seven children. CONCLUSION: LSDI is feasible in children, provides high-quality diffusion images with less chemical-shift and magnetic-susceptibility artifact and less geometric distortion than does EPID, and complements the routine MR examination. (+info)Are we overusing the diagnosis of psychogenic non-epileptic events? (2/88)
In order to determine how often results of video/EEG (V-EEG) studies may change the clinical diagnosis of paroxysmal events, we prospectively studied 100 consecutive patients (75 females, 25 males) admitted for diagnosis of recurrent paroxysmal spells. The presumed diagnosis of the referring physician was obtained. Episodes were classified as epileptic seizures (ES), psychogenic non-epileptic events (PNEE), or physiologic non-epileptic events (PhysNEE). Eighty-seven patients had diagnostic events. A final diagnosis of ES was made in 21 patients, PNEE in 39, PNEE + ES in 20, and PhysNEE in seven. All PhysNEE were unsuspected. ES were misdiagnosed as PNEE more frequently than the reverse (57% vs. 12%, P < 0.001). Among the 64 patients with recorded events who had been suspected of having PNEE, 14 (21.9%) were misdiagnosed: two had PhysNEE and 12 (18.75%) had ES. Among the 23 patients with recorded events who were thought to have ES, 12 (39.1%) were misdiagnosed: seven had PNEE, five PhysNEE. V-EEG changed the clinical diagnosis in 29.8% of the patients with recorded events. Our data suggests that clinicians have become more aware of PNEE since the advent of V-EEG and have little problem recognizing them. However, they may be more prone to make a false-positive diagnosis of PNEE in ES with some atypical features. At this point, efforts should be channeled to better training in the proper recognition of ES that mimic PNEE. (+info)Pseudo-narcolepsy: case report. (3/88)
This report describes the case of a 44-year-old woman presenting to a Sleep and Alertness clinic with symptoms of narcolepsy. The patient had clinical and polysomnographic features of narcolepsy, which disappeared after disclosure of severe psychological stress. Following a discussion of the differential diagnosis of narcolepsy, alternative diagnoses are considered. The authors suggest that the patient had a hysterical conversion disorder, or "pseudo-narcolepsy." Careful inquiry into psychological factors in unusual cases of narcolepsy may be warranted. (+info)Headaches and other pain symptoms among patients with psychogenic non-epileptic seizures. (4/88)
Studies of patients with psychogenic non-epileptic seizures (NES) typically focus upon the phenomenology and outcome of NES episodes. Little is known, however, about the frequency and nature of other somatic symptoms such as pain, in this population. To assess the frequency, location and severity of symptoms of pain among NES patients, we administered structured interviews to 56 patients, 6 or more months following the diagnosis of psychogenic non-epileptic seizures (NES). Patients were recruited from a tertiary hospital-based epilepsy monitoring unit. Seventy-seven percent of patients suffered from moderate to severe pain, most commonly headache (61%), while neck pain and backache were also common. Twenty-six of 27 patients with persistent NES vs. 17 of 29 patients whose NES resolved experienced moderate to severe pain (P < 0.001). Pain is an under-recognized problem that occurs frequently and with significant severity among NES patients. Pain symptoms are more common among patients with persistent NES than those whose NES resolve. (+info)An estimate of the prevalence of psychogenic non-epileptic seizures. (5/88)
The prevalence of psychogenic non-epileptic seizures is difficult to estimate. We propose an estimate based on a calculation. We used the following data, which are known or have been estimated, and are generally accepted. A prevalence of epilepsy of 0.5-1%; a proportion of intractable epilepsy of 20-30%; a percentage of these referred to epilepsy centers of 20-50%; and a percentage of patients referred to epilepsy centers that are psychogenic non-epileptic seizures: 10-20%. Using the low estimates, the prevalence of psychogenic non-epileptic seizures would be 1/50 000. Using the high estimates, the prevalence of psychogenic non-epileptic seizures would be 1/3000. The prevalence of psychogenic non-epileptic seizures is somewhere between 1/50 000 and 1/3000, or 2 to 33 per 100 000, making it a significant neurologic condition. (+info)Psychogenesis and somatogenesis of common symptoms. (6/88)
There are situations in clinical practice in which the physican should keep in mind the influence of emotional factors in the elaboration of symptoms and yet should not conclude hastily that "all is in the patient's mind". Symptoms are often the result of complex etiologic factors including life-threatening illnesses presenting psychologic symptoms as an early manifestation. Psychologic disorders and physical illnesses with similar symptoms may coexist in the same patient. There are also cases in which the symptoms are the result of the constant interaction of psychologic and physical factors. Some suggestions to help to clarify the diagnosis are given and a classification of the different clinical situations involved is presented. Becuase physicians should be constantly aware of the complexity of the factors involved in the elaboration of obscure symptoms, some recommendations are given in regard to undergraduate and graduate medical education. (+info)Hysterical aphonia--an analysis of 25 cases. (7/88)
Hysteria is a common neurotic disorder in psychiatric practice. Many of its conversion symptoms have not been studied in detail. In the present prospective study in a tertiary care teaching hospital, 25 cases of hysterical aphonia were analysed. There were 17 females and 8 males. Mean age of presentation was 18.4 years in females and 21.2 years in males. Majority of patients were literate upto primary class, belonging to joint family and had urban background. Duration of symptoms was within 2 weeks. Most common precipitating factor was stress of examination or failure followed by quarrels with peers or spouse. In 20% cases, cause was not known. Comorbid psychiatric disorders were found in 80% cases, the most common being mixed anxiety and depressive disorder (36%) followed by generalized anxiety disorder (20%). (+info)Functional neuroanatomical correlates of hysterical sensorimotor loss. (8/88)
Hysterical conversion disorders refer to functional neurological deficits such as paralysis, anaesthesia or blindness not caused by organic damage but associated with emotional "psychogenic" disturbances. Symptoms are not intentionally feigned by the patients whose handicap often outweighs possible short-term gains. Neural concomitants of their altered experience of sensation and volition are still not known. We assessed brain functional activation in seven patients with unilateral hysterical sensorimotor loss during passive vibratory stimulation of both hands, when their deficit was present and 2-4 months later when they had recovered. Single photon emission computerized tomography using (99m)Tc-ECD revealed a consistent decrease of regional cerebral blood flow in the thalamus and basal ganglia contralateral to the deficit. Independent parametric mapping and principal component statistical analyses converged to show that such subcortical asymmetries were present in each subject. Importantly, contralateral basal ganglia and thalamic hypoactivation resolved after recovery. Furthermore, lower activation in contralateral caudate during hysterical conversion symptoms predicted poor recovery at follow-up. These results suggest that hysterical conversion deficits may entail a functional disorder in striatothalamocortical circuits controlling sensorimotor function and voluntary motor behaviour. Basal ganglia, especially the caudate nucleus, might be particularly well situated to modulate motor processes based on emotional and situational cues from the limbic system. Remarkably, the same subcortical premotor circuits are also involved in unilateral motor neglect after organic neurological damage, where voluntary limb use may fail despite a lack of true paralysis and intact primary sensorimotor pathways. These findings provide novel constraints for a modern psychobiological theory of hysteria. (+info)Conversion disorder is a mental health condition that is characterized by the presence of neurological symptoms, such as blindness, paralysis, or difficulty swallowing, that cannot be explained by a medical condition. These symptoms are thought to be caused by psychological factors, such as stress or trauma, and may be a way for the individual to express emotional distress or avoid certain situations.
The symptoms of conversion disorder are typically dramatic and can interfere significantly with a person's daily life. They may include:
* Loss of or alteration in physical senses (such as blindness, deafness, or loss of touch)
* Weakness or paralysis in a part or all of the body
* Difficulty swallowing or speaking
* Seizures or convulsions
* Inability to move certain parts of the body
* Tremors or shaking
* Loss of consciousness
It is important to note that conversion disorder is not a fake or intentional condition. Rather, it is a genuine medical condition that requires treatment. Treatment typically involves addressing any underlying psychological issues and helping the individual develop more effective ways of coping with stress and emotional distress.
Freudian theory, also known as psychoanalytic theory, is a psychological clinical and theoretical framework proposed by Sigmund Freud and his followers. It focuses on the unconscious mind and the importance of childhood experiences in shaping an individual's behavior, thoughts, and feelings.
The theory posits that the human mind is divided into three parts: the id (primitive instincts), the ego (rational thought), and the superego (moral standards). According to Freudian theory, conflicts between these parts of the mind shape an individual's personality and behavior.
Freud also proposed several concepts such as the Oedipus complex, penis envy, and defense mechanisms, which are used to explain the development of personality and psychopathology. These concepts have been widely debated and criticized in the field of psychology, but Freudian theory has still had a significant impact on our understanding of human behavior and mental health.
Abreaction is a psychological term that refers to the reliving of a past traumatic or emotionally charged experience, often through therapy, with an accompanying release of emotional tension. This process can occur spontaneously or be facilitated by a therapist using techniques such as hypnosis, guided imagery, or other therapeutic interventions. The goal of abreaction is to help the individual confront and resolve unresolved emotions and memories associated with the traumatic event, leading to symptom relief and improved psychological functioning.
The term "hysteria" is an outdated and discredited concept in medicine, particularly in psychiatry and psychology. Originally, it was used to describe a condition characterized by dramatic, excessive emotional reactions and physical symptoms that couldn't be explained by a medical condition. These symptoms often included things like paralysis, blindness, or fits, which would sometimes be "hysterical" in nature - that is, they seemed to have no physical cause.
However, the concept of hysteria has been largely abandoned due to its lack of scientific basis and its use as a catch-all diagnosis for symptoms that doctors couldn't explain. Today, many of the symptoms once attributed to hysteria are now understood as manifestations of other medical or psychological conditions, such as conversion disorder, panic attacks, or malingering. It's important to note that using outdated and stigmatizing terms like "hysteria" can be harmful and misleading, so it's best to avoid them in favor of more precise and respectful language.
Malingering is a psychological concept that refers to the deliberate and intentional production or exaggeration of physical or psychological symptoms, motivated by external incentives such as avoiding work or military duty, obtaining financial compensation, or evading criminal prosecution. It's important to note that malingering should be distinguished from other conditions where individuals may experience genuine symptoms but have limited insight into their illness, such as in certain psychiatric disorders.
Malingering is not a mental disorder itself, and it requires careful clinical evaluation to distinguish it from legitimate medical or psychological conditions. It's also worth mentioning that malingering is considered uncommon, and its diagnosis should be made with caution, as it can have significant legal and ethical implications.
Neurology is a branch of medicine that deals with the study and treatment of diseases and disorders of the nervous system, which includes the brain, spinal cord, peripheral nerves, muscles, and autonomic nervous system. Neurologists are medical doctors who specialize in this field, diagnosing and treating conditions such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, multiple sclerosis, and various types of headaches and pain disorders. They use a variety of diagnostic tests, including imaging studies like MRI and CT scans, electrophysiological tests like EEG and EMG, and laboratory tests to evaluate nerve function and identify any underlying conditions or abnormalities. Treatment options may include medication, surgery, rehabilitation, or lifestyle modifications.
Dissociative disorders are a group of mental health conditions characterized by disruptions or dysfunctions in memory, consciousness, identity, or perception. These disturbances can be sudden or ongoing and can interfere significantly with a person's ability to function in daily life. The main types of dissociative disorders include:
1. Dissociative Amnesia: This disorder is characterized by an inability to recall important personal information, usually due to trauma or stress.
2. Dissociative Identity Disorder (formerly known as Multiple Personality Disorder): In this disorder, a person exhibits two or more distinct identities or personalities that recurrently take control of their behavior.
3. Depersonalization/Derealization Disorder: This disorder involves persistent or recurring feelings of detachment from one's self (depersonalization) or the environment (derealization).
4. Other Specified Dissociative Disorder and Unspecified Dissociative Disorder: These categories are used for disorders that do not meet the criteria for any of the specific dissociative disorders but still cause significant distress or impairment.
Dissociative disorders often develop as a way to cope with trauma, stress, or other overwhelming life experiences. Treatment typically involves psychotherapy, including cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), as well as medication for co-occurring conditions such as anxiety or depression.
Dyskinesias are a type of movement disorder characterized by involuntary, erratic, and often repetitive muscle movements. These movements can affect any part of the body and can include twisting, writhing, or jerking motions, as well as slow, writhing contortions. Dyskinesias can be caused by a variety of factors, including certain medications (such as those used to treat Parkinson's disease), brain injury, stroke, infection, or exposure to toxins. They can also be a side effect of some medical treatments, such as radiation therapy or chemotherapy.
Dyskinesias can have a significant impact on a person's daily life, making it difficult for them to perform routine tasks and affecting their overall quality of life. Treatment for dyskinesias depends on the underlying cause and may include medication adjustments, surgery, or physical therapy. In some cases, dyskinesias may be managed with the use of assistive devices or by modifying the person's environment to make it easier for them to move around.