Hysterical Psychosis Research Articles

The Symbolism in a Case of Hysterical Psychosis

The authors take inspiration from a case of hysterical psychosis to illustrate a typical condition of this evocative disease: the symbolic language of hysteria, conjurer of archetypical images. The authors encourage the clinician not to decode such aspects in rational analytical terms, rather to have a more wide-open approach that promotes the emergence of the individual unconscious, reconnecting with the collective imagination. This approach could help psychiatrists better understand a subject's inner experiences and interpersonal behavior.

Cliniques urbaines africaines

The team of therapists who gathered around Henry Collomb at the Fann Hospital of Dakar in the sixties has noticed the particularities of the African psychiatry with a noticeable predominance of delirious puffs on the other pathologies. In the eighties, Maurice Dorès drew attention to the evolution of this situation marked by a notable reduction of the delirious puffs in favor of hysterical psychosis and other symptomatologies. This text accounts for the psychotherapeutics of patients who come to consult a psychologist in urban area and currently the most frequent motivations of this approach.

Revisiting hysterical psychosis: A case report

IntroductionHoliender and Hirsch defined hysterical psychosis in 1964 and, while hysteria has a contemporary equivalent in somatoform/dissociation disorder, hysterical psychosis remains set adrift in the nosological understanding of psychiatric disorders.ObjectivesTo present a case report of a hysterical psychosis and to review this nosological construct.MethodsClinical interview, consultation of clinical records and review of literature using the Pubmed platform.ResultsThe authors present a case of a 38 year-old woman, admitted in a psychiatric emergency department for bizarre behavior, restlessness, auditory (pseudo)hallucinations and emotional lability, starting 1 week after a personal development retreat. This is the second episode of this nature, the first being a 15-day hospitalization 7 years ago, with rapid stabilization, extensive examination and restitium ad integrum. The patient initiated Olanzapine and was referred to an outpatient clinic, with rapid stabilization and restitium ad integrum throughout follow-up. Given the episode and patient characteristics, a hysterical psychosis diagnosis may be accurate, taking into account the acute onset and course, the pleomorphic nature of symptoms and the presence of a disturbing life event. The authors propose reviewing the concept of hysterical psychosis regarding its clinical implications and debating its therapeutic and prognostic utility.ConclusionsHysterical psychosis may not be a mere historic footnote and encompasses an entity with distinctive diagnostic, prognostic and therapeutic characteristics. While its etiology may not be understood, its clinical implications ensure the need for future research.DisclosureNo significant relationships.

Pseudodémence, de quoi parle-t-on ? Partie II : de Stertz à Alzheimer : une maladie psychogène après traumatisme

The aim of this work is to give a new anchorage for the initial concept of pseudodementia, its basic definitions and actual clinical implications. The original definition and framework of the concept are misidentified and therefore need to be reintroduced and analysed here. This approach, beyond its heuristic and epistemological goal, has a practical aim: to adjust the psychopathological point of view on pseudodementia.In addition to a conventional survey based on search engines (Medline, PsychINFO and google book), we conducted a systematic review of the concomitant papers related to the rise of the concept.Three moments of conceptualization are identified and linked to Wernicke's successors at the university of Breslau. Firstly, Stertz (1910) has described pseudodementia as a psychogenic illness that could occur after any trauma. According to our research, it is probably the first written use of the term pseudodementia in its psychogenic meaning. Secondly, we present Bonhoeffer's approach based on psychogenic reactions (1911). Finally, the views of Alzheimer and his student Schuppius are described: their understanding of pseudodementia is open to psychoanalytic concepts (1914).The concept of pseudodementia (Pseudodemenz) takes shape in a particular period of German history: the promulgation of laws settling railway (1871) and industrial accidents (1884) but also the law of compensation of the traumatic neurosis (1889), the nosological specificity of which was debated. German psychiatry of the beginning of the 20th century was strongly imbued with a moralizing sense of national duty. The disqualification of traumatic neurosis has been followed by a unanimous recognition of traumatic hysteria and its psychogenic hypothesis. As a consequence, traumatic events were rarely taken into consideration and the issue was moved into the private sphere (Privatsache) by questioning patients' morbid wishes. Breslau's psychiatrists analyzed the cognitive disorders of pseudodementia with regard to an ideogenic model of the trauma, which emphasized the subjectivity but which was still facing the primacy of the consciousness. It is in this context, and by reducing the question of the pseudodementia to the situations of detention (Gansersche Syndrom) and pension neuroses (Rentenneurosen), that Bonhoeffer promoted the notion of "wishing to be sick" (Wille zur Krankheit). This conception gave a social component to mental disorders but placed in the foreground a suggestive phenomenon, which Raecke included as secondary to the primary symptom of hysterical inhibition. Thus, Schuppius's article under the tutoring of Aloïs Alzheimer offers a double testimony. On one hand, it shows how neuropsychiatry was, by then, at least partially open to the notion of an unconscious causality. On the other hand, it exposes a hidden aspect of Aloïs Alzheimer: a brilliant histopathologist capable of interest for psychodynamic mechanisms.In his famous study of 1961, Leslie Gordon Kiloh argues that the concept of pseudodementia does not belong to any nosological system, is purely descriptive and does not imply an accurate diagnosis. The present work shows a very different conclusion. Initially, the term was introduced in German psychiatry to describe cases of hysterical psychogenic illness after trauma (psychogene Erkrankungen nach Trauma) in which the mechanism of inhibition was discussed. Topologically, we can even define its emergence in the Breslau's university and psychiatric clinic in which Wernicke, Stertz, Bonhoeffer and Alzheimer himself, promoted it. One should also note that the category of hysteria referred to an array of functional mental disorders, including "hysterical psychosis" (hysterische Psychosen).

Discussion de l’association signifiante de psychose hystérique comme problématisation de la terminologie psychiatrique classique de la « névrose » et de la « psychose »

Background and objectivesThe apparently oxymoronic significant association of “hysterical psychosis” has regularly been the subject of intense debate : this question of incoherence or existence of hysterical psychosis remains very topical, as reflected by recent French publications. Why is this question recurrent in the literature? What does the use of the term hysteric psychosis mean? What conceptual guidelines does it raise? Materials and materialsThe joint study we carried out concerning the historical determinants relating to this question, the distinction between the French and English descriptions, and discussions about the different theoretical models used to attempt to conceive the concept of hysterical psychosis reveal a common problem concerning the definition of “neurosis” and “psychosis”. ResultsIf Freud used the term “hysterical psychosis” on a few occasions, the clinical was clearly defined by Follin, Chazaud and Pilon in 1961. From brutal beginnings, often in reaction to a triggering factor of rupture or loss, appears a loosely structured multi-figured delusion, enough however to create an unstable, partially criticised neoreality. Whilst the mechanisms are multiple, the delirious theme is established around a mystic-sexual polarity associated with the “theme of the double”, which is expressed notably via elements of depersonalisation. Hallucinations are frequent, mainly visual, giving the impression that the subject is a spectator of their own delirium, spectacle sometimes veering towards a real fascination for this oneiroid state. This clinical description has often been used on the other side of the Atlantic in the American Journal of Psychiatry yet without this clinical entity being validated by operationalised criteria and without it being retained in the third edition of American Nosography. The absence of official designation in modern nosography does not impede the implicit perpetuation of the question of hysteric psychosis in epidemiological research. Furthermore, several French clinicians continue to show an interest in this question they have taken up as being that of “hysterical psychosis”. Contemporary French articles on the subject attest to the interrogations of practitioners without any real etiopathogenic structure or nosographic discussions being established. ConclusionsInnovative theories justifying the existence or incoherence of hysterical psychosis are rare and descriptive work is more frequent, yet a common problem unites the authors consulted: is it possible and/or useful to accurately define the signifiers of neurosis and psychosis, integrating the question of their relationship of continuity or opposition? In reference to the question of “hysterical psychosis”, the schools of psychopathology and epidemiology have not been able to clarify this question.

Pseudodémence, de quoi parle-t-on ? Partie I : à la recherche de la pseudodémence de Wernicke

The authors explore the history of pseudodementia in the elderly; an issue with growing momentum in a world where life duration expectancy has been constantly growing and the management and treatments of dementias has imposed an equally increasing burden. Although the issue is mainly therapeutic, some of the main tenets of the current approaches rest heavily on historical issues. The invention of the term pseudodementia (Pseudodemenz) is usually credited to Wernicke. However, the exact circumstances and the debates that have accompanied the emergence of the term have never been fully uncovered, and the references are not accurate. Most of the recent literature cites Kiloh as the key influence in structuring the current uses of the term, but the relationship between both sources is not clear. A research of anteriority has been conducted on the basis of Medline via Pubmed, PsychINFO and google book, using the following keywords: pseudodementia, pseudodementia, depressive pseudodementia, pseudodémence, Pseudodemenz. We have researched the quotations to localize the origin of the concept. Complementarily, we have attempted to clarify the nature of the debates by exploring the relevant German psychiatric literature at the end of the XIXth century and the beginning of the XXth. We have found that the very first occurrences of the notion appeared in a debate between the following authors: Ganser S.J.M. 1898, 1903; Wernicke C. 1898; Raecke J. 1901; Nissl F. 1902; Jung C.G. 1902, 1903; Stertz G. 1910; Bonhoeffer K. 1911; Schuppius S. 1914. We found that the term Pseudodemenz never appears in Wernicke's written works, although he was credited of its invention by his most direct students. It seems that the term was thought by the time it emerged to have originated in Wernicke's discussion of Ganser's syndrome. Ganser's syndrome, often defined as carceral psychosis, is a specific hysterical twilight state characterized by "talking past the point" (Vorbeireden), amnesia and hysterical stigmas, in which some trauma was thought to be causative. Wernicke presented it as determined by a "restriction of the field of consciousness", echoing Janet's theory (École de la Salpêtrière). He rejected the twilight characteristic: this differential point seems to have initiated the introduction of the concept of pseudodementia. Raecke argued that such states should not be understood as forms of simulation thus contributing to a heated debate of the time. Referring to Janet's works and expanding the syndrome of "traumatic hysteria", he argued in favor of a specific inhibiting factor which disturbs the process of associations. Jung, refusing Nissl's article dismissing Ganser, Wernicke and Raecke's views, confirmed the hysterical hypothesis. In a new contribution to the debate, Ganser contested Wernicke's differential point, arguing that in Vorbeireden, there was a Benommenheit - some sort of giddiness - and a "superficiality of the contents of consciousness" rather than a limitation of consciousness. It has been rightly argued that Wernicke's view of the pseudodementia issues was mainly related to the debates on hysteria and trauma, and that no relationship with old age symptomatology was established by him. However, we have found that he alluded to at least one case in which such a relationship was hypothesized. Moreover, one should note that Wernicke's views on hysteria included the rather pervasive notion of "hysterical psychosis", exhibiting "allopsychosis", which could include what would nowadays be seen as schizophrenia or psychotic mood disorders. First of all, the term Pseudodemenz, if it was ever used by Wernicke verbally, never appears in his published works. Besides, the debates concerning Ganser's syndrome, which served as a first paradigm to discuss pseudodementia, were highly influenced by the discussions on traumatic disorders, hysteria and simulation. Finally, although no direct connection is made between disorders of the senium and Pseudodemenz, the fact that Wernicke included both in what he termed "allopsychic disorders" seemed to indicate that some kind of relationship could not be absolutely excluded in Wernicke's mind.

EPA-0499 – Hysterical psychosis

Introduction The term hysterical psychosis has been in common usage for longer than half a century, but has never become part of the standard nomenclature. This entity is characterized by acute onset, often following the occurrence of an emotionally disturbing event, absence of any characteristic thought disturbance, and affectivity changes in the direction of volatility. Its manifestations can also include hallucinations, delusions, depersonalization and behavior disorders. Though the acute episode seldom lasts from one to three weeks, it has good prognosis and there is practically no residue after the symptoms disappear. Aims A review about the evolution and the actual interest and adequacy of this clinical entity. The very existence of hysterical psychosis as a diagnostic entity has been questioned as part of the general difficulty in defining both hysteria and psychosis. Methods A non-systematic review of PubMed articles. Conclusion The hysterical psychosis occurs in patients with a hysterical personality / histrionic, with more colorful psychotic symptoms, which are somehow characteristic. This seems to condition the definition of a well defined nosological entity, as long as diagnostic, prognostic and therapeutic implications. It still seems questionable whether the concept of hysterical psychosis should be kept as an entity with well-defined etiologic determinants, however in clinical terms this approach may have advantages.

P-1040 - The dissociative foundation of hysterical psychosis: a clinical case illustrating janet's original concept

Hysterical psychosis has never been part of the standard nomenclature. Janet postulated that a psychosis could be considered hysterical if its dissociative nature could be established. Breuer and Freud emphasized the traumatic origins and oneiroid form of the disorder. Hollender and Hirsch focused mainly on descriptive features: the dramatic onset, the temporal relation to an upsetting event, the short duration and the preponderance of females with histrionic behavior. To demonstrate the traumatic origins and distinct features of hysterical psychosis. A clinical case was followed and reviewed. A 48-year-old female presented acutely with disorganized behavior, negativism, loosening of associations, delusions of demonic influence and a fluctuating level of consciousness. Symptom onset was temporally related to severe family stressors. A complete medical evaluation ruled out the presence of an underlying organic factor. Dissociative conversion disorder was chosen as our working diagnosis. Rapid clinical response was achieved on low dose paliperidone. After the abatement of symptoms, our patient provided a comprehensive history of her experience, describing an oneiroid state in which she transiently submerged in vivid fantasies based upon past traumatic life events. Pharmacotherapy was gradually withdrawn and psychodynamic psychotherapy was introduced as a means to help her abreact the past traumata and integrate them into a cohesive self. This case supports Janet's formulation of hysterical psychosis and demonstrates the usefulness of the dissociative component in forming a diagnostic impression and treatment approach. It also underlines the need of distinctly classifying this clinical entity among dissociative disorders.

Psychose hystérique : solution psychotique à l’irruption de la sexualité génitale ?

The notion of hysterical psychosis implies the paradox of a psychotic genitality. Leaning on the psychoanalytic, phenomenological and gestaltist approach of Gisela Pankow, we try to define this nosographic entity, by underlining in a patient a special kind of relationship with imagos and own body we called dialectic of penetration. In that kind of pathological functioning, De Clérambault's syndrome could be understood as the realization, in the psychotic experience area, of a sort of intrusive genital sexuality, and delusion as a new performance of œdipal drama on the delusional scene. We finally question the place of a lacunar Oedipus complex in non-schizophrenic psychoses.

Approche théorique et conceptuelle du délire hystérique

Resume Si certains connaissent l'existence clinique et structurale d'une psychose particuliere : « la psychose hysterique », d'autres preferent maintenir une separation entre nevrose et psychose. Confrontes a la clinique, l'expression d'une symptomatologie delirante (aigue ou chronique) revelee sur une structure de personnalite nevrotique decompensee a conduit les auteurs a s'interroger sur la notion conceptuelle de « delire hysterique » d'une part, et celle de nevrose d'autre part, avec sa disparition dans les classifications des manuels de psychiatrie.

Approche th�orique et conceptuelle du d�lire hyst�rique

Approche th�orique et conceptuelle du d�lire hyst�rique

Chronic late-onset schizophrenia-like psychosis that remitted: revisiting Newton's psychosis?

According to historical records, Sir Isaac Newton developed new-onset psychosis at age 51, which was characterized by persecutory delusions. His psychotic symptoms remitted in less than 18 months, but their etiology has since remained a puzzle. The present case conference involves a present-day individual with late-onset paranoid psychosis with later remission, which has some interesting similarities to, as well as important differences front Newton's illness. Our patient had no history of psychiatric illness until age 52, when he developed paranoid delusions, which included thought broadcasting, auditory hallucinations, blunted affect, and poor insight. His early medical history was remarkable for grand mal seizures between ages 15 and 29. His psychosis improved with the use of antipsychotic medication. Approximately 6 years after its onset, his psychotic illness remitted, and all psychotropic medications were discontinued. Four years later, at the writing of this report, our patient continued to function independently with no psychiatric symptoms. We discuss the differential diagnosis for this chronic late-onset schizophrenia-like psychosis with remission.

Hysterical Psychosis: A Historical Survey

Back to table of contents Previous article Next article Book ReviewFull AccessHysterical Psychosis: A Historical SurveyLeslie Y. Rabkin, Ph.D.Leslie Y. RabkinSeattle, WASearch for more papers by this author, Ph.D.Published Online:30 Apr 2018https://doi.org/10.1176/appi.psychotherapy.1996.50.3.378AboutSectionsView PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Hysterical Psychosis: A Historical Survey." American Journal of Psychotherapy, 50(3), pp. 378–379 FiguresReferencesCited byDetailsCited ByNone Volume 50Issue 3 1996, pp. 257–388Pages 378-379 Metrics History Published online 30 April 2018 Published in print 1 July 1996

Hysterical psychoses revisited

The author, after reviewing the literature about hysterical psychosis, briefly presents some of the surveys made in this area. The point of departure are the Hollender and Hirsh criteria for hysterical psichosis defined in 1964. These authors assumed that the clinical picture responds to a psychopathological entity which results from a single process. The other surveys presented try to prove this concept through case report and epidemiological research. The author concludes leaving this concept as an open question, suggesting that this could be a pathway for further research.

Dissociative psychosis: an atypical presentation and response to cognitive-analytic therapy

AbstractWe report on a patient with a rare type of dissociative disorder, dissociative psychosis (hysterical psychosis), in whom gustatory, olfactory, visual and auditory hallucinations occurred. Auditory and visual hallucinations have been described in previous cases of dissociative psychosis, and olfactory and gustatory hallucinations have been described associated with sexual assault but this case is unusual in that hallucinations occur in all modalities in one patient, as yet not described in the literature The basis of the dissociative disorder lay in a childhood sexual trauma and therefore the traditionally advocated treatment for such a case is the psychotherapeutic abreaction of these previous traumatising events. This approach caused worsening symptomatology and the patient experienced frequent lapses into dissociative psychosis. However, focused cognitive-analytic therapy concentrating on the patient's personal conflicts at the time of presentation resulted in a resolution of symptoms and a return to health.

Hypnotic Assessment and Treatment of Trauma-Induced Psychoses: The Early Psychotherapy of H. Breukink and Modern Views

The role of hypnotizability assessment in the differential diagnosis of psychotic patients is still unresolved. In this article, the pioneering work of Dutch psychiatrist H. Breukink (1860-1928) during the 1920s is used as early evidence that hypnotic capacity is clinically helpful in differentiating highly hypnotizable psychotic patients with dissociative symptomatology from schizophrenics. Furthermore, there is a long tradition of employing hypnotic capacity in the treatment of these dissociative psychoses. The ways in which Breukink used hypnosis for diagnostic, prognostic, and treatment purposes are summarized and discussed in light of both old and current views. He felt that hysterical psychosis was trauma-induced, certainly curable, and that psychotherapy using hypnosis was the treatment of choice. Hypnosis was used for symptom-oriented therapy, as a comfortable and supportive mental state, and for the uncovering and integrating of traumatic memories. For the latter purpose, Breukink emphasized a calm mental state, both in hypnosis and in the waking state, thereby discouraging emotional expression, which he considered dangerous in psychotic patients. In the discussion, special attention is paid to the role and dangers of the expression of trauma-related emotions.

From hysterical psychosis to reactive dissociative psychosis

AbstractIn this paper Reactive Dissociative Psychosis (RDP) is seen as a post‐traumatic stress response and as a subcategory of Brief Reactive Psychosis (BRP). A review of the literature and the evolution of RDP from Hysteria and Hysterical Psychosis are given. Issue is taken with defining the duration of BRP as “Brief.” The authors argue that long‐standing psychotic symptoms may be traumatically induced. The dissociative aspects of RDP as its key feature and the concomitant implications for accurate diagnosis are proposed. The usefulness of applying hypnosis in RDP treatment is summarized in a case study from Janet and detailed in a case from the authors' practice.

From hysterical psychosis to Reactive Dissociative Psychosis

In this paper Reactive Dissociative Psychosis (RDP) is seen as a post-traumatic stress response and as a subcategory of Brief Reactive Psychosis (BRP). A review of the literature and the evolution of RDP from Hysteria and Hysterical Psychosis are given. Issue is taken with defining the duration of BRP as “Brief.” The authors argue that long-standing psychotic symptoms may be traumatically induced. The dissociative aspects of RDP as its key feature and the concomitant implications for accurate diagnosis are proposed. The usefulness of applying hypnosis in RDP treatment is summarized in a case study from Janet and detailed in a case from the authors' practice.

Is the diagnosis of hysterical psychosis justified?: Clinical study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia

Using the method of a “blind” retrospective evaluation of clinical charts, 21 female patients with hysterical psychosis were compared with 21 patients diagnosed as suffering from nonhysterical reactive/psychogenic psychosis and 42 patients diagnosed as schizophrenic according to the Ninth Revision of the International Classification of Diseases (ICD-9). All three groups were restricted to first admissions and matched with regard to sex, age, and year of admission. Many significant differences were found between hysterical psychosis and schizophrenia; the only significant differences between hysterical and nonhysterical reactive/psychogenic psychosis were the presence of histrionic personality and the frequent shift in symptomatology in the former. Thus, both disorders seem to be identical.

Multiple Personality: A Culture-Bound Variant of Hysterical Psychosis?

Multiple Personality: A Culture-Bound Variant of Hysterical Psychosis?