Non-organic Disorders Research Articles

Psychosoziale Aspekte bei Patientinnen und Patienten mit sexuellen Funktionsstörungen

Sexual dysfunctions are common among the general population. An essential part of the assignments to specialized sexual medicine care units are from primary care physicians. In 2002 to 2004 for a period of 18 months questionnaires were given to all patients, who attended the special sexual medicine care unit at the University Hospital of Zurich for the first time. At the beginning of their treatment, the patients were questioned about different psychosocial characteristics and aspects of their sexuality. We studied 43 women (48.3%) and 46 men (51.7%). Women were with an average age of 33.8 years 10 years younger than men, 43.5 years. The most common sexual dysfunction in women was lack or loss of sexual desire (51.2%), followed by nonorganic vaginism (20.9%) and orgasm disorders (11.6%), in men erectile dysfunction (50.0%), followed by premature ejaculation (26.1%) and lack or loss of sexual desire (15.2%). The studied subjects showed distinctively lower values in their sense of coherence than men and women in the general population. The patients were much more anxious than people in the average population. The questioned men were also much more depressive than men in the general population and than the examined women. The examined men reported sexual wishes, needs and sexual activities significant more frequently than the examined women. As men and women with sexual dysfunctions are much more anxious than people from the general population, physicians should address sexual themes in the conversations with their patients carefully but actively.

Service innovations: Is there a market for neuropsychiatry? A year in the life of a district-based neuropsychiatry service

Aims and MethodThis paper describes the clinical activity of a district neuropsychiatry service over a 1-year period. The data presented are drawn from a clinical database with individuals classified according to the following diagnostic groups: acquired brain injury, early-onset dementia, Huntington's disease, epilepsy, other neurological disorders, developmental disorders and non-organic disorders. Information is presented on out-patient case-load, new out-patient referrals, general hospital referrals and in-patient admissions.ResultsThe total out-patient case-load was 451; 189 new out-patient and 99 liaison referrals were seen and 90 individuals were admitted. Acquired brain injury was the most common neurological diagnosis in all groups.Clinical ImplicationsThe demand for this service indicates that there is a market for neuropsychiatry, even at a district level, and particularly in the management of the sequelae of acquired brain injury.

Resource-oriented music therapy for psychiatric patients with low therapy motivation: Protocol for a randomised controlled trial [NCT00137189

BackgroundPrevious research has shown positive effects of music therapy for people with schizophrenia and other mental disorders. In clinical practice, music therapy is often offered to psychiatric patients with low therapy motivation, but little research exists about this population. The aim of this study is to examine whether resource-oriented music therapy helps psychiatric patients with low therapy motivation to improve negative symptoms and other health-related outcomes. An additional aim of the study is to examine the mechanisms of change through music therapy.Methods144 adults with a non-organic mental disorder (ICD-10: F1 to F6) who have low therapy motivation and a willingness to work with music will be randomly assigned to an experimental or a control condition. All participants will receive standard care, and the experimental group will in addition be offered biweekly sessions of music therapy over a period of three months. Outcomes will be measured by a blind assessor before and 1, 3, and 9 months after randomisation.DiscussionThe findings to be expected from this study will fill an important gap in the knowledge of treatment effects for a patient group that does not easily benefit from treatment. The study's close link to clinical practice, as well as its size and comprehensiveness, will make its results well generalisable to clinical practice.

An E-Health Solution for Automatic Sleep Classification according to Rechtschaffen and Kales: Validation Study of the Somnolyzer 24 × 7 Utilizing the Siesta Database

To date, the only standard for the classification of sleep-EEG recordings that has found worldwide acceptance are the rules published in 1968 by Rechtschaffen and Kales. Even though several attempts have been made to automate the classification process, so far no method has been published that has proven its validity in a study including a sufficiently large number of controls and patients of all adult age ranges. The present paper describes the development and optimization of an automatic classification system that is based on one central EEG channel, two EOG channels and one chin EMG channel. It adheres to the decision rules for visual scoring as closely as possible and includes a structured quality control procedure by a human expert. The final system (Somnolyzer 24 × 7™) consists of a raw data quality check, a feature extraction algorithm (density and intensity of sleep/wake-related patterns such as sleep spindles, delta waves, SEMs and REMs), a feature matrix plausibility check, a classifier designed as an expert system, a rule-based smoothing procedure for the start and the end of stages REM, and finally a statistical comparison to age- and sex-matched normal healthy controls (Siesta Spot Report™). The expert system considers different prior probabilities of stage changes depending on the preceding sleep stage, the occurrence of a movement arousal and the position of the epoch within the NREM/REM sleep cycles. Moreover, results obtained with and without using the chin EMG signal are combined. The Siesta polysomnographic database (590 recordings in both normal healthy subjects aged 20–95 years and patients suffering from organic or nonorganic sleep disorders) was split into two halves, which were randomly assigned to a training and a validation set, respectively. The final validation revealed an overall epoch-by-epoch agreement of 80% (Cohen’s kappa: 0.72) between the Somnolyzer 24 × 7 and the human expert scoring, as compared with an inter-rater reliability of 77% (Cohen’s kappa: 0.68) between two human experts scoring the same dataset. Two Somnolyzer 24 × 7 analyses (including a structured quality control by two human experts) revealed an inter-rater reliability close to 1 (Cohen’s kappa: 0.991), which confirmed that the variability induced by the quality control procedure, whereby approximately 1% of the epochs (in 9.5% of the recordings) are changed, can definitely be neglected. Thus, the validation study proved the high reliability and validity of the Somnolyzer 24 × 7 and demonstrated its applicability in clinical routine and sleep studies.

Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders.

Repeated case series have documented the effectiveness of multidisciplinary in-patient behavioural treatment for conversion disorders. However, in the absence of controlled research, treatment success could be attributed to providing patients with a face-saving opportunity to get better. The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation of this population. Thirty-nine patients underwent a standard behavioural programme. Using a crossover design, patients who did not improve underwent a strategic-behavioural treatment in which they and their families were told that full recovery constituted proof of an organic aetiology whereas failure to recover was definitive proof of a psychiatric aetiology. Chart review indicated that the standard behavioural treatment was effective for 8/9 'acute' patients but only for 1/28 'chronic' patients. Of the 21 patients with chronic motor disorder who then under went the strategic-behavioural intervention, 13 were symptom-free at discharge. The strategic intervention was superior to standard behavioural treatment for patients with chronic motor disorder. Treatment components previously deemed critical for the effectiveness of behavioural treatment may be unnecessary.

Schizophrenia-like disorders and non-organic delusional disorders

Schizophrenia-like disorders and non-organic delusional disorders

Vocal cord dysfunction in children and adolescents.

Vocal cord dysfunction (VCD) is a nonorganic disorder of the larynx that involves unintentional paradoxical adduction of the vocal cords while breathing. The resultant symptoms can include dyspnea, chest tightness, cough, throat tightness, wheezing, or voice change. Most patients with VCD are female, and among adolescents and children, VCD tends to be triggered by exercise and is typically confused with exercise-induced asthma. Both gastroesophageal reflux disease (GERD) and psychiatric illness have been reported as having strong associations with VCD, although, to date, there is no evidence that either causes VCD. VCD often coexists with asthma, and should be suspected in any patient in whom asthma treatment fails. Confirming the diagnosis involves direct visualization of abnormal vocal cord motion, and this usually only occurs during symptoms. Adolescent athletes often require free running exercise challenge to reproduce their symptoms and confirm abnormal vocal cord motion laryngoscopically. The primary treatment for VCD involves a combination of patient education and speech therapy, and, in most cases, patients may resume their activities without significant limitation.

Quality of life in nonorganic and organic sleep disorders: II. Correlation with objective and subjective quality of sleep and awakening.

The purpose of this study of 100 patients suffering from sleep-disorders was to determine correlations between their subjective health-related quality of life (HRQoL) and objective variables in sleep initiation and maintenance, sleep architecture, objective quality of awakening, psychophysiological parameters and subjective quality of sleep and awakening. Objective measurements were obtained from overnight diagnostic polysomnography. Subjective HRQoL was determined from the Quality of Life Index (QLI, Mezzich and Cohen) completed prior to the adaptation night. Other measurements included subjective and objective quality of sleep and awakening (psychometry) the evening before and morning after polysomnographic investigations. 63% of the patients were suffering from nonorganic and 37% from organic sleep disorders (SDs). Within the first group, nonorganic insomnia predominated; within the second, sleep apnea. Subjective HRQoL correlated well with subjective sleep and awakening quality, especially in nonorganic SDs. There were only a few correlations of objective measurements with subjective HRQoL: in the total group of SD patients HRQoL correlated with sleep stage S2, and in nonorganic SDs with attention scores and psychophysiological measurements (mainly the pulse rate in the evening and morning). Our findings suggest only a weak relationship between objective sleep variables and subjective HRQoL in both organic and nonorganic SDs. However, we found various significant correlations of HRQoL with subjective measurements of sleep, especially in nonorganic SDs.

Quality of life in nonorganic and organic sleep disorders: I. Comparison with normative data.

Subjective health-related quality of life (HRQoL) was investigated in 100 patients with disturbed sleep (39 women aged 52 +/- 13 years and 61 men aged 53 +/- 10 years) referred to the sleep laboratory and compared with HRQoL in 100 normal healthy adults. Measurements included the Quality of Life Index (QLI) (Mezzich and Cohen), and objective (polysomnographic) and subjective (psychometric) quality of sleep and awakening. Statistical analysis (Mann-Whitney U-test) showed HRQoL to be significantly reduced in sleep disorders (SDs), with a more pronounced reduction in nonorganic than in organic SDs. Patients with nonorganic hypersomnia were more disturbed than those with nonorganic insomnia. Within organic SDs, patients with apnea were more disturbed than those with obstructive snoring. Out of ten elementary HRQoL components, seven were disturbed in SDs: physical well-being, psychological well-being, self-care and independent functioning, occupational functioning, interpersonal functioning, personal fulfillment, and overall quality of life. No differences between patients and normal healthy subjects where found in the components social support, community and services support or spiritual fulfillment. Patients suffering from nonorganic SDs had significantly worse scores in physical and psychological well-being and overall quality of life than those with organic SDs. Patients with both SDs and additional diagnoses of affective disorders had more profoundly reduced HRQoL than those with anxiety disorders. Follow-up of 51 patients (31 with nonorganic SDs and 20 with organic SDs) one year after sleep laboratory investigation and subsequent treatment found significantly improved HRQoL compared with pre-treatment. Moreover, patients diagnosed and treated in the sleep laboratory showed lower re-hospitalization rats.

Multifocal electroretinogram (mfERG) in a family with occult macular dystrophy (OMD).

Localized macular dysfunction, in Stargardt macular dystrophy for example, is frequently not detected by Ganzfeld electroretinography (ERG) but it may be detected by methods such as focal macular electroretinogram and pattern electroretinogram at the posterior pole of the eye or indirectly by recording of the visual evoked cortical potentials (VEP). The multifocal electroretinogram (mfERG) is a new diagnostic tool allowing analysis of local bioelectrical signals of circumscript areas across the macular region. Miyake recently described a type of macular dystrophy, which he termed "Occult Macular Dystrophy" (OMD) because of a normal fundus aspect and functional deficit even in aged patients. This is a case report about a family with a presumed OMD where mfERG demonstrated a central depression in the affected family members. Three members of a family with a suspected autosomal dominant trait complained of a reduced visual acuity since early childhood. The fundus of all patients appeared normal without signs of a maculopathy. The first order mfERG (ROLAND system) was recorded using 61 hexagons. The signals arising from the macular region of the 6 eyes (3 affected family members) were selectively depressed while the signals from the paracentral area were much less impaired. Statistical analysis of the mfERG signals (concentric hexagon rings) confirmed the central depression with a better performance of the peripheral rings. A new family with OMD is added to preceeding reports. A reduced visual acuity without visible fundus abnormalities may be misdiagnosed as amblyopia, optic nerve disease or nonorganic visual disorder. The mfERG offers the diagnostic tool to detect a circumscript retinal/macular dysfunction by a single procedure.

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in Vienna.

To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

5 P Are alarm symptoms of clinical utility in discriminating between organic from non-organic disorders?

5 P Are alarm symptoms of clinical utility in discriminating between organic from non-organic disorders?

Nonorganic and Organic Psychiatric Disorders in Patients after Epilepsy Surgery

This study aimed at describing preoperative psychiatric morbidity in a consecutive series of 70 epilepsy patients who were surgically treated and to analyze postoperative psychiatric morbidity and predisposing factors. Nonorganic (DSM-III-R) and organic (Lindqvist–Malmgren diagnostic system) psychiatric morbidity was prospectively assessed preoperatively and during the first two postoperative years. At presurgical evaluation 44.3% of the patients had a psychiatric diagnosis (nonorganic in 14.3%, organic in 38.6%). The most common nonorganic diagnosis was major depression; the most common organic diagnosis was Astheno-Emotional disorder (AE disorder). During the first two postoperative years 68.1% of the patients received some psychiatric diagnosis. The most common nonorganic diagnoses were anxiety and depressive disorders (AD disorders) in 36.2%; the most common organic diagnosis was AE disorder in 52.2%. Patients with a preoperative history of AD disorders or AE disorder had a significantly higher risk of postoperative AD disorders ( P < 0.01 and P < 0.001 respectively). Laterality, type of resection, histopathological diagnosis, or outcome were not significantly related to postoperative psychiatric morbidity. The importance of psychiatric assessment, including organic psychiatric disorders, is emphasized.

Are alarm symptoms of clinical utility in predicting organic from non-organic disorders?

Are alarm symptoms of clinical utility in predicting organic from non-organic disorders?

Effizienter Einsatz von Schlafkissen bei Personen mit nicht-organischen Schlafstörungen – eine Pilotuntersuchung

Efficient Action of Sleep Pillows in Patients Suffering from Non-Organic Sleep Disorders – a Pilot Study Objective: Sleep disorders may critically affect working performance and quality of life. Sleep pillows have been traditionally used to overcome such disorders. Scientifically based clinical trials to demonstrate the efficacy are missing. Methods: 28 patients with problems falling asleep and/or staying asleep not related to psychiatric or organic diseases were investigated in an accredited sleep laboratory. The diagnosis was confirmed by polysomnography. After 2 and 4 weeks of treatment the polysomnography was repeated to document any influences by the sleep pillows. Results: The polysomnographic records showed a monotonic trend to regain an age-related distribution of the non-REM sleep stages. The REM sleep phase increased nearly twofold; however, the norm values were not reached within the 4-week period of treatment. Sleep pillows of intensity 2 were superior to those of intensity 1; a further increase to intensity 3 did not create any additional effect. Conclusion: The results demonstrate an effective treatment of non-complicated sleep disorders with sleep pillows, which has been shown with objective measurements in a sleep laboratory.

Nonorganic disorders in ophthalmology: overview of diagnosis and therapy

Nonorganic diseases may be psychogenic (somatoform diseases) or due to malingering. Both occur frequently in the ophthalmologic practice. This article reviews the different diagnostic and therapeutic procedures in nonorganic ocular diseases. After presenting the general symptoms, the origins of psychogenic diseases are discussed. Then, the specific tests used in ophthalmology to diagnose nonorganic diseases and the organic eye diseases most frequently confused with nonorganic diseases will be reported. At the end, we will discuss the treatment and the prognosis of psychogenic diseases. An early diagnosis of nonorganic diseases is important, since a delayed diagnosis may worsen their prognosis.

Placebo-Controlled Sleep Laboratory Studies on the Acute Effects of Zolpidem on Objective and Subjective Sleep and Awakening Quality in Nonorganic Insomnia Related to Neurotic and Stress-Related Disorder

Recent investigations in our sleep outpatient clinic demonstrated that 30% of patients exhibited organic and 70% nonorganic sleep disorders, with 41% showing as an additional diagnosis neurotic, stress-related, and somatoform disorders, 31% affective disorders and 15% mental and behavioral disorders due to psychoactive substance use. Thus, the aim of the study was to investigate the acute effects of the imidazopyridine zolpidem on objective and subjective sleep and awakening quality in the largest of the above-mentioned groups. In this single-blind, placebo-controlled cross-over study, 15 patients (9 females and 6 males aged 51.1 + 11.3 years) diagnosed as having nonorganic insomnia (ICD–10: F 51.0) related to neurotic and stress-related disorders (F 1.1:12, F 41.2:2 and F 43.2:1) were included. Objective and subjective sleep and awakening quality measures were investigated in 3 subsequent nights in the sleep laboratory (adaptation, baseline/placebo and zolpidem 10 mg night), utilizing clinical, polysomnographic, psychometric and psychophysiological methods. The drug-free patients were matched according to age and sex with 15 normal healthy controls (age 51.2 + 11.8 years). Statistical analysis of polysomnographic variables demonstrated a significant lengthening of the total sleep period (TSP) and total sleep time (TST), an improvement in sleep efficiency and a shortening of sleep latencies after zolpidem as compared with placebo. These changes were opposite to the differences between patients and controls. Concerning sleep architecture, zolpidem increased the length of S4 and S3 + S4 as compared with placebo. Subjective sleep and awakening quality and the thymopsychic variables drive, mood, affectivity and wakefulness in the morning showed no significant changes, as a significant improvement had already occurred from the adaptation to the baseline/placebo night. Noopsychic variables (attention, concentration, attention variability, numerical memory, fine motor activity, reaction time measures) showed similar findings. Moreover, subjective sleep and awakening quality, thymopsychic and noopsychic measures during baseline/placebo recordings did not differ significantly from normative data (except for fine motor activity). Psychophysiological measures did not show any significant alterations either, except for a decrease in systolic blood pressure in the evening. Conclusion: As compared with placebo, zolpidem induced a significant improvement in objective sleep quality, mainly by increasing TSP, TST and sleep efficiency and shortening sleep latencies, thereby normalizing the disorder of initiating and maintaining sleep. Deep sleep stages S3 + S4 increased (although at baseline/placebo these stages did not differ from controls), while S1, S2 and SREM did not change significantly. Subjective sleep and awakening quality as well as thymopsychic and noopsychic performance in the morning mainly showed a placebo and ‘first- night effect’ phenomenon in these patients. Thus, the changes induced by zolpidem were somewhat different from those after classical benzodiazepines.

Somatizing disorders affecting the respiratory tract.

Respiratory disease in childhood is common but not all children presenting to the paediatrician have an underlying organic cause for their symptoms. This article reviews the spectrum of non-organic somatization disorders that might be encountered and advises about the diagnosis and treatment of habit cough, laryngeal dysfunction and hyperventilation.

An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders

Dynamic posturography comprises a series of balance control tests which help physicians overcome numerous diagnostic and treatment challenges arising when examining patients complaining of a debilitating balance disorder. These challenges include the specific differential diagnosis, documentation of symptoms and assessment of functional disability. It must be determined whether the cause of the disability is an organic sensory, deficit, a central nervous system (CNS) lesion or a non-organic (that is, possibly psychogenic or just overtly simulated) disorder. This review is targeted towards providing the reader (a) an overview of the effects sensorimotor deficits have on balance control, specifically vestibulospinal and proprioceptive reflex deficits; and, (b) how these effects may be assessed objectively in a clinical setting to differentiate between various organic and non-organic balance-disorders. The techniques used to study these effects are based on the analysis of both rapid balance-correcting and slow balance-stabilizing responses to fast and slow movements in the pitch plane of the support surface on which the test subject stands.

Shared social environment and psychiatric disorder: a multilevel analysis of individual and ecological effects.

We examined associations, in terms of relative and population-attributable risks, between shared social environment at the neighbourhood level and (1) treated incidence of non-psychotic, non-organic disorders, and (2) subsequent level of service consumption. The multilevel analysis used linked records of all individuals in contact for the first time with any catchment area mental health service for non-psychotic, non-organic disorder over various specified time periods between 1981 and 1995. Socioeconomic indicators of 36 neighbourhoods in the city of Maastricht yielded a multivariately defined neighbourhood deprivation score. There were significant linear trends in the association between level of deprivation and treated incidence, especially in the population under 35 years of age (adjusted rate ratio for linear trend 1.17, 95% confident interval 1.11-1.23), who constituted around half of the patient population. The fraction of the incidence of psychiatric disorder attributable to deprivation was 17.8%. Multilevel analyses of rates of a second cohort, with cases divided according to level of service use over a standardised follow-up of 5 years after first contact with psychiatric services, revealed that the effect of deprivation scores on rates declined with intensity of out-patient service use, but increased with level of in-patient use. Up to 50% of in-patient episodes in this group could be attributed to neighbourhood level of deprivation. The increase in risk conferred by neighbourhood deprivation remained after adjustment for the individual-level equivalent. The findings therefore suggest that elements in the shared social environment influence both incidence and severity of non-psychotic, non-organic disorders, over and above any individual-level effect.