Psychogenic Causes Research Articles

Role of folic acid deficiency as a possible risk factor for erectile dysfunction

Background: erectile dysfunction (ED) is the persistent inability to attain or maintain an erection. ED affects millions of men worldwide. The pathophysiology of ED includes vasculogenic, neurogenic, hormonal, anatomical, drug-induced and psychogenic causes. Endothelial dysfunction (EDys) is an important pathophysiologic factor underlying vasculogenic erectile dysfunction. The pathogenesis of both EDys and ED are linked through decreased expression and activation of endothelial nitric oxide synthase (NOS) which is responsible for formation of Nitric Oxide (NO). NO is a relaxing factor which plays a major role in activation and maintenance of the erection process. Aim of the work: this study aimed to detect the possible relationship between serum folic acid and erectile dysfunction by measuring serum FA concentration in patients with erectile dysfunction and comparing them with the healthy controls. Methodology: our study has been carried out on 90 individuals who were categorized into two groups. Group 1: 60 married males complained of ED. Group 2: 30 married potent males as a control.All participants were subjected to : personal history, past history of medical diseases and operations, sexual history, general examination, genital examination and evaluation of erectile function according to the International Index of Erectile Function (IIEF-5) Questionnaire). Fasting serum samples were collected from all participants and assayed for serum total testosterone, serum prolactin, serum cholesterol, serum triglycerides (TG), HbA1c and serum folic acid.Results: results of the current study showed a significant relation between folic acid and ED. FA level was declined as ED severity increased. It is thought that ED severity was related to HHcy which was related to the severity of FA deficiency.Conclusion: a significant association between serum FA level and ED severity was detected in the current study. Serum FA level decreased as the severity of ED increased. These results suggest that FA deficiency might reflect the severity of ED. Recommendations: serum folic acid assessment as a part of the routine investigations for patients complaining with erectile dysfunction. Additional experimental and clinical studies are needed to determine whether FA supplementation may be beneficial for patients having ED.

Role of folic acid deficiency as a possible risk factor for erectile dysfunction

Background: erectile dysfunction (ED) is the persistent inability to attain or maintain an erection. ED affects millions of men worldwide. The pathophysiology of ED includes vasculogenic, neurogenic, hormonal, anatomical, drug-induced and psychogenic causes. Endothelial dysfunction (EDys) is an important pathophysiologic factor underlying vasculogenic erectile dysfunction. The pathogenesis of both EDys and ED are linked through decreased expression and activation of endothelial nitric oxide synthase (NOS) which is responsible for formation of Nitric Oxide (NO). NO is a relaxing factor which plays a major role in activation and maintenance of the erection process. Aim of the work: this study aimed to detect the possible relationship between serum folic acid and erectile dysfunction by measuring serum FA concentration in patients with erectile dysfunction and comparing them with the healthy controls. Methodology: our study has been carried out on 90 individuals who were categorized into two groups. Group 1: 60 married males complained of ED. Group 2: 30 married potent males as a control.All participants were subjected to : personal history, past history of medical diseases and operations, sexual history, general examination, genital examination and evaluation of erectile function according to the International Index of Erectile Function (IIEF-5) Questionnaire). Fasting serum samples were collected from all participants and assayed for serum total testosterone, serum prolactin, serum cholesterol, serum triglycerides (TG), HbA1c and serum folic acid.Results: results of the current study showed a significant relation between folic acid and ED. FA level was declined as ED severity increased. It is thought that ED severity was related to HHcy which was related to the severity of FA deficiency.Conclusion: a significant association between serum FA level and ED severity was detected in the current study. Serum FA level decreased as the severity of ED increased. These results suggest that FA deficiency might reflect the severity of ED. Recommendations: serum folic acid assessment as a part of the routine investigations for patients complaining with erectile dysfunction. Additional experimental and clinical studies are needed to determine whether FA supplementation may be beneficial for patients having ED.

316 Low intensity shock wave tissue coverage for management of Erectile Dysfunction patients: preliminary comparative study

Is to evaluate the efficacy and safety of low intensity shockwave tissue coverage (LSTC) on management of impotent patients non- phosphodiesterase-5 inhibitors (PD5-I) responders. In, All 84 patients were included in the study from May 2015 to August 2017. They were divided into two groups; sever and non-sever. All patients fulfilled the inclusion criteria which were ED more than 6 months of organic cause, failed PD5-I and had a score ≤ 21 on SHIM and at least 1 month of PD5-I abstinence. Patients were excluded if they underwent radical prostatectomy, pelvic radiotherapy, and patient of ED of hormonal or psychogenic causes. Piezowave2 (Richard Wolf GmbH) was employed. Treatment protocol was once weekly of 4000 shocks of LSTC distributed on both corpora cavernousa and perineum for four weeks to reach 16000 shock waves. All patients were evaluated at base line and at 3, 6,9,12 months post.

EVALUATION OF NONCARDIAC CHEST PAIN

In the presented review of the current literature a lot of information about differente diagnostic approaches for patients management with a syndrome of noncardiac chest pain were system- atized and generalized.These patients have a diverse set of disease that requires the physician applying a wide range of ad- ditional surveys. In General, doctors need to exclude heart disease in patients who were treated with chest pain. If chest pain is noncardiac, then empirical treatment for gastro-intestinal reasons and the cor- responding assessment of psychogenic causes of chest pain are important for the symptomatology of pa- tients. In particular, primary care physicians should consider - besides the cardiac causes as a possible causes of thoracalgia - possible mental disorders, impaired motility of the upper gastrointestinal tract, problems with the thoracic spine - as a possible causes of thoracalgia. It would be beter to find out the rea- sons of thoracalgia with all available diagnostic tools and then - choose and assign appropriate adequate etiotropic therapy for most effectively cupping the patient's symptoms and reducing health care costs.

The first sign of loss of consciousness

The first clinically observable sign of an unconsciousness episode (UNCE) serves as the temporal sequence (kinetics) onset point for neurological events occurring during the loss of consciousness, unconsciousness and recovery of consciousness phases of the UNCE. The initial neurologic signs of 212 individuals exposed to gradual (N=114) and rapid (N=98) onset +Gz acceleration stress, inducing the ischemic LOC phase in 83.3±18.6s and 8.89±1.52s; p<0.001 respectively, were determined. The duration of the unconscious phase (considered absolute incapacitation) was 10.42±5.3s and 9.36±3.99s; p>0.1 for gradual and rapid onset +Gz-stress, respectively. Cerebral autoregulation may play a role in determination of ischemic UNCE induction and recovery. Five signs: loss of muscle control, eyelid closure, eye fixation, upward eye deviation, and muscular twitching occurred at LOC phase onset. The most frequent initial sign of LOC phase onset was loss of muscle control (84% of the episodes), followed by eye fixation (8.5%), and upward eye deviation (6.1%). Signs play a key role in differential diagnosis of syncopal, epileptic, psychogenic and other causes of UNCEs. Sign kinetics may provide insight into localization of the essential components and networks within the cephalic nervous system associated with UNCEs.

Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors.

Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years. The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED. To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man. Comprehensive review of the literature pertaining to ED in young men. ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed. Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes. Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections. Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment. ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5:508-520.

Dissociative Disorders with Haemolacria: Series of Case Reports

Bloody tears (Haemolacria) are a rare symptom that can be caused by local or systemic pathology. It is one of the most alarming symptom in ophthalmology. Besides those, idiopathic cases have been reported. A case of hyperthyroidism where haemolacria was secondary to the condition has also been reported. Haemolacria are also reported as secondary to epistaxis. Psychogenic causes are described including Munchausen Syndrome by proxy. Here we describe a series of four cases of haemolacria along with bleeding from other sites, found as associated features of dissociative disorders. In this series, patients with age ranging from 14-17 years, three of them are female and one male have been included. Examination excluded local ocular and nasal pathology, coagulopathy and hyperthyroidism. In course of their illness, two of these cases met the DSM 5 criteria for both dissociative disorders and conversion disorders, rest of them have been diagnosed as mixed dissociative disorders. After appropriate intervention, three patients recovered completely and in one patient symptoms (also bleeding) recurred on re-exposure to the previous stress factors. We report three cases of Dissociative disorders and one with both dissociative and conversion disorder where bloody tears were one of the feature. To the best of our knowledge this is the first official report of its kind in Bangladesh.J Bangladesh Coll Phys Surg 2017; 35(1): 36-42

Acute muscular weakness in children

Acute muscle weakness in children is a pediatric emergency. During the diagnostic approach, it is crucial to obtain a detailed case history, including: onset of weakness, history of associated febrile states, ingestion of toxic substances/toxins, immunizations, and family history. Neurological examination must be meticulous as well. In this review, we describe the most common diseases related to acute muscle weakness, grouped into the site of origin (from the upper motor neuron to the motor unit). Early detection of hyperCKemia may lead to a myositis diagnosis, and hypokalemia points to the diagnosis of periodic paralysis. Ophthalmoparesis, ptosis and bulbar signs are suggestive of myasthenia gravis or botulism. Distal weakness and hyporeflexia are clinical features of Guillain-Barré syndrome, the most frequent cause of acute muscle weakness. If all studies are normal, a psychogenic cause should be considered. Finding the etiology of acute muscle weakness is essential to execute treatment in a timely manner, improving the prognosis of affected children.

Scientific advances and evidence-based management in erectile dysfunction.

Significant advances have been made in the diagnosis and treatment of erectile dysfunction (ED) over the last half century. In the early 1970’s, ED or previously known as impotence, was thought to be related to psychogenic causes as popularised by Masters and Johnson; however, advances in our understanding of molecular biological factors and mechanisms governing sexual function have demonstrated that the underlying pathogenesis for ED is frequently multifactorial in nature.

Hyperammonaemia and associated factors in unprovoked convulsive seizures: A cross-sectional study

PurposeHyperammonaemia is frequently observed in patients who have experienced convulsive seizures. Although excessive muscle contraction is presumed to be responsible for the elevated levels of ammonia, the underlying mechanism is poorly understood. The present study aimed to identify the independent factors associated with ammonia elevation using large-scale multivariate analysis. MethodsWe conducted a cross-sectional study involving 379 adult patients who had been transported to our emergency department and treated for unprovoked convulsive seizures between August 2010 and September 2015. Elevation of venous plasma ammonia levels was set as the primary endpoint, and patients’ clinical and laboratory data were obtained. Those with severe liver dysfunction, known hepatic encephalopathy, or convulsions due to cardiovascular or psychogenic causes, and those taking valproate were excluded. ResultsUsing a cut-off value of 50μg/dL, 183 patients (48.3%) were found to have elevated levels of plasma ammonia. Four factors were identified as independent variables associated with hyperammonaemia following seizures: elevated venous lactate, lowered venous pH, sex (male), and longer duration of convulsion. ConclusionsThe results of the present study revealed independent factors associated with hyperammonaemia following unprovoked convulsive seizures in a larger scale and with more plausible statistical analysis. The authors further suggest that the excessive skeletal muscle contraction and/or respiratory failure during/after convulsive seizure may be the primary mechanism of hyperammonaemia.

A syndrome of erectile dysfunction in young men?

Erectile dysfunction in young men is an increasingly common chief complaint seen in urology clinics across the world (1). The international urologic community has taken an increased interest in this topic, with experts in the field of andrology and sexual dysfunction publishing multiple review articles (2,3) and an AUA Update Series Lesson (4) dedicated to this concerning issue. These articles skillfully address the epidemiology and diagnostic evaluation of ED and categorize ED into psychogenic or organic causes, addressing treatment options with specific interventions for each of the most common diagnoses.

Chorea: Classification, Differential Diagnosis, and Treatment

Chorea is a common hyperkinetic movement disorder that can have a large differential diagnosis. Causes can include genetic and sporadic etiologies, including metabolic abnormalities, autoimmune, structural, paraneoplastic, psychogenic, and iatrogenic causes. The workup can be challenging due to this large number of possible causes, and can include basic metabolic and specialized blood analysis such as genetic testing, in addition to imaging studies and cerebrospinal fluid analysis. Treatment of symptoms outside the realm of reversible causes can be challenging, and is a major focus of current research. This review covers sporadic causes, genetic causes, and management. Figures show a flowchart for evaluation of patients with chorea, a computed tomography scan of a Huntington disease patient showing caudate head atrophy, brain computed tomography scan showing calcification, and acanthocytosis. Videos show mild and moderate Huntington disease, Huntington disease-like 2, and chorea-acanthocytosis. Tables list metabolic abnormalities that can manifest as chorea, paraneoplastic and nonparaneoplastic syndromes associated with chorea, and reported successful therapies for chorea.

Chorea: Classification, Differential Diagnosis, and Treatment

Chorea is a common hyperkinetic movement disorder that can have a large differential diagnosis. Causes can include genetic and sporadic etiologies, including metabolic abnormalities, autoimmune, structural, paraneoplastic, psychogenic, and iatrogenic causes. The workup can be challenging due to this large number of possible causes, and can include basic metabolic and specialized blood analysis such as genetic testing, in addition to imaging studies and cerebrospinal fluid analysis. Treatment of symptoms outside the realm of reversible causes can be challenging, and is a major focus of current research. This review covers sporadic causes, genetic causes, and management. Figures show a flowchart for evaluation of patients with chorea, a computed tomography scan of a Huntington disease patient showing caudate head atrophy, brain computed tomography scan showing calcification, and acanthocytosis. Videos show mild and moderate Huntington disease, Huntington disease-like 2, and chorea-acanthocytosis. Tables list metabolic abnormalities that can manifest as chorea, paraneoplastic and nonparaneoplastic syndromes associated with chorea, and reported successful therapies for chorea. This review contains 4 highly rendered figures, 4 videos, 3 tables, and 108 references.

Chorea: Classification, Differential Diagnosis, and Treatment

Chorea is a common hyperkinetic movement disorder that can have a large differential diagnosis. Causes can include genetic and sporadic etiologies, including metabolic abnormalities, autoimmune, structural, paraneoplastic, psychogenic, and iatrogenic causes. The workup can be challenging due to this large number of possible causes, and can include basic metabolic and specialized blood analysis such as genetic testing, in addition to imaging studies and cerebrospinal fluid analysis. Treatment of symptoms outside the realm of reversible causes can be challenging, and is a major focus of current research. This review covers sporadic causes, genetic causes, and management. Figures show a flowchart for evaluation of patients with chorea, a computed tomography scan of a Huntington disease patient showing caudate head atrophy, brain computed tomography scan showing calcification, and acanthocytosis. Videos show mild and moderate Huntington disease, Huntington disease-like 2, and chorea-acanthocytosis. Tables list metabolic abnormalities that can manifest as chorea, paraneoplastic and nonparaneoplastic syndromes associated with chorea, and reported successful therapies for chorea.

Diagnostic Procedures of Itch.

A complex and multifactorial pathogenesis of itch makes the proper diagnosis of underlying disease a difficult and challenging clinical problem. The examination of every patient with itch should be started by gathering an accurate history. During the anamnesis it is important to obtain data about the beginning of the appearance of symptoms, its location, diurnal variation, and the factors influencing itch perception. After careful anamnesis the patient should undergo a detailed physical examination, with particular attention to the skin in order to look for any signs of skin lesions. Special attention should be paid to distinguish the primary lesion from the changes resulting from scratching. In patients in whom the etiology of the itch cannot be identified on the basis of the medical examination, a panel of primary screen laboratory examination may be required, and if necessary, depending on the results of basic laboratory results and data from medical history, additional diagnostic tests should be considered. In patients in whom an organic cause of itching has not been established, itch is most likely of undetermined origin; however, psychogenic causes should also be suspected and ruled out. In conclusion, it could be stated that itch is a common symptom of many skin diseases, systemic of neurological diseases. Despite the complex etiology of the disease, an exact cause of itch should be searched for in each patient, as successful therapy is largely dependent on the determination of the cause of the itching.

LBP - A Leading Cause of Workplace Absenteeism : Are We Doing Enough?

Low back pain (LBP) is a condition which affects most of the individuals at some point of time in their lives. The reportedprevalence of LBP in Indian population is highly variable, and ranges from 6.2% to 92%. The etiology of LBPcovers a vast number of factors including mechanical, psychogenic, degenerative, post traumatic and inflammatory causes. Meticulous history taking andphysical examination are of utmost importance while dealing with a case of LBR Various classes of medicines are available with promising results for control of LBR Non Steroidal Anti Inflammatory Drugs, selective COX2 inhibitors, muscle relaxants, opioid analgesics, tricyclic antidepressants, gabapentin, pregabalin etc. Non pharmacological intervention like spinal manipulation and acupuncture are of controversial effectiveness. Yoga and physiotherapy have evidence supporting their role in improving the pain. Strong need is there to improvise the conventional method of managing LBR Approximately 95% cases of LBP are of non speciJic mechanical wherein diagnostic imaging tests (including X-rays, CT and MRT) are not routinely indicated for acute non-specifi LBR Investigations should be limited for the small minority (<2-5%) where the cause of back pain is suspected to be either inflammatory (ie. systemic autoimmune diseases viz. ankylosing spondylitis or spondyloarthritis) or sinister. Active rehabilitation should be encouraged and the patients should not be prescribed bed rest as a treatntenf Management of LBPrequires an umbrella approach which, apart from pharmacological intervention, screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care along with patient empowerment in terms of health education, participation in decision muking and responsibility of taking good self-care.

Examination of validity in spoken language evaluations: Adult onset stuttering following mild traumatic brain injury1

Reports of increased incidence of adult onset stuttering in veterans and service members with mild traumatic brain injury (mTBI) from combat operations in Iraq and Afghanistan lead to a reexamination of the neurogenic vs. psychogenic etiology of stuttering. This article proposes to examine the merit of the dichotomy between neurogenic and psychogenic bases of stuttering, including symptom exaggeration, for the evaluation and treatment of the disorder. Two case studies of adult onset stuttering in service members with mTBI from improvised explosive device blasts are presented in detail. Speech fluency was disrupted by abnormal pauses and speech hesitations, brief blocks, rapid repetitions, and occasional prolongations. There was also wide variability in the frequency of stuttering across topics and conversational situations. Treatment focused on reducing the frequency and severity of dysfluencies and included educational, psychological, environmental, and behavioral interventions. Stuttering characteristics as well as the absence of objective neurological findings ruled out neurogenic basis of stuttering in these two cases and pointed to psychogenic causes. However, the differential diagnosis had only limited value for developing the plan of care. The successful outcomes of the treatment serve to illustrate the complex interaction of neurological, psychological, emotional, and environmental factors of post-concussive symptoms and to underscore the notion that there are many facets to symptom presentation in post-combat health.

Psychogenic cause is not the main risk factor for erectile dysfunction in young men compared to the aging group

Psychogenic cause is not the main risk factor for erectile dysfunction in young men compared to the aging group

ИНТЕНЦИОННАЯ СУДОРОГА РЮЛЬФА И ДРУГИЕ ПАРОКСИЗМАЛЬНЫЕ ДИСКИНЕЗИИ

Paroxysmal dyskinesia comprise a significant and fascinating part of movement disorders, which represent a diagnostic challenge for neurologists working on the borderlands of psychiatry and epilepsy. The current classification based on the relation of attacks to a movement is supported by the response to treatment and genetic difference. We reviewed clinical characteristics and the main advances in genetics of these unique, usually hereditary diseases. Clinical diagnosis remains the key to the treatment choice. Psychogenic causes are common in sporadic cases, but paroxysmal dyskinesia secondary to systemic or primary neurological disorders should not be missed and warrant careful investigation.

Gabapentin and venlafaxine reduce pain in a patient with somatic symptom disorder.

To the Editor: Here, a case of abdominal pain of unknown origin is presented. A thorough gastrointestinal workup was negative. The patient was then referred to psychiatry for further workup and management, with the suspicion that he was suffering from somatic symptom disorder. Case report. Mr A is a 58-year-old man with a psychiatric history significant for major depressive disorder, alcohol use disorder, cannabis use disorder, and cocaine use disorder, all in sustained, full remission. He presented to the psychiatry outpatient clinic with anxiety and worsening abdominal pain for a period of 3 months. Review of Mr A’s chart showed an extensive gastrointestinal workup that was negative for structural, infectious, and autoimmune processes. He had been treated with amitriptyline 10 mg at bedtime by a psychiatrist earlier in the month, which did not help the pain. This medication was switched to nortriptyline 25 mg at bedtime, which also did not help the pain. Mr A was desperate for relief and reported that the abdominal pain had remained constant since it began 3 months prior. He rated the pain on a scale of 1 to 10 as a 7 at the time of interview but said that the pain often reaches maximum intensity of a 10. He denied constipation or diarrhea associated with the pain. Following careful review of Mr A’s chart, the most likely diagnosis was somatic symptom disorder, according to DSM-5 criteria. His symptoms had been present for 3 months, which does not exclude the diagnosis of somatic symptom disorder; it only qualifies the diagnosis as atypical. It was decided to discontinue nortriptyline treatment and begin a combined treatment of gabapentin and venlafaxine. Gabapentin was titrated to 300 mg 3 times per day, and venlafaxine extended release was titrated to 150 mg per day. At a 2-week follow-up, he reported improvement in pain symptoms. On a scale of 1 to 10, Mr A said the pain had dropped from a 10 to a 6. Gabapentin was increased to 300 mg 4 times per day to control residual pain. At a 4-week follow-up, Mr A reported the pain to be a 5, with fluctuations up to 7. Mr A is still on the venlafaxine and gabapentin regimen and is being followed closely by psychiatry and primary care. In an animal study, gabapentin inhibited visceral pain when the pain was induced by an inflammatory stimulus or by stress.1 In another small study comparing the use of gabapentin to placebo in 40 patients with irritable bowel syndrome,2 a barostat study was used to determine threshold pressures for bloating, discomfort, and pain. The group given gabapentin showed an increased threshold compared to the placebo group. In a case report, gabapentin 1,800 mg allowed for a remission in somatoform pain disorder in a 48-year-old woman with depression.3 Venlafaxine was used in Mr A to control his depression, as well as to contribute to pain control. Venlafaxine has been shown in several studies to improve pain symptoms that are associated with depression4 as well as peripheral neuropathy.5 In any patient, the differential diagnosis and medical examination must be exhausted before considering a psychogenic cause to the patient’s illness. Mr A meets the criteria for somatic symptom disorder. Irritable bowel syndrome cannot be excluded and has considerable overlap with somatization disorder.6 More research is required to develop treatment modalities for somatic symptom disorder, as well as to differentiate between somatic symptom disorders affecting the gastrointestinal tract and irritable bowel syndrome. Although Mr A is not pain free, the reduction of pain is promising.