Psychogenic Disease Research Articles

What is the place for placebo in the management of psychogenic disease?

What is the place for placebo in the management of psychogenic disease?

What is the place for placebo in the management of psychogenic disease?

What is the place for placebo in the management of psychogenic disease?

Neuro-Ophthalmologic Manifestations of Psychogenic Disease

From a neuro-ophthalmologic standpoint, five areas may be affected by psychogenic disease: (1) vision, including visual acuity and visual field; (2) ocular motility and alignment; (3) pupillary size and reactivity; (4) eyelid position and function; and (5) corneal and facial sensation. The physician faced with a patient complaining of decreased vision or some other disturbance related to the afferent or efferent visual systems for which there is no apparent biologic explanation has three responsibilities. First, the physician must ascertain that an organic disorder is not present. Second, the physician should induce the patient to see or do something that would not be possible if the condition were organic in nature. Finally, the physician should attempt to determine whether the patient has an underlying psychiatric disease or is experiencing psychosocial stress. In this article, manifestations of psychogenic disease as they pertain to vision are considered, and, where appropriate, the various methods used to diagnose and treat these phenomena are discussed.

Evaluation of clinical diagnostic criteria for psychogenic movement disorders

Previous studies showed that there are certain features suggestive of a psychogenic disorder, and Fahn and Williams proposed criteria for psychogenic movement disorders. Data on the sensitivity and specificity of these criteria are lacking. We expanded on the Fahn and Williams criteria to create a new set of diagnostic criteria. We retrospectively reviewed 79 patients in a movement disorders specialty clinic. We applied the proposed diagnostic criteria to both cases and controls and analyzed sensitivity and specificity. The diagnostic criteria correctly identified "clinically probable" (or better) psychogenic movement disorders with a sensitivity of 83% and specificity of 100%. For "clinically possible" or greater, sensitivity was 97% and specificity was 96%. In addition, a significantly higher proportion of patients with psychogenic disease were female and reported either a family history of neurological disease or other exposure to neurological disease (P = 0.001 and 0.01, respectively). The diagnostic criteria are simple to apply and have high sensitivity and specificity for psychogenic movement disorders. Also, we report a correlation between previous exposure to a disease model and psychogenic disease.

Psychosomatic Pain: New Insights and Management Strategies

At least 40 to 60 percent of women and at least 20 percent of men with chronic pain disorders report a history of being abused during childhood and/or adulthood. This incidence of abuse is two to four times higher than in the general population. Patients with more severe or frequent abuse, usually during childhood and worse if sexual in nature. often develop specific syndromes or combinations of syndromes. These syndromes include posttraumatic stress disorder, fibromyalgia, and other conditions characterized by repression, somatization, and increased utilization of medical care. Psychosomatic symptoms and dysfunctional behaviors may emerge as these patients seek attention and validation of their suffering, while paradoxically repressing painful memories of trauma. Behavioral observations and key features of the physical examination may greatly help the clinician identify both the presence and severity of psychosomatic disease. In addition, it is very interesting that various studies document physiologic changes in the brains of patients with a history of abuse and in patients with a diagnosis of fibromyalgia. These studies suggest that abuse may physiologically and developmentally increase a person's susceptibility to pain and that some organic changes may be associated with psychogenic disease. Diagnosis and treatment of even the most challenging patients with chronic pain is much more effective if it includes (a) careful inquiry about any history of past or present abuse or other severe trauma, (b) empathy and constructive validation of disease and suffering, (c) recognition of dysfunctional pain behaviors and personality traits, (d) documentation of nonanatomic as well as anatomic features on examination, (e) multidisciplinary treatments including psychotherapy whenever indicated, and (f) noninvasive procedures and alternatives to potentially habit-forming medications whenever possible and appropriate. Furthermore, it has been shown that helping patients gain insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients.

Disc replacement with the SB Charité endoposthesis - experience, preliminary results and comments after 35 prospectively performed operations

Aim of this prospective study was an investigation concerning the indication for the implantation of an artificial disc endoprosthesis and the rating of this operation. 35 patients with 11 bi- and 24 monosegmental implanted disc endoprosthesis were observed over an average follow-up of 14.7 months. Indications for the operation were: unsuccessful, orthopedic conservative treatment > 6 months, segmental pain, age < 45 years, evidence of a radiologic (MRI) demonstrable mono- or bisegmental disc degeneration with or without disc prolabation, exclusion of psychogenic disease and positive preoperative, diagnostic measures. The average stay in the hospital was 16.8 days (preoperative: 4.3 days), the average operation time 85.5 minutes, the average blood loss was 125 ccm. 23 patients were operated in L 5 / S 1, 20 in L 4 / 5 and 2 in L 3 / 4. NSAR was given in 33 patients preoperatively, opiates in 2 further patients, postoperatively NSAR was necessary in 5 patients, opiates in 2 patients. The preoperative angle of lordosis (L 1 - S 1, n = 25) was changed from 35.6 degrees to 42.6 degrees (20,2 %), the segmental angle from 19 degrees to 30 degrees (57.5 %). The implantation of the artificial disc was followed by a good pain relief in patients suffering from a mono- or bisegmental disc degeneration. In patients with a facett joint arthrosis and elderly patients > 45 years this method cannot be used, the indication in patients with failed back surgery syndrome cannot be estimated yet. Improvements of the instrumentation and the discussion in the case of revisional operations are mandatory.

Dorsal Thoracic Pain in Manual Medicine

Abstract And IntroductionDorsal thoracic pain is common, but much less common than pain from the cervical and lumbar regions of the spine. Pater son (1987) reviewing 1037 cases of spinal pain seen in primary care, found only 21 cases; however, Bruckner et al. (1987) in a referral centre collected 73 patients in three years. The medical literature on this area of the spine is also sparse. Different causes have been cited, such as nerve entrapment, muscular sprain, trigger points, pain referred from the lower cervical spine, thoracic facet syndrome, discogenic pain or psychogenic disease. Our aim is to review these different sources of pain and to discuss them in light of our own studies and experience in thoracic pain.

A Review of Objective Measures of Gustatory Function

Several studies of diagnostic tests of gustatory function have been reported. Results show that none of the subjective tests are satisfactory because they cannot detect psychogenic disease or malingering. Of the objective modalities that have been investigated, gustatory-evoked potential testing has been the most widely studied because it does not require expensive equipment and can be used in multicenter studies. The techniques developed to date for measuring gustatory-evoked potentials are not yet clinically useful for diagnosing taste disorders. Future directions for improving this method of evaluating gustatory function include improving stimulation methods and equipment, in order to obtain better stimulation-related potentials and better means of distinguishing between normal and abnormal gustatory-evoked potential patterns, and applying these new standards to the evaluation of data.

What should be done in weight loss of unknown origin?

Involuntary weight loss is associated with increased mortality and morbidity. Differential diagnosis includes more than 50 disease entities; therefore the diagnostic strategy is determined by additional symptoms. THE SYNDROME OF "CONSUMPTION", i.e. weight loss as an isolated symptom or together with malaise, may indicate tumors (lung, pancreas, kidney cancer, malignant lymphoma), infections (tuberculosis, HIV), immunologic diseases (lupus erythematosus, vasculitis), hyperthyroidism, extraintestinal Crohn's disease, or psychogenic disease (depression, psychogenic eating disorders). Recognition of the underlying disease is often delayed by a lack of awareness for weight changes, both by physicians and by patients. Nutritional counselling and treatment should be initiated in time.

Effectiveness of therapies currently employed for persistent low back and leg pain

I n the Focus article, Drs. Loeser and Sullivan marshal several lines of argument to suggest that disability in the chronic low back pain syndrome is iatrogenic. The concept is intriguing, but not new. Shorter, in his excellent review of psychosomatic illness in the era of modern medicine, developed the thesis that somatization by patients follows a variety of societal and medical fashlons. There is much merit in what Loeser and Sullivan present. However, it is my view that the problem is much more broadly based than the contribution of physicians alone. The medical profession, society in general, and all of our legal and administrative institutions have failed to understand the concept of somatization. I believe this is the key to the problem. The real issue is the diagnosis of psychogenic physical symptoms and their appropriate treatment. Separating organic from psychogenic disease and appropriately determining the causes of both is key to improving the current confused situation. The documented history of psychosomatic symptoms begins early in the 18th century. About this time pseudoseizures, generally called hysteric fits, were recognized. Later in the century much unexplained malaise and pain was ascribed to gout. The erroneous physiology of the uterine theorists and the concept that psychiatric symptoms began in the sympathetic ganglia of the abdomen were used to explain most psychosomatic complaints. Toward the end of the century, William Cullen defined neuroses and firmly settled the nervous system as the source of these complaints, but many of these early physicians continued to invoke spurious causes, such as irritation or inflammation of nerves, to explain symptoms. This fallacious pathophysiology cul-

Psychogenic amblyopia and Stargardt's disease the differential diagnosis

Psychogenic amblyopia and Stargardt's disease are visual loss in children; however, their prognoses and management differ greatly. Stargardt's disease is a progressive bilateral macular dystrophy, with autosomal recessive inheritance. In time, visual acuity may decrease to 6/60. Stargardt's disease is characterised by retinal pigment epithelial defects on fluorescein angiography, and prolonged photostress recovery time. The ophthalmoscopic appearance is of macular atrophy and yellow flecks surrounding the macula (fundus flavimaculatus), although initially die macular appearance may be unremarkable. Psychogenic amblyopia is a juvenile functional bilateral amblyopia. Alternative labels include Streff syndrome, functional visual loss, visual conversion reaction, and hysterical amblyopia. Patients with psychogenic amblyopia often have multiple symptoms, as well as a reduced academic achievement. It is linked to visual or emotional stress and the prognosis is usually good. Visual acuity measures are variable, kinetic visual fields may spiral, and an accommodative/vergence disorder is often present. Two patients are presented to illustrate the differential diagnosis and management of the two conditions.

Psychosomatic Aspects of Primary Fibromyalgia Syndrome [PFS

Objectives: The importance of psychosomatic factors in Primary Fibromyalgia Syndrome [PFS] is discussed with regard to the controversy about the prevalence of psychiatric disorders and psychological dysfunction. Methods: In a multicenter controlled study we investigated the psychological and organic factors of 65 patients with PFS and 53 patients with rheumatoid arthritis. Results: Pain behavior, psychological distress and psychiatric disorders differed significantly between PFS and RA patients. PFS patients were generally more disturbed and had more developmental risk factors [for example loss of parents or family violence] in their childhood. Conclusions: Nevertheless, PFS does not seem to be a psychogenic disease. According to a bio-psychosocial model, psychosomatic factors play a different etiological role within the different subgroups. This prospective investigation was designed to better elucidate these interconnections.

Effects of endolymphatic mastoid shunt operation for patients with Menière's disease.

During the past 10 years, the endolymphatic mastoid shunt operation was carried out on 108 patients with Meniere's disease: 54 men and 54 women between 22 and 72 years old. According to criteria AAOO proposed in 1972, 86 cases (79.6%) belonged to class A, 19 cases (17.7%) to class B and 3 cases (2.7%) to class C. Forty patients took the body sway test before and after the operation. Four of the 40 patients were found to have Meniere's disease on the contralateral side within 12 months after the operation and one patient was found to have a complicating psychogenic disease. The abnormal body sway had recovered 2 to 9 months after the operation, but the medical treatment could not be stopped during this period. The average hearing gain after the operation was 21.3 +/- 14.4 dB; that for the patients with a short period of illness (within 23 months of the first onset to the operation) was 25.2 +/- 14.5 dB and that for the patients with a longer period of illness (over 24 months) was only 13.8 +/- 10.6 dB.

Evaluation of the first 70 patients in the center for male sexual dysfunction of Beth Israel Medical Center.

We evaluated 70 patients for male sexual dysfunction in our center during its first 6 months of operation. The results of the analysis demonstrated that 55 per cent had organic impairment. Several important findings should be emphasized. There was mild elevation of serum prolactin in 6 cases, none of which was the direct cause of the impotence. A total of 15 patients had a diagnosis of either impaired glucose tolerance or overt diabetes (7 with organic and 8 with psychogenic disease). Therefore, the diagnosis of diabetes or impaired glucose tolerance, whether known previously or not, should not be accepted as confirming the organicity of impotence. Also, nocturnal penile tumescence alone confirmed the diagnosis of psychogenic impotence only when a rigid erection 5 minutes in duration occurred. The absence of nocturnal erections cannot be interpreted as conclusive evidence of organic impotence. Finally, a definitive diagnosis of psychogenic impotence was made based only on visual sexual stimulation in 6 patients. Our results emphasize further that etiologic factors of organic or psychogenic impotence are complex and that a multidisciplinary approach should be used.

Book Review : The Side Effects of Estrogen Drug Therapy: Contraception and Postmenopause. By HAROLD E. SIMMONS. Published by Psychogenic Disease Pub. Co., California, pp. 92. Price: $4.95 (Paperback)

Book Review : The Side Effects of Estrogen Drug Therapy: Contraception and Postmenopause. By HAROLD E. SIMMONS. Published by Psychogenic Disease Pub. Co., California, pp. 92. Price: $4.95 (Paperback)

The Psychogenic Biochemical Aspects of Cancer. By H. E. Simmons. (Pp. 316; $9.95.) Psychogenic Disease Publishing Company: Sacramento, California. 1979.

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Psychotropic Drug Use in the Boston Area

During 1972, adults admitted to general medical and surgical wards in Boston area hospitals were interviewed to determine their use of prescribed psychotropic drugs prior to hospitalization. Patients hospitalized for psychiatric disorders or psychogenic ("functional") disease were excluded. Patients who had taken prescribed drugs that could not be identified were considered nonusers. Of the total sample, 20% gave a histroy of psychotropic drug use. Antianxiety drugs were taken by 15% of the patients and accounted for two thirds of total psychotropic drug use. Hypnotics were taken by another 4% of the sample. Slightly over half of antianxiety and hypnotic drug use was for a year or more. Use was more frequent in patients with potentially chronic medical disorders. The findings, in general, are consistent with other studies employing other methods to investigate the use of psychotropic drugs. Simple studies of use, however, do not provide a sole or adequate definition of treatment option, need, or efficacy.

The Causes and Treatment of Headaches

A HEADACHE is said to be one of the most common ills of the human race. It is one of the most frequent complaints of patients who seek medical help from the neurologist, the ophthalmologist, the otolaryngologist, the gynecologist, and other specialists, and especially from the general practitioner of medicine. It may be of minor significance in many instances, but it also may be an important symptom of either organic or psychogenic disease. Like any other pain, a headache is a symptom and not a disease. Consequently, diagnosis and treatment are not sufficient. If possible, the physician must diagnose the type and determine the etiology before he attempts to institute therapy. The presence of a headache, especially if severe or frequent, should always warrant a complete medical history and an examination of the patient. It is a rare person who has never experienced headaches on some occasions in his life. There seems to be a constitutional tendency for some people to have headaches as a result of excessive eating, excessive drinking, omission of meals, fatigue, tension, mental overactivity, emotional strain, worry, anger, excitement, frustration, resentment, or other organic and psychologic variations from the normal life routine. The headaches that occur in patients with an organic disease may be due, in part, to this individual variation or peculiarity rather than to the nature of the disease process itself. Sometimes this tendency may be dem-

PRIMER ON THE RHEUMATIC DISEASES

<h3>RHEUMATOID ARTHRITIS</h3><h3>ETIOLOGY</h3> Rheumatoid arthritis is a disease of unknown causation. Many theories of causation have been proposed but none has withstood critical evaluation. Some known facts are that it has a slight tendency to be familial; the sex incidence in peripheral rheumatoid arthritis is 3 women to 1 man, and 80 per cent of the cases occur between the ages of 25 to 50, with the peak at 35 to 40. According to a number of current theories, rheumatoid arthritis is variously claimed to be (1) an infectious disease, (2) a metabolic disease, (3) a disease with an endocrinologic basis, (4) a disease of the peripheral circulatory apparatus, (5) a disease of the nervous system, (6) a psychogenic disease and (7) a disease of hypersensitivity. Such a list as this indicates how little actually is known about the cause of rheumatoid arthritis. <h3>PATHOLOGY</h3> Rheumatoid arthritis is invariably described as

Is ulcerative colitis a psychogenic disease?

Is ulcerative colitis a psychogenic disease?