Psychogenic Disorders Research Articles

Occupational therapy for functional neurological disorders: a scoping review and agenda for research.

Functional neurological disorders (FND)-also called psychogenic, nonorganic, conversion, and dissociative disorders-constitute one of the commonest problems in neurological practice. An occupational therapist (OT) is commonly involved in management, but there is no specific literature or guidance for these professionals. Classification now emphasizes the importance of positive diagnosis of FND based on physical signs, more than psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physiotherapy and occupational therapy as part of a multidisciplinary team for functional movement disorders (FMD) and psychotherapy for dissociative (nonepileptic) attacks. The diagnosis and management of FND has entered a new evidence-based era and deserves a standard place in the OT neurological curriculum. We discuss specific management areas relevant to occupational therapy and propose a research agenda.

Clinical Features of Psychogenic Voice Disorder and the Efficiency of Voice Therapy and Psychological Evaluation

The aim of this study was to define the clinical features of psychogenic voice disorder (PVD) and explore the treatment efficiency of voice therapy and psychological evaluation. Fifty-eight patients who received treatment following the PVD diagnosis and had no organic or other functional voice disorders were assessed retrospectively based on laryngoscopic examinations and subjective and objective assessments. Epidemiological characteristics, accompanying organic and psychological disorders, preferred methods of treatment, and previous treatment outcomes were examined for each patient. A comparison was made based on voice disorders and responses to treatment between patients who received psychotherapy and patients who did not. Participants in this study comprised 58 patients, 10 male and 48 female. Voice therapy was applied in all patients, 54 (93.1%) of whom had improvement in their voice. Although all patients were advised to undergo psychological assessment, only 60.3% (35/58) of them underwent psychological assessment. No statistically significant difference was found between patients who did receive psychological support concerning their treatment responses and patients who did not. Relapse occurred in 14.7% (5/34) of the patients who applied for psychological assessment and in 50% (10/20) of those who did not. There was a statistically significant difference in relapse rates, which was higher among patients who did not receive psychological support (P < 0.005). Voice therapy is an efficient treatment method for PVD. However, in the long-term follow-up, relapse of the disease is observed to be higher among patients who failed to follow up on the recommendation for psychological assessment.

Neurological assessment and explanation of diagnosis of functional (Psychogenic) disorders

Functional symptoms and disorders (also called psychogenic, non-organic and conversion disorders) are a common cause of distress and disability and account for around 1 in 6 new referrals to the neurology clinic. In the last 10-15 years advances in understanding, diagnosis and treatment of patients with functional disorders have changed the clinical landscape1. These are turning traditionally negative views in to a more positive approach which brings these disorders back within standard neurological practice.

Attention and sensation in functional motor disorder

Functional motor disorder (FMD), also called psychogenic motor disorder or conversion disorder, describes impairments of motor function where there is no evidence of organic disease. The diagnosis is usually confirmed by positive clinical signs, such as Hoover's sign, in which normal power returns when attention is diverted away from the affected limb. This suggests that selective attention is an important determinant of these functional symptoms. The present study is the first specifically to explore the shifting of spatial attention in relation to the side of FMD. We tested 14 patients with unilateral functional upper limb weakness on three tasks requiring detection of visual targets close to the affected or unaffected hand, or touches to the hand itself. Targets were preceded by central cues promoting voluntary shifts of attention, or peripheral cues promoting automatic shifts. We observed a reduced response to visual and/or tactile targets on the affected side in around half of the patients, by comparison with age-matched controls, indicating that some degree of detection cost often accompanies FMD. Additionally, although the patient group showed normal cueing effects on the visual tasks, they had a unilateral absence of cueing effect on the affected side in the tactile task. Consideration of the data in the context of recent theory suggests that the abnormality may be not in the shifting of attention itself, but rather in the consequences of attending to the affected side. Specifically, the expected cueing effects may be absent on the affected side, because attention to a functionally weak limb increases the perception of the symptom, including any reduced sensory response. This preliminary research suggests promising new lines of investigation into the role of attention, and particularly somatic attention, in FMD.

PEMPHIGUS AND PSYCHOSOMATIC DISORDERS: CLINICAL TYPOLOGY

Psychosomatic disorders, comorbid with true acantholytic pemphigus (pemphigus) and identified clinical manifestations, the relationship of pemphigus with psychogenic disorders are described. Some patients had mental disorder (adjustment disorder) provoked by pemphigus - nozogenic reactions. In some patients with aberrant hypochondria iatrogenic (drug) hypomania was discovered on the high doses of systemic glucocorticoids. The Dermatоlоgy Index оf Disease Severity (DIDS) and The Dermatology Life Quality Index (DLQI) was calculated for all patients. According to the results of the study dissociation between the severity and the subjective perception of the disease with the help of these indicators was determined.

Chewing-induced facial dystonia: a rare presentation of task-specific dystonia

This case is an addition to scarce literature available for a rare condition, chewing-induced task-specific dystonia. The patient was a 63-year-old woman who presented with a 4-year history of progressive...

Cardiopulmonary Exercise Testing in Patients with Heart Failure with Specific Comorbidities.

Exercise capacity is one of the most powerful predicting factors of life expectancy, both in patients with and those without cardiac disease. Cardiopulmonary exercise testing provides a global assessment of the integrative exercise responses involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function. This relatively noninvasive, dynamic, physiologic overview allows the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision-making. Chronic heart failure is a significant cause of worldwide mortality and morbidity, whose clinical picture is characterized by exercise intolerance and impaired quality of life. The purpose of this review is to provide an update of the role of cardiopulmonary exercise testing in patients with heart failure with specific comorbidities. Patients with heart failure frequently present concomitant clinical conditions, such as obesity, anemia, lung or kidney disease, diabetes mellitus, cancer, depression, and psychogenic disorders, which could affect length and quality of life, including everyday activities and exercise performance. Poor effort and malingering may be suspected when early discontinuation of the exercise test with irregular breathing occurs.

TRUE ACANTHOLYTIC PEMPHIGUS FROM THE STANDPOINT OF PSYCHOSOMATIC MEDICINE: A REVIEW OF THE LITERATURE

Today the problem of correlation of mental disorders and skin diseases is relevant in Russia. Psychosomatic disorders, comorbid true acantholytic pemphigus (pemphigus) and cases of affective disorders are described on this literature review. The relationship between manifestation and exacerbations of pemphigus with psychogenic disorders is shown. Studies investigating quality of life of patients with pemphigus are described. The literature was searched in the following databases: MedLine, PubMed, Concilium Medicum, SCOPUS, Web of Science, LILACS, PEPSIC, Russian State Library, the Sechenov central science medical library.

Peculiarities of depressive disorders of “working” emigrants and re-emigrants

IntroductionThe problem of emigration and re-emigration in Ukraine is among the most actual state and social problems.ObjectivesTo research clinical-psychopathological peculiarities of depressions in “working” emigrants and re-emigrants.MethodologyThe investigation was carried out in Ternopil Region. Psychogenic depressive disorders (F43.21 and F43.22 according to ICD-10) were diagnosed in 69 non-emigrants, 68 emigrants, and 67 re-emigrants; endogenous ones (F31.3, F31.4, F32.1, F32.2, F33.1, and F33.2 according to ICD-10) were diagnosed in 65, 66, and 63 persons correspondingly; and organic ones (F06.3 according to ICD-10) were diagnosed in 64, 62, and 61 persons correspondingly.ResultsIt was found out an influence of emigration and re-emigration factors on psychoemotional sphere of the patients. The influence of the emigration factor was the most manifested in patients with psychogenic depressive disorders and was a less manifested in patients with endogenous and organic depression. Re-emigrants had the most severe depressive symptoms that might be explained by an impact of psychosocial factors. In the syndromological structure of depressive disorders it was determined that re-emigrants were more affected by typical affective syndromes – vital and apathic depression, whereas emigrants were more affected by atypical affective syndromes, including anxious-depressive and agitation ones. It might be explained by an influence of objective social-psychological factors as well as an intrapsychic transformation of actual stressors connected with emigration and re-emigration.ConclusionsEmigration should be considered as a factor promoting a pathologically characterological development towards anxious-depressive changes, whereas re-emigration should be considered as a factor of asthenic-depressive and apathic-depressive transformations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological traits of skin picking disorder and psychogenic itch

IntroductionDespite the intense discussion of psychiatric comorbidity in psychodermatology, research on psychological components of skin picking and psychogenic itch is limited, especially when it concerns patients’ representation of skin perception and their attitude towards disease.ObjectivesTo characterize psychological traits of skin picking and psychogenic itch disorder by comparing aspects of bodily experience.AimsTo reveal internal relations of different components of bodily experience in skin picking and psychogenic itch.MethodsThirty patients with skin picking disorder (L98.1) and 18 patients with psychogenic itch (F45.8) participated in the study. The psychosemantic method “Classification of sensations” was used to assess bodily experience. It includes estimation of 80 descriptors from 6 classes of bodily sensations: skin (ex. “itch”), inner body (ex. “sickness”), receptor (ex. “sticky”), emotional (ex. “anxiety”), dynamics (ex. “exhaustion”) and attitudinal descriptors (ex. “bad”). Cluster and factor analysis were performed.ResultsThe most significant aspect of bodily experience in skin picking was its dynamics as a transition from irritation to calmness connected with the sensation of itch opposed to all other sensations (there were opposite signs of factor loadings of these variables and they were included in the factor explaining 45% of total variance). In contrast, in psychogenic itch these relations are diffuse and consist of connections between skin sensations and inner bodily sensations and descriptors of emotions reflecting functional origin of disorder.ConclusionTraits of psychological components in skin picking disorder and psychogenic itch should be concerned in the complex (psychiatric, psychological and dermatological) treatment of these disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical features of PTSD in patients with TBI

ObjectiveModern scientific researches about interaction between TBI and PTSD are characterized by few amounts and contradiction of conclusions.MethodTwenty-eight persons with TBI were examined by means of questionnaires and structured clinical interviews. 17 patients were suffering from PTSD. We compared clinical features in patients with isolated TBI and group with both disorders.ResultsFour groups of symptoms were analyzed–sleep, emotions, cognition and personality features. Disorders of sleep were presented with violation of REM cycle, nightmares, hyperexcitation, increase watchfulness during the sleep. Emotional disorders were expressed as lability without external irritations; an excessive emotional reaction is on small events, agitation, irritability, inadequacy of emotional reactions and apathy (loss of desire to think, to feel, and/or to operate). Cognitive disorders included deceleration of psychomotor reactions, difficulties of searching of words in communication, problems of switching of attention, rigidity, difficulties in planning, decision of multistage tasks, violation of operative memory, executive dysfunction. Features of personality disorders were loss of initiation and self-control, decline of spontaneity, surplus attention is to the details, inadequacy of self-appraisal, feeling of inferiority, an increase necessity is for control and lordship over other, aggression (socially inadequate behavior, episodes of anger).ConclusionsPsychopathological features presented in patients with comorbidity of PTSD and TBI are not specific and can be within the framework of other psychogenic, exogenous, organic, posttraumatic or neurological disorders and diseases. PTSD can combine with other psychical and somatic disorders that caused chronological and pathogenetical comorbidity in patients with both states.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future.

A multidisciplinary expert review of key issues and future directions from the conference “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms.”On October 9 and 10, 2015, a conference entitled “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms” was held at the Center for Ethics, Emory University, Atlanta, GA, USA. This conference brought together a select group of 30 distinguished thought leaders and practitioners, including ethicists, researchers, clinicians, humanities scholars, and advocates to discuss the unique challenges and controversies related to the diagnosis, treatment, and stigma for patients with what is currently recognized as functional (“psychogenic”) neurological disorders. Our group of experts explored the conflicts and ethical tensions within health care that must be addressed in order to advance care for these disorders. What follows is a reflection on the conversations between conference attendees outlining key challenges and value conflicts in the diagnosis and treatment of patients with functional disorders. With this report, we aim to provide a roadmap for reducing stigma and improving care for functional neurological disorders (FND). A path forward would involve (1) setting a multifactorial research agenda that equally prioritized access to effective psychotherapy as well as identification of novel biomarkers; (2) empowering patients with FND to be heard and to drive changes in care; and (3) reducing isolation for clinicians by providing formal training and setting up multidisciplinary care teams and support networks.

ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА КЛІНІКО-ПСИХОПАТОЛОГІЧНИХ ОСОБЛИВОСТЕЙ ДЕПРЕСИВНИХ РОЗЛАДІВ У ЕМІГРАНТІВ ТА РЕЕМІГРАНТІВ, ХВОРИХ НА ДЕПРЕСИВНІ РОЗЛАДИ ПСИХОГЕННОГО, ЕНДОГЕННОГО ТА ОРГАНІЧНОГО ХАРАКТЕРУ

У даному розділі наведено результати аналізу клініко-психопатологічних особливостей депресивних розладів у емігрантів та реемігрантів, хворих на депресивні розлади психогенного, ендогенного та органічного характеру, з використанням даних клінічного (основна та додаткова симптоматика депресивного розладу відповідно до критеріїв МКХ-10, типологія провідного афекту, синдромологічна структура) та психометричного обстежень. Були використані шкала депресії M. Hamilton (HRDS), шкала тривоги M. Hamilton (HARS), опитувальник Symptom Check List-90-Revised – SCL-90-R. Порівняльний аналіз довів значущість розбіжностей між групами емігрантів та реемігрантів з переважанням у емігрантів проявів тривоги, страху, ажитації, а у реемігрантів – ангедонії, нездатності концентруватися і приймати рішення, поширеності думок про смерть та самогубство та явищ астенізації. Аналіз домінуючого типу афекту виявив статистично значуще переважання у емігрантів тривожно-депресивного, а у реемігрантів – тоскного й апатичного типів афекту. В синдромологічній структурі у емігрантів значуще частіше виявлялися атипові афективні синдроми, в т. ч. прояви ажитації, тривоги та соматовегетативні розлади, тоді як у реемігрантів – типові афективні синдроми (вітальна, апатична та анестетична депресія). Психометричне дослідження проявів депресії та тривоги виявило значуще більшу поширеність серед емігрантів тривожно-депресивних розладів, ажитованої депресії та депресії зі страхом, психічної та соматичної тривоги, тоді як у реемігрантів переважали адинамічна та недиференційована форми депресії. Порівняння психопатологічної структури виявило переважання у емігрантів тривожності, соматизації, обсесивно-компульсивної симптоматики, а у реемігрантів – депресії та міжособистісної сензитивності. Таким чином, основними клініко-психопатологічними закономірностями депресивних розладів у емігрантів є більша поширеність тривожно-депресивних та вегетосоматизованих форм депресії, а у реемігрантів – переважання астено-депресивних та адинамічних форм депресивних розладів.

Hysteria and Self Psychology

ABSTRACTThe article uses a self psychological lens to explore the notion of hysterical personality from our earliest understanding of it as the root of all psychogenic disorders, as discovered by Breuer and Freud, to its present elimination in the DSM-V. Can hysteria still be considered an applicable diagnosis or character style in the modern time? Or is it a culturally and historically limited phenomenon that no longer holds validity? Considering the case of Dora from Heinz Kohut’s revolutionary view, which privileges the subjective and empathic stance in treatment, one can infer that Dora’s own hysterical symptoms were not pathological, as Freud thought, but rather healthy attempts to bolster an enfeebled self. Nevertheless, both Kohut and his followers conclude that from a self psychological perspective both object-instinctual understandings, and self-object transferences, are essential for successful analytic treatment.

Hyperkinetic Movement Disorder Emergencies.

A movement disorder emergency has been defined by Fahn and Frucht as "any neurological disorder evolving acutely or subacutely, in which the clinical presentation is dominated by a primary movement disorder, and in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality." In this review, we discuss the most common situations in which hyperkinetic movement disorders, including chorea, ballism, dystonia, myoclonus, tics, as well as psychogenic disorders, can present as emergencies. Some acute hyperkinetic issues that can complicate Parkinson's disease and parkinsonism, such as the rare dyskinesia-hyperpyrexia syndrome, will be also covered. The phenomenology and natural history of medication-induced dystonic reaction, a common form of acute secondary dystonia frequently leading to emergency department consultations, are discussed in detail. Despite the acute nature, most of these conditions can result in a good outcome. Rare but serious disorders such as status dystonicus or malignant Gilles de la Tourette syndrome may lead to substantial morbidity and mortality. Thus, we emphasize the need to develop means for more accurate and prompt recognition and treatment of these syndromes.

Nferior Mesenteric Vein Thrombosis

Clinical Medical Image: A 50-year-old man with medical history of psychogenic disorder presented to the emergency department with lower abdomen and fullness sensation for 1 week. There were no fever or chills and the vital sign was stable. Physical examination revealed lower abdominal tenderness with rebounding pain. Laboratory reveals WBC 1,7400/ul, GOT/GPT 30/26 CRP 26 mg/dl, BUN/ Cr 6/0.5,D-Dimer 3600 mg/ml. Computed tomography scan with contrast demonstrated non-enhanced hypo dense inferior mesenteric vein thrombosis and adjacent mesenteric stranding (Figure 1A, arrows). In addition, some non-enhanced hypo dense thrombus in the main portal vein (Figure 1B, arrow head) noted. Inflammatory changes around peri-rectal site with fat standing (arrow), which indicated early inferior mesenteric venous thrombosis partial occlusion. There was no evidence of bowel obstruction or ischemia seen on imaging feature, the patient received antibiotic ceftriaxone treatment for 5 days and started with heparin therapy then bridged to warfarin. The comprehensive thrombophilia workup was unremarkable and the blood-culture revealed no organisms. The symptoms resolved without other complication and no signs of recurrent disease were observed 2 month later. Mesenteric ischemia refers to the sudden onset of intestinal hypo perfusion, which usually seen in the setting of thrombophilia or local inflammation. However, the inferior mesenteric venous thrombosis is rare and less common involved. Early diagnosis and management of mesenteric thrombosis can prevent further infarction or surgical intervention [1].

СИНДРОМОЛОГІЧНА ФЕНОМЕНОЛОГІЯ ДЕПРЕСИВНИХ РОЗЛАДІВ У ЕМІГРАНТІВ ТА РЕЕМІГРАНТІВ

Метою дослідження було вивчення синдромологічних особливостей депресивних розладів у емігрантів та реемігрантів. Для цього було клінічно обстежено 196 емігрантів, 191 реемігрантв та 198 неемігрантів, хворих на депресивні розлади психогенного, ендогенного та органічного характеру. При цьому виявлено більшу ураженість реемігрантів типовими афективними синдромами – вітальної та апатичної депресії, а емігрантів – атиповими афективними синдромами, зокрема тривожно-депресивними та ажитації, що може бути пояснено впливом об’єктивних соціально-психологічних факторів, а також інтрапсихічною трансформацією актуальних стресогенних подразників, пов’язаних з еміграцією та рееміграцією.

Functional Voice Disorders: The Importance of the Psychologist in Clinical Voice Assessment

The etiopathogenesis of functional voice disorders (FVDs) is multifactorial. The purpose of this study was to analyze the severity of depression and anxiety, and the incidence of affective and anxiety disorders, in patients who presented different types of FVDs and were followed at the University Clinic of Otolaryngology. This is a cross-sectional study. After ENT observation, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). A psychologist assessed the severity of depression and anxiety using the Hamilton rating scales, and screened for affective and anxiety disorders using the Mini International Neuropsychiatric Interview. Significant differences in the mean values were found between the groups, with the MTVD1 group having higher levels of depression and anxiety. In affective disorders (current major depression and current mood disorder with psychotic symptoms) and in anxiety disorders (lifetime panic disorder, current generalized anxiety, and current panic disorder with agoraphobia), significant differences in association were found between groups. Groups presented with significant differences in depression and anxiety levels, and in some psychiatric diagnoses. Patients with FVDs should be independently assessed regarding their voice disorder classification. The integration of a psychologist in the clinical voice assessment team is essential, as findings have corroborated an important incidence of psychiatric disorders in FVDs patients.

Possible neural mechanisms of psychotherapy for trauma-related symptoms: cerebral responses to the neuropsychological treatment of post-traumatic stress disorder model individuals.

Psychotherapy is often effective for treating psychogenic disorders, but the changes that occur in the brain during such treatments remain unknown. To investigate this, we monitored cerebral activity throughout an entire session using a psychotherapeutic technique in healthy subjects. Since post-traumatic stress disorder (PTSD) is a typical psychogenic psychiatric disorder, we used PTSD-model volunteers who had experienced a moderately traumatic event. The technique used as psychotherapy was eye movement desensitisation and reprocessing (EMDR), a standard method for treating PTSD. The oxygenated haemoglobin concentration ([oxy-Hb]), a sensitive index of brain activation, measured using multi-channel near-infrared spectroscopy, revealed changes in [oxy-Hb] in the superior temporal sulcus (STS) and orbitofrontal cortex (OFC). During a vital therapeutic stage, a significant reduction in the activation by forced eye movements was observed in the right STS, and a trend toward a reduction in the left OFC. The hyperactivation of the right STS on the recall of unpleasant memories, and its normalisation by eye movements, seem to reflect an important neural mechanism of the psychotherapy. These findings suggest that psychotherapy for traumatic symptoms involves brain regions related to memory representation and emotion, and possibly those that link memory and emotion, such as the amygdala.

Dizziness and anxiety disorders in the elderly

Perhaps each dizzy patient feels anxiety. Varying emotional disorders are particularly common in elderly patients with dizziness. The causes of the frequent concurrence of dizziness and mental disorders (anxiety and depression) are diverse. Amongst these there are two chief conditions: 1) vestibular vertigo may cause anxiety to a greater extent than many other symptoms; 2) anxiety and depression are themselves frequently manifested by the sensations resembling vestibular ones that patients are inclined to call dizziness. On the contrary, anxiety may appear in some cases as the sensations resembling dizziness. Besides the latter, the patient may present a lot of complaints, which serves as a manifestation of psychoautonomic syndrome (the basis for which is anxiety and depression). At the same time, the term 'phobic postural instability' is proposed to describe psychogenic disorders, in which dizziness becomes virtually the only chief complaint. The treatment of dizziness and anxiety disorders in the elderly encompasses a few areas: vestibular rehabilitation, drug therapy, and psychotherapy. The paper describes the possibilities of using anvifen as a pathogenetically sound treatment in patients with anxiety disorders, as anvifen is a GABA-ergic medication.