Strange Sensations Research Articles

Body image distortion: validation of a new scale for children and adolescents.

A possible definition of body image is the picture that an individual has of her/his own body, irrespective of how her/his body actually is. Body image is a competence that develops in children similar to many other skills. The aim of this study was to validate a new rapid 20-items questionnaire to study the body image distortion in children and adolescents: the Strange Sensations Questionnaire (SSQ). A secondary aim was to improve the knowledge about body image distortion and about depersonalization symptoms,and their correlation with possible hallucinations, in children and adolescents, as it can be investigated using a scale. 1557 children and adolescents, balanced for sex and age filled out a new 20-items questionnaire (SSQ) about body image, and a second validated questionnaire about fantasy with a Reality/Unreality distinction subscale to study the relationship with hallucinations (Free Fantasy Questionnaire-FFQ). Results showed a good validation of SSQ with three subscales: depersonalization, fragility and other shapes. We found a relative high frequency of proneness to out-of-body experiences. Children of primary school age have a higher mean score than pre-adolescents and adolescents in the total score of all the three subscales of SSG. Adolescents seem to have a significantly higher mean score in Fragility subscale. The mean total score and the mean scores of all the three subscales have a significant correlation with the Reality/Unreality subscale of FFQ. SSQ was validated. The research could confirm also the high frequency of body image distortion in developmental age, suggesting the possibility of a specific retardation as a possible origin of some body image distortion disorders. Data also confirm the proneness for hallucination of adolescents with body image distortion.

Un cas de forme longue de la Covid-19 rapporté par une adolescente en souffrance

Long-term Covid-19 is now part of our lives and can be questioned by adolescents and their families when faced with long- lasting and unexplained symptoms. This is the case of Alice, a 16-year-old teenager treated at the Cochin Hospital's adolescent centre, who presents digestive disorders and strange body sensations mas-king anxiety-depressive affects.

ERPS AS AN INDEX OF IMPAIRED WORKING MEMORY IN AN ISCHEMIC BRAIN STROKE APHASIC PATIENT AWAKENED FROM A LONG-TERM COMA FOLLOWING AN AMPHETAMINE OVERDOSE

Nowadays, amphetamines constitute the prescription drugs most commonly abused by adolescents and young adults (Berman, O’Neill, Fears et al. 2008). The prevalence of problematic (mainly illegal) use of amphetamines as a stimulant by college students, and here especially before serious examinations, has also been rising. This fact represents a serious public health concern. The patient, aged 19, was awakened from from a long-term coma that had lasted 21 days following an amphetamine overdose and manifested tetraparesis, cortical blindness and deficits in cognitive and emotional processes. After a year of rehabilitation the majority of symptoms had disappeared, but cortical blindness andworking memory deficits remained. In addition, frontal lobe syndrome symptoms appeared. After two years of therapy as a result of immense tiredness caused by all an night wedding reception she started to manifest Charles-Bonnet syndrome. She experienced strange visual sensations such as visual hallucinations and saw various non-existing shapes (coloured blots, patterns and fireworks of vivid colours). She also saw objects (often terrifying) as well as animals (mainly African) and people with deformed faces and long teeth, and persons in African dress with feathers and coral beads in their hair. Her real identity was not remembered by the patient for longer than 2 hours and even then she insisted on being referred to as Shakira. She was given a qEEG examination (in open and closed eyes conditions) and ERPs with the use of auditory stimuli at the period when the hallucinations (to a small degree) still occurred. Studies conducted into the functional neuroimaging of the brain work in milliseconds in the examined patient can explain her symptoms. A comparison of the subject’s ERPs with the grand average of ERPs in healthy controls shows that the N170 and N 250 components are impaired in the subject: the occipital-temporal area of the subject brain shows a strong positivity instead of negativities. This positivity might reflect an enhanced reactivity of neurons in the corresponding area induced by the removal of lateral inhibition from the neurons as a result of local damage. ------------------------------------------------------------------------------------------------------------------------------------

‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

Unusual olfactory perception during radiation sessions for primary brain tumors: a retrospective study.

During irradiation sessions for brain tumors or head and neck cancers, some patients experience abnormal olfactory sensations. To date, the frequency of such sensations during these treatment sessions has not been investigated. We analyzed abnormal olfactory sensations in patients who underwent radiation therapy at our institution for primary brain tumors, excluding malignant lymphoma, between January 2009 and January 2018. A total of 191 patients who were awake during radiation treatment and capable of communicating were analyzed in this retrospective medical study. Of these patients, 7 were aware of olfactory sensations during irradiation. The median age of these 7 patients was 13 (range 8–47) years, Six were <20 years of age, accounting for 10% of the total population of similar age (n = 60). However, only 1 of 131 patients aged ≥20 years complained of strange olfactory sensations. Four of seven patients had germ cell tumors, but none had a medulloblastoma. We investigated patients who experienced light sensation, as an internal standard to ascertain the accuracy of this study. Only 10 patients experienced light sensation during their irradiation sessions. This suggests that the frequency of these sensations was possibly underestimated in our study. In conclusion, a considerable number of patients experienced unusual olfactory sensations during radiation treatment. Further prospective studies on abnormal olfactory sensations during irradiation are needed to clarify the underlying mechanism of this sensation.

Oral cenesthopathy – the psychological malady: Report of two cases

Cenesthopathy is characterized by bizarre or strange sensations at various parts of body, and it is common to occur at the oral area (oral cenesthopathy). In such cases, the patients seek dentists for medical care, but will mostly fail to find any causes of the disease. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. Thus the aim of this article is to focus review on the various aspects of oral cenesthopathy with report of two cases.

Oral cenesthopathy.

Cenesthopathy is characterized by abnormal and strange bodily sensations and is classified as a ‘delusional disorder, somatic type’ or ‘somatoform disorder’ according to the DSM 5. The oral cavity is one of the frequent sites of cenesthopathy, thus the term ‘oral cenesthopathy.’ Patients with oral cenesthopathy complain of unusual sensations without corresponding abnormal findings in the oral area, such as excessive mucus secretion, a slimy sensation, or a feeling of coils or wires being present within the oral region. They usually visit multiple dentists rather than psychiatrists. Without a proper diagnosis, they repeatedly pursue unnecessary surgical procedures to remove their ‘foreign body’. This sometimes creates a dilemma between the dentists and patients. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. This review focuses on the various aspects of oral cenesthopathy.The estimated prevalence of cenesthopathy was 0.2 to 1.9 % in a study done at a Japanese university psychiatry clinic and 27 % in a study done at a Japanese psychosomatic dentistry clinic. Oral cenesthopathy do not have clear disposition, while some studies reported that elderly women were most commonly affected. Its pathophysiology has not been fully elucidated. However, recent studies have suggested a right > left asymmetrical pattern of the cerebral blood flow of patients with oral cenesthopathy. Antidepressants, antipsychotic drugs, electroconvulsive therapy, and psychotherapy might be effective in some cases, though it is known to be intractable.To date, the epidemiology, pathophysiology, etiology, classification and treatment of oral cenesthopathy are unknown due to the few reports on the disorder, though there are a few case reports. To overcome this difficult medical condition, clinico-statistical and case–control studies done under rigorous criteria and with a large sample size are required.

Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions.

Background:Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods:20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up.Results:Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires.Conclusion:This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery

ContextApproximately 30% of the women report pain in the affected breast before breast cancer surgery. ObjectivesThe purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain. MethodsDifferences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time. ResultsBetween-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast before surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. The LME modeling revealed significant group effects for most outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain. ConclusionInvestigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high-risk group, are needed.

Prospective cohort study of symptom resolution outside of the ulnar nerve distribution following cubital tunnel release.

Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after release of the ulnar nerve at the elbow. Twenty patients with isolated cubital tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones, and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected. The same data were collected at 6-week follow-up. Paired t tests or non-parametric Wilcoxon Signed-Rank tests were used where appropriate to examine for significant (p ≤ 0.05) changes between pre- and post-operative scores. Probability of resolution was greater outside of the ulnar nerve distribution than within at early follow-up. There was a decrease in pain, numbness, and tingling symptoms both within and outside the ulnar distribution after cubital tunnel release. There was a decrease in pain as measured by several validated questionnaires. This study documents resolution of symptoms in an extra-ulnar distribution after cubital tunnel release. Improvement in pain and function after cubital tunnel release may be associated with an improvement in symptoms both within and outside theulnar nerve distribution. Future studies could be directed at correlating pre-operative disease severity with probability of extra-territorial symptom resolution using a larger sample population.

Bosco et la dépersonnalisation, ou le battement d’un fantasme

All Bosco's work is fulfilled with strange places, strange sensations, strange situations, strange persons. We suppose this is around what Bosco writes his books. Throughout his novels, Bosco writer tells us a childhood in L’âne culotte, L’Enfant et la rivière, and then two kinds of adult's life in Le mas Théotime, Malicroix, four works crowned by literary prizes. We have therefore chosen these to argue our work. This is the use of the resort of this feeling of strangeness that will stop our thinking, more particularly the three moments of the hero's depersonalization. In his novels, Bosco learns to let free course to his inconscient life. At the episodes of depersonalization, is superposing the elaboration of his fundamental phantasm which subtends these, and the hero's intimity with his tearings, his fears and his desire to find the object of his love. Like this, Bosco seals in his novels his phantasmatic world with his unconscious life.

Effect of Implementing a Designed Nursing Protocol on Nurses’ Knowledge and Practice Regarding Epileptic Patients Outcomes

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness: More than 2 million people in the United States about 1 in 100 have experienced an unprovoked seizure or been diagnosed with epilepsy. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. However, about 25 to 30 percent of people with epilepsy will continue to experience seizures even with the best available treatment. The nurse plays a critical role in reducing complications of this method .The aim of the present study is 3 folds: first is to assess nurse's knowledge and practice regarding epileptic patients, design nursing protocol for nurses working with epileptic patient , and evaluate the effect of implementing the designed nursing protocol on nurse's knowledge and practice regarding epileptic patients. Four hypotheses were formulated: (1) the post mean knowledge scores of nurses who will be exposed to designed nursing protocol will be higher than their pre mean knowledge scores. (2) The post mean practice score of nurses who will be exposed to designed nursing protocol will be higher than their pre mean practice scores. (3) The incidence of complications during seizure for epileptic patient cared by nurses after protocol implementation will be lesser than that developed pre protocol implementation. (4) A positive relationship will exist between knowledge and practice score obtained by nurses receiving the designed nursing protocol. Research design: aquasi-experimental research design was utilized in this study on a convenient sample of 35 nurses and 30 Adult conscious patients with epilepsy, who are aged from 18 to 65 years from both sexes, agree to participate in the study. This study was conducted in the in neurological department at Assiut University Hospital. Tools utilize for data collection were a) Questionnaire sheet. .b) Observation checklist sheet. c) Patient assessment sheet. d) Construction of designed nursing protocol. Results: The first and the second hypotheses were supported as a good improvement in the mean knowledge & practice scores were found after the implementing of designed nursing protocol. The third hypothesis was supported, as epilepsy complications were improved after protocol implementation. The fourth hypothesis were not able to extract the statistical significance of the relationship between knowledge and nursing practices before and after the study due to the result is one and zero. Conclusion: patient with epilepsy exposed for several complications. Improving nurses' knowledge and practice can favorable affect the incidence of these complications. Recommendation: Nurses in need for in-services training programs and refreshing courses to improve their knowledge which will reflect into their practice while working with epileptic patients

Clinical competence of biopsychosocially trained physiscians and controls

To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training. A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness. The symptoms had begun before her final nursing- exam and exacerbated on her mother's 60th birthday two months later. The patient's mother is the sole caretaker for the patient's sister, who also attended the birthday party. The patient's sister is 19 and had been diagnosed with storage disease and is wheelchair-bound. The doctors were asked to record their observations and interpretations while reviewing the case report. Group A-physicians mentioned and interpreted the physician-patient relationship and the patient's body language as described in the case report more often (p = 0.002, Wilcoxon-Mann-Whitney rank sum test (RS)), mentioned physical symptoms more often (p = 0.0099, Fisher's exact test (FE)) and more often interpreted illness settings with respect to the patient's fear and guilt (Fisher's exact test, p = 0.007 and p = 0.015). A precise integrative diagnosis (life events leading to stress, the latter evoking fear and guilt, leading to symptoms of the fight-flight reaction) was suggested by 7 of group A and 4 of group C. Extensive laboratory work-up and requests for consultations were more frequently asked for by the C group (p = 0.048, RS). Residency training in biopsychosocial medicine in an Internal Medicine Department increased sensitivity to and interpretation of biological and psychosocial data many years after the training and decreased the extent of work-up and consultation costs. However it only tended to enhance psychosomatic conceptualisation with respect to anxiety/guilt/hyperventilation and conversion symptoms.

Efficacy of Small Doses of Ketamine With Morphine to Decrease Procedural Pain Responses During Open Wound Care

The purpose of this study was to evaluate differences in pain intensity, pain quality, physiological measures, and adverse effects when patients received morphine with saline (MS) compared with morphine and a small dose of ketamine (MK) before an open wound care procedure (WCP). A randomized, cross-over design was used to determine whether the addition of a small dose of ketamine would potentiate morphine's analgesic effects and decrease WCP pain intensity. Patients were randomized to receive either 0.1 mg/kg of morphine (8 mg maximum) plus saline intravenously (IV) or 0.05 mg/kg of morphine (4 mg maximum) plus ketamine 0.25 mg/kg IV before the WCP. Patients were crossed-over to receive the alternate treatment during the next WCP. Eleven male patients participated in the study. Mean rank of pain intensity during WCP-MK was significantly less than during WCP-MS (P=0.005). Mean±standard error of mean pain intensity during the WCP-MK was 3.09±0.99, whereas it was 6.82±0.92 during the WCP-MS. However, 91% of the patients had adverse effects (eg, strange sensations, hallucinations, blurred vision) with MK versus 0% with MS. Diastolic blood pressure was significantly higher during the WCP-MK. Ketamine with morphine significantly reduced procedural wound pain intensity during WCP. Adverse effects and higher diastolic BP occurred with MK. Further research is warranted to determine the optimal analgesic dose of ketamine or if the addition of a benzodiazepine would mitigate the psychotomimetic effects of ketamine.

S05-02 - Transcultural perspectives of medicine

The psy fields are predicated on the cartesian notion of a mind-body dualism. Suffering is understood to stem either from problems of mind or from problems of physiology. A related dualism is that of the “biological” and that of “cultural”. Recent commentators have worked at great length to collapse this dualism in day to day work with patients. At the same time, it clearly forms a fundamental part of medical epistemology. From a transcultural perspective, it is increasingly clear that there exists the possibility for considerable difference in the four “Es”: Experience, expression, explanation and expectations related to suffering. This variation is in large part related to the epistemic structure underlying any given culture, and, taken as such, can present a considerable challenge to consultation-liason psychiatry. A patient may experience suffering that is expressed in the form of strange sensations in a specific parts of the body. This is then explained as a consequence of a certain process that is culturally syntonic, and then expects a certain course of suffering as well as treatment. Given that we tend to take our epistemic perspectives for granted as representative of the “world as it is”. The C-L psychiatrist who does not take these variations into consideration could all to easily arrive at a misdiagnosis and as such erroeneous treatment.

S05-02 - Transcultural perspectives of medicine

The psy fields are predicated on the cartesian notion of a mind-body dualism. Suffering is understood to stem either from problems of mind or from problems of physiology. A related dualism is that of the “biological” and that of “cultural”. Recent commentators have worked at great length to collapse this dualism in day to day work with patients. At the same time, it clearly forms a fundamental part of medical epistemology. From a transcultural perspective, it is increasingly clear that there exists the possibility for considerable difference in the four “Es”: Experience, expression, explanation and expectations related to suffering. This variation is in large part related to the epistemic structure underlying any given culture, and, taken as such, can present a considerable challenge to consultation-liason psychiatry. A patient may experience suffering that is expressed in the form of strange sensations in a specific parts of the body. This is then explained as a consequence of a certain process that is culturally syntonic, and then expects a certain course of suffering as well as treatment. Given that we tend to take our epistemic perspectives for granted as representative of the “world as it is”. The C-L psychiatrist who does not take these variations into consideration could all to easily arrive at a misdiagnosis and as such erroeneous treatment.

A Case of Sleep Paralysis with Hypnopompic Hallucinations

EB is a 22-year-old Caucasian woman requesting evaluation for a 2-year history of “spells of paralysis.” These began after an auto accident that was not associated with head trauma, but did result in a broken ankle. She described the accident as intensely terrifying. During recovery, she began having episodes of emerging from sleep to a state of being fully awake but unable to move, accompanied by a sense of fear and breathlessness. Sometimes, she would have visual imagery or strange sensations, such as feeling a distinct foreign presence in the room, seeing shadows, or hearing footsteps. Typically, episodes would occur from a nocturnal awakening, and could happen at any time of night. Initially, they would occur at random, from weekly, to a month or two apart. For the preceding month, events increased to several times a night and occurred during daytime napping. She became fearful of sleeping. She admitted reluctance to discuss these events with a physician for fear of being labeled mentally ill.

Frontal nonconvulsive status epilepticus manifesting somatic hallucinations

Somatic hallucinations are subjective experience of false, strange sensations of things occurring in or to the body. They can be seen in psychotic disorders, but have not been well described as an ictal psychosis in patients with nonconvulsive status epilepticus (NCSE) of frontal origin. We reported a 69-year-old woman who had NCSE of frontal origin manifesting prolonged somatic hallucinations mimicking a psychiatric disorder and initially treated as such. Ictal EEG revealed the frontal focus and ictal single-photon emission computed tomography (SPECT) showed the activation, not only in the frontal area but also in the parietal area as the projected regions, both of which might be associated with the development of her symptoms. She also had two generalized tonic-chronic seizures out of psychosis. Her psychosis and ictal rhythmic discharges on EEG ceased with valproate and she has since remained free from the symptoms. The current case suggests that long-lasting somatic hallucinations could be an ictal psychosis in frontal NCSE and thus an EEG study is needed for an early diagnosis and treatment.

Axonal flip-flops and oscillators

The strange and unpleasant sensations (paraesthesiae) or asynchronous motor-unit activation (fasciculation) that result from a period of limb ischaemia are examples of ectopic discharge in peripheral nerves. Ectopic activity also results from demyelination and is associated with serious neurological conditions, such as multiple sclerosis. A build-up of extracellular K + in the internode and persistent Na + currents are now implicated in generating the different forms of activity arising in normal and demyelinated axons.

Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units

AimsThis study was designed to find out whether women operated in high volume surgical units have less chronic symptoms than women operated in smaller volume units.MethodsA questionnaire was sent to 265 consecutive women treated at the Department of Oncology, Helsinki University Central Hospital, from January to June 1996. Of the patients, 129 were operated in hospitals experienced in breast cancer surgery (high volume units=HVU) and 92 patients in district hospitals with less experience in breast surgery (low volume units=LVU).ResultsChronic symptoms were less common in HVU than in LVU: chronic pain (56 vs 43%,P<0.05) or strange sensations (45 vs 26%,P<0.01) in the ipsilateral arm or phantom sensations in the removed breast (66 vs 26%,P<0.001). The risk factors included in the multivariate model for chronic pain in the breast area were: intensity of acute post-operative pain, radiotherapy and depression and for the chronic arm pain: low volume unit and depression.ConclusionsMore careful surgical technique seems to reduce the risk of chronic pain following treatment of breast cancer. Chronic pain is associated with more intense post-operative pain and depression.