Briquet's syndrome in a man.

A case history is presented of a man who met the diagnostic criteria of Briquet's syndrome after a 7-year history of excessive use of psychiatric and medical health care services. Despite his having been seen by several psychiatrists, the diagnosis was made only following the use of the Schedule for Affective Disorders and Schizophrenia (SADS), a structured psychiatric interview, the results of which were applied to operationalized diagnostic criteria (Research Diagnostic Criteria [RDC]). This case demonstrates: 1) the fact that Briquet's Syndrome, commonly considered a female disorder, can occur in men; 2) the utility of structured interviews and defined diagnostic criteria in arriving at unexpected diagnoses; and 3) the importance of recognizing Briquet's Syndrome in order to avoid needless medical intervention for somatic complaints of psychological origins.     

Methodology and personality in Briquet's syndrome: a reappraisal.

The authors describe a case of Briquet's syndrome in a man and discuss the relationship of that condition to personality features. They view Briquet's syndrome as a set of behaviors arising from personality traits and suggest that examination of the genesis and treatment of the condition be shifted to a characterological approach.     

Munchausen's syndrome: a reconceptualization of the disorder

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) delineates three categories of factitious disorders: chronic with physical symptoms (Munchausen's syndrome); factitious disorder with psychological symptoms; and other factitious disorders with physical symptoms. Munchausen's syndrome served as the prototype for all factitious disorders at the time DSM-III was drafted, partly due to the disproportionate attention given to this variant of the disorder. Clinical experience suggests that existing categories do not adequately provide for commonly seen forms of factitious illness. It is now recognized that factitious disorder is the result of a complex interaction of personality factors and psychosocial stressors that often present with both medical and psychiatric symptomatology. Proposed changes in the revised edition of the diagnostic manual DSM-III-R include separate categories of factitious disorder with psychological, physical, and both psychological and physical symptoms. A case report of a patient for whom extensive records and thorough psychological assessment were available is exemplary of a more common course of the disorder (both psychological and physical symptoms) that by current classification would be considered "atypical." A reconceptualization of the disorder that gives emphasis to course and clinical features is suggested.     

Is Briquet's syndrome a heterogeneous disorder?

A structured interview that identified 78 female psychiatric outpatients as having Briquet's syndrome also indicated that 77 of the 78 fulfilled inclusive diagnostic criteria for one or more other psychiatric syndromes. If, as this finding suggests, Briquet's syndrome represents a heterogeneous disorder, its various components should be evaluated and patient responses to treatments should be assessed. Until such studies are done, the general and psychiatric physician should be aware that the diagnosis of Briquet's syndrome does not rule out the possibility of other psychiatric illnesses that may be more amenable to treatment.     

Early birth order in Briquet's syndrome

Birth order in 90 female patients with Briquet's syndrome was significantly earlier than the theoretical mean for a normally distributed population. In contrast, the birth order of 78 women with primary alcoholism did not differ from this mean. These results suggest an early environmental influence in the development of Briquet's syndrome in women.     

Psychological features in panic disorder: a comparison with major depression

OBJECTIVE: We aim to evaluate the psychodynamic model for panic disorder (PD) formulated by Shear et al. (1993), comparing PD patients and major depression (MD) patients. METHOD: We evaluated these parameters in open interviews in 10 PD patients and 10 patients with MD (DSM-IV). The data were recorded on videotape and were examined by 5 diagnostic blind appraisers. RESULTS: The data allowed a comparative analysis that underscores the existence of a psychological model for PD vs MD: 1) the protracted symbiotic phase of development and the existence of problems with separation in PD patients; 2) patients with MD tended to have a particularly negative impression of relationship with the first objects; furthermore, they had remarkable experiences of loss; and 3) while the PD patients tended to be shy and inhibited in childhood, especially showing a clear difficulty in expressing aggressiveness, the depressed patients tended to disclose an impulsive aggressiveness from infancy to adulthood. CONCLUSION: Exposure to parental behaviours that augment fearfulness may result in disturbances in object relations and persistence of conflicts between dependence and independence may predispose to anxiety symptoms and fears of PD.     

Caffeine challenge test in panic disorder and depression with panic attacks

Our aim was to observe if patients with panic disorder (PD) and patients with major depression with panic attacks (MDP) (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) respond in a similar way to the induction of panic attacks by an oral caffeine challenge test. We randomly selected 29 patients with PD, 27 with MDP, 25 with major depression without panic attacks (MD), and 28 healthy volunteers. The patients had no psychotropic drug for at least a 4-week period. In a randomized double-blind experiment performed in 2 occasions 7 days apart, 480 mg caffeine and a caffeine-free (placebo) solution were administered in a coffee form and anxiety scales were applied before and after each test. A total of 58.6% (n = 17) of patients with PD, 44.4% (n = 12) of patients with MDP, 12.0% (n = 3) of patients with MD, and 7.1% (n= 2) of control subjects had a panic attack after the 480-mg caffeine challenge test (chi(2)(3) = 16.22, P = .001). The patients with PD and MDP were more sensitive to caffeine than were patients with MD and healthy volunteers. No panic attack was observed after the caffeine-free solution intake. The patients with MD had a lower heart rate response to the test than all the other groups (2-way analysis of variance, group by time interaction with Greenhouse-Geisser correction: F(3,762) = 2.85, P = .026). Our data suggest that there is an association between panic attacks, no matter if associated with PD or MDP, and hyperreactivity to an oral caffeine challenge test.     

Neuroleptic-induced panic attacks in a patient with delusional depression

Panic attacks occurred for the first time in a patient suffering from delusional depression during treatment with a combination of an antidepressant and a neuroleptic. His anxiety proneness along with a dysphoric response to the neuroleptic were deemed responsible for these attacks. It is proposed that neuroleptic-induced dysphoric responses may be responsible for therapeutic failure in some cases of psychotic depression.     

Hyperventilation challenge test in panic disorder and depression with panic attacks.

Our aim was to determine whether panic disorder (PD) patients, major depressive patients without panic attacks (MD) and major depressive patients with panic attacks (MDP) respond similarly to hyperventilation challenge tests. We randomly selected 35 PD patients, 33 MDP patients, 27 MD patients and 30 normal volunteers with no family history of anxiety or mood disorder. The patients had not been treated with psychotropic drugs for at least 1 week. They were induced to hyperventilate (30 breaths/min) for 4 min, and anxiety was assessed before and after the test. A total of 16 (45.7%) PD patients, 12 (36.4%) MDP patients, four (11.1%) MD patients, and two (6.7%) normal volunteers had a panic attack after hyperventilating. The PD and MDP patients were significantly more responsive to hyperventilation than the MD patients and the normal volunteers. The MD patients had a significantly lower heart-rate response to the test than all the other groups. There is growing evidence that PD patients are more sensitive to the vasoconstrictive effects on basilar arterial blood flow caused by hyperventilation-induced hypocapnia than are comparison subjects. Our data suggest that there is an association between panic attacks and hyperreactivity to an acute hyperventilation challenge test.     

Polysymptomatic complaints and Briquet's syndrome in polycystic ovary disease

To test the hypothesis that there is an association between polycystic ovary disease and Briquet's syndrome, the authors administered a health questionnaire to infertile women with polycystic ovary disease, infertile women with tubal disease, and normal women. The patients with polycystic ovary disease endorsed significantly more physical and psychological complaints than either control group. Structured interviews revealed that five of the 39 (13%) met diagnostic criteria for definite or probable Briquet's syndrome. This study gives support to an association between polysymptomatic complaints, Briquet's syndrome, and polycystic ovary disease.     

Treatment-emergent depression with antidepressants in panic disorder

Two patients with panic disorder received therapeutic doses of antidepressants. They developed endogenomorphic symptoms of major depression according to DSM-III-R criteria despite remission of their panic attacks. Treatment-emergent depression in panic disorder has been previously associated with high potency benzodiazepines. Whether antidepressant medications may unmask a depressive diathesis or are coincidentally associated with depression is discussed in this report.     

The diagnosis of Briquet's syndrome in a male population: the Veterans Administration revisited.

Fifty psychiatric inpatients at a VA Hospital felt to be at high risk for the development of somatic complaints were surveyed for Briquet's syndrome. When criteria for the syndrome were strictly applied, no men were found with the disorder. If the criteria were minimally relaxed, two patients did have a sufficient number of symptoms in multiple areas to qualify for the diagnosis. However, they had alternative clinical and research diagnoses and none of the personality characteristics noted in previous populations of women surveyed for Briquet's syndrome.     

Interpersonal psychotherapy for depression with panic spectrum symptoms: a pilot study

Patients whose depression is complicated by a lifetime history of panic symptoms display a poorer treatment response to both psychotherapeutic and pharmacologic interventions. A newly adapted psychosocial treatment for depression with lifetime panic spectrum symptoms was evaluated in an open pilot study.     

Secondary depression: observations in alcoholism, Briquet's syndrome, anxiety disorder, schizophrenia, and antisocial personality. A form of comorbidity?

This article deals with the diagnostic issue of secondary depression and relates it to the broader question of comorbidity. The primary focus of the article is to summarize certain data supporting the validity of the concept of secondary depression; these data are used to point up an appropriate strategy for studying comorbidity involving psychiatric disorders.     

Specificity of panic response to CO(2) inhalation in panic disorder: a comparison with major depression and premenstrual dysphoric disorder

OBJECTIVE: The behavioral response to CO(2) inhalation has been used to differentiate panic disorder patients from normal subjects and other clinical populations. This study extended examination of the diagnostic specificity of CO(2)-induced anxiety by testing panic disorder patients and clinical populations with reported low and high sensitivity to CO(2) inhalation (patients with major depression and patients with premenstrual dysphoric disorder, respectively). METHOD: The behavioral responses to inhalation of 5% and 7% CO(2), administered by means of a respiratory canopy, were studied in 50 patients with panic disorder, 21 with major depression, and 10 with premenstrual dysphoric disorder and in 34 normal comparison subjects. Occurrence of panic attacks was judged with DSM-IV criteria by a blind rater. Subjects were rated on three behavioral scales at baseline and after each CO(2) inhalation. RESULTS: Panic disorder patients had a higher rate of CO(2)-induced panic attacks than depressed patients and normal subjects, whose panic rates were not distinguishable. The panic rate for patients with premenstrual dysphoric disorder was similar to that for panic disorder patients and higher than that for normal subjects. Subjects with CO(2)-induced panic attacks had similarly high ratings on the behavioral scales, regardless of diagnosis, including the small number of panicking normal subjects. Seven percent CO(2) was a more robust panicogen than 5%, and response to 7% CO(2 )better distinguished panic disorder patients from normal subjects than response to 5% CO(2). CONCLUSIONS: Patients with panic disorder and patients with premenstrual dysphoric disorder are highly susceptible to CO(2)-induced panic attacks, and depressed patients appear to be insensitive to CO(2) inhalation. The symptoms of CO(2)-induced panic attacks have a similar intensity regardless of the subject's diagnosis.