Abdominal pain in children and symptoms of somatization disorder

Children seen in a multispecialty medical clinic for abdominalpain were divided into three groups: 21 with confirmed organicfindings related to the abdominal pain, 14 with confirmed organicfindings unrelated to the pain, and 108 whose physical examinationswere negative (the functional pain group). For children withfunctional abdominal pain (but not for the others) the numberof symptoms of somatization disorder (Briquet's syndrome) wassignificantly related to the chronicity of the child's condition.Children with functional pain and no prior complaint had a meanof 1.95 symptoms; those with complaints of less than 1 year'sduration, 2.21 symptoms; those with complaints of more thana year since age 6, 4.04 symptoms; and those with complaintsfor more than a year with onset prior to age 6 years, 4.55 symptomsfrom the Somatization Disorder list. Findings were interpretedas preliminary evidence for a distinct, chronic, polysymptomatichysterical disorder beginning in childhood.     

Abnormal illness behaviour in young women in a primary care setting: is Briquet's syndrome a useful category?

In a study of abnormal behaviour in women aged 16-25 in one large group practice a screening instrument and an interview were used to identify Briquet's Syndrome. The prevalence, 2.04 per 1000, was lower than that found in previous studies. The fact that many other patients showed both the high consultation rates and the other correlates of Briquet's Syndrome brings the usefulness of a discrete syndrome into doubt.     

流浪乞讨精神病患者临床特征对比分析及综合性救治

目的 调查分析流浪乞讨精神病患者临床特征,以利于开展针对性救助.方法 将我院收治的100例流浪乞讨精神病患者作为研究组,选择同期在唐山精神病院住院治疗的100例非流浪精神病患者作为对照组.对两组一般情况,躯体状况,精神疾病诊断分型及严重程度进行临床特征对比.结果 ①两组一般情况,躯体状况比较:研究组男性多于女性(x2=49.42,P＜0.01),大多数为外省市户籍(x2=115.94,P＜0.01),平均年龄大(t=14.02,P＜0.01),伴躯体疾病明显多于对照组(x2=75.00,P＜0.01);②精神疾病诊断分型及严重程度方面:研究组前3位为精神分裂症,精神发育迟滞,其它待分类精神病;对照组为精神分裂症,情感障碍,其它功能性精神病;研究组以慢性阴性症状(t=51.43,P＜0.01)和行为症状(t=15.56,P＜0.01)为主,对照组则以短暂阳性(t=36.01,P＜0.01)和情感症状(t=10.44,P＜0.01)为主.结论 流浪乞讨精神病患者临床特征与普通精神病患者相比病情复杂而严重,需要进行综合性特殊救治.     

A study of the presentation of somatic symptoms in general practice by patients with psychiatric disturbance.

A computerized questionnaire was used to collect information on the presentation of symptoms in all 125 new patients presenting to one general practitioner in the course of one year who were considered to be suffering clinically significant psychiatric disturbance. Comparison was made between the 73 (58%) patients presenting with psychological symptoms and the 52 (42%) patients presenting with somatic symptoms for which no physical explanation was evident at the time of the consultation. Important differences emerged between the groups. Those patients presenting somatic symptoms had lower scores on the tests of psychiatric distress (indicating severity), fewer individual symptoms and fewer severe symptoms than patients presenting with psychological problems. This group also had statistically significant differences in personality profile and reported significantly fewer social problems. Prognosis for both groups was similar in that patients in both groups were equally likely to have a normal psychiatric distress score after six months. Adequate management of somatizing patients calls for vigilance and for improved detection and negotiating skills. Reviewing the computer results with patients helped them discuss their symptoms and the system allowed the general practitioner not only a clinical assessment of these patients' problems but a measure of psychological, social and personality components.     

Hysteria--a neurologist's view

Hysterical symptoms are defined as complaints that are not fully explained by organic or functional neurological disease. Hysterical symptoms are common in neurological practice, accounting for about 1% of neurological diagnoses. Of those with neurological hysterical symptoms, about 80% will not have the hysterical personality, and about 80% will not have Briquet's hysteria. Some 60% will have a physical disease and perhaps as many as 50% will have recognizable psychiatric illness, particularly depression. Others may have unrecognized physical or psychiatric illness. Many hysterical symptoms may be understood in terms of abnormal illness behaviour.     

Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain

Seventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of 'psychoneurosis' and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.     

Personality structure disturbances and psychiatric manifestations in primary Sj?gren's syndrome

It has been recently suggested that primary Sj?gren's syndrome (SS) patients present with a variety of personality structure disturbances and psychiatric symptoms. To evaluate this finding further, we assessed hostility structure and psychiatric symptoms in 33 Sj?gren's syndrome patients and compared the results with those of 33 healthy women, and 41 women with solid malignant tumors. The utilized psychometric instruments were the hostility and direction of hostility questionnaire (HDHQ) and the symptom checklist 90R (SCL-90R). High levels of introverted hostility were reported by SS patients in relation to the other two groups. Cancer and SS patients reported higher scores on anxiety and depressive symptoms compared to the healthy women, but the differences were not significant. In addition, high scores on paranoid ideation, somatization and obsessive compulsive symptoms were found in SS patients compared to the cancer and healthy controls. The results strongly suggest that psychiatric disorders are common in primary SS patients, who may need appropriate therapy.     

Psychiatric morbidity in patients with clinically isolated lesions of the type seen in multiple sclerosis: a clinical and MRI study

This study reports the psychiatric morbidity in 76 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brain stem and cord lesions). The presence or absence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 33 patients suffering from rheumatic and neurological conditions not known to involve the brain was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers. Over half of the patients with the clinical presentation of single lesions had MRI abnormalities in the brain, but past and present psychiatric morbidity were similar in patients and controls and no significant associations were found between the presence of MRI abnormalities and psychiatric morbidity. The degree of social stress experienced by the patients with clinically isolated lesions appeared to be highly relevant in the causation of psychiatric symptoms.     

Theory of mind in Asperger's syndrome,schizophrenia and personality disordered forensic patients

Introduction. The ability to conceptualise other individuals' mental states is dependent on having a ‘theory of mind’ (ToM). Individuals with Asperger's syndrome typically display ToM impairments, as do some individuals with schizophrenia, notably those with paranoid delusions. The presenting features of these and other individuals, such as those with some personality disorders, particularly in forensic patients, are often unclear. ToM performance was examined to see whether it could distinguish forensic patients with Asperger's syndrome from other patient groups. Methods. The performance of three male patient groups (N = 39) detained in high security psychiatric care, including those with Asperger's syndrome, schizophrenia (with paranoid delusions and/or auditory hallucinations as their predominant symptoms), or a dissocial and/or borderline personality disorder were compared using the revised eyes task and the modified advanced ToM test. Results. The Asperger's syndrome and schizophrenia groups performed significantly worse than the personality disorder group on both ToM measures. However, the Asperger's syndrome and the personality disorder groups had significantly higher levels of general intellectual functioning than the schizophrenia group. Conclusions. Whilst ToM performance may help to discriminate patients with Asperger's syndrome or schizophrenia from personality disorder ed patients, a wide range in performance made it difficult to specify a patient to a particular group. Theoretical and methodological issues are discussed along with the usefulness of ToM assessments with forensic patients.     

Irritable bowel syndrome: A test of the colonic hyperalgesia hypothesis

This study tested the hypothesis that, in patients with irritable bowel syndrome (IBS), there is a primary hyperalgesia of the colon. Previous work, which examined these patients and normals, has not included subjects who provide a control for relevant psychological characteristics. We compared ratings of pain, following varying degrees of distension of the sigmoid colon, in normals, patients with IBS, and patients who were psychologically disturbed but without bowel symptoms. Psychological characteristics were assessed by a psychiatric interview and psychometric inventories; response to distension was tested by placing a tube in the rectosigmoid colon and successively inflating and deflating a balloon at its tip at 10 cm³ increments up to 50 cm³. Ratings of pain were recorded at each volume. The results indicated that the two patient groups were psychologically similar and both were more disturbed than normals. A linear relation was found between reports of pain and volume of distension in all three groups. There were no significant differences between the proportions of subjects experiencing pain in each group or the average of the ratings. There were no significant associations between the pain ratings and measures of anxiety, depression, neuroticism, and extraversion. The data do not support the hypothesis that colonic hyperalgesia is an important contributory factor in the etiology of the irritable bowel syndrome.This work was supported by the Ontario Ministry of Health and the Medical Research Council of Canada. Paul Latimer was a Medical Research Council Research Scholar. Dugal Campbell is an Ontario Mental Health Foundation Research Associate.     

Similarity of depression in diabetic and psychiatric patients.

Diabetic and psychiatric out-patients were studied to determine whether the symptom profile of depression was similar in medically ill and medically well subjects. The diagnosis of major depression was determined using psychiatric interviews and DSM-IIIR criteria. The 21-item Beck Depression Inventory (BDI) was used to characterize the prevalence and severity of depression symptoms, and the measure was divided into cognitive (13 symptoms) and somatic (eight symptoms) subsets. Seventeen (81%) of 21 symptoms (including 12/13 cognitive and 5/8 somatic symptoms) were not statistically different in prevalence or severity between the depressed diabetic patients (N = 41) and the depressed psychiatric patients (N = 68). Both of these depressed groups were significantly different from a nondepressed diabetic comparison group (N = 58) in the prevalence and severity of every BDI symptom except weight loss. These data show that the symptom profile of depression in diabetic patients (in particular the cognitive symptoms) is similar to that in depressed psychiatric patients and is readily differentiated from the symptom profile in nondepressed diabetic patients. Our observations support the diagnostic validity of the DSM-IIIR criteria for major depression in this medically-ill outpatient sample.     

Self-schema in irritable bowel syndrome and depression

Some investigators have suggested that irritable bowel syndrome (IBS) represents a physiologic expression of an affective disorder. This study investigated whether IBS patients differed in their self-schema from depressed patients. Self-schema refers to a cognitive framework of the individual's beliefs, attitudes, and self-perceptions which is stored in memory and which influences incoming information. The sample consisted of 21 IBS patients, 21 psychiatric outpatients with major depression (MD), and 19 normal controls. All groups were age matched. Subjects completed a structured psychiatric interview (Diagnostic Interview Schedule (DIS) and a Beck Depression Inventory (BDI), in addition to a test of self-schema, which involved rating and recall of a variety of "depressed" and "nondepressed" content adjectives. Consistent with previous work on self-schema, the MD group recalled significantly more depressed adjectives rated under the self-referent task than the Control group (p less than 0.05) and, also, the IBS group (p less than 0.05). Most striking was the finding that a subgroup of IBS patients who met criteria for MD (43% of the sample) recalled significantly more self-referent nondepressed words (and less self-referent depressed words) than the MD group (p less than 0.05). In other words, IBS patients with MD do not view themselves as depressed. These findings suggest that while some IBS and depressed psychiatric outpatients may share depressive symptoms, these groups can be differentiated by their self-schema.     

Delusions of fatal contagion among refugee patients

Delusions of fatal contagion were encountered in about 10% of refugee psychiatric patients from Southeast Asia belonging to one ethnic group, the Hmong. Psychotic depression was the most common diagnosis among the Hmong patients with delusions of contagion, whereas paranoid and schizophrenic diagnoses predominate in patients with similar delusions from other refugee groups. Some cases also occurred as a shared delusional disorder. Associated findings included isolation from the community, intrafamilial conflict, failure to acculturate, and sexual frustration or conflict. Most patients responded to tricyclic medication, later supplemented in about half of the cases with a neuroleptic. This syndrome, which does not appear to have been described previously, should be considered in cases of somatizing refugees who present repeatedly to medical facilities.     

Personality and psychopathology in patients with temporomandibular joint pain-dysfunction syndrome. A controlled investigation

OBJECTIVE: Our aim was to deepen the understanding of the psychosomatic aspects of temporomandibular joint (TMJ) pain dysfunction syndrome. Patients affected by this syndrome were compared with both healthy subjects and psychiatric patients, using both self-report and physician-scored psychological measures. METHODS: Three sex- and age-matched groups were recruited: a TMJ group (n = 32), a healthy group (n = 22) and a psychiatric group (n = 22). The psychiatric group consisted of outpatients diagnosed as having a DSM-IV anxiety or depressive disorder of mild to moderate severity. Psychometric assessment included the Minnesota Multiphasic Personality Inventory (MMPI) and the Hamilton Anxiety Rating Scale (HARS). RESULTS: Psychiatric patients scored higher than both the comparison groups on all but one of the MMPI scales; the majority of the differences were significant or approached significance. TMJ patients scored higher than healthy controls on the Hs (hypochondriasis; p< or =0.01), Hy (hysteria; p< or =0.01) and D (depression; p< or =0.05) scales. Psychiatric patients scored higher than TMJ patients on the HARS psychic anxiety subscale (p< or =0.05), while TMJ patients scored higher than psychiatric patients on the somatic anxiety subscale (p< or = 0.05). CONCLUSIONS: Certain personality characteristics were associated with TMJ dysfunction. However, further longitudinal studies should be performed to properly assess causal relationships. Despite signs of neuroticism, anxiety and depression, patients with TMJ dysfunction differed from anxious and depressed patients. While the latter displayed a higher level of psychopathology, each group was characterised by a distinct pattern of anxiety symptoms. In addition, a substantial proportion of TMJ patients had little awareness of their inner states and emotions.     

How often is multiple sclerosis mistaken for a psychiatric disorder?

In a defined population of 112,000, an attempt was made to discover every patient with multiple sclerosis. Using strict diagnostic criteria, 91 patients were identified. A search of psychiatric records for the same population revealed that 15 (16%) of these patients were referred to psychiatrists between the onset of their symptoms and the diagnosis of multiple sclerosis. Ten (11%) were seen with symptoms attributable to multiple sclerosis. These symptoms were recognized as neurological in only two cases, while the other eight patients received a variety of psychiatric diagnoses. Possible reasons for diagnostic error included the subjective nature of many early symptoms, histrionic behaviour, and psychiatric disturbance which drew attention away from physical symptoms. The results underline the caution needed when patients with physical symptoms are referred for psychiatric assessment.     

The Premenstrual Syndrome and Fibromyalgia—Similarities and Common Features

The aim of the study was to assess the clinical similarities and common features of fibromyalgia syndrome (FM) and premenstrual dysphoric syndrome (PMDD). Thirty young patients who met the diagnostic criteria for PMDD were included in the study and compared to 26 women belonging to the medical staff of a general psychiatry department. All enrollees were interviewed and examined by a skilled physician. They completed the following nine survey items: demographic information, clinical health assessment questionnaire, fibromyalgia impact questionnaire, sleep and fatigue questionnaires, Sheehan disability scales, SF-36 assessment for quality of life, visual analog scale for pain, Mini International Neuropsychiatric Interview (MINI) questionnaire (assessment of coexistent psychiatric conditions), and the premenstrual severity scale. Additionally, each individual underwent a physical examination measuring the classical tender points and was asked to describe the distribution and continuum of her pain or tenderness. The PMDD group scored significantly higher in the measures pain and tenderness as well as in severity of premenstrual symptoms compared to the control group. Five patients in the PMDD group and none in the control group had FM. Quality of life measured by the SF-36 was higher in the control group than in the PMDD group and correlated with the degree of tenderness reported. Psychiatric comorbidity was significantly more common in the PMDD group, affecting 16 of the 30 PMDD patients compared to only three of the 26 control patients. In this study, patients with PMDD were found to have higher levels of tenderness, higher psychiatric comorbidity, greater level of physical disabilities, and a lower quality of life. These parameters were highly correlated with a lower pain threshold.     

How does the content of consultations affect the recognition by general practitioners of major depression in women?

BACKGROUND. Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM. The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD. The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS. A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION. General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.     

Ventilatory response to CO2. II. Studies in neurotic psychiatric patients and practitioners of transcendental meditation

The prominence of respiratory symptoms in patients with neurotic psychiatric disorders is noted and the literature on the control of respiration is reviewed to attempt to explain this finding. A previous study demonstrated a positive correlation between the ventilatory response to CO2 (S) and neurotic personality traits in a group of normal subjects. This study attempted to follow up this finding and hypothesized that a group of neurotically disturbed patients would have a higher S value and a group of individuals who practiced a calming technique such as transcendental meditation (TM) would have a lower S value than normal subjects. The second hypothesis was confirmed, but not the first, in that the neurotically disturbed patients had the lowest mean values for S of the three groups, rather than the highest. Particular characteristics of the sample of psychiatric patients cast doubt, however, on the validity of this finding. Three additional findings of this study were that anxious, depressive, and hyperventilating subject groups were no different from one another in terms of S values; that very experienced TM practitioners (sidhas) could significantly lower their ventilatory response to CO2 in the meditating state as compared to the nonmeditating alert state; and that the S value did not increase in two male subjects with endogenous depression after successful treatment with electroconvulsive therapy.