Enfermedad psicógena masiva. Reporte de tres episodios no recientes / Massive Psychogenic Disease. A report of three not recent episodes

Episodios de enfermedad psicógena masiva han ocurrido en entornos sociales diferentes, en todo el mundo, a lo largo de la historia de la humanidad. Cada vez los profesionales de la salud participan más en su atención y solución. Este trabajo presenta tres "casos" catalogados como tales, que el autor tuvo la oportunidad de asistir. Se realizan comentarios en cada uno de ellos y se actualizan conceptos sobre esta condición, que se expresa por los más variados síntomas en un grupo de personas ante un estrés intenso por supuestas amenazas, aunque no exista una razón física o ambiental para que se enfermen. Genera marcada tensión tanto en pacientes como en facultativos y en el público. Los médicos, y el personal sanitario en general, deben estar preparados para su adecuado diagnóstico y conducta a seguir.

Episodes of massive psychogenic disease have occurred in different social contexts, worldwide, throughout history. Every time health professionals participate more in their attention and solution. This work presents three ¨cases¨ classified as such, which the author had the opportunity to attend. There are, in this work comments, about each of them and concepts about this condition are updated; which is expressed by the most varied symptoms in a group of people facing intense stress due to supposed threatening even though there is no physical or environmental reason to get sick. It generates a marked tension in patients and doctors so as in the general public. Doctors and sanitary personnel should be prepared for its adequate diagnosis and conduct to follow.

La histeria moderna: Parte VII personalidad histérica y mujer / The modern hysteria. Part VII. hysterical personality and woman

El trastorno de personalidad histriónica (TPH) hizo su primera aparición oficial en el Manual Diagnóstico y Estadístico de Trastornos Mentales II (DSM-II) y desde el DSM-III, TPH es el único trastorno que mantuvo el término derivado del antiguo concepto de histeria. En general. la tendencia actual es la de incluir la personalidad histérica en el grupo de los trastornos de personalidad dramática o teatral, caracterizado exclusivamente por síntomas de orden caracterológico como: a) extrema vulnerabilidad al estrés; b) síntomas afectivos fluctuantes y reactivos; c) problemas recurrentes en las relaciones interpersonales; d) tendencia a la impulsividad. La dependencia con respecto del criterio masculino, el escaso desarrollo de habilidades adecuadas para generar recursos en el mercado, el altruismo y la auto postergación, la inhibición de la sexualidad y de la expresión hostil, se revelaron como factores cultivados por la socialización primaria del género femenino, que estimulan la aparición de trastornos de la serie histérica, fóbica y depresiva. Los investigadores han sugerido que la construcción de la psicopatía puede ser expresada diferencialmente por género como trastornos de personalidad 'Grupo B' que son típicamente más femeninos, Histriónico y Borderline, en lugar de más masculinos, Antisocial y Narcisista.

Histrionic personality disorder (HPD) made its first official appearance in the Diagnostic and Statistical Manual of Mental Disorders II (DSM-II) and since the DSM-III, HPD is the only disorder that maintained the term derived from the old concept of hysteria. In general, the current trend is to include the hysterical personality in the group of dramatic or theatrical personality disor ders, characterized exclusively by characterological symptoms such as: a) extreme vulnerability to stress; b) Fluctuating and reactive affective symptoms; c) recurrent problems in interpersonal relationships; d) tendency to impulsivity. The dependence on the masculine criterion, the scarce development of adequate skills to generate resources in the market, the altruism and self-postponement, the inhibition of sexuality and hostile expression, were revealed as factors cultivated by the primary socialization of the female gender, which stimulate the appearance of disorders of the hysterical, phobic and depressive series. Researchers have suggested that the construction of psychopathy can be differentially expressed by gender as 'Group B' personality disorders that are typically more feminine, Histrionic and Borderline, rather than more masculine, Antisocial and Narcissistic.

Parte III: las locuras histéricas / Part III: the hysterical follies

Caso Clínico Paciente María R.A., 28 años, Escolaridad básica en programa diferencial, dueña de casa, Casada, 9 años de matrimonio. Su pareja tiene 62 años. Actualmente vive con esposo e hijo de 2 años, en Maipú. Durante 2016, María consultó en distintos servicios de urgencia, recibiendo distintos diagnósticos: Conversión, Síndrome conversivo. Se ingresa en Urgencia con diagnóstico: Síndrome Psicótico lúcido. Paciente en cama, sin movimientos espontáneos, con rigidez, mirada fija, deshidratada, no acepta alimentarse, negativista, no establece contacto visual, no responde preguntas simples, sin embargo, en forma espontánea puede permanecer hablando, dando cuenta de contenidos delirantes. El día de su ingreso a sector se inició terapia Electro convulsiva, y completó 5 sesiones. Tras la primera sesión paciente evoluciona favorablemente, se levanta de la cama, solicita agua, es capaz de comer. Síntomas psicóticos ceden tras la tercera sesión, señalando además no recordar nada de lo ocurrido. En entrevista de evolución paciente vigil, orientada TE, actitud parcialmente cooperadora. En cuanto a las psicosis histéricas en sí, es una psicosis aguda, de rápida curación cuando se las trata adecuadamente y Bleuler habla de los llamados estados crepusculares histéricos. La duda diagnóstica es entre un trastorno disociativo tipo psicosis histérica o bien un trastorno psicótico agudo, refiriéndose a trastornos de presunto origen disociativo con sintomatología que podríamos denominar pseudopsicótica. La CIE-10 clasifica las psicosis agudas no afectivas, como Trastornos psicóticos agudos y transitorios (TPAT), (Acute and Transient Psychotic Disorders (ATPD) en inglés), comparten las características comunes de inicio agudo dentro de dos semanas, y la presencia de síntomas psicóticos típicos. La descripción de TPAT fue influenciada por los conceptos de psicosis cicloide, bouffée délirante y psicosis reactiva. No es sorprendente, por lo tanto, que los ATPD de la CIE-10 (al menos diagnósticamente) sean un heterogéneo grupo de trastornos. Tanto los sistemas CIE como DSM se basan en síntomas, y descuentan los aspectos "no empíricos" del diagnóstico, que pueden constituir el «fenómeno" esencia de un trastorno psicótico. Actualmente, no existe una categoría de diagnóstico para definir individuos que están experimentando tal psicopatología y tienen un riesgo significativamente mayor de desarrollar esquizofrenia u otro desorden psicótico. Trastorno histriónico de la personalidad (HPD), como argumento aquí, no es una patología mental real; más bien, "histriónico" se refiere a un rasgo o grupo de rasgos de personalidad que podría conducir a algún otro trastorno mental.

Clinical case. Patient María R.A., 28 years old, Basic schooling in differential program, housewife, Married, 9 years of marriage. His partner is 62 years old. Currently lives with husband and 2 year old son in Maipú. During 2016, Maria consulted in different emergency services, receiving different diagnoses: Conversion and conversion syndrome. Urgency is entered with diagnosis: Syndrome Psychotic lucid. Patient in bed, without spontaneous movements, with rigidity, stare, dehydrated, does not accept to feed, negativist, does not establish visual contact, does not answer simple questions, however, spontaneously can remain talking, giving account of delusional contents. On the day of his admission to the sector, Electro Convulsive therapy was started, and he completed 5 sessions. After the first patient session he progresses favorably, gets up from bed, requests water, is able to eat. Psychotic symptoms give way after the third session, noting also not remember anything of what happened. In an evolution interview, vigil patient , oriented TE, partially cooperative attitude. As for hysterical psychoses per se, it is an acute, rapidly healing psychosis when properly treated and Bleuler speaks of so-called hysterical crepuscular states. The diagnostic doubt is between a dissociative disorder type hysterical psychosis or an acute psychotic disorder. referring to disorders of presumed dissociative origin with symptomatology that we could call pseudopsychotic. The ICD-10 classifies acute non-affective psychoses, as Acute and Transient Psychotic Disorders (ATPD), share the common characteristics of acute onset within two weeks, and the presence of typical psychotic symptoms. The description of ATPD was influenced by the concepts of cycloid psychosis, bouffée délirante and reactive psychosis. It is not surprising, therefore, that the ATPD of the ICD-10 (at least diagnostically) is a heterogeneous group of disorders. Both CIE and DSM systems are based on symptoms and discount the "non-empirical" aspects of diagnosis, which may constitute the "phenomenon" essence of a psychotic disorder. Currently, there is no diagnostic category to define individuals who are experiencing such psychopathology and have a significantly increased risk of developing schizophrenia or other psychotic disorder. Histrionic Personality Disorder (HPD), as an argument here, is not a real mental pathology; rather, "histrionic" refers to a trait or group of personality traits that could lead to some other mental disorder.

Gender differences in the prevalence and impact factors of hysterical tendencies in adolescents from three eastern Chinese provinces

BACKGROUND@#Few studies have attempted to compare the differences in the prevalence and impact factors of hysterical tendencies (HTs) in adolescents. Thus, the aim of this study was to examine gender differences in the prevalence and impact factors of adolescents' HTs across three eastern Chinese provinces (Anhui, Jiangsu, and Zhejiang).@*METHODS@#A multicenter, school-based, cross-sectional study was conducted in three provinces (Anhui, Jiangsu, and Zhejiang) in China in 2014. The sample included 10,131 middle-school students aged 13-18 years who were randomly selected using a multiphase, stratified, cluster sampling technique. A two-stage appraisal procedure was used to determine the adolescents' HTs. We also designed a multicenter, school-based, case control (1329 cases with 2661 control individuals) study to collect data on the common factors affecting this population using a common protocol and questionnaire.@*RESULTS@#An overall positive rate of HTs among adolescents across the three eastern Chinese provinces studied was found at 13.1% (95% confidence interval (CI) 12.5-13.8%), at 14.5% (95% CI 13.3-15.7%) for females, and at 12.2% (95% CI 11.1-13.4%) for males. Gender-stratified, multiple conditional regression analyses revealed that superstitious beliefs pertaining to life, somatotype, teacher-student satisfaction, and family achievement orientation were significantly linked to HTs only in males, while left-behind adolescents, emotional and social adaptation, teacher-student support, family cohesion, and the Hospital Anxiety and Depression Scale - depression scores were significantly associated with female HTs only. The models indicated that of all the independent variables studied, family medical history was the strongest impact factor for both male HTs (adjusted matched odds ratio (amOR) = 2.92, 95% CI = 1.84-4.86) and female HTs (amOR = 2.74, 95% CI = 1.59-4.98).@*CONCLUSIONS@#HTs are prevalent among adolescents in the three eastern Chinese provinces studied. Gender differences in the prevalence and impact factors of HTs are significant in adolescents, and HTs seem to affect more females than males. Therefore, sex-specific intervention programs against HTs in adolescents should be considered to reduce HT prevalence in adolescents by modifying influential social, school, and family factors.

Personality assessment in chronic pain patients / Avaliação da personalidade em pacientes com dor crônica

Abstract In Brazil, studies investigating the personality characteristics of chronic pain patients are scarce. The present study aimed to evaluate the personality characteristics of patients with chronic pain and to compare them with those of patients without this condition. To this end, the Personality Disorders Dimensional Inventory and the Hypochondriasis scale of the Brazilian version of the Minnesota Multiphasic Personality Inventory were administered. Two different statistical analyses were carried out: the t - test to determine the differences between the scores for the two groups and the logistic regression analysis to examine the predictive power of the scales for the diagnosis of chronic pain. The results revealed significant differences (p < 0.05) among the Histrionic, Hypochondriasis, and Sadistic scales as predictors for the groups studied, with larger effect sizes on the Histrionic and Hypochondriasis scales. The authors suggest that the use of these scales in a clinical context may provide important information for health professionals.

Resumo No Brasil, estudos investigando as características da personalidade em pacientes com dor crônica são escassos. O objetivo da presente pesquisa foi avaliar as características da personalidade em pacientes com dor crônica e compará-las com as de pessoas sem esse diagnóstico. Para tanto, foram aplicados o Inventário Dimensional de Transtornos da Personalidade e a Escala de Hipocondria da versão brasileira do Minnesota Multiphasic Personality Inventory. Duas análises estatísticas distintas foram empregadas, sendo elas o teste t, para verificar diferenças entre as pontuações dos dois grupos, e a análise de regressão logística, para investigar a capacidade preditiva das escalas para o diagnóstico de dor crônica. Os resultados indicaram diferenças significativas (p < 0,05) nas escalas Histriônico, Hipocondria e Sádico como preditores dos grupos estabelecidos, com maiores magnitudes as escalas Histriônico e Hipocondria. Os autores sugerem que o uso das escalas para o contexto clínico pode agregar informações relevantes para o profissional.

Prevalence of personality disorders during the years 2003-2009 at the Institute of ClinicalPsychology, University of Karachi

The purpose of the present study was to investigate the prevalence rate of personality disorders reported at Institute of Clinical Psychology, University of Karachi-Pakistan during the years 2003-2009. Following archival method the total sample was consisted of [3917] registered clients out of which [88] were diagnosed on Axis II [Personality Disorders] according to DSM-IV-TR [2000] text revised criteria. The whole sample went through complete psychological assessment by trained clinical psychologists. All registered cases of year 2003-2009 were selected and files of personality disorders were reviewed. Demographic variables and their diagnoses were observed and analyzed. Frequency distribution and percentages of descriptive statistic were calculated. Findings showed that there are [2.22%] of cases, diagnosed on axis II [Personality disorders]. Borderline personality disorder [18.18%], Histrionic Personality Disorder [14.94%], and Narcissistic Personality Disorder [12.64%] have high prevalence rate as compared to other personality disorders. Furthermore, these personality disorders were mostly prevalent in single males belonging to middle class nuclear family systems. Present prevalence rate showed that people coming to psychological clinics are mostly diagnosed with Cluster B personality disorders. Awareness Programs should be developed for early identification of these disorders

Family functioning among depressive and dissociative [conversion] patients

To campare the family functioning, level of depression, anxiety and histrionic personality traits among depressive and dissociative [conversion] patients. A cross-sectional study. The Psychiatry Unit of Government Lady Reading Hospital, Peshawar, on depressive anddissociative [conversion] patients admitted from January to May 2004. Purposive sampling technique was used for the assignment of 75 patients [n=75] with depressive illness and 75 patients [n=75] with dissociative [conversion] disorders groups who fulfilled International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD 10], criteria. Test package was administered individually to all the patients and scores compared for the groups. On family APGAR scale, no significant difference [t=-2.472, p=0.16] was found between the scores of the two groups. Patients with depressive illness scored high on Hamilton Rating Scale for Depression with mean score of 26.92 and on Hamilton Rating Scale for Anxiety with mean score of 23.45, while dissociative group scored high on Hysteria [Hy] sub-scale of Minnesota Multiphasic Personality Inventory [MMPI] with mean score of 13.17. Dysfunctional family pattern is one of the contributing factor in developing and maintaining mental illnesses like depression and dissociative [conversion] disorders

[Psycological aspects of the alopecia]

Hair plays a primordial role both in relational life for the subject himself: natural ornament, privileged belonging of narcissism, and also a symbol of power and virility in man, of seduction and femininity in woman. The loss of hair "alopecia" is a real catastrophe: deep narcissism injury, feeling of uncovering. The first patient, aged 22, has shown an alopecia owing to stress which came with the father's disease. Dermatologic results were negative, psychiatric exam showed. The second patient, aged 14, was sent to us to dermatology service for alopecia of brutal appearance with no triggering factor, etiological results were negative. Psychiatric interview pointed out traits of a hysterical personality. Though alopecia aetiology is of various factors, psychological ones would be determining. In the first case the stress was acute, when as it was chronic in the second. Secondary benefit might could to maintain the disorder, than is a situation in the second case. The first case illustrates a decomposition of psychosomatique personality

As bases orais da histeria / Oral basis of hysteria

O objetivo principal do autor no artigo é considerar alguns aspectos teórico-clínicos sobre o tema Histeria e Caráter Histérico, a partir das suas bases orais, mais primitivas. Para tanto, destaca no texto dois casos clínicos a partir da sua experiência prática como psiquiatra e psicanalista, na tentativa de, num cotejo pari passu com o desenvolvimento histórico e teórico sobre o tema amplo e quase que sem limites que é a histeria, ressaltar pontos fundamentais, necessários, para o melhor entendimento do fenômeno histérico e seus impactos provocados no meio circunstante em geral e na mente do psicanalista em particular

Evolução e contemporaneidade das psicopatologias limítrofes / Evolution and contemporaneousness of borderline psychopathologies

As variações e características próprias das psicopatologias limítrofes contemporâneas são apresentadas juntamente com suas alterações metapsicológicas. Tais quadros e transtornos psicopatológicos são específicamente relacionados entre aqueles que denotam posição intermediária entre as neuroses de transferência e as psicoses. Principia-se com o transtorno de personalidade "borderline", seguindo-se o narcisismo erótico, agressivo e maligno; o masoquismo em sua vertente não predominantemente sexualizada; a adição objetal bipolar; o falso "self"; o complexo da mãe morta e finalmente o transtorno de personalidade histriônica. Em todos os casos lançamos mão de contribuições teóricas e conceituais do próprio autor, mas sobretudo de eminentes nomes especializados em cada uma dessas manifestações que atingem diretamente a contemporaneidade

Impulso sexual excessivo: um relato de caso / Impulsive sexual behavior: case report

Os autores relatam um caso de impulso sexual excessivo em comorbidade com ciclotimia e transtorno alimentar sem outra especificacao. Ressalta-se a importancia do diagnostico desse transtorno sexual na evolucao do caso por meio de uma breve revisao sobre o tema e de uma comparacao com as descricoes e propostas terapeuticas da literatura

Distúrbios de personalidade e depressäo / Personality's disturbs and depression

Trata-se de uma revisäo literária sobre as articulaçöes entre transtornos de personalidade e depressäo. A associaçäo entre estes dois distúrbios é uma constataçäo importante e freqüente, mas a natureza desta ligaçäo ainda é bastante discutível, assim como a prevalência exata desta comorbidade. Supöe-se que as variaçöes dos resultados sejam explicadas pelas diferenças metodológicas das avaliaçöes

Programa de Ansiedade e Depressäo - UFRJ. Série Psicofarmacologia - 14: Transtorno histriônico de personalidade: aspectos diagnósticos e de manejo terapêutico / The Anxiety and Depression Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro

O Programa de Ansiedade e Depressäo do IP-UFRJ utiliza o SCID-II (DSM-III-R) para o diagnóstico de Transtorno de Personalidade.O Transtorno Histriônico de Personalidade apresenta dificuldades no diagnóstico transversal através de entrevista estruturada. A abordagem cognitivo-comportamental e farmacológica säo discutidas

Las personalidades homeopáticas / The homeopathic personality

Este trabajo trata sobre el movimiento dinámico de los síntomas mentales en una personalidad tan controvertible como Veratrum Album, dominada por un afán de grandeza ilimitada que lo impulsa a trepar en su medio por competencia desleal, manipuleo de gentes, a toda costa caiga quien caiga; siendo por lo tanto tan peligroso para su medio, en especial cuando en sus ilusiones siente que es Cristo, un enviado divino o el Mesías y arrastra tras de sí a mentes débiles o muy confundidas por situaciones emocionales extremas, conformando esas sectas o cultos sui-generis de comportamientos inexplicables

Relacoes psicodinamicas entre pessoas com transtornos de personalidade histericos e paranoides / Psychodynamic relationships between persons with histerical and paranoid personalities disorders

O presente trabalho e uma tentativa teorica de relacionar os principais mecanismos de defesa utilizados nos disturbios de personalidade histerica e paranoide, respectivamente, suas inter-relacoes possiveis e de que maneira pode haver um "beneficio" na relacao inter-pessoal em portadores destes disturbios. O autor tenta demonstrar que, por caracteristicas proprias dos mecanismos descritos, cada individuo torna-se personagem dos conflitos intrapsiquicos do outro, conseguindo desta forma, com uma confirmacao na realidade externa, transformar o irreal e fantasiado, o delirante, em algo concreto, palpavel, objetivo e, com isto, sentir-se mais integrado e consequentemente alividado. Como nao conseguem uma "solucao", estas pessoas tem "necessidade" compulsiva de manter relacionamento, - uma legitima "folie a deux"

Psicoterapia dinâmica: importância do planejamento em um caso de transtorno de personalidade / Dynamic psychotherapy: the importance of treatment planning in a case report of personality disorder

Os autores, após breve revisäo bibliográfica sobre aspectos do planejamento psicoterápico, relatam o caso clínico de uma paciente com transtorno de personalidade, tipo histriônico (DSM-III), com o qual procuram demonstrar a importância que o planejamento inicial da psicoterapia - baseado em diagnóstico específico de transtorno de personalidade - exerce sobre a evoluçäo e o resultado do tratmaento de um caso de dificil abordagem. Com base nos trabalhos de O. F. Kernberg, fazem-se consideraçöes relativas à importância de se identificar a qualidade das relaçöes objetais internalizadas (diagnóstico estrutural), para efeito do tratamento dos conflitos nucleares da paciente

Personalidades borderline e histrônica: um perfil comparativo

Os autores fazem um estudo retrospectivo das características de dois grupos diagnósticos de pacientes atendidos na Unidade de Itnernaçäo Psiquiátrica do Hospital de Clínicas de Proto Alegre, no período de abril de 1984 a abril de 1987. Aqueles com diagnóstico de Transtorno de Personalidade Borderline e Transtorno de Personalidade Histriônico säo revisados quanto aos aspectos demográfico, fenomenlógico, familiar e terapêutico, comparando com os dados da literatura. O objetivo é alcançar maior compreensäo dos critérios diagnósticos do DSM-III e buscar identificar outras características psicossociais

Pensamiento dialéctico y estructuras de personalidad / Dialectic thought and structures of personality

Se intenta definir la dialéctica y luego seguir la evolución del concepto desde su nacimiento en la filosofía pre-socrática hasta su culminación en Hegel. Se postula luego la importancia que puede alcanzar el pensamiento dialéctico en la psiquiatría, aplicado al menos en dos de sus campos: el estudio de la biografía en relación con la enfermedad y el de las formsas, tipos o estructuras de personalidad. En el primer caso la dialéctica permitiría comprender la historia vital como el despegue en el tiempo de una conciencia que va escindiéndose en contradicciones de tensión creciente, hasta su resolución en una síntesis que implique un paso adelante en la maduración, plenitud o sabiduría. En el segundo caso, el pensamiento dialéctico permite concebir los distintos tipos más conocidos de personalidad como ordenados en polaridades (v. gr: estructura esquizoide-estructura depresiva;estructura histérica-estructura obsesiva), las que simultáneamente se atraen y repelen, pudiendo ser vista cada una como la positivaidad con respecto a la otra o viceversa. En otras palabras, la desviación hacia un lado de la alternativa no necesita ser vista como una carencia, sino como un desplazamiento dinámico de la existencia en contra del otro polo de la alternativa. Por último, se profundiza el estudio de estas polaridades a través del análisis respectivo de la forma de darse en cada uno de ellos la intersubjetividad, la temporalidad, la espacialidad y la corporalidad