Estridor y dificultad respiratoria: aproximación neurológica: caso clínico / Stridor and dyspnea caused by a conversion disorder: a case report

Paradoxical vocal cord motion or vocal cord dysfunction is a descriptive term for an inappropriate adduction of the vocal cords during respiration, which can cause respiratory obstruction and stridor. It is associated with psychiatric conditions in the great majority of cases. We report a 23 year-old high performance female athlete, referred for a recurrent bilateral paralysis of the vocal cords, with a history of four intensive care unit admissions for severe dyspnea and stridor, which were treated several times with intubation and with tracheostomy on two occasions. Myasthenia gravis was suspected and she was treated with pyridostigmine and prednisone. She was discharged but despite the treatment, she presented new episodes of stridor and was readmitted six months later. This time the pharmacological treatment was suspended. The neurological study disclosed a normal brain magnetic resonance, normal cerebrospinal fluid analysis and a normal electromyography. A conversion disorder was suspected and the patient was successfully treated with psychotherapy.

Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Psychiatric Co-morbidities Among Patients of Globus Hytericus Attending ENT OPD of a Tertiary Care Hospital.

Globus hystericus is a functional esophageal disorder, contributes a significant portion of ENT referral. Severe incapacitating symptoms of globus invariably compromise their quality of life which is further hampered by associated psychiatric co-morbidities. But in literature, conflicting results were reported regarding the pattern of psychiatric co-morbidities. Method: In an observational cross sectional study 53 consecutive consenting patients (N=53) of globus diagnose by criteria of R E Clouse, attending to the Department of ENT of tertiary care hospital of Eastern part of India were referred to Psychiatry OPD and screened for psychiatric comorbidities using Mini International Neuropsychiatric Interview (MINI) English Version 5.0.0 and confirmed by Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR). Result: 79.25 % (n=42) of globus patients had psychiatric co-morbidities which was significantly higher (p<0.05, odds ratio 14.02) than their relatives attending with the patients. Among the patients of globus, 32.01% (n=17) had multiple diagnoses. Major depressive disorder was found in 43.04% (n=23), obsessive compulsive personality disorder in 16.98% (n=9), undifferentiated somatoform disorder in 13.21% (n=7), generalized anxiety disorder and panic disorder with agoraphobia each in 9.43% (n=5), borderline personality disorder in 7.55% (n=4), obsessive compulsive disorder and dysthymia each in 3.77% (n=2) and hypochondriasis in 1.89% (n=1). No association was found between presence of psychiatric morbidity and socio-demographic variables of the globus patients. Conclusion: Burden of psychiatric co-morbidities among the patients of globus is quiet high. So, they should be regularly screened for psychiatric illness and an integrated treatment approach can be taken for them to get the opportunity of effective psychopharmacological and behavioral approaches.

Efeitos do tratamento psicanalítico em pacientes com crises não epilépticas psicogênicas / Effects of psychoanalytical treatment in patients with psychogenic non-epileptic seizures

As crises não epilépticas psicogênicas (CNEP) podem ser definidas como episódios de alteração de movimentos, sensações ou experiência similar à epilepsia causada por processo psicológico e sem associação com descarga elétrica cerebral anormal. Estima-se que o número de casos de pacientes com CNEP seja de 2 a 33 por 100.000 habitantes. O índice de CNEP corresponde ainda a aproximadamente 5% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como possuindo epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivos: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP. Método: A casuística foi composta por 37 pacientes com diagnóstico prévio de CNEP realizado por meio da monitorização por vídeo-EEG. Foram realizadas sessões individuais de tratamento psicanalítico, com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: Este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n=11) de cessação/cura dos sintomas e 51,4% (n=19) redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e sexo (p < 0,01), religião (p < 0,01) e término do tratamento (p < 0,01). Conclusão: Este estudo apontou a eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises.

Psychogenic non-epileptic seizures (PNES) can be defined as episodes of alteration of movement, feeling or a similar experience to epilepsy caused by a psychological process and with no association with abnormal electrical discharges in the brain. It is estimated that the number of cases of patients with CNEP is from 2 to 33 in 100.000 inhabitants. The number of patients with PNES reaches 5% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum limits. Objectives: to present the effects of individual psychoanalytical treatment in patients with PNES. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. . Psychoanalytical treatment was carried out through 12 months of weekly sessions of around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high success rate in the treatment of PNES patients. 29,7% (n=11) of patients saw cessation or cure of symptoms and 51,4% (n=19) saw a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p < 0,01), religion (p < 0,01) and concluding treatment (p < 0,01). Conclusions: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be considered as an essential form of assistance for the reduction of cessation of episodes. Psychogenic non-epileptic seizures, Conversion disorder, Psychoanalysis, Treatment.

Una perspectiva neurocientífica sobre la histeria / A neuroscientific approach to hysteria

En la última década, el desarrollo y la puesta en marcha de las modernas técnicas de neuroimagen en el campo de la neurociencia cognitiva han proporcionado una nueva vía de acercamiento al estudio experimental de algunos trastornos mentales. Dentro de esta perspectiva, denominada por algunos autores “neuropsiquiatría cognitiva”, la histeria (o trastorno de conversión, de acuerdo con la clasificación psiquiátrica actual) ha cobrado un amplio protagonismo. De acuerdo con lo anterior, el objetivo del presente trabajo consiste en introducir estudios pioneros basados en una perspectiva neurocientífica de la histeria. Conviene destacar que, si bien estos aportan evidencia significativa sobre algunas de las áreas cerebrales y las disfunciones cognitivas comprometidas en el mencionado trastorno, los resultados obtenidos a la fecha distan aún de ser concluyentes.

In the last decade, the development and implementation of modern neuroimaging techniques in the field of cognitive neuroscience have provided a new way to approach the experimental study of mental disorders. Several authors have proposed the name of “cognitive neuropsychiatry” for this alternative approach. In this context, hysteria (or conversion disorder, according to the current psychiatric classification) has reached a huge protagonism. Therefore, this paper is intended to introduce pioneer studies about hysteria from a neurocientific perspective. It is necessary to highlight that, although these studies offer significant evidence about some of the brain areas and cognitive dysfunctions involved in the above mentioned disorder, results are still far from being conclusive.

Temperamental traits associated with conversion disorder.

The aim of this study was to analyze the temperamental traits associated with conversion disorder in children. Thirty children with conversion disorder attending a child guidance clinic were compared with an age and sex matched control group of normal children for life stresses and temperament dimensions. The temperament measurement schedule (TMS) and the life event scale for Indian children (LESIC) were used for evaluating the temperament dimensions and life stresses respectively. Children with conversion disorder experienced significantly more stressful life events compared to the children in the control group. The stress factors included scholastic difficulties, examination failures, punishment by teacher, conflict with peers, parental disharmony and family problems and sibling rivalry. The characteristic temperamental traits associated with conversion disorder were low emotionality and low threshold of responsiveness.

La histeria: entre la mística y la locura. Madeleine Lebouc / The Hysteria: between mystics and madness. Madeleine Lebouc

El presente trabajo tiene por objetivo analizar un caso clásico en la psiquiatría: La Madeleine Lebouc, célebre paciente de Pierre Janet. Caso paradigmático de locura histérica que ha dado lugar a diversas investigaciones socio-históricas y psicoanalíticas interesadas en articular los elementos de su itinerario religioso y psicopatológico. Santa para su Director de conciencia; falsa mística para los teólogos, “extática” para Janet, se producen recubrimientos de categorías psiquiátricas y religiosas bajo el intento de discernir si sus síntomas constituyen una experiencia sobre Dios, intervención de la gracia divina, o si son explicables en el marco de la histeria. Para su desarrollo, se ha elegido tomar como punto de partida la biografía de Pauline Lair Lamotte, la correspondencia, recuerdos y testimonios de sus vivencias durante las fases patológicas, material extraído de las comunicaciones que el propio Janet realizó del caso (Janet, 1926) y de los documentos originales reunidos por Jacques Maître (MAÎTRE, 1993).

Risa en la histeria de conversión / Laughter in conversion hysteria

La risa es un fenómeno neurológico que pocas veces es explorado en forma habitual dentro del examen clínico. Cuando es patológico, revela un trastorno psicológico importante. Se presentan tres pacientes con risa histérica de carácter paroxístico y se hace el diagnóstico diferencial con la risa loca. Se analiza el valor representativo que tendría en la histeria de conversión, sería un acto motor, que revelaría inmadurez emocional y que busca procedimientos primitivos para hacerse valer

Alteraciones sensitivas en histeria de conversión / Sensitive disorders in convertion hysteria

Se analiza una casuística de 160 pacientes con síntomas histéricos sensitivos, 35 hombres y 125 mujeres examinados en el Servicio de Neurología del Hospital del Salvador y en la Consulta Privada en el período comprendido entre 1962 y 1986. Se analizan los principales síntomas sensitivos, hemianestesias, anestesias en segmentos geométricos, anestesias diseminadas en placas e hiperestesias. Se hace notorio el predominio de la hemianestesia al lado derecho. Los síntomas sensitivos representan una regresión a procedimientos arcaicos para hacerse querer o valer a través de vías de calidad psíquicas más altas y en este caso, los signos sensitivos son un fiel reflejo de lo expuesto