ABSTRACT
Seven cases are described in which the central symptoms were fear of contracting AIDS, avoidance of related cues, rituals and reassurance-seeking. Associated features include previous illness phobias and obsessive-compulsive disorder. Treatment with exposure and response prevention (plus a cognitive session in one case), led to improvement sustained up to three months after discharge, although one patient stopped treatment prematurely. Controlled trials of behavioural treatment in hypochondriasis are required.
Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Behavior Therapy/methods , Phobic Disorders/psychology , Phobic Disorders/therapy , Sick Role , Adult , Female , Hospitalization , Humans , Male , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Sarcoma, Kaposi/psychology , Skin Neoplasms/psychologyABSTRACT
This study reports the psychiatric morbidity in 116 patients with definite multiple sclerosis (MS). The presence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 48 physically disabled controls suffering from rheumatic or neurological conditions not involving the brain was used for comparison. Normative MRI data were obtained from a group of 40 healthy volunteers. Psychiatric morbidity was significantly higher in the MS group with nearly half of the patients scoring as cases at interview. There was no evidence to suggest that psychiatric symptoms in isolation were the first manifestation of MS in the present material. The presence of psychiatric illness at interview was significantly related to the degree of social stress as perceived by the patient. The severity of MRI abnormalities was greater in those with longer histories and greater physical disability, but did not show a significant relationship with global measures of psychiatric disability. Of the various psychiatric symptoms elation was significantly correlated with the presence of widespread MRI abnormalities, while flattening of affect, delusions and thought disorder correlated with the degree of pathology in the temporo-parietal region.
Subject(s)
Mental Disorders/etiology , Multiple Sclerosis/complications , Adult , Aged , Brain/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Mental Disorders/pathology , Middle Aged , Multiple Sclerosis/pathology , Nervous System Diseases/complications , Rheumatic Diseases/complications , Stress, Psychological/complicationsABSTRACT
This study reports the performance on psychometric tests of a group of 48 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brainstem and cord lesions). The cognitive functions studied were: 'IQ deficit', verbal and visual memory, abstracting ability, visual and auditory attention, and naming ability. The presence of brain pathology was investigated by means of magnetic resonance imaging (MRI). A group of 46 patients with rheumatic and neurological conditions not known to cause brain disease was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers. An overall 'Cognitive Ability Index' was significantly worse in patients with clinically isolated lesions when compared with physically disabled controls. IQ deficit and defective auditory attention were the more severely affected parameters. These deficits were significantly correlated with the duration of neurological symptoms and with the degree of brain pathology detected by MRI.
Subject(s)
Cognition Disorders/etiology , Multiple Sclerosis/complications , Adult , Aged , Brain/pathology , Cognition Disorders/diagnosis , Cognition Disorders/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/pathology , Multiple Sclerosis/psychology , PsychometricsABSTRACT
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.
Subject(s)
Brain/pathology , Magnetic Resonance Imaging , Multiple Sclerosis/pathology , Neurocognitive Disorders/pathology , Adolescent , Adult , Cerebral Cortex/pathology , Cerebral Ventricles/pathology , Disability Evaluation , Female , Humans , Male , Middle Aged , Multiple Sclerosis/psychology , Neurocognitive Disorders/psychologyABSTRACT
We performed brain MRIs on 21 patients with CNS sarcoidosis. Brain CTs were performed in 18 of these. Parenchymal lesions were seen in 17 of 21 with MRI, compared with 9 of 18 with CT. MRI detected a greater number of parenchymal lesions in cases where both CT and MRI were positive, and some lesions appeared more extensive with MRI than with CT. The most common MRI pattern was one of periventricular and multifocal white matter lesions (14 cases). Such a pattern is not specific, and other recognized causes for it were identified in four cases. It is likely, however, that sarcoid tissue causes this pattern in some cases, and confirmation was obtained from cerebral biopsy in one. In six patients, the white matter changes were indistinguishable from those seen in multiple sclerosis. Contrast-enhanced CT in two patients showed diffuse meningeal involvement not seen with MRI. MRI is the investigation of choice in detecting parenchymal changes in the brain of patients with CNS sarcoidosis and may prove useful in monitoring treatment in such cases.
Subject(s)
Central Nervous System Diseases/diagnosis , Magnetic Resonance Imaging , Sarcoidosis/diagnosis , Adolescent , Adult , Aged , Brain/pathology , Central Nervous System Diseases/diagnostic imaging , Central Nervous System Diseases/pathology , Female , Humans , Hypertension/diagnosis , Male , Meninges/pathology , Middle Aged , Optic Nerve/pathology , Sarcoidosis/diagnostic imaging , Sarcoidosis/pathology , Spinal Cord/pathology , Tomography, X-Ray ComputedABSTRACT
Post-ictal psychoses have so far received little attention. The clinical details of 14 cases, diagnosed according to newly formulated criteria, were examined. Psychoses were usually precipitated by a run of seizures and occurred after a lucid interval. The seizures were partial complex with secondary generalisation in 11 cases. Catego analysis of the Present State Examination confirmed pleomorphic phenomenology. Follow-up details were available in all cases, for up to eight years. Psychoses tended to recur. Similarities with chronic epileptic psychosis are discussed, and a possible organic aetiology for post-ictal psychosis is proposed.
Subject(s)
Epilepsy/psychology , Psychotic Disorders/etiology , Adolescent , Adult , Confusion , Delirium , Delusions , Female , Hallucinations , Humans , Male , Middle Aged , Time Factors , UnconsciousnessABSTRACT
The frequency and type of psychiatric disease were investigated in 40 patients suffering from systemic lupus erythematosus (SLE) and 27 control subjects with rheumatoid arthritis or inflammatory bowel disease. The psychiatric morbidity at the time of interview was the same in the two groups, but the patients with SLE had experienced more episodes of psychiatric illness in the past, and psychotic symptoms occurred only in this group. Half of the patients with SLE had previous or current evidence of neurological involvement; an association was found between neurological disease and psychotic symptoms in SLE, while anxiety and affective disturbances appeared to be closely related to environmental factors in both patients with SLE and controls. There was no correlation between psychiatric and neurological disease and clinical or laboratory indices of disease activity. Magnetic resonance imaging of the brain was performed in 15 patients with SLE. Abnormalities were more often present in those with neurological disease; no such correlation was found with psychiatric illness.
Subject(s)
Lupus Erythematosus, Systemic/complications , Mental Disorders/complications , Nervous System Diseases/complications , Adolescent , Adult , Brain/pathology , Female , Humans , Interview, Psychological , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Social ConditionsABSTRACT
T1 and T2 measurements of the brains of six human volunteers did not change in the presence of moderate blood alcohol levels.
