ABSTRACT
During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions Rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.
Subject(s)
Factitious Disorders/psychology , Self Mutilation/psychology , Sepsis/psychology , Skin Ulcer/psychology , Wound Infection/psychology , Actinomycetales Infections/drug therapy , Adult , Family , Female , Humans , Malingering , Proteus/isolation & purification , Recurrence , Rhodococcus/isolation & purification , Sepsis/drug therapy , Sepsis/etiology , Sepsis/microbiology , Skin Ulcer/drug therapy , Skin Ulcer/etiology , Skin Ulcer/surgery , Wound Infection/etiology , Wound Infection/microbiologyABSTRACT
Within a sample of 78 general practice patients, 13 patients were diagnosed as having functional somatic symptoms (FSS). In eight of these 13 patients, the FSS were associated with hypochondriasis, as indicated through a screening instrument (the Whitely index). In the remaining five patients, the FSS were associated with various other basic problems. Different subtypes of hypochondriasis with clinical relevance could be identified among the hypochondriac FSS patients. During a 3-year follow-up period, the FSS patients with hypochondriasis demonstrated considerably elevated general practice clinic utilization, compared with FSS patients without hypochondriasis. One of the FSS patients developed a serious physical disease during the follow-up period.
Subject(s)
Hypochondriasis/psychology , Somatoform Disorders/psychology , Adult , Aged , Anxiety Disorders/psychology , Depressive Disorder/psychology , Family Practice , Female , Follow-Up Studies , Humans , Hypochondriasis/diagnosis , Male , Middle Aged , Pilot Projects , Psychological Tests , Somatoform Disorders/diagnosisABSTRACT
"Somatizing syndromes" is proposed to describe all conditions in which patients present with somatic complaints but without signs of organic disease. Fifty consecutive G.P. patients were given a Swedish version of the 52-item Illness Behaviour Questionnaire (IBQ) to test whether this questionnaire identifies those with signs of somatizing syndromes. The patients were also independently categorized by the G.P. into seven clinical groups reflecting the presence or absence of somatic disease, social/psychological problems and various combinations thereof. The test-retest reliability of the IBQ expressed as Pearson's r was 0.89. Patients presenting with concern over non-existing somatic disease and apparently unaware of any related psychological problem had significantly higher mean IBQ scores than did other patients. The IBQ was thus found to be a satisfactory instrument for primary identification of patients with probable somatizing syndromes.
Subject(s)
Somatoform Disorders/diagnosis , Adult , Aged , Female , Humans , Male , Middle Aged , Physicians, Family , Sick Role , Surveys and QuestionnairesABSTRACT
Primary hyperparathyroidism was studied in a well-defined geriatric population of 1129 individuals during a three-month interval. Primary hyperparathyroidism was diagnosed in 1.5%. The diagnosis was based on a morphologic and biochemic basis. From clinical material consisting of 400 patients treated surgically for primary hyperparathyroidism during a ten-year period, 158 patients (38%) above the age of 64 were studied. At the preoperative evaluation, neuromuscular symptoms were present in 80%, renal insufficiency and kidney stones in each 16%, constipation and/or anorexia in 38%. Ten per cent were considered asymptomatic. In 80% the primary hyperparathyroidism was caused by a solitary adenoma. Ninety-four per cent became normocalcemic following the operation. Consistent hypocalcemia requiring vitamin-D treatment occurred in 3%, and 2% had a persisting hypercalcemia or later recurrence. The therapeutic effect on the neuromuscular symptoms, constipation, anorexia, and renal stone formation was considered good or fair in most of the cases. Primary hyperparathyroidism in the elderly occurs with a high prevalence. It can be treated successfully by surgical therapy with a low cost of morbidity, mortality, and medical care.
Subject(s)
Hyperparathyroidism/diagnosis , Adenoma/diagnosis , Adenoma/surgery , Aged , Cross-Sectional Studies , Female , Humans , Hypercalcemia/diagnosis , Hyperparathyroidism/surgery , Kidney Diseases/diagnosis , Male , Neuromuscular Diseases/diagnosis , Parathyroid Hormone/blood , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , SwedenABSTRACT
In a well-defined geriatric population the prevalence of primary hyperparathyroidism was 1.5%. From a clinical material consisting of 400 patients treated surgically for primary hyperparathyroidism during a 10-year period 158 patients (38%) above the age of 64 were studied. Neuromuscular symptoms were present in 80%, renal insufficiency or kidney stones in each 16%, constipation and/or anorexia in 38%. 10% were considered clinically asymptomatic. In 80% the primary hyperparathyroidism was caused by a solitary adenoma. Normocalcaemia was achieved in 94%. Hypocalcaemia requiring vitamin D treatment occurred in 3%, and in 2% hypercalcaemia persisted or recurred. All of these had multiglandular parathyroid disease. The therapeutic effect of the surgical treatment was considered good or fair in most of the cases. No mortality occurred. Primary hyperparathyroidism occurs with a high prevalence in the elderly. It can be treated successfully by surgical therapy with a low cost of morbidity, mortality and medical care.
