ABSTRACT
OBJECTIVES: The possible link between cognitive areas of perception and integration of consciousness was examined using assessments of hallucinations and derealisation/depersonalization. METHODS: Sixty-five subjects in three main diagnostic groups - posttraumatic stress disorder (PTSD), borderline personality disorder (BPD) and schizophrenia - identified by their treating psychiatrist as hearing voices were surveyed regarding characteristics of hallucinations, derealisation/depersonalization, delusions and childhood/adult trauma. RESULTS: A cluster analysis produced two clusters predominantly determined by variables of hallucinations measures, childhood sexual abuse and derealisation/depersonalization scores. CONCLUSIONS: History of childhood trauma and variability in derealisation/depersonalization scores were better predictors of external, negative, uncontrollable voices than diagnosis of BPD or PTSD. The potential links between dissociative states and pseudo-hallucinations are discussed.
Subject(s)
Borderline Personality Disorder , Dissociative Disorders , Hallucinations , Schizophrenic Psychology , Borderline Personality Disorder/psychology , Cluster Analysis , Humans , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Obesity is generally accepted as a global epidemic and the most common metabolic disorder in the world. Obesity affects every organ system but the consequences on the respiratory system are often underappreciated. While the respiratory consequences of being overweight are predominantly mechanical, an inflammatory element has also been proposed. For this discussion, the components of the respiratory system can be divided into the airways, pulmonary parenchyma, pulmonary vasculature, and the upper respiratory tract. This section will discuss respiratory physiology and the mechanisms leading to breathing difficulties in obesity followed by the impact of obesity on commonly occurring pulmonary disorders.
Subject(s)
Lung Diseases/etiology , Obesity/complications , Obesity/physiopathology , Respiratory Physiological Phenomena , Biomechanical Phenomena , Humans , Lung Diseases/physiopathology , Pulmonary Ventilation/physiology , Sleep Apnea, Obstructive/etiology , Sleep Apnea, Obstructive/physiopathology , Spirometry , Thoracic Wall/physiologyABSTRACT
Clinical diagnosis of chronic or slowly progressing pericardial effusion with impending tamponade remains a challenge, particularly when classical physical signs are subtle or absent. A high index of suspicion should be entertained in such cases in the appropriate setting even when the clinical signs and symptoms are missing. We present two cases where the pericardial effusion was missed in the emergency department due to subtle clinical features or mistaken for a more familiar "look-a-like" presentation. A review of the literature and an analysis of various clinical parameters of published cases were performed. It is pivotal that physicians should not only be aware of the limitations of the traditional clinical signs, but also be familiar with the use of other subtle findings and the importance of other modalities that may potentially enhance the sensitivity in diagnosing chronic pericardial effusion impending tamponade.
