Administration of 5-HT-1B agonist ameliorates pseudodementia induced by depression in rats.

Major depressive disorder (MDD) is the leading cause of memory impairment in general population. The serotonin hypothesis provides a target model for the treatment of depression and depression-associated memory loss. 5-HT-1B receptor is suggested as a potential candidate in the pathophysiology of depressive illness. Dysfunction of 5-HT-1B receptors has been observed previously in depressive patients. Zolmitriptan, 5-HT-1B agonist is clinically recommended for the treatment of migraine. However, in present study this drug was tested as a potential treatment for depression and associated memory loss by altering the serotonergic function at receptor level. Rats (n=24) were equally divided into unstressed and stressed groups. Depression was induced by 19 days of restraint stress for 4 h which was followed by forced swim test and pattern separation test to assess depressive symptoms and memory impairment, respectively. The initial sign of depression-associated memory loss involves impaired pattern separation which is regarded as pseudodementia. In this study stressed rats showed depression- and pseudodementia-like symptoms. After the induction of depression, rats were treated with zolmitriptan at a dose of 0.3 mg/kg which resulted in a significant attenuation of depression and depression-associated memory impairment. Results are discussed with reference to the modulation of function of 5-HT-1B receptor following the administration of exogenous agonist.

Per Oral Bleeding: Rare Presentation of Gardner-Diamond Syndrome.

A10-year boy presented with spontaneous episodes of oral bleeding for the last 6 months. Detailed ENT examination showed no pathology, bleeding profile was normal, endoscopy and dental examination also did not reveal any abnormality. Child abuse or malingering was also ruled out. Initially the child was managed with platelet transfusion and fresh frozen plasma and then put on follow-up treatment with antifibrinolytics, Vitamin C but the episodes became recurrent. Psychiatric evaluation revealed that child was suffering from depression. Antidepressants were prescribed by the psychiatrist that not only cured the depression with time but also the bleeding episodes which were actually related to child's depression (Gardner-Diamond syndrome or psychogenic purpura). This is a diagnosis by exclusion where the patients bleed due to dysregulated steroid secretion secondary to stress; resulting in development of sensitization to RBC membrane, and dysregulated fibrinolytic system activity.

["Factitious disorder and skin picking: Clinical approach". A case report]. / Trouble factice et dermatillomanie : approche clinique. À propos d'un cas.

OBJECTIVE: The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed. CASE REPORT: The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6 months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement. DISCUSSION: Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder. CONCLUSION: The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.

[Strategies to promote testosterone deficiency syndrome: a paradigm of disease mongering]. / Estrategias de promoción del síndrome por déficit de testosterona: un caso paradigmático de invención de enfermedad (disease mongering).

The so-called «testosterone deficiency syndrome¼ is a blend of nonspecific symptoms typical of the physiological process of aging. This syndrome has been the subject of intense promotional activity that has presented the phenomenon as highly prevalent and with a major public health impact. This strategy has been accompanied by the emergence of new and easy to administer testosterone devices into the pharmaceutical market and has generated significant sales for drug companies. The commercial promotion of testosterone deficiency syndrome and its remedies has exploited cultural stereotypes of aging and sexuality through awareness campaigns promoted by the laboratories involved and has been disseminated by media with the participation of numerous experts and with the support of scientific associations, representing a paradigmatic case of disease mongering. This example might be of use in the response to disease mongering activities from the clinical and public health fields.

Psychopharmacological therapies in dermatology.

When patients with psychodermatologic disorders present in clinic, the dermatologist can refer them to psychiatrists or other mental health care professionals. However, it is often the case that these patients will refuse a psychiatric referral because they either do not believe they have a disorder of psychiatric nature or they feel there is societal stigma associated with psychiatric illness. Therefore, it is essential for dermatologists to understand the common classifications for psychodermatological cases and to know how to optimally treat these patients with pharmacotherapy. The intent of this article is to help guide physicians in understanding the classifications of psychodermatological cases and in managing these conditions with pharmacotherapies. In this article, two classifications for psychodermatological cases are presented, followed by a discussion of medical therapies used to treat the main categories of psychopathologies that are more frequently encountered in dermatology. These include depression, anxiety, delusions, and obsessive-compulsive disorder.

Pseudodementia caused by severe depression.

The diagnosis of pseudodementia may be difficult in a patient with a history of major depressive disorder. Clinical case history. A 70-year-old man with a history of major depressive disorder, in remission for 3 years, presented with confusion, agitation and cognitive disorder. The differential diagnosis included depression with pseudodementia, drug-induced dementia or Alzheimer disease. Mild cognitive improvement was noted after discontinuation of simvastatin. After 9 months of treatment for depression, the patient had remission that was sustained for >1 year, with mild residual difficulty remembering words of songs. The differential diagnosis of dementia includes major depressive disorder and adverse events from simvastatin.

Letter: Factitial dermatitis: an unusual presentation in an old woman.

The importance of emotional factors in dermatological disorders has been recognized for several decades. However, very few reports have been published to date about the diagnosis and management of these disorders. A 78-year-old woman came to our department with 3 months evolution of a symmetrically distributed dermatosis involving only the face. It was characterized by multiple erosions, some of which had slightly geometrical shapes. We report an unusual case of late onset dermatitis artefacta with a rare successful outcome.

The current management of delusional parasitosis and dermatitis artefacta.

Psychocutaneous disorders involve a unique and somewhat difficult patient population, whose treatment requires the use of drugs unusual to the dermatologist and a significant investment of the clinician's time. This paper describes an effective interpersonal approach and appropriate drug therapy for patients with delusional disorders and dermatitis artefacta, as well as outlines the expectable course and prognosis in each.

Sobre el lugar del síndrome de Ganser en la nosotaxia: una muestra de la dificultad en la práctica psicopatológica / On the place of Ganser syndrome in nosology: an example of the difficulty of clinical practice in psychopathology

El texto que sigue trata de poner de manifiesto las limitaciones implícitas del proceder psicopatológico al uso, a través de la presentación de un caso clínico de síndrome de Ganser que resulta especialmente útil para dicha tarea. Nos referimos a este trastorno por lo controvertido de su naturaleza y porque el paciente en concreto evidenció, como tantos otros, las dificultades diarias con las que se enfrenta la psiquiatría, en especial cuando se salen de la norma o impiden un pensamiento simplista y estructurado en forma de las clasificaciones que empleamos habitualmente. El paciente con síndrome de Ganser es desconcertante y provoca en el médico observador diferentes reacciones y, sobre todo, la duda y la incertidumbre de lo incomprensible, en términos sintomáticamente determinantes. Para su enfoque se revisa la bibliografía concerniente, y se discuten las opiniones enfrentadas a lo largo de la historia del trastorno y, en especial, lo concerniente a la nosología y el origen psicótico, histérico u orgánico del cuadro, analizando la situación actual y extrapolando la problemática planteada al resto de patologías psiquiátricas conocidas

The present text aims to highlight the limitations implicit in currently used psychopathological procedures through a case report of Ganser's syndrome, which is especially suitable for revealing these limitations. This case is reported because of its controversial nature and because, like so many other patients, the patient illustrated the difficulties encountered daily in psychiatry, especially when patients are atypical and do not fit into commonly used classifications. Patients with Ganser syndrome are disconcerting and provoke different reactions in psychiatrists, especially doubt and uncertainty since these patients cannot be understood in terms of established symptomatology. As a focus, we review the relevant literature and discuss the various opinions held on this disorder throughout its history and, especially, that concerning nosology and whether the origin of the disorder is psychotic, hysterical or organic. The current situation is analyzed and the problems posed by Ganser's syndrome are extrapolated to all known psychiatric disorders

A case of factitious disorder involving menstrual blood smeared on the face.

This article presents a case of factitious disorder in which a female smeared menstrual blood on her face. The patient was admitted to our otolaryngology clinic complaining of bleeding from the mouth, nose, ears and eyes. This event reportedly occurred three to four times on a daily basis. She acknowledged nine prior admissions to different specialists over the last two years. Following psychiatric consultation, we diagnosed factitious disorder with predominantly physical signs and symptoms. She was started on Fluoxetine 20 mg/day and supportive interviews were organized. After diagnosis, we observed that her symptoms decreased over two months. The symptoms did not reoccur three to nine months after treatment. This case report outlines two important features. The first is that a case of this type has not been reported before, and the second feature is that this case demonstrates the effect of cultural factors greatly different from those seen in classical factitious disorder.

[A case report of factitious disorder with hallucinations]. / Varsanilarla giden bir yapay bozukluk olgusu.

Although factitious disorder has been known for a long time, its diagnosis and treatment continue to be a problem. It is an uncommon condition associated with considerable morbidity and health care expenditure. We present a case of factitious disorder with hallucinations. A 37 year-old single woman has had auditory and olfactory hallucinations for six years. She had been diagnosed with schizophrenia, hospitalized for a short term, taking classical antipsychotic drugs for years. She has been performing her job as a teacher and living with her family. A suitable dose of atypical antipsychotic drugs was administered at a convenient time for her illness (Psychotic Disorder NOS) in psychiatric outpatient clinic of Kocaeli University. She was admitted to inpatient clinic twice in order to allow a clear diagnosis to be made. Psychotic disorder and temporal lobe epilepsy were ruled out. Borderline and histrionic personality traits were determined. Her complaints were unchanged over the course of treatment taking three years. She later started to come into the emergency department with anxiety symptoms, conversion like fits and suicide attempts; hospitalized for these complaints in another hospital. She was diagnosed with factitious disorder because of her unchanged complaints, her adding new complaints to the old ones, her complaints unrelated to psychosocial stressors, her ambitions to come to hospital, her increasing hospital dependence and having no prominent secondary gain. This case emphasizes the need for the careful observation of patients to prevent unnecessary investigations at the diagnosis and treatment stage and to establish a specific management strategy for the patients.

Self-inflicted (factitious) conjunctivitis.

PURPOSE: To describe the diagnosis and management of self-inflicted factitious conjunctivitis in conscripted soldiers. DESIGN: Prospective, noncomparative, consecutive case series. PARTICIPANTS: Seventeen conscripted soldiers. METHODS: Soldiers with chronic conjunctivitis (>3 weeks) were referred by ophthalmologists, and cases of shorter duration were referred by primary-care physicians. All cases underwent thorough ophthalmic and systemic history and examination, as well as questioning regarding their military units, military duties, and social background. Exclusion criteria were any condition that may cause conjunctivitis. Inferior fornix specimen microscopy and culture and eye photography were performed in most cases. In cases suspected of self-inflicted conjunctivitis all medication, besides lubricant drops, was stopped. Underlying psychosocial problems were investigated and managed. Cases were followed for at least 3 months after resolution of the conjunctivitis, at which point the diagnosis was confirmed, and the case entered the analysis. MAIN OUTCOME MEASURES: Resolution of the conjunctivitis. RESULTS: Seventeen consecutive cases of self-inflicted conjunctivitis, 8 of long duration and 9 of short duration, were studied. All cases demonstrated inconsistent clinical findings. The ocular signs most suggestive of self-inflicted conjunctivitis were purulent discharge purposely left on the lashes and periorbital skin, discharge more severe than in conjunctival hyperemia, less conjunctival chemosis than in hyperemia, mainly inferior conjunctival involvement, and an uninvolved cornea. Five of the 8 chronic cases had significant underlying psychologic or social problems. Their conjunctivitis resolved only after their underlying problems were addressed. Two cases admitted introducing freshly scraped dental plaque into the lower conjunctival sac. In the remaining 15 the similarity of the clinical findings suggested that a similar method was used. CONCLUSIONS: In the context of a subject standing to gain by assuming the sick role and after exclusion of ocular pathology, self-inflicted conjunctivitis can be reliably diagnosed by noting the characteristic clinical profile. Effective management includes addressing the underlying psychologic and social problems.

Uncomplicated Gilles de la Tourette syndrome and probable Ganser syndrome. A case report and review of the literature.

Gilles de la Tourette syndrome (GTS) is a genetic neuropsychiatric disorder, which is more common than previously thought. Ganser syndrome is an uncommon disorder, particularly in children. We present the first report of a young girl aged 7 who was diagnosed independently as having both GTS and Ganser syndrome and who was otherwise well and remained well and improved at follow-up 8 years later. This highlights how the clinicians must always be vigilant when atypical behaviours begin, especially when one diagnosis has already been given. There may well be treatment implications.

[False parasitic diseases]. / Mnimye parazitozy.

The paper deals with the topical problem of false parasitic diseases (FPD) in patients with various organic (somatic and mental) disorders. A classification of groups of FPD patients is given according to their clinical and social signs. Examples of 6 cases of FPD observed by the authors and those published in the literature are presented. Simple and effective recommendations on the management of FPD patients are given.

Self-inflicted anterior scleritis.

PURPOSE: To describe and clinically characterize a syndrome of self-inflicted scleritis. STUDY DESIGN: Case reports and literature review. METHODS: Two patients had persistent scleritis at presentation. Both did not respond to prescribed therapy, including systemic corticosteroids and immunosuppression. The first had unexplained, diffuse anterior scleritis and persistent linear keratoconjunctival abrasions after a work-related injury. Several objective indicators pointed to concealed noncompliance with medications. The second patient was a medical assistant with diffuse, unilateral anterior scleritis and unexplained visual loss. Systemic work-up was negative. She had pharmacologic mydriasis and keratoconjunctival abrasions at presentation. RESULTS: Systemic therapy was stopped in both patients. The first patient, who was in the process of requesting permanent disability status, showed persistent inflammation on each follow-up visit. The second patient improved with no further therapy after she was confronted with objective indicators of a self-inflicted condition. CONCLUSIONS: Although the presentation of self-inflicted scleritis can be similar to that of idiopathic or autoimmune anterior scleritis, the former may show additional findings of traumatic conjunctival and corneal abrasions. Indicators of self-inflicted etiology, of which malingering is one such entity, include evidence of concealed noncompliance with prescribed treatments and lack of response to potent antiinflammatory and immunosuppressive agents. Correct diagnosis including early psychiatric evaluation in all such cases, may help prevent unnecessary treatment and unjustified work-related compensation.