Enfermedad psicógena masiva. Reporte de tres episodios no recientes / Massive Psychogenic Disease. A report of three not recent episodes

Episodios de enfermedad psicógena masiva han ocurrido en entornos sociales diferentes, en todo el mundo, a lo largo de la historia de la humanidad. Cada vez los profesionales de la salud participan más en su atención y solución. Este trabajo presenta tres "casos" catalogados como tales, que el autor tuvo la oportunidad de asistir. Se realizan comentarios en cada uno de ellos y se actualizan conceptos sobre esta condición, que se expresa por los más variados síntomas en un grupo de personas ante un estrés intenso por supuestas amenazas, aunque no exista una razón física o ambiental para que se enfermen. Genera marcada tensión tanto en pacientes como en facultativos y en el público. Los médicos, y el personal sanitario en general, deben estar preparados para su adecuado diagnóstico y conducta a seguir.

Episodes of massive psychogenic disease have occurred in different social contexts, worldwide, throughout history. Every time health professionals participate more in their attention and solution. This work presents three ¨cases¨ classified as such, which the author had the opportunity to attend. There are, in this work comments, about each of them and concepts about this condition are updated; which is expressed by the most varied symptoms in a group of people facing intense stress due to supposed threatening even though there is no physical or environmental reason to get sick. It generates a marked tension in patients and doctors so as in the general public. Doctors and sanitary personnel should be prepared for its adequate diagnosis and conduct to follow.

Parte III: las locuras histéricas / Part III: the hysterical follies

Caso Clínico Paciente María R.A., 28 años, Escolaridad básica en programa diferencial, dueña de casa, Casada, 9 años de matrimonio. Su pareja tiene 62 años. Actualmente vive con esposo e hijo de 2 años, en Maipú. Durante 2016, María consultó en distintos servicios de urgencia, recibiendo distintos diagnósticos: Conversión, Síndrome conversivo. Se ingresa en Urgencia con diagnóstico: Síndrome Psicótico lúcido. Paciente en cama, sin movimientos espontáneos, con rigidez, mirada fija, deshidratada, no acepta alimentarse, negativista, no establece contacto visual, no responde preguntas simples, sin embargo, en forma espontánea puede permanecer hablando, dando cuenta de contenidos delirantes. El día de su ingreso a sector se inició terapia Electro convulsiva, y completó 5 sesiones. Tras la primera sesión paciente evoluciona favorablemente, se levanta de la cama, solicita agua, es capaz de comer. Síntomas psicóticos ceden tras la tercera sesión, señalando además no recordar nada de lo ocurrido. En entrevista de evolución paciente vigil, orientada TE, actitud parcialmente cooperadora. En cuanto a las psicosis histéricas en sí, es una psicosis aguda, de rápida curación cuando se las trata adecuadamente y Bleuler habla de los llamados estados crepusculares histéricos. La duda diagnóstica es entre un trastorno disociativo tipo psicosis histérica o bien un trastorno psicótico agudo, refiriéndose a trastornos de presunto origen disociativo con sintomatología que podríamos denominar pseudopsicótica. La CIE-10 clasifica las psicosis agudas no afectivas, como Trastornos psicóticos agudos y transitorios (TPAT), (Acute and Transient Psychotic Disorders (ATPD) en inglés), comparten las características comunes de inicio agudo dentro de dos semanas, y la presencia de síntomas psicóticos típicos. La descripción de TPAT fue influenciada por los conceptos de psicosis cicloide, bouffée délirante y psicosis reactiva. No es sorprendente, por lo tanto, que los ATPD de la CIE-10 (al menos diagnósticamente) sean un heterogéneo grupo de trastornos. Tanto los sistemas CIE como DSM se basan en síntomas, y descuentan los aspectos "no empíricos" del diagnóstico, que pueden constituir el «fenómeno" esencia de un trastorno psicótico. Actualmente, no existe una categoría de diagnóstico para definir individuos que están experimentando tal psicopatología y tienen un riesgo significativamente mayor de desarrollar esquizofrenia u otro desorden psicótico. Trastorno histriónico de la personalidad (HPD), como argumento aquí, no es una patología mental real; más bien, "histriónico" se refiere a un rasgo o grupo de rasgos de personalidad que podría conducir a algún otro trastorno mental.

Clinical case. Patient María R.A., 28 years old, Basic schooling in differential program, housewife, Married, 9 years of marriage. His partner is 62 years old. Currently lives with husband and 2 year old son in Maipú. During 2016, Maria consulted in different emergency services, receiving different diagnoses: Conversion and conversion syndrome. Urgency is entered with diagnosis: Syndrome Psychotic lucid. Patient in bed, without spontaneous movements, with rigidity, stare, dehydrated, does not accept to feed, negativist, does not establish visual contact, does not answer simple questions, however, spontaneously can remain talking, giving account of delusional contents. On the day of his admission to the sector, Electro Convulsive therapy was started, and he completed 5 sessions. After the first patient session he progresses favorably, gets up from bed, requests water, is able to eat. Psychotic symptoms give way after the third session, noting also not remember anything of what happened. In an evolution interview, vigil patient , oriented TE, partially cooperative attitude. As for hysterical psychoses per se, it is an acute, rapidly healing psychosis when properly treated and Bleuler speaks of so-called hysterical crepuscular states. The diagnostic doubt is between a dissociative disorder type hysterical psychosis or an acute psychotic disorder. referring to disorders of presumed dissociative origin with symptomatology that we could call pseudopsychotic. The ICD-10 classifies acute non-affective psychoses, as Acute and Transient Psychotic Disorders (ATPD), share the common characteristics of acute onset within two weeks, and the presence of typical psychotic symptoms. The description of ATPD was influenced by the concepts of cycloid psychosis, bouffée délirante and reactive psychosis. It is not surprising, therefore, that the ATPD of the ICD-10 (at least diagnostically) is a heterogeneous group of disorders. Both CIE and DSM systems are based on symptoms and discount the "non-empirical" aspects of diagnosis, which may constitute the "phenomenon" essence of a psychotic disorder. Currently, there is no diagnostic category to define individuals who are experiencing such psychopathology and have a significantly increased risk of developing schizophrenia or other psychotic disorder. Histrionic Personality Disorder (HPD), as an argument here, is not a real mental pathology; rather, "histrionic" refers to a trait or group of personality traits that could lead to some other mental disorder.

[The differential diagnosis of hysteria in the ravines of contemporary psychiatry]. / Los diagnósticos diferenciales de la histeria en los desfiladeros de la psiquiatría moderna.

The diagnosis of "hysteria" has recently become part of the history of Psychiatry. Although fully trained dynamic psychiatrists, followers of psychoanalytic theories, still make use of some clinical and theoretical production upon hysteria, for many of the young psychiatrists this term has disappeared from their scope. They only know of dissociative disorders, somatoform disorders and histrionic personality disorders, or they rather distinguish other diagnosis with which hysteria could be mistaken for. Despite the diagnosis of hysteria has been removed from the DSM, the difficulties these patients frequently imposed to physicians still prevail.

Impulso sexual excessivo: um relato de caso / Impulsive sexual behavior: case report

Os autores relatam um caso de impulso sexual excessivo em comorbidade com ciclotimia e transtorno alimentar sem outra especificacao. Ressalta-se a importancia do diagnostico desse transtorno sexual na evolucao do caso por meio de uma breve revisao sobre o tema e de uma comparacao com as descricoes e propostas terapeuticas da literatura

Neurovegetative dystonia--psychiatric evaluation of 40 patients diagnosed by general physicians in Brazil.

The diagnosis of neurovegetative dystonia (NVD) is commonly made by general physicians in Brazil, but its precise meaning is unclear. Anecdotal evidence suggests that it is used to describe patients with a wide range of psychological and physical symptoms and is often used pejoratively, in a similar way to "crocks" in the USA. Forty patients who had been diagnosed as having NVD by general physicians working in a triage department of a general public hospital were compared with 40 non-NVD patients, matched for age and gender, from the same department. Patients were evaluated by a psychiatrist who was blind to the diagnosis that had been made. The assessment included a structured sociodemographic questionnaire, the Clinical Interview Schedule (CIS), and a routine psychiatric interview using DSM-III-R criteria. Using the CIS, the "reported symptoms" that most distinguished NVD patients from controls were somatic and anxiety, whereas for "manifest abnormality" NVD patients displayed more anxiety, histrionic behavior, hypochondriasis, and depressive thoughts. A total of 92.5% of NVD patients received diagnoses using DSM-III-R criteria compared to 37.5% of controls. The relative risk of NVD patients subsequently receiving a psychiatric disorder was 8.3 (95% CI = 2.5-43.1, p < 0.001). Although general physicians correctly identify most patients with psychiatric disorder they miss many others. Furthermore, they use an obsolete diagnostic category which has no psychiatric currency. Medical students and residents need better psychiatric training so that they can correctly identify patients in general medical settings who are suffering from mental disorders and make a diagnosis using accepted psychiatric terminology.

Programa de Ansiedade e Depressäo - UFRJ. Série Psicofarmacologia - 14: Transtorno histriônico de personalidade: aspectos diagnósticos e de manejo terapêutico / The Anxiety and Depression Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro

O Programa de Ansiedade e Depressäo do IP-UFRJ utiliza o SCID-II (DSM-III-R) para o diagnóstico de Transtorno de Personalidade.O Transtorno Histriônico de Personalidade apresenta dificuldades no diagnóstico transversal através de entrevista estruturada. A abordagem cognitivo-comportamental e farmacológica säo discutidas

Las personalidades homeopáticas / The homeopathic personality

Este trabajo trata sobre el movimiento dinámico de los síntomas mentales en una personalidad tan controvertible como Veratrum Album, dominada por un afán de grandeza ilimitada que lo impulsa a trepar en su medio por competencia desleal, manipuleo de gentes, a toda costa caiga quien caiga; siendo por lo tanto tan peligroso para su medio, en especial cuando en sus ilusiones siente que es Cristo, un enviado divino o el Mesías y arrastra tras de sí a mentes débiles o muy confundidas por situaciones emocionales extremas, conformando esas sectas o cultos sui-generis de comportamientos inexplicables (AU)

Las personalidades homeopáticas / The homeopathic personality

Este trabajo trata sobre el movimiento dinámico de los síntomas mentales en una personalidad tan controvertible como Veratrum Album, dominada por un afán de grandeza ilimitada que lo impulsa a trepar en su medio por competencia desleal, manipuleo de gentes, a toda costa caiga quien caiga; siendo por lo tanto tan peligroso para su medio, en especial cuando en sus ilusiones siente que es Cristo, un enviado divino o el Mesías y arrastra tras de sí a mentes débiles o muy confundidas por situaciones emocionales extremas, conformando esas sectas o cultos sui-generis de comportamientos inexplicables

Personalidades borderline e histrônica: um perfil comparativo

Os autores fazem um estudo retrospectivo das características de dois grupos diagnósticos de pacientes atendidos na Unidade de Itnernaçäo Psiquiátrica do Hospital de Clínicas de Proto Alegre, no período de abril de 1984 a abril de 1987. Aqueles com diagnóstico de Transtorno de Personalidade Borderline e Transtorno de Personalidade Histriônico säo revisados quanto aos aspectos demográfico, fenomenlógico, familiar e terapêutico, comparando com os dados da literatura. O objetivo é alcançar maior compreensäo dos critérios diagnósticos do DSM-III e buscar identificar outras características psicossociais

[Hysterical psychoneurosis and its psychopathological and clinical limits]. / La psiconeurosis histérica y sus límites psicopatológicos y clínicos.

The author's purpose in this paper is to delimit the clinical and psychopathological features of the hysterical psychoneurosis, correlating its symptoms (as characteristic of this neurosis) with the psychodynamic speculations of psychoanalysis. To achieve, this, the author starts by placing this disorder among the psychoneurosis as opposed to the actual neurosis and, within that group, among the transference neurosis, separating it, in that way, from the narcissistic and impulsive neurosis. The hysterical psychoneurosis is also distinguished from the fobic and the obsessive neurosis. The clinical picture of the hysterical psychoneurosis is then defined taking into account personality on one side and symptoms on the other. Dependence, sexual behavior disturbances, agressivity, effects of identification and repression are considered characteristics of this personality. Paroxistic symptoms, corporal and lasting symptoms and psychic syndromes are part of the hysterical symptoms. The author makes a clinical characterization of these phenomena as they are actually found. On this basis the author intends to distinguish hysteria from normality, from fobic and obsessive neurosis, from schizophrenic, manic-depressive and paranoic psychosis; from traumatic and actual neurosis and from psychosomatic diseases and epilepsy. He critically examines the validity of diagnostic-differential criteria and points to the overlapping with other pathologies, discussing in brief the theoretical and practical problems that those questions pose.