Distinguishing hypochondriasis and schizophrenia using regional homogeneity: a resting-state fMRI study and support vector machine analysis.

OBJECTIVE: A few former studies suggested that there are partial overlaps in abnormal brain structure and cognitive function between hypochondriasis (HS) and schizophrenia (SZ). But their differences in brain activity and cognitive function were unclear. METHODS: Twenty-one HS patients, 23 SZ patients, and 24 healthy controls (HC) underwent resting-state functional magnetic resonance imaging (rs-fMRI) with the regional homogeneity analysis (ReHo), subsequently exploring the relationship between ReHo value and cognitive functions. The support vector machines (SVM) were used on effectiveness evaluation of ReHo for differentiating HS from SZ. RESULTS: Compared with HC, HS showed significantly increased ReHo values in right middle temporal gyrus (MTG), left inferior parietal lobe (IPL), and right fusiform gyrus (FG), while SZ showed increased ReHo in left insula, decreased ReHo values in right paracentral lobule. Additionally, HS showed significantly higher ReHo values in FG, MTG, and left paracentral lobule, but lower in insula than SZ. The higher ReHo values in insula were associated with worse performance in MATRICS consensus cognitive battery (MCCB) in HS group. SVM analysis showed a combination of the ReHo values in insula and FG was able to satisfactorily distinguish the HS and SZ patients. CONCLUSION: Our results suggested that the altered default mode network (DMN), of which abnormal spontaneous neural activity occurs in multiple brain regions, might play a key role in the pathogenesis of HS, and the resting-state alterations of insula are closely related to cognitive dysfunction in HS. Furthermore, the combination of the ReHo in FG and insula was a relatively ideal indicator to distinguish HS from SZ.

Cenesthopathy in adolescence: an appraisal of diagnostic overlaps along the anxiety-hypochondriasis-psychosis spectrum.

OBJECTIVE: To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. METHODS: Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. RESULTS: The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. CONCLUSION: As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.

Acerca de un caso de síndrome referencial olfatorio / Apropos of an Olfactory Reference Syndrome case

El Síndrome Referencial Olfatorio (SRO) es una de las variedades del tipo somático del trastorno delirante y es definido por el juicio falso que el individuo afectado defiende respecto a la emisión de un olor fétido proveniente de su propio organismo y que los demás pueden advertir. En la venidera edición del Manual Diagnóstico y Estadístico de las Enfermedades Mentales (DSM-V), se ha propuesto desgajar al SRO como una patología independiente. A partir del reporte de un caso ilustrativo, revisamos la respectiva bibliografía y comentamos tal propuesta (AU)

Olfactory Reference Syndrome (ORS) is one of the varieties of the somatic type of the Delusional Disorder, and it is characterized by the mistaken statement of a patient who declares the issuance of a foul odor coming from his own body and that others may notice. In the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) it has been proposed to break off ORS as an independent pathology. From an illustrative case report, we review the relevant literature and discuss this proposal (AU)

Pituitary volumes in hypochondriac patients.

To date, no study has examined the pituitary volumes in patients with hypochondriasis. In the present study, we evaluated pituitary volumes in patients with hypochondriasis and healthy controls. Twenty individuals with hypochondriasis (ten males, ten females), aged 20 to 48 years, and healthy controls were included into the study. The pituitary volumes were obtained. Volumetric measurements were made with T1-weighted coronal MRI images, with 2.4-mm-thick slices, at 1.5 T, and were done blindly. Volumetric measurements did not demonstrate group differences in the brain measurements, i.e., whole brain volume, white, and gray matter volumes (P>0.05). We found significantly smaller pituitary volumes of the whole group of hypochondriac patients compared to healthy controls (age and ICV as covariates). To conclude, the results from the current investigation suggest that hypochondriac patients had smaller pituitary volumes compared with healthy controls. This could be the keystone to a better understanding of the neurobiological basis of hypochondriasis.

Clinical pictures and classification of somatoform disorders in dermatology.

Somatoform disorders in dermatology are a heterogeneous group from a biopsychosocial point of view. Among the clinical patterns we find, for example, pruritus, pain, paresthesia as well as feelings of disfiguration, eco-syndromes, erythrophobia or psychogenic pseudoeffluvium. The multiple clinical symptoms are usually accompanied by psychosocial disorders, these are subjective complaints by the patient which cannot be medically objectified. The relevant somatoform disorders in dermatology can be differentiated as somatisation disorders, hypochondriacal disorders, somatoform autonomous disorders, persistent somatoform pain disorders and "other somatoform disorders". A precise differential-diagnostic division is necessary in order to initiate adequate therapy strategies. With this overview article, we would like to make an updated classification recommendation for dermatology and present experiences in therapy.

The role of psychological and biological factors in postinfective gut dysfunction.

BACKGROUND: Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS). AIMS: To investigate how the psychological factors act, and the involvement of infective and physiological factors. METHODS: Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection. RESULTS: Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS-). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS- patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS- patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS- patients had returned to normal levels. IBS+ and IBS- patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant differences between IBS+ and IBS- patients for these physiological measurements. CONCLUSION: Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms.

Los medicamentos histéricos: Ignatia, Moschus, Nux moschata / Medicaments used for the hyteria: Ignatia, Moschus, Nux moschata

Se pretende realizar una ejercitación de materia médica comparada con los principales medicamentos de la HISTERIA, destacando sus caracteres diferenciales en un cuadro comparativo. Se describen los síntomas definitorios de Moschus y Nux Moschata los cuales junto con Ignatia son considerados como la "tríada de los histéricos". Nos referiremos a esta "tríada de histéricos", desarrollando las características más destacadas de MOSCH y NUX-M., presentando al final una sinopsis comparativa de los 3, por sus síntomas histéricos tal como figuran en el Moderno Repertorio de Kent del Dr. Francisco X. Eizayaga, con el agregado complementario de otros medicamentos afines. Previamente daremos un rápido repaso a los cuadros Histéricos e Histeriformes, clasificados como TRASTORNOS SOMATOFORMES por la American Psychiatric Association (DSM IV, Diagnostic and Statical Manual of Mental Disorders)

Los medicamentos histéricos: Ignatia, Moschus, Nux moschata / Medicaments used for the hyteria: Ignatia, Moschus, Nux moschata

Se pretende realizar una ejercitación de materia médica comparada con los principales medicamentos de la HISTERIA, destacando sus caracteres diferenciales en un cuadro comparativo. Se describen los síntomas definitorios de Moschus y Nux Moschata los cuales junto con Ignatia son considerados como la "tríada de los histéricos". Nos referiremos a esta "tríada de histéricos", desarrollando las características más destacadas de MOSCH y NUX-M., presentando al final una sinopsis comparativa de los 3, por sus síntomas histéricos tal como figuran en el Moderno Repertorio de Kent del Dr. Francisco X. Eizayaga, con el agregado complementario de otros medicamentos afines. Previamente daremos un rápido repaso a los cuadros Histéricos e Histeriformes, clasificados como TRASTORNOS SOMATOFORMES por la American Psychiatric Association (DSM IV, Diagnostic and Statical Manual of Mental Disorders) (AU)

Cutaneous artifactual disease. A review, amplified by personal experience.

Cutaneous artifactual disease is part of the general syndrome of contrived disease. While classical examples are easy to recognize, it can present in unusual ways. Difficulties in recognition include the unusual doctor-patient relationship, the doctor's fear of missing organic disease, and the reality of the disease to the patient's family and the family doctor. The diagnosis depends upon finding lesions whose morphology is consistent and an emotionally immature patient, whose personality shows, or has shown, hysterical and masochistic traits. Lesions "arrive" fully developed. Once there they begin to heal, so that a continuous supply of new ones is necessary if the illness is to continue. High intelligence is compatible with the diagnosis, but a mature personality is not. The differential diagnosis is extensive. Investigations prove negative or equivocal; in the latter case, the investigator is led even further into unfamiliar territory. It is suggested that the essence of management is to keep in contact with the patient.