Hysteria as a Trigger for Epidemic Decompression Sickness Following Hypobaric Hypoxia Training.

INTRODUCTION: Although hypobaric hypoxia training (HHT) is an essential component of aviation physiology training, it poses a risk of decompression sickness (DCS). DCS can sometimes be observed as a cluster of cases, which is referred to as epidemic DCS. In this report, we aim to evaluate an epidemic DCS episode that occurred following two consecutive HHT sessions.METHODS: A total of 16 trainees, all of whom were medical doctors, attended the aviation medicine training course in the aeromedical research and training center. They went through HHT in two sessions, each with eight trainees.RESULTS: Following two HHT sessions, five Type 1 DCS cases occurred among 18 personnel (16 trainees and 2 inside observers). DCS incidence rate was found to be 27.77%. They were successfully treated with hyperbaric oxygen therapy (HBOT).DISCUSSION: Since the DCS incidence rate was found to be higher than the average in such a short period of time, this cluster of cases was labeled as epidemic DCS. We carried out a thorough investigation into all possible causes by following some templates that were developed to conduct comprehensive investigations into epidemic DCS episodes. According to the psychological arguments discussed here, we placed a special emphasis on hysterical and psychosocial components, among other probable factors. In cases where the possibility of hysteria and placebo-nocebo responses exist, it is appropriate to conduct the training and treatment processes with these factors in mind. No matter what the triggering factor is and how the symptoms manifest, HBOT remains crucial in the treatment of DCS.Demir AE, Ata N. Hysteria as a trigger for epidemic decompression sickness following hypobaric hypoxia training. Aerosp Med Hum Perform. 2022; 93(10):712-716.

Clinical and psychological characteristics of patients with globus.

BACKGROUND/AIMS: Psychological factors are involved in many functional gastrointestinal disorders including globus. The aim of the present study was to assess the clinical and psychological correlates associated with globus. PATIENTS AND METHODS: 707 patients (69% female, 45.2 ± 16.5 years, BMI 27.2 ± 11.7 kg/m2) filled an MMPI-2 questionnaire and a standard Rome III clinical questionnaire and were included in this cross sectional study. Data analysis was performed using a univariate analysis and a multivariate logistic regression with a backwards selection procedure on significant scales after a univariate analysis. RESULTS: 140 patients (20%) reported suffering from globus. Globus appeared to be associated with older age (P = 0.001; OR = 1.022; 95% CI = [1.009-1.035]), increased BMI (P = 0.007; OR = 1.029; 95% CI = [1.008-1.051]), higher prevalence of regurgitations (P = 0.008; OR = 2.189; 95% CI = [1.228-3.902]), heartburn (P = 0.001 OR = 2.227; 95% CI = [1.406-3.530]), dysphagia (P < 0.001; OR = 2.399; 95% CI = [1.500-3.837]), epigastric pain (P < 0.001; OR = 3.768; 95% CI = [1.880-7.552]) and nonspecific dyspepsia (P = 0.018; OR = 1.786; 95% CI = [1.106-2.881]), and a higher score of hysteria (P = 0.008 OR = 1.034; 95% CI = [1.009-1.059]). By comparison with patients who reported globus and scores of hysteria in the normal range (n = 73), patients complaining of globus associated with high scores of hysteria (n = 67) have high scores of hypochondriasis (P < 0.001; OR = 1.235; 95% CI = [1.142-1.336]), high levels of Psychopathic deviate (P = 0.005; OR = 1.091; 95% CI = [1.026-1.161]) and a higher, but not significant, prevalence of complaints of regurgitation (P = 0.052; OR = 4.022; 95% CI = [0.989-16.351]). CONCLUSION: Approximately 50% of the patients complaining of globus have a high score of hysteria associated with other personality disorders, and complain more frequently of regurgitation than other patients complaining of globus. These results tend to confirm that globus has a strong, although not systematic, connections with some specific personality disorders.

Vías cruzadas para la psicologización del trauma en los saberes médicos de fin del siglo XIX / Crossing paths for psychologizing of trauma in medical knowledge by the end of the nineteenth century

En el presente artículo, procuraremos indagar tres vías que contribuyeron, de distinta manera, al proceso de "psicologización" del trauma. En primer lugar, la obra del cirujano Erichsen (1866), quien pretendió explicar ciertos casos de accidentados ferroviarios (ubicados en una zona gris entre la lesión comprobable y la simulación) con el marco de la anatomía patológica. En segundo lugar, la refutación de Page (1883), quien desde una perspectiva fisiológica intentó interpretar ese territorio dudoso de la clínica como la consecuencia de un shock general nervioso, producido por la acción de una emoción capaz de alterar la función sin lesionar el tejido. Finalmente, las lecciones de Charcot de 1885, dedicadas a la histeria traumática, volvieron pensable el papel que las emociones y las ideas podían tener en las situaciones traumáticas que generaban los síntomas, tomando como modelo el mecanismo de acción de la hipnosis y de la sugestión en el sistema nervioso. En el recorrido, procuraremos fundamentar que las transformaciones de la noción de trauma e, incluso, lo que cada autor podía observar y pensar, dependieron principalmente de los marcos conceptuales a partir de los cuales se abordó la experiencia clínica

In this article, we will try to investigate three different ways which contributed to the process of "psychologizing" of trauma. First, Erichsen's work (1866), a surgeon who explained certain cases of railway accident victims (which were located in a great field between the provable injury and simulation) with the framework of the pathological anatomy. Second, the physiological perspective of Page (1883), who tried to interpret that dubious territory of the clinic as a result of a Nervous Shock produced by an emotion that can alter the function without damaging the tissue. Finally, the lessons of Charcot in 1885, dedicated to traumatic hysteria, became plausible the idea that emotions and ideas could be traumatic by themselves, idea that was modeled on the action of hypnosis and suggestion in the nervous system. Throughout the text, we will try to justify that the transformations of the notion of trauma (and what each author could observe and think) depend on conceptual frameworks from which clinical experience was discussed

Minnesota Multiphasic Personality Inventory profile in patients with restless legs syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is associated with psychiatric disorders. We aim to investigate the personality traits of RLS patients using the Minnesota Multiphasic Personality Inventory. METHODS: Twenty adult patients with RLS (14 females and 6 males) and 20 healthy controls (14 females and 6 males) who were referred to university neurology were enrolled in the present study. Diagnosis of RLS was established using International Restless Legs Syndrome Study Group. Psychometric evaluation was made with the Turkish version of the Minnesota Multiphasic Personality Inventory. RESULTS: RLS patients have significantly higher absolute and clinical elevation scores on hypochondriasis and hysteria, and clinical elevation scores on psychasthenia, compared with the controls. Absolute scores on depression were higher at the border in RLS patients compared with the controls. DISCUSSION: RLS patients have hypochondriac, hysterical, depressive, and anxious personality traits.

'Fin-de-Siècle' epidemiology of hysteria.

An 'explanatory epidemiology' of disorders labelled 'hysteria' towards the end of the 19th century provides precious information--through the numerous statistical works of the period - about the conceptions of practitioners and the various cultural factors which made this era, in France, 'the golden age' of hysteria. The heyday of hysteria at the end of the century appears to be closely linked to the prestige of Charcot and the promotion of his ideas through the circle of his pupils. The disappearance after his death of hysteria, as he had described it in a defined and systematical manner, is a strong argument for considering it to be a transient mental illness, according to the definition of this concept by Ian Hacking. The regular appearance since then of new nonorganic diseases, avatars of hysteria, with a strong potential for contagiousness and whose causality is exterior to the person, as well as the persistence of the older, more characteristic forms, is evocative of the existence of an ancestral reactional mode taking on various clinical forms according to time and place.

Cuando despertó, la histeria todavía estaba allí. Globus hystericus en la hipermodernidad y relato de una psicoterapia / Upon waking, hysteria was still there. Globus hystericus in hypermodernity and a psychotherapy case report

La histeria, inmortal e irreductible, habituada a declararse una y otra vez en rebeldía cuando intenta ser ninguneada y expulsada de las nosografías contemporáneas, se ha mostrado siempre fugaz y proteica, capaz de evolucionar en sus expresiones clínicas y de adaptarse con brillantez a los cambiantes escenarios culturales con que se ha topado a lo largo de la historia. Así, resulta poco probable que la modernidad líquida en la que ha triunfado la fibromialgia asista a espectaculares ataques "à la Sapêtrière". Y, sin embargo, siguen apareciendo en ocasiones llamativos y deliciosamente anticuados cuadros como el bolo histérico que presentamos y que suscita el abordaje psicoterapéutico del que se da cuenta a continuación (AU)

Hysteria, immortal and elusive, has since forever tended to insurrection against the stablished order, specially when contemporary nosographies have tried to ignore and throw it out. Shooting and protean, it has shown the ability to evolve and adapt itself to changing cultural settings throughout history. Thus, it is strange that in liquid modernity, in which fibromyalgia reigns, severe attacks "à la Salpêtrière" happen. Nevertheless, delicious oldfashioned syndromes like globus hystericus show up in clinical settings, and they provoke psychotherapeutic approaches like the one described bellow (AU)

[Neurology of hysteria (conversion disorder)].

Hysteria has served as an important driving force in the development of both neurology and psychiatry. Jean Martin Charcot's devotion to mesmerism for treating hysterical patients evoked the invention of psychoanalysis by Sigmund Freud. Meanwhile, Joseph Babinski took over the challenge to discriminate between organic and hysterical patients from Charcot and found Babinski's sign, the greatest milestone in modern neurological symptomatology. Nowadays, the usage of the term hysteria is avoided. However, new terms and new classifications are complicated and inconsistent between the two representative taxonomies, the DSM-IV and ICD-10. In the ICD-10, even the alternative term conversion disorder, which was becoming familiar to neurologists, has also disappeared as a group name. The diagnosis of hysteria remains important in clinical neurology. Extensive exclusive diagnoses and over investigation, including various imaging studies, should be avoided because they may prolong the disease course and fix their symptoms. Psychological reasons that seem to explain the conversion are not considered reliable. Positive neurological signs suggesting nonorganic etiologies are the most reliable measures for diagnosing hysteria, as Babinski first argued. Hysterical paresis has several characteristics, such as giving-way weakness or peculiar distributions of weakness. Signs to uncover nonorganic paresis utilizing synergy include Hoover's test and the Sonoo abductor test.

[Diagnostic difficulties in a case of constricted tubular visual field]. / Dificultati de diagnostic în cazul unui câmp vizual îngustat concentric--prezentare de caz.

In the paper below we present the clinical case of a 48 year old female with various symptoms associated with functional visual disturbance -constricted tubular visual fields, wich lasts from 6 years; the extensive clinical and paraclinical ophthalmological investigations ruled out the presence of an organic disorder. In the present, we suspect a diagnosis of hysteria, still uncertain, wich represented over time a big challenge in psychology and ophthalmology. The mechanisms and reasons for hysteria are still not clear and it could represent a fascinating research theme. The tunnel, spiral or star-shaped visual fields are specific findings in hysteria for patients who present visual disturbance. The question of whether or not a patient with hysterical visual impairment can or cannot "see" is still unresolved.

Cefalea numular y clavo histérico. Réplica / Numular headache and clavus hystericus. Reply

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Cefalea numular y clavo histórico / Numular headache and clavus hystericus

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Psychogenic nonepileptic seizures: answers and questions.

Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient. Emphasizing the clinical picture throughout, the first part of this article is intended to "look and look again" at what we know about the epidemiology, semiology, clinical context, treatment, and prognosis of PNES. The second part is dedicated to the questions that remain to be answered. It argues that the most important reason our understanding of PNES remains limited is the focus on the visible manifestations of PNES or the seizures themselves. In contrast, subjective seizure manifestations and the biographic or clinical context in which they occur have been relatively neglected.

Personality type of the glaucoma patient.

PURPOSE: To characterize the personality profile of glaucoma subjects. PATIENTS AND METHODS: One hundred eight subjects including 56 open-angle glaucoma (OAG) and 52 controls were given the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test and all performed automated perimetry. Clinical and demographic information which could relate to personality type was collected. RESULTS: OAG subjects had significantly higher Hypochondriasis (Hs; P=0.0082), Hysteria (Hy; P=0.0056), and Health Concerns (HEA; P=0.0025) mean scores than the control group. OAG subjects also had a significantly greater frequency of clinically abnormal score for hysteria (P=0.0262), and health concerns (P=0.0018). Multivariate analysis of variance revealed that Hypochondriasis, Hysteria, and Health Concerns scores were related to number of systemic medications used and to diagnostic group. Other potential explanatory variables such as sex, ethnicity, number of medical problems, length of glaucoma diagnosis, occurrence of glaucoma surgery, intraocular pressure, and visual status (logMAR, visual field indices) were not related to these personality scores. CONCLUSIONS: Patients with a diagnosis of OAG had more abnormal MMPI-2 scores in areas that focus upon concerns of somatic complaints and poor health. The use of systemic medications, which may be a constant reminder of illness, is a factor that may contribute to higher MMPI-2 scores.

Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile.

Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.

Functional visual disturbance due to hysteria.

A 23-year-old male complained of loss of peripheral visual field and everything having purple shadows in the afternoon. This had lasted for 3 years but he had paid little attention to the symptoms. Investigations, including visual acuity, intra-ocular pressure, pupil reflex, and anterior and posterior segment of the eyes, were normal. He denied ocular pain, history of head injury, epilepsy or related family history. The Goldmann perimeter and tangent screen examinations showed a bilateral constricted tubular visual field defect within the central 10 degrees and steep margins. Tracing his past social history, he had been in jail for 3 months. He also complained his work was hard and caused him tension. The visual symptoms were a functional disturbance, not an organic disorder. We diagnosed him with hysterical functional visual disturbance. Hysteria, or conversion disorder, has long been a puzzling and fascinating problem in psychology and ophthalmology. The mechanism and reasons for hysteria are still not clear. The tangent screen is useful in diagnosis. The constricted tubular, spiral or star-shaped visual fields with steep slopes are specific findings in hysteria. We suggest that ophthalmologists should treat patients with psychogenic symptoms, using suggestion, patience and reassurance.

[Quantitative indices of gait in patients with psychogenic and organic dysbasia].

The study aimed at comparison of quantitative indices of gait in patients with hysteria and organic dysbasia. Two groups of patients were studied - 28 patients with psychogenic dysbasia and 22 with organic gait disturbances (cerebellar ataxia in multiple sclerosis and post stroke hemiparesis). A control group included 10 healthy subjects. Space and temporal gait characteristics were investigated using an impregnation method (footprint), i.e. analysis of gait parameters by footprints. Step width (base) and length, step frequency and gait speed were assessed. All parameters were recorded both at normal speed and accelerated gait. At accelerated gait, changes of step base (SB) were in different directions: in patients with hysteria and controls SB decreased and in patients with organic dysbasia increased. SB index (ratio of SB at accelerated gait to that at normal speed) was <1 in 82% of patients with psychogenic dysbasia and 90% controls and >1 in 91% of patients with organic gait disturbances. Maximal differences were found between subgroups with psychogenic and organic ataxia and less marked differences - in paresis.