1/14. The management of medically unexplained symptoms.Medically unexplained symptoms occur in up to 50% of new medical out-patients. health care seeking may not be related to the presence of physical disease but may reflect social problems, psychological disturbance, or frank psychiatric disorder. Management of unexplained physical symptoms depends on the duration of symptoms. If acute, exclusion of physical disease, as well as providing symptomatic care, is a priority. The patient's fears of illness need to be addressed and an explanation in simple terms of the symptoms provided. Adverse life situations should be identified and, where possible, rectified. Psychiatric disorders require appropriate treatment. When symptoms are chronic, conservative management is required to contain the symptoms and avoid iatrogenic problems.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/14. Psychogenic seizures--why women?The only consistent finding in studies of psychogenic seizures is the approximately threefold higher incidence in women. Therefore, why women? Charcot and Freud emphasized the sexual aspects of the seizure as has the current interest in childhood sexual abuse. From case studies and review of the literature the author believes that psychogenic seizures in women express rage, fear, and helplessness against the dominant and abusive male rather than sexual conflicts. Emphasizing the aggressive component of seizures does not minimize the traumatic effects of sexual abuse but rather includes it as leading to rage and helplessness.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/14. noise-induced psychogenic tremor associated with post-traumatic stress disorder.Tremors in post-traumatic stress disorders have not been previously well characterized. A 67-year-old man has a 46-year history of a noise-induced exaggerated startle reflex followed by a large amplitude rest, postural and kinetic tremor that may persist for up to 3 days. This tremor is superimposed on a continuous mild organic postural/kinetic tremor whose electrophysiological characteristics are different from those of the overlying tremor. We attribute the exaggerated startle reflex and the noise-induced tremor to Post-Traumatic Stress Disorder (PTSD) and postulate a psychogenic origin for the noise-induced tremor. The patient also believes the noise-induced tremor to be psychologically based and to be produced by the fear and anxiety he experiences when he hears loud, unexpected noises. The sudden onset of the noise-induced tremor, its intermittent character, its temporary disappearance on distraction despite the patient's inability to suppress it, inconsistencies in handwriting and figure drawing, and the fact that the noise-induced tremor is stimulus specific and persists long after the offending stimulus (noise) is no longer present all suggest a tremor of psychogenic origin.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/14. case reports on psychosomatic eye disorders.Symptoms of headache, floaters, blurred vision, eye strain may be respectable outward manifestations of secret fears or failure to adjust to life events. The work in this hospital of Mr W.S. Inman, ophthalmologist and psychoanalyst, has largely been forgotten. I will present case histories to show that the approach 'Let's have a chat about your problem' can reveal deep underlying tensions. The description of these by the patient, for the first time, to a neutral listener is usually curative. It takes longer than a detachment operation and can be more difficult than cataract surgery but the end result is a very grateful patient whose symptoms have been cured--by talking. We can easily dismiss these patients with 'Your problem is not ocular'. By spending time listening and being unafraid of their muddled lives, their confused sexuality and inadequate personal relationships, we can reach a wider range of patients to help, as Inman taught our predecessors. I find it rewarding.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/14. A cognitive neuropsychological and psychophysiological investigation of a patient who exhibited an acute exacerbated behavioural response during innocuous somatosensory stimulation and movement.We report findings from a cognitive neuropsychological and psychophysiological investigation of a patient who displayed an exacerbated acute emotional expression during movement, innocuous, and aversive somatosensory stimulation. The condition developed in the context of non-specific white matter ischaemia along with abnormalities in the cortical white matter of the left anterior parietal lobe, and subcortical white matter of the left Sylvian cortex. Cognitive neuropsychological assessment revealed a pronounced deficiency in executive function, relative to IQ, memory, attention, language and visual processing. Compared to a normal control group, the patient [EQ] displayed a significantly elevated skin conductance level during both innocuous and aversive somatosensory stimulation. His pain tolerance was also significantly reduced. Despite this, EQ remained able to accurately describe the form of stimulation taking place, and to rate the levels of pain intensity and pain affect. These results suggest that EQ's exaggerated behavioural response and reduced pain tolerance to somatosensory stimulation may be linked to cognitive changes, possibly related to increased apprehension and fear, rather than altered pain intensity or pain affect per se.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/14. Psychophysiological correlates of anxiety: a single-case study.We examined the relationship between self-reported anxiety and physiological measures (blood pressure and heart rate) in a series of exposures to a feared situation of a single participant with panic disorder with agoraphobia. During each exposure, readings of heart rate, systolic blood pressure and diastolic blood pressure were taken every 20 s. Over 30 exposures, we found a near-linear relationship between anxiety and the three physiological measures. Implications of this result for usefulness of physiological measures in anxiety research and in the clinical treatment of anxiety disorders are discussed.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
7/14. Studies on psychosomatic implications of infertility--effects of emotional stress on fertilization and implantation in in-vitro fertilization.A case report shows the long and stony path of a couple who had to go through eight attempts at IVF in 4 years until the desired child was achieved. The psychosomatic implications of the various 'failures' of treatment become clearer when compared with the results of a psycho-endocrinological questionnaire completed by 551 patients and 115 controls since 1982. This questionnaire contains among others the Giessen personality test for the image of self, mother and father, a somatic complaints score to evaluate the severity of autonomic disorders, items for the presence and severity of possible gynaeco-endocrinological symptoms and items to evaluate the reference persons and their changes during childhood. The following results could be obtained. In a comparison of the means of 58 different somatic complaints, patients rated significantly higher than controls (P = 0.002). women with menstrual disturbances, menstrual pains, acne or unclear skin or dry skin also suffered more from other complaints. These symptoms were also correlated with a higher score for depressive mood. Those women who were not brought up by both parents during their childhood also scored significantly higher (P less than 0.0001) in the somatic complaints score. In the Giessen personality test patients appeared significantly more compulsive (P less than 0.002) and depressive (P = 0.003) than the controls and identified themselves more with their mothers. From 60 patients in our IVF programme, 19 had no fertilization of oocytes and scored significantly higher (P = 0.008) on the social potency scale than did the patients with fertilized oocytes. women with unsuccessful treatments in terms of pregnancy scored significantly higher in the social resonance and social potency tests. We interpret this exaggerated positive attitude as an attempt to overcome inner fears, doubts and ambivalences. These results support the importance of psychosomatic aspects in infertility and reassure us of the necessity of including counselling in any infertility treatment, including IVF.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
8/14. Psychophysiological responses to dental injections.dentists frequently change local anesthetic formulations on the basis of a patient's experience of adverse effects. Frequently, less effective anesthetics are selected because a lack of understanding exists regarding the nature of untoward events. This may exacerbate the problem. Allergic reactions are overreported, whereas fear responses frequently are unrecognized. This article outlines the clinical problem of adverse reactions to local anesthetics in dental practice. Clinical recommendations based on proper diagnosis are provided to prevent recurrence of the problem.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
9/14. The pathophysiology of sleep disorders in pediatrics. Part II. sleep disorders in children.In this part of the chapter we have used new terminology and developed a new system for classification of sleep disorders in children. We suggest that excessive daytime sleepiness should be investigated by clinicians before troubles at school necessitate referral. The narcolepsy-hypersomnia syndrome generally has not been recognized in the pediatric age group. Symptoms of excessive fear of falling asleep need to be viewed in this context. Sleep apnea-hypersomnia has received insufficient attention in the American literature. It is a syndrome that affects both adults and children with potentially disastrous cardiovascular and pulmonary complications. The relationship of the sleep apnea-hypersomnia syndrome to the sudded infant death syndrome remains speculative, although preliminary results from our longitudinal study have indicated a possible link. Both the narcolepsy-hypersomnia and the sleep apnea-hypersomnia syndromes are reviewed in detail. In contrast, we review briefly the NREM dyssomnias, including night terrors, sleepwalking, sleep talking and enuresis. All are well known to clinicians dealing with children, and we have related them to findings emanating from the sleep laboratory. We suggest that they are physiologically rather than psychogenically based and frequently represent immaturities of the central nervous system. Finally, the insomnias of childhood are presented. We emphasize that they are rare, and after ruling out organic conditions and drug-dependency syndromes, cultural styles or family stresses generally account for the majority of complaints.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
10/14. Indigenous koro, a genital retraction syndrome of insular Southeast asia: a critical review.koro, a disorder characterized by complaints of genital hyperinvolution and fear of impending death, is found to be indigenous to certain populations of insular Southeast asia. koro is similar to, but nevertheless distinct from, the Chinese syndrome which carries its name and serves as the transcultural prototype; the category of genital retraction syndromes is proposed as a substitute for the use of "koro" as the transcultural rubric. In a review of the koro literature, an exploration of the many possible cultural and biomedical factors is begun; the issues and perspectives are relevant to the wider study of culture specific manifestations of genital retraction.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
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