A neuropsychological study of the stable syndrome of hysteria

Biological Psychiatry (Impact Factor: 10.25). 08/1981; 16(7):601-26.
Source: PubMed

ABSTRACT Ten patients with the stable syndrome of hysteria were matched for age, sex, handedness, and full-scale WAIS IQ with ten controls, ten psychotic depressives and ten schizophrenics. All were subjected to an extensive neuropsychological test battery. Compared to the controls, the hysteria group exhibited bifrontal impairment (R = L) and, globally, greater dysfunction of the nondominant hemisphere. A G analysis provided a complete separation between the hysteria and controls. However, a D-index analysis showed that the hysteria group was more impaired than normals and depressives because of greater dysfunction of the dominant hemisphere, whilst schizophrenia showed greater nondominant hemisphere dysfunction than hysteria. Further, a cluster analysis on the 40 subjects produced three clusters: normal controls, depressives, and a schizophrenia-hysteria grouping. These findings are interpreted as suggesting that dominant hemisphere dysfunction is fundamentally related to the syndrome of hysteria and that the dysfunction of the nondominant hemisphere is brought about by associated features: the female excess, the emotional instability and dysphoric mood, the presence of asymmetrical pain, and conversion symptomatology. It is further argued, in view of the familial associations, that hysteria in the female is a syndrome equivalent to psychopathy in the male (who also exhibits dominant hemisphere dysfunction) and might represent in the female a (relatively benign) variant of schizophrenia characterized by imprecise verbal communications, a subtle form of affective incongruity, together with the conversion parameter.

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    • "An active inhibition of motor, sensory, or even cognitive processes preventing their integration into conscious awareness was also proposed by more recent authors [10] [64] [78]. Other accounts have built on the notion that conversion symptoms may more often affect the left than right hemibody, on the one hand, and evidence that the right hemisphere might be dominant for emotion processing, on the other hand, to suggest a role for impaired communication or integration between the two hemispheres [29] [34] [90]. However, this left preponderance has been questioned by systematic reviews [95] and not all conversion symptoms are strictly lateralized. "
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    ABSTRACT: Conversion disorders are defined as neurological symptoms arising without organic damage to the nervous system, presumably in relation to various emotional stress factors, but the exact neural substrates of these symptoms and the mechanisms responsible for their production remain poorly understood. In the past 15 years, novel insights have been gained with the advent of functional neuroimaging studies in patients suffering from conversion disorders in both motor and non-motor (e.g. somatosensory, visual) domains. Several studies have also compared brain activation patterns in conversion to those observed during hypnosis, where similar functional losses can be evoked by suggestion. The current review summarizes these recent results and the main neurobiological hypotheses proposed to account for conversion symptoms, in particular motor deficits. An emerging model points to an important role of ventromedial prefrontal cortex (VMPFC), precuneus, and perhaps other limbic structures (including amygdala), all frequently found to be hyperactivated in conversion disorders in parallel to impaired recruitment of primary motor and/or sensory pathways at the cortical or subcortical (basal ganglia) level. These findings are only partly shared with hypnosis, where increases in precuneus predominate, together with activation of attentional control systems, but without any activation of VMPFC. Both VMPFC and precuneus are key regions for access to internal representations about the self, integrating information from memory and imagery with affective relevance (in VMPFC) and sensory or agency representations (in precuneus). It is therefore postulated that conversion deficits might result from an alteration of conscious sensorimotor functions and self-awareness under the influence of affective and sensory representations generated in these regions, which might promote certain patterns of behaviors in response to self-relevant emotional states.
    Neurophysiologie Clinique/Clinical Neurophysiology 10/2014; 44(4). DOI:10.1016/j.neucli.2014.01.003 · 1.46 Impact Factor
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    • "Also, it may provide unique insights into mechanisms that subserve normal conscious experience of sensation and volition. A variety of neuropsychological findings (Flor-Henry et al., 1981) and neurophysiological abnormalities (Tiihonen et al., 1995; Lorenz et al., 1998; Spence et al., 2000) have been reported in patients with hysterical conversion. However , many of these studies included only a few or single patients, and provided relatively conflicting or inconclusive results overall. "
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    ABSTRACT: Preliminary evidence revealed a decrease of regional cerebral blood flow in the thalamus and basal ganglia contralateral to the deficit and suggested that hysterical conversion deficits might entail a functional disorder in striatothalamocortical circuits. However, there is no systematic structural magnetic resonance imaging (MRI) study in the literature in patients with conversion disorder (CD). Therefore, we aimed to perform structural MRI to evaluate the brain regions of interest in first applying patients with CD. Morphometric MRI was used to compare regional brain volumes in ten women with CD and same number of healthy comparison subjects. Intracranial volume (ICV), whole brain volume, gray and white matter volumes did not differ between the patient and control groups. Patients with CD had significantly smaller mean volumes of the left caudate nucleus, lentiform nucleus (p<0.01 for caudate nucleus and p<0.05 for lentiform nucleus) and right caudate nucleus and lentiform nucleus (p<0.05 for both structures). In patients, the right thalamus was significantly smaller, and the left thalamus rendered to be smaller compared to healthy controls. Age at onset showed a significant relation with left caudate, and a near-significant trend with right thalamus volumes. In conclusion, our findings suggest that patients with CD have significantly smaller mean volumes of the left and right basal ganglia and smaller right thalamus, with a trend toward to smaller left thalamus compared to healthy controls and that these findings provide novel constraints for a modern psychobiological theory of hysteria.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 06/2006; 30(4):708-13. DOI:10.1016/j.pnpbp.2006.01.011 · 4.03 Impact Factor
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    ABSTRACT: Seit 1977 ist die psychogene Schmerzstörung in den jeweils gültigen Klassifikationssystemen eine eigenständige Diagnose neben der Konversionsstörung. In der vorliegenden retrospektiven Arbeit werden klinische und soziodemographische Variablen von Patienten mit psychogenen Schmerzen untersucht und mit denen von Patienten mit anderen psychogenen Symptomen verglichen. Schmerz ist ein häufiges psychogenes Symptom. Von den 274 untersuchten Patienten mit psychogenen Symptomen hatten 32,5% Schmerz als führendes psychogenes Symptom. Nimmt man die begleitenden psychogenen Symptome hinzu, litten 63,5% der untersuchten Patienten unter Schmerzen. Im Gruppenvergleich der Patienten mit Schmerz als führendem psychogenen Symptom versus der Patienten mit einem anderen führenden psychogenen Symptom zeigten sich bezüglich vieler soziodemographischer und klinischer Merkmale keine signifikanten Unterschiede. Dennoch fanden sich einige die Gruppen differenzierende Aspekte: Patienten mit psychogenen Schmerzen litten häufiger unter Depressionen. Bei ihnen wurde dementsprechend häufiger eine antidepressive Therapie durchgeführt als bei den Patienten mit einem anderen führenden psychogenen Symptom. Bei ihnen bestand schon bei der Indexuntersuchung signifikant häufiger ein chronischer Verlauf (>30 Tage), sie neigten vermehrt zu einer Chronifizierung der Beschwerden und sie unternahmen häufiger Suizidversuche. Nachdem der Schmerz als führendes psychogenes Symptom länger als sechs Monate oder zwei Jahre bestanden hatte, kam es erneut zu einer Verschlechterung der Prognose. Die Diagnose einer psychogenen Schmerzstörung sollte also möglichst innerhalb der ersten sechs Monate gestellt werden, um eine rechtzeitige therapeutische Intervention zu ermöglichen. Anhand dieser Daten erscheint es wenig sinnvoll für die Diagnosestellung einer somatoformen Schmerzstörung eine Mindestdauer von sechs Monaten zu fordern, wie dies in der ICD-10 und dem DSM-III-R der Fall ist. Aufgrund der genannten Unterschiede erscheint es sinnvoll, psychogenen Schmerz als eigenständige diagnostische Kategorie fortzuführen. Von den Patienten, die unter einem anderen führenden psychogenen Symptom als Schmerz litten, erhielten 80% die Diagnose einer dissoziativen Störung. Hiervon gaben 42,6% begleitend psychogene Schmerzen an. Bei 38,5% der Patienten wurde der psychogene Schmerz bei der Diagnosestellung nicht erfaßt, da er bei den dissoziativen Störungen im ICD-10 ausgeschlossen wird. Es erscheint sinnvoll, psychogene Schmerzen in Subgruppen zu unterteilen, z. B. anhand des Entstehungsmechanismusses. Eine Untergruppe wäre dann auch den dissoziativen Störungen zuzurechnen. The psychogenic pain disorder is a diagnosis of its own besides the conversion disorder since 1977. In the actual retrospective study clinical and sociodemographic features are examined between the patients with psychogenic pain and the patients with different psychogenic symptoms. Pain is a frequent psychogenic symptom. In this study 32,5% of the 274 patients with psychogenic symptoms had pain as leading symptom. Taking leading and accompanying symptoms together even 63,5% reported pain. Comparing the patients with pain as leading psychogenic symptom versus the patients with a different leading symptom than pain there did not show significant differences concerning most of the examined sociodemographic and clinical features. But there were some the groups differentiating aspects: Patients with psychogenic pain showed more frequent depressions and were prescribed more frequent antidepressive medication. They reported more frequent a long-standing disturbance (> 30 days) at the index-examination and showed more frequent a chronification as well as attempted more suicides. After a duration of more than six months and more than two years a detoriation of the prognosis was found. A psychogenic pain disorder should therefore be diagnosed in the first six months in order to make an early therapeutic intervention possible. To demand a duration of six months for diagnosing a somatoform pain disorder is not helpful, as demanded in the ICD-10 and the DSM-III-R. Regarding the differences it is reasonable to have psychogenic pain as a disorder of its own besides the conversion or dissociative disorder. The patients, who had a different leading psychogenic symptom than pain, were diagnosed a dissociative disorder according to ICD-10 in 80,0% of the cases studied. 42,6% of them had accompanying psychogenic pain. In 38,5% the pain was not included by the diagnosis, since it is excluded in the ICD-10. It seams reasonable to divide psychogenic pain in subgroups, for example regarding their etiology. One subgroup could be regarded part of the dissociative disorders.
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