Frontiers Of Neurology And Neuroscience[JOURNAL]
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200 papers
Neurology in Russian Writers: Tolstoy and Turgenev.
Altavilla R, Paciaroni M
Front Neurol Neurosci · 2018 · PMID 30336467 · Publisher ↗
The personal and bibliographical histories of the two Russian writers, Leo Nikolaevich Tolstoy and Ivan Sergeevich Turgenev, are strictly connected to social and scientific developments in nineteenth century Russia. In p...
The personal and bibliographical histories of the two Russian writers, Leo Nikolaevich Tolstoy and Ivan Sergeevich Turgenev, are strictly connected to social and scientific developments in nineteenth century Russia. In particular, in the field of medicine and of neurology, these two authors had personal issues and interests, kindled by Russia's opening to Western European thought. Neurology at the beginning of the nineteenth century was not developed in Russia, and in the second half of the century the new generation of neurologists trained abroad, in particular in France, where Charcot was an eminent figure who also travelled to Russia to help establish the new "Russian neurology." The following generation of neuropsychiatrists, in turn, looked upon Russian writers, and in particular Tolstoy, as models of psychopathology both for their personal biography and for character depictions. Tolstoy experienced depression, which he overcame after a religious/philosophical conversion; his renewed views were expressed in his later works, and led to the coining of the term "Tolstoyism" in medical literature. Turgenev admired the works by Tolstoy, but his vision was more pragmatic and close to those of his European colleagues of the time. His best effort was in the description of physical illnesses, and this was recognized by physicians and psychiatrists reading and commenting on his works.
Dissociation, Delusion and the Splitting of the Self in The Trial by Franz Kafka: Phenomenology and Neurobiology of Schizophrenia.
Castelon Konkiewitz E, Ziff EB
Front Neurol Neurosci · 2018 · PMID 30336466 · Publisher ↗
In this essay, we propose an association between Franz Kafka's novel, The Trial, and phenomenological and neurobiological processes in schizophrenia. We begin by presenting a summary of the plot, pointing to some of its...
In this essay, we propose an association between Franz Kafka's novel, The Trial, and phenomenological and neurobiological processes in schizophrenia. We begin by presenting a summary of the plot, pointing to some of its remarkable literary aspects. We next compare the mental processes of dissociation, disorientation and delusion as represented in the novel with phenomenological processes that take place in the prodromal states of schizophrenia. We discuss how such disorders of the self and disorders of thought, both crucial aspects of the schizophrenic experience, appear in The Trial and in other literary and private writings by Franz Kafka. We relate how these disorders may arise from the false attribution of salience and false associative learning caused by hyperactivity of dopaminergic function associated with chaotic firing of dopaminergic neurons. Finally, we show how Kafka leads not just the protagonist of The Trial, but even more the reader to experience a quasi-delusional state. We discuss the relationship between the perturbation of thought and disorientation of mind evoked by the novel in the reader and the need of our brains for empathy and predictability.
Cesare Pavese: The Laboratory of Loneliness - A study of Among Women Only.
Steffen J
Front Neurol Neurosci · 2018 · PMID 30336462 · Publisher ↗
The Italian poet, novelist, translator, editor and diarist Cesare Pavese (1908-1950) famously committed suicide after winning the coveted Strega prize for his 1949 trilogy of novels La bella estate (The Beautiful Summer)...
The Italian poet, novelist, translator, editor and diarist Cesare Pavese (1908-1950) famously committed suicide after winning the coveted Strega prize for his 1949 trilogy of novels La bella estate (The Beautiful Summer). This article discusses one of the novels in that trilogy, Among Women Only (Tra donne sole), presenting it as a psychological "laboratory" in which the intensely private Pavese explores the rationale for suicide on the very public stage of the novel. The author argues that the writing of Tra donne sole was one of the self-willed steps that made it not just possible for Pavese to commit suicide, but impossible not to.
Henrik Ibsen's Battle with Cerebrovascular Disease.
Frich JC
Front Neurol Neurosci · 2018 · PMID 30336461 · Publisher ↗
Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. Hi...
Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. His last play, When We Dead Awaken, was published in 1899. Why did Ibsen's dramatic writing come to an end? This chapter presents a medical account of Ibsen's health condition during the last 6 years of his life. It is based on a review of a document written by one of his doctors, Edvard Bull (1845-1925), letters, biographic information, and Ibsen's death certificate. The historical material suggests that he suffered from arteriosclerosis and cerebrovascular disease, and that he suffered several strokes, in 1900, 1901, and 1903. He suffered a paresis in his left foot, expressive aphasia, and a right hemiparesis, and he lost the ability to write. There is no evidence that Ibsen was hospitalised. He received medical treatment and care at his home and at a recreational spa. His health condition was unstable, and it is likely that he suffered from a series of smaller strokes in the last years of his life. Ibsen developed signs of heart failure, and he died peacefully from "paralysis cordis" at his home on May 23rd, 1906.
Dementia and Change of Style: Willem de Kooning - Obliteration of Disease Patterns?
Piechowski-Jozwiak B, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 30336460 · Publisher ↗
The studies on the relation between artistic production, especially visual art, and brain function gave a basis to the development of neuroesthetics. Most of the information on brain artistic creativity comes from studie...
The studies on the relation between artistic production, especially visual art, and brain function gave a basis to the development of neuroesthetics. Most of the information on brain artistic creativity comes from studies on brain disease in well-established visual artists. Brain disease may cause change, dissolution, or emergence of artistic creativity. The visual artistic production may become impaired in individuals with a variety of brain diseases, including focal and generalised disorders of sudden and slowly progressive onset. In addition to that, neurological disorders may add content into visual art production, even becoming the artistic theme. Here, we discuss the particular case of abstract expressionist Willem de Kooning and the evolution of his artistic production in the context of his neurodegenerative illness. The change of de Kooning's artistic style has been the subject of many reviews, and the main focus of this paper is on artistic style across his prolific artistic career in the context of his progressive neurological condition, which he developed in his late years, and his long history of alcohol addiction. There are conflicting data from the literature on the effect of his neurological condition and clear cognitive decline on his artistic output, with preservation of recognition and the quality of his art. Hence, two pertinent questions relate to how he was able to maintain his output despite his cognitive decline, and how his condition could have affected his work.
Travelling into Alienation and Neurology with a Painter: Georges Moreau (1848-1901).
Walusinski O
Front Neurol Neurosci · 2018 · PMID 30336459 · Publisher ↗
Georges Moreau (1848-1901) was a painter and the son of the famous psychiatrist Jacques-Joseph Moreau de Tours. Early in his career, his paintings aspired toward figurative perfection, exalting patriotic and historical t...
Georges Moreau (1848-1901) was a painter and the son of the famous psychiatrist Jacques-Joseph Moreau de Tours. Early in his career, his paintings aspired toward figurative perfection, exalting patriotic and historical themes. His prolific production includes numerous paintings for which he drew inspiration from psychology and certain mental pathologies. At the age of 45 years he suffered right hemiplegia which forced him to set aside large-scale subjects and focus instead on intimist, almost pointillistic works, which brought him closer to the Impressionists, as his portrait of Paul Cézanne shows. Possibly his most well-known painting, Les fascinés de la Charité, service du Dr. Luys, is analysed here by comparison with La Leçon clinique à La Salpêtrière by André Brouillet, which depicts Jean-Martin Charcot and his students.
Thomas Mann and Neurology.
Caputi N, Birnbaum D, Boller F
Front Neurol Neurosci · 2018 · PMID 30336458 · Publisher ↗
Thomas Mann (1875-1955) is considered one of the most influential writers of the late nineteenth and early twentieth century. In addition to his novels and essays, he was well known for his criticisms of the Nazi party,...
Thomas Mann (1875-1955) is considered one of the most influential writers of the late nineteenth and early twentieth century. In addition to his novels and essays, he was well known for his criticisms of the Nazi party, and particularly against the racial nationalism promoted by Adolf Hitler after the First World War, as well as for his depiction of diseases. Here, we provide a quick sketch of Mann's life and his relationship with nineteenth to twentieth century German society. We then proceed to describe how Mann became interested in diseases, how he used the diseases as metaphors, and his specific contribution to the field of neurology. We describe some of the neurological cases portrayed in Mann's work, and particularly epilepsy described in The Buddenbrooks, Felix Krull and The Magic Mountain, meningitis, neurosyphilis and migraines depicted in Doctor Faustus, and essential tremor described in The Magic Mountain and Doctor Faustus. We conclude with reflections about Mann's interest in diseases and particularly in neurology.
Joan Miró and Cyclic Depression.
Delgado MG, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 30336457 · Publisher ↗
Psychopathology has been closely related with artists. A link between creativity and a tendency to affective disorders has become widely accepted. Several studies have shown that artists suffer disproportionately high ra...
Psychopathology has been closely related with artists. A link between creativity and a tendency to affective disorders has become widely accepted. Several studies have shown that artists suffer disproportionately high rates of mood disorders, particularly manic depression and major depression. The famous twentieth century Spanish artist Joan Miró suffered from depression during the entirety of his life, as was recognized by some authors in private letters. The artist worked using several styles, as well as in ceramics and sculpture. Some of his work reflects the feelings he experienced during the Spanish Civil War and the Second World War. He contributed considerably to the world of art with works such as The Farm as the culminant work of detailism, The Harlequin's Carnival as one of the main expressions of surrealism, the Birth of the World as the precursor of abstract expressionism, or The Dutch Interiors with "mironians" shapes, among others. Whether depression was the inspiration for his work, or his work was the treatment for his depression, will never be clarified. However, he left a great legacy for humanity and his work is admired all over the world.
Édouard Manet's Tabes Dorsalis: From Painful Ataxia to Phantom Limb.
Bogousslavsky J, Tatu L
Front Neurol Neurosci · 2018 · PMID 30336456 · Publisher ↗
Édouard Manet (1832-1883) is considered the "father" of impressionism and even of twentieth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by...
Édouard Manet (1832-1883) is considered the "father" of impressionism and even of twentieth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by the banality of daily life. Technically, he erased volumes into flat two-dimensional coloured planes, and distorted conventional perspective with often gross brushstrokes intentionally giving an "unfinished" aspect to the work. It is little known that Manet had a very painful second part of his life, due to excruciating limb and chest pains, which developed in parallel with proprioceptive ataxia and gait imbalance. Manet always remained discreet about his private life, and we mainly know that his future wife was his family piano teacher, with whom he had a liaison at the age of 17 years. Later, the great but platonic passion of his life was the painter Berthe Morisot (1841-1895), who married Manet's brother Eugène. In fact, we do not know whether he had a mistress at all, although he had several elegant "flirts" in the mundane and artistic milieu. Thus, while Manet's progressive painful ataxia from the age 40 years yields little doubt on its tabetic origin, how he contracted syphilis at least 15-20 years before will probably remain a mystery. It is fascinating that Manet's daily struggle against pain and poor coordination may have led his art to become one of the most significant of modern times, opening the way to twentieth century avant-gardes, along with another victim of syphilis, Paul Gauguin (1848-1903). Manet never showed any sign of general paresis, and like his contemporary, the writer Alphonse Daudet, his clinical picture remained dominated by paroxysmal pain and walking impairment. Difficult hand co-ordination made him quit watercolour painting, and during the last 2 years of his life he had to focus on small format oil works, the subject of which was nearly limited to modest bunches of fresh flowers, now often considered to be his maturity masterpieces. Having become bedridden, he had to be amputated of one leg, which was developing gangrene, probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted that he was sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in the neurology of art.
Possessions Including Poltergeist: "Are You There, Madness?".
Walusinski O
Front Neurol Neurosci · 2018 · PMID 29208849 · Publisher ↗
Beliefs involving the devil and possession figured in the nosography of mental illness that alienists gradually established during the 19th century. The description of this form of cenesthetic hallucination resulted in "...
Beliefs involving the devil and possession figured in the nosography of mental illness that alienists gradually established during the 19th century. The description of this form of cenesthetic hallucination resulted in "the possessed" being viewed as patients, which protected them from the trials and punishments they so frequently faced in earlier centuries. According to psychologists, this illusion of mental duality is linked to impairment of introspective capacities. Current brain imaging suggests inappropriate activity of the default mode network, which interferes with attentional systems during the hallucinatory episode.
Camptocormia: New Signs in an Old Syndrome.
Tatu L, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29151099 · Publisher ↗
Camptocormia is defined as an involuntary flexion of the thoracolumbar spine, without fixed kyphosis, which increases during walking and standing, and abates in the supine position. First described during World War 1 in...
Camptocormia is defined as an involuntary flexion of the thoracolumbar spine, without fixed kyphosis, which increases during walking and standing, and abates in the supine position. First described during World War 1 in soldiers suffering from war psychoneuroses, camptocormia has progressively come to refer to any cause of trunk forward-flexed posture during standing and ambulation. It is now admitted that camptocormia should be considered as a syndrome related to many etiologies. In this chapter, we present the historical aspects of the syndrome and its main etiologies. We highlight camptocormia in Parkinson disease and its relationships with Pisa syndrome.
The Alice-in-Wonderland Syndrome.
Lanska DJ, Lanska JR
Front Neurol Neurosci · 2018 · PMID 29151098 · Publisher ↗
In 1955, English psychiatrist John Todd defined the Alice-in-Wonderland syndrome (AIWS) as self-experienced paroxysmal body-image illusions involving distortions of the size, mass, or shape of the patient's own body or i...
In 1955, English psychiatrist John Todd defined the Alice-in-Wonderland syndrome (AIWS) as self-experienced paroxysmal body-image illusions involving distortions of the size, mass, or shape of the patient's own body or its position in space, often accompanied by depersonalization and/or derealization. AIWS had been described by American Neurologist Caro Lippman in 1952, but Todd's report was the most influential. Todd named the syndrome for the perceptual disorder of altered body image experienced by the protagonist in Alice's Adventures in Wonderland (1865) by Lewis Carroll (Charles Lutwidge Dodgson). In Carroll's original story, Alice experienced several dramatic changes in body size and shape (e.g., shrinking to 10 inches high, growing unnaturally tall but not any wider, and growing unnaturally large). Todd reported 6 cases of AIWS, all of whom had episodic body-image distortions like those experienced by Lewis Carroll's Alice character; some also had visual perceptual disturbances, but none had visual perceptual disorders without body-image distortions. Therefore, AIWS may be accompanied by visual perceptual disorders (e.g., micropsia, macropsia, telopsia, pelopsia), but basing the diagnosis of AIWS on isolated visual perceptual disorders, as has subsequently been done by a number of authors, is inaccurate and misleading. Cases of isolated visual illusions without self-perceived distortions of body size, shape, or form, do not meet Todd's original criteria, nor are they commensurate with the experiences of the protagonist in Alice's Adventures in Wonderland. Furthermore, such cases differ by age and etiology from those that involve somesthetic perceptual disorders. Therefore, the use of the term AIWS for isolated visual illusions is problematic and should be discouraged. Although Todd's and Lippman's cases were adolescents or adults, AIWS is most commonly reported in children. Reported causes include infection (especially with Epstein Barr virus), migraine, epilepsy, depression, and toxic and febrile delirium.
The Dancing Manias: Psychogenic Illness as a Social Phenomenon.
Lanska DJ
Front Neurol Neurosci · 2018 · PMID 29151097 · Publisher ↗
The dancing mania erupted in the 14th century in the wake of the Black Death, and recurred for centuries in central Europe - particularly Germany, the Netherlands, and Belgium - finally abating in the early 17th century....
The dancing mania erupted in the 14th century in the wake of the Black Death, and recurred for centuries in central Europe - particularly Germany, the Netherlands, and Belgium - finally abating in the early 17th century. The term "dancing mania" was derived from "choreomania," a concatenation of choros (dance) and mania (madness). A variant, tarantism, was prevalent in southern Italy from the 15th to the 17th centuries, and was attributed at the time to bites from the tarantula spider. Affected individuals participated in continuous, prolonged, erratic, often frenzied and sometimes erotic, dancing. In the 14th century, the dancing mania was linked to a corruption of the festival of St. John's Day by ancient pagan customs, but by the 16th century it was commonly considered an ordeal sent by a saint, or a punishment from God for people's sins. Consequently, during outbreaks in the 14th and 15th centuries, the dancing mania was considered an issue for magistrates and priests, not physicians, even though the disorder proved intractable to decrees and exorcisms. However, in the 16th century Paracelsus discounted the idea that the saints caused or interceded in the cure of the dancing mania; he instead suggested a psychogenic or malingered etiology, and this reformulation brought the dancing mania within the purview of physicians. Paracelsus advocated various mystical, psychological, and pharmacological approaches, depending on the presumptive etiologic factors with individual patients. Only music provided any relief for tarantism. Later authors suggested that the dancing mania was a mass stress-induced psychosis, a mass psychogenic illness, a culturally determined form of ritualized behavior, a manifestation of religious ecstasy, or even the result of food poisoning caused by the toxic and psychoactive chemical products of ergot fungi. In reality, dancing manias did not have a single cause, but component causes likely included psychogenic illness, malingering, and ritualized behaviors.
Jumping Frenchmen, Miryachit, and Latah: Culture-Specific Hyperstartle-Plus Syndromes.
Lanska DJ
Front Neurol Neurosci · 2018 · PMID 29151096 · Publisher ↗
In the late 19th century, jumping (French Canadians in Maine, USA), miryachit (Siberia), and latah (Southeast Asia) were among a group of similar disorders described around the world, each of which manifests as an exagge...
In the late 19th century, jumping (French Canadians in Maine, USA), miryachit (Siberia), and latah (Southeast Asia) were among a group of similar disorders described around the world, each of which manifests as an exaggerated startle response with additional late-response features that were felt by some to overlap with hysteria or tics. The later features following the exaggerated startle reaction variably include mimesis (e.g., echopraxia, echolalia) and automatic obedience. These reaction patterns tended to persist indefinitely in affected individuals. Because of their dramatic stimulus-driven behaviors, affected individuals were prone to be teased and tormented by being repeatedly and intentionally startled. Despite clinical overlap between jumping and Tourette syndrome, these entities are now recognized as distinct: in jumping, the key feature is an abnormal startle response, the abnormal reaction is always provoked, and tics are absent, whereas in Tourette syndrome, the key feature is spontaneous motor and vocal tics, although patients with Tourette syndrome may occasionally also have an exaggerated startle response. These disorders have been conceptualized from anthropological, psychodynamic, and neurobiologic perspectives, with no complete resolution to date. Attempts at treatment have been generally unsuccessful, including attempts with bromization and hypnosis, although anecdotal reports of successful deconditioning have been published. In population groups affected, these disorders are usually considered as behavioral peculiarities and not as diseases per se, and there is no apparent tendency to develop disabling mental illness or neurodegenerative disorders. The genesis of these disorders, their cultural and social components, and their interactions with the presumed underlying physiological substrate need further study. Careful descriptive and analytic epidemiological studies are also lacking for all of these disorders.
Violent Behavior.
Sopromadze S, Tsiskaridze A
Front Neurol Neurosci · 2018 · PMID 29151095 · Publisher ↗
Violence is a significant public health problem representing one of the leading causes of death worldwide for people aged 15-44 years. Although violence and aggression are more frequent in adolescence and early adult lif...
Violence is a significant public health problem representing one of the leading causes of death worldwide for people aged 15-44 years. Although violence and aggression are more frequent in adolescence and early adult life and decline with advancing age, these conditions can still develop for the first time in old age especially in association with organic brain disorder. Rates of violent death vary according to country income levels and are twice as higher in low- to middle-income countries than in high-income countries. Males are more affected than females. Violence is a multifactorial condition. A combination of biologic, psychodynamic, and social factors may play a role in development of violence and aggression. Since it may accompany or be result of different medical conditions it is important to determine the underlying condition or disease including mental illness for targeting the proper therapeutic strategy. In the acute setting with a behavioral emergency the primary task for the clinician is to act as soon as possible in order to stop the violence from escalating and to find the quickest way to keep the patient's agitation and violence under control with the maximum of safety for everybody using the less severe yet effective interventions. Multiple steps of talk down interventions and non-coercive behavioral and environmental treatments have been proposed. If such an approach is not effective, more coercive interventions are needed including involuntary medications and chemical restrain as well as physical restraint or seclusion in some cases.
Glossolalia and Aphasia: Related but Different Worlds.
Chouiter L, Annoni JM
Front Neurol Neurosci · 2018 · PMID 29151094 · Publisher ↗
The word glossolalia, also referred to as "speaking in tongues," originates from the Greek "glossa" which means "language" and "Lalia" which means "speak." It simply means to talk language. On a linguistic perspective, g...
The word glossolalia, also referred to as "speaking in tongues," originates from the Greek "glossa" which means "language" and "Lalia" which means "speak." It simply means to talk language. On a linguistic perspective, glossolalia is characterized by almost no recognizable words or semantic content, apart from biblical words and phrases, with an overrepresentation of a small phonemes number, accelerated speech output, and modification of accents and melody. Its phonemic properties have been said to resemble those of the language(s) of the speaker. It is generally a voluntary intimate communication act associated with religious spiritual thoughts, although it has also been described in mental disorders. Glossolalia state is a special mental state, completely different from aphasia. Aphasia is characterized by some phonological and grammatical rules; however, these are related to neurolinguistics and not to developmental principles. Unlike aphasia, glossolalia is not associated with central nervous system affection. There is, however, a psychiatric type of glossolalia, which, although similar in terms of phenomenology, is probably a different phenomenon. A common thought is that there is a linguistic trend, whose basic component is a stream of speech. This stream is suggested to use early-acquired rules of phonation, adapted according to socially meaningful values and attitudes, in an unconscious way. Therefore, the act of glossolalia is out of the "glossolalists" control. It would appear, therefore, that there is a broad spectrum of anomalous speech, of which religious glossolalia is only one manifestation. The aim of this chapter is to understand the mental state of glossolalia in comparison to aphasia in the light of neurolinguistic and psychiatric features. Moreover, we tried to highlight the underlying brain network. Pilot neuroscientific data suggest that it is associated with a deactivation of the cognitive system and an activation of some parts of the mirror neuron networks.
Munchausen Syndrome and the Wide Spectrum of Factitious Disorders.
Tatu L, Aybek S, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29151093 · Publisher ↗
Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chroni...
Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chronic. The syndrome was named after Karl Friedrich Hieronymus, Baron von Münchhausen (1720-1797), a German nobleman who became famous as a narrator of false and exaggerated exploits. His name was progressively corrupted to Munchausen. Factitious disorders and Munchausen syndrome remain a great diagnosis challenge for physicians. All medical specialities are concerned by these disorders. The diagnosis process involves a first step to exclude an unusual presentation of a common medical condition. The second step consists of excluding somatoform disorders and malingering. Unfortunately, the boundaries between factitious disorder, somatization, and malingering are often unclear. In 1977, the term "Munchausen's syndrome by proxy" was coined to define a situation where a person produces false symptoms in another one, especially a child. This term was extended to similar interactions between human and pets. Because varied conditions have been included in the definition of this syndrome, there is ongoing debate about alternative names.
Conversion, Factitious Disorder and Malingering: A Distinct Pattern or a Continuum?
Galli S, Tatu L, Bogousslavsky J … +1 more , Aybek S
Front Neurol Neurosci · 2018 · PMID 29151092 · Publisher ↗
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of...
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist's consultation. The first challenge is to detect them, and recent studies have confirmed the importance of "positive" clinical bedside signs based on incoherence and discordance, such as the Hoover's sign for the diagnosis of conversion disorder. Functional neuroimaging has allowed a better understanding of the pathophysiology, and highlighted abnormal cerebral activation patterns in conversion disorder in relation to motor, emotional, and limbic networks, different from feigners. This supports the theory evoked by Charcot of a "psychodynamic lesion," which is also reflected by the new term introduced in the DSM-5: functional neurological disorder. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Couvade Syndrome - Custom, Behavior or Disease?
Piechowski-Jozwiak B, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29151091 · Publisher ↗
The custom of Couvade and Couvade syndrome is a phenomenon observed since ancient times. Whether it constitutes a disease entity or it should be considered a ritual or custom remains a matter of debate. Historical transc...
The custom of Couvade and Couvade syndrome is a phenomenon observed since ancient times. Whether it constitutes a disease entity or it should be considered a ritual or custom remains a matter of debate. Historical transcripts shed light into the distinct origins and inclinations of couvade behaviors, some of them having religious inclinations. Currently, there are several views on this phenomenon including medical, psychoanalytic, and psychological. Some explain this syndrome as part of men's preparation and participation in pregnancy and post-partum period. Others see it as men rivalling with women for procreative ability or ability to carry an unborn child in the womb. There are a set of criteria that can be used in diagnosing Couvade syndrome, which may be helpful in standardizing clinical detection and management of patients. It is important to embed this syndrome in contemporary society to understand the complexity of male involvement in pregnancy and fatherhood, which at the end may not be a disease. In this review, the authors will guide the reader through history, possible etiologies, and clinical aspects of Couvade syndrome.
De Clérambault Syndrome, Othello Syndrome, Folie à Deux and Variants.
Delgado MG, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29151090 · Publisher ↗
Non-bizarre delusion, defined as a false belief possible although highly unlikely, is the main manifestation of delusional disorders, previously known as paranoia. Based on the predominant delusional themes, 5 main subty...
Non-bizarre delusion, defined as a false belief possible although highly unlikely, is the main manifestation of delusional disorders, previously known as paranoia. Based on the predominant delusional themes, 5 main subtypes may be described - erotomanic, grandiose, jealous, persecutory, and somatic. We present here 2 main delusional disorders, the De Clérambault syndrome and the Othello syndrome, and another closely related to the previous ones - Folie à deux. In the De Clérambault syndrome, the main delusional theme is erotomanic type, related to passional delirium where the patient has strong sexual feelings towards another person and has the belief that this other person is deeply in love with him or her. Patients with the Othello syndrome present a delusional disorder of jealous type, a pathological delusion that the partner is unfaithful. In Folie à deux, 2 individuals shared the same psychiatric symptom. However it may be variable, describing variants such as folie imposée or folie simultenée. The risk of aggressive behavior exists in these patients. Knowledge of these syndromes is essential to allow an accurate diagnosis and prompt treatment.
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