Body Dysmorphic Disorder High Rate of Suicidal Behavior: In a study of 200 adults with body dys-morphic disorder (BDD), patients had high rates of lifetime suicidal ideation (78.0%) and suicide attempts (27.5%). Body dysmorphic disorder was the primary reason for suicidal ideation in 70.5% of those with a history of ideation and nearly half of subjects with a past attempt. Suicidal subjects often did not reveal their BDD symptoms to their clinician. In univariate analyses, both suicidal ideation and suicide attempts were associated with lifetime functional impairment due to BDD (p < .001), current functional impairment (p < .001 to < .05), lifetime bipolar disorder (p < .05), any personality disorder (p < .05 to .001), and comorbid borderline personality disorder (p < .01 to < .001). A history of suicidal ideation (but not suicide attempts) was additionally associated with comorbid lifetime major depression (p = .001). A history of suicide attempts (but not suicidal ideation) was additionally associated with delusional appearance beliefs (p = .01) and lifetime posttraumatic stress disorder (PTSD), an eating disorder, or a substance use disorder (p < .001 to < .05). In logistic regression analyses, suicidal ideation was significantly predicted by comorbid major depression (p = .010) and greater lifetime impairment due to BDD (p = .003); suicide attempts were significantly predicted by PTSD (p = .011), a substance use disorder (p = .011), and greater lifetime impairment due to BDD (p = .005). Suicidal ideation and suicide attempts in body dysmorphic disorder. Phillips KA, et al. Butler Hospital, Providence, RI. . J Clin Psychiatry. 2005 Jun;66(6):717-25
Delirium May Help Mental Illness: Incidental delirium, i.e. due to a med side-effect or electrolyte disturbance and causing 24-72 hr confusion, disorganized speech, and halluc, found to help 5 patients with chronic mental illnesses with improvement in both psychotic and affective symptoms. Similar benefits reported with ECT, insulin coma. Chitra Malur, SUNY-Stony Brook, 5/17/99.
Dissociative Symptoms: 6.3% of population, Not Associated with Child Sex Abuse: Many individuals experience occasional dissociative symptoms with 6.3% having three or more frequently occurring dissociative symptoms. Physical abuse and current psychiatric illness is directly related to a high rate but not sex abuse. Mulder, Christchurch, Am J Psychiatry '‘8;155:806-11
Divorce: Internet Divorce $50-300 & Booming: CompleteCase.com y LegalZoom.com 20,000 per year in 2003. MyLawyer.com sólo ofrecen las planillas para rellenar. En el caso de CompleteCase, los empleados compilan información de los clientes y luego rellenan los formularios.
Enuresis: Fluvoxamine: 13 children. 75% benefited in open study. SSRIs and imipramine have also been used. TCAs said potential for serious cardiac arrhythmia. Desmopressin has also been used. J Amer Acad Child Adol Psychiatry 00;39:1464
Enuresis: Fluvoxamine Ineffective with Five Children: Hum Psychopharmacol 2001 Jun;16(4):327-332
Enuresis: Palate Widening, Adenoid Removal Help Enuresis: Children who have enlarged adenoids or tonsils removed often helped. A 2001 study of 321 children found that over a third of them wet their beds prior to surgery. 63 per cent stopped completely three months after surgery (International Journal of Pediatric Otorhinolaryngology, vol 59, p 115). Other studies similar results. Small studies using dental appliance to widen narrow palates also help. Low oxygen from obstructed nighttime breathing may increase ADH. 8/1/03
False Memory: Study of recanters: APA 5/18/1999. Harold Lief: Therapists have often been radical feminists. Memories of patients arose during adult life with no objective evidence of truth. It is thought that vast majority of child abuse not forgotten. Multiple diagnoses given by therapists with multiple personalities the highest. Typical patient is stable, European-American, and from intact families with only 10% of parents divorced. 55% report sexual violence, 50% satanic ritual abuse memories, nurtured by therapist with increased frequency of sessions after recalled "memories" and frequent contact via phone, etc. outside of office. Wild stories of child cannabilism, etc. Often multiple abusers accused. One hour phone interviews with seven of the fathers of recanters. Most typical response was shock and disbelieve, numbness, shell-shock. One father had a stroke, another a heart attack after learning of accusations. Two fathers became suicidal. Most father felt too helpless to response. Fathers tried to understand what might have led to the belief. One took a lie detector and another checked into a hospital to search for lost memories. Several sought therapy and one found a presumption of guilt by the psychiatrist. Some reached out for support, or meet with daughter’s therapist. Connection to church was supportive to some but one church shunned him after daughter’s therapist announced it at an open church meeting! Most feared spousal rejection but subsided as received support especially where wife was also accused of complicity. Felt need to search for what they had done wrong as parents. Some felt closer to non-accusing children. In 1900 Charcot found many hysterics and these faded away. Charcot had had hysterics and epileptics on same ward and then Babinski suggested separate the two on different wards and epilepsy imitation almost disappeared. Lief studied a total of 40 retractor families on family self-report and it was clear that these were usually stable families.
Intermittent Explosive Disorder: Sertraline In 3 Cases: Reported helpful in 3 adults with weekly angry outbursts and irritable moods. 50-100mg/d. J Clin Psychiatry ’99;60:195
Somatization Disorder: St. John’s Wort Helped: In a DB PC 6-week study of 184 outpatients with somatization disorder, undifferentiated somatoform disorder, or somatoform autonomic dysfunction, but not major depression, 300 mg of SJW extract twice daily was tested. Six outcome measures were evaluated as a combined measure by means of the Wei Lachin test: Somatoform Disorders Screening Instrument--7 days (SOMS-7), somatic subscore of the HAMA, somatic subscore of the SCL-90-R, subscores "improvement" and "efficacy" of the CGI, and the global judgment of efficacy by the patient. In the intention to treat population (N=173), for each of the six primary efficacy measures as well as for the combined test, statistically significant medium to large-sized superiority of SJW treatment over placebo was demonstrated (p <.0001). Of the SJW patients, 45.4% were classified as responders compared with 20.9% with placebo (p =.0006). Tolerability of SJW treatment was equivalent to placebo. Treatment of somatoform disorders with St. John's wort: a randomized, double-blind and placebo-controlled trial. Muller T, Mannel M, Murck H, Rahlfs VW. Ruhr-University Bochum, Germany. Psychosom Med. 2004 Jul-Aug;66(4):538-47