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Conditions for mental disorders formation at different stages of the underlying disease have been specified as a result of clinico-psychopathological, clinico-catamnestic and experimental psychological studies carried out in 55 patients with myocardial infarction. The authors show an important role of the clinical features of myocardial infarction in the formation of asthenic symptomatology and affective pathology in the acute period of myocardial infarction. In the subacute period of the illness, the premorbid characteristics and psychotraumatic factors preceding the disease exert a noticeable effect on the development of depressive and ++astheno-hypochondriac disorders. In the clinical picture of acute myocardial infarction, a less significant role is played by age-associated factor. At the outpatient stage of myocardial infarction treatment, the psychotraumatic factors due to chronic disease and related situations assume a particular significance in the formation of depressive hypochondriac symptomatology.

A total of 230 patients with neurocirculatory dystonia (NCD) were investigated. Different mental disorders associated with the atherogenic nature of dyslipoproteinemia were revealed in the majority of patients using the clinical scale and MMPI test. Psychotropic agents used for a period of 2-4 mos improved the mental status of these patients, increased exercise tolerance, and decreased blood levels of free fatty acids (FFA). A course of exercise training (graded walking) for 4-6 mos. helped to enhance exercise tolerance, to lower the blood levels of cholesterol, triglycerides, FFA, the total fraction of low- and very low-density lipoproteins, to reduce manifestations of hypochondriasis, depression, and neurasthenia . The results obtained can be used for developing programs of NCD patients' rehabilitation.

Forty patients with neurosis-induced hypochondriac conditions were placed on the fasting diet combined with a complex of psychotherapeutic measures. This makes it possible to enlarge the armamentarium of treatment measures to be given to patients suffering from neurosis-induced hypochondriac conditions. Criteria for predicting the efficacy of such measures were established, enabling early changes to be made in the treatment policy. Regularities of the reverse dynamics of hypochondriac conditions in patients on the fasting diet combined with psychotherapy are described.

The authors studied the Personality and Aggressiveness of fifty-three cancer patients by using MMPI and the Instrument I for the Aggressiveness Measurements. The common characteristics in all of then were that they suffered solid tumors, were submitted to hospital treatments and had an absence of psychiatric illness in their personal history. Among the results that stand out most is the sensations of change that the patients experience due to their own illness, the hospitalization and the treatments which they undergo. There exists on increase of self-aggressiveness or a decrease of hetero-aggressiveness which predominates the scales of depression and social introversion, with a decrease of inner strength. In any case, the neuroticism and the dependence are increased and there are decreases in the scales of psychopathic deviation and domination. The four psychosis is staying normal, the hysteria is decreased in men and the hypochondria is increased in women. The defence mechanism that predominates are the denial and the avoidance reaction.

The author analyzes the results of an experimental study into sense regulation of the activity of patients with the hypochondriac syndrome. Three groups of patients were examined: with neurosis, slow-progressive schizophrenia, and myocardial infarction. Four types of self-regulation were distinguished: related to the attitude towards the world, to oneself, to other people, to the characteristic features of the mediation of the relations indicated. It has been discovered that the egocentric tendencies, impoverishment, narrow motivation sphere, rigidity of senses, valuables are psychological causes of the derangement of higher sense regulation in hypochondriac conditions.

It has been established on the basis of clinical and clinico-catamnestic studies of hypochondriac conditions seen at the debut of juvenile schizophrenia (98 patients) that in spite of a considerable diversities of their clinical pictures one can speak about their well-defined general psychopathological characteristics determined both by pathoplastic and pathogenetic influences of the pubertal phase of development. The author describes five major types of hypochondriac conditions seen at the juvenile age, correlating with varying disease progress. Provides criteria for their determination to employ that classification with a purpose of solving prognostic problems.

Based on clinicopsychopathological and paraclinical examinations of 150 patients afflicted with organic diseases of the brain of infectious, traumatic and alcoholic nature, the clinical picture and formation of hypochondriac conditions were traced depending on the type of exogeny and the stage of cerebral sufferings. It is shown that hypochondriac conditions develop by stages, namely from hypochondriac fixation to hypochondriac reaction and to the hypochondriac syndrome and that psychasthenic, vasovegetative and CSF dynamic disorders play the leading part in their establishment. Seven varieties of the hypochondriac syndrome are distinguished.

In a study of 165 employees of a retail firm, life events were associated with several hypochondriacal concerns and with most of the self-rating distress scales. Life events related to illness and death were associated with fear of disease and showed weak associations with somatic symptoms and anxiety. Life events unrelated to illness and death were associated with hypochondriacal beliefs, bodily preoccupations, fear of death, and most of the distress scales. Illness and death do not appear to be common recent precipitants of hypochondriacal concerns in a normal population. One of the reasons for the observed associations appears to be that preoccupation with illness and death can occur at times of distress, regardless of the nature of the recent stressful life events.

A psychological study, which included personality testing (BDI, MMPI, RO, TAT), was performed on 42 patients with clinical symptoms of chronic prostatitis. The patients were characterized by prolonged symptoms and poor response to treatment by general practitioners. Some degree of psychic difficulty was revealed in 80% of the patients, and signs of severe psychic disturbance in 20 to 50%. The outstanding psychic symptoms were anxiety, depression, affect-lability, weak masculine identity and other sexual disorders, and even psychotic features. This pattern of psychic disorders corresponds with that described for borderline personality. The common occurrence of specific psychic and sexual disturbances suggests that these psychic factors may have a causative role in chronic prostatitis.

A follow-up study of 18 patients hospitalized for hypochondriac disturbances revealed that in none of the cases was suggestive of a specific hypochondriac neurosis. A formed hypochondriac syndrome was observed at the stage of the neurotic development of the principal forms of neuroses: neurasthenia, neurotic depression, hysterical and obsessive neuroses. The mechanisms of eliminating hypochondriac fixation in all these clinical forms of neuroses are identical.

The case of an autopsied patient with hypophyseal prolactinoma and dermatozoic delusions is reported, and the mechanism of onset of this special form of delusion is discussed from the neuroendocrinological view point, including response to medications, and neuropathological and pituitary hormonal studies. The subject (69-year-old female) with dermatozoic delusions suffered hypophyseal prolactinoma with high serum prolactin level. Major tranquilizers, minor tranquilizers, or drugs enhancing cerebral blood flow and/or cerebral metabolism did not expell the delusion. Bromocriptine (dopamine agonist) was administered for prolactinoma treatment. After bromocriptine treatment, small doses of haloperidol successfully expelled the delusion. The neuropathological study indicates that the genesis of this delusion is not based on any organic change, but is induced by functional changes related to the prolactin and dopamine systems.

An account is given of the manner in which patients suffering from psychoneurosis and psychoses present to the Dermatologist. Cases of monosymptomatic hypochondriasis, trichorrhexis nodosa in an obsessional neurotic, acne excoriée, schizophrenia, depression and delusions of infestation are described. The value of modern neuroleptic drugs in the management of monosymptomatic hypochondriasis in cluding delusions of infestation is confirmed.

A total of 101 patients suffering from slowly progressive schizophrenia with hypochondriac symptomatology and a manifestation or a relapse of the disease in the involutional age have been studied. Three variants of the disease course have been identified. The authors have considered the significance of sex, premorbid peculiarities of the personality, aggravated heredity, as well as the rate and character of exogenic manifestations in the patient's history as possible pathogenetic factors of a late manifestation (recurrence) of the disease. The incidence of adynamic-anergic component of depression in the involutional period is correlated with processes of accelerated mental ageing in schizophrenic patients with exogenously aggravated history. Cases with the first manifest attack in the involutional period have been referred to true late schizophrenia.

Patients who suffer and complain of symptoms for which no adequate organic pathology is found present serious management problems. Patients who display somatization phenomena are discussed with respect to incidence, psychopathology and predisposing factors-social and cultural, early life experiences, personality characteristics and individual psychodynamics. Although primary prevention of somatization is not yet feasible, early recognition and treatment are possible. The role of the psychiatrist includes: formulation of diagnosis; assessment for therapy; planning of treatment; and, at times, becoming the primary therapist. The family physician has the best opportunity for early detection and prevention of chronicity of somatization phenomena. Pharmacotherapy, behavior modification and some newer approaches in the management of these persistent somatizers are discussed.

On the basis of clinical, experimental psychological and EEG data of 133 blind patients 4 types of neurotical personality development were distinguished: asthenical, hysterical, obsessive and hypochondrical. Each of these variants had its certain clinical traits. On all phases of the disease which were related to a sudden loss of sight, the authors mark the necessity of a manifold medical treatment and psychotherapeutical approach directed towards a sociovocational adaptation.

The authors analyze the results of clinical investigation, including bicycle ergometry, of 140 men, after myocardial infarction. The psychic state was studied with the aid of a clinical scale and also of the psychological MMPI test. In 66.4% of the cases various psychopathological changes have been recorded. The more severe psychic changes, mainly in the form of hypochondriac disorders were seen in patients with cardialgia (76.9%) and when cardialgia was associated with angina pectoris (88.9%). These data point to the important role played by the psychological factors in the pathogenesis of the cardialgia syndrome, which suggests that a comprehensive scheme of treatment of these patients after myocardial infarction must include, besides the antianginal drugs, psychotherapy and psychotropic medicines.

The notion of psychosomatic disorder will be given preference over that of disease as we believe it most important to identify the mechanism of somatization which underlies and commands the formation of polyvalent and polymorphic symptoms. The practitioner's first task is not to mistake the different mechanisms of somatization. This relies on the quality of the physical examination and the appositeness of the organic workup. It rests on demonstration of the psychosomatic connection by painstaking elicitation of the case history. The purpose is to make the patient himself aware of the psychosomatic nature of his distress and capable of an understanding attitude towards his own symptoms. It is this process that will allow the patient to turn towards a specific mechanism, rather than the clinical presentation of the symptom strictly speaking, or even the identifiable personality characteristics which in many cases are only suggestive. Similarly, it is this identification of mechanisms which will enable the practitioner to implement the appropriate therapeutic strategy.

hypochondriasis in the elderly is a common but often frustrating problem. The certainty of the diagnosis is complicated by the existence of physical disabilities that accompany the aging process. An increase in social stress and loss of sources of self-esteem are also influential factors. Approximately one-third of elderly hypochondriacs undergo a fortuitous remission, which is usually related to changes in the social environment. Recognition of these features is important to management.

Between 60% and 80% of healthy individuals experience somatic symptoms in any one week. About 10% to 20% of a random sample of people worry intermittently about illness. A substantial proportion of patients present physicians with somatic complaints for which no organic cause can be found. Patients who are hypochondriacal do not understand the benign nature of functional somatic symptoms and interpret these as evidence of disease. Hypochondriacal concerns range from common short-lived worries to persistent and distressing fears or convictions of having a disease. Hypochondriasis can be secondary to other psychiatric disorders (eg, melancholia or panic disorder), and hypochondriacal attitudes remit when the primary disorder is successfully treated. Patients with primary hypochondriasis are also anxious or depressed, but the fear of disease, or the false belief of having a disease, persists and is the most important feature of their psychopathology. There are substantial differences among hypochondriacal patients in their personalities and psychopathologies. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies on the value of psychotherapy in hypochondriasis; the recommended guidelines are based on uncontrolled studies of hypochondriasis and on controlled studies of the psychotherapy in similar disorders. The prognosis of functional somatic symptoms as well as that of hypochondriasis is good in a substantial proportion of patients.

The MMPI questionnaire was used as a personality test on 20 painfree cancer patients, otherwise in good health and undergoing outpatient chemotherapy. Analysis of the data shows that even in an early stage cancer can produce significant alterations in personality. 85% of the patients studied had emotional disorders with hypochondria and depression being the psychopathological profiles most commonly observed.

Configurational frequency analysis according to Krauth and Lienert is a multivariant no-parameter statistical test method by which to identify types and syndromes. It was used in an attempt to disclose combinations of symptoms by which the various forms of functional urinary incontinence of women could be systematised by types. Efforts were made with particular reference to psychological symptoms, COG findings, and frequency of micturitional urge. The point is made that outcome of this study should be evaluated in terms of heuristics, with further studies being necessary.

Primary hypochondriasis is a poorly understood condition for which there is no accepted effective treatment. A cognitive-behavioural formulation is described which identifies the psychological processes and factors involved in the aetiology and maintenance of the condition. Using this formulation, it is also possible to account for the development and course of health concerns in non-hypochondriacal individuals. Modification of the aetiological and maintaining factors identified by the cognitive-behavioural formulation should provide an effective treatment for primary hypochondriasis. Cognitive-behavioural treatment strategies derived directly from the formulation have been used successfully in case-studies and require further systematic evaluation.

A household health survey of residents living near two hazardous waste disposal sites in Calcasieu Parish, Louisiana was conducted in 1981-1982 as part of a comprehensive study of the effects of those sites on the environment and on the health of nearby residents. An unexposed community was included in the health survey for comparison. Due to media coverage and public concern about the sites, two potential indices of reporting bias, hypochondriasis and respondent's opinion about the environmental effects of waste sites, were included in the survey. Because air and water quality data showed little evidence that hazardous concentrations of chemicals were being released from the sites, questions were raised about the interpretation of the health survey data. The data were analyzed, therefore, for the association between symptom reports and the potential indices of reporting bias. Hypochondriasis scores were associated with symptom reports regardless of location of residence while an individual's opinion showed a different pattern by area of residence. Respondents living near one of the waste disposal sites who answered "yes" to the opinion question were 2-3 times more likely to report some types of symptoms than residents of the comparison community. In contrast, there was little difference in symptom reports between the exposed and comparison communities for those answering "no" to the opinion question. The usefulness of self-reported symptom data in studies of communities near hazardous waste disposal sites is discussed, and attention is called to the need to develop measures sensitive to reporting bias in epidemiologic studies.

The authors investigated the characteristics of the patient's insight into the disease in 80 patients (45 males, 35 females, mean age, 32 years) with neuroses with the cardialgophobic syndrome. To exclude organic pathology, all patients were subjected to EEG and ECG; in 55 patients the central and peripheral hemodynamics were also studied. Psychological examination was carried out using the method of the semantic differential. The data obtained were processed by a correlational analysis. The authors have identified differences in the patient's insight into the disease in asthenic and hysterical neuroses, which point to differing mechanisms of the formation of the cardialgophobic syndrome in them and involvement in these mechanisms of the patient's insight into the disease. The experience with differential pathogenetic therapy based on the findings is described.