Search

Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4 mg, with 0.25 mg to be taken at bedtime, to prevent daytime sedation) [corrected] and a topical solution of 20% aluminum chloride in anhydrous ethyl alcohol (Drysol). Over a period of 2 or 3 weeks, the patient achieved a complete remission of symptoms, while having only mild side effects. The treatment regimen also had the added advantage of lowering generalized anxiety.

A psychotherapeutic approach to the treatment of depersonalization disorder is presented. The treatment process enables the patient to drop dissociation as a defense against overly vigorous scrutiny of a "self," which is felt to be inadequate when compared to highly demanding standards set by parents. When feelings of worthlessness and helplessness are "transferred" back to original sources of childhood trauma, the patient is then taught how to handle conflict without needing to dissociate from the stress as overpowering and literally depersonalizing the threat.

Depersonalization is discussed and a brief outline of the primary symptoms is presented. The relationship between obsessionalism and depersonalization is reviewed in the literature, and subsequent similarities are presented. The intellectual obsessive depersonalization syndrome is postulated as a variant, and also as an exposition of what might occur in many other cases of depersonalization. Finally, a picture is presented which takes into account a strong component of obsessionalism in both the etiology and course of depersonalization.

As with many psychiatric syndromes, there are multiple etiological factors which seem to play a role in the development of delusions of parasitosis. Our case report suggests that a psychotherapeutic approach may prove valuable in treatment. Acaraphobic and other monosymptomatic hypochondriacal patients, despite an extreme defensive stance, will adhere to and cooperate with a therapeutic process which enables them to voice psychic pain without challenging the validity of a somatic complaint. In finally sharing feelings of deprivation and hurt, the patient can, with some additional rather "concrete" advice, proceed to a point where he no longer must prove the legitimacy of his complaint. By the very nature of this freedom, he can then work with the therapist in a meaningful, rather than stalemated, psychotherapeutic process.

The longstanding diagnostic controversy over the concept of "hysteria" has taken on new significance with the advent and development of the third edition of the Diagnostic and Statistical Manual (DSM-III). The problem of defining hysteria is therefore discussed and re-examined. A retrospective study of cases diagnosed as conversion reaction or hysterical neurosis, conversion type was then completed and analyzed. These cases were redefined using DSM-III criteria and were analyzed using a number of demographic and clinical variables. In a comparison of those patients classified as having conversion and those classified as having psychalgia, no significant differences were found. Those patients under the diagnosis of conversion and those carrying the diagnosis psychalgia differed significantly from a control group of patients with random "neurotic" diagnosis on five variables: a) symptoms are defensive; b) symptoms are expressive; c) secondary gain; d) previous physical trauma; and e) previous conversion symptoms.