Forensic assessment of somatoform and functional neurological disorders.

Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness-related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.

Munchausen by internet and false perinatal crises.

BACKGROUND: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. METHODS: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. RESULTS: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. CONCLUSIONS: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI.

[Hypoglycaemia and seizures in a 32-year-old woman with maple syrup urine disease]. / Hypoglykämien und Krampfanfälle bei einer 32­jährigen Patientin mit Ahornsiruperkrankung.

A 32-year-old woman with maple syrup urine disease presented with recurring episodes with hypoglycaemia and cerebral seizures. In most cases a connection to the inborn metabolic disorder is assumed, resulting in symptomatic treatment. Due to these treatments invasive procedures are required. This leads to prescriptions of multiple medications and medical aids. After 2 years of unexplained symptoms a routine examination led to the diagnosis of factitious disorder. The patient received the offer for psychiatric/psychotherapeutic treatment. Further prognosis remains uncertain.

Ointment Pseudo-Cheilitis: A Disease Distinct From Factitial Cheilitis. A Series of 13 Patients From São Paulo, Brazil.

BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a separate entity. RESULTS: Eight patients were male and 5 patients were female. All patients reported pain and presented with crusts consisting of dried saliva and topical medications adherent to the surface of the lips. These patients expressed great concern with their condition, and reported several previous, ineffective treatments. Simple reassurance only was not effective; saline compresses alleviated symptoms for a few patients. Most patients were lost to follow-up. Biopsies were not performed on all patients. CONCLUSION: This particular type of cheilitis artefacta has been previously described, but some features described herein are new and allow a specific approach: patient's behavior, the "protrusion sign," and possible improvement with antidepressants. For these cases, we propose the term ointment pseudo-cheilitis because it comprises the nature of the attached material and the lack of true inflammation. Further psychiatric characterization is a logical next step in further characterizing this difficult-to-treat condition.

Differentiating factitious psychological presentations from malingering: Implications for forensic practice.

Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Building on Rogers' central motivations for malingering, the current article provides four explanatory models for FPPs; three of these parallel malingering (pathogenic, criminological, and adaptational) but differ in their central features. In addition, the nurturance model stresses how patients with FPPs attempt to use their relationship with treating professionals to fulfill their unmet psychological needs. Relying on these models, practical guidelines are recommended for evaluating FPPs in a forensic context.

[Self-inflicted lesions in the context of hidradenitis suppurativa: Pathomimicry]. / Lésions auto-provoquées dans un contexte d'hidradénite suppurée : un cas de pathomimicrie.

BACKGROUND: Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent. Herein we report on a case of pathomimicry in a context of hidradenitis suppurativa. PATIENTS AND METHODS: A teenage girl whose main previous medical history consisted of grade-2 obesity and an episode of pubic abscess was seen at our clinic for axillary lesions. She presented in a state of negligence, was suspicious and aggressive, and refused to undress. After gaining her trust, clinical examination revealed prominent ulcerations (each with a granulated base) at a distance from the folds in the axillary areas, as well as typical hidradenitis lesions of Hurley Grade 2 with purulent openings and rope-like scars from the inguinal folds. Hospitalization was recommended and a positive outcome was achieved under antibiotic therapy with doxycycline, topical alginate and hydrocellular dressings. A psychiatric evaluation concluded that the patient was presenting dysmorphophobic narcissistic weakness, probably in reaction to recurrent harassment at school since childhood. Once she developed trust with us, which was difficult to establish, the patient admitted to having caused the lesions herself. Given the history and clinical data, as well as the negative laboratory tests, a diagnosis of pathomimicry was made. DISCUSSION: Several cases of dermatological pathomimicry (sustainment by the patient of an ulcer with a known cause, contact with an allergen found in eczema, or renewed use of a medication implicated in toxiderma) or systemic disease (insulin injection in a diabetic patient) have been reported. To the best of our knowledge, this is the first description of pathomimicry associated with hidradenitis suppurativa. Regarding therapy, aftercare should be multidisciplinary. Confessions should not be forced and confrontations, which risk serious psychiatric collapse, should be avoided. A reassuring attitude enables psychiatry to be applied once trust has been sustainably established, hence the crucial role of the dermatologist.

Malingering and factitious disorder.

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate. Neurological disorders where difficulty in determining the degree of willed exaggeration is most likely include functional weakness and movement disorders, post-concussional syndrome (or mild traumatic brain injury), psychogenic non-epileptic attacks and complex regional pain syndrome type 1 (especially when there is an associated functional movement disorder). Symptom amplification or even fabrication are more likely if the patient might gain benefit of some sort, not necessarily financial. Techniques to detect deception in medicolegal settings include covert surveillance and review of social media accounts. We also briefly describe specialised psychological tests designed to elicit effort from the patient.

A 90-year-old man with factious disorder: Separating fact from fiction.

Objective Factitious disorders are known to exist in the medical community but are not commonly diagnosed in clinical practice. The majority of the literature on factitious disorder comes from case reports or case series. This particular case is unusual because it describes a patient who initially presented with purely physical complaints, but over time, the symptoms transitioned into predominantly psychiatric concerns. This case describes the patient's unique presentation and is followed by a discussion of the management of factitious disorder. Methods The patient was seen during the course of an inpatient psychiatric hospitalization. Electronic chart review was conducted, and information from each prior hospitalization was gathered between the dates of first initial documented presentation available in the electronic record in 1995 to most recent hospitalization in 2017. Results The patient still continues to present to the emergency department. Upon each presentation, staff work to objectively assess his complaints to be sure that there is no true underlying medical emergency. There is also a focus on providing non-judgmental, supportive, and compassionate care. Conclusion This case highlights the importance of corroborating objective findings with the patient's subjective reports gathered during a history and physical, and to recognize that patients with this disorder can present to any specialty. Thus, the collaboration between specialties is critical in the care of these patients to minimize unnecessary, costly, and sometimes dangerous interventions.

Administration of 5-HT-1B agonist ameliorates pseudodementia induced by depression in rats.

Major depressive disorder (MDD) is the leading cause of memory impairment in general population. The serotonin hypothesis provides a target model for the treatment of depression and depression-associated memory loss. 5-HT-1B receptor is suggested as a potential candidate in the pathophysiology of depressive illness. Dysfunction of 5-HT-1B receptors has been observed previously in depressive patients. Zolmitriptan, 5-HT-1B agonist is clinically recommended for the treatment of migraine. However, in present study this drug was tested as a potential treatment for depression and associated memory loss by altering the serotonergic function at receptor level. Rats (n=24) were equally divided into unstressed and stressed groups. Depression was induced by 19 days of restraint stress for 4 h which was followed by forced swim test and pattern separation test to assess depressive symptoms and memory impairment, respectively. The initial sign of depression-associated memory loss involves impaired pattern separation which is regarded as pseudodementia. In this study stressed rats showed depression- and pseudodementia-like symptoms. After the induction of depression, rats were treated with zolmitriptan at a dose of 0.3 mg/kg which resulted in a significant attenuation of depression and depression-associated memory impairment. Results are discussed with reference to the modulation of function of 5-HT-1B receptor following the administration of exogenous agonist.

Psychocutaneous disease: Clinical perspectives.

Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.

Self-Inflicted Lesions in Dermatology: A Management and TherapeuticApproach - A Position Paper From the European Society for Derma-tology and Psychiatry.

The classification of self-inflicted skin lesions proposed by the European Society for Dermatology and Psychiatry (ESDaP) group generated questions with regard to specific treatments that could be recommended for such cases. The therapeutic guidelines in the current paper integrate new psychotherapies and psychotropic drugs without forgetting the most important relational characteristics required for dealing with people with these disorders. The management of self-inflicted skin lesions necessitates empathy and a doctor-patient relationship based on trust and confidence. Cognitive behavioural therapy and/or psychodynamic and psychoanalytic psychotherapy (alone, or combined with the careful use of psychotropic drugs) seem to achieve the best results in the most difficult cases. Relatively new therapeutic techniques, such as habit reversal and mentalization-based psychotherapy, may be beneficial in the treatment of skin picking syndromes.

[Factitious disorders]. / Artifizielle Störungen.

Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants.

Identifying and Managing Malingering and Factitious Disorder in the Military.

Malingering is the intentional fabrication of medical symptoms for the purpose of external gain. Along similar lines as malingering, factitious disorder is the intentional creation or exaggeration of symptoms, but without intent for a concrete benefit. The incidence of malingering and factitious disorder in the military is unclear, but likely under reported for a variety of reasons. One should be aware of potential red flags suggesting malingering or factitious disorder and consider further evaluation to look for these conditions. A deliberate and intentional management plan is ideal in these cases. Furthermore, a multi-disciplinary team approach, a non-judgmental environment, and the use of direct but dignity sparing techniques will likely be most "successful" when confronting the patient with malingering or factitious disorder.

Hypochondriasis Circumscripta: A Neglected Concept with Important Implications in Psychodermatology.

The article is devoted to a psychodermatological disorder with self-destructive behavior - hypochondriasis circumscripta. Presented data are based on a clinical analysis of 22 consecutive cases (15 female; mean age - 56.1 ± 12.6 years) observed in the dermatologic department of First Moscow State Medical University and managed in a multidisciplinary approach by dermatologists and a consultation-liaison psychiatrist. Psychopathology, clinical presentations, historical aspects and treatment options are discussed. The self-inflicted skin lesions result from a severe repetitive autodestruction of focal skin loci primarily affected with heterogeneous sensations associated with a hypochondrical over-valued idea. Hypochondriasis сircumscripta is a serious diagnostic and treatment challenge and should be distinguished from dermatitis artefacta, skin picking disorder and delusional infestation.

[Self injury in adolescence]. / Selbstverletzungen in der Adoleszenz.

Self-injury often occurs for the first time in adolescence. The current classification distinguishes several groups: (1) factitious disorder imposed on self and factitious disorder imposed on another, (2) nonsuicidal self-injury (NSSI) and (3) obsessive-compulsive (OCD) and related disorders. The differential diagnosis includes a wide spectrum of psychiatric diseases, including borderline personality disorder (BPD), inherited disorders like Lesch-Nyhan syndrome (LNS) and also body modifications. In all these cases, self-harm is a subphenomenon. This review focuses on typical dermatological pictures.

Factitious disorders and malingering: challenges for clinical assessment and management.

Compared with other psychiatric disorders, diagnosis of factitious disorders is rare, with identification largely dependent on the systematic collection of relevant information, including a detailed chronology and scrutiny of the patient's medical record. Management of such disorders ideally requires a team-based approach and close involvement of the primary care doctor. As deception is a key defining component of factitious disorders, diagnosis has important implications for young children, particularly when identified in women and health-care workers. Malingering is considered to be rare in clinical practice, whereas simulation of symptoms, motivated by financial rewards, is regarded as more common in medicolegal settings. Although psychometric investigations (eg, symptom validity testing) can inform the detection of illness deception, such tests need support from converging evidence sources, including detailed interview assessments, medical notes, and relevant non-medical investigations. A key challenge in any discussion of abnormal health-care-seeking behaviour is the extent to which a person's reported symptoms are considered to be a product of choice, or psychopathology beyond volitional control, or perhaps both. Clinical skills alone are not typically sufficient for diagnosis or to detect malingering. Medical education needs to provide doctors with the conceptual, developmental, and management frameworks to understand and deal with patients whose symptoms appear to be simulated. Central to the understanding of factitious disorders and malingering are the explanatory models and beliefs used to provide meaning for both patients and doctors. Future progress in management will benefit from an increased appreciation of the contribution of non-medical factors and a greater awareness of the conceptual and clinical findings from social neuroscience, occupational health, and clinical psychology.

Early recognition and management of fabricated or induced illness in children.

Fabricated or induced illness (previously known as Munchausen syndrome by proxy) takes place when a caregiver elicits health care on the child's behalf in an unjustified way. Although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders specifies deception as a perpetrator characteristic, a far wider range is encountered clinically and is included in this Review. We describe the features of fabricated or induced illness, its effect on the child, and the psychosocial characteristics of caregivers and their possible motives. Present evidence suggests that somatoform and factitious disorders are over-represented in caregivers, with possible intergenerational transmission of abnormal illness behaviour from the caregiver to the child. Paediatricians' early recognition of perplexing presentations preceding fabricated or induced illness and their management might obviate the development of this disorder. In cases of fully developed fabricated or induced illness, as well as protection, the child will need help to return to healthy functioning and understand the fabricated or induced illness experience. Management of the perpetrator is largely dependent on their capacity to acknowledge the abusive behaviour and collaborate with helping agencies. If separation is necessary, reunification of mother and child is rare, but can be achieved in selected cases. More collaborative research is needed in this specialty, especially regarding close study of the characteristics of women with somatoform and factitious disorders who involve their children in abnormal illness behaviour. We recommend that general hospitals establish proactive networks including multidisciplinary cooperation between designated staff from both paediatric and adult mental health services.

Dermatitis Artefacta in Childhood: A Retrospective Analysis of 44 Patients, 1976-2006.

BACKGROUND: Dermatitis artefacta (DA) consists of self-inflicted skin lesions that the patient denies having produced. OBJECTIVES: To conduct a single-center retrospective clinical review of children and adolescents diagnosed with DA. METHODS: From 1976 to 2006, data were collected on children diagnosed with DA who were seen in the Department of Dermatology in our hospital. Clinical and epidemiologic features are described. Forty-four children (mean age 12.9 yrs) were selected, representing 21.9% of the total patients with DA recorded (n = 201) during this period. RESULTS: The most frequent clinical forms were excoriations (16 [36.4%]) and ulcers (10 [22.7%]), followed by blisters (7 [15.9%]), burns (3 [6.8%]), contact dermatitis (3 [6.8%]), hematomas (2 [4.5%]), panniculitis (1 [2.3%]), cheilitis (1 [2.3%]), and hyperpigmentation (1 [2.3%]). Sixteen were located exclusively on the face and neck, whereas 28 also had other locations (upper limbs, n = 10; lower limbs, n = 9; thorax, n = 5; abdomen, n = 4). Cutaneous lesions were treated with occlusive bandages using zinc paste or a plaster splint when necessary. CONCLUSION: To our knowledge, this is the largest reported series of DA in childhood. This complicated psychodermatologic condition requires correct diagnosis, appropriate management, and psychiatric assessment.

[Pseudodementia, what are we talking about? Part II: From Stertz to Alzheimer: A psychogenic disease after trauma]. / Pseudodémence, de quoi parle-t-on ? Partie II : de Stertz à Alzheimer : une maladie psychogène après traumatisme.

OBJECTIVE: The aim of this work is to give a new anchorage for the initial concept of pseudodementia, its basic definitions and actual clinical implications. The original definition and framework of the concept are misidentified and therefore need to be reintroduced and analysed here. This approach, beyond its heuristic and epistemological goal, has a practical aim: to adjust the psychopathological point of view on pseudodementia. METHODOLOGY: In addition to a conventional survey based on search engines (Medline, PsychINFO and google book), we conducted a systematic review of the concomitant papers related to the rise of the concept. RESULTS: Three moments of conceptualization are identified and linked to Wernicke's successors at the university of Breslau. Firstly, Stertz (1910) has described pseudodementia as a psychogenic illness that could occur after any trauma. According to our research, it is probably the first written use of the term pseudodementia in its psychogenic meaning. Secondly, we present Bonhoeffer's approach based on psychogenic reactions (1911). Finally, the views of Alzheimer and his student Schuppius are described: their understanding of pseudodementia is open to psychoanalytic concepts (1914). DISCUSSION: The concept of pseudodementia (Pseudodemenz) takes shape in a particular period of German history: the promulgation of laws settling railway (1871) and industrial accidents (1884) but also the law of compensation of the traumatic neurosis (1889), the nosological specificity of which was debated. German psychiatry of the beginning of the 20th century was strongly imbued with a moralizing sense of national duty. The disqualification of traumatic neurosis has been followed by a unanimous recognition of traumatic hysteria and its psychogenic hypothesis. As a consequence, traumatic events were rarely taken into consideration and the issue was moved into the private sphere (Privatsache) by questioning patients' morbid wishes. Breslau's psychiatrists analyzed the cognitive disorders of pseudodementia with regard to an ideogenic model of the trauma, which emphasized the subjectivity but which was still facing the primacy of the consciousness. It is in this context, and by reducing the question of the pseudodementia to the situations of detention (Gansersche Syndrom) and pension neuroses (Rentenneurosen), that Bonhoeffer promoted the notion of "wishing to be sick" (Wille zur Krankheit). This conception gave a social component to mental disorders but placed in the foreground a suggestive phenomenon, which Raecke included as secondary to the primary symptom of hysterical inhibition. Thus, Schuppius's article under the tutoring of Aloïs Alzheimer offers a double testimony. On one hand, it shows how neuropsychiatry was, by then, at least partially open to the notion of an unconscious causality. On the other hand, it exposes a hidden aspect of Aloïs Alzheimer: a brilliant histopathologist capable of interest for psychodynamic mechanisms. CONCLUSION: In his famous study of 1961, Leslie Gordon Kiloh argues that the concept of pseudodementia does not belong to any nosological system, is purely descriptive and does not imply an accurate diagnosis. The present work shows a very different conclusion. Initially, the term was introduced in German psychiatry to describe cases of hysterical psychogenic illness after trauma (psychogene Erkrankungen nach Trauma) in which the mechanism of inhibition was discussed. Topologically, we can even define its emergence in the Breslau's university and psychiatric clinic in which Wernicke, Stertz, Bonhoeffer and Alzheimer himself, promoted it. One should also note that the category of hysteria referred to an array of functional mental disorders, including "hysterical psychosis" (hysterische Psychosen).

[Pseudodementia, what are we talking about? Part I: In search of Wernicke's pseudodementia]. / Pseudodémence, de quoi parle-t-on ? Partie I : à la recherche de la pseudodémence de Wernicke.

OBJECTIVE: The authors explore the history of pseudodementia in the elderly; an issue with growing momentum in a world where life duration expectancy has been constantly growing and the management and treatments of dementias has imposed an equally increasing burden. Although the issue is mainly therapeutic, some of the main tenets of the current approaches rest heavily on historical issues. The invention of the term pseudodementia (Pseudodemenz) is usually credited to Wernicke. However, the exact circumstances and the debates that have accompanied the emergence of the term have never been fully uncovered, and the references are not accurate. Most of the recent literature cites Kiloh as the key influence in structuring the current uses of the term, but the relationship between both sources is not clear. METHODOLOGY: A research of anteriority has been conducted on the basis of Medline via Pubmed, PsychINFO and google book, using the following keywords: pseudodementia, pseudodementia, depressive pseudodementia, pseudodémence, Pseudodemenz. We have researched the quotations to localize the origin of the concept. Complementarily, we have attempted to clarify the nature of the debates by exploring the relevant German psychiatric literature at the end of the XIXth century and the beginning of the XXth. RESULTS: We have found that the very first occurrences of the notion appeared in a debate between the following authors: Ganser S.J.M. 1898, 1903; Wernicke C. 1898; Raecke J. 1901; Nissl F. 1902; Jung C.G. 1902, 1903; Stertz G. 1910; Bonhoeffer K. 1911; Schuppius S. 1914. We found that the term Pseudodemenz never appears in Wernicke's written works, although he was credited of its invention by his most direct students. It seems that the term was thought by the time it emerged to have originated in Wernicke's discussion of Ganser's syndrome. DISCUSSION: Ganser's syndrome, often defined as carceral psychosis, is a specific hysterical twilight state characterized by "talking past the point" (Vorbeireden), amnesia and hysterical stigmas, in which some trauma was thought to be causative. Wernicke presented it as determined by a "restriction of the field of consciousness", echoing Janet's theory (École de la Salpêtrière). He rejected the twilight characteristic: this differential point seems to have initiated the introduction of the concept of pseudodementia. Raecke argued that such states should not be understood as forms of simulation thus contributing to a heated debate of the time. Referring to Janet's works and expanding the syndrome of "traumatic hysteria", he argued in favor of a specific inhibiting factor which disturbs the process of associations. Jung, refusing Nissl's article dismissing Ganser, Wernicke and Raecke's views, confirmed the hysterical hypothesis. In a new contribution to the debate, Ganser contested Wernicke's differential point, arguing that in Vorbeireden, there was a Benommenheit - some sort of giddiness - and a "superficiality of the contents of consciousness" rather than a limitation of consciousness. It has been rightly argued that Wernicke's view of the pseudodementia issues was mainly related to the debates on hysteria and trauma, and that no relationship with old age symptomatology was established by him. However, we have found that he alluded to at least one case in which such a relationship was hypothesized. Moreover, one should note that Wernicke's views on hysteria included the rather pervasive notion of "hysterical psychosis", exhibiting "allopsychosis", which could include what would nowadays be seen as schizophrenia or psychotic mood disorders. CONCLUSIONS: First of all, the term Pseudodemenz, if it was ever used by Wernicke verbally, never appears in his published works. Besides, the debates concerning Ganser's syndrome, which served as a first paradigm to discuss pseudodementia, were highly influenced by the discussions on traumatic disorders, hysteria and simulation. Finally, although no direct connection is made between disorders of the senium and Pseudodemenz, the fact that Wernicke included both in what he termed "allopsychic disorders" seemed to indicate that some kind of relationship could not be absolutely excluded in Wernicke's mind.