Phenomenon of Nightclub Shots: Mass Psychogenic Disease?

BACKGROUND: This article examines the possibility that the "nightclub shots" epidemic is a "mass psychogenic disease" phenomenon, by comparing the various cases of "mass sociogenic diseases" reported in the literature. We carried out a literature review on PubMed. The keywords used were "mass hysteria", "mass sociogenic disease", "mass psychogenic disease" and "epidemic of multiple unexplained symptoms". RESULTS: Our review of the literature revealed several elements common to the various "mass hysterias" we identified. These phenomena generally appear in a climate of anxiety specific to the era in which they occur, in this case the fear of bioterrorism in the 21st century. Symptoms are generally benign and transient, appearing and resolving easily without the identification of an organic cause. They usually occur in a small group of individuals, and more frequently in young people and women. The media can exacerbate the phenomenon. CONCLUSION: The phenomenon of epidemics of nightclub shots seems to fit into the common framework of "mass psychogenic diseases" identified in the literature. This diagnosis could therefore be evoked, in the absence of any other objective somatic explanation.

Investigating "mass hysteria" in early postcolonial Uganda: Benjamin H. Kagwa, East african psychiatry, and the Gisu.

In the early 1960s, medical officers and administrators began to receive reports of what was being described as "mass madness" and "mass hysteria" in Tanganyika (now Tanzania) and Uganda. Each epidemic reportedly affected between three hundred and six hundred people and, coming in the wake of independence from colonial rule, caused considerable concern. One of the practitioners sent to investigate was Benjamin H. Kagwa, a Ugandan-born psychiatrist whose report represents the first investigation by an African psychiatrist in East Africa. This article uses Kagwa's investigation to explore some of the difficulties facing East Africa's first generation of psychiatrists as they took over responsibility for psychiatry. During this period, psychiatrists worked in an intellectual climate that was both attempting to deal with the legacy of colonial racism, and which placed faith in African psychiatrists to reveal more culturally sensitive insights into African psychopathology. The epidemics were the first major challenge for psychiatrists such as Kagwa precisely because they appeared to confirm what colonial psychiatrists had been warning for years-that westernization would eventually result in mass mental instability. As this article argues, however, Kagwa was never fully able to free himself from the practices and assumptions that had pervaded his discipline under colonial rule. His analysis of the epidemics as a "mental conflict" fit into a much longer tradition of psychiatry in East Africa, and stood starkly against the explanations of the local community.

[Hysterical mutism]. / Le mutisme hystérique.

BACKGROUND: Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known. METHOD: A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria. RESULTS: The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches. CONCLUSION: Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.

Mass hysteria attack rates in children and adolescents: a meta-analysis.

OBJECTIVES: There are few systematic assessments of mass hysteria (MH) attack rates (ARs) in adolescents and children. The study aim was to assess the ARs of MH in this population. METHODS: We used a meta-analysis to systematically review studies and assess ARs. RESULTS: The reviewed studies included 32,887 participants, of which 2968 were children and adolescents with a history of MH. Twenty-eight studies were included, of which 22 (78.6%) had high to moderate methodological quality. The pooled AR of MH was 9.8% (95% confidence interval [CI] 6.3, 14.0). Of MH studies between 2010 and 2020, 78.6% were conducted between 2010 and 2014. ARs were higher between 2010 and 2014 (10.3%) than between 2015 and 2020 (8.1%). Regarding population characteristics, the AR in girls was 2.43 (95% CI 1.70, 3.46) times higher than in boys. Most studies were on primary school students (46.4%), who showed the highest AR (15.4%). Of six trigger factors, water pollution showed the highest AR (16.3%). ARs were higher in rural areas (11.1%) than in urban areas (5.6%). CONCLUSIONS: MH in children and adolescents seems prevalent and shows some epidemiological characteristics. These findings may assist governments to control and prevent MH epidemics among children and adolescents.

In the psychiatrist's chair: how neurologists understand conversion disorder.

Conversion disorder ('hysteria') was largely considered to be a neurological problem in the 19th century, but without a neuropathological explanation it was commonly assimilated with malingering. The theories of Janet and Freud transformed hysteria into a psychiatric condition, but as such models decline in popularity and a neurobiology of conversion has yet to be found, today's neurologists once again face a disorder without an accepted model. This article explores how today's neurologists understand conversion through in-depth interviews with 22 neurology consultants. The neurologists endorsed psychological models but did not understand their patients in such terms. Rather, they distinguished conversion from other unexplained conditions clinically by its severity and inconsistency. While many did not see this as clearly distinct from feigning, they did not feel that this was their problem to resolve. They saw themselves as 'agnostic' regarding non-neuropathological explanations. However, since neurologists are in some ways more expert in conversion than psychiatrists, their continuing support for the deception model is important, and begs an explanation. One reason for the model's persistence may be that it is employed as a diagnostic device, used to differentiate between those unexplained symptoms that could, in principle, have a medical explanation and those that could not.

Hysterical traits are not from the uterus but from the testis: a study in men with sexual dysfunction.

INTRODUCTION: The relationship between testosterone (T) and psychopathology in subjects with sexual dysfunction has not been completely clarified. AIM: To evaluate the association between T levels and different psychopathological symptoms and traits in men seeking treatment for sexual dysfunction. METHODS: A consecutive series of 2,042 heterosexual male patients (mean age 51.8 +/- 13) consulting an outpatient clinic for sexual dysfunction was retrospectively studied. MAIN OUTCOME MEASURES: Several hormonal, biochemical, and instrumental parameters were investigated, including testis volume (Prader orchidometr) and penile blood flow (penile Doppler ultrasound). Patients were interviewed, prior to the beginning of any treatment, with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). They also completed the Middlesex Hospital Questionnaire (MHQ) a brief self-reported questionnaire for the screening of the symptoms of mental disorders in nonpsychiatric setting. RESULTS: T levels showed a negative correlation with depressive and anxiety (somatized and phobic) symptoms. Conversely, histrionic/hysterical traits were strongly and positively associated with elevated T. Men with histrionic/hysterical traits had higher androgenization, as suggested by both higher total and free T, higher testis volume and a lower ANDROTEST score. They were also characterized by better self-reported sexual functioning and penile blood flow. Accordingly, when SIEDY scales were considered, SIEDY scale 2 (relational domain) was significantly lower in subjects with histrionic/hysterical traits further indicating a more satisfying sexual relationship. CONCLUSIONS: In men consulting for sexual dysfunction, histrionic/hysterical personality is associated with higher androgenization and better sexual functioning. Hysteria, previously considered as a typically feminine psychopathological trait (the uterine theory), should now be considered as an index of better masculine sexual well-being.

Psychiatric symptoms and dissociation in conversion, somatization and dissociative disorders.

OBJECTIVE: Conversion, dissociation and somatization are historically related in the long established concept of hysteria. Somewhere along the way they were separated due to the Cartesian dualistic view. The aim of the present study was to compare these pathologies and investigate whether symptoms of these pathologies overlap in their clinical appearance in a Portuguese sample. METHOD: Twenty-six patients with conversion disorder, 38 with dissociative disorders, 40 with somatization disorder, and a comparison group of 46 patients having other psychiatric disorders answered questions about dissociation (Dissociative Experiences Scale), somatoform dissociation (Somatoform Dissociation Questionnaire), and psychopathological symptoms (Brief Symptom Inventory). RESULTS: Dissociative and somatoform symptoms were significantly more frequent in dissociative and conversion disorder than in somatization disorder and controls. There were no significant differences between dissociative and conversion patients. CONCLUSIONS: Conversion disorder is closely related to dissociative disorders. These results support the ICD-10 categorization of conversion disorder among dissociative disorders and the hypothesis of analogous psychopathological processes in conversion and dissociative disorders versus somatization disorder.

The clinical and psychological profiles of patients with hypogonadism, followed in 3 reference hospitals of Cameroon: an observational study.

INTRODUCTION: Hypogonadism refers to a syndrome that results from failure of gonads to function properly. The main concern is considerable rise in morbidity, as shown by increased cardiovascular risk, infertility, osteoporosis and above all, the psychological impact on the life of the patients with hypogonadism. Judicious steroid replacement and culturally-sensitive psychological support before and during steroid therapy remains the key tool in the management of this condition. The present study aimed at filling the knowledge gap on hypogonadism in Cameroon. METHODS: We conducted a cross-sectional study over a period of 12 months, in 3 reference hospitals of Cameroon. We included males and females diagnosed with hypogonadism, aged 16 to 50 years and 16 to 45 years respectively. After a complete clinical examination, patients were invited to fill the modified middlesex hospital questionnaire for psychoneurotic evaluation. RESULTS: We recruited 59 patients with a sex ratio of 1:1. The mean age of the females and males were 27.7 ± 9.1years and 30.8 ± 11.7 years respectively. Normosmic Idiopathic Hypogonadotropic Hypogonadism (NIHH) was the most common presentation. Compulsive obsessive traits, phobic anxiety and hysterical trait, were most pronounced in these patients. Testosterone titers significantly correlated positively with testicular size and negatively with body mass index (BMI). A significant positive correlation was found between the testicular volumes measured with ultrasound (US) and with the orchidometer. CONCLUSION: Normosmic idiopathic hypogonadotropic hypogonadism is the most common presentation of hypogonadism in the study population. There is a significant psychosocial impact requiring further investigation and attention.

Polonium-210 poisoning in London: hypochondriasis and public health.

INTRODUCTION: In November 2006, a Russian dissident died from radioactive Polonium-210 (210Po) poisoning in London. Providing reassuring messages during a public health incident may be ineffective for individuals with high health anxiety (hypochondriasis). METHODS: Members of the public who called a 24-hour telephone helpline were offered a follow-up call by a health protection specialist for reassurance. A psychiatrist attempted to contact those callers who were unable to be reassured by the health protection specialist. RESULTS: Of 872 individuals contacted for reassurance, seven (0.6%) could not be reassured. The psychiatrist contacted four of these individuals. Three had a history of health-related anxiety and two attributed somatic symptoms to 210Po exposure. CONCLUSIONS: For individuals with hypochondriasis, reassurance during major public health incidents may be ineffective. Having a psychiatrist available was helpful in managing individuals with excessive health anxiety.

Epidemic hysteria following the National School Deworming Day, Zamboanga Peninsula, Philippines, 2015.

INTRODUCTION: In July 2015, the Philippines conducted a school-based mass drug administration using albendazole for soil-transmitted helminths infection. Reports of adverse events were subsequently made through the event-based surveillance system, mostly from the Zamboanga Peninsula on the island of Mindanao. A team from the Epidemiology Bureau investigated the reports of adverse events following mass drug administration (AEFMDA). METHODS: Five schools were identified for the investigation which comprised an unmatched case-control study, key informant interviews and laboratory examinations. AEFMDA cases were students who had sudden onset of abdominal pain, vomiting, diarrhoea, loss of consciousness, headache or dizziness within 24 hours after intake of deworming tablet; controls were healthy students who did not develop signs and symptoms after deworming. RESULTS: Most (85%) of the 7313 AEFMDA cases reported nationwide were from Zamboanga Peninsula. Most reports were made after rumours of deaths following deworming and of the use of expired drug were spread through the region. Many parents sent their children to hospital, even if asymptomatic. The case-control study found that being an AEFMDA case was associated with no history of previous deworming (odds ratio = 4.08, 95% confidence interval: 1.77-9.42). DISCUSSION: The investigation concluded that epidemic hysteria was the cause of the increased number of AEFMDA cases in the Zamboanga Peninsula. The false information, aggravated by social media, caused panic and an increase in reporting. Some cases had no history of deworming, and they may not have been aware that albendazole is safe and that side-effects are expected. Risk communication before, during and after future national deworming programmes are recommended to prevent unnecessary reporting of AEFMDA.

Mass psychogenic illness (epidemic sociogenic attacks) in a village in Lebanon.

Mass psychogenic illness (epidemic sociogenic attacks/mass hysteria) refers to a rapid spread of well-described signs and symptoms affecting members of a group. It might be difficult to differentiate at first from illnesses due to infections, intoxications or "bio-terrorism." We investigated such an occurrence in a small village in Lebanon chronically under threat of war. A 16-year-old single female, school student, was referred to Saint George Hospital University Medical Center, Beirut, for attacks of shortness of breath, muscle cramps, tremors and dizziness, for several days. She was referred because she was the first of eight cases from the same village to have similar symptoms. In parallel to an inpatient multidisciplinary evaluation and treatment, meetings were held with the crisis group comprising members of the hospital Psychiatry and Psychology Department, a public health representative of the Ministry of Health of Lebanon, physicians who were taking care of the other cases and a psychologist working in the area where these cases were declared. The diagnosis of mass psychogenic illness (epidemic sociogenic attacks) was reached. A common strategy was adopted in an effort to control the epidemic. Several explanations had been put forward initially by the community : bioterrorism, noxious fumes and "bad spirits." At the time of writing this report--nine months later--, the epidemic, which had abated within six weeks, was still inactive.

Does personality at college entry predict number of reported pain conditions at mid-life? A longitudinal study.

UNLABELLED: The purpose of this study was to evaluate whether personality traits, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), at time of college entry can predict the number of reported pain conditions at an approximate 30-year follow-up for 2332 subjects, 1834 men and 498 women, who were administered the MMPI on entry to the University of North Carolina (Chapel Hill) between 1964 and 1966. In 1997, a follow-up was conducted in which subjects were administered a self-report questionnaire regarding whether they had experienced 1 or more chronic pain conditions. Analyses of the relationship between the MMPI clinical scales at college entrance and the report of number of chronic pain conditions at follow-up were conducted. Among male participants, elevations of Scales 1 (Hypochondriasis), 3 (Hysteria), and 5 (Masculinity/Femininity) predicted increases in number of chronic pain conditions at follow-up. For female participants, elevations in Scales 1, 3, and 6 (Paranoia) predicted increases in number of chronic pain conditions at follow-up. The current study suggests that a statistically significant relationship exists between MMPI responses at college entry and reports of chronic pain conditions at mid-life. PERSPECTIVE: This study found a small, but significant relationship between elevations on MMPI scales measuring hypochondriasis and hysteria and the report of chronic pain conditions at follow-up. The study is important because it is the first to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later.

Outbreak of itching and rash. Epidemic hysteria in an elementary school.

Fifty-seven of 159 rural elementary school students had an explosive spread of pruritus and rash--a rarely described manifestation of epidemic hysteria. In a sample of 13 children (23%), each child examined had irregular, macular, erythematous lesions that were excoriated and actively changed during examination. Rash occurred only at sites readily accessible to hands. The symptoms disappeared promptly when the children left school and recurred each morning when they returned. There were no secondary family cases in sample children. School-wide attack rates were higher in girls and younger children. The outbreak resolved after two to three weeks, with identification of its nature and resumption of normal activities. Academic stresses were circumstantially linked to the outbreak.

Forensic psychiatry: female offenders.

The authors examined the records of 127 female and 1,068 male offenders referred by the courts to a forensic service over a 22-year-period. Female offenders were less likely than male offenders to be referred for psychiatric evaluations when they were charged with criminal behavior. They were more likely to be charged with homicide, arson, forgery, or fraud and more frequently received diagnoses of affective disorder and neurosis.

A study of the symptom patterns of psychiatric referrals in a tropical diseases unit.

Undoubtedly the commonest psychiatric conditions seen in patients from the tropics are reactive depression and hysterical illness. These may both be seen as responses to stress, often over a prolonged period. Although typical depressive and hysterical syndromes are seen in all races, severe tiredness seems to be the principal hysterical symptom amongst Europeans as opposed to bizarre somatic symptoms in Negroes and Asians. Headaches are an important depressive sign in Negroes and Asians. Diarrhoea and abdominal pains may be linked directly to anxiety and depression or may emerge as an unconscious defence against insoluble problems.

'Repetition strain injury': an Australian epidemic of upper limb pain.

An analysis is provided of a recent Australian epidemic of an upper limb regional pain syndrome known as 'repetition strain injury' (RSI). 'RSI' was originally attributed to occupational over-use of the upper limb and biomechanical and ergonomic solutions were sought. More sceptical commentators argued that 'RSI' was an epidemic form of hysteria. More recently, a consensus has emerged that the epidemic is attributable to a combination of factors: a change in the perception of endemic symptoms of upper limb pain; the iatrogenic effects of the term 'RSI' and the methods used to manage it; and complications of the medico-legal process in which many sufferers became entangled.

The social recognition of repetition strain injuries: an Australian/American comparison.

In the mid 1980s the problem of occupational overuse injuries, particularly among keyboard operators, gained widespread recognition in Australia. The country appeared to be experiencing an epidemic, the like of which was unknown elsewhere in the world. Three explanations are canvassed in the paper: first, the psychiatric theory that it was a case of 'epidemic hysteria'; second the hypothesis that there really were more such injuries in Australia than elsewhere; and third, the hypothesis that the institutions of Australian society facilitated recognition of the problem, while those of other countries repress awareness of it. The paper focuses on this last hypothesis and seeks to demonstrate it by means of a comparison between Australia and the United States. It shows how, in particular, the system of workers' compensation in the Australian public service facilitated recognition of the problem, while the compensation system in the United States makes it very difficult for sufferers to have their disability acknowledged. Since workers' compensation is virtually the only source of injury statistics, this has led to the visibility of the problem in Australia and its invisibility in the United States.

Changes in MMPI profiles after low-back surgery.

Sixty-nine patients who had completed a Minnesota Multiphasic Personality inventory (MMPI) test preoperatively and had had low-back surgery for discogenic disease were seen in follow-up one to 11 years later. Each completed an MMPI test and pain drawing postoperatively, was examined clinically and radiographically, and was rated for surgical outcome. The preoperative MMPI hypochondriasis (Hs) and hysteria (Hy) scales were only modestly related to treatment outcome, but the postoperative scales were strongly related to outcome. Patients with good surgical outcome had lower Hs and Hy scores postoperatively than preoperatively, whereas patients with poor outcomes had higher Hs and Hy scores postoperatively. The MMPI profile of these operated low-back-pain patients was found to be changeable rather than static. The numerical value of the pain drawings was highly correlated with the elevation of the Hs or Hy scales. The MMPI should be utilized to identify patients with neurotic tendencies and prompt referral for psychologic treatment. Those patients who respond favorably to psychotherapy tend to have a better surgical outcome than those with untreated psychoneuroses or those who fail to improve with treatment.

Psychogenic epidemics and work.

Psychogenic epidemics cover various forms of collective behavior and include mass hysteria, mass psychogenic illness, and hysterical contagion for which no physical explanation can be found. The typical course of a psychogenic epidemic at a workplace progresses from sudden onset, often with dramatic symptoms, to a rapidly attained peak that draws much publicity and is followed by quick disappearance of the symptoms. Over 90% of the affected persons are women, and the symptoms range from dizziness, vomiting, nausea, and fainting to epileptic-type seizures, hyperventilation, and skin disorders. The background mechanisms are thought to be generalized beliefs and triggering events which create a sense of threat that leads to a physiological state of arousal. This state, in turn, creates new beliefs which give meaning to the sense of arousal. The new belief spreads through sociometric channels. Predisposing factors include boredom, pressure to produce, physical stressors, poor labor-management relations, and impaired interpersonal communications, and lack of social support. It is important that a thorough investigation be carried out in all instances. Investigation is not only necessary for diagnosis, but it also reassures the management, the employees, and the press that physical factors are unlikely to be responsible for the disease.

Rape-related psychotraumatic syndromes.

OBJECTIVE: This study took place in a forensic center for rape victims. Our aims were: first, to explore the longitudinal course of post-traumatic stress disorder (PTSD) and prevalence of disorders over the 6-month period following rape, then second, to group these disorders into syndromes related to chronic PTSD whilst remaining distinct from it, and third, to establish some predictive factors for chronic PTSD. STUDY DESIGN: 92 rape victims consecutively admitted to the center were regularly interviewed over a 6-month period by a psychiatrist. RESULTS: The paper confirms that rape leads to a high proportion of PTSD. Generally speaking, the psychopathology following rape is severe. PTSD at 6 months is associated with phobic and dissociative disorders. It is further associated with a cluster of symptoms arising after rape that we term borderline-like. Incestuous rape is a predictive factor for PTSD at 6 months. CONCLUSION: In the aftermath of rape several semiologically distinct psychotraumatic syndromes exist.