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.

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.

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.

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.

Vísceras, humores, alientos. Alma premoderna y subjetividad moderna / Humors, entrails, spirits. Premodern soul and modern subjectivity

La medicina premoderna se ocupó tempranamente de la locura. Sin embargo, no supo proporcionar un concepto sólido de enfermedad mental a la psiquiatría naciente, que permaneció atrapada en las contradicciones de la forma sujeto moderna con la que nace. Este texto reconstruye algunos conceptos básicos de la medicina premoderna para mostrar cómo dan expresión metafórica a ciertas características de la estructura ontológica humana necesarias para comprender la enfermedad mental: escisión, individuación, mediación, confluencia en un proceso de apropiación/y desapropiación de sí mismo y del mundo que se puede definir como vida. Se concluye apuntando la necesidad de reelaborarlos como tarea pendiente de la psiquiatría contemporánea (AU)

Premodern medicine deals with madness since its very beginning. Nevertheless, it couldn’t furnish nascent psychiatry with a solid concept of mental illness. Psychiatry remains enmeshed in the conundrums of modern subjectivity in which it was born. This text addresses the reconstruction of some basic concepts of premodern medicine to show how they deal through metaphors with some features of human ontological structure which are key to understand mental illness: splitting, individuation, mediation and confluence in a process of appropriation/desappropriation of the world and of the subject itself. This process may be called life. Their reelaboration is the pending task of contemporary psychiatry (AU)

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.

Socioeconomic background of hysteria's metamorphosis from the 18th Century to World War I.

The many changes in the etiopathogenic theories of hysteria, developed from the end of the 18th century to the end of World War I, can only be understood by studying the social, political, economic, and cultural transformations of the Western world during the same period. These transformations, presented below along with concurrent medical discoveries, make it possible to explain the ongoing metamorphosis of both hysteria and the image of the hysteric patient.

'Fin-de-Siècle' epidemiology of hysteria.

An 'explanatory epidemiology' of disorders labelled 'hysteria' towards the end of the 19th century provides precious information--through the numerous statistical works of the period - about the conceptions of practitioners and the various cultural factors which made this era, in France, 'the golden age' of hysteria. The heyday of hysteria at the end of the century appears to be closely linked to the prestige of Charcot and the promotion of his ideas through the circle of his pupils. The disappearance after his death of hysteria, as he had described it in a defined and systematical manner, is a strong argument for considering it to be a transient mental illness, according to the definition of this concept by Ian Hacking. The regular appearance since then of new nonorganic diseases, avatars of hysteria, with a strong potential for contagiousness and whose causality is exterior to the person, as well as the persistence of the older, more characteristic forms, is evocative of the existence of an ancestral reactional mode taking on various clinical forms according to time and place.

Hysteria around the world.

In the 20th century the term hysteria declined and the interest in the hysteria-related diseases decreased in comparison to the florid period of studies that was inspired by Charcot's legacy in the second half of the 19th century. Scientific interest has once again increased in the 21st century, and dissociative and somatoform disorders (previously indicated as hysteria or hysterical neurosis) have come to be regarded as conditions that are known to be much more prevalent than formerly estimated. Available current epidemiological data from several countries on different continents (adopting DSM criteria for diagnosis) suggest not only that the prevalence is probably similar, but also that there is a consistency in their clinical manifestation around the world and across different cultures, social classes, and institutional settings. In line with this uniformity, and also with Charcot's concept of hysteria as a functional disorder, neuroimaging studies suggest that for some of these disorders, there might be some changes of neural connectivity in specific pathways at the origin of the behavioral aspects. Only large-scale multidisciplinary transcultural studies can improve the research and the development of therapeutic interventions for these disorders.

[Comorbidity of hysterical pathologies associated with gynecological diseases: historical perspectives and current evidence]. / Comorbilità di patologie dello spettro isterico con patologie dell'apparato ginecologico: nozioni storiche ed evidenze attuali.

BACKGROUND: In spite of a large amount of observations made in Psychiatric Day-Hospital of Sapienza University of Rome relating to comorbidity between sexual and gynecological disorders and hysteria, we have attempted to quantify the incidence of this phenomenon in order to assess their significance. METHODS: A retrospective study was conducted on medical records of patients hospitalized at the Day-Hospital of the Policlinico Umberto I in Rome between 1989 and 2009. RESULTS: It seems to be confirmed the hypothesis of a high frequency of correlating these disorders, although the results lead to a number of critical reflections on its significance and the method adopted. CONCLUSIONS: This research needs larger and more accurate future investigations, cause the type of study was made without direct information.

Outbreak of mass sociogenic illness in a school feeding program in northwest Bangladesh, 2010.

BACKGROUND: In 2010, an acute illness outbreak was reported in school students eating high-energy biscuits supplied by the school feeding programme in northwest Bangladesh. We investigated this outbreak to describe the illness in terms of person, place and time, develop the timeline of events, and determine the cause and community perceptions regarding the outbreak. METHODS: We defined case-patients as students from affected schools reporting any two symptoms including abdominal pain, heartburn, bitter taste, and headache after eating biscuits on the day of illness. We conducted in-depth interviews and group discussions with students, teachers, parents and community members to explore symptoms, exposures, and community perceptions. We conducted a questionnaire survey among case-patients to determine the symptoms and ascertain food items eaten 12 hours before illness onset, and microbiological and environmental investigations. RESULTS: Among 142 students seeking hospital care, 44 students from four schools qualified as case-patients. Of these, we surveyed 30 who had a mean age of 9 years; 70% (21/30) were females. Predominant symptoms included abdominal pain (93%), heartburn (90%), and bitter taste (57%). All students recovered within a few hours. No pathogenic Vibrio cholerae, Shigella or Salmonella spp. were isolated from collected stool samples. We found no rancid biscuits in schools and storage sites. The female index case perceived the unusually darker packet label as a "devil's deed" that made the biscuits poisonous. Many students, parents and community members reported concerns about rumors of students dying from biscuit poisoning. CONCLUSIONS: Rapid onset, followed by rapid recovery of symptoms; female preponderance; inconsistent physical, microbiological and environmental findings suggested mass sociogenic illness rather than a foodborne or toxic cause. Rumours of student deaths heightening community anxiety apparently propagated this outbreak. Sharing investigation results and reassuring students and parents through health communication campaigns could limit similar future outbreaks and help retain beneficiaries' trust on nutrition supplementation initiatives.

Jaqueca asociada a trastorno de conversión (jaqueca de Babinski). Análisis de una serie de 43 casos / Migraine associated with conversion symptoms (Babinski's migraine): evaluation of a series of 43 cases

Introducción: En 1890 el neurólogo francés Babinski describió como migraine ophthalmique hystérique o jaqueca oftálmica histérica, cuatro casos de cefalea asociada a síntomas visuales y trastornos histéricos. Desde entonces esta asociación ha sido raramente descrita, aunque la frecuencia, posiblemente elevada de acuerdo con descripciones anteriores, está por establecer. Este trabajo recupera la descripción de Babinski e intenta rehabilitar el síndrome descubierto por el semiólogo francés en la relativamente alta frecuencia de este tipo de pacientes observada en un hospital público. Asimismo, se especula sobre los motivos del olvido de esta descripción. Método: El estudio presenta una serie de 43 casos de jaqueca, la gran mayoría compatibles con jaqueca de tipo basilar de acuerdo con los criterios IHS, asociados a síntomas de conversión. El diagnóstico de trastorno de conversión (histeria) se basa en los criterios establecidos por el DSM-IV. Resultados: Todos los pacientes mostraron una o más manifestaciones de histeria durante las crisis de jaqueca, y algunos en los intervalos. Se discuten los detalles de las cefaleas, de los síntomas asociados y de las manifestaciones histéricas. La mayoría de los pacientes mejoró con medicación antijaquecosa. La alteración de la conciencia pudo haber contribuido al desencadenamiento de los síntomas histéricos. Conclusiones: La jaqueca basilar asociada a trastorno de conversión descrita de forma sistematizada por Babinski no es una entidad rara. Cuadros similares se han descrito a lo largo de la historia de la medicina. El silencio durante el último siglo sobre la entidad se debe posiblemente a la dificultad histórica en definir de forma apropiada los trastornos de conversión. La jaqueca de Babinski es una entidad bien establecida y debe ser recuperada para el clínico (AU)

Background: In 1890 four cases of headache associated with visual symptoms and hysterical disorder were described by the French neurologist Babinski as migraine ophthalmique hystérique, or hysterical ophthalmic migraine. Since that time this association has seldom been described, and the possibly high frequency previously reported still remains to be established. This paper has reused Babinski's description and it tries to rehabilitate the syndrome described by the French semiologist across the relatively frequent experience of this type of patients in a public hospital. Also it analyzes the reason of the oblivion of his description.Method: This study presents a series of 43 cases of headache of the migraine type associated with other symptoms, most consistent with basilar-type migraine according to IHS criteria. Diagnosis of conversion disorder (hysteria) was grounded in the criteria set forth in the DSM-IV. Results: All patients exhibited one or more manifestations of hysteria (conversion symptoms) during migraine attacks, and some did in the intervals between attacks as well. Details of the headaches, associated symptoms, and hysterical manifestations are discussed. Most patients improved with antimigraine medication. Altered consciousness may have contributed to the onset of hysterical symptoms. Conclusions: The basilar type migraine associated with conversion symptoms described of systematized form by Babinski, it is not a rare entity. Similar pictures have been described along the history of the medicine. The later silence possibly is due to the historical difficulty in defining accurately the conversión disorders. The Babinski's migraine is a certain well entity and must be recovered for the clinic (AU)

Patología psicógena en la planta de neurología. Revisión de los últimos 10 años de hospitalización en un servicio de tercer nivel / Psychogenic pathology in the neurology unit. A review of the hospital admissions over the last 10 years in a third-level service

Introducción. Los trastornos psicógenos son frecuentes en la práctica neurológica, y, en ocasiones, obligan a hospitalizar al paciente para descartar una patología orgánica potencialmente grave. Objetivo. Conocer el perfil de los pacientes con diagnóstico al alta de trastorno psicógeno que ingresan en la planta de neurología de un hospital español. Pacientes y métodos. Se revisaron los informes de alta de neurología de los últimos 10 años, se seleccionaron los pacientes que tenían un diagnóstico de ‘no organicidad’ y se recogieron hasta un total de 28 variables demográficas, epidemiológicas y clínicas. Resultados. Sesenta y cuatro pacientes (el 1% de los hospitalizados) tenían diagnóstico de psicogenicidad, con una edad media de 40 años. La proporción de sexos era de 1 a 1, y la estancia media, de 10 días. Los síntomas mixtos eran los más habituales (50%), seguidos de los motores aislados (22%). Los posibles diagnósticos neurológicos de ictus isquémico y enfermedad desmielinizante fueron la mayoría de los casos. Sólo se consultó un 25% a psiquiatría durante el ingreso. En un 11% de los casos hubo historia posterior de intento de autolisis y en ocho casos (12,5%) se llegó a un diagnóstico ambulatorio de organicidad gracias al seguimiento evolutivo (‘error’ en el diagnóstico provisional al alta). Conclusión. Este trabajo dibuja por vez primera en nuestro medio el perfil del paciente psicógeno que ingresa en la planta de neurología, y examina su manejo hospitalario y su seguimiento ambulatorio. Se recuerda la necesidad de no menospreciaresta patología y de generar una vía ordenada para su manejo, siempre multidisciplinar y con el protagonismo del neurólogo y el psiquiatra

Introduction. Psychogenic disorders are frequently seen in neurological practice and sometimes make it necessary to hospitalise the patient in order to rule out a potentially severe organic pathology. Aim. To determine the profile of patients with a discharge diagnosis of psychogenic disorder that are admitted to the neurology unit of a Spanish hospital. Patients and methods. The neurology unit discharge abstracts from the last 10 years were reviewed and the patients who were diagnosed with ‘non-organicity’ were selected; a total of 28 demographic, epidemiological and clinical variables were also collected. Results. A total of 64 patients (1% of those admitted to hospital), with a mean age of 40 years, had a diagnosis of psychogenicity. The proportion between sexes was one to one and the mean length of stay in hospital was 10 days. Mixed symptoms were the most usual (50%), followed by isolated motor symptoms (22%). Most cases consisted of possible neurological diagnoses of ischaemic stroke and demyelinating disease. Only 25% of cases consulted psychiatry during hospitalisation. In 11% of cases there was a later history of suicide attempts and in eight cases (12.5%) an ambulatory diagnosis of organicity was reached thanks to the developmental follow-up (‘error’ in the provisional diagnosis on discharge). Conclusions. This study traces, for the first time in our setting, the profile of the psychogenic patient who is admitted to the neurology unit and examines their hospital management and their outpatient follow-up. We highlight the need not to underestimate this pathological condition and to generate an ordered way of managing it, which should always be multidisciplinary with the leading roles played by the neurologist and the psychiatrist

[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.

¿Histeria, simulación o neurosis de renta? / Hysteria, simulation or compensation neurosis?

Los médicos de atención primaria y los profesionales de salud mental somos testigos de un alarmante incremento de los denominados por López Ibor (1966) “enfermos-problema”. Para dicho autor, los “enfermos-problema” son aquéllos que ofrecen disparidad entre los síntomas subjetivos y los objetivos. Estos enfermos ¿son histéricos, son simuladores o son neuróticos de renta? El objetivo del presente artículo es volver sobre los orígenes y evolución de las neurosis con la finalidad de sensibilizarnos a una mejor comprensión de este tipo de pacientes (AU)

Primary care doctors and mental health professionals are witnessing an alarming increase in what López Ibor (1966) termed “problem-patients”. For this author “problem-patients” are those for whom there is a disparity between objective and subjective symptoms. Are these patients, hysterical, simulators or compensation neurotics? The aim of this article is to retrace the origins and evolution of these neuroses in order to a gain a better understanding of this type of patient (AU)