Rivista di patologia nervosa e mentale最新文献

The Authors describe a case of aphasia acquired in childhood together with epilepsy (syndrome of Landau and Kleffner) and treated for seven years. The patient had simple and complex partial attacks, motor dysphasia, frequent and heavy headache, and electroencephalographic paroxysmal anomalies with multifocal distribution. While the disease evolved with regression of disphasia and epilepsy, the EEG alterations persisted. In view of similar cases reported in the literature and the present treatment the Authors feel that syndrome is an inflammatory disease, its evolution being slow. The results of neuroradiological investigations support such hypothesis. The prognosis is poor (anomalies of speech persisted in 2 out of 3) and further studies are essential. A systematic use of cerebral biopsy is suggested.

Nocturnal sleep was poligraphycally recorded in three male patients aged 54-67, with progressive supranuclear palsy (PSP). All patients suffered from insomnia. In case 1 REM sleep was markedly reduced and spindles were less numerous than in normal subjects. In cases 2 and 3, EEG patterns were not distinguishable from those observed when the patients were awake. Sleep, therefore, was recognized only by constant observation of the patients. As seen in the literature EEG changes during sleep can be correlated to the severity of the clinical picture and the stage of evolution of the disease. EEG patterns of sleep in PSP are similar to those reported in patients with presenile dementia.

Fibrillation activity and membrane depolarization which follow denervation, were studied in skeletal muscles of control and pretreated adult rats. The investigation was carried out on both fast (Tibialis Anterior) and slow (Soleus) muscles. The pretreatment consisted in prolonged (4 days) starvation, or Streptozotocin-induced diabetes, preceding denervation. Denervation was performed by cutting the sciatic nerve. In fast as well as in slow muscle, both pretreatment significantly delayed the onset of fibrillation. Starvation enhanced depolarization only in fast muscle, while diabetes was effective also in slow muscle. The results support the view that membrane depolarization (but not fibrillation activity) in denervated muscle is related to an altered carbohydrate metabolism.

In spite of their recognized effectiveness with psychotic pathologies and their unquestionable therapeutic advantages, long-acting neuroleptics, in use for more than a decade, still generate more bewilderment and resistance than other medicines. Within the profession, it is assumed that the difficulties associated with their use are related to the interference of subjective experience in the rational motivations of therapy. The strictly inherent aspects to the therapeutic relationship are taken into consideration in an attempt to systematize the subjective implications of the psychiatrist who prescribes the medicines and the patient who takes them. Experiences of rejection and/or total acceptance of the drugs are traced in the patient: these experiences are often determining factors in the progress of the therapy. These observations lead to an evaluation of the importance of the therapeutic relationship and the psychotherapeutic aspects this takes on during the course of chemotherapy. Thus the use of long-acting neuroleptics presents special difficulties connected with the fact that they create new means of communication in the patient, means which the psychiatrist must take into consideration in his relationship with the patient.

The clinical case of little Hans is the story of a five-year-old child's phobia; it was published by Freud in 1909 using material gathered from his supervision of the "analytical treatment" brought before the child's father. Freud put the case as a clinical confirmation of the relative theory of infantile sexuality and the existence of an infantile neurosis based on the castration complex and oedipal conflict. Freud also focused his attention on the development of the "theories" the child uses to understand the world: the analysis is constructed as the hermeneutics of the private conditions with which the mind develops omnipotent cognitive theories about external reality. In addition to the clinical material, the peculiar conditions of the setting opened up new avenues in psychoanalysis; the case of little Hans in particular is considered a prelude to infantile analysis. This work emphasizes how Han's cure is the result of a complex interaction involving the entire family nucleus and proposes a possible relational significance of the kind of therapeutical operation which develops through the father of little Hans.

In a patient affected by Thevenard's disease (degenerative disease of the spinal ganglia and posterior roots) we measured levels of intraerythrocytic, plasmatic and cerebrospinal fluid aminoacids. In the plasma we found an increased concentration of taurine and glycine, expression of hypercatabolism, which was confirmed by the presence of a decreased level of the free intraerythrocytic aminoacids. In the cerebrospinal fluid we found increased concentrations of methionine, valine and lysine which indicates the presence of an enzymatic inhibition that involves the systemic transport of aminoacids at the barrier level. The increased levels of glutamic acid and arginine suggests an alteration of the synthesis of alpha-guanino butyric acid. We have also found an increase in the levels of valine, methionine, glycine, tyrosine which suggests the presence of an enzymatic alteration in the collateral reactions that biochemically feed into the Krebs cycle. The authors therefore conclude that the basis of this disease may be found in a metabolic defect biochemical synthesis.

The classical thalamic syndrome of Dejerine and Roussy is very rare. Sensory disorder are almost constant but the thalamic hyperpathia had not been reported. Clinical findings are reported in 14 patients with restricted lesions of the thalamus visible with the CT scan. Occasionally aphasia was found in patients with left sided lesion (with Thalamic Neglect, apraxia, mainly of ideomotor type and the so-called "Central Dazzle"). Thalamic lesions can produce a great variability of signs and symptoms.

Paternity, like maternity, provides an occasion for profound modifications of an individual's social role and internal world. Such modifications may be defined as "the job of becoming a parent". The authors examine psychological symptoms that appear at the advent of paternity, with special attention given to acute disorders and the couvade syndrome. Recalling the anthropological meaning of the term "couvade", this syndrome is regarded as a sort of "individual defense rite" from various conflicting elements that are stimulated by paternity. In the majority of these cases, this syndrome, fairly rare on the whole, is considered a "physiological" paternity symptom which through somatic symptoms expresses the father's conflicting drives toward his wife and child. In detail, the authors examine certain cases of acute disorder in which psychopathological symptoms are preceded by a somatic symptomology identifiable as a couvade syndrome. A hypothesis that a connexion exists between the psychosomatic symptomatology of couvade and acute disorders on a neurotic and psychotic level of paternity is formulated, analogous to what is observed in certain psychosomatic illnesses during whose course somatic symptoms alternate with psychotic symptoms.