Schweizer Archiv fur Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie最新文献

The literature concerning hereditary neuropathy with liability to pressure palsies is reviewed. We describe 23 affected members of 7 families; one of them studied since 1966. The differential diagnosis with heredofamilial plexus brachialis neuropathy and Charcot-Marie-Tooth syndrome is discussed. Our subjects are similar to those described in the literature; they have presented episodes of recurring painless palsies, most often related to minimal neural trauma. Neuromyographic examinations revealed chronic denervation, slowed conduction velocities particularly at entrapment sites and sometimes neurapraxia. We emphasise the conduction blocks for we believe their tendency to long duration (up to 8 years) and presence at several sites in a same patient are characteristic of this affection. Moreover we suggest that this neurapraxia is related to the existence of the tomacula. The possibilities of prevention and treatment are reviewed (two neurolyses performed in one patient presenting with long lasting conduction blocks at 2 entrapment sites have proved to be a successful treatment.

This research investigates the relationship and link between intellectual cathexis, school achievement and personality functioning in a representative sample of secondary school students aged 12 to 15 years. The level of structure of the personality plays a most significant role. Good school achievement does not necessarily depend on an optimal psychological equilibrium. In fact, the most determining factor seems to be the part played by the defense mechanisms--particularly those which aim at controlling libidinal drives--developed and elaborated during the period of latency. A certain intellectual potential, however, is a necessary but not sufficient condition for school achievement - indeed, an end of school certificate i.e. the Swiss "certificat de maturité" could be obtained by students of average intelligence. The capacity of maintaining an active intellectual investment seems to be an equally determining factor. This quality of functioning contains an oedipal component - particularly the ability of taking one's stand and of competing - as well as a pre-oedipal one - the narcissistic integrity, allowing one to preserve one's self-esteem facing difficulties. Contrary to our hypothesis, the quality of subject-environment interaction with family, peers, teachers, plays a relatively minor role. A more important aspect concerns the effects and results of relations established during childhood such as the interiorization of parental expectations, the quality of the superego, the degree of internal autonomy allowing compromise with external demands, etc. Underlying conflicts can intervene at several levels. One of these levels could result in the subject's incapacity to utilize his own resources and these imply consequences ranging from difficulties in basic school achievement to non-acquisition of cognitive mecanisms and under-development of symbolization. Psychological testing is a means of identifying the underlying difficulties and determining their nature. Remediating methods include psycho-pedagogical or psychotherapeutic intervention or, in some cases, both.

Forty patients with chronic duodenal ulcer were studied to determine whether some particular personality and psychological factors are associated with this disease. To this purpose the Cattell's PF 16 personality Test was utilized. Duodenal ulcer population presented a typical personality profile characterized by: high anxiety, dependence and introversion. Some biological parameters, suggested as predictors of slow healing and/or relapse of ulcer, were studied: patients with maximal acid output greater than 60 mEq/h and /or total serum pepsinogen greater than 109 micrograms tyr/ml/24 hrs and/or serum pepsinogen group I greater than 99 ng/ml showed an anxiety level significantly higher than that of patients with values less than the reported thresholds. These results suggest a contributory role by psychological factors in duodenal ulcer disease. The association of anxiolitic drugs to the traditional antiulcer therapy may be proposed, particularly in hypersecretors.

The authors propose a method of quantitative evaluation of excessive diurnal sleepiness intensity. They perform in each patient a 45-minute polygraphic examination to evaluate the occurrence of manifestations of wakefulness as well as all forms and stages of sleep, together with their latencies and total durations. In this way it is possible to describe the patients' sleepiness both quantitatively and qualitatively. The above test was used in the study of 8 healthy controls, 8 patients with narcolepsy-cataplexy, 8 patients with idiopathic hypersomnia and 8 patients suffering from the syndrome of hypersomnia with sleep apnea. All three groups of patients differed significantly from the control group showing deeper sleep stages of shorter latency and longer total duration. The three groups of patients differed also in some aspects from each other.

Since the "Wandervogelbewegung" (german youth movement), there has been a formation of youth movements in all industrialized countries throughout the 20th century. They may have different aspects, but they have a mutual concern: Youth movements are the expression of countercultural trends. The sensibility regarding social conflicts is increased during puberty, youth is therefore particularly ready to accept to be employed against existing cultural trends and for humanization of the computer society. Youth movements therefore must be understood as a cultural self-healing attempt of industrialized societies.

We have recently observed 11 cases of thalamic hematomas. 5 of them (3 left and 2 right) were submitted to a detailed neuropsychological examination. All hematomas were mainly limited to the thalamus and the internal capsula without significant invasion or compression of surrounding structures. The level of consciousness was usually good. 4 of the 8 patients with left-sided hematomas showed dysphasia and the 3 patients submitted to a detailed neuropsychological examination suffered also severe and persistent mnesic disturbances (verbal and non-verbal). On the other hand, the two patients with right thalamic hematomas presented on neuropsychological testing non-verbal mnesic disturbances and features indistinguishable from right parietotemporal cortical lesions. Vital outcome was highly favourable since no patient died. Functional recovery was also rather satisfactory but formal neuropsychological testing of memory, language and right cortical functions showed significant persistent deficits at time of follow-up in most cases examined. Relevant literature is reviewed and possible pathogenetic mechanisms are discussed. Among various hypothesis concerning neuropsychological impairments, dysfunction of a specific alerting system appears the most seducing possibility but does not explain all observed deficits.

Intergroup-comparison and hierarchical cluster analyses (method Lance and Williams, x2-test, t-test, p less than 5%) of 170 facts at biological, psychodynamic and social level in 35 patients suffering from anorexia nervosa and 30 patients suffering from postpill-amenorrhea confirm the close relations of these levels for aetiopathogenesis. Postpill-amenorrhea can be taken as hypothalamic dysfunction (overpressing of LH-RH-release after anticonceptives) and therefore as a model for the biological disturbance at anorexia nervosa. Cluster analyses resulted in a division into 3 groups: one group of anorexia nervosa (C) with deep biological disturbances; a main group of anorexia nervosa (B) and the group of postpill-amenorrhea (A). In cluster C are combined early age of onset, rigidity-type in hormonal tests, EEG-changes, psychopathic personality in MMPI and strongest disturbed social interactions. In cluster B are neurotic profile in MMPI combined with severe biological and social difficulties. 13 out of 30 showing anorectic-like behaviour during adolescence are even more disturbed as the other postpill-amenorrhea patient in cluster A. Regressions analyses could not confirm a dependence between loss of weight and some endocrine functions.

In this paper we hope to share our experience in developing socio-psychiatry in our regional practice, the Zurich Oberland with its 160,000 inhabitants most of which are rural and suburban. Following government's rules the Psychiatric Center Wetzikon started in 1979 with an outpatient clinic, a day clinic and a geropsychiatric aid service. The ways of introducing this new program into an already existing network of social aids are explained. Sociopsychiatric patients need help in 3 fields: Housing, working and therapy. The different activities and forms of therapy used in the Center are shown, but also what lacks in psychiatric primary care: a psychiatric emergency and crisis intervention service, a night clinic and protected working places, part of it being planned now. Our Center fulfills of duties at once: Psychiatric outpatient clinic for examination and treatment of mostly intra-psychic disturbances and furthermore sociopsychiatric ambulatory where extrapsychic troubles related to the patients social surroundings is being dealt with. To make reintegration of psychiatric patients easier we use a form of indirect care by which the lay-helper's stress capacity and understanding is developed so that his help becomes more effective in the end.