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

108 cases of spontaneous intracerebral haemorrhages (SICHs) are reviewed. Over 50% were in a mild condition on admission. 31% could not be accurately diagnosed as SICHs before CT. Intraventricular haemorrhage (IVH) was observed in 38%. 36% of cases died during the first month and 13 patients died during the follow-up period. At the time of the follow-up or of death 66% of cases had a fair recovery. Level of consciousness predicted both mortality and functional recovery. Degree of initial neurologic deficit (IND) was correlated with functional recovery, not significantly with immediate mortality. CT images revealed that mortality and functional recovery were significantly correlated with size and location of SICHs as well as with the occurrence of an IVH involving two or more ventricles. Effects of intraparenchymatous haemorrhage and IVH upon mortality were additional. Casting of the third ventricle was indicative of poor outcome.

The concept of the borderline syndrome is briefly discussed in the light of recently published surveys. In the author's view, the concept as formulated by Benedetti can be usefully applied in the European context. The pictorial creations of borderline patients reveal with striking clarity the general and essential features associated with this polymorphous psychopathological concept, despite its variable symptomatology. Referring to examples drawn from extensive collections of drawings by two female patients, the author demonstrates that existential suffering is definitely a major theme in this expressive work.

Since the turn of the century the practice of general upbringing has been shaken by a number of authority crises. In this field a new way is currently being paved in the comprehension of education in which the authoritative powers are limited to two directions: on one hand to discussion (discourse) between equal partners and on the other hand in counselling that neither binds nor obliges. Authority lies between discussion and counselling: it must materialize as a social, communicative and identity-promoting competent form of action.

In the democratic industrial society authority is no longer granted by birth, social status or office, but must be deserved time and again. Authority calls for flexibility, the ability to change between conscious integration into the team on the one hand and initiative combined with independence on the other hand. Conflicts have to be solved in a productive fashion. The superior or the teacher should overcome disturbed relationships by discussions. He should create conditions for successful cooperation and for learning by success. His staff must be given the opportunity to develop initiative and independence. In order to achieve this goal the person in charge must be capable of accepting solutions different from his own.

The definition of the notion "integrated therapy" is given referring to the tasks of general medicine. The differences between the work of the family doctor in comparison with a specialist is given. Case histories illustrate in which way the treatment of psychic or psychosomatic disorders on a somatic base can facilitate the approach to the underlying problems and which advantage given a simultaneous or alternative somatic and psychic treatment.

A Central Nervous System (CNS) acetylcholine receptors involvement in Myasthenia Gravis (MG) has been suggested but never fully demonstrated. On the other hand, although the question concerning the neurotransmitters connected to REM sleep is still unsettled, the importance of acetylcholine as a neurotransmitter involved in the maintenance of this sleep stage has been outlined. The spontaneous night sleep organization has been studied in 9 male subjects with MG and results are compared with those obtained in normal subjects matched for age and sex. Statistically significant differences have been found: 1) slow-waves sleep better represented in MG patients; 2) average REM period length shorter in MG patients; 3) instability of the EEG consisting in a tendency toward lightening of sleep. These findings may confirm the presence of a disturbance in the CNS cholinergic activity of MG patients.

The author proposes to make explicit various models underlying psychoanalytic epistemology. This is done in the spirit of enhancing dialogue with other epistemologies such as the theory of systems. Three main models are discussed: --the scientific model, based on the understanding of phenomena characterized by a splitting between object and subject according to the tradition of natural sciences; --the hermeneutic model, which proposes a search for meaning; --the intersubjective model, which centers all knowledge on the interrelation between analyst and patient. Crucial characteristics and drawbacks of these models are discussed; their necessary complementarity is presented.

For evaluation of the possible effect of Carbamazepine (CBZ) in the treatment of endogenous affective disorders 15 patients with manic-depressive illness including 2 cases in the manic and 13 cases in the depressive phase were studied in an open controlled clinical trial. Blood-levels of CBZ were determined weekly. Clinical response was measured by using different psychopathometric methods (SPES, AMP, HAMD, B-S [v. Zerssen], Beck-Inventory). In the two cases with dominant manic syndrome we observed good regression of psychopathological symptomatology during the first week of the treatment. In the same way good therapeutic results were found in the group of depressive patients. In 11 cases we observed improvement already in the first days of the treatment. There did not exist a defined correlation between blood-levels of CBZ and clinical responses of the patients. Side-effects were rare and disappeared during the further treatment after some days.