Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

The purpose of the study is to discover whether there is an association between changes in the psychiatric services offered by the largest psychiatric hospital in Iceland during the period 1955-1978 and changes in the rate of suicide. Marked changes occurred in the services after 1965. The rate of suicide in the patient population was significantly higher during 1965-1978 than during 1955-1964. It is concluded that the changes in the psychiatric services are associated with an increase in the rate of suicide and that this increase may to some extent be a side effect of therapeutic methods introduced after 1965. The conclusion is thought to imply the necessity for further evaluation of those therapeutic methods as applied in the hospital and increasing the application of measures for the prevention of suicide.

The CT findings of 73 patients with spontaneous and traumatic intracerebral haematomas are described. The course and pattern of resorption of the bleeding is evaluated. It is shown that the resorption of all haematomas is terminated by the end of week 7 independent of their maximum diameter. Only smaller haemorrhage of less than 2 cm can be resorbed in a shorter time. Moreover, the underlying pathophysiologic mechanisms of faster resorption of bleeding located in the basal ganglia and the neighbouring white matter are discussed. The CT findings revealed no clear-cut characteristics for differential diagnosis of the etiology of haematomas, but proved very helpful in defining the prognosis.

A total of 27 different amino acids were determined in the fasting, morning lumbar CSF of 12 patients with Huntington's Disease (HD), 8 at-risk offspring and 16 non-choreic control patients. A significant (P less than 0.001) decrease was observed for asparagine, isoleucine, leucine, phenylalanine, histidine, arginine, alpha-aminoadipic acid and homocarnosine in patients with HD compared to the non-choreic controls. Only tyrosine was increased in HD. These alterations were to an extent more pronounced in 5 neurophysiologically conspicuous offspring. The alterations suggest that amino acid imbalance is an early metabolic disturbance in HD.

This study is concerned with the diagnostic process of psychiatrists. Two concepts are investigated; the internalized nosological theory and the psychiatric diagnostic scheme. If patients or diseases are judged on predefined lists of symptoms (e.g. AMDP-list), we assume that judgments are based on the first one. If the psychiatrist, however, is free in the choice of relevant attributes in judging patients or diseases, we assume that his judgments are based on his individual diagnostic scheme. Results show high agreement in internalized nosological theories, but strong individual differences in diagnostic schemes. Interindividual agreement in internalized nosological theories is still greater than intraindividual agreement between diagnostic scheme and nosological theory. This proves that distinguishing the two concepts is meaningful. Structural components of both concepts, e.g., their dimensions, pregnant structures, and their metric, were analyzed by multidimensional scaling. We assume that the psychiatric diagnostic scheme determines the clinical diagnosis in everyday practice, whereas the internalized nosological theory is of importance mainly in research. The differences between both concepts suggest that lists of symptoms are not very helpful in analyzing clinical diagnosis. Thus, in order to achieve greater agreement in diagnosis, further and detailed analysis of individual "implicit" theories which determine the greater part of diagnostic schemes is necessary.

The present experiment was designed to replicate and extend the previous finding of an increased postimperative negative slow brain potential shift (PINV) in healthy subjects following an unexpected change from the condition of control over an aversive imperative stimulus to that of loss of control. Two groups of 16 male students each participated in a constant-foreperiod reaction time paradigm with two warning stimuli (WS), each of 6 s duration, followed by two imperative stimuli (IS) of either aversive (loud noise) or neutral (soft tone) quality. The experimental subjects could terminate each IS by pressing a microswitch within 300 ms of IS-onset. After they had experienced this contingency for 40 trials, control was withdrawn in that the IS lasted for 5 s during another 40-trial block, irrespective of the actual motor response of the subject. The yoked control subjects received the same stimuli and performed the same motor response as the experimental subjects, but experienced no contingency between response and IS-termination. EEGs were recorded monopolarly from Fz, Cz, and Pz. In response to the unexpectedly uncontrollable aversive IS, the experimental subjects showed a pronounced PINV over frontal areas, while no comparable PINV developed in yoked controls. Experimental subjects showed no PINV during the first trial block (control conditions), and in response to the neutral uncontrollable IS. Statistical analyses of principle components documented that the PINV can be considered an independent endogenous component.

Sixty unipolar (23 male and 37 female) patients and 67 patients (25 male and 42 female) suffering from a neurotic-reactive depressive disorder, consecutively admitted to the Department of Psychiatry of Umeå University have participated in a family study aimed at identifying morbidity risks for psychiatric illnesses among first degree relatives (n = 437). Besides the classification of affective disorders used in Umeå for research purposes the patients have been classified, according to the ICD-9, DSM-III, age at onset (below or above 40 years), and the Winokur's classification of primary affective disorders. However, only the findings regarding the Umeå classification and the Winokur's classification are given in the present article. Of the patients 90% fulfilled Kendell's criteria for depression at the time of the investigation whereas the others were in a phase of remission when studied. The diagnosis of secondary cases were made without knowledge of the diagnoses of the probands. Among relatives of unipolar probands only two secondary cases of bipolar affective disorder were found--one among parents, and one among siblings (MR% 1.1 and 0.6 respectively). The overall morbidity risk for affective disorders (MR% 22.8 among parents and 15.5 among siblings) proved to be higher than in previous studies. In the families of neurotic-reactive patients the morbidity risk for bipolar affective disorders was also very low (MR% 1.0 among parents and 0.7 among siblings), whereas the overall MR% for affective disorders proved to be surprisingly high (12.1 among parents and 6.7 among siblings). No increased risk for schizophrenia or alcoholism was found among the relatives of either group. When the relatives were divided according to their sex no clear-cut difference in morbidity risk emerged when fathers and brothers were compared with mothers and sisters but alcoholisms occurred more frequently in male relatives. Preliminary findings in second degree relatives suggest that secondary cases of affective disorders might occur among second degree relatives of patients classified as suffering from "sporadic depression" according to Winokur's classification.

In a case of Whipple's disease the diagnosis was made by careful cytologic evaluation of the cerebrospinal fluid (CSF), identifying "Sieracki cells". A basal granuloma invaded the hypothalamus, diencephalon, and rostral parts of the brainstem. An exploration in the initial stage led to misdiagnosis as a granular cell tumor. Diagnosis was then confirmed by intestinal biopsy.

A case of spontaneous dissecting aneurysm of the right internal carotid and middle cerebral arteries is presented in 13-year-old boy. The pathogenetic factors incriminated in previously reported cases are reviewed and the pathological findings are discussed. The abnormalities of the internal elastic lamina as seen in this patient have been observed in numerous cases of intracranial dissecting aneurysms. It is concluded that these defects play an important role in the development of dissection.

Before treatment 80 unselected patients suffering from delirium tremens were examined with regard to 13 psychopathological criteria. For the data a matrix of correlation was computed and it was factor analyzed according to the principal-component method. In consideration of the course of the value-curve two factors were interpreted. The result, however, is an undetailed classification. In addition to that, the data were cluster-analyzed according Ward. The results of the multivariate statistical analysis admit the assumption of two great, though heterogenous groups of symptoms (hallucination/vigilance). Factor I comprises the symptoms, disorder of orientation and consciousness, sweating, agitation and tremor on its positive pole, the duration of the delirant state on its negative pole. Factor II combines paranoid-hallucinatory symptoms, fearful affects and suggestibility on its positive pole, while on its negative, there are happy affect and grand-mal seizures. The bipolarity of this factor and additional diagnoses show that paranoid-hallucinatory symptoms without disorder of consciousness and grand-mal seizures mutually exclude each other. From this a differential therapy treating patients suffering from paranoid-hallucinatory symptoms with neuroleptics (e.g. Haloperidol) can be deduced, while the danger of grand-mal seizures has to be considered when disorders of consciousness appear.

The Na+, K+, Ca2+, Mg2+, Cl-, and Pi concentrations in serum and lumbar CSF of 17 controls and 62 patients with neuromuscular diseases were determined and the values statistically evaluated. Although alterations in ion concentrations specific to different groups were not observed in either of these biological fluids, the significant increase in serum Pi concentration in Duchenne muscular dystrophy seems to be remarkable. It is suggested that the possible alterations in the ion content of the serum and CSF may contribute additional data to the diagnosis of various neuromuscular diseases.