Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

In 15.3% of 295 hospitalized suicide attempters (94% with intoxication) severe intoxication that would have had a lethal outcome without medical treatment was significantly associated with previously described factors characterizing persons who committed suicide. A strong death wish (47.3%), as judged by physicians, was highly associated with almost the same factors. A high degree of physical harm and a firm intention to die correlated significantly with the intensity of care during hospitalization and after discharge from the emergency unit.

Phenylethylamine (PEA) is an endogenous substance with amphetamine-like stimulant properties. On the basis of this ability an abnormal brain PEA metabolism has been proposed as an etiological factor in some forms of schizophrenia. In the present study 28 schizophrenic patients and 15 healthy controls were investigated. No significant difference from control values was found in PEA concentration in cerebrospinal fluid (CSF) of either untreated of neuroleptic-treated schizophrenics. However, 2 schizophrenics with highest BPRS scores had extremely high PES concentrations. Free phenylacetic acid (PAA), the major metabolite of PEA, was significantly decreased in ummedicated but not in drug-treated schizophrenics. Because of the assumed neuromodulatory properties of PEA, it is suggested that lowered PAA concentrations and the tendency for PEA to be elevated may imply that altered central neurotransmission occurs in certain forms of schizophrenia.

In 33 normal subjects aged between 15 and 60 years, the cortical somatosensory evoked potentials (SEP) recorded above the mastoid process, HWK2, LWK1, and the nerve action potential above the poplitea were examined following single stimulation of the tibial nerve at the medial malleolus. There is a correlation between size and N1, P1 latencies of the cortical SEP, but no relationship was found between age and N1, P1 latencies. The spinal conduction velocity determined as the difference between HWK2 and LWK1 did not show any correlation with age. The double stimuli examination showed a rise in the N1, P1 latencies within the relative refractory period on shortening of the interstimulus time. The cerebral relative and absolute refractory times were higher than those of the median nerve.

The incorporation of labelled carbon from glucose U-14C into CSF amino acids was investigated in three patients with Parkinson's disease and in three control persons with comparable age and physical stature. Comparing the specific radioactivities of serum and CSF one can postulate that the labelled amino acids found in the CSF are synthesized mainly by brain tissue. The resorption of glucose into the CNS and therefore the synthesis of amino acids from glucose was more rapid in controls; labelled alanine and glutamine appeared later in the CSF of the patients. As expected, in the controls the specific radioactivity of glutamic acid was found to be higher than that of glutamine, in patients the labelling of glutamine was higher as was that of serine, glycine, aspartic acid and asparagine. From our knowledge concerning the compartmentation of the metabolism of glutamate, we assume that in Parkinsonism the metabolic activity of neurons is reduced but that of astroglia is enhanced.

Slow brain potentials, evoked potentials and autonomic responses were investigated in anhedonic subjects and controls. The distribution of physical anhedonia (PA) scores from different samples (students, soldiers, schizophrenics, depressives) is compared. Within a S1-S2 reaction time paradigm, an additional, S2-similar stimulus was introduced during the anticipation interval in 50% of trials (pseudorandom). Subjects had to press the button only to the S2. The additional stimulus (AS) elicits a distinct positive deflection. Anhedonics show larger pre-AS negativity and less reduction in negativity after the S2 (PINV) than controls. The slow wave to S1 as well as the pre-AS negativity vary with the conditional probability of the AS, but to a lesser extent in anhedonics. Anhedonics provide more preparatory negativity prior to and following ambiguous or difficult discrimination tasks, but at the frontal site. Results may suggest impaired contingency evaluation in anhedonic subjects.

Compared to normals, groups of inpatients with unipolar and involutional depression show a higher proportion of consistent right-handers, whereas bipolar patients do not differ from normals. All patient-groups show a clearly higher proportion of persons with a "dominance" of the right thumb when habitually clasping the hands or fingers. The variables "eyedness" and "familial sinistrality" do not show significant differences between groups. When drawing geometric figures in a bimanual-coordinated fashion, all patient groups demonstrate a prevalence of simultaneous counter-clockwise drawing with both hands, whereas normals overwhelmingly prefer a discordant mode of drawing, the left hand acting counter-clockwise and the right hand clockwise. We interpret this behavior in depressives to be an expression of an interhemispheric functional relationship in which the left hemisphere is subordinated to the right hemisphere.

Tests that have rarely been used up to now in the psychomotor examination of psychiatric patients have been put together in accordance with our preliminary investigations to form a broader, standardized battery. With this new battery, which consists of the motorische Leistungsserie, a modified version of the Lincoln-Oseretzky motor development scale and the motor subtest of the Luria-Nebraska neuropsychological battery, a study has been carried out on 15 schizophrenics not actually treated with drugs, 15 endogenous and 15 non-endogenous depressed persons and 15 healthy controls. With the results of such a psychomotor "profile", measured over all items, psychotic patients can be clearly separated from the non-endogenous depressed patients and healthy controls. No significant differences have been found between non-endogenous depressed patients and healthy controls. These results are basically in agreement with many single findings in the literature. Results based on a broader battery for the investigation of psychomotor abilities in psychiatric patients could be of value in difficult differential-diagnostic problems and ought therefore to be studied further. In addition, the movement disturbances in psychotic patients, which have been measured by a broader standardized battery, could be the starting point in the development of specific psychomotor training programmes, which could improve the efficiency of conventional gymnastic and ergotherapeutic treatment methods. In this direction too, further studies would be useful and are indicated.

To examine the validity of the syndrome scales of the AMDP system, various diagnostic groups as defined by the ICD were described by these scales and distinguished from each other by discriminant analyses. As a comparison the same diagnostic groups were distinguished using the syndrome scales of the AMP system. The analyses using the AMDP system were performed in a sample of 659 patients of the Psychiatric Clinic of the Free University of Berlin during 1979-1980, the analyses with the AMP system in a sample of 2269 patients of the same clinic during the period 1971-1976. It could be shown that different endogenous and organic psychoses as well as neuroses can be described in their psychopathology and discriminated from each other by means of the syndrome scales of the AMDP system. The validity of the syndrome scales in relation to this criterion could be proved. Moreover, we found a high similarity between the results with the AMDP system and the results with the AMP system, which demonstrates that the two systems compare well.

Organic brain syndromes among the elderly have been studied prospectively in a total population during the 25-year period 1947-1972. The population (2,550 persons) originates from a geographically delimited area in southern Sweden (Lundby). The original population has been followed for 25 years irrespective of domicile. A comparison of incidences for the first 10-year period (1947-1957) and the second 15-year period (1957-1972) shows a decrease in organic brain syndromes in the population concerning multi-infarct as well as senile dementias.

It is assumed that established antidepressants exert their clinical efficacy by potentiation or decrease of central noradrenergic and serotonergic neurotransmission. However, recent experimental work suggests that antihistaminic and/or cholinolytic effects may also be involved. This double-blind controlled study compared amitriptyline (catecholamine potentiating, antihistaminic, cholinolytic) with promethazine (antihistaminic, cholinolytic) in 50 severely depressed inpatients over a 30-day treatment period. Analysis of the Hamilton depression rating scale revealed significant clinical superiority of amitriptyline over promethazine in such major depressive symptoms as depressed mood, suicidal ideation, psychic anxiety, and sleep disturbances. No significant difference was evident as far as autonomous side effects were concerned. Similar results were found by analysis of the AMP rating system. It is concluded that antihistaminic or cholinolytic effects per se do not explain the antidepressants' efficacy. However, potentiation of noradrenergic neurotransmission by cholinolytic activity might be the major antidepressive mechanism.