Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

Three cases are presented to demonstrate the diagnostic value of sensory neurography in combination with somatosensory evoked potentials in the diagnosis of proximally located neuropathy and its differentiation to centrally located demyelinating processes. Simultaneous recording of cortical and spinal evoked potentials, as well as peripheral nerve action potentials, revealed in two cases (herpes zoster, Guillain-Barré syndrome) a site of lesion at the spinal roots suggesting radiculitis and in one case (tick bite) a site of lesion central to the source of lumbar evoked potentials suggesting myelitis. In all cases almost complete recovery of sensory conduction velocities suggests a complete repair myelination not previously described.

Within the framework of a large and ongoing study of depression in its biological, clinical, psychological and social aspects, 141 patients of both sexes in the age range 21 to 65 years participated in a study of parental rearing practices and personality characteristics. The perceived parental rearing behaviour was assessed by means of a specially constructed inventory (EMBU), and the personality characteristics by means of a Swedish personality inventory, the KSP, which had previously been shown to measure relatively stable personality characteristics. Several important correlations emerged between parental rearing practices and personality traits. In particular, power assertive practices and psychological types of discipline (shaming, guilt-engendering) showed significant correlations with aspects of aggression and significant negative correlations with socialization. There was a good agreement between male and female patients in the judgement of the rearing behaviour of their fathers. However, female patients scored their mother as more abusive, whereas male patients scored them as more over-protective. On the whole, the rearing practices of the mothers were judged more negatively than those of the fathers. The findings of this study appear to be consistent with earlier results reported by other authors.

The question of the potential aggressiveness in families of schizophrenics in relation to the danger of relapse was investigated (schizophrenics n = 40, ICD and AMDP selection). The aspect of subjective intrapsychic coping with the aggressive potential in families was operationalized by 12 self-ratings divided into 3 categories: extrapunitive attitude, intrapunitive attitude, experience of divergency. Analysis of variance showed that there was no significant relation between the 3 categories and the relapse quote. The claim following "expressed emotion" research which would have indicated different results was not supported by investigating the patients' subjective experience. Within the framework of our results various rehabilitation strategies and potential shelter functions in the families are discussed.

CSF/serum albumin and immunoglobulin G ratios were determined in 520 patients suffering from various neurological diseases. Blood-brain barrier impairment was detectable in most cases of spinal tumour, meningitis, Guillain-Barré syndrome and in two-thirds of the patients with cerebral infarctions. A local IgG formation in the CNS has to be assumed for some cases of meningitis considering the course of the protein dysequilibrium. Autochthonous IgG production together with a barrier dysfunction was found in patients with encephalitis, meningoradiculitis and neurosyphilis. In cases of multiple sclerosis local IgG formation in the CNS was the predominant finding.

The case of a patient with occlusion of the external carotid artery is reported; he suffered from vertebrobasilar insufficiency with Wallenberg's syndrome. Arteriography showed stealing of intracranial blood from the vertebral artery via the occipital artery, and thromboendarterectomy was successfully performed. Since no localised processes could be demonstrated could the lateral medullary infarction be due to the haemodynamic changes? In cases of external carotid steal thromboendarterectomy might be the appropriate treatment.

A total of 437 acute psychiatric inpatients were investigated with the help of a questionnaire containing DSM-III diagnostic criteria for schizotypal as well as for borderline personality disorder and criteria of the Flexible System for the diagnosis of schizophrenia. All patients were also independently diagnosed according to the ICD-9. The clinical ICD-9 diagnoses were compared with the diagnoses given on the basis of the three operational criteria sets mentioned. Patients fulfilling the operational criteria for schizotypal personality disorder were clinically diagnosed as mostly schizophrenic, and there was also a considerable overlap between the two groups of patients, those fulfilling the operational criteria for schizotypal personality disorder and those fulfilling the criteria of the Flexible System for the diagnosis of schizophrenia. Schizotypal personality disorder does not seem to be a clinical entity in the sense of a traditional personality disorder. The majority of patients diagnosed as borderline personality disorder received a clinical diagnosis of a personality disorder. The DSM-III criteria of borderline personality disorder discriminated satisfactorily against schizophrenia as diagnosed by the Flexible System and as diagnosed according to ICD-9. On the other hand, there was no relationship between the borderline personality disorder diagnosis and any single of the ICD-9 personality disorder types. The patients fulfilling the criteria of the borderline personality disorder were equally distributed across all ICD-9 personality disorder types. They were also significantly younger than both the non-borderline and the ICD-9 personality disorder patients. The relationship between borderline personality disorder criteria and age might thus be of a greater relevance than the relationship between these criteria and a clinical type.

The relationship of L-DOPA plasma level, parameters of ERG and severity of extrapyramidal symptoms after a single dose of L-DOPA was investigated in 11 patients suffering from parkinsonism of idiopathic or arteriosclerotic origin. After a drug-free night, each patient received his/her usual morning dose of L-DOPA. In the subsequent 3 h, the ERG recordings, blood levels and clinical ratings of extrapyramidal symptoms significantly dropped after a delay of 60 min in relation to the occurrence of the peak plasma L DOPA level. The initial "b" wave amplitudes as well as initial serum potassium values were abnormally high. There was a statistically significant correlation between the decrease of "b" wave amplitude (delta "b") and the potassium "normalization index" (i.e. the ratio between the observed decrease of serum potassium and the pretreatment difference from the middle normal potassium value). A definite interpretation of the data cannot be provided until more knowledge about the origin of "b" wave of ERG is available. It can be concluded tentatively that dopaminergic processes influence electrophysiological reactivity of the retina.

Cisternal CSF specimens were obtained from 144 fasted individuals free from organic brain disease (42 males and 102 females; mean age 41 +/- 10.3 years, range 16-69 years). In 30 cases a simultaneous lumbar puncture was also performed. The concentration of CSF glucose (G1) was measured by the o-toluidine method, and that of lactate (La) and pyruvate (Py) by enzymatic tests. No significant difference was found between the mean G1 and Py values of the lumbar and cisternal CSF but the lumbar La was somewhat higher than the cisternal one (P less than 0.10). In the cisternal CSF the frequency distribution of G1, La and Py samples was a Gaussian one (P less than 0.05). The normal ranges, as mean +/- 2SD, were for La 0.680-2.100 mM/1, and for Py lower limits of the range (between mean +/- 2 SD and mean +/- 1 SD) are considered to be potentially pathological. No significant difference was found between the mean G1, La and Py values in males and females. Consistent age-related changes could not be detected either in the G1 or Py levels, however, a tendency for La increase was observed in the oldest-age-group (over 54 years). A negative correlation was found between the G1 and La concentrations of the cisternal CSF (r = 0.375; P less than 0.001).

Neurophysiological examinations of brainstem functions before, during and after selective interventional neuroradiology i.e. selective intraarterial thrombolytic therapy of an acute occlusion of the basilar artery are reported. The success of the therapy was demonstrated by the reappearance of normal somatosensory potentials and of the blink reflex immediately after the thrombolysis. The BAEPs were continuously recorded during the thrombolysis. Normalization of the latencies and of the interpeak latencies at a very early stage of the therapy indicated the improvement of brainstem functions.