Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

Disulfiram is known to produce toxic encephalopathy and peripheral neuropathy. The case of a 37-year-old alcoholic who attempted to commit suicide by taking 22.5 g disulfiram is described. During the first 6 days after the intoxication he was stuporous and had cerebellar ataxia and dysarthric speech. Then he became comatose, and as he recovered from coma, he showed peripheral neuropathy including diplegia faciei and severe tetraparesis. Denervation potentials were detected in both facial muscles and distal muscles of the upper and lower limbs, while conduction velocity was normal. Axonal degeneration was verified by sural nerve biopsy. In addition neurofilamentous axonopathy was documented. The recovery from his paresis lasted 2 years.

Muscle biopsies were carried out on five patients affected by a chronic neuromuscular disorder, mostly in the form of a spinal muscle atrophy. All patients had suffered from acute trichinellosis many years before, the interval between acute parasitic infection and the appearance of the slowly progressive neuromuscular syndrome being of 21, 13, 35, 26 and 16 years respectively. In biopsy specimens, morphological and enzyme-histochemical changes typical of a progressive neurogenic muscular atrophy were present; in addition, encapsulated but still living, enzyme-positive parasites and signs of focal myositis were detected. The possible pathogenetic correlations between the "chronic" trichinellosis and the "degenerative" neuromuscular disorder are discussed.

The brains of 34 patients at the chronic stage of acute carbon monoxide poisoning (CO poisoning) were examined using computerized tomography (CT). Ventricular and sulcal dilatations were measured quantitatively, with picture analysis of CT for the measurement of ventricular dilatation. Significant ventricular and sulcal dilatations were found in all cases of the CO group compared with age-matched controls, and bilateral low density areas in the globus pallidus were seen in 9 of the patients. There were significant correlations between duration of initial unconsciousness and the ventricular dilatation or cortical atrophy. Such dilatations were considered to be due to the cerebral damage in the acute stage.

The study reported in this article is part of a larger investigation of life events and depression approached from a multifactorial point of view. In total 83 patients, participating in a larger study of depression, have also participated in a study of parental rearing practices and of life events in relation to the onset of depression. From these patients information has also been obtained concerning the loss of a parent before the age of 15. In the present study patients (n = 33) who had been reared by rejecting mothers have been compared for the report of life events with patients (n = 28) reared by fewer stressful events than stimulated patients before becoming depressed. The results supported this hypothesis to some extent. In fact, the rejected patients reported that they experienced fewer events, however categorized than the stimulated ones. In this series 11 patients had lost one parent before the age of 15. No significant or otherwise consistent differences were found compared with those patients who had not lost parents during childhood. The results related to rearing practice are discussed in terms of individual vulnerability. Alternative explanations are also mentioned.

Anxiety and depression were assessed with self-rating and observer-rating scales on admission and at discharge in 225 inpatients with hebephrenic, catatonic, paranoid or residual schizophrenia. The control subjects were 104 patients with endogenous depression and 63 with anxiety neurosis. The results were also compared with findings for a reference group of 2493 inpatients with a wide range of psychiatric disorders and a representative sample of the general population consisting of 1952 persons. On admission the group of schizophrenic patients was markedly more anxious than the group of healthy persons, slightly less anxious than the psychiatric reference group and much less anxious than the group with endogenous depression and anxiety neurosis. Anxiety correlated significantly with acute paranoid symptoms, whereas depression dominated just prior to discharge, when the acute symptoms had subsided. This indicates that anxiety is a consequence of the underlying schizophrenic disorder and also that the psychotic symptoms may not be a defense against anxiety.

The 21 HLA-A and -B antigens were typed in 38 patients with the senile form of Alzheimer's disease and 301 healthy individuals. No statistically significant difference was found in the frequency of HLA antigens after correction of P.

The present article describes a patient with ischemia in the vascular territory of the posterior inferior cerebellar artery, who developed, in addition to other typical signs of the dorsolateral medulla oblongata, myoclonic movements of the ipsilateral vocal cord. The essential neuropathological lesion is considered to be an impairment of the dentato-olivary system. In this respect there is a close relationship to other types of rhythmical myoclonus due to lesions of the brain-stem and cerebellum.

Among 11,136 psychiatric patients admitted between 1977 and 1982 14 cases of initially unrecognized severe head injuries were originally admitted for psychiatric disorders in connection with alcohol abuse. While the overall incidence at 0.13% was low, this figure increased for the 1310 alcoholic patients of this period to 1.06% and 2.1% respectively, depending on the ready availability of computerized tomography. Plain skull X-rays showed fractures in only 2 patients and in 6 cases trivial head injuries indicated a more severe trauma. In the lucid period 2 patients talked of having fallen. Information from relatives revealed in 10 cases that the patients had had a fall, the majority during an epileptic fit in a predelirant state. Five patients underwent surgery on the day of diagnosis, 4 patients died before a correct diagnosis could be made. The avoidable factors contributing to death included above all, the failure to recognize an extracerebral hematoma.

A program for the training of perceptual speed and attention with a duration of four weeks was developed and given to thirty brain damaged patients. In order to evaluate a possible generalization effect of the training all subjects were tested three times, i.e. at the beginning of the training, after four and after eight weeks with a series of 16 standardized psychometric tests. These comprised tasks which closely resembled the training procedures as well as tasks testing psychomotor functions in a broader sense and even tasks of reasoning and other intellectual functions. To test the different effects of training, spontaneous recovery and test repetition an experimental design with two groups of patients and two control groups was necessary. Only the groups of patients showed a significant and marked improvement in all tests which could neither be explained by spontaneous recovery nor by test repetition. The training effect proved to be stable after four weeks. The most marked improvement, however, was seen with those tasks most closely resembling the training procedures; in no case the performance level of the control groups was reached.

Circumscribed defects in the elastic lamina as a possible cause of intracerebral hemorrhage are reported. The abnormality was present in the right middle cerebral artery of a 24-year-old women. The patient died of large intracerebral hemorrhage which extended into the lateral ventricle on the same side and to the subarachnoid space. In the absence of vascular malformation and secondary degenerative changes attributed to hypertension these defects of the internal elastic lamina associated with the rise of the blood pressure appear to lead ultimately to bleeding.