Archiv Fur Psychiatrie Und Nervenkrankheiten最新文献

We report 9 subjects from 2 families with the syndrome of cerebral gigantism, seven of the patients also had jaw cyst basal cell naevoid syndrome. Neurological, radiological, somatic and biochemical features of this hitherto unreported association are described. Neurological symptoms included mild hydrocephalus, ventricular malformation, cerebellar syndrome, intracranial calcification, oculomotor disturbances, EEG abnormalities and rarely, mild peripheral nervous disorders. A disturbance of calcium metabolism appears to be a prominent feature of the genetically determined nonprogressive syndrome.

The personality characteristics of 208 depressed patients of both sexes were studied by means of a Swedish personality inventory--the KSP--when the patients had recovered from the depressive syndrome. The patients in the study were divided into unipolars, bipolars, neurotic-reactive and "unspecified", i.e. those patients who did not meet the criteria for inclusion in any of the aforementioned groups. Female patients scored higher on variables of anxiety and psychasthenia and male patients scored higher on variables indicating distance preference and hostility. Several traits, in particular those reflecting aggression-out and hostility-out, appeared to be negatively correlated with age, whereas inhibition of aggression appeared to be positively related with age. Bipolar patients scored slightly differently from unipolars in many variables but none of the differences was significant. Neurotic-reactive patients distinguished themselves from the other in variables of aggression-out. Several interrelations between different personality characteristics and aspects of aggression have been investigated. Significant correlation could be shown between aspects of aggression and socialization, impulsiveness and aspects of anxiety. A positive correlation was shown between inhibition of aggression and social desirability, and both variables were shown to correlate with age. It is concluded that the difference in inhibition of aggression between "endogenous" and "non-endogenous" patients found in earlier studies might be due to a difference in age, and to the influence of social desirability.

In rats, probenecid exhibits a dose-dependent increase in the concentration of cyclic adenosine 3',5'-monophosphate (cAMP) in cisternal cerebrospinal fluid (CSF). Maximal accumulation is reached 2 h after IP administration at a dosage of 150 mg/kg body weight. Serum levels of cAMP are unchanged after 200 mg/kg probenecid. In vitro investigations show an inhibitory effect of probenecid on the uptake of cAMP into the isolated choroid plexus of the rabbit. A non-competitive inhibition of probenecid on a high affinity fraction of cyclic nucleotide phosphodiesterase from rat brain homogenates is demonstrated with an inhibitor constant of 3.4 X 10(-3M. The results appear to validate the "probenecid test" for cAMP in clinical diagnostics.

Platelet scintigraphic examination using indium-111 was performed on 12 patients with cerebral ischemia. Of these patients 5 had a history of TIA, 3 had a prolonged reversible neurologic deficit (PRIND), 3 cases were presented with a completed stroke and 1 patient suffered from a suspected venous thrombosis of the sinus sagittalis superior. In total 8 cases showed pathological platelet accumulations in the vessel clinically affected, 5 extracranially and 3 intracranially. In the other 4 cases the platelet scintigraphy was normal. The cases with TIA showed pathological platelet accumulations in the appropriate vessel, even if the angiogram was normal. On the other hand platelet scintigraphy did not show any abnormality in 2 patients with an occlusion of the carotid artery. So platelet scintigraphy might be useful in the detection of small arterial lesions producing small strokes, and which remain undetected by other diagnostic methods.

The implementation of a community mental health service in Mannheim (FRG), a city with 315,000 inhabitants, is being evaluated by means of the data of the Cumulative Psychiatric Case Register at the Central Institute of Mental Health. Within a four-year period of extending services for crisis intervention and emergency care, aftercare (sheltered apartments, homes, workshops) and of providing psychiatric beds in the city, the total number of treatment episodes has increased by more than 100% from about 1.1 to about 2.2 per 1000 inhabitants aged over 14, mainly at the out-patient level of care. Admissions to hospital showed an increase of about 40% whereas bed occupancy remained stable at a rate of about 1.7/1000-respectively 1.3/1000 if beds provided by a psychogeriatric nursing home are deducted. This development can be attributed to various factors: (1) A true increase of morbidity may occur mainly in diagnostic groups I.C.D. No.300, 301, 305-308, especially an increase in attempted suicides and in alcohol- and drug-related diseases. (2) The increased provision of help, mainly on the sector of crisis intervention and emergency care and - in diagnostic categories - mainly in minor neurotic disorders, crises, and affective psychoses, has resulted in a large rise in utilization. (3) The continuous decrease of long-term hospital stays, above all in schizophrenic patients, has led to increased utilization of out- and in-patient services in the community when crises and relapses occurred. A comparison of two cohorts of "old" and "new" patients, the latter having accumulated under the conditions of a community mental health service, has shown that these patients are admitted for a long-term hospital stay considerably later and less frequently than formerly, mostly only after several attempts for rehabilitation. In the group of schizophrenic patients, only about 5% of all first admissions stayed in a psychiatric hospital for more than one year in 1979/80. About the year 1900, this group had still amounted to between 60% and 70%. A comparison with evaluations of comprehensive community care systems in other countries shows that there are largely identical trends, although the initial rate for psychiatric beds was comparably lower in Mannheim.

In this morphological-clinical analysis it was possible to study the clinical and angiographical results of extra-intracranial bypass in a continued series. Small changes in management result from the indications in the groups with TIA's and completed strokes. Preoperative angiographical findings allow determination of the most favourable bypass-feeder taking into consideration age and morphology. From the postoperative dilatation of the donor artery conclusions may be drawn as to the indication for operation with respect to the angiogram and the choice of the branch of the superficial temporal artery.

The visual disturbances of 45 patients following open heart surgery could be divided into disturbances of (1) visual acuity, (2) visual accuracy, and (3) visual reality testing. The non-hallucinatory phenomena consisted mainly of loss of colour vision, metamorphopsias, visual gnostic disorders and cortical blindness. The hallucinatory phenomena could be divided into the delirium type of hallucinations with clouding of consciousness and the spectator type of hallucinations with a clear sensorium. The causes of the visual symptomatology and cardiac psychoses are seen in microembolization and/or ischemic hypoxia. The basal ganglia and the occipital lobe are areas of predilection for embolic and hypoxic changes. Identical psychoses also occur in cerebral malaria and polycythemia vera which show the same embolic and anoxic neuropathological changes of vascular occlusion as do many patients who die following open heart surgery with extracorporal circulation.

The case is described of a 35-year-old housewife diagnosed as having membranous lipodystrophy (as described by Nasu et al. in 1970 and called lipomembranous polycystic osteodysplasia by Hakola in 1972). The main symptom of this patient was a slowly progressive dementia. Skeletal symptoms were not seen. The computerized tomogram of the brain showed calcification of bilateral basal ganglia and the plain roentgenograms of the bones revealed cystic radiolucent areas at the distal end of the bones of the patient's extremities. Histological examination of the curretted material from the right talus revealed fa 'membranocystic' pattern. The fatty tissue curetted from the cyst of the talus and the lysosomal enzymes of the white blood cells were biochemically normal. A possible relationship between this disease entity and connective disorders is considered.

From 1973 to 1974 research psychiatrists studied 1,274 patients in general practices in the county of Traunstein (FRG). On the basis of an interview developed by Goldberg et al. (1970), it could be shown that objective symptoms registered by the interviewers generally differentiate better between cases and non-cases than do subjective symptoms. According to the weighting suggested by the developers of the interview, singly weighting the subjective and doubly weighting the objective symptoms, a total score was compared with the psychiatric diagnosis made by the interviewer. At a cut-off of 20 points, the overall agreement reached an optimum of 83.1% and increased only slightly due to a-posterior weighting of the items. A cluster analysis of the symptoms showed that patients demonstrate significantly different combinations of symptoms according to the nature of their mental disorder.

In a 5 year follow-up study of 81 patients suffering from schizophrenic or similar psychoses many of the predictors known from the literature concerning the outcome of schizophrenia were confirmed. In accordance with the results of the follow-up study on patients from the International Pilot Study of Schizophrenia (IPSS), long lasting professional disintegration and psychiatric hospitalisation preceding index-admission were of special prognostic importance. However in contrast to this follow-up study, other psychopathological data, especially minus symptoms proved to be of considerable prognostic significance. As a result of stepwise multiple regression analyses, combinations of the 5 best characteristics for each outcome-criterion have been found which explain a significantly greater part of the variance than single characteristics.