Psychiatric developments最新文献

We are reporting about the stability of n = 218 female in-patient treatments of Anorexia nervosa carried out at the University Clinic at Hamburg-Eppendorf from 1965 to 1979 mainly by a special program: introductory interview (with the family present), in-patient medical treatment (bed-rest, phenothiazines, tube-feeding), strict regimen and addressing the patients' conflict situation. The average interval between the end of therapy and the follow-up examination was 9.8 years. We were able to collect data about 93 per cent (n = 202) of the former patients concerning their somatic, psychological and psychosocial status. Based on these data we could assess 30 patients (14 per cent of our basic sample) as free of symptoms while 84 patients (39 per cent) presented slight symptoms so that 53 per cent of the former patients could exercise their profession without being considerably handicapped and able to keep up a relationship with a partner. On the other hand, 39 patients (18 per cent) still showed marked symptoms at follow-up and with 19 patients (9 per cent) there were manifestations of severe or extreme symptoms. Thirty former patients (14 per cent) had died with the mortality rate distinctly increasing over the years. Possible interpretations of our results and consequences for therapy are presented.

We have observed increased relative blood flow to the left globus pallidus and evidence for subtle forms of right-sided hemineglect in neuroleptic-naive schizophrenic patients. These findings occur in animals following certain lesions such as unilateral destruction of midbrain dopaminergic neurons, and are presumed to be due to left striato-pallidal hyperactivity. A survey of the literature reveals many similarities between animals with unilateral dopaminergic denervation and schizophrenic patients. It has previously been suggested that available evidence does not preclude the possibility that schizophrenic patients have something like a dopaminergic deficiency. Other studies demonstrate that neuroleptics reverse asymmetries in indices of dopamine turnover. A model based upon dopaminergic hemideficiency is outlined, and can potentially explain other abnormalities in schizophrenic patients including eye movement abnormalities and the link between temporal lobe epilepsy and psychosis. A companion article describes how this model can account for some of the phenomenological symptoms of psychosis.

In recent years it has often been suggested that there is no such thing as mental illness. In naive Cartesianism this assertion starts out from the assumption that illness may develop solely from physical causes. Before clarifying what mental illness is, we should ask what is understood by the general notion of 'illness'. A constituent of the general disease concept is an unvoluntary and sufficiently serious disturbance of vital functions that needs to be defined in detail-and not just any region of disease causes or symptoms. The general disease concept can be defined in the context of everyday life and in the social and legal context and be filled with detailed normative and threshold values in the medical context. A society with a humanitarian orientation responds to the incapacity of its members owing to illness with attempts at institutionalization, which find their expression in norms, privileges and duties. Special disease concepts were developed for defining specific diseases and distinguishing them from others. Since solely the general disease concept, on which the distinction between illness and deviations from moral or legal norms is founded, is aetiologically neutral, it can be filled with any explanation model at the physical or at the mental level in the frame of specific disease concepts: e.g. with the one cause--one disease model, with multifactorial models or behavioural dysfunction models.

The impact of life stress on dreaming continues to be an area of clinical and research significance. Examined is recent research addressing sleep- and dream-related activity within the context of life stress events. Attention to dream activity as a function of maintaining psychological health and the therapeutic issues involved in health maintenance are discussed. Import for further clinical research is explored.

The clinical efficacy of drug treatment for panic disorder has been evaluated in several studies, especially in the last decade. In this paper we reviewed double-blind controlled clinical trials of antidepressants and benzodiazepines in the treatment of panic disorder. Tricyclic antidepressants (principally imipramine) and benzodiazepines were equally effective in reducing panic symptomatology. This evidence does not support the hypothesis that panic-related symptomatology is a psychopathological entity, requiring a specific antidepressant drug treatment. The combination of psychological therapy with drug treatment was associated with even better outcome. On the other hand, the efficacy of MAOI remains to be demonstrated. Better compliance with benzodiazepines may favor the clinical use of these drugs rather than antidepressants. However, more prospective controlled studies including follow-up examinations are required, in order to assess the risk/benefit ratio of these treatments after long-term therapy.

For the past 20 years, researchers have been using genetic linkage studies as a tool to better understand the etiology of bipolar disorder. During this time, there have been reports of linkage between the symptom complex of bipolar disorder and 7 genetic markers located on 4 different chromosomal areas. All of these reports continue to be surrounded by controversy causing some observers to consider the field to be ambiguous and contradictory. This review provides some historical perspective on the controversies, while outlining the current status and future direction of the field.

This paper examines the nosological and aetiological relationships of panic disorder to the anxiety states and depression. The phenomenology is detailed from an unbiased sample of 90 cases selected, on the basis of meeting positive criteria for panic disorder, from 3 series of consecutive cases. Panic attacks were found to be only quantitatively distinct from non-panic anxiety. Truly spontaneous attacks, not preceded by anxiety-provoking cognitions, were uncommon. No unique association with agoraphobia was seen, other anxiety states and depression being common. Social phobia and generalized anxiety often preceded the development of panic disorder, as did some cases of agoraphobia. Depression was usually non-specific and secondary when only DSM-III MDE criteria were used. Significant neurotic traits were found, particularly anxiety, dependency and poor sexual adjustment. Panic disorder has multiple causal factors only one of which is a genetic tendency for panic attacks. While important therapeutically, panic attacks should not be given the primary place in diagnosis.

A large number of experimental studies on animals suggest that intraventricular administration of NGF to Alzheimer patients may attenuate the degeneration of cholinergic neurons and the behavioral consequences associated with the cholinergic deficits. Based on these findings clinical trials with NGF seem justified, if potential detrimental effects are ruled out. Once NGF administration is proven effective it will be possible to develop alternative ways of NGF administration.

An association between recurrent motor and phonic tics and obsessive-compulsive behaviors has been noted since Tourette's Syndrome (TS) was first described. Obsessive-compulsive disorder (OCD) until recently was considered a rare disorder with poor prognosis. Currently, OCD is considered among the most common psychiatric diagnoses, and new treatments have spurred the development of considerable clinical, epidemiological, genetic, and biological research. Recent studies suggest a high rate of obsessive-compulsive symptoms in Tourette's Syndrome patients. A high rate of OCD among relatives of TS probands, both with and without OCD symptoms, suggest that some forms of OCD may represent an alternative expression of factors responsible for TS and/or chronic motor tics. Areas of conceptual controversy in the differentiation of tics, impulsions, and compulsions are discussed, confusing aspects of differential diagnosis are explored, and the relationship of diagnostic issues to clinical and familial studies are highlighted. There is considerable evidence for neuropsychiatric abnormalities in both OCD and TS; however, no studies have directly compared both disorders with similar methodological design. While studies of neurotransmitter function have primarily implicated dopaminergic dysfunction in TS and serotonergic function in OCD, other systems may be involved in each disorder, and neurotransmitter systems may be tightly linked, such that alterations of one system will affect other systems. This article reviews and discusses some of the conceptual and methodological issues associated with clinical, familial, neuropsychiatric and biological studies attempting to elucidate the association among tics, obsessive-compulsive disorder, and Tourette's Syndrome.

Our previous paper summarized abundant evidence that schizophrenic patients show forms of sensory and motor hemineglect compatible with a left striato-pallidal hyperactivity model of schizophrenia. In this paper we discuss how the model may also account for some of the cognitive and phenomenological aspects of this disorder. Hemineglect can be associated with pallidal hyperactivity through its mediation of the anterior attention system of the frontal lobe. We postulate that this same attentional deficit can also affect higher functions such as the control of language and thought by internal motivations. Many symptoms of schizophrenia can be explained as a form of hemineglect of these higher functions.