An Operationalized Multisymptomatic Model of Neuroses (OMMON): Toward a reintegration of diagnosis and treatment in behaviour therapy

Summary Experimental results from a sample of 216 patients with four different symptom-neuroses show that 65% to 90% of these patients have different combinations of multiple symptomatology.With a background of these data, we present an Operationalized Multisymptomatic Model of Neuroses (OMMON), based on self-rating assessment of these patients on 4 symptom scales. Individual ratings on each scale are dichotomized into (+) or (-) results with regard to defined cut-off points and the model is derived from their 16 mathematically possible combinations. Subsequent analysis of these data (from a single test application) with our Varying Cut-Off Point Assessment (VACOPA) leads to hypotheses regarding causal symptom interactions and prediction of symptom changes over time, easily evaluated by repeated test application.In treatment research the model seems suitable to: (a) build more homogeneous diagnostic groups; (b) operationalize varying degrees of neurotic disturbance, from normal via client to patient—independently of existing illness theories; (c) support prognoses of individual developments within and without treatment; (d) specify treatment aims and optimal sequences of interventions; (e) monitor predicted outcome; (f) reconsider earlier apparently contradictory outcome studies; (g) evaluate theoretical concepts regarding neurotic symptom formations in neuroses, psychoses, and psychosomatic disturbances.For treatment purposes, OMMON should only be used together with clinical hypotheses; its prognostic potential can be increased by additional application of our Operationalized Multivariate Model of Motivation (OMMOM).All three diagnostic approaches may be used for mutual evaluation.Different sections of this paper have been presented to:1. International Congress of Behaviour Therapy, Trondheim/Norway, 19.–22. 8. 19812. The 1st European Conference on Psychotherapy Research, Trier/Federal Republic of Germany, 18.–20. 9. 19813. 2. Kongreß für Klinische Psychologie und Psychotherapie, Berlin, 14.–19. 2. 1982We wish to thank the patients and the Allgemeines Krankenhaus Ochsenzoll for their cooperation, and Profs. F. Kanfer and R. Liberman for valuable comments on a first draft (May 1981) of this paper.     

Cytoplasmic and axoplasmic density variations in relation to hyperactivity

Summary The density of the cytoplasm and axoplasm of the anterior horn cell in rats was determined by X-ray microradiography. The average density of the cytoplasm of more than 400 cells from control rats was 0.31 g/³, while that of over 600 cells from rats fed IDPN (- iminodipropionitrile) was 0.43 g/³.Hyperactivity developed during the first 5 weeks and was associated with a gradual increase in cytoplasmic density to 0.51 g/³.At 6 weeks there was a drop in density to 0.36 g/³ which coincided with the appearance of axonal balloons having a density of 0.17 g/³.During the 7–12th week on the diet, the cytoplasmic density showed a gradual increase to 0.59 g/³ and the balloons to 0.29 g/³.The volume of the nerve cells remained fairly constant. The density increases were discussed in relation to hypertrophy, dystrophy, and hyperactivity.

---

Zusammenfassung Die Dichte des Cytoplasmas und Axoplasmas der Vorderhornzellen von Ratten wurde durch Röntgenmikroradiographie bestimmt. Die mittlere Dichte des Cytoplasmas von mehr als 400 Zellen der Kontrollratten war 0,31 g/³, während die mittlere Dichte von mehr als 600 Zellen der Ratten, die mit IDPN (- iminodipropionitrile) gefüttert waren, 0,43 g/³ war.Hyperaktivität entwickelte sich während der ersten 5 Wochen und war mit einer progressiven Zunahme der Cytoplasmadichte bis auf 0,51 g/³ verbunden.Nach 6 Wochen sank die Dichte auf 0,36 g/³. Diese Tatsache traf mit dem Auftreten der Axonauftreibungen zusammen, die eine Dichte von 0,17 g/³ hatten.Nach 7–12 Wochen zeigte die Cytoplasmadichte eine progressive Zunahme auf 0,59 g/³ und die der Auftreibungen eine Zunahme auf 0,29 g/³.Das Volumen der Nervenzellen blieb ziemlich konstant.Die möglichen Zusammenhänge zwischen Zunahme der Dichte, Hypertrophie, Dystrophie und Hyperaktivität werden dargestellt.

---

---

Supported by U. S. Public Health Grant NB 1305.     

Cognitive functioning in female patients with 21-hydroxylase deficiency

The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11–41 yrs) and 13 of their healthy sisters (13–31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in full IQ (p<0.05) and subtest scorings for Information, Similarities, and Picture Completion (p<0.05–<0.10). SW patients displayed more masculine behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.

---

Zusammenfassung 27 Patientinnen mit dem Adrenogenitalen Syndrom (AGS) (11–41 J.) und 13 ihrer Schwestern (13–31 J.) wurden hinsichtlich intellektueller Funktionen verglichen (Kurzformen von HAWIK, HAWIE). Im Unterschied zu den meisten früheren Untersuchungen wurden weder für Patientinnen (mean: 99.0) noch für Kontrollen (97.7) über dem Durchschnitt liegende IQ-Werte gefunden. Im Gegensatz zur Literatur unterschied sich die Teilgruppe der Salzverlust-Patientinnen (SW)>16 J. (N=6, mean: 111.5) von den Schwestern und den Patientinnen mit einfachem AGS (SV) im Gesamt-IQ (p<0.05) und in den Untertests Allgemeines Wissen, Gemeinsamkeiten und Bilderergänzen (p<0.05–<0.10). SW-Patientinnen hatten signifikant männlichere Verhaltensmuster gezeigt (vs. SV-Patientinnen und Schwestern), die auf differentielle Hormoneffekte pränatal bezogen worden waren. Es fanden sich aber keine klaren Zusammenhänge zwischen IQ-bzw. Untertest-Resultaten und Ergebnissen für Geschlechtsrollenverhalten.

---

Résumé Le fonctionnement cognitif de 21 patientes avec une hyperplasie congénitale surrénale (âgée de 11 à 41 ans) et de 13 de leurs soeurs saines (13–31 ans) a été comparé au moyen de versions raccourcies de l'échelle de Wechsler appropriée à l'âge. En contraste avec d'autres études, il n'a été retrouvé un Q.I. plus haut que la moyenne ni pour les patientes (moyenne 99.0) ni pour leurs soeurs (moyenne 97.7). De façon inattendue, et en contraste avec d'autres études, le sous-groupe de patientes déprivées en sel (SW)>16 ans (N=6), moyenne score: 111.5) différait de leurs soeurs aussi bien en tant que patientes présentant des signes de virilsation (SV) pour le Q.I. complet (p<0.05) et les scores aux subtests d'information, de similarité et de complément d'images (p<0.05–0.10). Les patientes déprivées en sel (SW) montraient un comportement plus masculin (vs. SV et leurs soeurs) qui en retour était relié aux influences hormonales prénatales différentes. Il n'y avait pas de relation de différences nettes entre les résultats aux sous-tests cognitifs du Q.I. et le comportement de genre.

     

International (NL-UK) double-blind study of Sinemet CR and standard Sinemet (25/100) in 170 patients with fluctuating Parkinson's disease

One hundred and seventy patients with fluctuating Parkinson's disease participated in an international clinical trial to compare the effects of controlled-released Sinemet 50/200 (mg carbidopa/mg levodopa; Sinemet CR) with standard Sinemet 25/100 (Sinemet STD). The study design involved an 8-week open-label titration (dose-finding) phase (STD and CR preparations given individually during weeks 1–4 and 5–8 respectively) followed by a 24-week double-blind, double-dummy (placebo) treatment period. Drug efficacy was assessed using: (a) data from patients' diaries (i.e. on-off periods) (b) the functional disability profile (Northwestern University Disability Scale), (c) the neurological signs and symptoms (New York University Parkinson's Disease Scale, NYUPDS), (d) global evaluations made by the patient and treating physician and (e) the patient's evaluation of sleep. The results indicate that the number of off periods and the total NYUPDS score decreased significantly in the patients treated with Sinemet CR compared with those treated with Sinemet STD. Furthermore, the patient's global evaluation was significantly better in the Sinemet CR group. The number of drug-related adverse experiences was similar in the two groups, and only one serious event of this nature was reported.     

Etude histologique du ganglion de Gasser Types de neurones et leur fréquence

Résumé Nous avons étudié 100 ganglions de Gasser de 50 individus (34 hommes et 16 femmes; 16 blancs, 12 noirs et 22 mulâtres) dont l'âge variait entre 15 et 75 ans. Les neurones de ces ganglions, imprégnés par différentes techniques (Cajal, Feyrter, Boeke etGros modifié parFernandez), ont été divisés en typiques (monopolaires et bipolaires) et atypiques (fenêtrés, corrodés déchiquetés, irrités et appendiculés). De tels neurones présentent les pourcentages suivants: monopolaires 86,34%±5,21; bipolaires 1,46%±0,98; fenêtrés 3,89%±1,87; corrodés 0,96%±0,85; déchiquetés 1,08%±1,03; irrités 2,24%±1,38; appendiculés 4,03%±1,91. On a constaté qu'il existait une corrélation de régulier à fort (r=0,63) entre le nombre de cellules atypiques dans les ganglions droit et gauche d'un même individu, ce qui indique que les modifications qui peuvent s'y dérouler sont approximativement de la même intensité. Des diverses infirmités étudiées, aucune n'a altéré spécifiquement l'aspect général du ganglion.Les neurones monopolaires ont été distribués en deux groupes: glomérulés (dont le prolongement contourne le corps de la cellule avant de sortir de la capsule) et aglomérulés (dont le prolongement s'éloigne immédiatement du soma cellulaire). Ils ont été divisés, quant à la taille, en petits, moyens et grands. Ces neurones se présentent dans les pourcentages suivants: glomérulés 72,61%±5,64 (3,18%±1,68 petits; 46,49%±7,48 moyens; 22,94%±5,10 grands), et aglomérulés 27,39%±5,64 (1,97%±1,51 petits; 18,64%±4,73 moyens; 6,78%±2,39 grands).Nous avons aussi remarqué que le nombre de cellules atypiques augmente proportionnellement avec l'âge, et on trouve pour les différentes décennies les incidences suivantes: de 15 à 24 ans, 7,21%±2,30; de 25 à 34 ans, 9,63%±4,81; de 35 à 44 ans, 11,50%±2,69; de 45 à 54 ans, 14,35%±3,70; de 55 à 64 ans, 17,80%±6,39; de 65 à 75 ans, 19,66% % 5,40. Le coefficient de corrélation calculé pour le cas est de régulier à fort (r=0,66).

---

Summary We studied 100 Gasser ganglia in 50 individuals (34 males, and 16 females; 16 white, 12 negros, and 22 mulattoes), whose ages varied from 15 to 75 years. The neurons of the these ganglia, impregnated by means of various techniques (Cajal, Feyrter, Boeke andGros, modified byFernandez) were divided into typical (monopolar and bipolar) and atypical (fenestrated, corroded, unattached, irritated and appendiced). These neurons presented the following percentages: monopolar 86.34% ±5.21; bipolar 1.46%±0.98; fenestrated 3.89%±1.87; corroded 0.96%±0.85; unattached 1.08%±1.03; irritated 2.24%±1.38; appendiced 4.03%±1.91. It was ascertained that a relationship exists from regular to strong (r=0.63) between the numbers of atypical cells existent in the right and left ganglion of the same individual, indicating that the modifications, which occur in them, are approximately of the same intensity. Of the various maladies studied, none altered specifically the general aspect of the ganglion.The monopolar neurons were distributed into 2 groups: glomerulated (whose prolongations pass around the cell's body before leaving the capsule) and agglomerulated (whose prolongations withdraws itself near the cell's soma) these 2 groups are subdivided into small, medium and large. The occurrences of these neurons are as follows: glomerulated 72.61%±5.64 (small 3.18%±1.68; medium 46.49%±7.48; large 22.94%±5.10), and agglomerulated 27.39%±5.64 (small 1.97%±1.51; medium 18.64%±4.73; large 6.78%±2.39).We also observed that the number of atypical cells increased proportionally with age, the following indices being found for the various decades: from 15 to 24 years, 7.21%±2.30; from 25 to 34 years, 9.63%±4.81; from 35 to 44 years, 11.50%±2.69; from 45 to 54 years, 14.35%±3.70; from 55 to 64 years, 17.80%±6.39; from 65 to 75 years, 19.66%±5.40. The calculated correlation coefficient ranges from regular to strong (r=0.66).

---

Zusammenfassung Wir untersuchten 100 Ganglia geniculi von 50 Personen (34 Männer, 16 weiblichen Geschlechts; 16 Weiße, 12 Schwarze und 22 Mulatten), deren Alter zwischen 15 und 75 Jahren schwankte. Die Neuronen dieser Ganglien wurden nach verschiedenen Methoden imprägniert (Cajal, Feyrter, Boeke undGros in Abänderung vonFernandez) und typische (monopolare und bipolare) oder atypische («vergitterte, korrodierte, zerfetzte und mit Anhängen versehene) eingeteilt. Die verschiedenen Typen waren folgendermaßen an der Gesamtzahl beteiligt: monopolare 86,34%±5,21; bipolare 1,46%±0,98; vergitterte 3,89%±1,87; korrodierte 0,96%±0,85; zerfetzte 1,08%±1,03; irritierte 2,24%±1,38; mit Anhängen versehene 4,03%±1,91. Es ließ sich bei ein und derselben Person ein regelmäßiger bis starker Zusammenhang (r=0,63) zwischen der Zahl des atypischen Neuronen im rechten oder linken Ganglion feststellen, so daß die Veränderungen, die sie befallen, beiderseits ungefähr gleich stark sind. Keine der zur Untersuchung gekommenen Krankheiten verändert irgendwie spezifisch die Struktur des Ganglions im ganzen.Die monopolaren Neuronen wurden in zwei Gruppen eingeteilt: in die knäuelförmigen (deren Fortsätze die Zellkörper umwickeln, bevor sie die Kapseln verlassen) und die ohne Knäuel (deren Zellfortsätze sich sofort von den Zellkörpern entfernen), weiterhin in kleine, mittlere und große. Diese Neuronen kommen in folgenden Prozentsätzen vor: knäuelförmige 72,61%±5,64 (3,18%±1,68 kleine, 46,49%±7,48 mittlere, und 22,94%±5,10 große); ohne Knäuel 27,39%±5,64 (1,97%±1,51 kleine, 18,64%±4,73 mittlere, und 6,78%±2,39 große).Wir beobachteten weiterhin, daß die Zahl der atypischen Zellen mit zunehmendem Alter ebenfalls größer wird. Für die verschiedenen Abschnitte von je 10 Jahren finden wir folgende Angaben: von 15–24 Jahren 7,21%±2,30; von 25–34 Jahren 9,63%±4,81; von 35–44 Jahren 11,50%±2,69; von 45–54 Jahren 14,35%±3,70; von 55–64 Jahren 17,80%±6,39; von 65–75 Jahren 19,66%±5,40. Die entsprechenden Korrelationskoeffizienten betragen in diesem Fall r=0,66 und sind somit regelmäßig bis stark.

---

---

Avec 10 Figures

---

Professeur Adjoint d'Histologie et Embryologie Générale de la Faculté de Médecine de Bahia, Brésil (chaire du Prof.Tulio Miraglia); Professeur Assistant de Neuroanatomie (chaire du Prof.J. J. A. Seabra); Pathologiste de la Fundação Hospitalar Octavio Mangabeira et de l'Hospital Manicomio Juliano Moreira.     

Effects of chronic treatment with methadone and naltrexone on sleep in addicts

Previous studies have described sleep disturbance secondary to chronic opiate use and abuse. Drug-dependency insomnia is of interest because chronic sleep disturbances can promote depressive symptoms which could lead to a drug relapse. For the first time we compared the polysomnographic parameters of 10 methadone-substituted outpatients and 10 naltrexone-treated outpatients. Methadone (-opioid agonist) produced a marked fragmentation of the sleep architecture with frequent awakenings and a decrease in EEG arousals. In comparison with methadone and controls, the naltrexone (-opioid antagonist) group showed the shortest sleep latency and the longest total sleep time. These data indicate that -agonists and -antagonists have different effects on sleep. The implications, especially the involvement of opioid-dopamine interactions on sleep and movements during sleep, are discussed.     

Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis

Objects The aim of this study was to clarify predictors for poor intellectual outcome in pediatric moyamoya disease.Methods Fifty-two pediatric patients were included. Clinical diagnosis was transient ischemic attacks (TIA) in 35 and completed stroke in 17. Ten patients underwent indirect synangiosis through small craniotomy, whereas the other 42 underwent superficial temporal artery (STA)–middle cerebral artery (MCA) anastomosis and indirect synangiosis through large craniotomy. Full-scale IQ (FSIQ) was measured using the Wechsler intelligence scale for children (WISC) after surgery. Multivariate logistic regression models were applied to test the effect of clinical factors on intellectual outcome.Results and conclusion Eight patients revealed mentally impaired status (FSIQ<70). Multivariate analysis revealed that completed stroke and small craniotomy surgery were significantly associated with poor intellectual outcome. Odds ratios of each factor were 33.4 (95% CI, 2.4–474) and 19.6 (95% CI, 1.8–215) respectively. Early diagnosis and the revascularization procedure over as wide an area as possible may be essential to improve their intellectual outcome.     

A disease-specific psychosocial questionnaire for Parkinson’s disease caregivers

Abstract. Objective: To evaluate the Belastungsfragebogen Parkinson Angehörigen—kurzversion (BELA-A-k), a questionnaire for measuring psychosocial problems and need for help in Parkinsons disease (PD) caregivers. Methods: The Belastungsfragebogen Parkinson Angehörigen—kurzversion was translated into Dutch. It consists of 15 items with a Bothered by (Bb) and a Need for Help (NfH) score. The BELA-A-k was tested for cultural differences, relevance and feasibility in a pilot (n = 10). We determined the psychometric properties in a validation study (n = 50) and compared the BELA-A-k with the Sickness Impact Profile, the COOP/WONCA Functional Health Assessment Charts and the Loneliness Questionnaire (de Jong-Gierveld). All questionnaires were administered in person at home, in a prescribed order. Results: The BELA-A-k was completed by 60 PD-caregivers. The internal-consistency reliability coefficients for the total Bothered by (0.90) and Need for Help (0.92) scales were excellent. The internal consistency of the subscales exceeded the 0.70 standard except for the Bothered by and Need for Help Social functioning scale (Bb = 0.62; NfH = 0.65) and the Partner-bonding/Family scale (NfH = 0.69). Almost all BELA-A-k subscales correlated highly (P < 0.001) with the corresponding scales of the standard quality of life indices. Conclusion: The BELA-A-k is a relevant, reliable and valid measure for assessing psychosocial problems and need for help of PDcaregivers.     

Soviet psychotherapy: The tasks and methodological problems

Soviet psychotherapy follows Western European traditional pre-psychoanalytical rationalistic methodology. On the other hand, Soviet therapists assign great importance to clinical diagnosis within the framework of the classical scheme of Kraepelin. Finally, methods close to behavior therapy, especially so-called training approaches, are popular.     

Attitudes toward mental health professionals in a hospital-based community mental health center

This study examined the attitudes of several diverse subject groups in a large medical center toward various mental health professionals. The groups consisted of: 1) general hospital staff; 2) professional mental health workers; and 3) psychiatric in-patients. Subjects evaluated a selection of 11 professional health related role titles (clinical psychologist, physician, psychiatrist, etc.) and the categories me and mental patient by marking a series of 19 seven-step rating scales, each composed of bipolar anchoring adjectives. Additionally, a familiarity rating for each of the role titles was obtained. An understanding and a value cluster were derived from the 19 adjectives along with an overall favorability-unfavorability score for each role title. It was expected that subjects would value mental health professional roles more strongly than they would indicate an understanding of these same roles. Secondly, it was expected that the hospital setting itself, the subject's role within that setting, and the degree of familiarity with the role being rated would have a significant impact on the subject's attitude. Results generally supported the above expectations. Overall ratings of the professional groups were consistently high, with less difference between the health designations (physician, nurse) and the psych designations than has been previously reported in the literature.     

Electroconvulsive therapy in Parkinsonian patients with the “on-off” syndrome

Summary Marked, abrupt and disabling oscillations in motor performance—the on-off phenomenon-frequently occur in the course of long-term levo-dopa therapy for Parkinson's disease. Although these fluctuations are usually refractory to available medications it has recently been suggested that electroconvulsive therapy (ECT) may be beneficial.Five Parkinsonian patients with incapacitating and unpredictable on-off changes who were free of significant depression were given conventional bilateral ECT while usual drug regimens were maintained. While ECT was well tolerated, after a total of six treatments no significant improvement in Parkinsonian disabilities or on-off changes were seen.     

Hyperkinetic children: Early indicators of potential school failure

Hyperkinetic children are identified as a population-at risk upon admission to kindergarten. The etiology of hyperkinetic behavior is controversial. Organic driveness, hyperkinetic behavior disorder, postencephalitic behavior, brain damage with behavioral and conceptual deficit, Strauss syndrome, have all been used to label essentially similar symptom constellations. Bypassing the area of controversy, a study is reported that demonstrates that children who were identified as hyperkinetic (using behavioral criteria developed in an earlier study) were (1) absent from school more frequently, and (2) did remarkably less well on standardized tests of school readiness than their peers rated nonhyperkinetic. The implications are discussed and suggestions made for the development of intervention programs.An earlier version of this paper was presented at the Annual Meeting of the American Orthopsychiatric Association, March, 1967.     

Relationship of maternal parenting behaviors to preschool children's temperament

Mothers of 182 preschool nursery school children rated their own parenting responses on a Parent's Report questionnaire. At the same time the mothers responded to the Behavior Style Questionnaire (BSQ) from which scores were determined for nine categories of temperament. On the basis of category scores the children were grouped into one of five temperament clusters i.e. easy, difficult, slow to warm up, high intermediate, low intermediate. The children's membership in BSQ clusters was independent of sex, age, birth order, and mothers employment status but there was a significantly higher ratio of easy children from higher socioeconomic classes I and II. Mothers of children grouped in either the difficult or slow to warmup clusters were more likely to use guilt inducing and temper-detachment parenting styles than mothers of children grouped in the easy cluster.     

Recent observations on the clinical pharmacology of (-)deprenyl

Summary Serial tyramine challenges were given to 4 patients with Parkinson's disease who had taken 10 mg of a selective monoamine oxidase B inhibitor, (-)deprenyl, for up to eighteen months. In doses sufficient for complete inhibition of the platelet enzyme, no clinically significant adverse pressor reactions (cheese effects) occurred nor were any significant tyramine responses seen when higher doses of deprenyl (40–60 mg daily) were given for three weeks.A balanced crossover study in six healthy young male adults showed that (-)deprenyl was associated with a significant increase in the frequency of periods of wakefulness and stage 2 sleep and a significant decrease in REM sleep and sleep stages 3 and 4.In 85 patients with Parkinson's disease taking 10 mg of (–) deprenyl daily with levodopa and carbidopa for up to eighteen months, a mean dosage reduction of 200 mg levodopa daily was possible; 19 of the 39 patients who had end-of-dose akinesia responded favourably and only one of the 10 patients with on-off oscillations improved. On 10 mg (-)deprenyl daily only 4 patients showed an amphetamine response, but this was more frequent when 40 mg deprenyl was given daily. In 5 patients taking 40 mg (-)deprenyl daily without other medications a mild antiparkinsonian response occurred comparable to that seen with amphetamine.     

Glial and neuronoglial malformative lesions associated with medically intractable epilepsy

In a large series of 116 cortical resections for treatment of medically intractable epilepsy, 10 glial hamartomas and 11 neuronoglial malformative lesions were found. Glial hamartomas were astrocytic in 3 cases, oligodendrocytic in 6 and mixed oligoastrocytic in 1. Neuronoglial lesions corresponded to focal cortical dysplasia in 6 patients and to microdysgenesis in 5 others. This study focuses on the various neuropathological presentations of these malformative epileptogenic lesions, and on correlations with neuro-imaging data.     

Differential potentiation by calcium antagonists of neuromuscular blockade induced by pancuronium and succinylcholine in cats in vivo

Summary The effects of several calcium antagonists (verapamil, nicardipine and two diltiazem isomers, d-cis and l-cis diltiazem) alone and associated to non-depolarizing (pancuronium) and depolarizing (succinylcholine) neuromuscular blockers, were evaluated on sciatic nerve-tibialis anterior muscle preparations from cats in vivo. The calcium antagonists used (at 0.1 and 0.5mg/kg iv) did not modify the height of muscular twitches elicited indirectly. However, these agents potentiated in a dose-dependent way the neuromuscular blockade induced by iv pancuronium (2–40g/kg) and succinylcholine (6–200g/kg). The order of potency in increasing the effects of pancuronium was nicardipine d-cis diltiazem verapamil, whereas the order of potency in enhancing succinylcholine effects was d-cis diltiazem verapamil nicardipine. The effects of diltiazem were stereoselective, thus the potentiation induced by d-cis diltiazem was significantly greater in all cases than that induced by l-cis diltiazem, which suggests that calcium channel blockade plays a role in these interactions. However, other mechanisms such as calcium antagonists-induced nicotinic receptor desensitization may also be involved.     

Effects of zuclomiphene in combination with triparanol and AY-9944 on developing rat CNS morphology and biochemistry

Summary Developing rats were injected intraperitoneally twice weekly with a combination of three hypocholesterolemic agents: Zuclomiphene (formerly calledtrans-clomiphene; dosage, 30 mg/kg body weight), Triparanol (30 mg/kg body weight) and AY-9944 (3 mg/kg body weight). Treatment was initiated at 4 days of age. Biochemical and electron microscopic examination was conducted on animals sacrificed at 20 days of age. Cytoplasmic inclusion bodies were not seen in the CNS. Isolated edematous changes were seen in myelinated axons. Analysis of the sterol content of the brain and spinal cords of drugtreated animals indicated the presence of abnormal concentrations of five sterols, desmosterol, 5-cholesta-7,24-dien-3-ol, zymosterol (5-cholesta-8,24-dien-3-ol), 7-dehydrocholesterol (cholesta-5,7-dien-3-ol) and 7-dehydrodesmosterol (cholesta-5,7,24-trien-3-ol). Zymosterol and 5-cholesta-7,24-dien-3-ol were minor constituents (5–7% and 1–1.5% of total sterol, respectively). The 7-dehydrosterols represented approximately one-half (44–52%) of the total CNS sterol.     

Hirnembolie und Psychose

Zusammenfassung Hirnembolisationen können in bestimmten Fällen als reine Psychosen verlaufen. Ist die Tatsache einer Embolisation nicht bekannt, so werden häufig sogar endogene Psychosen aus dem schizophrenen oder manisch-depressiven Formenkreis diagnostiziert.Herzerkrankungen und die Herzchirurgie gehen mit einem großen Embolierisiko einher. Mikroembolien spielen eine besondere Rolle bei der extrakorporalen Zirkulation, bei der signifikant öfter kardiogene Psychosen auftreten als bei geschlossenen Herzoperationen. Unmittelbar postoperativ treten nach Herzoperationen stuporös-akinetisch-parkinsonähnliche Zustandsbilder auf, die nach 3–5 Tagen abklingen. Hierbei handelt es sich mit großer Wahrscheinlichkeit um einen reversiblen embolischen Parkinsonismus bei Basalganglienapoplexie infolge von Mikroembolisation. Das spätere Auftreten depressiver und produktiv-psychotischer Syndrome, nach dem 3.–5. postoperativen Tag, wird ebenfalls im Zusammenhang mit Störungen im Bereich der Basalganglien gesehen. Für das Auftreten produktiv-psychotischer Syndrome ließ sich ein signifikanter Zusammenhang mit einer erblichen Belastung für endogene Psychosen in der Familien- und Eigenanamnese nachweisen.Auf der psychopathologischen Ebene kann man hier nicht zwischen endogenen und exogenen Psychosen unterscheiden. In diesem Zusammenhang haben psychopathologische Syndrome mit neurologischen Syndromen das Gemeinsame, daß die Art eines bestimmten Symptoms von der Akuität und dem Ausmaß der Hirnschädigung, der Hirnlokalisation und von hereditären Faktoren bestimmt wird.

---

Cerebral embolism and psychosis with special reference to cardiac surgery

Summary Cerebral embolism can manifest itself in certain cases as pure psychosis. In the absence of neurological symptoms it might be mistaken for schizophrenia or manic-depressive psychosis.Cardiac disease and cardiac surgery involve a high risk of embolism. Microembolism plays a special role with extracorporal circulation. There is a significant increase of postoperative psychosis in cases with E.C.C. in comparison to closed heart surgery. Immediately postoperatively there occurs what has been described as the catastrophic reaction or immobilization syndrome. This reaction is in fact an akinetic, parkinsonian-like state for which there is good evidence that it is due to transient microembolism of the basal ganglia (striatum apoplexy). After its disappearance around the 3rd–5th day cardiac psychoses (cardiac delirium) may manifest themselves.Patients who develop these late psychoses have a significantly higher correlation with endogenous psychoses in their family histories. On the psychopathological level—in the absence of disturbances of consciousness and orientation—it is not possible to differentiate between exogenous and endogenous psychosis. A special type of psychopathological reaction is dependent, as in neurological disease, on the severity of brain damage, its localization and on hereditary factors.

     

Intelligence and temperament as protective factors for mental health. A cross-sectional and prospective epidemiological study

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible salutogenic (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988–1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988–1989 using the concept love well, work well, play well and expect well. The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988–1989 super capacity (high intellectual function), super validity (high activity level) and super solidity (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.     

Serum creatine kinase B subunit levels in neurogenic atrophies

Summary This study is an attempt to determine the creatine kinase B (CK-B) subunit levels in neurogenic atrophies. A group of 69 patients was studied and the results were compared with those in a group of 32 patients with muscle disease. The results showed that the CK-B levels are considerably higher in patients with amyotrophic lateral sclerosis (P<0.001) and peroneal muscular atrophy (P<0.001). Further studies in the various subgroups of neurogenic atrophies showed that, regardless of the nosological entity, the CK-B activity is considerably higher: (1) in the widespread as opposed to limited forms (P<0.001); (2) in the chronic than in the acute neurogenic atrophies (P<0.001); and (3) in the active as opposed to residual forms (P<0.02). It is suggested that the increase of CK-B in neurogenic atrophies is a strong indication of an active regeneration process in the denervated muscle.