Measuring the sensitivity to change of the Role Functioning Scale through the utilization of the RCID index

This study presents data on the sensitivity to change of the Role Functioning Scale (RFS) in assessing improvement in psychosocial functioning among persons with severe and persistent mental illness after exposure to different clinical interventions. The sample for this study was composed of 122 severely and persistently mentally ill clients who received outpatient services in one of three case-management conditions as part of a randomized clinical trial. Utilizing the twofold criteria of the RC_ID index proposed by Jacobson and Truax (1991) evidence was found for the sensitivity of the RFS to detect statistically reliable and clinically significant changes in client functioning as a result of the treatment interventions. The global score of the RFS demonstrated highly significant treatment effects, as well as moderate to large effect sizes. Results from the current study, as well as those presented in previous psychometric studies of the RFS indicate that this measure can be used effectively in outcome studies of the severely and persistently mentally ill to assess treatment efficacy reliably and accurately. Copyright © 1998 Whurr Publishers Ltd.     

Descending efferent connections of the sub-pallidal areas in the cat: Projections to the subthalamic nucleus,the hypothalamus,and the midbrain

The efferent connections of the sub-pallidal regions to the mediodorsal thalamic nucleus, the subthalamic nucleus, the lateral hypothalamic area, and the midbrain were investigated in the cat, using Phaseolus vulgaris—leucoagglutinin (PHA-L) as an anterograde label. The results indicate that the sub-pallidal regions of the cat project to the (dorso)medial tip of the subthalamic nucleus and the adjoining lateral hypotha-lamic area as well as to the ventral tegmental area and the greater extent of the dorsolateral tier of the substantia nigra pars compacta. Extensive projections were also found to the peripeduncular nucleus. The central gray as well as the mesencephalic locomotor region receive some input from the basal forebrain too. In contrast only very limited projections were found to the mediodorsal thalamic nucleus. The results are discussed in view of the possible role of these output regions in oro-facial dyskinesia. © 1993 Wiley-Liss, Inc.     

When the microbiome helps the brain-current evidence

The gut microbiota-brain axis has been recognized as a network of connections that provides communication between the gut microflora and both central and autonomic nervous system. The gut microbiota alteration has been targeted for therapy in various neurodegenerative and psychiatric disbalances. Psychobiotics are probiotics that contribute beneficially to the brain function and the host mental health as a result of an interaction with the commensal gut bacteria, although their mechanism of action has not been completely revealed. In this state-of-art review, the findings about the potential therapeutic effects of the psychobiotics alone or in combination with conventional medicine in the treatment of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, as well as in some psychiatric diseases like depression, schizophrenia, and bipolar disorder, have been summarized. The evidence of the psychobiotics therapeutic outcomes obtained in preclinical and clinical trials have been given respectively for the observed neurodegenerative and psychiatric disorders.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Afferent connections of the dorsal sections of the pars magnocellularis in the red nucleus of the cat

Location of retrogradely labelled neurons in various structures of the central nervous system was studied by microiontophoretic injection of horseradish peroxidase into dorsal sections of the magnocellular part of the cat red nucleus. Projections were revealed from some hypothalamic nuclei, centrum medianum, as well as from nucleus parafascicularis and subthalamic nucleus; from zone incerta, field of Forel, nucleus medialis habenulae; from reticular formation of the pons, medulla oblongata and midbrain, central gray matter, colliculus superior, nucleus interstitialis Cajal; from contralateral red nucleus, nucleus fastigii and facial nucleus; from nucleus vestibularis lateralis (pars dorsalis) and nucleus vestibularis medialis as well as from ventral horn of the spinal cord cervical segments. Connections between substantia nigra and the red nucleus have been studied more accurately. Bilateral trajectories of retrogradely labelled fibre systems are described.     

Research in geriatric psychiatry and the care of the aged

First of all, to take care of the aged, the medical profession, as well as the public, has to assume the same obligation in the caring for the aged as in the same manner as other age groups. Second, good mental care is very closely linked to adequate treatment of physical illness. Third, judicious use of psychotropic drugs is as helpful in old age as at other ages. Fourth, psychotherapy must be crisis intervention combined with physical and social rehabilitation. Fifth, psychotherapy has to be directed primarily against depression and it has to realize that the elderly demonstrate not only biologic drives but also goal-seeking behavior, as Adler and Parsons emphasize. Sixth, mental health service facilities must be established in hospitals as well as in the community. Integration of health and social services should be the keyword. Seventh, the aged have to be taught to live as full-fledged members of society, which must be changed to meet the needs of the elderly.One can pessimistically say that this program is impossible to work out, especially in a large and desperate city like New York. I would answer with an adage I learned many years ago: The pessimist is usually right, but the optimist is the only one who can achieve results.     

The effect of the development of the group on the therapeutic effect

The authors compared the results of six-week treatment in a therapeutic community comprising 484 patients who had therapy in groups which were classified as "good" by their therapists, and 91 patients having therapy in groups, classified by the therapists as "poor". No significant difference was found in the two groups as regards mitigation of symptoms, insight, change of attitudes and behavior at the time of completion of treatment and after an interval of one year. Effective factors of group psychotherapy obviously are equally effective also in groups with which the therapists are not satisfied.     

Direct projections from the parvocellular part of the posteromedial ventral nucleus of the thalamus to the infralimbic cortex in the cat

It was shown in the cat by the anterograde and retrograde WGA-HRP method that the medial portion of the parvocellular part of the posteromedial ventral nucleus of the thalamus sent fibers ipsilaterally to the caudoventral part of the infralimbic cortex on the medial surface of the frontal lobe, as well as the orbital cortical regions and the rostrodorsal part of the lateral amygdaloid nucleus.     

Recent advances in the genetics of schizophrenia and the practical implications of the results

Research targeting the genetic background of schizophrenia has expanded our knowledge substantially about genes and possible pathophysiological processes playing a role in the disorder. In addition to earlier approaches, new genetic methods have been developed which offer new insight. In this review we make an attempt to summarize the findings of earlier genetic research, as well as to interpret newly emerging results that help the development of pathophysiologically oriented models of schizophrenia. We argue that besides genetic research, findings on cognitive function and of imaging studies, as well as gene-expression analyses and pharmacogenetic studies must be interpreted to reach a better understanding of the complex phenomena in schizophrenia. Synthesis of data from the different areas allows speculation about future research and practical implications.     

Psychological approach to the rehabilitation of the spinal cord injured: the contribution of relaxation techniques.

We analyse the benefit of learning relaxation techniques as an essential coping strategy in the behavioural medicine field. This has proved useful as a part of the newly spinal cord injured rehabilitation treatment or concerning later problems if there is readmission. We report the changes we have made in the relaxation standard methods to be used in spinal cord injured patients as well as the timing in the rehabilitation process when these techniques were applied.     

Shame and contempt in the everyday life of the psychotherapist

This article describes aspects of the impact of shame and contempt in psychotherapy and in our daily lives. Psychotherapy is seen as moving between the poles of shame and hope. Shame-anxiety alerts us to the imminent danger of being shamed; shame is described as the experience of finding our individuality unacceptable and contempt is seen as a means of coping with shame where the other is made to feel one's shame. Examples of each are provided as well as comments about psychotherapy issues with patients who exhibit shame-anxiety, shame and contempt. Shame-anxiety, shame, contempt and tyranny are seen as points along a spectrum of humiliation experiences. Presented at Department of Psychiatry Grand Rounds, Albany Medical College, March 1990, and University of Natal Faculty of Medicine (South Africa), November, 1990.     

Projections of the nucleus accumbens in the cat

Due to the recent advances in knowledge on the function of the limbic system it would be wise to consider this system as being widely distributed throughout the diencephalic and mesencephalic levels as well as the forebrain. Numerous regions have been discovered that are related to the limbic structures in anatomical and functional respects. According to Koikegami et al. (1967), it would be adequate to divide this system into two main categories--the major limbic rim or the structure proper and the paralimbic structures. The former defined phylogenetically and ontogenetically as those structures around the third ventricle such as: the hippocampus, septum, dentate gyrus, fimbria hippocampi, anterior and posterior cingulate gyri, area paraolfactoria, amygdala and Diagonal Band of Broca. The paralimbic structures may represent those brain regions, which have direct connections or functional correlations with the limbic formation proper. These areas include the posterior orbital gyrus, insula, nucleus accumbens, head of the caudate, nucleus habenula, nucleus interpendencularis, nucleus pulvinaris thalami, intralaminar and anterior thalamic nucleus, preoptic area, hypothalamic nuclei, mammillary body, subthalamus, limbic midbrain area of Nauta, temporal lobe pole, superior temporal gyrus, praecuneus, nucleus dorsalis et profundis tegmenti of Gudden and claustrum. In the present paper we will deal with the projections of the nucleus accumbens. This nucleus was described by Meynert (1872) as the anterior polar region of the caudate nucleus. Kappers describes the nucleus accumbens in 1908 as the nucleus accumbens septi and considers it as a part of the striatum. Later on, the histological studies of Brochaus (1942) relate a part of the nucleus with olfactory functions, and he describes another part, which is very well developed in microsmatic mammals and in anosmic mammals like the dolphin. Szteyn (1960) describes two main areas, the accumbens septi and the accumbens caudate. Nevertheless, the accumbens constitutes a very important region of the paralimbic system and seems to play an important role in some behavioral patterns.     

Adenylate cyclase in the microvessels of the rat brain

Summary The presence of adenylate cyclase (AC) in the microvessels of the rat brain was studied by a new histochemical method for light and electron microscopy. The method is based on the precipitation of strontium and the subsequent conversion of the formed strontium salt into lead phosphate. Isoproterenol and 5-guanylylimidodiphosphate were used as enzyme activators. In the light microscope, the final reaction product was detected in the choroid plexus as well as in the walls of the microvessels in the brain parenchyma. In the electron microscope, both the luminal and abluminal endothelial membrane as well as the basal lamina of the parenchymal microvessels displayed reaction product. The observations demonstrate that isoproterenol-stimulated AC is located in the endothelium of the rat brain microvessels and suggest that the enzyme may play a role in the receptor-mediated regulation of endothelial functions.Supported by a grant from the Finnish Academy     

Intracranial self-stimulation in the thalamus of the rat

Rats were tested for intracranial self-stimulation (ICSS) via bipolar electrodes situated throughout the thalamus. Of 112 animals in the study, 55 met the criteria for ICSS, with scores ranging from 55 to 921 bar-presses in a 15 minute session. A map of both positive and neutral placements is presented. Positive sites for ICSS were found in all aspects of the mediodorsal nucleus, except for the central segment. The ventromedial nuclear complex was also a positive area of ICSS, with the exception of the submedial nucleus (nucleus gelatinosus). Each of the intralaminar nuclei (central medial, parafascicular, paracentral, and central lateral) supported ICSS, as did each of the midline nuclei (rhomboid, paratenial and paraventricular). No placements were found in the nucleus reunions. Both “major” relay nuclei, the ventrobasal and ventrolateral, supported ICSS; but neither the laterodorsal nor the lateral posterior nuclei had positive sites. Positive sites were found in the anterior and posterior nuclear groups, as well as in the paraventricular gray area of the caudal thalamus. As a general rule, ICSS scores appeared to be higher as the electrode placements approached the midline. Sites in which no positive placements were seen included the reticular nucleus, as well as the stria medularis, the mammillothalamic tract, and the fasciculus retroflexus.     

Projections of the Nucleus Accumbens in the Cat

Abstract: Due to the recent advances in knowledge on the function of the limbic sys tem it would be wise to consider this system as being widely distributed throughout the diencephalic and mesencephalic levels as well as the forebrain. Numerous regions have been discovered that are related to the limbic structures in anatomical and functional respects. According to Koikegami et al. (1967), it would be adequate to divide this system into two main categories–the major limbic rim or the structure proper and the paralimbic structures. The former defined phylogenetically and ontogenetically as those structures around the third ventricle such as: the hippocampus, septum, dentate gyrus, fimbria hippocampi, anterior and posterior cingulate gyri, area paraolfactoria, amygdala and Diagonal Band of Broca. The paralimbic structures may represent those brain regions, which have direct connections or functional correlations with the limbic formation proper. These areas include the posterior orbital gyrus, insula, nucleus accumbens, head of the caudate, nucleus habenula, nucleus interpendencularis, nucleus pulvinaris thalami, intralaminar and anterior thalamic nucleus, preoptic area, hypothalamic nuclei, mammillary body, snbthalamus, limbic midbrain area of Nauta, temporal lobe pole, superior temporal gyrus, praecuneus, nucleus dorsalis et profundis tegmenti of Gudden and claustrum. In the present paper we will deal with the projections of the nucleus accumbens. This nucleus was described by Meynert (1872) as the anterior polar region of the caudate nucleus. Kappers describes the nucleus accumbens in 1908 as the nucleus accumbens septi and considers it as a part of the striatum. Later on, the histological studies of Brochaus (1942) relate a part of the nucleus with olfactory functions, and he describes another part, which is very well developed in microsmatic mammals and in anosmic mammals like the dolphin. Szteyn (1960) describes two main areas, the accumbens septi and the accumbens caudate. Nevertheless, the accumbens constitutes a very important region of the paralimbic system and seems to play an important role in some behavioral patterns.     

The Patient-Psychiatrist Relationship on the Axis of the Other and the Same

The patient-psychiatrist relationship is a cornerstone of psychiatric professionalism and ethics. We discuss this topic along the axis of the Other and the Same, concepts defined by continental philosophy. The self of Anglo-American philosophy is typically described in individualistic terms. Individualism, autonomy and ideal self are valorized within the current model of care. These characteristics belong to the Lacanian Imaginary Order, which is the core of narcissism. Patients may yearn for another model of interaction. For Levinas, ethics should not involve a search for perfectionism and accomplishment but responsibility toward others. Ethics is, according to him, rooted in the calling into question of one’s Sameness by the other’s Otherness. The question of hospitality and of the welcoming of Otherness is central to his thought. Derrida further asks whether hospitality is not an interruption of the self. Hospitality may thus become a fundamental way of re-thinking clinical practices. A relationship to the Other as an-other is characterized as of Euclidian-type, establishing borders between the self and the Other, whereas a relationship to the Other as same is characterized as of fractal-type, emphasizing similarities between self and other as same and obliterating boundaries. Winnicott’s object-relating versus use of object and Buber’s I-you and I-it relations are also examined along the axis of Sameness and Otherness. Since psychiatric clinical practice requires to our view adequate and adaptive to and fro movements along this axis, the two forms of relating to the Other are discussed both theoretically and through a clinical case presentation.     

Neurogenesis of the sexually dimorphic nucleus of the preoptic area in the rat

The sexually dimorphic nucleus of the preoptic area (SDN-POA) of Sprague-Dawley rats is larger in volume in the male and hormone-dependent early in postnatal life. In the present study, we compared for each sex the time course of neuroblast proliferation which forms SDN-POA or adjacent medial preoptic area (MPOA) neurons. Additionally, we investigated whether there is a temporal gradient of production of neurons in relation to their final position within the SDN-POA. On day 14, 15, 16, 17, or 18 postfertilization (pf) pregnant rats were given a single injection of ³H-thymidine (*thy). At 30 postnatal days of age the pups were sacrificed and brain sections were prepared and processed for autoradiography. Three sections of the SDN-POA and an adjacent area just lateral to it in the MPOA wer also analyzed. In the MPOA and the SDN-POA the percentage (%) of labeled neurons decreases as the day of injection of *thy approaches the end of gestation, but the time period in which neuroblast divisions occurred is markedly different for the SDN-POA as compared to that for the MPOA. DNA synthesis occurs as late as day 18pf for neurons which form the SDN-POA but ceases on day 16pf for those destined for the MPOA. There is a sex difference in neuronal production on both day 14 and 17pf for neurons destined for the SDN-POA. After injection on day 14pf the % labeled neurons is larger in the female than in the male but after injection on day 17pf this is reversed. There are also significant sex differences as well as a temporal gradient associated with the % labeled neurons in the SDN-POA in relation to their final anterior-posterior position. In addition, this study confirms our previous results which justify labeling the SDN-POA a nucleus, since neuronal density in this region in the male and female is significantly greater than that in the surrounding MPOA. These data illustrate that the specific neurons which comprise the SDN-POA in both the male and female are being produced as late as day 18pf, whereas neurons located in the MPOA but not in the SDN-POA have all been born by day 16pf. Neuroblast division which produces the neurons of the SDN-POA may begin earlier and terminate sooner in the female than in the male. These differences in neuronal production may partially account for the sexual dimorphism seen in the volume and neuronal number of the SDN-POA of the adult rat.     

Functions of the thalamus in psychiatry: the relationship between the thalamus and schizophrenia]

The thalamus involves two electrophysiological systems of the specific projection system and the non-specific projection system. The electrical stimulation of the former induces the augmenting response in the cerebral cortex and the same of the latter induces the recruiting response in the cortex. The non-specific projection system is also known as the diffuse thalamo- cortical projection system and it is concerned with the maintenance mechanism of consciousness such as sleep and wakefulness. The thalamus is concerned in the higher nervous functions such as language, cognition, memory and intelligence. Severe nerve cell loss with proliferation of hypertrophic astroglia was found in the association nuclei and sensory relay nuclei in the thalami of patients suffering from Creutzfeldt-Jakob disease. In the brain imaging study, volume reduction of the thalamus, especially of dorsomedial nuclei, degradation of glucose metabolism were observed in the thalami of patients with schizophrenia. Carlsson considered schizophrenia as a subcortical neurotransmitter imbalance syndrome based on the hypothesis of a thalamic filter. Andreasen defined schizophrenia as a misconnection syndrome or cognitive dysmetria induced by dysfunction of the cortico-cerebellar-thalamic-cortical circuit (CCTCC).     

Development of the vagal innervation of the gut: steering the wandering nerve

Background The vagus nerve is the major neural connection between the gastrointestinal tract and the central nervous system. During fetal development, axons from the cell bodies of the nodose ganglia and the dorsal motor nucleus grow into the gut to find their enteric targets, providing the vagal sensory and motor innervations respectively. Vagal sensory and motor axons innervate selective targets, suggesting a role for guidance cues in the establishment of the normal pattern of enteric vagal innervation. Purpose This review explores known molecular mechanisms that guide vagal innervation in the gastrointestinal tract. Guidance and growth factors, such as netrin‐1 and its receptor, deleted in colorectal cancer, extracellular matrix molecules, such as laminin‐111, and members of the neurotrophin family of molecules, such as brain‐derived neurotrophic factor have been identified as mediating the guidance of vagal axons to the fetal mouse gut. In addition to increasing our understanding of the development of enteric innervation, studies of vagal development may also reveal clinically relevant insights into the underlying mechanisms of vago‐vagal communication with the gastrointestinal tract.     

Existential issues in the management of the demented elderly patient

Four major existential themes are explored, as they relate to the predicament of the relative supporting a demented elderly dependent at home. These issues, namely, death, isolation, freedom, and meaning are discussed with respect to their dynamic impact on the stressed supporter as well as their implications for anxiety management.