Remission of Tardive Dystonia with ECT

A 30-year-old patient with tardive dystonia, who had failed to respond to cessation of neuroleptics, placebo, diazepam, biperiden, propranolol, and clonidine, had an impressive response to courses of electroconvulsive therapy (ECT) on three successive trials.     

Anxiogenic effects of Sumatriptan in panic disorder: a double-blind, placebo-controlled study.

BACKGROUND: Several lines of evidence point to serotonergic abnormalities in patients with panic disorder (PD). Our goal was to further examine central serotonergic function in panic patients using autonomic and subjective responses to the postsynaptic serotonin 5-HT1D receptor agonist Sumatriptan. METHOD: Using a double-blind, randomized, placebo-controlled design, we assessed autonomic and subjective responses to oral Sumatriptan (100 mg) and placebo in 15 patients with PD, free of medication. Subjective responses were measured using the Hamilton Anxiety Rating Scale (HAM-A), National Institute of Mental Health Anxiety Scale (NIMHA), a modified version of the Panic Symptom Inventory (PI), Hamilton Depression Rating Scale (HAM-D), and Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: PD patients exhibited significantly enhanced autonomic and subjective responses following challenge with Sumatriptan. We observed an increased pulse rate and augmentation of various parameters measured on different anxiety scales. A constant inclination of aggravation of the measured parameters was detected during the hour post challenge. CONCLUSION: Oral administration of Sumatriptan, a 5-HT1D agonist, has been associated with an anxiogenic effect in PD patients.     

Morphologic and electrophysiologic maturation in developing dentate gyrus granule cells

Dentate gyrus granule cells from immature (7-28 days) Sprague-Dawley rats were examined with whole cell patch clamp recordings and biocytin filling in in vitro hippocampal slice preparations. Although recordings were confined to the middle third of the suprapyramidal limb of the dentate, the granule cells exhibited marked variability in their physiologic properties: input resistance (IR) ranged from 250 MOmega to 3 GOmega, and resting membrane potential (RMP) from -82 to -41 mV. Both IR and RMP were inversely correlated with dendritic length, a morphometric indicator of cell maturity. Thus the highest IR cells were the youngest, and maturation was characterized by a progressive decrease in IR, hyperpolarization of RMP, and elongation of the dendritic arbor. When cells were grouped by IR, significant intergroup differences were found in RMP, dendritic length, and number of dendritic terminal branches. Although cells of all IR categories were examined throughout the age spectrum under study, none of the inter-IR group differences was age-dependent. These data suggest that IR provides a reasonable estimate of granule cell maturity and that maturation entails predictable changes in cell properties and morphology. These aspects of maturation correlate with each other, are independent of animal age, and most likely proceed according to a program related to cell birth.     

Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder.

Post-traumatic stress disorder (PTSD) affects about 20-30% of exposed individuals. Clinical studies of PTSD generally employ stringent criteria for inclusion in study populations, and yet in animal studies the data collection and analysis are generally expressed as a function of exposed vs nonexposed populations, regardless of individual variation in response. Prior data support an approach to animal models analogous to inclusion criteria in clinical studies. This series of studies sought to assess prevalence rates of maladaptive vs adaptive responses determined according to a more stringent approach to the concept of inclusion/exclusion criteria (cutoff behavioral criteria-CBC), consisting of two successive behavioral tests (elevated plus maze and acoustic startle response tests). The rats were exposed to stressors in two different paradigms; exposure to a predator and underwater trauma. The prevalence rates of maladaptive responses to stress in these two distinct models dropped over time from 90% in the acute phase to 25% enduring/maladaptive response at 7 days, to remain constant over 30 days. As setting the affected individuals apart from the unaffected approximates clinical studies, it might also help to clarify some of the pending issues in PTSD research.     

Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women

IntroductionDespite studies showing that individuals with insecure attachment suffer from poor body image, and that poor body image is a main risk factor for sexual dysfunction, the mediating role of body image between attachment insecurities and sexual functioning has not been assessed. Moreover, differences in body self-consciousness among sexual minority women have not been examined, even though LGB individuals have been found to be more conscious of stigma and the disapproval of others.AimTo fill this gap, the current study examines the mediating role of body image self-consciousness between insecure attachment and sexual functioning among LGB and non-LGB women.MethodsThe study sample consisted of 1,001 women; of them, 808 defined themselves as heterosexual (80.7%), and 193 (19.3%) identified as LGB. The sample was a convenience sample of women who responded to ads on social media. Participants completed an online questionnaire (via Qualtrics) about their attachment orientation, body-image self-consciousness, and sexual functioning.Main OutcomeBody image self-consciousness mediated the relationship between insecure attachment and sexual dysfunction among women in general and LGB women in particular.ResultsResults indicated that among LGB women, the relationship between attachment and sexual functioning was fully mediated by body image self-consciousness. For non-LGB women, a full model with statistically significant direct and indirect effects was revealed. Both avoidant attachment and anxious attachment were related to body image self-consciousness which was, in turn, related to sexual functioning. A statistically significant direct path from avoidant attachment to sexual functioning was also revealed.ConclusionThe study findings contribute to the literature by revealing the mediating role that body image self-consciousness plays between insecure attachment and sexual dysfunction among women in general and LGB women in particular.Clinical ImplicationsThis study provides support for the negative relationship between body image self-consciousness and sexual functioning of women regardless of sexual orientation, and suggests that women affected by body image concerns might be prone to more sexual dysfunction. Therefore, body image self-consciousness should be brought up in sex therapy sessions and future interventions. Clinicians should also be cognizant of differences between LGB and non-LGB women in terms of this effect, taking into account the history of stigma that LGB women may have endured and how this history affects their body image.Gewirtz-Meydan A, Mitchell KJ, Spivak-Lavi Z. Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women. J Sex Med 2021;18:1245–1257.     

Eigentlich eine Routinemaßnahme

A 76-year-old patient developed necrosis of the index finger after placement of a radial artery catheter. This article discusses the risks associated with invasive blood pressure monitoring and treatment options in cases of critical ischemia. The authors conclude that there is no consensus concerning optimal treatment and that a discussion on options for preoperative risk assessment and quickest possible recognition of such complications is worthwhile. Despite the risk of ischemia invasive blood pressure monitoring is an indispensable procedure.     

Efficacy and impact of monophasic versus biphasic countershocks for transthoracic cardioversion of persistent atrial fibrillation

This report compares the cumulative efficacy of cardioversion and skeletal muscle injury after either damped sine wave monophasic or truncated exponential biphasic transthoracic cardioversion of persistent atrial fibrillation. The trial sought to refute the null hypothesis of therapeutic equivalence between monophasic and biphasic waveforms. Results of the study reveal similar cumulative efficacy of waveforms and greater levels of skeletal muscle damage when patients are younger and male, and when monophasic waveforms are used.