Patients’ accounts of memory lapses in interactions between neurologists and patients with functional memory disorders

One of the most commonly made diagnoses in secondary care memory services is functional memory disorder (FMD). FMD is non‐progressive and characterised by persistent worries about memory failures without objective evidence of cognitive impairment. This study explores how patients with FMD present their memory concerns. Utilizing video recordings of consultations between patients and neurologists in a memory clinic, we show that FMD patients account for their memory deficits as significant disruptions to their daily lives. Resonating with research which identified a dissonance between self‐reports of memory functioning by FMD patients and the outcome of neuropsychological assessments, we demonstrate that, in giving a detailed account of their perceived memory problems, patients provide objective conversational evidence of their cognitive and memory capacity, implicitly undermining the claim of an objective problem. Using conversation analysis, we examine three of the more prominent interactional practices FMD patients draw on when attempting to communicate memory deficits to the doctor – they are (i) contrasts with a standard of ‘normal’; (ii) third‐party observations; and (iii) direct reported speech. These interactional features are recurrent devices for displaying memory concerns as legitimate problems, embedded within patients’ accounts of their day‐to‐day lives.     

Carcinogenicity of dimethoate

Studies on the carcinogenicity of the insecticide dimethoate in animals were reviewed. Examination of histological sections showed that dimethoate is highly carcinogenic in Osborne-Mendel rats. Neoplasms at all sites, as well as malignant neoplasms, were increased in both low and high doses of dimethoate-treated male rats in the National Cancer Institute study. The malignant neoplasms were both carcinomas and sarcomas. Neoplasms of the endocrine organs, particularly carcinomas, were increased in male and female rats given dimethoate. These carcinomas were observed in the adrenal, thyroid, and pituitary glands. Neoplasms were also increased in the liver of male and female rats and in the reproductive organs of female rats given dimethoate. Male and female rats treated with dimethoate developed monocytic leukemia. There also were toxic changes in rats. Male rats had atrophy of the testes, chronic renal disease, parathyroid hyperplasia, and polyarteritis. Wistar male and female rats given dimethoate by gavage or intramuscularly developed a significant increase in malignant neoplasms, mainly sarcomas, and granulocytic leukemia. AB male and female mice also had an increased incidence of malignant neoplasms and granulocytic leukemia after dermal applications of dimethoate.     

Carcinogenicity of methylated nitrosopiperazines in rats and hamsters

A comparison has been made of the carcinogenic activities ofdinitroso-2,6-dimethylpiperazine (Me₂DNP) and nitroso-3-4,5-trimethylpiperazine(Me₃NP) in F344 rats and Syrian golden hamsters. The compoundswere administered in drinking water to the rats and by gavageto the hamsters, at similar dose rates. As measured by the increasedrate of mortality from tumors induced, Me₂DNP was a more potentcarcinogen in rats than Me₃NP; Me₂DNP induced mainly esophagealtumors, while Me₃NP induced tumors of the nasal cavity, butno esophageal tumors. In contrast, in Syrian hamsters, by thesame criterion, Me₃NP was at least as potent as Me₂DNP. Me₃NPwas more potent in hamsters than Me₂DNP as measured by the numberand multiplicity of tumors induced. The most numerous tumorsinduced by both compounds in hamsters were papillomas of theforestomas, but in addition Me₃NP induced a high incidence oflung tumors. A small number of hamsters treated with eithercompound had liver angiosarcomas. Two hamsters given Me₃NP hadpapillomas of the esophagus, a highly unusual tumor in Syrianhamsters.     

The effect of deuterium labeling on the carcinogenicity of nitroso-2,6-dimethylmorpholine in rats

Nitroso-2,6-dimethylmorpholine (Me₂NMOR) was labeled with deuterium in either the alpha or beta positions. Both the deuterium-labeled, and the unlabeled, compounds were administered to female Fischer 344 rats at equimolar concentrations in drinking water. The animals were then allowed to die naturally with tumors. The parent compound and the -d₄-labeled derivative were given at 50 mg/liter and 20 mg/liter, while, because of a shortage of the compound, the β-d₂-labeled derivative was given only at 20 mg/liter. Almost all of the animals died with basal cell carcinomas and papillomas of the esophagus; many animals fed the lower doses also had tumors of the nasal cavity and tongue. The rate of death from induced tumors was lower in the -d₄-treated group than in those treated with the unlabeled compound (at both dose levels), but was higher in the rats treated with the β-d₂ compound. It appears that deuterium in the alpha positions decreases carcinogenic potency, while deuterium in the beta positions increases it. This suggests that oxidation at the beta carbon atoms is less likely to be involved in esophageal carcinogenesis in the rat by Me₂NMOR than is oxidation at the alpha carbon atoms.     

Comparative carcinogenicity of two isomers of nitroso-2,6-dimethylmorpholine in guinea pigs

The cis and trans isomers of nitroso-2,6-dimethylmorpholine (Me₂NMOR) were administered by gavage to male Strain-2 guinea pigs as solutions in oil twice weekly for 30 weeks. Those animals treated with the cis isomer developed almost 100% incidence of liver tumors, together with tumors of the lung and adrenal cortex. In contrast, almost none of the animals treated with the trans isomer died with tumors. In rats, the trans isomer was considerably more potent than the cis, whereas this is not the result in guinea pigs, in which the cis is possibly more potent than the trans. This suggests that the mechanisms of activation in the 2 species might be different.     

Treating patients with psychogenic non-epileptic seizures

While the diagnostic features of psychogenic non-epileptic seizures have been better characterized in recent years, comparatively little is written about management. This review provides guidance to clinicians involved in the treatment of patients with psychogenic non-epileptic seizures and generates ideas for future research. It summarizes the recent literature specifically dealing with the treatment of such seizures and draws on the wider psychiatric literature on effective treatments for patients with other medically unexplained symptoms.