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.     

Group psychotherapy and the mosaic adolescent society

Discussion of the influence of peer group mores and values on the adolescent patient's dysfunctional behaviors and treatment outcome. When the group therapist thinks peer, the group will focus on important issues such as inclusion, acceptance and awareness of the contrasting beliefs of the numerous peer subcultures within adolescent society. Strategies and approaches to create a therapeutic group milieu and structure are outlined to enable unwanteds to enter peer groups which support rather than impede the attainment of treatment goals. The need for leadership to be responsive to group members who have not experienced negentropic or functional systems is emphasized.     

Focal ependymal differentiation in the choroid plexus of human newborn brain confirmed by immunohistochemistry with monoclonal antibodies

Summary Ependymal proliferation [Ependymzotten, G. Becker, Beitr Pathol Anat Allg Pathol 103:457–477 (1939)], found in choroid plexus of newborns, can be made easily visible by immunostaining with antiglial fibrillary acidic protein (GFAP) antibodies. The expression of both GFAP and cytokeratin is an unusual feature of these structures.     

Static and dynamic pupillometry for determination of the course of gradual detoxification of opiate-addicted patients

Summary In order to assess the course of methadone (Heptadone) substitution therapy, 29 inpatients at the Vienna Psychiatric University Clinic (21 males, mean age=27 years, SD 4 years; 8 females, mean age 29.75 years, SD 5.28 years) who were addicted to opium tea or to a mixture of opium and heroin were investigated by means of computer-assisted static- and light-evoked dynamic pupillometry. Pupillary measurements were carried out before the start of withdrawal, on the 2nd day 48 h after the administration of 10 mg methadone, and again after the maximum and half of the maximum dose of methadone had been administered. The constricted pupils (the effect of opiate) showed dilatation after the withdrawal syndrome appeared, but immediately after the start of the detoxification treatment, as well as 1 day after administration of the maximum methadone dose a decrease of pupillary diameter was observed. The narrowing of the pupil was followed by an increase in pupillary diameter, which peaked 48 h after the last minimal dose of methadone and nearly reached the normal level. The widening of the pupil reflects an increase of noradrenergic activity under conditions of opiate withdrawal. An increase of spontaneous fluctuations was observed during withdrawal and was only inhibited by the maximum dose of methadone. Finally, pupillary dynamics (shortening of latency time and increase of relative changes) improved during therapy. The pupillary measurement coresponded with clinical observations as well as with self-evaluation during treatment. Thus pupillometry seems to be a useful instrument for assessment of treatment of opiate-addicted patients.     

Zur Frage des Off-On-Effektes bei Levodopa-Behandlung des Parkinsonismus

Zusammenfassung Tagesschwankungen der Leistungsfähigkeit bei Parkinsonkranken unter langdauernder Levodopabehandlung sind als sogenanntes Off-On-Phänomen bekannt. Reduzierter Proteingehalt in der Nahrung soll diesen Effekt bei Kranken, die nur mit L-Dopa allein behandelt werden, beheben können, nicht aber bei denjenigen, die eine Behandlung mit L-Dopa Dekarboxylasehemmer erhalten (Cotzias et al.). Die Hypothese von Cotzias beruht auf der Annahme, daß eine Transportkonkurrenz zwischen L-Dopa und Aminosäuren zu den Hirnganglien besteht.Um diese Ergebnisse zu prüfen, wurde bei 23 Parkinsonkranken mit Off-On-Phänomen der Einfluß einer proteinarmen Nahrung untersucht.Alle Patienten waren 5–8 Jahre mit L-Dopa vorbehandelt und erhielten zumindest in den letzten 3 Jahren eine Kombinationsbehandlung mit Dopa/Dekarboxylasehemmer. Der Eiweißgehalt der Nahrung wurde auf 25 g pro Tag beschränkt (weniger als 0,5 g pro kg Gewicht) und dies für eine Zeit von 1–4 Monaten.In 6 Fällen konnte eine deutliche Besserung mit Verminderung des Off-On festgestellt werden, in 1 Fall kam es zum völligen Verschwinden des Phänomens. Eine auffallende Besserung der allgemeinen Leistungsfähigkeit konnte in weiteren 5 Fällen beobachtet werden und eine objektive Besserung der Symptome, aber nur während der Off-Periode, festgestellt werden. Die restlichen 12 Fälle haben nicht angesprochen. Bei allen Patienten mit Hyperkinesie wurde eine Steigerung des Symptoms während der Diätperiode beobachtet. Eine Abhängigkeit von Diät zum Alter, Schwere, Dauer der Krankheit und der Dopabehandlung konnte nicht festgestellt werden. Der mögliche Mechanismus des Off-On-Phänomens sowie einige Vorschläge es zu beeinflussen werden dargestellt.

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The off-on phenomenon during treatment of Parkinson's disease with Levodopa

Summary The fluctuation in daily performance of Parkinson patients on long-term L-dopa therapy is known as the so called off-on phenomenon. Cotzias et al. found that a low protein diet is able to control this phenomenon in patients taking L-dopa alone but not in those receiving a combination of L-dopa and decarboxylase inhibitor. The author's hypothesis was based on the competition between the alimentary aminoacids and L-dopa for transport to the brain ganglia.In our attempt to prove the findings of Cotzias group we tested the influence of a low protein diet on 23 Parkinson patients manifesting the off-on phenomenon. All had been pretreated with L-dopa for 5–8 years and taking dopa DI for a minimum of 3 years. The protein intake was limited to 25 g/day (which is less than 0.5 g/kg body weight) for 1–4 months.In 6 cases there was a marked improvment with reduction of the off-on effect, and in one it disappeared completely.A distinct improvement of general capability was seen in the other 5 cases, and an objective improvement of the symptoms was noted, exept during the off period. No response could be observed in the remaining 12 cases. All cases with hyperkinesia showed an augmentation of this symptom during the use of the diet. The diet restriction was not found to be correlated with age, stage, duration of illness or duration of dopa treatment. The possible mechanism of the off-on phenomenon and some suggestions to influence it, are presented.

     

Ultrastructural changes in blood vessels of peripheral nerves in leprosy neuropathy

Summary Radial or superficial peroneal nerve biopsies of 6 patients with tuberculoid or borderline-tuberculoid leprosy and 6 control nerve biopsies were examined by electron microscopy.Endoneurial blood vessels showed histopathology in all the leprosy patients. Changes, in particular, involved the basement membrane in postcapillary venules and venules. Multilayered parellel basement membranes, with collagen and ground substance, formed a thick coat (hyaline zone) around the vessels. It is suggested that the zone inhibits passage of nutrients and metabolites and, thus, contributes to or is the main cause of the local destruction of (unmyelinated) nerve fibres and the lack of nerve fibre regeneration observed in this type of leprosy. The perivascular zone, presumably, is produced by pericytes in response to defects in the blood-nerve barrier of endoneurial vessels. In granulomata of leprosy skin lesions, a perivascular zone was not present.The endothelium of endoneurial vessels, in affected nerves, generallywas normal. Occasionally, however, gaps and fenestrations were seen and there were histological indications that leakage of blood plasma had occurred through the gaps and through the basement membrane of the endothelium.Occlusion of endoneurial vessels was found only in the oldest patient and the degeneration of nerve fibres generally observed thus is considered not to be caused by ischaemia.Histopathology in epi-and perineurial vessels was definitely less pronounced than in endoneurial vessels.     

Energy gradients for the homeostatic control of brain ECF composition and for VT signal migration: introduction of the tide hypothesis

Summary. The present paper enlightens a new point of view on brain homeostasis and communication, namely how the brain takes advantage of different chemical-physical phenomena such as pressure waves, and temperature and concentration gradients to allow the renewal of the extra-cellular fluid (i.e., the homeostasis of the brain internal milieu) as well as some forms of intercellular communications (Volume Transmission) at an energy cost much lower than the classical synaptic transmission (the prototype of Wiring Transmission).In particular, the possible functional meaning of the intracranial pressure waves is discussed in the frame of the so called tide hypothesis which maintains that the pressure waves, created by the cardiac pump, modulate the cerebro-spinal fluid flow from and towards the subarachnoid space as well as towards and from the Virchow-Robin spaces. These fluid push-pull movements favor both the migration of signals and the extra-cellular fluid renewal, especially in the cerebral cortex.Dedicated to Prof. B. Magnani, Professor of Cardiology, Medical Faculty of Bologna, Italy     

Metopic synostosis: in favour of a “simplified” surgical treatment

Metopic synostosis is a relatively simple form of craniosynostosis, resulting from premature fusion of the metopic suture. In this pathology different degrees of dysmorphia of the anterior cranial fossa and the presence of associated anomalies of the skull might enable specific subgroups to be identified. Since most functional and cosmetic anomalies benefit from early surgical treatment, over the last few years neurosurgeons have been forced to elaborate less drastic, but nonetheless effective, surgical techniques. In the present report we analyze the surgical results obtained in a series of 62 infants with trigonocephaly operated on within their 1st year of life. Patients were subdivided into two groups (group I: 8 patients; group II: 54 patients) according to the specific dysmorphic characteristics of the frontal bone and anterior cranial fossa, and the presence of compensatory deformities affecting the anterior cranial base and temporo-parietal region. All the patients were treated using one of two relatively simple surgical techniques (procedure A: inversion of two hemifrontal bone flaps-48 cases; procedure B: the shell operation-14 cases). Both surgical procedures appeared to be effective, allowing adequate functional and cosmetic correction of the cranial deformity. In patients operated on following procedure B surgical time and and blood loss were dramatically reduced. Long-term outcomes were satisfactory in all cases, irrespective of the surgical technique used. In the group II patients, however, progressive normalization of the interorbital distance was constantly observed, suggesting a different degree of stenotic involvement at the level of the anterior cranial base in these patients.Presented at the Consensus Conference on Craniosynostoses, Rome, 4–6 May 1995     

The significance of cytoplasmic inclusions in late infantile and juvenile amaurotic idiocy

Summary The electron microscopic findings of cerebral biopsies from two siblings with late infantile-juvenile amaurotic idiocy are presented. One patient had a mixture of fingerprint and multilamellar inclusions, often in the same cytosome. The second patient had only fingerprint inclusions.Electron microscopic findings in autopsied tissues from two other cases of late infantile-juvenile amaurotic idiocy with multilamellar cytosomes are also presented. Evolution of the multilamellar cytosomes into lipofuscin was not observed. We concluded that cases of late infantile-juvenile amaurotic idiocy with multilamellar and fingerprint inclusions should be distinguished from cases with lipofuscin.The present investigation was supported by Research Grants NS 05572-08, 1 T01 NS 05712-01 and RR 75.     

“Conservative” surgical approach and early postoperative radiotherapy in a patient with a huge cystic craniopharyngioma

Objective The treatment of huge craniopharyngiomas represents a therapeutic challenge for neurosurgeons. Some authors prefer to run the high risks of total removal at primary surgery, while others do not despise subtotal removal in accordance with a multidisciplinary treatment.Methods We report the case of a 17-year-old girl who underwent subtotal removal (tumour remnant with maximum diameter of 2.5 cm) of a huge cystic craniopharyngioma by frontotemporal approach, followed by early external fractionated radiotherapy by linear accelerator. Serial magnetic resonance imaging during a follow-up period of 5 years showed a progressive marked reduction of the tumour remnant, accompanied by a complete recovery of visual deficits and an almost complete regression of diencephalic disturbances.Conclusions Subtotal removal followed by early fractionated radiotherapy can be an effective treatment for huge craniopharyngiomas. Such a multidisciplinary treatment may favour tumour control and assure a satisfactory quality of life as well.Commentaries on this paper are available at , , , , and     

The fine structure of cerebral capillaries in “overgrown” neural tissue

Summary Cerebral capillaries in overgrown neural tissue of chick embryo brains ranging in age from 5–18 days of incubation were studied by means of electron microscopy. The vessels in the abnormal tissue showed more extensive and prolonged interdigitations and overlapping of adjacent endothelial cells than did those in normal control brains. In the abnormal neural tissue the appearance and distribution of endothelial cell organelles was similar to that in normal tissue; however, the Golgi complex was less highly developed, and there was an increased amount of coated vesicles in the capillaries of the abnormal brains.     

Upgaze palsy and monocular paresis of downward gaze from ipsilateral thalamo-mesencephalic infarction: a vertical “one-and-a-half” syndrome

Summary A patient with an infarct limited to the paramedian thalamus and upper mesencephalon on the right side suffered a conjugate upgaze palsy associated with a monocular paresis of downward gaze in the ispsilateral eye (vertical one-and-a-half syndrome). This paresis involved tonic and phasic components. Vertical oculocephalic movements and conjugate horizontal gaze were normal. It is suggested that the unilateral lesion destroyed the fibres of the posterior commissure and the descending fibres to the ipsilateral subnucleus of the inferior rectus and contralateral subnucleus of the superior oblique just after they decussate, probably above the level of the third nerve nucleus. A complex disturbance of vertical gaze may be due to a unilateral thalamo-mesencephalic lesion.

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Zusammenfassung Wir beschreiben einen Patienten mit einem Infarkt rechts paramedian im Thalamus und oberen Mesencephalon mit Blicklähmung nach oben und einer Parese nach unten nur ipsilateral. Betroffen waren sowohl die tonischen wie die phasischen Bewegungskomponenten. Die vertikalen okulocephalen Reflexe und der konjugierte horizontale Blick waren normal. Wir vermuten, daß die einseitige Läsion Fasern der hinteren Kommissur und abwärts führende Fasern zum ipsilateralen Kern des Rectus inferior und zum gegenseitigen Kern des Obliquus superior zerstörte kaudal ihrer Kreuzung, wahrscheinlich rostral des Nucleus oculomotorius. Eine komplexe Störung der vertikalen Blickbewegung kann auf eine einseitige thalamo-mesencephale Läsion hinweisen.

     

Das Phänomen der periodisch alternierenden Bulbusdeviation

Zusammenfassung Anhand einer klinischen und elektrookulographischen Beobachtung wird das Phänomen der periodisch alternierenden Blickdeviation erörtert. Unter besonderer Berücksichtigung der wenigen in der Literatur beschriebenen Fälle werden Überlegungen zur Topographie der verursachenden Läsionen angestellt.     

Succinoxidase activity in reticular neurons of hyperactive rats

Summary The succinoxidase activity of single neurons from the reticular formation was measured with the Cartesian diver technique. The average activity of nerve cell bodies from the nucleus gigantocellularis or pontis caudalis from control rats was 4.5 l O₂×10^–4 per hour at 37°C. After rats had received --iminodipropionitrile, the succinoxidase activity of the same type neuron increased to an average of 8.0 l O₂×10^–4. It was suggested that this increase was of etiological significance for the symptoms of hyperactivity which developed later. Also when --iminodipropionitrile had been added to the reticular neurons from normal rats in vitro, the succinoxidase activity increased to 8.4 l O₂×10^–4 per hour.Supported by USPH Grant NB 1305.     

A case history analysis of the “manic type” and the “melancholic type” of premorbid personality in affectively ill patients

Summary The use of case histories in examining the premorbid personality of affectively ill patients is especially useful in the case of patients with a predominantly manic course of the disorder, because this kind of affective illness is very rare. The concept of the manic type of premorbid personality is described in detail and contrasted with the concept of the melancholic type often found in patients with a purely depressive course of the illness.     

S-100 protein and 2′,3′-cyclic nucleotide 3′-phosphohydrolase in human brain tumors

Summary Biopsy specimens from 23 human brain tumors have been analyzed for the nervous system specific protein S-100 and the membrane-associated enzyme 2,3-cyclic nucleotide 3-phosphohydrolase (CpNase). Biopsy specimens from an additional seven brain tumors were tested for either S-100 or CpNase alone.All astrocytomas and glioblastomas tested were found to contain S-100 and CpNase although there does not appear to be a strong correlation between the levels of these two markers in the 14 such tumors assayed for both. S-100 levels varied over a 19-fold range while CpNase varied over a 835-fold range. Postoperative survival in the astrocytoma and glioblastoma patients showed only a weak correlation with either tumor CpNase or S-100 levels.Two acoustic neurinomas, two oligodendrogliomas, one mixed glioma, and one choroid plexus papilloma were also assayed and found to have detectable levels of both S-100 and CpNase with the acoustic neurinomas and the mixed glioma having relatively high levels of each marker. All six meningiomas tested had low levels of CpNase. S-100 assays in three benign meningiomas were negative, while low levels of this protein were found in the one malignant meningioma tested.Tissue cultures were grown out from biopsy specimens of additional human brain tumors and tested at confluency for S-100. Of 15 astrocytoma and glioblastoma cultures tested, three had easily detectable amounts of S-100, two appeared to contain trace levels and ten were negative. The two acoustic neurinoma cultures tested were positive for S-100 while all three oligodendroglioma cultures were negative.     

Zur Therapie mit Dimethylaminoäthanol (Deanol) bei neuroleptikainduzierten extrapyramidalen Hyperkinesen

Summary Most earlier studies and all studies on national samples in Scandinavia and in England and Wales have shown that schizophrenics have a significant excess of births in the winter or early months of the year when compared with the expected distribution of the normal population. The present German study, carried out on schizophrenic patients diagnosed in a strongly Kurt Schneider-oriented clinic, in contrast to almost all other authors, demonstrated no such significant overrepresentation of births in the winter months. Thus, the findings of Danneel's (1973) German report, also utilizing Schneider-diagnosed schizophrenics, seem, at least for the present, to be confirmed.     

An ultrastructural comparison of peripheral nerve allografts and autografts

Summary There is a marked difference in the cellular response of the host to peripheral nerve allografts and autografts. The response elicited by allografts is characterised by invasion of tissue with lymphocytes, plasma cells and activated macrophages. These cells disrupt the nerve architecture, and cause rupture and consequent compression of the neurolemmal tubes which are the essential conduit element of a nerve graft.By contrast, in the autograft, regeneration follows the initial process of Wallerian degeneration without the complication of immune reaction. The Schwann cells and macrophages rapidly remove the myelin and axons from the neurolemmal tubes of the donor nerve; new axonal sprouts are then able to traverse these channels and reach the periphery in large numbers. If this process is delayed, the neurolemmal tubes in the distal nerve segment are compressed by surrounding collagen which limits the size of regenerating axons.     

Quantitative histological studies on the aged human brain

Summary Brains from 75 people were studied to assess the occurrence of senile plaques and argyrophilic tangles in a population selected as far as possible for its probable mental normality.Histological methods were devised and validated to permit quantitative assessment of the numbers of these lesions as well as their frequency of occurrence in the two areas studied—frontal cortex and Ammon's horn.There was significant correlation between increasing age over 60 years and the proportion of patients who showed these changes at both sites. No definite relationship was found between age, site of occurrence and the intensity of the pathological changes.

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Zusammenfassung 75 menschliche Gehirne wurden untersucht, um das Auftreten von senilen Plaques und argyrophilen Fibrillen in einer wegen mutmaßlicher psychischer Unauffälligkeit ausgewählten Population zu erfassen. Die histologischen Methoden wurden standardisiert und überprüft, um eine quantitative Erfassung der Zahl und Häufigkeit dieser Läsionen in zwei untersuchten Hirnregionen — Frontalrinde und Ammonshorn — zu ermöglichen. Es fand sich eine signifikante Korrelation zwischen zunehmendem Alter über 60 Jahren und dem Anteil an Patienten mit diesen Veränderungens in beiden Regionen. Zwischen Alter, Ort des Auftretens und Intensität der pathologischen Veränderungen fand sich keine Beziehung.

     

Characterization of amyloid deposits in biopsies of 15 patients with “sporadic” (non-familial or plasma cell dyscrasic) amyloid polyneuropathy

Summary Review of the clinical and laboratory findings of 39 patients with amyloid polyneuropathy (AP) showed 12 cases to be hereditary and 12 to be associated with plasma cell dyscrasia (PCD). The remaining 15, termed sporadic AP, had neuropathy clinically indistinguishable from the other two groups but without a clinicopathologically identified PCD or positive family history. In an attempt to identify the type of amyloid in sporadic AP, the immunoreactivity of amyloid deposits was investigated using specific antisera raised against the following different chemical types of amyloid fibril proteins: variable regions of amyloid light chains (A) and (A), amyloid protein AA, and prealbumin. It was found that the amyloid in sporadic AP had A antigenic determinants in ten cases, A in one and prealbumin in three; in one case, the A nature of amyloid was confirmed biochemically on the extracted amyloid fibrills. Thus, the most common type of AP in our population appears to be the sporadic form. In sporadic AP, the amyloid is most commonly of immunoglobulin light chain origin, even in the absence of overt PCD, and it can be rapidly categorized immunocytochemically to determine therapeutic directions or provide genetic guidance.