MIGRAINE AND PERSONALITY IN RENAL PAPILLARY NECROSIS

This study deals primarily with the new type of renal papillary necrosis which appeared during the 1950's and which was explained by the excessive use of phenacetin-containing analgesics. It was observed that many of the patients used the analgesic compound because of their migraine and/or tension headaches. The clinical analysis of 95 migraine patients has given the following results: 1. migraine patients abused or overconsumed phenacetin. 2. 6 migraine patients did not at all use analgesics and 8 patients took very small doses. None of them showed signs of diabetes or urinary tract obstruction. 3. The migraine headache is usually of a grave character and classified as classical migraine in 2/3 of the cases. 4. Psychasthenic personalities dominate. 5. Peptic ulcers, mainly duodenal ulcers, occur more frequently than in a 'normal' population and are much more common than in other migraine material. 6. Hyperthyroidism is much more common than in a 'normal' population. 7. Allergy, including asthma, is much more common than in a 'normal' population. 8. Nearly 1/4 of the migraine-patients suffer from peripheral vascular disturbances (cold hands and feet).     

PERSONALITY IN EPILEPSY

Three groups of epileptic out-patients (juvenile myoclonie epilepsy, psychomotor epilepsy, and cryptogenic grand mal) were studied. the groups were matched as closely as possible with each other with regard to sex, age, and treatment. Out-patients suffering from Menière's disease served as a control group; these patients were treated with placebo and matched with the epilepsy groups with regard to sex, duration of disease and social level. the Marke-Nyman inventory was used as a quantitative assessment of personality traits. This inventory is an operative definition of Sjöbring's neurophysiological model of personality, including the three dimensions: validity, stability and solidity. Our results showed that epileptic patients irrespective of the type of seizures were substable. Low validity was found in patients with juvenile myoclonic epilepsy and in patients with psychomotor epilepsy with temporal EEG focus. In those latter epilepsy groups a tendency to subsolidity was also observed. In Sjöbring's frame of reference these substable patients of low validity have a psychological vulnerability since they are unable to overcome the small concrete adversities of life. They adhere to problems, and being unable to solve them they tend to react in a mood of discontent or of maladjustment. In the usual psychiatric frame of reference substable patients of low validity are classified as psychoastenic patients with emotional instability.     

PERSONALITY FEATURES AND DISORDER IN THE SUBJECTS IN THE NEW YORK HIGH-RISK PROJECT

One hundred and seventy-five offspring of parents in two psychiatrically ill groups and of normal controls in the New York High-Risk Project (NYHRP) were assessed for Axis II personality traits and disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). These offspring include: subjects at high risk for schizophrenia (HRSz, n = 48), all of whom have a parent with schizophrenic disorder; subjects at high risk for affective disorder (HRAff, n = 40), all of whom have a parent with affective disorder; and subjects at no increased risk for psychiatric illness (NC, n = 87), whose parents are psychiatrically normal. The trained interviewers, who administered a standardized direct interview, were blind to parental clinical status and to previous clinical status of the offspring.

The rates for any personality disorder (PD) ranged from 7% to 20%. Comorbidity between Axis I and Axis II disorders was high for all groups.     

PSYCHOLOGICAL EVALUATION OF INTELLIGENCE AND PERSONALITY IN PARKINSONISM BEFORE AND AFTER STEREOTAXIC SURGERY

In a series of Parkinsonian patients subjected to stereotaxic surgery, the mental function was studied by means of psychological tests. The purpose was to throw light on the possible postoperative mental changes which together with fear of speech disturbances seem to be the most important contra-indications for neurosurgical treatment. In the study, 41 patients operated on for Parkinsonism were subjected to preoperative and postoperative psychological tests (average observation period 8.7 months). Bilateral operation was performed in seven cases. The mean age of the patients was 60 years. The tests used were the Wechsler Adult Intelligence Scale and the Rorschach test. In the series as a whole, no significant quantitative changes in the postoperative mental function were revealed by the two tests. The Rorschach test revealed as an interesting finding that all the Parkinsonian patients preoperatively showed some mental reduction and that there was no significant difference between the patients with paralysis agitans and those with postencephalitic Parkinsonism. Slight postoperative changes, viz. a diminished and more rigid activity, were demonstrated in three clinical groups: patients subjected to operation on the globus pallidus, patients with postencephalitic Parkinsonism, and those with unilateral affection in the dominant hemisphere. The results of the study thus seem to indicate that a certain reluctance should be exercised in offering stereotaxic surgery to postencephalitic patients and to those with unilateral affection in the dominant hemisphere. Apart from this, it seems justified to conclude that in patients who otherwise meet the indications, the risk of postoperative mental impairment does not constitute a contra-indication for this type of surgery.     

EXECUTIVE PERSONALITY TRAITS AND EATING BEHAVIOR

Eating disorders, such as anorexia, bulimia, and binge eating disorder, commonly involve a dysregulation of behavior (e.g., a lack or excess of inhibition and impulsive eating patterns) that is suggestive of prefrontal dysfunction. Functional neuro-imaging studies show that prefrontal-subcortical systems play a role in eating behavior and appetite in healthy individuals, and that people with eating disorders have altered activity in these systems. Eating behavior is often disturbed by illnesses and injuries that impinge upon prefrontal-subcortical systems. This study examined relationships between executive functioning and eating behavior in healthy individuals using validated behavioral rating scales (Frontal Systems Behavior Scale and Eating Inventory). Correlations demonstrated that increased dysexecutive traits were associated with disinhibited eating and greater food cravings. There was also a positive association with cognitive restraint of eating, suggesting that increased compensatory behaviors follow disinhibited eating. These psychometric findings reinforce those of other methodologies, supporting a role for prefrontal systems in eating     

ALCOHOLIC TENDENCY AND EEG AROUSAL IN WOMEN: EFFECTS OF FAMILY HISTORY AND PERSONALITY UNDER EMOTIONAL STIMULATION

Alcoholism runs in families and is influenced by both genetic and personality factors. Important questions remain, however, as to just how neurological functioning is affected by these predispositions. As a result, the present study assessed the effects of both familiality and personality factors on electroencephalographic (EEG) responses. College students were prescreened for family history (FH) of and personality predisposition (PAP) toward alcoholism, and 60 subjects were assigned to four extreme groups representing the crossover of the familial and personality dimensions. Each participant was exposed to nonverbal positive and negative emotional stimuli. Electroencephalography was recorded at frontal, parietal, and temporal sites in both hemispheres throughout and analyzed to assess response in the fast and slow alpha and beta ranges. Results showed that those with either a positive family history of alcoholism alone or predisposing personality characteristics alone were less aroused than those without predispositions. However, those high on both dimensions had lower arousal than subjects in other cells. Findings were interpreted as supporting the theoretical inverted U-shaped relationship of arousal input to arousal output.     

FOETAL THYROIDECTOMY AND BRAIN DEVELOPMENT IN THE SHEEP

Sheep foetuses were surgically thyroidectomized at 50-60 days gestation, when thyroid function begins, and the pregnancy was then allowed to continue until 90, 120 or 150 days (term). At these times the foetuses were removed by caesarean delivery, exsanguinated, weighed and dissected. The central nervous system was divided--cerebral hemispheres, brain stem, cerebellum and spinal cord for subsequent analysis. Comparison was made with sham operations on seven foetuses. Thyroidectomy led to a fall in body weight (24.7%) and brain weight (11.7%) at 120 days and 150 days, 31.1% and 24.5% respectively. The hemispheres showed the greatest change and the cerebellum the least. DNA and protein contents were reduced in the hemispheres and cerebellum at 150 days, while in the brain stem and spinal cord the DNA content was not significantly affected. Protein content was, however, reduced indicating a reduced cell size, but not a reduced cell number as in the other two regions. Somatic changes included reduced wool growth, delayed osseous development in the limbs (X-ray assessment) a reduced heart weight (39.1%) and an increased pituitary weight (48.1%). The thyroidectomized lambs failed to survive for more than a few hours after birth or caesarean delivery at 150 days. The findings indicate significant effects of foetal thyroidectomy on brain development in the sheep late in pregnancy along with other evidence of foetal hypothyroidism.     

SELF-MUTILATION IN AN ELDERLY PATIENT WITH PERSONALITY DISORDER

A 76-year-old woman presenting with depression, self-mutilation and substance abuse, in the context of physical illness, was referred for psychotherapy. Her past history was marked by long-standing dysthymia, a propensity to somatization, drug overdoses and antisocial behaviour, including the killing of her grandson. She had suffered substantial deprivation and abuse from her earliest years. She was considered unsuitable for dynamic psychotherapy because of her personality organization, her use of primitive defence mechanisms and her inability to tolerate frustration, given her propensity to act out in destructive ways towards herself and others. She was managed within a multidisciplinary team in an old age day hospital. This patient illustrates that personality dysfunction does not necessarily ameliorate with advancing age. Less overt manifestations of destructive behaviour, such as sabotage of treatment, starvation and polypharmacy, may be seen in this age group.