Anorectal foreign bodies - only a surgical question?

Treatment of anorectal foreign bodies is a frequent surgical and proctologic question. However, psychiatric implications of paraphilias are rarely discussed. Since the liberalisation of sexual behaviour in the 1970 s, the reported number of severe complications due to paraphilias is increasing, and sexuality is performed until higher age. We describe the case of an 88 year old man who had undergone laparotomy for removal of foreign bodies. The initial diagnosis of a dementia with inappropriate sexual behaviour could not be confirmed as the paraphilia existed since his youth. Etiologic, diagnostic and therapeutic implications of the case are discussed.     

Vertical bias in neglect: a question of time?

Neglect is defined as the failure to attend and to orient to the contralesional side of space. A horizontal bias towards the right visual field is a classical finding in patients who suffered from a right-hemispheric stroke. The vertical dimension of spatial attention orienting has only sparsely been investigated so far. The aim of this study was to investigate the specificity of this vertical bias by means of a search task, which taps a more pronounced top-down attentional component. Eye movements and behavioural search performance were measured in thirteen patients with left-sided neglect after right hemispheric stroke and in thirteen age-matched controls. Concerning behavioural performance, patients found significantly less targets than healthy controls in both the upper and lower left quadrant. However, when targets were located in the lower left quadrant, patients needed more visual fixations (and therefore longer search time) to find them, suggesting a time-dependent vertical bias.     

Peer support working: a question of ontology and epistemology?

There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health.     

To be or not to be: a question of B-Raf?

A recent study has identified the B-Raf gene as essential for the survival of explanted sensory and motor neurons in culture in response to neurotrophic factors. This finding sheds new light on the control of neuronal development and poses new questions with regard to Raf-isozyme-specific functions.     

Effectiveness of physical exercise in psychiatry: a therapeutic approach?

Introduction

There is a general belief that physical activity and exercise have positive effects on mood and anxiety. Intervention studies describe an anxiolytic and antidepressive effect of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological inconsistencies. Our review of the literature showed the importance of distinguishing three items in studies regarding efficacy of physical exercise in psychiatry: operationalisation of concepts (duration, frequency, intensity, type of exercise), the type of disorder, the diagnosis, and exploratory hypotheses. The aim of this article is to demonstrate that physical exercise in the psychiatry department contributes to the improvement of the mental health of in-hospital patients.

Methods

Sociodemographical data, the diagnosis and the physical exercise (duration, distance, type and frequency) of 283 in-hospital patients in the psychiatry department were listed. Physical exercise (cycling, long walks, short walks, soft and hard gymnastics) included in a database has been proposed to patients for many years in this hospital. After their hospitalisation, the members of the medical staff (20 persons) evaluated the patients on a visual analogic scale from 1 to 10 related to the improvement of their mental health. No experimental manipulation was made.

Subjects

One hundred and twenty-eight men, mean age: 45.67 years (±13.59) exhibited the following disorders: major depressive disorder (117), anxious disorders (25), alcoholic addiction (85), toxicomania (10), psychotic decompensation (33), bipolar disorder (3) and others (10). Patients practised at least one exercise during their hospitalisation, mean duration of 15.93 (±9.18) working days. The frequency of physical exercises per patient was 5.65 (±6.20). The improvement of each patient was evaluated around six times (6.16 ± 3.83). The average amelioration score for all the patients was close to 50% (4.99 ± 1.65).

Results

Correlations between the improvement of mental health and participation in physical exercises were all significant (frequency: r = 0.228; P < 0.001; duration: r = 0.236; P < 0.001; distance: r = 0.201, P = 0.001). In comparison with psychotic patients, drug addiction and alcoholic, depressive patients showed greater interest in physical exercise. This is similar for anxious disorders. According to the results, two groups were created regarding their improvement (cut out point: 5.08). We observed that patients suffering from major depression considerably improved thanks to physical exercise (P = 0.048), spent more time practising (P = 0.037) and walked or cycled greater distances (P = 0.038). Finally, cycling (frequency: P = 0.008; distance: P = 0.016; duration: P = 0.011) and “hard” gymnastics were the physical exercises which optimized the results.

Discussion

Physical exercise is correlated with the improvement of mental health. The practice of physical exercise depends on the mental disorder. People suffering from major depressive disorder benefit more from physical exercise than other groups. Cycling and “hard” gymnastics are both exercises to be proposed in every programme.

Conclusion

To practice physical exercise during hospitalisation in a psychiatric department has a positive influence on the symptomatology, and contributes to the improvement of mental health.     

Intraventricular blood after “traumatic” lumbar puncture: a report of two cases

Blood was detected in the lateral ventricles on head computed tomograms performed after traumatic lumbar punctures in two children. This finding has not previously been observed or reported. The likely mechanisms by which blood from the spinal thecal sac reached the ventricles are discussed. This potentially confusing observation, if not correctly accounted for, may lead to an unnecessary, fruitless search for the site of a supposed primary intraventricular haemorrhage.     

Withdrawal of warfarin prior to a surgical procedure: time to follow the guidelines?

BACKGROUND AND OBJECTIVE: Patients with cardiogenic sources of embolism may be at increased risk of cerebral infarction when anticoagulation therapy is suspended for surgical procedures. The purpose of this study was to determine frequency of cardioembolic cerebral infarction during periprocedural warfarin withdrawal. METHODS: Retrospective analysis of prospective cerebral infarction registry data from two tertiary medical centers. RESULTS: Over a 12-month period, 14 cases of cardioembolic cerebral infarction occurring during the period of warfarin withdrawal for a medical procedure were observed, accounting for 7.1% of the 197 cardioembolic cerebral infarctions encountered. Across all patients, cerebral infarctions developed an average of 5.4 days after the last dose of warfarin (range 3-8). Among the 14 patients (8 males and 6 females) with warfarin cessation-related infarcts, age ranged from 54 to 91 years. Each had been on chronic anticoagulation with warfarin for more than 1 year. Retrospective analysis suggested that all these cerebral infarctions had been potentially preventable. In each case, either the planned procedure did not require discontinuation of warfarin or, when withdrawal was required, no bridging, parenteral anticoagulation was provided to lessen the risk during the warfarin-free period. CONCLUSION: Patients at high risk of cardioembolic cerebral infarction may benefit from more intensive management strategies to reduce cerebral infarction risk during periprocedural periods.     

Do monkeys have a theory of mind? How to answer the question?

Since Premack and Woodruf (1978), the study of mindreading abilities in nonhumans, especially primates, has been thoroughly investigated. But attempts to understand the evolution of this aspect of human intelligence have mainly focused on comparisons between apes and human infants, while relatively little is known about the abilities of monkeys. This lack of data on monkeys seems mainly due to the hypothesis of a cognitive “gap” between apes and monkeys. However, in recent years monkeys have been featuring more prominently in the landscape of social cognition research, and some of these systematic studies appear promising. This paper reviews i) current knowledge about monkeys' socio-cognitive abilities, especially regarding gaze processing, attention and intention reading, and perspective-taking, ii) alternative hypotheses regarding the underlying mechanisms of such complex behaviors, and iii) potential new perspectives and future directions for studying ToM in monkeys.     

Do skull base lesions and their surgical treatment cause epileptic seizures?

OBJECTIVES: Few reports exist on the risk of seizures with skull base lesions and their surgical treatment. PATIENTS AND METHODS: All patients referred for surgery of a skull base lesion at George Washington University Hospital from January 1998 to August 1999 were reviewed. After excluding patients with other risk factors 136 patients were included. RESULTS: No seizures were reported before or after surgery, but 59 patients (43%) were taking anticonvulsants. Only 17 (12.5%) had EEG. Four of these showed no abnormalities, 2 were abnormal without sharp waves and 11 had sharp waves (an increase compared to the general population). Most sharp waves affected the temporal lobe on the side of surgery. All EEGs were performed less than 4 months after surgery. CONCLUSION: This study does not indicate that seizures are common in this patient group, but there was an increased amount of epileptiform activity on EEG and many patients were taking AED. A prospective study with systematic patient interviews, pre- and post-surgical EEG and a longer follow up is needed.     

Dual modification of Alzheimer’s disease PHF-tau protein by lysine methylation and ubiquitylation: a mass spectrometry approach

In sporadic Alzheimer’s disease (AD), neurofibrillary lesion formation is preceded by extensive post-translational modification of the microtubule associated protein tau. To identify the modification signature associated with tau lesion formation at single amino acid resolution, immunopurified paired helical filaments were isolated from AD brain and subjected to nanoflow liquid chromatography–tandem mass spectrometry analysis. The resulting spectra identified monomethylation of lysine residues as a new tau modification. The methyl-lysine was distributed among seven residues located in the projection and microtubule binding repeat regions of tau protein, with one site, K254, being a substrate for a competing lysine modification, ubiquitylation. To characterize methyl lysine content in intact tissue, hippocampal sections prepared from post mortem late-stage AD cases were subjected to double-label confocal fluorescence microscopy using anti-tau and anti-methyl lysine antibodies. Anti-methyl lysine immunoreactivity colocalized with 78 ± 13% of neurofibrillary tangles in these specimens. Together these data provide the first evidence that tau in neurofibrillary lesions is post-translationally modified by lysine methylation.     

Progression of cerebral white matter lesions in Alzheimer's disease: a new window for therapy?

BACKGROUND: White matter lesions (WML) are a risk factor for Alzheimer's disease. Progression of WML is associated with vascular factors and cognitive decline in population based studies but the course of WML is unknown in Alzheimer's disease. OBJECTIVE: To investigate the prevalence and risk factors for progression of WML in Alzheimer's disease. SUBJECTS: 38 patients with Alzheimer's disease for whom blood pressure measurements and sequential brain MRIs were available. METHODS: The proportion of patients with progression of WML was calculated, stratified on baseline absence or presence of WML by analysis of variance. Odds ratios (OR) were calculated by age and sex adjusted logistic regression to quantify the relation between blood pressure and progression of WML. RESULTS: About 25% of the patients showed progression of WML. Patients with WML at baseline had significantly more progression than those without WML at baseline (adjusted mean difference = 1.2; 95% confidence interval (CI), 0.6 to 1.8). Diastolic blood pressure (DBP) was particularly related to progression of WML (OR = 5.9 (95% CI, 1.0 to 37.6) per 10 mm Hg DBP, p = 0.05). CONCLUSIONS: Alzheimer's disease patients with WML at baseline are at risk for rapid progression of WML. WML may offer a potential treatment target in this disease to ameliorate the rate of cognitive decline.     

Is tau aggregation toxic or protective: a sensible question in the absence of sensitive methods?

In Alzheimer's disease brain, the microtubule-associated protein tau detaches from the microtubules, pathologically interacts with cellular proteins, and eventually forms insoluble aggregates that also bind and trap a myriad of proteins. As these proteins are depleted from the cellular pool, they are unavailable for physiological functions. Thus elevated tau levels are pathogenic, even in the absence of tau aggregation. Whereas it is reasonable to assume that tau aggregation is toxic during late stages of disease, the question arises whether early in disease it may be protective. This question can be addressed in tau transgenic animal models in which tau aggregation has been correlated with behavioral impairment. We discuss ways of how tau aggregation is monitored in these mice and what the detection limits are of these methods. We conclude that new tools are needed to measure the different stages of tau aggregation.     

Focused principal component analysis: a promising approach for confirming findings of exploratory analysis?

In many psychiatric studies, the objective is to describe and understand relationships between a large set of quantitative variables, with a particular interest in the relationship between one variable (often regarded as a response) and the others (often regarded as explanatory). This paper describes a new method to apply in such situations. It is based on principal components analysis (PCA). Like this technique, it conveys the structure of a correlation matrix into a low‐dimensional diagram but, unlike PCA, it makes it possible to represent accurately the correlations of a given variable with the other variables (and even to test graphically the hypothesis that one of these correlations is equal to zero). Two examples in the field of psychiatry research are provided. Copyright © 2001 Whurr Publishers Ltd.