Differentiating organic from functional psychosis.

Psychosis is not pathognomonic of psychiatric illness. It is simply a nonspecific cluster of signs and symptoms that may occur in a broad array of medical, neurologic and surgical disorders or as a consequence of pharmacologic treatment, substance abuse or the withdrawal of drugs and alcohol. Psychoses are classified as organic or functional mental disorders. Organic disorders with psychosis are caused by structural defects or physiologic dysfunction of the brain. The causes of functional disorders have not yet been identified. Psychoses are also categorized as effective or nonaffective in character. Affective and nonaffective psychoses may be associated with either organic or functional disorders.     

Ciprofloxacin-induced psychosis.

OBJECTIVE: To report a case of ciprofloxacin-induced psychosis and to discuss occurrence rates, risk factors, possible etiologies, preventive measures, and treatment courses for this adverse reaction. DATA SOURCES: Case reports and review articles identified by MEDLINE. DATA EXTRACTION: Data from pertinent published sources were reviewed and abstracted. DATA SYNTHESIS: A 49-year-old man developed symptoms of severe psychosis concomitant with ciprofloxacin (250 mg bid) treatment. Central nervous system effects secondary to ciprofloxacin treatment are uncommon and usually consist only of minor dizziness or mild headache, although rare occurrences of seizures and hallucinations have been reported. The mechanism by which ciprofloxacin causes these adverse effects is not fully understood. It has been suggested that quinolones may produce an epileptogenic effect by inhibiting the binding of gamma-aminobutyric acid to its receptor sites in the brain. There is yet no explanation for the occurrence of hallucinations or psychosis. CONCLUSIONS: Caution should be exercised when using ciprofloxacin in the treatment of patients with personality abnormalities or symptoms of psychosis.     

Acute versus chronic pain treatment in Alzheimer's disease.

Several studies have suggested a lower consumption of analgesics in patients with Alzheimer's disease (AD) than in cognitively intact individuals (ND), but little attention has been paid to a distinction in analgesic consumption between acute and chronic pain treatment. The aim of this prospective and longitudinal study is a comparison in AD and ND residents at selection, and one year later, of analgesic consumption for acute and chronic pain, with an assessment of cognitive status (with the Mini Mental State Examination (MMSE)). Three hundred institution residents (150 AD and 150 ND), 20% male and 80% female (84.4 +/- 8.3 years old), were included in this study. Analgesic consumption and MMSE were reassessed at one year's distance (period 1 P1 and 2 (P2)). Analgesic consumption for acute pain was not significantly different for AD and ND at selection time or one year later, while MMSE declined significantly for AD (6 +/- 7 (P1) versus 4 +/- 6 (P2) p < 0.01, and ND individuals 23 +/- 5 (P1) versus 20 +/- 6 (P2), p < 0.01, respectively). Chronic pain analgesic consumption however was significantly lower in AD than in ND (p < 0.01). These findings may suggest a dissociation between sensory-discriminative (lateral pain system) and motivational-affective (medial pain system) aspects of pain in individuals with AD. This dissociation must be further investigated as it may have important consequences for pain evaluation and pain treatment in this vulnerable population.     

Differences between functional versus organic low back pain patients.

There are contradictory findings about whether there are differences in personality and/or amount of emotional disturbance between patients with functional versus organic low back pain. The MMPI scores of 42 back pain patients diagnosed as "organic" were compared with the scores of 37 patients classified as "functional". The functional patients scored significantly higher than the organics on the Hs, Hy, Pd, Sc, Ma, and Si scales. The organics scored significantly higher than the functionals on the K scale. The results confirm the view that certain symptoms of emotional disturbance are more characteristic of patients who have relatively little evidence of physical findings. However, the degree of overlap between groups was high enough to suggest caution in making predictions and diagnoses about functional versus organic pain on individual patients solely on the basis of personality data.     

Acute confusion assessment instruments: clinical versus research usability.

Acute confusion (AC), also referred to as delirium (AC/delirium), is a common problem seen by health professionals who work in a variety of care settings. This is an evaluative report on the clinical usability of instruments to assess AC/delirium as a part of nursing practice. Specifically, five instruments [the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Delirium Symptom Inventory (DSI), Mini-Mental State Examination (MMSE), and Neelon/Champagne (NEECHAM) Confusion Scale] are discussed. The work demonstrates how the cooperation of nurses in practice, education, and research can improve both patient and staff outcomes.     

奥氮平联合多奈哌齐治疗脑器质性精神障碍疗效观察

目的：探讨奥氮平联合多奈哌齐治疗脑器质性精神障碍的临床疗效和安全性。方法将82例脑器质性精神障碍患者随机分为两组,均接受脑器质性疾病常规治疗及口服奥氮平治疗,研究组在此基础上联合多奈哌齐治疗。于治疗前后采用简明精神病量表、阳性与阴性症状量表、日常生活能力量表评定临床疗效及不良反应。结果治疗后两组各量表评分均较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;两组不良反应发生率比较差异无显著性（P＞0．05）。结论奥氮平联合多奈哌齐治疗脑器质性精神障碍临床疗效显著,安全性高,优于单用奥氮平治疗。     

Functional compartmentation of glycolytic versus oxidative metabolism in isolated rabbit heart.

To investigate whether energy derived from glycolytic and oxidative metabolism are preferentially used for different functions in heart, tension, intracellular potential, and extracellular [K+] and pH (using triple barrel K/pH electrodes, tip diameter 0.5 mm) were monitored in isolated arterially perfused rabbit interventricular septa during exposure to hypoxia and metabolic inhibitors. Myocardial content of high energy phosphates, lactate, and glycogen were determined under the same conditions. Inhibiting oxidative metabolism with hypoxia, dinitrophenol (10(-5)M), or Na-azide (10(-3)M) caused marked suppression of tension (by 73 +/- 5, 65 +/- 8, and 50 +/- 14%, respectively) and a small increase in [K+]0 (0.8 +/- 0.4, 0.5 +/- 0.25, and 0.4 +/- 0.2 mM, respectively) after 10 min. Inhibiting glycolysis with iodoacetate (IAA) (10(-3)M) had a much smaller suppressant effect on tension (28 +/- 24%) but markedly increased [K+]0 accumulation (by 1.8 +/- 1.1 mM) at 10 min. These differences, when IAA was compared individually to the other interventions, were highly significant. The shortening of action potential duration was not significantly different for the four interventions. pH0 increased slightly during IAA (+0.04-+0.06 U) and fell during the other interventions (-0.10--0.16 U), but this did not account for the differences in [K+]0 accumulation and tension between inhibition of glycolytic vs. oxidative metabolism. Except for hypoxia, total cellular content of high energy phosphates was not significantly depressed under the various conditions. This data suggests that energy from glycolysis is preferentially used to support sarcolemmal function (as manifested by K+ loss), whereas oxidatively derived energy preferentially supports contractile function. Indexing terms: cardiac metabolism, extracellular pH, metabolic inhibitors, hypoxia, extracellular K+ accumulation, and glycolysis.     

Acute versus chronic exercise-induced left-ventricular remodeling

Exercise-induced cardiac remodeling (EICR) is the process by which the heart adapts to the physiologic stress of exercise. Non-invasive cardiovascular imaging has led to advances in the understanding of EICR, with sport-specific changes in left-ventricular (LV) structure and function being described; however, the majority of data stem from cross-sectional and short-duration longitudinal studies. Due to the paucity of long-term longitudinal EICR studies, the time course of this process and any distinct differentiation between acute and chronic adaptations remain largely unexplored. In order to clarify the natural history of EICR, longer duration longitudinal study is required. Such work will determine whether exercise-induced changes in myocardial structure and function occur in discrete stages. Examination of prolonged exposures to exercise training will also be necessary to determine normative values across the age and training spectrums of athletic patients. This information will help to distinguish the boundary between physiology and pathology in athletic patients.     

Acute psychosis secondary to steroid responsive encephalopathy associated with autoimmune Hashimoto's thyroiditis

Approach to Hashimoto thyroiditis encephalopathy.     

Functional versus radiological assessment of chronic intestinal ischaemia

Introduction: The diagnosis chronic intestinal ischaemia (CII) is based on the clinical symptoms postprandial pain and weight loss combined with abnormal findings during angiography. Despite the well‐known poor correlation between symptoms and morphology, physiological tests are rarely performed. Perspectives: It is possible to measure the total splanchnic blood flow (SBF) before and after a test meal, and the results supply additional information to the morphologic investigations. To date, no papers have addressed the impact of morphologic changes of the mesenteric arteries on the SBF. Materials and methods: Forty‐six consecutive patients suspected of CII were investigated. The routine investigation included angiography and measurements of the SBF before and after a test meal. Measurements of the total SBF were performed using the ‘Fick principle’. ^99mTechnetium‐labelled Mebrofenin^® was used as a tracer. Digital subtraction angiography was performed. Results: Agreement between SBF and angiography was found in 44 of 46 patients. Mean baseline SBF for all patients was 985 ml/min, total range (525–1932) and within the reported normal range. The mean postprandial increase in SBF was 480 mL min^?1 (?130 to 1353), thus 36 patients were categorized as normal by both angiography and SBF, eight patients were abnormal by both methods and two patients had abnormal SBF but normal angiography. Discussion: In this cohort, SBF detects CII with sensitivity of 1·0, and specificity  of 0·95. SBF supplies additional information in patients with convincing symptoms and normal angiography. In these patients, the affection of the intestinal arteries may be too distant or too subtle to be visualized on angiography.     

Functional magnetic resonance imaging: measuring versus estimating

Brain imaging techniques largely spread in neuroscience literature. Due to initial technical limitations such as the very low signal-to-noise ratio, group experiments became the rule. This fact, together with the wide use of standard brains to localize the activations, lead several experimenters to the wrong idea that the brain can be described by a Cartesian coordinate system, neglecting at the same time the importance of individual neuroanatomy. My commentary on the paper by Devlin and Poldrack reinforces their reminder that it is necessary to deal with anatomy. Moreover, it adds some considerations on the relevance of single subjects studies and on the importance of the BOLD intensity signal, which should be used to describe brain activity together with the most used statistical tools.