GSK-3β in cerebrospinal fluid of schizophrenia patients

Summary. Cerebrospinal fluid contains proteins and metabolites of brain origin and was extensively studied in psychiatry in the 1970s with few definitive results. We have recently found 40% reduced protein levels of GSK-3 in schizophrenia in postmortem prefrontal cortex, but our attempt to develop a diagnostic marker using peripheral lymphocyte GSK-3 was not successful. In this study we aimed to find whether the reduction in brain GSK-3 is reflected in CSF of schizophrenia patients. We report a significant reduction in CSF GSK-3 protein levels in six schizophrenia patients compared to seventeen healthy subjects. Our results corroborate other studies in which CSF protein levels reflect the alteration found in these proteins in schizophrenia patients postmortem brain.     

Facial affect recognition in the course of schizophrenia

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.     

On the hazards of assessing character pathology in an outpatient setting: A brief clinical note

Personality disorder patients are not regarded favorably by young doctors eager for good therapy cases. In addition, examining physicians may experience thinlyveiled hostility to the hedonistic orientation of such patients.The authors stress the importance of overcoming prejudice toward this very large percentage of patients appearing at outpatient clinics.     

Does social deprivation during gestation and early life predispose to later schizophrenia?

Summary We employed a case-control study design to investigate whether schizophrenic patients differed from non-psychotic psychiatric patients in terms of place of birth and paternal occupation. Cases were first-contact schizophrenic patients ascertained from the Camberwell Cumulative Psychiatric Case Register. Controls were the next (non-psychotic) patient on the Register matched for age and sex. In comparison with controls, cases were more likely to have: (1) been born in the deprived innercity Camberwell catchment area (odds ratio 2.3), and (2) had fathers who had manual as opposed to non-manual occupations (odds ratio 2.1). The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.     

Electroconvulsive therapy in Parkinson's syndrome with “on-off” phenomenon

Summary During long-term treatment with L-dopa in Parkinson's syndrome on-off phenomenon develops in many cases, often entailing considerable therapeutic problems. Decreased sensitivity in postsynaptic striatal dopamine (DA) receptors has been shown to occur in parkinsonian patients during long-term treatment with L-dopa. This has been suggested as one possible mechanism for development of the on-off phenomenon. In contrast to L-dopa treatment electroconvulsions have been shown to increase sensitivity in the DA receptors, when administered to animals.The antiparkinsonian effect of electroconvulsive therapy (ECT) was investigated in five parkinsonian patients with on-off phenomenon, with or without concomitant signs of mental depression. ECT was administered according to praxis in treatment of mental depression. Drug therapy, including L-dopa, was maintained on previously adjusted doses during and after ECT.A marked improvement in the parkinsonian symptoms as well as in the on-off phenomenon occurred in three of the patients, persisting for several months. The other two patients showed only slight and transient improvement.It thus seems that ECT may be useful as a supplementary treatment in parkinsonian patients with on-off phenomenon. The antiparkinsonian effect of ECT is probably mediated by increased sensitivity in postsynaptic DA structures.     

Elektroencephalographische und oscillographische Untersuchungen beim Schulter-Hand-Syndrom

Zusammenfassung EEG-Untersuchungen bei 98 Patienten mit sympathischer Reflexdystrophie unterschiedlicher Genese ergaben in 46% der Fälle eine abnorm frequente und frequenzlabile Hirnaktivität im Sinne der corticalen Desynchronisation (Monnier) bzw. der hyperexcitabilité neuronique (Gastaut). Seltener wurden bilateral synchrone Ausbrüche von Sharp-waves-Formationen (diencephale Hyperexcitabilität nachMonnier) beobachtet.Die prozentuale Verteilung der EEG-Abnormitäten beim Schulter-Hand-Syndrom ähnelte den Untersuchungsbefunden einer Kontrollgruppe von Frauen mit klimakterischen Beschwerden und unterschied sich von den EEG-Befunden beim vegetativ-neurasthenischen Syndrom der Männer einer vergleichbaren Altersklasse sowie von der EEG-Abnormitätsverteilung bei der essentiellen Trigeminusneuralgie.Bei polygraphischen Untersuchungen waren bei den Reflexdystrophikern Labilitätszeichen der Blutdruckregelung, des Atemverhaltens und respiratorische Variationen des Muskeltonus nachzuweisen. Bei der photoelektrischen Registrierung der peripheren Volumpulse an 30 Patienten fanden sich — je nach dem Krankheitsstadium — funktionelle seitendifferente Mehr- oder Minderdurchblutungen. Kältereize führten im akuten Stadium zu überschießender Vasokonstriktion.

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Summary The EEG patterns of 98 patients with reflex sympathetic dystrophy of different origin showed in 46% of the cases an abnormally fast and instabil activity of the brain, like patterns of cortical desynchronisation (Monnier) or hyperexcitabilité neuronique (Gastaut). More seldom bilaterally synchronous outbursts of sharp waves (diencephalic hyperexcitability —Monnier) were observed.The percentage distribution of EEG abnormalities in shoulder-hand-syndrome resembled observations on a control group of women with climacteric complaints and was different from the EEG findings in the vegetative neurasthenic syndrome in men of comparable age or as found in essential trigeminus neuralgia.By means of polygraphic investigation in these reflex dystrophics signs of lability of blood pressure regulation, of respiration and respiratory variations with muscle tone were established. Photoelectric peripheral plethysmography of 30 patients also showed — in the different stages — some functional, side-different alterations of blood flow. Cold stimuli in the acute stage evoked violent vasoconstriction.

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Résumé EEG. — Des recherches faites chez 98 malades avec différents types de «dystrophie réflexe sympathique» ont montré dans 46% des cas, un rythme cérébral anormalement rapide dans le sens d'une «désynchronisation corticale» (Monnier) ou d'une «hyperexcitabilité neuronique» (Gastaut). Les bouffées de fréquence théta ou complexes onde aiguë-onde synchronisées étaient plus rares («hyperexcitabilité diencéphalique» —Monnier).Le pourcentage des anomalies à l'EEG dans le syndrome douloureux de l'épaule et du bras ressemblait à celui résultant des recherches faites sur un groupe test de femmes atteintes de troubles ménopausiques, et était différent de celui provenant des recherches réalisées sur un syndrome de neurasthénie végétative chez des hommes du même âge; il différait également d'un pourcentage d'anomalies trouvées dans les névralgies faciales essentielles.Il restait à montrer par des graphiques le résultat des recherches faites sur l'instabilité de la tension artérielle et sur les variations du tonus musculaire lors des changements de rythme respiratoire. Par des enregistrements photoélectriques des pulsations périphériques chez 30 malades on trouva — selon le stade de la maladie — des augmentations ou des diminutions fonctionelles du débit cardiaque. L'épreuve bain froid conduisit à une vasoconstriction aiguë.

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Riassunto In 98 pazienti con distrofia riflessa simpatica a genesi diversa, in fase acuta o subacuta, l'elettroencefalogramma ha dimostrato — nel 46% dei casi — un'abnorme frequenza dell'attività cerebrale ed un'abnorme labilità nel senso di una desincronizzazione corticale (Monnier) e soprattutto di ipereccitabilità neuronica (Gastaut). Più raramente si è avuto l'insorgere di gruppi di sharp waves (ipereccitabilità diencefalica secondoMonnier), associati a disturbi dell'emozionalità e ad insufficiente controllo del comportamento.Il comportamento percentuale delle anomalie elettroencefalografiche della sindrome spalla-mano somigliava a quello di un gruppo di controllo di 130 donne in climaterio e si differenziava significativamente da un secondo gruppo di controllo di 132 pazienti della stessa età con sindrome neurastenica vegetativa.Nei soggetti con distrofia riflessa dell'età media di 51 anni si sono dimostrati graficamente segni di labilità della pressione arteriosa, del respiro e delle variazioni respiratorie del tono muscolare. Con la registrazione fotoelettrica del volume del polso periferico in 30 pazienti si sono osservate, accanto ad alterazioni organiche vascolari — a seconda dello stadio della malattia —, variazioni ischemiche od iperemiche funzionali. Lo stimolo da freddo ha provocato negli stadi acuti una eccessiva vasocostrizione.Le ricerche sull'evoluzione elettroencefalografica hanno dimostrato la possibilità che vi sia la responsabilità di una modificata capacità relativa delle stazioni centrali per quanto riguarda la abnorme reafferenz: la situazione endrocrina vegetativa premorbosa di una gran parte dei malati viene interpretata come importante fattore nella genesi della distrofia riflessa.

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Mit 5 Textabbildungen     

What is schizophrenia?

Summary The psychotic syndrome at the core of schizophrenia appears to be invariable across cultures. The risk of morbidity also seems to vary very little from country to country and over medium periods of time. Moreover, apart from gender differences in first onset, the cumulative lifetime risk is the same in females and males. A similar epidemiological pattern is only found in pathological conditions that are characterized by a precisely defined section of a psychopathological dimension with a continuous distribution in the population, e.g. severe mental retardation being the extreme section of normally distributed IQ values. The interpretation of schizophrenic psychosis as the extreme section of a psychopathological dimension or disposition that is almost evenly distributed in all populations is supported by the fact that milder psychiatric disorders occur more frequently before the onset of the psychosis and in close relatives of schizophrenic patients. The psychopathological heterogeneity of these disorders argues against the assumption of a manifest psychopathological dimension with a continuous transition from the schizophrenic psychosis to the normal schizothymic personality. More probable is a continuously distributed latent vulnerability to schizophrenia — with or without a threshold effect — which in severe degrees disposes to the uniform reaction pattern of the schizophrenia syndrome. Smaller degrees of vulnerability are associated with an increased risk for milder patterns of disturbances, which are also more strongly determined by environment and personality and therefore are rather heterogeneous. These assumptions lead to other epidemiological and genetic models than Kraepelin's early concept of a disease entity does.     

Peripheral chromatolysis after transection of mouse facial nerve

Summary Adult male mice, after transection of the facial nerve near the stylomastoid foramen, were sacrificed at predetermined intervals by the two-step perfusion fixation with a modified Heidenhain's Susa solution and subsequently autopsied after a delay of at least four hours.The normal population of neurons consists of one small form with small basophil granules and one large with numerous coarse granules.The initial change demonstrable in the large neuron 12 hours post-operatively is the loosening of cytoplasmic basophil material which proceeds to a disappearance peripherally at the 24-hour stage; simultaneously an increased staining of the non-particulate cytoplasm takes place. The disintegration of basophil material reaches a maximum 9 days post-operatively and from 12 through 49 days post-operatively occurs an increasingly prominent restoration of basophil material near the nuclear membrane. At the 49-day stage the number of recovered large neurons is small and many are lost. At the 9-and 12-days post-operative stages appears a dark abnormal neuron of questionable origin. Histiocyte reaction is apparent by an increasing number of mitotic figures along vascular walls from the 2nd day to the 9th day; the invasion of microglia cells occurs from the 3rd day and clusters of microglia from the 9th day.The sequential changes in the small neuron are somewhat similar to those in the large type. In its recovered forms, it exceeds the large in number, but is abnormal in color and poorly supplied with basophil material.A concurrent study of the rabbit facial nucleus discloses two types of neurons which after axotomy react differently but mimic at a slower rate the sequence in mice.The cardinal feature of acute retrograde cell changes is the inability of the cytoplasm to store properly its basophil material, as first manifested by a loosening of texture with an early disappearance along the cell periphery and then by haphazard deposition of granular material.With 2 Figures in the Text     

Hirnembolie und Psychose

Zusammenfassung Hirnembolisationen können in bestimmten Fällen als reine Psychosen verlaufen. Ist die Tatsache einer Embolisation nicht bekannt, so werden häufig sogar endogene Psychosen aus dem schizophrenen oder manisch-depressiven Formenkreis diagnostiziert.Herzerkrankungen und die Herzchirurgie gehen mit einem großen Embolierisiko einher. Mikroembolien spielen eine besondere Rolle bei der extrakorporalen Zirkulation, bei der signifikant öfter kardiogene Psychosen auftreten als bei geschlossenen Herzoperationen. Unmittelbar postoperativ treten nach Herzoperationen stuporös-akinetisch-parkinsonähnliche Zustandsbilder auf, die nach 3–5 Tagen abklingen. Hierbei handelt es sich mit großer Wahrscheinlichkeit um einen reversiblen embolischen Parkinsonismus bei Basalganglienapoplexie infolge von Mikroembolisation. Das spätere Auftreten depressiver und produktiv-psychotischer Syndrome, nach dem 3.–5. postoperativen Tag, wird ebenfalls im Zusammenhang mit Störungen im Bereich der Basalganglien gesehen. Für das Auftreten produktiv-psychotischer Syndrome ließ sich ein signifikanter Zusammenhang mit einer erblichen Belastung für endogene Psychosen in der Familien- und Eigenanamnese nachweisen.Auf der psychopathologischen Ebene kann man hier nicht zwischen endogenen und exogenen Psychosen unterscheiden. In diesem Zusammenhang haben psychopathologische Syndrome mit neurologischen Syndromen das Gemeinsame, daß die Art eines bestimmten Symptoms von der Akuität und dem Ausmaß der Hirnschädigung, der Hirnlokalisation und von hereditären Faktoren bestimmt wird.

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Cerebral embolism and psychosis with special reference to cardiac surgery

Summary Cerebral embolism can manifest itself in certain cases as pure psychosis. In the absence of neurological symptoms it might be mistaken for schizophrenia or manic-depressive psychosis.Cardiac disease and cardiac surgery involve a high risk of embolism. Microembolism plays a special role with extracorporal circulation. There is a significant increase of postoperative psychosis in cases with E.C.C. in comparison to closed heart surgery. Immediately postoperatively there occurs what has been described as the catastrophic reaction or immobilization syndrome. This reaction is in fact an akinetic, parkinsonian-like state for which there is good evidence that it is due to transient microembolism of the basal ganglia (striatum apoplexy). After its disappearance around the 3rd–5th day cardiac psychoses (cardiac delirium) may manifest themselves.Patients who develop these late psychoses have a significantly higher correlation with endogenous psychoses in their family histories. On the psychopathological level—in the absence of disturbances of consciousness and orientation—it is not possible to differentiate between exogenous and endogenous psychosis. A special type of psychopathological reaction is dependent, as in neurological disease, on the severity of brain damage, its localization and on hereditary factors.

     

Facial Emotion Recognition in Schizophrenia: The Impact of Gender

Objective

Previous studies reported gender differences for facial emotion recognition in healthy people, with women performing better than men. Few studies that examined gender differences for facial emotion recognition in schizophrenia brought out inconsistent findings. The aim of this study is to investigate gender differences for facial emotion identification and discrimination abilities in patients with schizophrenia.

Methods

35 female and 35 male patients with schizophrenia, along with 35 female and 35 male healthy controls were included in the study. All the subjects were evaluated with Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), and Benton Facial Recognition Test (BFRT). Patients'' psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS).

Results

Male patients performed significantly worse than female patients on FEIT total, and negative scores. Male controls performed significantly worse than female controls on FEIT total and negative scores. On all tasks, female patients performed comparable with controls. Male patients performed significantly worse than controls on FEIT, and FEDT.

Conclusion

Women with schizophrenia outperformed men for facial emotion recognition ability in a pattern that is similar with the healthy controls. It could be claimed that male patients with schizophrenia need special consideration for emotion perception deficits.     

<Superscript>123</Superscript>I-β-CIT binding and recovery from depression

Abstract. Eighteen depressive outpatients were investigated using single-photon emission computerized tomography (SPECT) with a high-affinity dopamine (DA) and serotonin transporter (SERT) specific radioligand, ¹²³I-labeled -CIT (2-carbomethoxy-3-(4-iodophenyl)-tropane). The patients were tested at the beginning of the study and on follow-up after six months. The severity of depression was evaluated using the 17-item Hamilton Rating Scale of Depression (HRSD). Eight of the eighteen patients had an HRSD score below the median (12 points) on follow-up, and they had a significantly greater increase in ¹²³I--CIT binding in the midbrain region compared with those patients who did not recover (ANCOVA: F = 8.12; df = 1, 14; p = 0.013). These results indicate that recovery from depression is associated with an increase in ¹²³I--CIT binding in the midbrain.     

A disease-specific psychosocial questionnaire for Parkinson’s disease caregivers

Abstract. Objective: To evaluate the Belastungsfragebogen Parkinson Angehörigen—kurzversion (BELA-A-k), a questionnaire for measuring psychosocial problems and need for help in Parkinsons disease (PD) caregivers. Methods: The Belastungsfragebogen Parkinson Angehörigen—kurzversion was translated into Dutch. It consists of 15 items with a Bothered by (Bb) and a Need for Help (NfH) score. The BELA-A-k was tested for cultural differences, relevance and feasibility in a pilot (n = 10). We determined the psychometric properties in a validation study (n = 50) and compared the BELA-A-k with the Sickness Impact Profile, the COOP/WONCA Functional Health Assessment Charts and the Loneliness Questionnaire (de Jong-Gierveld). All questionnaires were administered in person at home, in a prescribed order. Results: The BELA-A-k was completed by 60 PD-caregivers. The internal-consistency reliability coefficients for the total Bothered by (0.90) and Need for Help (0.92) scales were excellent. The internal consistency of the subscales exceeded the 0.70 standard except for the Bothered by and Need for Help Social functioning scale (Bb = 0.62; NfH = 0.65) and the Partner-bonding/Family scale (NfH = 0.69). Almost all BELA-A-k subscales correlated highly (P < 0.001) with the corresponding scales of the standard quality of life indices. Conclusion: The BELA-A-k is a relevant, reliable and valid measure for assessing psychosocial problems and need for help of PDcaregivers.     

On the way to expert systems

Summary Operationalized diagnostics deal with the standardized assessment of psychiatric symptoms as well as diagnostic criteria. As a diagnostic system based on criteria, the DSM-III was chosen to identify operationalized diagnoses based on the Present State Examination (PSE-9) and some additional DSM-III specific items. By relating PSE symptoms to the diagnostic criteria of DSM-III, an easily applicable expert system leading to DSM-III diagnoses was developed. In two samples of 30 schizophrenic and 51 depressive patients the DSM-III computer diagnoses are contrasted with the ICD-8 diagnoses of the PSE/CATEGO system. In defining a case, only minimal differences between the two computer programs were found. In the sample of schizophrenics, CATEGO led to 114 (81%) diagnoses and the DSM-III program to 112 (79%) diagnoses; for the depressive patients 43% cases were identified by CATEGO and 45% by the DSM-III algorithm. Comparing the diagnosis of acute schizophrenic disorders, both programs arrived at similar percentages. (CATEGO: 51%; DSM-III: 57%). However, CATEGO is limited to two different subtypes (295.2 and 295.3), whereas the DSM-III program covers the total range of possible schizophrenic subtypes. Furthermore, the DSM-III program identified residual subtypes of schizophrenia in 23% of the diagnostic decisions. In the short-term course of the schizophrenic patients, CATEGO identified 27%–43% with affective diagnoses with high stability per cross-section. Using the DSM-III algorithm affective diagnoses were rather rare (maximum of 17%), marking unstable changes from acute to residual states of the psychosis. In the cohort of affective patients the correspondence between both programs was quite good, especially for the patients with a diagnosis of depression, but in total the DSM-III program requires stricter criteria for affective — especially manic — disorders, whereas CATEGO needs a somewhat higher symptom level for anxiety syndromes to reach the diagnostic threshold.Modified version of a paper presented by K. Maurer at the 2nd Psychiatric Autumn Symposium of the ZISG at St. Martin, Palatinate, 15–17 September 1988Funded by the ZISG (Zentralinstitut für Seelische Gesundheit) and the BMFT (Bundesministerium für Forschung und Technologie) under the coordination of the GSF (Gesellschaft für Strahlenforschung)     

Der Hirnstoffwechsel und die Häufigkeit cerebraler Durchblutungsstörungen beim organischen Psychosyndrom

Zusammenfassung Bei 200 Patienten mit den typischen Zeichen eines organischen Psychosyndroms wurden Hirndurchblutung, cerebraler Verbrauch von Sauerstoff und Glucose sowie der zur Oxydation gelangende Glucoseanteil bestimmt. In 170 Fällen (85%) war eine dieser Größen führend herabgesetzt, bei 28 Fällen (14%) lagen gesteigerte Werte vor, bei zwei Patienten (1%) waren die Befunde normal. Lediglich in 35 Fällen (17,5%) war eine Minderung der Hirndurchblutung der führende Befund. Bei 68% der von uns untersuchten Patienten waren Störungen des Hirnstoffwechsels mit einem zum Teil erheblichen cerebralen Energiedefizit vorherrschend. Das bedeutet, daß beim organischen Psychosyndrom viermal häufiger cerebrale Stoffwechselstörungen im Vordergrund stehen als cerebrale Durchblutungsstörungen. Damit werden auch die aus dem psychopathologischen Bild, dem EEG oder dem Pneumencephalogramm gestellten Diagnosen cerebrale Durchblutungsstörungen, cerebrovasculäre Insuffizienz, Cerebralsklerose oder Hirnarteriosklerose in ihrem Aussagewert zweifelhaft.

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Incidence of disorders of cerebral blood flow in the organic psychosyndrome

Summary Cerebral blood flow, consumption of oxygen and glucose, and the fraction of glucose subject to oxidation were measured in 200 patients. Either one of these parameters was critically reduced in 170 cases (85%), while being elevated in 28 (14%) and within normal limits in two others. Only in 35 cases (17.5%) was a diminished cerebral blood flow the main finding. In 68% of the patients of this study the prominent feature of the disturbed cerebral metabolism was an energy deficit assuming appreciable extents in some cases. From this it follows that in the organic psychosyndrome an impaired cerebral metabolism was the leading symptom four times more often than a diminished cerebral blood flow. Thus diagnoses like disturbed cerebral blood flow, cerebrovascular insufficiency, cerebral sclerosis, or brain arteriosclerosis which are usually based on either psychopathologic impression, EEG or pneumencephalogram become doubtful as to their conclusiveness.

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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Semiquantitative Bestimmung der körperlichen Gewöhnung („physical dependence“) bei Morphin- und Methadon-Therapie

Zusammenfassung Es werden Untersuchungen über die Entwicklung der körperlichen Morphingewöhnung (physical dependence) während fortgesetzter therapeutischer Anwendung von Morphin und Methadon beim Menschen ohne Morphinerfahrung beschrieben. Als Maßstab für die Größe der physical dependence dienten die Abstinenzsyndrome nach Nalorphininjektion und nach abruptem Entzug des Mittels. Es wird besonders betont, daß die Entziehungserscheinungen zwar unmittelbare Folge des primären Prozesses physical dependence darstellen, daß sie jedoch bereits durch die Persönlichkeit und Individualität des einzelnen transformiert worden sind, wodurch sich die außerhalb der Versuchsanordnung liegende Streuung der Versuchsergebnisse erklärt. Eine quantitative oder auch nur annäherd quantitative Erfassung der Abstinenzsyndrome ist nach dem Vorgehen von Himmelsbach nicht möglich. Es wird daher ein eigenes Auswertungsverfahren (Hamburg-Punktsystem) mitgeteilt, das eine genaue Bestimmung der Stärke einer Abstinenzperiode erlaubt und — unter Berücksichtigung der prinzipiellen Schwierigkeiten eines Schlusses auf die physical dependence — eine semiquantitative Bestimmung der physical dependence ermöglicht. Auf diese Weise gelang uns die kurvenmäßige Darstellung der Entwicklung von physical dependence, als deren wesentlichstes Ergebnis die Tatsache Beachtung verdient, daß — entsprechend den Ergebnissen aus Lexington — bereits nach 4 tägiger Verabreichung von 50 mg Morphin bzw. 15 mg Methadon auch beim. Menschen ohne Morphinerfahrung massenstatistisch eine für beide Verbindungen gleichgroße physical dependence angenommen werden muß, sofern man analgetisch äquiaktive Dosen zugrunde legt. Auf die differenten Abstinenzmuster von Methadon und Morphin wird hingewiesen. Die Verschiedenheit legt nahe, daß es ungenügend ist, die Stärke der physical dependenc property lediglich nach dem Ergebnis des Lexington-Tests zu ermitteln.Auf die Besonderheiten und Schwierigkeiten der Deutung des Nalorphin-Abstinenztests wird hingewiesen. Demnach hat — was für die Anwendung des Nalorphintests bei Suchtverdächtigen wichtig ist — nur ein positiver Testausfall diagnostisches Gewicht. Er beweist das Vorliegen von physical dependence — nicht hingegen von Sucht (denn unter unserem Untersuchungsgut befand sich nicht ein einziger Süchtiger!). Ein negativer Testausfall schließt hingegen das Bestehen von physical dependence nicht mit Sicherheit aus. Zu berücksichtigen ist aber, daß die diagnostische Treffsicherheit des Nalorphintests mit steigender Dosierung von morphinähnlich wirkenden Verbindungen und zunehmender Toleranzentwicklung ansteigt. Zu beachten ist ferner, daß es bei entzogenen Morphinisten mitunter eine paradoxe Nalorphinwirkung gibt (Nalorphin wirkt dabei morphinähnlich!), worauf wir an anderem Ort hinwiesen (Wende u. Schrappe; Schrappe). Der diagnostische Nalorphintest sollte daher bei Suchtverdacht nur von erfahrenen Untersuchern vorgenommen werden, die mit der Problematik dieser Methode vertraut sind.Die dieser Arbeit zugrunde liegenden Untersuchungen wurden durch eine großzügige Unterstützung, welche uns die Firma Deutsche Hoffmann-La Roche AG., Grenzach, gewährte, sehr gefördert.     

Childhood asociality in the differential diagnosis of schizophrenia with drug abuse vs. psychosis with drug intoxication

In a sample of 15 patients who had schizophrenia with drug abuse and 11 patients who had psychosis with drug intoxication, the presence or absence of the constellation of childhood asociality discriminated between these two entities. Furthermore, unexpectedly, schizophrenic drugabusing patients with asocial childhood histories believed that the drugs they had abused had caused their illness, while patients with the acute brain syndromes believed the drug abuse was NOT related to their illness.     

Health care of the chronically mentally Ill: The culture broker model

The chronically mentally ill tend to receive inadequate medical care for nonpsychiatric illnesses and to have poor health care status. Their medical problems lead to excessive morbidity and mortality and adversely affect their adjustment to psychiatric illness. The authors argue that many of the barriers to medical care for these patients can be overcome by using case managers as culture brokers—persons who provide bridges between the worlds of the chronically mentally ill and medical providers. This paper presents the culture broker model and its roots in anthropology, and illustrates its application to the medical care of the chronically mentally ill with case examples.     

A study of the capacity of myelinated and unmyelinated nerves to induce experimental allergic neuritis

Summary The capacity of myelin-free Schwann cells to induce EAN was investigated. Human foetal peripheral nerve and human adult abdominal vagus nerve, both containing little or no myelin, failed to induce EAN when injected intradermally (together with Freund's adjuvant) into rabbits. In contrast, human adult sciatic nerve, which is heavily myelinated, induced characteristic signs and histopathology of EAN. Thus in the myelin-free antigens Schwann cell plasma membrane, from which myelin is apparently derived, failed to induce EAN. Reasons for this paradox are discussed.     

Neurological soft signs in schizophrenia: Assessment and correlates

A German version of the Neurological Evaluation Scale (NES) was administered to 143 schizophrenic patients, 45 of them being severly chronic and disabled. Seventy-eight alcohol-dependent inpatients and 57 healthy volunteers were tested as control groups. Neurological soft signs (NSS) were rated with convincing agreement. Schizophrenic patients are more impaired on all scales than healthy controls. The chronic, severly disabled schizophrenic patients are more impaired compared with the main group of schizophrenic patients and both control groups. A significant patients and alcohol-dependent patients was only found for the subscale Motor Coordination. Compared with healthy controls the alcohol-dependent patients show a higher NES total score. The NES total score was related to the relative width of the third ventricle. Total score and subscales were correlated consistently with the level of cognitive functioning as measured by the Raven Standard Progressive Matrices and various neuropsychological tests presumably sensitive to dysfunctions of the prefrontal cortex. The NSS were related to positive as well as to negative symptoms, the correlations with negative symptoms being confined to items of Cognitive Disorganization. This close association of psychomotor and cognitive dysfunctions may be seen as related to the frequently discussed dysfunctions of the prefrontal cortex or the neurointegrative deficit postulated by Meehl.     

Schizophrenia and social skills: an ‘identify and train’ approach

As the majority of treatment for schizophrenia has become community based, a barrier faced by many clients as they attempt a higher quality of life is social integration. Social skill deficits are a pervasive developmental issue among this population, yet this has only been addressed peripherally as opposed to intensively in existing community rehabilitation programs. The authors outline the developmental social deficits resulting from the insidious nature of schizophrenia and propose a comprehensive treatment program that focuses on an identify, train and support approach. Transferring successful inpatient social skill training to the community is explored as a viable adjunct for existing community treatment.