Zum Problem der sogenannten Simultanagnosie

Zusammenfassung Bei einem Patienten mit einem vorzugsweise lobär verlaufenden hirnatrophischen Prozeß wurden die Störungen der Gesamtauffassung bildlich dargestellter Situationen (Simultanagnosie), die er neben Wortfindungsschwierigkeiten, Paraphasien, Dysgraphie, Dyskalkulie und Merkschwäche bot, einer Analyse unterzogen. Die gestörte Intellektualität der Wahrnehmung zeigte sich als ein Darniederliegen ihrer sinngerichteten Aktivität. Der Patient war nicht in der Lage, Strukturen in eine Wahrnehmungsgegebenheit zu bringen, war unfähig, eine Gestalt aufzubauen. Durch Störungen des Übersehens hatte die Überschaubarkeit des Wahrnehmungsfeldes gelitten. Bei schneller Absättigung des Sinnfindungsbedürfnisses kam es zum sinngemäßen Illusionieren innerhalb kurzschlüssig hergestellter Sinneinheiten. Die durch das Zurücktreten der Gestalt gegenüber der Physiognomie des Gegenstandes gekennzeichneten Zeichnungen des Patienten wurden den raumagnastischen Gestaltungsstörungen zugeordnet. Die Bedeutung der Störungen für das Leben des Patienten erhellen sein Verzicht auf Wahrnehmung und seine Unsicherheit gegenüber einer eindringlicher gewordenen, nicht mehr dahingestellten Welt.     

Myostatin is increased and complexes with amyloid-β within sporadic inclusion-body myositis muscle fibers

Myostatin is a negative regulator of muscle mass and strength. Sporadic inclusion-body myositis (s-IBM) is the most common degenerative muscle disease of older persons and is characterized by pronounced muscle wasting. s-IBM is of unknown etiology and pathogenesis, and it lacks definitive treatment. We have now demonstrated in samples from 12 s-IBM biopsies that: (1) by light and electron microscopic immunocytochemistry, myostatin/myostatin precursor is accumulated within muscle fibers and co-localized with amyloid- (A); (2) by immunoblots, both myostatin and myostatin precursor are increased; and (3) by immunoprecipitation, myostatin precursor complexes with A. Our study suggests that myostatin/myostatin precursor, either alone, or bound to A, may play a novel role in the pathogenesis of s-IBM.     

AMP-rated psychopathology in chronic alcoholics

Summary In a group of 39 alcoholics within a withdrawal process, the psychical situation was rated using AMP scales (Angst et al. 1969). Cluster analysis of the items rendered the following five-cluster solution: (1) aggressive-depressive patients, (2) less impaired persons, (3) slowed persons with diminished contact, (4) emotionally inadequate persons, (5) appealing depressive persons. These results are discussed with respect to other data from clinical history and diagnostic findings.Supported by Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 115, Teilprojekt C21     

Styles of Case Management: The Philosophy and Practice of Case Managers

A great deal of discussion and research has gone into defining and clarifying the role of case manager (CM) for persons with severe mental illness. This three state survey examines the philosophy and activities of practicing CMs in an attempt to identify current styles of case management. A cluster analysis based on CM rankings of five CM functions suggested four styles of case management: supportive social worker, individual therapist, therapist broker, and community advocate. Overall, CMs rated supportive interventions as most important and formal psychotherapy as relatively unimportant. CM style was related to CM activity (i.e., distribution of effort). Differences between states are noted and implications for future research are discussed.     

Apolipoprotein E co-localizes with newly formed amyloid β-protein (Aβ) deposits lacking immunoreactivity against N-terminal epitopes of Aβ in a genotype-dependent manner

Different types of amyloid -protein (A)-containing plaques occur in brains of Alzheimers disease (AD) patients. Diffuse plaques seen during early stages of AD differ from neuritic plaques in later stages both with respect to the length of the A peptides and the presence of other proteins, e.g., apolipoprotein-E (apoE). Since apoE is involved in A transport and clearance, and the 4-allele of the apolipoprotein-E gene (APOE) is a major risk factor for sporadic AD, it is plausible to speculate that apoE plays a pathophysiological role in the initiation of A deposition. To address the issue of whether binding of apoE to A is involved in initial A deposition, we studied the human medial temporal lobe of 60 autopsy cases encompassing the full spectrum of AD-related pathology. In temporal lobe regions, which become involved for the first time at a given stage of -amyloidosis, all plaques represent newly formed plaques, and these were studied with immunohistochemical methods. ApoE was present in 36 cases, and was frequently co-localized with newly formed A deposits detectable with anti-A₄₂ but not with antibodies raised against N-terminal epitopes of A. In 10 additional cases, immunoreactivity against apoE was completely lacking in newly formed plaques, which, at the same time, displayed immunoreactivity against N-terminal epitopes of A. The failure of N-terminal epitopes of A to co-localize with apoE in newly formed plaques indicates that these deposits presumably contain apoE-A complexes, in which the N-terminal epitopes of A are often concealed after complexing with apoE, thus preventing subsequent binding of antibodies. Moreover, apoE-positive newly formed plaques were seen more frequently in APOE 4/4 cases than in non-APOE 4/4 individuals, thereby underlining the potentially crucial role of apoE for the development of A deposits.     

Die Hamburger Schätzskala für Psychische Störungen nach Herzoperationen (HRPD)

Zusammenfassung An einer Stichprobe von 99 herzoperierten Patienten wurde zur Erfassung, Beschreibung und Klassifikation früh-postoperativer psychischer Störungen aus dem psychopathologischen Befundbogen des AMP/AMDP-Systems eine Kurzform (HRPD) entwickelt. Weitgehend mit Hilfe einer klassischen Itemanalyse wurde eine Auswahl von 36 Symptomen vorgenommen.Eine Faktorenanalyse dieser Kurzform ergab 8 Merkmalsfaktoren bzw. Syndromskalen: Desorientierung, Konzentrations-/Denkstörungen, paranoid-halluzinatorische Symptomatik, Angstsymptomatik, gehemmt-depressive Symptomatik, Hostilität, Kontrollverlust sowie Selbstaufgabe.Clusteranalytisch wurden 6 psychopathologisch verschiedene Patientengruppen gefunden: unauffällig, fast unauffällig, leichte psychoorganische Symptomatik mit Affektstörungen, schwere psychoorganische Symptomatik mit Kontrollverlust, Hostilität mit paranoid-halluzinatorischer und psychoorganischer Symptomatik, sowie delirante Symptomatik.Ein Vergleich der Ergebnisse der HRPD mit Syndrombeschreibungen anderer AMP/AMDP-Untersucher ergab zum Teil gute Übereinstimmungen, zum Ted aber auch deutliche Unterschiede, die am ehesten durch die besondere Situation herzoperierter Patienten bedingt sein dürfte.Vorform in englischer Sprache: HRPD = Hamburg Rating Scale for Psychic Disturbances     

Brain-derived neurotrophic factor gene polymorphisms and Alzheimer’s disease

Summary. Several lines of evidence have made brain-derived neurotrophic factor (BDNF) an important candidate gene conferring risk for Alzheimers disease (AD). Recently, three studies reported an association between two single-nucleotide polymorphisms (SNP) – i.e., C270T and G196A – in the BDNF gene and AD. This attempt to confirm these associations in a larger AD sample included examination of the linkage disequilibrium of these two SNPs. Comparison of 487 Japanese AD subjects with 471 cognitively normal elderly controls showed higher frequencies of the G allele (60.5 vs. 55.5%, p=0.028) and of both the GG and GA genotypes (85.8 vs. 79.8%, p=0.025) of the G196A polymorphism in AD subjects than in controls and higher frequency of the T allele of the C270T polymorphism in AD subjects who were negative for apolipotrotein E4 (2.0 vs. 4.4%, p=0.035) or positive for AD family history (2.8 vs. 7.1%, p=0.046). These findings suggest that BDNF gene polymorphisms play some role in the development of AD.     

Kritische Anmerkungen über die Gedankeneingebung

Zusammenfassung Gedankeneingebung ist eines der Symptome ersten Ranges im Sinne von Kurt Schneider. Schon früher hatte Karl Jaspers eine feinere Trennung vollzogen: Er unterschied zwischen der Gedankeneingebung in einem engeren Sinne und gemachten Gedanken. Indessen haben die meisten deutschen und englischen Autoren die Jasperschen Kriterien dieser Unterscheidung verschmolzen und dadurch den Gebrauch des Terminus ausgeweitet. Auch Kurt Schneider und Weitbrecht sprachen von Gedankeneingebung, gemachten Gedanken und Gedankenbeeinflussung, als ob diese Phänomene identisch seien. Demgegenüber bietet die Jaspersche Differenzierung eine Trennschärfe bei der Erfassung psychopathologischer Symptome, auf die nicht verzichtet werden sollte. Logischerweise und aus praktischen Gründen läßt sich diese Differenzierung auf alle gemachten oder Beeinflussungserlebnisse ausdehnen, so daß man vier Aspekte solcher Phänomene unterscheiden kann. Einige differential-diagnostische Überlegungen hinsichtlich der Gedankeneingebung werden abschließend kurz besprochen.Professor H. -H. Meyer zum 65. Geburtstag herzlich zugeeignet.     

Types of authority and two problems of psychiatric wards

This paper concerns the relationship between authority structures and two problems reported in the literature as common to milieu or therapeutic community wards. Psychiatric wards with rational-legal and charismatic authority structures are found more likely to experience mood and morale swings on the part of patients and staff and to spend excessive time and energy changing ward rules.     

Partners in ministering — A psychiatrist and a pastor

Interdisciplinary relationships can complement and effect successful outcomes in therapy. Some essential criteria are suggested as the result of a pastor and psychiatrist working conjointly in a compatible fashion. Stereotypes and traditional roles are barriers which must be worked-through. The working-through process may not be applicable to every professional dyadic relationship, but the conjoint approach might be considered in addition to current modus operandi. Interdisciplinary co-therapists must utilize the same process they are trying to teach their patients—practice what you preach. The authors wish to express their appreciation to the cotherapist and family participants in the Multi-Family Group Therapy and to others who have helped to make this paper possible.     

Exhibitionism: Genesis,dynamics and treatment

Summary A successfully treated case of Male Genital Exhibitionism is described.Privacy is an essential component of a growth-promoting environment. Lack of privacy during childhood may well be a central contributing factor in the genesis of exhibitionism.An exhibitionist affirms, in the act of exposure, that which is denied in the childhood home situation where privacy is lacking: (a) I exist, I have life-space, (b) It doesmake a difference (confirmed by the reaction of the victim) that I have a penis.The act simultaneously affirms his right to show-off. Exhibitionism constitutesnon-legitimate showing-off; the treatment includes a shift tolegitimate showing-off.The arrest, asa means to avoid success, appears to be more important motivation than any strictly sexual or psychological gratifications inherent in the act itself.A six-point program for the treatment of exhibitionists (and perhaps other sexual offenders) is offered as a set of efficacious tools (procedures) for successful treatment.a unique prison offering a psychotherapy program to felons. He is also engaged in the private practice of psychiatry, with emphasis on group therapy.     

Meningiomas with a non-meningotheliomatous component

Summary Seven cases of meningiomas with pseudopsammoma bodies have previously been described in the literature. Two additional cases are presented. Electron microscopy of the cells surrounding the pseudopsammoma bodies reveals an ultrastructure different from that of the meningotheliomatous cells. It is concluded that meningotheliomatous meningiomas with pseudopsammoma bodies are mixed tumours, including a non-meningotheliomatous component, the origin and significance of which is uncertain.     

Enlarging skull fractures in children

Large skull fractures are conventionally followed radiographically until healing occurs. Fractures which enlarge or remain unhealed are commonly termed leptomeningeal cysts or growing skull fractures. This study of ten children with this injury and a review of the literature shows that a true leptomeningeal cyst is seldom present and that skull fractures do not grow. Moreover, careful history-taking and physical examination will correctly identify all enlarging or unhealed skull fractures of childhood without the need for plain radiographs or computed tomography of the skull.     

Electron microscopic structure of the alzheimer's neurofibrillary changes in case of atypical senile dementia

Summary A man aged 70, showed early disorientation, memory defects, delusions and rages at 66, later mental deterioration with muteness and dysphagia. He died of cardiac failure. The postmortem examination revealed macroscopically and light microscopically the neuropathological findings of atypical senile dementia.Moreover, it is the interesting characteristic in the presented case that there are electron microscopically two types of filaments making the neurofibrillary tangles. One showed the so-called paired helical filaments, which were observed in the cerebral cortex. The other showed parallel straight filaments. These straight filaments were found in the bilateral hippocampi.     

Analytic work with LSD 25

Summary In this paper, work with LSD 25 as an aid to analysis has been described. Of particular interest, has been theseeming unpredict-ability and arbitrariness of experiences elicited by the drug, and an attempt has been made at finding the determining factor in emerging material. This appears to be the selection of complementary and compensatory unconscious contents; selected in accordance with Jung's idea of the psyche as a self-regulating system, striving toward wholeness.Clinical material has been grouped in five categories, in which different aspects of complementation are illustrated. Some questions of transference and resistance in connection with LSD treatment have been discussed; and ideas about typical mechanisms in certain categories of neuroses, as suggested by the patient's response to the drug, have been put forward.This report is based on a paper read at a meeting of the (British) Society of Analytical Psychology in 1957.     

The yield of laboratory investigations in children with infantile autism

Summary. Purpose: To evaluate the yield of laboratory investigations in infantile autism. Methods: We retrieved and evaluated the results of investigative procedures recorded in the medical files of autistic infants in four child developmental centers and two pediatric psychiatric outpatient clinics. Results: One-hundred and thirty-two infants were included in the study of whom 47 (36%) underwent autistic regression at an average age of 20 months. The investigative procedures included electroencephalogram (n=132), neuroimaging (n=70), genetic studies to detect Fragile-X (n=59) and a metabolic workup (n=53). Except for the molecular diagnosis that revealed Fragile-X syndrome in two children (3%), all other tests were negative. The two infants with the Fragile-X syndrome belonged to the non-regressive group. Conclusions: The only investigative study that contributed to the diagnosis of autistic infants was the molecular diagnosis detecting Fragile-X. In spite of the high frequency of epilepsy and epileptiform abnormalities in the electroencephalograms of autistic children in general, the contribution of epilepsy, both clinical and subclinical, to the etiology of autism is apparently minimal.     

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     

Schizophrenia suspecta

Summary We investigated what makes a Schneider-oriented psychiatrist diagnose suspected schizophrenia yet nevertheless stop short of a definitive diagnosis of schizophrenia. We compared the case records of 1208 patients hospitalised for schizophrenia for the first time in their life and all patients with discharge diagnosis suspected schizophrenia (n = 358).We found that the main factors for making the diagnosis of suspected schizophrenia are, as when using Bleuler's concept, intrasymptomatological ones, i.e. type, structure and constellation of symptoms. Hereby the non-committal character of the expression symptoms in the wider sense (Schneider), i.e. disorders of thought, of affect and behaviour, is of particular importance. Psychotic productive symptoms in the form of delusions or hallucinations alone are not always sufficient to confirm the diagnosis of schizophrenia. Even first rank symptoms cannot establish the diagnosis schizophrenia if certain factors reducing their pathognomonic value are present.Elaboration of the computer programme: Dr. rer. nat. E. Godehardt, Cologne University Institute of Medical Documentation and Statistics (Director: Prof. Dr. V. Weidtman)     

The selling of community mental health

The author criticizes what he considers to be the golden rhetoric, questionable statistics, and even more questionable practices of The Movement.Although the article leans heavily toward pessimism and will therefore irritate many readers, Dr. Steinhart's warning deserves serious consideration. Certain it is that rampant over-optimism can lead to big trouble, as David Halberstam has documented with regard to the evaluations of our Saigon experts in the early 60s.     

Pelizaeus-Merzbacher disease

Summary A girl of non-Jewish origin, with non-contributory family history, at the age of 3 developed progressive mental deterioration, an ataxic-spastic syndrome and died in a decerebrate state at the age of 18 10/12 years. Neuropathological examination disclosed severe discontinuous-subtotal demyelination and diffuse sclerosis of the cerebral and cerebellar white matter with some small myelin islets and sparing of the subcortical arcuate fibres as well as of the deeper myelinated regions. There were remarkably sparse residua of orthochromatic myelin breakdown chiefly of the fixed type. The axons were preserved. Additional atrophic lesions of the thalamus and cerebellar folia were considered to be of anoxic origin. This sporadic case is suggested to represent a transitional form between the classical and the co-natal (Seitelberger) type of Pelizaeus-Merzbacher Disease.

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Zusammenfassung Ein Mädchen aus gesunder, nicht-jüdischer Familie erkrankte im 3. Lebensjahr mit schubförmig-progressiver psychischer Retardierung, cerebellar-spastischem Syndrom und starb mit 18 10/12 Jahren in einem Decerebrationszustand. Neuropathologisch fand sich eine schwere diskontinuierlich-subtotale Entmarkung und Sklerose im Groß- und Kleinhirn mit wenigen erhaltenen Markinseln, intakten U-Fasern und tiefen Markstrukturen bei nur diskretem fixen orthochromatischen Abbau. Eine symmetrische Thalamusatrophie und Kleinhirnläppchensklerose wird als Anoxieschaden aufgefaßt. Die sporadische Beobachtung wird der Übergangsform zwischen klassischem und konnatalem Typ der Pelizaeus-Merzbacherschen Krankheit zugeordnet.