Neurobiological background of pain and analgesia: the attempt at revaluation according to position of the organism's adaptive activity

The most adequate and successful way to understand the essence of any complex psychophysiological phenomenon, including pain, is obviously the study of its origin, its genesis, i.e., its biological background. Based on critical analysis of recent literature and our own electrophysiological, biochemical and pharmacological data we tried to overcome the difficulties and contradictions derived from the traditional reflex approach and analytical orientation in understanding the experimental investigation of pain-related problems and to determine the neurobiological background of pain and analgesia through the notion of the organism's adaptive activity. Interrelations between the notion of pain and other biological and psychological ideas, the place and functional significance of pain and endogenous analgesic mechanisms in the organization, maintenance and regulation of the organism's adaptive activity, characterization of the involvement of endogenous opioid peptides and monoamines in central processes associated with pain and analgesia, the essence and mechanisms of pain-depressing activity of the opiates are the main stages in our neurobiological consideration of the phenomenon of pain and its natural and pharmacological regulation.     

Comorbidity of depression and anxiety in nursing home patients

OBJECTIVES: To assess the occurrence and risk indicators of depression, anxiety, and comorbid anxiety and depression among nursing home patients and to determine whether depression and anxiety are best described in a dimensional or in a categorical classification system. METHODS: DSM and subthreshold anxiety disorders, anxiety symptoms, major and minor depression and depressive symptoms were assessed in 333 nursing home patients of somatic wards of 14 nursing homes in the north west of the Netherlands with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Geriatric Depression Scale (GDS). Comorbidity was studied along a severity gradient. Logistic regression analyses were carried out to identify demographic, health-related, psychosocial and care-related correlates of anxiety and depression. RESULTS: The prevalence of pure depression (PD) was 17.1%, of pure anxiety (PA) 4.8%, and of comorbid anxiety and depression (CAD) 5.1%. Comorbidity increased dependent on severity of both anxiety and depression. Different patterns of risk indicators were demonstrated for PA, PD and CAD for the investigated baseline characteristics. CONCLUSIONS: Comorbidity of anxiety and depression is most prevalent in the more severe depressive and anxious nursing home patients. The gradual increase of comorbidity of anxiety and depression dependent on the levels of severity of depression and anxiety suggests that for nursing home patients a dimensional classification of depression and anxiety is more appropriate than a categorical one. The observed differences in patterns of risk indicators for PA, PD and CAD support a distinguishing of anxiety and depression. Future studies are needed to assess the effect of treatment of PA, PD and CAD in nursing home patients.     

Quantitative histological studies on the lateral geniculate nucleus in the cat. IV. Numerical aspects of the transfer from restinal fibers to cortical relay.

The numerical data, gained both from the quantitative histology and Golgi stained material was completed with those of optic fibers. The number of X and Y fibers was estimated on the basis of our results, on the data of literature and from the ratio of the large and medium size relay neurons. The crossed and uncrossed fibers were counted and compared with the number of relay neurons in layer A and A1. Knowing the different numerical and metrical counts of neuronal elements in LGN of cat some calculations were carried out on the overlaping of optic fiber arborizations, on the intersections of dendritic ramification points of relay neurons and on the spatial arrangement of both the optic terminals and the relay neurons. The comparison of the neumerical data on relay neurons and optic fibers and their relations were the basic factors of considerations on divergence and convergence of retinal input.     

Summary of the practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. American Adademy of Child and Adolescent Psychiatry

This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents Who are Sexually Abusive of Others. The parameters were written to aid clinicians in the assessment and treatment of children and adolescents with symptoms of sexually abusive behavior. The assessment and treatment of children and adolescents with sexually abusive behavior requires an understanding of normal sexual development. A multiplicity of biological and psychosocial factors determines the child's sexual development, gender role, sexual orientation, patterns of sexual arousal, sexual cognitions, sexual socialization, and the integration of sexual and aggressive patterns of behavior. The individual's sexuality evolves in concert and as a result of interaction with family, ethnic, social, and cultural influences. These parameters summarize what we know about the epidemiology and phenomenology of sexually abusive youths and provide guidelines for the assessment and the selection of treatment interventions for these youths. Essential considerations in the assessment and treatment of sexually abusive youths, as well as the different categories of sexually abusive youths which should be recognized and which influence treatment decisions, are presented. The spectrum of currently available psychosocial and biological treatments will be summarized.     

加速度记录仪定量化评价血管性痴呆精神行为症状的研究

目的:便携式加速度记录仪定量化评价血管性痴呆患者(VD)精神行为症状(BPSD)程度的前瞻性研究。方法:将便携式加速度记录仪佩戴于21例VD患者非利手侧手腕,于第1和第18周连续记录6 d以上,量化记录身体活动,并通过神经精神问卷(NPI)与AD病理行为评分表(BEHAVE-AD)评价VD患者的BPSD变化,解析加速度记录仪所得身体活动的平均活动量(MA)、昼间活动量(DA)以及夜间活动量(NA)的变化,分析BPSD的变化与身体活动量变化的相关性。结果:第18周时BEHAVE-AD总评分和NPI总评分呈增加趋势,与第1周比较无统计学意义(分别P=0.082和0.079);BEHAVE-AD评分中的行为紊乱、日夜节律紊乱、焦虑和恐惧评分和NPI量表中的激越、易激惹、睡眠障碍评分与第1周比较差异有统计学意义。第18周时VD患者MA、DA、NA均增加,与第1周比较,其中NA差异有统计学意义(P=0.037);BEHAVE-AD评分中的行为紊乱加焦虑和恐惧评分改变量与MA的改变量呈直线相关(r=0.674,P=0.032);日夜节律紊乱评分改变量与DA改变量呈直线相关(r=0.721,P=0.046);NPI量表的激越评分加易激惹评分的改变量与MA改变量呈直线相关(r=0.668,P=0.042);睡眠障碍评分的变化量与NA的变化量呈直线相关(r=0.809,P=0.029)。结论:利用加速度记录仪所得的身体活动的MA、DA与NA参数在一定程度上能够体现VD患者的BPSD程度,动态观察VD患者BPSD随时间推移所发生的变化,在临床上客观、定量化评价VD患者的BPSD程度有一定可行性。     

帕金森病患者记忆障碍及事件相关电位相关因素分析

目的观察帕金森病(PD)患者记忆障碍及电生理变化.方法对39例PD患者测试韦氏记忆量表及事件相关电位(ERP),并与其临床因素进行相关分析.结果PD患者主要为短时及瞬时记忆障碍,ERP的N2、P3潜伏期延长,P3波幅降低.运动功能障碍程度、脑萎缩、抗胆碱药应用时间与N2、P3潜伏期呈正相关,与记忆商呈负相关.结论帕金森病患者存在短时、瞬时记忆功能损害;N2、P3潜伏期延长,P3波幅降低是ERP异常的主要表现.脑萎缩、抗胆碱药应用时间对记忆及N2、P3有显著影响.     

Correlates of Anxiety and Depression among Young Men Living in Dar Es Salaam,Tanzania

Depression and anxiety are important sources of morbidity globally, but we have little knowledge of risk groups and risk factors for both classes of disorders in Tanzania and other low-resource settings. We aimed to identify sociodemographic markers and risk and protective factors associated with symptoms of anxiety and depression among 1249 young men belonging to social groups known as “camps” in Dar es Salaam. Anxiety and depression were measured using the HSCL-25. Twenty-two percent of men reported clinically significant symptoms of depression and 20% reported clinically significant symptoms of anxiety. Men living apart from family reported greater symptoms of anxiety and depression than men living with family, and employment was associated with a greater likelihood of clinically significant symptoms of both anxiety and depression. Childhood experience of violence was strongly associated with both anxiety and depression. Social support was associated with lower levels of anxiety and depression, and with a lower likelihood of clinically significant levels of anxiety and depression. Youth not living with family and the working poor may be important populations for future investigation. Interventions targeting survivors of childhood violence and social support-based interventions should be tested to address the burden of anxiety and depression in this setting.

     

Morphological characteristics of acetylcholinesterase-containing neurons in the CNS of DFP-treated monkeys. Part 3. Brain stem and spinal cord.

The distribution of acetylcholinesterase (AChE, EC 3.1.1.7) was studied in the lower brain stem and spinal cord of 4 monkeys following the i.m. administration of bis-(1-methylethyl) phosphorofluoridate (di-isoprophylfluorophosphate: DFP). In 1 animal that received 0.43 mg/kg of DFP 4 hr prior to death, AChE was virtually absent in all structures. In the other 3 animals sacrificed 10, 12 and 18 hr after the injection of 0.20 mg/kg of DFP, AChE activity was considerably lighter in the neuropil of different structures normally displaying a moderate to intense AChE activity in pharmacologically unmanipulated monkeys. As a consequence of the lighter background activity several groups of neurons were easily identified and their cell bodies and processes were sharply outlined. Brain stem and spinal cord groups of neurons that show an intense AChE activity include the nuclei of the somatic motor column (cranial nerves III, IV, VI and XII, and ventral horn cells) and of the special visceral (cranial nerves V and VII and nucleus ambiguus) and general visceral (Edinger-Westphal and salivatory nuclei, dorsal nucleus of the Xth nerve and intermediomedial and intermediolateral spinal nuclei) motor columns. Other neurons of the midbrain that display intense AChE activity include the rostral division of nucleus linearis, the magnocellular division of the red nucleus, perirubral giant neurons, the nucleus of the mesencephalic root of V, the substantia nigra and the subnucleus compactus of the pedunculopontine tegmental nucleus. Midbrain neurons with a light to moderate AChE activity are located in the periaqueductal gray, the parvocellular division of the red nucleus, the interstitial nucleus of Cajal, and the magnocellular nucleus of the posterior commissure. Other intensely stained groups of neurons at isthmus and pontine levels include the intermediate and caudal divisions of nucleus linearis, all divisions of the dorsal nucleus of the raphé, the laterodorsal nucleus, nucleus annularis, nucleus centralis superior, neurons of the loci coeruleus and subcoeruleus and of the mesencephalic root of V, the few and large neurons of nuclei pontis oralis and pontis caudalis and nuclei paraabducens and paramedianus dorsalis. Other groups of neurons with a light to moderate AChE activity at isthmus and pons levels include the pontine and reticulotegmental nuclei. The neurons of the cerebellar fastigial nucleus are intensely stained and those of nucleus interpositus and nucleus dentatus, as well as the cell bodies of the Golgi cells of the cerebellar cortex, are moderately stained. At medulla and spinal cord levels the neurons of the lateral vestibular nucleus, the gigantocellular nucleus, the dorsal nucleus of Clarke and the lumbo-sacral border cells are intensely stained. Other neurons with lightly to moderately stained cell bodies include the superior and medial vestibular nuclei, nucleus praepositus, the lateral cuneate and lateral reticular nuclei, and the principal inferior and accessory olivary nuclei.     

Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age

ABSTRACT– The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut-off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD-classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild-moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive-compulsive neuroses of moderate-severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67–85% of subjects with psychoses, about one half of them in psychiatric services, and by 35–65% of subjects with neuroses, about one fifth of them in psychiatric services.     

Considering context, place and culture: the National Latino and Asian American Study

This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research.     

Sexual assault history in a community mental health center clinical population

One hundred and twenty-two adult outpatients, 81 women and 41 men, in a community mental health center responded to a survey of history of sexual assault and abuse. Overall, 48% reported they had been sexually assaulted or abused, 59% of women and 24% of men. Forty-two percent of women and 17% of men reported they had been raped, 27% of women and 7% of men reported attempted rape, and 31% of women and 10% of men reported molestation. Characteristics of assaults and assailants were examined. Implications for training clinicians in the treatment of victims of sexual assault and abuse are discussed.     

Can risperidone and olanzapine in elderly patients with dementia and other mental disorders be discontinued?

BACKGROUND: In March 2004, the UK Committee of Safety of Medicines (CSM) informed clinicians that risperidone and olanzapine should not be used to treat behavioural and psychological symptoms of dementia (BPSD) because of increased risk of strokes with both drugs and increased risk of mortality with olanzapine. An audit to examine the implications of the implementation of the CSM guidance was undertaken. METHODS: All patients receiving these two drugs, in one psychogeriatric service, at the time of CSM guidance were identified and reviewed. Data on clinical and demographic features, patient and carer involvement in the review and clinical outcome of the efficacy of the overall treatment package at 6 month follow-up was ascertained from the case-notes. RESULTS: The main findings were: (i) all patients receiving risperidone or olanzapine were identified and reviewed at a median interval of 8 days after the CSM guidance; (ii) most patients and carers were involved in the initial review; (iii) risperidone and olanzapine were discontinued in 22 and 12 of the patients respectively, and in 19 of these patients another neuroleptic was substituted; (iv) there was no relationship between discontinuation of these two drugs and presence of cerebrovascular and cardiovascular risk factors; and, (v) there was no relationship between the clinical outcome of efficacy at six months and discontinuation of these two drugs. CONCLUSIONS: This study illustrates that it is possible to identify, review and follow-up patients on these two drugs and involve the patient and carer in the review, and clinical outcome of efficacy of the overall treatment package is not adversely affected by continuation or discontinuation of these two drugs.     

MMP-9、TIMP-1及其mRNA在脑膜瘤中的表达

目的探讨基质金属蛋白酶-9（MMP-9）、MMP-1组织抑制剂（TIMP-1）以及MMP-9 mRNA、TIMP-1 mRNA在脑膜瘤中的表达及其与脑膜瘤侵袭性的关系。方法采用免疫组化技术法测定手术切除的70例不同组织学类型脑膜瘤标本中MMP-9及TIMP-1的蛋白表达，并用原位杂交技术检测在不同组织类型脑膜瘤中MMP-9、TIMP-1基因在转录水平的表达，并测量其吸光度比值进行对比。结果MMP-9和TIMP-1在良性脑膜瘤中的阳性表达率分别为35.00％和52.50％，在恶性脑膜瘤中的阳性表达率分别为76.67％和53.33％。MMP-9在恶性脑膜瘤和良性脑膜瘤中的表达存在显著性差异（P〈0.05），而TIMP-1在二者之间差异无显著性（P〉0.05），但MMP-9 mRNA及TIMP-1 mRNA的表达在不同组织学类型脑膜瘤中存在显著性差异（P〈0.05）。结论MMP-9与脑膜瘤的生物学特性相关，促进脑膜瘤的侵袭性生长，其表达在基因转录水平已经上调，MMP-9和TIMP-1表达的失衡与脑膜瘤的恶性程度和侵袭能力相关，MMP-9、TIMP-1基因参与了脑膜瘤的发展过程，与脑膜瘤的生物学行为有关。     

Neural activity and the levels of high energy phosphates during deprivation of oxygen and/or glucose in hippocampal slices of immature and adult rats

To investigate the relationship between neural activity and cerebral energy metabolism during anoxia or ischemia in neural tissue of different ages, hippocampal slices were prepared from four-, seven- and 10-day-old and adult rats. For the index of the neural activity, the population spikes were recorded in the pyramidal cell layer of the CA3 area. ATP and phosphocreatine levels inthe slices were measured during oxygen and/or glucose deprivation.After deprivation of both oxygen and glucose, population spikes of the slices from four, seven- and 10-day-old and adult rats ceased completely in 14.2, 11.8, 9.4 and 5.3 min, respectively. The level of ATP at the time of cessation of population spike in four-, seven- and 10-day-old and adult rats was 37.4, 30.2, 28.5 and 56.4% of the original concentrations. After deprivation of glucose only, the decay time of the population spikes of the slices from four-, seven- and 10-day-old and adult rats was 17.8, 14.5, 9.0 and 10.0 min and at the time of population spikes cessation the level of ATP was 99.8, 84.2, 79.3 and 49%, respectively. After deprivation of oxygen only, population spikes of the slices from four, seven- and 10-day old and adult rats ceased completely in 257, 283, 109 and 8.5 min, respectively. The level of ATP at the time of population spikes cessation was 50, 40, 36.6 and 94.4% of the initial values, respectively.These results indicate that the immature rat is extremely resistant to oxygen deprivation from a functional and a metabolic view, whereas in the adult rat, preservation of neural activity depends much on both oxygen and glucose. During glucose deprivation, population spikes of the slices of immature and mature rats ceased rapidly although the level of ATP is preserved at high levels. This suggests that glucose plays an important role in the preservation of neural activity in addition to its major function as an energy substrate especially in immature animals.     

论临床经验的总结和积累——深入探究某些特殊病例的重要性

在日常临床工作中,由于我们知识的欠缺,对患者病情观察不仔细,对化验、检查结果认识不透彻,会使得某些病例的临床诊治过程充满曲折。本文通过详述一例以脑梗死为首发表现的隐匿性恶性肿瘤病例以及两例视神经脊髓炎谱系疾病病例的诊治过程并加以剖析,试图探讨深入研究这些特殊病例在临床思维训练及经验积累方面的重要意义。通过研究这些病例的临床诊治过程,我们能够掌握最新知识和进展,学会关注病情演变、化验、检查等细节,梳理其中的逻辑思维过程从而训练临床思维能力,不断总结经验和教训,做到举一反三。     

A child psychiatry chairman's view.

Knowledge and services for children do not fare well when they are subordinate to either general or adult organizations. The history of the American Academy of Pediatrics and its publication, Pediatrics, and of the American Academy of Child and Adolescent psychiatry and the Journal of the American Academy of Child and Adolescent Psychiatry provides eloquent evidence of how independence and autonomy foster organization and productivity for forging ahead in the service of a richer collaboration with adult psychiatry departments. Independence in acquiring and disseminating clinical and scientific knowledge based on child and adolescent perspectives enriches in breadth and depth our capacity to improve priorities for children and youth as part of the continuum of the life cycle in human development. It is long overdue that child psychiatry should follow the inspiration and support of the Academy in establishing independent, autonomous clinical and academic departments of child psychiatry. I believe the department of child psychiatry can be replicated nationally and internationally, but not without conviction, medical center commitment, and major independent fund-raising.     

Rehabilitation interventions in multiple sclerosis: an overview

Multiple sclerosis is a complex, heterogeneous disease associated with long-term disability. Despite the availability of advanced disease-modifying and symptomatic therapies that may decrease activity and progression of disease and alleviate complaints to a certain extent, there is still a need for comprehensive rehabilitation interventions in order to reduce sequels and symptoms of the disease on personal activities and social participation to achieve the highest possible independence and the best quality of life. Timing and setting of rehabilitation interventions should be selected individually depending on disease phase, functional deficits, personal requirements, as well as specific goals. In addition, limitations and disease-specific characteristics that may influence rehabilitation outcome should be noted. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing risk for losing important abilities or independence. Due to gradual failure of adaptive compensatory mechanisms along the course of disease, benefits of rehabilitation interventions are generally higher in earlier phases of MS. Inpatient and outpatient multidisciplinary rehabilitation has been shown to be beneficial in improving disability, participation and quality of life despite progression of the disease. Good evidence exists for different specific interventions improving physical and cognitive performance. Other important issues responsible for beneficial effects of comprehensive rehabilitation in MS include education, instruction, and information of patients and caregivers. Comprehensive assessment of health domains in MS patients using standardized framework and common language for describing the impact of disease at different levels, using International Classification of Functioning, Disability and Health (ICF) core sets may increase the knowledge of needs of these patients for more efficient and adapted rehabilitation interventions meeting these individual requirements, and promote perception and acceptance of rehabilitation as a valuable treatment option in MS. ICF core sets may increase the knowledge of more efficient and adapted rehabilitation measures meeting more properly individual requirements, and promote perception and acceptance of rehabilitation as a valuable treatment option in MS.     

Normalization of dystrophic brain cortex neurons after hypoxia and transplantation of embryonic nervous tissue in rats

It was established by us previously that mass reversible and irreversible dystrophy and death of neurons occur in the cortex and hippocampus of adult rats after acute hypoxic hypoxia. Transplantation of embryonic nervous tissue into the brain of rats exposed to hypoxia leads to partial normalization of the nervous tissue and brain cortex and to the reduction in the number of irreversibly degenerative neurons. The objective of the present work is to find out how this visually detected normalization of brain cortex is achieved: by means of elimination of dead neurons and preservation of normal ones or by means of compensatory-restorative processes on the cellular and intracellular levels. To elucidate this question, adult Wistar rats were subjected to acute hypoxic hypoxia and cortex tissue pieces of 19-day-old rat embryos were transplanted into their brain and the brain of intact rats. Intact and hypoxia-subjected rats served as a control. Parts of their brain were injured by puncturing with a syringe needle and injecting 0.01 ml of physiological solution. The rats were killed 4 and 100 days after the operation, their brains were examined histologically and the number of normal nerve cells and those with signs of irreversible and reversible dystrophy or compensatory restoration per 1,000 neurons was determined: uninucleolate, binucleolate, binuclear and paired morphologically similar nerve cells. It has been established that normalization of brain cortex in rats after hypoxia and transplantation occurs not only due to elimination of dead neurons and preservation of normal ones but mainly due to transition of reversibly degenerative neurons into the normal state and, probably, partly due to compensatory-restorative processes on the cell level. Transplantation has a stronger influence than a single injury of the brain.     

Early-onset schizophrenia as a progressive-deteriorating developmental disorder: evidence from child psychiatry

Summary. The developmental perspective as reflected by investigations of childhood and early-onset schizophrenia has become a major research area during recent years and contributed much to the understanding of schizophrenia at all ages. This paper reviews clinical features, neurobiological and neuropsychological findings in childhood and adolescent onset schizophrenia including some results of studies of the author on age at onset, premorbid symptoms, treatment and course. Childhood-onset schizophrenia is a rare disorder with a prevalence of one child in 10,000 before the age of 12 and a remarkable increase around puberty and early adolescence. Developmental events and precursors of schizophrenia cover a wide range of dysfunctions and disturbances including elevated rates of soft neurological signs and birth complications, slow habituation and high baseline autonomic activity, high rate of developmental disorders of speech and/or language and overall and specific cognitive deficits. Brain morphological studies and intelligence testing as well as investigations of the course provide evidence of deterioration. Therefore, early-onset schizophrenia can be understood as a progressive-deteriorating developmental disorder. Received April 9, 2001; accepted September 7, 2001