Prospective study of clinical epidemiology of Guillain-Barré syndrome in Harbin, China

Clinical manifestations, outcomes, prognostic indicators, and clinico-epidemiological subgroups were described based on the information of 71 patients with Guillain-Barré syndrome (GBS), who were identified from a prospective survey in Harbin, China during a 1-year period from 1 October 1997 to 30 September 1998. GBS diagnoses of the patients were validated by senior neurologists and most patients were followed up for 6 months after onset. Antecedent events, mainly respiratory infections, were found in 55 (78%) patients during the month before onset. The clinical features, like motor weakness as initial symptoms (82%) and tendon areflexia or hyporeflexia (100%), are similar to those reported from other populations. However, the proportion (70%) of patients reaching to nadir less than 7 days after onset was rather high. Intravenous human immunoglobulin and/or plasmapheresis were used in 45% of the patients and steroids in 58%. At 6 months after onset, 82% of the patients could walk without aid, 46% of the patients had no any residual signs. Four (6%) patients died within 1 month due to respiratory failure. Three subgroups with different clinico-epidemiological characteristics were identified by using cluster analysis.In conclusion, GBS patients in Harbin, China were younger, had shorter time to nadir, frequently preceded by a respiratory infection, and often treated with steroids. Clinical and epidemiological differences of GBS might exist between various populations.     

Do psychiatrists understand research-related experiences,attitudes, and motivations of schizophrenia study participants?

Psychiatrists serve in different but important capacities with research participants. Because ethical problems may arise in research when participants misunderstand motives and responsibilities of clinical-investigators (i.e., "therapeutic misconception"), it is important that relationships between research participants and psychiatric caregivers and investigators be based on genuine mutual understanding. Considerations about attunement of psychiatrists with schizophrenia research participants have never been studied empirically. As part of a larger structured interview-survey study, we assessed the predictions of psychiatrists regarding self-reported experiences, attitudes, and motivations of individual schizophrenia research volunteers who were known to the respondent psychiatrists. Fourteen patient-psychiatrist pairs were identified for inclusion. Psychiatrists predicted schizophrenia research participants' ease of participation, privacy concerns, and willingness to participate in future research but underestimated their positive overall experience. Psychiatrists also were attuned to schizophrenia participants' attitudes and motivations regarding personal benefit but did not accurately predict their responses concerning helping others and science. Also, psychiatrists underestimated the schizophrenia participants' perceived degree of influence by researchers and caregivers during recruitment. Psychiatrists recognized the burden, primary concerns, future participation willingness, and personal benefit orientation of schizophrenia participants, but they did not appear to fully understand the overall positive quality of research experience, altruistic orientation, and relationship orientation of their schizophrenia patients who volunteer for research participation.     

The Lausanne–Geneva cohort study of offspring of parents with mood disorders: methodology,findings, current sample characteristics,and perspectives

Purpose

Studies focusing on the offspring of affected parents utilize the well-established familial aggregation of mood disorders as a powerful tool for the identification of risk factors, early clinical manifestations, and prodromes of mood disorders in these offspring. The major goals of the Lausanne–Geneva mood cohort study are to: (1) assess the familial aggregation of bipolar and unipolar mood disorders; (2) prospectively identify risk factors for mood disorders as well as their early signs and prodromes; (3) identify their endophenotypes including cognitive features, alterations in brain structure, HPA-axis dysregulation, and abnormalities of the circadian rhythm of activity.

Methods

Probands with bipolar disorders, major depressive disorder, and controls with at least one child aged from 4 to 17.9 years at study intake, their offspring, as well as their spouses are invited to take part in follow-up assessments at predetermined ages of the offspring. Direct semi-structured diagnostic interviews have been used for all participants. Probands, spouses, and adult offspring also undergo neurocognitive testing, anthropomorphic measures and biochemical exams, structural Magnetic Resonance Imaging, as well as objective assessments of physical activity using accelerometers in combination with ecological momentary assessments.

Results

Currently, our study has up to seven follow-up assessments extending over a period of 20 years. There are 214 probands and 389 offspring with one direct interview before age 18 as well as a second assessment over follow-up. Data on 236 co-parents are also available from whom 55% have been directly interviewed. First publications support the specificity of the familial aggregation of BPD and the strong influence of an early onset of the parental BPD, which amplifies the risk of developing this disorder in offspring.

Conclusions

Information from clinical, biological, cognitive, and behavioral measures, based on contemporary knowledge, should further enhance our understanding of mood disorder psychopathology, its consequences, and underlying mechanisms.

     

Long-term persistence of symptomatic effect of selegiline in parkinson’s disease, a two-months placebo-controlled withdrawal study

Summary. Following a two-months of placebo-controlled withdrawal, the MAO-B inhibitor selegiline was found to maintain a long term significant mild to moderate symptomatic effect on bradykinesia and tremor at rest in nine patients with Parkinson's disease (stage II and III of H&Y), whose functional impairment had also required a dopaminergic therapy with low-dose bromocriptine. Both motor signs found worsened during the wash-out showed a full recovery to pre-withdrawal condition within two months after reinstitution of the drug. Received November 22, 1999; accepted August 17, 2000     

A morphometric MRI study of the hippocampus in first-episode, neuroleptic-naïve schizophrenia

Magnetic resonance imaging (MRI) studies have frequently, although not unambiguously, reported hippocampal volume deficit in schizophrenia. Data on the hippocampal volumes in first-episode schizophrenia, however, are sparse. In addition, a recent topographic MRI study proposed a regionally specific volume loss in the hippocampus of chronic schizophrenics, but to date no reports have replicated this finding. In this study two-dimensional MRI-based topographic brain mapping was used to study the possibility of regional changes in the hippocampus of 22 controls and 18 patients with first-episode, neuroleptic-na?ve schizophrenia. Compared to controls, there were no significant differences between hippocampal volumes, regional volumes, or length of the hippocampus in the patients with schizophrenia. These data are at odds with the previous reports on hippocampal volume loss in first-episode schizophrenia, and with the hypothesis of regionally specific hippocampal volume deficit in schizophrenia.     

Is the diagnosis of hysterical psychosis justified?: Clinical study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia.

Using the method of a "blind" retrospective evaluation of clinical charts, 21 female patients with hysterical psychosis were compared with 21 patients diagnosed as suffering from nonhysterical reactive/psychogenic psychosis and 42 patients diagnosed as schizophrenic according to the Ninth Revision of the International Classification of Diseases (ICD-9). All three groups were restricted to first admissions and matched with regard to sex, age, and year of admission. Many significant differences were found between hysterical psychosis and schizophrenia; the only significant differences between hysterical and nonhysterical reactive/psychogenic psychosis were the presence of histrionic personality and the frequent shift in symptomatology in the former. Thus, both disorders seem to be identical.     

A translational study of somatosensory evoked potential time–frequency components in rats,goats,and humans

Somatosensory evoked potentials(SEPs)have been widely used to assess neurological function in clinical practice.A good understanding of the association between SEP signals and neurological function is helpful for precise diagnosis of impairment location.Previous studies on SEPs have been reported in animal models.However,few studies have reported the relationships between SEP waveforms in animals and those in humans.In this study,we collected normal SEP waveforms and decomposed them into specific time–frequency components(TFCs).Our results showed three stable TFC distribution regions in intact goats and rats and in humans.After we induced spinal cord injury in the animal models,a greater number of small TFC distribution regions were observed in the injured goat and rat groups than in the normal group.Moreover,there were significant correlations(P<0.05)and linear relationships between the main SEP TFCs of the human group and those of the goat and rat groups.A stable TFC distribution of SEP components was observed in the human,goat and rat groups,and the TFC distribution modes were similar between the three groups.Results in various animal models in this study could be translated to future clinical studies based on SEP TFC analysis.Human studies were approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster(approval No.UM 05-312 T/975)on December 5,2005.Rat experiments were approved by the Committee on the Use of Live Animals in Teaching and Research of Li Ka Shing Faculty of Medicine of the University of Hong Kong(approval No.CULART 2912-12)on January 28,2013.Goat experiments were approved by the Animal Ethics Committee of Affiliated Hospital of Guangdong Medical University(approval No.GDY2002132)on March 5,2018.     

Cognitive impairment or inadequate norms? A study of healthy,rural, older adults with limited education

Abstract

This study established preliminary norms for nine commonly administered neuropsychological tests for a biracial sample (N = 133; White = 64, African American = 69) of nondemented, rural community-dwelling elders (mean age = 76.48; SD = 7.87) with 10 or fewer years of formal education (mean education = 6.65 years; SD = 2.14). Hierarchical multiple regression analyses revealed that education was an important predictor of performance on the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), Clock Drawing, Ravens' Colored Progressive Matrices, Wechsler Adult Intelligence Scale-Revised (WAIS-R) Vocabulary and Block Design, Verbal Fluency (Category) and Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale-Revised (WMS-R), but did not predict scores on the Fuld Object Memory Evaluation or memory savings scores from the WMS-R. Race was a predictor only for WAIS-R Vocabulary and Block Design, and WMS-R Logical Memory Delayed. Approximately half of the subjects scored below the published cut-offs for the MMSE and MDRS and would have been considered mildly to moderately impaired on many of the test measures.     

Evaluating the effects of amantadin,modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized,blind study

ObjectiveFatigue affects more than 60% of multiple sclerosis (MS) patients and is one of the most troublesome symptoms of the disease. Current treatment options for MS fatigue include amantadine, modafinil and acetyl-l-carnitine (ALCAR). The aim of our study was to compare efficacy of amantadine, modafinil and ALCAR with placebo in patients with MS.MethodsPatients with MS and a disability level ≤5.5 on the Kurtzke Expanded Disability Status Scale (EDSS) and fatigue were included in the study. Patients were assigned to a one month treatment with either amantadine 200 mg, ALCAR 2 g, modafinil 200 mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS).ResultsSixty patients were included in the study (39 females). The mean age of patients was 38 ± 6.7 years and the mean disease duration was 6.6 ± 1.2 years. Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference = 17.3, p = 0.001). There was also a trend of a lower MFIS score in ALCAR group in comparison to placebo (mean difference = 12.4, p = 0.05, with Keppel-corrected alpha of 0.046). The quality of life measured as SF 36 – PCS and SF 36 – MCS proved to be significantly influenced by treatment.ConclusionOne month treatment with amantadine improved fatigue in patients with relapsing-remitting MS as evaluated by MFIS. No or only a trend of improvement was seen in patients treated with modafinil or ALCAR, respectively.     

Danger of social breakdown: compulsory admission, but not treatment? A case study

Compulsory treatment is permitted (article 38 paragraph 5 Bopz (the Act on Special Admissions to Psychiatric Hospitals in the Netherlands)) if this is necessary for preventing danger to the patient or other persons and if this danger arises from impairment of the patient's mental functioning. Two patients are described in which compulsory drug treatment was considered on the grounds that the patients were in danger of social breakdown if they remained without hope or perspectives in a psychiatric hospital. The court ruled that that danger was insufficient to justify compulsory drug treatment. The authors are of the opinion that a stay in hospital with no hope or perspectives constitutes social breakdown and that the compulsory drug treatment should be applied.     

Thioproperazinbehandling,en “pilot study”

Nordentoft M. Deinstitutionalization and homelessness among the mentally ill – a historical review.

The number of psychiatric beds has decreased dramatically in the Western world during the past three decades. At the same time there has been a shift in psychiatric care from being mainly custodial in big asylums to a more active, often psychotherapeutically oriented treatment in the psychiatric departments of general hospitals or in community mental health centers. This development has benefited many psychiatric patients, but during the same period severely ill psychiatric patients, mostly schizophrenics, have dropped out of psychiatric care and are now in increasing numbers to be found in jails, in board-and-care homes, or homeless in the streets. It is stressed that there is a need for analysis of the cause of homelessness among psychotic patients and of development of aid programs that can be accepted by this specific group of patients.     

Systemic amyloid myopathy — Light-microscopic and fine-structural study of the skeletal muscles with histochemical and immunohistochemical study of amyloid

Summary Studies were made on skeletal muscles obtained by biopsy and autopsy from a 59-year-old man with immunocyte dyscrasia and amyloidosis; he had progressive muscular stiffness with palpable tumors and -type Bence-Jones protein, but no overt myeloma.Histologically, much amyloid was seen deposited preferentially in the skeletal muscles, especially in the endo- and perimysia, forming tumors of various sizes and occasionally associating influx of amyloid into some muscle fibers, and in the smaller-sized blood vessel walls, frequently associated with extreme narrowing or occlusion of their lumina.Most muscle fibers were replaced by much amyloid or showed extensive atrophy, having a characteristic circular space under the endomysium, which was concluded to be not due to compression atrophy but to ischemic atrophy. Ischemic neuropathy was observed and seemed to be responsible for the diffuse atrophy without spaces seen exceptionally in some parts. Amyloid was shown histochemically to contain AL as the major protein component, immunohistochemically to have a close relation with -type light chain, and fine-structurally to be formed just outside the basement membrane of the blood vessels and deposited in the endo- and perimysia through perivascular infiltration.The clinicopathologic features of nine similar autopsy cases in the literature were compared with those in the present case.The causes of damage in muscle fibers and of preferential deposition of amyloid in the skeletal muscles were discussed.Supported by grant no. 81-01-09 from The National Center for Nervous, Mental and Muscular Disorders (NCMMD) of the Ministry of Health and Welfare of Japan     

Therapists’ honesty,humor styles,playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect

Objective: This study examined whether therapists’ honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. Method: In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. Results: Therapists’ Aggressive Humor Style (AHS) was a significant negative predictor of clients’ symptom change over time. The therapists’ honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. Conclusions: Therapists’ inferred traits of Honesty–Humility and AHS may influence the effectiveness of their treatments.