Hyperkinetic children: Early indicators of potential school failure

Hyperkinetic children are identified as a population-at risk upon admission to kindergarten. The etiology of hyperkinetic behavior is controversial. Organic driveness, hyperkinetic behavior disorder, postencephalitic behavior, brain damage with behavioral and conceptual deficit, Strauss syndrome, have all been used to label essentially similar symptom constellations. Bypassing the area of controversy, a study is reported that demonstrates that children who were identified as hyperkinetic (using behavioral criteria developed in an earlier study) were (1) absent from school more frequently, and (2) did remarkably less well on standardized tests of school readiness than their peers rated nonhyperkinetic. The implications are discussed and suggestions made for the development of intervention programs.An earlier version of this paper was presented at the Annual Meeting of the American Orthopsychiatric Association, March, 1967.     

Immunohistochemical study on the distribution of α and β subunits of S-100 protein in brain tumors

Summary The immunohistochemical distribution of and subunits of S-100 protein (S-100, S-100, respectively) in 138 cases of human brain tumors was investigated by the avidin-biotin immunoperoxidase method. Brain tumors can be divided into four groups: group 1 [S-100 (+) and/or S-100 (+)]; astrocytoma, glioblastoma, ependymoma, subependymoma, oligodendroglioma, choroid plexus papilloma, gangliocytoma, meningioma, chordoma, malignant melanoma. Group 2 [S-100 (+) and S-100 (-)]; pineoblastoma, pituitary adenoma, craniopharyngioma, rhabdomyosarcoma. Group 3 [S-100 (-) and S-100 (+)]; acoustic Schwannoma. Group 4 [S-100 (-) and S-100 (-)]; medulloblastoma, malignant lymphoma, germinoma. The S-100 immunoreactivity pattern in brain tumors was similar to those obtained using conventional anti-S-100 protein sera. In the first group of brain tumors both the number of positively stained tumor cells and the staining intensity were generally greater for S-100 than for S-100 with a few exceptions including one gemistocytic astrocytoma, one subependymoma, one malignant melanoma, and some cases of glioblastomas. As to the relationship between malignancy and S-100 protein in glioma, S-100 immunoreactivity decreased according to degree of malignancy, while that of S-100 varied, suggesting a heterogeneity of tumor cells in glioblastomas. Immunostaining for S-100 and S-100 might become a useful diagnostic procedure in brain tumors and may give us more detailed and precise data of S-100 protein in brain tumors.     

Cytoplasmic and axoplasmic density variations in relation to hyperactivity

Summary The density of the cytoplasm and axoplasm of the anterior horn cell in rats was determined by X-ray microradiography. The average density of the cytoplasm of more than 400 cells from control rats was 0.31 g/³, while that of over 600 cells from rats fed IDPN (- iminodipropionitrile) was 0.43 g/³.Hyperactivity developed during the first 5 weeks and was associated with a gradual increase in cytoplasmic density to 0.51 g/³.At 6 weeks there was a drop in density to 0.36 g/³ which coincided with the appearance of axonal balloons having a density of 0.17 g/³.During the 7–12th week on the diet, the cytoplasmic density showed a gradual increase to 0.59 g/³ and the balloons to 0.29 g/³.The volume of the nerve cells remained fairly constant. The density increases were discussed in relation to hypertrophy, dystrophy, and hyperactivity.

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Zusammenfassung Die Dichte des Cytoplasmas und Axoplasmas der Vorderhornzellen von Ratten wurde durch Röntgenmikroradiographie bestimmt. Die mittlere Dichte des Cytoplasmas von mehr als 400 Zellen der Kontrollratten war 0,31 g/³, während die mittlere Dichte von mehr als 600 Zellen der Ratten, die mit IDPN (- iminodipropionitrile) gefüttert waren, 0,43 g/³ war.Hyperaktivität entwickelte sich während der ersten 5 Wochen und war mit einer progressiven Zunahme der Cytoplasmadichte bis auf 0,51 g/³ verbunden.Nach 6 Wochen sank die Dichte auf 0,36 g/³. Diese Tatsache traf mit dem Auftreten der Axonauftreibungen zusammen, die eine Dichte von 0,17 g/³ hatten.Nach 7–12 Wochen zeigte die Cytoplasmadichte eine progressive Zunahme auf 0,59 g/³ und die der Auftreibungen eine Zunahme auf 0,29 g/³.Das Volumen der Nervenzellen blieb ziemlich konstant.Die möglichen Zusammenhänge zwischen Zunahme der Dichte, Hypertrophie, Dystrophie und Hyperaktivität werden dargestellt.

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Supported by U. S. Public Health Grant NB 1305.     

Effect on hypothalamic self-stimulation of the novelβ-carbolines ZK 93 426 (a benzodiazepine receptor antagonist) and ZK 91296 (a putative partial agonist)

Summary Low doses (300/kg-1.0 mg/kg) of the novel-carboline, ZK 91 296, a putative agonist at the benzodiazepine receptor, produced a significant increase in the rate of variable-interval self-stimulation responding, similar to that found with typical benzodiazepines. This effect was blocked by simultaneous administration of the specific benzodiazepine-receptor antagonists Ro 15-1788 (2.0 mg/kg), and ZK 93 426 (10 mg/kg). Neither antagonist, ZK 93 426 (100g/kg-10 mg/kg) or Ro 15-1788 (2.0 mg/kg), had any effect on self-stimulation when given alone. Unlike all benzodiazepine-receptor agonists previously tested, higher doses of ZK 91 296 did not depress self-stimulation response rates, even at a dose-level 100 times greater than the maximally stimulant dose. It is uncertain why ZK 91 296 lacks depressant effects: available evidence does not conclusively favour any single current explanation, but is consistent with it acting as a partial agonist.     

Assessing the potential of change in institutions

The present article discusses the importance of evaluating the strengths and weaknesses of key institutional personnel prior to attempting program innovations. The importance of such individuals in making or breaking effective programs is emphasized, and various key hospital staff members are described. A simple evaluation process is discussed with the purpose of better anticipating problem areas in program development. It was concluded that in some cases, project implementations should not be attempted when assessed personnel problems appear capable of seriously limiting the effectiveness of a program.     

„Fingerprint inclusions” in muscle fibres in dystrophia myotonica

Summary Fingerprint inclusions were observed in numerous muscle fibres of 3 cases of dystrophia myotonica studied by electron microscopy in two different laboratories. They consist of parallel or concentric palisades of short electron dense linear elements. Identical fingerprint inclusions were reported in two other clinical conditions and cannot therefore be regarded as specific for a particular muscle disease. Their origin and significance remain obscure.     

Schizophrene „Endstadien“

Zusammenfassung Der Autor macht eine Analyse langfristiger katamnestischer Untersuchungen für die Periode 1958–1962 über 212 Kranken und für die Periode 1963–1967 über 154 Kranke im Endstadium der Schizophrenie, welche Kranke zu den 636 chronisch Schizophrenen zählen, die er seit 1957 studiert. Das Problem Defekt wird in Hinblick auf die neuroleptische Therapie der Schizophrenie beurteilt. Der Autor erklärt die sog. schizophrenen Endzustände als relativ reversible und kurable Etappen in der Krankheitsentwicklung und bezeichnet sie als schizophrene Endstadien, von denen er 4 klinische Arten beschreibt: apathisch-hypobulische (AH), halluzinatorisch-paranoide (HP), paranoide (P) und katatone (K).Bei den Nachuntersuchungen zeigen die einzelnen Arten von schizophrenen Endstadien verschiedene Häufigkeit: bei Ktm₂ — AH (37%), HP (35%), K (19%), P (9%) und bei Ktm₃ — AH (45%), HP (38%), K (2%), P (15%). Dabei ist eine beträchtliche Zahl der Kranken außerhalb des Krankenhauses als sozial eingliederbar (33%) und davon 29% arbeitsfähig unter neuroleptischer Behandlung.Die Arbeitsfähigkeit der schizophrenen Kranken im Endstadium in und außerhalb des Hospitals wächst beträchtlich in den letzten Jahren von 93% in 1962 bis 98,7% in 1967. Allgemein 10% von den Kranken können zu Hause bleiben und einige davon sogar als praktisch gesund beurteilt werden.     

Somatosensory evoked potentials in patients with thalamic lesions

Summary Somatosensory evoked potentials (SEPs) were recorded in 20 patients with thalamic lesions confirmed by CT (10 with infarction, 10 with haemorrhage). The changes in SEP configuration are discussed in their relationship to clinical symptoms. Four types of SEP abnormality produced by thalamic lesion are distinguished: (1) FF type, (2) N20/P23 dissociation type, (3) N18/N20 false shift type, and (4) reduced early component type. It was shown that clinically similar lesions might produce different SEP patterns.     

Positron emission tomographic studies on aromatic L-amino acid decarboxylase activity in vivo for L-dopa and 5-hydroxy-L-tryptophan in the monkey brain

Summary The regional brain kinetics following 5-hydroxy-L-(-11 C)tryptophan and L-(-11 C)DOPA intravenous injection was measured in twelve Rhesus monkeys using positron emission tomography (PET). The radiolabelled compounds were also injected together with various doses of unlabelled 5-hydroxy-L-tryptophan or L-DOPA. The radioactivity accumulated in the striatal region and the rate of increased utilization with time was calculated using a graphical method with back of the brain as a reference region. The rate constants for decarboxylation were 0.0070 ± 0.0007 (S. D) and 0.0121±0.0010min^–1 for 5-hydroxy-L-(-11C)tryptophan and L-(-11 C)DOPA, respectively. After concomitant injection with unlabelled 5-hydroxy-L-tryptophan, the rate constant of 5-hydroxy-L-(-11 C)tryptophan decreased dose-dependently and a 50 percent reduction was seen with a dose of about 4mg/kg of unlabelled compound. A decreased utilization rate of L-(-11 C)DOPA was seen only after simultaneous injection of 30 mg/kg of either L-DOPA or 5-hydroxy-L-tryptophan. This capacity limitation was most likely interpreted as different affinity of the striatal aromatic amino acid decarboxylase for L-DOPA and 5-hydroxy-L-tryptophan, respectively.     

Psychometric properties of the parental bonding instrument in a spanish sample

Summary The Parental Bonding Instrument was translated into Spanish and administered to a sample of 205 Spanish primiparae 3 days after childbirth. Reliability, factorial structure and predictive validity for affective disorders were evaluated. The Spanish version of the PBI has psychometric features similar to those described in other cultures. However, the results suggest that in future research the predictive power of the Control factor in affective disorders might be improved by splitting it into two subfactors: Overprotection and Restraint.     

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.     

Cognitive functioning in female patients with 21-hydroxylase deficiency

The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11–41 yrs) and 13 of their healthy sisters (13–31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in full IQ (p<0.05) and subtest scorings for Information, Similarities, and Picture Completion (p<0.05–<0.10). SW patients displayed more masculine behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.

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Zusammenfassung 27 Patientinnen mit dem Adrenogenitalen Syndrom (AGS) (11–41 J.) und 13 ihrer Schwestern (13–31 J.) wurden hinsichtlich intellektueller Funktionen verglichen (Kurzformen von HAWIK, HAWIE). Im Unterschied zu den meisten früheren Untersuchungen wurden weder für Patientinnen (mean: 99.0) noch für Kontrollen (97.7) über dem Durchschnitt liegende IQ-Werte gefunden. Im Gegensatz zur Literatur unterschied sich die Teilgruppe der Salzverlust-Patientinnen (SW)>16 J. (N=6, mean: 111.5) von den Schwestern und den Patientinnen mit einfachem AGS (SV) im Gesamt-IQ (p<0.05) und in den Untertests Allgemeines Wissen, Gemeinsamkeiten und Bilderergänzen (p<0.05–<0.10). SW-Patientinnen hatten signifikant männlichere Verhaltensmuster gezeigt (vs. SV-Patientinnen und Schwestern), die auf differentielle Hormoneffekte pränatal bezogen worden waren. Es fanden sich aber keine klaren Zusammenhänge zwischen IQ-bzw. Untertest-Resultaten und Ergebnissen für Geschlechtsrollenverhalten.

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Résumé Le fonctionnement cognitif de 21 patientes avec une hyperplasie congénitale surrénale (âgée de 11 à 41 ans) et de 13 de leurs soeurs saines (13–31 ans) a été comparé au moyen de versions raccourcies de l'échelle de Wechsler appropriée à l'âge. En contraste avec d'autres études, il n'a été retrouvé un Q.I. plus haut que la moyenne ni pour les patientes (moyenne 99.0) ni pour leurs soeurs (moyenne 97.7). De façon inattendue, et en contraste avec d'autres études, le sous-groupe de patientes déprivées en sel (SW)>16 ans (N=6), moyenne score: 111.5) différait de leurs soeurs aussi bien en tant que patientes présentant des signes de virilsation (SV) pour le Q.I. complet (p<0.05) et les scores aux subtests d'information, de similarité et de complément d'images (p<0.05–0.10). Les patientes déprivées en sel (SW) montraient un comportement plus masculin (vs. SV et leurs soeurs) qui en retour était relié aux influences hormonales prénatales différentes. Il n'y avait pas de relation de différences nettes entre les résultats aux sous-tests cognitifs du Q.I. et le comportement de genre.

     

Zur Bedeutung der γG-Globulinfraktion im Hirngewebe bei der subakuten sklerotisierenden Leukoencephalitis

Zusammenfassung Im Vergleich zu 10 Kontrollen wurde im Gehirngewebsextrakt der weißen wie auch der grauen Gehirnsubstanz bei 5 Patienten mit subakuter sklerotisierender Leukoencephalitis immunoelektrophoretisch die eindeutige Vermehrung der G-Globuline festgestellt. Im Extrakt aus der Gehirnsubstanz konnte dabei die Verdoppelung der G-Globulin-Präcipitationslinie wie auch die Verstärkung und Verlängerung dieser Eiweißfraktion im anodischen Gebiet beobachtet werden. Es wurde die Möglichkeit, die Befunde zu erklären, kurz diskutiert.

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Summary Extracts from white and grey matter of the brain were submitted to immunoelectrophoresis. Considerable increases of the gamma-G-globulin fractions were found in extracts from brains of 5 patients with subacute, sclerosing leuco-encephalitis as compared to 10 controls. A doubling of the gamma-G-globulin precipitation line could be observed as well as an increase and extension toward the anodic region. Possible explanations for these findings are discussed.

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Die Nomenklatur G-Globuline wurde im Sinne des Entwurfes der World Health Organisation (Prag 1964) angewendet und ist dem Begriff der 7 S -Globuline, der ₂-Globuline wie auch der _ss-Globuline gleich. So wurden die anderen zwei Immunoglobuline A- und M-Globulin benannt.     

Die prämorbide Persönlichkeit von monopolar und bipolar Depressiven

Zusammenfassung Die prämorbide Persönlichkeit von 65 monopolar Depressiven (ICD-Nrn. 296.0,296.2) und von 45 bipolar Depressiven (ICD-Nr. 296.3) wird in einem Krankheitsintervall durch retrospektive Selbstbeurteilung untersucht. Die verwendeten Instrumente sind zwei eigens für diese Fragestellung konstruierte Tests v. Zerrsens und zusätzlich der Persönlichkeitstest AUPI, der auf Eysenck's Persönlichkeitstherorie fußt. Die zwei Gruppen werden bezüglich jeder einzelnen Testskala miteinander verglichen. In zwei Skalen resultieren signifikante Unterschiede: Monopolare skoren höher als Bipolare auf der Skala, die Tellenbachs Typus melancholicus entspricht. Dieser kann mit dem Begriff Ordentlichkeit umschrieben werden. Die Bipolaren erweisen sich dagegen als extravertierter als die Vergleichsgruppe. Keine der Probandengruppen kann in den AUPI-Skalen (Extraversion, Neurotizismus und Psychotizismus) von der Normalpopulation unterschieden werden.Herrn Prof. Angst sei für die Anregung zu dieser Arbeit und wertvolle Unterstützung gedankt, Herrn Dr. Dittrich für seine Kritik bei der Interpretation des AUPI.     

Chronic levodopa therapy enhances dopa absorption: Contribution to wearing-off

Summary Effects of the chronic administration of levodopa on its peripheral pharmacokinetics and the contribution of the pharmacokinetics to the pathogenesis of the wearing-off phenomenon are re-evaluated. The concentration of plasma levodopa and clinical symptoms were determined 4 hours after oral levodopa (levodopa 100 mg+benserazide 25 mg) administration on 55 parkinsonian patients. Long-term levodopa therapy markedly increased the peak levodopa concentration (Cmax) and the area under the time-concentration curve (AUC); whereas, it decreased time to the peak concentration (Tmax) and the elimination half-life (T1/2). These results suggest that longterm levodopa therapy accelerates the absorption of levodopa. The wearingoff group (n=23), however, had a markedly higher Cmax and AUC, and a shorter Tmax and T1/2 than the stable group (n=32). We speculate that the clinical expression of stable or wearing-off depends on the absorption of levodopa as well as the presynaptic terminal and post synaptic receptors.     

Fluctuating parkinsonism: a pilot study of single afternoon dose of levodopa methyl ester

Thirty-four patients with idiopathic fluctuating Parkinson's disease and early afternoon delayed on or severely resistant off periods, in spite of long-term antiparkinsonian therapy, were studied. The first afternoon levodopa administration was substituted with an equimolar dosage of the liquid formulation levodopa methyl ester (LDME). The major end-points for efficacy were latency to on and duration of on periods. The patients were divided into five subgroups according to their baseline treatment and they were evaluated monthly for 6 months using the Unified Parkinson's Disease Rating Scale. The patients completed weekly self-evaluation using an on-off chart. LDME was well tolerated by all the patients. A statistically significant reduction in latency to on was observed in all patients. The clinical effect of LDME remained stable during the treatment period (repeat measures ANOVA). The more rapid clinical effect of LDME and its stable and predictable antiparkinsonian activity represents a new and useful approach for treating patients with complicated Parkinson's disease.     

Soviet psychotherapy: The tasks and methodological problems

Soviet psychotherapy follows Western European traditional pre-psychoanalytical rationalistic methodology. On the other hand, Soviet therapists assign great importance to clinical diagnosis within the framework of the classical scheme of Kraepelin. Finally, methods close to behavior therapy, especially so-called training approaches, are popular.     

Comparison of integrin adhesion molecules expressed by primary brain lymphomas and nodal lymphomas

The expression of 17 adhesion molecules was immunohistochemically examined in 5 primary cerebral lymphomas (PCL) and in 5 histologically similar nodal lymphomas (NL) to evaluate their possible involvement in selective targeting of lymphoma cells to the brain. PCL and NL tumor cells showed very similar expression patterns: they were consistently positive for ₃, ₄ and ₁ integrin chains; negative for ₂, ₆, ₃ and ₄ integrin chains; and heterogeneous for ₅, _L, _M, _X, ₂ and ₇ integrin chains, as well as for intercellular adhesion molecule-1 (ICAM-1) and the selectin LECAM-1. Loosely infiltrating PCL showed lower levels of the _L2 integrin than compact cell clusters. Vessels stained for ICAM-1 and vascular cell adhesion molecule-1 (VCAM-1). We conclude that the adhesion molecules implicated in the extravasation of non-neoplastic leukocytes (₄₁/VCAM-1 and _L2/ICAM-1) are also expressed by both PCL and NL. The adhesion molecules examined are apparently not selective mediators of lymphoma cell homing to the brain, but at least _L2 integrin might be related to the infiltration pattern of PCL within the brain parenchyma.Supported by the Sander Foundation     

Glial fibrillary acidic protein in medulloblastoma

Summary Twenty-four cases of classical medulloblastoma and one case of desmoplastic medulloblastoma were examined for glial fibrillary acidic protein (GFAP) using the immunoperoxidase method to assess astrocytic differentiation. In 16 cases of classical medullablastoma GFAP-positive cells were present in variable numbers.These cells were classified as three different types according to size and shape. The type 1 cell was morphologically identical to the ordinary tumor cell, with a hyperchromatic nucleus and a scanty cytoplasm. The type 2 cell had a fairly rich cytoplasm with short cytoplasmic processes. The type 3 cell was characterized by a relatively large nucleus with sparse chromatin and well-developed cytoplasmic processes, and was considered a reactive astrocyte. The type 1 and some of the type 2 cells seemed to be neoplastic, displaying astrocytic differentiation. The remaining type 2 cells may have been reactive astrocytes.In one case of desmoplastic medulloblastoma, the majority of GFAP-positive cells were arranged in islands, and had delicate fibrillated processes. GFAP-positive cells were also observed outside these islands, though they were less numerous. Most of them were regarded as type 3 cells, but some were type 2. This may be interpreted as meaning that the glial character of the tumor was expressed more within than outside these islands.     

Depression in Parkinson disease: a disabling but neglected factor

20 depressed and 20 non depressed patients with Parkinson disease were rated for disability on the Northwestern University Disability Scale and for severity of the typical motor symptoms on the Columbia University Rating Scale and were assessed for mental deterioration. The severity of the typical symptoms was practically equivalent in the two groups but the depressed patients not only presented mild mental deterioration but were significantly more disabled (less independent) than the patients without depression. A significant correlation was found between severity of depression and degree of disability but not between severity of depression and severity of typical motor symptoms. Depression was diagnosed much later than the typical symptoms. Only 25% of the depressed parkinsonians had received tricyclic antidepressants, about 20% had been treated with dopamine-antagonist psychotropic drugs and some 50% had received no treatment at all against depression. Timely diagnosis and appropriate treatment of depression in parkinsonian patients limits the effects of a major disabling factor.Party supported by Regione Piemonte, grant n. 17