Genealogic study of patients with admission diagnosis of functional psychosis

Summary The results are reported of a genealogic study of 313 patients (171 males and 142 females) consecutively admitted to the psychiatric department of the Medical School of Charles University in Prague, Czechoslovakia. Patients suffering from psychosis were selected and divided into five groups: schizophrenia, bipolar psychosis, unipolar depressive psychosis, schizoaffective psychosis and unspecified disorder (the diagnosis of psychosis suspected but not yet certain at the time of investigation). A total of 1086 first degree relatives (parents and siblings) were ascertained and one or more first degree relatives of each proband were interviewed. The total morbidity risk of psychiatric disorder for parents and siblings was 12.6% for schizophrenic probands, 17.8% for bipolar probands, 10.7% for unipolar probands, 12.0% for schizoaffective probands and 12.6% for probands with unspecified psychosis. A striking increase of the frequency of affective disorders was found among secondary cases of schizoaffective probands.Heterogeneity between schizophrenia and primary affective disorders was tested and demonstrated.The pros and cons of the study design was discussed.     

Perspectives and directions in juvenile corrections

The historic discrepancy between the rhetoric of humanitarianism and actual performance is aggravated by the growing tendency to view individual deviations from the norm as indicative of psychopathology or illness. This too glib a use of the concept of mental illness prevents us from seeing the important role of social conditions and systems in the development and exacerbation of a number of social problems.The author concludes with a penetrating analysis of specific issues and needs which should be addressed if we are interested inlong-term protection of the community rather than increasingly massive expenditures for shortterm controls.This is a slightly revised version of a paper presented to the Conference on Innovative Programs for the Treatment of Juvenile Offenders-Alternatives to Incarceration at Rutgers University, New Brunswick, New Jersey, on May 11, 1970.The views expressed are those of the author and do not necessarily reflect the official policy of NIMH.     

Affective and schizoaffective mixed states

Abstract. Although both DSM-IV and ICD-10 define schizoaffective mixed states, they have not received much attention—neither in the clinical nor in research context. We present preliminary results of a prospective study of bipolar affective (n = 100) and bipolar schizoaffective (n = 177) patients. 25% of the bipolar affective and 32% of the bipolar schizoaffective patients had at least one (schizo)mixed episode during the illness course. Nevertheless, (schizo)mixed episodes were rare—only 5.6% of all episodes. There was a trend that patients with (schizo)mixed episodes were more often women and exhibited more disability (reflected by higher rates of disability payments). Nevertheless, these differences failed to reach significance. Overall, schizo-mixed episodes are as frequent as pure affective mixed episodes. They might be linked to a less favourable course. Nevertheless, while their diagnostic criteria are problematic, they are systematically underdiagnosed.     

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.     

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.     

The Phenomenology of Psychosis Associated with Complex Partial Seizure Disorder

Psychosis commonly occurs as a direct result of complex partial seizure disorder (CPSD). This organic mental disorder is indeed complex and is easily and frequently misdiagnosed as a variety of functional disorders, including schizophrenia, schizoaffective disorder, bipolar illness, psychotic depression, and, at best, atypical psychosis. However, this important clinical syndrome has several clinical features that suggest its presence and which often permit it to be distinguished from other forms of psychosis. Furthermore, this disorder can be successfully treated with limbic anticonvulsants, with or without neuroleptics and/or lithium, but it is generally refractory to neuroleptic medications alone. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic and illustrates the clinical profiles of 10 treatment-refractory patients admitted to a state hospital with previously undiagnosed psychoses secondary to CPSD. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments.     

Amyloid β peptide 1–42 highly correlates with capillary cerebral amyloid angiopathy and Alzheimer disease pathology

Recent studies reported both positive [Thal et al. (2003) J Neuropathol Exp Neurol 62:1287–1301] and negative [Tian et al. (2003) Neurosci Lett 352:137–140] correlations between cerebral amyloid angiopathy (CAA) and Alzheimers disease (AD) pathology. We have recently shown high correlations between neuritic AD pathology and amyloid peptide (A) deposits in the capillary/pericapillary compartment (CapCAA) with only low correlations to general CAA (non-capillary). We have now studied the relationship between CapCAA and AD pathology with respect to the distribution of A40 and 42 in the frontal cortex of 100 human postmortem brains from both male and female, demented and non-demented patients (mean age ± SD 84.3±9.3 years). Using polyclonal antibodies to A40 and 42, capillary and plaques positivity were assessed semiquantiatively on a four-point scale. A42 deposits in capillaries correlated highly with both A42 deposits in plaques and morphological AD criteria (CERAD, Braak stages, and NIA-Reagan-Institute criteria), while only a low correlation with CAA was observed. A40 deposits in capillaries differed morphologically from A42 ones: they were limited to capillary walls, were significantly less frequent in both capillaries and plaques compared to A42 (P<0.01), and showed a low correlation with morphological AD criteria (P<0.05) and general CAA (P<0.01). By contrast, A42 deposits were seen in the glia limitans rather than in capillary walls themselves, and showed high correlation with morphological AD criteria (P<0.01). These data indicate that CapCAA is characterized by A42 deposits in pericapillary spaces or in the glia limitans. A low correlation between CAA and CapCAA, but high correlations between morphological AD criteria and CapCAA suggest different pathomechanisms for both types of CAA, and a close relation between CapCAA and AD pathology (both neuritic and plaque type). These data support the concept of a neuronal origin of A via drainage from interstitial fluid from the central nervous system along basement membranes to capillaries.List of Abbreviations AD Alzheimer disease - A beta amyloid peptide - A 40/42 CapS score of deposits of A 1–40/42 in capillaries - A 40/42 C number of A 1–40/42 positive cortical vessels - A 40/42 PS score of deposits of A 1–40/42 in plaques - A 40/42 TS total score of A 1–40/42 deposits - A 40/42 Csev severity of A 1–40/42 affection of cortical vessels - A 40/42 CS A 1–40/42 cortical score - A 40/42 L percentage of A 40/42 positive leptomeningeal vessels - A 40/42 Lsev severity of A 40/42 affection of leptomeningeal vessels - A 40/42 LS A 40/42 leptomeningeal score - ACTS A cortical total score - ALTS A leptomeningeal total score - CAA cerebral amyloid angiopathy - CAATS CAA total score - CapCAA capillary CAA - CERAD Consortium to Establish a Registry of Alzheimers Disease - NFT neurofibrillary tangle - NIA National Institute of Aging - NIA-RI National Institute of Aging and Reagan Institute - NP neuritic plaque - SP senile plaque - TS total scoreAn erratum to this article can be found at     

Electron microscope studies of Schwann cells during the Wallerian degeneration with special reference to the cytoplasmic filaments

Summary The fine structure of Schwann cells of the sciatic nerve of adult rabbits during the several phases of Wallerian degeneration was studied. For electron microscopy buffered osmium tetroxide, Vestopal W and the lead and uranyl staining was used As a result of the axon degeneration, the Schwann cells are activated and the myelin sheaths break down. During the phase of intraplasmatic digestion of the myelin, the ribosomes increase considerably and the ER swells. Afterwards a conspicuous granular thickening of the ground plasm is to be noted (stage of dark cells). The granular ground plasm forms into filaments, which stand out clearly before the light background as tender strings about 60–80 Å in thickness (stage of light cells). During this stage, the ribosomes have disappeared almost completely and the ER has collapsed. The Schwann cell has entered into its stage of rest which is characterized by a high amount of plasmatic filaments. Schwann cell filaments differ from so-called neurofilaments in respect of their genesis and their ultrastructure. In conclusion, the differences in genesis and morphology between the two filamentous structures are discussed.

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Zusammenfassung Elektronenoptisch wurden die verschiedenen Phasen untersucht, die Schwannsche Zellen während der Wallerschen Degeneration durchlaufen. Als Untersuchungsmaterial dienten der N. ischiadicus des erwachsenen Kaninchens. Für die Elektronenmikroskopie wurden Osmium-tetroxyd, Vestopal W sowie die Bleiund Uranylkontrastierung verwendet.Als Folge der Axondegeneration werden die Schwannschen Zellen aktiviert und die Markscheiden fragmentiert. In der Phase des intraplasmatischen Myelinabbaus findet eine hochgradige Vermehrung der Ribosomen und eine Schwellung des endoplasmatischen Reticulums statt. Danach tritt eine starke granuläre Verdichtung des Grundplasmas in Erscheinung (Phase der dunklen Zellen). Aus dem granulären Grundplasma formieren sich anschließend die Filamente, die sich vor dem hellen Untergrund als zarte, etwa 60–80 Å dicke Fäden abzeichnen (Stadium der hellen Zellen). In diesem Stadium sind die Ribosomen bis auf kleine Reste verschwunden, und das ER ist abgeschwollen. Die Schwannsche Zelle hat ihr Ruhestadium eingenommen, das durch eine starke Anhäufung der Plasmafilamente charakterisiert ist. Die Schwannschen Zellfilamente unterscheiden sich von sogenannten Neurofilamenten in bezug auf die Genese und die Feinstruktur. Abschließend werden die Unterscheidungsmerkmale in der Genese und der Morphologie beider filamentärer Strukturen diskutiert.

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Supported by the Deutsche Forschungsgemeinschaft.     

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.     

The course of affective disorders

Summary All patients suffering from affective psychoses (ICD 296) who were admitted to the Psychiatric University Clinic of Zurich between 1959 and 1963 were studied in a follow-up investigation until 1975. Of 254 affective psychoses, 95 were bipolar patients (37.4%) and 159 were monopolar (62.6%). The sample of bipolar patients was complemented with all patients who had been admitted in the period 1959–1963 because of manic or mixed manicdepressive syndromes.This paper describes the change of diagnosis in the two diagnostic groups. In 10% (N= 20) of monopolar depression cases there was a change of diagnosis to bipolar affective illness. An analysis shows that the diagnosis of patients with three or more depressive episodes (unipolar depressives) was especially prone to change.A mathematical correction of some diagnostic errors leads to the conclusion that the ratio of unipolar depression to bipolar illness may be about 11.A major source of diagnostic error lies in the change of affective to schizoaffective illness. Up to now, no clinical criterion exists that would exclude this error, which was found in 6% (n=12) of the monopolar but also in 7.5% (n=3) of the bipolar index patients.It is recommended that studies of affective disorders should be based on truly representative samples of the illness, including patients with one or two episodes, and that the term unipolar depression be used synonymously with the term monopolar depression, originally created by Kleist (1947) and Leonhard (1957).     

Acetylcholine and affective disorder

Summary We reviewed the evidence for involvement of central cholinergic neurons in affective disorder. Cholinomimetics inhibit speech, thought, and activity in most subjects, decrease manic symptoms and, in some affective disorder patients, produce depressive symptoms. Cholinomimetics also cause ACTH and cortisol secretion and decrease latency to REM sleep. It is unclear whether cholinomimetics are specifically antimanic or depressogenic or whether their fundamental effect is nonspecific behavioral inhibition; whether the observed effects of cholinomimetics are mediated largely through cholinergic pathways, are secondary to changes in other neurotransmitters or are part of a nonspecific stress response. The suggestion that anticholinergic agents have mood elevating properties has not yet been subjected to controlled investigation.Although the proposal that affective disorders involve cholinergic neurons has received some support from clinical investigation further research is required to substantiate the intriguing observations to date and to clarify the physiologic and psychologic processes mediating them.     

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.     

Applying the Readiness to Change Model to Implementation of Family Intervention for Serious Mental Illness

Family intervention for serious mental illness is known to be highly efficacious in reducing patient relapse, improving social functioning, enhancing caregivers knowledge of mental illness, and ultimately reducing overall costs of care. However, very few families receive services. The reasons for this gap between empirical findings and program implementation are complex and not yet fully understood. Prochaska and DiClementes Readiness to Change Model provides a helpful structure for understanding key issues for the four relevant stakeholders (patients, family members, clinicians and administrators). Staging each stakeholder group and applying corresponding interventions (processes of change) are useful in a sites implementation of family services.     

Über angeborene Mischgeschwülste des Kleinhirns

Zusammenfassung Es wird über neun umschriebene Geschwülste der hinteren Schädelgrube berichtet, die feingeweblich aus zwei verschiedenen, in Feldern und Zügen angeordneten Gewebsanteilen bestehen. Die Zellen der Felder sind kleine, körnerzellähnliche Elemente mit runden, stark chromatinreichen Kernen. Die Zellen der Züge sind größere Elemente mit rund-ovalen, kommaartigen, chromatinarmen Kernen. In den Zügen läßt sich regelmäßig ein ausgedehntes Reticulinfasernetz nachweisen. Die Felder sind dagegen reticulinfrei, sie bestehen aus einer feinfaserigen neuroectodermalen Grundsubstanz. Charakteristikum dieser Tumoren ist, daß das Mengenverhältnis der zwei Gewebsanteile von Fall zu Fall und sogar innerhalb des gleichen Falles stark variieren kann, so daß die Beobachtung von nur einzelnen Geschwulstpartien oft nicht erlaubt, die gesamte Struktur des Tumors zu erfassen und zu falschen Diagnosen führt.Diese als angeborene Mischtumoren des Kleinhirns bezeichneten Geschwülste sind feingeweblich von den Mischgewächsen des Unterwurmes Ostertags zu trennen. Sie zeigen hingegen gewisse Ähnlichkeiten mit dem sogenannten umschriebenen Arachnoidealsarkom des Kleinhirns (Foerster u. Gagel), von dem sie aber ebenfalls zu trennen sind.Die formale Genese dieser Geschwülste wird unter Berücksichtigung histogenetischer, feingeweblicher und lokalisatorischer Aspekte diskutiert. Sie werden als Kombinationstumoren angesehen mit einer mesodermalen Züge- und einer neuroectodermalen Felder-Gewebskomponente. Ihre dysembryogenetische Natur bzw. ihr früher Entstehungszeitpunkt wird durch das Vorkommen von Kleinhirnmißbildungen bestätigt. Schließlich werden ihre Beziehungen zu den Geschwülsten der sogenannten Medulloblastomgruppen erörtert.

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Summary Nine circumscribed tumors of the posterior cerebral fossa are described; histologically, they were characterized by two different types of tissue components arranged in strands and fields. The parvicellular fields are of neuroectodermal origin, the mesodermal strands consist of large cells and are rich in reticulin containing fibers. One of the two components may considerably outgrow the other one and become responsible for quantitative alterations.These tumors show some resemblance with the so-called circumscribed arachnoidal sarcoma of Foerster-Gagel, but should not be confused with it. They are morphologically also different from Ostertag's mixed tumors of the posterior vermis.This group of tumors is generally combined with cerebellar malformations which underline their dysontogenetic nature or at least the early onset of their development. As to their formal genesis they may be compared with the congenital mixed tumors of other organs (kidney, liver), and therefore be classified as combination tumors according to Meyer.Finally, their relation to so-called medulloblastomas is discussed.

     

DL-lysine-H3 uptake in “light” and “dark” neurons of the inferior olivary nucleus of euthyroid and dysthyroidal rats

Summary Uptake of DL-Lysine-H³ into light and dark cells of the rat inferior olivary nucleus was studied by radioautographiy. Uptake in light cells was higher than in dark cells and appears to be possibly related to the greater frequency of relationship with glial satellites. Dysthyroidal states were also observed to increase uptake of radioactivity which was prominently observed in hypothyroid rats. Since dark cells appear to take up less lysine than normal cells and are less frequently closely associated with glial satellites it is suggested these cells may represent a less physiologically active unit than the light cells rather than being simply artifactually produced by the procedures employed.

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Zusammenfassung Die Aufnahme von DL-Lysin-H³ in hellen und dunklen Zellen im unteren Olivenkern der Ratte wurde mit Autoradiographie beobachtet. Die Aufnahme war höher in den hellen Zellen als in den dunklen, was möglicherweise mit einer größeren Häufigkeit von Glia-Satellit-Verbindungen in Zusammenhang gebracht werden könnte. Veränderungen im hormonalen Zustand der Schilddrüse konnten auch dazu beitragen, die Aufnahme von Radioaktivität zu erhöhen, was besonders bei Ratten mit niedriger Schilddrüsenaktivität hervortrat. Da dunkle Zellen offenbar weniger Lysin aufnehmen als normale Zellen, und sie seltener mit Glia-Satelliten verbunden sind, wird angenommen, daß diese Zellen möglicherweise eine weniger aktive physiologische Einheit darstellen als die hellen Zellen und daß es sich nicht einfach um ein Kunstprodukt handelt.

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This investigation was supported in part by a PHS research grant (NB-456802) from the division of Neurological Disease and Blindness and in part by Contract NONR 4018(01), (NR 101-592), between the Office of Naval Research, Department of the Navy, and the Research Foundation of the State University of New York.     

The Diverse Roles of Anticonvulsants in Bipolar Disorders

Anticonvulsant drugs (ACs) have diverse antiseizure, psychotropic, and biochemical effects. Carbamazepine and valproate have mood-stabilizing actions, benzodiazepines and gabapentin have anxiolytic actions, lamotrigine is useful in rapid cycling and acute treatment and prophylaxis of bipolar depression, and topiramate and zonisamide can yield weight loss. Limited controlled data suggest the carbamazepine keto derivative oxcarbazepine has antimanic effects. A categorical approach to the diverse roles of ACs in bipolar disorders is proposed, using broad categories of ACs, on the basis of their predominant psychotropic profiles. Thus, some ACs have sedating profiles that may include sedation, cognitive difficulties, fatigue, weight gain, and possibly antimanic and/or anxiolytic effects. In contrast, some newer ACs have activating profiles that may include improved energy, weight loss, and possibly antidepressant and even anxiogenic effects. Still other newer ACs have novel mixed profiles, combining sedation and weight loss. A categorical–mechanistic extension of this approach is also presented, with hypotheses that sedating profiles might be related to prominent potentiation of gamma-aminobutyric acid (GABA) inhibitory neurotransmission, activating profiles could be related to prominent attenuation of glutamate excitatory neurotransmission, and for mixed profiles, sedation and weight loss might be related to concurrent GABAergic and antiglutamatergic actions, respectively. The categorical approach may have utility as an aid to clinicians in reinforcing the heterogeneity ACs, and recalling psychotropic profiles of individual ACs, but is limited as it fails to address the etiology of the heterogeneity of AC psychotropic effects. The categorical–mechanistic extension strives to address this issue, but requires systematic clinical investigation of more precise relationships between psychotropic profiles and discrete mechanisms of action to assess its merits.     

Mental Hygiene of the Special Schools Teachers in Kerman,Iran

The goal of this research is to identify and study the mental hygiene and its related factors (individual, family, organizational) in the Kerman special schools teachers. 266 teachers of the special schools of the cities of the province Kerman were chosen as the research sample. The necessary data were obtained by questionnaire which its validity and reliability were determined. The statistical analysis of the research findings (by Spearman coefficient test) Man-Whithey and Kruskal wallis tests showed that there was a positive and meaningful relationship between Level of education, service of record the number of the members of teachers family, income, dwelling-place, economic power, acceptance of the teachers job in their family, leadership style, suitable educational possibilities, suitable educational space, job satisfaction with the mental hygiene of the teachers. The results of the research also showed that the Kerman special schools teachers enjoyed a relatively desirable mental hygiene.     

“Echoing approval”: A new speech disorder

We report the cases of two patients presenting a peculiar speech disorder, which we have named echoing approval, in which the patients echo, in replying to questions in a dialogue with short phrases, the positive or negative syntactical construction of a question, or its positive or negative intonation, but without any repetition of whole or part of sentences. When asked about their symptoms, the patients replied 80% of the time with yes, yes, that's right, or exactly to positive questions and no, no or absolutely not to negative questions, regardless of their actual symptoms and oblivious to self-contradiction. In addition, when the examining doctor was speaking to a medical colleague in the patient's presence and using medical terminology that the patient did not understand, he/she agreed or disagreed with any sentence and technical word uttered in a way entirely dependent on the syntax or intonation used. To distinguish this speech disorder from echolalia or verbal perseverations, with which it may be superficially confused, we suggest that it be called echoing approval, as it may be part one of the manifestations of the environment-dependency syndrome. This clinical picture was found to be associated with features of transcortical motor aphasia and frontal lobe signs. One patient had a bilateral callosofrontal malignant glioma and the other a probable multiple system atrophy with global deterioration, pre-eminent frontal release signs, diffuse leukoencephalopathy and multiple lacunes. On the basis of these clinical deficits and neuroimaging features, we are unable to delineate the common, or minimal, lesioned network required for this symptomatology to occur, especially in the absence of a series of patients, and with such a difference in both the location and causes of the lesions. However, bilateral frontosubcortical dysfunction was pre-eminent in the clinical picture in both patients, even though more diffuse brain pathology was seen in one, and it might be speculated that dysfunction of the bilateral orbitofrontal and frontomesial motor frontosubcortical circuits might be involved in the aetiology of this peculiar speech disorder.     

The relation of social class to the characteristics and treatment of parasuicide

Summary The subjects for study were all parasuicides admitted to the Regional Poisoning Treatment Centre between 1968 and 1973. The parasuicides were divided into four social class groups: Registrar General's Classes I and II; Class III; Class IV; Class V. The characteristics and disposal of parasuicides from each class were compared. A large number of items showed a significant difference across class. Lower class parasuicides were more often characterised by a variety of social problem items including overcrowding, trouble with the law, debt, unemployment and violence in interpersonal relationships. They were more often diagnosed as personality disorders whereas higher class parasuicides were more likely to be diagnosed as depressive. The latter were also more frequently referred to the R. P. T. C. by a medical agent. For higher class patients, after-care more often took the form of in- or out-patient psychiatric treatment; lower class patients were more commonly recommended for social work on discharge. The association between social class and type of after-care was maintained when the diagnostic groups were considered separately. Patients of higher social class within the categories personality disorder only, depression only, depression with personality disorder, other psychiatric illness with personality disorder were markedly more likely to receive a psychiatric referral.     

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.