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.     

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.     

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.     

A simplified radioimmunological method for the determination of human β-endorphin in cerebrospinal fluid

Summary Human -endorphin-like immunoreactive substances ( _h -EI) in human cerebrospinal fluid (CSF) were determined radioimmunologically. The cross reactivity of the antibodies to human -endorphin ( _h -E) amounted to 40% for human -lipotropin ( _h -LPH) whilst it was less than 1% for leu-and metenkephalin, - and -endorphin, fraction I and II [5], substance P and -MSH. Prior to radioimmunological determination, an adsorbtion of _h -EI from CSF with silicic acid was carried out and followed by a desorbtion, using a mixture of aceton/hydrochloric acid. This method was chosen because the ratio of _h -LPH to _h -E in the desorbat can be shifted in favour of _h -E owing to the variation in recoveries r ( =33%, =64%). On the one hand, this enables a more specific determination of _h -E and, on the other hand, and separation of any peptidase than may be present [9]. An adsorbtion/desorbtion of 2 ml CSF suffices to prove the presence of 20–150 pg/ml (6–48 fmol/ml) of _h -EI.The CSF of 28 patients with various neurological diseases was examined and 24 of them had concentrations of 20–70 pg/ml _h -EI. The remaining four, which had concentrations less than 20 pg/ml, came from meningitis patients undergoing corticoid therapy.A purchasable RIA kit was tested for its determination of _h -E and was found to be unsuitable.

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Zusammenfassung Beta-human-Endorphin-like immunreaktive Substanzen ( _h -EI) im menschlichen Liquor (CSF) wurden radioimmunologisch bestimmt. Die Kreuzreaktivität des von uns eingesetzten Antikörpers gegen Beta-human-Endorphin ( _h -E) zum Beta-human-Lipoprotein ( _h -LPH) betrug 40%, während sie zu Leu- und Met-Enkephalin, Alpha- und Gamma-Endorphin, Fraktion I und II nach Terenius [10], Substanz P und Alpha-MSH geringer war als 1%. Vor der radioimmunologischen Bestimmung wurde eine Adsorption von _h -EI aus CSF an Kieselsäure mit anschließender Desorption mittels eines Gemisches aus Aceton/Salzsäure durchgeführt. Diese Methode wurde gewählt, weil sich dadurch das Verhältnis von _h -LPH zu _h -E im Desorbat zugunsten von _h -E aufgrund der unterschiedlichen Recoveries R ( =33%, =66%) verschob. Damit wird einerseits eine erhöhte Spezifität bei der Bestimmung von _h -EI und andererseits eine Abtrennung von eventuell vorhandenen Peptidasen erreicht. Eine Adsorption/Desorption aus 2 ml CSF genügt, um _h -EI von 20–150 pg/ml (6–48 fmol/ml) nachzuweisen.Patienten (n=28) mit verschiedenen neurologischen Erkrankungen wiesen Werte von 20–70 pg/ml auf. Vier Liquores unter 20 pg/ml stammten von Meningitis-Patienten, welche unter einer Corticoidtherapie standen.Ein käuflicher RIA-Kit wurde auf seine Eignung zur Bestimmung von _h -E untersucht und verworfen.

     

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.

     

Kritische Anmerkungen über die Gedankeneingebung

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

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.     

Die ZNS-Veränderungen bei den olivo-ponto-cerebellaren Atrophien

Zusammenfassung Es wird über 20 Autopsiefälle und einen klinisch beobachteten Geschwisterfall von olivo-ponto-cerebellarer Atrophie (OPCA) berichtet. Es handelte sich um 6 familiäre, darunter 2 dominante, Formen und 15 sporadische Fälle. Letztere waren durch ein durchschnittlich höheres Erkrankungsalter und seltenere spinale Ausfälle gekennzeichnet. Extrapyramidale Syndrome wurden bei 8 Probanden verzeichnet. Morphologisch fanden sich neben der typischen Atrophie der cerebellopetalen Systeme (Brückenfuß, untere Oliven, Kleinhirnhemisphären) in allen Fällen atrophisierende Läsionen wechselnden Grades in anderen Neuronen-system (Nebenlokalisationen): Außer fast konstanter Schädigung der Z. compacta nigrae und des Putamen bestanden häufig Läsionen im Thalamus (Centrum medianum), in der Z. reticularis nigrae und in Hirnstammkernen. Die Hälfte der Fälle bot höhergradige Großhirnrindenatrophie. Spinale Strang- und Kerndegenerationen traten nicht nur bei allen hereditären, sondern auch in einem Teil der sporadischen Formen auf. Ein reiner Fall von OPCA wurde nicht beobachtet. Zwischen den sporadischen und hereditären Formen ergaben sich keine grundsätzlichen morphologischen Unterschiede. Auf das konstante Auftreten variabler Nebenlokalisationen bei der OPCA als einem Prototyp der kombinierten Systematrophien des ZNS wird hingewiesen.

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CNS lesions in olivo-ponto-cerebellar atrophies

Summary 20 autopsy cases and one clinical case of siblings with olivopontocerebellar atrophies (OPCA) are reported. They include 6 familial cases, two of them of dominant transmission, and 15 sporadic cases. The latter type was characterized by a higher mean age at the onset of the disease and by a more frequent incidence of spinal symptoms. Extrapyramidal symptoms were reported in 8 cases. The morphological examination revealed, in addition to the typical atrophy of the cerebellopetal systems (basis of the pons, inferior olives, and cerebellar hemispheres), further atrophic lesions of different intensity involving various neuron systems (associated lesions) in all cases examined. Substantia nigra and putamen were almost consistently affected, the thalamus (centrum medianum) and the reticular part of the substantia nigra frequently. Severe cerebral cortical atrophy was seen in almost half the cases. Losses of neurons and fibres of the spinal cord occurred in all hereditary cases and in some of the sporadic ones. Pure cases of OPCA were not observed in this sample. Morphologically there were no essential differences between hereditary and sporadic forms of OPCA. The regular occurrence of associated lesions in this group of combined systemic degenerations of the CNS is emphasized.

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Herrn Prof. Dr. G. Peters zum 8. 5. 1971 in Verehrung zugeeignet.     

Peripheral chromatolysis after transection of mouse facial nerve

Summary Adult male mice, after transection of the facial nerve near the stylomastoid foramen, were sacrificed at predetermined intervals by the two-step perfusion fixation with a modified Heidenhain's Susa solution and subsequently autopsied after a delay of at least four hours.The normal population of neurons consists of one small form with small basophil granules and one large with numerous coarse granules.The initial change demonstrable in the large neuron 12 hours post-operatively is the loosening of cytoplasmic basophil material which proceeds to a disappearance peripherally at the 24-hour stage; simultaneously an increased staining of the non-particulate cytoplasm takes place. The disintegration of basophil material reaches a maximum 9 days post-operatively and from 12 through 49 days post-operatively occurs an increasingly prominent restoration of basophil material near the nuclear membrane. At the 49-day stage the number of recovered large neurons is small and many are lost. At the 9-and 12-days post-operative stages appears a dark abnormal neuron of questionable origin. Histiocyte reaction is apparent by an increasing number of mitotic figures along vascular walls from the 2nd day to the 9th day; the invasion of microglia cells occurs from the 3rd day and clusters of microglia from the 9th day.The sequential changes in the small neuron are somewhat similar to those in the large type. In its recovered forms, it exceeds the large in number, but is abnormal in color and poorly supplied with basophil material.A concurrent study of the rabbit facial nucleus discloses two types of neurons which after axotomy react differently but mimic at a slower rate the sequence in mice.The cardinal feature of acute retrograde cell changes is the inability of the cytoplasm to store properly its basophil material, as first manifested by a loosening of texture with an early disappearance along the cell periphery and then by haphazard deposition of granular material.With 2 Figures in the Text     

“Dorm D:” A form of group psychotherapy with children in residential treatment

In this paper, Dorm D, a form of group psychotherapy for severely emotionally disturbed children, is described, along with the inpatient setting in which this specific form of treatment evolved. Three paradigms of Dorm D are presented as prototypes for conceptualizing groups in the inpatient residential setting, followed by a discussion of the technical demands evoked by all three paradigms, including limit setting. The paper is intended as an illustration of how classical group therapy techniques can be expanded and modified to provide a viable treatment alternative in a great variety of settings in which children are placed into groups.     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Use of plasma levels for antiepileptic drug monitoring in clinical practice

A multi-center survey of antepileptic treatment was conducted in Italy on 245 previously untreated (new) patients with epilepsy and 355 patients treated for more than three months (old patients). Therapeutic drug monitoring (TDM) of antiepileptic drugs was evaluated in the context of routine clinical conditions, in relation to individual therapeutic problems and mode of treatment. Plasma levels (PL) were determined in 75% of new patients and 78% of old patients, with wide intercenter variability. TDM was done at 69% of the follow-up attendences for new patients and at 34% for old patients, but was apparently unrelated to specific therapeutic problems, such as poor disease control or adverse drug reactions. Plasma drug concentration measurements were made more often among patients on polytherapy. The age of the patient and the time elapsing since diagnosis did not seem to affect request patterns significantly. From these findings it appears that TDM is largerly influenced by factors unrelated to the common recommendations in the literature. In addition, the use of TDM in clinical practice reflects the limitations of the available techniques.

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Sommario In uno studio multicentrico condotto su 245 casi di epilessia di nuova diagnosi (trattati da meno di 3 mesi) e su 355 casi di epilessia di vecchia diagnosi (trattati da almeno 3 mesi)l'uso dei livelli plasmatici dei farmaci anticonvulsivanti è stato valutato in relazione alle modalità di trattamento e a problemi specifici indicati dai clinici. La percentuale di richieste di livelli plasmatici era del 75% e riguardava il 69% delle visite di follow-up nei pazienti di nuova diagnosi. Le percentuali erano rispettivamente del 78% e del 34% per i pazienti di vecchia diagnosi. In entrambi i casi vi era una marcata variabilità tra centri nelle percentuali di prescrizioni. Le richieste di livelli plasmatici erano più numerose nei pazienti in politerapia. Per contro, il monitoraggio dei farmaci antiepilettici non risultava influenzato dalla presenza di specifici problemi, quali il non completo controllo della crisi o la presenza di segni di tossicità farmacologica, né dall'età del paziente o dal tempo intercorso dalla formulazione della diagnosi. Da tutto ciò deriva che l'utilizzo dei livelli plasmatici dei farmaci antiepilettici nella pratica clinica è influenzato da fattori che spesso non riflettono le norme di comportamento comunemente suggerite dalla letteratura. Risultano inoltre ampiamente confermati i limiti delle metodiche attualmente in uso.

     

Electron microscopic observations of peripheral myelin in a central nervous system lesion

Summary After cyanide intoxication and after triethyltin implantation in the brain, cystic spaces were found in the forebrains, of two rats. Within these spaces, many examples of remyelinating axons were observed. Most of them displayed typical mature or developing central type myelin sheaths. Some, however, showed all the morphological features characteristic of mature or developing peripheral myelin. In both rats, the cavities of the cysts were open to the overlying subarachnoid spaces due to partial disruption of the subpial astrocytic layer. It was concluded that the myelin-forming cells responsible for the formation of the peripheral type myelin within the cyst were probably Schwann cells derived from peripheral nervous elements accompanying some subarachnoid blood vessels. It could not be determined whether the axons within the peripheral type sheaths were part of the central or peripheral nervous systems. These data might be relevant to the origin of central neurinomas.This investigation was supported by United States Public Health Service Research Grant No. B3533 from the National Institute of Neurological Diseases and Blindness, National Institutes of Health, and Grant No. 317-3 from the National Multiple Sclerosis Society.     

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.     

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     

Intrafamilial phenotype variation in Friedreich's disease: possible exceptions to diagnostic criteria

Summary Three families are described which include members with typical Friedreich's disease (FD) and others who are ataxic but do not satisfy all the diagnostic criteria for that disease. In family A two patients have an early-onset, rapidly progressive FD, while two others have a late-onset, more benign form. In families B and C one member has typical FD, and another has a similar ataxic syndrome, except for preservation of knee jerks. Laboratory evaluation is consistent with the diagnosis of FD in all cases. FD diagnosis appears justified in secondary cases with late onset or preserved tendon reflexes, provided that the index case fulfils all diagnostic criteria. Whether the diagnosis of FD is tenable in sporadic atypical cases remains to be seen. Echocardiographic and neurophysiological examination may be valuable in classifying such cases.     

Early and late effects of imprisonment in Nazi concentration camps

Summary This paper explores some of the disagreements in the literature on prisoner behavior in the Nazi concentration camps. It also cites wide differences in the findings of early observers of imprisonment effects. Conflicting views of psychoanalysts on the symptom-free interval are noted. A high degree of agreement on the pattern of late effects known as the CC syndrome, is indicated. The paper reports that there is apparent acceptance of the limited evidence available that clinical records of survivors of Nazi persecution who lived in hiding but were not in camps also fit the CC syndrome. Studies are reviewed which suggest that a narrowly psychodynamic or neurobiological emphasis leads to defective interpretations. In this connection disagreements over the importance of the guilt factor (existential, survival, or survivor guilt) are examined. Finally, the paper considers some probable relationships between duration of CC experience, the factor of stress, and early and late sequelae of NCC experience.

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Zusammenfassung Diese Arbeit geht einigen Meinungsverschiedenheiten innerhalb der Verhaltensbeschreibungen von Häftlingen nationalsozialistischer Konzentrationslager nach. Sie berichtet ferner weitgehende Unterschiede in den Ergebnissen von frühen Beobachtern der Auswirkungen von Gefangenschaft. Sich widersprechende Ansichten von Psychoanalytikern über das symptomfreie Intervall werden aufgeführt. Es wird ein hoher Grad von Obereinstimmung hinsichtlich der Struktur von späten Auswirkungen, die als CC-Syndrom bekannt wurden, verzeichnet. Es wird berichtet, daß die beschränkt erhältlichen Zeugenaussagen offensichtlich akzeptiert werden und daß die klinischen Berichte von diesen Verfolgten, die in Verstecken, aber nicht in Lagern überlebten, auch in das CC-Syndrom hineinpassen. Es werden Untersuchungen besprochen, die vermuten lassen, daß eine rein psychodynamische oder rein neurobiologische Akzentuierung zu unzulänglichen Interpretationen führt. In diesem Zusammenhang werden Meinungsverschiedenheiten über die Bedeutsamkeit des Schuldfaktors (existentiell, Überleben oder Überlebensschuld) untersucht. Schließlich zieht die Arbeit einige wahrscheinliche Beziehungen zwischen der Dauer der CC-Erfahrung, dem Streßfaktor und frühen oder späteren Folgeerscheinungen der NCC-Erfahrung in Betracht.

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Résumé Ce travail étudie quelques-uns des désaccords existant dans la littérature sur le comportement des prisonniers des camps de concentration nazis. Il note aussi de grandes divergences dans les résultats d'observations antérieures sur les effets de la détention. Les vues divergentes des psychanalystes quant à «l'intervalle sans symptômes» sont relevées. Dans l'ensemble, les auteurs sont d'accord quant à la structure des effets tardifs connus sous le nom de «CC-syndrome». Le travail relève que les témoignages limités obtenus sont facilement acceptés et que les rapports cliniques des persécutés qui ont survécu en se cachant et non pas dans des camps correspondent également au «CC-syndrome». Des études sont discutées qui laissent supposer qu'une accentuation purement psychodynamique ou purement neurobiologique mène à des interprétations insuffisantes. A cet égard, les divergences sur l'importance du facteur de la culpabilité («existentielle», «culpabilité de survivre») sont examinées. Finalement, le travail considère quelques relations probables entre la durée de l'expérience en camp de concentration, le facteur du stress et les suites précoces ou tardives de la détention.

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This paper was prepared with the support of Grant No. 4040, Penrose Fund, American Philosophical Society. It is a revised version of one that was presented at the VIth World Congress of Sociology at Evian, France, September 1966.     

β-CIT SPECT demonstrates blockade of 5HT-uptake sites by citalopram in the human brain in vivo

Summary The cocaine analogue 2--carbomethoxy-3--(4-iodophenyl)-tropane (-CIT) is a potent ligand for both dopamine- and serotonin uptake sites which in its¹²³I labeled form can be used for single photon emission computerized tomography (SPECT). It was demonstrated previously by SPECT-studies in non-human primates that¹²³I--CIT binds to dopamine transporters in the striatum and to serotonin transporters in hypothalamus and midbrain. The aim of the present study was to compare¹²³I--CIT binding in the brain stem of normal controls and a group of subjects under treatment with the selective serotonin reuptake inhibitor (SSRI) citalopram.¹²³I--CIT- SPECT was performed in 12 depressed patients under 20 mg (n=5), 40 mg (n=6) and 60 mg (n=1) citalopram daily, in one untreated depressed patient and in 11 controls at regular time intervals up till 24 hours p.inj. A highly significant reduction of -CIT binding was found in an area including mesial thalamus, hypothalamus, midbrain and pons in patients under citalopram compared to controls (44.1 ± 14.4 vs. 82.3 ± 18.6 cpm's/mCi × kg body weight; specific binding 4 hrs p.inj.; p=0.0001). No differences were seen between the high and low dose group and no changes were found in the striatum.¹²³I--CIT binding in the brain stem and striatum in one untreated depressed patient fell within the range of control values.To our knowledge this is the first report directly demonstrating the effect of a selective serotonin uptake inhibitor in the brain in humans in vivo. SPECT measurements of serotonin uptake sites in patients with depression and other psychiatric disorders might provide better insights into the pathophysiology of these disorders and into mechanisms of drug action.     

Chronic mental hospital dependency as a character defense

Summary Prolonged hospitalization may cause atrophy of the patient's self-confidence, through excessive dependent gratifications of an oral-receptive nature. Hospital dependency results, and the possibility of discharge arouses such anxiety that the patient exhibits increased psychotic behavior with the effect of maintaining the hospital adjustment. Certain persons are excessively predisposed by previous experience to develop this dependency. The basic predisposition, however, is rooted in the normal course of childhood development.Hospitalization results in three major gains for the mentally disturbed patient: (1) primary relief from anxiety caused by instinctual impulses overwhelming the ego defenses; (2) secondary gains resulting from the socially-recognized sick role; and (3) the satisfactions of becoming an accepted member of a stable social system. If a mental patient is hospitalized, the danger of chronic dependency must be recognized and guarded against. Limited hospitalization is an important therapeutic modality, but as with other therapies, excess may cause secondary complications.Therapy of the chronic patient seeks first to convert dependence on the hospital as an ego-fortifying agent into a general confidence that help will be available if needed. Subsequently, the therapy aims to work through the secondary gains of illness byh viewing psychotic behavior as resistance to giving up the hospital. For the purpose of therapy, the chronic patient is viewed as environmentally-oriented, his behavior as based in present reality; and his active co-operation as essential to any change.The author, now program chief, mental health section, County Department of Public Health and Welfare, San Mateo, Calif., takes full responsibility for the contents of this paper, but wishes to acknowledge his intellectual debt to the staff of the Winter Veterans Administration Hospital, Topeka, Kansas.     

The Proustian itinerary from sensation to memory

Information processing streams that proceed through the sensory unimodal and multimodal areas of the cerebral cortex, and hence the limbic system, bring from perception to memory. This itinerary through the neural networks underlying perception and cognition is briefly outlined through famous passages from Marcel Proust's Swann's Way, in which the flavour of the petites madeleines triggers vivid recollection.La mémoire est nécessaire pour toutes les opérations de la raison