SOME THOUGHTS ON SCHREBER (AND FREUD): DEPRESSION, PARANOIA AND A DELUSIONAL SYSTEM

ABSTRACT Freud's paper on Daniel Paul Schreber is a seminal psychoanalytic text (Freud 1911). In it, he sets out his argument that Schreber's paranoid delusions arose from repressed homosexuality. This paper reconsiders the case of Schreber from a contemporary perspective chiefly by studying, as did Freud, Schreber's autobiographical Memoirs of My Nervous Illness (Schreber 1903), but also by drawing upon more recent biographical information. It follows the view put forward by Lothane (1992), and recently elaborated by Steiner (2004), that Schreber's illness was originally depressive in nature, and then progressed to paranoia and finally to a settled delusional system. It reviews many of Freud's insights, contending that although some, such as his understanding of the mechanism of paranoia and the manner by which a delusion of persecution is converted into a religious delusion of grandeur, have stood the test of time, others, such as the causal relationship he proposes between homosexuality and paranoia, do not.     

Xenopus Tadpole Melanophores Are Controlled by Dark and Light and Melatonin Without Influence of Time of Day

Melanophores were studied in tadpoles of the South African clawed toad, Xenopus laevis , during the first week after hatching (stages 46–49) at 25°C. The tadpoles had melanophores with dispersed melanosomes in the light and punctate melanophores in the dark in LD12:12. The melanophores remained punctate in constant dark and the melanosomes remained dispersed in constant light. Lights-out (in the light-time of LD12:12) caused the melanophores to become punctate, which occurred more quickly than the dispersion of melanosomes, which commenced when the lights were turned on (in the dark-time of LD12:12). Melanophores with dispersed melanosomes in tadpoles (in constant light) became punctate in response to a series of melatonin concentrations (0.2–5 ng/ml) in their bathing water irrespective of the time of day melatonin was administered. An image-analysis technique for assessing melanophore responses was tested.     

Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan.

This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.     

Issues of obesity in kidney transplantation.

The purpose of this literature review is to evaluate the scientific evidence regarding the relationship between obesity and outcome of renal transplant recipients. The impact of obesity on kidney transplant outcomes continues to be controversial. Obesity seems to influence delayed graft failure, graft survival, and patient survival. A body mass index of 35 kg/m(2) or more is significant for greater posttransplant complications, especially new-onset transplant diabetes mellitus, wound complications, and posttransplant weight gain. Several important advances in the general medical management of the patient, both before and after transplantation, have occurred over the last decade. The decrease in mortality may be related to better patient management, whereas the improvement in graft survival is most likely the result of more effective immunotherapy and better management of hypertension and hyperlipidemia, which overall lessens the risk of obesity among kidney transplant recipients.     

Time course of muscle atrophy and recovery following a phenol-induced nerve block

Clinically, phenol is used often as a neurolytic agent to treat pain and spasticity. The purpose of this study was to examine the time course of denervation and recovery in several hindlimb muscles following application of a 5% aqueous solution of phenol to the sciatic nerve. Phenol was applied to the sciatic nerve of adult female rats either by intraneural or perineural injection. Axonal degeneration was evident within the sciatic nerve 2 days following phenol application, although variable amounts of damage were observed. By 2 weeks, the soleus and tibialis anterior had atrophied to 63% and 51% of control. Reinnervation of hindlimb muscles occurred between 2 and 4 weeks following the nerve block. Following denervation, the soleus became slower in that all of the fibers expressed the slow myosin heavy chain (MHC). At 5 months, maximum tension of the soleus was 74% of control and the muscle consisted of more fast fibers on average, some of which expressed IIx MHC. These data suggest that 5% phenol causes an injury to the nerve that is more severe than a crush injury, and that reinnervation of denervated muscles may be by motoneurons other than those that originally innervated the muscles. © 1996 John Wiley & Sons, Inc.