Phosphate levels as a possible state marker in panic disorder: preliminary study of a feasible laboratory measure for routine clinical practice

Objective

Low serum phosphate level is considered one of the metabolic adaptations to the respiratory alkalosis induced by hyperventilation associated with panic disorder. The aim of this study was to assess phosphatemia as a possible state marker for panic disorder.

Methods

Sixteen panic disorder patients underwent clinical assessment with a semi-structured interview, a set of rating scales and the self-rated State and Trait Anxiety Inventory (STAI), as well as extraction of venous blood samples at baseline and after 12 weeks of pharmacological treatment. Ten healthy volunteers of similar sex, age and educational level filled out the STAI and gave blood samples at baseline and 12 weeks later.

Results

The median (25th–75th percentiles) of phosphate levels (mg/dl) was 2.68 (2.22–3.18) among patients and 4.13 (3.74–4.70) among healthy volunteers respectively (P < 0.001). Seven (44%) patients and no healthy volunteers presented low serum phosphate (<2.50 mg/dl) at baseline; this patient abnormality was corrected in all cases after successful treatment. At baseline, the age-adjusted correlation between phosphate levels and state-anxiety was −0.66 (P < 0.001) among all 26 participants and −0.51 (P = 0.05) among the 16 panic disorder patients.

Conclusions

Measurement of phosphate levels could be easily introduced into clinical practice as a possible marker for chronic hyperventilation in panic disorder, although further investigations with larger sample sizes are necessary to characterize panic disorder patients with low versus normal phosphate levels.     

Hyperventilation-induced high-amplitude rhythmic slowing with altered awareness: a video-EEG comparison with absence seizures

PURPOSE: Hyperventilation-induced high-amplitude rhythmic slowing (HIHARS) in children may be associated with clinical episodes of altered awareness. The presence of automatisms has been proposed as a distinguishing feature that helps to differentiate absence seizures from nonepileptic causes of decreased responsiveness. This retrospective, controlled, video-EEG study compared the clinical characteristics of episodes of HIHARS with loss of awareness with those of absence seizures. METHODS: The database of a tertiary Children's Hospital was searched for patients studied between April 1993 and April 1997 who had at least one episode of HIHARS with loss of awareness. The absence control group was obtained by selecting the next patient, after an HIHARS study subject, who met the following criteria: (a) had at least one absence seizure occurred during hyperventilation in the EEG recording, and (b) had a diagnosis of idiopathic generalized epilepsy. The video-EEG and medical histories of all patients were reviewed and summarized. RESULTS: We reviewed video-EEG recordings of 77 episodes of HIHARS with loss of awareness from 22 children and 107 absence seizures during hyperventilation from 22 children. Eye opening and eyelid flutter were seen more frequently in absence seizures, whereas fidgeting, smiling, and yawning occurred more frequently during HIHARS episodes. Arrest of activity, staring, and oral and manual automatisms were observed in both groups. CONCLUSIONS: Automatisms are common in both HIHARS and absence seizures. Yawning, smiling, and particularly fidgeting occur more commonly and eye opening and eyelid flutter less commonly in HIHARS. However, episodes of HIHARS with loss of awareness clinically mimic absence seizures, and these conditions can be distinguished reliably only by EEG.     

过度通气对重型颅脑创伤病人的脑血流和脑组织氧分压的影响

目的研究过度通气(HV)对重型颅脑创伤(sTBI)病人的颅内压(ICP)、脑血流(CBF)和脑组织氧分压(PbtO2)的影响。方法20例sTBI(GCS3～8分)病人,伤后2～5dICP超过20mmHg时,应用机械通气法使呼气末二氧化碳分压(PetCO2)维持在27～32mmHg之间30min,同时连续监测ICP、CBF和PbtO2。结果所有病人共进行了46次HV,HV可使ICP明显下降(43/46),而CBF和PbtO2对CO2的反应差异较大,其中大部分试验(38/46)CBF和PbtO2明显下降,但仍然保持在各自的缺血阈值(50AU和10mmHg)之上;5次试验CBF和PbtO2下降低于各自的缺血阈值;3次试验ICP无明显变化,CBF轻度升高,而PbtO2下降。结论HV可降低ICP,但有导致或加重脑缺血的危险,应尽量避免早期长时程应用。HV应在CBF持续监测下应用。     

不同通气方式对机械通气引起急性肺损伤兔模型的影响

目的：通过表面活性物质缺乏的兔肺模型,评估传统通气模式（ｃｏｎｖｅｎｔｉｏｎａｌ ｍｅｃｈａｎｉｃａｌ ｖｅｎｔｉｌａｔｉｏｎ,ＣＭＶ）与允许性高碳酸血症加最佳ＰＥＥＰ（ｐｅｒｍｉｓｓｉｖｅ ｈｙｐｅｒｃａｐｎｉａａｓｓｏｃｉａｔｅｄ ｗｉｔｈｉｄｅａｌＰＥＥＰｖｅｎｔｉｌａｔｉｏｎ,ＰＨＹ＋ ＰＥＥＰｉ）的通气模式对肺损伤的影响,了解肿瘤坏死因子α（ｔｕｍｏｒ ｎｅｃｒｏｓｉｓｆａｃｔｏｒα,ＴＮＦα） 与机械通气引起肺损伤（ｖｅｎｔｉｌａｔｏｒｉｎｄｕｃｅｄｌｕｎｇｉｎｊｕｒｙ,ＶＩＬＩ） 的关系。方法：１２ 只成年兔,以反复肺灌洗法制备表面活性物质缺乏兔肺模型。以ＣＭＶ（Ｃ组） 或ＰＨＹ＋ ＰＥＥＰｉ （Ｐ 组） 通气４ ｈ 后,测定通气前、后的支气管肺泡灌洗液（ｂｒｏｎｃｈｏａｌｖｅｏｌａｒ ｌａｖａｇｅ ｆｌｕｉｄ,ＢＡＬＦ）中ＴＮＦα含量和白细胞分类计数,测定肺水量,进行动脉血气分析和病理检查。结果：ＣＭＶ 组表现为明显的低氧血症,ＢＡＬＦ中较多的中性粒细胞数,总肺水量及血管外肺水量明显增多,肺内病理改变为较明显透明膜形成及炎性细胞聚集;而ＰＨＹ＋ ＰＥＥＰｉ 组引起较少的上述病理、生理变化。且ＣＭＶ 组ＢＡＬ     

A peculiar form of epilepsy induced by crying in infancy

We describe a peculiar form of epilepsy following prolonged and vigorous bouts of crying in infancy which was misdiagnosed as breath holding spells. Three patients with crying-induced epilepsy had the following characteristics. The patients were born after uncomplicated pregnancy, labor, and delivery. The seizures presented between the ages of 10 and 18 months, the patients had normal development and cranial MRIs, no past or family histories of epilepsy or cardiac disease, and developed generalized tonic clonic seizures only following crying after a sudden, unexpected and mildly unpleasant stimulus. The seizures usually lasted no longer than 1 min and their EEG showed focal spikes in interictal states and generalized spikes in ictal states. The seizures were well controlled with valproate sodium. This peculiar form of epilepsy may be a benign age-dependent reflex epilepsy in infancy.     

Organisasjon og målsettinger: Refleksjoner omkring en personal-undersøkelse

Psykofarmaka: Odd Lingjaerde Tano: Oslo 1988. 1b. 572 s. N. kr. 448,-. 3. ut-gave.

Alice Miller slår til igjen

A. Der Gemiedene Schliissel: Alice Miller Suhrkamp Verlag, Frankfurt am Main 1988, ISBN 3-518-02226-1.

B. Das Verbannte Wissen: Alice Miller Suhrkamp Verlag, Frankfurt am Main 1988. ISBN 3-518-02227-X.

My work with borderline-patients: Harold F. Searles Forlag Jason Aronson, Inc., Northvale, New Jersey, London. 1986.     

过度通气对在体大鼠脊髓背角WDR神经元兴奋性影响的实验研究

目的:考察过度通气对大鼠脊髓背角广动力范围(Wide dynamic range,WDR)神经元自发和疼痛诱发放电频率的影响。方法:将25只SD大鼠随机分为N(正常通气)和H(过度通气)两组。两组均在吸入麻醉下行椎板切除,记录与大鼠后足掌部皮肤感觉对应的脊髓背角WDR神经元放电频率百分比。N组正常通气120分钟,旨在排除手术创伤对WDR神经元的影响;H组实施过度通气60分钟后,恢复正常通气继续观察60分钟,目的为考察过度通气对该神经元电活动的影响。结果:(1)N组各采样点间WDR神经元自发和诱发放电频率百分比均无显著性差异。(2)H组过度通气后WDR神经元自发和疼痛诱发放电频率百分比较对照值显著降低,并随正常通气的恢复而恢复。(3)H组过度通气期间WDR神经元自发及诱发放电频率百分比均较N组相应时间点显著降低。结论:过度通气可使大鼠脊髓背角WDR神经元兴奋性降低。     

Early ventilation in traumatic brain injury

While airway and ventilatory compromise are significant concerns following traumatic brain injury (TBI), there is little data supporting an aggressive approach to airway management by prehospital personnel, and a growing number of reports suggesting an association between early intubation and increased mortality. Recent clinical and experimental data suggest that hyperventilation is an important contributor to these adverse outcomes in TBI patients. Various mechanisms appear to be responsible for the worsened outcomes, including hemodynamic, cerebrovascular, immunologic and cellular effects. Here, relevant experimental and clinical data regarding the impact of ventilation on TBI are reviewed. In addition, experimental data regarding potential mechanisms for the adverse effects of hyperventilation and hypocapnia on the injured brain are presented. Finally, the limited data regarding the impact of hypoventilation and hypercapnia on outcome from TBI are discussed.