Childhood predictors of states of anxiety

Development of the characteristics of social phobia often requires a diathesis in the form of a temperamental bias. A behavioral profile marked by vigorous motor activity and crying to unfamiliar stimuli at 4 months of age - called high reactivity- is characteristic of about 20% of healthy, Caucasian infants. This pattern predicts shy behavior in preschool children and symptoms of social anxiety at age 7, and, at age 11, a subdued personality and biological features that are consonant with a hypothesis of amygdalar excitability. The biological variables that best characterize the children who had been high-reactive infants are right-hemisphere activity in the electroencephalogram (EEC), a larger evoked potential from the inferior colliculus, higher sympathetic tone in the cardiovascular system, and larger event-related potentials to discrepant stimuli. About a quarter of 11-year-olds who had been high reactives displayed behavioral and biological characteristics that are in theoretical accord with the hypothesis of amygdalar excitability, while only 1 of 20 displayed a profile characterized by features in opposition to their temperament. The evidence points to a modest temperamental contribution to the development of symptoms currently regarded as diagnostic of social phobia.     

Development of a liposarcoma out of the capsules of a hygroma.

We treated a patient who had a very rare finding: the development of a malignoma out of the capsules of the subdural hygroma covering the right occipitotemporal brain. Lumbar encephalography and arteriography confirmed the fact that surgery was necessary. A subdural-auricular shunt was performed and revised 2 years later. During the second operation, the external and internal capsules were removed in addition to the shunt. 3 years later the hygroma and large capsules were removed again and a ventricular-subdural drainage performed. 1 year later once more a subdural-auricular shunt was performed. 10 months later a tumour was found to be a pseudomucinous liposarcoma with large hyperchromatic nuclei and oval cells with large vacuoles of neutral fat. Renewed growth of the tumour led to the child's death. The histological and macroscopic findings of the capsules suggest the development of a malignoma within the last 3 years.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

An investigation of methods of measurement of the electrical phenomena of the skin

Summary We have shown that it is reasonable to expect from the nerve sectioning studies on resistance of the skin and on the galvanic reflex, that a valid, standard technique can be worked out to give an index of sympathetic nerve reactivity, but that a systematic study of techniques and of the relationship between measures is a necessary first step toward such a measure if it is to be valid. Our experimental results indicate that curves for basic resistance vary with location of skin area and with technique used. Measurements with an ordinary standard Wheatstone bridge and a source of 1 1/2 volts gave no indication of a relationship to the functions under nervous control. Richter's technique was apparently more sensitive in that it shows a greater range of variation, though we are not yet satisfied as to the exact nature of the electrical phenomena which the technique measures. We plan to make a more extensive study with simultaneous measures and to use still other techniques.In closing we wish to stress two points which we have raised in this paper. First, that resistance and galvanic reflex curves from differing techniques cannot beassumed to be comparable untilshown to be so; and second, previous experimental and clinical studies, indicate that valid measures of electrical skin phenomena when developed should provide valuable indices of neurological and physiological functions.Presented in part before the American Psychological Association, Ithaca, N. Y., Sept. 10, 1932.     

The concept of the integrative activities of neurons and mechanisms of neuroplasticity

The current state of the problem of the integrative activities of neurons is considered on the basis of literature data and system analysis of results obtained in the studies of mechanisms of a simple form of learning in the edible snail. We describe postsynaptic mechanisms of mediation, excitatory inputs that converge to a neuron, and their specific molecular transformations and integration inside the cytoplasm and nucleus. We propose a hypothetical scheme of intracellular integration of excitatory inputs in a neuron during learning as a basis for long-term postsynaptic plastic changes.     

Stages of onset of schizophrenic psychosis

On the basis of a review of the literature describing the process of schizophrenic illness, the authors conclude that schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding consisting of the sequential appearance of hierarchically ordered, distinguishable, and recognizable psychological states. They present on illustrative case history of a patient who was able to describe her feelings during the process of decompensation to schizophrenic psychosis and two case histories of patients whose decompensations were rated according to the authors' State of Illness Rating Scale.     

Epidemiology of subtypes of depression

OBJECTIVE: There is a general clinical impression that depression differs qualitatively from non-depressive conditions, and that it can be identified as a categorical entity. In contrast, epidemiological studies support the view that depression is dynamic in nature and develops on a continuous scale. The present article reviews selected epidemiological studies of depressive subtypes. METHOD: A selective review. RESULTS: Prior studies have found no clear differences in clinical presentation or long-term outcome between patients with melancholic and with neurotic/reactive depression. In addition, recent studies suggest that there is no clear demarcation between mild, moderate, and severe depression, pointing toward a continuity rather than categories of illness. For the individual patient, depressive symptoms seem to change over time, fulfilling criteria for major depression, minor depression, dysthymia, and subsyndromal states; the association between stressful life events and depression appears to diminish with the number of depressive episodes. Finally, recent genetic findings are congruent with a model indicating that the majority of depressions develop in the interplay between genes and stressful experiences, whereas 'reactive' depressions and 'endogenous' depressions apparently exist at a lower prevalence. CONCLUSION: Further longitudinal, analytical, and genetic epidemiologic studies are needed to reveal which conditions are mild and transient, and which may be precursors of more severe and substantial illness such as melancholia.     

Diagnosis and follow-up of pseudo-meningiomatous metastasis of prostatic cancer: value of MRI

We present the case of a patient with neurological signs, who underwent a CT scan then a MRI which displayed a meningiomatous lesion. The general and biological examination revealed a metastatic prostatic carcinoma, and the meningeal lesion was considered a secondary lesion. Follow-up during hormonal therapy showed the regression of the meningeal lesion and thus confirmed our hypothesis, which avoided surgical biopsy.     

Critical review of measures of quality of life in schizophrenia

In order to provide clinicians, researchers, program evaluators and administrators with current information on the assessment of humanistic outcomes of services for schizophrenic patients, a literature review is performed in which references to quality of life (QOL) assessment were made in the context of schizophrenia. Measures are summarized according to purpose, content, psychometric properties. Fifteen QOL instruments are summarized and reflect considerable variability on the relevant criteria: 11 are developed for persons with severe and persistent mental illnesses and used among populations including a major part of schizophrenic patients; 3 are specific QOL measures for schizophrenic patients; 1 is a generic QOL instrument used among psychotic patients. Given that none of these QOL measures has been widely used or accepted as a standard, the choice of a measure must rest on the investigator's particular purpose and needs. CONCLUSION: There is a clear need for a QOL instrument that is specific for schizophrenia, given its high prevalence and chronic nature. The lack of information related to responsiveness of these scales stresses the problems of their inclusion in clinical trials. Scales that have been used in studies of schizophrenia were nearly all developed in the United States and the relevance of their content must be questioned. Rather than relying on the literature or experts to determine those needs that are important to patients with schizophrenia, the content of the instrument should be derived from qualitative interviews with patients who are at different stages of their illness. Moreover, the questionnaire should be self-administered.     

Disgust as a motivator of avoidance of spiders

Individuals with small animal phobias show elevated general disgust sensitivity, and spider phobics often endorse both fear and disgust in response to a spider. Some researchers have argued that the link between disgust and fear of small animals is spurious. On the other hand, disgust may play a functional role, as might any negative emotion that is strongly stimulus-bound, in which escape or avoidance is negatively reinforced. It is therefore important to clarify whether disgust has a functional or epiphenomenal role in avoidance of feared stimuli. The present study examined the degree to which disgust motivates avoidance of spider-related stimuli using a series of behavioral avoidance tests comparing a harmless tarantula, a pen that had come in contact with the spider, and a clean pen. Peak disgust was a stronger predictor than anxiety of avoidance of both the spider and the "contaminated" pen.     

Microsuture repair of intra-operative ruptures of cerebral aneurysms of the internal carotid artery

We report on two patients with intra-operative rupture of cerebral aneurysms that were managed by microsuturing. This is one of only a few reports of successful direct repair using suturing. We found that stitching remains an option to repair a tear of a saccular part of an aneurysm and a torn neck of a blister-like aneurysm, and thus this technique can be considered before sacrificing the artery.     

Patterns of care of anorexia nervosa

Using a local Psychiatric Case Register we studied patterns of mental health care of patients with anorexia nervosa as the main diagnosis from 1974 to 1982. The incidence rate was 5.0 per year per 100,000 population and 37.1 per year per 100,000 females aged 15 to 24. The patients had an intensive pattern of care compared with other diagnostic groups. Using the national case register of inpatients we studied some characteristics of patients with anorexia nervosa. Patients with anorexia nervosa have a higher degree of education and more general education than average. Patients with anorexia nervosa only are younger, have a higher degree of education and more general education than patients with anorexia nervosa and another psychiatric disorder. The results suggest that in some cases we should consider anorexia nervosa as a symptom, not as a disease entity by itself.     

Automatic morphometry of synaptic boutons of cultured cells using granulometric analysis of digital images

Numbers, linear density, and surface area of synaptic boutons can be important parameters in studies on synaptic plasticity in cultured neurons. We present a method for automatic identification and morphometry of boutons based on filtering of digital images using granulometric analysis. Cultures of cortical neurons (DIV8 and DIV21) were fixed and marked with fluorescently labeled antibodies for synapsin I (a marker for synaptic boutons) and MAP-2 (a marker for dendrites). Images were acquired on a confocal microscope and automatically processed. Granulometry, a morphological operator sensitive to the geometry and size of objects, was used to construct a filter passing fuzzy fluorescent grains of a certain size. Next, the filter was overlaid with the original image (masking) and the positive pixels were identified by an integral intensity threshold (thresholding). Disjoint grains, representing individual boutons, were reconstructed from the connected pixels above the threshold, numbered and their area was measured. In total, 1498 boutons with a mean diameter of 1.63 +/- 0.49 microm (S.D.) were measured. Comparisons with manual counts showed that the proposed method was capable of identifying boutons in a systematic manner at the light microscopic level and was a viable alternative to manual bouton counting.     

Spatial delusion: sign of lesions of the non-dominant hemisphere

Two cases with respectively an ischemic and a tumoral lesion of the right hemisphere showing a striking and isolated delusional belief to be relocated elsewhere are reported. Delusion had the remarkable intrinsic coherence of a paranoid delirium but was limited to the localization in space. In contrast these patients had no mental clouding or hallucinations and were well orientated for time and persons. Associated findings were a misrepresentation of space in drawing in the first case, and a left hemiparesis, a left sensory extinction, a left hemianopsia, a left visual neglect, a constructional apraxia and a misrepresentation of space in the second case. Such a spatial delirium has been described after severe head injury but rarely after unilateral cerebral lesions. The latter involve constantly the right hemisphere, either in the frontal, temporo-parietal or thalamic region. Usual neurobehavioral correlates in these cases were a disorder of visual memory, a topographical disorientation, a lack of representation and use of visuospatial data, and an anosognosia. The putative role of a 'release' of the left hemisphere is discussed.     

Impact of phase-specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version)

OBJECTIVE: The objective of this study was to assess the impact of a phase-specific community-focused treatment program on different dimensions of self-reported quality of life in a representative sample of first episode psychosis patients. Method: Data were collected on patients presenting with a first episode of psychosis on the Wisconsin Quality of Life Index (client version), positive and negative symptoms, and demographic and clinical variables at baseline following clinical stabilization and at 1 year. RESULTS: Complete data on a representative sample of 41 patients showed a significant improvement in most dimensions of the WQOL at 1 year; these changes were generally independent of changes in symptoms and there were no significant differences in the magnitude of improvement in QOL between those with DUP < or >6 months. CONCLUSION: Patients with a first episode of predominantly schizophrenia spectrum psychosis show a highly significant improvement in subjectively assessed quality of life following a year of phase-specific comprehensive treatment.     

Predictors of the course of schizophrenia--a review of the literature

As the course of schizophrenia shows a large variability, a prognosis of outcome is extremely difficult. The search for valid predictors shows that there exist numerous predictors with variable predictive significance for distinct outcome criteria and also for different phases of the illness. The indications in the literature are accordingly variable or even inconsistent. The following statements seem us to be proved: A good premorbid social adjustment, a harmonious premorbid personality, and an acute onset of the illness predict a better course, whereas an insidious onset and a development of marked negative symptoms correspond to a poorer outcome. A combination of several factors improves the predictive significance. The importance of the following indicators remains questionable: Genetic loading, neuropathological findings, positive symptoms, and age at onset of the illness. Equally open are these questions: How are the various indicators interrelated and for what span of time have they a predictive power? Psychosocial indicators have more predictive significance than the so far known biological variables. Probably the difficulties in finding valid predictors are not only related to unsolved methodological problems, but above all to intrinsic characteristics of the illness itself.     

Validation of the phenomenon of regression of seizure frequency in epilepsy

A phenomenon known as regression of seizure frequency toward the median was observed in a previous clinical study performed in patients with partial seizures. Regression of seizure frequency is a situation in which patients with a frequency of seizures above the median value for the group during an initial period have a tendency to have frequency of seizures decrease during a subsequent period, and other patients with a lower frequency of seizures during the initial period increase their frequency during a subsequent period. To investigate this further, eight published sets of clinical data obtained in epileptic patients with various seizure types were identified by a literature search. Three separate analyses were conducted for each data set. All three analyses clearly demonstrated that regression to the median was present in the studies evaluated. It was concluded that this phenomenon is a real effect in epilepsy and occurs in patients with a wide variety of seizure types. The implication of this phenomenon for physicians treating epileptic patients is that there is value in establishing pattern of seizure frequency for individual patients. This information can be used in assessing those patients whose seizure frequency has increased. The implications of this phenomenon for designing and evaluating antiepileptic drug studies are also discussed.     

A case of auditory agnosia with impairment of perception and expression of music: cognitive processing of tonality

There is fairly general agreement that the melody and the rhythm are the independent components of the perception of music. In the theory of music, the melody and harmony determine to which tonality the music belongs. It remains an unsettled question whether the tonality is also an independent component of the perception of music, or a by-product of the melody and harmony. We describe a patient with auditory agnosia and expressive amusia that developed after a bilateral infarction of the temporal lobes. We carried out a detailed examination of musical ability in the patient and in control subjects. Comparing with a control population, we identified the following impairments in music perception: (a) discrimination of familiar melodies; (b) discrimination of unfamiliar phrases, and (c) discrimination of isolated chords. His performance in pitch discrimination and tonality were within normal limits. Although intrasubject statistical analysis revealed significant difference only between tonality task and unfamiliar phrase performance, comparison with control subjects suggested a dissociation between a preserved tonality analysis and impairment of perception of melody and chords. By comparing the results of our patient with those in the literature, we may say that there is a double dissociation between the tonality and the other components. Thus, it seems reasonable to suppose that tonality is an independent component of music perception. Based on our present and previous studies, we proposed the revised version of the cognitive model of musical processing in the brain.     

Stability of mothers' recall of the age of onset of their child's attention and hyperactivity problems

The stability of mothers' recall of age of onset of attention deficit and hyperactive behaviors was assessed over a 1-year interval. The paper reports on which behaviors have the highest stability and the stability of a psychiatric diagnosis of attention deficit hyperactive disorder using different age cut-offs. The data showed a moderate degree of stability over a 1-year period, with school-related symptoms showing the least amount of change. An argument is made for keeping the current DSM-III-R diagnostic cut-off at age 6.