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Biomedical subjects

P Kramp

Publications and source records attributed to P Kramp.

At least 37 records · Page 2Linked to original sources
PubMed1983

The Melancholia Scale and the Newcastle Scales. Item-combinations and inter-observer reliability.

The reliability of the total scores on three rating scales (Melancholia Scale and the two Newcastle Scales) and the algorithms leading to the Feighner, Research Diagnostic Criteria, and the DSM-III subtypes of depression have been compared. The degree of inter-observer agreements for the various item-combinations was significantly higher than would be expected by chance. The average agreement for each assessment system ranged from 80 to 93 per cent. This 7 to 20 per cent lack of total agreement probably reflects the limitation of clinical assessments including the influence of halo effects.

Adult↗
PubMed1983

Organic cerebral reactions in alcoholism: psychobiological aspects of treatment.

The paper considers the rational biological basis for treatment of alcohol withdrawal reactions, alcoholic hallucinosis and the Wernicke-Korsakoff syndrome. Both clinical and experimental data indicate that the alcohol withdrawal reaction reflects a state of hyper-reactivity of the central nervous system. The evidence comprises physiological, electrophysiological and biochemical findings. Magnesium, vitamins and antipsychotics are not specific in the treatment of the alcohol withdrawal reactions per se; rational treatment comprises drugs that may substitute for the suppressive effects of alcohol in the CNS during readaptation to the alcohol free condition (e.g. barbiturates or benzodiazepines). Alcoholic hallucinosis is characterised by acutely developed auditory hallucinations of an evil or reproachful nature. The condition may develop during or shortly after excessive alcohol consumption in chronic alcoholics. Suggestibility and unclear consciousness is not part of the condition. Tentatively three subgroups are suggested to occur: a) a withdrawal reaction; treatment with sedatives is recommended; the prognosis is good, b) a toxic reaction occurring during the drinking bout; this condition should be treated with antipsychotics until symptoms have disappeared. The prognosis is fairly good, c) a schizophreniform condition. Long-term treatment with antipsychotics must be applied. The Wernicke-Korsakoff syndrome is described. The condition often occurs during or shortly after an acute withdrawal reaction. The biochemical role of the etiological factor thiamine in glucose metabolism suggests that precautions (thiamine treatment) must be taken when giving a glucose load to alcoholics. Finally focus is set on the recent suggestion that the syndrome may in some cases result from an inborn enzymatic abnormality comprising low binding of thiamine pyrophosphate to transketolase. Psychobiological aspects of treatment in alcoholism may apply to a very large spectrum of conditions involving symptoms of cerebral, hepatic, gastrointestinal, cardial and peripheral nervous system origin. In the present expose we shall concentrate on organic cerebral reactions partly or exclusively presenting with psychiatric symptoms and signs. Thus the review will consider the rational biological basis for treatment of alcohol withdrawal reactions (including delirium tremens), alcoholic hallucinosis and the Wernicke-Korsakoff syndrome.

Alcohol Amnestic Disorder↗
PubMed1980

Effects of acute ethanol intoxication, chronic ethanol intoxication, and ethanol withdrawal on magnesium and calcium metabolism in the rat.

Effects of ethanol intoxication and withdrawal on magnesium and calcium metabolism were studied in rats. During acute ethanol intoxication, plasma [Mg2+] was increased and plasma [Ca2+] decreased. During chronic intoxication, plasma [Mg2+] was normalized whereas plasma [Ca2+] was persistently subnormal. Ethanol withdrawal was followed by a decrease in plasma [Mg2+] and a normalization of plasma [Ca2+]. These various changes are probably related to changes in systemic pH and to the biochemical effects of ethanol and ethanol withdrawal on intermediary metabolism. Cerebrospinal fluid [Mg2+] was unchanged during intoxication and withdrawal and it was concluded that no etiological role can presently be ascribed to the magnesium ion as far as cerebral signs of ethanol intoxication and withdrawal in the rat are concerned. No consistent changes in erythrocyte [Mg2+] were encountered during ethanol intoxication and withdrawal in rats.

Alcoholic Intoxication↗
PubMed1980

Blood-brain barrier selectivity and synaptic turnover during delirium tremens and related clinical states. A study of brain and blood proteins in the cerebrospinal fluid.

The synaptic membrane protein D2 was measured in the cerebrospinal fluid (CSF) from patients with delirium tremens and related clinical states immediately after admission to the hospital before treatment was initiated and again after recovery. during this period of on average 5 days duration the concentration of D2 increased to double normal value possible indicating increased breakdown of old synapses during the process of readaptation to the alcohol free state. IgG, albumin and alpha 2-macroglobulin were measured in plasma and in CSF and the results indicated a decreased selectivity of blood-CSF-barrier permeability to proteins in the clinically recovered patients; this was probably due to increased micropinocytotic activity also occurring during readaptation to the alcohol free state.

Albumins↗
PubMed1980

Delirium tremens: some clinico-chemical features. A study of alanine-aminotransferase, alcaline phosphatase, prothrombine and enolase.

The relationship between variables reflecting liver disease (serum-alanine-aminotransferase (SGPT), serum alcaline phosphatase and plasma prothrombine) and the clinical signs and symptoms during delirium tremens (DT; grade 3) and related clinical states (grade 2) was studied. Furthermore, it was investigated whether the two isoenzymes of enolase which predominante in brain tissue were present in plasma or cerebrospinal fluid (CSF) in DT patients. A correlation between SGPT and clinical state was not observed, which indicates that a causal relationship does not exist between acute liver cell damage and clinical state during DT of grade 3 or 2. In grade 2 patients, but not in grade 3 patients, both SGPT and serum alcaline phosphatase decreased between admission and recovery. This difference between the groups may be due to a higher alcohol consumption and a shorter interval between last drink and admission in grade 3. The difference in recent drinking history may also account for the finding of a higher plasma prothrombine index in grade 3 compared with grade 2, because chronic ethanol intoxication may be accompanied by enhanced hepatic protein synthesis. "Brain-enolase" was not present in detectable amounts in blood or CSF during DT thus suggesting that brain cell damage resulting in leakage of this enzyme from the cells did not prevail during DT.

Alanine Transaminase↗
PubMed1980

Haematological changes and state of hydration during delirium tremens and related clinical states.

In order to obtain some information about the state of hydration and possible haematological changes in patients with delirium tremens (grade 3) and related clinical states (grade 2) various clinico-chemical variables were measured at the time of admission and repeatedly until clinical recovery from the psychotic state. In grade 3 patients plasma protein concentration, blood haemoglobin concentration, blood haematocrit and erythrocyte count decreased between admission and recovery probably reflecting a slight haemodilution. The changes were all within the normal range for the variables and there was thus no indication of hypo- or hypervolemia. Delirium tremens patients without concomitant somatic diseases should not be routinely treated with intravenous fluid therapy. In grade 2 patients no statistically significant changes occurred in the above mentioned variables. In the grade 3 patients there was a dramatic (100%) increase in plasma iron concentration between admission and the subsequent morning and this was probably related to the elimination of ethanol from the body. In grade 2 patients, where the initial blood alcohol concentration was lower than in grade 3 patients, no change in plasma iron concentration occurred. A statistically significant increase in reticulocyte count between admission and recovery in both grade 3 and grade 2 patients probably reflected the recovery of haemopoietic tissue from the insult of the preceding ethanol intoxication. The same may be true for the prevailing anisocytosis, whereas the trend towards leucocytosis may be due to unspecific stress during the ethanol withdrawal reaction. The rapid changes in some of the clinico-chemical variables stress the importance of initiating investigational procedures immediately at the hour of admission.

Alcohol Withdrawal Delirium↗
PubMed1979

Magnesium concentrations in blood and cerebrospinal fluid during delirium tremens.

Magnesium in plasma, erythrocytes, and cerebrospinal fluid (CSF) was measured immediately after hospital admission in 9 patients with delirium tremens (DT) and 11 patients with impending DT. Blood samples were taken daily during the acute state; a second lumbar puncture was performed when the patient's condition had improved. Plasma magnesium was low in patients with DT during the first days of the acute state and then spontaneously normalized. Normal plasma magnesium was consistently seen among patients with impending DT. Magnesium in erythrocytes and CSF was normal in both diagnostic categories. Patients with a high blood-alcohol concentration (BAC) at admission had a decreasing plasma magnesium, patients with a low BAC had a moderately increasing plasma magnesium, and patients with a BAC at nil had a more marked increase in plasma toms or with their duration. This finding, combined with the normal CSF magnesium and the lack of correlation between plasma and CSF magnesium, indicates that disturbances in magnesium metabolism do not play a role in the etiology or pathogenesis of DT; but it may be that disturbances in magnesium metabolism contribute to the development of alcoholic encephalopathy.

Alcohol Withdrawal Delirium↗
PubMed1979

Delirium tremens. Some clinical features. Part I.

Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as "Predelirium" (grade 2). The material was found to be representative for the condition under discussion. Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed. The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro-intestinal disturbances for 12-24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours. Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood--several even concentrations about 2 g/l--at the time of admission compared to patients with a less severe clinical state. This lack of "latency period", which previously has been described as a typical feature in the development of delirium tremens, is discussed. It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed delirium tremens.

Adult↗
PubMed1979

Delirium tremens. Some clinical features. Part II.

Twenty patients with delirium tremens (grade 3) and a less severe clinical state (grade 2) were investigated thoroughly from the time of admission until recovery from the acute state. A lumbar puncture was performed in the majority of the patients immediately after admission and then repeated after recovery from the acute state. The cerebrospinal fluid was found to be both macroscopically and microscopically normal, as was the spinal fluid pressure. The clinical course was without complication, none of the patients were severely dehydrated. All the patients were treated with barbital, a long acting barbiturate. The duration of the acute state and the total amount of drug necessary in the treatment were equal in the two groups of severity. However, patients with proper delirium tremens needed significantly fewer barbital doses during the first hours after treatment was initiated than did patients with a less severe clinical state. The opposite was seen about 12 hours later. These findings are discussed in relation to the high blood alcohol concentration seen at the time of admission in the majority of the patients with proper delirium tremens, but not in patients with grade 2. It is concluded that barbital exerts its effect due to cross-dependence properties with alcohol. The majority of the patients had moderately elevated blood pressure, pulse rate and rectal temperature at the time of admission; these variables were to a great extent normalized within 48 hours after admission. No differences in those physical signs were seen between patients with fully developed delirium tremens and patients with less severe clinical states. The patients' condition during the acute state was followed by means of a delirium tremens rating scale. Physical symptoms were similar in various degrees of severity of the clinical condition. 18-24 hours after admission the differences in mental symptoms between patients with grade 3 and patients with grade 2 had disappeared, 48 hours after admission the patients' condition was to a large extent normalized. Methodological problems in using a rating scale in conditions as delirium tremens are discussed. The results are discussed in relation to aetiology and pathogenesis of delirium tremens. It is concluded that it may be that a qualitative, and not only a quantitative, difference exists between a severe withdrawal reaction and fully developed delirium tremens, and a hypothesis about a "point of no return" is suggested.

Adult↗
PubMed1979

Delirium tremens and related clinical states. Aetiology, pathophysiology and treatment.

Definitions of Delirium Tremens (DT) and related clinical states are discussed together with the concepts of aetiology and pathogenesis in relation to psychiatric disease. The withdrawal theory which considers reduction or cessation of alcohol intake as an important precipitating factor in DT is discussed; this theory is supported by experimental studies of ethanol withdrawal in man and by studies indicating cross dependence between ethanol and several other CNS depressors; the arguments in the literature for and against the withdrawal theory are discussed. Other possible aetiological factors such as type of liquor, hypovitaminosis, liver disease, dysfunction of the adrenals and fat emboli are reviewed, and it is concluded that these factors are unimportant as precipitating or specific aetiological factors in DT. Possible pathophysiological mechanisms are discussed, especially concerning electrolyte metabolism and cerebral blood flow and oxygen consumption. It is concluded that the pathophysiology of the disease is poorly understood, and some possibilities for future research are indicated. The discussion about treatment of DT is concentrated on drug treatment, and the literature concerning antipsychotics and sedatives is reviewed. It is concluded that barbital, a long-acting barbiturate, is the most effective treatment; diazepam can be recommended as an acceptable alternative. Finally, practical recommendations concerning treatment are given.

Adrenal Insufficiency↗
PubMed1979

The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale.

In a study of 18 patients with manic symptomatology and 31 patients with melancholic symptomatology the Bech-Rafaelsen Mania Scale (BRMS) and the Hamilton Depression Scale (HDS) have been compared. The results showed that the inter-observer reliability of the BRMS was adequate compared with the HDS. Both scales are constructed for assessing the severity of manic or melancholic states, and no difference was found in the total BRMS or HDS score between the various diagnostic groups, when the patients were classified by an index of the course and symptomatology otive disorder, using the Multi-axial Classificetion System for Affective Disorders (MULTI-CLAD). The homogeneity of the BRMS seemed more adequate than that of the HDS, when each item was correlated to the corresponding total score. Although the homogeneity of the BRMS needs to be evaluated by other statistical models than correlation analysis, our results seem to indicate that the improvement in assessing manic-melancholic states quantitatively is a matter of redefining items or incorporating new items in the melancholic rather than the manic part of these rating scales.

Adult↗
PubMed1979

Barbital and diazepam plasma levels during treatment of delirium tremens.

Plasma concentrations of barbital and diazepam were measured daily during a double-blind study of the efficacy of the two drugs in the treatment of delirium tremens and less severe clinical states. Treatment was estimated as satisfactory in the majority of cases; the present study deals with the satisfactory groups only. Both in the barbital group and in the diazepam group the same plasma level was seen in different clinical states. This result is discussed in relation to the theories about the aetiology of delirium tremens, and it is concluded that the data fits best with the assumption that delirium tremens is released from a withdrawal state, but once established, the delirious state is not interrupted by the drugs. The barbital concentrations were rather high, many at a level where non-alcoholics would show pronounced intoxication symptoms not seen in the present material. The diazepam concentrations on the other hand were low, often below a level where a cerebral effect is measurable in normal subjects. On this basis it is concluded, that the two drugs have different modes of action. Barbital may act by its cross-dependence properties with alcohol and thus diminish the withdrawal reaction, whereas diazepam may act by its anti-anxiety effect, but not in the doses here applied, by cross-dependence properties with alcohol. Finally, this hypothesis is discussed in relation to clinical experience in the treatment of delirium tremens.

Alcohol Withdrawal Delirium↗
PubMed1978

Delirium tremens: a double-blind comparison of diazepam and barbital treatment.

The effect of diazepam and barbital in the treatment of delirium tremens and other acute conditions related to alcohol abuse was evaluated in a double-blind trial. 91 patients participated in the study, 44 in the diazepam group, 47 in the barbital group. The choice of diazepam rather than chlordiazepoxide was motivated by its major anticonvulsive properties. Barbital was given by the oral route, diazepam as intramuscular injections. Different ways of drug administration to patients with delirium tremens are discussed. It is concluded that the two different ways used in the study probably did not have a noteworthy influence on the results. All patients were excluded who had taken psychoactive drugs before admission. Nevertheless a considerable part of the patients had diazepam, but not barbital, in the blood before treatment was initiated. This may give support to the use of barbital as a "special purpose drug" in the treatment of these conditions. The patients were divided into three diagnostic categories, according to the severity of the clinical condition. No difference between the two drugs tested was found in the milder conditions, but barbital was found superior to diazepam in the treatment of fully developed delirium tremens.

Administration, Oral↗