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Foamy spheroid bodies in the substantia nigra. Report of an unusual case with recurrent attacks of peculiar twilight state.

An unusual case of recurrent attacks of peculiar twilight state persisting for 41 years is the subject of this clinicopathological report. During the attacks the patient had depersonalization, showing a stiff face, and the electroencephalogram showed constant 5 Hz diffuse theta waves. The unique and characteristic neuropathological finding were many foamy spheroid bodies (FSB) in the substantia nigra which sometimes contained varying numbers of fine or coarse eosinophilic granules. Ultrastructurally, the FSB contained various small electron-dense granules and/or membranous structures quite different from so-called spheroids (axonal swellings). Bodian staining demonstrated that some FSB were situated within the bundles of the neuronal processes, suggesting that the FSB has originated from the degeneration of the axon and/or dendrites in the substantia nigra.

Aged↗

[Comparison of altered states of consciousness induced by the hallucinogens (--)-delta9-trans-tetrahydrocannabinol (delta9-THC) and N,N-dimethyltryptamine (DMT) (author's transl)].

The study compares altered states of consciousness induced by the hallucinogens (--)delta9-trans-Tetrahydrocannabinol (delta9-THC) and N,N-Dimethyltryptamine (DMT) using two placebo control groups. A total of 24 subjects received 250 mug delta9-THC p.o./kg body weight and 26 subjects were treated with 250 mug DMT i.m./kg. Placebo was given to 24 subjects. The effects were assessed by a questionnaire administered following the experimental conditions. Questionnaire items were combined into the following eight scales according to their content and several cirteria of the theory of mental testing: visual hallucinations (illusions), auditory hallucinations (illusions), impairment of memory and attention, depersonalization syndrome, deprealization syndrome, changes of body image, euphoric state and anxious-depressive state. The two hallucinogen groups differed significantly from placebo on all eight scales. No difference, however, between delta9-THC and DMT was significant. On the scale "optical hallucinations (illusions)" a tendency that DMT might have stronger effects than delta9-THC was found. Methodological problems of comparing different hallucinogens are discussed.

Cognition Disorders↗

Effects of THIP on chronic anxiety.

The effects of THIP, a GABA agonist, were examined in patients with anxiety disorders. Eight patients were prescribed THIP (5-20 mg) to be taken three times a day for 2 weeks in a single-blind study, with placebo conditions preceding and following the active drug period. Anxiety ratings significantly decreased on several measures during active drug treatment and increased again with placebo administration. However, the anxiolytic effects of THIP appeared to be weak and occurred at, or close to dose levels which induced sedation and undesirable side effects. As with other GABA agonists and GABA-mimetic drugs, side effects included giddiness, depersonalization, poor concentration, and transitory delirious states, suggesting that excessive stimulation of the GABAergic system may disrupt normal brain functioning.

Adult↗

Expectation and burnout in the developmental disabilities field.

Psychological burnout was assessed in staff members at workshops and community residences for the developmentally disabled. Participants also rated expectations for client progress and for their own contribution to clients. They reported on change in expectation since they entered the field. High expectations were related to low burnout; workers who reported experiencing large negative expectation change were most burned out. Burnout seemed to be prevented when staff members made an expectation shift from reliance on client progress to a sense of personal efficacy. This finding is discussed in terms of personal causation, internal control of reinforcement, and adaptation-level theory. There was little evidence of client depersonalization, a usual component of burnout. Such a burnout pattern may be a function of the ethic of community care for the developmentally disabled.

Age Factors↗

Organizational control and treatment program design as dimensions of institutionalization in settings for juvenile offenders.

The relationship between organizational control and normalization in treatment program design was examined in 30 community-based settings for juvenile offenders. Although these two dimensions were hypothesized to be converging indicators of the institutionality of a setting, the findings indicated that they are only marginally related. More hierarchical models of decision making were not associated with more depersonalized, isolating programming, and involvement of residents and line staff in decision making did not covary with autonomy and personalization in programming. The results are discussed as evidence that institutionality is a multidimensional construct, and that future investigations must distinguish between organizational decision making and characteristics of treatment program design when assessing the institutional quality of residential service settings.

Adolescent↗

Community integration of the mentally ill in residential facilities.

Much of the empirical research on the social adjustment of the mentally ill has focused on client variables. More recently, recognition of environmental factors as influences on behavior has led to attempts to determine environmental factors that may play a role in former mental patients' community integration. The secondary data analysis of 87 former state hospital patients in residential facilities suggests that while client characteristics are important in explaining community integration, facility, and community characteristics, particularly the level of skills training offered in the facility, size of city, and level of depersonalization of residents, have a significant impact. Results indicating the major importance of informal interactions between staff and clients are discussed, with implications for facility staff noted.

Activities of Daily Living↗

[Continuity and change in medical ethos (author's transl)].

The report develops first of all a general concept of ethos and categories for comprehending its structure [2]. Classical hippocratic ethos then emerges as a "modell" which medical treatment standardizes as a matter of "practical" science-oriented values in the service of the "private" welfare of the patient [3]. The will, under changing conditions of medical practice, to permanently engage the substance of the ethos, demands a) consciousness of the "practical" character of the misunderstanding of medicine as a theoretical physical science, b) recognition of the importance of the "private" doctor-patient relationship vs. the widening of a purely social objective, c) orientation to the whole needs of the patient in opposition to a technologically created "depersonalization".

Ethics, Medical↗

Current status of interferon alpha in the treatment of chronic hepatitis B.

Interferon alpha is the only available therapy for patients with chronic hepatitis B. With interferon alpha 3-15 MU thrice weekly or 5 MU daily during 3-6 months one-third of the patients achieve seroconversion of HBeAg and HBV-DNA together with normalization of aminotransferases and slight improvement of histology. Loss of HBsAg is reported in a minority of responders during treatment, but increases during follow-up. Patients with baseline alanine aminotransferase of at least twice the upper limit of normal and low HBV-DNA concentration achieve the best response rates. HIV-positive patients with low CD4 counts and Asians are poor responders. As side-effects influenza-like symptoms are experienced by almost all patients. Mild leukopenia, thrombocytopenia and decreased hairgrowth are frequently reported. Severe depression, depersonalization and psychosis are reported in a small number of patients but tend to be poorly recognized in some studies. The decision whether dose reduction is indicated seems strongly related to the opinion of the investigator. Although long-term effects on the occurrence of cirrhosis and the development of hepatocellular carcinoma are not available yet, the achieved results are promising.

Hepatitis B↗

Psychiatric side effects of indomethacin in parturients.

PURPOSE: To examine the central nervous system side effects of the non-steroidal anti-inflammatory drug (NSAID) indomethacin in a case-series of obstetric patients. METHODS: The hospital records of patients experiencing any postpartum complication between 1994 and 1999 were reviewed for adverse drug reactions (ADR) attributed to indomethacin. Additional cases of indomethacin-induced adverse effects were identified through reports to the nursing administration and the Saskatchewan ADR reporting program. The Naranjo ADR probability scale was applied to all cases. RESULTS: Thirty-two patients experienced a psychiatric reaction after receiving indomethacin for postpartum pain. The symptoms were often severe and included dizziness, anxiety, fear, agitation, affective lability, depersonalization, paranoia, and hallucinations. There was no past psychiatric history documented in any of the cases. CONCLUSION: This study identifies a possible ADR to indomethacin occurring in postpartum patients. Whether the vulnerability to these neuropsychiatric reactions is randomly distributed or if parturients are at increased risk is yet to be determined. Proposed mechanisms of these side effects include a postpartum dopamine supersensitivity exacerbated by prostaglandin inhibition as well as a structural similarity between serotonin and indomethacin. The severity of the reactions to indomethacin in parturients and the potential for these disturbing psychiatric side effects to compromise the safety of both mother and infant have led to the use of alternative analgesics including different classes of NSAIDs for this population at our institution.

Adult↗

The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale.

OBJECTIVE: To investigate the psychometric properties of the Body Uneasiness Test (BUT), a 71-item self-report questionnaire that consists of two parts: BUT*A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT*B which looks at specific worries about particular body parts or functions. METHODS: We recruited a clinical sample of 531 subjects (491 females) suffering from eating disorders and a general population sample of 3273 subjects (2016 females) with BMI <25 and Eating Attitudes Test-26 scores under the cut-off 20. RESULTS: The exploratory and confirmatory analyses confirmed a structural five-factor model for BUT*A and an eight-factor model for BUT*B. Internal consistency was satisfactory. The test-retest correlation coefficients were highly significant. Concurrent validity with other tests (Eating Disorder Inventory, EDI-2; Eating Attitudes Test, EAT-26; Symptom Check List, SCL-90R and Coopersmith Self-Esteem Inventory, SEI) was evaluated. Normative values for BUT scores in non-clinical samples of normal-weight non eating disordered subjects, from adolescence to old age, males and females, were calculated. The differences between males and females were highly significant, above all in the 18-39-age range. As for the comparison between women with eating disorders and controls, the results demonstrated a good predictive validity for anorexia nervosa and bulimia nervosa. CONCLUSIONS: The BUT is psychometrically sound. It can be a valuable tool for the screening and the clinical assessment of abnormal body image attitudes and eating disorders.

Adolescent↗

[Hoigne syndrome. Case report and current literature review].

Hoigne's syndrome is currently considered a pseudoanaphylactic or pseudoallergic reaction following intramuscular and aqueous procaine penicillin administration. This disorder is characterized predominantly by neuropsychiatric alterations including severe psychomotor agitation with confusion, sensations of disintegration, depersonalization, and derealization, perceived changes of body shape, visual and auditory hallucinations, panic-like anxiety including fear of death as well as alterations of consciousness and seizures. Beside the "classic" immediate manifestation of Hoigne's syndrome, subacute forms as well as reactions of the so-called latent type are also known. Including a typical case report, we present a review of the currently available literature concerning clinical picture, hypotheses on origin, and possible therapy regimens of this underdiagnosed complication of antibiotic penicillin treatment.

Adult↗

Work and mental health.

BACKGROUND: Studies investigating the psychological correlates of types of occupation have focused on such disorders as stress, depression, suicide and substance abuse. There have also been some models proposed to allow understanding of factors common to different types of occupations. We sought to provide an overview of research related to work and mental health and consider future research directions. METHODS: A literature search was conducted using the Medline, PsycInfo, Embase and PubMed databases. The key words "occupation" or "work" were searched in combination with the key words "mental health", "risk factors", "disorders", "depression", "suicide", "trauma", "stress" or "substance use". RESULTS: Studies of "stress" tend to be more applicable to specific workplace issues. While some of the studies relating to onset of depression, suicide, substance abuse and trauma pertain to specific occupational issues and results are often not generalizable, they have progressed our understanding of risk factors to those disorders. There are workplace factors involving exposure to danger and crisis that lead to posttraumatic stress disorder (PTSD), substance abuse (including stimulants) and depersonalization. Workplace risk factors for depression involve situations promoting lack of autonomy, and involving "caring" for others as part of the work role, particularly where there is dependence on others for their livelihood. Risk factors for alcohol abuse include workplaces with access to alcohol and where use of alcohol is sanctioned. There appears to be a bi-directional relationship between personality and work, so that people are drawn to particular occupations, but the occupations then have an effect on them. An interactional model is proposed to consider this. CONCLUSION: The research questions pertaining to mental health are varied and will determine what mental health issues are of interest and the models of work applicable. There need to be more longitudinal studies and consideration of factors which the worker brings to the workplace (psychosocial issues, personality traits), as well as interpersonal issues and consideration of systemic, organizational, political and economic factors, including leadership styles.

Alcoholism↗

Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans.

RATIONALE: The availability of the highly selective and specific kappa opioid agonist enadoline provides an opportunity to explore the function of kappa receptors in humans and their potential utility as a target for substance abuse pharmacotherapy development. OBJECTIVES: The purpose of this study was to characterize the pharmacodynamic effects of enadoline, a selective kappa agonist, and to compare it with butorphanol, a mixed mu/kappa agonist, and hydromorphone, a mu agonist, in humans. METHODS: Pilot evaluation (n=3) served to establish intramuscular doses of enadoline (20, 40, 80, and 160 microg/70 kg), butorphanol (1.5, 3, 6, and 12 mg/70 kg), and hydromorphone (1.5, 3, and 6 mg/70 kg) of comparable activity. These acute doses were examined under double-blind, placebo-controlled and constrained randomized conditions with a minimum of 72 h between tests in volunteers with polysubstance abuse histories (n=6). Physiological and subject- and observer-rated measures were collected 30 min before and for 4 h after administration. RESULTS: Enadoline significantly increased measures of sedation, confusion and dizziness, produced visual distortions and feelings of depersonalization, and increased urinary output. The highest dose (160 microg/70 kg) was not tolerated and led to psychotomimetic effects. Hydromorphone produced prototypic mu opioid effects including respiratory depression, miosis, and euphoria. Butorphanol was most similar to hydromorphone and shared few effects with enadoline. CONCLUSIONS: These results are discussed with respect to the potential use and safety of kappa agonists for clinical indications.

Adult↗

Stories from doctors of patients with pain. A qualitative research on the physicians' perspective.

GOAL OF WORK: The aim of this study was to explore the physicians' internal representation of the doctor-patient relationship in the dramatic field of the patient with pain. METHODS: Using an open narrative format, 151 physicians were asked to "Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain". The narrations were examined in accordance with a clinical-interpretive method. MAIN RESULTS: Three "perspectives of observation" were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the "depersonalization" of pain. In the professional perspective, the narrative concerns the patient as a "person" and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives. CONCLUSIONS: The professional perspective seemed to be the only place in which physicians could "stop", a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.

Communication↗

Panic disorder or temporal lobe epilepsy: A diagnostic problem in an adolescent girl.

Similarities in the clinical presentation of panic disorder and temporal lobe epilepsy suggest that the two disorders are related and can lead to difficulties in a differential diagnosis. We describe the case of a young girl suffering from paroxysmal anxiety, derealization-depersonalization and autonomic symptoms, lasting from seconds to several minutes; these episodes were very frequent and disabling. The interictal EEGs and MRI were normal. After having diagnosed panic disorder based mainly on the duration of the attacks and the family history, a pharmacological treatment was started.

Adolescent↗

The demystification of autoscopic phenomena: experimental propositions.

Autoscopic phenomena (AP) are rare, illusory visual experiences during which the subject has the impression of seeing a second own body in extrapersonal space. AP consist of out-of-body experience, autoscopic hallucination, and heautoscopy. Recent neurologic reports support the role of multisensory integration deficits of body-related information and vestibular dysfunctions in AP at the temporo-parietal junction. A caveat to test the underlying neurologic and cognitive mechanisms of AP has been their rare and spontaneous occurrence. Recent evidence linked AP to mental own-body imagery engaging brain mechanisms at the temporo-parietal junction. These recent observations open a new avenue for testing AP-related cognitive mechanisms in selected clinical and normal populations. We review evidence on several clinical syndromes (psychosis, depression, anxiety, depersonalization, body dysmorphic disorder), suggesting that some of these syndromes may relate to AP-proneness, thereby leading to testable propositions for future research on body and self processing in addition to AP.

Awareness↗

Symptoms of interpersonal sensitivity in depression.

Six self-rated items of interpersonal sensitivity (IPS) were examined in 174 depressed outpatients. These items were "feeling critical of others," "your feelings being easily hurt," "feeling others do not understand you or are unsympathetic," "feeling others are unfriendly," "feeling inferior to others," "feeling shy or uneasy with the opposite sex." The population was grouped into tertiles based on their pretreatment IPS score. High levels of IPS were associated with earlier onset and greater chronicity of depression, higher Hamilton Rating Scale for Depression (HRSD) score, more severe depressed mood, guilt, suicidality, impaired work and interest, retardation, depersonalization, paranoia, and cognitive symptoms of depression. More frequent atypical features were found, e.g., overeating/weight gain, self-pity, phobic avoidance, and panic attacks. Response to a monoamine oxidase (MAO) inhibitor drug increased at higher levels of IPS, while the response to a placebo decreased.

Clinical Trials as Topic↗

The psychological impact on staff of caring for people with serious diseases: the case of HIV infection and oncology.

Psychological stress and work-related burnout in staff working with AIDS and with cancer patients were compared using a self-report method of assessment. Measures included the General Health Questionnaire (GHQ), Maslach Burnout Inventory (MBI), and the Social Adjustment Scale (SAS-M). More than 80% of those staff who were approached responded to the questionnaire, including 70 doctors and nurses working with people with AIDS and 41 doctors and nurses working in oncology. More than a third of staff had substantial levels of psychological morbidity, and about a fifth had significant levels of work-related stress. Factors associated with the presence of high levels of psychological morbidity and with abnormal levels of emotional exhaustion, depersonalization, and concerns about personal accomplishment were identified. Staff described the work situations with which they had difficulty dealing and some of the coping strategies they used. The findings confirm that staff working with people with cancer or AIDS experience psychological difficulties of the kind likely to respond to interventions aimed at improving their ability to cope with work-related stresses. The mental health services could play an important role in carrying out research in this field and in providing practical help to deal with staff's difficulties.

Acquired Immunodeficiency Syndrome↗