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PubMed1979

The concept of "classical" psychoanalysis.

In this essay, the term classical psychoanalysis is discussed historically and conceptually. What characterizes classical analysis and distinguishes it from current innovative trends in the practice of psychoanalysis is reviewed from a comparative standpoint. The impact of the widened scope of conditions the psychoanalyst currently includes in his therapeutic work is considered, with special attention to the distinction between psychoanalysis per se in the classical sense and psychoanalytic psychotherapy.

Awareness↗
PubMed1986

[Abnormal cerebrospinal fluid plasma cells in a case of myeloma].

Cerebrospinal fluid (CSF) involvement in myeloma is rarely seen. Recently we experienced a case with this lesion. A 70-year-old man developed consciousness level disorder during the course of bronchopneumonia. Neurological examination revealed stuporous consciousness, neck stiffness and Kernig's sign. Immunoelectrophoresis showed monoclonal IgG in serum. CSF which was obtained through lumbar puncture was clear and its pressure was 155 mm H2O. It contained 207 white cells/3 mm3; glucose, 54 mg/dl; and protein, 33 mg/dl. The differential count of the CSF was (in %) monocytes, 48.0; plasma cells, 25.5; neutrocytes, 15.5; and lymphocytes, 11.0. Cytoplasm and nucleus of the plasma cells were in various sizes. Some irregular multiple nuclei, flaming cells and grape cells were also observed in them. The cytoplasm of the plasma cells fluoresced with antisera against lambda chains IgG. The value of immunofluorescent technique in identifying plasma cells in the CSF is emphasized.

Aged↗
PubMed1982

[Effects of trimebutine maleate on the gastrointestinal motility in conscious dogs].

Trimebutine maleate is known to have beneficial effect in the treatment of gastrointestinal disorders. In conscious dogs with implanted force transducers, effects of trimebutine maleate on the gastrointestinal motility were investigated by intravenous injection, and the results were compared to those with metoclopramide and hyoscine-N-butylbromide. When trimebutine maleate was administered during the motor quiescence in the interdigestive state, contractions were evoked or the quiescent time was shortened in the gastrointestinal tract. In the digestive state, the gastric antral contractile activity was reduced, and duodenal activity was somehow suppressed by trimebutine maleate; but in the jejunum, ileum or colon, the activity was augmented. Injection of metoclopramide evoked a continuous contraction in the gastric antrum and duodenum during the period of motor quiescence in the interdigestive state. In the digestive state, metoclopramide caused a slight enhancement in the contractile activity of the gastric antrum. On the other hand, hyoscine-N-butyl-bromide produced no effect during the period of motor quiescence in the interdigestive state and suppressed the activity of the gastrointestinal tract during the digestive state. Thus, the pattern of action of trimebutine maleate was different from metoclopramide and hyoscine-N-butylbromide. It was concluded that trimebutine maleate produces dual actions, suppression and acceleration, on the gastrointestinal motility in conscious dogs.

Animals↗
PubMed1998

[Inherited hyperammonemia].

Inherited hyperammonemia disorders are caused by specific enzymatic defects in the urea cycle or in metabolic pathways related to it. These disorders can be divided into the following groups: deficiencies of urea cycle enzymes, transport defects of dibasic amino acids, organic acidemias, defects in beta-oxidation of fatty acids, transient hyperammonemia of the newborn-probably a not genetically determined disorder. Manifestation of the mentioned disorders includes elevated serum ammonia level resulting in altered level of consciousness and/or persisted vomiting. Occurrence of irreversible neurologic sequelae depends mostly on the extent of hyperammonemic period. Differential diagnosis includes blood gas, anion gap, plasma amino acids analysis and urine organic acids analysis. In some cases specific tissue enzymes activity measurement is necessary. Dialysis, sodium benzoate, sodium phenylacetate and arginine are used in the treatment of acute hyperammonemia. In addition oral or rectal neomycin and/or lactulose can be used, which reduces intestinal ammonia production.

Amino Acid Metabolism, Inborn Errors↗
PubMed1975

Tardive dyskinesia treated with pimozide.

We have investigated the action of pimozide in tardive dyskinesia induced by prolonged administration of phenothiazines. Improvement was recorded in a double blind study of 18 patients treated with maximum tolerated dosage (mean 18.8 mg/day) for 6 weeks. There was no deterioration in the therapeutic action of pimozide over this time. Parkinsonism and sedation were the main adverse effects. They were corrected by reduction of the dose of pimozide, but often recurred so that further adjustments of dosage were necessary. Our findings support the view that tardive dyskinesia is produced by a disturbance in the balance of central transmitters such that dopaminergic transmission is increased.

Aged↗
PubMed2005

Reactive oxygen species and related haem pathway components as possible epigenetic modifiers in neurobehavioural pathology.

The neuroendocrine response to stress utilizes several bio-communicative pathways which also play a role in neurodevelopmental plasticity. The mechanism of action of steroidal compounds includes DNA alteration by reactive oxygen species (ROS) arising through redox cycling of reactive hormone derivatives. ROS and reactive nitrogen species play a significant role in signaling networks affecting gene transcriptional regulation during normal as well as stress-induced responses. ROS-associated synaptic and regulatory region plasticity may have been important for normal brain evolution, but probably simultaneously lowered the threshold for inducing neuropathology. A shift from 'plasticity' to 'instability' is likely to be associated with the emergence of complex effects depending on the timing, duration and intensity of the ROS insult, and is suggested to include heritable epigenetic chromatin/regulatory region remodeling differentially influencing expression levels of significant neuropsychiatric genes and their variant alleles. Neurobehavioural disorder clinical manifestations have been linked with ROS effects. The concepts discussed here relate to ROS-associated instability of DNA regulatory region sequences and a proposal that it may play an important modifying role in brain and neuro-behaviourally related gene expression. Genes encoding key steps in mitochondrial, haem, iron and bilirubin ROS metabolic pathways have been used as examples to illustrate how ROS-modified regulatory networks could possibly alter the context within which (even ostensibly unrelated) neuropsychiatric gene candidates may sometimes be recruited. Furthermore, reactions of certain radicals release sufficient energy to generate UV-photons. DNA conformational changes accompanied by changes in photon emission suggest that functional neuroimaging findings probably reflect interaction on the level of ROS/biophoton/genome regulatory region domains rather than the signatures of individual neurobehavioural disorder candidate genes.

Bilirubin↗
PubMed2003

A pathology of the animal spirits -- the clinical neurology of Thomas Willis (1621-1675) part I -- background, and disorders of intrinsically normal animal spirits.

Thomas Willis (1621-1675), author of the classical work Cerebri Anatome (1664), was arguably the father of the modern era of neurology. As compared with his neuroanatomy, relatively little attention has been paid to Willis' clinical neurology, as described in his Pathologiae Cerebri (1667) and De Anima Brutorum (1672), where he gave a structured account of disease of the nervous system as it was known in his day. His account was largely derived from personal observations and not from traditional authorities and was based around his concept of the animal spirits, a fictitious entity in many ways analogous to the present day idea of the nerve impulse. This concept allowed him to develop a pathology of the animal spirits which embraced the whole content of the clinical neurology and psychiatry of his times. The anatomical and physiological background to Willis' concepts of animal spirit dysfunction, and those disorders he regarded as due to disturbed function of intrinsically normal animal spirits (mainly headache, disorders of consciousness, apoplexy and palsy) are dealt with in the present paper. The disorders he attributed to inherently abnormal animal spirits are considered in a second part of the paper.

Animals↗
PubMed2004

Adjunctive stimulant use in patients with bipolar disorder: treatment of residual depression and sedation.

BACKGROUND: Residual depression and medication-induced sedation remain significant problems for many patients with bipolar disorder (BD). Some evidence indicates that bipolar depression may be more responsive to dopaminergic agents, suggesting that adjunctive stimulant medication may be an effective treatment for bipolar depression as well as for medication-induced sedation. However, there are few data regarding the use of these medications in BD, likely due in part to concerns regarding potential stimulant-induced switching and stimulant abuse. METHODS: In order to evaluate the effectiveness and safety of psychostimulants in BD, we retrospectively reviewed the cases of eight consecutive individuals from our clinic (five with bipolar I and three with bipolar II) who received adjunctive stimulants (either methylphenidate or amphetamine) within the last 2 years. Primary target symptoms of stimulant therapy included residual depression and medication-induced sedation. The degree of clinical change in target symptoms was estimated, and the Clinical Global Impression-BP Version scale (CGI-BP) was used to evaluate the overall severity of illness at baseline, 6 months after stimulant initiation, and at last visit. RESULTS: The eight patients generally showed moderate clinical improvement in their target symptoms and substantial improvement of overall bipolar illness (mean change in CGI-BP overall score 2.9). There was no evidence of stimulant-induced switching or abuse. The stimulants were well tolerated. CONCLUSION: The present case series suggests that adjunctive stimulants may be a reasonable therapeutic option for treating residual depression and medication-induced sedation in some patients. Controlled trials are needed to assess the safety and effectiveness of stimulant augmentation in BD.

Adult↗
PubMed1986

Consciousness as a neurological concept in epileptology: a critical review.

This essay explores the usefulness of the concept of consciousness in epileptology and concludes that it does not further the understanding of seizure mechanisms and brain function. The reasons for this are both theoretical and empirical. Consciousness cannot be adequately defined. This may explain why attempts at accounting for it in neurobiological terms have failed. Epistemological and scientific arguments are reviewed which suggest why a satisfactory explanation of consciousness is not now and may never be possible. There are, however, aspects of conscious experience such as perception, cognition, memory, affect, and voluntary motility that are open to neurobiological research. Careful observations of epileptic seizures with "loss of consciousness" often reveal that only some components of consciousness are impaired. "Loss of consciousness" during a seizure, often presenting as unresponsiveness, may be due to aphasia, inability to perform voluntary movements, ictal or postictal amnesia (sometimes with preservation of memory during the ictus itself), or to diversion of attention by a hallucinated experience. A plea is made to observe accurately and interact with the patient during an attack in order to distinguish between these various behavioral disturbances masquerading as "loss of consciousness."

Adult↗
PubMedDate not supplied

[Diagnosis and treatment of chronic traumatic subdural hematomas in middle and old age].

The peculiar features of the clinical picture, diagnosis, and surgical treatment of chronic traumatic subdural hematomas were studied in 72 patients of elderly and old age. In 98% of patients they occurred after mild craniocerebral trauma of the type of brain concussion. Local signs prevailed over general cerebral signs in all phases of the disease, productive disorders of consciousness were rare as compared to nonproductive disturbances, marked intellectual-mnemonic disorders were often encountered. Echo-EG, radionuclide scintigraphy, carotid angiography and computed tomography proved to be the most informative paraclinical diagnostic methods. The expediency of performing maximally sparing operative intervention of a short duration in individuals over 60 years of age is pointed out.

Adult↗
PubMed2000

Distinct behavioral and EEG topographic correlates of loss of consciousness in absences.

PURPOSE: To describe the behavioral and EEG topographic correlates of absences with 3-Hz generalized spike-waves and partitioned impairment of consciousness. METHODS: Two adult women had so-called "phantom" absences, characterized by brief and mild impairments of consciousness that were previously inconspicuous to both patient and physician. Neuropsychological examination was performed under video-EEG monitoring during absence status. EEG topographic mapping of spike-wave discharges was obtained in the two cases. RESULTS: Only mild attentional and executive disturbances were observed during absence status despite prolonged discharges. Spike-wave bursts were associated with selective impairment in the initiation of response and self-generated action, whereas short-term storage of external information during discharges was fully preserved. This is consistent with a predominant involvement of frontomesial cortex demonstrated by topographic mapping of spike-wave discharges in the two cases. By contrast, in two other patients with typical absences and a complete lack of retention for information given during the discharges, topographic mapping found a more lateral frontal involvement by spike-wave activity. CONCLUSIONS: Different types of absence seizures may impair distinct components of conscious behavior. A predominant involvement of frontomesial thalamocortical circuitry may underlie an "inconspicuous" disorder of consciousness as seen in phantom absences with selective loss of initiation and goal-oriented behavior, whereas involvement of more lateral frontal areas in typical absences may additionally disrupt working memory processes.

Adult↗