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PubMed1997

[Instenon in the treatment of acute disorders of the cerebral circulation].

Effectiveness of Instenon (Alkaloid Pharm. Co.), the preparation, containing hexobendin, hydroxytheophyllin, etamivan was investigated in treatment of patients with acute cerebrovascular disorders. Instenon was applied in acute phase of ischemic stroke both in form of ampules and dragee as well as for intravenous injections too. Marked positive influence of Instenon was observed on motor, sensory, autonomic and psychic functions. Instenon in form of ampules had advantage compared to dragee form in terms of faster positive alterations onset. Application of Instenon in form of ampules was more effective in patients with disorders of consciousness while usage of drug in the form of dragee was more effective in patients with cerebrovascular disorders in vertebro-basilar system. The drug hadn't significant influence on systemic arterial pressure either after single injection or long-termed treatment; the mild hypotensive effect was observed after therapeutical session. The drug was well tolerated by patients in both forms and hadn't any side effects. There were no negative consequences of Instenon interaction with other preparations. The conclusion was made about possibility of application of Instenon for the treatment of ischemic stroke.

Acute Disease↗
PubMed1997

The phenomenology of psychosis associated with complex partial seizure disorder.

Psychosis commonly occurs as a direct result of complex partial seizure disorder (CPSD). This organic mental disorder is indeed "complex" and is easily and frequently misdiagnosed as a variety of functional disorders, including schizophrenia, schizoaffective disorder, bipolar illness, psychotic depression, and, at best, "atypical psychosis." However, this important clinical syndrome has several clinical features that suggest its presence and which often permit it to be distinguished from other forms of psychosis. Furthermore, this disorder can be successfully treated with limbic anticonvulsants, with or without neuroleptics and/or lithium, but it is generally refractory to neuroleptic medications alone. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic and illustrates the clinical profiles of 10 treatment-refractory patients admitted to a state hospital with previously undiagnosed psychoses secondary to CPSD. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments.

Adolescent↗
PubMed1981

[On the neuro-psychiatric symptomatology of the so-called "hepatic coma" (author's transl)].

The definition of hepatic coma has been used for the most severe course of hepatic insufficiency, independent from the pathogenesis. This means, that from the psychiatric point of view the hole survey of the exogen reaction type was subdivided. The neurologic symptomatology was rather neglected. In this study an attempt is made to show--using the reports of 77 patients with severe hepatic insufficiency of different etiology--that with very exact and repeated examinations a typical course of neuro-psychiatric symptoms can be observed. A distinct hierarchy of symptoms is existing, which is similar to the well known princip of dissolution (Jackson). As a main factor one has to differentiate between an acute and a subacute course. The acute course is characterized by a rapid decrease of vigilance and increase of neurologic symptoms, which end in most of the cases with an acute midbrain- and bulbarbrain-syndrome, while the subacute course shows primary a disturbance of thymo- and noopsychic function in different relations. In addition to the organic "Achsensyndrom" amnestic or amentiell symptoms can be found, which might be covered by a decrease of the vigilance--if the primary noxis continoues--end up with unconsciousness. The parallel developing neurologic symptomatology shows a distraction of the general motoric, including so-called basic movements. later stereotypies and automatismes, and the delicate distal movements change into rough general-rotation-and pointing movements of the hole body. There is also a temporary bending of all extremities and at this time also a rigidospasticity. In the following course preponderate transient bending or stretching, finally there exists a lack condition, which does not respond to external provocations. The symptomatology is not always symmetric. Transient or longstanding hemiparetic symptoms and also crossed brainstem symptoms can be seen frequently. Sometimes there are general or focal epileptic seizures. If a brain edema occurs it leads to a tentorial herniation with the symptoms of an acute midbrain- or bulbarbrain syndrome, which exists in nearly every second patient. If the course turns, the clinical symptomatology is passed in reverse direction. A good relation exists to the known biochemical changes. The disturbed monoaminmetabolism influences the structures, which are important for the vigilance. The serotonin and 5-hydroxyindolaminoacid level in the tegmentum and the hippocampus are increased. Worth to mention, that this is not a specific hepatic disturbance. Additional one can find false transmitters, for example octopamin, which are concerning the excitation, less potent than dopamin or noradrenalin and also a decrease of the latter in the extrapyramidal structures, which corresponds very well with the motoric deficiency and defectsymptoms. Not all of the symptoms can be explained by disturbances of the catecholaminmetabolism. It seems, that electrolyt and acid-base disturbances are also of some value...

Acetoin↗
PubMed1998

Psychoses in Parkinson's Disease.

Psychotic symptoms occur in up to 40% of patients with Parkinson's disease (PD) and other degenerative parkinsonian disorders, usually but not exclusively in the context of their pharmacologic treatment. We describe the following six psychotic syndromes in PD based on existing literature: (1) hallucinations with preserved insight; (2) medication-induced psychotic disorders (in clear consciousness); (3) delirium; (4) schizophrenia-like psychotic disorders (in clear consciousness and in the absence of medication treatment); (5) schizophrenia with subsequent development of PD; and (6) other psychotic disorders. Psychosis in PD has been noted to be a marker for illness deterioration. Psychotic symptoms can profoundly affect the quality of life for PD patients and their families and may increase the economic burden of this illness. Various approaches have been used to treat psychotic symptoms in PD. We critically review this literature, which is limited, but includes studies indicating promise for "atypical" antipsychotics in these patients. Further elucidation of the phenomenology, course, pathophysiology, and treatment of the different psychotic disorders in PD is urgently needed.

Journal Article↗
PubMedDate not supplied

[On the anatomo-physiological basis of trance and dissociation].

This article presents information regarding the anatomic and physiological basis of hypnotic type trances and dissociation. Conjugated upward deviation of the eyes, as well as the so-called "rolling of the eyes" (explained in the text), which are present during trances, are suitable entry points for the study of the anatomic substrate underlying these experiences. The thalamus, posterior commissure, pretectal zone, and Cajal and Darschewitsch nuclei are the anatomic zones related with the upward gaze, "eye rolling" and trance type changes of consciousness. Independently of these facts, at least three different types of trance behavior can be differentiated: the form that we call passive is present in physiological sleep, and consists of the eyes turning upwards spontaneously. In the form called active, the trance is linked clearly to the upward stare and ocular rotation. Finally, a form that we call intermediate in this study accompanies personality changes in multiple personality disorder and some cases of psychogenic flight. This study attempts to demonstrate that the conjugated upward deviation of the eyes can be, in the absence of another disorder, a first-order indicator of disorder of consciousness of the type found in dissociative disorders.

Dissociative Disorders↗
PubMedDate not supplied

XIII. Cerebral circulation and metabolism in stroke. Cerebral circulation and metabolism in stroke study group.

An understanding of the cerebral circulation is so fundamental to comprehension of the pathogenesis of stroke that cerebral blood flow and metabolism merit review in this series of reports. The authors recognize that the research described here is very technical in nature and may appear to have little practical application to clinical medicine. Nevertheless, these matters are basic to the development of precise methods for the measurement of regional cerebral blood flow in man which could be used to monitor the therapy of stroke with greater success than is possible at present.

Brain↗
PubMed2006

What do we mean by "conscious" and "aware"?

The concepts of consciousness and awareness are multifaceted, and steeped in cultural and intellectual history. This paper explores their complexities by way of a series of contrasts: (1) states of consciousness, such as wakefulness and sleep are contrasted with awareness, a term that picks out the contents of consciousness: these range across all our psychological capacities; the scientific background of the two concepts is briefly outlined; (2) consciousness is contrasted to self-consciousness, itself a complex term embracing self-detection, self-monitoring, self-recognition, theory of mind and self-knowledge; (3) "narrow" and "broad" senses of consciousness are contrasted, the former requiring mature human awareness capable of guiding action and self-report, the latter involving the much broader capacity to acquire and exploit knowledge; (4) an "inner" conception of consciousness, by which awareness is essentially private and beyond the reach of scientific scrutiny, is contrasted with an "outer" conception which allows that consciousness is intrinsically linked with capacities for intelligent behaviour; (5) finally "easy" and "hard" questions of consciousness are distinguished, the former involving the underlying neurobiology of wakefulness and awareness, the latter the allegedly more mysterious process by which biological processes generate experience: Whether this final distinction is valid is a focus of current debate. Varied interests converge on the study of consciousness from the sciences and the humanities, creating scope for interdisciplinary misunderstandings, but also for a fruitful dialogue. Health professionals treating disorders of consciousness should be aware both of its scientific complexities and of its broad cultural background, which influences the public understanding of these conditions.

Animals↗
PubMed1996

Electroencephalographic abnormalities in liver transplant recipients: practical considerations and review.

This article reviews the central nervous system complications of orthotopic liver transplantation (OLT) and the contribution of EEG in their assessment. The utility of EEG in the evaluation of disturbances of the level of consciousness, cerebrovascular disorders, infections, seizures, medication effects, and central pontine myelinolysis is discussed. EEG may aid in the assessment of altered levels of consciousness, correlate a variety of behavioral manifestations, demonstrate the presence of subclinical seizure patterns, and monitor the treatment response, thus contributing to the management of the OLT patient.

Adult↗
PubMed2001

Psychotic consciousness.

ABSTRACT Congruent with recent demands for greater attention to be given to patients' actual experiences at a fine-grained level in the understanding of psychosis (e.g. Thomas 1997) the present paper first describes one day in an actual psychotic episode suffered by the author in 1979 and then subjects this narrative to analytic and normalisation interpretations. It is suggested that acute psychotic thinking of paranoid form is critically mediated by real social events and by intrapsychic deficits in attentional capacity; metacognition; thought regulation and signal discriminative ability. Cognitive processes in delusion however, are suggested to be influenced by the presence of a threatening external locus of control. This reflects the strong social and political quality to delusional suffering. The effects therefore of victimisation on cognitive processes is suggested to be an important issue in social cognitive psychology and psychiatry.

Brain↗
PubMed2004

Perspective-taking deficits in people with schizophrenia spectrum disorders: a prospective investigation.

BACKGROUND: This study examined data from a Danish prospective longitudinal project in attempt to address the state/trait controversy regarding theory of mind deficits in schizophrenia. Deficits in perspective-taking--a component of theory of mind--were investigated prospectively among children who developed schizophrenia spectrum disorders as adults in comparison to children who did not develop schizophrenia spectrum disorders. METHOD: A total of 265 high risk and control subjects were studied in 1972. At the time of initial assessment, the Role-Taking Task (RTT) was administered. Two hundred and forty-two of these children were evaluated in 1992 during follow-up examinations. Sixteen developed schizophrenia, 10 developed a schizophrenia spectrum disorder, 70 had outcomes of other psychopathology, and 146 did not develop a mental illness. RESULTS: Children who later developed schizophrenia or a schizophrenia spectrum disorder had lower RTT scores, controlling for verbal IQ and age, compared to those who did not develop any mental illness. Although in the expected direction, RTT scores for those with schizophrenia spectrum disorders were not significantly different from those who developed a non-psychotic disorder. CONCLUSIONS: Deficits in perspective-taking among children who later developed schizophrenia spectrum disorders suggest that a facet of theory of mind is impaired prior to development of schizophrenia. Our findings lend support to the hypothesis that theory of mind deficits in schizophrenia are trait markers of the disorder.

Adolescent↗