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PubMed1999

[Sex role identity in persons with paraphilias].

Specificity of sexual role identity was studied in individuals with disorders of sexual drive with focus on the study of individual expression of sexual role signs and correlation between value-regulatory and standard-role components of sex self-consciousness in paraphilias. By means of modified psychologic projective methods, two groups who had committed criminal sex delicts were examined: a group with different variations of paraphilias (69 examinees), a group without any anomalies of sexual drives (57 examinees), a control group (65 healthy men). The data obtained about a divergence of value-regulatory and standard-role components of sexual role self-consciousness indicated disorder of the stage of forming of stable role self-identity at juvenile age and reflected difficulties in interiorization of male sex-role standards in individuals with the disorders of sex drive.

Adolescent↗
PubMed1986

Legal aspects of the treatment of delirium.

In a medical emergency, a delirious patient can be treated without consent under the common law doctrine of implied consent, but in nonemergency situations legal guidelines are less clear. Implied consent may be extended if measures are taken to safeguard the patient's interests; these include involving family members in the treatment decision, obtaining a second clinical opinion, and seeking administrative consultation. Time permitting, if there are several alternative treatments and the risk of intervention is great, a court should appoint a temporary guardian. Documentation of the course of action is strongly recommended. The authors discuss the appropriateness of diagnostic procedures and the use of antipsychotic drugs to treat combative delirious patients. Legal precedents are offered and clinical examples given.

Antipsychotic Agents↗
PubMed1993

Consciousness, schizophrenia and scientific theory.

The positive symptoms of acute schizophrenia are, of their very nature, aberrations of conscious experience. A recent theory of the mechanisms underlying their occurrence spans four levels: neuroanatomical, neurochemical, cognitive and the symptoms themselves. The theory is capable of being tested in animals and human subjects, and it has passed a number of experimental tests at both levels with success. Implications of the theory for the scientific treatment of consciousness are considered. Although the theory permits useful questions relating to consciousness to be put and even to some extent to be answered, it leaves the most basic issue--the theoretical link between the occurrence of conscious experience and the neural substrate of the brain--unresolved, as do all similar theories so far.

Animals↗
PubMed2006

Alteration of regional cerebral blood flow to thyrotropin-releasing hormone therapy in acute encephalitis and encephalopathy during childhood.

BACKGROUND: Thyrotropin-releasing hormone (TRH) is now used as a therapeutic agent for various neurological disorders. Animal study has shown that TRH was attributable to increased cerebral blood flow (CBF). AIMS: There have been occasional reports that TRH therapy was effective for improving symptoms of persistent disturbance of consciousness after acute encephalitis or encephalopathy during childhood. To determine whether TRH has an effect on increasing CBF to patients who have consciousness disturbance caused by acute encephalitis or encephalopathy, and to determine the optimal method of administration. METHODS: Sixteen patients aged 0.7-10.9 years (mean age, 3.2+/-3.1 years) who presented with persistent disturbance of consciousness resulting from acute encephalitis or encephalopathy and were treated with TRH. Regional CBF (rCBF) was measured by single photon emission computed tomography before and after TRH therapy. The alteration rates of rCBF were compared between the divided two groups concerning the dose levels, dosing periods, and treatment lags. RESULTS: The alteration rates of rCBF of the high dose group were higher than those of the low dose group. Differences in the dosing periods and treatment lags did not cause any significant difference of the alteration rates of rCBF. CONCLUSION: The study showed that higher alteration rates of the CBF were observed in the higher dosing group, and TRH have the potency of increasing CBF. TRH therapy would have the potential for effective treatment of persistent consciousness disturbance caused by childhood acute encephalitis or encephalopathy.

Autoradiography↗
PubMed2006

Survival rates through time of hypocretin grafted neurons within their projection site.

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, inadvertent transitions from wakefulness to rapid eye movement sleep (so called "sleep-onset REMS period") and cataplexy (sudden bilateral skeletal muscle weakness during waking without impairment of consciousness). This disorder has been recently linked to a loss of hypocretin (HCRT) neurons making narcolepsy a neurodegenerative disease. Neuronal replacement could be used to reverse the symptoms of narcolepsy. Towards this end, we have recently reported that HCRT neurons from rat pups can survive when grafted into the pons of adult rats. Here, we investigate the time-course of survival of grafted HCRT neurons into the pons of adult rats. The HCRT neurons are present only in the lateral hypothalamus, and therefore suspension of cells from this region was derived from 8- to 10-day-old rat pups (donor), and grafted into the pons of adult (60 days old) host rats. Control rats received a transplant that consisted of cells from the cerebellum where no HCRT neurons are present. All adult host rats were sacrificed 1, 3, 6, 9, 12, 24, or 36 days after grafting. Immunohistochemistry was used to identify and count the presence of the HCRT grafted neurons in the target area. The tally of HCRT neurons present in the graft zone 1 day post-grafting was considered to be the baseline. From day 3 to 36 post-transplant there was a steady decline in the number of HCRT neurons. We also noted that on day 36, the HCRT neurons that survived in the pons had morphological features that were similar to mature HCRT neurons in the adult lateral hypothalamus, suggesting that these neurons might be functionally active. Control rats that received grafts of cerebellar tissue did not show HCRT neurons in the target area. These results demonstrate that there is a progressive decline in the number of transplanted neurons, but a significant percentage of HCRT neurons do survive until day 36. This study highlights the potential use of transplants as a therapeutical tool in order to treat narcolepsy.

Animals↗
PubMed1998

[A case of Churg-Strauss syndrome overlapping with sarcoidosis].

We report a case of a 55-year-old woman with Churg-Strauss syndrome (CSS) overlapping with sarcoidosis. She had suffered from bronchial asthma since she was 42, then was diagnosed with sarcoidosis at the age of 50, with typical bilateral hilar lymphadenopathy and noncaseating granulomas in the specimen from the scalene lymph node biopsy. Five years later she was admitted to our hospital in a state of mild confusion. Since she had mononeuropathy multiplex and positive serum pANCA, in addition to bronchial asthma and marked eosinophilia, she was diagnosed as having CSS too. To the best of our knowledge, no case reports on CSS overlapping with sarcoidosis have yet been published. Although CSS can occur with sarcoidosis merely by chance, both disorders cause systemic granulomatous vasculitis and share several clinical features. Therefore, we speculate that CSS and sarcoidosis share pathogenesis in part and may present a clinical condition in which CSS overlaps with sarcoidosis. The disturbed state of consciousness in this case may be caused by a diffuse cerebral dysfunction from microangiopathy in the brain.

Churg-Strauss Syndrome↗
PubMed2000

Dissociation in people who have near-death experiences: out of their bodies or out of their minds?

BACKGROUND: Some people who come close to death report having experiences in which they transcend the boundaries of the ego and the confines of time and space. Such near-death experiences (NDEs) share some features with the phenomenon of dissociation, in which a person's self identity becomes detached from bodily sensation. This study explored the frequency of dissociative symptoms in people who had come close to death. METHODS: 96 individuals who had had self-reported NDEs, and 38 individuals who had come close to death but who had not had NDEs completed a mailed questionnaire that included a measure of "depth" of near-death experience (the NDE scale) and a measure of dissociative symptoms (the Dissociative Experiences Scale). Median scores in the two groups were compared with Mann-Whitney U tests. The association between depth of NDE and dissociative symptoms was tested by Spearman's rank-order correlation between scores on the NDE scale and the dissociative experiences scale. FINDINGS: People who reported NDEs also reported significantly more dissociative symptoms than did the comparison group. Among those who reported NDEs, the depth of the experience was positively correlated with dissociative symptoms, although the level of symptoms was substantially lower than that of patients with pathological dissociative disorders. INTERPRETATION: The pattern of dissociative symptoms reported by people who have had NDEs is consistent with a non-pathological dissociative response to stress, and not with a psychiatric disorder. A greater understanding of the mechanism of dissociation may shed further light on near-death and other mystical or transcendental experiences.

Consciousness Disorders↗
PubMed2001

Runner-up in the young physician's section of the Gowers' prize 2000. Epilepsy and the physical basis of consciousness.

The issue of human consciousness, in both its popular and neuroscientific sense, is considered from a clinical perspective. The ictal semiologies of the various epilepsies, together with associated clinical features, are demonstrated to highlight certain neuroanatomical and neurophysiological facets of consciousness. It is suggested that further insights into consciousness, even those bordering on the philosophical, may be led by clinical neurological phenomena and emerging neuroinvestigative techniques.

Awards and Prizes↗
PubMed2005

Raising consciousness.

The national debate over Terri Schiavo exposed a critical gap between emotional fervor about brain-injured patients and the medical science that informs standards of care for them. Some of the questions raised in the public and legal forums point to a need for research and enhanced understanding of the mechanisms of recovery from disorders of consciousness.

Female↗
PubMed1998

Epileptic seizures and pseudoseizures from the viewpoint of the hierarchy of consciousness.

Epileptic seizures and pseudoseizures in temporal lobe epilepsies were studied from the viewpoint of the hierarchy of consciousness. Twenty-two patients with temporal lobe epilepsies (TLE) who showed true amnesia or impairment of consciousness developing from the dreamy state, even though their actions and movement continued, were selected among 160 patients with TLE, nine patients with manifested pseudoseizures, pseudoseizure status, and complex partial seizure status (CPSE) were investigated. Twelve patients in whom impairment of consciousness followed the dreamy state recognized their own existence and maintained some self-directed consciousness. The other 10 patients with amnesia were aware of their goals. Furthermore, pseudostatus ranged from epileptic seizures during pseudoseizure status to pseudoseizures during status epilepticus (SE). In some cases of CPS, awareness and self-directed consciousness were only partially pseudoseizures, disorders of self-directed consciousness are assumed to influence awareness and arousal.

Adult↗
PubMed2002

Central auditory processing disorders.

Central auditory processing is essential for the perception of speech, environmental sounds and music, and may be deranged in two ways. Lesions of the ascending auditory pathway or cortex can produce deficits. Abnormal activity of the central auditory system is becoming increasingly recognized in disorders such as tinnitus. Recent work has investigated sound processing by the unconscious brain; such investigations may provide a 'window' into residual brain function and prognosis.

Agnosia↗
PubMedDate not supplied

[Psychiatric syndromes in epilepsy. Case contribution].

The Authors have taken into consideration the psychiatric disorders during epilepsy and subdivide them in: behavioural disorders, epileptic deterioration, Petit Mal status and epileptic psychoses. Epileptic psychoses have been divided in: episodic (confusional and disthymic) and chronic (syndromes where ideation troubles and schizophrenic syndromes prevail). On the basis of a nosographic approach the Authors consider the possibility to relate the latter to epilepsy, while for others the association of two diseases has probably taken place. The Authors agree with the assumption that the epileptic psychosis is the result of a multifactorial activity finally resulting in a real disorder at the level of the temporo-limbic structures, such activity is not always revealed by surface EEG.

Adolescent↗
PubMed2006

Awareness and knowing: implications for rehabilitation.

It has been known for well over a century that brain-damaged patients are often unaware of the very deficits that impair performance in everyday life. Pathologies of awareness have been described for many neurological, psychiatric and neuropsychological deficits and the construct of "awareness" or "insight" understandably now receives attention from many researchers within the clinical and cognitive neurosciences. This paper does not attempt to explain the nature of consciousness or its impairment but rather considers four aspects of consciousness/awareness that health care professionals interested in understanding, measuring and improving deficits of awareness should consider.

Awareness↗
PubMed1980

Traumatic cerebral mass lesions: correlations between clinical, intracranial pressure, and computed tomographic data.

After surveying the different phases of their previous experience with the diagnosis and management of traumatic cerebral mass lesions, the authors analyze the correlation between clinical, computed tomographic (CT), and intracranial pressure (ICP) data in 29 patients with traumatic intracerebral hematomas and/or brain lacerations. Clinically, the patients are classified in three groups: (a) deeply comatose patients (Glascow coma scale (GCS), 4 to 5); (b) patients with intermediate disturbances of consciousness (GCS, 6 to 10); and (c) patients with minor impairment of consciousness (GCS, more than 10). Sixteen patients were operated upon. Operation was ineffective in the patients who were already deeply comatose in the first hours after injury, even though elevated ICP was definitely reduced after operation in some of them. Conversely, patients with well-limited lesions, moderate disorders of consciousness, and persisting intracranial hypertension despite medical therapy seemed to be good candidates for delayed operation by limited procedures. In patients with intermediate disturbances of consciousness and no tendency to improvement or deterioration, ICP monitoring correlated with CT scan appearance may be of practical use for making the decision to operate. However, most cases diagnosed on CT scan have a benign course; the patients recover uneventfully with conservative management. In such patients careful clinical observation is usually sufficient. (Neurosurgery, 7: 337-346, 1980).

Adolescent↗