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Reversible palinopsia and the Alice in Wonderland syndrome associated with topiramate use in migraineurs.

Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses, but recurred or increased in frequency or duration on higher doses. Both patients had complete resolution of palinopsia when topiramate was discontinued. A third patient is described who developed the "Alice in Wonderland" syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping. Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.

Adult↗

Ictal body scheme disturbance induced by looking through a small opening.

The case of a patient is reported in which seizures consisting of a feeling that the left arm was absent were induced by looking through a small opening (e.g. camera view finder). The EEG showed right parietal sharp wave discharges between and during such seizures. This observation is interpreted as an example of a reflex epilepsy triggered by the specific stimulus of looking through a small opening, and involving the right parietal lobe.

Adolescent↗

Patterns of transactional style deviance in the TAT's of parents of schizophrenics.

Parents of schizophrenics show more transactional style deviance in diverse situations than do other parents. In a sample of families of nonschizophrenic outpatient adolescents, a manual for scoring such deviance on stories told for seven TAT cards was developed. This scoring system was shown to be composed of six meaningful factors. When this system was applied to the TAT's of parents of offspring with a variety of psychiatric diagnoses, a total deviance score did not discriminate among the parents. High scores on two particular factors were found only in parents of hospitalized schizophrenics, but four factors were nondiscriminating. Parents of young adults with schizophrenia spectrum disorders were more likely to show high scores on at least one of these six factors than other parents. Considering the scores of mothers and fathers together yielded the best discrimination of parents of schizophrenia spectrum disorders from other parents.

Adult↗

Time passes slowly for patients with depressive state.

Twenty-three depressive inpatients and the same number of matched non-psychiatric controls were examined on three occasions - following admission, 14 days after, and 28 days after the admission - by administering a self-rating questionnaire of time awareness and Hamilton's Rating Scale for Depression (HRS). The patients were found to feel time passing slowly. This was correlated with the severity of depression expressed as the total HRS score. No significant differences emerged between diagnostic groups, namely endogenous depression, neurotic depression, and schizophrenia or paranoid state with depressive symptoms. Correlations of the time awareness with symptoms listed in the HRS also denied a specific relationship of time awareness to specific diagnoses. The subjective feeling of slow time flow reflects, therefore, the depth of depressive state in general, which is nevertheless not specific to any diagnostic subcategory.

Adult↗

Appearance, body image and distress in facial dysmorphophobia.

Compared with surgical patients awaiting rhinoplasty and control subjects, dysmorphophobic patients were more dissatisfied with facial appearance, more anxious, more depressed, more neurotic and less extrovert. Morphanalysis, an objective measure of facial appearance, was applied to the first 11 dysmorphophobic and first 11 surgical subjects. The dysmorphophobic group had a variety of abnormal features that were not identified by medical practitioners or the patient. These subtle anomalies were often unrelated to the focus of dissatisfaction which was usually normal. A panel of lay judges rated the appearance of the dysmorphophobic group as being intermediate between the control and surgical groups but not significantly different from either.

Adolescent↗

Therapeutic options in Charles Bonnet syndrome.

The term 'Charles Bonnet syndrome' refers to visual pseudohallucinations occurring especially in elderly people with reduced visual acuity. Despite numerous case reports, few successful methods of treatment have been described. Therapies with classical neuroleptics, antidepressants or benzodiazepines have generally been found to be unpromising. Only with carbamazepine treatment has improvement been observed in a few cases. In the three cases reported here, we successfully treated the condition with the atypical neuroleptic melperone.

Aged↗

A new neurotological test for detecting cerebellar dysfunction.

The adaptation of the vestibulo-ocular reflex (VOR) was studied in 26 normal subjects and 26 patients with cerebellar lesions, using horizontal vision-reversal prisms. In normal subjects, the adaptation of gain after wearing prisms for one hour was approximately 50% of the VOR value in the dark. In contrast to this, patients with cerebellar lesions showed less adaptation--approximately 20% after a one-hour forced adaptation task. These were type A, higher gain in the initial level and abnormal adaptation (10 cases); type B, higher gain in the initial level and normal adaptation (5 cases); and type C, normal initial level and abnormal adaptation (11 cases). The cases showing the typical type-A responses tended to have severe widespread or midline lesions of the cerebellum. Typical type-B cases had mild cerebellar lesions, and typical type-C cases tended to have lesions restricted to one side of the cerebellum. From these results, it can be speculated that reduction of VOR adaptation occurs when one side of the cerebellum has severe lesions, but it is sufficient to produce a normal vestibulo-ocular reflex if at least half of the cerebellum is intact.

Adult↗

Into the dangerous world: an in vivo study of information processing in agoraphobics.

The differential processing of threatening information in anxious patients is now well established, but there has been little attention to situational variation in information processing. A review of the experimental literature suggests that agoraphobics should show interference in the performance of the modified Stroop task for threat words and that this interference should increase in phobic situations. In the present study, agoraphobics and normal controls carried out the Stroop task either in a safe setting or a public place. Agoraphobics showed greater interference with threat words but this interference was not affected by setting. The implications of this result are considered.

Adult↗

Maladjustment and socio-cognitive problem solving: the validity of quantitative and qualitative assessment.

General socio-cognitive problem-solving deficits have become accepted as the basis for applied interventions with maladjusted children despite conflicting findings and problematic assessment procedures. This study used Kendall's deficit/distortion distinction to compare the performance of conduct disorder and non-problem boys on means-ends and optional thinking measures, using both quantitative and qualitative indices. Although quantitative problem/non-problem deficits were found, the pattern of results did not support the notion of a consistent maladjustment deficit. The nature of the qualitative differences, however, suggested a more specific role for the assessment of socio-cognitive problem solving with increased emphasis on context and problem differentiation.

Adolescent↗