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PubMed1984

Self-injurious behavior and stereotypy in an institutionalized mentally retarded population.

Demographic variables and behavioral characteristics of institutionalized mentally retarded clients exhibiting both self-injurious behavior (SIB) and stereotypy, stereotypy alone, SIB alone, or neither of these behaviors were analyzed. Overall, there were no significant differences for the demographic variables measured. Multivariate analyses revealed that severity and frequency of behavior, sensory handicap, and sex of the subject were the best predictors of group membership. Moreover, this research suggests that SIB and stereotypy can be classified as stereotyped SIB and withdrawal stereotypy, respectively. Thus, the treatment modalities presently being applied to these behaviors could be inappropriate. Additional evidence is discussed that supports the belief that an organic physiological substrate or mechanism could be related to these aberrant behavior patterns, which would necessitate a new diagnostic classification and alternative forms of treatment.

Adolescent↗
PubMed1984

Deceleration of self-injurious and stereotypic responding by exercise.

A jogging exercise program was implemented for two severely retarded adults who exhibited high rates of self-injurious behavior and stereotyped mannerisms. Exercise was increased from one mile per day to three miles per day over a six-week period. Baseline measures were taken on the self-injurious behavior, stereotyped body rocking and pacing, sitting, and social interactions. Aberrant responding gradually decreased over the six weeks. Daily response rates were lower after the exercise as contrasted with before. When the program was terminated aberrant responding again increased.

Adult↗
PubMed1984

An ecobehavioral assessment of a special education classroom.

The present study combined a multiple category observational data system with a correlational analysis in order to test the value of such a combination as an ecobehavioral assessment instrument and determine whether this package would reveal relationships both between and within the behavioral repetoires of several children. Four severely and profoundly mentally retarded children between the ages of 9 and 12 years were observed in their self-contained special education classroom, and the teacher collected the data over a 20-day period using an interval recording system. Bivariate correlational analysis of the 38 observed categories with the school-day as the unit of analysis revealed significant relationships both between and within children. Two children showed a pattern of relationships in which social interaction in either child was associated with maladaptive behavior in the other, and another child's destructive and self-injurious behaviors were positively associated with his noncompliance. Patterns of related child behaviors suggested ways in which they may have been affected by the behavior of adults in the classroom. The value of such an instrument for ecological assessment is discussed.

Child↗
PubMed1986

Exfoliative cheilitis--a factitious disorder?

Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.

Adult↗
PubMed1997

Diet can modify autotomy behavior in rats following peripheral neurectomy.

Partial sciatic nerve ligation in rats (PSL) produces neuropathic pain disorders [Seltzer, Z., Dubner, R. and Shir, Y., Pain, 43 ( 1990) 205-18 (corrected) ]. Recently we reported that diet markedly affected the levels of these disorders. Here we questioned whether diet also affects neuropathic pain-related behavior in another model, produced by total denervation of the hindpaw following peripheral sciatic and saphenous neurectomy. Sabra rats and HA line rats were fed for 2-3 weeks preoperatively and up to 58 days postoperatively (PO) with one of five different diet formulas. We found that the autotomy behavior differed significantly between the diet groups. Surprisingly, in some diets the effects on autotomy and PSL models were different and even contrasting. Modulation of diet in humans may emerge as a novel therapy of neuropathic pain.

Animals↗
PubMed1998

Substantia nigra lesion suppresses the antagonistic effects of N-methyl-D-aspartate receptor antagonist (MK-801) on the autotomy in the rat.

Rats received right dorsal root ganglionectomy (DRGn) to induce autotomy, and were treated with MK-801 and/or left substantia nigra (SN) lesion after DRGn. The behavior was quantified using an autotomy grading scale. All the rats in the control groups manifested autotomy from 4 to 19 days after DRGn and attained the highest autotomy score. The group treated with MK-801 immediately after DRGn showed suppression of the development of autotomy. The groups receiving left SN lesion with 6-hydroxydopamine immediately, 2, or 4 days after DRGn showed similar patterns of autotomy as the control groups. However, when combined with the administration of MK-801 immediately after DRGn, SN lesion done immediately or 2 days after DRGn suppressed the antagonistic effect of MK-801 (P < 0.01). When the SN lesion was delayed by 4 days, the suppression effect disappeared. These data suggest that the action of the NMDA receptor antagonist on the autotomy within 4 days after DRGn depend on the integrity of the dopaminergic system.

Animals↗
PubMed2000

Preoperative open field behavior predicts levels of neuropathic pain-related behavior in mice.

Exploratory open field (OF) activity was assessed in seven different mouse strains and selection lines. We counted the number of beam interruptions made by three cagemate mice at a time. This assay tests reactivity to aversive stimuli, anxiety and emotionality. One hindlimb was then totally denervated by transecting the sciatic and saphenous nerves on one side, and autotomy, a behavior thought to be related to neuropathic pain, was quantified over 35 days. We report that OF activity and autotomy are highly variable across different strains/lines. These results reaffirm the genetic control of these behaviors. We also found that these behaviors are inversely and significantly correlated. We suggest that common genetically-determined neural mechanisms may underlie anxiety, emotionality and neuropathic pain in mice.

Animals↗
PubMed2002

Intractable postherpetic itch and cutaneous deafferentation after facial shingles.

Some patients develop chronic itch from neurological injuries, and shingles may be a common cause. Neuropathic itch can lead to self-injury from scratching desensate skin. A 39-year-old woman experienced severe postherpetic itch, but no postherpetic neuralgia, after ophthalmic zoster. Within 1 year, she had painlessly scratched through her frontal skull into her brain. Sensory testing and skin biopsies were performed on itchy and normal scalp to generate preliminary hypotheses about mechanisms of neuropathic itch. Quantitation of epidermal neurites in PGP9.5-immunolabeled skin biopsies demonstrated loss of 96% of epidermal innervation in the itchy area. Quantitative sensory testing indicated severe damage to most sensory modalities except itch. These data indicate that in this patient, severe postherpetic itch was associated with loss of peripheral sensory neurons. Possible mechanisms include electrical hyperactivity of hypo-afferented central itch-specific neurons, selective preservation of peripheral itch-fibers from neighboring unaffected dermatomes, and/or imbalance between excitation and inhibition of second-order sensory neurons.

Adult↗
PubMed1996

Mechanical and thermal allodynia in chronic central pain following spinal cord injury.

Spinal cord injury (SCI) results in variable motor recoveries and chronic central pain syndromes develop in the majority of SCI patients. To provide a basis for further studies, we report a new rodent model of chronic central pain following spinal cord trauma. Male Sprague-Dawley rats (N = 10) were hemisectioned at T13 and were tested both preoperatively and postoperatively and compared to sham-operated controls (N = 10) for locomotor function, and mechanical and thermal thresholds of both paw withdrawal and supraspinal responses. Results support the development and persistence of allodynia which persists for 160 days. Locomotor function was tested using the Basso, Beattie and Bresnahan (BBB) open field test and only the limb ipsilateral to the hemisection was affected, demonstrating acute flaccid paralysis with motor recovery which approached normal values by postoperative day (POD) 15. Prior to the hemisection, the rats showed little to no paw withdrawal response to von Frey stimulation of 4.41 mN or 9.41 mN in both forelimbs and hindlimbs. Postoperatively, responses in both ipsilateral and contralateral forelimbs and hindlimbs increased over time and the increase was statistically significant compared to intra-animal presurgical and sham control values (P < 0.05). There were no significant side-to-side differences in limb responses preoperatively or beyond POD 15. The forelimbs and hindlimbs responded to von Frey hair strengths of 122 mN preoperatively and postoperatively with similar withdrawal frequencies that were not statistically significant. Preoperatively, the paw withdrawal latency to heat stimuli was 22.9 +/- 3.0 (mean +/- SE) and 20.1 +/- 3.1 sec for the hindlimbs and forelimbs, respectively. Postoperatively, the mean hindlimb and forelimb latency of paw withdrawals decreased to 11.9 +/- 1.8 and 9.2 +/- 2.5 sec, respectively. This decrease in thermal thresholds is statistically significant when compared to intra-animal preoperative and sham control values (P < 0.05). These data indicate that somatosensory thresholds for non-noxious mechanical and radiant heat which elicit paw withdrawal (flexor reflex) are significantly lowered following SCI. To further support the development and persistence of chronic pain following hemisection, supraspinal responses such as paw lick, head turns, attacking the stimulus, and vocalizations were elicited in response to mechanical and thermal stimuli and were statistically significant compared to presurgical intra-animal or sham control values (P < 0.05). Hemisected animals vocalized to von Frey hair bending forces of 49.8 with a mean of 6.0 +/- 1.2 times out of 10 stimuli compared to intra-animal presurgical and sham control values of zero. Supraspinal responses of hemisected animals to thermal stimuli occurred at lower temperatures that were statistically significant compared to sham control or preoperative values (P < 0.05). These chronic changes in thresholds to both mechanical and thermal stimuli represent the development and persistence of mechanical and thermal allodynia after SCI.

Animals↗
PubMed1998

Burns in a suicide attempt related to psychiatric side effects of interferon.

A 50-year-old woman was admitted to our critical care center after pouring lamp oil on herself and setting herself on fire. Diagnosed with chronic hepatitis, she had received interferon-alpha at another hospital. During interferon therapy she developed anxiety, irritability, sleeplessness, and depression. At our hospital she underwent fluid resuscitation according to the method of Baxter. After treatment with topical cream and ointment, she underwent skin grafting. Interferon was not given. After discharge, wound healing proved satisfactory. She was intelligent and insightful, and her mental condition remained stable with no apparent emotional problems. As she had no significant past medical or psychiatric history and no history of substance abuse, we believe that her depression was a side effect of interferon therapy. A number of reports have described depression and other psychiatric disorders associated with interferon, but none of these accounts have concerned burns sustained in suicide attempts. This case underscores the potential seriousness of adverse reactions to interferon characterized by emotional disturbance and also illustrates that physicians who treat burn patients need to have an understanding of affective disorders and unusual side effects of medication.

Antiviral Agents↗
PubMed2000

The effect of intrathecal endomorphin-2 on the flexor reflex in normal, inflamed and axotomized rats: reduced effect in rats with autotomy.

Endomorphin-2, a newly discovered endogenous opioid peptide and agonist at the mu-opioid receptor, was injected intrathecally in normal rats and animals with unilateral peripheral inflammation or sciatic nerve section and its effect on the nociceptive flexor reflex was analysed. In normal rats, intrathecal endomorphin-2 induced a strong and dose-dependent depression of the reflex, which was naloxone-reversible. The effect of intrathecal endomorphin-2 was fairly brief, lasting for about 20-30 min at the highest dose, 4 microg. The effect of endomorphin-2 in inflamed rats was not significantly different from that in normals. After nerve section some rats developed autotomy behavior. In these rats endomorphin-2 had significantly reduced effect. However, the reflex depressive effect of intrathecal endomorphin-2 was unchanged in axotomized rats without autotomy. It is suggested that intrathecal endomorphin-2 has antinociceptive effect in the rat spinal cord under normal and inflammatory conditions. After peripheral nerve injury the sensitivity to endmorphin-2 may be reduced in rats that exhibit ongoing neuropathic pain-like behaviors.

Analgesics, Opioid↗
PubMed2001

Hyperexcitability in sensory neurons of rats selected for high versus low neuropathic pain phenotype.

Selection line rats congenitally high or low for autotomy in the neuroma model of neuropathic pain (HA and LA rats) were found to be correspondingly high and low in a second type of neuropathic pain, the Chung model, which employs an alternative phenotypic endpoint, tactile allodynia. It has been proposed that both phenotypes reflect ectopic hyperexcitability in axotomized primary sensory neurons. To test this hypothesis we made in vitro recordings from sensory neurons in the L4 and 5 dorsal root ganglia. Baseline excitability was similar in HA and LA rats, and axotomy caused an increase in both lines. However, in the one neuronal subclass previously linked to neuropathic pain in these models the increase was significantly greater in HA than LA rats, and only at the time when pain scores in the two lines were diverging. Heritable differences in electrical response to axotomy in a specific afferent cell type appear to be a fundamental determinant of neuropathic pain.

Action Potentials↗
PubMed2002

Central noradrenergic blockade prevents autotomy in rat: implication for pharmacological prevention of postdenervation pain syndrome.

Following transection of peripheral nerve, rats exhibit autotomy, which is considered to be the animal model of postdenervation pain syndrome. It has been suggested that phantom limb pain is a result of peripheral denervation leading to reorganization of somatosensory pathways, particularly in the cerebral cortex, which is shown to depend upon central noradrenergic activity. In this study, sciatic and saphenous nerves were sectioned in the left hindpaw of 30 adult rats resulting in complete loss of pain sensation in the hindpaw. A group of rats received normal saline, compared to another group which received N-(2-) Chloroethyl-N-ethyl-2-bromobenzylamine (DSP4) injection 24 h prior to transection. The latter group was also compared to a third group whose central noradrenergic system were also blocked by bilateral injection of 6-OHDA into the ascending noradrenergic bundle 1 week prior to transection. A fourth group received contralateral cortical ablation in addition to peripheral nerve transection and was compared to the first group whose cortex remained intact. The animals were observed daily for 60 days and autotomy was scored in accordance to the system of Wall et al. After 1 week, control animals began to exhibit autotomy. In contrast, autotomy was absent in rats treated with DSP4, similar to rats which received 6-OHDA. Rats which had contralateral cortical ablation showed a considerably delayed onset of autotomy and a reduction in final autotomy scores. We conclude that autotomy, as a model of postdenervation pain syndrome, can be prevented by blockade of noradrenergically mediated cortical reorganization. The clinical implications of this finding are discussed.

Afferent Pathways↗
PubMed1982

Experience with peritendinous fibrosis of the dorsum of the hand.

Fifteen patients with a diagnosis of peritendinous fibrosis of the dorsum of the hand (Secretan's disease) were treated between 1958 and 1980. Thirteen patients had excision of a dorsal fibroma with extensor tendolysis when necessary. Preoperative findings included a hard dorsal mass and limitation of motion. Postoperative courses were characterized by prolonged periods of rehabilitation and recurrent episodes of swelling. Twelve of 15 patients returned to work 3 to 30 months postoperatively. Permanent disability was substantial. None of these patients had significant wound healing problems, and all had improved range of motion. The question of self-inflicted injury was raised in five cases but could not be demonstrated.

Accidents, Occupational↗
PubMed1985

The upper extremity and psychiatric illness.

Thirty-three patients who had various conversion reactions manifested by signs and symptoms involving the upper extremities were seen over a 13-year period. Factitious lymphedema, factitious ulcers, clenched fists, as well as other dysfunctional postures of the hand and upper extremity, were the most frequently recognized patterns of illness. Denial of knowledge of the cause of the physical problem and a lack of insight into the illness are major parts of the disease process. Twenty-nine of the 33 patients in this study had work-related and therefore compensable injuries. The physical signs and symptoms resolved in four of the patients when compensation was withdrawn. The average follow-up in this study was 4 1/2 years. Unfortunately, the long-term follow-up of these patients revealed that this disease process was chronic and most frequently failed to resolve. Various efforts at treatment have been unsuccessful, including extensive psychotherapy. Confrontation with the patient is contraindicated.

Adolescent↗