Fortschritte der Neurologie, Psychiatrie, und ihrer Grenzgebiete

120 pairs of parent-child and sibling relationships with endogenous psychoses--registered through 60 schizophrenic and manic-depressive probands each--are statistically investigated with regard to the nosologically and biologically relevant parameters of sex distribution, diagnosis and age of onset.
In this paper 120 pairs of parent-child and sibling relationships with endogenous psychoses are statistically analyzed with reference to symptomatics and syndromatics. The symptoms of all 240 endogenous psychotic pair-individuals, established during one of the first hospitalizations, were documented with the AMP-system on the basis of the case history. The documentation was restricted to stating either 'symptom evident' (1), or 'symptom not evident' (0). For the statistical analysis and interpretation three levels of findings were established: level of single symptoms, level of symptom-groups, level of syndromes. As objective syndromes the symptom-configurations of the 9 AMP-factors of Mombour et al. (1973) were applied. Some essential results can be summarized as follows. Level of single symptoms: A number of single symptoms, represented in the schizophrenic and manic-depressive collectives with frequencies > 20%, reveals significant differences in the distributions which are of importance for differential typology. Level of symptom groups: Within the schizophrenic or the manic-depressive groups the portions of significant intra- and interpair correlations are approximately equal. This finding suggests that modifying genes and/or environmental influences has only slight effects. Yet, comparing schizophrenic with manic-depressive collectives significant differences in distributions are found concerning the portions of significant intra- and interpair correlations (among schizophrenic psychoses about 2/3, among manic-depressive psychoses about 1/3). A greater genetic dependency is assumed with symptoms of schizophrenic psychoses occurring frequently. The blood related and the non blood related schizophrenic or manic-depressive groups are alike only with regard to the symptom-profiles. Level of syndromes: Within schizophrenic or manic-depressive groups, significant syndrome differences can be observed only sporadically, especially within pairs of parent-child relationships. This is probably due to age factors. The blood related and the non blood related schizophrenic or manic-depressive groups are alike as to the syndrome-profiles. The specificity of the main gene effects stands out clearly when comparing the syndrome-profiles of the schizophrenic with the manic-depressive collectives: 7 out of 9 syndrome differences are highly significant; between the syndrome-profiles there is no resemblance. On the whole, the results confirm the assumption of nosological and biological heterogeneity of schizophrenic and manic-depressive psychoses.
Evaluation of 2937 case notes of patients admitted for attempted suicide to the department in Lübeck between 1947 and 1968. This series can be seen as resentative for the Lübeck region. During this period the number of cases has increased about fourfold and has been rising since. Mortality could be reduced to 3% or below. Earlier typical differences between the sexes have since approached each other so that in the end men and women showed the same increase by age during the third decennium. Women were admitted significantly more frequently than men. Drugs, particularly sleeping pills and transquilizers, have greatly increased in suicide attempta. Earlier attempts occurred in 30% of cases. Measured by additional diagnoses, the morbidity of the series lay be 44.8%.
According to videotape analysis, laughter is a frequent (42.7%) symptom during psychomotor attacks. The results of our investigations show that it is no longer possible to regard it as a "curiosity", as did Janz (1969). It is an epileptic phenomenon like others and a symptom of automatism. It can occur in all phases of an attack. It is not remembered by the patient. We have been unable to establish any connection with age or sex. The form of expression is usually natural but inadequate and no affective motivation has been established. Laughter during an epileptic attack is an inborn emotional expression, structurally triggered by the involvement of the area around the hypothalamus-thalamic nucleus with the process causing the epilepsy. It is not actively experienced and is therefore not conscious and not an expression of the pleasant side of the affective complex moderated by the limbic system. The EEG's showed the usual variations occurring in psychomotor epilepsy. The temporal lobes are particularly involved. There is no "EEG Laughter Pattern". The group of patients considered here consist of severe, therapy-resistent cases of partial seizure epilepsy with pronounced cerebral lesions. In order to determine whether laughter is so common in less severe cases, a comparison group must be investigated. Laughter as a symptom of an epileptic attack is unknown to doctors and nursing staff and thus is either not recorded at all or, only very seldom. "Gelastic epilepsy" so-called does not exist as a nosology entity. This term should thus only be used--if at all--in cases where the laughter, together with a change in the level of consciousness, has over a period of years constantly been the only symptom of an attack, expecially when these attacks first became manifest in earliest childhood and are due to connatal changes in the hypothalamus-thalamic region.
Clinical findings, the further course and prognosis of the alcoholic Korsakow-syndrome based on both a review of literature and own experiences in 55 patients are discussed. The psychosis of the alcohol addicts usually occurs during the 5th and 6th decade of life. It is remarkable that females are affected more frequently than males. Due to alcoholism usually an acute reversible psychosis is the forerunner of the amnestic-confabulatory syndrome. Most frequently this episode is characterized by a delirant type. The four main psychopathological features of the Korsakow-syndrome rather often are accompanied by signs of personality deficit and dementia. Somatic findings that cover both aspects of internal medicine and neurological states as well as the results of laboratory investigations are presented. Follow up studies show that some of the patients already die during the first years of the disease. The amnestic-confabulatory syndrome recedes in 16 to 36 percent of cases. In the final stage as judged from clinical grounds the amnestic deficits found are slight in 11 to 25 per cent, moderate in 23 to 30 per cent and severe in 26 to 50 per cent of cases. The confabulations and the impairment of orientation always show a good tendency of remission. In all cases without complete recovery the disturbance of recent memory and the amnesia are the leading criteria of the final defective stage. It is almost impossible to give an early prognostical assessment of the further clinical course in the individual case. In general, those factors indicating poor prognosis are: old age, signs of arteriosclerosis, slow development of the amnestic-confabulatory syndrome and signs of organic psychosis with or without dementia at onset of the disease.
The performance of 105 schizophrenic patients was tested in 22 cognitive, psychomotor and general ability tests and compared with that of a normal control group. In practically all tests, the patients were most highly significantly inferior in respect of verbal and non-verbal intelligence, manual dexterity and speed, reaction time or vigilance, concentration, coordination and, generally speaking, in susceptibility to interference, as well as tempo and fatigability. The factorial ability structure is mainly patterned by differences in intelligence, in contrast to differences in speed displayed by normals. Test performances correlate positively with previous school and job training and with the father's professional position, whereas there is a negative correlation with the duration of present hospitalisation and the total duration of all hospitalisations, the ratings of ward behaviour, and partly also with the neuroleptic sedation. Enhanced inter-individual variability of performance was largely clarified via subclassification of the patients by cluster analysis, using their test profiles as basis. The various performance clusters differed not only strongly in the height and shape of their average test profiles, but additionally also through configurations of characteristics which differed in their favourable or unfavourable nature, approximately in the sense of the correlational findings. The discussion deals with the deficiency of susceptibility to interference, which is typical of schizophrenia, and also with slowing-down, intelligence, motivation and rehabilitative consequences. The discussion also touches upon problems of sampling artifacts and the interactions between the patient and the institution in which he is hospitalised.
Due to modern methods of resuscitation and intensive care, chances are better today of surviving a severe brain trauma. As a result of this, however, posttraumatic conditions of long duration in the form of akinetic mutism (apallic syndrome) occur more often. The intensive care unit represents a considerable psychic stress that is not yet sufficiently recognized, which, especially in the case of brain damaged children awakening from a long period of unconsciousness, is likely to evoke abnormal psychic reactions. Some observations are presented of psychic primitive reactions (according to Kretschmer) in the form of the signed death reflex in children who were cared for on the intensive care unit after severe brain traumas. These psychogenic states could be taken for organic akinetic mutism if attention is paid exclusively to organic brain damage. The significance of the following factors in the origin of such psychoreactive disturbances is discussed: the environment, bodily restriction, isolation and emotional deprivation, and the state of total helplessness as well as the interruption of continuity of experience resulting from traumatic amnesia. This syndrome is differentiated from organic akinetic mutism. The appropriate psychiatric treatment is suggested.
On the base of three autoptically controlled cases with ring-shaped findings in the CT the problem of the differential diagnosis of the brain abscess in axial computerized tomography is discussed. A brain abscess must especially be taken into account when the hyperdense anulus already occurs without enhancement by contrast media. The ring-shaped finding is then caused by the high amount of collagen fibres within the abscess membrane, which has no comparable correlate in other focal processes of the brain.
A series of 13 cases of occlusions of the posterior cerebral artery are presented as verified by angiography. 9 of these were between the age of 20 and 39. The symptoms and clinical courses are compared with the angiographic findings, especially with the collateral circulation. On the basis of our observations and similar cases reported in the literature the factors, disposing to vascular occlusions are discussed in detail particularly the role of oral contraceptives and nicotine-abuse.
Unlabelled: An attempt was made to establish the prevalence of alcoholism in the State of Bremen in 1973. A sample of the adult population was sent a questionnaire. The selection of questions was based on the principles of the WHO definition of 1952 and on dependence on alcohol. Amount of drinks, behavior, psychosocial consequences and dependence on alcohol were gone into. The assessment of answers was weighted. Results: When very strict criteria are applied, alcoholism existed among 2-2.5% of the population samples. With slightly less strict criteria which probably correspond more closely with reality, it was 3-4%. This, calculated for the whole population of Bremen, shows a prevalence of at least 1.6-2%, probably 2-3%. Alcoholism is not evenly distributed between sexes, age groups, social status and income-groups. The relation between men and women is 2 to 1. Most alcoholics are found among those aged 16-29 years and among unskilled workers, in the income group between 800 and 1399 DM p/month and among those not stating their income. The smallest number of alcoholics was in the group between 40 and 49 years old, among people not in top positions of the civil service or in business and in the lowest income group (less than DM 800 p/month). It is remarkable that no difference was found to be related to educational standards.
The author gives a review of the problems of drug dependences in Norway. The rate of use of and dependency to drugs is discussed with special reference to adolescent drug habits, as registered yearly since 1968. About 18 percent of adolescents in Oslo have tried cannabis once or several times (1972, 1973). Although, the situation seems to have stabilized during the last two or three years. In other big towns in Norway the percentage is about half of that in Stockholm and Copenhagen. The attitude of young people to the use of drugs, including cannabis, is strongly negative. Tendencies in adolescent use of and dependency on drugs are described. In adults dependency on benzodiazepines seems to be the most common type of dependency. The methods used in treatment of drug dependents in Norway are described, as are also the prophylactic measures.
1. In contrast to healthy adult subjects many schizophrenics are unable to drum synchronically with a uniform acoustic frequency. 2. But many schizophrenics can do this when their full attention is diverted by additional light-stimuli. 3. Healthy subjects can be induced to desynchronization, when perception of acoustic frequency is blurred. 4. This desynchronization in healthy subjects can be abolished when their full attention is diverted by additional light-stimuli.
The diagnosis and surgical planning of the acoustic neurinoma are based on the results of cisternomeatography using Pantopaque contrast medium, after appropriate audiological, roentgenological and neuro-otological examination. This x-ray contrast medium method is suitable for the early detection of acoustic neurinomas at the time of their beginning intrameatal growth at the transition from the sheath of the N. vestibularis to the dura. At this time, the patient will not show any remarkable neurological signs, originating, for example, from the n.trigeminus and the n.facialis. At this stage, it will hardly be possible to obtain a finding which points to the presence of a space-occupying growth, neither by means of the brain scintigram, angiography of the A. vertebralis, pneumoencephalography, puncture of the CSF for protein determination, nor by computer tomography. Indication for the performance of cisternomeatography is interpreted liberally in authors' clinic, in view of the fact that acoustic neurinomas are often discovered late, resulting in high operative mortality. Every auditory disturbance, especially of a unilateral and unidentified nature, when combined with a postural or positional nystagmus, can point to an acoustic neurinoma, quite independent of the x-ray film of the petrosal bones; the authors found this in 92% of their acoustic neurinoma patients. Suspected acoustic neurinoma can only be excluded via cisternomeatography. Early diagnosis of this tumour can considerably reduce the mortality and complication risk associated with surgery. No serious complications have so far been observed subsequent to cisternomeatographies. Out of 14 diagnosed acoustic neurinomas, 2 were discovered in the internal auditory meatus while still in the early stage. No death occurred following otomicrosurgery performed in 30 acoustic neurinoma patients.
Cerebral chemical vasomotor reactivity and autoregulation were tested in normal baboons before and after intravertebral, intravenous and (or) intracarotid infusion of atropine and neostigmine. Furthermore, disordered cholinergic neurotransmission and dysautoregulation after acute experimental cerebral infarction have also been investigated. Intravertebral injection of atropine suppressed the increase of CBF by inhalation of 5% CO2 and enhanced the decrease of CBF induced by hyperventilation, but did not appreciably affect autoregulatory response. On the other hand, cerebral autoregulatory vasoconstriction during increases of CPP was significantly reduced following both intravertebral and intracarotid neostigmine infusion. Cerebral vasodilatory reactivity to CO2 inhalation was significantly enhanced only following intravertebral neostigmine and cerebral vasoconstrictive response to hyperventilation was not influenced by neostigmine. Following experimental cerebral infarction regional dysautoregulation was found in infarcted gray matter and correlated significantly with increased AChE levels in the same zones of cortex and basal ganglia. Intravenous infusion of scopolamine restored autoregulation to the ischemic zones. The results thus obtained support the view that central cholinergic cerebrovascular influences exist and are vasodilatory in nature. Furthermore, in acute experimental cerebral infarction disordered cholinergic neurotransmission seems to play a role in vasoconstrictive dysautoregulation.
In the case of seizures which are difficult to diagnose, the demonstration of epilepsy-typical graphoelements in the EEG confirms the suspected presence of an epilepsy. Activation methods are employed, since epilepsy-typical potentials may be even absent in established cerebral convulsibility in the routine wake EEG. The purpose of these method is the activation of epilepsy-typical potentials in patients, whereas the activation should not be so strong that those potentials may also be activated in healthy persons - since they can be provoked by a sufficiently strong stimulation in any individual. Hyperventilation, photostimulation, sleep, sleep deprivation and, in addition, drug provocation with Bemergrid, have proved most effective in routine diagnostic procedures; the diagnostic significance of the latter is still most problematic. - The various activation methods show a variably marked effect in the different types of seizures.
1. This report is concerned with 44 cases of acute viral encephalitides which were seen in the eight-year period 1965-72. 2. There is a significant difference in sex distribution: 63% males and 37% females. Nearly two-thirds of our patients were aged up to 30 years. There is no seasonal accumulation of incidence of the sporadic encephalitides. 3. The clinical diagnosis was based on "influenza-like" preliminary symptoms (25 patients), acute onset of neurological symptoms (30 patients) with signs of cerebral alterations like headache, drowsiness, confusion and epilepsy (22 patients), partly focal neurological signs (14 patients), inflammatory cerebro-spinal fluid alterations (36 patients) and other virus caused simultaneous diseases like myocarditis, hepatitis, pneumonia and exanthemata (19 patients). Alterations of blood sedimentation rate, number of white or red blood cells and differential blood count have no bearing on rapid diagnosis of acute viral encephalitides. Results of usual virological examinations often come to late for early diagnosis. Neuro-radiological procedures and isotope encephalography cannot help to get diagnosis in the initialphase of encephalitis. 4. 6 patients died, 5 had residual neurological deficit. 33 patients recovered completely though they partly had severe encephalitides. 5. There is no spezific treatment of acute viral encephalitides. Application of cortisone and antipyretic drugs is not indicated. 6. Most of the viral encephalitides may be classified when an extensive virological examination will be carried out.
Neurologic hemisyndromes in childhood may be due to congenital or acquired changes in cerebral vessels. Among the congenital vascular malformations, which very rarely become manifest already in children, the arteriovenous angiomata and saccular aneurysms are relatively the most common (in childhood about 4-8% manifest, 1-2% of all diseases). Venous angiomata, micro-angiomata and congenital dissecting aneurysms are very rare. But acquired thrombotic blocks of cerebral arteries are of greater importance as causes of acute neurologic hemisyndromes in childhood. Most often they have an inflammatory or traumatic cause, often the cause is unknown. Rare diseases only very recently described as arterial blocks of cerebral vessels are fibromuscular dysplasia and Moya-Moya-disease, the etiology of which is not yet fully understood. The prognosis of these diseases is generally unfavorable, but the focal signs in migraine as visual, sensory, aphasic and motoric defector irritative signs are as a rule reversible. In order to establish, where possible, the cause of acute neurologic hemisyndromes in childhood, early angiography may-classic migraine accompagnee types excepted-help. But also modern biochemical, immunologic, virologic, serologic, bacteriologic, clotting analytic and, possibly, histologic and histochemical techniques should be employed with particular attention to fat metabolism and to auto-immune disease.
Top-cited authors
Mechthild Papousek
  • Ludwig-Maximilians-University of Munich
Jules Angst
  • University of Zurich
Johannes Dichgans
  • University of Tuebingen
Uwe Henrik Peters
  • University of Cologne
Walter Fröscher
  • Epilepsiezentrum Bodensee