[Significance of the study of slow cerebral potentials in the psychiatric expert testimony in civil law cases].
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Biomedical subjects
Publications and source records attributed to M Timsit.
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The aim of this study was to display the result obtained by the contingent negative variation (CNV) recording in patients suffering from headache. Eighty-five patients were taken into account: 59 with migraines (M) and 26 with tension headache (TH). A typical CNV pattern (high CNV amplitude with no habituation) differentiated M from TH. Moreover, psychological data were collected through Rorschach ink blot test among 42 headache sufferers (31 M and 11 TH). The typical Rorschach repressive pattern of alexithymia was found as well in M as in TH while CNV amplitude was significantly higher in the 31 M (-25 microV) than in the 11 TH (-19 microV FP less than 0.04). Biochemical data collected among 28 patients (17 M and 11 TH) revealed a positive correlation between CNV amplitude and plasma level of noradrenaline, regardless of the type of headache (r = 0.58; P less than 0.01). Thus, besides psychological factors, catecholaminergic mechanisms seem implicated in the determination of the CNV pattern in migraine. CNV may help the clinician both to specify diagnosis and to decide between the many therapeutic strategies available.
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Contingent negative variation (CNV), an event-related slow cerebral potential, was analyzed in 79 consecutive headache patients. Compared to normal controls (n = 33), CNV did not differ in tension headache (n = 21) or in combined headaches with a predominant tension component (n = 13). The mean amplitude of CNV was significantly (p less than 0.001) increased in migraine (n = 29) as well as in combined headache with predominant migraine (n = 16). All migraineurs were studied between attacks and without prophylactic treatment. CNV may be a useful diagnostic test in headache. Its increased amplitude in migraine might reflect central catecholaminergic hyperactivity.
Thirty-three patients with common migraine underwent contingent negative variation (CNV) recordings before receiving prophylactic beta-blocker treatment with either metoprolol (27 patients) or propranolol (6 patients) at mean daily dosages of 110 mg and 122 mg, respectively. After 3 months the therapeutic efficacy of the beta-blocker was assessed in each patient by means of a global severity score and compared with the initial CNV recordings. The mean clinical improvement was 62%. A significant positive correlation was found between CNV amplitude before prophylaxis and the clinical response to beta-blockers: patients with higher CNV tended to respond better to therapy. Eight of 10 patients with a CNV amplitude higher than -25 microV had a more than 50% reduction of the severity score--that is, a good or excellent response to the beta-blocking agent--whereas only 2 of 9 patients with an amplitude lower than -20 microV had a good response.
Three groups of patients were compared statistically: 79 with the diagnosis psychosomatic headache' (in the strict sense of the term), 450 others whose headache was part of another disorder (termed symptomatic headache'), and 850 patients free from headache symptoms. The following characteristics were found for the group with psychosomatic headache: More psychosomatic diseases in the family, usually the eldest in birth rank, usually living in towns, married, two children, intellectual level above average, overweight, ego-strength with compulsive features, tendency towards oral abuse of different kinds, few other psychosomatic complaints (contrary to the group with symptomatic headache). In the discussion the Authors try to demonstrate the defensive function of this selective somatisation.
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Three groups of patients were compared statistically: 79 with the diagnosis "psychosomatic headache" (in the strict sense of the term), 450 others whose headache was part of another disorder (termed "symptomatic headache"), and 850 patients free from headache symptoms. The following characteristics were found for the group with psychosomatic headache: More psychosomatic diseases in the family, usually the eldest in birth rank, usually living in towns, married, two children, intellectual level about average, overweight, ego-strength with compulsive features, tendency towards oral abuse of different kinds, few other psychosomatic complaints (contrary to the group with symptomatic headache). In the discussion the authors try to demonstrate the defensive function of this selective somatisation.
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According to their own standardized Patient Data Inventory, the authors proceed to a statistical comparative evaluation of 55 males neurotic or psychosomatic hospitalized alcholics and of two control groups of non-alcoholic neurotic or psychosomatic male patients: 252 ambulatory and 72 hospitalized. The authors find significant differences between alcoholics and non-alcoholics, especially: 1 no.) heavier family history (psychoses, dysgenetic disorders), greater incidence of psychosomatic disorders in the previous history, more distrubed parental relations in childhood (maternal overprotection and lack of paternal authority); 2 no.) from the patient viewpoint: a louder expression of somatic and functionnal complaints; 3 no.) from the therapist viewpoint, less emotionality, weaker expression of aggressiveness (either overt or latent).
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