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A patient with Gilles de la Tourette syndrome and severe self-injurious compulsions who had failed to respond to drug treatment and behavioural therapy obtained a complete and sustained resolution of his destructive behaviour and improvement in his tics following bilateral limbic leucotomy.
Two different neurobehavioural abnormalities have been reported under the term hypergraphia. One has been described in temporal lobe epilepsies and the other in the acute stage of strokes of the right cerebral hemisphere. The latter type of hypergraphia in a patient with a metastatic brain tumour confined to the right hemisphere is reported. Such hypergraphia is a general right hemisphere sign that is not peculiar to strokes in the acute stage and the writing behaviour is inattentive.
Fifteen patients with epilepsy and hypergraphia were compared with 32 patients with epilepsy but without hypergraphia. The number of previous psychiatric episodes, the number of Washington Psychosocial Seizure Inventory (WPSI) items indicating emotional maladjustment, and the number of CT scan abnormalities were significantly greater in the hypergraphic patients than in the non-hypergraphic patients. Cognitive performance, EEG laterality and the scores of WPSI items related to the psychological stress of seizures did not differ significantly between the two groups. Hypergraphia reflects changes in emotional responsiveness secondary to organic temporal lobe lesions.
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Chronic primary polydipsia (POLY) in humans is associated with impaired urinary concentrating ability. However, the molecular mechanisms responsible for this finding have not been elucidated. The purpose of this study was to examine the effect of chronic primary POLY on water metabolism and renal aquaporin (AQP) water channels and sodium and urea transporter abundance in rats. Primary POLY was induced in male Sprague-Dawley rats by daily administration of 15 g powdered rat chow mixed in 100 ml water for 10 days. Control rats (CTL) received 15 g powdered rat chow per day and ad libitum drinking water. Rats were studied following this period before further intervention and with a 36-h period of water deprivation to examine maximal urinary concentrating ability. At baseline, POLY rats demonstrated significantly greater water intake (100 +/- 1 vs. 22 +/- 2 ml/day, P < 0.0001) and urinary output (80 +/- 1 vs. 11 +/- 1 ml/day, P < 0.0001) and decreased urinary osmolality (159 +/- 13 vs. 1,365 +/- 188 mosmol/kgH2O, P < 0.001) compared with CTL rats. These findings were accompanied by decreased inner medulla AQP-2 protein abundance in POLY rats compared with CTL rats before water deprivation (76 +/- 2 vs. 100 +/- 7% CTL mean, P < 0.007). With water deprivation, maximal urinary osmolality was impaired in POLY vs. CTL rats (2,404 +/- 148 vs. 3,286 +/- 175 mosmol/kgH2O, P < 0.0005). This defect occurred despite higher plasma vasopressin concentrations and similar medullary osmolalities in POLY rats. In response to 36-h water deprivation, inner medulla AQP-2 protein abundance was decreased in POLY rats compared with CTL rats (65 +/- 5 vs. 100 +/- 5% CTL mean, P < 0.0006). No significant differences were noted in renal protein abundance of either AQP-3 or AQP-4 or sodium and urea transporters. We conclude that the impaired urinary concentrating ability associated with primary POLY in rats is due to impaired osmotic equilibration in the collecting duct that is mediated primarily by decreased AQP-2 protein abundance.
BACKGROUND: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. METHOD: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. RESULTS: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. CONCLUSIONS: The consistency of relationship patterns seems to be connected with the severity of psychopathology.
The relation of ABO blood types to obsessional personality traits, as measured by the Leyton Obsessional Inventory (LOI), was studied in a sample of 600 normal individuals. High scorers of the LOI trait portion demonstrated a significantly lower incidence of phenotype O and a significantly higher incidence of phenotypes AB, A and B, taken together, compared to those of a general population sample and the entire study group. Findings of the present study, in conjunction with previous findings concerning a lower incidence of phenotype O and a higher incidence of phenotype A in obsessive compulsive patients, could be interpreted as indicating that phenotype O may be associated with personality traits hindering the development of obsessive-compulsive symptomatology.
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61 patients suffering from chronic pancreatitis were studied in order to clarify the psychosomatic aspects of this disease. They were classified into 5 types, out of which 3 types were examined in detail according to their personality traits and life habits. It was found that the mind-body relationship took the primary form in the psychosomatic and neurotic types, while in the organic type it took the secondary form such as distorted life habits. This finding indicated that the distortion in the personality structure and that of life habits were closely interrelated. The authors also discussed the clinical features of chronic pancreatitis from the standpoint of alexithymia. The patients with the organic type were most alexithymic, which were followed by the psychosomatic type. It was learned that alexithymic problems were reflected in the patients' life habits.
Stresses of medical practice, recognized as severe, do not increase physical morbidity and mortality of physicians but are know to have deleterious effects upon their mental well-being. This has been documented by a study of 100 physicians reported by the author previously. The hypothesis of motivation for the choice of medical profession as a vocation was explored from the point of view of personality vulnerability due to reaction formation to the fear of death and resulting compulsivity. In search of validity of vulnerability a study was undertaken on 50 lawyers residing in the same community as the studied physicians. A structured interview identical to the one used in the study of physicians was employed and computer analyzed. Results of this comparative study are reported in the current presentation.
Certain gouty subjects with excessive de novo purine synthesis are deficient in hypoxanthineguanine phosphoribosyltransferase (HG-PRTase [EC 2.4.2.8]). The mechanism of accelerated uric acid formation in these patients was explored by measuring the incorporation of glycine-(14)C into various urinary purine bases of normal and enzyme-deficient subjects during treatment with the xanthine oxidase inhibitor, allopurinol. In the presence of normal HG-PRTase activity, allopurinol reduced purine biosynthesis as demonstrated by diminished excretion of total urinary purine or by reduction of glycine-(14)C incorporation into hypoxanthine, xanthine, and uric acid to less than one-half of control values. A boy with the Lesch-Nyhan syndrome was resistant to this effect of allopurinol while a patient with 12.5% of normal enzyme activity had an equivocal response. Three patients with normal HG-PRTase activity had a mean molar ratio of hypoxanthine to xanthine in the urine of 0.28, whereas two subjects who were deficient in HG-PRTase had reversal of this ratio (1.01 and 1.04). The patterns of (14)C-labeling observed in HG-PRTase deficiency reflected the role of hypoxanthine as precursor of xanthine. The data indicate that excessive uric acid in HG-PRTase deficiency is derived from hypoxanthine which is insufficiently reutilized and, as a consequence thereof, catabolized inordinately to uric acid. The data provide evidence for cyclic interconversion of adenine and hypoxanthine derivatives. Cleavage of inosinic acid to hypoxanthine via inosine does not contribute significantly to the formation of uric acid in either normal man or in patients with HG-PRTase deficiency.HG-PRTase was not completely absent in red blood cells from a boy with the Lesch-Nyhan syndrome; with hypoxanthine as substrate, the activity in erythrocyte hemolysates was 0.64% of normal values.
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Explore the source record for details and available documents.
Nineteen subjects completed a 12-week double-blind crossover study comparing phenytoin with placebo in the treatment of severe binge eating. In the placebophenytoin sequence the number of binges decreased during phenytoin treatment from both placebo and pretreatment levels. However, in the phenytoin-placebo sequence, not only did phenytoin reduce the number of binges from pretreatment levels, but there was no reversal of this effect during the placebo period. This sequential effect was unexpected and is still unexplained. The mechanism of phenytoin action and the significance of EEG abnormalities found in 7 of the subjects remain uncertain.