bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychopathology in Children of Patients with Panic Disorder or Animal Phobia
Authors: Unnewehr Suzan , Schneider Silvia , Florin Irmela , Margraf Jürgen
Published: April 2003

Several studies reveal a heightened risk for anxiety and other mental disorders in the offspring of patients with panic disorder and other anxiety disorders. Data on the specific type of transmitted disorders, however, are inconsistent. We investigated the specificity of the relationship between parents’ and children’s psychopathology. We assessed current and past mental disorders in 5- to 15-year-old children of patients with panic disorder (CPAN, n = 34), children of parents with no diagnosis of a mental disorder (CCON, n = 30) and children of animal phobics (CPHOB, n = 23) using a structured diagnostic interview according to DSM-III-R criteria. Diagnoses are based on parent as well as child information. CPAN and CPHOB had significantly more often at least one current mental disorder than children of the healthy control parents. Compared to CPHOB and CCON, children of panic patients had significantly more severe diagnoses and more often multiple diagnoses. Furthermore, a higher rate of internalizing anxiety disorders, particularly separation anxiety disorder, was found in CPAN. In contrast, children of animal phobics showed a higher rate of externalizing anxiety disorders. Our results suggest a specific transmission of such disorders that share common features of parental symptomatology.
The Phenomenology of Post-Traumatic Stress Disorder
Authors: Sims Andrew , Sims David
Published: April 2003

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hillsborough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.
Koro-Like Syndrome in a Bedouin Man
Authors: Witztum, Eliezer , Bersudsky, Yuly , Mayodovnik, Hanoch , Kotler Moshe
Published: April 2003

A case report is presented of a koro-like syndrome in a 34-year-old Bedouin man living in the Negev desert in Israel. The patient’s disturbance is accompanied by voyeurism and the onset appears to be related to his sexual practices. This is the first reported case among Bedouins, who are an Arab nomadic tribe living in Asia and Africa.
Ethological Remarks on Mannerisms
Authors: Brüne Martin
Published: April 2003

Mannerisms are symptoms of various psychiatric disorders. The term has not been defined thoroughly and is often confused with stereotypies or the more generally used term ‘bizarreness’. From an ethological perspective, mannerisms may be regarded as pathologically altered forms of ritualised behaviour that serve a communicative purpose. Mannerisms are maladaptive behaviours since they lead to withdrawal of and rejection by the socially interacting partner, or even induce aggressive behaviour due to the pathologically exaggerated and overdrawn appearance. The behaviour-physiology interactions of manneristic behaviour are not fully understood. Altered brain metabolism and disturbed perceptivity of social signals may be involved.
Delusion of Maternity
Authors: Hrdlička Michal
Published: April 2003

A few case reports on the delusion of pregnancy can be found in the published literature. However, the delusion of maternity, a delusional conviction of the patient that she is a mother of one or more children, has not yet been studied closely. The author describes the case of a 62-year-old childless patient with a diagnosis of chronic paranoid schizophrenia. She developed a delusion of maternity, persistent for many years. This markedly influenced her behaviour.
The Modern Assessment of Personality Disorders
Authors: Bronisch, T. , Mombour W.
Published: April 2003

Although both dimensional and categorical approaches to an assessment of personality disorders (PD) exist, only instruments for a categorical approach to the assessment of PD have been developed. The reliability of the diagnostic assessment of PD could be improved by using questionnaires, checklists, and structured interviews. However, a comparison of structured interviews among themselves and with checklists or self-rating questionnaires showed only insufficient to satisfactory agreement. Therefore, there are no instruments for the assessment of DSM-III/DSM-IV and ICD-10 PD that could be clinically and scientifically interchanged. There is an increasing tendency to a dimensional approach to the assessment of PD.
What Is Meant by ‘Misidentification’ in Delusional Misidentification Syndromes?
Authors: Murai, Toshiya , Toichi, Motomi , Yamagishi, Hiroshi , Sengok u Akira
Published: April 2003

The semantic structure of Capgras’ syndrome (CS) was analyzed within the framework of ‘the theory of reference’ of analytic philosophy to elucidate the concept of misidentification in delusional misidentification syndromes (DMS). The close relationship between the semantic structure of CS and the ordinary use of a proper name, which is not synonymous with the description but has the function of indicating an object rigidly, is shown. CS is redefined from this perspective, and a novel misidentification symptom, which we call ‘clonal pluralization of a person’, is contrasted to CS. Among so-called DMS, there are at least two types of misidentification with different semantic structures.
Recurrent Delusions of Pregnancy in a Male
Authors: Radhakrishnan R. , Satheeshkumar G. , Chaturvedi S.K.
Published: April 2003

Delusions of pregnancy in men have been reported rather infrequently. This case report is of a male schizophrenic patient who developed a delusion of pregnancy on two successive occasions each time when his wife became pregnant. The authors view briefly various aetiological hypotheses of delusions of pregnancy and whether the couvade phenomenon had any role in the origin of this delusion.
Is Schizophrenic Symptomatology Independent of the Phase of the Illness?
Authors: Nakaya M. , Suwa H. , Komahashi T. , Ohmori K.
Published: April 2003

The difference in symptomatology between the acute and post-acute phase of schizophrenia was examined in the present study using prospective and longitudinal assessment of 86 newly admitted schizophrenic patients. In the acute phase of illness, four symptom components emerged (negative symptoms, excited, delusional/hallucinatory, and thought disorder) and three components were evident (negative symptoms, mixed symptoms, and thought disorder) in the post-acute phase. The negative component in the post-acute phase had the same composition as that in the acute phase. The composition of thought disorder barely persisted over the phase of illness. These findings suggest that the negative symptom component is stable while the difference in the phase of illness has some effects on the symptom structure of schizophrenia.
Musical Hallucinations and Palinacousis
Authors: Terao Takeshi , Matsunaga Kaoru
Published: April 2003

So far, little attention has been paid to the similarities between musical hallucinations and palinacousis. Since the authors found a 75-year-old woman suffering from both symptoms, the similarities were investigated. As a result, musical hallucinations have all the four components of palinacousis structurally, although there are some differences in content. Thus, there exist substantial similarities. Moreover, both symptoms are often associated with seizure activity and there have been several case reports where anticonvulsants were successfully used to treat both symptoms. These findings indicate the possibility that there may exist a common pathway generating musical hallucinations and palinacousis.
Patterns of Parent-Reported Problems Indicative in Autism
Authors: Bölte S. , Dickhut H. , Poustka F.
Published: April 2003

Parental report Child Behavior Checklists (CBCL) of 77 male and female subjects aged 4–18 years were analyzed in this study. Individuals had been given diagnoses of autistic disorder using the Autism Diagnostic-Interview-Revised (ADI-R) within a research project on the genetics of autism. A feature of behavior problems independent of sex but influenced by age and IQ level could be identified for the autistic sample with highest relative scores on the scales measuring attention problems, social problems and thought problems and low scores on the scale for somatic complaints.
The Ethical Crisis in Psychiatry: Consequences for a Comprehensive Diagnosis and Therapeutic Practice
Authors: Kick H.
Published: April 2003

Whereas antipsychiatry left the medical concept of disease and medical institutions intact at the turn of the century, this sector was fiercely called into question in the subsequent reform efforts. The disclosure that an argumentation in terms of pure, exact science was questionable encouraged these reform efforts and cast doubt on the objectivism dominant at that time. However, in the clinical domain, it also led to a profound crisis of legitimation and thus to a crisis in psychiatry’s ethical self-conception. The absence of an integrative perspective comprising clinical theory and practice became obvious. In the future, the basic anthropological preconditions involved in a given clinical situation may serve as a guideline.
Long-Term Course and Outcome of Severe Postpartum Psychiatric Disorders
Authors: Pfuhlmann B. , Franzek E. , Beckmann H. , Stöber G.
Published: April 2003

Thirty-nine women who had suffered from a severe first-episode postpartum psychiatric illness were re-examined after a period of 6–26 years (averaging 12.5 years). Diagnoses were established according to ICD-10 and Leonhard’s classification, revealing a marked predominance of cycloid psychoses (54%) according to Leonhard. There was no evidence of the nosological independence of postpartum psychosis. Only 4 patients (10%) had never recovered fully since the onset of the illness. In contrast, 6 patients had undergone a monophasic course without any further psychopathology. In 20 cases (51%) the illness had run a multiphasic course. The average number of episodes per patient was 2.5 (range 2–6). The course was not determinable in 4 patients (10%). Nineteen women (49%) had 22 further deliveries after the first manifestation of the illness. The frequency of a relapse in connection with further pregnancy or delivery was 50%. Applying the Strauss-Carpenter Outcome Scale, we found a favourable outcome for the total sample with a mean value of 14.1 (SD = 2.6). The vast majority of patients (75%) showed no persistent alterations. Our findings provide further evidence of a favourable prognosis of severe postpartum psychiatric disorder despite the remarkably high rate of puerperal relapses.
Comparison of Delusions among Schizophrenics in Austria and in Pakistan
Authors: Stompe T. , Friedman A. , Ortwein G. , Strobl R. , Chaudhry H.R. , Najam N. , Chaudhry M.R.
Published: April 2003

One of the central purposes of cross-cultural psychiatry is to scrutinize the sociocultural influences on the phenomenology of psychiatric diseases. On the other hand it is possible to lay bare a nucleus of symptoms, common to all cultures, which, independently of all influences, occupies a central position for an understanding of the disease considered. In this study an attempt was made to approach this problem by means of investigating the contents of delusion of schizophrenic patients in Austria and Pakistan. The contents of delusion among 126 Austrian and 108 Pakistani patients diagnosed as having schizophrenia according to DSM-III-R (art. 295) were compared following the classification of Huber and Gross. Additionally the kind of persecution and the type of the persecutor were registered. However it appeared that only a few contents of delusion are frequent in both countries. In both countries persecution was the most frequently mentioned content of delusion. The comparison of the contents of delusion revealed significantly higher frequencies of delusions of grandeur, guilt and religious delusions in Austrian patients. Significant differences could also be found with the kind of persecution and the persecutor’s type. Cultural factors seem to have a decisive influence on shaping the contents of delusion.
Demonic Attributions in Nondelusional Disorders
Authors: Pfeifer Samuel
Published: April 2003

Objective: Belief in demonic influence has repeatedly been described as a delusion in schizophrenic patients. The goal of this explorative study was to examine the frequency, as well as the psychodynamic and social functions of such beliefs in a sample of nondelusional patients. Method: The sample consisted of 343 psychiatric outpatients who described themselves as religious. In semistructured interviews they were asked to give their view of demonic causality of their illness. Results: A high prevalence of such beliefs was not only found in schizophrenic patients (56%) but also in the following groups of nondelusional patients: affective disorders (29%), anxiety disorders (48%), personality disorders (37%) and adjustment disorders (23%). Belief in demonic oppression tended to be associated with lower educational level and rural origin, and was significantly influenced by church affiliation. Conclusions: Beliefs in possession or demonic influence are not confined to delusional disorders and should not be qualified as a mere delusion. Rather they have to be interpreted against the cultural and religious background which is shaping causal models of mental distress in the individual.
Non-Right-Handedness and Obstetrical Complications in Paranoid Hallucinatory Schizophrenics
Authors: Sperling Wolfgang , Martus Peter , Barocka Arnd
Published: April 2003

In previous studies a link between pregnancy complications, minor physical anomalies and non-right-handedness was described in schizophrenic patients. There is evidence of an anomaly in the lateralization process in schizophrenia. Many studies of handedness and schizophrenia have found that schizophrenic patients have an increased rate of non-right-handedness compared with normal subjects. The contemporary neurodevelopmental hypothesis of schizophrenia emerged from pathobiological findings. In addition there is evidence for early brain lesions and malformations in fetal brain development. Especially pregnancy and birth complications have been found to be a risk factor for the later development of schizophrenia. In this study we set out to test the possible association between diagnosis and handedness, diagnosis and risk factors, as well as gender and handedness for 60 patients (30 men, 30 women) and 60 controls. The percentage of non-right-handedness was significantly elevated in the patient group (p = 0.0025). In a gender-specific analysis this result could be confirmed only for male patients. Peri- and postnatal developmental risk factors were significantly elevated in schizophrenics compared with controls. The percentage of all risk factors in the male group of schizophrenic non-right-handers was significantly elevated compared with right-handed male schizophrenics.
Sibling Orders of Schizophrenic Patients in Austria and Pakistan
Authors: Stompe T. , Ortwein-Swoboda G. , Friedmann A. , Chaudhry H.R.
Published: April 2003

The influence of siblings on the socialization of the individual has been recognized as a fact by both psychology and sociology. The significance of sibling order for the outbreak of psychiatric diseases on the other hand is still discussed controversially. In our study, we compared the expected values and the positions actually found in the sibling order of 379 (233 males, 146 females) Austrian and 144 (101 males, 43 females) Pakistani patients diagnosed with schizophrenia according to DSM-IV (295). The position in the sibling order had no influence on the outbreak of schizophrenia in Austria; with Austrian schizophrenics, the results found were very near to the expected values. In Pakistan on the other hand, the eldest brothers from families with 2–4 siblings had a significantly higher risk of falling ill. The investigation of the composition of the sibships of schizophrenic patients also showed a high overrepresentation of men in the firstborn position in Pakistan. These facts seem to exercise influences that may either protect against the outbreak or encourage it. The differences found agree well with the fact that in Pakistan, both the gender of a child and the position in the sibling order entail different ways of treatment and different scopes of responsibility. Socialization in Austria on the other hand, at least in the recent decades, has become very uniform for both sexes, regardless of the sibling position.
Study of the Onset of Autism through Home Movies
Authors: Maestro S. , Casella C. , Milone A. , Muratori F. , Palacio-Espasa F.
Published: April 2003

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis.
Recurring Short Delirium with Postpartum Onset in Two Sisters
Authors: Sieche Angelika , Giedke Henner
Published: April 2003

We report on a 30-year-old woman who twice developed a short postpartum psychosis with organic signs, but without obvious organic cause. Extensive investigations only yielded a state of moderate hypercoagulability. Her sister had developed similar signs and symptoms during her second puerperium and died 5 days after her delivery. We discuss the combination of various precipitating factors for postpartum psychosis, the possible impact of the findings on its cause and its classification.
Cognitive Dysfunction at Baseline Predicts Symptomatic 1-Year Outcome in First-Episode Schizophrenics
Authors: Moritz Steffen , Krausz Michael , Gottwalz Evelin , Lambert Martin , Perro Christian , Ganzer Stefanie , Naber Dieter
Published: April 2003

The present study addresses the consequences of cognitive disturbances on symptomatic outcome. Fifty-three first-episode schizophrenics were reassessed (n = 32) 1 year after admission. Simple regression analyses revealed that several self-perceived cognitive deficits at baseline as measured with the Frankfurt Complaint Questionnaire significantly predicted increased Brief Psychiatric Rating Scale global scores at follow-up (p = 0.05 to p = 0.005). A stepwise regression analysis proved memory dysfunction to be the strongest predictor of symptomatic worsening (p = 0.005). It is suggested that the exploration and treatment of neuropsychological deficits in schizophrenia is of great clinical importance with regard to its impact on both functional and symptomatic outcome in schizophrenia.
Magico-Religious Beliefs in Schizophrenia: A Study from North India
Authors: Kulhara Parmanand , Avasthi Ajit , Sharma Avneet
Published: April 2003

Psychiatric disorders in India are often attributed to influence of supernatural phenomena, and many patients are subjected to various kinds of ‘magico-religious’ treatments. We studied 40 cases of schizophrenia and ascertained magico-religious beliefs held by their key relatives. The effects of such magico-religious beliefs on psychopathology and treatment-seeking behaviour were explored. The sample were schizophrenia patients diagnosed according to ICD-10 of the World Health Organisation. Psychopathology was assessed on the 9th version of the Present State Examination (PSE-9). Supernatural Attitude Questionnaire was administered to the key relatives of the patients to ascertain their beliefs about various supernatural phenomena and magico-religious treatments. It was observed that the majority of the patients had undergone magico-religious treatment (n = 23). Nearly 74% of the patients who had symptoms coloured by cultural influences such as delusional explanation in terms of paranormal phenomena had undergone magico-religious treatment. It was also seen that though many relatives denied personal conviction in such magico-religious beliefs, yet they sought some kind of magico-religious treatment for the patients. The prevalence of culturally influenced delusions as defined by the PSE-9 was very low. Belief in supernatural influences is common in patients’ relatives from urban background and with adequate education, and treatment based upon such beliefs is sought to a considerable extent in such cases. Local and community belief in such phenomena appeared to be a factor in influencing the decision to seek magico-religious treatment.
Patterns of Comorbidity among DSM-III-R Personality Disorders
Authors: Marinangeli M.G. , Butti G. , Scinto A. , Di Cicco L. , Petruzzi C. , Daneluzzo E. , Rossi A.
Published: April 2003

The aim of this study was to examine patterns of comorbidity among personality disorders (PDs) in a sample of 156 psychiatric inpatients. PDs were assessed with Semistructured Clinical Interview for DSM-III-R Personality Disorders. To determine significant co-occurrence among axis II diagnoses, odds ratio and the percent of co-occurrence of pairs of disorders were calculated. Both statistical methods revealed high rates of comorbidity: significance association was found for 36 pairs of disorders using the percent of co-occurrence, and for 22 pairs of disorders using the odds ratio. These results support the concept of ‘apparent comorbidity’ for most PDs, deriving from conceptual and definitional artifacts or from a ‘state-biasing effect’. In light of these observations, a categorical approach to PDs, resulting in a list of diagnoses, appears useless in psychiatric practice. A dimensional classification is probably better suited for PDs, improving the understanding of personality psychopathology and its clinical implications.
Use of the ICD-10 Classification in Psychiatry: An International Survey
Authors: Müssigbrodt H. , Michels R. , Malchow C.P. , Dilling H. , Munk-Jørgensen P. , Bertelsen A.
Published: April 2003

On the background of some years of experience with ICD-10 psychiatric diagnoses in many countries of the world, an international comparison was performed to evaluate the frequency and use of the ICD-10 psychiatric diagnoses. For future revision of the ICD-10, it is important to know which diagnostic categories are either not used or are used possibly in an unspecific manner. Nineteen departments of psychiatry in 10 different countries took part in the study, presenting data on 33,857 treatment cases leading to a total of 25,470 ICD-10 main diagnoses. The analysis of data reveals that on a four-character level (Fxx.x), the 10 most often used diagnostic categories represent 40% of all main diagnoses, and 70% on a three-character level (Fxx.–). There are 32 specific diagnostic categories on a four-character level which are not used at all and 121 which are used less frequently than 0.1% in inpatient and outpatient treatment. The study shows that the ICD-10 classification is in use in a variety of treatment settings worldwide. Further results and limitations of this study are discussed against the background of transcultural differences.
Polythetic Diagnostic Approach to the Borderline Personality Disorder
Authors: Burgmer Markus , Jessen Frank , Freyberger Harald J.
Published: April 2003

The present study addresses the question whether the polythetic approach of ICD-10 and DSM-IV is useful in clinical practice for the diagnosis ‘Borderline’ personality disorder (BPD). A questionnaire containing all individual criteria for the 9 personality disorders and the schizotypal disorder used by the ICD-10, completed by the DSM-IV criteria for the BPD not covered by the ICD-10, was developed. Eight hundred therapists were asked to mark the importance of every single criterion for forming the diagnosis or for ruling out BPD. Our data analysis of the received questionnaires performed a rankscore based on an altered calculation of the mean value. The criteria which described the patients’ instability in relationship and mood, and identity disturbances were seen as the most important features for the diagnosis of BPD. The criterion of cognitive disturbances, newly introduced in DSM-IV, was not felt to be a major clinical feature. In conclusion, our study reflects the results of other authors in the sense that a single criterion cannot be considered pathognomonic for BPD, but has greater importance and a higher priority in establishing the diagnosis BPD. This should be taken into account to reconsider the polythetic concept in favor of a hierarchical approach with core criteria.
When to Get Mad: Adaptive Significance of Rage in Animals
Authors: Camperio Ciani Andrea
Published: April 2003

The wide distribution of rage in animals suggests that rage should have an adaptive significance. In the present work, the function of rage is explored under an evolutionary perspective. I try to assess the selective advantage conferred to the individual presenting rage compared to one that does not. In this work, I considered animals under the ‘strategist’ perspective rather than the ‘stimulus-reactor’ one. I suggest that rage has a highly adaptive significance both as: (1) an emotion to prepare antagonistic actions and (2) as a communicative act. I suggest therefore that, as a communicative act, rage can be explored through the theory of games. In three crucial scenarios, I investigate, using the theory of games framework, when, and how, there is a selective advantage for individuals expressing, bluffing and simulating rage.
Paranoia and Dysphoria: Historical Developments, Current Concepts
Authors: Schanda Hans
Published: April 2003

Regarding diagnostic criteria for paranoia (delusional disorder) today psychiatry usually refers to Kraepelin, suggesting that this diagnostic category has existed more or less unchanged since the end of the 19th century. But, reviewing German literature on this topic, one can find a lively discussion with regard to definition, development and course. In this context, the position of affective symptomatology – especially dysphoria with its various meanings – is of major interest. This paper aims at clarifying some definitory questions and at recalling the ‘old’ paranoia dispute which is worth rediscovering as a stimulation for modern classification and clinical practice.
Dysphoria and Aloneness in Borderline Personality Disorder
Authors: Pazzagli Adolfo , Monti Mario Rossi
Published: April 2003

A close examination of dysphoria, anger and aloneness (three main characteristics of the borderline syndrome) provides a theoretical model of reference for the therapist. Dysphoria results from the cyclical emotional oscillation between hope for stability and disappointment in its inattainability; a dependent-anaclitic depression arises from the mixture of anger, aloneness and inner emptiness which is so characteristic of the borderline syndrome. The tendency to be immersed in the here-and-now, an intra-festum mentality, exacerbates the sense of isolation, causing more irritation, mute frustration and, consequently, anger. The effects and ramifications of anger, and the resultant precarious cohesion of the self, are explored in the borderline syndrome; they are especially illuminated by the application of Kernberg’s pain-anger-hate-vengefulness cycle concept. Meanings of solitude, in its forms of aloneness and loneliness, are explored in their pertinence. Aloneness – the constant needy search for, but condemnation to never finding, objects to fill an inner sense of emptiness – is especially germane. Suggestions for assisting subjects with borderline personality disorder to overcome aloneness and the lack of historical progression are made.
Anger and Narcissism: Between the Void of Being and the Hunger for Having
Authors: Muscatello Clara F. , Scudellari Paolo
Published: April 2003

The borderline syndrome, a typical marginal structure, is certainly a specific, autonomous pathology, with its own distinctive characteristics: among them, acting out, cyclical repetition of events without historical progression and anaclitic depression. Kohut’s concept of ‘narcissistic hunger’ is particularly pertinent to the borderline condition: the borderline patient hungers to have that which is missing in his being. Through the application of the related notions of ‘tragic man’, ‘self objects’, ‘grandiose self’, and ‘damaged self’, the authors further develop their theory that the borderline syndrome has much in common with paranoid personalities.
Depressive Symptomatology and Short-Term Stability at a Nigerian Psychiatric Care Facility
Authors: Otote David I. , Ohaeri Jude U.
Published: April 2003

The aims of the study were to examine: the frequency of the subtypes and symptoms of depression, the stability of symptoms in 3 months and to compare the data with previous studies. Ninety-six consecutive patients (31 males, 65 females) fulfilling ICD-10 criteria were assessed. Compared with the WHO study, the core symptoms of depression were similar; pathological guilt and suicidal behaviour were less prevalent, and psychoticism was more prevalent. Overall, 61.5% had severe depression, 64.6% had somatic syndrome, and subjects were in remission at follow-up. The results were similar to those of a report from the hospital 26 years earlier. The purported rarity of guilt, self-depreciation, suicide and psychotic symptoms should not imply rarity of severe depression among Africans; for these are not its commonest symptoms.
Prescription of Medications by Primary Care Physicians in the Light of Asthma Guidelines
Authors: Gourgoulianis K.I. , Hamos B. , Christou K. , Rizopoulou Despina , Efthimiou A.
Published: April 2003

The purpose of this study was the evaluation of the extent of dissemination of asthma guidelines among primary health care physicians in Greece. Sixty-five of 80 primary care physicians (response rate 80.2%) answered a questionnaire about asthma morbidity, manner of choice of treatment and asthma management plans. One out of 12 patients who were examined by a primary care physician suffered from bronchial asthma. Forty-two physicians treated their asthma patients according to the pulmonologist’s recommendations, and only 15 prescribed asthma treatment according to asthma guidelines. β2-agonist inhalers and theophylline tablets represent 41% of all prescribed medicines in asthma and corticosteroid inhalers 24% of medications. Eight physicians prescribed theophylline as the first and 20 physicians corticosteroid inhalers as the third choice of medication in asthma treatment. Consequently, the prescription of β2-agonist inhalers and theophylline tablets seems to be higher than asthma guidelines recommend. Better dissemination of guidelines among specialists and primary health care physicians will hopefully make asthma management optimal.
Hypoxic Ventilatory Responses and Gas Exchange in Patients with Parkinson’s Disease
Authors: Serebrovskaya T. , Karaban I. , Mankovskaya I. , Bernardi L. , Passino C. , Appenzeller O.
Published: April 2003

Ventilatory responses to isocapnic, progressive hypoxic rebreathing (HVR), in supine and sitting positions, lung ventilation and gas exchange while breathing air and during 5 min of breathing 11% O2 in N2 were studied in 12 healthy young (20–28 years), 5 old (57–73 years) male subjects, and in 7 male patients with Parkinson’s disease (PD) aged 55–67 years. The piecewise linear approximation technique was used for evaluation of the ventilatory response curves, which allowed a separate analysis of slopes during minor and severe hypoxia. It has been shown that body position affected HVR. In the range of PETO2 from 60 to 35 mm Hg, the ventilatory response in the sitting position was higher than supine: in young persons by 43%, in healthy old persons by 76%, and in the PD patients by 211%. No significant differences in HVR to minor hypoxia (PETO2 from 100 to 60 mm Hg) were found in the 3 groups. During severe hypoxia (PETO2 from 60 to 35 mm Hg) the slope of minute ventilation versus O2 was 4.6 (supine) and 2.6 (sitting) times greater in healthy old men than PD patients’ slopes. PD patients compared to old controls had 32% lower alveolar ventilation, 10% lower PETO2 and 15% elevation of PETCO2 while breathing air; similar differences were found while the patients were breathing 11% O2. The reduced alveolar ventilation under severe hypoxia in patients with PD could not be attributed to mechanical restriction of lung function. We suggest that the discrepancy in HVR under minor and severe hypoxia results from dysfunction in chemoreception associated with Parkinsonism.
Effects of Inhalation of Nitroglycerin on Hypoxic Pulmonary Vasoconstriction
Authors: Bando Masashi , Ishii Yoshiki , Kitamura Satoshi , Ohno Shoji
Published: April 2003

Recent studies suggest that nitric oxide (NO) may play an important role in the pathophysiology of pulmonary hypertension. Nitroglycerin is metabolized to NO, which is a potent vascular smooth muscle relaxant. The aim of the present study was to compare the effects of inhaled and infused nitroglycerin on pulmonary hemodynamics and gas exchange in anesthetized, artificially ventilated dogs. Nitroglycerin was administrated either by inhalation or by infusion. Systemic blood pressure (SBP), pulmonary arterial pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured, and cardiac output was estimated by an electromagnetic flowmeter. Blood gas measurements were performed during hypoxic gas exposure (FiO2; 0.1) with a continuous inhalation or infusion of nitroglycerin (1, 2.5 µg/kg/min). Inhaled (n = 4) and infused (n = 4) nitroglycerin (1 µg/kg/min) did not produce any detectable effects on the hemodynamics. Inhaled nitroglycerin (2.5 µg/kg/min) reduced SBP, PAP and calculated pulmonary vascular resistance (PVR) in all dogs. Cardiac output did not change. In addition, inhaled nitroglycerin increased PaO2. In contrast, the continuous infusion of nitroglycerin (2.5 µg/kg/min) did not change in PAP, whereas infused nitroglycerin decreased the mean SBP. Infused nitroglycerin did not alter cardiac output and calculated PVR. A decreased PaO2 was noted in 2 dogs on nitroglycerin infusion. These findings indicate that inhaled nitroglycerin effects the pulmonary circulation relatively more than infused nitroglycerin, which tends to have more of a general effect on the systemic circulation. The effects of inhaled nitroglycerin may thus be comparable to the effects of NO inhalation.
CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses
Authors: Bilaçeroğlu Semra , Kumcuoğlu Ziya , Alper Hüdaver , Osma Emine , Çağırıcı Ufuk , Günel Özden , Bayol Ümit , Çelikten Emel , Perim Kunter , Köse Timur
Published: April 2003

CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2–5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third–fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.
Bi-Level Positive Airway Pressure Treatment of Obstructive Sleep Apnoea Syndrome
Authors: Laursen Søren Bjørn , Dreijer Bjørn , Hemmingsen Claus , Jacobsen Erik
Published: April 2003

We evaluated the effect of non-invasive nocturnal ventilation with the bi-level positive airway pressure (BiPAP) ventilator in 12 overweight patients with verified obstructive sleep apnoea syndrome (OSAS) and nocturnal hypercapnia. All patients exhibited subsequently less overnight CO2 accumulation (p < 0.0001), the desaturation event frequency was reduced (p < 0.002), daytime O2 tension rose (p < 0.001), daytime CO2 tension was reduced (p < 0.01), and apnoeas were eliminated. All symptoms characterising the syndrome, when present at the beginning of the therapy, were eliminated during the treatment. Patient compliance was high. This study showed that OSAS patients with hypercapnia can be effectively treated by BiPAP ventilation during sleep.
Use of Whole-Body Plethysmography to Compare Bronchodilator Inhaler Efficacy
Authors: Morice A.H. , Waterhouse J.C. , Peers E.M. , Parry-Billings M.
Published: April 2003

Whole-body plethysmography is not included in guidelines from regulatory authorities for the development of treatments or delivery devices for lung disease, despite its potential advantages compared to spirometry. Two separate studies were undertaken to assess the use of specific airway conductance (sGaw) as a pharmacodynamic endpoint for the comparison of two bronchodilator delivery systems (a novel dry powder inhaler and a standard metered dose inhaler). The first pilot study involved delivery of a single dose of salbutamol (200 µg) to 12 healthy volunteers and determination of sGaw up to 120 min after treatment. The second study involved delivery of cumulative doses of salbutamol (100, 200 and 400 µg) to 19 healthy volunteers with demonstrated reversibility of sGaw to the bronchodilator and measurement of sGaw up to 240 min after treatment. In both studies, increases in sGaw after treatment were significant compared to placebo and larger than the recorded increases in FEV1. Increases in sGaw were similar for both delivery devices and support the therapeutic equivalence of the two products. Power calculations indicated that the second study had appropriate statistical power to discriminate between treatments. It is concluded that the assessment of sGaw in healthy volunteers may be a useful and sensitive pharmacodynamic endpoint for use in the development of bronchodilators and their delivery devices.
Pulmonary Function and Regional Distribution of Emphysema as Determined by High-Resolution Computed Tomography
Authors: Haraguchi Masahiko , Shimura Sanae , Hida Wataru , Shirato Kunio
Published: April 2003

In patients with pulmonary emphysema, emphysematous changes are not uniform and vary from minimum alveolar destruction to advanced bullous formation, depending on the lobe or site in the lungs. However, we have little knowledge on whether or how this nonuniformity or localization affects pulmonary function in PE patients. Therefore, we measured the computed tomography (CT) density of divided sites in lungs with high-resolution CT images from 25 PE patients (FEV1.0%, mean ± SD 36 ± 9%, %DLCO 48 ± 16%, all men, 68 ± 4 years) and compared them to various parameters of pulmonary function. The mean CT density of whole lungs correlated with 12 pulmonary function parameters including FEV1.0 and diffusion capacity. When both lung fields were divided into peripheral, intermediate and central portions, the CT density of the central portion correlated with all pulmonary function parameters with which CT density of whole lungs correlated. In contrast, the CT density of the peripheral portion significantly correlated with only 7 parameters with smaller correlation coefficient values than those of the central portion. When divided into upper, middle and lower portions, the CT densities of upper, middle and lower portions correlated with 6, 8 and 10 of the 12 pulmonary function parameters which correlated with the density of whole lungs, respectively. The delta value of CT densities between the upper and lower portions or between the lateral and medial portions correlated with obstructive impairment (FEV1.0 and FEV1.0%). These findings suggest that (1) central rather than peripheral emphysematous changes affect pulmonary function, and (2) uniformity of emphysematous change correlates with the severity of airway obstruction in PE patients.
Paradoxical Pleural Response to Antituberculous Chemotherapy and Isoniazid-Induced Lupus
Authors: Hiraoka Katsumi , Nagata Nobuhiko , Kawajiri Tatsunori , Suzuki Kazumasa , Kurokawa Susumu , Kido Masamitsu , Sakamoto Nobuo
Published: April 2003

Among 28 inpatients receiving antituberculous chemotherapies including isoniazid (INH) and rifampicin, we found 2 patients with newly developing pleural effusion in the hemithorax during the initial phase of successful chemotherapy. The analysis of the effusion fluids revealed an elevated level of antinuclear antibody and a decreased level of total component, which are findings compatible with lupus pleuritis. The peripheral lymphocyte stimulation test using INH was positive in 1 patient. To the best of our knowledge, there has been no published disussion of the relationship between a paradoxical response to antituberculous treatment and INH-induced lupus.
Intramural Bronchogenic Cyst of the Oesophagus: A Rare Entity
Authors: Kollias Vasilios D. , Panagiotides Hercules C. , Kantidakis George H. , Charonis Constantinos G.
Published: April 2003

Bronchogenic cysts are congenital cystic lesions of foregut origin, usually intrapulmonary or mediastinal in location. Peri-oesophageal bronchogenic cysts are rare, while intra-oesophageal cysts are almost always considered as enterogenous owing to their location and their composition. We report here an unusual case of a young adult with an intramural bronchogenic cyst causing dysphagia. Despite the fact that the cyst was completely embedded in the oesophageal wall, the pathological findings revealed the respiratory origin of the cyst. An extramucosal excision of the cyst was performed establishing the diagnosis and alleviating all our patient’s symptoms.
Diffuse Pulmonary Hemosiderosis after Exposure to Pesticides
Authors: Kayser Klaus , Plodziszewska Monika , Waitr Elzbieta , Slodkowska Janina , Altiner Mithat , Gabius Hans-Joachim
Published: April 2003

This report describes the clinical, radiological, microscopical and ligandohistochemical findings in a 17-year-old woman who suffered from an acute onset of pulmonary hemosiderosis after inhalation of pesticides used for the cultivation of strawberries. She complained of headache, dyspnea, rhinitis, weakness and recurrent severe hemoptysis. Chest radiographs revealed bilateral patchy infiltrates, predominantly in the lower parts of both lungs. The consecutive severe anemia was treated by multiple blood transfusions which were repeated every 4–5 days. Open lung biopsies displayed signs of diffuse hemorrhage with hemosiderin-loaded macrophages, some hyaline membranes, focal fibroid deposits with intermingled histiocytes, mild interstitial fibrosis and focal intra-alveolar calcified bodies surrounded by foreign body giant cells. Analysis of endogenous lectins failed to demonstrate expression of binding capacities for maltose, fucose, mannose, lactose and sialic acid. Neither binding capacities for the macrophage-migration-inhibitory factor nor its presence, as analyzed by labeled sarcolectin, could be detected histochemically. The light microscopical findings are consistent with a longer-lasting diffuse pulmonary hemosiderosis; the presence of calcified bodies and foreign body giant cells (including the ligandohistochemical data) argues for a causal role of inhaled substances. The patient’s clinical course improved after cyclophosphamide treatment, which restored her ability to work and released her from the need for recurrent blood transfusions.
Pulmonary Infiltrate in an Asymptomatic Kidney Donor
Authors: Tamm Michael , Dalquen Peter , Solèr Markus
Published: April 2003

A 61-year-old man with a smoking history of 30 pack-years, but no relevant disease was evaluated for kidney donation to his wife, who suffered from end-stage renal disease. Routine testing before kidney donation consisted of the patient’s history, laboratory measurements, ECG, ultrasound of the abdomen and a chest X-ray. The leukocyte number, hemoglobin level and platelet count in the blood were normal. Laboratory parameters including C-reactive protein, serum creatinine, liver enzymes and the lipid profile were also within the normal range.
Cytokine Responses in Patients with Pneumonia Caused by Chlamydia or Mycoplasma
Authors: Kragsbjerg Peter , Vikerfors Tomas , Holmberg Hans
Published: April 2003

The serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were measured by enzyme immunoassays in 44 patients with Chlamydia (n = 13) or Mycoplasma (n = 14) pneumonia or influenza A infection (n = 17) and in 20 control subjects. The levels of IFN-γ were raised in 29/44 patients. The concentrations of IL-6 were raised in 32/44 patients. Raised levels of TNF-α were seen in 26/44 but there was no significant difference between the levels of the different groups of patients. All three cytokines indicated clinical recovery when acute and convalescent samples from 10 patients with Chlamydia pneumonia were analyzed. IFN-γ, IL6 and TNF-α are present in the circulation in the majority of patients with Chlamydia and Mycoplasma pneumonia and in influenza A infection. We suggest that repeated measurement of cytokines, such as IL-6, IFN-γ and TNF-α, may be useful in the management of lower respiratory tract infections but further studies are needed to define the value of cytokine measurements in acute pneumonia.