Unusual visual symptoms and Ganser-like state due to cerebral injury: a case study using (18)F-deoxyglucose positron emission tomography

Bizarre visual symptoms and absurd verbal responses to questions, in a 32-year-old man recovering from a severe asthma episode, suggested a possible conversion disorder with Ganser-like symptoms. Positron Emission Tomography (PET)revealed bilateral lesions involving occipital association cortex and posterior temporal and parietal lobes, most likely infarcts from hypoxia. PET permitted correlation of the patient's specific cortical lesions with his unusual perceptual, cognitive, and speech symptoms, including Ganser-like state, to a degree not previously possible in such cases.     

Mitochondrial myopathy complicated by eating disorder: a case report highlighting the potential interaction of genetic, metabolic, and psychodynamic factors

A case is presented of a 56-year-old woman with a history of an eating disorder that preceded recognition of a mitochondrial myopathy. The possibility exists that her eating disorder was causally related to a more fundamental defect in mitochondrial oxidative metabolism. This case report highlights the phenotypic variability of mitochondrial myopathies. An increased risk of eating disorder may be associated with drugs that interfere with mitochondrial oxidative respiration.     

Mesothalamic discharge in a chronic pain,allergy and fluid retention syndrome (case report)

A 32-year-old woman was bedridden for a year because of chronic pain and headaches. She had insomnia, depression, suicidal thoughts and a severe chemical allergy. She had been on steroid therapy for two years and became Cushingoid with striae in the arm pits, groins and abdomen. However, she had no hypertension, nor the buffalo fat and hirsutism. She was very edematous, with a weight gain from 112 to 180 lbs. The fluid retention did not conform to the syndrome of inappropriate antidiuretic hormone. Studies revealed abnormal scalp EEG discharges and high-voltage seizure discharges in the posterior thalamus. Electrothalamic stimulation suppressed the thalamic discharges and relieved the patient’s pelvic pain and headaches. After one month of several thalamic stimulations per day, she was able to get out of bed and ambulate. In addition, the patient no longer was edematous and was tolerating perfumes and floor detergents. Steroids were progressively reduced without complications of withdrawal. She went from a completely steroid dependent state to independent during the first 1-1/2 yrs of thalamic stimulation. With continued thalamic stimulation she has done well for 8-1/2 yrs, weighs 112 lbs, keeps house and drives a car. It’s speculated the illness is a chronic pain multiple system syndrome predominantly due to mesothalamic discharges and body infirmities. The mesothalamic discharge implicated neural networks, which represent biologic systems, i.e. pain, sleep, fluid retention, etc. Therapeutic stimulation attenuates the discharges and the neural networks return to their normal set points of homeostasis.     

Development of a measure of symptoms in chronic fatigue syndrome: The profile of fatigue-related symptoms(pfrs)

Abstract

Chronic fatigue syndrome (CFS) is a disorder of uncertain aetiology which attracts increasing research interest. This paper describes the development of a multidimensional measure incorporating the diverse symptoms associated with the illness. The Profile of Fatigue-Related Symptoms (PFRS) has four scales: emotional distress, cognitive difficulty, fatigue and somatic symptoms. These showed good convergence with comparison measures, high reliability and high internal consistency. CFS patients had markedly elevated scores compared with a student comparison group, and these scores correlated with indices of illness severity. The PFRS is a short and easily administered measure which, it is suggested, may be used to assess patients in terms of the severity and pattern of their disorder, to relate subjective symptoms to immunological and other findings, to evaluate the effects of treatments, and to compare the symptomatology of CFS with that in other fatiguing illnesses.     

Transgenic mice expressing a truncated form of CREB-binding protein (CBP) exhibit deficits in hippocampal synaptic plasticity and memory storage

Deletions, translocations, or point mutations in the CREB-binding protein (CBP) gene have been associated with Rubinstein-Taybi Syndrome; a human developmental disorder characterized by retarded growth and reduced mental function. To examine the role of CBP in memory, transgenic mice were generated in which the CaMKII alpha promoter drives expression of an inhibitory truncated CBP protein in forebrain neurons. Examination of hippocampal long-term potentiation (LTP), a form of synaptic plasticity thought to underlie memory storage, revealed significantly reduced late-phase LTP induced by dopamine-regulated potentiation in hippocampal slices from CBP transgenic mice. However, four-train induced late-phase LTP is normal. Behaviorally, CBP transgenic mice exhibited memory deficits in spatial learning in the Morris water maze and deficits in long-term memory for contextual fear conditioning, two hippocampus-dependent tasks. Together, these results demonstrate that CBP is involved in specific forms of hippocampal synaptic plasticity and hippocampus-dependent long-term memory formation.     

Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report.

The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.     

Neuropsychiatric and neuropathologic findings in an adult case of cri-du-chat syndrome (Lejeune syndrome, crying cat syndrome)

It is reported on a mental retarded female, observed from 3-33 years of age, which demonstrated even in adulthood with long lasting shrill crying the clinical leading symptom of Lejeune syndrome and further typical symptoms with inhibition of physical maturation, important delayed motoric and mental development, microcephaly resp. characteristic craniofacial dysmorphia, anomalies of extremities, muscular hypotonia and susceptibility to infection. Psychically there were a striking affective instability and irritability, neuropathologically pachygyria and multiple cortical heterotopias.     

Use of a religious hymn in remission of symptoms of social phobia (social anxiety disorder): a case study

This case report described a veteran with social anxiety disorder who reported fears of negative evaluation by others, social avoidance, and accompanying physiological symptoms of heart palpitations, gastrointestinal discomfort, muscle tension and mental confusion. The symptoms of social anxiety disorder subsided with the use of a Christian hymn "Be Still My Soul" and its accompanying musical poem, in Finlandia. The veteran attributed the symptom remission to the feeling of stillness and surrender to God conveyed by the words and music of the hymn. Although previous studies have shown that both music and religious beliefs can affect mental health, the findings in this case cannot be generalized without conducting further prospective empirical studies.     

A barbiturate derivative-induced depressive syndrome in a 9-year-old boy with complex focal seizures and secondary generalization--a case report

The mental side-effects of long-term anticonvulsant medication are still not widely enough known. The paper describes the case of a depressive syndrome induced in a nine-year-old boy, with complex localised attacks and secondary generalisation, which completely receded on treatment with Convulsofin.     

Genetic counseling for a family with two distinct anomalies: A case report of a neural tube defect and 5p- syndrome in a fetus

A couple presented for genetic counseling because of an elevated maternal serum alpha fetoprotein. Ultrasound examination revealed the presence of a neural tube defect. The couple declined an amniocentesis, but chose serial ultrasound evaluations instead. Ultrasounds eventually identified microcephaly, but the couple continued to decline amniocentesis. After the child's birth, the diagnosis of 5p- syndrome was made. The couple's decision not to have an amniocentesis allowed the family their right to autonomy; however, prenatal chromosome analysis would have provided this couple with a great deal more prognostic information. We discuss the conflict between a counselor's duty to respect a client's freedom vs. duty to care for a client's welfare. We address issues of nondirective counseling and the need for more studies looking at the decision-making process in prenatal diagnosis.     

Necessary considerations for a theory of form perception: a theoretical and empirical reply to Boselie and Leeuwenberg (1986)

Boselie and Leeuwenberg (1986) recently defended their version of the minimum principle, called structural information theory or SIT, against a varied set of criticisms. Two of the most notable of these criticisms are (i) that perceptual organization can proceed as a piecemeal, rather than as a global, process (as demonstrated by partially-biased Necker cubes and 'impossible' figures), and (ii) that perceptual organization is influenced by subjective variables as well as by stimulus variables (Peterson and Hochberg 1983). The second criticism was acknowledged by Boselie and Leeuwenberg but not addressed. The first criticism was addressed by the introduction of two new variables into SIT in order to argue that the perceived organization of partially-biased Necker cubes and impossible figures can be predicted by a global coding scheme, thereby supporting rather than refuting global minimum principles. It is argued here that the criticisms cannot be dismissed by this rebuttal, which is focused narrowly on single examples rather than on the general principles embodied by the demonstrations. The implications of piecemeal perception and subjective mediation are spelled out, and both old and new data showing that the applicability of global minimum principles must be reexamined, not merely defended, are discussed. Finally, the argument for a richer, more interacting, theory of form perception is presented.     

Expanding variance and the case of historical changes in IQ means: a critique of Dickens and Flynn (2001)

The Flynn effect is the rise in mean IQ scores during the 20th century, amounting to about 0.33 IQ points per year. Many theoretical explanations have been proposed, though none are universally accepted. W. Dickens and J. R. Flynn's (2001) new approach explains the large IQ changes by means of recursive models of IQ growth. A salient feature of their models is that IQ phenotypes and their supportive environments are correlated; in addition, environmental effects can rebound on phenotypic IQ to increase or lower IQ. In this critique, the authors examine an empirical challenge to their models, which typically imply large changes in IQ variance. However, the historical rise in IQ mean level has not been accompanied by substantial variance changes, a finding inconsistent with the properties of the proposed model.     

Psychometric properties and correlates of the Lester-Bean Attribution of Causes to Suicide Scale (German form)

Psychometric properties and correlates of the German form of Lester and Bean's 1992 Attribution of Causes to Suicide Scale, of 18 items tapping into lay theories of suicide (intrapsychic problems, interpersonal conflicts, and societal forces as causes), were investigated in a sample of the general population in Austria (n=156). The three attributional dimensions presented moderate internal consistencies and the 18 items appeared to be factorially orderly, as indicated by exploratory factor analysis. Previous results were replicated, with positive interrelations among all three dimensions, but these were largely confined to men. Societal causes of suicide were significantly less frequently endorsed than intrapsychic or interpersonal causes. Respondents' sex, intelligence, and knowledge about suicide were unrelated, and scores on the Big Five personality factors and social desirability were largely unrelated to the three dimensions. Endorsing intrapsychic causes to suicide was correlated with advanced age, religiosity, and conservative political orientation, and the three dimensions entertained meaningful associations with locus of control (internality, social externality, and fatalistic externality). All observed demographic and attitudinal correlates were, however, of modest magnitude. Implications of the findings and directions for further inquiry are discussed.     

Male and female images in a case of frigidity (discussion)

Abstract

The case of Anna presented by Professor Giliberti is discussed from an interpersonal perspective. Attention is given to Anna's real experiences of hypocrisy, social inadequacy, hatred and blame projection. Paranoid aspects are emphasized and seen as connected with a disparity between appearance and reality in the communicative pattern of the family.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.