Liepmann's test and its specific significance in the alcoholic delirium]

The perceptional characteristics of hallucinatory events and the phenomenal forms of artificially produced hallucinations were studied on a total of 210 patients (144 patients with delirium tremens, alcoholic hallucinosis, abstention from alcoholic beverages freedom from abstinence symptoms and 66 subjects with schizophrenia, symptomatic epilepsy, general paralysis, neuroses, and conditions of intoxication). The results of our studies show that Liepmann's test may be used to reliably diagnose genuine hallucinoses. They are usually preceded by a number of different stages, these being the stages of stability of development and full development of prehallucinatory phenomena, simultaneous and suggestive periods of geniune hallucinations. Liepmann's test is specifically distinctive of psychopathological disorders associated with delirium tremens.     

Plasma ACTH, STH and other hormone levels in various groups under chlormethiazole, haloperidol or reserpine load in alchohol delirium, alcoholic hallucinations, and chronic alcoholism]

Studies of 135 men with safely diagnosed alcohol delirium mostly revealed increased ACTH blood values when sober and increased T4 values in about 1/3 of these patients. There is a correlation between the psychiatric clinical picture of the alcohol delirium and the ACTH content of the plasma. Under load with chloromethiazole, halperidole or with reserpine, there is a significant drop in the increased ACTH and T4 values. In an acute alcoholic hallucinosis (n=16) similar endocrinological changes as in most cases of safely diagnosed alcohol delirium were observed. In a chronic alcoholic hallucinosis (n=11) and in chronic alcoholics (n=31) the endocrinological values were similar to those of patients after alcohol delirium.     

Morbidity rate in delirium tremens

On evaluating an analysis of 105 cases of delirium tremens over a period of five years in a psychiatric base-unit, the following findings were obtained: Delirium tremens, particularly in conjunction with secondary diseases, constitutes a life-endangering medical emergency and requires intensive medical treatment. Letality was 8,57%. The morbidity-rate and the relapse-rate showed a clearly marked increase; the age of contracting the disease had its frequency peak between 30 and forty, i. e. earlier than in many other statistical surveys. Epileptic attacks as symptoms starting off or accompanying delirium occurred in almost one third of our delirium patients. The impact which these attacks have on the development in the course of process-like alcoholism was discussed.     

Therapy concept and initial experiences of an inpatient department at a district hospital on the therapy of alcoholic patients

The basic therapeutic considerations underlying the establishment of an in-patient department for the treatment of alcoholic cases at district level are set forth, and the advantages and disadvantages of the move are discussed. In practice, in-hospital treatment of alcoholic cases at district level has been shown to be justified in the creation of a locally self-contained therapeutic chain.     

The Association Between Delirium and Cognitive Decline: A Review of the Empirical Literature

Delirium is a common neurobehavioral syndrome that occurs across health care settings which is associated with adverse outcomes, including death. There are limited data on long-term cognitive outcomes following delirium. This report reviews the literature regarding relationships between delirium and cognitive impairment. Psych Info and Medline searches and investigation of secondary references for all English language articles on delirium and subsequent cognitive impairment were carried out. Nine papers met inclusion criteria and documented cognitive impairment in patients following delirium. Four papers reported greater cognitive impairment among patients with delirium than matched controls. Four papers reported higher incidence of dementia in patients with a history of delirium. One study found 1 of 3 survivors of critical illness with delirium developed cognitive impairment. The evidence suggests a relationship between delirium and cognitive impairment, although significant questions remain regarding the nature of this association. Additional research on delirium-related effects on long-term cognitive outcome is needed.     

Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism

The authors examined heterogeneity in risk for externalizing symptoms in children of alcoholic parents, as it may inform the search for entry points into an antisocial pathway to alcoholism. That is, they tested whether the number of alcoholic parents in a family, the comorbid subtype of parental alcoholism, and the gender of the child predicted trajectories of externalizing symptoms over the early life course, as assessed in high-risk samples of children of alcoholic parents and matched controls. Through integrative analyses of 2 independent, longitudinal studies, they showed that children with either an antisocial alcoholic parent or 2 alcoholic parents were at greatest risk for externalizing symptoms. Moreover, children with a depressed alcoholic parent did not differ from those with an antisocial alcoholic parent in reported symptoms. These findings were generally consistent across mother, father, and adolescent reports of symptoms; child gender and child age (ages 2 through 17); and the 2 independent studies examined. Multialcoholic and comorbid-alcoholic families may thus convey a genetic susceptibility to dysregulation along with environments that both exacerbate this susceptibility and provide few supports to offset it.     

Non-motor aspects of Parkinson's disease

Parkinson's disease is primarily considered to be a movement disorder and is defined by its motor signs. Yet, the behavioral manifestations of the disease are often more debilitating than its motor complications. This review will focus on the non-motor aspects of Parkinson's disease, including mood, psychosis, cognitive, sleep, fatigue, apathy, delirium, and repetitive disorders, that may occur. The phenomenology, pathology, and treatment of the behavioral symptoms of Parkinson's disease will be discussed.     

Disaggregating the Distal,Proximal, and Time-Varying Effects of Parent Alcoholism on Children’s Internalizing Symptoms

We tested whether children show greater internalizing symptoms when their parents are actively abusing alcohol. In an integrative data analysis, we combined observations over ages 2 through 17 from two longitudinal studies of children of alcoholic parents and matched controls recruited from the community. Using a mixed modeling approach, we tested whether children showed elevated mother- and child-reported internalizing symptoms (a) at the same time that parents showed alcohol-related consequences (time-varying effects), (b) if parents showed greater alcohol-related consequences during the study period (proximal effects), and (c) if parents had a lifetime diagnosis of alcoholism that predated the study period (distal effects). No support for time-varying effects was found; proximal effects of mothers' alcohol-related consequences on child-reported internalizing symptoms were found and distal effects of mother and father alcoholism predicted greater internalizing symptoms among children of alcoholic parents. Implications for the time-embedded relations between parent alcoholism and children's internalizing symptoms are discussed.     

The pre-delirium syndrome in alcoholic patients in ambulatory care and its treatment

In an administrative district of roughly 70,000 inhabitants, two-thirds urban, one-third rural, 60 patients, 46 male, 14 female, received out-patient treatment for alcoholic predelirious syndromes during the period 1982-1986. The total number of predeliorious attacks was 91, age incidence lay between 18 and 65, peaking at 35 to 45. In 61.7% of the cases only one predelirious attack occurred, in 28.3% two, and in 10.0% three or more. Through the period there is a perceptible rising tendency. In eight cases there was an epileptic grand mal fit in the course of a predelirious attack. Out-patient treatment was successful in all but three cases, which definitely called for hospitalised treatment. Diazepam, Diazepam/Haloperiodol, and Distraneurin were administered orally as a regular part of the program of treatment. 30 times Diazepam and Haloperidol effected a cure, while in 61 attacks it appeared that treatment with Chlormethiazol was inevitable. Results are discussed and conclusions drawn.     

颅内脂肪瘤的诊断与治疗

为了分析和讨论颅内脂肪瘤的诊断和治疗,我们回顾性分析23例颅内脂肪瘤患者的临床特点、影像学资料,对17例有症状的患者行手术治疗,6例无相关症状患者行CT或MRI随访。结果显示,17例手术患者中,除1例较术前症状加重外,余16例症状缓解或明显改善。6例无症状患者随访1年～6年,CT或MRI显示脂肪瘤无明显增大。因此,无相关症状患者可行CT或MRI随访;有明显的神经表现者可行手术治疗,手术目的是充分的神经结构减压,部分切除及减压术可实现长期的症状缓解。     

ICU谵妄患者病因分析以及处理

分析急诊ICU患者出现谵妄症状的原因以及处理对策。分析总结我院急诊ICU3年间所有患者的资料,发现20．2％的患者出现谵妄症状,原因为：（1）疾病相关;（2）药物相关;（3）监护环境等多种因素作用结果。经过调整治疗方案、加强心理护理后,需要镇静药物的仅为谵妄患者的19．7％。因此寻找谵妄原因很重要,治疗重点在于去除谵妄原因以及相关促发因素。     

Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.     

An Unusual Case of Motor and Vocal Tics With Obsessive-Compulsive Symptoms in a Young Adult With Behcet's Syndrome

Behcet's disease is a chronic relapsing-remitting, multi-system inflammatory disorder of unknown etiology, characterized by recurrent oral and genital ulcers, uveitis, and skin lesions. The most common central nervous system findings are demyelization and perivascular cell infiltration; meningoencephalitis, cerebral atrophy, and vascular thrombosis may also occur. Neuropsychiatric symptoms may include: paroxysmal dystonia, parkinsonism, delirium, hallucinations, and behavioral disturbances. We report an unusual case of explosive onset of motor and vocal tics with obsessive-compulsive symptoms in a 22-year-old male with Behcet's disease. The putative roles of infection and autoimmune mechanisms in the pathogenesis of tics and obsessive-compulsive symptoms are explored.     

Risky sexual behavior among married alcoholic men.

The current study explored whether the wives of men entering alcoholism treatment are at risk for sexually transmitted infections (STIs) exposure as a result of their husbands' sexual risk behaviors. The extramarital relationships of married alcoholic men entering outpatient treatment (n = 125) were compared with those of a demographically matched community sample of nonalcoholic married men (n = 125). The proportion of alcoholic men who reported 1 or more extramarital affairs in the previous year (14%) was significantly higher than that of the community sample (4%). Additionally, only 2 alcoholic husbands and 1 nonalcoholic husband reported that his wife was aware of the extramarital relationship. For both groups, none of the men who engaged in extramarital relationships reported consistent use of condoms when having sexual intercourse with their wives or with their extramarital partners. These results suggest that wives of alcoholic men are unknowingly placed at risk for indirect exposure to STIs as a result of their husbands' sexual risk behaviors. Thus, infidelity in treatment-seeking alcohol-abusing men represents a significant public health issue.     

Uncovering Strengths of Children of Alcoholic Parents

Being a child of an alcoholic (COA) is neither a diagnosis nor a psychosocial death sentence. Neither alcoholic families nor COAs are monolithic. A variety of factors converge in developmental trajectories resulting in diverse individual outcomes. Supportive relationships with non-substance using parents and siblings and appropriate levels of parentification all may enable a significant proportion of COAs to enjoy high self-esteem, lack of problematic substance use, and good adaptive capability. Therapists and clients should refrain from looking at COAs through a deficit framework and instead should look for evidence of relational resilience in alcoholic families of origin. Such strengths-based assessments will increase therapeutic leverage with COAs seeking treatment for a range of presenting problems.     

Studies of the side effect profile of clozapine

All patients treated at the County Hospital for Neurology and Psychiatry in Ueckermuende from 1981 to 1984 with Klopazin were included in a critical analysis of the side effects of the drug, paying special attention to those reported in the literature. Besides the symptoms already identified, delirium and hypotonic circulation dysregulation are receiving increased clinical attention, which indicates that special care methods are called for.     

Risk and Protective Factors for Comorbid Posttraumatic Stress Disorder among Homeless Individuals in Treatment for Substance-Related Problems

Homeless individuals undergoing treatment for substance use disorders (SUD) can pose clinical challenges. Posttraumatic stress disorder (PTSD) symptoms have been observed in the most difficult clients. The study sample consisted of 51 homeless individuals, 9 women and 42 men, undergoing consultation for SUD in Montreal. The mean age was 46 years (SD = 7.19). Of the sample, 49% had a potential PTSD diagnosis. Most participants had the following characteristics: an alcoholic parent, a history of an early trauma, and little social support. The participants with a potential PTSD diagnosis were significantly more likely to have had an alcoholic parent, to have experienced an early trauma, and to use more maladaptive coping strategies. The study results and limits are discussed.     

Delirium and isolated angiitis of the central nervous system: a case report and review

Central nervous system (CNS) vasculitis is a rare entity, especially when it occurs in isolation; it is seen more commonly as part of a multisystem vasculitis. Common presenting symptoms include persistent headache, encephalopathy, and multifocal signs. We discuss the case of a 68-year-old female who presented twice in 1 month with confusion and choreaform movements. Extensive workup was negative for a connective tissue disease or other conditions in the differential, including neurosarcoidosis, Creutzfeldt-Jakob disease, and neurosyphilis. The only significant findings were elevated erythrocyte sedimentation rate, inflammatory signs in the CNS, and diffuse slowing of the electroencephalogram. A presumptive diagnosis of isolated angiitis of the central nervous system (IACNS) was made and the patient was successfully treated with steroids. She recovered fully with no residual symptoms. The diagnosis of IACNS is often difficult given there are no definitive laboratory investigations or pathognomonic presentation. However, a series of signs, symptoms, and laboratory findings have been proposed that are helpful in making the diagnosis. To our knowledge, IACNS presenting primarily with delirium has not been previously reported in the literature. The diagnosis of IACNS is purely speculative for this case, as the gold standard for diagnosis, a leptomeningeal cortical biopsy, was not performed.     

An Organizational Framework for Occupational Therapy in the Treatment of Alcoholism

Because occupational therapists are increasingly involved with alcoholism rehabilitation, an organizational treatment framework is presented that is based upon the psychodynamics of this diagnosis. Factors that contribute to the development of a unique defense structure characteristic of alcoholism are discussed as prerequisites for understanding the treatment needs of the adult. Treatment is organized into three hierarchical levels that correspond with progressive changes in the alcoholics' defense structure. Alcoholics at level one require directive treatment approaches that do not aggressively confront the preferred, but maladaptive defense mechanism in order to attain abstinence. Teaching coping strategies that provide alternatives to the preferred defense mechanisms are beneficial at level two. The third level involves stimulating the arrested emotional development of the alcoholic thus effectively challenging the continued utilization of these defense mechanisms. Specific occupational therapy methods and frames of reference are outlined that are appropriate for implementation at each treatment level.     

Dynamically oriented group therapy with alcoholics: Making it work despite the prevailing bias

A bias exists in the psychiatric community against dynamically oriented group therapy with alcoholics. The basis for this bias lies primarily in negative experiences of practitioners who have attempted to use traditional therapy with alcoholic patients who continued to drink. At Appleton Outpatient Clinic, we have found that dynamically oriented group therapy is a highly suitable treatment modality for alcoholic patients when negative biases of treators can be addressed and when initial preparatory work is done with patients. This preparatory work includes: (a) building a working alliance around abstinence and providing adequate supports to make this possible; (b) explicit contracting that establishes clear treatment goals and consequences should the goals not be met; (c) preparatory short-termgroup experiences.This paper was presented at the 1988 annual meeting of the American Group Psychotherapy Association.