[Tobacco use and smoking cessation in the psychiatric patient]

Smoking is far more prevalent among psychiatric patients than with healthy individuals. Particularly patients with substance-related disorders and schizophrenia often are addicted smokers. This is of great importance, as heavy smoking is clearly accompanied by a higher morbidity and mortality. Up to now there is no convincing explanation for the high prevalence of smoking. Numerous studies point to the fact that smoking is practised as a form of self-medication by psychiatric patients. The influences on cerebral dopaminergic or cholinergic transmission or even psychopharmacological treatment may reinforce smoking behaviour. Efforts to reduce the frequency of smoking in case of psychiatric patients have mostly proved fruitless. Prevention strategies as well as smoking cessation therapies seldom achieve success due to the poor motivation. Besides that smoking cessation often is complicated due to the simultaneous psychopharmacological treatment. The latest investigations, however, confirm the efficacy of cessation strategies, also in case of schizophrenia, mood or substance related disorders. Intensive behavioural treatment strategies as well as high dose nicotine replacement achieve encouraging long-term abstinence rates. Nicotine replacement by patch, gum or nasal spray might be a kind of causal treatment, assuming biological mechanisms to be responsible for heavy smoking.

Uterine arteriovenous malformations: the role of intravenous 'dual-phase' CT angiography

The authors describe the use of dual-phase intravenous CT angiography of the pelvis in two female patients, who presented with ongoing excessive vaginal bleeding, to demonstrate large adnexal and uterine arteriovenous malformations (AVMs). Power Doppler was used as the initial modality to diagnose the AVMs. CT angiography, along with 3-D rendering in the form of maximum intensity projections and shaded surface display, were especially useful for anatomical conceptualization to the gynecologist. This greatly helped in the subsequent management in the form of therapeutic embolization in both patients by reducing the time, radiation dose, and contrast required for the procedure. Subsequent surgery, which was required in both patients (due to failed embolization), was also greatly aided by the demonstration of the exact extent of the AVMs on axial CT images. Thus, CT angiography emerged as an impressive non-invasive imaging modality for the complete evaluation and management of the uterine AVMs.

Topical mometasone furoate for the treatment of childhood vltiligo

Forty-five children with vitiligo were treated with topical applications of mometasone furoate for 2 to 6 months. The best results occurred in the facial vitiligo. Repigmentation of 90-100% was achieved in more than 80% of patients with vitiligo of the face and more than 60% of patients with vitiligo on other part of the body. Interestingly there was no single side effect noted even after six months application in children.

Psychological characteristics of patients with normal-tension glaucoma

BACKGROUND

A study was carried out to evaluate the extent of psychosomatic complaints in patients with normal-tension glaucoma.

METHODS

Twenty-four patients (M:F=3:21; mean age 58+/-15.3 years) with normal-tension glaucoma were rated according to the von Zerssen Symptom List (psychosomatic discomfort), the Maudsley Personality Inventory (MPI-N, emotional status and MPI-E, extroverted-introverted), the Beck Depression Inventory (BDI), and the Sixteen Personality Factor Questionnaire (16PF). An age- and sex-matched control group (n=24; M:F=3:21; mean age 56+/-13 years) without any ocular or other general chronic disease was selected.

RESULTS

In comparison with the control group the patients with normal-tension glaucoma showed significantly more complaints (von Zerssen Symptom List) and were more emotionally unstable (MPI-N). No group differences were found regarding extroversion-introversion (MPI-E) and depression (BDI). In the 16PF, patients with normal-tension glaucoma were remarkable, only for a significant negative correlation between the duration of illness and psychic endurance.

CONCLUSION

The results demonstrate that patients with normal-tension glaucoma show evident psychosomatic involvement. However, the sequence of the pathogenetic development remains unclear. Therefore, it is not known whether these psychological disturbances are factors contributing to the development of normal-tension glaucoma or whether they are a result of normal-tension glaucoma. Nevertheless, some patients with normal-tension glaucoma had these disturbances. Besides reduction of intraocular pressure and improvement of vascular condition, those who display psychological disturbances should receive psychological support, such as autogenic training.

Angiokeratoma of fordyce on unusual site

A 19-year-old married man presented with multiple, bright-red and reddish-blue papular lesions on glans and prepuce with intermittent bleeding on maceration since 6 months duration. Histopathological study revealed features of angiokeratoma.

Pathogenesis of borna disease virus: granulocyte fractions of psychiatric patients harbor infectious virus in the absence of antiviral antibodies

Borna disease virus (BDV) causes acute and persistent infections in various vertebrates. During recent years, BDV-specific serum antibodies, BDV antigen, and BDV-specific nucleic acid were found in humans suffering from psychiatric disorders. Furthermore, viral antigen was detected in human autopsy brain tissue by immunohistochemical staining. Whether BDV infection can be associated with psychiatric disorders is still a matter of debate; no direct evidence has ever been presented. In the present study we report on (i) the detection of BDV-specific nucleic acid in human granulocyte cell fraction from three different psychiatric patients and (ii) the isolation of infectious BDV from these cells obtained from a patient with multiple psychiatric disorders. In leukocyte preparations other than granulocytes, either no BDV RNA was detected or positive PCR results were obtained only if there was at least 20% contamination with granulocytes. Parts of the antigenome of the isolated virus were sequenced, demonstrating the close relationship to the prototype BDV strains (He/80 and strain V) as well as to other human virus sequences. Our data provide strong evidence that cells in the granulocyte fraction represent the major if not the sole cell type harboring BDV-specific nucleic acid in human blood and contain infectious virus. In contrast to most other reports of putative human isolates, where sequences are virtually identical to those of the established laboratory strains, this isolate shows divergence in the region previously defined as variable in BDV from naturally infected animals.

Prolong continuous versus weekly oral acyclovir in recurrent herpes genitalis

Patients with frequent recurrences of genital herpes were treated with oral acyclovir tablet, 800 mg once daily or once a week for 2 years. Confirmed recurrences for all patients were treated with acyclovir, 200 mg orally 5 times per day, for five days. Of 58 patients enrolled, 12 of 26 daily acyclovir recipients and 22 of 32 weekly acyclovir recipients completed two years of study. Patients receiving daily acyclovir experienced a mean of 0.0991 recurrences / month compared with mean of 0.113 recurrences / month for patients receiving weekly acyclovir. A total of 33% of daily acyclovir recipients and 27% weekly acyclovir recipients were free of recurrences for two years.

[Need for approval of electroconvulsive therapy from the Guardian- ship Court within the context of guardianship (Section 1904 BGB)]

If patients who need electroconvulsive therapy are unable to consent, it is necessary to gain the guardian's permission to carry out the treatment. It remains unclear if, due to possible side effects, it is necessary to gain an additional approval from the Guardianship Court according to Section 1904 of German Civil Code (BGB). The high court of Hamburg (Landgericht Hamburg) decided that legal permission is necessary as a result of the risk of persisting retrograde amnesia and the ensuing danger of permanent damage to the patient's health. This paper points out however, that electroconvulsive therapy, even considering the contraindications, is a safe and effective treatment for depression and schizophrenic psychoses. Application of unilateral short-pulse stimulation reduces the frequency and intensity of cognitive side effects. In particular, retrograde amnesia is very rare with regard to frequency and intensity and is negligible when compared with the dangers of the illness itself. Therefore, it is not necessary to apply for approval from the Guardianship Court.

Psychiatrists meet on the web: the chance for a virtual congress. Results and experiences from the First International Internet Congress on Psychiatry 1997

From December 1-31, 1997, the Department of Psychiatry and Psychotherapy in co-operation with the Department of Information Technology, University of Tübingen, Germany, organised the first virtual congress on psychiatry in the Internet. The congress was aimed at facilitating exchange of results of psychiatric studies and ideas and at stimulating discussion among interested colleagues. Almost 100 participants from 17 countries on four continents took part in this event. Sixteen contributions were presented and discussed. The problems and opportunities of this medium in the organisation and running of congresses are presented and discussed. The experience gained in this congress suggests that the Internet will find increasing use as a medium for medical congresses within the next few years.

Antibrain antibodies in mental disorder: no evidence for antibodies against synaptic membranes

Antibody reactivity in serum to synaptic membranes from human was investigated in major depressive disorder (N = 20), paranoid schizophrenia (N = 20), schizoaffective psychosis (N = 20), and in controls (N = 20) using Western and Immunoblots and ELISA technique. None of the patients showed a significant immune response to synaptic membranes. There was a base-line activity in both controls and patients with antibodies directed to a double band of proteins at 66kD. These antibodies may represent natural autoantibodies. The authors conclude from this and other studies that there is at present no proof of antibrain antibodies in mental disorder.

Cytohormonal evaluation of vaginal smears by phase contrast microscopy with special reference to progesterone deficiency pattern during early pregnancy as predictor of abortion

Cytohormonal profile of unstained vaginal smears were studied under phase contrast microscope to define various cell morphologies in detail and build up of smear pattern serially in various stages of menstrual cycle and first trimester of pregnancy. The findings were correlated clinically and found comparable to Papanicolaou stained smears. The maturation index was calculated more objectively by phase contract microscopy because of the refractile appearance of the pyknotic nuclei of superficial cells. The prognostication of abortion was done by combining abnormal maturation index and the presence of syncytiotrophoblasts in vaginal smears. Under phase contrast microscope, the sensitivity of abnormal smear was 87.5%, the specificity was 95%, the positive predictive value was 96.55% and the overall accuracy was 90% as compared to positive Papanicolaou smear whose sensitivity though 93%, had low specificity of 50% only. Phase contrast study appears to offer certain distinct advantage over the conventional light microscopy for quick, comprehensive and quantitative assessment of the study material. It allows the physician to detect changes in the material obtained from the patients without detour of laboratory fixation and staining. It is technically easy as errors in interpretation due to unsatisfactory fixation, staining and artefacts are obviated. Thus phase contrast microscopy offers an alternative and easy method of cytohormonal evaluation of wet and unstained smears.

Acrokerato - elastoidosis of costa: Report of three cases

Three cases of acrokeratoelastoidosis of Costa are reported. All the patients were females with marginal keratodermas composed of cornified papules, some of which were umbilicated, distributed along the borders of the hands and feet. A positive family history was present in all the cases.

Therapeutic options in Charles Bonnet syndrome

The term 'Charles Bonnet syndrome' refers to visual pseudohallucinations occurring especially in elderly people with reduced visual acuity. Despite numerous case reports, few successful methods of treatment have been described. Therapies with classical neuroleptics, antidepressants or benzodiazepines have generally been found to be unpromising. Only with carbamazepine treatment has improvement been observed in a few cases. In the three cases reported here, we successfully treated the condition with the atypical neuroleptic melperone.

Autoantibody reactivity in serum of patients with Alzheimer's disease and other age-related dementias

Serum antibodies against a series of antigens, including an organ-specific central nervous system (CNS) antigen and the neurotransmitter serotonin, were investigated in 22 patients with Alzheimer's Disease (n=15) and other age-related dementias (n=7) by indirect immunofluorescence assay and enzyme-linked immunosorbent assay. Patients with dementia showed an increase of antibody-positive sera against nuclear antigen, gastric parietal cells, CNS antigen, gangliosides (Gm1), laminin, and keratin. Alzheimer's Disease patients alone exhibited antibodies against CNS antigen. However, the results do not show sufficient specificity and sensitivity for use as a diagnostic indicator.