The pathobiography and death of Wolfgang Amadeus Mozart: from legend to reality

Use and safety of unfractionated heparin for anticoagulation during maintenance hemodialysis

Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States. However, there is no universally accepted standard for its administration in long-term hemodialysis. Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers. Adjustments are based largely on clinical signs of under- and overanticoagulation. Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than UFH, are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.

Wolfgang Amadeus Mozart's psychopathology in light of the current conceptualization of psychiatric disorders

The study of Mozart's letters and biography leads us to reconsider the psychiatric disorders from which he suffered. Indeed, it seems that Mozart demonstrated depressive episodes, some of which were severe and corresponded to the criteria of the DSM-IV classification. However, the arguments put forward by other authors supporting the occurrence of manic or hypomanic episodes (thus constituting a bipolar disorder diagnosis) are not supported by sufficient historic proof. Indeed, the length of time that the behaviors suggesting manic symptoms lasted is not compatible with such a diagnosis. Rather, Mozart's mood swings and impulsive behavior correspond to some traits of a personality disorder, that is, for the most part, symptoms of the dependent personality disorder. Evidence for this diagnosis appears most notably in Mozart's reactions to his wife's absences, but also in occasional behaviors as well as mood lability. The divergences in the classification of Mozart's symptoms, either into the field of bipolar disorders or into that of personality disorders, are closely linked to the nosological uncertainties that are still a source of debate in today's psychiatric research. We discuss a means of overcoming this limitation by considering the concept of "soft bipolar spectrum," a conceptualization that corresponds to Mozart's psychiatric history.

Musical Skills and Neural Functions

An overview of the history of debates on the correlation of musical skills with neurological functions in health and disease is presented. Selected biographical sketches of composers (Hildegard von Bingen, Mozart, Donizetti, Mussorgsky, and Ravel), whose neurological disease may have influenced musical creativity, are discussed. The search for information on the localization of skills in the brains of musicians is reviewed. The relation of mental ability to brain structure is a prominent theme in the history of neuroscience, and the effort to localize musical skills dates back to the excesses of phrenology in the early nineteenth century. The phrenological tables included an "organ of music" among the sites subserving intellectual capabilities, mapped on the basis of palpation of the head bumps. Since the second half of the nineteenth century, when the study of brain physiology, anatomy, and pathology had a remarkable development and impact on the neurosciences, structural features of the brain, particularly the cerebral cortex, of individuals with peculiar talents, including musical skills, have been examined to search for clues on the localization of mental phenomena. These studies, which continued in the twentieth century, are currently difficult to validate in view of the rigor imposed by current scientific standards. However, the issue of localization of functions in the musical brain is still debated and is now at the forefront of the neurosciences, exploiting especially functional neuroimaging. The historical overview of these problems is certainly exemplary of progress of knowledge, but also warns against excessive "localizationist" efforts.