Early experience on a modern, thin cochlear implant family. A retrospective, international multicenter study.

RATIONALE: Cochlear implantation is the most effective method of rehabilitation for patients with severe to profound sensorineural hearing loss. Binaural hearing forms the basis of the development of hearing-associated cortical networks in infants and toddlers, but simultaneous bilateral implantation is often postponed due to the demands of classical surgical methods, which are associated with large incisions and a deep bony well. OBJECTIVE: The authors report on the use of a modern, thin implant type and the possibilities it provided to simplify the surgical technique. METHODS AND RESULTS: Recent models of the Cochlear™ Nucleus® implant family were studied in an international retrospective multi-center study: 6 otolaryngologists in 5 centers shared their experiences on 73 consecutively implanted, thin implants. The surgical incision could be made shorter than before and only shallow bony wells or none at all were created in 4 out of 5 centers. No complications occurred. DISCUSSION: This study underlines that implants with thin electronics capsules enable a simplified, fast and safe implantation procedure that allows simultaneous bilateral cochlear implantation.

The dexamethasone suppression test in panic disorder and major depressive episodes.

Dexamethasone Suppression Tests (DST) were performed on 30 patients with panic disorder and on 30 patients treated for major depressive episodes in order to seek an answer to the question of whether or not the two disorders have a common biological background. The hypothesis was based on the results of family studies known from the literature and on the favorable therapeutic response obtained with tricyclic antidepressants. Normal suppressive (i.e., negative in our terminology) DSTs were found in 16.7% of the patients with panic disorder and in 56.7% of patients suffering from major depressive episodes. The anxiety indices of the two groups differed significantly from each other. The results do not suggest the possibility of a close genetic relationship between the two conditions.

Electroconvulsive therapy in neuroleptic-induced parkinsonism.

The effect of electroconvulsive therapy (ECT) on the severity of neuroleptic-induced parkinsonism was studied in nine schizophrenic inpatients in a longitudinal triphasic design: neuroleptics-neuroleptics plus ECT-neuroleptics. The results suggest that ECT has a true antiparkinsonian potential. The role of ECT in the treatment of Parkinson's disease, especially with therapy-resistant patients complicated with on-off symptoms, is highlighted.

Prolactin response to fentanyl in depression.

Ten unmedicated female inpatients with major depression (DSM-III) and 10 healthy volunteer women were given an intravenous injection of 0.1 mg fentanyl at 9:00 AM and 9:00 PM on different days. The prolactin secretory response to this opioid agonist was investigated for 1 h with serial blood sampling. Repeated measures Analysis of Variance yielded a significant effect of fentanyl administration on prolactin secretion (p less than 0.0001), and there were elevated hormone responses in the evening (p less than 0.005). No group difference was seen between healthy volunteers and depressed patients, but four of the depressives showed the most blunted response, and three of these low responders committed suicide within 1 year.

Ten-year outcome of tardive dyskinesia.

OBJECTIVE: The purpose of this study was to assess the long-term outcome of patients with tardive dyskinesia. METHOD: A group of 122 neuroleptic-treated Hungarian outpatients were assessed for tardive dyskinesia on the Abnormal Involuntary Movement Scale and the Tardive Dyskinesia Rating Scale by the same rater over a 10-year period. RESULTS: Sixty-three of the patients received both 5- and 10-year follow-up assessments and are the subjects of this report. The overall prevalence of tardive dyskinesia in this group changed little over time; it was 30.2% at baseline, 36.5% at 5 years, and 31.7% at 10 years. However, there were changes in the tardive dyskinesia status of individual patients; 11 patients had remissions, and 12 who did not have tardive dyskinesia at the baseline assessment had developed it by the 10-year assessment. These two subgroups did not differ significantly on demographic and drug history variables. Outcome of tardive dyskinesia was not significantly related to neuroleptic treatment or to age. CONCLUSIONS: The data of this 10-year follow-up study provide evidence for the long-term stability of tardive dyskinesia and for the feasibility of maintenance neuroleptic therapy for chronic psychotic patients who have tardive dyskinesia.

Seven-year follow-up of tardive dyskinesia in Hungarian outpatients.

Of 122 Hungarian outpatients treated with neuroleptics, 79 (64.8%) were available for follow-up 7 years after their original assessment for tardive dyskinesia (TD). Ratings on the Abnormal Involuntary Movements Scale and the Simpson Dyskinesia Rating Scale increased significantly. The number of TD cases identified by research diagnostic criteria increased by only 9%: 12 of 28 patients no longer showed TD 7 years later, while 19 of 51 patients developed new TD.

Diurnal variation in fentanyl-induced hormone responses and side effects.

The prolactin (PRL) and thyrotropin (TSH) secretory response to the opioid agonist fentanyl (0.1 mg IV) was investigated with serial blood sampling in ten healthy women at 9 AM and 9 PM on different days. In five subjects saline control trials were also performed. A repeated-measures analysis of variance yielded a highly significant effect of fentanyl administration both on PRL and TSH secretion. In every case there were elevated hormone responses in the evening, and more drug-related subjective symptoms were reported at this time than before noon. These findings indicate a diurnal variation of opioid responsiveness, with lower sensitivity in the morning.

Tiapride in the treatment of tardive dyskinesia: a clinical and biochemical study.

The effect of tiapride treatment was investigated in 10 patients with tardive dyskinesia. The effects of the drug on the symptoms of tardive dyskinesia, parkinsonian symptoms, and patients' mental conditions were evaluated using standardized rating scales before and weekly during the 28-day drug trial. Patients were reassessed 14 days after withdrawal of tiapride. The symptoms of tardive dyskinesia significantly improved during treatment and deteriorated after tiapride was withdrawn. Parkinsonian symptoms remained unchanged both during and after treatment. The patients' mental conditions significantly improved while they were taking tiapride, and did not appreciably deteriorate after treatment was discontinued. Plasma prolactin levels increased significantly during treatment, while plasma dopamine-beta-hydroxylase activity did not change.

Decrease in dopamine, its metabolites and noradrenaline in cerebrospinal fluid of schizophrenic patients after withdrawal of long-term neuroleptic treatment.

Dopamine (DA), homovanillic acid (HVA), dihydroxyphenylacetic acid (DOPAC), noradrenaline (NA), and 5-hydroxyindolacetic acid (5HIAA) were measured in cerebrospinal fluid (CSF) of 15 chronic schizophrenic patients before and 2 weeks after withdrawal of long-term neuroleptic treatment. Total neuroleptic-like activity in serum (NLA) was determined at the same times. Levels of DA and its metabolites (DOPAC and HVA) and NA were significantly reduced after the discontinuation of neuroleptic treatment. No change was observed in 5HIAA values. NLA was substantially reduced, but still remained detectable. The decrease in DA, DOPAC, and HVA all showed positive correlations with each other, and correlated negatively with NLA measured after 2 weeks. Our data implies that the decrease in DA turnover is the result of the discontinuance of DA receptor blockade, while the change in NA level is independent of it.

Relationship of symptomatology of schizophrenia and tardive dyskinesia.

The role of drug factors and patient factors in the development of tardive dyskinesia (TD) was examined in 31 TD patients and 31 non-TD patients matched by age and sex. TD patients achieved significantly lower total scores on the anxiety-depression factor of Brief Psychiatric Rating Scale (BPRS) (5.2 +/- 1.4 vs. 6.5 +/- 2.2; less than P) and significantly higher total scores on the activation factor (6.4 +/- 2.2 vs. 5.3 +/- 2.5; less than P). The finding that TD patients were less depressed may be explained by a hypermonoaminergic state developing in TD. Based on the findings of this study it is suggested that catatonic schizophrenic patients are more vulnerable to the development of TD.

Negative symptoms, depression, and parkinsonian symptoms in chronic, hospitalised schizophrenic patients.

BACKGROUND: Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. METHODS: A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). RESULTS: No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms (r=0.299, P < 0.05) and negative symptoms (r=0.443, P < 0.001). Dose of antipsychotic was also correlated positively with negative symptoms (r=0.260, P < 0.05). Age was negatively correlated with depressive symptoms as assessed by the HDRS (r=0.306, P <0.05). CONCLUSION: The data suggest that depressive and negative symptoms can be separated in chronic schizophrenia, while pointing to a possible role of antipsychotic medication in the aetiology. LIMITATIONS: The study was conducted in a small chronically hospitalised population treated with relatively high doses of antipsychotics. It is not clear that the results obtained here would be applicable to an acute patient population.

Parkinsonian symptoms with lithium, lithium-neuroleptic, and lithium-antidepressant treatment.

Eighty-one patients treated for a least 3 months with lithium were examined for the presence of parkinsonian symptoms. Twenty-four patients were receiving treatment with lithium alone, 30 with lithium and 1 or more neuroleptics, and 27 with lithium and antidepressant. Twenty-four of the patients were found to be free from parkinsonian symptoms. Severe rigidity was not found. Two patients receiving neuroleptic with lithium and 6 on lithium-antidepressant combinations exhibited severe tremor. Neuroleptics administered concomitantly with lithium did not aggravate parkinsonian symptoms. The combination of lithium and an antidepressant significantly increased tremor in comparison to lithium alone.

Changes in extrapyramidal symptoms following anticholinergic drug withdrawal.

An antiparkinson drug (APK) withdrawal study was carried out in 34 schizophrenic outpatients on maintenance neuroleptics. Sixty-five percent of patients were without major complaints after 2 weeks of APK discontinuation, while 35% reported adverse effects including extrapyramidal, autonomic, and behavioral symptoms. Male patients and those on higher diethazine doses before withdrawal reported more complaints. Ratings showed significant increases of parkinsonism, as well as dyskinesia following APK withdrawal. No clinical evidence was obtained in support of the notion of cholinergic hypersensitivity in patients showing "tremors" at baseline.

CSF dopamine turnover and positive schizophrenic symptoms after withdrawal of long-term neuroleptic treatment.

Dopamine (DA), dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) were measured in cerebrospinal fluid (CSF) of 14 schizophrenic inpatients before and 2 weeks after withdrawal of long-term neuroleptic medication. Total neuroleptic-like activity (NLA) in serum was determined at the same times. DA and its metabolites (DOPAC and HVA) were significantly reduced after neuroleptic discontinuation. NLA was substantially diminished. The decrease in DA and DOPAC was positively correlated with positive symptoms of postwithdrawal deterioration, and low prewithdrawal DOPAC level predicted severe relapse. These results are compatible with the hypothesis linking an overregulated central DA system to the positive symptoms of schizophrenia.

Biochemical markers in the study of clinical effects and extrapyramidal side effects of neuroleptics.

Neuroleptic treatment was instituted in 20 female schizophrenic patients, who had not received neuroleptics for at least the preceding 3 months. Both the therapeutic response to neuroleptics and the development of parkinsonian side effects were monitored in these patients. In addition, plasma dopamine-beta-hydroxylase (DBH) and platelet monoamine oxidase (MAO) activities were measured. None of the neuroleptic responders developed parkinsonian symptoms. During the course of the 28-day treatment, there was a significant decrease in platelet MAO activity. There was a tendency for responders without parkinsonian symptoms to have lower plasma DBH activity than did nonresponders with parkinsonian symptoms.

Comparative neurochemical investigation of tardive dyskinesia and neuroleptic-induced chronic parkinsonism.

Cerebrospinal fluid (CSF) homovanillic acid (HVA), cyclic adenosine 3', 5'-monophosphate (cAMP), and serum prolactin were measured in schizophrenic male patients with tardive dyskinesia (TD) and in those exhibiting the symptoms of chronic neuroleptic parkinsonism (P). The patients (nine TD and eight P) were chronic paranoid schizophrenics. Levels of HVA in CSF were found to be significantly higher in the TD group. Normal prolactin levels were observed in both groups and are indicative of tolerance developed in the hypothalamic tuberoinfundibular dopaminergic system.

Analysis of compliance, morbidities and outcome in neurodevelopmental follow-up visits in urban African-American infants at environmental risk.

The objectives of this study were to determine compliance rate in a uniform, urban African-American patient population at environmental risk for adverse neurodevelopmental outcome and to define risk factors for non-compliance with neurodevelopmental follow-up. A retrospective chart review was performed which included 481 infants with birth weight (BW) of 495-4195 g and gestational ages (GAs) between 23 and 42 weeks born at our hospital. Statistical analysis was performed using the Jonckheere-Terpstra test for ordinal variables. For 2 × 2 tables, χ 2 test and Fisher's exact test (P < 0.05) were used. To determine significant predictive variables, data were analyzed by multiple logistic regression with one independent variable at a time. Infants compliant with follow-up had significantly more morbidities in the very low BW category (⩽1500 g) than infants with larger BW. The highest compliance rate (70%) was found among the smallest and most immature (GA ⩽28 weeks) infants. Based on this finding, we postulate that the number of infants with severe disability is not likely to be underestimated. The significantly more frequent developmental anomalies found in the largest BW (⩽2500 g) category raises significant concern, though findings in this subset of infants may not be representative of the whole population. There was no significant difference between the compliant and non-compliant groups regarding socio-economic status. Severe or multiple morbidities and prolonged hospital stay may provide parents with greater opportunity to learn and understand about the infant's condition which may lead to greater compliance.