"Epileptosis"--a syndrome or useless speculation?

102 patients were divided into 3 groups: epileptics, psychotics and epileptics with psychotic symptoms. All had long been monitored for a number of clinical and laboratory parameters. Though different in many respects, all share states of sudden dysphoria, cacophoria, panic anxiety, horror, and EEG (stereo-EEG, too) signs of epileptic or other gross anomalies, often correlated to those affective disorders. Attacks of dysphoria, epilepsy, and psychosis come spontaneously and in response to biological (hypoglycemia, sleep deprivation, alcohol, menses) or psychosocial stimulation (agitation, quarrels, fear of redundancy, psychic trauma). These states (attacks, dysphoria, "neurotic" or even psychotic episodes) often provoke one another. -Calling this syndrome epileptosis, we believe its mechanism is due to lesions of the limbic and brainstem modulation systems. At the start of the process there is an epileptic focus in the amygdalo-hippocampal complex (AHC) which in itself can trigger simple or complex partial paroxysm but also-by means of electric stimulation of the AHC-states of dysphoria, anxiety, and psychotic hallucinations. Besides, a form of pathological learning develops in premorbid "hypersensitive" personality which can be put down to associative learning and to Overton's phenomenon of "state-dependent retention of learned responses". This may give rise to mutual stimulation where epileptic focal activity in AHC can provoke dysphoria while an external psychosocial situation can trigger epileptic activity there, too (AHC). Since there need not always be mydriasis (though other vegetative signs such as tachycardia, tachypnoea, nausea, blush and others are frequent) or unconsciousness, and some psychomotor manifestations may be out of the ordinary, and scalp EEG may be normal, such patients are often regarded as "hysterics" or malingerers.

Brofaromine in treatment-resistant depressed patients--a comparative trial versus tranylcypromine.

In a controlled clinical inpatient trial (n = 93) comparing the efficacy and safety of brofaromine versus tranylcypromine for 6 weeks in treatment-resistant major depressed patients, the two drugs were found to be of comparable afficacy and tolerability. The response rate (a 50% reduction) on the Hamilton Scale for Depression (HAMD) in both groups was about 73%. The most common side effects in the brofaromine group were sleep disorders, hypotension, tremor and dryness of mouth; and in the tranylcypromine group sleep disorders, fatigue, hypotension, tremor and vertigo. Methodological and practical clinical implications of the results are discussed.

[Pimozide in the treatment of psychogenic eating disorders]. / Pimozid v lécbe psychogenních poruch príjmu potravy.

PIMOZIDE was given to 14 pat. with anorexia nervosa and 21 pat. with bulimia nervosa The drug evaluated positively some symptoms of eating disorders. Most significantly it improved the bulimic episodes and purging. The accompanying psychiatric symptomatology (depression and anxiety) was mostly not improved. We conclude that Pimozide may be a useful medication in the therapy of basic symptoms (bulimia, purging) in bulimic forms of eating disorders.

[Intensive psychiatric care of patients with psychogenic eating disorders]. / Intenzívní psychiatrická péce o nemocné s psychogenními poruchami príjmu potravy.

The authors summarize their therapeutic results in anorexia nervosa achieved at the unit of specialized care for eating disorders at the Psychiatric Clinic of the First Medical Faculty, Charles University, Prague. They find that applications for hospitalization of these patients have a rising trend and that in recent years in the unit mainly patients with severe forms of these diseases are admitted. During the past 7 years in the unit a total of 147 patients were hospitalized. By comprehensive regime treatment 84% of the patients with bulimia nervosa. As to basic symptoms, in bulimia nervosa the results were achieved in vomiting and bulimic attacks and in anorexia nervosa as regards appetite, hunger and general attitude to food. Finally the authors summarize the advantages of the unit specialized care for psychogenic eating disorders.

Sexuality of women with anorexia nervosa.

The sexual development and life of 30 adult women with anorexia nervosa and of 50 control women was investigated using a structured interview and 3 sexological questionnaires. Heterosexual development was found to be normal in the initial stages, but psychosexual adaptation in adulthood was impaired. Primary or secondary insufficiencies of sexual life were found for 80% of the anorectic patients. Biological and psychosocial factors may participate in this unfavourable state. Discussion of sexual problems should be part of the process of treating women with anorexia nervosa.

[An EEG study in anorexia nervosa and an attempt to use it for prognostic prediction]. / EEG studie u mentálních anorexií a pokus o její prediktivní vyuzití.

Visual evaluation of EEG tracings was made in 77 patients with the clinical diagnosis of anorexia nervosa and in 76 neurotic patients. The following criteria were evaluated and correlated: age, height, body weight on admission and discharge, weight increment per day, presence of basic EEG activities [alpha, beta, gamma, delta], foci, paroxysms, reactions to hyperventilation and general evaluation of EEG (normal, atypical, abnormal). A significant correlation was found between the weight increment and the initial weight. A lower weight correlated with a higher weight increment. The relations between clinical variables and EEG criteria were statistically close to zero. A significant relationship was found between the presence of focal activity and weight increments. Thus only in anorectic patients with the presence of a focus prognostic possibilities of EEG may be presumed.

[Sulpiride in psychiatric practice]. / Sulpirid v psychiatrické praxi.

Sulpiride is a substituted benzamide which blocks selectively D-2 receptors. The authors tested its clinical effectiveness in schizophrenia, anorexia nervosa and bulimia nervosa. In schizophrenia its action was compared with that of haloperidol. It was revealed that sulpiride is an effective drug, in particular in schizophrenia with abulic and depressive symptoms without productive symptoms and in psychoaffective psychoses. In the treatment of anorexia nervosa and bulimia nervosa its therapeutic action was not superior to that of other preparations used in these diseases.

The therapist's therapist.

The authors present questionnaire data from 509 psychologists, psychiatrists, and social workers on their personal treatment experiences. The findings address the relative importance of various therapist selection criteria, the professional and personal attributes of the chosen therapist, and the nascent trend of seeking more female and nonmedical psychotherapists.

Neuroleptic bioavailability, psychosocial factors, and clinical status: a 1-year study of schizophrenic outpatients after dose reduction.

Serum neuroleptic levels, prolactin levels, and clinical state were assessed for 1 year in 29 schizophrenic outpatients whose clinically determined neuroleptic dose had been reduced by 50%. Fifty-five percent of the subjects remained stable. Neuroleptic dose did not differ between relapsed and stable patients. Serum prolactin (PRL) assessed 2 weeks after dose reduction and mean PRL after reduction were significantly lower among relapsers. Serum neuroleptic levels were significantly lower for relapsers in patients on haloperidol. Among relapsers, there were no serum PRL or neuroleptic level differences between stable periods and the relapse episode. Among patients with relatively low neuroleptic bioavailability, relapsers reported lower levels of social activity and had social networks that were less enjoyable, more aversive, and less helpful than those of stable patients.