Management of postpolio syndrome.

Recent research has shed light on the pathogenesis of the postpolio syndrome and has helped explain its symptoms and the rationale for management. The aim of this article is to familiarize physicians with this syndrome. The history, acute infection, definition, and diagnosis are discussed, as well as the various symptoms and their management. People with postpolio syndrome can educate health professionals about this condition and can help others inflicted with this syndrome. Thus far, no cure is available. A correct diagnosis is important, and the physician must realize that severe comorbidities tend to afflict people with this syndrome. Numerous management options are available to help these people enjoy a high quality of life.

The Nordic concept of reactive psychosis--a multicenter reliability study.

Reactive psychosis is a common diagnosis in the Nordic countries (Norway, Sweden, Denmark, Finland and Iceland) and in several other parts of the world. In ICD-9 and DSM-III-R, the concept is defined more narrowly than in the Nordic tradition. In this study we examined the interrater reliability of the Nordic concept by the case-summary method between clinicians from 9 university departments in the Nordic countries. The results show that Nordic psychiatrists have a reasonably reliable concept of reactive psychosis, and that this psychosis can be diagnosed as reliably as schizophrenia and affective psychosis.

Stiff-man syndrome updated.

Stiff-man syndrome, a rare disorder characterized by intermittent spasms and stiffness of the axial muscles, is associated with an electromyographic pattern of continuous motor unit activity in affected muscles. Since the initial description in 1956, the stiff-man syndrome has been reported to occur in various clinical and neurologic settings. In this study, we reviewed the current state of knowledge about this syndrome, defined diagnostic criteria, provided a long-term follow-up of the disorder, and assessed rehabilitative attempts in affected patients. Use of rigorous criteria that identify patients who have the stiff-man syndrome is important because the initial clinical manifestations are similar to those of other neuromuscular diseases. Analysis of 13 patients with stiff-man syndrome examined at the Mayo Clinic during the past 30 years revealed that treatment with diazepam decreased the muscle spasms. Because some muscle spasms usually persist, rehabilitation is an important adjunct that may further improve function when it is centered on the treatment of low-back pain and hyperlordosis, mobility problems, gait abnormalities, and muscular stiffness.

Can transcutaneous electrical nerve stimulation be safely used in patients with permanent cardiac pacemakers?

In 51 patients who had 20 different models of permanent cardiac pacemakers, we conducted transcutaneous electrical nerve stimulation studies at four anatomic sites--the lumbar area, cervical spine, left leg, and lower arm area ipsilateral to the pacemaker. With a mean stimulation of 24.7 Hz, no episodes of interference, inhibition, or reprogramming of the pacemakers occurred. The proximity of the stimulation site to the pulse generator had no effect. We did not study electrodes placed parallel to the pacemaker electrode vector, a position that has been of concern to others and that should probably be avoided until proved safe. On the basis of our findings, we believe that most patients with permanent cardiac pacemakers can safely undergo transcutaneous nerve stimulation.

Chronic pain: use of TENS in the elderly.

Transcutaneous electrical nerve stimulation (TENS) can be an important adjunct to the management of pain in elderly patients. Chronic neuropathy and postfracture recovery are the leading indications for using the portable stimulative device, although it has also been applied successfully in relieving low-back pain, postherpetic neuralgia, myofascial pain, phantom-limb pain, and advanced, painful malignancies. However, TENS is rarely used alone in pain relief, but instead should be part of a larger management program that may include other modalities.

Present functions of forensic psychiatry in Scandinavia.

An attempt is made to give a description of the functions of forensic psychiatry in the Scandinavian countries, including some statistical information on activities and persons involved. Definitions are given. Organizational differences in preparing psychiatric reports to the court in the five countries are outlined, as are the ways in which psychiatrists participate at the post-trial level. Some problems and divergent trends are mentioned. It is concluded that a demand for psychiatric evaluation and treatment of offenders who are psychotic or moderately and more severely mentally retarded will continue to exist, whereas it seems unclear how psychiatrists should deal with the psychiatric problems of offenders with other mental abnormalities. Forensic psychiatric research should include analysis of the functions of this discipline (frequency studies, studies of content, organization and effect).

Present status of forensic psychiatry in Iceland.

This paper gives a brief survey of forensic psychiatry in Iceland at the present time. Because of few inhabitants and limited financial resources there are no special forensic psychiatric institutions in the country, nor any forensic psychiatrists; this kind of work is mainly carried our by general psychiatrists, but also to a certain extent by general practitioners, Formalities around compulsory admission and detention of mental patients, uncooperative and lacking insight, are briefly described. The psychiatric examination of probably mentally ill offenders is also accounted for. Such investigations are without doubt the main task of forensic psychiatry in Iceland to-day. Finally the main faults of forensic psychiatric services in Iceland and very limited educational facilities in this domain are referred to. Some future plans are also mentioned.

Transcutaneous electrical stimulation: a double-blind trial of its efficacy for pain.

A double-blind trial was done using a stimulator and a placebo device on patients who had chronic pain to determine the effectiveness of transcutaneous electrical stimulation in controlling pain. Ninety-three patients were studied, and 83 of these completed the Minnesota Multiphasic Personality Inventory (MMPI). Thirty-three patients had low-back pain and 24 had neuropathies. The stimulator was more effective than the placebo during treatment when used over the center of pain (P less than .005) or over an unrelated nerve trunk (P less than .01) and after treatment over the center of pain (P less than .05). The stimulator was significantly more effective than the placebo in neuropathies when stimulating over the related nerve trunk (P less than .005), where the stimulator response was nearly three times better than that of the placebo. The duration of subsequent relief was not significantly different after treatment with the stimulator or with the placebo device. Follow-up showed significant declines in the use and effect of the stimulator with the greatest decline noted by the depressed group.