[Bilateral pallidal infarction in sleep apnea syndrome]. / Bilaterale Palliduminfarkte bei Schlaf-Apnoe-Syndrom.

Patients suffering from sleep apnea syndrome are known to be at higher risk of cardiac and cerebral infarction. In this case report, we describe bilateral pallidal lesions, which are normally seen after sudden asphyxia due to cardiac arrest or carbon monoxide intoxication. Some epidemiological and pathophysiological observations are cited.

[Spongiform leucoencephalopathy after inhaling illicit heroin and due to carbon monoxide-intoxication]. / Spongiforme Leukenzephalopathie nach Inhalation von illegal gehandeltem Heroin und bei Kohlenmonoxid-Intoxikation.

A spongiform leucoencephalopathy sometimes develops as a result of inhaling illicit heroin as well as due to carbon monoxide-intoxication. Clinically psychiatric symptoms precede a neurological deterioration. Some patients die. After a brief description of several epidemiological and historical-cultural aspects regarding the smoking of opiates, the typical neuroradiological signs such as hypodensity of the white matter in CCT and signal alterations in MRT, and neuropathological sequelae such as intramyelinic vacuolisation are listed. Pathophysiologically an edema of the white matter in the beginning is suspected. Second, a dysfunction of the mitochondria is addressed relying on the particular metabolism of the oligodendrocytes. Since smoking of heroin is an increasingly preferred way of application in all continents and therapeutic options are still lacking, the need of further explanation of the underlying processes is stressed.

[Metachromatic leukodystrophy simulating schizophrenia-like psychosis]. / Metachromatische Leukodystrophie mit dem klinischen Erscheinungsbild einer schizophrenieähnlichen Psychose.

A case of late onset metachromatic leukodystrophy with a clinical picture of paranoid hallucinatory psychosis and severe dyskinesia is described. The problem of diagnostic recognition is discussed. In the case, diagnostic procedures were initiated after atypical clinical course, and established on the basis of MRI and specific biochemical tests.

The politics of closing state mental hospitals: a case of increasing policy gridlock.

There are political and administrative barriers to closure of the remaining state mental hospitals. Some of these barriers owe their existence to the current lack of community-based alternatives for the care and treatment of the severely mentally ill. In addition, uncertainty of the future funding and regulatory commitment of state governments to community programs contributes to an unwillingness by influential groups to recommend or implement closure. Finally, other barriers include rigid budgetary processes, the self-interest of public employees, and the lack of consensus in the decision making process. The result is that even when the case for closure of a state mental hospital is convincing, these political and administrative factors can cause "policy gridlock." This article describes how such policy gridlock occurs and offers several suggestions as to how it can be prevented.

Expenditure effects of changes in Medicaid benefit coverage: an alcohol and substance abuse example.

An evaluation of the effect on total health care costs of a Medicaid demonstration project to provide coverage for alcoholism and substance abuse was conducted in Illinois in 1985. A pre/post-treatment analysis of expenditures for a subgroup of demonstration clients suggests that the addition of the alcohol and drug benefit did not result in higher total expenditures. [An important policy implication is that, when medical services substitute for one another, costs savings (increases) will not necessarily be realized when benefit packages are cut (expanded).]

Early identification of high social risk.

Many hospital social work departments depend on a referral system based on other professionals' decisions regarding when and with whom social work intervention is appropriate. Changing such systems should help facilitate the early evaluation of high-risk clients by social work staff. To achieve this goal, a model is provided for the identification of high social risk.