Towards a cognitive model of hallucinations in the course of alcohol dependence? A source monitoring-based pilot study.

BACKGROUND: We investigated whether source-monitoring deficits (here a discrimination between imagined and performed actions) underlie hallucinations among patients with a history of hallucinations in the course of their alcohol dependence. METHOD: We assessed 29 patients with alcohol dependence who had no history of hallucinations during their course of alcoholism and 29 patients with a history of at least one episode of hallucinations of any modality during their course of alcohol dependency. The control group consisted of 24 healthy participants. Participants were assessed with an action memory task. Simple actions were presented to the participants verbally or non-verbally. Some actions were performed physically and others were imagined. In the recognition phase, participants were asked whether the action was presented verbally or non-verbally (action presentation type discrimination) and whether the action was performed or imagined (self-monitoring). A confidence score related to self-monitoring responses was also obtained. RESULTS: Alcoholics with a history of hallucinations misremembered imagined actions as perceived ones more frequently than patients without hallucinations, but not the reverse. Only patients with a history of hallucinations committed more errors of this type than healthy subjects. There were no group differences regarding discrimination between an action presentation type. Both clinical groups committed errors with a higher degree of confidence than healthy subjects. CONCLUSIONS: Our results tentatively suggest that a specific type of source-monitoring deficit (i.e., confusing imagery with reality) may be involved in the hallucinations in patients with alcohol dependence. The findings are discussed in the light of a transdiagnostic approach to hallucinations.

Epidemiology of severe sepsis in intensive care units in the Slovak Republic.

BACKGROUND: We investigated the number, clinical characteristics, and outcomes of ICU patients, who met precise clinical and physiological criteria for severe sepsis (as defined in the PROWESS study) in Slovak intensive care units. We designed an observational cohort epidemiological study with retrospective analysis of prospectively collected data. 12 adult general intensive care units participated in the Slovak Republic between July and December 2002. PATIENTS AND METHODS: Patients included 1,533 adult ICU admissions during the second half of 2002 in 12 adult ICUs. Descriptive statistical methods (independent sample T-test, chi(2) test, and linear Pearson coefficient of correlation) were used. RESULTS: We found that 7.9% of hospitalized critically ill patients met severe sepsis criteria in the intensive care units. The most frequent primary sources of infection were lungs and abdomen. Hospital mortality of severe septic patients was 51.2% (62 pts/121 pts). Most patients (85.1%) were > 40 years of age. Mortality increased with age; mean average age of survivors (53 years) was significantly lower than in nonsurvivors (61 years, p = 0.01). Factors associated with mortality were age over 50 years, three or more dysfunctional organs, and elevated admission and maximum SOFA scores. Survivors had a significantly lower number of sites with organ system dysfunction (MODS 2.56) than nonsurvivors (MODS 3.98). SOFA score seems to be a valuable tool to differentiate survivors from nonsurvivors. All the septic patients had SOFA scores greater than 4 points. Survivors of severe sepsis were characterized with significantly lower admission and maximum SOFA scores (median 8.7 and 9.4 points, respectively) than septic nonsurvivors (median 11.6 and 14.0 points, respectively, p = 0.001). CONCLUSION: We estimate 1,770 cases of severe sepsis hospitalized at Slovak adult intensive care units per year. Hospital mortality for severe sepsis remains very high (51.2%) and is associated with advanced age (over 50 years), number of failing organs and higher admission and maximum SOFA scores.

Computerized tomography and rehabilitation outcome after severe head trauma.

Thirty patients with severe head trauma underwent an extensive in-hospital multidisciplinary rehabilitation program. Computerized tomographic(CT) scans were arranged into 4 distinct groups. Group 1 comprised those individuals with normal CT scans, group 2 those with small ventricles, group 3 had focal intracranial hemorrhage or mass effect, and group 4 enlarged ventricles (disproportionate to patient's age and size of cortical sulci). The outcome after a rehabilitation program was assessed by functional and psychologic criteria. Groups 1 and 2 had the best outcome, although many in these categories were left with permanent physical and psychologic disabilities. Those with focal intracranial hemorrhage did not do as well. The group with enlarged ventricles had the poorest outcome of all. Other factors relating to outcome included age, length of coma, presence of motor disabilities, seizures, and skull fractures.

Tegmental afferents of the amygdaloid body in the rat.

Horseradish peroxidase (HRP) was injected to various parts of the amygdala in 50 rats. Retrograde axonal transport revealed that tegmental areas containing biogenic amines: dorsal and median raphe nuclei, locus coeruleus and ventral tegmental area, project diffusely to various amygdaloid areas. Moreover, HRP labeled cells were found in the parabrachial nucleus (following injection of the lateral amygdaloid nucleus) and in tegmental dorsolateral nucleus (after injection of the central nucleus of amygdala).

Thalamoamygdaloid connections studied by the method of retrograde transport.

On the basis of retrograde horseradish peroxidase transport from nuclei ot the amygdaloid body of the rat to the thalamus, it was found that several groups of thalamic nuclei send fibers to the amygdala. These are: (i) nuclei of posterior region of thalamus and neighboring area of the tegmentum - peripeduncular nucleus, suprageniculate-limitans nucleus, (ii) midline nuclei - paraventricular nucleus, parataenial nucleus, nucleus reuniens, (ii) intralaminar nuclei - central medial nucleus, parafascicular nucleus, (iv) medidorsal nucleus. There are two main systems of thalamoamygdaloid connections. One of them arising in the posterior region of the thalamus terminates in the lateral nucleus of the amygdala and the lateral part of its central nucleus. The other system begins in the intralaminar and midline nuclei and in the mediodorsal nucleus of the thalamus. It reaches the remaining nuclei of the amygdala. Amygdalopetal connections of the interlaminar and middline nuclei of the thalamus, especially those arising in the paraventricular and parataenial nucleus, are mostly bilateral.