Neuropathic pain in Charcot-Marie-Tooth disease.

OBJECTIVES: To determine the frequency and extent to which subjects with Charcot-Marie-Tooth (CMT) disease report pain and to compare qualities of pain in CMT to other painful neuropathic conditions. STUDY DESIGN: Descriptive, nonexperimental survey, using a previously validated measurement tool, the Neuropathic Pain Scale (NPS). PARTICIPANTS: Participants were recruited from the membership roster of a worldwide CMT support organization. MAIN OUTCOME MEASURES: NPS pain descriptors reported in CMT were compared with those reported by subjects with postherpetic neuralgia (PHN), complex regional pain syndrome, type 1 (CRPS-1), also known as reflex sympathetic dystrophy, diabetic neuropathy (DN), and peripheral nerve injury (PNI). RESULTS: Of 617 CMT subjects (40% response rate), 440 (71%) reported pain. with the most severe pain sites noted as low back (70%), knees (53%), ankles (50%), toes (46%), and feet (44%). Of this group, 171 (39%) reported interruption of activities of daily living by pain; 168 (38%) used non-narcotic pain medication and 113 (23%) used narcotics and/or benzodiazepines for pain. The use of pain description was similar for CMT, PHN, CRPS-1, DN, and PNI in terms of intensity and the descriptors hot, dull, and deep. CONCLUSIONS: Neuropathic pain is a significant problem for many people with CMT. The frequency and intensity of pain reported in CMT is comparable in many ways to PHN, CRPS-1, DN. and PNI. Further studies are needed to examine possible pain generators and pharmacologic and rehabilitative modalities to treat pain in CMT.

Simian AIDS type D serogroup 2 retrovirus: isolation of an infectious molecular clone and sequence analyses of its envelope glycoprotein gene and 3' long terminal repeat.

We describe the molecular cloning of a serogroup 2 simian retrovirus (SRV; D2/RHE/OR) and present the sequence of its envelope (env) glycoprotein gene and 3' long terminal repeat region. This report documents the first infectious molecular clone of a serogroup 2 SRV and provides env sequence verification of genetic diversity among serogroup 2 SRV isolates.

Impotence associated with the Charcot-Marie-Tooth syndrome.

We report 7 men (ages 45-61 years) with impotence associated with the Charcot-Marie-Tooth syndrome (CMT). The range of onset of erectile dysfunction varied from 38 to 55 years of age. One patient had classic CMT 1A with autosomal dominant inheritance, slow motor nerve conduction velocities and the 17p DNA duplication. One had probable type-II hereditary motor and sensory neuropathy. None of the patients had diabetes. There was some benefit from papaverine injection therapy or penile implants. The association of impotence with CMT is likely to be more common than previously recognized.

Charcot-marie-tooth disease as a disabling disorder.

The author looks at Charcot-Marie-Tooth disease and the disabling effects that it can have on the patient. A course of action is outlined to help the patient cope more fully with this fairly common but little understood disorder.

Prediction of lithium response in young adult psychotic patients.

Through an assessment of affectivity by means of the Crabtree - Horsham Affective Trait Scale, the author was able to predict, with 83-90% accuracy, who would and who would not be judged to be lithium responsive in a sample of hospitalized young adult psychotic patients who received a trial of lithium carbonate. The scale combines an assessment of the psychosis, premorbid personality, family pedigree, family interactional character and the presence or absence of a history of minimal brain dysfunction and drug-induced hypomania. Treatment outcome was found to be significantly better in the group of high affect psychotic patients who received a trial of lithium, when compared with the comparison group of high affect psychotic patients who did not.

Minimal brain dysfunction in adolescent and young adult psychiatric inpatients.

This paper presents data on a study of 100 consecutive young adult psychiatric admissions to Horsham Hospital, to determine the incidence of minimal brain dysfunction in this population, to define the subcategories of common psychiatric presentation, and to compare these data with those from the companion study conducted by our research group of fifty consecutive adolescent psychiatric admissions, reported by Horowitz, 1981.

Hospitalized adolescents who act out: a treatment approach.

The general propensity of hospitalized adolescents to act out and to become locked in conflict with the staff is well documented. The fact that these patients are adolescent and incarcerated all but guarantees that disruptions will take place, and when these disruptions reach impasse proportions, collective distress and disturbance will generally result (Crabtree and Cox 1972; Marohn, Dalle-Molle, and Offer 1973; Levinson and Crabtree 1979; Crabtree and Levinson 1980). Often the catalyst for this type of ward tension is the borderline or sociopathic delinquent. The sensitivity of these patients to injustice and their capacity to provoke abuse exacerbates the ever-present tendency of their fellow adolescent patients to rebel and oppose. This paper will provide guidelines which can help to maximize the treatability of severely acting-out adolescent patients in the hospital setting and protect the treatment program from their destructiveness. First, I will focus on a specialized unit in a general psychiatric hospital. The unit consisted of approximately 20 patients, male and female, in their teens to early 20s, with an average stay of three months. One-fourth were psychotic, one-fourth had marked problems of behavior with school, family and the law, and one-half were suicidally depressed or afflicted with other self-destructive personality disorders. Next I will explore aspects of handling the "outlaw leader"--the persistent delinquent who initiates and orchestrates a process of disruptive transformation of the therapeutic community, characterized by the dominance of frustration, provocation, and retaliation by the staff.

Ward tension and staff leadership in a therapeutic community for hospitalized adolescents.

Mental health workers on inpatient units spend a great deal of time trying to cope with interpersonal tensions that disrupt ward life. We have focused our attention on two aspects of this problem. The first is clarifying the nature of the social processes that underlie periods of increased tension and conflict on wards. The second is clarifying the kinds of staff leadership required to manage these tensions. We are sure that those who have worked on interactive treatment wards will recognize this situation: for a period of weeks or more there is an uneasy tension; patient cliques form and disruption occurs between cliques and with the staff. Often there is a climax of disruptive behavior, such as a day or weekend when a large number of patients break ward rules. Trouble seems to be contagious. Throughout the period staff members disagree about how to manage the patients and the disruption, and usually this disagreement is tinged with old philosophical or personal differences. No one feels very confident about taking leadership initiatives, and the formal leaders are blamed for various failures and lacks. Eventually, often after a climactic disturbance is resolved, ward life returns to "normal" and people feel much better about living and working on the ward. In this paper we review previous work on this kind of ward process and discuss some of the problems involved in conceptualizing it. We report on two period of ward observation that illustrate the sequence from low to high tension and back to relative calm. We then discuss our ideas about the kinds of staff leadership needed to manage different phases of this sequence and the problems of developing and integrating multiple ward leadership roles.