Clinical Neuroscience

[Connected to the tetraaethylthyuram disulphide treatment psychiatric analysis of exogenous psychoses]


FEBRUARY 01, 1959

Clinical Neuroscience - 1959;12(02)

[To summarise our clinical cases, we can identify two groups of psychiatric phenomena that occur during TATD treatment. The first group includes psychic phenomena that coincide with vegetative symptoms, such as drowsiness, erythema, pain, mood instability, etc. The second group of psychic phenomena takes a very varied form, and the following forms of psychosis were identified: 1. mood disturbance, which may take the form of depression or mania, or a "mixed" form as a separate TATD alcohol psychosis; 2. disturbance of consciousness manifested as mild "benommenheit" or simple tenebrositas in the Kleistian sense, or as a perplexed tenebrositas, or as a rarely observed hallucinatory foggy state; 3. in the context of alcohol treatment for TATD, ecstatic states similar to the image described by Müller-Freienfels as "Rausch" may occur; 4. hypnagogic hallucinations in other cases ; 5. delirium tremens or 6. amentiform images may occur. The paradoxical thirst for alcohol that develops during "drink body" treatment may be seen as an interesting complication. ]


  1. Budapesti Orvostudományi Egyetem Psychiatriai Klinika



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Clinical Neuroscience

[Ethical considerations in neuro- and mental medicine ]


[From the problems discussed, it is clear that for doctors in general, and neurologists and psychiatrists in particular, not only is professional competence important, but perhaps even more important - ethical purity! Mistakes can be made, and we cannot be completely insured against them. But it is an inexcusable sin to knowingly misrepresent oneself in the service of individual interests. In guiding our actions, conscience plays a leading role, dictating our actions and enabling us to take the elevated view that 'duty before interest, honour before money' ('le devoir avant l'intérêt, l'honneur avant l'argent', Desfosses). The doctor's role is facilitated by the fact that people are not to be judged by their spiritual worth, material possessions or social position, but solely by their suffering. This basis enables him to develop to an artistic height not only the noble feelings of understanding, compassion and sympathy, but also those of selfless help. ]

Clinical Neuroscience

[Extinction as a disruption of the cooperation between specific and non-specific afferent systems]


[The author lists the physiological and pathological conditions under which extinction is observed. He reviews data on specific and non-specific afferent system cooperation. The theory is presented that pathological extinction is caused by a combined impairment of the specific and non-specific afferent system. Diffuse dysfunction of nonspecific afferents results in extinction with generalized attention deficit and rostral dominance. Co-injury of the thalamocortical specific and non-specific fibrous system causes localized attention deficit and localized extinction in the contralateral hemisphere. Both physiological and pathological extinctio show rostral dominance. The rostral dominantia is explained by bilateral cortical representation of the face and the special wakefulness of trigeminal impulses. In pathological extinction, a dysfunction of the sensory system can be detected even when no sensory dysfunction is found by routine tests. Even in such cases, a threshold elevation and a shortening of the sensory adaptation time are always detectable. The adaptation time shows the greatest degree of shortening in cases of combined damage to specific and non-specific systems. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study


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Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias


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