Clinical Neuroscience

[Data for the pathogenesis of morphinismus]

GARTNER Pál1, KELEMEN Endre1

JULY 29, 1952

Clinical Neuroscience - 1952;5(02)

[Since December 1950, authors have performed morphine withdrawal treatment on 32 morphine users referred from the KEKSZ. Their procedure is as follows: morphine is withdrawn immediately. On the first day of withdrawal, the patient receives 0.1-0.1 ccm of 2% morphine intracutaneously into the flexor aspect of both forearms, for a total of 4 mg. The same is given for the next 3 days. The fifth day is a break. On the sixth and seventh days he receives the same again. In addition: on days 1-3-6, another 3-5-10 ccm of foreign group blood is given intravenously. If there is an obstacle to hetero-blood injection, 10 ccm Resactor is given intramuscularly instead. This procedure is used to minimise withdrawal symptoms, and mood correctors are rarely needed. Patients usually leave on day 10 with no symptoms or complaints. The pathogenesis of morphinism is thought to be essentially immunobiological. They consider their new withdrawal treatment to be intracutaneous desensitisation and attribute the success of the treatment to the reduction in tolerance induced by the binding of morphine antibodies. Hetero-blood or Resactor injections mobilise antibodies through their effect on the RES system, which enhances the efficacy of the treatment. Treatment does not resolve the issue of relapse. ]

AFFILIATIONS

  1. Fővárosi Korányi Frigyes és Sándor Kórház Elme-Idegosztálya

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Clinical Neuroscience

[A new version of Jacod's syndrome]

MARIA Filipowicz

[Brain symptoms in nasopharyngeal tumours were observed as early as the second half of the 19th century. Observations on the frequency of certain brain lesions have been supplemented by descriptions of the pathways by which nasopharyngeal tumours penetrate the inside of the skull. For some time there were two opposing views on the origin and development of tumours. According to some authors, the tumour originates either from the nasopharynx or from the connective tissue of the skull base, and thus invades the skull from the outside, destroying the cranial nerves in its path. Others have argued that, on the contrary, elements within the skull are the starting point of the tumour, and that the process in the nasopharynx is independent or has been considered as a tumour metastasis from the inside of the skull to the outside. Doubts in this respect have only been dispelled by detailed study. It was found that in the majority of cases the nasopharyngeal space was the starting point. ]

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[According to the prevailing psychiatric view, schizophrenia is rare in childhood, and some authors, such as Vogt and Weichbrodt, have denied that it occurs before adolescence. However, a critical review of the older literature on childhood psychosis leads to the conclusion that it is not so much the rarity of childhood schizophrenia as its recognition and correct pathology: in the older descriptions, we often find images of childhood schizophrenia that are typified by the current understanding. ]

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[The introduction and use of cumulative electroshock (ES) in our clinic, in addition to the therapeutic results, has also provided an opportunity to further investigate the basic and concomitant phenomena of the spasm mechanism. In this brief, quasi-preliminary report, we describe the ocular fundus lesions associated with spasm. As the essence of shock therapy is seen by many authors (Abély, Delay, Morin, Gastant, Cain) in the stimulation of the diencephalon, and Krienberg and Eberhardt have drawn attention to the fundamental importance of cerebral blood circulation in the mechanism of shock, the study of the orbital vessels of the fundus is of prime importance. The behaviour of the fundus blood vessels provides an analogous picture of the probable identical behaviour of the cerebral blood vessels, and the vasovegetatively congruent state of the pupils and fundus blood vessels also provides information on the fluctuations of the vegetative tone.]

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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.

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]