Clinical Neuroscience

[The dexamethasone suppression test in psychiatric practice ]

SZÁDÓCZKY Erika1, ARATÓ Mihály1, RIHMER Zoltán1, MOUSSONG-KOVÁCS Erzsébet1

MAY 01, 1986

Clinical Neuroscience - 1986;39(05)

[The authors examined dexamethasone suppression test results in 186 patients diagnosed according to DSM III criteria and treated in an open psychiatric ward. The test was found to have a relatively high sensitivity (61%) and a relatively low specificity (64%) for major depression. Abnormal test results above those reported in healthy individuals were observed in a group of patients with dysthymia and panic. A close association of these two categories with major affective disorder is assumed.]

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  1. Orvostovábbképző Intézet Psychiatriai és Klinikai Psychológiai Tanszék

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Clinical Neuroscience

The independence of cycloid psychosis from schizophrenia and affective psychosis

CARLO Perris

A short survey of the evidence supporting the independence of cycloid psychotic disorders from both schizophrenic and manic-depressive disorders is presented. Converging results from different quarters support the view that the concept of cycloid psychosis has represented a kind of blind spot in the search of a solution to a correct identification of psychotic conditions which do not fit into current conceptions of schizophrenia and of bipolar manic-depressive psychosis. A warning is also given against the identification of cycloid psychosis with schizoaffective psychosis and the risk of letting the former follow the nosological uncertainties of the latter concept.

Clinical Neuroscience

[Agoraphobic and panic neurotic patients management of respiratory control]

KOPP Mária, MIHÁLY Katalin, TRINGER Katalin, VADÁSZ Péter

[We report on a domestic adaptation of the cognitive-behavioural therapy for panic syndrome and agoraphobia with panic attacks described by Salkovskis and Clark (1984), based on the treatment of fourteen patients. During the six-week treatment period, the number and intensity of panic attacks and the level of anxiety reflecting their subjective state were significantly reduced. At the beginning of treatment, an abnormal breathing pattern was observed in the group of patients, and changes in autonomic parameters were well monitored during treatment. Among the questionnaires translated for the diagnostic study, the Anxiety and Panic Attack Diary seems to be a good measure for monitoring the effect of treatment, and the Hyperventilation Symptom List and the Marks and Mathews Fear Questionnaire may be useful tools for grouping patients. ]

Clinical Neuroscience

[Surgical outcomes of brain aneurysms ]

OROSZ Éva, VAJDA János, JUHÁSZ János, SLOWIK Felicia

[The authors evaluate the records of patients operated on for cerebral aneurysms at the National Institute of Neurosurgery over a period of 8 years (1977-1984) using computer processing. The overall mortality of 894 operations is 15%. They examined the role of patient age, sex, preoperative status, aneurysm location, time between bleeding and surgery, and surgical complications, as well as spasm on angiography, in the outcome and evaluated the sectional findings of patients who died. Special attention was paid to the evaluation of late ischaemic complications. The most important factor for surgical outcome appears to be the patient's preoperative condition and the appropriate timing of surgery. ]

Clinical Neuroscience

[Aseptic sinus thrombosis with a predominantly benign course]

SÁTORI Mária, GÁCS Gyula

[The authors studied 7 cases of sinus thrombosis among 1390 patients in a 2-year study of a neurology department, of whom only 1 patient died. A significant proportion of patients had a coagulopathy leading to thrombosis. The authors attempt to outline the symptom clusters and unusual symptom associations that may underlie suspected benign sinus thrombosis. It is likely that fatal sinus thromboses due to various coagulation disorders may be preceded by mild attacks with a warning course similar to TIAs that predict ischaemic events. ]

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Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.