VOICE QUAUH IN DEPRESSION. William A.Hargrror:es, ]. A. Starkweather, and K. H. Blacker,]. Almorrlwl Psych., 70:218-221 (June) 1965.

Severe deprpssion is accompanied by changes inpattern of mO\"t'ment and speech, in postural andfacial indkations of apathy and anxiety. Relativelylittle attention has been given to detailed measure­ment of such changes in patients over a period oftime. As a first step toward the comprehensivemeasureml'nt of depressive symptoms, this is a studyof thl' sound of thl' Yoke.

Thirty-two patients were interviewed daily for fiveweeks jointly by a psychiatrist and a psychologistand their n'sponsl'S recorde<1. At the end of each ses­sion the interviewprs rated the voice quality on aneight-point seal.· allll compared these analyses withmood ratings from the contents of the interviews.For 25 of the patients therl' was a statisticallysignificant correlation. Since the investigators didnot exped the same kind of deprl'ssed voice qualityin l'n'ry suhjpd. it was npcl'ssary to study eaeh in­dividual pattern of change. The drug regimen oftl1('se patients \\'as quite variahle, making it difficultto aSSl'SS drug effl'ds on the voke. Howl'ver, in apn'vious study the same investigators had found noeffeds of 150 milligrams of pl'ntoharhital on thevoit'e sped rum. even though slurring occurn'd insevl'ral suhjeds. Quantitative studil's sueh as thisshould pnwidp valuable criterion measures in thetrl'atment of d<'pn·ssion.-ELIZAIlETH THo~IA

,\lANAGE.\IEST OF PATIENTS WITH TERMINALILLNESS. P. S. Rlwads. l.A.M.A., 192:661-66.5,1965.

The physician caring for a patient with a knowntI'rminal illness has rl'sponsihilities which go \wyondthe provision of pwry reml'dy that may reasonablybe administered to prolong life and relieve suffering.The family must he told the facts and prognosisabout the patient's iIInl'ss as fully and honestly asthe physician knows them. Except in the case ofchildren and adults who have little capacity for goodjud",rrnent. the patient must usually he told the tfllthalso-hut always with an admixture of hope andoftcn of optimistk uneertainty.

The degree to whkh last-ditch measures (e.g.,orchiectomy, hypophysectomy, adrenalectomy, radia­tion therapy, chemotherapy) are to be used must bedecided by the physician in charge and his col­leagues. The family should always be consulted onsuch matters and their wishes and those of the pa­tient should be respected. However, the physicianhas an obligation to recommend the course to be

March-April, 1966

followed, hased on the dictates of his own conscience.He should be steadfast in his refusal to listen tohindsight thoughts and recriminations directedagainst l'olleagues, the patient, or himself, after thefinal diagnosis has be{'n made.

At this time, provision of spiritual support is asimportant as the clinical managem('nt. The hospitalchaplain or the patient's own minister is usually avail­able for help, and the physician should sec to itthat he enters the pkture. But this docs not absolvethe physician from involwment with the patient'sspiritual and ('motional problems. llow much he willbe ahle to hl'1p will depend on how thoroughly he,himself, has thought through the deeper probll'ms oflife and death. If he bdieves that every humanbeing is important and has the right to dignity andsympathy in this time of trial, he can be of im­mense assistance in hdping the patient hear thesuffering of the malady which he cannot cure.­JAY H. SCHMIJ)T, ~I.D.

SEDATIVES, STIMULANTS, AND INTRAOCULARPRESSURE IN GLAUCOMA. lose D. Peczon,M.D., and W. Morlon Grant, M.D. Archives ofOphth., 72:178-188 (August) 1964.

The anthors point out that there is not yet a satis­factory answer as to wh<'ther the state of mind in­f1u{'nces the intraocular pressure in patients havingprimary open angle glaucoma. They studied the ef­fects of pentobarhital, diphenylhydantoin, primidone,methylphenylethyl hydantoin and dextro ampheta­mine on the diurnal ocular tension curves of openangle glaueomatons patients. In tests lasting fromone to five days, they found little evidenel' of con­sistent relationship between sedation, central stimula­tion and intraocular pn'sslue.-T. F. SCHI.AEGEL, In.,~I.D.

A CASE OF SUSPECTED PSYCHIC BLINDNESSDUE TO OCCLUSION OF POSTERIOR CERE­BRAL ARTERY. M. Kondo. lap. J. Clin. Opht1uIl.•18:851-854 (July) 1965. A1Jstractecl in Amer. Jour.of Ophth., 60:1161-1162 (December) 1965.

Symptoms simulatin~ psychic blindness were seenin a 63-year-old female who presented with intenseimpainnent of visual acuity, left-sided homonymousheminopsia and psychic disorder. There were noother ophthalmologic findin~s. On cerebral angi­ography occlusion of the right posterior cerebralartery was found. Among the symptoms which madethe conditions simulate psychic blindness were dis­turbance of mathematical calculation, impairment of

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PSYCHOSOMATICS

memory and re<:ognition, visual agnosia of matter andpersons, space agnosia in the left side and coloragnosia.-T. F. SCHLAEGEL, JR., M.D.

DIAGNOSING CONGESTED PELVIS. E. M. Marsll.Consultant, 5(4):24-26, 1965.

Abdominal pain that is vague and low, vaginaldischarg<" dyspareunia, dysm('norrhea, fatigue, andinsomnia, in the presence of essentially normal pelviclindings reprcsents the cong<'sted pelvis, a psycho­somatic disease. The patient is typically single,around 30, livin/!; alone, and oft<'n filling a responsible;oh eompet{'ntly. Her sexual needs an' neither satis­lied nor sublimated. She feels malevolent, but actsbenevolent; she is "well adjusted" to a miserablestate of affairs. Physiolo/!;ic and psychologic tensioncn'ates pelvic venous pooling; this in turn createsedema and stasis, pulls on uterosacral and cardinalligaments causin/!; pain. Dilated veins around thebladder and rectum upset normal functions.

Pelvic lindin/!;s an' positive. Tissues are edematousand painful, but readily distinguished from pelvicinHammation. The cervix; is hypertrophied, theuterus soft and enlar/!;ed, and the adnexae are boggyand prolapsed. To establish the diagnosis, a bimanualexamination is done, "squirting" the uterus betweenthe lingers. The "typical" pain described by thepatient is reproduced.

As a sequelae to these lindings, secondary effectsmay occur. These include anovulation, polycysticovaries, hyperestrinism, menometrorrhagia, infertility,improper implantation of a rarely fertilized ovum,early ahortion from improper uterine blood supplyand irre/!;ular uterine contractions, recurrent vaginitis( trichomonas and monilia), labial lissures from chronicvaginal dischar/!;{', ('te. These secondary diseases maybe so severe that it distracts the physician from thepelvic congestion which preceded.-JAY H. SCHMIDT,M.D.

GROUP PSYCHOTHERAPY WITH PSYCHOTICS.Bernard A. Stotsky and Eelwin S. Zolik. Internat. J.Gr01l/l Psycher., 15:321-342 (July) 1965.

This is a review of the literature from 1921 to1963. In contrast with the lar/!;e number of descrip­tive studies on group psychotherapy with psychotics,there are very few well-mntrolled studies of out­come. The latter do not /!;ive a clear endorsementfor the use of group process as an independent mo­dality. They do suggest that combined with an ag­gressive interest in hdping psychotics, or with EST,or tranquilizing medication, group therapy can bevaluable for such patients. What is needed is thedevelopment of various r('liable measures to providea basis for comparison among future studi('s.-EuzA­BETH THOMA

ENURESIS: DIFFERENTIAL DIAGNOSIS ANDTREATMENT. R. M. Silberstein and S. Blackman.Amer. J. PSljch., 121:1204-1206, 1965.

The categories of <'mudics wen' delined on the

122

basis of the condition producing the symptom and,on this basis, treatment appropriate to each cate­gory was clarilied.

The persistent enuretic attempts to acquire blad­der control throughout his life; about 85 per centare classilied in this category. The situation presentedby enuresis is analogous to the problem of the stu­dent who cannot read because he has n('ver beenadequately taught. Both suffer from an immaturityof personality and resultant disability of function.

The regressed enuretic repres('nts slightly morethan ten per cent of the enuretie population. Pa­tients in this group originally had bladder control,but later regressed due to an emotional disorder. Thetreatment indicated is psychotherapy directed towardsmore mature methods of resolving conHicts, ratherthan an attempt to deal directly with the symptom bymedication or training.

The ego disturbed make up about one per cent ofthe total number. These individuals suffer fromserious breaches of ego functioning. They undergomassive loss of many ego functions, including boweland bladder control. The prognosis for patients inthis category is least hopeful. Mitigation of theenuresis must often wait for successful treatrn{'nt ofthe basic psychiatric illness.

Enuretics with an organic basis account for aboutthree per cent of the total enuretic group. In thesepatients the physician's attention should be directedtowards management of the organic disease.-JAY H.SCHMIDT, M.D.

EVALUATION OF COMBINED ANTIDEPRES­SANT AND TRANQUILIZING DRUG (AMITRIP­TYLINE-PERPHENAZINE) IN THE TREAT­MENT OF HOSPITALIZED CHRONIC SCHIZO­PHRENIC PATIENTS. L. Karacan, F. Jones, andI. Ersedm. Amer. J. at Psychiat., 120(5):500-502,1963.

The authors conducted a study of nineteen pa­tients over a period of 12 weeks. Evaluation of pro­gress was made by the use of rating scales in addi­tion to clinical observations. Their conclusionspointed to the value of this <.'Ombination of drugs;however, they note the lack of placebo <.'Ontrol.

DEPERSONALIZATION IN TEMPORAL LOBEEPILEPSY AND THE ORGANIC PSYCHOSES.J. C. Kenna and G. Seelman. Brit. J. Psychiat.111:293-299, April 1965. '

The author's case material consisted of patientswho had been diagnosed as suffering from (a) epi­lepsy, and (b) organic syndromes. In the epilepticgroup (32 patients) there were 11 who reporteddepersonalization (feeling of unreality in the seHor in the external world). A highly significant rela­tionship was noted between the presence of de­personalization and depression. All had abnormalEEG tracings. In the organic group (64 patients),there were live who reported depersonalization. Twoof these were acute organic syndromes; three were

Volume VII

ABSTRACTS

chronic. Only four EEG tracings had been recorded;three were within normal limits and one showed ageneral dysrhythmia. All five patients were de­pressed.

BASILAR ARTERY THROMBOSIS. G. Gauthier.Schwerz. Arch. Neurol. Neurochr. Psychiat., 91/2;387, 1963.

The author reviews 387 patients with basilar arteryocclusion. He recognizes a premonitory phase char­acterized by repeated transient episodes of neuro­logical deficit with complete recovery. A phase ofpermanent occlusion shows signs of permanent neuro­logical deficit. The prognosis in this phase is serious;anatomically there is usually a bilateral lesion of thebasal portion of the pons. ~fedullary lesions are un­common, unless one vertebral artery is also throm­bosed.

Angiographic examination is recommended for allpatients with transient cerebral attacks; however,complete visualization of both the carotid and verte­bral systems is not without danger. It is importantto examine the site of origin of the carotid andvertebral arteries; also the subclavian and innomi­nate arteries. A surgical approach is possible when thestenosis is not intracranial.

Patients with vertebro-basilar insufficiency canoften be diagnosed clinically and rarely require angio­graphic confirmation. According to the author, transi­tory episodes will disappear with anticoagulant ther­apy.

A CONTROLLED CLINICAL TRIAL OF ALPHAMETHYL DOPA IN PARKlNSONIAN TREMOR.D. O. Marsh, H. Schnieden, /. Marshall. J. Neurol.Ncurosurg. Psychiat., 2:26, 1963.

With the oral dose of 2 g. of alpha methyl dopa agreater suppression of Parkinsonian tremor wasnoted in those treated with a placebo. In a double­blind trial, tremor was seen to be diminished; how­ever, sidt, effects occurred at doses of 1 to 1.5 g.per day for one week. These sidt' effects includeddrowsiness, deprt'ssion, faintness, dry mouth andslight constipation.

PSYCHOENDOCRINE ASPECTS OF ACUTESCHIZOPHRENIC REACTIONS. E. J. Sachar,J. W. Mason, H. S. Kolmer, Jr., ami K. L. Artiss.PsycllOsom. Med., 25(6):510, 1963.

Four young male soldiers suffering from an initialepisode of acute schizophrenia were studied fromboth a psychiatric as well as endocrinological pointof view. Phases of the illness characterized by ahigh degree of anxiety or depression were associatedwith marked elevations of 17-hydroxycorticoid excre­tion. The output of corticosteroids dropped duringperiods of equilibrium and recovery when the patientswere relatively calm. Epinephrine excretion followeda similar pattern, with elevations as high as eighttimes normal during phases of emotional turmoil.

March-April, 1966

PRIMARY AND SECONDARY ANOREXIA NER­VOSA SYNDROMES. A. King, Brit. J. Psychiat.,109:470, 1963.

In an investigation of 21 patients with anorexianervosa, two main types were delineated. Primaryanorexia nervosa was characterized by a "pleasurable"indulgence in food refusal; it was noted to occur inpost-pubertal, obsessional and highly intelligent girls.The initial symptoms were anorexia and/or amenor­rhea. Later there is usually the development ofalimentary, autistic and emotional symptoms. Theauthor links this primary type to disturbances inparental relationships and with specific abnormal per­sonality traits. In secondary states of anorexianervosa, the illness is considered to be a psychiatricresponse to phobic fears, delusions or severe depres­sion.

DISTURBED CALCIUM METABOLISM PRO­DUCED BY DIENCEPHALIC LESION. G.Vysotskii, Ocherki Klin. Neurologii (Leningrad).(abstracted in Ercerpta Medica, Vol. 16, Section 8,/I. 1341, Nov., 1963.)

A case is presented with a complex syndrome con­sisting of disturbed calcium metabolism, osteolysis ofthe distal parts of the terminal phalanges, pathologicalchanges in the mandible, calcification of the choroidplexus of the lateral ventricles, and frontal hyper­ostosis. The patient suffered from periodic t'pisodes ofdisordered vasomotor function of the skin; she alsosuffered from salivation, paresthesiae, tremor of thehands, rigors, increased perspiration and a sensationof hunger when the episode was terminated. Trophicchanges of the skin, hair, nails and teeth were ob­served. The author feels that all of these disordersstemmed from a lesion in the diencephalic area.

ORGANIC MERCURIAL ENCEPHALOPATHY. W.J. Hay, A. G. Rickards, W. H. McMenemetJ, andJ. N. Cummings, /. Neurol. Neurosurg. Psychiat.,26:199, 1963.

In a case report of fatal mercurial encephalopathy,the main neuropathological findings included selec­tive cortical damage, especially in the calcarine,parastriate, motor and sensory areas, and the caudalportion of the first temporal gyrus. A loss of neuroneswas noted to be associated with marked porosity ofthe white matter underlying them. In addition, therewas a swelling of the oligodendrocytcs. Cht'micalanalysis of the corpus callosum showed an especiallyhigh level of mercury.

"PSEUDO-PSEUDOHYPOPARATHYROIDISM." J.Jancar, ]. Aled. Genet., 2:32-37, 1965.

In this condition serum calcium and phosphorusare normal, and clinical signs of hypoparathyroidismare lacking. An abnormality in the metacarpophalan­geal line is pathognomonic; this line is usually convexbut here it is straight, irregular or concave due to

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PSYCHOSOMATICS

shortening of the metacarpal bone. Other commonfeatures include stocky build, short stature, obesity,broad or round face, mental retardation and an ab­normal electroencephalogram. The frequency isgreater in females. Physical or mental defects, some­times similar to those seen in the patient, are oftenfound in relatives.

DIAGNOSIS OF DEPRESSIVE SYNDROMES ANDPREDICTION OF ECT RESPONSE. M. W. P.Carney, M. Roth and R. F. Garside. Brit. ]. ofPsychiC/t., Vol. Ill, pgs. 659-674, Aug. 1965.

The authors point out that there are two maincategories of depression: endogenous and neurotic.The cluster of symptoms in an endogenous reactioninclude: adequate premorhid personality, absence ofadequate psychogenic factors in relation to illness,a distinct quality to the depression, weight loss,pyknic body build, occurrence of previous depressiveepisode, early morning awakening, depressed psycho­motor activity, nihilistic, somatic and paranoid de­lusions, and ideas of guilt. In neurotic depressionprominent symptoms include anxiety, aggravation ofsymptoms in the evening, self-pity and hystericalfeatures.

After three months, only 12 of 63 neurotic depres­sives were found to have responded well to ECT,whereas 44 of 53 endogenous depressives had doneso; the corresponding figures for six months wereeight out of 53 and 34 out of 44.

SUICIDE PROBLEMS IN CHILDREN AND ADO­LESCENTS. R. E. Gould, M.D., Amer. ]. Psycho­ther., 19:228-246, April 1965.

The psychodynamics of suicide are somewhat dif­ferent in children, adolescents and adults. Thechild's sense of being abandoned and rejected tendsto make him feel that he is bad and deserving ofpunishment. The decrease in self-esteem and thesense of worthlessness becomes intolerable. Aggres­sion towards the depriving parent (or environment)who is also a loved object, increases the feelingsof badness in the child or adolescent and this inturn increases the depression and guilt. His greatstake in preserving the image of a loving good parentincreases the likelihood of his turning his rage againsthimself. In the suicidal act, the unconscious hatredof the frustrating, depriving parent results in theneed to punish by making the parent feel sorry andresponsible for the suicide.

CALCIUM METABOLISM IN STATES OF DE­PRESSION. F. F. Flach. Brit. ]. Psychiat., 110:588,1964.

A total of 57 patients were treated on the MetabolicUnit of Payne Whitney Clinic (Cornell UniversityMedical College). Their dietary intake of calciumwas kept constant; daily 24-hour urine collectionswere done, and in some determination of faecal cal­cium was also added.

After a control period of two weeks, each of thedepressed patients was given either a series of 6-15

124

ECT or 150 mg. of imipramine orally daily. Thedrug was continued for a minimum of four weeks;failure to respond might then result in their beingshifted to ECT.

Patients were carefully observed for changes insymptoms, emotions and behavior. Social Behaviorcharts were rated by nurses twice daily; in addition,the observations of psychiatrists were recorded. Anadditional parameter of study was the "social contactindex."

The diagnostic categories noted were as follows:26 were classified as Endogenous Depressions (mid­cUe-life or early aging period); five were manic­depressives; 14 were psychoneurotics and 11 wereschizophrenics. 20 of the patients received ECT; 32were given imipramine and five received ECT afterfailing to respond to the drug. Moderate or markedimprovement was noted in 17, while 27 respondedto a lesser degree. Thirteen patients failed to re­spond; three apparently became worse.

Thirty-three patients demonstrated a decrease inurinary calcium excretion in excess of 15 per cent.

Reduced calcium excretion was not seen to be re­lated to the sex of the patient or the mode of therapybut was noted to correlate with eventual clinical im­provement. These results were seen in those withaffective disorders as well as paranoid schizophrenicreactions; but not in the psychoneurotics. Those whoshowed a rise in urinary calcium (15 pts.) werenoted to show this increase shortly after the institu­tion of treatment, whether by ECT or imipramine.These values, however, fell, with clinical improve­ment.

Improvement in general was associated with a re­duction of urinary calcium excretion. Reduction isusually first noted between the 18th and 25th day ofimipramine therapy or following the second or thirdECT. In the psychoneurotic, there was a tendencyto show a rise in calcium output prior to improve­ment, rather than a fall, suggesting that diHerentbiological mechanisms exist for the neurotic and theendogenous depressed patient.

DIPHENYLHYDANTOIN FOR ARRHYTHMIA. H.Bernstein, H. Gold, E. Corday, Tzu-Wang Lang,S. Pappelbaum and V. Bazika, I.A.M.A., 191:695­697, 1965.

Many arrhythmias resistant to conventional prophy­lactic treatment may be prevented by the use of thisdrug in a dosage of 100 mg. tid. Such arrhythmiasmay recur despite abstinence from stimulants (thy­roid, amphetamine) or the use of sedatives, quinidine,procaine-amide, digitalis and potassium. Prematureventricular contractions, paroxysmal atrial tachycardiaor fibrillation, and premature atrial or nodal systolesare responsive. The drug may act directly on themyocardium rather than through the central nervoussystem. The mechanism may lie in a relative shift ofpotassium into the cell, while sodium moves out. Thisexchange raises membrane resting potential.

In 37 of 60 patients, regular sinus rhythm wasmaintained for an average of 16.8 months.-W.D.

Volume VII