L'entre-langue de l'exil / O entre-línguas do exílio / Inter-language of exile

Parti très jeune de son Irlande natale pour ne pas y revenir, Joyce a mené une vie d'errance. Il se définit lui-même comme un exilé et il a souhaité le rester sa vie durant. Il avait un amour des langues, un immense désir de connaissance à leur sujet. Richard Ellmann son biographe taxe ce long exil de « volontaire ¼. Joyce ne souhaitait pas que les choses changent. Il confie dans une lettre à son frère Stanislaus qu'il interprétait sa propre situation comme celle d'un exilé « J'en suis venu à accepter ma situation présente comme un exil volontaire - n'est-ce pas la vérité ? [...] ¼. Dès le "Portrait de l'artiste en jeune homme ¼ le signifiant « exil ¼ est sous-entendu. R. Ellman affirme qu'« Il avait besoin de l'exil comme un reproche adressé aux autres et d'une justification de lui-même. [...] On ne le renvoyait pas et il ne lui était pas défendu de revenir ; [...].

Tendo partido muito jovem de sua Irlanda natal para não mais voltar, Joyce levou uma vida de errância. Ele se autodefinia como um exilado e desejou permanecer assim durante toda a sua vida. Ele tinha um amor pelas línguas, um desejo imenso de conhecê-las. Richard Ellmann seu biógrafo taxa esse longo exílio de "voluntário". Joyce não queria que as coisas mudassem. Ele confessa ao seu irmão Stanislaus numa longa carta que ele interpretava sua própria situação como a de um exilado "eu cheguei a aceitar minha situação atual como um exílio voluntário ­ não é a verdade¿ [...]" Desde o "Retrato do artista quando jovem", o significante « exílio ¼ está subentendido. R. Ellman afirma que « ele tinha necessidade do exílio como uma reprovação endereçada aos outros e de uma justificativa de si mesmo[...] Não o expulsavam e ele não estava impedido de voltar; [...].

Having left his native Ireland at a very young age never to return, Joyce led a life of wandering. He defined himself as an exile and wished to remain so all his life. He had a love of languages, an immense desire to know them. Richard Ellmann his biographer rates this long exile as "voluntary." Joyce did not want things to change. He confesses to his brother Stanislaus in a long letter that he interpreted his own situation as that of an exile "I have come to accept my present situation as a voluntary exile - isn't that the truth¿ [...]" From the "Portrait of the artist as a young man" the signifier " exile " is implied. R. Ellman states that " he had need of exile as a reproach addressed to others and a vindication of himself[...] They did not expel him and he was not prevented from returning; [...].

O entre-línguas do exílio / L'entre-langue de l'exil / Inter-language of exile

Tendo partido muito jovem de sua Irlanda natal para não mais voltar, Joyce levou uma vida de errância. Ele se autodefinia como um exilado e desejou permanecer assim durante toda a sua vida. Ele tinha um amor pelas línguas, um desejo imenso de conhecê-las. Richard Ellmann seu biógrafo taxa esse longo exílio de "voluntário". Joyce não queria que as coisas mudassem. Ele confessa ao seu irmão Stanislaus numa longa carta que ele interpretava sua própria situação como a de um exilado "eu cheguei a aceitar minha situação atual como um exílio voluntário ­ não é a verdade¿ [...]" Desde o "Retrato do artista quando jovem", o significante « exílio ¼ está subentendido. R. Ellman afirma que « ele tinha necessidade do exílio como uma reprovação endereçada aos outros e de uma justificativa de si mesmo[...] Não o expulsavam e ele não estava impedido de voltar; [...].

Parti très jeune de son Irlande natale pour ne pas y revenir, Joyce a mené une vie d'errance. Il se définit lui-même comme un exilé et il a souhaité le rester sa vie durant. Il avait un amour des langues, un immense désir de connaissance à leur sujet. Richard Ellmann son biographe taxe ce long exil de « volontaire ¼. Joyce ne souhaitait pas que les choses changent. Il confie dans une lettre à son frère Stanislaus qu'il interprétait sa propre situation comme celle d'un exilé « J'en suis venu à accepter ma situation présente comme un exil volontaire - n'est-ce pas la vérité ? [...] ¼. Dès le "Portrait de l'artiste en jeune homme ¼ le signifiant « exil ¼ est sous-entendu. R. Ellman affirme qu'« Il avait besoin de l'exil comme un reproche adressé aux autres et d'une justification de lui-même. [...] On ne le renvoyait pas et il ne lui était pas défendu de revenir ; [...].

Having left his native Ireland at a very young age never to return, Joyce led a life of wandering. He defined himself as an exile and wished to remain so all his life. He had a love of languages, an immense desire to know them. Richard Ellmann his biographer rates this long exile as "voluntary." Joyce did not want things to change. He confesses to his brother Stanislaus in a long letter that he interpreted his own situation as that of an exile "I have come to accept my present situation as a voluntary exile - isn't that the truth¿ [...]" From the "Portrait of the artist as a young man" the signifier " exile " is implied. R. Ellman states that " he had need of exile as a reproach addressed to others and a vindication of himself[...] They did not expel him and he was not prevented from returning; [...].

Accès d'euphorie au réveil d'une sédation avec le propofol

L'objectif de cette revue était de rapporter les effets hallucinatoires survenus chez un sujet de 30 ans, au réveil d'une sédation au propofol pour endoscopie digestive. Le propofol est un hypnotique intraveineux d'utilisation courante lors des anesthésies pour gestes de courte durée comme les procédures diagnostiques en radiologie et en endoscopie. Le réveil post-anesthésie est qualifié « de très bonne qualité », cependant des effets hallucinatoires et psychodysleptiques ont fait l'objet de quelques écrits dans la littérature. Nous rapportons un cas d'accès d'euphorie post-anesthésique après sédation au propofol pour une endoscopie digestive

Trasplante cardiaco en paciente bipolar: reporte de caso / Bipolar Disorder and Heart Transplantation: A Case Report

RESUMEN Introducción: El trastorno bipolar es una afección del estado de ánimo, crónico y recurrente, que cursa con síntomas que fluctúan entre la euforia y la depresión. El trasplante cardiaco es el tratamiento de elección para pacientes con insuficiencia cardiaca y arritmias que no responden al tratamiento convencional, pero este tipo de procedimiento está contraindicado de manera absoluta o relativa para pacientes con trastorno bipolar. Métodos: Reporte de caso y revisión narrativa de la literatura. Caso: Mujer de 34 arios con trastorno bipolar desde los 13, en tratamiento con litio y aripiprazol, que requirió un trasplante cardiaco como opción terapéutica por taquicardia ventricular refractaria al tratamiento convencional. La paciente no sufrió descompensación afectiva al retirársele el litio y el aripiprazol, que se debió suspender porque se asociaron con prolongación del intervalo QTc, y permaneció eutímica a lo largo del proceso con ácido valproico y clonazepam. Conclusiones: Este reporte de caso muestra un trasplante cardiaco exitoso en una paciente con trastorno afectivo bipolar en eutimia y sin otras contraindicaciones psicosociales para el injerto. Además, destaca la importancia del seguimiento por psiquiatría de enlace durante el proceso.

ABSTRACT Introduction: Bipolar disorder is a chronic and recurrent mood disease that includes symptoms that fluctuate from euphoria to depression. As a mood disorder, itis one of the main contraindications for transplantation procedures. The case is presented of a patient with bipolar disorder who had a heart transplant after a cardiac arrest. Heart transplantation is the treatment of choice in patients with heart failure and arrhythmias that do not respond to conventional treatment. Methods: Case report and narrative review of literature. Case report: A 34-year-old woman with bipolar disorder diagnosed when she was 13, treated with lithium and aripiprazole. She required a heart transplant as the only therapeutic option, after presenting with ventricular tachycardia refractory to conventional treatment. The patient did not suffer an emotional decompensation with the removal of the lithium and aripiprazole that were associated with prolonged QTc interval, and remained eurhythmic throughout the process. Discussion: Heart transplantation can be performed safely and successfully in patients with bipolar disorder, when suitably followed-up by a liaison psychiatry group. Conclusions: Bipolar disorder should not be considered as an absolute contraindication for heart transplantation.

The euphoria, the warnings and the downfall of the current bioresorbale stents: could the journey be restarted?

No abstract available.

Clinical and psychological characteristics of propofol abusers in Korea: a survey of propofol abuse in 38, non-healthcare professionals / 대한마취과학회지

BACKGROUND: The aim of this study is to investigate the characteristics of propofol abuse based on the results of a survey analysis of abusers among non-healthcare professionals in Korea. METHODS: Thirty-eight propofol abusers were questioned between October and December 2010, and were enrolled and voluntarily participated in a structured survey consisting of an interview and completing a previously prepared questionnaire. The questionnaire was divided into three distinct parts: part 1 dealt with the history of propofol abuse; part 2 highlighted the problems caused by propofol abuse; and part 3 enquired regarding demographics of abusers. RESULTS: Thirty-one (81.6%) of the 38 interviewees abused propofol for more than one year. During the last 12 months, 34 (89.0%) received propofol at two or three times a week. The minimum and maximum amounts of propofol (median, range) administered each time were 500 (100, 1000) and 2000 (500, 4000) mg, respectively. Stress relief and the maintenance of a sense of well-being were quoted the most important reasons for the first-time administration of propofol and its subsequent abuse, respectively. The majority of abusers (36.0, 97.3%) reported a sense of pleasure or euphoria at the time of their propofol injection. Withdrawal symptoms occurred in five abusers (13.2%). Thirteen (36.1%) reported disruptions in their work life. None of the respondents had previously admitted to and or reported abuse of any other controlled substances. CONCLUSIONS: These results provided reference data for the regulation of propofol in Korea as a controlled substance and may also be of interest to international agencies in other countries.

Abuse potential assessment of propofol by its subjective effects after sedation

In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients' feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio [p > 0.05] in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio [p > 0.05]. All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses [r= -0.044, p= 0.761]. We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no residual after-effects should arise. We suggest that propofol may carry potential for abuse, and further abuse liability testing is indicated

The champion: Conquering the challenges of bipolar disorders

@#<p style="text-align: justify;">Bipolar Disorder has been one of the leading psychiatric conditions here in the Philippines. . It is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening period of normal mood (euthymia). The frequency, duration, and severity of manic and/or depressive episodes varies and is unique to each individual (Haber, 1997). In general, there are five in every 100 Filipinos who are suffering from some form of depression, and other may have a different reaction such as hyperactivity or swinging from depression to euphoria, unable to function normally, and in real danger of hurting themselves and others. Sadly, many of those with bipolar illness are left undiagnosed and, consequently, untreated. This case study presents how nurses play a role in helping patients overcome the challenges of having a psychiatric illness particularly those with Bipolar Disorder. </p>

A Case of Codeine Induced Anaphylaxis via Oral Route

Codeine is widely prescribed in clinical settings for the relief of pain and non-productive coughs. Common adverse drug reactions to codeine include constipation, euphoria, nausea, and drowsiness. However, there have been few reports of serious adverse reactions after codeine ingestion in adults. Here, we present a case of severe anaphylaxis after oral ingestion of a therapeutic dose of codeine. A 30-year-old Korean woman complained of the sudden onset of dyspnea, urticaria, chest tightness, and dizziness 10 minutes after taking a 10-mg dose of codeine to treat a chronic cough following a viral infection. She had previously experienced episodes of asthma exacerbation following upper respiratory infections, and had non-atopic rhinitis and a food allergy to seafood. A skin prick test showed a positive response to 1-10 mg/mL of codeine extract, with a mean wheal size of 3.5 mm, while negative results were obtained in 3 healthy adult controls. A basophil histamine release test showed a notable dose-dependent increase in histamine following serial incubations with codeine phosphate, while there were minimal changes in the healthy controls. Following a CYP2D6 genotype analysis, the patient was found to have the CYP2D6*1/*10 allele, indicating she was an intermediate metabolizer. An open label oral challenge test was positive. To the best of our knowledge, this is the first report of a patient presenting with severe anaphylaxis after the ingestion of a therapeutic dose of codeine, which may be mediated by the direct release of histamine by basophils following exposure to codeine.

Abuse potential of propofol used for sedation in gastric endoscopy and its correlation with subject characteristics / 대한마취과학회지

BACKGROUND: Propofol has been widely used for an induction and/or maintenance of general anesthesia, or for sedation for various procedures. Although it has many ideal aspects, there have been several cases of drug abuse and addiction. The authors investigated whether there are abuse liable groups among the general population. METHODS: We surveyed 169 patients after gastric endoscopic examination, which used propofol as a sedative, with the Addiction Research Center Inventory (ARCI) questionnaire. Other characteristics of the patients, such as past history, smoking habits, depression, anxiety, alcohol abuse liability and sleep disturbance, were recorded by history taking and several questionnaires before the exam. RESULTS: Propofol had a high Morphine-Benzedrine Group (MBG) score (representative value for euphoria) of 6.3, which is higher than marijuana, and a Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score (representative value of sedation) of 8.1, which is lower than most opioids. The MBG score showed no statistically significant correlation between any of the characteristics of the groups. In females, the PCAG score showed a correlation with age, and in males, it showed a correlation with a sleeping problem. CONCLUSIONS: Propofol had relatively high euphoria and low residual sedative effects. It had a more potent sedative effect in the female group who were young, and in the male group who had a low sleep quality index. There were differences in the abuse liability from a single exposure to propofol in the general population. Further study is needed to evaluate the abuse liability of repeated exposure.

Propofol abuse among healthcare professionals

The number of healthcare professionals (HCPs) abusing propofol has been steadily growing, while recreational use of propofol among the general public has become a social concern. Propofol was once believed to be unsuited for the purpose of abuse because it wears off too quickly and induces unconsciousness more frequently than euphoria. However, studies have demonstrated the abuse potential of propofol. Animal studies have shown that propofol increases dopamine levels in the mesolimbic dopamine system, which is a putative mechanism of addiction for most addictive drugs. Behavior studies, not only with animals but also with human beings, have demonstrated that administration of propofol induces conditioned rewards and reinforcement. Although the incidence of propofol abuse among HCPs seems to be lower than that of abuse of common addictive substances, multiple articles and case reports have documented cases. Easy access to the drug is closely associated with its abuse among HCPs. In addition, the pharmacologic properties of propofol, specifically its short onset and offset, is one of reasons HCPs start to abuse this drug without any serious consideration and makes propofol abuse difficult to detect. To reduce propofol abuse among HCPs, we should develop a strict pharmacy control system for limiting access to propofol. Adopting radio-frequency identification system for controlled drugs could be an effective option. However, substance dependent HCPs are quite resourceful even in obtaining controlled drugs. Therefore, a multilateral approach to stem the rising tide of propofol abuse among HCPs is needed: a combination of preventative education, early identification and intervention, aggressive treatment, and consistent rehabilitation.

Assessment of differential doses of buprenorphine for long term pharmacotherapy among opiate dependent subjects.

The aim of the present study was to evaluate, two different doses of sublingual buprenorphine (2 mg and 4 mg) among patients on maintenance treatment and to assess the relationship of steady state plasma level with craving. Twenty three male opioid dependent (ICD-10 DCR) subjects, were assigned to double blind randomized controlled trial of 2 and 4 mg/day doses of buprenorphine in an inpatient setting. They were evaluated thrice (2nd, 7th and 14th day) in 2 weeks for withdrawal symptoms (acute and protracted), sedation, euphoria, craving, side effects, global rating of well being and for measurement of plasma levels of buprenorphine. The data showed that there were no significant difference in scores of euphoria and sedation, protracted withdrawal symptoms and side effects, craving and overall well being and plasma level of buprenorphine among the subjects. However, both the groups had significant difference in score on almost all the measurements on final observation in comparison to initial observation. Both 2 mg/day and 4 mg/day dose of buprenorphine were effective in long term pharmacotherapy of opioid dependence without significant difference as compared by different measures used in the study.

Postoperative manic episode by sleep deprivation and stressful event

La euforia del último Nietzsche: I el comienzo del final / The euphoria of the late Nietzsche: I the beginning of the end

Background. This article attempts to evaluate the mood disorder that Nietzsche suffered from the last year of his lucid life. Method. In a two-part series, a detailed description of his daily life and his mental symptomatology during 1888 is given. Results. He was moderately stable as well exceptionally productive from January 1888 until he rushed in madness in January 1889. Conclusions. A meticulous analysis of his own creativity over this year shows that his emotional illness supplied material peculiar to his nature for his philosophy.

Antecedentes: Este artículo intenta evaluar el trastorno del humor que sufrió Nietzsche el último año de su vida lúcida. Método: En una serie de dos artículos se entrega una descripción minuciosa de su vida cotidiana y sintomatología mental durante 1888. Resultados: Él estuvo moderadamente estable así como excepcionalmente productivo desde enero de 1888 hasta que se precipitó en la locura en enero de 1889. Conclusiones: Un análisis detallado de su propia creatividad durante ese año muestra que su trastorno del humor proporcionó material peculiar a su esencia para su filosofía.

A Case of Orgasmic Aura Associated with Temporal Lobe Epilepsy from the Nondominant Hemisphere

We experienced a patient with an orgasmic aura originating from the right mesial temporal structure. A 36-year-old right-handed woman suffered from a specific sensation of sexual arousal and orgasm-like euphoria lasting 1~2 minutes for several years. Video EEG monitoring ascertained those sensations as epileptic in nature arising from the right mesial temporal area through a foramen ovale electrode. The findings of 99mTc-ECD-SPECT and 18F-FDG PET were concordant with those of the brain MRI which was pathologically consistent with hippocampal sclerosis.

The Change of Behavioral and Psychological Symptoms according to the Progression of Alzheimer's Disease

BACKGROUND: The evaluation of behavioral and psychological symptoms (BPSD) is important for the diagnosis and management of Alzheimer's disease (AD). Previous studies have reported the prevalence and severity of BPSD changes. However, these studies have mainly focused on the AD patients with mild to moderate severity. Our study investigated the BPSD in AD patients with more advanced stages and looked at the prevalence and severity of BPSD with the progression of disease. METHODS: One hundred thirty six patients with probable AD received the Korean version of the neuropsychiatric inventory along with the expanded version of the Korean Clinical Dementia Rating Scale (CDR) and the Korean version of the Mini-Mental State Examination (K-MMSE). RESULTS: The mean K-MMSE, CDR and NPI scores were 10.1 (SD=7.1), 2.0 (SD=1.5) and 32.7 (SD=26.2), respectively. CDR and K-MMSE scores did not correlate with the total NPI score but did correlate with some of the subscale NPI scores. Apathy had the highest relationship to CDR (r=0.39, p<0.01). Aberrant motor was most correlated with the total score of NPI (r=0.65, p<0.01). The mean number of positive NPI items was 4.3, which ranged from 2.1 (CDR 5 group) to 5.4 (CDR 2 group). The most frequent symptom was apathy and the least was euphoria. The severity of BPSD increased as the dementia severity increased to CDR 2 except apathy. Night-time behavior and anxiety were frequent in the early stages whereas apathy and aberrant motor were frequent symptoms in later stages. CONCLUSIONS: These observations suggest that BPSD is relatively independent of cognitive functions. The prevalence and severity of BPSD with the exclusion of apathy, increased as the dementia severity increased from CDR 0.5 to CDR 2 and then declined declined except apathy.

A Case of Diencephalic Syndrome / 대한소아내분비학회지

Diencephalic syndrome is a rare cause of failure to thrive in infancy and early childhood. The syndrome is characterized by profound emaciation with normal appetite, loss of cutaneous adipose tissue, hyperactivity, euphoria, and nystagmus. It commonly occurs in association with chiasmatic and hypothalamic gliomas. It has also been described in association with other histologic types. There is the marked increase of serum growth hormone, which may exhibit an inappropriate, even paradoxical response in stimulation test. A male infant of 12 months of age, showed markedly elevated growth hormone but he had failure to thrive findings. Evenly enhanced round mass was seen at suprasella area in brain CT. Its histological findings was "Desmoplastic infantile ganglioglioma", very rare histologic type. Here we report a case of diencephalic syndrome presented by failure to thrive in association with hypothalamic tumors.

Abuse liability of buprenorphine--a study among experienced drug users.

Six male post-detoxified opiate dependent subjects were evaluated for abuse liability of buprenorphine (0.6 mg), morphine (16 mg), pentazocine (30 mg) and distilled water (placebo) intramuscular injection in a single blind cross-over random order. Subjective states, drug discrimination, drug linking, sedation and euphoria were assessed at pre-injection, 30 min and 4 hrs post-injection. Buprenorphine caused significant euphoria and was identified as heroin. On all parameters, buprenorphine resembled morphine rather than pentazocine and placebo. The data suggest that abuse liability of buprenorphine is similar to morphine i.e. moderate rather than low.