The neurophysiology of sexual desire, with particular reference to paedophilia.

Bancroft has proposed a central arousability system as an androgen-sensitive neurophysiological substrate of sexual desire. The present paper describes the author's explorations of a brain-wave measure, the contingent negative variation (CNV), as a putative index of sexual desire under conditions of sexually-relevant stimulation in paedophilic child sex offenders and in non-offender control men. As a group, the former showed undifferentiated CNV responses to adult and child stimuli, unlike non-paedophilic child sex offenders and controls, who showed larger CNVs to adult than to child stimuli. These results suggest that CNV may be usefully developed as an adjunct to penile plethysmographic (PPG) assessment of deviant sexual interests in offenders. Some possible directions for future research are indicated.

Premenstrual syndrome: a double-blind controlled trial of desipramine and methylscopolamine.

The aim of this study was to compare the effect of the selective noradrenergic reuptake inhibitor desipramine and methylscopolamine bromide, a parasympatholytic agent, on late luteal phase dysphoric disorder (LLPDD), or premenstrual syndrome (PMS), as defined in DSM-III-R. Fourteen patients with PMS were assessed both retrospectively and prospectively during premenstrual cycles. All met the DSM-III-R criteria for LLPDD. They received 3 months treatment each with both desipramine and methylscopolamine in random order using a double-blind cross-over design. PMS symptomatology was significantly reduced after treatment with desipramine and methylscopolamine bromide compared with baseline, but there was no significant difference between them in efficacy. There is evidence from this study that both anticholinergic and noradrenergic pathways may be involved in the genesis of PMS.

Contingent negative variation (CNV) and erotic preference in self-declared homosexuals and in child sex offenders.

Contingent negative variation (CNV) was recorded bilaterally from central electrodes using a "match/mismatch" paradigm in (Study 1) samples of heterosexual men (N = 6), gay men (N = 10) and lesbian women (N = 14) and (Study 2) in samples of child sex offenders (N = 34) and heterosexual control men (N = 19). Sexual orientation was assessed using the Multidimensional Scale of Sexuality (MSS) and the Human Sexuality Questionnaire (HSQ). Separate CNV averages were formed for each condition of stimulation: for Study 1, slides of adult male and female nudes; for Study 2, slides of child, pubescent and adult male and female nudes. Penile plethysmographic (PPG) data were also obtained from 15 of the child sex offender sample while they viewed stimuli of the same categories as were used in the CNV recording. On the basis of their PPG responses to children, child sex offenders were classified as either "pedophiles" or "non-pedophiles". In Study 1 significant Group x Sex (of slide) and Group x Electrode interactions indicated that: (i) heterosexual men (but neither homosexual group) showed significantly larger CNVs to female than to male slides; (ii) both homosexual groups showed significantly asymmetrical (R > L) CNVs. In Study 2, controls showed significantly greater CNVs to adult females than to both adult males and female children. Child sex offenders showed no significant differences in CNV to male and female slides for any age. "Non-pedophiles" showed significantly larger CNVs to female adults than to female children, but "pedophiles" did not. It is concluded that CNV has promise as a measure of both deviant and non-deviant sexual preference.

Patients infected with human immunodeficiency virus type 1 have low levels of virus in saliva even in the presence of periodontal disease.

In two consecutive studies, 80 subjects human immunodeficiency virus (HIV)-1-seropositive (21 asymptomatic, 6 persistent generalized lymphadenopathy, 13 AIDS-related complex, and 40 AIDS) were examined for oral lesions. Paired serum and saliva specimens were tested for HIV isolation, DNA, and antigen. HIV antigen was detected in sera from 31 patients, but not in saliva. HIV was isolated from blood mononuclear cells of 83% and saliva supernatants of 21%. In the second study of 25 patients, HIV was detected in plasma of 56% (titers, 1/10 to > 1/1000) but not in diluted saliva supernatants, even in those with severe periodontal disease. HIV DNA was detected using polymerase chain reaction in 2 of 7 saliva cell pellets and 4 of 5 blood samples. Hence, infectious HIV and DNA was found at very low concentrations in 21% and 28% of HIV-seropositive patients, respectively, at all stages of HIV infection.

Fluoxetine's spectrum of action in premenstrual syndrome.

This study extends our previous report of the efficacy and tolerability of fluoxetine in severe premenstrual syndrome (PMS), describes which aspects of the disorder are responsive to such treatment, and assesses the relationship between steady-state drug level and clinical outcome. Twenty-one women with documented PMS satisfied criteria for late luteal phase dysphoric disorder (DSM-III-R) and accepted the offer of a double-blind, randomized crossover trial of fluoxetine hydrochloride 20 mg/day vs placebo. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews after 3 months each of baseline, placebo and fluoxetine treatment. Compared with an inconsistent placebo response, fluoxetine produced marked improvement in 15 of 16 women completing the trial, eight showing virtually complete remission of PMS symptoms. Fluoxetine's efficacy extended over a range of affective, physical and behavioural symptoms; its superiority obtained whether it preceded or followed placebo. Three women withdrew due to adverse effects of fluoxetine, and 10 of 16 completing the trial reported at least one adverse effect of this agent. Compared with placebo, fluoxetine produced more (but usually transient) insomnia, sweating, gastrointestinal and menstrual disturbance. Plasma levels of fluoxetine and its active metabolite were not reliably associated with efficacy nor with side effects. Serotonergic agents appear to have considerable promise in treating a range of symptoms in women with severe PMS.

Psychiatric symptoms, personality and ways of coping in chronic fatigue syndrome.

This study aimed to investigate the psychological characteristics of chronic fatigue syndrome (CFS: Holmes et al. 1988). A battery of psychometric instruments comprising the General Health Questionnaire (GHQ), the Beck Depression Inventory (BDI), the Minnesota Multiphasic Personality Inventory (MMPI) and the Lazarus Ways of Coping (WoC) inventory, was administered to a sample of clinically-defined CFS sufferers (N = 58), to a comparison group of chronic pain (CP) patients (N = 81) and to a group of healthy controls matched for sex and age with the CFS sample (N = 104). Considerable overlap was found between CFS and CP patients at the level of both physical and psychological symptoms. This raises the possibility that CFS sufferers are a sub-population of CP patients. However, while there was some commonality between CFS and CP patients in terms of personality traits, particularly the MMPI 'neurotic triad' (hypochondriasis, depression and hysteria), CFS patients showed more deviant personality traits reflecting raised levels on the first MMPI factor, emotionality. Moreover, results were not consistent with the raised emotionality being a reaction to the illness, but rather were consistent with the hypothesis that emotionality is a predisposing factor for CFS. The majority of CFS patients fell within four personality types, each characterized by the two highest MMPI scale scores. One type (N = 20) reported a lack of psychological symptoms or emotional disturbance contrary to the overall trend for the CFS sample. This group conformed to the ICD-10 classification of neurasthenia.

Salivary THC following cannabis smoking correlates with subjective intoxication and heart rate.

A cannabis smoking trial was conducted using paid volunteers. Subjective intoxication, measured using a visual analogue scale, was compared with heart rate and with salivary delta-9-tetrahydrocannabinol (THC) levels at various times after smoking a cigarette containing 11 mg THC. Subjective intoxication and heart rate elevation were significantly correlated with the log of salivary THC. Salivary THC levels are a sensitive index of recent cannabis smoking, and appear more closely linked with the effects of intoxication than do either blood or urine cannabinoid levels.

Use of auditory evoked responses as a measure of recovery from benzodiazepine sedation.

The amplitude of the P300 component of auditory evoked responses was found to be depressed by benzodiazepine sedation and was subsequently used to monitor the recovery of volunteers sedated with midazolam. The amplitude of the evoked responses was found to be highly correlated with blood midazolam levels but to be no more sensitive than standard psychomotor testing in assessing recovery from sedation.

Internal reliability of the WISC-R with male juvenile delinquents.

The internal reliability of the WISC-R was examined with a sample of 200 male delinquents. Scale IQ reliabilities ranged from .92 to .80, and subtest reliabilities ranged from .90 to .52. The standard errors of measurement for Scale IQs were approximately 1 point and for individual subtests significantly differed from that reported in the WISC-R manual. The results indicated the WISC-R to be acceptably internally consistent when used with male juvenile delinquents.

Stability of WISC-R scores in a juvenile forensic sample.

The temporal stability of WISC-R IQ Scale and subtest scores was examined in a Juvenile Court sample comprised primarily of neglected youth (N = 36). Stability coefficients were calculated for an average test-retest span of more than 2 years. WISC-R IQ Scale subtest scores were found to be stable to a degree comparable with WISC-R standardization data despite the considerably longer test-retest interval. Stability coefficients were .88 for Verbal IQ, .86 for Performance IQ, and .93 for Full Scale IQ. Subtest stability coefficients range from .49 to .82; many coefficients are equal to or greater than .70. No practice effects were apparent.

The contingent negative variation (CNV) to fear-related stimuli in acquisition and extinction.

Contingent Negative Variation (CNV) in anticipation of phobic and neutral slide material was recorded in Acquisition of a learned association between tone pitch and slide type, and in Extinction (following removal of slide presentation). In phobic volunteers, no clear CNV differentiation between 'phobic' and control condition was apparent in either Acquisition or Extinction. For Control subjects, a different pattern entirely has been demonstrated, with anticipation of the neutral condition giving rise to a larger CNV than anticipation of the 'phobic' condition (in Acquisition). In addition, Extinction led to a reversal of this CNV amplitude relationship, with the tone previously associated with the phobic slide producing a DC-shift which was larger than that following the tone previously paired with the neutral slide. The results are compatible with a dynamic model of CNV generation according to which CNV amplitude is positively related to an expectancy for reward or non-punishment but inversely related to an expectancy for punishment or non-reward.

Factors associated with juvenile detention truancy.

Factors influencing truancy from a juvenile court treatment facility were investigated. Youth born in 1962 (N = 124) who were placed in the facility were compared for number of truancies, background, and personality variables. Results showed that males with prior adjudication for home or school truancy had a 65% probability of eloping from the court facility as compared to a 34% probability for youth adjudicated for other offenses. Most females were adjudicated for truancy offenses and showed a 62% probability of truancy while in the court facility. Further, for females who eloped and were returned, the probability of a subsequent truancy was above 80%. Personality characteristics of truants varied with sex: male truants were more likely to be conduct disordered youth for which impulsivity and disregard for social norms is prevalent; female truants appear more likely to be in conflict over autonomy issues.

The clinical EEG and personality in mentally abnormal offenders.

A retrospective survey was undertaken of the clinical EEG in a series of consecutive admissions to Broadmoor Special Hospital (N = 265). Following reporting of the records by visual inspection, the EEGs were classified according to 4 descriptive categories: predominantly monorhythmic; low voltage fast, 'choppy'; dysrhythmic with excess theta; and dysrhythmic with paroxysmal features. The last 3 categories constituted EEG patterns with atypical or anomalous features. The EEGs of patients with high scores on Welsh's MMPI Anxiety scale ('withdrawers') were compared with those of patients with low scores ('approachers'). Lateralization of paroxysmal EEG features was studied with reference to MMPI personality measures (Blackburn's Impulsivity and Sociability and Welsh's Anxiety), legal diagnosis, type of offence, and relationship to victim. The EEGs were studied in a further sample of 29 admissions who had been assessed, using Hare's Research Scale for the Assessment of Psychopathy (Hare, 1980). While the overall incidence of atypical EEG features reported in the present study (around 60% of cases) was comparable with that reported previously for offender populations, they occurred significantly more frequently in 'withdrawers' than in 'approachers'. This suggests that the high frequency of atypical EEG features in abnormal offenders may be due to the preponderance of 'withdrawers' in this population. Patients who had committed violent offences against strangers, as opposed to people known to them, tended to have bilateral paroxysmal features in their EEG. High scores on Hare's Psychopathy scale were significantly associated with prominent Posterior Temporal Slow Activity. The study offers some prospect that the combined use of EEG and personality assessments may be of potential value in the assessment of dangerousness.

The contingent negative variation, personality and antisocial behaviour.

Using a classical click/flash paradigm the contingent negative variation (CNV) was recorded from 60 consecutive male admissions to Broadmoor Hospital. Clinical and psychometric Minnesota Multiphasic Personality Inventory (MMPI) assessments were made independently of the electroencephalography (EEG) data. A trend for higher amplitude CNV's to be recorded from patients with a clinical diagnosis of antisocial (psychopathic) personality was observed. Patients with a Mental Health Act diagnosis of psychopathic disorder had significantly higher voltage CNV's than those in the mental illness category. These CNV differences were only found in the primary (non-anxious, sociable) psychopaths. Secondary (neurotic, unsociable) psychopaths did not differ from staff controls. A positive association between CNV voltage and the personality factor of sociability(sociable-shy dimension) was observed. A weak, negative correlation between CNV amplitude and impulsivity (impulsive-controlled dimension) was also apparent. All subjects showed an habituation effect across trials. No difference in response variability between successive series of trials was apparent in any of the patient groups.

Thoracoscapular fusion for facioscapulohumeral dystrophy.

Eleven thoracoscapular fusion operations have been done on six patients. The indication is symptomatic winging of the scapula caused by thoracoscapular muscle paresis with intact function in the deltoid. This situation almost exclusively occurs in facioscapulohumeral dystrophy. The operation is successful in achieving stability of the scapula and in greatly improving function and cosmesis. Although the course of this type of muscular dystrophy is variable, the benefits of operation have not deteriorated with progression of the disease over a maximum follow-up period of twenty-three years.