Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.

For centuries, heat has been used in various ways for the cure of mental diseases. Hippocrates noted that malarial fever could have a calming effect in epileptics. Centuries later, Galen described a case of melancholy cured as a result of an attack of quartan fever. In 19th century, the eminent French psychiatrist Philippe Pinel, in his treatise on insanity referred to the beneficial effect of fever. An opinion expressed few years later by his pupil Jean-Étienne Dominique Esquirol in his treatise entitled Des maladies mentales considérées sous les rapports médical, hygiénique et médico-légal. However, in 1917, the Austrian neuro-psychiatrist Julius Wagner Jauregg pointed out the therapeutic value of malaria inoculation in the treatment of dementia paralytica. In 1927, Wagner Jauregg received for this work the Nobel Prize in Medicine, being actually the first psychiatrist to win the Nobel Prize. He studied medicine at the University of Vienna and received his doctorate in 1880. In 1889, he was appointed Professor of Psychiatry and Director of the Graz's Psychiatric Clinic, a position that he held until 1928. Working in the asylum, Wagner Jauregg noted that insane patients with general paralysis occasionally became sane after some febrile episode. After experimenting with several artificial methods (streptococci, tuberculin) to induce fever, he concluded that malaria was the most satisfactory. Actually, malaria infection was an acceptable risk for the patients, as quinine would be administered as soon as syphilis was cured. In 1917, he reported the first favorable results of his study. Patients were inoculated via intravenous injections with malaria. Some physicians were starting the administration of anti-syphilitic treatment (bismuth, salvarsan and later penicillin) after 10-12 febrile paroxysms, while others initiated the regimen the first febrile-free day after 8 malarial paroxysms. The therapeutic regimen was completed with the administration of quinine sulfate to terminate the malaria infection. It is worth mentioning that the above treatment was followed in hospital under strict monitoring of patients' vital signs and regular laboratory tests. In the following years of his discovery, artificial fever was induced by any one of the following methods: the introduction into the patient of a parasitic disease; the injection of a foreign protein; injections of chemical substances such as sulphur; electrical means such as the administration of diathermy or radiotherapy, or placing the patient in an electromagnetic field; and simple immersion of the individual in a hot bath, or placing him in a heat cabinet. Wagner Jauregg's therapy was highly admired and was used on neurosyphilis cases well onto the 1950's. However, with the introduction of penicillin in syphilis' treatment, fever therapy effectively ended. Wagner Jauregg's study led to all the methods of stress therapy used in psychiatry, as electric shock, and insulin.

Clovis Vincent (1879-1947): founder of French neurosurgery and promoter of oncologic neurosurgery.

The eminent neurologist Clovis Vincent decided to become neurosurgeon at an advanced age. His is considered the founder of French neurosurgery and the Europe's first neurosurgeon. He was mainly interested in pituitary tumors and his work on oncologic neurosurgery remains valuable.

[Sexual mutilations through ages]. / Les mutilations sexuelles à travers les âges.

Among the ethnic mutilations (volunteer mutilations performed for religious, aesthetic, moral or hygienic purposes), genital mutilation (circumcision, castration, total emasculation, infibulation, excision, etc.) have always fascinated the human mind and are the subject of our historical overview.

The oncologic conceptions of the great clinician, phtisiologist, pathologist and statistician Gaspard-Laurent Bayle (1774-1816).

Gaspard-Laurent Bayle was a 19th century eminent clinician, pathologist, phthisiologist and statistician that deserves our attention. His very advanced oncologic conceptions rank him among the all-time great pioneers of oncology.

The Nobel Prize laureate - father of anaphylaxis Charles-Robert Richet (1850-1935) and his anticancerous serum.

Professor of physiology Charles-Robert Richet, winner of the Nobel Prize in 1913, is best known for his work on anaphylaxis. However, with his collaborator Jules Héricourt studied the effects of antibody treatment and made the very first attempts to fight cancer with serotherapy. Being versatile, Richet contributed in neurology, psychology and was also a poet, playwrighter, pacifist and pioneer in aviation.

[Reliability and validity of the Greek version of the Alcohol Use Disorders Identification Test (AUDIT)].

Problems associated with alcohol abuse are recognised by the World Health Organization as a major health issue. Because of the size and severity of the problem, early detection is very important.This requires easy to use and specific tools. One of these is the Alcohol Use Disorders IdentificationTest (AUDIT). AUDIT was translated and back-translated from its original language by two Englishspeaking psychiatrists. The tool contains 10 questions. A score ≥11 is an indication of serious abuse/dependence. In the study, 218 subjects took part: 128 were males and 90 females. From the218 individuals, 109 fulfilled the criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and presented requesting admission; 109 subjects were healthy controls. Internal reliability (Cronbach a) was 0.80 for the controls and0.80 for the alcohol dependent individuals. Controls had significantly lower average scores when compared to the alcoholics. The questionnaire's sensitivity for scores >8 was 0.98 and its specificity was 0.94 for the same score. Ιn conclusion, the Greek version of AUDIT has increased internalreliability and validity and is easy to use and can be very useful in detection alcohol problems in sensitive populations.

Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.

Platelet monoamine oxidase, plasma dopamine beta-hydroxylase activity, dementia and family history of alcoholism in chronic alcoholics.

The authors measured platelet monoamine oxidase (MAO) activity and plasma dopamine beta-hydroxylase activity in 36 male chronic alcoholics during a period of non-abstinence, and in 29 normal controls. The influence of family history, dementia, chronicity of drinking and liver injury on the enzyme activities was also examined by multiple regression analysis. Platelet MAO was significantly lower in the alcoholic group. Both enzyme activities were negatively related to the presence of dementia, while low MAO activity was associated with positive family history (parents, sibs) of alcoholism.

Depression among general hospital patients in Greece.

We estimated the prevalence of depression in 150 medical and surgical inpatients. Forty-three patients (29%) scoring at 14 or above on the Beck Depression Inventory (BDI) were classified as depressed. An excess of women and white-collar workers and more stressful life events during the last 12 months were found among the depressed patients. Of the 21 BDI items, 6 differentiated the 43 medical-surgical depressed patients from a group of 43 psychiatric inpatients with a diagnosis of primary or secondary depression (Feighner's criteria). Medically ill depressed patients scored higher in social withdrawal, work inhibition and irritability but lower in loss of libido, sleep disturbance, and lack of satisfaction. Our results show rates of depression in a medical inpatient population in Greece comparable with those in other studies. The use of BDI may help assessment of depression in general hospital patients.

Neurochemical variables in delusional depression.

The authors assayed plasma dopamine beta-hydroxylase activity, platelet monoamine oxidase (MAO) activity, plasma prolactin, the urinary monoamine metabolites 3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), and homovanillic acid (HVA), and urinary cAMP from 18 delusional and 22 nondelusional depressed inpatients. No significant differences between the two groups were found.

Platelet monoamine oxidase and plasma dopamine-beta-hydroxylase activities in non-abstinent chronic alcoholics. Relation to clinical parameters.

Platelet monoamine oxidase (MAO) and plasma dopamine-beta-hydroxylase (DBH) activities were determined in 27 male non-abstinent chronic alcoholics. Compared to 24 normals, no significant difference in both enzyme activities was found. Alcoholics with at least one alcoholic first degree relative had a trend toward lower platelet MAO activity compared to those without such a history. Matched pair analysis showed that alcoholics of the former subgroup had significantly lower MAO activity than controls. Demented alcoholics had significantly reduced plasma DBH activity compared with the non-demented subgroup and with age, and sex, matched controls.

Recurrence risk for the relatives of delusional depressed patients.

The recurrence risks for major depression among the relatives of patients with delusional depression have been calculated using a computer program. The risk tables have been based on the data from the 454 first-degree relatives of 77 probands with delusional depression, the 503 first-degree relatives of 76 non-delusional probands and the 980 first-degree relatives of 153 controls. The results showed that: the familial aggregation of the delusional depression seem to follow the multifactorial pattern of inheritance (segregation analysis), the heritability of the delusional depression was found to be 62, the recurrence risk varies from 0.5% to 36.2% for the various relatives and tables for recurrence risks are provided.

Delusional depression: phenomenology and response to treatment. A prospective study.

In a prospective study, the authors compared 22 delusional and 36 non-delusional depressive patients with respect to demographic and clinical variables, personality, and response to treatment. Delusional depressives had a higher total score than non-delusional depressives on Hamilton's Rating Scale for Depression, as well as a higher score for depressed mood and psychomotor retardation. The type of treatment failed to differentiate the two groups as to outcome at discharge. However, six of the seven delusional depressives who did not respond to tricyclic antidepressants had a full recovery with ECT. The results indicate that delusional depression represents a more severe type of major depression.

Delusional depression: phenomenology and response to treatment.

In this retrospective study demographic and clinical characteristics, personality traits, family psychiatric history and response to treatment were compared in 55 delusional and 40 nondelusional hospitalized patients who met DSM-III criteria for major depression. Male delusional depressives had a greater frequency of delusional ideas at the index episode than female delusionals. Delusional depressives had a greater frequency of family history for alcoholism, a smaller frequency of previous depressive episodes and tended to respond more favorably to treatment with electroconvulsive therapy or tricyclic antidepressants combined with neuroleptics than to antidepressants alone. The findings and the implications arising from them are discussed.

Type and content of delusions in unipolar psychotic depression.

In a prospective study the authors compared unipolar psychotic and non-psychotic patients for the presence of delusional ideation in previous episodes. Psychotic patients had a significantly higher frequency of delusions in previous episodes. The type and content of delusional ideas were similar from episode to episode. The results and their implications are discussed.

Disturbances of perception in depressive patients.

In a sample of 121 depressive patients hospitalized at Eginition Hospital from 1976 to 1980, 22 (18.2%) patients manifested disturbances of perception and, with 1 exception, all patients had hallucinations. Auditory and visual hallucinations were the most frequent. The group of patients with disturbances of perception had a positive family history for affective illness (p less than 0.025), a smaller number of previous depressive episodes (p less than 0.05), a greater frequency of delusional thinking (p less than 0.001) and psychomotor agitation (p less than 0.05).

Neuroses and ABO blood types.

Determination of ABO blood types was carried out in 72 (35 female and 37 male) patients with obsessive-compulsive neurosis, 73 (35 female and 38 male) patients with phobic neurosis, 75 (54 female and 21 male) patients with hysteria and a random sample of 600 individuals (268 female and 332 male) drawn from the general population. Results provide evidence of: (1) a positive association between obsessive-compulsive neurosis and blood type A and a corresponding negative association between the former and blood type O; (2) a positive association between phobic neurosis and blood type O and a corresponding negative association between the former and blood type A, and (3) a positive association between hysteria and blood type A and a corresponding negative association between the former and blood type O. Moreover, sex does not appear to modify the ABO blood type distribution in our patients with obsessive-compulsive neurosis, phobic neurosis or hysteria. These findings might be considered as supporting the view that hereditary factors in the neurotic individual may influence the clinical form of his neurosis.

Short-term social prognosis of schizophrenia.

Two groups of schizophrenic patients with diametrically opposed illness outcomes were compared, 14 months after discharge, with respect to 21 parameters. The first group comprised patients who relapsed and were readmitted into hospital and the second group comprised patients who achieved satisfactory occupational rehabilitation in the community. Satisfactory occupational rehabilitation was positively associated and relapse was negatively associated with the following parameters: compliance to maintenance pharmacotherapy, satisfactory work record, compulsory admission into hospital, living apart from parents or spouse after discharge, illness precipitated by stressful events, longer duration of hospitalization and more advanced age at onset of illness. The authors express the view that awareness of the parameters influencing short-term social outcome might contribute to a more efficient management of schizophrenic patients.

Abrupt lithium discontinuation in manic-depressive patients.

Prophylactic lithium was abruptly discontinued (under double-blind conditions and using placebo) in 18 manic-depressive patients for 15 days. Following lithium withdrawal tremor of hands, polyuria, general muscular weakness, polydipsia and dryness of mouth were significantly reduced. No withdrawal symptoms were noted. Three patients relapsed within 4 days of lithium discontinuation. The questions arising from these findings are discussed and the possibility of a rebound phenomenon produced by lithium is considered.

Subtypes of schizophrenia and ABO blood types.

Determination of ABO blood types was carried out in 430 (171 female and 259 male) patients with hebephrenic schizophrenia and in 340 (155 female and 185 male) patients with paranoid schizophrenia. Results were compared with a random sample of 600 individuals (268 female and 332 male) drawn from the general population. No significant association was detected between any of the ABO blood phenotypes and affliction either with hebephrenic or paranoid schizophrenia