[Sensitive character: an almost forgotten personality disorder - illustrated by the case Anton Reiser]. / Der sensitive Charakter: Eine fast vergessene Persönlichkeitsstörung - illustriert am Fall Anton Reiser.

n his famous 1918 book "The sensitive relative delusion" Ernst Kretschmer not only described this specific delusional disorder but also the underlying sensitive personality disorder. Until now, relatively little attention has been paid to this part of his work. The incomplete reception is outlined, followed by a description of the symptoms, psychodynamics and course of sensitive personality disorder. The interpretation of "Anton Reiser: a psychological novel" - the autobiographical work by Karl Philipp Moritz in 1785 ­ is used as an example since it describes Anton Reiser as a sensitive personality.

[An internist for psychiatry: Carl August Wunderlich (1815 - 1877)]. / Ein Internist für die Psychiatrie: Carl August Wunderlich (1815 - 1877).

In 19th century Germany C. A. Wunderlich (1815 - 1877) was one of the most important specialists of internal medicine. In addition he was receptive and alive to psychiatry. He translated an important book and held a lecture on psychiatry. He helped his friend Wilhelm Griesinger in the foundation of zhis career and later published his works. Wunderlich brought forward the principal of "clinical method" in medicine in general and particularly in psychiatry. Wunderlich rendered outstanding services to the development of psychiatry in the 19th century.

[Between Griesinger and Kraepelin--Ludwig Meyer (1827-1900): anatomist and reform psychiatrist]. / Zwischen Griesinger und Kraepelin--Ludwig Meyer (1827-1900): Anatom und Psychiatriereformer.

Ludwig Meyer worked as resident psychiatrist, scientist and university teacher in Berlin, Schwetz, Hamburg and for the longest time in Göttingen. He promoted social psychiatry, i. e. extramural treatment, "Milieutherapie" within the institution and especially the non restraint system. Mention should be made of the casuistic works, in which Meyer connected clinical and neopathological methods, morphologic studies of progressive paralysis and--beyond psychiatry--the discovery of "Progenie" in anatomy. Forensic psychiatry he saw as an expert task as well as a medical task. In the training of psychiatrists Meyer broke new ground. Ludwig Meyer is the most important representative of the late 19th century. His work was mainly influenced by Griesinger's concepts (1868). Within the following thirty years Meyer further developed these concepts and added ideas of his own. In Meyers works Kraepelin's clinical methods and pluralistic psychiatry already shine through.

[Eugen Bleuler (1857-1939) and German psychiatry]. / Eugen Bleuler (1857-1939) und die deutsche Psychiatrie.

Eugen Bleuler was born 150 years ago, and about 100 years ago he published his "Schizophrenia" for the very first time-giving rise to a retrospective view especially concerning German psychiatry. Together with Emil Kraepelin, who was more or less of the same epoch as Freud, E. Bleuler is one of the fathers of modern psychiatry. From the broad spectrum of his psychiatry with many findings, two achievements are particularly meaningful: the schizophrenia monography of 1911 and the first edition of his educational manual from 1916. Psychiatry owes two achievements to E. Bleuler: "deepened" psychopathology, which depicted schizophrenic symptoms and their relation, and the importance of psychoanalysis for psychiatry. Bleuler was not a psychoanalyst himself but rather a pluridimensional psychiatrist in the best sense of the word and at the same time sympathetic to psychoanalysis. The reception and historical effect of Bleuler's work are described. Another important subject that Bleuler himself regarded as the central field in his work is pointed out: the fight against alcoholism.

[Science and clinical practice. 1865 psychiatric convention in Hannover]. / Wissenschaft und Praxis. Zur Psychiatertagung 1865 in Hannover.

Psychiatric conventions in Germany have taken place since the 1840s. Concerning content and influence, outstanding was one in 1865 for scientists and physicians in Hannover, Germany. Practical and scientific problems of current psychiatric interest were discussed, particularly the question of monomania in the context of Unitarian theory, and further new, extramural ways of psychiatric care which already had received notice abroad (family care, agricultural colonies). The Hannover congress reveals the progressive influence of German institutional psychiatry.

[Wilhelm Griesingers "Magna Charta" of psychiatry. Its reception and impact on modern psychiatry]. / Wilhelm Griesingers magna charta der Psychiatrie - Zur Rezeptions- und Wirkungsgeschichte.

The work of Wilhelm Griesinger, really a magna charta of psychiatry, is usually reduced to just one sentence: "Geisteskrankheiten sind Gehirnkrankheiten", roughly: "mental illnesses are brain disorders". However, this is neither explicitly stated in Griesingers work nor does it adequately summarise his conception. This misinterpretation will be questioned by a careful analysis of the literature, and, in addition to that, the dimensions of Griesingers psychiatry including its delayed impact on the development of modern psychiatry will be described.

Information technology tools for efficient SNP studies.

We are currently facing a new era of studies involving single nucleotide polymorphisms (SNPs). This increased attention is stimulated by interest in individual differences in disease susceptibility as well as individual responses to drug treatment and the falling cost of genotyping. This review is a guide to the numerous public data repositories and Information Technology (IT) tools that may aid planning, preparation, running and analysis of studies involving SNPs. I will also highlight areas where researchers will have to resort to home-made IT solutions. Unfortunately, both information and IT tools are scattered throughout the internet and a lack of data exchange conventions can hamper the efficient use of these existing resources. This can lead to situations where the planning, preparation and analysis of a SNP study can actually cost more than the actual genotyping. We propose that only a customizable backbone IT infrastructure for SNP studies can help reduce costs associated with SNP data handling and tool launching.

[Persecution in Nazi everyday life. The pathological aspects of extreme stress]. / Verfolgungserleben im nationalsozialistischen Alltag. Zum pathischen Aspekt der Extrembelastung.

The extensive literature on persecution during the Third Reich lacks a first person account of the psychological distress induced by public Nazi harassments in everyday life--with the only exception of Victor Klemperer's diary. His records are outstanding in their unusual authenticity. They have gained widespread publicity and have been extensively reviewed, but almost exclusively from historical or political perspectives. The following is focused on his personal view. Taking his diaries as a starting point three subjects are treated: It is first discussed what kind of persecutional measures had to be faced by a Jewish person who was neither imprisoned nor had gone underground, but seemed to lead a normal life. Klemperer's records reveal an extreme kind of distress with permanent fear of death very close to that described by psychiatrists as victims of the Nazi persecution. It is then discussed how Klemperer experienced himself under these circumstances. Severe depression, distorted perception of time, stupefaction, egoism, and retreat from his compassion for fellow-sufferers may be understood from a psychodynamic point of view but were of course perceived as demoralization by Klemperer himself. Finally the present paper pursues the potentials of coming through and coping with persecution. Klemperer describes various ways and means of compensating and coping which were subsequently taken away from him with growing persecution. His non-Jewish wife was his only personal supporter. Writing was a constantly effective coping measure to him, initially as an essayist. After he had been banned from the academic community his diary remained his only opportunity for writing. In spite of being under constant fear for his life, he kept on writing. The subjective experiences of this situation are discussed. His recording of everyday life under persecution enabled him to survive it. Hence his diaries had a life-preserving function.

Vaccine candidate MSP-1 from Plasmodium falciparum: a redesigned 4917 bp polynucleotide enables synthesis and isolation of full-length protein from Escherichia coli and mammalian cells.

The Plasmodium falciparum malaria parasite is the causative agent of malaria tropica. Merozoites, one of the extracellular developmental stages of this parasite, expose at their surface the merozoite surface protein-1 complex (MSP-1), which results from the proteolytic processing of a 190-200 kDa precursor. MSP-1 is highly immunogenic in humans and numerous studies suggest that this protein is an effective target for a protective immune response. Although its function is unknown, there are indications that it may play a role during invasion of erythrocytes by merozoites. The parasite-derived msp-1 gene, which is approximately 5000 bp long, contains 74% AT. This high AT content has prevented stable cloning of the full-size gene in Escherichia coli and consequently its expression in heterologous systems. Here, we describe the synthesis of a 4917 bp gene encoding MSP-1 from the FCB-1 strain of P. falciparum adjusted for human codon preferences. The synthetic msp-1 gene (55% AT) was cloned, maintained and expressed in its entirety in E.coli as well as in CHO and HeLa cells. The purified protein is soluble and appears to possess native conformation because it reacts with a panel of mAbs specific for conformational epitopes. The strategy we used for synthesizing the full-length msp-1 gene was toassemble it from DNA fragments encoding all of the major proteolytic fragments normally generated at the parasite's surface. Thus, after subcloning we also obtained each of these MSP-1 processing products as hexahistidine fusion proteins in E.coli and isolated them by affinity chromatography on Ni2+agarose. The availability of defined preparations of MSP-1 and its major processing products open up new possibilities for in-depth studies at the structural and functional level of this important protein, including the exploration of MSP-1-based experimental vaccines.

[Delusion in depression]. / Wahn bei Depression.

The present article endeavours an outline of depressive delusions, their symptomatology and their various topics. Their relations to depressive feelings of guilt and anxiety are discussed and differentiated. Delusions of guilt, poverty or disease including their preliminary states are by no means rare but regularly occurring symptoms which substantiate the diagnosis of major depressive disorder/endogenous depression/melancholia. Preliminary states like hypochondriatic fears of guilt and poverty are likewise characteristic clinical signs which may be differentiated with high validity from the kind of anxiety associated to neurotic depression/dysthmia. Delusional depression did not prove to be a nosological entity but as a concept may bear considerable heuristic value concerning therapeutic considerations. This particularly serious form of depression requires specific therapeutic procedures.

Repeated sleep deprivation once versus twice a week in combination with amitriptyline.

OBJECTIVE: Although a combination of antidepressive pharmacotherapy with repeated sleep deprivation therapy has proved to be an effective and easily applied treatment strategy, no systematic study investigating the most favourable interval between the sleep deprivation trials is available. METHOD: In a cross-over design, 44 patients with a major depressive episode (ICD-10) were randomly allocated to 4 weeks treatment with amitriptyline (150 mg/d) in combination with either late sleep deprivation (of the second half of the night, LSD) twice weekly during week 1 and 2 followed by LSDs once weekly during week 3 and 4 or vice versa. Two hypotheses were tested: Does LSD twice weekly during week 1 and 2 accelerate the clinical response compared with LSD once weekly? Does LSD twice weekly during week 3 and 4 improve the response rate compared with LSD once weekly? RESULTS: According to both observer rating (Hamilton Rating for Depression, 21-item version) and self-rating (Visual Analogue Mood Scale), no significant differences could be ascertained between the groups compared at any time of the investigation. With respect to drop-outs and immediate LSD effects there is a trend for patients undergoing twice weekly LSDs followed by once weekly LSD trials to have a more favourable treatment course than the control group. CONCLUSION: The hypotheses tested were answered in the negative. "High dose" LSD administration does not prove to be clearly superior to "low dose" LSD. This finding is in line with most of the corresponding data on antidepressive pharmacotherapy.

Electroconvulsive therapy vs. paroxetine in treatment-resistant depression -- a randomized study.

Failure to respond to adequate pharmacological treatment for major depression is now the most common indication for the use of electroconvulsive therapy (ECT). The advantages of ECT with respect to both speed and quality of response are clinically important issues, but surprisingly few studies have examined the efficacy of ECT in relation to newer antidepressant agents such as selective serotonin reuptake inhibitors (SSRIs). A total of 39 subjects with major depression and with at least two failed antidepressant trials (mean 4.9 trials) were randomized to either paroxetine treatment (n=18) or right unilateral (RUL) ECT (n=21). Up to the end of the study treatment we found a reduction in the HAMD score of 59% for the ECT group and of 29% for the paroxetine group (P<0.001 paired t-test). In the ECT group, 71% of subjects fulfilled the response criteria (at least a 50% decrease in total HAMD score). The present study found ECT to be superior to paroxetine in medication-resistant major depression, in terms of both degree and speed of response.

Epitope analysis of human T-cell response to MSP-1 of Plasmodium falciparum in malaria-nonexposed individuals.

BACKGROUND: MSP-1 of Plasmodium falciparum induces strong proliferative T cell responses even in malaria-nonexposed individuals. Epitopes recognized by malaria-nonimmune T cells have not been identified, and immunological mechanisms inducing such T cell responses remain to be uncovered. MSP-1 is a vaccine candidate, and it should be understood whether those epitopes have any roles in MSP-1-mediated protective immunity. The T epitopes-inducing malaria-naive T cell response was analyzed in the hope of understanding the underlying mechanisms. METHODS: Human T cell lines and clones reactive to MSP-1 of P. falciparum were established from malaria-nonexposed Japanese donors in vitro, and epitope peptides were identified. Sequences of those epitope peptides were compared to unrelated peptides in the data base. One of those peptides was tested for both binding to HLA-DR molecules and inducing proliferative responses of MSP-1-reactive T cells. RESULTS: There are at least 6 epitopes recognized by malaria-naive T cells under the restriction by HLA-DRB1*1502 or 0802. Important amino acids for the T cell recognition were identified for an MSP-1 peptide. A yeast peptide which shared those residues induced proliferative responses of MSP-1-reactive T cells. CONCLUSION: We identified T epitopes in the N-terminal region of MSP-1, some of which showed molecular similarities with unrelated environmental antigens, suggesting the presence of cross-reactive T epitopes in MSP-1. Cytokine production in response to those epitopes suggests regulatory functions of those T cells during primary infection with P. falciparum.

Recognition of synthetic 104-mer and 102-mer peptides corresponding to N- and C-terminal nonrepeat regions of the Plasmodium falciparum circumsporozoite protein by sera from human donors.

In the present work, we analyze the recognition of synthetic polypeptides encompassing the aminoterminal (amino acids 22-125) and the carboxy terminal (289-390) regions of the circumsporozoite (CS) protein of Plasmodium falciparum by sera from donors living in endemic area of South America and Africa. Two populations were studied: one on the Colombian Pacific coast, with low endemicity for malaria; and a western African village exposed to a very intense transmission of P. falciparum. Antibodies directed to the two polypeptides were found at high titers in both populations. Furthermore, this response was observed in individuals lacking antibodies to the highly repetitive central sequence of the CS protein (NANP). The epitopes responsible for this recognition were mapped to the region 81-125 and 316-346 of the N- and C-termini, respectively. When the two populations were compared, both showed high titers of antibodies to the two flanking peptides. However, while 95% of the sera from African adults showed antibodies against the repeat region of the CS protein, only 37% of the Colombian adults studied had these antibodies. Furthermore, African donors of various ages exhibited different patterns of recognition of the two polypeptides. In African children less than five years of age, antibodies were found in comparable levels to Colombian adults; however, in older African donors, the response to NANP became dominant. These findings may reflect the skewing effect of the humoral response towards the central repetitive epitope under conditions of frequent exposure to malaria infections. The production of such polypeptides encompassing regions that contain multiple epitopes for antibodies, T helper, and cytotoxic T lymphocyte epitopes would be advantageous in the generation of new and more efficient malaria vaccines.

Serum prolactin, growth hormone, total corticoids, thyroid hormones and thyrotropine during serial therapeutic sleep deprivation.

In 13 patients fulfilling DSM-III-R criteria for a major depressive episode, hormone serum levels were measured at 8 AM on the day before and on the first and second days after partial sleep deprivation (PSD) late in the night during a 4-week course of therapy with amitriptyline in combination with 6 PSDs. Prolactin, human growth hormone (HGH) and total corticoids were not influenced by PSD. In contrast, T3 and thyrotropine (TSH) were elevated significantly on the 1st day after PSD throughout the series, but T4 less regularly. Although TSH reverted regularly to baseline values on the 2nd day after PSD, i.e. after a full night's sleep, T3 remained elevated. The hormones under discussion do not predict the therapeutic PSD effect. Nor can any correlation be determined between endocrine and clinical changes on the 1st or 2nd day after PSD. In connection with findings from sleep deprivation research in animals and in healthy subjects, the results suggest that thyroid changes under PSD may be nonspecific and unrelated to antidepressive PSD effects.

Amitriptyline in combination with repeated late sleep deprivation versus amitriptyline alone in major depression. A randomised study.

Only few systematic studies are available on the status of sleep deprivation therapy in the overall treatment regimen of depressive patients. 51 patients suffering from a major depressive episode (ICD-10) were randomly allocated to 4 weeks' treatment with amitriptyline (150 mg/day) or to a combination of amitriptyline with six partial-sleep-deprivation treatments late in the night (at 4-5 day intervals). According to observer rating (Hamilton Rating Scale for Depression, 21- and 10-item version), a highly significant amelioration was recorded in both groups until the 14th day of treatment. A further improvement occurred, however, only in those patients treated with both antidepressants and sleep deprivation. Hence the response rate ( > or = 50% HAMD reduction) after 4 weeks' treatment was distinctly more favourable in this group than in those patients under pharmacotherapy alone. The superiority of the combined therapy cannot be confirmed statistically by self-rating (Befindlichkeitsskala: von Zerssen; Visual Analogue Mood Scale). The immediate antidepressive effect of sleep deprivation diminished in the course of the sleep deprivation series. The response to the first sleep deprivation was a predictor neither for the response to further sleep deprivation treatments nor for the overall treatment outcome.

[Dyssocial identity disorder (double identity) in psychopathology and poetry]. / Dissoziative Identitätsstörung (Doppelleben) in der Psychopathologie und in der Dichtung.

Identity dissociation signifies: there seem to exist two identities in one personality that take turns-apparently without knowing about each other. Descriptions of this rare state are often spectacular. As scientifically proven they depend on culturally specific conditions and iatrogeneous influences. The disorder is to be analysed in this article for the case of both psychiatry and every-day-life-experiences in a matter-of-fact way. The first description of the phenomenon is not found in psychiatric literature but in poetry. The novellas of E.T.A. Hoffmann contain at least eight descriptions of 'double life'. The 'Fräulein von Scuderi' (1820) seems to be the most interesting of these and is therefore focused on in this article. E.T.A. Hoffmann himself was at the same time well respected jurist and significant artist of great versatility: poet as well as musician, composer, painter. Hoffmann's artistic and his civic life stood in sharp contrast, which gives reason to use of the term 'double life'.

Plasmodium falciparum: variations within the C-terminal region of merozoite surface antigen-1.

Sequence variations at the 3'-end of the Plasmodium falciparum merozoite surface antigen-1 gene show that the C-terminus of the protein may not be as conserved as has been assumed in the past. We have therefore examined the sequences of the 3' terminal 2 kb, i.e., blocks 12-17 of four isolates, RO-33, RO-71, 3D7A, and FCH5. We discuss different mechanisms of genetic exchange that could account for the observed variations. Furthermore the deduced amino acid sequences allow us to identify allelic epitopes of three monoclonal antibodies. Finally, our data complete the sequence of two additional independent alleles of this gene (RO-33 and RO-71).