Performance of 225 Dutch school children on Rey's Auditory Verbal Learning Test (AVLT): parallel test-retest reliabilities with an interval of 3 months and normative data.

Performance on Dutch adaptations of Rey's AVLT was examined in a sample of 225 6- to 12-year-old Dutch school children, selected to be representative of the general population. With an interval of 3 months, they were tested twice, using two out of three test forms which proved to be parallel. No test-retest practice effects were apparent. Age had a considerable impact on test performance. Measured imperfectly, socioeconomic background and intellectual level had some additional influence, as did the examiner who administered the tests. Boys made more errors than girls. Normative data corresponded well with those collected in a smaller Australian sample, suggesting usefulness outside The Netherlands. With a parallel test-retest reliability of.70, which was reduced to.59 when the influence of age was taken into account, the most reliable AVLT measure was the total number of words correctly recalled over the five learning trials. On the basis of reliability data, implications for the clinical use of the AVLT are discussed.

The relationship between tiredness prior to sleep deprivation and the antidepressant response to sleep deprivation in depression.

Recently it was hypothesized that the antidepressant response to total sleep deprivation (SD) results from a disinhibition process induced by the increase of tiredness in the course of SD. In the present study, the role of tiredness in the antidepressant response to SD is further investigated. Seventy-two depressed patients scored subjective tiredness and depressed mood three times daily (in the morning, afternoon, and evening) on the days preceding and following SD. It was found that averaged tiredness on the day prior to SD was related to the SD response, when the severity of depression prior to SD had been held statistically constant. Also, when both severity of depression and diurnal variation of mood prior to SD were partialed out, tiredness showed a positive correlation with the SD response: patients who reported a relatively low degree of tiredness on the day preceding SD improved by SD. This result suggests that tiredness has an influence on SD effects, and that this influence is independent from that of the severity of depression. The findings are in accordance with current ideas on the role of tiredness as a mediating factor in the induction of the therapeutic effects of SD.

Biological theories of depressions: premisses - and progress?

Although less undisputed in biological psychiatry than formerly, there are basically still two premisses which underly most hypotheses in biological depression research. These are deeply rooted in the medical way of thinking and have guided the construction of DSM-III. The first is that depressive symptoms and complaints cluster in one or more discrete syndromes, and the second is that these correspond to separate nosological entities, characterized by specific biological derangements and pathogenetic processes. Below a number of issues are raised which cast doubts on the validity of these premisses and on the progress made in pinpointing the derangements looked for.

Self-rated arousal concurrent with the antidepressant response to total sleep deprivation of patients with a major depressive disorder: a disinhibition hypothesis.

In view of the opposing theories regarding the arousing or de-arousing action of total sleep deprivation (TSD) in producing antidepressant effects, 23 patients with a major depressive disorder were deprived of a night's sleep twice weekly for two weeks, and self-rated their condition 38 times using von Zerssen's scale for depression and, concurrently, Thayer's Activation Deactivation Adjective Check List (AD ACL). Transient relief of depression after TSD, indicated by eight patients, was mimicked by their AD ACL scores, which revealed the same underlying factors as were found in Thayer's studies. TSD appears to be simultaneously arousing (giving more energy) and de-arousing (leading to less tension), while this response takes place against a background of increased tiredness/sleepiness. It is argued that TSD sets off a psychological disinhibition process on the basis of cerebral fatigue; in particular the prefrontal (orbital?) areas of the cerebral cortex may be implicated, possibly in relation to a dampening down of subcortical arousal systems.

In vivo phosphorus magnetic resonance spectroscopy in multiple sclerosis.

Localized phosphorus magnetic resonance spectroscopy at 1.5 T was performed in 39 patients with multiple sclerosis and in 15 healthy controls. The multiple sclerosis spectra showed increased creatine phosphate levels. This increase was correlated with the severity of the handicap and was greater in patients with a progressive course of the disease than in patients with relapsing-remitting disease. No clear abnormalities were observed in the spectra of patients with multiple sclerosis regarding the phosphomonoesters, phosphodiesters, inorganic phosphate, and beta-adenosine triphosphate or with respect to pH values. There was an increased creatine phosphate level in the spectra in relation to a low metabolic state of the brain.

Sleep deprivation in bright and dim light: antidepressant effects on major depressive disorder.

Twenty-three patients with a major depressive disorder were deprived of a night's sleep twice weekly, one week staying up in the dimly lit living room of the ward (less than 60 lux), and one week in a brightly lit room (greater than 2000 lux). Immediate, but transient beneficial effects of sleep deprivation were observed primarily in eight patients (the 'responders'). The immediate effects did not differ greatly for the two conditions, indicating that exposure to light at night is an implausible explanation for the antidepressant effects of total sleep deprivation. There was some evidence that the bright light condition led to a more prolonged improvement of the responders.

Testing Multivariate Partial, Semipartial and Bipartial Correlation Coefficients.

Stressing the close resemblance between univariate and multivariate situations, it is shown that a proper test for a multivariate semipartial correlation being zero is given by the test for the corresponding partial correlation. No legitimate test seems to be available for bipartial correlations. The procedures proposed by Cohen (1982) and Timm and Carlson (1976) are not well-founded and, in the case of multivariate semipartial correlations, unnecessarily conservative.

Effects of i.v. contrast administration on intraspinal and paraspinal tissues: a CT study. 2. Visual assessment.

Paired and matched CT scans, one before and one after IV injection of contrast material, from 30 spinal CT studies were presented in a blind fashion to six observers with varying degrees of radiologic experience. The observers were asked to indicate which section of each pair gave the best delineation of intraspinal soft tissues. Seventy-five percent of the verdicts indicated the postcontrast image was superior in this respect, but the six observers were unanimous on this in only 50% of the cases. At a follow-up viewing of the same cases several weeks later, some 20% of the verdicts were changed. Experience in interpreting spinal CT scans did not prove to influence rating performance or improve intraobserver consistency. In summary, contrast material, in the dosage and injection mode used by us, appeared to be the most important factor in improving scan interpretation.

Meige syndrome: double-blind crossover study of sodium valproate.

A double-blind crossover study of sodium valproate and placebo was conducted in five patients with Meige syndrome. CSF neurotransmitter studies were performed at the end of each treatment period. GABA levels were not influenced by the administration of sodium valproate. An increase in HVA levels was observed in every patient, which may reflect an increase in central dopaminergic activity. This finding may explain the trend towards clinical deterioration which was observed during treatment with sodium valproate. Sodium valproate appears to be ineffective in Meige syndrome.

Cognitive impairment in patients with multiple sclerosis and mild physical disability.

Forty mildly disabled and clinically stable patients with multiple sclerosis (MS), representative of the corresponding population in Northern Holland, with disability Status Scale scores evenly distributed within the 1 to 4 range, were compared with 40 age-, sex-, and education-matched normal controls on a battery of neuropsychological tests. Apart from impairments in perceptual-motor functioning, generally mild deficiencies in intelligence and, specifically, in memory were displayed in the MS group. Attentional processes appeared uncompromised. Increasing fatigue during testing could not account for poor performance. The memory deficits could be attributed to poor initial learning, although there was also evidence suggesting that accelerated forgetting of what had been learned may appear with the progression of MS. Seven patients (17.5%), as compared with none of the controls, were classified by blind clinical judgement of test performance as definitely impaired.

Anti-acetylcholine receptor antibodies in myasthenia gravis. Part 3. The effect of thymectomy.

The clinical condition and the serum levels of antibodies to acetylcholine receptor protein were followed in 30 patients with myasthenia gravis before and in a period varying from 2 to 4 (mean 3) yr after thymectomy. Twenty-five patients improved in the 2 yr following thymectomy. A highly significant correlation was found between the change in clinical condition and the change in antibody levels. Only 3 patients improved without a fall of antibody level. Prethymectomy antibody levels were positively correlated with the severity of the clinical condition and with the degree of thymus hypertrophy.

Carotid endarterectomy: does it improve cognitive or motor functioning?

In a group of 20 patients who were to undergo endarterectomy for atherosclerotic occlusive disease of the internal carotid artery, the stenosis did not appear to have resulted in cognitive or motor deficits. Consistent with this finding, surgery could not be shown to have a beneficial effect on cognitive or motor functioning. Control data were supplied by 20 patients who underwent peripheral vascular surgery and 20 healthy subjects. The test-retest interval was 10 weeks.

Residual complaints of patients two years after severe head injury.

In a follow up study of 57 patients who had sustained a severe closed head injury, 84% still reported some residual deficit in their psychological functioning after two years, with forgetfulness being the most common complaint. Expressing the severity of the injury in terms of both the duration of post-traumatic amnesia (PTA) and the extent to which previous work could be resumed (RTW), principal components analyses showed that the occurrence of "impairment complaints"--viz forgetfulness, slowness, poor concentration and inability to divide attention over two simultaneous activities--was positively related to severity. The other complaints, which in the main could be labelled as "intolerances" were not. The same pattern was found when the analyses were based on deficits of the patients as they were reported by relatives. Severity was not appreciably related to the total number of complaints. The correlation between PTA and RTW was 0.52, indicating that with longer PTA duration, work is likely to be resumed at a lower level, or not at all. Though Russell's cut-off of one week PTA to differentiate between severe and very severe concussion appeared useful, in the present study a further cut-off point at the unlucky number of 13 days was considered.

Spasmodic torticollis: treatment with Tizanidine.

A randomized double-blind cross-over study was performed to compare the efficacy of Tizanidine to that of placebo in the treatment of spasmodic torticollis. No evidence was found that Tizanidine was effective in 10 patients with spasmodic torticollis who received Tizanidine during 6 weeks, up to a dose of 12 mg a day.

Role of stenosis of spinal canal in L4-L5 nerve root compression assessed by flexion-extension myelography.

Myelographic flexion-extension studies were performed in four groups of 10 patients each, with (A) normal myelogram; (B) bilateral nerve root compression at L4-L5; (C) unilateral nerve root compression at L4-L5 and (D) nerve root compression at L5-S1. The aim of the investigation was to assess the role of spinal stenosis in contributing to nerve root compression. The results indicate that a form of stenosis of the spinal canal plays an important role in bilateral nerve root compression at L4-L5, and to a lesser extent in unilateral nerve root compression at L4-L5. It does not appear to play a role in L5-S1 nerve root compression (stenosis of the lateral recess left aside). It is advocated that in myelographic L4-L5 nerve root compression additional flexion-extension studies should be performed in order to evaluate the possible role of stenosis of the spinal canal contributing to this compression. Even in nerve root compression by disc extrusion, concomitant spinal stenosis may necessitate additional decompressive laminectomy.

Acid metabolites and precursor amino acids of 5-hydroxytryptamine and dopamine in affective and other psychiatric disorders.

Levels of various compounds related to monoamines were assessed in 96 patients with a variety of depressive and nondepressive syndromes. The diagnostic categories were composed retrospectively after examination of International Classification of Diseases (ICD) classifications and all available data in medical reports. All patients underwent the 8-hour probenecid test. Administration of probenecid was partly intravenous (1 g) and partly oral (4 g). In all patients, the cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and probenecid were estimated, while in about half of the patients tryptophan and tyrosine were determined in CSF and serum. When the group is taken as a whole, significant positive correlations are found between the CSF levels of 5-HIAA, HVA and probenecid, between the CSF levels of tryptophan and tyrosine, and between tyrosine levels in serum and CSF. A negative correlation is found between CSF probenecid and serum tryptophan. The group of patients was divided in several ways into various subgroups. Analysis of covariance of clinical and biochemical data indicates no significant biochemical differences between any of the subgroups. This retrospective study lacks supportive evidence that any of the clinical syndromes, including the depressive syndromes, is characterized by specific deficiencies of monoamine neurotransmission.

[Measurements of aphasic disorders. A brief description of the SAN-battery]. / Het meten van afatische stoornissen. Een korte beschrijving van de SAN-batterij.

A Dutch test series for the measurement of aphasic disturbances is introduced. Factor analyses demonstrate three factors that can be interpreted clearly as spontaneous speech, production and comprehension of speech. This structure is very stable during a follow-up of one year. The tests and the production, comprehension and severity scores derived from them have high indices of reliability. Norms based on 147 cerebrovascular aphasics and 179 normal controls have been calculated.

Nature and severity of hydrocephalus and its relation to later intellectual function.

In 102 cases of infantile hydrocephalus, treated within 365 days of birth, the possibilities of predicting later intelligence were investigated, largely by means of multiple regression methods. No significant effect of aetiology, date of shunting or severity (measured in various ways) could be demonstrated. Within the spina bifida group however the 3 cases of encephalocele had considerably lower IQ's. There was no effect of lesion level in the rest of this group. Educational level of the parents had a significant, but not very marked impact on the IQ's of their children. Most outstanding was the difference between non-communicating and communicating hydrocephalus: nearly 50% of the non-communicating cases were mentally retarded, while this percentage was 22 for the communicating ones.