Clomipramine treatment of stereotypic behaviors and self-injury in patients with developmental disabilities.

The authors report an open clinical trial of clomipramine for chronic stereotypic and self-injurious behaviors in 11 consecutive patients with concomitant developmental disorders. Ten patients (91%) had marked decreases in rates of target behaviors. No seizures occurred despite the inclusion of six patients with previous histories of epileptic events, and improvement was evident regardless of level of mental retardation. These findings support both the clinical use of serotonergic medications in this population and the need for further research.

Magnetic resonance imaging of the posterior fossa in autistic adults.

Magnetic resonance imaging measurements were obtained for 12 adults with DSM-III-defined autism and a matched group of 12 normal subjects. No significant differences were found for mean midsagittal areas of pons, fourth ventricle, cerebellar vermis, or vermis lobules. No significant brain abnormalities were observed in either group.

T2 hyperintense foci on magnetic resonance images of schizophrenic patients and controls.

High resolution magnetic resonance imaging (MRI) of the brain was performed on 18 male schizophrenic patients and 15 male normal control subjects using an identical imaging protocol. The number and size of T2 hyperintense foci were clinically quantified by an academic radiologist. Large foci (greater than or equal to 3 mm in diameter) were observed more frequently on patient images (7/18) than on control images (1/15). The imaging protocol detected high rates of focal hyperintensities, but no differences between patients and controls were noted in the total affected brain area (sum of focal areas) or in the presence or absence of foci.

MRI in tardive dyskinesia: shortened left caudate T2.

High-resolution magnetic resonance imaging of the brain was performed on 18 male schizophrenic patients, 14 with a cumulative exposure to neuroleptics of more than 1 year and 4 with less than 3 months of exposure. Calculated T2 relaxation time values were obtained for the basal ganglia. Patients with tardive dyskinesia (n = 9) had significantly shortened left caudate T2 relaxation times when compared to patients without tardive dyskinesia (n = 5). The group of four patients with fewer than 3 months' exposure to neuroleptics demonstrated a significantly greater variability of their left caudate T2 values. T2 relaxation time shortening may be related to iron levels in the basal ganglia and may be of predictive value in evaluating risk of tardive dyskinesia.

MRI gradient fields increase brain mannitol space.

Following nephrectomy and intravenous injection of tritiated mannitol, adult male rats were exposed to magnetic resonance imaging (MRI) procedures at 1.5 T, 0.5 T, and 0.3 T. Compared to rats similarly handled but not exposed to MRI procedures, brain mannitol concentration, expressed as a percentage of mean body concentration, was significantly increased at 0.3 T and 0.5 T but not at 1.5 T. At 0.3 T, exposure to gradient-field fluctuations used for imaging increased brain mannitol concentration, but exposures to static main field and pulsed radiofrequency energies did not. Increased brain mannitol associated with gradient-field flux may reflect increased blood-brain barrier permeability or blood volume in brain. MRI effects on brain mannitol space are of uncertain clinical significance, but are consistent with prior evidence of an MRI-induced increase of brain capillary endothelial cell transport observed with horseradish peroxidase. Further studies are needed to confirm these findings and to explore the processes underlying changes in mannitol distribution related to MRI.

Nuclear magnetic resonance study of obsessive-compulsive disorder.

Magnetic resonance imaging (MRI) of the brains of 32 patients who met the DSM-III criteria for obsessive-compulsive disorder and of 14 normal subjects frequently revealed abnormalities, but none was specific to obsessive-compulsive disorder. Spin-lattice relaxation time (T1) for right frontal white matter was prolonged in the patients compared to the control subjects, and the patients had greater right-minus-left T1 differences for frontal white matter. Right-minus-left T1 differences in the orbital frontal cortex were strongly correlated with symptom severity in the unmedicated patients and in the patients with family histories of obsessive-compulsive disorder.

Clinical use of topographic brain electrical activity mapping in psychiatry.

The authors report clinically relevant results from topographic brain electrical activity mapping of patients undergoing psychiatric evaluation. Topographic methods are discussed and compared with electroencephalographic (EEG) and evoked potential (EP) techniques. Suggestions are made for using topographic analysis of EEG and EP data in clinical psychiatric practice.

A magnetic resonance imaging study of autism: normal fourth ventricle size and absence of pathology.

Magnetic resonance imaging did not diagnose neuropathology in 15 autistic patients. Measurements of the midsagittal area and volume of the fourth ventricle did not differ between these patients and matched control subjects.

Use of magnetic resonance imaging in psychiatry.

The authors report four cases in which magnetic resonance imaging (MRI) provided diagnostic information not apparent by X-ray CAT in clinical investigations of patients with neuropsychiatric disorders. The relative capabilities and contraindications for MRI and CAT are reviewed. The authors suggest that MRI is indicated 1) instead of CAT when there is suspicion of neuropathology that is better visualized by MRI because of its type or location and 2) after CAT when an atypical psychiatric symptom or presentation has not been definitively evaluated by means of CAT.

Partial resolution of ranitidine-associated delirium with physostigmine: case report.

A healthy 25-year-old woman experienced probable ranitidine-induced confusion that partially resolved with intravenous physostigmine. The only known prior report of confusion associated with this relatively new agent was in a severely ill 86-year-old woman. Clinicians should be alert for mental status changes with ranitidine and consider a trial of physostigmine when indicated.