Clinical utility of oral valacyclovir compared with oral acyclovir for the prevention of herpes simplex virus mucositis following autologous bone marrow transplantation or stem cell rescue therapy.

Oral acyclovir has been demonstrated to prevent reactivation of herpes simplex virus (HSV) infections when administered prophylactically to autologous bone marrow transplant (BMT) recipients or patients undergoing stem cell rescue therapy. Oral valacyclovir, which is converted in the body to acyclovir, has greater oral bioavailability than oral acyclovir and compared with oral acyclovir yields similar acyclovir plasma concentrations with less frequent (twice-daily) dosing. This study compared the efficacy of oral valacyclovir with that of oral acyclovir at preventing HSV mucositis in BMT recipients. A total of 60 HSV-1-positive patients scheduled for BMT or stem cell rescue therapy were treated prophylactically with valacyclovir 500 mg twice daily until resolution of neutropenia. Data from these patients were compared with those of a historical control group of 60 patients who had received acyclovir 600 mg every 6 h until resolution of neutropenia or acyclovir 125 mg/m(2) intravenously every 6 h. The results show that none of the patients developed oral or oropharyngeal HSV infection while receiving either treatment. Of the 60 patients receiving valacyclovir, 38 (63%) completed treatment without the need for intravenous acyclovir compared with 12 of 60 (20%) patients in the acyclovir group. Additionally, the total number of doses of drug administered to the valacyclovir group was significantly less than the number received by patients in the acyclovir group. No serious adverse events occurred in either group of patients. This study demonstrates that oral valacyclovir and acyclovir are comparably effective and safe in preventing reactivation of HSV infections in autologous BMT and stem cell recipients. The less frequent dosing schedule with valacyclovir compared with acyclovir offers a potential advantage for patients undergoing BMT who frequently suffer with severe mucositis and have difficulty taking oral medications.

The cycloid type and its differentiation from core schizophrenia: a phenomenological approach.

The heterogeneity within schizophrenia or the group of schizophrenias remains a vexing and limiting problem. An alternative to the "classic" explanatory construct of a schizophrenic unitary psychosis is the current concept of a positive/negative dichotomy with or without mixed type. However, the validation by findings from brain imaging, specificity, and prognostic validity of these multiple-entity approaches are still uncertain. Psychopathology is challenged to identify discrete types as homogenous as possible, providing closer relationship to distinct disease processes. Such types are to be defined by one or more axial syndromes, syndromes in an essential, not correlative, sense. One of these types is embraced by the term cycloid psychosis, implying a good prognosis. Using an integrative phenomenological methodology, the present study is able to show the specific quality of phenomena occurring in this type to pinpoint their "inner" relationships and to demonstrate cycloid syndromes as axial syndromes in the phenomenological sense. Thus, it is shown that positive symptoms in the cycloid type are different from those in core schizophrenia. In addition to the quality and inner coherence of the constituent elements, the absence of structural deformations of (1) emotional expression and affect, (2) thought, and (3) movement impulses and sequences is the decisive specificity feature that allows differentiation of the cycloid type from poor-prognosis core schizophrenia. These syndromes of structural deformations are the axial syndromes of core schizophrenia, occurring with or without "productive" (positive) phenomena. Its conceptualization makes a contribution to the actual negative-symptom discussion shifting the perspective from a low specific level (e.g., abulia) to phenomena of higher specificity. On the basis of a precise definition of cycloid axial syndromes, previous operationalization suggestions are reviewed and evaluated, and an alternative approach is outlined. Finally, it is hypothesized that the cycloid type may be a primary neurotransmitter disease, while core schizophrenia seems closer to the pathophysiological mechanisms described in Stevens' theory.

The hysterical personality disorder: a phenomenological approach.

The background of the present study is a general uncertainty as to what comprises the essence of hysterical (histrionic) personality disorder. Using phenomenological methodology, phenomena observable in the 'classic' hysterical personality are analysed, described, named, and classified according to the basic functions of human experience and behaviour. The resulting psychopathological picture of the hysterical personality facilitates a differential diagnosis that is often decidedly difficult. The phenomenon of dissociation of the mental processes is demonstrated for the various basic functions. A specific feature of the disorder is shown which generates a dissociation of contents of the personality along a conscious-preconscious-unconscious continuum. It is concluded that dissocation is, in the final analysis, the prerequisite for a compromised and partial acting out of prohibited non-integrated elements, e.g. aggression, as a coping strategy.

[Delusions and intuition]. / Wahn und Intuition.

Taking into account the different concepts of delusion and analysing rational and intuitive cognition, the present phenomenological-conceptual study aims at defining the essential nature of delusion. Intuitive cognition as a result of holistic processing is founded in the development of polysensoric-kinaesthetic basic pictures (eidetic matrices), which are recognized preverbally and prereflexively by subliminal perception of corresponding eidetic structures. A positive match between a matrix and a given phenomenon produces an eidetic feeling. This eidetic feeling encompasses three aspects. The first is a preverbal knowledge of something as something definite. As a direct self-reference, the second is the feeling of an object-inherent significance of the given phenomenon for the subject itself. Thirdly, a power vector is perceived to derive from the object. The application of this concept allows us to consider delusion as a disturbance in the system of holistic information processing. This disturbance is characterized by a disinhibition and actualization of eidetic matrices in different ways. The resulting eidetic feeling we call delusion; its expression in thoughts and words we call a delusional idea. All features of an eidetic feeling can be demonstrated in delusion. Owing to their special intensity and suspended reason, they mostly appear to be unique. The analysis of the eidetic structures of delusion allows a deeper understanding of delusion and facilitates both its diagnosis and its differentiation. Heterogeneous terms, such as delusional mood, idea of meaning, idea of reference, delusional notion and delusional perception emerge in an understandable context.

[Phenomenology of cycloid axis syndromes and their delineation from a schizophrenic core group]. / Phänomenologie zykloider Achsensyndrome und ihre Abgrenzung gegen eine schizophrene Kerngruppe.

The concept of cycloid psychoses means a certain species as part of the group of schizophrenias. From our clinical point of view, the subtypes of Leonard and their poles are axial syndromes. They can occur simultaneously or intermingle during one phase. In the present phenomenological study the inner connections of these axial syndromes are shown. Apart from these connections, cycloid psychoses can be differentiated from core schizophrenia by three conditions: (1) the lack of deformation of affect and affect expression; (2) the lack of deformaton of thought structure; and (3) the lack of certain movement deformations, e.g., parakinesis. Our concept of phenomenon is explained to criticize the current operational definitions of cycloid psychoses. A different approach is suggested.

Recidivism and concomitant criminality in pathological firesetters.

The purpose of this study was to explore dangerousness and fire setting recidivism of mentally disordered firesetters in comparison with mentally healthy arsonists. In Germany, all trials are registered centrally by the Federal Central Register. The records of this Register for the three year period from 1983 until 1985 were used in this follow-up study of arsonists to identify three samples of subjects: (1) All persons convicted of arson who have been found not guilty by reasons of insanity (n = 186), (2) all person convicted of arson who have been found guilty of diminished responsibility (n = 97), and (3) a random selection from all persons convicted of arson who have had no psychiatric examination in their trial (n = 187). The follow-up ended in 1994, providing a period of, on average, ten years. Mentally disordered arsonists differed from non-mentally disordered arsonists in the following ways: They were more likely, first, to have a history of arson before 1983, and secondly, to be convicted of arson again (11% relapse compared to 4%). Mentally disordered arsonists had fewer registrations of common offenses, such as theft as well as traffic violations and alcohol-related offenses. Based on the present sample, mentally disordered firesetters have a higher rate of recurrence of firesetting than non-mentally disordered firesetters and commit fewer common offenses other than firesetting.

Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.

A crossover 'placebo'-controlled, double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder. Effects of diet were compared with those yielded by stimulant medication (methylphenidate). The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim. Change in behavior was measured in standardized situations by trained raters, including behavior assessment when testing with CPT and PAT, during a free play situation, and at school. Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions. Methylphenidate used in 36 children yielded more responders (44%) than diet. The amount of positive changes in behavior in those who received both treatments was about the same. Although only effective in a minority of children, dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation.

[Phenomenology of hysterical pseudopsychoses]. / Phänomenologie der hysterischen Pseudopsychosen.

Clinical observation shows that hysteria can produce states that are difficult to differentiate from all forms of endogenous psychoses. Using phenomenological methodology, the elements and qualities of these hysterical states are analysed and described. It is demonstrated that the phenomena are properties of hysterical personalities, intensified and pronounced, but nevertheless intra- and extrapsychically targeted as "useful", i.e. serving a purpose. Phenomena that would be characteristic of real psychoses, are never seen. There is no "deprivation" of ego poser, and structural deformations are always absent. Considering the phenomenologico-psychopathological definitions of "psychosis", these hysterical states must be considered as pseudopsychoses.

[Aphoria of psychopathology: attempt at a meta-analysis]. / Die Aporie der Psychopathologie: Versuch einer Metaanalyse.

A psychiatric differential diagnosis is first of all an eidetic typology, a taxonomy of specific types. Psychopathological effort as yet did not fully succeed to unveil the respective specificity. Therefore we may well speak of a certain aporia. By the example of the group of schizophrenias the question, inherent in the notion of aporia, is followed, if it is created by the subject itself or by the methodological approach. As a result we can show various methodical problems. The effect of these methodical problems seems to be very proper to melt away the differentia specifica, if existent and so could be valued as arguments for the possibility of a methodical aporia. Given such an aporia, another reading of the findings concerning course and outcome of schizophrenia may result. Possible perspectives to further methodical developments are suggested.

Hypereosinophilic syndrome: successful allogeneic bone marrow transplantation.

A patient with well-documented hypereosinophilic syndrome who underwent successful allogeneic bone marrow transplantation (BMT) is reported. This therapeutic modality should be considered in patients who fail standard therapy. End-organ damage may be reversible to some extent, and should not exclude patients from consideration of BMT.

[The phenomenology of hysterical personality disorder]. / Die Phänomenologie der hysterischen Persönlichkeitsstörung.

Phenomena that are observable in the "classic" hysterical personality disorder are named, described and classified according to the basic functions of human experience and behavior. In this way, a psychopathological picture of the hysterical personality arises, which can facilitate the sometimes difficult task of diagnosis and differential diagnosis. It is shown that the phenomenon of dissociation is one essential characteristic of this disorder. The dissociation of the mental processes is demonstrated for the various basic functions. It implies a dissociation of contents and of parts of personality on the axis conscious-preconscious/unconscious. The dissociation ultimately becomes a prerequisite for living these not permitted and not integrated parts of personality in a partial and compromising way.

IDDM is a risk factor for adolescent psychiatric disorders.

OBJECTIVE: To determine whether the rate of psychiatric disorders increases in children and adolescents with IDDM. RESEARCH DESIGN AND METHODS: The rate of psychiatric disorders was assessed by highly structured interviews in a group of 93 IDDM adolescents 17-19 yr of age and compared with a healthy (nondiabetic) age-, sex-, and socioeconomic status-matched control group. RESULTS: The rate of psychiatric disorders was 33.3% in the diabetic group, more than threefold higher than in the control group (9.7%). With regard to the rate of psychiatric disorders, no sex-specific differences between the two groups were found. The diabetic adolescents suffered from significantly more introversive symptoms than their healthy counterparts, especially somatic symptoms, sleeping disturbances, compulsions, and depressive moods. In spite of the elevated rate of psychiatric disorders, the rates of life events and familial adversities did not increase in the diabetic group. CONCLUSIONS: The results support the notion that IDDM adolescents should be seen as a high-risk group for psychiatric disorders.

Untreated neuroborreliosis: Bannwarth's syndrome evolving into acute schizophrenia-like psychosis. A case report.

In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.

Embryonal sarcoma of the liver in an adult treated with preoperative chemotherapy, radiation therapy, and hepatic lobectomy.

A rare case of embryonal sarcoma of the liver in a 28-year-old man is reported. The patient was treated preoperatively with a combination of chemotherapy and radiation therapy. Complete surgical resection, 4.5 months after diagnosis, consisted of a left hepatic lobectomy. No viable tumor was found in the operative specimen. The patient was disease-free 20 months postoperatively.

[Endogenous paranoid-hallucinatory syndrome caused by Borrelia encephalitis]. / Endomorphes paranoid-halluzinatorisches Syndrom durch Borrelienenzephalitis.

We describe a case with no neurological signs but marked psychiatric symptoms induced by borrelia burgdorferi, whose clinical picture was indistinguishable from an endogenous schizophrenia. The symptoms within one week under antibiotic treatment with ceftriaxon, but afterwards the patient showed a mild organic brain syndrome. The case demonstrated the aetiologic nonspecificity of paranoid symptoms and hallucinations and emphasizes that in psychotic patients without psychiatric history additional diagnostic measures should be performed.