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History and Admission Findings:  A 76-year old man was admitted with a globus sensation and weight loss for further investigations to our geriatric ward. A gastroscopic evaluation executed before had been unremarkable., Investigations:  Physical examination was unremarkable, including a neurological examination., Treatment and Course:  All radiological findings (computer tomography of chest, abdomen and neck) were unremarkable. In a FEES investigation we found retentions and a reduction of frequency of swallowing after a while. During the investigation the patient complained about a muscular weakness in his neck. The assumed diagnosis of a myasthenia gravis was confirmed by antibodies against acetylcholine receptors and a decrement in repetitive irritation of the orbicularis and trapezius muscle., Conclusion:  FEES can be a valid diagnosis tool for a pharyngeal type of a myasthenia gravis., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Recent years have seen a widespread integration of technology into the daily lives of families. Psychological science has recently started to focus on the use of smartphones by parents while they are engaged in parenting activities, a behavior known under the terms "phubbing," "technoference," "parental screen distraction," and various other terms. We argue that understanding the real impact of co-present smartphone use by parents is inhibited by problems related to the conceptualization and methodology employed in empirical studies. In the present commentary, we identify the features of current research that may contribute to the theory crisis and hamper the progress of psychological research. Specifically, we discuss the implications of (a) inconsistent conceptualization of the phenomenon and (b) suboptimal operationalizations that may prevent us from understanding what is being studied and call for greater consideration of definitional clarity and valid operationalization in future research., (© 2023 Association for Child and Adolescent Mental Health.)

The COVID-19 pandemic has impacted the world in many ways; for example, evidence from the United Kingdom indicates that higher rates of discriminatory behaviours against immigrants have been recorded during this period. Prior research suggests that political orientation and trust are instrumental in discriminatory beliefs against immigrants. A longitudinal study (six waves and a follow-up) was conducted in the United Kingdom during the COVID-19 pandemic (September 2020-August 2021) using convenience sampling (N = 383). The hypotheses enquired about whether political orientation predicts trust in government, trust in science and discriminatory beliefs. Multilevel regression and mediation analyses were conducted, using repeated measures nested within individuals. It was found that conservative views are associated with higher discriminatory beliefs, lower trust in science and higher trust in government. Furthermore, trust in science promotes reduction of discrimination, whereas trust in government, increases discriminatory beliefs. However, a nuance revealed by an interaction effect, shows that a positive alignment between political and scientific authorities may be required to reduce prejudice against immigrants. Exploratory multilevel mediation showed that trust is a mediator between political orientation and discriminatory beliefs., (© 2023 The Authors. British Journal of Social Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Hope, gratitude, fear, and disgust may all be key to encouraging preventative action in the context of COVID-19. We pre-registered a longitudinal experiment, which involved monthly data collections from September 2020 to September 2021 and a six-month follow-up. We predicted that a hope recall task would reduce negative emotions and elicit higher intentions to engage in COVID-19 preventative behaviours. At the first time point, participants were randomly allocated to a recall task condition (gratitude, hope, or control). At each time point, we measured willingness to engage in COVID-19 preventative behaviours, as well as experienced hope, gratitude, fear, and disgust. We then conducted a separate, follow-up study in February 2022, to see if the effects replicated when COVID-19 restrictions were relaxed in the UK. In the main study, contrary to our pre-registered hypothesis, we found that a gratitude recall task elicited more willingness to engage in COVID-19 preventative behaviours in comparison to the neutral recall task. We also found that experienced gratitude, hope, and fear were positively related to preventative action, while disgust was negatively related. These results present advancement of knowledge of the role of specific emotions in the COVID-19 pandemic.

Introduction: One of the most important geriatric syndromes is dizziness in conjunction with gait disorder and consequent falls. There are various differential diagnoses for dizziness, one of them is benign paroxysmal positional vertigo (BPPV)., Objectives: A targeted diagnostic work-up and treatment of BPPV can prevent subsequent falls and a decline in the patients' quality of life, prolonged hospitalization with unnecessary examinations and medication., Design: Prospective examination of patients with a positive medical history of BPPV., Setting and Participants: All patients treated within the Department of Geriatrics between 05/2015 and 03/2018 were included. A total of n = 5166 patients were screened (n = 2651 geriatrics; n = 2515 controls)., Methods: All patients from other wards subjected to a neurological examination due to vertigo served as controls. Patients with typical hints in the medical history for a BPPV were subjected to the diagnostic Dix-Hallpike maneuver and, if positive, subsequent canalith repositioning maneuvers. The percentage of successful positional treatments was determined in both groups., Results: N = 254 patients (4.9 %) had indications in the medical history for a BPPV. For 71 of n = 254 patients (28 %; in total 1.4 %; mean age: 78.4 ± 12.3 years) the diagnosis of BPPV was proven by a positive Dix-Hallpike maneuver. N = 39 (54.9 %) patients belong to the geriatric group (mean age 82 years) and n = 32 (45.1 %) to the control group (mean age 73.9 years). The frequency of BPPV was similar in both groups (1.3-1.5 %). In 91.9 % of patients the BPPV was localized in the posterior semicircular canal. Up to 93 % were asymptomatic after one or repeated canalith repositioning maneuvers., Conclusions and Implications: The BPPV should be considered as an important differential diagnosis for geriatric patients with dizziness and falls. After therapeutic repositioning maneuvers most of the patients are asymptomatic. Therefore, targeted screening and therapy ("theragnostic") of BPPV at an advanced age increases diagnostic accuracy and prevents unnecessary examinations, medications and future falls., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Neurocysticercosis is the most common parasitic infection of the brain. Epilepsy is the most common clinical presentation, though it may also present with headache, symptoms of raised intracranial pressure, hydrocephalus and ocular symptoms depending upon the localisation of the parasitic cysts. Anthelmintic drugs, anti-oedema drugs, such as steroids, and antiepileptic drugs (AEDs) form the mainstay of treatment.This is an updated version of the original Cochrane Review published in 2015, Issue 10., Objectives: To assess the effects (benefits and harms) of AEDs for the primary and secondary prevention of seizures in people with neurocysticercosis.For the question of primary prevention, we examined whether AEDs reduce the likelihood of seizures in patients who have neurocysticercosis but have not had a seizure.For the question of secondary prevention, we examined whether AEDs reduce the likelihood of further seizures in patients who have had at least one seizure due to neurocysticercosis.As part of primary prevention studies, we also aimed to examine which AED has been found to be beneficial in people with neurocysticercosis in terms of duration, dose and side-effect profile., Search Methods: For the latest update of this review, we searched the following databases on 8 July 2019: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to July 05, 2019) and LILACS (1982- ). CRS Web includes the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), and randomised or quasi-randomised, controlled trials from Embase, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We also checked the references lists of identified studies, and contacted experts in the field and colleagues to search for additional studies and for information about ongoing studies., Selection Criteria: Randomised and quasi-randomised controlled trials.Single-blind, double-blind or unblinded studies were eligible for inclusion., Data Collection and Analysis: Two review authors screened all citations for eligibility (MS screened the initially identified 180 citations, MF and BDM screened the 48 citations identified for the purpose of this update).Two review authors independently extracted data and evaluated each study for risk of bias., Main Results: We did not find any trials that investigated the role of AEDs in preventing seizures among people with neurocysticercosis, presenting with symptoms other than seizures.We did not find any trials that evaluated evaluating individual AEDs in people with neurocysticercosis.We found one trial, comparing two AEDs in people with solitary neurocysticercosis with seizures. However, we excluded this study from the review as it was of poor quality.We found four trials that compared the efficacy of short term versus longer term AED treatment for people with solitary neurocysticercosis (identified on computed tomography (CT) scan) presenting with seizures. In total, 466 people were enrolled. These studies compared various AED treatment durations, six, 12 and 24 months. The risk of seizure recurrence with six months treatment compared with 12 to 24 months treatment was not statistically significant (odds ratio (OR) 1.34 (95% confidence interval (CI) 0.73 to 2.47; three studies, 360 participants; low-certainty evidence)). The risk of seizure recurrence with six to 12 months compared with 24 months treatment was not statistically significant (OR 1.36 (95% CI 0.72 to 2.57; three studies, 385 participants; low-certainty evidence)).Two studies co-related seizure recurrence with CT findings and suggested that persistent and calcified lesions had a higher recurrence risk and suggest longer duration of treatment with AEDs. One study reported no side effects, while the rest did not comment on side effects of drugs. None of the studies addressed the quality of life of the participants.These studies had certain methodological deficiencies such as a small sample size and a possibility of bias due to lack of blinding, which affect the results of this review., Authors' Conclusions: Despite neurocysticercosis being the most common cause of epilepsy worldwide, there is currently no evidence available regarding the use of AEDs as seizure prophylaxis among people presenting with symptoms other than seizures. For those presenting with seizures, there is no reliable evidence regarding the duration of treatment required. There is therefore a need for large scale randomised controlled trials to address these questions.

History and Clinical Findings: We present a 86-year-old patient who suffered from progressive weakness in his right leg. Due to a hypercholesterinemia he had received Simvastatin for a few years. Because of higher cholesterine levels the dosis had been increased from 40 to 80 mg 6 months ago., Investigations and Diagnosis: We saw elevated levels of creatinine kinase and creatinine. In the EMG, a neuromuscular impairment was detected. In context with the medical history we could make the diagnosis of a statin-induced myopathy with rhabdomyolysis., Treatment and Course: After stopping the medication with statin and under liquid substitution, creatinine kinase and creatinine levels dropped. After therapy the weakness of the leg was totally recurrent., Conclusion: In case of unclear neurological symptoms and under therapy with statins, a myopathy should be considered., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Admission Findings: A 74-year old man was admitted after neurosurgical treatment of a lumbar vertebral fracture. He had a slight paresis of the right leg in combination with bladder dysfunction., Investigations: There were signs of a postoperative anemia (hemoglobin 10.4 mg/dl) and mildly elevated infection parameters (CRP 2 mg/dl). Routine ECG and chest X-ray were normal., Treatment and Course: Physical training was initiated, but diarrhea occurred 2 days after admission. As the patient had received antibiotics after the operation, a treatment with metronidazole was initiated under the suspicion of diarrhoea induced by clostridium difficile. At day 6 of treatment a hypertensive crisis (blood pressure 230/120 mmHg) developed, followed by sensory aphasia. Despite treatment at the stroke unit and blood pressure regulation, the clinical signs of aphasia persisted. MRI could not detect an acute cerebral infarction. After discontinuation of metronidazole complete reconstitution occurred within 72 h., Conclusion: Metronidazole should be taken into account as cause of severe neurological side effects including ischemia-like syndromes like aphasia., (© Georg Thieme Verlag KG Stuttgart · New York.)

The thinking of Franco Basaglia helps to improve understanding of the complexity of the relationships between theory and practice. Medicine must be thought out on the basis of the political organisation where it is situated and the psychiatric institution reflects an organisation founded on exclusion. It is essential to re-establish a place for an individual's difference in psychiatric practice. The challenge is to enable the patient to emerge as a subject.

Background: Predictors of outcome and safety in intravenous thrombolysis within 3 h in clinical routine is a matter of ongoing debate. Available reports contain small patient numbers or summarize heterogeneous multicenter data., Methods: Four hundred and fifty patients received intravenous thrombolysis within 3 h after stroke. Pretreatment NIHSS score and detailed medical history were analyzed. Noncontrast CT was performed before thrombolysis, 24-36 h later and in case of clinical deterioration. Symptomatic intracranial hemorrhage (SICH; any bleeding with an NIHSS increase of > or =4 points) and clinical outcome (modified Rankin Scale, mRS) after 3 months were recorded. Logistic regression identified parameters predictive of independence (mRS 0-2) and SICH., Results: Median onset to admission, door to needle and onset to treatment time was 75, 50 and 135 min, respectively. Direct presentation by emergency service (64%) was the fastest way of referral. Median pretreatment NIHSS was 11 points. Independence (mRS 0-2) was reached by 53%. Mortality was 11% (7% intracerebral, 4% extracerebral complications). Logistic regression identified low NIHSS, low age and absent diabetes as predictors of independence. Overall hemorrhagic complications and SICH were found in 18 and 4% of the patients, respectively. Extracerebral bleeding complications and allergic reactions were found in 3 and 1%, respectively., Conclusion: This largest single center report presents a sample in the range of the 3 h rt-PA cohort of all randomized controlled trials. Outcome was comparable to randomized studies with a higher rate of independence and a lower rate of mortality and SICH.

Background: Brain tissue hypoattenuation on early computed tomography is frequently included in decision making in acute stroke management. However, its pathophysiological counterpart needs further evaluation., Methods: By comparative imaging with diffusion-weighted imaging and 15O-water positron emission tomography we aimed to interpret early (<6 h) hypoattenuation., Results: In 11 patients, the hypoattenuation corresponded to a decreased proton diffusion (median 115.9% relative DWI value) measured by magnetic resonance imaging and to a severe hypoperfusion (below 12 ml/100 g/ min) assessed by positron emission tomography. The volume of parenchymal hypoattenuation correlated to the tissue with disturbed diffusion (Spearman's rho=0.73), but largely underestimated the hypoperfusion below 20 ml/100 g/min., Conclusions: Early hypoattenuation reflects the coupling of the severity of ischemia and resulting diffusion changes. It allows an estimate of the infarct core but underestimates the penumbral hypoperfusion., (Copyright (c) 2006 S. Karger AG, Basel.)

The Minnesota Multiphasic Personality Inventory (MMPI), and now the MMPI-2, are the most widely researched personality assessment tools in correctional and related forensic settings (MMPI; Hathaway & McKinley, 1940; MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Using the original MMPI, Megargee (1977a) and colleagues (Megargee & Bohn, 1977; Megargee & Dorhout, 1977) developed an extensive and meaningful classification system for correctional inmates. However, few studies, with the exception of Toch and Adams (1994) cluster analytic study of emotionally disturbed violent offenders, have explored possibilities of a statistically derived categorical classification paradigm within the growing population of forensic psychiatric patients awaiting discharge into the community (Bannatyne, 1996). The present exploratory study investigates the utility of a commonly employed and replicable cluster analytic method in establishing an MMPI-2-based categorical classification system within a substantial forensic psychiatric outpatient sample (N = 300). Here, we present results of a seven-cluster solution, augmented by contemporaneous Rorschach inkblot data utilizing Exner's Comprehensive System (Exner, 1991; Exner et al., 1995). Descriptive cluster characteristics are provided along with potential clinical correlates in an attempt to move closer to the goal of pairing informed assessment with effective treatment in this growing, but unique, population., (Copyright 2003 Wiley Periodicals, Inc. J Clin Psychol.)