Search

This chapter argues for the integration of public engagement into language teaching in order to respond to the current challenging environment for language study. Impact teaching seeks to develop language education through engagement with audiences beyond the classroom and especially outside higher education. One illustration of this approach is the student projects which have been designed as part of the module ‘Contemporary German-speaking film’, first introduced at the University of York in 2018/2019. The project brief asks students to organise, prepare, and deliver a film evening event including a film introduction and a post-screening Q&A in German. The approach has proven very successful with very positive student feedback on the initial in-person format, despite the limited audience numbers. The move to an online format during the pandemic has increased the impact of the event dramatically and the newly collected attendee feedback has confirmed very positive responses to the projects.

Background Previous research indicated the complexity of autonomic dysfunction during acute alcohol withdrawal. This study aimed to investigate the pupillary light reflex as an indicator of midbrain and brainstem regulatory systems in relation to cardiovascular autonomic function. Methods Thirty male patients were included in the study. They were investigated during acute alcohol withdrawal syndrome and 24 h later during clomethiazole treatment and compared to healthy controls. Parameters of pupillary light reflex of both eyes as well as heart rate variability, blood pressure variability and baroreflex sensitivity (BRS) were studied. Results We observed significantly reduced sympathetic (small diameter, e.g., left eye: 5.00 in patients vs. 5.91 mm in controls) and vagal modulation (e.g., prolonged latencies, left eye: 0.28 vs. 0.26 ms) regarding both pupils during acute alcohol withdrawal syndrome. Cardiovascular parameters showed reduced vagal modulation (e.g., b-slope of BRS: 7. 57 vs. 13.59 ms/mm Hg) and mixed results for sympathetic influence. After 24 h, autonomic dysfunction improved significantly, both for the pupils (e.g., left diameter: 5.38 mm) and the heart (e.g., b-slope of BRS: 9.34 ms/mm Hg). While parameters obtained from the pupil correlated with cardiac autonomic function (e.g, BRS and left diameter: r = 0.564) in healthy controls, no such pattern was observed in patients. Conclusion Results obtained from the pupil during acute alcohol withdrawal do not simply mirror autonomic dysfunction regarding the heart. Pupillary and cardiovascular changes after 24 h indicate state dependencies of the results. The findings are discussed with respect to autonomic mechanisms and potentially involved brain regions.

Obesity and depression are common conditions in the general public and show a high level of co-morbidity. Both conditions are stigmatized, i.e., associated with negative attitudes and discrimination. Previous research shows that devalued conditions can overlap or combine to produce a layered stigma which is associated with more negative health outcomes than either single devalued condition alone. This study therefore set out to investigate the double stigma of obesity and depression.A telephone-based representative study of the German population was conducted. Vignettes describing women with obesity, depression or both conditions were presented, followed by a set of items on semantic differentials based on previous stigma research of depression (depression stigma DS) and obesity (Fat Phobia Scale FPS). Personal experience with depression and obesity was assessed.All comparisons were significant in univariate ANOVA, showing negative attitudes measured by the FPS and the DS to be most pronounced in the double stigma condition. Multivariate analysis, controlling for age, gender, education and personal experience with the stigma condition (e.g. having obesity or depression), show that the double stigma obesity and depression is associated to more negative attitudes on the FPS (b=0.163, p0.001) and the DS (b=0.154, p=0.002) compared to the single-stigma condition.The magnitude of the layered stigma of obesity and depression may need to be considered in mental health settings when treating the depressed patient with obesity, but likewise in obesity care when treating the obese patient with depression.

Delirium occurs as a pathophysiological state in connection with various diseases, particularly among patients in critical care. Since it may be a life-threatening condition, any physician should be able to initiate correct assessment and treatment of delirium. This review summarizes current knowledge on care of patients with delirium. The symptoms of delirium contain primarily disturbance of consciousness, attention, cognition, and perception and may comprise disturbance of psychomotor activity, emotions, and sleep. High prevalence of delirium is observed in critically ill patients in intensive care units. It is thus necessary to monitor the comorbid conditions when patients are diagnosed with delirium, especially since delirium is a prognostic factor for rise in morbidity and mortality. The identification of underlying aetiology of delirium and immediate intervention and treatment for urgent general medical conditions should be in the focus, and should be paralleled by measures ensuring patient's safety and continuous monitoring. Somatic interventions depend on underlying aetiology, and patient's clinical as well as comorbid conditions, but they mainly consist of treatment with high-potency neuroleptic drugs such as haloperidol. Interventions which reduce or eliminate environmental factors contributing to an exacerbation and maintenance of delirium are strongly recommended. Eventually, it is important to establish and maintain psychological support to the patient and his family regarding illness, including post-delirium management.

Electroconvulsive therapy (ECT) is an established treatment option for major depressive disorder when other treatments have failed. However, the underlying mechanisms responsible for these therapeutical effects are insufficiently understood to date. Furthermore, treatment outcome is difficult to predict. Recent research suggested an important role of autonomic modulation for successful treatment. We aimed to examine putative associations between autonomic modulation and response to ECT treatment and hypothesized a role for vagal modulation prior to therapy. Twenty-four patients with MDD who received ECT were assessed by means of heart rate and blood pressure variability analysis as well as baroreflex sensitivity measurements before, during and after a course of ECT. Autonomic parameters from the complete study population revealed that ECT did not significantly alter basic autonomic modulation after six sessions. Analyses showed a significant association of the reduction of HAMD scores during therapy when compared with baseline autonomic function as reflected in SDNN(RR) (p

Background Electroconvulsive therapy (ECT) has been shown to exhibit strong beneficial effects in the treatment of major depressive disorder (MDD). While the exact underlying mechanisms are under debate, a role for the sympathetic response upon ECT has been suggested. When assessing patients with MDD for autonomic function, however, a loss of vagal function is prominent. Objective Here, we aimed to assess the immediate effects of ECT on vagal activity and to test the hypothesis that surrogates of the latter correlate with therapeutic outcome. Methods Twenty patients with MDD who underwent ECT treatment were assessed regarding their vagal function using electrophysiological measures and determination of pancreatic polypeptide (PP), which is known to be released upon vagal stimulation. Parameters were correlated to the improvement of disease severity upon ECT treatment. Results Patients showed a significant increase of PP shortly after ECT which correlated with clinical improvement. Furthermore, the described association with the sympathetic phase after ECT could be verified. Conclusion ECT increases vagal activity which might be associated with the beneficial effect seen following this treatment. PP elevation after administration of ECT might be a useful parameter to estimate the degree of such vagal stimulation after treatment.

Withdrawal from analgesic and addictive substances such as opioids or ethanol is associated with increased sensitivity to sensory stimulation in animal models. Here, we investigated perception of innocuous and noxious thermal or electric stimuli applied to the left hand or sternum in 30 male patients undergoing withdrawal from alcohol, 30 male abstained alcoholics and matched controls. The alcohol withdrawal scale and the Banger score were obtained to estimate the severity of withdrawal. In addition, the Beck depression inventory was used to estimate the influence of depressive symptoms on pain perception. The data presented provide substantial evidence that subjects undergoing alcohol withdrawal show increased heat pain sensitivity. Interestingly, this effect was observed both on the left hand and sternum. Pain thresholds and tolerances of electric stimuli did not differ between groups. However, in a subgroup analysis, a higher sensitivity for electrical pain thresholds and tolerances was observed in those patients that were identified to require pharmacological treatment for withdrawal according to disease severity. Furthermore, the perceived painful thermal and electrical sensation was substantially influenced by the affective state of patients. No differences were found between patients of the abstained group and control subjects for any pain parameter. In conclusion, we demonstrate withdrawal-induced hyperalgesia upon thermal stimulation in patients. Since the influence of affective symptoms on pain perception during withdrawal is remarkable, we assume that peripheral and central mechanisms might account for this finding, which should be assessed in detail in future studies.

Background Chronic alcoholism represents a risk factor for cardiac arrhythmias. One underlying mechanism is a sympathetically dominated autonomic imbalance. This is especially apparent during acute withdrawal from alcohol. Since linear analysis of heart rate variability may not be entirely adequate to detect such autonomic dysfunction in acute alcohol withdrawal, we applied novel non-linear parameters and measures for cardio-respiratory coupling. Methods 20 patients suffering from acute alcohol withdrawal syndrome and 20 controls were included. For patients, heart rate and respiration were recorded on admission, after medication and at discharge. From these data, complexity measures (symbolic dynamics, approximate entropy) of heart rate modulation and respiration as well as parameters for cardio-respiratory coupling (coherence, cross-approximate entropy) which relate to vagal function were calculated. Results Heart rate modulation was significantly less complex in patients acutely admitted for alcohol withdrawal. Furthermore, coupling between beat-to-beat (RR) intervals and respiration time series was significantly diminished. Of the parameters assessed, cross-approximate entropy showed a trend for correlation with symptom severity. Conclusion These data indicate diminished vagal function in acute alcohol withdrawal. Applying the methods described thus allows a sensitive detection of vagal neuropathy in this disease.

A new software tool, P2P, for electrical simulation of power nets is presented. The Rmap functionality of P2P calculates resistances from specified starting points to all points on the net, and visualizes the results in resistance color maps - which enables quick identification and debugging of layout errors. P2P also enables point-to-point resistance calculation, IR voltage drop analysis, and current density verification. Case studies are presented for overall power/ground net verification, and for specific tasks of guard ring and ESD device resistance and current density verification.

Acute alcohol withdrawal is often associated with increased sympathetic activity, and a decreased baroreflex sensitivity (BRS) can be assumed. Parameters of heart rate variability (HRV), blood pressure variability (BPV), BRS as well as cardiac index (CI), left ventricular work index (LVWI) and total peripheral resistance (TPR) were investigated in 20 patients undergoing acute alcohol withdrawal and matched controls. Measures were obtained during the peak of withdrawal symptomatology prior to treatment as well as 2 and 24h under continuous clomethiazole treatment. Alcohol withdrawal scores were obtained and correlated with autonomic measures. In addition, parameters were assessed in 15 subjects who abstained from alcohol after long-term intake. We found a severe down-regulation of BRS during acute alcohol withdrawal and to a milder extent in abstained alcoholics. Furthermore, HRV and BPV did not unequivocally reveal signs of elevated sympathetic activity. Non-linear parameters of HRV and parameters of BRS correlated with the severity of AWS. The distinct decrease of BRS in AWS and in long-term abstained subjects described here is of importance since similar alterations have been identified as independent prognostic factors for cardiac mortality in other diseases.

Background: Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. Methods: We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n 5 20, no treatment required) and in patients with moderate to severe AW syndrome (n 5 20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. Results: Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. Conclusions: We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies.

A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of antipsychotic medication on the patients' responses. We investigated 23 schizophrenic subjects who had been not received antipsychotic treatment for 8 weeks, and we then reassessed them 3 days later after the introduction of neuroleptics. Acute symptoms of schizophrenia were measured using the Scales for the Assessment of Positive and Negative Symptoms. Thresholds were determined by a contact thermode on both volar wrists. Schizophrenic patients showed significantly increased thresholds of WP and TPO relative to healthy controls. Antipsychotics did not alter pain thresholds. We found no correlation between pain perception and psychometric scales. Our findings demonstrate altered warmth and heat pain perception in acute schizophrenia. We believe that our findings can be attributed to information-processing abnormalities of the disorder and that they are not specific to pain processing, per se, since both WP and TPO were significantly different. Future studies should evaluate attentional deficits in schizophrenia in relation to pain perception.

An implanted electroencephalogram (EEG) recorder would help diagnose infrequent seizure-like events. A proof-of-concept study quantified the electrical characteristics of the electrodes planned for the proposed recorder. The electrodes were implanted in an ovine model for eight weeks. Electrode impedance was less than 800 Ohms throughout the study. A frequency-domain determination of sedation performed similarly for surface versus implanted electrodes throughout the study. The time-domain correlation between an implanted electrode and a surface electrode was almost as high as between two surface electrodes (0.86 versus 0.92). EEG-certified clinicians judged that the implanted electrode quality was adequate to excellent and that the implanted electrodes provided the same clinical information as surface electrodes except for a noticeable amplitude difference. No significant issues were found that would stop development of the EEG recorder.

A piglet model was developed to study the effect of epidural volume expansion on cerebral perfusion pressure (CPP) by stepwise elevating intracranial pressure (ICP). Mean arterial blood pressure (ABP) was strictly maintained using an extracorporeal ABP controller. Two-week-old piglets (n = 10) were studied by surgically placing an epidural balloon over the right parietal region and gradually increasing the inflation to increase ICP to 25, 35 and 45 mm Hg, maintaining each pressure level for 30 min. Regional cerebral blood flow was measured using the colored microsphere technique, and cerebral oxygen delivery and cerebral metabolic rate of oxygen were calculated at baseline conditions and after reaching ICP levels of 25, 35 and 45 mm Hg. The results showed that this model of epidural volume expansion reproducibly reduces CPP to 70, 50 and 33% of baseline CPP values with elevation of ICP, and that the physiological variables remained stable throughout each increase in ICP. We conclude that the model simulates the effects of an acute intracranial focal mass expansion and is well suited for the evaluation of different therapeutical strategies for increased ICP in newborns and infants.

Brucellosis is prevalent in North and East Africa, the Middle East, South and Central Asia, South and Central America and the Mediterranean countries of Europe. In 5% of cases it may lead to central nervous system manifestation presenting most often as a meningitis or meningoencephalitis. Here we report and discuss a case of neurobrucellosis with meningitis with cranial nerves neuritis. A 56-year-old German male was admitted with bilateral abducens nerve palsy, amblyacousia and intractable headaches. An enzyme-linked immunosorbent assay (ELISA) revealed antibodies against Brucella in serum and cerebrospinal fluid (CSF). Additionally, our patient suffered from an infarction of the left thalamus. In conclusion, in cases of unresponsive meningitis or meningoencephalitis and history of travel in endemic regions, neurobrucellosis should be considered. If initial microbiological tests fail, complementary investigations such as ELISA are indicated to detect Brucella species in serum and/or CSF.

The Rush head model is an approximation of the volume conducting properties of the human head. A planar saline bath phantom was developed to simulate the key properties of the Rush head model while creating a testing platform for implantable neural devices. The phantom closely mimics electrical properties of human tissue such as increased resistivity through the skull region and current flow that wraps around the head. Preliminary testing shows good agreement of the saline bath phantom to predictions from a computer model.

Background Alcohol withdrawal syndrome is associated with an increased incidence of cardiac arrhythmias and sudden cardiac death. Heart rate turbulence (HRT) parameters were applied during withdrawal to estimate cardiac regulation during treatment with clomethiazole. Methods Twenty-two patients suffering from alcohol withdrawal syndrome were included in the study. Heart rate regulation was obtained by means of Holter ECG analyzing time intervals before medication, and 2 and 6 h after medication. Slope and onset of HRT were calculated in addition to heart rate variability (HRV) parameters. Furthermore, we calculated the slope and the onset of ectopic beat-like events. Results Heart rate variability parameters indicated a minor reduction of vagal modulation during withdrawal syndrome. Especially, the fractal scaling exponent BBI alpha1 (4–16) indicated the autonomic shift. In contrast to HRV parameters, no significant changes were observed in the HRT parameters. Significant correlations were observed between severity of withdrawal, as assessed by the AWS scale, and the fractal scaling exponent BBI alpha2 (16–64), and the onset and the slope of HRT of ectopic beat-like activity. Conclusion Increased sympathetic modulation during withdrawal and clomethiazole treatment is not associated with changes of heart rate turbulence parameters predictive of cardiac death after myocardial infarction.

Background Endothelial dysfunction (EF) is a central phenomenon in a variety of conditions associated with increased cardiovascular morbidity. Here, we investigated EF during acute alcohol withdrawal syndrome before and 24 h after medication. We aimed to analyze microcirculation, applying the post-occlusive reactive hyperemia (PORH) test and spectral analysis of skin vasomotion as markers of EF. Additionally, we explored whether segmentation of spectral analysis data may disclose more detailed information on dynamic blood flow behavior. Methods We investigated 30 unmedicated patients during acute alcohol withdrawal syndrome and matched controls. Patients were reinvestigated after 24 h when half of them had been treated with clomethiazole. Capillary blood flow was assessed on the right forearm after compression of the brachial artery. Parameters of PORH such as time to peak (TP), slope and PORH indices were calculated. Spectral analysis was performed in order to study five different frequency bands. Withdrawal symptoms were quantified by means of the alcohol withdrawal scale (AW scale). Results We observed a blunted hyperemic response in patients after occlusion of the brachial artery indicated by significantly increased TP and decreased PORH indices. In contrast, vasomotion as investigated by spectral analysis was not altered. Segmentation analysis revealed some alterations in the cardiac band at rest, and indicated differences between treated and untreated patients after 24 h. Conclusion Our results suggest peripheral endothelial dysfunction in patients during acute alcohol withdrawal. No major influence of treatment was observed. Future studies need to address the relation of EF to cardiac morbidity during alcohol withdrawal.

Heavy alcohol consumption increases the risk for all major types of stroke and is associated with autonomic dysfunction during alcohol withdrawal syndrome (AWS). Cerebral autoregulation is the mechanism by which cerebral perfusion is maintained stable, representing an intrinsic protective system of the cerebral circulation. Here, we aimed to analyze the influence of acute AWS on cerebral hemodynamics in alcohol-dependent patients. We investigated 20 men in the unmedicated acute state of AWS and repeated the investigation 24h after initiation of clomethiazole treatment. Dynamic cerebral autoregulation (dCA) was assessed by the correlation coefficient index and transfer function analysis (phase and gain) from oscillations of arterial blood pressure and cerebral blood flow velocity (CBFV). The vasomotor reserve (VMR) was measured by the CO(2)-reactivity test. In addition, we assessed autonomic modulation by means of heart rate variability and baroreflex sensitivity. We observed impaired dynamic autoregulation as shown by a multivariate analysis of variance (p

A fully implantable neural data acquisition system is a key component of a clinically viable brain-machine interface. This type of system must communicate with the outside world and obtain power without the use of wires that cross through the skin. We present a 96-channel fully implantable neural data acquisition system. This system performs spike detection and extraction within the body and wirelessly transmits data to an external unit. Power is supplied wirelessly through the use of inductively-coupled coils. The system was implanted acutely in sheep and successfully recorded, processed, and transmitted neural data. Bidirectional communication between the implanted system and an external unit was successful over a range of 2 m. The system is also shown to integrate well into a brain-machine interface. This demonstration of a high channel-count fully implanted neural data acquisition system is a critical step in the development of a clinically viable brain-machine interface.

Significant progress has been made in systems that interpret the electrical signals of the brain in order to control an actuator. One version of these systems senses neuronal extracellular action potentials with an array of up to 100 miniature probes inserted into the cortex. The impedance of each probe is high, so environmental electrical noise is readily coupled to the neuronal signal. To minimize this noise, an amplifier is placed close to each probe. Thus, the need has arisen for many amplifiers to be placed near the cortex. Commercially available integrated circuits do not satisfy the area, power and noise requirements of this application, so researchers have designed custom integrated-circuit amplifiers. This paper presents a comprehensive survey of the neural amplifiers described in publications prior to 2008. Methods to achieve high input impedance, low noise and a large time-constant high-pass filter are reviewed. A tutorial on the biological, electrochemical, mechanical and electromagnetic phenomena that influence amplifier design is provided. Areas for additional research, including sub-nanoampere electrolysis and chronic cortical heating, are discussed. Unresolved design concerns, including teraohm circuitry, electrical overstress and component failure, are identified.

The human body odor contains of different volatile organic compounds. In patients with liver cirrhosis and patients who are addicted to alcohol the compound of sweat and volatile gases are changed because of the liver dysfunction and remaining alcoholics and alcoholic decomposition products within the blood. This leads to changes of the metabolic balance. Therefore, the purpose of this study was to apply an electronic nose for detecting such metabolic changes at the skin surface. A special applicator was developed to collect and analyze the transpired dermal gases directly on the skin surface. The measured values were analyzed by principal component analysis and quadratic discriminant function analysis. We could show in a pilot study on 25 patients that an electronic nose is able to detect changes in the human body odor and to discriminate between healthy subjects (controls), patients with liver cirrhosis and primed alcoholic addicted patients.

Complex interactions between pain perception, anxiety and depressive symptoms have repeatedly been described. However, pathophysiological or biochemical mechanisms underlying the alterations of pain perception in patients suffering from anxiety or depression still remain a matter of debate. Thus, we aimed to perform an investigation on pain perception in an animal model of extremes in anxiety-related behaviour, which might provide a tool for future studies. Here, thermal pain thresholds were obtained from rats with a genetic predisposition to high anxiety-related behaviour (HAB), including signs of comorbid depression-like behaviour and from controls (low-anxiety rats (LAB); cross-bred HAB and LAB rats; Wistar rats). Furthermore, the effect of eight-week antidepressive treatment using citalopram and of short-term anxiolytic treatment with diazepam on pain-related behaviour was assessed. Simultaneously, anxiety-related behaviour was monitored. At baseline, HAB animals showed 35% higher thresholds for thermal pain than controls. These were normalized to control levels after eight weeks of continuous citalopram treatment paralleled by a reduction of anxiety-related behaviour, but also acutely after diazepam administration. Overall, thermal pain thresholds in HAB animals are shifted in a similar fashion as seen in patients suffering from major depressive disorder. Antidepressive, as well as anxiolytic treatments, attenuated these differences. As the relative importance of the factors anxiety and depression cannot be derived from this study with certainty, extending these investigations to additional animal models might represent a valuable tool for future investigations concerning the interrelations between anxiety, depression, and pain at a molecular level.

Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.

An increased heart rate has been reported in schizophrenia. It is unclear whether this is due to disease-related autonomic nervous system changes or a side effect of antipsychotic medication. Altered cardiac autonomic function might to some extent account for the elevated cardiovascular mortality rate of schizophrenic patients. We assessed heart rate variability (HRV) in 30 acute unmedicated schizophrenic patients and matched controls. Patients were re-investigated 2–4 days after initiation of treatment to assess effects of medication. Our study demonstrates that non-medicated schizophrenic patients were significantly different in heart rate (increase) and parasympathetic parameters (loss of efferent vagal activity) at rest and during deep respiration. No significant effect was found after initiation of neuroleptic therapy. We found a correlation between duration of disease and parasympathetic parameters as well as very low frequency power (VLF) and delusion (SAPS subscale). These data suggest that schizophrenia is accompanied by a loss of vagal efferent activity, probably due to disturbed cortical–subcortical circuits modulating the autonomic nervous system in acute psychosis. The definite mechanisms by which vagal activity might be suppressed in schizophrenia are unknown. Parasympathetic hypoactivity might increase the risk for sudden cardiac death and arrhythmias in this disease. Future studies are warranted to investigate the interaction between cardiac autonomic function and schizophrenia and to identify patients on risk.

Background: The link between depression and autonomic dysfunction has attracted more attention since epidemiological studies have revealed that depressed patients have an augmented risk of cardiovascular morbidity and mortality. Former studies of autonomic dysfunction in major depression have shown inconclusive results. Aims: To further elucidate the effect of depression and medication on autonomic function, 18 patients and 18 matched control subjects were comprehensively assessed once medicated and once non-medicated as well as after full clinical recovery. Methods: Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters, and central autonomic tone was investigated by obtaining parameters of the pupillary light reflex (PLR). Results: Acutely depressed patients who had not taken antidepressant medication for 8 weeks prior to the investigation differed significantly neither in heart rate parameters nor in parameters of the PLR from their controls. However, after 2 days of antidepressant treatment (SSRI and NaSSRI), parameters of heart rate analysis and PLR (except relative amplitude) changed significantly and remained significantly different after clinical recovery. Limitations: The study needs to be repeated using larger patient groups. Long-term studies are absolutely essential. Conclusion: The state of depression did not influence autonomic parameters significantly. In fact, treatment influenced autonomic function far more than the disease itself. Other branches of the autonomic nervous system (ANS), as well as new techniques should be applied to elucidate whether small changes in autonomic function exist. This might clarify whether disease or treatment might influence cardiac mortality in depression.

OBJECTIVE To study the effect of mild hypothermia on cerebral oxygen metabolism and brain function in piglets during reduced cerebral blood flow because of gradual reduction of the effective cerebral perfusion pressure (CPP). DESIGN Comparison of two randomized treatment groups: normothermic group (NT; n = 7) and hypothermic group (HT; n = 7). SETTING Work was conducted in the research laboratory of the Institute for Pathophysiology, Friedrich Schiller University, Jena, Germany. SUBJECTS Fourteen piglets (14 days old) of mixed German domestic breed. INTERVENTION Animals were anesthetized and mechanically ventilated. An epidural balloon was gradually inflated to increase intracranial pressure to 25 mm Hg, 35 mm Hg, and 45 mm Hg every 30 mins at adjusted mean arterial blood pressures. After determination of baseline CPP (NT, 79+/-14 mm Hg; HT, 84+/-9 mm Hg), CPP was reduced to approximately 70%, 50%, and 30% of baseline (NT, 38.1+/-0.5 degrees C; HT, 31.7+/-0.5 degrees C). MEASUREMENTS AND MAIN RESULTS Every 25 mins after the gradual CPP reductions. Mild hypothermia induced a reduction of the cerebral metabolic rate of oxygen (CMRO2) to 50%+/-15% of baseline values (baseline values, 352+/-99 micromol x 100 g(-1) x min(-1)) (p < .05). Moreover, the electrocorticogram was altered to a pattern of reduced delta activity (p < .05) but unchanged higher frequency activity. The cerebral oxygen balance in HT animals remained improved until CPP reduction to 50%, indicated by a reduced cerebral arteriovenous difference of oxygen but elevated brain tissue Po2 (p < .05). Further CPP reduction gave rise to a strong CMRO2 reduction (NT, 19+/-21%; HT, 15+/-15%; p < .05). However, the high-frequency band of electrocorticogram was less reduced in hypothermic animals (p < .05). CONCLUSIONS Mild whole body hypothermia improves cerebral oxygen balance by reduction of brain energy demand in juvenile piglets. The improvement of brain oxygen availability continues during a mild to moderate CPP decrease. A loss of the difference in CMRO2 between the hypothermic and normothermic piglets together with the fact that brain electrical activity was less suppressed under hypothermia during severe cerebral blood flow reduction indicates that hypothermic protection may involve some other mechanisms than reduction of brain oxidative metabolism.

Topiramate is a novel antiepileptic drug (AED) that has been in use for several years, mainly as add on treatment for partial and secondarily generalising seizures that are otherwise refractory to treatment.1 Despite the good efficacy of topiramate, dizziness, ataxia, double vision, and somnolence have been noted as the main side effects. While older AEDs such as carbamazepine and sodium valproate are now routinely used for the treatment of mood disorders, recent studies suggest that novel AEDs, such as lamotrigine, gabapentin, tiagabine, and topiramate, have mood stabilising efficacy as well.2 Exacerbation of psychotic symptoms has been reported but mostly in patients with pre-existing psychiatric disorders.3,4 However, more patients than previously assumed may be affected by a broader range of side effects. We present a case of a patient taking topiramate who presented with an acute manic episode, lacking any previous history of affective disorders or episodes. A 57 year old woman with a history of temporal lobe epilepsy was referred to our hospital by her local general practitioner due to suicidal ideation …