Kazutoyo Inanaga

A case of tardive Tourette-like syndrome

Abstract: We have had experience in treating tardive Tourette‐like syndrome on a chronic schizophrenic patient. The patient was a 38‐year‐old woman. A diagnosis of schizophrenia was made in 1971 and she received repeated medications for 17 years. In 1989, she began to show vocal tic with coprolalia and motor tic. The medications were haloperidol 18 mg, zotepine 200 mg, levomepromseine 100 mg, biperiden 3 mg and nitrazepam 10 mg at the beginning of Tourette‐like syndrome. We have tried to change the medications but this tardive Tourette‐like syndrome continued to hang on. However, the symptoms gradually improved after a change in drugs; cessation of biperiden 3 mg and the administration of clonazepam 3 mg. The present case suggested that tardive Tourette‐like syndrome might be a subtype of neuroleptic‐associated tardive syndromes which might be treated with clonazepam.

Effects of centrally acting drugs on the frontal midline theta activity in man

Abstract: The frontal midline theta activity which appears during a performance of mental tasks has been designated as Fmθ. Sixteen male university students who showed the appearance of Fm(9 in 3 consecutive days were given 4 centrally acting drugs, i.e., diazepam 5 mg, amobarbital 80 mg, methylphenidate 15 mg and placebo, in a double‐blind, crossover design. Scores were made on the state anxiety scale of Spielbergers State Trait Anxiety Inventory (STAI), and EEGs were recorded monopolarly before and during the performance of an arithmetic addition. The test was done twice, before and one hour after the drug administration. Placebo increased the appearance time of Fmθ, decreased the STAI scores and increased the tasks. Diazepam increased the appearance of Fmθ and decreased the state of anxiety but did not influence the amount of tasks. Amobarbital changed neither the appearance of Fmθ nor STAI scores but decreased the tasks slightly. Methylphenidate failed to influence the appearance of Fmθ but increased both the STAI scores and performed tasks. These results suggest that the appearance of Fmθ is influenced by the drugs and that the relief from anxiety might be involved in the appearance of Fmθ.

Three Cases of Respiratory Dyskinesia

Abstract: We present here three cases of respiratory dyskinesia (RD). RD was observed with a video recording and other recordings were made of a respiratory airflow with a thermistor, and abdominal movement with a strain gauge. Neurological findings end CT scanning indicated marked organic changes in the brain in these 3 cases. RD was complicated with tardive dyskinesia of the tongue and lips, and the symptoms were aggravated during stress and absent during sleeping, which are the characteristic features of extrapyramidal symptoms. The symptoms of the three cases have improved by decreasing the dose of butyrophenone derivatives and discontinuing anti‐parkinsonian drugs, which suggested that an intracerebral imbalance of DA and ACh may be the cause of RD.

Parkinsonism Manifesting Depression as the First Sign

Abstract: We have had experience in treating two patients with parkinsonism of which the first manifestation was depression. Case 1 was a 61‐year‐old woman. A diagnosis of depression had been made and repeated medication consisting mainly of antidepressants was given. However, the depressive state persisted and the signs of parkinsonism gradually became evident. The initial treatment with antidepressant drugs was replaced with one based on L‐DOPA (400 mg a day).

Panic anxiety after abrupt discontinuation of mianserin

Abstract: We observed a case of withdrawal after abrupt discontinuation of mianserin. A 41‐year‐old woman was treated according to a diagnosis of depression, which was her 6th episode. Mianserin 30 mg/day, etizolam 1 mg/day and flunitrazepam 1 mg/day were administered. When the patient discontinued taking the drugs by herself because of subsiding of these symptoms, severe panic anxiety appeared. This panic anxiety was not relieved by taking etizolam and flunitrazepam again, but subsided rapidly by the re‐administration of mianserin 30 mg/day, and because of that the depressive symptom also disappeared.

Individual Differences in Psychophysiological Responses after Alcohol Ingestion

Abstract: We have conducted a study on the individual differences in psychophysiological responses to alcohol. The subjects were 12 flushers and 12 non‐flushers. In the flushers, significant increases in the blood acetaldehyde (AcH) level, skin temperature and pulse rate were found. In the non‐flushers, on the contrary, no significant increase was observed. There was no difference between the flushers and the non‐flushers concerning the change in the blood ethanol (EtOH) level nor the change of P1 and P2 latencies in photopalpebral reflex (PPR). Also, no difference was found in the change of the state anxiety level.

The Effect of Anticonvulsants on the Electroconvulsive Threshold: Different Response to GABA and DA-Inhibitory Systems

Recently it has become evident that yaminobutyric acid (GABA) and dopamine ( DA)IO are important inhibitory neurotransmitters in the central nervous system. There have been some clinical reports of a decreased level of these neurotransmitters in certain types of epileptic patients.1° I2 l4 In the present study the anticonvulsant effects of valproate, barbital Na, phenytoin and a new TRH analog, DN-1417, all of which are thought to act via these inhibitory systems, were further clarified by injection directly into the brain of rats and observing the effects on the electroconvulsive thresholds. Inanaga et U Z . ~ c, reported that DN1 4 17 (y-butyrolactone-y-carbonyl-histidylprolinamide citrate) was effective in improving clinical seizures with refractory epilepsy, such as the Lennox syndrome and myoclonus epilepsy.

Present Status of Clinical Practice in Epileptology — Psychiatric Aspects

Considering the changes in clinical practice concerned with epilepsy during the past 30 years, we psychiatrists have recognized some important changes. First of all, we have the impression that 30 years ago there were more ambulatory epileptic patients than now in the outpatient service, although we cannot present exact statistical figures here. Many patients or their families visited the hospitals only to receive antiepileptic drugs. In the clinical records of these patients, we see only very brief descriptions such as “seizure free,” and a note on the prescriptions. Nowadays EEG examinations or other neurological tests are often carried out. However, families still visit the hospitals. Furthermore, we have the impression that the relative number of neuroses and psychoses is increasing and the relative number of epileptic patients is decreasing in the psychiatric outpatient services. To ascertain these trends, we investigated the number of epileptic patients who visited our clinic for the first time every year since 1965, and found that it was certainly decreasing gradually. Patients suffering pure petit mal, who were occasionally seen, are now seldom found in our clinic. How can we explain these changes? They may be due to the fact that patients visit neurosurgeons or pediatric neurologists more often, since these specialists are becoming more interested in epileptic patients. Hence,