Martin A. Green

The face-hand test as a diagnostic sign of organic mental syndrome.

In the course of sensory studies by the method of double simultaneous stimulation, i t has been observed that patients with mental changes may show perceptual errors which are not demonstrable by routine single stimulation.’ When stimuli are simultaneously applied t o the cheek and the hand (the face-hand test’), patients frequently report only one of the two stimuli, or when reporting the two stimuli mislocalize one to another part of the body or even into space. These changes in perception are seen on repeated trials of the face-hand test and seem to form a consistent part of the syndrome usually labelled “organic mental syndrome” or “organic psychosis.”

Phenytoin: EEG effects and plasma levels in volunteers.

Summary The electroencephalographic (EEG) and behavioral effects of oral doses of phenytoin from 100 mg to 1 g in normal male volunteers were measured. The electroencephalogram exhibited decreases in power in the slow frequencies and increases in the fast frequencies, accompanied by an increase in mean frequency. These changes are similar to those seen with psychostimulants. They occurred at average plasma levels of 8 μg/ml and above. The time course and the intensity of EEG effects parallel plasma levels. Drug-related EEG changes were bilaterally symmetric. EEG changes at plasma levels of 8–12 μg/ml were not associated with behavioral toxic signs. These findings suggest that future psychiatric studies of phenytoin as a psychostimulant should include monitoring for plasma levels, with a minimum of 8 μg/ml as a guide to clinical efficacy.

Standardization of the Face‐Hand Test

A SIMPLE PERCEFTUAL TEST, the face-hand test, has been introduced in previous studies and the responses of normal subjects and of patients with psychiatric disorders described in The test consists of applying touch or pinprick stimuli simultaneously to the face and hand while the subject’s eyes are closed. The subject is then asked to describe and to localize the percepts. Two general types of responses occur. The two stimuli may be perceived and localized correctly, or the subject may perceive only one stimulus and either not perceive the other (phenomenon of extinction) or mislocalize the second stimulus (phenomenon of displacement) .’ Most often the mislocalization or displacement occurs to another part of the subject’s body, but occasionally there is displacement into extrapersonal space or onto the examiner (exosomesthesia ) Displacement of stimuli across the midline of the body (allesthesia) may also occur.@ Normal adults show errors in perception on the initial trials of the facehand test. Characteristically these errors consist of extinction of the stimulus to the hand whereas the face stimulus is perceived correctly (phenomenon of face dominance). As tests are repeated the errors disappear so that by the tenth trial nearly all subjects correctly perceive both stimuli and then continue to be correct on subsequent trials. This type of response has been termed a “negative face-hand test.” It occurs not only with normal adults but also in patients with schizophrenia, depression, or severe anxiety. In contrast, patients with an organic mental syndrome show extinction and displacement after ten trials of testing or as long as testing is continued. Such a response is termed a “positive face-hand test.” A “positive face-hand test” is also manifested by normal children, normal aged persons, and mental def edives . Because of the differential response of these several groups of subjects, the face-hand test has become useful clinically in detecting the presence of organic brain disease. During the course of our studies, however, it has been noted that patients with an organic mental syndrome vary greatly in the type and

Aphasia: Effect of Intravenous Sodium Amytal

IT IS well known that patients with aphasia speak more easily when they are relaxed and have greater difficulty when anxious, tired or embarrassed. Reports have appeared describing improvement of aphasia after intravenous administration of sodium Amytal. It has been suggested that Amytal removes the inhibiting effect of anxiety usually present in patients with aphasia, thereby resulting in improved language function. For this reason, the effect of intravenous sodium Amytal was studied in 27 patients with aphasia.

Clinical and electroencephalographic effects of megimide in patients without cerebral disease.

FOLLOWING the introduction of Mcgimide (beta, beta methylethylglutarimide) as an antagonist for barbiturate intoxication in 1955, considerable interest has been stimulated in its clinical applicability. Initial reports noted its efficacy in barbiturate poisoning,l-‘ but subsequent studies failed to substantiate this application.6-8 In this laboratory, barbiturates are frequently administered under the standardized conditions of the “amobarbital test.”Q It was thus possible to assess the efficacy of Megimide in altering the behavioral response of human subjects to physiologic equivalent amounts of barbiturate. In addition to its suggested antagonism to barbiturate, Megimide induces both paroxysmal discharges in the electroencephalogram and clinical grand ma1 seizures.10-14 The present report concerns our experience with both the behavioral and electroencephalographic effects of Megimide.