Peter Reich

Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management.

A 39-year-old man twice experienced ventricular fibrillation and exhibited numerous ventricular premature beats. Coronary arteries were normal, and no impaired cardiac function was found upon catheterization. Evidence was adduced that the ventricular premature beats were related to higher nervous activity. The patient had serious psychiatric problems; the ventricular premature beats were provoked by psychophysiologic stress, increased during REM sleep, were reduced by meditation, and were controlled by beta-adrenergic blockade, phenytoin and digitalization. We conclude that psychologic and neurophysiologic factors may predispose to life-threatening cardiac arrhythmia in the absence of organic heart disease. Effective management of the recurrent ventricular arrhythmia involved; acute drug testing for assessing antiarrhythmic efficacy; use of programmed trendscription to provide on-line information on drug action; a treatment program involving more than one agent; and use of measures to reduce sympathetic nervous activity.

The Influence of the Psyche and the Brain on Immunity and Disease Susceptibility: A Critical Review

&NA; In critically reviewing the sources of evidence connecting psyche and brain with the immune system, the authors include a brief review of current knowledge of the immune system, its interactions with the neuroendocrine system, and other factors influencing its regulation. These include developmental stages, aging, rhythmicity, and a variety of exogenous influences. The need for developing further information about normal base lines is emphasized. Against that background, many sources of data demonstrating connections between the central nervous system and the immune system are presented: indirect evidence from clinical and experimental illnesses involving the immune system, and direct changes in either humoral or cellular immunity after natural or experimental stress, conditioning, hypnosis, and direct brain stimulation. Possible mechanisms are discussed, as well as some important methodological issues for further research.

Changes in brain glycogen during slow-wave sleep in the rat.

Abstract: During slow‐wave sleep, rat brain glycogen increases within a few minutes to about 70% above waking levels. Upon awakening, the increment is lost within 2–5 min. After repeated episodes of sleep, brain glycogen levels are comparable to those observed after only a single episode of sleep. Liver glycogen is unaffected by slow‐wave sleep.

Suicide Attempts by Hospitalized Medical and Surgical Patients

To characterize siucidal behavior among hospitalized medical and surgical patients, all suicide attempts in the Peter Bent Brigham Hospital were surveyed for seven years. Seventeen attempts occurred, non of them fatal. Only four patients were seriously ill, two with neoplasia. All the attempts were impulsive and were associated with stress and disturbances of impulse control. Anger, not depression, was the effect most often seen before the attempts. In all cases the precipitating stress was loss of emotional support. However, patient vulnerability to suicide seemed to be the key determinant. Fifteen patients had mental disorders, including eight with personality disorders, three with schizophrenia, three with organic brain syndromes, and one with manic depressive psychosis. Seven were psychotic, and six had made prior suicide attempts. These findings suggest that the characteristics of impulsive suicide should be considered when a suicide prevention program is being developed for a general hospital.

METABOLISM OF BRAIN DURING SLEEP AND WAKEFULNESS

Abstract— The levels in brain of lactate, pyruvate, creatine phosphate, ATP, ADP and AMP were examined in sleeping and waking adult rats. The animals were monitored electrophysiologically and the biochemical measurements were made after approx. 25 min of sleep or wakefulness. The previous treatment of the animals had a marked effect on the levels of brain metabolites during sleep. In animals not acclimatized to the observation chamber, brain levels of lactate and pyruvate rose during sleep above those in the waking state: creatine phosphate and ATP were depressed somewhat. When the animals were acclimatized by being placed in the observation chamber for at least 2 h on four or more consecutive days prior to the experiment, sleep was accompanied by a depression of brain levels of lactate and pyruvate and slight elevations of brain levels of creatine phosphate and ATP. No significant differences in the EEG recordings were noted between the sleeping rats of the acclimatized and non‐acclimatized groups. These observations on the effect of acclimatization on brain metabolism during sleep may have clinical relevance in man.

Pedophilia Occurring After Onset Of Cognitive Impairment

Four married patients are reported who first manifested pedophilia and other signs of disinhibition after sustaining illnesses that led to cognitive impairments. Although pedophilia may often be related to a long-standing inadequacy of sexual functioning, the onset of pedophilia in an individual without a previous history of sexual perversion may indicate the presence of recently sustained cognitive impairments.

Sleep: Effects on Incorporation of Inorganic Phosphate into Brain Fractions

During sleep there is a two- to threefold increase in the incorporation of inorganic orthophosphate-32P into a chemical fraction of the brain of the 20-day-old rat. This increase is not in the lipids or nucleic acids, but is associated with an acid-labile phosphate entity of the tissue residue after extraction of these fractions and phosphorus-containing substances of low molecular weight.

INCORPORATION OF PHOSPHATE INTO RAT BRAIN DURING SLEEP AND WAKEFULNESS

Abstract— Labelled inorganic phosphate (32P1) was administered intraventricularly to unrestrained sleeping and waking adult rats. After about 20 min of sleep or a comparable period of wakefulness, as monitored by EEG and EMG, the animals were frozen in liquid nitrogen and the brains were analysed. One group of animals (A) was not previously acclimatized to the apparatus. A second group (B) was acclimatized. The specific radioactivity of a phosphoprotein fraction was elevated during sleep in group A but not in group B. The specific radioactivity of the phosphatides of group B was depressed in sleeping as compared with waking animals. This effect was not observed in group A. No significant difference was detected between the EEG patterns of sleeping animals in groups A and B, as evaluated by standard criteria. These observations suggest that the physiological conditions attributable to environmental, emotional or other determinants can influence shifts in brain metabolism during the sleep‐wakefulness cycle.

Incapacitating childhood-onset insomnia

Abstract One patient with severe childhood-onset insomnia showed an abnormally high percentage of stage 4 sleep and was relieved by opiates, whereas a second patient showed an abnormally low percentage of stage 4 sleep and was relieved by trazadone. The nosologic entity, childhood-onset insomnia, therefore, may represent several types of sleep disorder. Insomnia patients who consult a sleep disorders clinic probably suffer insomnia of above average severity. Their insomnia problems arise from a diversity of causes 1 but are largely remediable. 2 In a classification of insomnia, the Association of Sleep Disorders Centers described childhood-onset insomnia as a separate nosologic entity. 3 In a series of 20 patients with childhood onset insomnia, Hauri and Olmstead suggested that this condition derived possibly from some neurologic rather than psychologic abnormality. 4 They did not discuss the treatment of such patients. This paper describes two cases of childhood-onset insomnia of incapacitating severity that responded to different treatments. This outcome suggests that childhood-onset insomnia, like other insomnia, has diverse causes, may be treated by various means, and therefore is not a separate nosologic entity.

Biochemistry of Sleep

The problem of defining sleep in biochemical terms is extraordinarily difficult, yet studies in this area are numerous and have a long history. Many of them focus on the general metabolism of the sleeping animal compared with the waking animal. They provide observations often really only peripheral to the central question: what biochemical manifestations are intrinsically causative of, or directly the result of, sleep?