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Query: UMLS:C0085632 (apathy)
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Three patients had neurologic signs due to isopropyl alcohol (IPA) intoxication. Over a several-week period, a known alcoholic developed apathy, confusion, ataxia, and hyperreflexia. During this period, there was no ethanol available to him, and he denied use of other intoxicants. He was found stuporous in the hospital after drinking IPA and admitted to IPA abuse during the preceding weeks. Two other men were admitted in a stupor after large ingestions of IPA. Intoxication with IPA has two different presentations: stupor in a known alcoholic and encephalopathy of unknown cause in individuals who hide their addiction. Ethanol, methanol, IPA, and ethylene glycol intoxications are associated with different clinical and laboratory findings.
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PMID:Isopropyl alcohol intoxication. 198 19

None of the existing formal diagnostic categories in psychiatry today addresses adequately the issues of excessive power-seeking, corruption and destructiveness. Excessive power strivings both poison the personality of the individual who is obsessed in his spirit and mind with power and do unacceptable harm to other peoples' lives. The present proposal of a diagnostic category of a Personality Disorder of Excessive Power Strivings is intended to fit into current diagnostic schema of DSM as well as into an earlier proposal (1) to examine in all psychopathology not only the burdens and damage people do and impose on their own selves and their own functioning, but also the harm they do to other peoples' lives and functioning. The diagnosis is to be used when the individual displays prolonged and severe manifestations of the following listed criteria: The basic feature which is always present in this personality disorder is: 1. Intense and extensive power strivings. In addition, at least three other of the following characteristics should be present; 2. Lack of empathy for people, and indifference to the suffering of others; 3. "Street smart" alertness and remarkable cunning committed to seizing and expanding power; 4. Ruthlessness in cultivation of power; 5. Scapegoating and projection of blame on to targeted individuals or a group, an insistent need to identify certain others as lowly, worthless and intended victims; 6. Corruption by power and addiction to power; 7. Demands of other people to be dependent on one's powerful personality, or that they become one's obedient followers; 8. Emphasis on symbolisms of pure vs. impure, holy vs. infidel, chosen vs. condemned; 9. A basic disrespect for the lives of others evidenced in callous or indifferent exposure of others to undue risks; 10. An absence of conscience in contexts of self-interest and opportunity; 11. A homicide/suicide orientation.
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PMID:A personality disorder of excessive power strivings. 917 38

DRUG ABUSERS: Drugs are widely used by toxicomaniacs to reproduce drug effects. Drug abusers generally start with psychotrops, but other abuse drug classes. Toxicomanic behavior leads to addictive practices that are difficult to control. BARBITURATES: Both the oral and intravenous routes are used. The expected result is a state of ecstasy with a feeling of comfort. Intoxication may cause respiratory depression. Barbiturates induce physical and psychic dependence. Abuse is not widespread with this class of drugs. BENZODIAZEPINES: Drug abuses widely use benzodiazepines orally or intravenously. They search for a flash effect, with sedation and a feeling of comfort. All benzodiazepines induce physical and psychic dependence. Death may result from combinations leading to respiratory depression. Flunitrazepam is the most widely abused benzodiazepine in France. It induces serious neuropsychic disorders. ANTIDEPRESSANTS: Few are used, mostly at high doses. OPIATES: Administration gives the same effect as heroine injection. Opiates induce physical and psychic dependence. The adverse effects are similar to those of morphine with a higher risk of respiratory depression. AMPHETAMINES: Few are used, either orally or intravenously. They induce a flash with excitation, euphoria, and a period of invincibility. This is followed by a period of depression with risk of suicide. Psychic dependence is high. ANTICHOLINERGIC ANTIPARKINSONIANS: These drugs are well known to abusers for their hallucinatory effect. They induce atropinic adverse effects and physical and psychic dependence. GAMMA-HYDROXYBUTYRATE: This anesthetic is used for its euphoria and sedation effects. It may induce falling sickness or coma, with a risk of respiratory depression. KETAMINE: Administered via the intranasal route, ketamine induces a state of indifference. Death has been observed. ANABOLIC AND ANDROGENIC STEROIDS: These drugs are used for their physical and psychic stimulating effect. They induce potentially dangerous adverse effects such as cardiovascular, hepatic, neurological and psychiatric disorders. Clinical signs of addiction and weaning are observed. OTHERS: Several other drug classes are used by abusers, including analgics, beta-adrenergic agents, nasal vasoconstrictors and corticosteroids.
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PMID:[Drugs and drug abusers]. 1125 79

Sydnocarb [(phenylisopropyl)N-phenylcarbamoylsydnonimine; SYD] was introduced to clinical practice in Russia as a psychostimulant drug used for the treatment of asthenia and apathy, which accompany schizophrenia and manic depression. It has been described as a psychostimulant with addiction liability and toxicity less than amphetamine (AMPH). The precise cellular mechanisms by which sydnocarb elicits its psychostimulant effect are still unclear. At present its neurochemical and neurotoxic effects are compared to those of AMPH in the striatum, the main input structure of the basal ganglia. The expression of c-fos protein in striatal neurons was much more increased after a single injection of D-AMPH (5 mg/kg) than after an equimolar concentration of SYD (23.8 mg/kg) in both the anterior and the posterior part of the striatum. Using in situ hybridization on striatal slices, we observed that AMPH increased the striatal levels of preprodynorphin (PPDYN) mRNAs in both parts of the striatum, while SYD did not affect basal levels of PPDYN mRNAs. Furthermore, AMPH and SYD increased striatal preprotachykinin (PPT-A) and preproenkephalin (PPE) mRNA levels. The effects of AMPH and SYD on PPT-A-mRNA levels were similar. A differential effect of AMPH and SYD was observed only on the PPE-mRNA levels measured in the anterior striatum where SYD increased these levels more than AMPH. The acute neurotoxicity of these two psychostimulants was analyzed by measuring their effects on the parameters of oxidative stress, such as nitric oxide (NO) generation, as well as specific indices of lipid peroxidation (i.e., thiobarbituric acid reactive substances; TBARS), while, on the other hand, the alpha-tocopherol level was taken as an index of antioxidant defense processes. Measuring generation of NO directly by electron paramagnetic resonance, it was observed that AMPH shows a more pronounced increase in comparison to SYD, in the striatum and in cortex. TBARS levels in the striatum and cortex were significantly less enhanced than AMPH after a single injection of SYD. Similarly, the alpha-tocopherol level was decreased only by AMPH in the striatum, and neither AMPH nor SYD had any effect in the cortex. Results show that a single injection of a high dose of AMPH is able to induce several neurotoxic effects. The study also demonstrates that SYD has mild neurochemical effects as well as fewer neurotoxic properties than AMPH.
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PMID:Neurochemical changes and neurotoxic effects of an acute treatment with sydnocarb, a novel psychostimulant: comparison with D-amphetamine. 1210 94

Evidence supporting the application of Brown's (1991, 1993) conception of behavioural addiction to computing behaviour is presented. Questionnaire items tapping Brown's addiction criteria were factor-analysed along with others, including computer apathy-engagement and computer anxiety-comfort items of Charlton and Birkett (1995). Items relating to some of Brown's criteria (tolerance, euphoria, and cognitive salience) were found to be complex, an Addiction factor loading upon them but an Engagement factor loading more highly. Items tapping other criteria (conflict, withdrawal, behavioural salience, and relapse and reinstatement) were shown to be factor pure, with only the addiction factor loading highly upon them. It is concluded that Brown's conception of behavioural addiction can be applied to computer-related behaviour, although the relationship of milder facets of addiction, which are also merely indicative of high engagement, to computer-related addictions is non-unique. It is also concluded that classifying individuals as exhibiting pathological computer use using checklists based upon adaptations of DSM criteria for pathological gambling is likely to overestimate the number of people addicted to computing activities.
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PMID:A factor-analytic investigation of computer 'addiction' and engagement. 1223 Aug 34

Schizophrenic patients suffer from positive (delusions, hallucinations) and negative signs (social withdrawal) as well as emotional disturbance that included quantitative (blunted affect) and qualitative impairments (discordance of emotional level). Ketamine, a phencyclidine derivative, is a non competitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist. In healthy subjects its administration induces some positive symptoms (perceptual distortions.), negative symptoms (emotional deficit, apathy, social withdrawal) and cognitive changes (memory impairments and perseverations) that resemble some aspects of the symptoms of schizophrenia. A double blind cross over, placebo controlled was performed in 12 normal subjects with 2 sessions separated by one week of wash-out to determine ketamine-induced effects on behavioral and emotional responses. During each session, subjects received either ketamine or placebo (saline) infusion. A subanesthetic dose of ketamine (0,5 mg/kg) was administered by constant perfusion over 60 min. Behavioral and cognitive responses were assessed using positive and negative symptoms scales (BPRS, items from SAPS and SANS), vigilance and mood visual analog scale, subjective feelings using the Addiction Research Center Inventory (ARCI) and the Profile of Mood States (POMS). Using Philippot's method, emotions were elicited by films segments which induce a diversity of predictable emotions (fear, anger, sadness, joy, disgust and neutral state) and emotional responses were assessed by the Differential Emotions Scale (DES Izard). Low dose of ketamine induced significant effects on 7-items BPRS score (positive and negative items) and significant effects on positive and negative symptoms from SANS and SAPS. This was associated with emotional blunting of visually-induced responses that resemble aspects of schizophrenic emotional impairments. Ketamine impaired ARCI subscales (benzedrine subscale, pentobarbital-chlorpromazine subscale and LSD subscale). The recent findings of ketamine's pharmacology and imaging studies allow to draw several hypothesis related to neurotransmitter systems (glutamate, dopamine, serotonin interactions) and cerebral areas (particularly prefrontal cortex, anterior cingulate cortex, hippocampus) underlying some of these ketamine-induced effects.
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PMID:[Effects of a subanaesthetic dose of ketamine on emotional and behavioral state in healthy subjects]. 1290 92

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.
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PMID:Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment. 1521 41

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.
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PMID:Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment. 1521 44

Increasing evidence indicates that substance abusers are impaired in cognitive-executive control tasks relying on different functional systems converging in the prefrontal cortex (PFC). Different PFC functional systems relevant to addiction have been described: the dorsolateral (DLC), orbitofrontal (OFC), and anterior cingulate (ACC) circuits. Each system is associated with different behavioral, cognitive, and emotional deficits, including apathy, disinhibition, and executive dysfunction. In this study, we examined the effects of severity of use of different drugs on apathy, disinhibition and executive dysfunction behavioral deficits as measured by the Frontal Systems Behavior Scale (FrSBe). The FrSBe, and a severity of substance use interview were administered to 32 poly-substance abusers. Multiple regression analyses showed that severity of cannabis use significantly predicted greater apathy and executive dysfunction behavior; and that severity of cocaine use significantly predicted greater disinhibition behavior. These results are consistent with previous studies using cognitive measures and support the notion that severity of substance use significantly affects behavioral symptoms associated with PFC systems functioning. These clinical symptoms should be specifically addressed during rehabilitation.
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PMID:Differential impact of severity of drug use on frontal behavioral symptoms. 1632 22

Apathy and fatigue, sexual disturbances, mania, sleep disturbances, personality changes, pathologic gambling, and addiction to antiparkinson agents occur in patients with PD and may pose considerable stress on the patients themselves and their caregivers. With the exception of apathy and fatigue, little is known regarding the prevalence of these symptoms in patients with PD. The pathophysiologic mechanisms are unknown, although disturbances of the mesolimbic and mesocortical dopaminergic pathways are probably involved. Antiparkinsonian drugs or surgery seem to be the main etiologic factors for sexual disturbance, hypomania, addiction, and pathologic gambling, whereas hypodopaminergic states may contribute to symptoms such as apathy, fatigue, RBD, and possibly personality changes. Although some placebo-controlled trials have been published recently, no established treatments are currently available for these symptoms (85) (see Table 5-2), and thus future clinical trials are needed.
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PMID:Disorders of motivation, sexual conduct, and sleep in Parkinson's disease. 1638 12


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