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HYPERBARIC OXYGEN AND SENILE PSYCHOSIS
1348
They conclude that an isolated trigeminal sensory neuropathy sparing motor function and corneal reflex
only transient (mean twelve hours). Nevertheless, the
may be
benign, but that motor involvement requires investigation. (The experience of others may not entirely support this conclusion 6.8) They recommend that radiographs of the skull and sinuses should always be taken, and the postnasal space examined, serological tests for syphilis undertaken, and the erythrocyte-sedimentation rate estimated. Many clinicians would also advise examination of the cerebrospinal fluid. The benign prognosis of trigeminal neuropathy
psychosis
intensive
The drug treatment of senile psychosis (other than the improvement in manageability achieved by chlorpromazine and allied compounds) has not
which spares motor function and the corneal reflex can only be substantiated by time. All patients with isolated cranial-nerve palsies should be reviewed frequently, so that further investigation may be undertaken if other structures become involved.
HYPERBARIC OXYGEN AND SENILE PSYCHOSIS
setiology and pathology of senile dementia (more satisfactorily called senile psychosis) and of the changes in intellectual function which accompany old age remain obscure. Treatment is symptomatic, and the care of those with senile psychosis makes large demands on medical, psychiatric, and welfare services. The subject is complicated by the difficulty of diagnosis and nomenclature in the psychiatric disorders of the elderly. They can be broadly divided into a reversible THE
and an irreversible group. The toxi-confusional states which accompany physical illness; the depressive states; and the mental disorders caused by myxaedema, pernicious ansemia, or vitamin-B deficiency are all usually amenable to treatment. The two dementiassenile psychosis and arteriosclerotic psychosis-are at present progressive, intractable conditions. The intellectual changes, such as slight memory loss, which are often considered natural in old age, occupy a debatable position between a normal " and a
results
Roth, M., Tomlinson, B. E., Blessed, G. Proc. R. Soc. Med. 1967, 60, 254. 2. Jacobs, E. A., Winter, P. M., Alvis, H. J., Small, S. M. New Engl. J. Med. 1969, 281, 753.
that
be,
mental
at any rate
deterioration in senile
temporarily, improved.
"
senile animals.’!5 This is a laborious
area for research. Psychological is testing time-consuming and needs experienced staff. Consecutive testing is difficult because of possible " practice effects." As more drugs emerge which might be of value, an easy, repeatable, quick, and objective method of psychological testing would be valuable. Possibly the automated method using a teaching machine6 might be useful. Corsellis,7 pointing to degeneration of small vessels in senile psychosis (noted by W. Scholz in 1938 and Surbek in 1961), believes the importance of the vascular component may have been underestimated. The findings of Jacobs et a1. will also direct attention to oxygen lack as a cause of symptoms in senile
psychosis. Sir FRANK HOLDSWORTH, director of the university department of orthopxdic surgery at the Royal Infirmary, Sheffield, died on Dec. 11 at the age of 65. J. Psychiat. 1958, 114, 943; Cameron, D. E., Solyom, L., Beach, L. Neuropsychopharmacology, 1961, 2, 351; Cameron, D. E., Sved, S., Solyom, L., Wainrib, B., Barik, H. Am. J. Psychiat. 1963, 120, 320. See Lancet, 1965, ii, 1281. Nandy, K. J., Bourne, G. H. Nature, Lond. 1966, 210, 313. Nandy, K. J. J. Geront, 1968, 23, 82. Gedye, J. L. Proceedings of the Loughborough Conference on Programmed Learning. London, 1967. Corsellis, J. A. N. Proc. R. Soc. Med. 1967, 60, 259.
3. Cameron, D. E. Am.
pathological change.1
1.
can
unexpectedly been disappointing. R.N.A. was reported3 to give some benefit; and other drugs have received favourable comment. The pharmacological basis for their use varies but most are thought to act by increasing cerebral blood-flow or to have a direct Examples are leptazol, psychotropic " effect. xanthinol niacinate, and pyritinol, methylphenidate, has been said meclofenoxate cyclandelate. Recently, to improve intellectual function in old age and also to cause the disappearance of the lipofuscin granules which accompany age changes in the brain cells of
"
For various reasons, therefore, keen interest is being shown in recent work on the improvement in " cognitive functioning in the aged " by hyperoxygenation. Jacobs et a1. describe the results of exposure to hyperbaric oxygen in 13 elderly male patients who had been in hospital unable to care for themselves for many months and who had severe intellectual deterioration. The experiment was carefully controlled by a double-blind crossover method. The results showed a highly significant improvement, after hyperoxygenation, in the pretreatment psychological test scores and a manifest behavioural improvement noted by the ward staff. The improvement outlasted the increase in arterial Po2. The use of hyperbaric oxygen in the treatment of senile psychosis presents many problems. The exposures were frequent (90 minutes twice a day for fifteen days). The apparatus is expensive and the chamber must look formidable to elderly patients. The effect, although it lasts longer than expected, is
show
4. 5. 6.
7.
SPECIAL SUBSCRIPTION TO THE LANCET
From Jan. 1, 1970, the annual subscription is be reduced to 25s. for medical students, and to E2 10s. for doctors in the five years from provisional registration in the United Kingdom (or from medical graduation in other countries). to
The new rates will be automatically extended, on renewal of subscriptions, to those who already receive the journal at a reduced rate. In North America, where The Lancet is published by Little, Brown and Company, 34 Beacon Street, Boston, Mass. 02106, the.full subscription is S15, with a special rate for residents and interns of
$9
per
annum.
They conclude that an isolated trigeminal sensory neuropathy sparing motor function and corneal reflex
only transient (mean twelve hours). Nevertheless, the
may be
benign, but that motor involvement requires investigation. (The experience of others may not entirely support this conclusion 6.8) They recommend that radiographs of the skull and sinuses should always be taken, and the postnasal space examined, serological tests for syphilis undertaken, and the erythrocyte-sedimentation rate estimated. Many clinicians would also advise examination of the cerebrospinal fluid. The benign prognosis of trigeminal neuropathy
psychosis
intensive
The drug treatment of senile psychosis (other than the improvement in manageability achieved by chlorpromazine and allied compounds) has not
which spares motor function and the corneal reflex can only be substantiated by time. All patients with isolated cranial-nerve palsies should be reviewed frequently, so that further investigation may be undertaken if other structures become involved.
HYPERBARIC OXYGEN AND SENILE PSYCHOSIS
setiology and pathology of senile dementia (more satisfactorily called senile psychosis) and of the changes in intellectual function which accompany old age remain obscure. Treatment is symptomatic, and the care of those with senile psychosis makes large demands on medical, psychiatric, and welfare services. The subject is complicated by the difficulty of diagnosis and nomenclature in the psychiatric disorders of the elderly. They can be broadly divided into a reversible THE
and an irreversible group. The toxi-confusional states which accompany physical illness; the depressive states; and the mental disorders caused by myxaedema, pernicious ansemia, or vitamin-B deficiency are all usually amenable to treatment. The two dementiassenile psychosis and arteriosclerotic psychosis-are at present progressive, intractable conditions. The intellectual changes, such as slight memory loss, which are often considered natural in old age, occupy a debatable position between a normal " and a
results
Roth, M., Tomlinson, B. E., Blessed, G. Proc. R. Soc. Med. 1967, 60, 254. 2. Jacobs, E. A., Winter, P. M., Alvis, H. J., Small, S. M. New Engl. J. Med. 1969, 281, 753.
that
be,
mental
at any rate
deterioration in senile
temporarily, improved.
"
senile animals.’!5 This is a laborious
area for research. Psychological is testing time-consuming and needs experienced staff. Consecutive testing is difficult because of possible " practice effects." As more drugs emerge which might be of value, an easy, repeatable, quick, and objective method of psychological testing would be valuable. Possibly the automated method using a teaching machine6 might be useful. Corsellis,7 pointing to degeneration of small vessels in senile psychosis (noted by W. Scholz in 1938 and Surbek in 1961), believes the importance of the vascular component may have been underestimated. The findings of Jacobs et a1. will also direct attention to oxygen lack as a cause of symptoms in senile
psychosis. Sir FRANK HOLDSWORTH, director of the university department of orthopxdic surgery at the Royal Infirmary, Sheffield, died on Dec. 11 at the age of 65. J. Psychiat. 1958, 114, 943; Cameron, D. E., Solyom, L., Beach, L. Neuropsychopharmacology, 1961, 2, 351; Cameron, D. E., Sved, S., Solyom, L., Wainrib, B., Barik, H. Am. J. Psychiat. 1963, 120, 320. See Lancet, 1965, ii, 1281. Nandy, K. J., Bourne, G. H. Nature, Lond. 1966, 210, 313. Nandy, K. J. J. Geront, 1968, 23, 82. Gedye, J. L. Proceedings of the Loughborough Conference on Programmed Learning. London, 1967. Corsellis, J. A. N. Proc. R. Soc. Med. 1967, 60, 259.
3. Cameron, D. E. Am.
pathological change.1
1.
can
unexpectedly been disappointing. R.N.A. was reported3 to give some benefit; and other drugs have received favourable comment. The pharmacological basis for their use varies but most are thought to act by increasing cerebral blood-flow or to have a direct Examples are leptazol, psychotropic " effect. xanthinol niacinate, and pyritinol, methylphenidate, has been said meclofenoxate cyclandelate. Recently, to improve intellectual function in old age and also to cause the disappearance of the lipofuscin granules which accompany age changes in the brain cells of
"
For various reasons, therefore, keen interest is being shown in recent work on the improvement in " cognitive functioning in the aged " by hyperoxygenation. Jacobs et a1. describe the results of exposure to hyperbaric oxygen in 13 elderly male patients who had been in hospital unable to care for themselves for many months and who had severe intellectual deterioration. The experiment was carefully controlled by a double-blind crossover method. The results showed a highly significant improvement, after hyperoxygenation, in the pretreatment psychological test scores and a manifest behavioural improvement noted by the ward staff. The improvement outlasted the increase in arterial Po2. The use of hyperbaric oxygen in the treatment of senile psychosis presents many problems. The exposures were frequent (90 minutes twice a day for fifteen days). The apparatus is expensive and the chamber must look formidable to elderly patients. The effect, although it lasts longer than expected, is
show
4. 5. 6.
7.
SPECIAL SUBSCRIPTION TO THE LANCET
From Jan. 1, 1970, the annual subscription is be reduced to 25s. for medical students, and to E2 10s. for doctors in the five years from provisional registration in the United Kingdom (or from medical graduation in other countries). to
The new rates will be automatically extended, on renewal of subscriptions, to those who already receive the journal at a reduced rate. In North America, where The Lancet is published by Little, Brown and Company, 34 Beacon Street, Boston, Mass. 02106, the.full subscription is S15, with a special rate for residents and interns of
$9
per
annum.