30 results
An Analysis of 17 Catatonic Patients Diagnosed With Neuroleptic Malignant Syndrome
- Denise A. C. White, Ashley H. Robins
-
- Journal:
- CNS Spectrums / Volume 5 / Issue 7 / July 2000
- Published online by Cambridge University Press:
- 07 November 2014, pp. 58-65
-
- Article
- Export citation
-
This study was conducted to show that catatonia is a predisposing factor for neuroleptic malignant syndrome (NMS) and to review the nosological relationship between catatonia and NMS. Seventeen consecutive cases of NMS were analyzed prospectively with reference to clinical and investigative findings before and after exposure to a neuroleptic. The series comprised eight males and nine females, ranging in age from 18 years to 65 years. Prior to neuroleptic exposure, all patients exhibited features compatible with criteria for catatonia (mutism/excitement) according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R). Following neuroleptic administration (single dose in nine cases), patients deteriorated into a febrile, rigid, and obtunded state accompanied by autonomic dysfunction and raised creatine phosphokinase levels. These features were consistent with a diagnosis of NMS. Neuroleptics were discontinued and supportive medical treatment instituted. Benzodiazepines were beneficial in eight cases in relieving stupor, but bromocriptine and dantrolene were generally ineffective. In all patients diagnosed with NMS in the authors' series, catatonia was an invariable prodromal state. It appears that the administration of a neuroleptic intensified the preexisting catatonic state and precipitated a malignant variant of the disorder, which is currently recognized as NMS. The authors, therefore, challenge the separate nosological status of NMS and catatonia and suggest that these syndromes are part of a unitary pathophysiological disorder.
Contributors
-
- By André Aleman, Narmeen Ammari, Alan Anticevic, Deanna M. Barch, Christopher R. Bowie, Katherine E. Burdick, Sara J. Czaja, Anthony S. David, Colin A. Depp, Dwight Dickinson, Gary Donohoe, Melissa Fisher, Benjamin Glicksberg, Michael F. Green, Maya Gupta, Philip D. Harvey, R. Walter Heinrichs, Katherine Holshausen, William P. Horan, Daniel C. Javitt, Richard Keefe, John H. Krystal, David Loewenstein, Susan R. McGurk, Kristopher I. Mathis, Brent Mausbach, Ashley A. Miles, Kim T. Mueser, Eva Muharib, Robin Murray, Akshay Nair, Rogerio Panizzutti, Thomas Patterson, Amy E. Pinkham, Abraham Reichenberg, Manuela Russo, Jonathan Schaefer, Karuna Subramaniam, Laura Vergel de Dios, Sophia Vinogradov, Daniel R. Weinberger, Jonathan K. Wynn
- Edited by Philip D. Harvey, University of Miami
-
- Book:
- Cognitive Impairment in Schizophrenia
- Published online:
- 05 February 2013
- Print publication:
- 24 January 2013, pp vii-x
-
- Chapter
- Export citation
Contributors
-
- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
-
- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
-
- Chapter
- Export citation
Skin melanin concentrations in the affective disorders: possible relationships to the catecholamine hypothesis1
- Ashley H. Robins
-
- Journal:
- Psychological Medicine / Volume 2 / Issue 4 / November 1972
- Published online by Cambridge University Press:
- 09 July 2009, pp. 391-396
-
- Article
- Export citation
-
SYNOPSIS Skin melanin concentrations were measured by reflectance spectrophotometry in patients during the active phase of a primary affective illness and in normal subjects. There were no significant differences between 27 females with depression (unipolar illness) and 17 females with mania (bipolar illness) or between a mixed group of 30 male patients with mania and depression (predominantly mania) and a normal sample of 27 male subjects. These negative results are discussed in terms of the catecholamine hypothesis of the affective disorders. A study of brain pigmentation is suggested as being a potentially useful investigation in manic-depressive psychosis.
Clinical and biochemical comparison of clorazepate and diazepam
- Ashley Robin, Stephen H. Curry, Robin Whelpton
-
- Journal:
- Psychological Medicine / Volume 4 / Issue 4 / November 1974
- Published online by Cambridge University Press:
- 09 July 2009, pp. 388-392
-
- Article
- Export citation
-
Clorazepate and diazepam were compared with respect to clinical effectiveness and concentrations of benzodiazepine compounds in plasma in 15 severely anxious outpatients. Each patient was studied in a double blind trial incorporating two-week periods of the two drugs and of placebo. The doses were almost equimolar—5 mg diazepam or 7·5 mg clorazepate three times daily. Clinical progress was assessed by visual analogue scales and by the Symptom Rating Test. Psychopathology scores were highest at the end of the placebo periods, and lowest at the end of the clorazepate periods, regardless of the order of treatments. After diazepam, both diazepam and N-desmethyldiazepam (nordiazepam) were detected in blood, and after clorazepate, only N-desmethyldiazepam was detected. N-Desmethyldiazepam concentrations were higher after clorazepate. Clinical progress was apparently related to the concentration of N-desmethyldiazepam in plasma.
Contents
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp vii-ix
-
- Chapter
- Export citation
Frontmatter
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp i-vi
-
- Chapter
- Export citation
References
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 213-240
-
- Chapter
- Export citation
Acknowledgements
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp xiii-xiv
-
- Chapter
- Export citation
8 - Disorders of hyperpigmentation
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 123-138
-
- Chapter
- Export citation
-
Summary
Chapter 1 reviewed the biology of human skin pigmentation, and it is now appropriate to consider the pathology of the melanin pigmentary system and, if possible, to clarify the mechanisms producing these abnormalities. Basically, disturbances in human pigmentation manifest clinically as either excessive pigmentation (hyperpigmentation) or deficient pigmentation (hypopigmentation). Any respectable textbook of dermatology will provide lists of the legion conditions which fall under the rubric of the hyperpigmentation and hypopigmentation disorders respectively. Most of these are rare and of no interest to the general reader. This chapter will discuss some selected examples of the hyperpigmentation disorders and the following chapter will consider certain conditions associated with hypopigmentation.
It must be emphasized at the outset that the diagnosis of hyperpigmentation may be difficult. The normal skin colour of a Caucasoid of Mediterranean origin, for example, may not differ in the intensity of its hue from the abnormal pigmentation of a fair-skinned Scandinavian patient. Furthermore, pigmentation of the oral mucosa (e.g. gums) is usually pathological in fair-skinned Caucasoids but not in the darker ethnic groups (see p. 76).
Hormonal and metabolic factors
Reference was made in Chapter 2 to hyperpigmentation caused by the sex hormones (oestrogens and progesterone) and particularly to the chloasma induced by pregnancy and oral contraceptive agents (see Fig. 2.2).
The classic pathological condition causing hyperpigmentation is Addison's disease. This disease, described by Addison in 1855, is due to a failure of the adrenal glands to produce sufficient quantities of the adrenal hormones (corticosteroids). A common cause (and probably the commonest in Third World countries) is tuberculosis of the adrenal glands. Addison's disease results in weakness, lassitude and low blood pressure.
Index
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 241-253
-
- Chapter
- Export citation
9 - Disorders of hypopigmentation
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 139-165
-
- Chapter
- Export citation
-
Summary
Albinism
Albinism consists of a group of genetic disorders of the melanin pigmentary system which occurs throughout the animal kingdom from insects, fish and birds right up to human beings. It is characterized by an absence of or decrease in melanin which, in the human varieties of albinism, takes two forms: oculocutaneous albinism and ocular albinism. The former (which is by far the commoner) manifests as a lack of pigmentation in the skin, hair and eyes; in ocular albinism the loss of melanin is limited to the eyes and skin pigmentation is normal. All human albinos have visual problems – there is hypopigmentation of the iris, choroid and retina as well as maldevelopment of the fovea, a part of the retina which mediates central vision. The typical eye signs are photophobia (an abnormal, often painful, sensitivity to sunlight leading to its avoidance), nystagmus (involuntary, rhythmical oscillations of the eyeballs, usually in a horizontal plane), squint and a decreased visual acuity (in severe cases amounting to partial blindness). This chapter will concern itself only with oculocutaneous albinism.
History
Allusions to albinism date from antiquity but the actual term ‘albino’ (from the Latin albus, white) was coined by the seventeenth-century Portuguese explorer, Balthazer Tellez, who sighted certain ‘white’ Negroids on the west coast of Africa. Columbus, however, was claimed to have encountered such people (near Trinidad) at the time of his fourth voyage to America in 1502. The identification of albinos was hardly a feat of recognition: compared with normally pigmented Negroids, these albinos were highly conspicuous, and it was noted that their marked photophobia confined them to their huts until twilight.
Dedication
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp x-x
-
- Chapter
- Export citation
Preface
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp xi-xii
-
- Chapter
- Export citation
-
Summary
Benjamin Franklin is alleged to have written: ‘But in this world nothing can be said to be certain, except death and taxes’. And one is sorely tempted to add ‘the colour problem’. As black people have discovered during this and previous centuries, skin colour is the most decisive and the most abused of all the physical characteristics of humankind. It determines social perceptions, value judgments and interpersonal relationships, and it can wreak havoc on an individual's sense of dignity and selfesteem.
In this book I have endeavoured to analyse the essential nature and functions of human skin colour. I have done this predominantly from a biological standpoint, although I have included a chapter on the psychosocial dimensions of the subject and also one on the possible evolutionary forces which have determined skin colour variations among populations in different geographical regions. Disorders of pigmentation receive special attention, and I have given fairly detailed consideration to the pigmentation that occurs in sites other than the skin and hair.
The field of melanin pigmentation in all its guises is awash with journal articles, monographs and books. I have generally restricted references either to the original authors or to updated reviews, as it would have been unnecessarily cumbersome to cite the multiplicity of contributors to a particular topic. An exception is where the matter under discussion is controversial, or where I expose a personal viewpoint (as I do in assessing the vitamin D hypothesis of skin depigmentation). Here I have felt obliged to furnish fuller documentation for the arguments advanced.
The problem of race and racial labelling has been one of the most taxing for me.
3 - Ultraviolet radiation and the pigmentary system
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 42-58
-
- Chapter
- Export citation
-
Summary
The previous chapter discussed the variable influences of hormones on the epidermal melanin unit. The secretion of the pineal hormone, melatonin, is governed by the amount of light reaching the eye and this mechanism enables animals like the weasel and arctic fox to alter their coat colour according to the seasons. In humans light also plays a dominant role in pigmentation; not indirectly through hormones, but by the direct effect of solar ultraviolet radiation (UV) on the epidermal melanin unit. This effect induces the so-called tanning reaction, which can increase the pigmentation of sun-exposed areas markedly above the level of natural pigmentation. The contrast can be striking and, as Noel Coward observed, ‘Sunburn is very becoming – but only when it is even – one must be careful not to look like a mixed grill’!
In this century, and particularly in the Western world, the pursuit of a tan has become a passion, and there are people who will spend hours sunbathing (Fig. 3.1) or in sunbeds and suntan parlours. The achievement of a bronzed appearance is believed to signify health and beauty whereas, in fact, exposure to the sun (particularly in vulnerable, light-skinned Caucasoids) can have the very harmful effects which are discussed below.
Types of ultraviolet radiation (UV)
UV is part of the electromagnetic spectrum and it lies between the visible and X-ray regions (Fig. 3.2). Of the total radiant energy received by the earth from the sun, only 5–10 per cent is in the ultraviolet, the remainder being divided between the visible (about 40 per cent) and the infrared (about 50 per cent). Different wavebands in the UV spectrum show different capacities to cause biological injury.
11 - The evolution of skin colour
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 187-212
-
- Chapter
- Export citation
Biological Perspectives on Human Pigmentation
- Ashley H. Robins
-
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991
-
Skin colour is perhaps the most decisive and abused physical characteristic of humankind. This book presents a multidisciplinary overview of how and why human populations vary so markedly in their skin colour. The biological aspects of the pigment cell and its production of melanin are reviewed. The functions of melanin in the skin, brain, eye and ear are considered, and the common clinical abnormalities of pigmentation, such as albinism, are described and illustrated. Detailed reflectance data from worldwide surveys of skin colour are also presented. The historical and contemporary background of the phenomenon is explored in relation to the so-called 'colour problem' in society. Finally, the possible evolutionary forces which shape human pigmentation are assessed. This fascinating account will be of interest to graduate students and researchers of biological anthropology, anatomy, physiology and dermatology, as well as medical practitioners.
5 - Non-cutaneous melanin: distribution, nature and relationship to skin melanin
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 74-87
-
- Chapter
- Export citation
-
Summary
This chapter deals with the occurrence of melanin in sites other than skin and hair, and it will explore the putative role of the pigment in these situations. With the exception of melanin in the eye all the other melaninbearing tissues are internal and are totally shielded from light. Hence arises the problem of what likely use melanin would have in locations where it is deprived of its primary functions of photoprotection, thermoregulation and ecological adaptation (e.g. camouflage). Indeed, unlike beauty, melanin is not skin deep!
Eye
Iris
This is the visible pigmented region of the eye, and in describing an individual's eye colour one is referring to the pigmentation of the iris. The iris consists of several layers but, from the standpoint of colour, the two most important portions are the anterior layer together with its underlying stroma (both containing melanocytes) and the posterior pigmented epithelium.
Eye colour depends partly on the amount of melanin pigment in the anterior layer and stroma and partly on optical phenomena. In brown and dark brown irises there is an abundance of melanocytes and melanosomes in the anterior layer and stroma. Blue eyes are not the effect of a blue pigment, but represent Tyndall scattering (see p. 72). In blue-eyed individuals the anterior layer and stroma contain very little (if any) melanin. As light traverses these relatively melanin-free layers, the minute protein particles of the iris scatter the short blue wavelengths to the surface. The blue colour is heightened because the longer wavelengths (yellow and red) are absorbed by the dark background of the posterior pigmented epithelium, which also obscures the reddish hue of the adjacent blood vessels.
10 - Skin colour and society: the social–biological interface
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 166-186
-
- Chapter
- Export citation
-
Summary
W. E. B. DuBois once remarked that the problem of the twentieth century was the problem of the colour line; and even in the closing years of this century there is little doubt that the impact of skin colour continues to be profound, whether at the macro-level of global politics or the microlevel of a person-to-person transaction. Like three other exceedingly small entities – the atom, the ovum and the AIDS virus – the melanosome still has a place on the agenda of human catastrophe. It would therefore be a glaring omission in a book such as this to overlook the immense interaction between skin pigmentation and the psychosocial dimensions of human behaviour.
Legends, symbolism and culture
The colour of the skin, hair and eyes has intrigued people from time immemorial, as it has also engendered curiosity about the reasons for colour differences between human populations. In prescientific eras much of the thinking on the subject was based on mythology or primitive religious concepts. The well-known scriptural interpretation from Genesis blamed blackness on a curse delivered by Noah to his son Ham as a punishment for having gazed on him when he lay naked and drunk in his tent. The Ancient Greeks narrated that Phaeton, the son of Helios (god of the Sun), successfully coaxed his father to allow him to drive the fiery chariot of the Sun for one day. His maladroitness caused him to lose control of the reins so that the chariot came too close to the earth in one region (Ethiopia), burning the people there black, and was too far from the earth in other regions, turning the inhabitants there pale from cold.
4 - Functions of melanin
- Ashley H. Robins
-
- Book:
- Biological Perspectives on Human Pigmentation
- Published online:
- 02 December 2009
- Print publication:
- 25 July 1991, pp 59-73
-
- Chapter
- Export citation
-
Summary
Photoprotection
The two major defences of the skin against radiation injury are the presence of melanin pigment and the thickness of the stratum corneum. There was a time when the role of melanin in photoprotection was subordinated to that of the stratum corneum but, in the recent past, the burden of evidence has declared melanin to be the natural sunscreen par excellence. The arguments in favour of the superior photoprotective properties of melanin have been convincingly set out by Pathak & Fitzpatrick (1974) and they are based on clinical, epidemiological and experimental findings.
Skin cancer
The most obvious clue to the photoprotective role of melanin resides in the prevalence of skin cancer, which is by far the commonest of the cancers. As already noted, it is associated with intense and long-term exposure to UV-B and it therefore occurs more frequently on the chronically exposed body areas, such as the head and neck (see Fig. 9.4). There is a relative infrequency of skin cancer in Negroids and other pigmented peoples (Amerindians, Asians), even at the equator where UV is strongest. Susceptibility to skin cancer (including malignant melanoma) is enhanced in fair-skinned, light-haired Caucasoids who sunburn easily and tan poorly.
Persons of Celtic background appear to be significantly over-represented in the skin cancer statistics (Urbach, 1969). The Republic of Ireland has the third-highest death rate from skin cancer (next to Australia and South Africa), even though it is located between 52° N and 54° N and receives a relatively low annual influx of UV-B. It may be that the individual with Celtic skin and red hair has a genetic inability to resist the deleterious effects of UV.