Race, alcohol and general paralysis: Emil Kraepelin's comparative psychiatry and his trips to Java (1904) and North America (1925)

This article examines Emil Kraepelin's notion of comparative psychiatry and relates it to the clinical research he conducted at psychiatric hospitals in South-East Asia (1904) and the USA (1925). It argues that his research fits awkwardly within the common historiographic narratives of colonial psychiatry. It also disputes claims that his work can be interpreted meaningfully as the fons et origio of transcultural psychiatry. Instead, it argues that his comparative psychiatry was part of a larger neo-Lamarckian project of clinical epidemiology and was thus primarily a reflection of his own long-standing diagnostic practices and research agendas. However, the hospitals in Java and America exposed the institutional constraints and limitations of those practices and agendas.

A young man presenting with paralysis after vigorous exercise

Thyrotoxic periodic paralysis (TPP) is a rare metabolic disorder characterised by muscular weakness and paralysis in predisposed thyrotoxic patients. Although patients with TPP are almost uniformly men of Asian descent, cases have been reported in Caucasian and other ethnic populations. The rapid increase in ethnic diversity in Western and European nations has led to increase in TPP reports, where it was once considered exceedingly rare. Correcting the hypokalaemic and hyperthyroid state tends to reverse the paralysis. However, failure to recognise the condition may lead to delay in diagnosis and serious consequences including respiratory failure and death. We describe a young man who was diagnosed with hyperthyroidism who presented with acute paralysis. The clinical characteristics, pathophysiology and management of TTP are reviewed.

Effects of sex steroid hormones, thyroid hormone levels, and insulin regulation on thyrotoxic periodic paralysis in Chinese men

Our study is to determine the expression of thyroid hormone, sex hormone, insulin, and C-peptide in Chinese male patients with thyrotoxic periodic paralysis (TPP). This study covered 102 patients with hyperthyroidism from Xijing Hospital. According to whether occurrence of TPP or not, patients were divided into two groups (those that were hyperthyroid with and without TPP) that were, matched with age, blood pressure, urea, and creatinine. We found the body mass index (BMI) in patients with TPP was higher than that in pure hyperthyroidism patients. The levels of the total thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4) were significantly lower in patients with TPP compared with pure hyperthyroidism patients, while serum testosterone levels were higher compared with pure hyperthyroidism patients. Moreover, after glucose administration, the concentration of insulin at 60, 120, and 180 min were significantly higher in patients with TPP than those in pure hyperthyroidism patients. The insulin area under the curve (AUC) was significantly increased in patients with TPP compared with pure hyperthyroidism patients. The levels of thyroid hormone, sex hormone, and insulin were different in Chinese male patients with TPP compared to those with only hyperthyroidism.

And they shall walk: ideal versus reality in polio rehabilitation in the United States

This essay explores the significance that rehabilitation physicians and polio patients in the United States put on recovering the ability to walk. Polio often paralyzed or severely weakened the legs of those who contracted the disease. Regaining the ability to walk was thus a significant measure of recovery from the disease. However, walking meant more than the physical act itself. Regaining the ability to walk meant, in a symbolic sense, that one was no longer disabled, that one had again become normal. This attitude was shared by rehabilitation specialists and patients alike. This essay examines this attitude and the cultural values it embodied through a study of the efforts of selected polio survivors to learn to walk again and of the rehabilitation literature that held walking as an ideal. It also explores what happened when polio patients were unable to walk again because of the severity of their paralysis.

Isolated sleep paralysis in African Americans with panic disorder

Isolated sleep paralysis (ISP) was assessed in African Americans and Whites diagnosed with panic disorder and other anxiety disorders. Participants were recruited from an outpatient clinic where they were diagnosed with panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, social phobia, and simple phobia. Control groups of volunteers without a history of psychiatric disorder were included. All research participants completed a questionnaire to assess for ISP. Group differences were analysed through a series of chi-square analyses. The incidence of recurrent ISP was significantly higher in African Americans with panic disorder (59.6%) as compared with African Americans with other anxiety disorders (11.1%), African American control group participants (23%), Whites with panic disorder (7.5%), Whites with other anxiety disorders (0%), and White control group participants (6%). Recurrent ISP was found to be more common among African American participants, particularly for those with panic disorder. African Americans with panic disorder may experience recurrent ISP as a feature of their disorder.

Clinical and sociocultural differences in African American and European American patients with panic disorder and agoraphobia

Much attention has been paid to the study of panic disorder symptomatology among primarily European American populations. However, such research has not adequately generalized to include minority groups. The present study examined phenomenological differences between African American and European American patients with panic disorder with or without agoraphobia. African American (N = 48) and European American (N = 33) patients with panic disorder were assessed by structured interview and self-report questionnaires upon presentation to an anxiety disorders clinic for treatment. African Americans evidenced a higher rate of comorbid posttraumatic stress disorder (16% vs. 0%). European Americans reported having their initial panic attack at an earlier age than African Americans (21 vs. 29). In terms of discrete panic attack symptoms, African Americans reported more intense levels of numbing/tingling in extremities (4.3 vs. 2.5) as well as greater fear of dying (6.3 vs. 4) or going crazy (4.6 vs. 3) than European Americans. African Americans evidenced less satisfaction with social support (2.7 vs. 3.2), especially financial support (2.3 vs. 3.2), than European Americans. African Americans employed coping strategies such as counting one's blessings (1.9 vs. 1.4) and religiosity (1.9 vs. 1.2) more often than European Americans but evidenced less self blame (1.7 vs. 2). This study extends previous findings by showing that African Americans have a later age of onset as well as different coping strategies than European American patients with panic disorder.

Thyrotoxic periodic paralysis in Mexican mestizo patients: a clinical, biochemical and HLA-serological study

BACKGROUND

Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of a group of Mexican mestizo patients with TPP.

METHODS

The sample was comprised of 14 men with TPP diagnosed since January 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available for HLA testing.

RESULTS

Hyperthyroidism was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population.

CONCLUSIONS

TPP is more common than previously thought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications.

Sudden periodic paralysis: rare manifestation of thyrotoxicosis

Nonfamilial hypokalemic thyrotoxic periodic paralysis is rarely diagnosed among Caucasians and blacks in the western world but it is relatively common among Asiatics. Sudden paralysis occurring while at rest after a large carbohydrate meal or strenuous exercise in an undiagnosed mild thyrotoxic patient is a common presentation. A case illustrating such presentation is reported. Intracellular shifts of potassium triggered or facilitated by hyperthyroidism and hyperinsulinemia are the biochemical features. Correction of the thyrotoxic state is the definitive treatment for this disorder. Judicious administration of potassium is indicated during the hypokalemic episode to prevent life-threatening arrhythmias.

A prospective clinical and electrophysiologic survey of acute flaccid paralysis in Chinese children

We studied 29 children admitted to Beijing Children's Hospital (BCH) with acute flaccid paralysis between June 1991 and June 1993. Twenty-seven patients had Guillain-Barré syndrome--7 with acute inflammatory demyelinating polyneuropathy and 20 with acute motor axonal neuropathy (AMAN). Two had poliomyelitis. The most common cause of acute flaccid paralysis at BCH is the AMAN pattern of GBS.

Thyrotoxic periodic paralysis in a Chinese population

We retrospectively evaluated the characteristics of adult patients admitted with thyrotoxic hypokalaemic periodic paralysis in Hong Kong. From 1984 to 1993, 45 Chinese adult patients were admitted with acute limb weakness, plasma potassium < or = 3.5 mmol/l and thyrotoxicosis confirmed by laboratory investigations. All but one were male. Seventy-five percent of attacks occurred between 9pm and 9am. Half of the attacks occurred between July and October (49.1%), most commonly in August (20%). Mean (+/- SEM) plasma potassium on admission was 2.17 +/- 0.08 mmol/l (range 1.1-3.5). In 15 episodes (27.3%), plasma potassium on recovery exceeded 5.0 mmol/l, while in three episodes (5.5%), potassium exceeded 6.0 mmol/l. No patient had a positive family history of thyrotoxic periodic paralysis. Only 28.9% had a known history of thyrotoxicosis before their first presentation with periodic paralysis. Twenty-seven (60%) had clinical evidence of thyrotoxicosis. Although all were biochemically thyrotoxic, 11.4% had only a mild degree of thyrotoxicosis (suppressed thyroid-stimulating hormone, high free thyroxine, but normal free triiodothyronine). One quarter of the patients had a normal erythrocyte zinc concentration, indicating either a short history of thyrotoxicosis or transient thyrotoxicosis. The diagnosis of thyrotoxic hypokalaemic paralysis should always be considered in Chinese patients with acute muscle weakness, especially in young males. Absence of clinical thyrotoxicosis does not exclude the diagnosis. Plasma potassium should be monitored carefully during treatment to prevent rebound hyperkalaemia.

Sleep paralysis in Chinese: ghost oppression phenomenon in Hong Kong

Despite reports of wide variation in the prevalence of sleep paralysis among different ethnic groups, there has never been any study in Chinese. In Hong Kong, a condition known as ghost oppression is descriptively identical to sleep paralysis. To examine this phenomenon, the response of 603 undergraduate students to a questionnaire were analyzed. Thirty-seven percent had experienced at least one attack of ghost oppression. There was no sex difference in the prevalence, and the peak age of onset was at the range of 17-19 for both sexes. A strong familial association was found and 20% of subjects reported a positive family history. Over one sixth of the subjects identified sleep disruption and stress as precipitating events.

Thyrotoxic periodic paralysis

Periodic flaccid paralysis of skeletal muscle occurring in a thyrotoxic patient, an unusual and dramatic event, is seen predominantly in Oriental men. It is important to remember the clinical association between periodic paralysis and thyrotoxicosis.