We have reviewed the literature on transcranial magnetic stimulation studies in patients with brain death, coma, vegetative, minimally conscious, and locked-in states. Transcranial magnetic stimulation permits non-invasive study of brain excitability and may extend our understanding of the underlying mechanisms of these disorders. However, use of this technique in severe brain damage remains methodologically ill-defined and must be further validated prior to clinical application in these challenging patients.

Objective: Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD). The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™) to screen for ADHD. Methods: Matched samples pre- (N = 120) and post-bariatric surgery (N = 128) were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. Results: Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. Conclusion: The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

In a randomized, double-blind study of 40 patients undergoing total abdominal hysterectomy, we have compared continuous subcutaneous infusion (CSCI) of morphine with discontinuous extradural injection of morphine for postoperative analgesia at rest and during cough. The CSCI group received a bolus of morphine 0.1 mg kg-1 i.v. at the end of the operation and continued with s.c. infusion of morphine 30 micrograms kg-1 h-1. The extradural group received morphine 4 mg extradurally at 0, 2, 10 and 18 h after operation. Pain and side effects were evaluated at 2, 4, 8, 12 and 24 h after operation. In the extradural group, significantly smaller pain-scores were observed both at rest and during cough compared with the CSCI group. No significant difference was observed between the groups regarding supplementary doses of morphine, peak expiratory flow values or side effects. We conclude that morphine by CSCI is not as effective as morphine injected extradurally. However, CSCI seems to provide simple and relatively effective analgesia with a low rate of side effects.

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IntroductionInformation about the relationship between personality disorder and ethnicity or migration is sparse. The few studies regarding the prevalence of borderline personality disorder (BPD) in immigrants compared to an indigenous population are inconsistent.AimsThe aim of the present study was to compare the frequency of a BPD diagnosis in psychiatric inpatients with and without an immigrant background.Methods2494 consecutive patients over a 3-year period at a psychiatric university hospital were reviewed. Data included socio-demographic and clinical variables and also information about an immigrant background. The psychiatric diagnosis was limited to information available from the digital documentation system of the psychiatric clinic and additionally from discharge letters. The diagnosis of borderline personality disorder was based on ICD-10 criteria.Results374 individuals (15%) of the study population had an immigrant background. The rates of BPD were 6.5% in the indigenous group (n = 2120) vs. 3.5% in the immigrant group (n = 374). The difference between the indigenous and the immigrant group regarding the rates of BPD-diagnoses was statistically significant (chi2 = 5.02, df = 1, p = 0.025).ConclusionsThe findings suggest that in a clinical sample BPD was diagnosed less frequently in the immigrant group than in the indigenous group. Therefore, our results do not support the concept of immigration as a risk factor for BPD. However, future investigations with a prospective study design and at epidemiological levels need to be conducted in order to get more precise information about the prevalence of BPD in different immigrant groups.