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OBJECTIVE: The role of a deficiency of vitamin B1 in the development of alcoholic complaints is confined to the case of the Wernicke-Korsakov syndrome. Findings concerning a deficiency of thiamine in alcoholics in comparison with normal persons are contradictory and there are no differentiated tests in the case of delirium tremens. In this study the vitamin B1 absorption in patients with delirium tremens was of interest in connection with the presence or absence of hallucinations and autonomic symptoms. METHOD: Male patients (N = 70) with delirium tremens were compared with a group of 13 controls. The controls and patients were hospitalized in order to ensure abstinence from alcohol. The examination of the delirium patients was carried out with their consent after termination of the delirium tremens and again on discontinuance of drug therapy. In the case of 33 delirium patients the absorption of thiamine was tested again 4 weeks after the first examination. RESULTS: The absorption of vitamin B1 was in general only minimally lower in the case of the delirium patients in comparison with the nonalcoholics. The results showed, however, a considerably greater range of scattering of vitamin B1 absorption in the delirium patients. The absorption conditions showed marked improvement in the 4 weeks after delirium. The extent of absorption of vitamin B1 showed no influence on the duration of delirium. The patients with visual hallucinations, however, showed lower thiamine absorption than patients without such symptoms, whereas no dependence of autonomic symptoms on vitamin B1 absorption was seen. CONCLUSIONS: The disturbed absorption conditions in the delirium patients were obvious at the time of the examination as demonstrated by the wide range of absorption values. Improvement or near normal conditions were registered 4 weeks after the delirium. The absorption conditions had possibly already improved during the few days of alcohol abstinence in the course of the delirium treatment. The reduced vitamin B1 absorption of patients suffering from visual hallucination corresponds to observations of alcoholic hallucinosis.

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The alcohol-withdrawal syndrome was examined in 76 persons suffering from chronic alcohol dependency. Twenty persons showed only slight withdrawal symptoms. Thirty-two showed pronounced predelirium. Twenty-four patients developed delirium tremens. Commencing on the day on which alcohol was last consumed, potassium and magnesium levels in the blood serum were measured for 8 days until the 7th day after withdrawal from alcohol. The more pronounced the alcohol withdrawal syndrome, the sharper the decline in the level of potassium and magnesium in the blood serum. In each case, the decline in the magnesium serum level preceded that of the potassium serum level by one day. On the basis of the clinically and experimentally observed repercussions of the magnesium level (delirium symptoms, including grand mal), the magnesium blood level decline is attributed greater significance than that of the potassium blood level decline. The repercussions on magnesium and potassium blood levels resulting from the accompanying catecholamine release and of hyperventilation during delirium are discussed.

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This is a survey of the treatment courses provided so far during the initial period after the foundation of a psychotherapeutic outpatient ward of a Department of Psychiatry in a General Hospital. A relatively small benefit only is actually derived from this institution by the Department of Psychiatry: this benefit consisting of the fact that inpatients requiring psychotherapeutic treatment can be referred quickly to outpatient treatment in the psychotherapeutic ward. As a matter of fact, however, the outpatient ward barely fills the considerable gap in psychotherapeutic facilities available in the city of Oberhausen in Germany, whereas on the other hand adequate financial sponsoring has not been satisfactorily assured to date. Almost half of the referred patients were unsuitable for the depth psychology treatment offered by the outpatient ward and had therefore to be ruled out.

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In 83 alcoholics admitted to the University of Würzburg mental hospital with delirium tremens, the relationship was studied between hallucinations occurring in the delirium and psychological variables in the post-delirium state. Psychological tests were used and resulted in 13 variables of cognitive achievement and 12 variables of emotion and motivation. The alcoholics were tested on the 4th day and in the 4th week after completing therapy. Alcoholics suffering from hallucinations in the delirium differed from those not suffering from hallucinations, but the differences were not significant. However, there were only a few alcoholics who were not suffering from hallucinations. On the other hand, there were statistically significant correlations between the nature of the hallucinations and personality traits. Patients suffering from "polymorphic" hallucinations differed from those suffering from "monomorphic" hallucinations in having lower cognitive deficits but increased anxiety. The latter subjects suffered more from inhibition; the former regained more of their cognitive abilities during the recovery period. The few significant correlations between the variables of sense modality of the hallucinations and psychological characteristics were interpreted as resulting from the differences between "polymorphic" and "monomorphic" hallucinations.

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Following admission with delirium tremens to the University of Würzburg mental hospital, 83 alcoholics were investigated on their fourth day and their fourth week after finishing therapy for the delirium. They were investigated by psychological tests for achievement, resulting in 13 variables, and by a personality inventory. Of the 13 variables of achievement 4 increased significantly from the first investigation to the second, one was for verbal thinking, another was for numerical thinking, and finally they were two tests for attention. The personality inventory scores showed 3 significant changes indicating a clinical improvement: "nervousness", "depression", and "inhibition". For 7 variables of achievement the patients scored significantly below the normal average score, these were the 2 numerical tests, all variables of the memory tests, the verbal test, and 1 variable of the attention test. Except for the last test the average scores remained significantly below the normal average at the second investigation. The results of 5 scales of the personality inventory were significantly different to the norm in the first investigation; there were no differences on the second date.

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We could demonstrate by a non-selected group of 103 patients with delirium tremens in the course of a chronical abuse of alcohol that the delirium was preceded by an alcohol-withdrawal (either step or reduction of drinking or both of them). This had to be cleared up as in the last decades studies had been made mostly by means of a later looking over the medical records and as by incomplete data questions were left especially concerning the nosological demarcation of an "occasional delirium" and a "continual delirium". Starting from the observation at the "alcohol-withdrawal syndrome" we also watched both the reduction of the daily quantity of alcohol and the often short latency between the reduction of alcohol and the beginning of the delirium. When the delirium was preceded by psychotic events (to be conceived as alcohol-hallucination and alcohol-paranoia) it only came into existence after an abstinence of alcohol. The observations suggested that the delirium tremens with the typical psychotic symptoms and vegetative excitation principally is a delirium of alcohol-withdrawal and that other forms cannot be defined.

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Before treatment 80 unselected patients suffering from delirium tremens were examined with regard to 13 psychopathological criteria. For the data a matrix of correlation was computed and it was factor analyzed according to the principal-component method. In consideration of the course of the value-curve two factors were interpreted. The result, however, is an undetailed classification. In addition to that, the data were cluster-analyzed according Ward. The results of the multivariate statistical analysis admit the assumption of two great, though heterogenous groups of symptoms (hallucination/vigilance). Factor I comprises the symptoms, disorder of orientation and consciousness, sweating, agitation and tremor on its positive pole, the duration of the delirant state on its negative pole. Factor II combines paranoid-hallucinatory symptoms, fearful affects and suggestibility on its positive pole, while on its negative, there are happy affect and grand-mal seizures. The bipolarity of this factor and additional diagnoses show that paranoid-hallucinatory symptoms without disorder of consciousness and grand-mal seizures mutually exclude each other. From this a differential therapy treating patients suffering from paranoid-hallucinatory symptoms with neuroleptics (e.g. Haloperidol) can be deduced, while the danger of grand-mal seizures has to be considered when disorders of consciousness appear.

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Tachycardia in delirium tremens is often not adequately controlled by present delirium therapy but it can be treated with beta-receptor blockers. The favorable effect on the disorder expressed as adrenergic tachycardia due to raised excretion of catecholamine during delirium tremens is shown by pindolol (Visken) in a series of 14 patients. A favorable effect on the hypertensive circulatory condition in delirium tremens was also shown by certain ECG changes beyond those of tachycardia. In one case, a severe anaphylactic reaction occurred after the i. v. application of pindolol. No other side-effects were observed.

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Based on observations of sexual pathology and the findings of psychoanalysis the polarizing character of sexual deviations is presented with its phenomenons. Two kinds of sexual behavior, called 'receptive' and 'processive', are especially characterized. In the light of actual anthropological views it is made evident that it is a question of a fundamental reference system that is not confined to an 'abnormal' or 'normal' sexual conduct, but which founds every human communication.

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Fifty chronic alcoholics with acute withdrawal (in the state of delirium tremens) were examined initially and in the following weeks by quantitatively testing immunoglobulins in the serum and in the cerebrospinal fluid to study the dynamics of the blood-CSF barrier. Compared -to other persons of the same age, acutely delirious patients show a pathologic IgG-IgA constellation in the CSF which does not depend on the serum. That points to an infrastructural barrier function disorder. After 2--4 weeks, delirium tremens, normally in the process of recovering, shows distinct sanitation of the immunologic spectrum of the CSF. With regard to their dynamic proceedings, the results confirm other findings on brain metabolism, biochemistry, neurophysiology, and pathologic anatomy during delirium tremens. The totally and progressively disturbed blood-CSF barrier system of complicated cases of delirium tremens (e.g., Korsakov's and Wernicke's syndromes) seems to provide the possibility of deterioration of the clinical syndrome. The method, simple to implement in the laboratory, permits not only an overall evaluation of the dynamic blood-CSF barrier function in acute and postdelirious state, but also provides both the possibility to diagnose a persistent infrastructural residual syndrome and to indicate a pathophysiologic complication of the clinical course.

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This is a representation of the developing of "Don Juan" from a dramatic figure into a prototype of a particular human behaviour. First was described a general view of the literary dramatic essay on this theme, of the philosophical, psychoanalytic, anthropological, sexual-pathological aspects of the figure of Don Juan and of "Don Juanism". Then a case of Don Juanism was discussed. The special characteristic style of sexual behaviour was not seen isolatedly, but was regarded as an expression of a special structure of social behaviour. Finally an attempt was made to depict the different interpretations of the figure of Don Juan within our cultural reach in a common perspective. The interpretation and evaluation of this phenonmenon essentially refer to the anthropological conception of v. Gebsattel and Giese.

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