0
July 1972, Vol 27, No. 1 >
Article | July 1972

Central Core Fibers in an Acutely Psychotic Patient: Title and subTitle BreakEvidence for a Neurogenic Basis for the Muscle Abnormalities in the Acute Psychoses

Herbert Y. Meltzer, MD
[+] Author Affiliations

Accepted for publication Feb 22, 1972.

Reprint requests to Department of Psychiatry, University of Chicago, 950 E 59th St, Chicago 60637 (Dr. Meltzer).


Arch Gen Psychiatry. 1972;27(1):125-132. doi:10.1001/archpsyc.1972.01750250109015
Text Size: A A A
Published online
Article
References
Comments

A 24-year-old black woman with probable manic-depressive illness was found to have central cores in all type I muscle fibers in a biopsy of the gastrocnemius muscle and in some type I fibers in a biopsy of the vastus lateralis muscle. Both biopsy specimens were differenteated into two main fiber types. The ultrastructural changes in the cores were more profound than in other cases of central core disease. Small atrophic fibers indicative of denervation or loss of the neurotrophic influence were also present. An electromyogram had both myopathic and neurogenic features. The question of whether the etiology of the muscle abnormalities in at least some acutely psychotic patients is neuropathic or myopathic, or a mixture of both, is discussed.

REFERENCES

1 +
Engel WK, Meltzer HY:  Histochemical abnormalities of skeletal muscle in patients with acute psychoses: Part I . Science 168:273-276, 1970;.
2 +
Meltzer HY, Engel WK:  Histochemical abnormalities of skeletal muscle in acutely psychotic patients: Part II . Arch Gen Psychiat 23:492-502, 1970;.
3 +
Fischman DA, Meltzer HY, Poppei RW:  The disruption of myofibrils in the skeletal muscle of acutely psychotic patients . Arch Gen Psychiat 23:503-515, 1970;.
4 +
Meltzer HY:  Creatine kinase and aldolase in serum: Abnormality common to acute psychoses . Science 159:1368-1370, 1968;.
5 +
Meltzer HY:  Muscle enzyme release in the acute psychoses . Arch Gen Psychiat 21:102-112, 1969;.
6 +
Meltzer H, Elkun L, Moline R:  Serum enzyme changes in newly admitted psychiatric patients . Arch Gen Psychiat 21:731-738, 1969;.
7 +
Meltzer HY, Moline R:  Muscle abnormalities in acute psychoses . Arch Gen Psychiat 23:481-491, 1970;.
8 +
Meltzer HY, Nankin R, Raftery J:  Serum createne phosphokinase activity in newly admitted psychiatric patients: Part II . Arch Gen Psychiat 24:568-572, 1971;.
9 +
Meltzer HY, Moline R:  Plasma enzymatic activity after exercise: Study of psychiatric patients and their relatives . Arch Gen Psychiat 22:390-407, 1970;.
10 +
Engel WK, Cunningham GG:  Alkaline phosphatase positive abnormal fibers of humans . J Histochem Cytochem 18:55-57, 1970;.
11 +
Lipkin KM, Dyrud JD, Meyer G:  The many faces of mania: Therapeutic trial of lithium carbonate . Arch Gen Psychiat 22:262-267, 1970;.
12 +
Meltzer HY:  Factors affecting serum CPK levels in the general population: The role of race, activity and age . Clin Chim Acta 33:165-172, 1971;.
13 +
Gonatas NK, Perez MC, Shy GM, et al:  Central "core" disease of skeletal muscle: Ultrastructural and cytochemical observations in two cases . Amer J Path 47:503-524, 1965;.
14 +
Dubowitz V, Platts M:  Central core disease of muscle with focal wasting . J Neurol Neurosurg Psychiat 28:432-437, 1965;.
15 +
Bethlem J, Van Gool J, Hulsmann WC, et al:  Familial nonprogressive myopathy with muscle cramps after exercise: A new disease associated with cores in the muscle fibers . Brain 89:569-588, 1966;.
16 +
Dubowitz V, Roy S:  Central core disease of muscle: Clinical, histochemical and electron microscopic studies of an affected mother and child . Brain 93:133-146, 1970;.
17 +
Shy GM, Magee KR:  A new congenital non-progressive myopathy . Brain 79:610-621, 1956;.
18 +
Seitelberger F, Wanko T, Gavin MA:  The muscle fiber in central core disease: Histochemical and electron microscopic observations . Acta Neuropath 1:223-237, 1961;.
19 +
Bethlem J, Posthumus Meyjes FE:  Congenital, nonprogressive central core disease of Shy and Magee . Psychiat Neurol Neurochir 63:246-251, 1960;.
20 +
Engel WK, Foster JB, Hughes BP, et al:  Central core disease—an investigation of a rare muscle cell abnormality . Brain 84:167-185, 1961;.
21 +
Afifi AK, Smith JW, Zellweger H:  Congenital nonprogressive myopathy, central core disease and nemaline myopathy in one family . Neurology 15:371-381, 1971;.
22 +
Armstrong RM, Koenigsberger R, Mellinger J, et al:  Central core disease with congenital hip dislocation: Study of two families . Neurology 21:369-381, 1971;.
23 +
Resnick JS, Engel WK:  Target fibers: Structural and cytochemical characteristics and their relationship to neurogenic muscle disease and fiber types , in Milhorat AT (ed): Exploratory Concepts in Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, p 255-265.
24 +
Shafiq SA, Milhorat AT, Gorycki MA:  Fine structure of human muscle in neurogenic atrophy . Neurology 17:934-948, 1967;.
25 +
Schotland DL:  An electron microscopic study of target fibers, target-like fibers and related abnormalities in human muscle . J Neuropath Exp Neurol 28:214-228, 1969;.
26 +
Brooke MH, Engel WK:  The histographic analysis of human muscle biopsies with regard to fiber types . Neurology 19:221-233, 1969;.
27 +
Edstrom L, Nystrom B:  Histochemical types and sizes of fibers in normal human muscles . Acta Neurol Scand 45:257-269, 1969;.
28 +
Karpati G, Carpenter S, Andermann F:  A new concept of childhood nemaline myopathy . Arch Neurol 24:291-303, 1971;.
29 +
Engel AG, Gomez MR, Groover RV:  Multicore disease: A recently recognized congenital myopathy associated with multifocal degeneration of muscle fibers . Mayo Clin Proc 46:666-681, 1971;.
30 +
Engel WK:  The essentiality of histo- and cytochemical studies of skeletal muscle in the investigation of neuromuscular disease . Neurology 12:778-784, 1962;.
31 +
Engel WK: The multiplicity of pathologic reactions of human skeletal muscle, in Proceedings of the Fifth International Congress of Neuropathology, Zurich, 1965. Amsterdam, Excerpta Medica Foundation, 1966, pp 613-624.
32 +
Dubowitz V:  Cross-innervated mammalian skeletal muscle: Histochemical, physiological and biochemical observations . J Physiol 193:481-495, 1967;.
33 +
Engel WK: Histochemistry of neuromuscular disease: Significance of muscle fiber type, in Proceedings of the Eighth International Congress of Neuropathology, Vienna, 1965. Amsterdam, Excermendellica Foundation, 1965, pp 67-101.
34 +
Mendell JR, Engel WK:  The fine structure of type II muscle fiber atrophy . Neurology 21:358-365, 1971;.
35 +
Engel AG:  Late-onset rod myopathy (a new syndrome?): Light and electron microscopic observations in two cases . Mayo Clin Pro 41:713-741, 1966;.
36 +
Cape CA, Johnson WW, Pitner SE:  Nemaline structures in polymyositis . Neurology 20:494-502, 1970;.
37 +
Benitez-Bribiesca L, Dela-Vega G:  Occurrence of alkaline phosphatase-containing muscle fibers after denervation . J Histochem Cytochem 19:691-692, 1971;.
38 +
Heyck H, Landahn G:  Muscle and serum enzymes in muscular dystrophy and neurogenic muscular atrophy: A comparative study , in Milhorat AT (ed): Exploratory Concepts in Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, pp 232-240.
39 +
Williams ER, Bruford A:  Creatine phosphokinase in motor neurone disease . Clin Chim Acta 27:53-56, 1970;.
40 +
Dubo H, Park DC, Pennington RJT, et al:  Serum creatinekinase in case of stroke, head injury and meningitis . Lancet 2:743-748, 1967;.
41 +
Acheson J, James DC, Hutchinson EC, et al:  Serum-creatine-kinase levels in cerebral vascular disease . Lancet 1:1306-1307, 1965;.
42 +
Eisen AA, Sherwin AL:  Serum creatine phosphokinase activity in cerebral infarction . Neurology 18:263-268, 1968;.
43 +
Cao A, DeVirgilus S, Lippi C, et al:  Creatine kinase isoenzymes in serum of children with neurological disorders . Clin Chim Acta 23:475-478, 1969;.
44 +
McComas AJ, Sica REP, Brown JC:  Myasthenia gravis: Evidence for a "central" defect . J Neurol Sci 13:107-113, 1971;.
45 +
Fenichel GM, Daroff RB, Glaser GH:  Hemiplegic atrophy: Histological and etiologic considerations . Neurology 14:883-890, 1964;.
46 +
Munsat TL, Thompson LR, Coleman RF:  Centronuclear ("myotubular") myopathy . Arch Neurol 20:120-131, 1969;.
47 +
Mass JW, Fawcett J, Dekirmenjian H:  3-Methoxy-4-hydroxy phenylglycol (MHPG) excretion in depressive states: A pilot study . Arch Gen Psychiat 19:129-134, 1968;.
48 +
Narasimhachari N, Heller B, Spaide J, et al:  N, N-Dimethylated indoleamines in blood . Biol Psychiat 3:21-23, 1971;.
49 +
Cadoret RJ, Winokur G, Clayton PJ:  Family history studies: VII. Manic depressive disease versus depressive disease . Brit J Psychiat 116:625-635, 1970;.
50 +
Rosenthal D: Genetics of Psychopathology . New York, McGraw Hill Book Co Inc, 1971;.
51 +
Schou M:  Lithium in psychiatric therapy and prophylaxis . J Psychiat Res 6:67-95, 1968;.
52 +
Pare CMB, Mack JW:  Differentiation of two genetically specific types of depression by the response to antidepressant drugs . J Med Genet 8:306-309, 1971;.
53 +
Engel AG:  Pathological alterations of the Z-disk , in Milhorat AT (ed): Exploratory Concepts of Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, pp 398-411.
54 +
Faris AA, Reyes MO:  Reappraisal of alcoholic myopathy . J Neurol Neurosurg Psychiat 34:86-92, 1971;.
55 +
Foster JA, Matzke HA:  The neurocytology of experimental ascending tetanus . World Neurol 2:22-37, 1961;.
56 +
Zacks SI, Sheff MF:  Studies on tetanus toxin: I. Formation of intramitochondrial dense granules in mice acutely poisoned with tetanus toxin . J Neuropath Exp Neurol 22:306-323, 1964;.
57 +
Luby ED, Cohen BD, Rosenbaum G, et al:  Study of a new schizophrenomimetic drug-Sernyl . Arch Neurol Psychiat 81:363-369, 1959;.
58 +
Meltzer HY:  Muscle toxicity produced by phencyclidine and restraint stress . Res Comm Chem Path 3:369-378, 1972;.
59 +
Corssen G, Domino EF:  Dissociative anesthesia: Further pharmacologic studies and first clinical experience with the phencyclidine derivative Cl-581 . Anesth Analg 45:29-40, 1966;.
60 +
Cherington M:  Ketamine and polyneuropathy . Lancet 2:569, 1970;.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Engel WK, Meltzer HY:  Histochemical abnormalities of skeletal muscle in patients with acute psychoses: Part I . Science 168:273-276, 1970;.
2 +
Meltzer HY, Engel WK:  Histochemical abnormalities of skeletal muscle in acutely psychotic patients: Part II . Arch Gen Psychiat 23:492-502, 1970;.
3 +
Fischman DA, Meltzer HY, Poppei RW:  The disruption of myofibrils in the skeletal muscle of acutely psychotic patients . Arch Gen Psychiat 23:503-515, 1970;.
4 +
Meltzer HY:  Creatine kinase and aldolase in serum: Abnormality common to acute psychoses . Science 159:1368-1370, 1968;.
5 +
Meltzer HY:  Muscle enzyme release in the acute psychoses . Arch Gen Psychiat 21:102-112, 1969;.
6 +
Meltzer H, Elkun L, Moline R:  Serum enzyme changes in newly admitted psychiatric patients . Arch Gen Psychiat 21:731-738, 1969;.
7 +
Meltzer HY, Moline R:  Muscle abnormalities in acute psychoses . Arch Gen Psychiat 23:481-491, 1970;.
8 +
Meltzer HY, Nankin R, Raftery J:  Serum createne phosphokinase activity in newly admitted psychiatric patients: Part II . Arch Gen Psychiat 24:568-572, 1971;.
9 +
Meltzer HY, Moline R:  Plasma enzymatic activity after exercise: Study of psychiatric patients and their relatives . Arch Gen Psychiat 22:390-407, 1970;.
10 +
Engel WK, Cunningham GG:  Alkaline phosphatase positive abnormal fibers of humans . J Histochem Cytochem 18:55-57, 1970;.
11 +
Lipkin KM, Dyrud JD, Meyer G:  The many faces of mania: Therapeutic trial of lithium carbonate . Arch Gen Psychiat 22:262-267, 1970;.
12 +
Meltzer HY:  Factors affecting serum CPK levels in the general population: The role of race, activity and age . Clin Chim Acta 33:165-172, 1971;.
13 +
Gonatas NK, Perez MC, Shy GM, et al:  Central "core" disease of skeletal muscle: Ultrastructural and cytochemical observations in two cases . Amer J Path 47:503-524, 1965;.
14 +
Dubowitz V, Platts M:  Central core disease of muscle with focal wasting . J Neurol Neurosurg Psychiat 28:432-437, 1965;.
15 +
Bethlem J, Van Gool J, Hulsmann WC, et al:  Familial nonprogressive myopathy with muscle cramps after exercise: A new disease associated with cores in the muscle fibers . Brain 89:569-588, 1966;.
16 +
Dubowitz V, Roy S:  Central core disease of muscle: Clinical, histochemical and electron microscopic studies of an affected mother and child . Brain 93:133-146, 1970;.
17 +
Shy GM, Magee KR:  A new congenital non-progressive myopathy . Brain 79:610-621, 1956;.
18 +
Seitelberger F, Wanko T, Gavin MA:  The muscle fiber in central core disease: Histochemical and electron microscopic observations . Acta Neuropath 1:223-237, 1961;.
19 +
Bethlem J, Posthumus Meyjes FE:  Congenital, nonprogressive central core disease of Shy and Magee . Psychiat Neurol Neurochir 63:246-251, 1960;.
20 +
Engel WK, Foster JB, Hughes BP, et al:  Central core disease—an investigation of a rare muscle cell abnormality . Brain 84:167-185, 1961;.
21 +
Afifi AK, Smith JW, Zellweger H:  Congenital nonprogressive myopathy, central core disease and nemaline myopathy in one family . Neurology 15:371-381, 1971;.
22 +
Armstrong RM, Koenigsberger R, Mellinger J, et al:  Central core disease with congenital hip dislocation: Study of two families . Neurology 21:369-381, 1971;.
23 +
Resnick JS, Engel WK:  Target fibers: Structural and cytochemical characteristics and their relationship to neurogenic muscle disease and fiber types , in Milhorat AT (ed): Exploratory Concepts in Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, p 255-265.
24 +
Shafiq SA, Milhorat AT, Gorycki MA:  Fine structure of human muscle in neurogenic atrophy . Neurology 17:934-948, 1967;.
25 +
Schotland DL:  An electron microscopic study of target fibers, target-like fibers and related abnormalities in human muscle . J Neuropath Exp Neurol 28:214-228, 1969;.
26 +
Brooke MH, Engel WK:  The histographic analysis of human muscle biopsies with regard to fiber types . Neurology 19:221-233, 1969;.
27 +
Edstrom L, Nystrom B:  Histochemical types and sizes of fibers in normal human muscles . Acta Neurol Scand 45:257-269, 1969;.
28 +
Karpati G, Carpenter S, Andermann F:  A new concept of childhood nemaline myopathy . Arch Neurol 24:291-303, 1971;.
29 +
Engel AG, Gomez MR, Groover RV:  Multicore disease: A recently recognized congenital myopathy associated with multifocal degeneration of muscle fibers . Mayo Clin Proc 46:666-681, 1971;.
30 +
Engel WK:  The essentiality of histo- and cytochemical studies of skeletal muscle in the investigation of neuromuscular disease . Neurology 12:778-784, 1962;.
31 +
Engel WK: The multiplicity of pathologic reactions of human skeletal muscle, in Proceedings of the Fifth International Congress of Neuropathology, Zurich, 1965. Amsterdam, Excerpta Medica Foundation, 1966, pp 613-624.
32 +
Dubowitz V:  Cross-innervated mammalian skeletal muscle: Histochemical, physiological and biochemical observations . J Physiol 193:481-495, 1967;.
33 +
Engel WK: Histochemistry of neuromuscular disease: Significance of muscle fiber type, in Proceedings of the Eighth International Congress of Neuropathology, Vienna, 1965. Amsterdam, Excermendellica Foundation, 1965, pp 67-101.
34 +
Mendell JR, Engel WK:  The fine structure of type II muscle fiber atrophy . Neurology 21:358-365, 1971;.
35 +
Engel AG:  Late-onset rod myopathy (a new syndrome?): Light and electron microscopic observations in two cases . Mayo Clin Pro 41:713-741, 1966;.
36 +
Cape CA, Johnson WW, Pitner SE:  Nemaline structures in polymyositis . Neurology 20:494-502, 1970;.
37 +
Benitez-Bribiesca L, Dela-Vega G:  Occurrence of alkaline phosphatase-containing muscle fibers after denervation . J Histochem Cytochem 19:691-692, 1971;.
38 +
Heyck H, Landahn G:  Muscle and serum enzymes in muscular dystrophy and neurogenic muscular atrophy: A comparative study , in Milhorat AT (ed): Exploratory Concepts in Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, pp 232-240.
39 +
Williams ER, Bruford A:  Creatine phosphokinase in motor neurone disease . Clin Chim Acta 27:53-56, 1970;.
40 +
Dubo H, Park DC, Pennington RJT, et al:  Serum creatinekinase in case of stroke, head injury and meningitis . Lancet 2:743-748, 1967;.
41 +
Acheson J, James DC, Hutchinson EC, et al:  Serum-creatine-kinase levels in cerebral vascular disease . Lancet 1:1306-1307, 1965;.
42 +
Eisen AA, Sherwin AL:  Serum creatine phosphokinase activity in cerebral infarction . Neurology 18:263-268, 1968;.
43 +
Cao A, DeVirgilus S, Lippi C, et al:  Creatine kinase isoenzymes in serum of children with neurological disorders . Clin Chim Acta 23:475-478, 1969;.
44 +
McComas AJ, Sica REP, Brown JC:  Myasthenia gravis: Evidence for a "central" defect . J Neurol Sci 13:107-113, 1971;.
45 +
Fenichel GM, Daroff RB, Glaser GH:  Hemiplegic atrophy: Histological and etiologic considerations . Neurology 14:883-890, 1964;.
46 +
Munsat TL, Thompson LR, Coleman RF:  Centronuclear ("myotubular") myopathy . Arch Neurol 20:120-131, 1969;.
47 +
Mass JW, Fawcett J, Dekirmenjian H:  3-Methoxy-4-hydroxy phenylglycol (MHPG) excretion in depressive states: A pilot study . Arch Gen Psychiat 19:129-134, 1968;.
48 +
Narasimhachari N, Heller B, Spaide J, et al:  N, N-Dimethylated indoleamines in blood . Biol Psychiat 3:21-23, 1971;.
49 +
Cadoret RJ, Winokur G, Clayton PJ:  Family history studies: VII. Manic depressive disease versus depressive disease . Brit J Psychiat 116:625-635, 1970;.
50 +
Rosenthal D: Genetics of Psychopathology . New York, McGraw Hill Book Co Inc, 1971;.
51 +
Schou M:  Lithium in psychiatric therapy and prophylaxis . J Psychiat Res 6:67-95, 1968;.
52 +
Pare CMB, Mack JW:  Differentiation of two genetically specific types of depression by the response to antidepressant drugs . J Med Genet 8:306-309, 1971;.
53 +
Engel AG:  Pathological alterations of the Z-disk , in Milhorat AT (ed): Exploratory Concepts of Muscular Dystrophy and Related Disorders . Amsterdam, Excerpta Medica Foundation, 1967;, pp 398-411.
54 +
Faris AA, Reyes MO:  Reappraisal of alcoholic myopathy . J Neurol Neurosurg Psychiat 34:86-92, 1971;.
55 +
Foster JA, Matzke HA:  The neurocytology of experimental ascending tetanus . World Neurol 2:22-37, 1961;.
56 +
Zacks SI, Sheff MF:  Studies on tetanus toxin: I. Formation of intramitochondrial dense granules in mice acutely poisoned with tetanus toxin . J Neuropath Exp Neurol 22:306-323, 1964;.
57 +
Luby ED, Cohen BD, Rosenbaum G, et al:  Study of a new schizophrenomimetic drug-Sernyl . Arch Neurol Psychiat 81:363-369, 1959;.
58 +
Meltzer HY:  Muscle toxicity produced by phencyclidine and restraint stress . Res Comm Chem Path 3:369-378, 1972;.
59 +
Corssen G, Domino EF:  Dissociative anesthesia: Further pharmacologic studies and first clinical experience with the phencyclidine derivative Cl-581 . Anesth Analg 45:29-40, 1966;.
60 +
Cherington M:  Ketamine and polyneuropathy . Lancet 2:569, 1970;.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems