Avi Valevski

Elevated levels of serum interleukin-1β in combat-related posttraumatic stress disorder

Levels of serum interleukin-1 beta (IL-1 beta) and soluble interleukin-2 receptor (sIL-2R) were assessed in 19 male patients with combat-related posttraumatic stress disorder (PTSD) in comparison to 19 age- and sex-matched healthy volunteers. Serum IL-1 beta levels (but not sIL-2R) were significantly higher (p < .001) in the PTSD patients than in the controls. IL-1 beta levels did not correlate with cortisol levels, severity of PTSD, anxiety, depressive symptoms, or alexithymia score; however, they did correlate significantly (r = .54, p < .005) with the duration of PTSD symptoms. It is possible that desensitization of the hypothalamic-pituitary-adrenal axis in chronic PTSD patients counteracts the stimulatory effect of IL-1 beta on cortisol secretion.

An integrative quantitative model of factors influencing the course of anorexia nervosa over time

OBJECTIVE To identify factors influencing the course of anorexia nervosa (AN) over time. METHOD Former female patients with AN (36 remitted and 24 nonremitted) and 31 healthy females responded to standardized interviews and self-rating questionnaires. Remitted patients maintained normal eating, normal weight, and regular menses for the past 12 months. Patients not fulfilling these criteria were considered nonremitted. RESULTS Using logistic regression, we identified that number of hospitalizations, duration of ambulatory treatment, past vegetarianism, past anxiety, and childhood sexual abuse differentiated remitted from nonremitted patients, predicting nonremission. A similar analysis identified that elevated follow-up vegetarianism and eating-related concerns and lower body mass index (BMI) differentiated remitted from nonremitted patients, contributing to nonremission. Univariate analyses identified that remitted patients had elevated anxiety and eating-related obsessionality compared with the controls, suggesting these variables to potentially predispose to AN. DISCUSSION Elevated anxiety and eating-related obsessionality may increase the risk for the development of AN and for nonremission.

Differences in audiovisual integration, as measured by McGurk phenomenon, among adult and adolescent patients with schizophrenia and age-matched healthy control groups.

BACKGROUND McGurk effect is a perceptual phenomenon that reflects the integration of visual and auditory information during speech perception. Using McGurk effect, the authors examined the audiovisual integration in adolescents and adults with schizophrenia as compared with healthy volunteers. SAMPLING AND METHODS Thirty hospitalized patients with schizophrenia and 20 age-matched healthy controls were examined for perception of ambiguous audiovisual stimuli. RESULTS The mean of McGurk-positive responses was significantly lower in adolescent patients with schizophrenia than in healthy adolescents (3.13 +/- 2.09 vs 5.60 +/- 0.7, respectively; t = 3.591, P = .001). The McGurk-positive responses were significantly higher in healthy adolescents than in healthy adults (5.60 +/- 0.7 vs 3.60 +/- 1.43, respectively; t = 3.974, P = .001). No significant difference in McGurk-positive responses was found between adults with schizophrenia and healthy adult individuals, or between adolescent and adults with schizophrenia. Duration of schizophrenia, soft sign status, type of symptoms, and type of antipsychotic medication showed no influence on the audiovisual integration ability. CONCLUSIONS (I) Age effect: It seems that the audiovisual integrative function increases from childhood to adolescence and decreases from adolescence to early adulthood. (II) Schizophrenia: Audiovisual integration is poor in adolescent and adult patients with schizophrenia. Thus, it seems that schizophrenia is associated with early and persistent impairment in the development of the audiovisual integration ability. (III) Reliance on visual cue stimuli: Although several previous investigations concluded that patients with schizophrenia rely less on visual cue stimuli than healthy controls, our data suggest that this is true only for specific types of visual cue stimuli.

Abnormal thermoregulation in drug-free male schizophrenia patients

Schizophrenia patients may develop various thermoregulatory disturbances. We hypothesized that a standardized exercise-heat tolerance test [two 50-min bouts of walking a motor-driven treadmill at 40 degrees C (relative humidity=40%)] would reveal abnormal thermoregulation in drug-free schizophrenia patients. Six drug-free schizophrenia outpatients and seven healthy comparison subjects participated in this study. The schizophrenia patients exhibited significantly higher baseline and exertion-related rectal temperature. The relevance of these findings to the pathophysiology of schizophrenia-related thermoregulatory disorders is as yet unclear.

Clozapine-lithium combined treatment and agranulocytosis.

A case report of clozapine-induced agranulocytosis in a patient treated concomitantly with lithium is reported. The possible role of lithium in the mechanism of clozapine myelosuppression is discussed.

Mianserin or placebo as adjuncts to typical antipsychotics in resistant schizophrenia.

The beneficial effect of atypical antipsychotic drugs (APDs) in treatment-resistant schizophrenia patients has been attributed, mostly, to their relatively high serotonergic (5-HT)2 to dopaminergic (D)2 receptor blockade ratio. We hypothesized that a combination of typical APDs (D2 antagonists) and mianserin, a potent 5-HT2 antagonist, might also exert superior efficacy in this population. Eighteen inpatients with treatment-resistant schizophrenia who had an acute psychotic exacerbation of the disorder received, in a double-blind design, 30 mg/day mianserin (n =9) or placebo (n =9) in conjunction with typical neuroleptics [haloperidol (n =9) or perphenazine (n =9)]. Clinical status was evaluated before, during, and at the end of 6 weeks of combined treatment with the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms and Hamilton Rating Scale for Depression. The typical APD/mianserin group exhibited significantly greater improvement in total BPRS scores (17.6% versus 5.5%;P =0.03) and a trend towards greater improvement in SAPS scores (35.3% versus 13.0%;P =0.07). Our study indicates that patients with chronic treatment-resistant schizophrenia who have an acute psychotic exacerbation (‘acute-on-chronic’) may benefit from the addition of a potent 5-HT2 blocker, such as mianserin, to typical antipsychotics. Our findings may further emphasize the contribution of enhanced 5-HT2 blockade to the ‘atypicality’ of the atypical APDs and to their greater efficacy in alleviating symptoms of chronic treatment-resistant schizophrenia.

Response of catatonia to risperidone: two case reports.

The present study describes two patients, both of Yemenite origin, with catatonic schizophrenia who responded to treatment with risperidone. One had a long history of psychiatric disorder, whereas the other was a first-episode, drug-naive patient. Our observation agrees with previous reports on the use of risperidone and other novel neuroleptic agents in the treatment of catatonia of different etiologies.

Recurrence pattern of serum creatine phosphokinase levels in repeated acute psychosis

BACKGROUND Elevated serum creatine phosphokinase (CPK)MM level is frequently found in acute psychosis. Theories relate this CPKemia to psychomotor agitation and medication. We hypothesized that psychosis-related CPKemia observed in individual patients is relatively consistent. METHODS Ninety psychotic patients were studied; 83% were schizophrenics (Brief Psychiatric Rating Scale scores > or = 40) whose serum CPKMM levels were recorded during two or more different acute psychoses. The serum CPKMM levels used were the maximal levels monitored during the beginning of each hospitalization. The last CPK measurement in a circumscribed period was defined as the index serum CPK level (IndCPK). The mean of all other individual maximal CPK measurements during other psychotic episodes was defined as the average CPK (AvgCPK). RESULTS Multiple linear regression analysis showed a significant correlation of natural logarithm (Ln) of (IndCPK with Ln(AvgCPK), as well as with gender (coefficient = .65 and .63, p < .0001 and p < .01, respectively). There were significantly higher IndCPK levels among male patients than among female patients (p < or = .001). A relatively consistent individual pattern of serum CPKMM levels during repeated acute psychotic episodes was observed. CONCLUSIONS Serum CPKMM levels and gender were found to be good predictors of maximal serum CPKMM levels during every repeated acute psychotic episode. High IndCPK levels are probably risk factors for neuroleptic malignant syndrome.

Circulatory neurosteroid levels in underweight female adolescent anorexia nervosa inpatients and following weight restoration

Nineteen female adolescent inpatients diagnosed with anorexia nervosa, restricting type (AN-R) and 16 non-eating disordered (ED) controls were assessed for plasma dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and cortisol levels, and for eating-related and non-eating-related psychopathology. AN-R patients were assessed at admission, 1 month and 4 months following hospitalization. The non-ED controls were assessed once. No baseline between-group differences were found in plasma cortisol, DHEA, and DHEA-S levels, whereas the patient group had a significantly lower Cortisol/DHEA-S ratio and elevated scores on most psychopathological parameters. A significant increase was found in the body mass index of the AN-R patients at 4 months post-hospitalization, accompanied by a decrease in plasma cortisol levels and a trend towards decreased Cortisol/DHEA and Cortisol/DHEA-S ratios, whereas no change occurred in psychopathology. The difference in Cortisol/DHEA-S ratio between AN-R patients and non-ED controls, and the different patterns of change in cortisol vs. DHEA(-S) levels following weight restoration, may in part account for the feeding difficulties in AN, particularly during refeeding.

Homicide by schizophrenic patients in Israel

Thirty-three schizophrenic inpatients aged 45.3 +/- 13.5 years who had been found not guilty of homicide by reason of insanity were compared with 28 schizophrenic patients matched for age, sex and duration of disease who had not committed any crime. Statistical analysis revealed a high rate in the study group of individual factors associated with aggression, such as alcohol abuse, previous contact with the police, aggressive behavior and threats (P < 0.05). Significantly more of them were also immigrants (P < 0.05). There was no between-group difference in familial factors. These findings support earlier studies indicating that schizophrenic patients with the profile of alcoholism, aggressiveness and foreign country of origin are at high risk of homicidal behavior.