Charalambos Papageorgiou

Neuropsychological and hypothalamic–pituitary-axis function in female patients with melancholic and non-melancholic depression

BackgroundExecutive function deficits in depression implicate involvement of frontal–striatal circuits. However, studies of hypothalamic–pituitary-axis (HPA) function suggest that stress-related brain changes of hippocampus may also implicate prefrontal–hippocampal circuits, which may explain the profile of both executive dysfunction and memory deficits. In this study we examined the performance of patients with major depressive disorder (MDD) on tasks of memory and executive function in relation to melancholic features and to cortisol levels. Our hypothesis was that raised cortisol levels in melancholic patients would correlate with these deficits.MethodForty female MDD patients, 20 having melancholic features (MEL vs. Non-MEL), and 20 sex- age- and education-matched normal controls were investigated using the Cambridge neuropsychological test automated battery (CANTAB), to assess memory (paired associative learning, PAL; short-term recognition memory, SRM) and executive (intradimensional/ extradimensional set-shifting, ID/ED; Stockings of Cambridge, SOC) functions. Plasma and salivary cortisol levels were measured.ResultsThe MDD patients performed worse than controls on PAL and both executive tasks. The MEL group differed from controls on all tests, and differed from the non-MEL only at the ED stage of the ID/ED task. Patient cortisol levels were within the normal range and did not correlate with neuropsychological performance for any group.ConclusionsMDD patients showed neuropsychological deficits on tasks of executive function and memory, supporting the model of frontal-temporal dysfunction. MEL vs. non-MEL performed worse overall and demonstrated a qualitative difference in set shifting, perhaps implicating more extensive prefrontal involvement. Cortisol levels did not correlate with depression severity or the observed deficits.

Can cognitive deficits differentiate between schizophrenia with and without obsessive–compulsive symptoms?

BACKGROUND The frequent occurrence of obsessive-compulsive symptoms (OCS) in the course of schizophrenia and their impact on the functional outcome of the illness underlie the suggestion that the presence of OCS represents a separate subtype of schizophrenia, with a distinct clinical presentation and prognosis and specific neurobiological characteristics. This study investigated whether the presence of OCS in schizophrenia is associated with worse cognitive functioning in the domains of processing speed, executive functions and visuospatial memory. We also explored whether the degree of impairment in any of these cognitive domains could predict group membership (i.e. Schizophrenia with OCS [Sch-OCS] and Schizophrenia without OCS) and if there was a relationship between cognitive functioning and severity of OCS within the Sch-OCS group. METHODS Forty patients with schizophrenia, 20 with and 20 without OCS, individually matched for age, gender, years of education and severity of psychotic symptoms and 20 healthy controls underwent a comprehensive neuropsychological assessment. RESULTS Only lower performance in processing speed discriminated patients with OCS from patients without OCS. Processing speed impairment not only classified patients in OCS or non-OCS group but was also independent of the severity of OCS symptoms. CONCLUSIONS The notion of additive effects of both schizophrenia and OCD on the structural and functional integrity of the brain circuits that support cognitive functions warrants further investigation in longitudinal neuropsychological and neuroimaging studies with larger samples and sufficient variation in the severity of OCS.

Levetiracetam in the treatment of antipsychotics-resistant Tourette syndrome

Levetiracetam, an anti-epileptic agent that enhances GABAergic neurotransmission, is one of the newest alternative treatments of Tourette syndrome (TS). We present the case of a 23-year-old female patient suffering from TS since the age of 7, who exhibited poor response to a variety of agents (haloperidol, pimozide, clonidine and various adjunctive agents) and had four hospitalizations during the previous 2 years due to the deterioration of her clinical state. On her last admission, in addition to clonidine 600 µg/day (already part of her regimen for the previous 4 years), levetiracetam was prescribed, up to 2000 mg/day, progressively titrated over a 3-week period. The patient presented a significant improvement on her TS symptomatology (the score on the Yale Global Tic Severity Scale dropped from 70 at admission, to 25 five weeks later, at discharge), which was preserved during the subsequent 4 months, without any serious side-effect.

Acute Dystonia in a Patient with 22q11.2 Deletion Syndrome

The 22q11.2 deletion syndrome (di George syndrome) is one of the most prevalent genetic disorders. The clinical features of the syndrome are distinct facial appearance, velopharyngeal insufficiency, conotruncal heart disease, parathyroid and immune dysfunction; however, little is known about possible neurodegenerative diseases. We describe the case of an 18-year old patient suffering from 22q11.2 deletion syndrome. Since adolescence, he presented with behavioral disorders, recommended treatment with 2 mg aloperidin and he presented cervical dystonia and emergence of torticollis and trunk dystonia. Antipsychotic medications either accelerate or reveal dystonic symptoms.

The association between smoking and psychopathology adjusted for body mass index and gender

Objective: This study examined the correlation between smoking habits and psychopathology status, as well as the impact of confounders such as body mass index and gender. Method: A total of 134 non-smokers and 152 smokers were enrolled in this study. We measured psychopathology features using Symptom Checklist 90-Revised. We ran logistic regression models testing the smoking–psychopathology association, controlling for body mass index and gender. Results: Smoking was positively correlated with depression, interpersonal sensitivity, hostility, somatization, paranoid ideation and psychoticism (P<0.05). Adjusting for body mass index and gender, the results remained largely unchanged, with a slight independent effect of body mass index. Conclusions: Our data suggest that smoking is a stronger predictor of psychopathology than body mass index and gender.

P-394 - Psychological factors affecting diabetes mellitus type 2 in correlation with cortizol and homocysteine

Introduction Chronic poor metabolic control of type 2 diabetes is characterized by elevation of plasma homocysteine and there is a evidence of both hypothalamic-pituitary-adrenocortical(HPA) axis and cognitive dysfunction in type 2 diabetes. Objectives Recent research indicates an association between cortizol and homocysteine and psychological factors in diabetes type 2 however the nature of this relationship remains unclear. Aims The aim of this study was to investigate the association of cortizol and homocysteine with trait and state psychological factors in diabetic patients. Methods In this study cortizol and homosysteine and psychological data were analyzed from 86 controlled diabetic patients (Glycosylated Haemoglobin HbA1c One year later (T1), the uncontrolled diabetic patients were re-evaluated with the use of the same psychometric instruments and with an identical blood analysis. Results Uncontrolled diabetic patients type 2 with high levels of cortizol score lower in the extraversion subscale of EPQ. In the controlled diabetic patiens high levels of homocysteine are correlated with high scores in the psychotism subscale of EPQ. Conclusions These findings give credence to the idea that cortizol and homocysteine in association with personality traits may be implicated in diabetes type 2.

The concomitant use of venlafaxine and orphenadrine citrate plus paracetamol can produce acute cutaneous reaction: a case report study

Background Coadministration of various drugs together with antidepressants can induce different side-effects in depressed patients. The authors report the case of a middle-aged woman, suffering from recurrent unipolar mood disorder, who developed an acute cutaneous reaction after the concomitant use of venlafaxine 225 mg/day and a combination product of orphenadrine citrate 105 mg/day and paracetamol 1350 mg/day.