Dargut Kemali

Long-term outcome of lithium prophylaxis in patients initially classified as complete responders

The long-term outcome of lithium prophylaxis was explored in 43 bipolar and 36 unipolar patients who had been classified as complete responders after the first 2 years of treatment. These patients were followed up prospectively for a further period of 5 years (treatment period II), during which their psychopathological state was assessed monthly or bimonthly. Forty-nine patients completed treatment period II, 2 died during this period, 7 did not attend the unit anymore and could not be traced, and 21 definitively interrupted lithium treatment before the end of the period. In 18 cases the decision to stop lithium was taken by the patient. Twenty-five patients relapsed during the treatment period II. Four relapsers had three or more episodes concentrated during the last 2 years of treatment. These results suggest that the predictive value of an initial favourable response to lithium should not be overrated, and that the impact of the drug on the long-term course of major affective disorders in ordinary clinical conditions might be less dramatic than currently believed.

Prediction of affective psychoses response to lithium prophylaxis

ABSTRACT: A set of socio‐demographic, clinical, psychological and biological variables was examined in 100 patients diagnosed according to Perris as bipolar affective psychotics or unipolar depressive psychotics, maintained on prophylactic lithium for 2 years and divided into responders and non‐responders to this treatment on the basis of strict criteria. The results confirmed the potential role of four indices as predictors of response to prophylaxis: a positive family history of bipolar affective illness and a high red blood cell/plasma lithium ratio (positive predictors) and the presence of the HLA‐A3 antigen and a high score on the Neuroticism Scale of the Eysenck Personality Questionnaire (negative predictors). A stepwise discriminant analysis showed that neuroticism score, lithium ratio and HLA‐A3 antigen, taken together, correctly classified 74.6% of responders and 68.3% of non‐responders. It is hypothesized that these variables as a group may be of practical value in predicting response to lithium prophylaxis, and that pharmacogenetic and, perhaps, personality factors may be involved in treatment failures.

Ventricle-to-brain ratio in schizophrenia: a controlled follow-up study

The presence of enlarged lateral cerebral ventricles on computed tomography (CT) scans of a subset of schizophrenic patients has been reported by several authors (for a review, see Shelton and Weinberger 1986). This enlargement is commonly believed to predate the onset of illness and to be nonprogressive: in fact, most studies found no correlation between lateral ventricle size and duration of illness, and ventricular enlargement was also observed in young patients with schizophreniform disorder (Weinberger et al. 1982). Nevertheless, controversy on this topic persists. It has been argued (Woods and Wolf 1983) that the relationship between ventricle size and duration of illness was missed in some investigations as a consequence of the homogeneity of the patient sample with respect to the duration itself. Indeed, some studies ex-

Prevalence of psychiatric disorders among subjects exposed to a natural disaster

ABSTRACT– A general practice study was carried out in 3 areas of the province of Naples, in southern Italy: Pozzuoli (PZ), a town exposed to significant seismic events in 1983, Monte Ruscello (MR), a village built to accommodate the victims of the earthquake, and Monte di Procida (MP), a town selected as a control since it is situated near PZ and was not significantly affected by the earthquake. The sociodemographic characteristics of the subjects examined were comparable in the 3 areas. The estimate of the real prevalence of psychiatric disorders according to Diamond & Lilienfeld was found to be higher in PZ and MR than in MP. Neurotic depression was the most frequent psychiatric diagnosis. The relative risk of mental disorders in subjects who reported none one or more social problems compared with those who reported none was more than 4 times greater in PZ and MR than in MP. Social problems also differed qualitatively, being more frequently related to living conditions in PZ and MR and to the primary social network in MP.

Physical exercise at night blunts the nocturnal increase of plasma melatonin levels in healthy humans

The effects of physical exercise on nighttime melatonin secretion have never been investigated in humans. For this purpose, plasma melatonin levels were measured at different times during the day and the night in seven healthy men (aged 26-33 yrs), both in resting condition and before and after a physical exercise performed between 10.40 and 11.00 p.m.. The exercise consisted in bicycling on a bicycle ergometer at 50% of the personal maximal work capacity (MWC) for 10 min, followed by other 10 min of bicycling at 80% of the MWC. The results clearly showed that physical stress at night significantly blunts the nocturnal increase in plasma melatonin levels (group X time interaction: p less than 0.00001; two-way ANOVA with repeated measures). These findings, taken together with the data of the literature, suggest that the response of the pineal gland to provocative stimuli may depend on its level of activity when the stimulus is applied.

Clinical, biological, and neuropsychological features associated with lateral ventricular enlargement in DSM-III schizophrenic disorder

Clinical, historical, neuropsychological, and biological correlates of lateral ventricular enlargement on computed tomography (CT scan) were explored in a sample of DSM-III schizophrenics. Patients with enlarged ventricles, as compared with those whose ventricles were normal, presented a longer duration of illness and mean duration of hospitalization, and higher scores on the subscales alogia, affective flattening, and attentional impairment of the Scale for the Assessment of Negative Symptoms (SANS), on the scales self-care, participation in household activities, work performance, and behavior in crises and emergencies of the Disability Assessment Schedule, on the scales rhythm, writing, reading, arithmetic, and left hemisphere of the Luria-Nebraska Neuropsychological Battery, and on the subtests digit span, digit symbol and block design of the Wechsler Adult Intelligence Scale. Furthermore, on the computerized electroencephalogram, beta relative activity was significantly higher in patients with normal ventricles on the right frontal, left frontal, and right central leads. On stepwise discriminant function analysis, the patient groups with enlarged and normal ventricles could be separated statistically, and duration of illness and summary score on the SANS were found to be the best discriminators.

Depressed nocturnal plasma melatonin levels in drug-free paranoid schizophrenics.

The 24-h profiles of plasma melatonin and cortisol were evaluated in 7 drug-free male paranoid schizophrenics and in 7 healthy subjects matched to the patients for age, sex, body weight, height and season of testing. Blood samples were obtained at 20.00, 22.00, 24.00, 01.00, 02.00, 06.00, 08.00 and 12.00 h. Light was turned off from 21.00 to 07.00 h. Compared with that of the normal controls, the circadian rhythm of plasma melatonin was absent in paranoid schizophrenics (F7.84 = 7.30, p less than 0.0001; two-way ANOVA with repeated measures) whereas the 24-h profile of plasma cortisol was preserved, although at a slightly higher level (F1.12 = 26.810, p less than 0.0002). The melatonin/cortisol ratio was significantly higher in healthy subjects than in the schizophrenic patients. A functional relationship between disturbances in the melatonin rhythm especially and schizophrenia may be proposed, although the significance of this relationship remains to be elucidated.

Effects of Phosphatidylserine on the Neuroendocrine Response to Physical Stress in Humans

The activity of brain cortex-derived phosphatidylserine (BC-PS) on the neuroendocrine and neurovegetative responses to physical stress was tested in 8 healthy men who underwent three experiments with a bicycle ergometer. According to a double-blind design, before starting the exercise, each subject received intravenously, within 10 min, 50 or 75 mg of BC-PS or a volume-matched placebo diluted in 100 ml of saline. Blood samples were collected before and after the exercise for plasma epinephrine (E), norepinephrine (NE), dopamine (DA), adrenocorticotropin (ACTH), cortisol, growth hormone (GH), prolactin (PRL) and glucose determinations. Blood pressure and heart rate were also recorded. Physical stress induced a clear-cut increase in plasma E, NE, ACTH, cortisol, GH and PRL, whereas no significant change was observed in plasma DA and glucose. Pretreatment with both 50 and 75 mg BC-PS significantly blunted the ACTH and cortisol responses to physical stress.

Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men.

The effect of chronic administration of phosphatidylserine derived from brain cortex on the neuroendocrine responses to physical stress has been examined in a placebo-controlled study in 9 healthy men. Phosphatidylserine 800 mg/d for 10 days significantly blunted the ACTH and cortisol responses to physical exercise (P = 0.003 and P = 0.03, respectively), without affecting the rise in plasma GH and PRL. Physical exercise significantly increased the plasma lactate concentration both after placebo and phosphatidylserine. The results suggest that chronic oral administration of phosphatidylserine may counteract stress-induced activation of the hypothalamo-pituitary-adrenal axis in man.

CEEG mapping in drug-free schizophrenics : differences from healthy subjects and changes induced by haloperidol treatment

A topographic CEEG investigation was carried out in 20 drug-free, DSM-IIIR diagnosed schizophrenics and in a group of matched healthy controls. The effects of acute and chronic haloperidol treatment were then assessed in the patient group. On the baseline recording, schizophrenics showed a widespread increase in delta, theta 1 and beta 3 amplitude. Acute haloperidol administration produced a decrease in delta and an increase in slow beta amplitude. After 28 days of treatment, delta and fast beta were reduced while theta 2 and alpha 1 were increased. CEEG abnormalities in schizophrenic subjects appear, therefore, to be reduced by chronic neuroleptic treatment.