Jerome Kroll

Altered levels of Reelin and its isoforms in schizophrenia and mood disorders

Reelin is a secreted extracellular matrix protein ∼410 kDa mol. wt that is reduced in brains of patients with schizophrenia, autism, bipolar disorder and major depression. Recent reports also indicate its near absence in sera of some patients with an autosomal recessive form of lissencephaly. Moreover, Reelin is involved not only in normal cortical lamination of the brain during mammalian embryogenesis but is also implicated in cell signaling systems subserving cognition in adult brain. Here, we show that blood levels of Reelin and its isoforms are altered in three psychiatric disorders, namely, schizophrenia, bipolar disorder and major depression. The changes include significant increases in 410 kDa Reelin moiety of 49% in schizophrenic patients (p < 0.022) of four ethnic compositions (Caucasian, Vietnamese, Hmong and Laotian) and non-significant increases in depressed patients by 34%vs control blood. In contrast, 410 kDa Reelin levels decreased by 33% in bipolar blood, albeit non-signficantly, vs controls. There was a significant increase of 90% (p < 0.0061) in 330 kDa Reelin in Caucasian schizophrenics; the depressed value was elevated by 30%vs control but non-significantly. Again, in contrast, bipolar 330 kDa value decreased by 31%vs control (p < 0.0480). Finally, all 180 kDa Reelin values varied minimally in schizophrenics vs controls. In contrast, the 180 kDa Reelin values dropped significantly by 49% (p < 0.0117) and 29% (p < 0.0424) in bipolar and depressed patients, respectively, compared with controls. The alterations in blood Reelin values appear to be specific since levels of two other blood proteins, ceruloplasmin and albumin did not vary significantly between all psychiatric subjects and controls. These findings suggest that blood Reelin levels and its isoforms may be used as potential peripheral markers to diagnose presence of several psychiatric disorders and may also serve as targets for future therapeutic interventions.

Psychiatry, moral worry, and the moral emotions.

There has been increased philosophical, psychological, and, more recently, psychiatric interest in the moral emotions, most specifically the emotions of guilt, shame, regret, and remorse. Interest in these emotions has not been in their role as symptoms of a particular mental illness, but in their presence in everyday life and in their importance in defining our character and our very humanity. Moral emotions are those emotions that arise in the context of life experiences and daily choices that bear upon our perceptions of the rightness or wrongness of particular actions or inactions. Human beings have a moral scanner that constantly provides both a cognitive judgment and a feeling tone of ease or unease in the moral evaluation of life’s moment-to-moment activities. This paper discusses the intersection of psychiatry and the moral emotions, providing case examples and a review of empirical studies to illustrate the relevance of patients’ concerns about their moral choices to psychiatric evaluation and practice.

Visions and Psychopathology in the Middle Ages

Descriptions of visionary experiences from written medieval sources are examined from a cross-cultural perspective. The mental states of the persons having the visions range from terminal illnesses, states of starvation, stress-related syndromes, dreams and hypnagogic states, and seemingly unremarkable mental states. Although a few of the visions elicited some skepticism on the part of contemporaries, most reports of visions were accepted at face value as bona fide visions, with no discernible differentiation between starvation visions, dreams, deliria of illnesses, and possible mental illness. Only four of the visions appeared causally related, by todays standards, to mental illnesses. These persons were not recognized as mentally ill by their contemporaries. Since there was a recognition of mental illness in the Middle Ages, it would appear that such recognition was based on symptoms other than visions or hallucinations. It is also possible that hallucinations, as culturally supported phenomena, were not as available as forms of expression of psychoses in the Middle Ages as they are today. Such a possibility has interesting implications regarding the role of a culture in shaping the forms by which mental illnesses are expressed, recognized, and labeled.

Medication compliance, antidepressant blood levels, and side effects in Southeast Asian patients.

A study of medication compliance, side effects, and clinical change with the use of antidepressants in 32 Southeast Asian refugee patients seen at an urban mental health center is reported. Patients met criteria for either major depressive episode, posttraumatic stress disorder, or both. Only five of the 32 patients who stated that they were taking their medications regularly had antidepressant blood levels in the therapeutic range. Another 10 patients had subtherapeutic levels and the remaining 17 had undetectable blood levels. Patients with therapeutic blood levels had fewer side effects (p = 0.049) than patients with undetectable blood levels. Blood levels tended (p = 0.070) to be correlated with clinical improvement. The authors discuss cultural attitudes of Southeast Asian refugee patients toward medication use and side effects that appear to influence medication compliance.

Medieval Visions and Contemporary Hallucinations

The hallucinations of 23 patients with predominantly religious themes were compared with descriptions of visions from the Middle Ages. Although there were many points of similarity between the two classes of phenomena, none of the medieval visionaries was identified as mentally ill. The role of cultural norms in determining the attribution of mental illness, and the limitations of Euro-American criteria of psychoses, are discussed in the light of these findings.

Self-destructive behavior on an inpatient ward.

Suicidal and self-destructive behavior on a psychiatric inpatient service are said to be related to the degree of staff demoralization and dissension. Staff factors that may permit or encourage self-destructive acts include poor communications, staff disagreements, scapegoating of patients, poor staff judgment, staff self-preoccupation, and reversal of staff-patient roles. However, it is also possible that a major contributory factor is not individual patient or staff psychopathology, but rather the destruction of the underlying traditions and values of the ward which occurs at times of major change. The thesis is presented that the ritualization of ward values, when operative, provides a coherent world-view which renders the therapeutic activities, and life itself, meaningful, and that such ritualization can provide a framework of stability in times of critical staff turnover. Without such tradition and ritualization, however, therapeutic activities become hollow and meaningless, and fail to provide self-destructive patients a reason to view their life more positively.

The concept of childhood in the middle ages

The question is raised of whether the Middle Ages held a view of the nature of childhood as distinct from adulthood. Evidence is offered from legal documents, medical writings, and church and monastic chronicles to support the viewpoint that the special nature of the child was perceived (although with great ambivalence) as being fragile, vulnerable, and naive, while also possessing a potential for closeness to God and the supernatural world.

Moral conflict, religiosity, and neuroticism in an outpatient sample.

Our sense of identity is inextricably connected to our sense of ourselves as moral beings. However, concerns about the rightness and wrongfulness of our own actions, and a range of emotions connected to moral worry, such as regret and remorse, rarely receive clinical attention. The present study sought to develop and operationalize the construct of moral concern or worry in a psychiatric outpatient sample and to investigate relationships between moral worry and age, gender, religiosity, and the tendency to worry in general. The Eysenck Personality Inventory, Duke Religiosity Scale, and a 20-item Worry Scale (containing eight moral worry items) were administered to 225 psychiatric outpatients. Data analysis included principal components analysis, repeated measures MANOVA to examine extent of worry among factor scales and interactions between age and sex, and multiple regression to identify significant correlates of each factor scale. Worry about moral issues emerged as a domain distinct from worry about practical matters. Although respondents reported more worry about practical matters than about moral concerns, worry about the former declined with age, whereas worry about the latter did not. Intrinsic religiosity was negatively correlated and neuroticism positively correlated with both scales. Because patients are concerned about the moral aspects of their character and behavior, this area deserves further research and consideration.

Moral conflict as a component of ordinary worry.

This article contributes to the psychology of moral behavior by inquiring into the presence and extent of worrying about moral concerns in ones life relative to worrying about practical concerns. A 20-item questionnaire was developed, mixing eight moral worry questions with twelve ordinary worry items (finances, health) identified in previous research on worry. Factor analysis produced three domains of worrisome thinking: moral concerns, social desirability, and personal and family health. A single item inquiting into worry about not living up to Gods expectations did not load onto any other factor and was dropped from further analysis. Internal consistency for the moral worry factor scale was .85. Mean scores for this scale (moral domain) were significantly lower than mean scores for the two practical worry domain factors. Limitations of the study and directions for further research are outlined.

Child Care and Child Abuse in Early Medieval Europe

The concern about widespread abuse of children in modern Western society has led historians and health care professionals to examine the past for evidence of similar abusive practices. The expectation has been that the past, especially the Middle Ages, will reveal even worse attitudes and practices toward children. Our research, based upon an analysis of care given to sick children in early medieval Europe, suggests that considerable attention, effort, and expense were devoted to seeking help for sick and crippled children. At the same time, there is no body of evidence to sustain the notion of widespread child abuse during these Dark Ages of Western civilization.