John F. Neil

Waking and All-Night Sleep EEG's in Anorexia Nervosa

Despite an abundance of literature on EEG findings in other psychiatric syndromes and renewed interest in the biological aspects of eating disorders, there is a surprising scarcity of published information about the EEG in anorexia nervosa. In fact, several major reviews of the EEG in psychiatric populations fail to mention this disorder entirely.(1-3) A small number of reports describe the EEGs of individual cases of the illness, but diagnostic criteria have often been poorly-defined, and the majority of these patients appear to have been suffering from concurrent neurologic illnesses.(4-8) The only systematic study of the EEG in anorexia nervosa was performed by Crisp et al.,(9) in a series of 32 patients. Of these, 59% had abnormal EEG background activity, 31% had unstable responses to hyperventilation, and 12.5% displayed epileptiform paroxysmal dysrhythmias. While a few patients presented evidence of a primary CNS etiology for these abnormalities, the majority were attributed by the investigators to reversible secondary manifestations of self-starvation: electrolyte imbalance, metabolic alkalosis, and relative hypoglycemia. All-night EEG sleep profiles have become increasingly important tools for the assessment and classification of psychiatric disorders. (10) In an earl ier controlled study of EEG sleep in a small number of patients from our laboratory, a significant reduction of both tonic and phasic components of REM sleep was found in primary anorexia nervosa.(11, 12) This type of abnormality has most frequently been observed in neurological disorders(13) and in symptomatic psychiatric syndromes accompanying primary medical illnesses.(14, 15) Unlike the clinical EEG findings of Crisp et al.,(9) this EEG sleep profile persisted even after patients had regained weight during therapy.(11) Moreover, a pedigree study revealed concordance of this sleep marker in three siblings, each of whom was in a different stage of an eating disorder or its remission.(12) The present study was designed to reexamine the clinical EEG findings of Crisp, et al.,(9) using standardized research diagnostic criteria. In addition, we compared waking EEG abnormalities to all-night EEG sleep profiles in this series of anorectics, as an extension of previous work by Foster et al. (11,12,14)

Children of parents with affective illness.

Abstract Symptom ratings of 126 offspring of 59 families were made by both parents, one of whom had previously been diagnosed as having a primary affective disorder of either bipolar or unipolar type. Unipolar offspring were found to have significantly more symptoms on factors measuring conduct problems, anxiety, and impulsivity/hyperactivity. Divorced families had higher symptom scores on the antisocial and muscle-tension factors. Female unipolar offspring were significantly more anxious than male unipolars or bipolars. Results were interpreted as reflecting a greater impact of home environment on the unipolars and a genetically determined later onset for bipolar depressive illness.

When a Schizoaffective Diagnosis Has Meaning

Recently, there has been a flurry of studies showing that schizoaffective patients, diagnosed using acute symptom complexes, usually turn out to have affective disorders if they are rediagnosed applying more reliable longitudinal parameters. However, Occams razor cuts both ways. This investigation shows that if schizoaffective illness is diagnosed using the nonacute parameter “presence of interepisodic thought disorder,” it looks more like schizophrenia. Schizoaffectives diagnosed this way have earlier onset of illness, tend to remain unmarried, usually do not abuse alcohol or sedatives, have a worse response to psychopharmacological treatments, relapse more frequently, and tend to deteriorate.

RBC and plasma choline levels in control and depressed individuals: A critical evaluation ☆

Red blood cell (RBC) and plasma choline (Ch) were measured in 78 depressed, drug-free patients and in 23 normal, drug-free control subjects. RBC Ch levels displayed a huge variability among the patients, in contrast to those measured in normal controls. Plasma Ch levels, on the other hand, were more consistent within each group, and were correlated with age among the two populations studied. RBC Ch levels would appear to be independent of plasma Ch levels, and to be highly individualized and reproducible within each subject. A segment of the depressed population exhibited significantly higher RBC Ch levels than those seen in the normal control population. A clinical correlation of RBC and plasma Ch levels within the depressed population indicated that the patients with RBC Ch levels exceeding 35 nmole/ml might represent a diagnostically distinct subpopulation with specific clinical characteristics. Results presented here, although preliminary, suggest a role for RBC Ch as a biological marker in certain categories of depressive illness.

Adjustment of lithium dose during lithiumchlorothiazide therapy

There has been a long‐held belief that lithium salts cannot be used in the presence of thiazide diuretics. Recently, however, thiazldes have been demonstrated to be not only safe, but actually indicated in two situations in which lithium salts are used. The first is in the treatment of lithium‐induced nephrogenic diabetes insipidus and the second is in severe manic depressive illness in whicli high doses of lithium do not produce therapeutic serum or intraerythrocytic lithium concentrations . This new information now makes it possible for some manic depressive patients with serious medical illnesses (such as hypertension or congestive heart failure), in whom thiazide diuretics are routinely used, to be treated cautiously with lithium carbonate. This paper analyzes data from 13 patients taking lithium carbonate and varying doses of chlorothiazide in order to indicate the approximate magnitude of down ward adjustment of daily lithium dose which the clinician must make to safely give 500, 750, and 1,000 mg/day of chlorothiaride.

PLATELET MAO AND URINARY MHPG IN AFFECTIVE DISORDERS

We have determined the platelet MAO activity and urinary MHPG levels in 99 and 38 drug-free depressed patients, respectively. The unipolar and bipolar groups of patients did not differ with respect to the mean values obtained for either of these biochemical measures. However, the greater variance of platelet MAO activity in the bipolar group suggests that the group may be heterogeneous.

MHPG excretion in depression

3-Methoxy-4-hydroxyphenylethyleneglycol (MHPG) was measured in 24-hour urine collections obtained from 44 drug-free patients hospitalized for a major depressive disorder, MHPG was significantly lower in a group of three biopolar 1 patients than in a group of unipolar patients. The excretion of MHPG did not significantly differ among patients classified as psychoatic, agitated, or retarded subtypes of depression as compared to patients not assigned to these subtypes.

EEG sleep alterations in olivopontocerebellar degeneration

All-night polygraphic recordings of the electroencephalogram, horizontal electrooculogram, and submental electromyogram were performed in two patients with familial olivopontocerebellar degeneration. Sleep was characterized by subnormal measurements of both rapid eye movement (REM) and delta (slow-wave) sleep. Phasic eye movements were reduced out of proportion to tonic components of REM sleep. These findings lend further support to theories linking the pontine nuclei to the primary regulation of sleep in both experimental animals and humans.

EEG sleep and affective psychoses: I. Schizoaffective disorders

The sleep electroencephalogram (EEG) was studied in 41 depressed inpatients. EEG sleep records were compared for two diagnostic subgroups; patients with psychotic depression (n = 29) or with schizoaffective disorders (n = 12). As was true in the previous pilot study, no major EEG sleep variables distinguished the patients with psychotic depression from those with schizoaffective disorders. These data are consistent with the theory that all psychotic depressive states may have certain common psychobiologic features such as shortened rapid eye movement (REM) sleep latency.

The efficiency of ECT: I. Response rate in depressive episodes.

A great deal of variation in opinion and practice remains regarding the most efficient use of electroconvulsive therapy (ECT) in treating depression. In this study we used an estimate of maximal improvement point to look at the rate of response to conventional ECT (one seizure per session, three times per week) in 66 patients with depressive episodes. Of the variables examined, increasing age was found to be significantly associated with slower response rate. Comparison of our results with studies of the multiple seizure technique suggests that giving multiple seizures per session does not speed response rate. We therefore conclude that within the limits of current clinical practice age is probably more important than number of frequency of seizures in determining the rate at which depression responds to ECT.