M. Markianos

Clinical, endocrine and neurochemical effects of moclobemide in depressed patients

The clinical efficacy of the monoamine oxidase A inhibitor moclobemide and its effect on the dexamethasone suppression test (DST) and plasma and urine methoxyhydroxyphenylglycol (MHPG) were investigated in 26 depressed patients during a 4‐week clinical trial. Fourteen patients (54%) responded favourably to the treatment (50% or more reduction of the Hamilton Rating Scale for Depression score). All (8) patients with an abnormal DST responded to treatment; 11 of 16 patients with a normal DST did not respond. Patients with low pretreatment MHPG excretion, according to the median value, were more frequently treatment responders. Plasma and urine MHPG were significantly decreased by treatment. The results indicate that low excretion of MHPG and cortisol nonsuppression may be considered as predictors of favourable clinical response to moclobemide treatment.

Hormonal responses to clonidine and urinary MHPG in delusional and nondelusional melancholic patients: a placebo-controlled study

SummaryThe growth hormone (GH) and cortisol responses to intravenous clonidine (0.15mg) treatment of 25 melancholic patients, 12 with and 13 without delusions, were studied with placebo control. The baseline concentrations of the main noradrenaline metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG) were also estimated in urine. Cortisol plasma levels decreased significantly and equally after both placebo and clonidine. Baseline cortisol levels correlated positively with urinary MHPG. Clonidine did not increase GH levels significantly over time compared with placebo. Delusional melancholic patients tended to have smaller GH responses to clonidine than nondelusionals (F=2.18,P=0.06). There were no differences in GH response to clonidine between high and low MHPG excretors.

Prolactin secretion in response to haloperidol challenge in delusional (psychotic) and non-delusional depression.

Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F = 0.12, P = 0.97). These data do not show a difference in D(2) receptor responsivity, at least at the hypothalamus-pituitary level, between psychotic and non-psychotic depression.

Neurochemical and neuroendocrine correlates of overactive bladder at first demyelinating episode

Bladder dysfunction is frequent during the course of multiple sclerosis (MS), observed in up to 75% of patients. Urinary symptomatology can be a feature of the first episode of MS in a minority of cases, and most often shows characteristics of an overactive bladder (OAB), with voiding symptoms seen less frequently, often in combination with OAB. The neural control of micturition is complex, involving systems located in the brain, spinal cord, and periphery, and implicating central noradrenergic, serotonergic, and dopaminergic activities. Urinary disorders are also linked to anxiety and depression, conditions connected to hypothalamus–pituitary–adrenal axis activity. In this study we aimed to investigate neurochemical and neuroendocrine correlates of bladder dysfunction in early MS.

Intracoronary and systemic release of the atrial natriuretic factor and cyclic-guanosine monophosphate during coronary angioplasty

This study was undertaken to investigate intracoronary production and systemic release of the atrial natriuretic factor (ANF) and cyclic-guanosine monophosphate (c-GMP) during coronary angioplasty (PTCA). three coronary blood samples were collected, through a balloon catheter, from the area distal to the lesion: before balloon inflation, at maximum inflation and 5 min later. Four additional venous samples were collected: before PTCA, and 5 min, 2 h and 24 h after the procedure. Local intracoronary c-GMP production increased from the baseline level of 7.5±0.9 pmol/ml to 11.1±1.3 pmol/ml at maximum balloon inflation (p<0.01) and decreased 5 min later to 9.5 ±1.0 pmol/ml (p=NS). In contrast, intracoronary ANF production failed to show any significant change at any time during the procedure. Peripheral venous ANF levels increased from 79.1±11.1 pmol/ml to 99.9±16.6 pmol/ml 5 min after balloon inflation (p<0.05) and gradually decreased 2 h (91.9±13.6 pmol/ml) and 24 h (85.6±10.4 pmol/ml) after the procedure. Similarly, peripheral venous c-GMP levels increased from 11.3±1.7 pmol/ml before PTCA to 14.9±1.9 pmol/ml 5 min after balloon inflation (p<0.05), and then gradually decreased 2 h (10.8±1.4 pmol/ml) and 24 h (8.2±1.4 pmol/ml) after the procedure (p<0.01 and <0.0001 compared to the peak value, respectively). In conclusion, acute vessel occlusion and distension during balloon inflation stimulates intracoronary c-GMP production without affecting ANF release.

The effect of ECT on plasma cyclic nucleotides: A simulated ECT controlled study in melancholic patients

SummaryConcentrations of cAMP and cGMP in plasma were measured in 20 drug-free melancholic patients during a simulated electroconvulsive treatment (SECT) and a bilateral ECT session. Blood samples were taken every 15min beginning 15min before and ending 60min after the SECT or the ECT. Two-way ANOVA and pairedt-test demonstrated a significant and greater fall in cAMP over time following SECT. ECT induced a marginal increase (P < 0.05) at 45 min postictally. It is postulated that ECT causes an increase in cAMP levels which is masked by the decrease observed during SECT, caused presumably by the anaesthetic medication. The plasma cGMP levels were increased gradually and significantly after SECT and the same rise was observed during ECT. These effects are discussed in relation to changes in adrenergic-cholinergic activities induced by the medication and the electrical stimulus.

Psychoticism in patients with panic disorder with or without comorbid agoraphobia

Abstract Objective: A few case-reports have previously described transient psychotic-like symptoms in non-psychotic patients with panic disorder (PD). We aimed to systematically explore whether PD patients without any current or past psychosis can be differentiated according to the severity of ‘psychoticism’ as a dimension, comprising clinical features such as psychotic-like experiences, increased social alienation, hostility and suspiciousness. Methods: Sample included 35 (female = 26) medication-free, non-psychotic patients consecutively referred from our Department’s Outpatient Clinic for acute symptoms of DSM-5 PD with (PDA; N = 29) or without concurrent agoraphobia. Psychometric measures included the Symptom Checklist–90–Revised (SCL-90-R), Agoraphobic Cognitions Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), and panic attacks during last 21 days PA-21d. Results: Multiple regression analysis (forward stepwise) revealed that, among all SCL-90-R subscales, the psychoticism-subscale was most significantly associated with panic-related beliefs included in the ACQ, while significant associations emerged between the paranoid ideation-subscale and the ACQ and BSQ measures. Moreover, significant correlations emerged between the SCL-90-R psychoticism-subscale and all three measures of PD symptoms (ACQ, BSQ, PA-21d) and between the SCL-90-R paranoid ideation-subscale and both the ACQ and BSQ. Conclusions: This significant association between levels of psychoticism and severity of panic symptoms may reflect a more severe subtype of PD.

Thyrotropin and prolactin responses to TRH in delusional (psychotic) and nondelusional depressed patients

The thyrotropin (TSH) and prolactin (PRL) responses to protirelin (TRH) were studied in 62 female unipolar depressive alients. 24 delusional (psychotic) and 38 nondelusional (Diagnostic and Statistical Manual [DSM]-III-R criteria). The TSH response to ~H was blunted (:5 6 jllU/mL) in ten of the 24 delusional (41.6%) and in 18 of the 38 nondelusional (47.4%) patients, the difference ing not significant. The TSH and PRL responses to TRH. calculated as area under the curve, were not different between the two ~OUp5. Similar results were obtained when the response patterns were compared by repeated measure analysis of covariance.