Martin Aigner

Paroxetine decreases platelet serotonin storage and platelet function in human beings

Serotonin is a platelet agonist and potent vasoconstrictor that has recently received attention concerning its potential role in acute coronary artery thrombosis. Selective serotonin‐reuptake inhibitors, such as paroxetine, are widely used antidepressant agents. We sought to characterize the potential inhibitory effect of paroxetine on platelet function.

Memory Deficits in Patients with DSM-IV Obsessive-Compulsive Disorder

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers’ rituals. Another account of doubting implicates metacognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to metacognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

Carbocyanine Postmortem Neuronal Tracing: Influence of Different Parameters on Tracing Distance and Combination with Immunocytochemistry

SUMMARY Carbocyanines (DiI, DiA, DiO) are able to travel along membranes by diffusion and therefore have been used as postmortem neuronal tracers in aldehyde-fixed tissues. Surprisingly, detailed data on the influence of different parameters on tracing distances are still missing. This study was carried out to optimize tracing procedures and to reveal the validity of the combination of postmortem tracing with immunocytochemistry. Carbocyanine crystals were applied to the cervical spinal cord, sciatic nerves, and brachial plexuses of humans and guinea pigs. Incubation in the dark at 37C for 12-15 weeks proved optimal to achieve longest tracing distances (28.9 ± 2.2 mm) in human and animal tissues. Longer incubation times and incubation temperatures higher than 37C did not result in longer tracing distances. No differences were evident between adult and newborn animals and between central and peripheral nervous system. The diffusion coefficient for DiI was calculated to be 2.5 × 10-7 cm2sec-1. After application of DiI to nerves of guinea pig extraocular muscles, DiI-positive afferent perikarya were observed in the anteromedial part of the trigeminal ganglion. These perikarya were identified by calcitonin gene-related peptide immunoreactivity (CGRP-IR). The percentage of CGRP-IR neurons after tracing was concordant with the percentage of CGRP-IR in trigeminal ganglia exclusively processed for CGRP-IR without previous postmortem tracing. These results demonstrate carbocyanines to be specific tracers for exact neuronal mapping studies.

Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients.

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25 % Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as ‘good prognosis course’. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Clinical utility of DSM-IV pain disorder.

The utility of DSM-IV criteria for pain disorder was investigated within a consecutive sample of 90 chronic pain patients aged between 18 and 65 years. In this sample, 65.6% (n = 59) fulfilled diagnostic criteria for DSM-IV pain disorder. Of the patients with DSM-IV pain disorder, 22% fulfilled additional criteria for depressive disorder, 6.8% for hypochondriasis, and 23.7% for any other DSM-IV diagnosis. Only 54.2% of the patients with DSM-IV pain disorder had no comorbid psychiatric disorder. When assessing somatoform symptoms without hierarchical guidelines, there is a great overlap between the symptomatology of pain disorder and other somatoform disorders. Of 59 patients with DSM-IV pain disorder, 93.2% also met criteria for DSM-IV undifferentiated somatoform disorder and 10.2% for DSM-IV somatization disorder. The mean number of somatoform symptoms was 17 in the total sample. Despite the presence or absence of a general medical condition, there was no significant difference between pain disorder associated with both psychological factors and a general medical condition (code 307.89) and pain disorder associated with psychological factors (code 307.80) with regard to the pain duration, intensity, and type and the level of disability and educational level. The formulation of a distinct psychiatric entity for pain conditions may improve the consideration of psychosocial factors in the pathogenesis and clinical cause of pain. However, with regard to our data, the distinctive validity of different subtypes of pain disorder as provided by DSM-IV awaits further clarification.

Brain Abnormalities and Violent Behavior

Abstract Introduction: It is difficult to rationally discuss the question of whether violent behaviour is a disorder because violent actions engender very strong emotional reactions in the public. But there are good reasons to believe that a variety of social and biological factors predispose the individual toward criminal behaviour. This study concerns the question, whether there is an association between violent behaviour and brain abnormalities. Method: Ninety-six mentally ill offenders of a high security prison consecutively underwent magnetic resonance imaging of the brain (MRI). The number of sex offenders was 62.5%. Fourteen offenders were excluded because they had a neurological disease, a psychotic disorder, a severe organic mental disorder or they were older than 60 years. All scan reports were in narrative format, and they were reviewed and coded according to presence or absence of brain abnormality. Neuroradiologists were blind to clinical diagnoses and offence history. Offenders were distributed either to a “high violent group” or to a “no or low violent group.” There was no significant difference in age between both groups. Results: In the included sample (n = 82; 50 sex offenders) 48.8% had MRI abnormalities. In the high violent group 65.5% showed MRI abnormalities. In the low violent group 16.6% had MRI abnormalities. This difference is significant (p = 0.001). The high violent sex offender group showed a MRI abnormality rate of 59.4%, and the low violent sex offender group 22.2%. The difference is significant (p = 0.011). There is no significant difference in MRI abnormality rate between the sex offender and the “non sex offender.” Conclusions: The results indicate that there is an association between unspecified brain anomalies and high violent behaviour in the whole sample as well as in the sex offender group. There is no association between sexual offence and unspecified brain abnormalities. Modern brain imaging techniques such as magnetic resonance imaging should be included in the diagnostic procedure of mentally ill offenders.

Sleep Disturbances in Somatoform Pain Disorder

Patients with chronic somatoform pain often complain about sleep disorders. However, sleep disorder/disturbances are not an integrated part of the somatoform disorders in the DSM-IV and the ICD-10. Sleep is important for recreation. Deprivation of deep sleep stages is experimentally linked to muscle pain. Therefore, sleep disorder may play an important part in the persistence of somatoform pain disorder. The aim of the study was to evaluate the frequency of sleep disorder in patients with somatoform pain disorder and to correlate it with comorbid depression, pain parameters and psychosocial parameters. Method: In this study, 147 patients (mean age: 48.8 years; SD: 11.0) with the diagnosis of a somatoform pain disorder were studied with regard to affective comorbidity, pain duration (months), maximum pain within the last month, minimum pain within the last month and medium pain within the last month, psychosocial disability within the last month and the presence of a sleep disorder. Results: Eighty-four percent of the patients had a sleep disorder. The patients with a sleep disorder had significantly higher maximum and medium pain, a significantly higher level of psychosocial disability and a significantly lower overall subjective well-being. The medium pain and psychosocial disability in leisure and social activities are significant predictors for sleep disorder. Conclusions: The presence of a sleep disorder may be a hint for higher pain intensity and a higher level of psychosocial disability. Sleep disorder may be a factor in the persistence and aggravation of pain as well as psychosocial disability. Therefore, sleep disorder should be integrated in the therapeutic targets. It is suggested that sleep disorder should be a diagnostic criterion in somatoform pain disorder.

Clinical Validity of ICD-10 Neurasthenia

Background: Neurasthenia was defined over a century ago. In view of a questionable clinical validity, it was omitted from the 3rd edition of the American Psychiatric Association’s DSM, while it remains as an own diagnostic category in the WHO’s ICD-10. The purpose of this study was, therefore, to examine the clinical validity of ICD-10 neurasthenia in a consecutive sample of chronic pain patients. Patients and Methods: We included 193 patients (mean age 45.1, SD ± 10.2, 63% females) in the study. Psychiatric diagnoses were established by the use of ICD-10 Diagnostic Criteria for Research. In addition, the Screening List for Somatization Symptoms was administered: self-rating of 53 medically unexplained somatic symptoms, and 11 additional screening questions concerning weakness after slight mental or physical exertion and disease conviction. Results: Thirty-three percent of the patients who fulfilled the criteria of ICD-10 neurasthenia also fulfilled the criteria of ICD-10 somatization disorder, 69% the criteria of ICD-10 undifferentiated somatoform disorder, 14% the criteria of ICD-10 hypochondriacal disorder, 66% the criteria of ICD-10 somatoform autonomic dysfunction, 85% the criteria of ICD-10 persistent somatoform pain disorder and 14% the criteria for sexual dysfunction not caused by organic disorder or disease. The symptom profile of ICD-10 neurasthenia was not clearly distinguishable from the symptom profiles of ICD-10 somatoform disorders and ICD-10 sexual dysfunction. Discussion: Due to this substantial diagnostic overlap, the clinical validity of ICD-10 neurasthenia remains questionable.

Observations on the number, distribution and morphological peculiarities of muscle spindles in the tensor tympani and stapedius muscle of man

Although the middle ear muscles have been described for the first time more than four hundred years ago their role in modulation and transmission of sound is not yet fully understood. Surprisingly very little is known about proprioceptors in these muscles, especially in man, although this seems to be the key to the understanding of their various functions. Therefore, the question for proprioceptive sensory organs in these muscles is still relevant. The tensor tympani and stapedius muscles of four women who had donated their bodies to our institute were taken. Complete serial sections of these muscles were made which were either impregnated with silver, stained with ferric oxide for acidic polysaccharides or incubated with antibodies against S-100 protein. Thereby four to eight (mean five) muscle spindles distributed along the whole muscle could be detected in the tensor tympani muscles. These spindles contain one to three intrafusal muscle fibres and their length ranges from 140 to 4270 microm (mean 1492.8 microm). Furthermore, in three stapedius muscles one to two (mean 1.7) muscle spindles were found. They were from 350 to 500 microm (mean 482 microm) long and contained only one intrafusal muscle fiber. Regarding the diameter of intrafusal muscle fibers in both, the tensor tympani as well as the stapedius muscle, no difference to extrafusal muscle fibers of these muscles could be detected. The structure of these spindles differs considerably from those found in skeletal muscles. The morphological findings presented strongly suggest that muscle spindles occur regularly in both middle ear muscles. The results presented herein are consistent with clinical findings obtained from electromyographic studies and may help to elucidate all functions the middle ear muscles might serve in man.

Sensory innervation of the guinea pig extraocular muscles: A 1,1′-dioctadecyl-3,3,3′3′-tetramethylindocarbocyanine perchlorate tracing and calcitonin gene-related peptide immunohistochemical study

The sensory apparatus of the extraocular muscles attains special interest because of the great variation among different species with respect to the proprioceptors. The sensory innervation of the guinea pig extraocular muscles, lacking both muscle spindles and tendon organs, was investigated with a fluorescence double‐labelling method. Primary sensory perikarya were assessed by postmortem application of 1,1′‐dioctadecyl‐3,3,3′3′‐tetramethylindocarbocyanine perchlorate (Di‐I) to the extraocular muscle nerves. Traced neurons were found in the ipsilateral ophthalmic part of the trigeminal ganglion. This is in line with findings in other species. Calcitonin gene‐related peptide (CGRP) was detected immunohistochemically within the trigeminal ganglion. No somatotopic organization was observed for CGRP‐like immunoreactive perikarya. Small (maximal diameter below 30 μm), medium (maximal diameter between 30 and 50 μm), and large (maximal diameter larger than 50 μm) trigeminal ganglion cells were found among the primary afferent perikarya from extraocular muscles. Among CGRP‐like immunoreactive cells, only small and medium cells were observed. Double‐labelling experiments indicated the CGRP content of primary afferents of the guinea pig extraocular muscles. The relationship to former morphological categories of ganglion cells is discussed. Primary afferent neurons with CGRP‐like immunoreactivity might have efferent functions and might also be involved in inflammatory processes of extraocular muscles. J. Comp. Neuol. 380:16–22, 1997.