Petros Petrikis

Treatment of alcohol withdrawal with gabapentin

Gabapentin is an anticonvulsant agent, also effective in the treatment of mood disorders and anxiety disorders. Three cases of alcohol withdrawal treated with gabapentin are presented. All patients received gabapentin 400 mg tid for 3 days, 400 mg bid for 1 day, and finally 400 mg for 1 day. Withdrawal symptoms subsided and no adverse effects were observed. The possible effectiveness of gabapentin in the treatment of alcohol withdrawal warrants further investigation by systematic and well-designed studies.

Community dysfunction in schizophrenia: rate-limiting factors.

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.

Treatment of acute mania with topiramate in hospitalized patients

The purpose of this study was to evaluate the efficacy of topiramate in the treatment of acute manic symptoms. Fourteen patients, admitted with an acute manic episode, were treated with topiramate. All required supplementation therapy with benzodiazepines. Nine patients received topiramate as monotherapy; four of them required zuclopenthixol acutard 100 mg/48 h intramuscularly (im) for not more than 6 days. In three treatment-resistant patients, topiramate was added to the existing therapy. Finally, in two patients topiramate was coadministered with an antipsychotic from the beginning. Patients were assessed every week for 4 weeks with the Bech and Rafaelsen Mania Scale (BRMS). Mean BRMS scores declined from 26.2 to 11.6 in the fourth week (P<.001); a significant decline (P<.001) was observed after the first week. Response rate (> or = 50% reduction of BRMS) was 61.5% (8 out of 13 patients). All patients tolerated topiramate well. Reduced appetite and weight loss was observed in four patients; however, two patients presented weight gain. These preliminary findings provide support for a modest efficacy of topiramate, especially as monotherapy, in the treatment of acute mania.

Familial bipolar disorder and multiple sclerosis: a three-generation HLA family study.

The coexistence of bipolar disorder (BD) and multiple sclerosis (MS) is well known. Manic symptoms may represent initial symptoms of MS, at least in some cases, and follow the MS-HLA phenotype frequencies. The purpose of this study was to examine the possible relation of BD and MS based on an HLA family study of a woman with BD and comorbid MS, with family history of BD. Five members of the family from three generations (the patient, her mother, her brother, and her two daughters) were examined regarding the two disorders and the HLA class I and II specificities, performed by serology and molecular techniques. Her deceased father, her brother, and her older daughter suffered from BD. Moreover, in her brother, BD and MS comorbidity was diagnosed. The three affected members and the nonaffected grandmother share the same class I and II, HLA-A2, B18, CW8, DR2, DQ1 haplotype. The shared class II, HLA-DR2, DQ1 haplotype among affected individuals, which is well known to be associated with MS in Caucasians, suggests a possible susceptibility locus for BD, mapped on chromosome 6, very close to the HLA region, underlying the clinical comorbidity of the two disorders.

Humor appreciation deficit in schizophrenia: the relevance of basic neurocognitive functioning.

The purpose in undertaking the present study was to investigate humor appreciation in patients with schizophrenia. Moreover, we sought to explore the potential relationship of humor appreciation with measures of psychopathology and cognitive functioning among the patients. Thirty-six patients with schizophrenia were compared with 31 normal controls matched for age, sex, and education on a computerized test comprising captionless cartoons: Penn’s Humor Appreciation Test (PHAT). The patients were also evaluated on the symptom dimensions derived from the Positive and Negative Symptom Scale (positive symptoms, negative symptoms, cognitive symptoms, depression, and excitement), as well as a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and psychomotor speed. Patients with schizophrenia had significantly lower scores on the PHAT than normal controls. The patients’ performance on the PHAT correlated with scores on Penn’s Continuous Performance Test, the Stroop Color-Word Test, and the phonological subscale of the Greek Verbal Fluency Test. Our findings indicated impaired humor appreciation among patients with schizophrenia. The relationship found between the appreciation of captionless cartoons involved an incongruous detail and performance on a broad neuropsychological battery suggested that the deficit in humor appreciation in schizophrenia could be attributed to impairment in more basic neurocognitive domains, namely, selective and sustained attention as well as phonological word fluency.

Schizophrenic-Like Symptoms in a Patient with Thrombo-Angiitis Obliterans (Winiwarter-Buerger's Disease)

In this article a case of schizophrenic-like symptoms in a patient with thrombo-angiitis obliterans (TAO) is presented. His CT and MRI findings indicated a diffuse ischemia in the white matter, suggestive of TAO, not of focal lesions. The patient, except for age, did not have other risk factors for other cerebrovascular diseases. Psychotic symptoms may be the result of cerebral TAO, via deep and periventricular white matter lesions.

Effective use of olanzapine for obsessive-compulsive symptoms in a patient with bipolar disorder.

Dear Editor: Attention-deficit hyperactivity disorder (ADHD) is a common disorder affecting schoolchildren and adolescents (1,2). Studies conducted elsewhere (especially in the West) suggest a prevalence rate ranging from 3% to 15% among schoolchildren, although even higher figures have been reported. ADHD affects boys 3 to 10 times more than girls and is characterized by high comorbidity. Delayed diagnosis and inadequate treatment of ADHD can lead to repeated school failure, antisocial behaviour, road traffic accidents, family problems, and delinquencies. Research on ADHD from developing countries is scarce, despite the preponderance of youth in their communities. Conners’ Rating Scale is a screening tool that is widely used in both community and hospital studies to detect hyperactivity, inattention, and behaviours related to ADHD (3,4). It has been translated into Arabic and validated (5,6).

Impact of cognitive dysfunction and symptoms on social outcome of outpatients with schizophrenia

Material and Methods Participants were 40 outpatients with schizophrenia (DSM-IV): 25 men and 15 women, all receiving antipsychotic medication at the time of the study. Their mean age was 36.3 years (SD = 9.6), their mean level of education was 10.9 years (SD = 3.3) and their mean duration of illness was 11.0 years (SD = 8.2). Social adjustment was assessed with the Greek version of Quality of Life Scale (QLS; interpersonal relations, instrumental role functioning, intrapsychic foundation, and common objects and activities subscales). Symptoms of schizophrenia were measured with the Greek version of the Positive and Negative Syndrome Scale (PANNS; positive, negative, and general psychopathology subscales), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS; subjective complains, parkinsonism, dystonia, and tardive dyskinesia). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functions-abstraction, executive functions-inhibition, executive functions-fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Results Scores on the interpersonal relations subscale were significantly (at p < 0.01) related with negative symptoms [r(40) = 0.66], parkinsonism [r(40) = -0.47], and executive functions-fluency [r(35) = 0.60]. The relationship of scores on the instrumental role functioning subscale with other measures did not meet our conservative criterion of significance. Performance on the intrapsychic foundation subscale was significantly correlated with negative symptoms [r(40) = -0.61], and executive functions-fluency [r(35) = 0.51]. Finally, scores on the common objects and activities subscale were significantly related with negative symptoms [r(40) = -0.60], parkinsonism [r(40) = -0.57], executive functions-fluency [r(35) = 0.48], visual memory [r(38) = 0.47], and psychomotor speed/visual scanning [r(38) = 0.47].

Neuropsychological profile of a patient with Fregoli syndrome

Case Report The Fregoli syndrome consists in the delusional conviction that an individual (usually a persecutor, but not always) assumes the guise of persons that the patient meets; it falls into the general category of delusional misidentification syndromes. These syndromes have been repeatedly associated with structural or functional cerebral abnormalities, and an association with impaired facial recognition has been observed in some cases. In the present study we present the neuropsychological profile of a female patient with schizophrenia, paranoid type, who manifested Fregoli syndrome.

The beginnings of clinical neurochemistry: dopamine and Parkinson's disease

Discussion A. Carlsson was the first to suggest a neurotransmitting role for dopamine in 1955; a few years later, his team observed the great dopamine concentrations in the basal ganglia. The clinical implications of this finding were soon realized – it was already known since the beginning of the century that the basal ganglia are involved in Parkinsons disease. The studies of O. Hornykiewicz and T. Sourkes suggested a dopamine deficiency in Parkinsons patients, and in the mid-1960s considerable evidence was gathering in favor of the existence of a nigrostriatal dopaminergic pathway, involved in the regulation of motility. The renewal of the pharmaceutical treatment of the disease followed closely: Hornykiewicz and Birkmayer (1960), and almost concurrently Sourkes and Barbeau (1962), conceived the idea of administering L-DOPA in patients with Parkinsons disease, with spectacular results. The treatment of Parkinsons disease evolved in the following years, with optimisation of administration regimens by Cotzias et al (1967), as well as with the introduction of decarboxylase inhibitors. In the mid1960s the concept of dopamine as a neurotransmitter had reached mainstream status, and the nigrostriatal pathway had become a model for the study of central synapses. from International Society on Brain and Behaviour: 1st International Congress on Brain and Behaviour Hyatt Regency Hotel, Thessaloniki, Greece, 20–23 November, 2003