Ranan Rimón

Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior

Relationships of impulsive and nonimpulsive violent behavior to cerebrospinal fluid (CSF) monoamines and their metabolic concentrations were studied in thirty-six violent offenders. A relatively low 5-hydroxyindoleacetic acid (5HIAA) concentration was found in the CSF of impulsive violent offenders. This was not true for the offenders who had premeditated their acts. Other CSF monoamine or metabolite concentrations were not significantly different between the two groups. Of the groups studied, impulsive violent offenders who had attempted suicide had the lowest 5HIAA levels. A low CSF 5HIAA concentration may be a marker of impulsivity rather than violence.

The content of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid of patients with acute schizophrenia☆

Abstract The level of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid were determied in a group of acute untreated schizophrenic patients and an age-matched group of other acute phychiatric patients as controls. No significant differences could be shown between the patients and the controls. When all paranoid patients are compared to all non-paranoid patients of the series, those patients with dominant paranoid thought content and/or paranoid hallucinations had a significantly higher level of HVA ( p

RIMON'S BRIEF DEPRESSION SCALE, A RAPID METHOD FOR SCREENING DEPRESSION

A brief scale for evaluating depression, called Rimons Brief Depression Scale, was developed using responses of 103 patients with primary or secondary depression. The validity of the scale was evaluated by comparing scores with those on Becks Depression Scale. The results showed high reliability and concurrent validity and encourage the adoption of Rimons scale in general psychological and medical practice.

Human impulsive aggression: a sleep research perspective.

Impulsive aggression is commonly associated with personality disorders, in particular antisocial and borderline personality disorders as well as with conduct disorder and intermittent explosive disorder. The relationship between impulsive aggression and testosterone is well established in many studies. One of the aims of this study was to characterize the relationship between earlier-mentioned different categorical psychiatric diagnosis describing human impulsive aggression and sleep using polysomnography and spectral power analysis. Another aim was to study the relationship between serum testosterone and sleep in persons with severe aggressive behaviour. Subjects for the study were 16 males charged with highly violent offences and ordered for a pretrial forensic psychiatric examination. The antisocials with borderline personality disorder comorbidity had significantly more awakenings and lower sleep efficiency compared with the subjects with only antisocial personality disorder. The subjects with severe conduct disorder in childhood anamnesis had higher amount of S4 sleep and higher relative theta and delta power in this sleep stage compared with males with only mild or moderate conduct disorder. The same kind of sleep architecture was associated with intermittent explosive disorder. In subgroups with higher serum testosterone levels also the amount of S4 sleep and the relative theta and delta power in this sleep stage were increased. The study gives further support to the growing evidence of brain dysfunction predisposing to severe aggressive behaviour and strengthens the view that there are different subpopulations of individuals with antisocial personality varying in impulsiveness. The differences in impulsiveness are reflected in sleep architecture as well.

EEG and CT findings in patients with panic disorder

Fifty-four patients with panic disorder were investigated using extensive electroencephalographic (EEG) recordings and computerized tomography (CT). Fifteen (28%) of these patients had previously been treated for temporal lobe epilepsy or were considered to have another neurological disorder. EEG recordings showed increased slow-wave activity in 13 (24%) patients and CT scan revealed incidental abnormalities in 6 (20%) of the 30 patients investigated. Taking into account the limitations of the methods applied, the present results indicate that clear-cut epileptic EEG patterns only rarely occur in panic disorder: the vast majority of panic patients exhibit normal EEG and CT findings.

Asperger Syndrome, Alexithymia and Perception of Sleep

Two research traditions, the one on Asperger syndrome (AS) and the other on alexithymia, have produced similar findings independently of each other indicating a possible association between these two phenomena. Both conditions are also associated with impaired initiation and continuity of sleep. Twenty AS adults were compared with 10 healthy controls using the Toronto Alexithymia Scale and the Basic Nordic Sleep Questionnaire. AS subjects were significantly more alexithymic and reported lower sleep quality as compared with controls. AS and alexithymia are associated although the mediating factors are unknown. It is possible that alexithymic traits predispose to anxiety, which in turn lowers the sleep quality in AS adults. Alternatively, low sleep quality might be due to AS itself.

Production of interferon-α and -γ by leukocytes from patients with schizophrenia

Abstract Production of interferon (IFN)-α and -γ by leukocytes from 34 patients with acute schizophrenia and 34 controls was measured before and after 5–6 weeks of antipsychotic treatment by using Sendai virus as IFN-α inducer and lentil lectin as inducer for IFN-γ production. The schizophrenia series included 13 first admission patients (mean duration of illness 1.1 years) and 21 re-entry patients (mean duration of illness 10.1 years). Of the total series 23 were drug-free at the time of pretreatment sampling. In all subgroups the schizophrenic patients produced less IFNs than healthy controls although the differences reached statistical significance only in the total group of schizophrenic patients with regard to production of IFN-α. The antipsychotic drug treatment did not have an effect on IFN production. The techniques used, the influence of genetic factors, and eventual clinical implications are discussed.

Altered White Cell Count, Protein Concentration and Oligoclonal IgG Bands in the Cerebrospinal Fluid of Many Patients with Acute Psychiatric Disorders

In a prospective study, an abnormal white cell count and/or elevated protein concentration in the cerebrospinal fluid (CSF) was observed in 14/54 patients (26%) with acute psychiatric disorders, but in none of the 46 control subjects (p less than 0.001). In addition, electrophoretic analysis of immunoglobulin G (IgG) showed an oligoclonal pattern in the CSF of 22 psychiatric patients (41%). No such pattern could be detected in the control group (p less than 0.001). These findings reinforce the value of lumbar puncture and CSF analysis in acute psychiatric disorders.

Dynorphin A and substance P in the cerebrospinal fluid of schizophrenic patients

Radioimmunoassay procedures were used to assay levels of dynorphin A (DYN A) and substance P-like activity (SP) in cerebrospinal fluid (CSF) obtained from 10 schizophrenic patients before and after neuroleptic treatment, from 10 matched patients with other psychiatric disorders before and after treatment, and from 10 nonpsychiatric surgical controls. The highest mean concentration of CSF DYN A was found in the schizophrenic group on admission (significant vs. nonpsychiatric controls). The concentration remained almost unaltered after 4 weeks of zuclopenthixol treatment despite a highly significant decrease of overt psychopathology assessed by the Brief Psychiatric Rating Scale (BPRS). There was no significant difference between the mean CSF DYN A levels of the nonschizophrenic psychiatric patients and the surgical controls. When all psychiatric patients were pooled together, there was a significant correlation between the level of CSF DYN A and the BPRS total score. With regard to CSF SP levels, no statistically significant differences were observed within or between the groups studied. Neither was there a significant correlation between the concentration of CSF SP and overt psychopathology. Nevertheless, the mean CSF SP concentration of three patients with major depression was clearly higher than the corresponding mean concentration of the other patients in the nonschizophrenic group.

Long-term efficacy and safety of milnacipran compared to clomipramine in patients with major depression

Milnacipran is a new antidepressive drug, a combined noradrenaline/serotonin (NA/5‐HT) reuptake inhibitor, which has been suggested to be as effective as and better tolerated than tricyclic antidepressants. Since long‐term studies are lacking, we compared the efficacy, safety and tolerability of milnacipran and clomipramine in a double‐blind, randomized, parallel‐group study setting during 26 weeks of treatment in patients with major depression. A total of 107 patients were treated with either milnacipran (n=52) or clomipramine (n=55). Due to active treatment of duration less than 12 days in four patients and protocol deviation in one patient, in total 47 milnacipran‐treated patients were eligible for efficacy analysis. Nine patients in the clomipramine group continued on active treatment for less than 12 days. Thus 46 clomipramine‐treated patients were finally included in the efficacy analysis. After 1 week of dose escalation, there was a fixed dosage regimen of either milnacipran (200 mg daily) or clomipramine (150 mg daily) during weeks 2 to 10, followed by flexible dosing of milnacipran (100,150 or 200 mg daily) or clomipramine (75, 100 or 150 mg daily) during weeks 11 to 26. A total of 53 patients (49%) completed the 26‐week study period; 21% (11/52) of the patients in the milnacipran group and 38% (21/55) of the patients in the clomipramine group discontinued their medication prematurely due to adverse events, whereas 19% (10/52) of those on milnacipran and 7% (4/55) of those on clomipramine treatment withdrew due to either lack of efficacy or clinical deterioration. The mean change (±SD) in the Hamilton Depression Rating Scale (HAMD) score between the baseline and the last rating ranged from 23.7±3.1 to 12.0±9.5 in the milnacipran‐treated patients and from 23.1±3.5 to 8.0±8.5 in the clomipramine‐treated patients, revealing a significant difference in favour of clomipramine. In total 58% of the milnacipran‐treated patients vs. 72% of the clomipramine‐treated patients showed a ≥50% reduction in their baseline HAMD scores and 45% vs. 63% had an HAMD score of ≤7 at the last rating, respectively. Moreover, the time to the onset of the antidepressant action (defined as ≥50% reduction of the baseline HAMD score) showed a significant difference in favour of clomipramine. In addition, clomipramine was significantly more efficacious in patients with a baseline HAMD score of ≥24 as evidenced by the analysis of the HAMD score at week 6 and at the last rating. The Montgomery Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) scale did not show significant differences between the treatment groups. The safety analysis did not reveal any differences of clinical significance in cardiovascular variables between the study drugs. Dry mouth was significantly less frequently reported by the milnacipran‐treated patients during the early and later phases (weeks 6 to 26) of the study, while insomnia was more common in the milnacipran group during weeks 1 to 6. In conclusion, milnacipran appeared to be less effective than clomipramine in the long‐term treatment of depression. The side‐effects of the drugs differed to a certain extent, and milnacipran tended to be somewhat better tolerated than clomipramine.