Stefano de Cataldo

Cerebellar vermal size in schizophrenia: A male effect

Magnetic resonance (MR) was used to examine the cerebellar vermis in 23 patients with schizophrenia and 16 matched controls. MR midsagittal images were processed with computerized image analysis to control partial volume effects as precisely as possible. No between-group differences were found for vermal-to-cerebrum ratio. When gender differences were examined, male patients showed a lower vermal-to-brain ratio than their female counterparts, mainly because of a reduction of the lobules I-V.

Temporal lobe structure by magnetic resonance in bipolar affective disorders and schizophrenia

Sixteen bipolar and 10 schizophrenic patients, all male, underwent magnetic resonance imaging scans. Areas derived from five coronal sections were measured separately and then summed to obtain an estimate of temporal lobe volumes. Schizophrenics showed a reduction of temporal lobe areas in those sections corresponding to the hippocampal region. This finding was more pronounced for the left side, although no diagnosis by side interaction was present. Temporal lobe volume was also reduced in schizophrenics. When a lateralized difference was present, the right temporal lobe was larger than the left in both patient groups.

Cortical and subcortical computed tomographic study in schizophrenia

Thirty-six chronic schizophrenics and 24 controls, all males, were evaluated by computed tomography (CT) scans. The lateral, third and fourth ventricles, the Sylvian fissure and the largest sulcus from each lobe were measured. In the schizophrenic patients there was a significant increase in third ventricle, ventricular brain ratio (VBR) and cortical measures. The possible implications of these findings in the aetiopathology of schizophrenia are discussed.

Schizophreniform Disorder: A 1-Year Follow-Up Study

The study reports the preliminary data from a small 12-patient sample assessed at the time of their first psychotic episode and diagnosed as having a schizophreniform disorder. After a 1-year follow-up period all the patients were newly evaluated on clinical and global functioning variables, using clinical diagnosis as an outcome measure. A diagnostic stability in the schizophrenic spectrum was found.

Plasma brain‐derived neurotrophic factor in earthquake survivors with full and partial post‐traumatic stress disorder

FLUVOXAMINE, WHICH DOES not have anticholinergic activity, is suitable for elderly patients. Selective serotonin re-uptake inhibitors (SSRI), however, are metabolized by and inhibit isozymes of cytochrome P450 (CYP). Therefore, when SSRI are prescribed, drug interactions are a concern. Here we report the case of an elderly patient whose mental state had been controlled by fluvoxamine for several years, and who developed delirium following the additional prescription of celecoxib. Informed consent was obtained from her proxy. The patient was a 94-year-old woman at the time of the present episode. Six years previously she had become amnesic, and her daily life had been supported by her family. She was anxious because of the amnesia. At 4 years before the present episode she was referred to Showa University Fujigaoka Hospital. Her score on the Revised Hasegawa Dementia Scale was 25. We diagnosed her with Alzheimer’s disease. Because her cognitive functions were relatively preserved, we decided to treat her anxiety first. Therefore, we prescribed fluvoxamine (25 mg) to be taken after dinner. Subsequently, her mental state was stable for 4 years. Just before the present episode she developed a swelling in her ankle due to arthritis for which celecoxib was prescribed by another physician, without knowledge of her fluvoxamine medication history. On the first night of taking both medications, she became restless and said ‘I should go to work,’ and tried to leave her home. Her family was upset and stopped both medications. However, because she became irritable and her ankle was swollen, they restarted fluvoxamine, and her physician changed her prescription from celecoxib to loxoprofen. Since then, her mental state and ankle swelling have improved. This episode was narrated to us by her proxy once she started recovering. Therefore, we cannot elucidate the true nature of the symptoms. We suggest, however, that this condition was caused by drug interaction. Because fluvoxamine is metabolized by and celecoxib inhibited the CYP2D6 enzyme, blood concentrations of fluvoxamine seem to be increased by celecoxib. The time at which maximum concentration occurs for fluvoxamine and celecoxib is approximately 5 h and 2 h after oral intake, respectively. The plasma half-life of celecoxib is 5 h. When the patient took this medication around 8 pm, the concentration of fluvoxamine may have reached a peak and the concentration of celecoxib may have reached half of its peak by midnight. Therefore, the blood concentration of fluvoxamine reached toxic levels because of inhibition of CYP2D6 by celecoxib. Moreover, loxoprofen does not inhibit the CYP2D6 enzyme and is not metabolized by the CYP1A2 enzyme. Therefore, loxoprofen and fluvoxamine do not interact. Although we have not found any reports on this issue, SSRI should be carefully prescribed when combined with other medicines, particularly in elderly patients. REFERENCES

Community Mental Health Service Utilization After the L’Aquila Earthquake

This study investigated the use of the facilities for the mental health by the population affected by the L’Aquila (Italy) 2009 earthquake. The data about the activities of the Mental Health Centre of L’Aquila during the years from 2008 to 2010 were obtained by the service Information System. In the months following the event the percentage of referrals was reduced. Failure to use specialized facilities after disasters should not be seen as reassuring. It is conceivable that a relevant rate of frank or sub-threshold psychopathology is present that the traditional mental health facilities may not be able to intercept.

Brain Imaging as a Tool to Investigate Heterogeneity of Schizophrenia: a Magnetic Resonance Study

AbstractThe brain morphology of cerebral measures from magnetic resonance scans of 50 schizophrenic patients and 40 healthy controls was examined using cluster analysis in order to investigate heterogeneity in schizophrenia. This multivariate analysis defined a cluster of schizophrenics only (28% of patient group) with enlarged ventricular sizes, corpus callosum dimensions at the lower limits of the range of controls, and more severe illness. The remaining two clusters produced were composed of mixed subgroups of patients and controls, schizophrenics showing a milder form of illness. The implications of morphological abnormalities and association with negative/positive symptomatology and sporadic/familial dicotomy in these clusters are discussed.