Tero Taiminen

Striatal dopamine D1 and D2 receptors in burning mouth syndrome

&NA; Animal studies have indicated that the nigrostriatal dopaminergic system is involved in central pain modulation. In a recent positron emission tomography (PET) study, we demonstrated presynaptic dysfunction of the nigrostriatal dopaminergic pathway in burning mouth syndrome, which is a chronic pain state. The objective of the present study was to examine striatal dopamine D1 and D2 receptors in these patients. We used 11C‐NNC 756 and 11C‐raclopride to study D1 and D2 receptor binding in a PET study in ten burning mouth patients and 11 healthy controls. Patients underwent a structured psychiatric evaluation and an electrophysiological test for the excitability of the blink reflex. The striatal uptake of 11C‐NNC 756 did not differ between patients and controls. In a voxel‐level analysis, the uptake of 11C‐raclopride was statistically significantly higher in the left putamen in burning mouth patients (corrected P‐value 0.038 at cluster‐level). In the region of interest analysis, the D1/D2 ratio was 7.7% lower in the right putamen (0.64±0.04 vs. 0.69±0.04, P=0.01) and 6.4 % lower in the left putamen (0.65±0.05 vs. 0.70±0.05, P=0.05) when compared to controls. Increased 11C‐raclopride uptake and the subsequent decrease in the D1/D2 ratio may indicate a decline in endogenous dopamine levels in the putamen in burning mouth patients.

Altered dopamine D2 receptor binding in atypical facial pain.

&NA; Animal studies suggest that the dopaminergic system plays a role in central pain modulation. We have previously demonstrated with positron emission tomography (PET) that striatal dopaminergic hypofunction may be involved in the burning mouth syndrome. The aim of the present study was to evaluate the nigrostriatal dopaminergic system in patients with atypical facial pain using PET. In seven patients with atypical facial pain, striatal presynaptic dopaminergic function was assessed with [18F]FDOPA and dopamine D1 and D2 receptor availabilities with [11C]NNC 756 and [11C]raclopride, respectively. The results were compared with those of healthy controls. A quantitative region‐of‐interest analysis showed that the uptakes of [18F]FDOPA and [11C]NNC 756 did not differ between patients and controls. There was a tendency of increased D2 receptor availability in the left putamen (P=0.056), and the D1/D2 ratio in the putamen was decreased bilaterally by 7.7% (P=0.002) in patients when compared to controls. In a voxel‐based analysis, the uptake of [11C]raclopride was increased in the left putamen (P=0.025). In conclusion, the increase in D2 receptor availability in the left putamen and the decrease in D1/D2 ratio imply that alterations in the striatal dopaminergic system as evaluated by PET may be involved in chronic orofacial pain conditions.

Contagion of Deliberate Self-Harm Among Adolescent Inpatients

OBJECTIVE To explore the quantitative importance and clinical features of deliberate self-harm (DSH) contagion in a closed adolescent psychiatric unit. METHOD The authors investigated with statistical methods and a sociogram whether acts of DSH were clustered during a 12-month study period. Twelve subjects were involved in acts of DSH, and their mean length of hospitalization during the study period was about 90 days. Six adolescents with four or more contagion incidents were interviewed. RESULTS DSH incidents were clustered during the study period (p < .05). Most DSH incidents were skin cutting committed by depressed female subjects with borderline personality disorder. The majority of DSH contagion can be understood in terms of small-group rites for feelings of togetherness. CONCLUSIONS Even a majority of DSH events in closed adolescent units may be triggered by contagion, and DSH can spread to previously DSH-naive adolescents.

Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients.

The aims of this study were: a) to assess the prevalence of posttraumatic stress disorder (PTSD) after an acute psychotic episode in schizophrenic and delusional patients, b) to explore which psychotic symptoms and aspects of treatment were associated with traumatization, and c) to compare the extent of the traumatic impact of psychosis and involuntary hospitalization. Forty-six schizophrenic and delusional patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Impact of Event Scale-Revised (IES-R), and the Clinician-Administered PTSD Scale (CAPS) at weeks 1 and 8 after acute psychiatric admission. Traumatic symptoms related to psychosis and coercive measures were scored separately. The prevalence of PTSD was found to be 11%. Sixty-nine percent of traumatic symptoms were related to psychosis and 24% to hospitalization. High PANSS score at week 8 was the strongest risk factor for the development of PTSD. Particularly positive and depressive/anxious symptomatology were associated with psychosis-related traumatic symptoms at both weeks 1 and 8. These data suggest that, in general, schizophrenic and delusional symptoms are more traumatic than the coercive measures used to control them.

Alexithymia after traumatic brain injury: its relation to magnetic resonance imaging findings and psychiatric disorders.

Objective: People with traumatic brain injury (TBI) were studied to assess the prevalence of alexithymia and its relationship to magnetic resonance imaging (MRI) findings and psychiatric disorders. Methods: Fifty-four participants, 67% men, were evaluated after a median of 30 years since TBI. A control group was matched for age, gender, and severity of depression. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). In patients with TBI, axis I psychiatric disorders were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1), and axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). MRI examinations were carried out with a 1.5 T MRI scanner. Results: Alexithymia was significantly more common in patients with TBI than in controls (31.5% versus 14.8%; odds ratio 2.64, 95% confidence interval 1.03–6.80). None of the variables representing TBI, ie, severity of TBI or the presence, laterality, or location of contusions on MRI, was associated with the TAS-20 total scores. Several current axis I and II psychiatric disorders, particularly organic personality syndrome, were connected to higher TAS-20 scores. Conclusion: Alexithymia is common, along with psychiatric disorders, in patients with TBI. Both of them may reflect dysfunction of the injured brain. In clinical practice, alexithymic features should be taken into consideration in psychosocial rehabilitation after TBI. MRI = magnetic resonance imaging; TBI = traumatic brain injury; TAS-20 = 20-item Toronto Alexithymia Scale; OR = odds ratio; 95% CI = 95% confidence interval; BDI-13 = 13-item Beck Depression Inventory; DAI = diffuse axonal injury.

Axis I and II psychiatric disorders in patients with traumatic brain injury: A 12-month follow-up study

Objective: To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI). Design: Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed. Measures: Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Results: Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%) and the rate of alcohol dependence was especially elevated (18.4%). During the 12 months after TBI, axis I disorders were found in 47.4% of subjects. Six patients (15.8%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%). Almost one third of the subjects (29.0%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%). Conclusions: Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI.

Psychiatric (axis I) and personality (axis II) disorders in patients with burning mouth syndrome or atypical facial pain

Abstract Background and aims Burning mouth syndrome (BMS) and atypical facial pain (AFP) are often persistent idiopathic pain conditions that mainly affect middle-aged and elderly women. They have both been associated with various psychiatric disorders. This study examined current and lifetime prevalence of psychiatric axis I (symptom-based) and II (personality) disorders in patients with chronic idiopathic orofacial pain, and investigated the temporal relationship of psychiatric disorders and the onset of orofacial pain. Method Forty patients with BMS and 23 patients with AFP were recruited from Turku university hospital clinics. Mean age of the patients was 62.3 years (range 35–84) and 90% were female. BMS and AFP diagnoses were based on thorough clinical evaluation, and all patients had undergone clinical neurophysiological investigations including blink reflex and thermal quantitative tests. Current and lifetime DSM-IV diagnoses of axis I and II disorders were made on clinical basis with the aid of SCID-I and II-interviews. The detected prevalence rates and their 95% confidence intervals based on binomial distribution were compared to three previous large population-based studies. Results Of the 63 patients, 26 (41.3%) had had an axis I disorder that preceded the onset of orofacial pain, and 33 (52.4%) had had a lifetime axis I disorder. Rate of current axis I disorders was 36.5%, indicating that only about 16% of lifetime disorders had remitted, and they tended to run chronic course. The most common lifetime axis I disorders were major depression (30.2%), social phobia (15.9%), specific phobia (11.1%), and panic disorder (7.9%). Twelve patients (19.0%) had at least one cluster C personality disorder already before the emergence of orofacial pain. Patients with cluster C personality disorders are characterized as fearful and neurotic. None of the patients had cluster A (characterized as odd and eccentric) or B (characterized as dramatic, emotional or erratic) personality disorders. The most common personality disorders were obsessive–compulsive personality (14.3%), dependent personality (4.8%), and avoidant personality (3.2%). The majority of the patients (54%) had also one or more chronic pain conditions other than orofacial pain. In almost all patients (94%) they were already present at the onset of orofacial pain. Conclusions Our results suggest that major depression, persistent social phobia, and neurotic, fearful, and obsessive–compulsive personality characteristics are common in patients with chronic idiopathic orofacial pain. Most psychiatric disorders precede the onset of orofacial pain and they tend to run a chronic course. Implications We propose that the high psychiatric morbidity, and comorbidity to other chronic pain conditions, in chronic idiopathic orofacial pain can be best understood in terms of shared vulnerability to both chronic pain and specific psychiatric disorders, most likely mediated by dysfunctional brain dopamine activity.

Variation in the dopamine D2 receptor gene plays a key role in human pain and its modulation by transcranial magnetic stimulation

&NA; The 957C>T polymorphism of the dopamine D2 receptor gene acts as an independent determinant of thermal pain sensitivity and susceptibility to neuropathic pain. &NA; We tested whether variation of the dopamine D2 receptor (DRD2) gene contributes to individual differences in thermal pain sensitivity and analgesic efficacy of repetitive transcranial magnetic stimulation (rTMS) in healthy subjects (n = 29) or susceptibility to neuropathic pain in patients with neurophysiologically confirmed diagnosis (n = 16). Thermal sensitivity of healthy subjects was assessed before and after navigated rTMS provided to the S1/M1 cortex. All subjects were genotyped for the DRD2 gene 957C>T and catechol‐O‐methyltransferase (COMT) protein Val158Met polymorphisms. In healthy subjects, 957C>T influenced both innocuous and noxious thermal detection thresholds that were lowest in 957TT homozygotes (P values from .0277 to .0462). rTMS to S1 cortex had analgesic effect only in 957TT homozygote genotype (P = .0086). In patients, prevalence of 957TT homozygote genotype was higher than in a healthy Finnish population (50% vs 27%; P = .0191). Patients with 957TT genotype reported more severe pain than patients with other genotypes (P = .0351). COMT Val158Met polymorphism was not independently associated with the studied variables. Genetic regulation of DRD2 function by 957C>T polymorphism thus seems to influence thermal and pain sensitivity, its modulation by rTMS, and susceptibility to neuropathic pain. This indicates a central role for the dopamine system and DRD2 in pain and analgesia. This may have clinical implications regarding individualized selection of patients for rTMS treatment and assessment of risks for neuropathic pain.

MRI findings and Axis I and II psychiatric disorders after traumatic brain injury: a 30-year retrospective follow-up study.

We studied the association between psychiatric disorders and the presence and location of traumatic lesions on magnetic resonance imaging (MRI) in 58 patients, on average, 30 years after traumatic brain injury. Axis I psychiatric disorders that had begun after the injury were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (version 2.1), and Axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders. A 1.5-Tesla MRI scanner was used. One-third of the subjects had traumatic lesions visible on MRI. Only three psychiatric disorders, that is, delusional disorder, dementia, and the disinhibited type of organic personality syndrome, were significantly more common in subjects with contusions. Concerning the location of contusions, organic personality syndrome and its disinhibited subtype were associated with frontal lesions, and major depression was, surprisingly, inversely associated with temporal lesions. These results, which should be interpreted with caution due to the limited size of the study group, suggest that the majority of psychiatric disorders after traumatic brain injury are not closely related to the specific location or even the presence of contusions detectable with post-acute MRI.

Impaired Wisconsin Card Sorting Test performance in first-episode severe depression

An important issue in the practice of clinical neuropsychology is to define the degree to which impaired executive functions associated with severe depression are a result of organic dysfunction or of only current depressive experience, reflecting clinical state. Twenty-eight patients with psychotic depression, 29 with nonpsychotic depression and 30 healthy controls, matched for age and education were tested on WCST, WAIS-R, and the Rorschach according to the Comprehensive System, providing indices of depression (DEPI) and coping deficit (CDI). Patients were impaired in WCST performance. The stepwise regression for WCST scores yielded two significant predictor variables: the DEPI and Digit Symbol as a measure of complex attention and response speed. Within the groups, Picture Completion in patients with nonpsychotic depression and the CDI in patients with psychotic depression emerged as the significant predictors of WCST scores. Patients with severe major depressive disorder have profound executive impair...An important issue in the practice of clinical neuropsychology is to define the degree to which impaired executive functions associated with severe depression are a result of organic dysfunction or of only current depressive experience, reflecting clinical state. Twenty-eight patients with psychotic depression, 29 with nonpsychotic depression and 30 healthy controls, matched for age and education were tested on WCST, WAIS-R, and the Rorschach according to the Comprehensive System, providing indices of depression (DEPI) and coping deficit (CDI). Patients were impaired in WCST performance. The stepwise regression for WCST scores yielded two significant predictor variables: the DEPI and Digit Symbol as a measure of complex attention and response speed. Within the groups, Picture Completion in patients with nonpsychotic depression and the CDI in patients with psychotic depression emerged as the significant predictors of WCST scores. Patients with severe major depressive disorder have profound executive impairments as assessed by the WCST at early stages of the illness. Intense emotional distress and psychomotor retardation seem to contribute to impaired performance. The depression groups revealed different response patterns, reflecting more severe deterioration and signs of possible organic dysfunction in patients with psychotic depression.