Some observations on the opiate peptides and schizophrenia

Opioid antagonists are associated with a reduction in the symptoms of schizophrenia: a meta-analysis of controlled trials

Current treatments for the symptoms of schizophrenia are only effective for positive symptoms in some individuals, and have considerable side effects that impact compliance. Thus, there is a need to investigate the efficacy of other compounds in treating both positive and negative symptoms. We conducted a meta-analysis of English language placebo-controlled clinical trials of naloxone, naltrexone, nalmefene, and buprenorphine in patients with schizophrenia to determine whether opioid antagonists have therapeutic efficacy on positive, negative, total, or general symptoms. We searched online databases Ovid Medline and PsychINFO, PubMed, EMBASE, Scopus, Cochrane library/CENTRAL, Web of Science, and Google Scholar from 1970 through February 2019. Following PRISMA guidelines, Hedges g was calculated for each study. Primary study outcomes were the within-subject change on any symptom assessment scale for positive, negative, total, or general symptoms of schizophrenia between active drug and placebo conditions. Thirty studies were included with 434 total patients. We found a significant effect of all drugs on all scales combined with both a standard random effects model: (g = 0.26; P = 0.02; k = 22; CI = 0.03-0.49) and a more inclusive bootstrap model: (g = 0.26; P = 0.0002; k = 30; CI = 0.11-0.51) and a significant effect on total scales with the bootstrap model (g = 0.25288; P = 0.015; k = 19; CI = 0.04-0.35). We also observed a significant effect of all drugs on all positive scales combined with both the random effects (g = 0.33; P = 0.015; k = 17; CI = 0.07-0.60) and bootstrap models (g = 0.32; P < 0.0001; k = 21; CI = 0.13-1.38). This evidence provides support for further testing in randomized clinical trials of a new class of non-D2-receptor drugs, based on opioid mechanisms, for the treatment of positive and negative symptoms of schizophrenia.

Reframing schizophrenia and autism as bodily self-consciousness disorders leading to a deficit of theory of mind and empathy with social communication impairments

Prior observations and studies suggest self-consciousness disorders in schizophrenia and Autism Spectrum Disorder (ASD), two neurodevelopmental disorders sharing social communication impairments. First, the relationships between schizophrenia and autism are explored regarding social communication impairments. Then, self-consciousness disorders in schizophrenia and autism are described and discussed in relation with impairments of body self leading to impairments of self-other differentiation, a deficit of theory of mind and empathy, and their consequences on social communication. Also, neurological dysfunction involved possibly in self-consciousness disorders in schizophrenia and autism is presented. In conclusion, a new model is proposed integrating results of studies presented here and stating the existence of bodily self-consciousness disorders in schizophrenia and autism associated with altered/absent intermodal sensory integration (especially visual-kinesthetic-tactile integration). This would result in problems of self-other differentiation, leading in turn to a deficit of theory of mind and empathy as well as social communication impairments. This model opens new perspectives to understand better self-consciousness disorders and social communication impairments in schizophrenia and ASD and to develop therapeutic strategies.

Reunifying autism and early-onset schizophrenia in terms of social communication disorders

Autism and early-onset schizophrenia share common dimensions of social communication deficits. The possible role of common genetic factors has to be seriously considered, such as the serotonin transporter gene that influences the severity of social communication impairments (negative symptoms) and hallucinations (positive symptoms). Autism and the negative syndrome of schizophrenia might be at one extreme of a continuum, and paranoid schizophrenia (positive symptoms) at the other extreme.

Animal models relevant to schizophrenia and autism: validity and limitations

Development of animal models is a crucial issue in biological psychiatry. Animal models provide the opportunity to decipher the relationships between the nervous system and behavior and they are an obligatory step for drug tests. Mouse models or rat models to a lesser extent could help to test for the implication of a gene using gene targeting or transfecting technologies. One of the main problem for the development of animal models is to define a marker of the psychiatric disorder. Several markers have been suggested for schizophrenia and autism, but for the moment no markers or etiopathogenic mechanisms have been identified for these disorders. We examined here animal models related to schizophrenia and autism and discussed their validity and limitations after first defining these two disorders and considering their similarities and differences. Animal models reviewed in this article test mainly behavioral dimensions or biological mechanisms related to autistic disorder or schizophrenia rather than providing specific categorical models of autism or schizophrenia. Furthermore, most of these studies focus on a behavioral dimension associated with an underlying biological mechanism, which does not correspond to the complexity of mental disorders. It could be useful to develop animal models relevant to schizophrenia or autism to test a behavioral profile associated with a biological profile. A multi-trait approach seems necessary to better understand multidimensional disorders such as schizophrenia and autism and their biological and clinical heterogeneity. Finally, animal models can help us to clarify complex mechanisms and to study relationships between biological and behavioral variables and their interactions with environmental factors. The main interest of animal models is to generate new pertinent hypotheses relevant to humans opening the path to innovative research.

Pain insensitivity in schizophrenia: trait or state marker?

OBJECTIVES

As early as the turn of the 20th century, clinicians observed patients with schizophrenia failing to respond to the pain of a myocardial infarction, ruptured appendix, or perforated bowel. Although this pain insensitivity in individuals with psychosis has been described in the literature for many years, the phenomenon is still poorly understood. We therefore reviewed the literature for findings concerning whether pain insensitivity in schizophrenia represents a state or a trait marker.

METHODS

A comprehensive Medline search of the literature on pain insensitivity in subjects with schizophrenia was conducted.

RESULTS

While the literature contains anecdotal observations, case reports, and a few rigorous clinical studies concerning patients with schizophrenia being relatively indifferent to pain, there is a dearth of empirical, well-controlled studies in this area. Although early studies that examined the response of individuals with schizophrenia to thermal or electrical pain were constrained by a variety of methodological confounders, studies on this topic suggest that the higher pain thresholds observed in schizophrenia are best explained by a complex, multifactorial model. Most intriguing are the results of one recent study that found pain insensitivity in family members of persons with schizophrenia, suggesting that this phenomenon may be a trait or endophenotype rather than being due to a psychotic state.

CONCLUSIONS

Pain insensitivity in individuals with schizophrenia, which is associated with increased morbidity and mortality, is poorly understood. It is possible that pain insensitivity might serve as a prodromal predictor of susceptibility for schizophrenia. Future studies are needed to further clarify the neurobiology, pathophysiology, and practical clinical implications of this phenomenon.

The therapeutic role of naltrexone in negative symptom schizophrenia

1. Naltrexone (50 mg bid, p.o.) was administered in a double-blind fashion (with placebo control) to chronic schizophrenic patients who maintained their routine neuroleptic and anxiolytic therapy. 2. Both positive and negative symptom patients who received naltrexone improved with regard to symptoms involving deterioration and social withdrawal. No significant amelioration was recorded in subjects assuming placebo relative to the same psychopathological areas. 3. Favourable results were obtained mainly from patients affected by negative symptom schizophrenia. 4. Naltrexone may have acted by direct or indirect neurochemical mechanisms related to negative symptom schizophrenia.

Opiate antagonists for the treatment of schizophrenia

Numerous studies suggest that opiate antagonists may have antipsychotic properties. A review of the literature describing the use of naloxone to treat schizophrenic patients has shown mixed results. The three studies on naltrexone have found no benefit in controlling auditory hallucinations. We present a synopsis of these studies.

Pain insensitivity in schizophrenia. Case report and review of the literature

We describe a schizophrenic man whose lack of pain and related objective signs of a perforated small bowel led to a delay in diagnosis and surgical intervention. A review of the literature suggests that both psychodynamic and specific biologic factors can produce atypical presentations in psychotic patients with illnesses in which pain is characteristically a prominent presenting symptom. While research into the cause of altered pain perception in psychotic patients is continuing, clinicians should maintain a high index of suspicion of serious medical illness when evaluating such patients.

The opioid system in neurologic and psychiatric disorders and in their experimental models

Evidence from experimental and clinical studies suggests the involvement of the endogenous opioid system in several neurologic and psychiatric disorders (Alzheimer's, Huntington's and Parkinson's diseases, drug-induced movement disorders, Gilles de la Tourette syndrome, stroke, ischemia, brain and spinal cord injury, epilepsy, schizophrenia and affective disorders). However, its involvement is rather a secondary one, perhaps being a severe consequence of a primary, nonopioid disturbance. Thus, treatment of an opioidergic manifestation of a disorder of nonopioidergic origin is necessarily symptomatic and targets only the restoration of the opioid system; such treatment may be beneficial in ameliorating the clinical symptoms of the disorder.

Human antiidiotypic antibody against opiate receptors

Sera containing antibodies to beta-endorphin from 2 patients with major depressive disorder were shown to have antidiotypic antibodies that specifically inhibited reactivity between anti-beta-endorphin IgG and beta-endorphin. Autologous and homologous antiidiotypic anti-anti-beta-endorphin IgG antibodies were isolated by affinity chromatography. The purified antiidiotypic antibody did not bind beta-endorphin but competed with [125I]beta-endorphin for rat brain opiate receptors. Normal IgG that was similarly treated had negligible competitive effects. The antibody bound to the membrane preparation; such binding was inhibited by opiate receptor ligands. Binding of the antiidiotype to a 60,000-dalton protein from rat brain was detected by Western immunoblot analysis. This protein corresponds in molecular weight to proteins proposed to be components of opiate receptors. These findings imply that immune reactivity to neuropeptides could contribute to psychiatric impairment.

Nicotine-produced antinociception in minimally deprived smokers and ex-smokers

The antinociceptive effects of two different modes of nicotine administration were investigated using a within-subject design. Ten minimally-deprived, habitual smokers and fifteen ex-smokers were studied in separate experiments. Nicotine was delivered in research cigarettes and tobacco snuff. Pain was induced using the cold pressor test. Subjects in both experiments exhibited pain reduction after nicotine administration without changes in nicotine withdrawal. The results suggest that nicotine can produce physiological and psychological changes that are relevant to the reinforcement of smoking but are independent of the state of nicotine withdrawal.

Beta-endorphin-(10-16) antagonizes behavioral responses elicited by melatonin following injection into the nucleus accumbens of rats

The behavioral changes induced by low doses of melatonin bilaterally injected into the nucleus accumbens of rats (decrease of locomotor activity and rearing and increase of grooming and sniffing behavior) were not affected by local pretreatment with beta-endorphin, but could be completely antagonized by alpha-type and gamma-type endorphins. Structure activity relationship studies revealed that the peptide beta-endorphin-(10-16) contains the essential information in this respect. The lowest effective dose of this peptide was 10 pg. The peptide, in contrast to gamma-type endorphins, did not interfere with the decrease of locomotor activity and rearing induced by injection of low doses of apomorphine into the nucleus accumbens. It is concluded that the described action of beta-endorphin-(10-16) resembles that of serotonin and various antidepressant drugs.

Dopamine and schizophrenia: an analysis of the theory

The postulated relationship of dopamine to schizophrenia ranks among the most important contemporary theories pertinent to the biological bases of behavior. However, as an examination of the relevant research literature makes clear, the theory has not yet been convincingly validated. This lack of validation is due, in part, to a failure to address the following questions: Is dopamine hyperactivity an etiological and/or a symptom factor in schizophrenia; do laboratory measures used to test the theory truly parallel the relevant clinical phenomena; is attenuated dopamine activity a necessary and/or sufficient condition for remission of schizophrenic symptoms? Analysis of these questions not only provides a departure point for examining the theory, but sets the stage for a reformulation of the theory itself.

Acupuncture mechanisms in rabbits studied with microinjection of antibodies against beta-endorphin, enkephalin and substance P

Injection of protein-A purified antibodies against Met-enkephalin and beta-endorphin into the periaqueductal gray matter (PAG) was shown to decrease the analgesic effect of electroacupuncture (EA) in rabbits. Met-enkephalin antibodies were more potent than the beta-endorphin antibodies in causing a statistically-significant effect on electroacupuncture analgesia. Antibodies to Met-enkephalin were also active at the spinal level, whereas antibodies against beta-endorphin were without effect: this is in agreement with a rich enkephalinergic innervation and absence of beta-endorphin-containing fibres in the spinal cord. Substance P, the other neuropeptide of this study, also seems to be important in mediating effects of electroacupuncture. Injection of antibodies into the periaqueductal gray caused decrease of the effect of electroacupuncture whereas intrathecal administration of Fab-fragment substance P antibodies caused a marked potentiation. The demonstration of site specificity of the neuropeptides in mediating analgesia induced by electroacupuncture supports the validity of this experimental approach.

Is schizophrenia an immunologic receptor disorder?

A model is proposed for an autoimmune etiology for schizophrenia. We propose that schizophrenia is a syndrome (not a disease). We suggest that autoantibodies (and/or cell-mediated immunity) directed against autologous neurotransmitter receptors are responsible for the ebb and flow of psychotic symptomatology. The hypothesis is predicated on autoimmune models in other known receptor diseases as well as on the newly emerging recognition that general immune dysfunction exists in certain schizophreniform psychoses.

Inhibition by lithium of beta-endorphin-induced psychomotor excitation in cats

beta-Endorphin injected into the cerebral ventricles of unanesthetized cats produced dose-dependent and long-lasting restlessness, locomotion, stereotyped sideways movements of the head, vacant staring, apprehension and flight accompanied with mydriasis and tremor. The most impressive features of the psychomotor excitation were the locomotion and the sideways movements of the head. Intracerebroventricular nalorphine prevented the psychomotor excitation caused by intracerebroventricular beta-endorphin. Lithium chloride and lithium carbonate injected into the cerebral ventricles prevented and reversed the psychomotor excitation evoked by beta-endorphin similarly injected. In cats showing spontaneous locomotor activity, intracerebroventricular lithium chloride also suppressed this activity. It is suggested that beta-endorphin elicited psychomotor excitation by acting on central opiate receptors. However, the effect of lithium cannot be solely ascribed to an action on central opiate receptors and endogenous peptides. Since lithium affected the spontaneous as well as the beta-endorphin-induced locomotion, it may be supposed that the cation suppressed the ongoing input activity at central locomotion activity levels.

Neuropeptides, mental performance and aging

The presence of peptidergic neuronal networks in the brain and the modulating action of neuropeptides on brain functions as evidenced by their behavioral influence in particular support the concept that the brain like the peripheral endocrine glands is an endocrine target organ which is as sensitive to treatment with neuropeptides as the peripheral glands are to pituitary hormones. Animal and human data are reviewed showing that neuropeptides related to ACTH/MSH affect motivational and attentional processes and that those related to vasopressin are involved in memory processes. Since these functions decline during aging it is postulated that a decreased bioavailability of neuropeptides in brain of elderly people is associated with specific disturbances in mental performance. Thus, the decreased mental ability of the aged may be restored by treatment with neuropeptides particularly those with little, if any, peripheral, endocrine activity, like the ACTH neuropeptide Org 2766 and the vasopressin neuropeptide DGAVP.

Cardiovascular effects of beta-endorphin after microinjection into the nucleus tractus solitarii of the anaesthetised rat

The cardiovascular effects of beta-endorphin after administration directly into the nucleus tractus solitari (NTS) of urethane-anaesthetised rats were investigated. Unilateral injection resulted in a U-shaped dose-response relationship with a fall in mean arterial pressure and heart rate occurring at low doses (less than 10 ng). No change in respiratory frequency was observed at any of the doses examined. The hypotensive effects of beta-endorphin were anatomically specific and restricted to the NTS. The depressor response was prevented and bradycardia reduced by naloxone (1 mg/kg s.c. or 10 ng injected into the NTS) and also by beta-endorphin antiserum (1:50 dilution) but not by antiserum to [Met5]enkephalin (1:50 dilution) applied locally into the NTS. The beta-endorphin antiserum caused a rise in blood pressure when administered alone. Conversely microinjection of antiserum to [Met 5]enkephalin resulted in a brief depressor response. Doses of beta-endorphin larger than 10 ng induced a rise in blood pressure accompanied by variable effects on heart rate. Similarly unilateral administration of Des-tyr-endorphin (100 pg) resulted in a blood pressure increase and [D-Ala2,Met5]enkephalin produced a dose-related pressor response and tachycardia. The results indicate that at least two separate endorphin systems are involved in cardiovascular control at the level of NTS, one being depressor in nature (beta-endorphin-like) and the other pressor ([met5]enkephalin-like).

Analgesic efficacy of parenteral metkephamid acetate in treatment of postoperative pain

The analgesic efficacy and side-effects of a single parenteral dose of metkephamid acetate 70 mg were compared with those of pethidine (meperidine) hydrochloride 100 mg and placebo in a double-blind, randomised, controlled clinical trial. 30 out of 32 postoperative patients completed the study--10 in the metkephamid group, 11 in the pethidine group, and 9 in the placebo group. The time-effect curves of summated pain measures and analyses of derived measures all indicated that the analgesic activity of metkephamid 70 mg was significantly greater than that of placebo and not less than that of pethidine 100 mg. The metkephamid group had a greater incidence of side-effects than the other two treatment groups. Some side-effects, such as sensations of heaviness of the extremities and nasal congestion, were peculiar to metkephamid but not distressing.

A peptide-containing fraction of plasma from schizophrenic patients which binds to opiate receptors and induces hyper-reactivity in rats

A serum fraction from schizophrenic patients has been investigated for its effect on opiate receptor sites and on behaviour in rats. Serum from schizophrenic patients was ultrafiltered and fractionated on DEAE-Sephadex A-25. The concentration of peptide material eluting under 0.1 M HCl (fraction I) was further purified on Sephadex-G10 and four major peaks were identified (fractions II to V). When injected intracerebroventricularly in rats, fraction II produced a characteristic behavioural syndrome, which included hyperactivity associated with hyperemotionality. The effects were long lasting, bouts of hyperemotionality accompanied by analgesia were recorded over a two-week period. The same fraction from control non-patients produced a transient and much reduced, but qualitatively similar response. There was evidence that fraction III was also active. An in vitro opiate receptor binding test showed that fraction II from schizophrenic patients inhibited [3H]naloxone binding.

The distribution of enkephalin immunoreactive fibers and terminals in the monkey central nervous system: an immunohistochemical study

Using immunohistochemical techniques, the distribution of met-enkephalin fibers and terminals was studied in the central nervous system of adult old-world monkeys. Areas which showed the greatest density of immunoreactivity included substantia gelatinosa, nucleus tractus solitarius, nucleus parabrachialis, substantia nigra, median eminence, globus pallidus (external segment), patches within the striatum and the region of nucleus accumbens and the olfactory area. Striking and discrete zones of enkephalin immunoreactive fibers and terminals which did not conform to known nuclear boundaries were observed in the latter areas. The distribution of enkephalin in the monkey is compared to what has been described in the rat central nervous system. In general, the two species are similar, however, differences were observed in some areas including the hypoglossal nucleus, substantia nigra and in the region of the nucleus accumbens and olfactory area. The results are discussed with regard to the possible functional significance of enkephalin localization in regions related to regulation of pain, mood, and autonomic function.

Opioid peptides as neuroregulators: potential areas for the study of genetic-behavioral mechanisms

The opioid peptides have been related to behavior in both animal and human studies. Further investigation can be anticipated which could lead to the elucidation of genetic controls over enzymes which process these peptides and the receptors upon which the peptides act. The enzymes, both synthetic and degradative, can lead to the formation of different forms of the opiate peptides. Differential control of these enzymes or of the multiple forms of opiate receptors could lead to discrete changes in opiate status and subsequent behavioral changes. Conversely, genetically regulated behavioral modification could also lead secondarily to opiate changes.

Degradation of met-enkephalin by extracts of various regions of the human brain: effects of antipsychotics and narcotics in vitro

Antischizophrenic drugs, reduced in a concentration-dependent fashion enkephalin degradation by the soluble and particulate fractions of the human cerebral cortex and cerebellum. The order of potency is as follows: thioridazine greater than chlorpromazine greater than fluphenazine greater than haloperidol greater than or equal to promazine with IC50 of 50, 80, 120, 200-250 micro M, respectively. Kinetic studies revealed non-competitive and competitive inhibition by thioridazine and chlorpromizine, respectively. Narcotics, were weak inhibitors of enkephalin degradation. For dl-, d-, l-methadone and l-alpha-acetylmethadol, IC50 was about 500 micro M, and 1000 micro M for heroin and morphine. It is suggested that inhibition of the degradation of endogenous morphinomimetic peptides in the CNS may be a crucial factor governing the pharmacology of some neuroleptics and other psychoactive drugs. Enkephalin-hydrolyzing activity was ubiquitous and exhibited considerable regional differences in the normal human and in Huntington's chorea brains. The rate of enkephalin degradation is generally higher in the subcortical nuclei than in the cortex and cerebellum. The highest hydrolytic activity was found in the substantia nigra, anterior thalamus, septal area, globus pallidus and caudate nucleus, in this decreasing order.

Metkephamid, a systemically active analog of methionine enkephalin with potent opioid alpha-receptor activity

Metkephamid is an analog of methionine enkephalin that retains high affinity for the delta receptor and is a systemically active analgesic. Since it is at least 100 times more potent than morphine as an analgesic when placed directly into the lateral ventricles, and is 30 to 100 times more potent on the delta receptor and yet is roughly equipotent on the mu receptor in vitro, it is concluded that it probably produces analgesia by action on delta receptors as well as, or rather than, on mu receptors. It has less tendency to produce respiratory depression, tolerance, and physical dependence than standard analgesics, and it is presently undergoing clinical trial.

Assessment of naltrexone in the treatment of schizophrenia

Naltrexone, a long acting opiate antagonist, and placebo were administered to eight schizophrenics in doses of 200 mg per day for 1 week in a double-blind, crossover design. No improvement was noted, and no side effects resembling the opiate withdrawal syndrome with naltrexone were found. Naltrexone does not appear to alter schizophrenic symptomatology.

Immunoreactive beta-endorphin and adrenocorticotropin in human cerebrospinal fluid

To elucidate the significance of beta-endorphin in human cerebrospinal fluid (CSF), CSF levels of beta-endorphin-like immunoreactivity (beta-EP-LI) in various diseases were determined by a specific radioimmunoassay and compared with simultaneously determined ACTH-like immunoreactivity (ACTH-LI) levels in CSF. CSF beta-EP-LI and ACTH-LI in the control group, consisting of 5 normal subjects and 19 patients with nonendocrine diseases, were 22.2+/-1.3 and 14.6+/-0.4 fmol/ml, respectively. CSF levels of these peptides in patients with schizophrenia (n = 19) and acromegaly (n = 10) were not significantly different from those in the control group. Patients with Cushing's disease (n = 7) had significantly lower CSF beta-EP-LI and ACTH-LI levels than those in the control group. Four of them showed a parallel increase in CSF beta-EP-LI and CSF ACTH-LI levels after the complete removal of pituitary microadenomas (P < 0.05). Gel chromatography of CSF beta-EP-LI from a normal volunteer, a control patient, and one patient each with catatonia, Nelson's syndrome, Cushing's syndrome (adrenal adenoma), and acromegaly gave similar patterns consisting of three peaks with the elution positions comparable to those of authentic beta-endorphin, beta-lipotropin, and possibly their precursor molecule. Gel chromatographic patterns of CSF beta-EP-LI and ACTH-LI were compared in a normal volunteer. The first peaks of beta-EP-LI and ACTH-LI eluted at the same position and the second peak of ACTH-LI coincided with the elution position of authentic ACTH.CSF beta-EP-LI and ACTH-LI levels determined every 5 min over a period of 80 min in three normal volunteers did not show moment-to-moment variability.A significant correlation (r = 0.75, P < 0.001) was seen between CSF beta-EP-LI and ACTH-LI levels in normal subjects and patients studied (n = 73). This suggests that beta-endorphin and ACTH in human CSF share the common regulatory mechanism in normal and pathologic conditions.

Pharmacological regulation of calmodulin

A number of psychotropic drugs, particularly the phenothiazines and related antipsychotic compounds, inhibit a variety of calmodulin-dependent enzymes. The mechanism by which these compounds inhibit the activity of calmodulin is through a selective calcium-dependent binding to this protein. With the notable exception of certain stereoisomers, compounds that are clinically effective antipsychotic agents showed the greatest degree of binding to calmodulin. Other classes of pharmacological agents, including aminergic agonists and antagonists, and nonspecific central nervous system depressants and stimulants, showed little or no binding to calmodulin. In fact, the specificity with which antipsychotic drugs bind to calmodulin suggests the possibility of screening for new and clinically more effective antipsychotic agents based on their selective binding to calmodulin. Certain neuropeptides that produce behavioral effects in animals also were found to inhibit the activity of calmodulin, suggesting that there may be endogenous psychotogens or antipsychotic peptides that interact with calmodulin. Although under ordinary conditions the binding of antipsychotics to calmodulin is reversible, the binding of phenothiazine antipsychotics to calmodulin can be made irreversible either photochemically by ultraviolet irradiation, or enzymatically by a hydrogen peroxide-peroxidase system. Such a labeling technique should prove to be a useful tool to study the localization and turnover of calmodulin. These results indicate that several of the diverse biochemical actions of antipsychotic agents can be explained by a common mechanism, namely, by their binding to and inhibition of calmodulin, and raise the possibility that calmodulin may serve as one of the cellular receptors for certain antipsychotic compounds. However, further studies must be completed before we can state with any degree of certainty that these in vitro biochemical findings can explain the pharmacological and clinical actions of the antipsychotics.

Faster cholinergic REM sleep induction in euthymic patients with primary affective illness

Arecoline, a cholinergic muscarinic receptor agonist, induced rapid eye movement sleep significantly more rapidly in patients with primary affective illness in remission than in normal control subjects matched for age and sex. These results, and others, suggest that patients with primary affective illness may have a supersensitive cholinergic system both when they are ill and when their symptoms are in clinical remission.

The role of endorphins in stress: evidence and speculations

Several lines of evidence suggest that the endogenous opioid peptides endorphins may play a role in the defensive response of the organism to stress. The present paper summarizes these findings as well as evidence linking endorphins to the anterior pituitary polypeptide hormone adrenocorticotropin (ACTH). Evidence is presented that endorphins may function as trophic hormones in peripheral target organs such as the adrenal medulla and the pancreas. As such they may be part of the physiological mechanisms that mediate adrenaline and glucagon release in response to stress. Endorphins (enkephalins) are also suggested to play a role in the control of the pituitary gland during stress. In such capacity they may act as hormone-releasing or inhibiting factors. Finally, endorphins appear to play a role in the behavioral concomitants of stress. In such capacity endorphins are suggested to function as modulators of neural systems that mediate the elaboration and expression of the reactive/affective components of stress. Speculations on the mode of interaction between endorphins and ACTH in the global response to stress are discussed.

Paradoxical effect of naloxone on nitrous oxide analgesia in man

The effect of naloxone on nitrous oxide analgesia in man has been investigated. The paradoxical response so obtained indicates the possibility of a dural system mediating the pain response in man. These results support previous animal experiments indicating that nitrous oxide analgesia is mediated by the opiate receptors.