The Role of Dorsal Raphe Nucleus Serotonergic Systems in Emotional Learning and Memory in Male BALB/c Mice

Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for a variety of anxiety-, trauma- and stressor-related disorders. Although they are efficacious, therapeutic improvements require several weeks of treatment and are often associated with an initial exacerbation of symptoms. The dorsal raphe nucleus (DR) has been proposed as an important target for the modulation of emotional responses and the therapeutic effects of SSRIs. Using a fear-conditioning paradigm we aimed to understand how SSRIs affect emotional learning and memory, and their effects on serotonergic circuitry. Adult male BALB/c mice were treated with vehicle (n = 16) or the SSRI fluoxetine (18 mg/kg/d) acutely (n = 16), or chronically (21d, n = 16), prior to fear conditioning. Treatment was stopped, and half of the mice (n = 8/treatment group) were exposed to cued fear memory recall 72 h later. Activation of DR serotonergic neurons during fear conditioning (Experiment 1) or fear memory recall (Experiment 2), was measured using dual-label immunohistochemistry for Tph2 and c-Fos. Acute and chronic fluoxetine treatment reduced associative fear learning without affecting memory recall and had opposite effects on anxiety-like behaviour. Acute fluoxetine decreased serotonergic activity in the DR, while chronic treatment led to serotonergic activity that was indistinguishable from that of control levels in DRD and DRV subpopulations. Chronic fluoxetine facilitated fear extinction, which was associated with rostral DRD inhibition. These findings provide further evidence that SSRIs can alter aspects of learning and memory processes and are consistent with a role for discrete populations of DR serotonergic neurons in regulating fear- and anxiety-related behaviours.

Acute treatment with 5-hydroxytryptophan increases social approach behaviour but does not activate serotonergic neurons in the dorsal raphe nucleus in juvenile male BALB/c mice: A model of human disorders with deficits of sociability

BACKGROUND

The BALB/c mouse has been proposed as a model of human psychiatric disorders characterised by elevated anxiety and altered sociability. Juvenile BALB/c mice show decreased social exploratory behaviour, increased anxiety, and reduced brain serotonin synthesis compared to other strains including C57BL/6J mice.

AIM

To determine whether supplementation of brain serotonin synthesis alters social behaviour and activation of serotonergic neurons across subregions of the dorsal raphe nucleus (DR) in BALB/c mice.

METHODS

Juvenile male BALB/c mice were assigned to one of four treatment conditions: vehicle/vehicle, carbidopa (25 mg/kg)/vehicle, vehicle/5-HTP (10 mg/kg), carbidopa (25 mg/kg)/5-HTP (10 mg/kg). Social behaviour was measured using the three-chamber social approach test, followed by immunohistochemical staining for TPH2 and c-Fos to measure activation of serotonergic neurons across subregions of the DR.

RESULTS

Mice treated with carbidopa/5-HTP spent more time in the social cage zone and covered more distance in the social approach test compared to other treatment groups. There was no difference between treatment groups in the activation of serotonergic neurons across subregions of the DR. However, the DRD was associated with increased social approach behaviour in carbidopa/5-HTP treated animals.

CONCLUSIONS

Supplementation of serotonin synthesis can increase social approach behaviour in juvenile BALB/c mice. An increase in locomotor behaviour was also observed suggesting that increasing central serotonin synthesis may have led to a reduction in state anxiety, manifesting in increased exploratory behaviour. As no effect on serotonergic activation within the DR was found, alternative mechanisms are likely important for the effects of 5-HTP on social behaviour.

The impact of SMARTpass algorithm status on inappropriate shock rates in the UNTOUCHED Study

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Boston Scientific Corporation

Background

The current Subcutaneous ICD (S-ICD) model incorporates SMART Pass (SP) to improve sensing and discrimination capabilities to reduce inappropriate shocks (IAS). SP status is programmable but may also be disabled automatically in the setting of low amplitude signals or low heart rate in order to avoid under-sensing of VT/VF.

Objective

To evaluate SP impact on IAS, appropriate shocks (AS), complications and mortality in the UNTOUCHED S-ICD trial.

Methods

Primary prevention patients (pts, n=1111) with ejection fraction ≤35% and no pacing requirement were followed for up to 18 months. SP status during a study visit was programmed ON or OFF and status between visits was either consistently OFF, ON, or automatically disabled (DIS). The impact of SP status on pt outcomes was evaluated using Kaplan-Meier (K-M) analysis. Multivariable proportional hazard analysis identified predictors of IAS and SP disable events.

Results

Percent of pts with SP always ON, always OFF, ON with DIS, and OFF then ON with no DIS were 56, 16, 15, and 13%, respectively. At least one SP DIS occurred in 177 pts, but only 13% had 2 or more, mostly due to PVCs and low EGM amplitudes. Significant multivariable predictors of SP disable events are history of atrial fibrillation (hazard ratio (HR) 2.49, odds ratio (OR) (1.49-4.16); p=.0005), only one passing vector at S-ICD screening, (HR 1.85, OR (1.10-3.10; p=.0202) and lower left ventricular ejection fraction (HR 1.05, OR (1.01-1.08); p=.0074). K-M IAS rates were highest for pts experiencing DIS (fig 1) and lowest for SP ON. While neither AS (p=0.58) nor complication (p=0.58) rates varied significantly according to SP status, mortality was lower for pts with SP ON during any duration of time (p=0.044) by univariate analysis. Further analysis is planned to better understand the relationship between SP status and mortality.

Conclusion

Patients in the UNTOUCHED trial with SMART Pass (SP) consistently ON had significantly fewer inappropriate shocks, with no impact on appropriate therapy for VT/VF. Patients with history of atrial fibrillation, lower left ventricular ejection fraction, and only one passing vector at S-ICD screening are at higher risk of SP disable events; therefore, care should be taken for these patients to assess SP status and their higher risk for inappropriate shocks.

Involvement of dorsal raphe nucleus serotonergic systems in social approach-avoidance behaviour and in the response to fluoxetine treatment in peri-adolescent female BALB/c mice

Serotonergic systems are involved in the development and regulation of social behaviour, and drugs that target serotonin neurotransmission, such as selective serotonin reuptake inhibitors (SSRIs), also alter aspects of social approach-avoidance. The midbrain dorsal raphe nucleus (DR), which is a major serotonergic nucleus and main source of serotonergic innervation of the forebrain, has been proposed as an important target for SSRIs, although evidence in females is lacking. In this study, we examined the involvement of the DR serotonergic systems in social behaviour and in response to SSRI treatment, using peri-adolescent female BALB/c mice. Mice were exposed to the SSRI fluoxetine either chronically (18 mg/kg/day, in drinking water, for 12 days) or acutely (18 mg/kg, i.p.), or to vehicle control condition (0.9 % saline, i.p.), prior to being exposed to the three-chambered sociability test. Activation of serotonergic neurons across subregions of the DR were subsequently measured, using dual-label immunohistochemistry for TPH2 and c-Fos. Acute fluoxetine administration increased generalised and social avoidance, while mice exposed to chronic fluoxetine treatment showed levels of social approach behaviour that were comparable to controls. Serotonergic populations across the DR showed reduced activity following acute fluoxetine treatment. Further, activation of serotonergic neurons in the ventral DR correlated with social approach behaviour in vehicle-treated control mice. These data provide some support for the involvement of discrete populations of DR serotonergic neurons in the regulation of social approach-avoidance, although more research is needed to understand the effects and mechanisms of chronic SSRI treatment in females.

P3517Failure to achieve adequate heart rate control in women during therapy optimization

Background

Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking.

Methods

The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months.

Results

There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure).

Figure 1

Conclusions

A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.

P2832Outcomes of catheter ablation for atrial fibrillation based on sex: data from the cabana trial

Background

Sex-specific outcomes may differ amongst patients receiving catheter ablation for atrial fibrillation (AF).

Purpose

Assess sex-specific outcomes in the patients randomized to catheter ablation or drug therapy in CABANA.

Methods

CABANA randomized 2204 pts with AF to catheter ablation or drug therapy (rate/rhythm-control). The outcomes of combined death, disabling stroke, severe bleeding, or cardiac arrest (intention to treat-ITT) or all-cause death were not different. But, ablation significantly improved combined death or CV hospitalization. This analysis compares clinical characteristics by sex and determines sex-specific hazard ratios based on a comparison of ablation vs drug therapy.

Results

Females were 37.3% of ablation and 37.0% of drug therapy patients. Females were older, more often white race, had less CAD, or sleep apnea, but had higher NYHA Class, higher CHA2DS2VASc, and more often had paroxysmal (v. persistent) AF, and prior AF hospitalization. (Table) HTN, CVA and diabetes were the same (Table).

For the CABANA primary endpoint, an ITT comparison of ablation vs. drug therapy, showed a female hazard ratio (HR) of 1.14 (95% confidence interval (CI) 0.70–1.86), and a male HR of 0.74, (95% CI 0.52–1.06). For all-cause mortality, the female HR was 0.75 (95% CI 0.41–1.40) and male HR was 0.91 (95% CI 0.59–1.40) and for all-cause mortality or CV hospitalization, the female HR was 0.90 (95% CI 0.75–1.09) and male HR was 0.79 (95% CI 0.69–0.92). All interaction p values were non-significant.

Recurrent AF (post 90-day blanking) was significantly reduced for both females and males: female HR 0.64 (95% CI 0.51–0.82), male HR 0.46 95% CI 0.39–0.56), p=0.035

Clinical Characteristics and Outcomes Baseline Characteristics Female (N=818) Male (N=1385) p-value Age: Median (Q1, Q3) 69 (65, 74) 66 (60, 71) <0.001 White 766 (93.9%) 1259 (91.0%) 0.015 CAD 92 (11.2%) 332 (24.0%) <0.001 NYHA ≥II 345 (42.4%) 433 (31.5%) <0.001 Sleep apnea 136 (16.6%) 372 (26.9%) <0.001 CHA2DS2-VASc: Median (Q1, Q3) 3 (3, 4) 2 (1, 3) <0.001 Paroxysmal AF 406 (49.6%) 540 (39.0%) <0.001 Persistent AF 412 (50.4%) 845 (61.0%) AF Hospitalization 353 (43.2%) 521 (37.7%) 0.011

Conclusion

Significant sex-specific outcomes differences were not observed. Sex should not be used as a determining factor in selecting patients for AF therapy.

Acknowledgement/Funding

NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation

P1462Return to physical activity among women following newly diagnosed dilated cardiomyopathy or myocardial infarction

Background

Resuming activity following a new diagnosis of dilated cardiomyopathy (DCM) or myocardial infarction (MI) is important for improvements in morbidity and mortality. Activity is also associated with an improved ejection fraction (EF) and lower risk of reinfarction. Patient management could benefit from having normative values and expected gains in activity early following diagnosis of DCM or MI.

Purpose

Assess the change in activity among women for the first 30 days after hospital discharge following a new DCM diagnosis or MI.

Methods

Female adult patients prescribed a wearable cardioverter defibrillator (WCD) for a diagnosis of DCM (n=3550) or MI (n=1422) with low EF were included. Step count was measured by WCD accelerometer. Change in activity over time was analyzed, including weekly percentage gains.

Results

Women with DCM were significantly younger (64, SD = 13) than women post-MI (67, SD = 12). Median daily step count across the entire 30-day period was 4093 (IQR: 2123–6609). Women with DCM demonstrated a higher step count compared to women post-MI, 4405 (IQR: 2348–6986) and 3352 (IQR: 1644–5709), respectively, even after correcting for the difference in age between the groups. The greatest increases in activity for all occurred from week 1 to week 2. Women with DCM or post-MI had a 15.4% and 19.1% increase, respectively. Incremental increases in activity continued throughout the month.

Conclusion

Physical activity among women with newly diagnosed DCM or MI and a low EF increased within the first 30 days. The most significant increase occurred from week 1 to week 2. This data can be used as a benchmark to develop and assess prescriptive activity programs for women.

Social approach, anxiety, and altered tryptophan hydroxylase 2 activity in juvenile BALB/c and C57BL/6J mice

Autism spectrum disorder (ASD) is a heterogeneous and highly heritable condition with multiple aetiologies. Although the biological mechanisms underlying ASD are not fully understood, evidence suggests that dysregulation of serotonergic systems play an important role in ASD psychopathology. Preclinical models using mice with altered serotonergic neurotransmission may provide insight into the role of serotonin in behaviours relevant to clinical features of ASD. For example, BALB/c mice carry a loss-of-function single nucleotide polymorphism (SNP; C1473 G) in tryptophan hydroxylase 2 (Tph2), which encodes the brain-specific isoform of the rate-limiting enzyme for serotonin synthesis, and these mice frequently have been used to model symptoms of ASD. In this study, juvenile male BALB/c (G/G; loss-of-function variant) and C57BL/6 J (C/C; wild type variant) mice, were exposed to the three-chamber sociability test, and one week later to the elevated plus-maze (EPM). Tryptophan hydroxylase 2 (TPH2) activity was measured following injection of the aromatic amino acid decarboxylase (AADC)-inhibitor, NSD-1015, and subsequent HPLC detection of 5-hydroxytryptophan (5-HTP) within subregions of the dorsal raphe nucleus (DR) and median raphe nucleus (MnR). The BALB/c mice showed reduced social behaviour and increased anxious behaviour, as well as decreased 5-HTP accumulation in the rostral and mid-rostrocaudal DR. In the full cohort of mice, TPH2 activity in the mid-rostrocaudal DR was correlated with anxious behaviour in the EPM, however these correlations were not statistically significant within each strain, suggesting that TPH2 activity was not directly associated with either anxiety or sociability. Further research is therefore required to more fully understand how serotonergic systems are involved in mouse behaviours that resemble some of the clinical features of ASD.

Antibody levels by indirect ELISA test in Trypanosoma evansi infected horses following treatment with quinapyramine sulphate

An ELISA test was used to determine the persistence of antibody levels in horses following treatment for Trypanosoma evansi. In 17 horses with T. evansi from two farms treated and cured with quinapyramine sulphate, ELISA antibody levels fell progressively post-treatment, but remained with positive results for 22.6 months in one horse, 12.8 months in a second, 4.1 months in another four and 2.3 months in three, whilst the rest became negative at 2.3 months. In two horses that suffered a post-treatment infection relapse the decrease in ELISA levels was only temporary, and a new increase in antibody levels was proven. The follow-up of these antibody levels could prove useful in clinical cases and in epidemiological studies, as well as for assessing the efficacy of drug treatment.

Hybrid therapy for ventricular arrhythmia management

Optimum arrhythmia management has evolved to couple ICD therapy with catheter ablative and drug therapy to attempt to eliminate or reduce arrhythmia risk. No longer should the clinician approach such therapy as a choice among single alternative strategies only. Optimum patient management includes not only recognition of the indications and benefits of such hybrid therapy but also a complete understanding of potential pitfalls of such therapy.

Persistence of Tritrichomonas foetus in naturally infected cows and heifers in Argentina

Tritrichomonas foetus infection was investigated in 76 pregnant and 64 non-pregnant cows slaughtered in the local abbattoir and in two different lots of first-service heifers that were found to be non-pregnant 60 days post breeding (PB). In live and slaughtered animals, mucus samples were obtained from the vagina and from the vagina and uterus, respectively, using a "screw-head scraper rod". In pregnant cows, samples of amniotic and allantoid fluid were also collected, as well as samples from the stomach contents of the fetuses. All samples were cultured in Modified Plastridge Medium. T. foetus was isolated from three pregnant and two non-pregnant slaughtered cows. Parasites were recovered from the vagina of these five cows, as well as from the uterus in two cases and from the fetus in one case. Lot I of first-service heifers consisted of 323 females from eight different farms. Bulls infected with T. foetus from these farms were culled or treated, and heifers found empty at diagnosis of pregnancy were culled. Lot II consisted of 120 heifers from a single farm where T. foetus was controlled only in bulls. All heifers from Lot I were T. foetus negative. In Lot II, 12 of 120 heifers (10%) were T. foetus positive. In ten of these the parasites were observed once, in one at 60 days PB, in seven at 160 days PB and in two at 240 days PB; in the remaining two infected heifers, an irregular pattern of isolation persisted during 300 days PB. On the basis of these results, control methods are discussed and analysed.

Perceived and actual risks of driving in patients with arrhythmia control devices

BACKGROUND

We surveyed patient attitudes about driving and about driving restrictions for patients with automatic defibrillators and pacemakers, and we assessed risk of arrhythmias occurring during driving.

METHODS

One hundred two patients responded to a questionnaire (57 patients with defibrillators and 45 patients with pacemakers) about driving habits and opinions on restriction of patients who have devices and want to drive. In addition, the literature was reviewed for approximate incidences of sudden death and syncopal or nonsyncopal device therapy to estimate risk while driving of having a defibrillator discharge.

RESULTS

Thirty-two patients with defibrillators (56%) and 28 patients with pacemakers (62%) currently drove an average of 196 and 161 km/wk, respectively. Most patients felt that driving was a right and 75% felt that restriction imposed a hardship on them. Respondents felt that common sense, limited distances, or physician input should set driving limitations. A minority felt that no restrictions should be placed on these drivers or that they should not drive at all. The risks of sudden death and syncopal and nonsyncopal defibrillator discharge were estimated at 0.0009%, 0.0011%, and 0.0015% per kilometer driven, respectively, based on weekly kilometers and published occurrences of these phenomena.

CONCLUSIONS

Patients perceive that driving is their right and that there is a low risk of an arrhythmic event behind the wheel. The estimated risk and published accounts of sudden death support this. However, concurrent medical problems and stresses imposed by driving may increase risk. The physician must make reasonable recommendations to ensure patient and public safety, keeping in mind both state and federal driving regulations and reporting requirements.

[Eumycotic mycetomas in horses caused by Curvularia verruculosa]

The fungus Curvularia verruculosa, which produces eumycotic mycetomas, was isolated from skin of horses with granulomatous lesions on the legs. The isolation was made in Sabouraud dextrose agar medium. The horses came from Comandante Fontana suburb, Formosa-Argentina. This finding would be the first report of Curvularia in horses in Argentina.

Oral amiodarone loading for the rapid treatment of frequent, refractory, sustained ventricular arrhythmias associated with coronary artery disease

To evaluate the efficacy and safety of oral amiodarone in the treatment of recurrent, sustained, refractory ventricular arrhythmias, rapid high-dose oral loading was used to treat 12 critically ill patients with frequent, sometimes incessant, sustained ventricular arrhythmias refractory to 2 to 6 antiarrhythmic agents. Presenting arrhythmias included sustained monomorphic ventricular tachycardia and ventricular fibrillation associated with cardiac arrests in 6 patients. Patients experienced 2 to 10 episodes (mean 5 +/- 2) of sustained ventricular arrhythmias over a mean period of 6.2 +/- 5.0 days (range 1 to 14) before oral amiodarone was initiated at 1,200 to 1,400 mg/day. This included at least 1 to 4 episodes (mean 2.2 +/- 1.1) within 24 hours before amiodarone. One to 4 antiarrhythmic drugs were administered concurrently during amiodarone loading. Sustained ventricular arrhythmias no longer occurred after a mean of 5.2 days (range 1 to 22) with amiodarone. Arrhythmias were controlled in 4 patients within 24 hours, 5 patients within 48 hours, 7 patients within 4 days and 10 patients within 6 days. Patients experienced a mean of 0.6 +/- 0.8 episodes within 24 hours after amiodarone. Nine patients survived to hospital discharge. No patient had significant adverse effects during high-dose loading. In conclusion, high-dose oral amiodarone loading, when added to previously unsuccessful conventional antiarrhythmic therapy, is safe and often rapidly effective for at least short-term control of frequent, refractory, sustained ventricular arrhythmias.

Atypical presentations and echocardiographic findings in patients with cardiac tamponade occurring early and late after cardiac surgery

Cardiac tamponade, a potentially lethal complication following cardiac surgery, may present either early or late postoperatively and may be difficult to diagnose due to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequency and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery. The incidence of postoperative cardiac tamponade was 2.0 percent (10/510 patients) and occurred following valvular, bypass, and aortic surgery. Nine of ten patients had either atypical clinical, hemodynamic, and/or echocardiographic findings. The diagnosis of tamponade was made 1 to 30 days (mean = 8.5 days) postoperatively. Presenting symptoms were often mild and nonspecific. Classic signs including hypotension, pulsus paradoxus greater than 12 mm Hg, and elevated jugular venous pressure were present in 7, 6, and 5 patients, respectively. Right heart hemodynamics revealed elevated and equalized diastolic pressures in three of six patients. Two-dimensional echocardiography revealed selective compression of the left ventricle (LV) (four patients), right ventricle (RV) (one patient), left atrium (LA)/RV (one patient), LA/LV (one patient), LA/LV/RV (one patient), all four chambers (one patient), and no diastolic collapse of any chamber (one patient). There was often an absence of anterior pericardial fluid (six patients) with tethering of a portion of the RV to the chest wall anteriorly (five patients). Coagulation parameters were "supratherapeutic" in only three of eight patients who were receiving systemic anticoagulants at the time of diagnosis. The initial diagnosis was confused with congestive heart failure in one patient, pulmonary embolism in three patients, acute myocardial infarction in two patients, and sepsis in one patient. Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating room. We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, often due to selective chamber compression by loculated fluid or clot. Due to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low output failure occur in the postcardiotomy patient.

Follow-up of pathological gamblers after treatment

Pathological gamblers entering a comprehensive treatment program were thoroughly assessed before treatment and 6 months after completion of treatment. The reports of gamblers and collateral informants were highly consistent. Follow-up interviews were conducted with 57 of the 66 patients entering treatment. Total abstinence was reported by 56% (N = 32) of the patients located for follow-up, and significant improvement on a wide range of measures was documented. The authors feel that the results demonstrate that pathological gambling is a treatable mental disorder.

An outcome study of an inpatient treatment program for pathological gamblers

In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

Affective disorders among pathological gamblers seeking treatment

Clinical impressions and psychological testing suggest that pathological gamblers demonstrate a high incidence of affective disorders. To assess the frequency of such disorders, the Schedule for Affective Disorders and Schizophrenia was administered to 50 patients admitted successively to the gambling treatment program of a VA hospital. Seventy-six percent of the subjects were diagnosed as having major depressive disorder and 38% as having hypomanic disorder according to the Research Diagnostic Criteria. The patients with major depressive disorder and one patient with schizoaffective disorder, depressed type, were significantly more likely to miss work often due to gambling. A large number of patients displayed suicidal tendencies.

Patterns of substance abuse in pathological gamblers undergoing treatment

Increasing public exposure to gambling as a recreational option is leading to increased pathological gambling . The prevalence and correlates of substance abuse in a population of severe pathological gamblers is investigated. The results indicate a high rate of alcohol abuse and drug abuse in this population and in their biological families. The implications of these findings for clinicians working with pathological gamblers and substance abusers are discussed.

Serum-ferritin in diagnosis of haemochromatosis. A study of 43 families

242 members of 43 families with idiopathic haemochromatosis were investigated for increased body-iron stores in order to assess the value of serum-ferritin determination as a screening-test to detect preclinical disease. The serum-iron concentration was elevated in only 76% of relatives with increased iron stores, and it was also elevated in 10% of relatives with normal iron stores. The percentage saturation of transferrin was elevated in all relatives with increased iron stores but also in 33% of relatives with normal iron stores. Serum-ferritin was raised in 98% of relatives with increased iron stores and in only 3 (1.8%) of those with normal iron stores. These 3 subjects consumed alcohol in excess of 100 g ethanol per day, and their serum-ferritin levels fluctuated widely. Increased iron stores were reflected in increased serum-ferritin concentrations in subjects as young as 14 years in whom the liver-iron concentration was twice the normal upper limit and before there was any evidence of architectural damage to the liver. The serum-ferritin concentration is a useful non-invasive screening test for precirrhotic haemochromatosis.