Anatomically curated segmentation of human subcortical structures in high resolution magnetic resonance imaging: An open science approach

Magnetic resonance imaging (MRI)-based brain segmentation has recently been revolutionized by deep learning methods. These methods use large numbers of annotated segmentations to train algorithms that have the potential to perform brain segmentations reliably and quickly. However, training data for these algorithms are frequently obtained from automated brain segmentation systems, which may contain inaccurate neuroanatomy. Thus, the neuroimaging community would benefit from an open source database of high quality, neuroanatomically curated and manually edited MRI brain images, as well as the publicly available tools and detailed procedures for generating these curated data. Manual segmentation approaches are regarded as the gold standard for brain segmentation and parcellation. These approaches underpin the construction of neuroanatomically accurate human brain atlases. In addition, neuroanatomically precise definitions of MRI-based regions of interest (ROIs) derived from manual brain segmentation are essential for accuracy in structural connectivity studies and in surgical planning for procedures such as deep brain stimulation. However, manual segmentation procedures are time and labor intensive, and not practical in studies utilizing very large datasets, large cohorts, or multimodal imaging. Automated segmentation methods were developed to overcome these issues, and provide high data throughput, increased reliability, and multimodal imaging capability. These methods utilize manually labeled brain atlases to automatically parcellate the brain into different ROIs, but do not have the anatomical accuracy of skilled manual segmentation approaches. In the present study, we developed a custom software module for manual editing of brain structures in the freely available 3D Slicer software platform that employs principles and tools based on pioneering work from the Center for Morphometric Analysis (CMA) at Massachusetts General Hospital. We used these novel 3D Slicer segmentation tools and techniques in conjunction with well-established neuroanatomical definitions of subcortical brain structures to manually segment 50 high resolution T1w MRI brains from the Human Connectome Project (HCP) Young Adult database. The structural definitions used herein are associated with specific neuroanatomical ontologies to systematically interrelate histological and MRI-based morphometric definitions. The resulting brain datasets are publicly available and will provide the basis for a larger database of anatomically curated brains as an open science resource.

Anxiety, Depression and Health Beliefs in End Stage Renal Disease (ESRD) Patients

Health locus of control (HLOC) constitutes an important psychological domain of interest to the manifestation and course of disease. Research has shown that health locus of control beliefs can be predictive of anxiety and depression and could therefore act as a good determinant of psychological adjustment for patients with chronic conditions. The aim of this study was to explore the relationship between locus of control health beliefs with depression and anxiety in end stage renal disease patients. Also, to explore whether these beliefs can indeed predict patients’ psychological adjustment. 144 adult patients undergoing haemodialysis or peritoneal dialysis participated in this cross-sectional prospective study. Sociodemographic and medical characteristics were recorded and the following structured questionnaires were administered: the Multidimensional Health Locus of Control (MHLC) (Wallston et al, 1994), the Centre of Epidemiological Studies Depression Scale (CES-D) (Fountoulakis et al, 2001), the State-Trait Anxiety Inventory 2 (STAI 2) and the General Health Questionnaire (GHQ) (Garyfallos et al, 1991). ANOVA analysis was performed to examine whether patients’ MHLC scores correlated with CES-D, STAI 2 and GHQ scores and regression analysis was performed to determine the degree to which health locus of control beliefs can predict depression and anxiety. Results revealed significant relationships between health locus of control beliefs and anxiety, depression thus demonstrating the role health beliefs can play in patients’ psychological adjustment with important implications for clinical practice.

6082A prospective, multicenter, nationwide, observational study of flecainide controlled release on the quality of life of patients with atrial fibrillation in Greece, the REFLEC-CR study

Background/Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia with a considerable impact on patients' quality of life (QoL). Flecainide acetate, is a class Ic antiarrhythmic agent, recommended as first line treatment in AF patients without underlying structural heart disease.

Purpose

This prospective, multicenter, nationwide, observational study aimed to evaluate the effect of oral treatment with controlled-release (CR) flecainide administered once daily on AF patients' QoL and treatment compliance during a 12-week period.

Methods

A total of 70 cardiologists participated in the study enrolling consecutive adult patients with paroxysmal or persistent AF, treated with flecainide CR in the context of a rhythm control strategy. The effect on QoL was assessed by the Canadian Cardiovascular Society Severity of Atrial Fibrillation scale (CCS-SAF) measured at baseline and at 12 weeks of treatment.

Results

In total, 679 patients (53.2% females, mean age 65.9±11.7 years, 86.9% paroxysmal AF) were included in the analysis. At least one prior antiarrhythmic treatment was documented in 43.8% of patients. The initial daily dose of flecainide CR was 100mg in 71.7% of the patients, with a titration to 200mg by the end of study achieved in 67%. In 93.6% of patients an excellent compliance score (100%) to treatment was recorded at the end of the study period. Treatment with flecainide CR resulted in a significant improvement in QoL as presented in the table.

Table 1 CCS-SAF score Baseline (Week 0) End of study visit (Week 12) N=679 N=634 Class 1 (minimal effect on QoL) 343 (50.5) 464 (73.2) Class 2 (minor effect on QoL) 253 (37.2) 140 (22.1) Class 3 (moderate effect on QoL) 73 (10.8) 28 (4.4) Class 4 (severely impairs QoL) 10 (1.5) 2 (0.3) CCS-SAF continuous score   Mean ± SD 1.64±0.73 1.32±0.57 Change from baseline‡   Mean (95% CI) −0.325 (−0.379, −0.271)   p-value <0.0001 ‡Paired t-test is used.

Conclusions

This prospective, multicenter, observational study demonstrated that treatment of AF patients with flecainide CR, was associated with a significant improvement of QoL and excellent compliance to treatment.

Acknowledgement/Funding

Sponsored by WinMedica S.A.

Lifespan Trajectories of White Matter Changes in Rhesus Monkeys

Progress in neurodevelopmental brain research has been achieved through the use of animal models. Such models not only help understanding biological changes that govern brain development, maturation and aging, but are also essential for identifying possible mechanisms of neurodevelopmental and age-related chronic disorders, and to evaluate possible interventions with potential relevance to human disease. Genetic relationship of rhesus monkeys to humans makes those animals a great candidate for such models. With the typical lifespan of 25 years, they undergo cognitive maturation and aging that is similar to this observed in humans. Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking white matter brain maturation and aging. While lifespan trajectories of white matter changes have been mapped in humans, such knowledge is not available for nonhuman primates. Here, we analyze and model lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys. We report quantitative parameters (including slopes and peaks) of lifespan trajectories for 8 individual white matter tracts. We show different trajectories for cellular and extracellular microstructural imaging components that are associated with white matter maturation and aging, and discuss similarities and differences between those in humans and rhesus monkeys, the importance of our findings, and future directions for the field. Significance Statement: Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking brain maturation and aging. While lifespan trajectories of structural white matter changes have been mapped in humans, such knowledge is not available for rhesus monkeys. We present here results of the analysis and modeling of the lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys (age 4-27). We report and anatomically map lifespan changes related to cellular and extracellular microstructural components that are associated with white matter maturation and aging.

Erratum: Prediction for a Four-Neutron Resonance [Phys. Rev. Lett. 117, 182502 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.117.182502.

The "Biopsychosocial Model": 40 years of application in Psychiatry

In 1977, the American pathologist and psychiatrist George Engel (1913-1999) published in the Journal Science his paper "TheIn 1977, the American pathologist and psychiatrist George Engel (1913-1999) published in the Journal Science his paper "Theneed for a new medical model: A challenge for biomedicine", introducing the term Biopsychosocial Model. This model basedon the results of Engel's studies in ulcerative colitis, depression and psychogenic pain, constituted a challenge for biomedicineand the biomedical model. The basic principles of the model included the biological, psychological and social dimensions of the person's life and theperception that the person suffers as a whole and not as isolated organs. The doctor should use a holistic approach regardingillness and should consider his/her relation with the patient socially equal. The personality and the emotional reserves of thepatient, as well as the particular environmental conditions in which the person lives in should be taken into account. There is no doubt that the biopsychosocial model has established a more empathetic and compassionate approach in medical practice. Already since 1936, the general adaptation syndrome had been proposed by the Austrian-Canadian endocrinologist HansSeley (1907-1982), who emphasized that psychological stressful factors may have injurious consequences on health, while theresponse systems to stress may be dysregulated not only by genetic factors, but also from experiences and stressful life events,as well as by harmful behaviors such as smoking, alcohol consumption and lack of physical exercise. Psychosocial factors may co-determine the patient's vulnerability and the illness's severity and course. The biopsychosocialmodel consider the interactions with genetic susceptibility, personality, stressful events and, generally, with the patient's socialcontext. Environmental factors increase the probability of the clinical expression of a mental disorder, play a role in the time ofonset of an illness's manifestation, and they can also protect a vulnerable person from the disease. Stressful experiences modify immunological response and influence treatment compliance. Non adherence to pharmacotherapy,as well as to the psychosocial interventions, may cause defective recovery of psychosocial functioning, recurrence ofthe disorder, as well as insufficient use of health resources and a higher health care cost. The psychoeducation of patients andtheir relatives by the application of the biopsychosocial model plays an important role in psychiatric therapeutics, and it mayalso be used via Internet in the frame of telepsychiatry. Results from neuroimaging studies have shown that the different kinds of human experiences, traumatic or therapeutic, havemeasurable influences on the brain function. Psychotherapy may modify the neuronal connections of the brain in the frame ofits plasticity, as was found by the discovery of synaptogenesis in response to learning and can, thus, be considered not only as astrictly psychological but also as a biopsychosocial form of treatment. Among the disadvantages of the biopsychosocial model have been reported the lack of a concise theoretical frameworkregarding its function and content, that it is complicated, difficulties in its coordination and assignment of responsibilities, aswell as problems with the education on it being multifaceted. The biopsychosocial model has been criticized that it does notconstitute a scientific or philosophical model, it does not provide an answer to the crucial question of how the biological, psychologicaland social variables interact in the disease's expression, that it does not provide guidance on the exact time of itsapplication and, finally, that it allows for a wide range of interventions without providing specific guidelines of a concrete therapeutic scheme. The person-centered diagnosis is based on the biopsychosocial model, connects science with humanism and uses all thepossible ways so that the clinicians, the patients and their families collaborate for a more effective management of the disease.This approach has been established by the World Psychiatric Association (WPA, 2007) as the program "Psychiatry for the Person". Psychiatry in everyday practice presents particularities versus other medical disciplines due to the complexity and polymorphismPsychiatry in everyday practice presents particularities versus other medical disciplines due to the complexity and polymorphismof the expression of mental disorders, their close relation to psychosocial factors, the lack of explicit pathognomonicelements and the stigmatization of mental illness. For these reasons, the biopsychosocial model is particularly applicable inpsychiatric disorders, but it should not be over looked also in somatic illnesses. The biopsychosocial model, despite the criticism it was subjected to, continues to offer valuable clinical, educational andresearch services, as well as to provide an important contribution to the formation of health policies, not only for psychiatry, butfor the whole of medicine as well.

Prediction for a Four-Neutron Resonance

We utilize various ab initio approaches to search for a low-lying resonance in the four-neutron (4n) system using the JISP16 realistic NN interaction. Our most accurate prediction is obtained using a J-matrix extension of the no-core shell model and suggests a 4n resonant state at an energy near E_{r}=0.8  MeV with a width of approximately Γ=1.4  MeV.

Religiosity dimensions and subjective health status in Greek students

The quest for existential meaning constitutes a universal phenomenon traditionally manifested in official religions (religiosity) or personal modes of transcendence (spirituality). Religiosity and spirituality have been found to be associated with a variety of mental health and illness parameters. In the last decades there is an increasing number of publications with interesting results on the relationship between religiosity and mental health, both on a theoretical and a clinical level. Recent research suggests the presence of clinically important interactions between religious beliefs and mental health, although the exact nature of the associations remains unclear. The aim of the present study is to investigate subjective health status in relation to specific dimensions of religiosity and spirituality in Greek students; 202 students of the faculty of Theology of the University of Athens were interviewed using the Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS), which assesses the dimensions of "daily spiritual experiences", "meaning", "values/beliefs", "forgiveness", "private religious practices", "religious/spiritual coping", "religious support", "religious/ spiritual history", "commitment", "organizational religiousness", and "religious preferences". Subjective health status was measured by the General Health Questionnaire (GHQ-28) which examines four areas of health in the following sub-scales: (a) somatic symptoms, (b) anxiety and insomnia, (c) social dysfunction and (d) severe depression. Pearson correlations coefficients and linear regression analyses were used to estimate the associations of GHQ-28 subscales with religiosity dimensions. High scores in each dimension of BMMRS corresponded to a low level of religiosity. The dimension of "daily spiritual experiences" was positively correlated with the subscales of anxiety/ insomnia, social dysfunction and severe depression, while the dimension of "values/beliefs" with social dysfunction and severe depression and the dimension of "forgiveness" with all GHQ-28 subscales. The "organizational religiousness" dimension was positively correlated with anxiety/ insomnia, while overall self-ranking with social dysfunction and severe depression. Additionally, the dimension of "meaning" had a negative correlation with somatic symptoms. Moreover, in the multiple linear regression analyses, "meaning" was independently negative associated with somatic symptoms (p=0.032), whilst "daily spiritual experiences" were positively associated with anxiety/insomnia (p=0.023). Also, "values/beliefs and the overall self-ranking were positively associated with social dysfunction (p=0.026), (p=0.01) and "daily spiritual experiences", "values/beliefs", "forgiveness", as well as the overall self-ranking with severe depression (p=0.03), (p=0.01), (p=0.017), (p=0.009). Certain religiosity dimensions ("daily spiritual experiences", "values/beliefs", "forgiveness" and "organizational religiousness") were correlated with lower morbidity, in accordance to previous reports in different populations, whereas "meaning" was correlated with more somatic symptoms.

Female sexuality after female cancer treatment: a clinical issue

PURPOSE OF INVESTIGATION

The aim of the present study was to record how the treatment of female cancer may affect sexuality and interpersonal relations in the couple.

MATERIAL AND METHODS

From September 2008 until February 2012, the authors prospectively studied 67 patients with breast cancer (Group A) and 43 with gynecological cancers (Group B). As control groups 33 patients with benign breast and 30 patients with benign gynecological lesions (group 0a and 0b respectively) were used. Sexuality and interpersonal relations were evaluated by a questionnaire. The authors also evaluated interpersonal relations focusing on sexual function at the time of diagnosis and a year after the initial treatment for cancer.

RESULTS

A significant reduction of the "sexual desire", "sexual Arousal", and "orgasm" dimension was found in both cancer groups, in contrast to the control group, revealing no significant change. The "sexual enjoyment" scale was significantly decreased in gynecological cancer group but not in breast cancer group. While the score on the "relationship quality" dimension significantly increased in both cancer groups. In all groups, there was a significantly positive correlation between sexual function and enjoyment; on the contrary, there was a significantly negative correlation between relationship quality and sexual function and enjoyment.

CONCLUSION

Sexual dysfunctions is a clinical problem which should be evidenced at the beginning of therapy, from the oncologists in order to provide integrated treatment to their patients.

Glandular cystitis and lithium intoxication in a patient with bipolar disorder

A 42-year-old woman, with a 12-year history of bipolar disorder was referred to our department due to tremor, sedation, dysarthria, polyuria and polydipsia. She had been on lithium monotherapy during the last 3 years. On admission, her cognitive status was intact, and neither depression nor euphoria was reported. Lithium plasma levels were 1.6 mEq/L, whereas creatinine and urea levels were 2.8 IU/L and 110 IU/L, respectively. The patient did not take other medications or misused lithium. Lithium was immediately discontinued. Ultrasound scans of the urinary tract were suggestive of bilateral hydronephrosis secondary to bladder contraction and cystoscopy-guided bladder biopsy revealed glandular cystitis a benign tumour into the bladder's wall, which impeded the bladder's contraction leading to hydronephrosis and subsequent toxic lithium plasma levels. The patient was switched to valproate and was referred for surgical excision of the lesion. One year later, she was in good physical and mental health under treatment with valproate (1000 mg/day). This is the first case report of glandular cystitis leading to lithium intoxication by impairing renal function. Acute renal failure leading to lithium intoxication would be possible. However, a thorough imaging, endoscopical and histological study revealed glandular cystitis as the cause of renal impairment. Although physicians are alert about lithium's toxicity and a monitoring of renal function is routinely prescribed, little focus has been made on the integrity of the urinary tract. We suggest that urinary tract imaging should be part of the routine work-up in patients presenting with symptoms and signs of lithium intoxication, since concomitant urinary tract lesions might occasionally be the cause of renal impairment leading to reduced lithium excretion.

The impact of HPV diagnosis on women's sexual and mental health: preliminary findings

PURPOSE OF INVESTIGATION

The objective of the present study was to demonstrate the impact of HPV diagnosis on sexual function and mental health of Greek women.

METHODS

The study population included 51 patients who proceeded to the gynecological outpatient clinic of "Aretaieion" Hospital, Athens, during 2008-2009. The participants were asked to complete a questionnaire regarding demographic characteristics, knowledge on HPV, gynecological and sexual history, as well as questions regarding their mental and sexual health after the diagnosis.

RESULTS

Mean age of the participants was 36 years and mean age of their first Pap smear test was 24.4 years. Mean age of HPV diagnosis was 34 years and mean number of sexual partners was four. Regarding mental health, the majority experienced anxiety after the HPV diagnosis as well as fear regarding their health in the future. Nearly half of the women experienced guilt and anger and some of them distress, shame, diminution of self-esteem and stigmatization. Diminution in the level of sexual interest and desire and decrease in sexual intercourse frequency were quite often reported.

CONCLUSION

Except for the important physical impact of HPV infection, its diagnosis seems to trigger several negative feelings and reduce sexual desire.

Contrasting patterns of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral

BACKGROUND

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses.

METHOD

Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and non-psychiatric Controls (matched groups, n=15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

RESULTS

ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p=0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p<0.03; Control/NECT p<0.01) and the Spatial Recognition Memory (SRM) task (p<0.05; Controls/NECTs p<0.05); ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p<0.01; Controls/ECTs p<0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H=11, p<0.01) but ECTs who completed SOC performed comparably to the other two groups.

CONCLUSIONS

A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT depressives.

Hormones in the immediate postpartum period as a risk factor for postnatal depression, at two months postpartum

Introduction

Postnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.

Objectives

It is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.

Aims

This study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.

Methods

95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.

Results

Women who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).

Conclusions

Our study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.

Genomewide linkage scan of schizophrenia in a large multicenter pedigree sample using single nucleotide polymorphisms

A genomewide linkage scan was carried out in eight clinical samples of informative schizophrenia families. After all quality control checks, the analysis of 707 European-ancestry families included 1615 affected and 1602 unaffected genotyped individuals, and the analysis of all 807 families included 1900 affected and 1839 unaffected individuals. Multipoint linkage analysis with correction for marker-marker linkage disequilibrium was carried out with 5861 single nucleotide polymorphisms (SNPs; Illumina version 4.0 linkage map). Suggestive evidence for linkage (European families) was observed on chromosomes 8p21, 8q24.1, 9q34 and 12q24.1 in nonparametric and/or parametric analyses. In a logistic regression allele-sharing analysis of linkage allowing for intersite heterogeneity, genomewide significant evidence for linkage was observed on chromosome 10p12. Significant heterogeneity was also observed on chromosome 22q11.1. Evidence for linkage across family sets and analyses was most consistent on chromosome 8p21, with a one-LOD support interval that does not include the candidate gene NRG1, suggesting that one or more other susceptibility loci might exist in the region. In this era of genomewide association and deep resequencing studies, consensus linkage regions deserve continued attention, given that linkage signals can be produced by many types of genomic variation, including any combination of multiple common or rare SNPs or copy number variants in a region.

A study of eating attitudes and related factors in a sample of first-year female Nutrition and Dietetics students of Harokopion University in Athens, Greece

OBJECTIVE

To investigate eating attitudes and related factors in a sample of first-year female students of Harokopion University, Nutrition and Dietetics (ND) School.

METHOD

The Eating Attitudes Test (EAT-26), a set of 12 male and female figures, and two questionnaires for demographic, clinical and nutritional data were administered to 53 ND students and 54 first-year female students of Athens Technological Institution Health Visitors (HV) School.

RESULTS

The ND group scored higher in EAT-26 total score (p=0.05) and Diet subscale (p=0.02) than the HV group. EAT-26 score in the ND group correlated significantly with dinner avoidance (correlation coefficient: 0.3, p=0.02). Logistic regression analysis showed that avoidance of dinner (p=0.03), choosing leaner ideal women figures (p=0.005) and larger self images (p=0.01) were the three factors that could predict high EAT-26 scores in the ND group (EAT-26>or=20).

CONCLUSIONS

First-year ND students might have more often disordered eating attitudes as opposed to students from other university programs.

Correlation Between Depression and Interferon-Beta Therapy in Patients with Multiple Sclerosis: A Systematic Review

Introduction:

Depression is the most frequent psychiatric disorder encountered in patients with Multiple Sclerosis (MS), with a life-time prevalence of approximately 50%. INF-beta (INF-β) shows beneficial effect on the course of MS. Although it has been suggested that interferons may be associated to depression, the validity and the nature of this relationship remain unclear regarding INF-β. The objective of this study is to review the scientific literature in order to elucidate the relationship between depression and INF-β therapy.

Methods:

This systematic review was based on Medline, Embase and, PsycLIT literature searches (through January 2005), supplemented by bibliographical citations in identified papers.

Results:

The majority of studies ruled out a correlation between INF-β1a/1b and depression in MS patients. However, patients with a recent history of depression may be at higher risk for depression particularly in the early phase of treatment (first 6 months), even if they are not depressed at the initiation of medication. There is an association between depressive symptoms and discontinuation of INF therapy but INF-β does not seem to be associated with suicide attempts. Treating patient-reported depression increases adherence to treatment.

Conclusions:

Clinicians should not refrain from including patients with MS in INF-β treatment programs, even those with depression in the past or at the present time. Screening, monitoring, and early antidepressant treatment is necessary to optimize IFN therapy for the majority of patients with MS.

Quetiapine and Hypothyroidism: A Literature Review

Objective:

Recently, there is an interest on the possible association between quetiapine and hypothyroidism. the aim of this study is to critically review all the reported cases in the international literature.

Methods:

A Medline search for all studies dealing with quetiapine induced hypothyroidism was carried out from January 1997 to June 2008.

Results:

Published literature on quetiapine's impact on thyroid function consists of 1 double-blind study, 1 observational study, 2 open studies, 3 case reports and data from the product monograph. A study on elderly psychotic patients revealed only small decreases in T4 levels, while another one in adolescents show trends for decrease in T4 and a marked increase in TSH. an observational study of thyroid function in patients treated with quetiapine and other antipsychotics, found a decrease in T4 with no changes in TSH and T3 and another one only slight increases in TSH. in the case reports all patients excibited clinical hypothyroidism. in one case there was a positive history for hypothyroidism, while in another one the patient had experienced lithium induced hypothyroidism in the past. According to quetiapine manufacturer 0.4% of the patients experienced TSH increases with half of them requiring thyroid replacement treatment. in studies, where quetiapine was adjunct to lithium or divalproate, 12% of patients had elevated TSH levels.

Conclusion:

We suggest a careful thyroid monitoring for patients initiating quetiapine, since hypothyroidism may emerge and masquerade psychopathologic manifestations. However, there is an open question whether thyroid dysfunction is a permanent or reversible condition.

Directional Persistence in the Rewarded Alternation Model of Obsessive-compulsive Disorder is Responsive to both Dopaminergic and Serotonergic Manipulations

Rationale:

In the rewarded alternation model of obsessive compulsive disorder (OCD), the serotonin agonist m-chlorophenylpiperazine (mCPP) increases persistent behaviour, while chronic pretreatment with selective serotonin reuptake inhibitor (SSRI-fluoxetine) but not benzodiazepine or desipramine abolishes mCPP effects. However, we noted that acute SSRI administration also causes transient persistence increases, counteracted by mCPP pretreatment.

Objectives:

This study

a.

Methods:

In both experiments, baseline and drug testing was carried out under daily T-maze alternation training.

Exp.1:

Matched group (n=8) pairs of rats received one of the following 20-day pretreatments (daily intraperitoneal administration):

1.

One group per pretreatment then received a 4-day challenge with high-dose fluoxetine (10mg/kg), the other with high-dose mCPP (2.5mg/kg).

Exp.2:

One group (n=12) of rats received 20-day treatment with saline, another with quinpirole (0.5 mg/kg).

Results:

Exp.1:

Saline and low-dose mCPP- or fluoxetine-pretreated animals showed significant persistence increases under both challenges, while combined low-dose fluoxetine+mCPP pretreatment afforded full protection from either challenge.

Exp.2:

Quinpirole significantly increased directional persistence after 13 administration days.

Conclusions:

These results establish the sensitivity of the rewarded alternation OCD model to D2,3receptor activation, thereby extending its profile of pharmacological isomorphism with OCD. Furthermore, they suggest a common mechanism of action of an SSRI and a serotonin agonist in the control of directional persistence.

an Investigation of 5-ht2 Involvement in the Acute Behavioural Effects of Fluoxetine and MCPP in an Animal Model of OCD

Background:

We reported that the non-specific 5HT agonist m-chlorophenylpiperazine (mCPP) and the SSRI fluoxetine (FLX) both cause acute persistence increases in the rewarded alternation (RA) model of OCD. Chronic pretreatment with either substance or their combined subclinical doses protects from this ‘pathogenic’ effect, so mCPP and fluoxetine exhibit cross-tolerance and synergy.

Aims:

Using specific 5HT2A and 5HT2C receptor antagonists we investigated whether these receptors participate in a common mechanism of action mediating the acute mCPP/fluoxetine effect in our model.

Methods:

Naïve, male Wistars were used. Drugs used (intraperitoneally): FLX (10mg/kg), mCPP (2.5mg/kg), M100907 (5HT2A antagonist, 0.03mg/kg), SB242084 (5HT2C antagonist, 0.5mg/kg), vehicle. Experiments included a drug-free training/baseline phase in T-maze RA (group-matching for spontaneous persistence: SP).

Experiment 1: Effects of M100907, SB242084, vehicle were assessed on 3 matched low SP and 3 high SP groups.

Experiment 2: the acute effect of FLX, mCPP and saline were examined on RA in 3 SP-matched groups.

Experiment 3: Effects of Vehicle+FLX, M100900+FLX, SB242084+FLX and Vehicle were examined on RA, in 4 SP-matched groups.

Experiment 4: Correspondingly for mCPP.

Results:

Experiment 1: Neither M100907 nor SB242084 affected high or low SP.

Experiment 2 replicated the pathogenic effects of FLX/mCPP.

Experiment 3: Neither M100907 nor SB242084 affected the pathogenic effect of FLX.

Experiment 4: in contrast, SB242084 (but not M100907) significantly reduced the pathogenic mCPP effect.

Conclusions:

The acute pathogenic action of mCPP, but not of FLX, involves 5HT2C but not 5HT2A receptors. the similar acute action of mCPP and FLX on persistence cannot be attributed to 5HT2 mediation.

Can Quetiapine Induced Hypothyroidism be Reversible?

Objective:

Quetiapine induced hypothyroidism is a rare side effect requiring either drug discontinuation or initiation of thyroid replacement therapy. We highlight the potential reversibility of quetiapine induced hypothyroidism in two such cases.

Methods:

Two case reports.

Results:

Case 1.Quetiapine (200mg/day) was initiated to a psychotic female patient due to exaggeration of positive symptomatology. Although her thyroid function tests (TFTs) upon admission were normal after a month significant decreases in T3 and T4 level and an elevation in TSH was observed. 45 days later the TFT returned to normal, although she remained on quetiapine. Case 2. Quetiapine (300mg/daily) was prescribed to a bipolar male patient due to a mixed affective episode with a very good response. Despite his normal admission TFTs, three weeks later a decrease in total T4 and a marked increase in TSH was observed .45 days later, although no measures were taken, TFTs returned within reference range.

Conclusions:

These are the first cases reporting reversibility of quetiapine induced hypothyroidism. TFTs alterations are dose related, relatively slight and linked to a positive history of thyroid abnormality. Our patients did not fulfil any of these criteria. Besides, hypothyroidism resolved although the antipsychotic therapy was continued and no thyroid replacement therapy was given. We suggest a careful thyroid monitoring for patients initiating quetiapine. However, physicians should wait in cases of thyroid dysfunction, since thyroid dysregulation may soon be resolved.

Abduction of Children by Their Parents: The Psychopathological Approach of the Problem in Mixed-ethnicity Marriages

Introduction:

Children abduction by one parent and their transport refers to a foreign country is a gradually increasing phenomenon worldwide as well as Greece. Data from the Greek Ministry of Justice show that the frequency of such incidences is up to one a day (360/year). Some but not all of these cases come to the attention of the International Social Services (Division of Greece).

Method:

Records of fifty (50) cases of inter family abduction were obtained. These were cases that took place during the year 2003. These records were studied and analysed. The majority of cases concerned abductions within the European Union. Permission from the Personal Data Protection service was obtained before the research.

Results:

It was found that fathers were predominantly the abductors (60%). Based on the medical records of the parents, the abductor had established psychopathology (fathers 51,1%; mothers 48,5%). The abducting fathers made significant use of violence (50%) compared to the mother abductors (20%). The legal procedures that ensued the abductions were particularly prolonged: The trial period until the reach of a verdict took an average of 3 years.

Conclusions:

In the cases of children abduction by a parent, there is high correlation between the action and the psychopathology of the abductor. The need for establishment of services appropriate to face this multidisciplinary problem is imminent. The long time each case takes to be resolved has obvious implications for the mental health of the children and the parents involved.

Depressive Symptoms as Predictors of the Severity of Fatigue in Major Depression

Objective:

Fatigue in patients with major depression is understudied, although highly prominent. The objective of this study was to investigate the independent correlation of various depressive symptoms with the severity of fatigue in major depression.

Methods:

Eighty-one patients (70 female/11 male, 40 inpatients/41 outpatients), aged 23-65 years (mean 48.6±10.6), with a DSM-IV main diagnosis of Major Depressive Disorder (М.Ι.Ν.Ι. 5.0.0.) and currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score ≥15], were studied. Patients with physical diseases or other fatigue-related conditions were excluded. The 14-item Fatigue Questionnaire (FQ) was used for the assessment of reported fatigue. Factor analysis of all HDRS items was performed. Pearson's correlations between the derived regression factor scores and the FQ score were calculated. Age, gender, and factor scores that significantly correlated with the FQ score entered a multiple regression analysis, with the FQ score as the dependent variable.

Results:

Factor analysis of HDRS items indicated a 6-factor structure (F1 ‘depressed mood’, F2 ‘middle/late insomnia and somatic anxiety’, F3 ‘anorexia/ weight loss’, F4 ‘general somatic symptoms’, F5 ‘anxiety/hypochondriasis’, F6 ‘early insomnia’). Only factors F1 (items 1,3,7,8), F2 (items 5,6,11) and F4 (items 13,14,17) were significantly correlated with the FQ score (p< 0.05). F1, F2 and F4 turned out to be significant predictors of FQ in the multiple regression, with standardised beta coefficients of 0.291, 0.290 and 0.278 (p< 0.05), respectively.

Conclusions:

Depressed mood, somatic anxiety, middle and late insomnia correlate independently with the severity of fatigue reported by patients with major depression.

Reversible Glückspielsucht unter Pramipexol

In the recent past, pathological gambling has been increasingly reported to be related with dopamine agonist application in patients with Parkinson's disease. We present the case of a female patient whose gambling behavior occurred shortly after reaching the final dose of a combined levodopa and pramipexole therapy and resolved completely after stopping pramipexole. Pathological gambling seems to be a rare and serious but reversible adverse reaction to treatment with dopamine agonists of which clinicians should be aware in patients with Parkinson's disease.

Rates and social patterning of household smoking and breastfeeding in contrasting European settings

OBJECTIVE

To compare rates and social patterning of household smoking and breastfeeding in families with newborn infants in birth cohorts in Coventry, UK and Veria, North Greece.

METHODS

Infants born in 1996 in Coventry, 1999 in Veria were recruited into birth cohort studies using similar methodologies. In Coventry recruitment was by family health visitor at the primary visit; in Veria, hospital-based paediatricians enrolled infants at the neonatal examination. Data were collected at the initial contact on household smoking, type of feeding, and household socio-demographic characteristics. Rates of initial breastfeeding and household smoking with 95% confidence intervals were estimated and breastfeeding and household smoking regressed on parental education and housing tenure in logistic regression models.

RESULTS

Data were available on 2612 Coventry infants and 773 Veria infants. Rates of household smoking and breastfeeding were higher in Veria compared to Coventry. In Coventry, living in rented accommodation and lower maternal and paternal education were associated with household smoking and bottle feeding. Logistic regression models fitted on initiation of breastfeeding failed to show social patterning in Veria but more educated mothers showed a longer duration of breastfeeding. Only low paternal education was associated with household smoking after adjustment for maternal education and housing tenure.

CONCLUSIONS

Smoking and breastfeeding are more prevalent among households with young infants in Veria compared with Coventry. The social patterning of health-related behaviours noted in Coventry is less marked in Veria. The relevance of these findings for public health interventions in the contrasting settings is discussed.

Multicenter linkage study of schizophrenia loci on chromosome 22q

The hypothesis of the existence of one or more schizophrenia susceptibility loci on chromosome 22q is supported by reports of genetic linkage and association, meta-analyses of linkage, and the observation of elevated risk for psychosis in people with velocardiofacial syndrome, caused by 22q11 microdeletions. We tested this hypothesis by evaluating 10 microsatellite markers spanning 22q in a multicenter sample of 779 pedigrees. We also incorporated age at onset and sex into the analysis as covariates. No significant evidence for linkage to schizophrenia or for linkage associated with earlier age at onset, gender, or heterogeneity across sites was observed. We interpret these findings to mean that the population-wide effects of putative 22q schizophrenia susceptibility loci are too weak to detect with linkage analysis even in large samples.

Lack of association between GABRA3 and unipolar affective disorder: a multicentre study

Available data on gamma amino butyric acid (GABA) support the hypothesis that a dysfunction in the brain GABAergic system activity contributes to vulnerability to affective disorders (AD), including bipolar disorder (BPAD) and unipolar disorder (UPAD). The localization of the alpha3 subunit GABA receptor (GABRA3) gene in Xq28, a region of interest for BPAD suggests that GABRA3 may be a relevant candidate gene. In the present study, we tested the genetic contribution of the GABRA3 dinucleotide polymorphism in a European multicentre UPAD case-control sample [UPAD (n = 106), controls (n = 212)]. Our negative results suggest that GABRA3 does not confer susceptibility nor is it in linkage disequilibrium with another close gene involved in the genetic aetiology of UPAD.

Association between GABA-A receptor alpha 5 subunit gene locus and schizophrenia of a later age of onset

Heritability is considered to be a major etiologic factor for schizophrenia. Among the genes considered as candidates for the disease, are those related to GABAergic neurotransmission. Our aim was to test for a genetic association between GABA-A receptor alpha 5 subunit gene locus (GABRA(5)) and schizophrenia. Genotyping of the GABRA(5) locus was performed by the use of a dinucleotide (CA) repeat marker in 46 schizophrenic patients and 50 healthy individuals, all unrelated Greeks. Eight alleles were identified, 276-290 bp long. A nonsignificant excess of the 282-bp allele, which was found in a previous study in a Greek population to be associated with bipolar affective disorder, was observed in schizophrenic patients (33.8 vs. 23.9% in the controls). The frequency of this allele was 43.3% among patients with a later age of onset (over 25 years), differing at a statistically significant level from the controls (p < 0.05). These results suggest that common pathophysiological mechanisms may possibly underlie affective disorders and schizophrenia, at least in a subgroup of patients.

Tryptophan hydroxylase polymorphism and suicidality in unipolar and bipolar affective disorders: a multicenter association study

BACKGROUND

Being the rate-limiting enzyme in the biosynthesis of serotonin, the tryptophan hydroxylase gene (TPH) has been considered a possible candidate gene in bipolar and unipolar affective disorders (BPAD and UPAD). Several studies have investigated the possible role of TPH polymorphisms in affective disorders and suicidal behavior.

METHODS

The TPH A218C polymorphism has been investigated in 927 patients (527 BPAD and 400 UPAD) and their matched healthy control subjects collected within the European Collaborative Project on Affective Disorders.

RESULTS

No difference of genotype distribution or allele distribution was found in BPAD or UPAD. No statistically significant difference was observed for allele frequency and genotypes counts. In a genotype per genotype analysis in UPAD patients with a personal history of suicide attempt, the frequency of the C-C genotype (homozygosity for the short allele) was lower in UPAD patients (24%) than in control subjects (43%) (chi(2) = 4.67, p =.03). There was no difference in allele or genotype frequency between patients presenting violent suicidal behavior (n = 48) and their matched control subjects.

CONCLUSIONS

We failed to detect an association between the A218C polymorphism of the TPH gene and BPAD and UPAD in a large European sample. Homozygosity for the short allele is significantly less frequent in a subgroup of UPAD patients with a history of suicide attempt than in control subjects.

A European multicenter association study of HTR2A receptor polymorphism in bipolar affective disorder

The available data on the role of 5-HT in a variety of behaviors support the hypothesis that a dysfunction in brain serotoninergic system activity contributes to vulnerability to major depression. The diversity in the electrophysiological actions of 5-HT in the central nervous system can now be categorized according to receptor subtypes and their respective effector mechanisms. In particular, the implication of central postsynaptic 5-HT2A receptor in affective disorders has been supported by findings consistent with the hypothesis of 5-HT2A receptor up-regulation in depression. For these reasons, the 5-HT2A receptor (HTR2A) gene can be considered as a candidate gene in bipolar affective disorder (BPAD). We tested the possible genetic contribution of the polymorphic DNA variation T102C in exon 1 of HTR2A (chromosome 13q14-21) gene in a large European multicentric case-control sample. Allele and genotype frequencies, as well as homo-heterozygote distributions were compared between the two groups of 309 bipolar affective disorder patients and 309 matched controls. No significant differences were observed in the allelic and genotypic (also for homo-heterozygote) distribution between BPAD and controls. These results indicate that, in our sample, the 5-HT2A receptor polymorphism studied is unlikely to play a major role in the genetic susceptibility to BPAD. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:136-140, 2000.

The dexamethasone suppression test and sleep electroencephalogram in nonbipolar major depressed inpatients: a multivariate analysis

BACKGROUND

The present study further examined relationships between postdexamethasone cortisol plasma values and sleep electroencephalogram (EEG) parameters.

METHODS

The dexamethasone suppression test (DST) and polysomnographic recordings were performed in a sample of 300 inpatients with primary major depressive disorder (MDD) (102 men and 198 women, mean age 44 +/- 12 years, range 20-74 years) consecutively admitted to Erasme Hospital (Brussels, Belgium) between 1981 and 1992.

RESULTS

The DST was abnormal in 40% of the sample. Postdexamethasone cortisol plasma values at 4:00 PM were significantly influenced by age, but not by gender. They were also significantly and positively correlated with weight loss, total scores on the Hamilton Depression Rating Scale, total scores on the Newcastle Scale, percentage of awakenings during sleep, and percent of stage 1. They were significantly and negatively correlated with percent of stage 2, slow-wave sleep, and REM sleep. Multiple regression analyses were conducted in two successive steps. First among clinical variables, only age and depressive symptom severity remained correlated with postdexamethasone plasma cortisol values. In the second step, with age and severity held constant, postdexamethasone plasma cortisol values were positively associated with amount of wake time and stage 1, and negatively with amount of slow-wave sleep.

CONCLUSIONS

These findings provide further indirect support for an overarousal state in MDD with sympathoadrenal system hyperactivity and impaired sleep continuity. They also underline the importance of taking into account various clinical confounding factors in the interpretation of both DST and sleep EEG results.

TSH response to TRH and EEG sleep in non-bipolar major depression: a multivariate approach

The TSH response to TRH and selected sleep EEG variables were studied in a homogeneous sample of 280 non-bipolar major depressed inpatients (95 males and 185 females). The TSH response to TRH was blunted in 28% of the sample. delta max TSH was correlated negatively with age, Hamilton rating scale, Newcastle scale, percentage of wake, and positively with basal TSH, percentage of stage II, slow wave sleep, REM sleep and REM latency. delta max TSH was also lower in male patients and in patients suffering from an endogenous or a psychotic subtype of major depression. Basal TSH was only correlated negatively with the Newcastle score. In view of intercorrelations between all these variables, and because of the confounding effect of age, gender and severity on both the TSH response to TRH and sleep EEG variables, a multiple regression analysis was performed and demonstrated that basal TSH and gender were the two variables with the highest contribution to the delta max TSH variance, followed by age and the presence of psychotic symptoms. When controlling strictly for these significant effects, correlation with the severity or with the endogenous character of depression, and with sleep EEG parameters disappeared.

Prolactin and thyrotropin responses to ECT after pindolol administration. A placebo controlled study

The effect of pindolol, a beta-receptor blocker with potent 5-HT1 receptor antagonistic properties, on the prolactin (PRL) and thyrotropin (TSH) responses to electroconvulsive therapy (ECT) was systematically studied in 12 female depressed patients. In a balanced order, crossover design, the patients were given placebo or pindolol 5 mg orally, 1 h prior to bilateral ECT. The last five patients were additionally tested with 10 mg pindolol during the third ECT. Plasma levels of PRL and TSH increased in all three trials, but no consistent effect of pindolol on these hormonal responses could be demonstrated. Pindolol tended to attenuate seizure duration, especially at the 10 mg dose. The participation of 5-HT1 receptor activity in the secretion of PRL and TSH during ECT remains uncertain.

Thyrotropin and prolactin responses to ECT in schizophrenia and depression

Thyroid stimulating hormone (TSH) and prolactin (PRL) plasma levels were studied during electroconvulsive therapy (ECT) in five schizophrenic patients in a simulated ECT (SECT) controlled experimental design. The data were compared to those obtained from a group of 10 depressed patients treated with ECT. In the schizophrenic group, both PRL and TSH increased significantly during ECT compared to SECT, as they did in the depressive group during ECT. Thus, the hormonal TSH and PRL profile during ECT is similar in schizophrenia and depression. It is concluded that the changes in TSH and PRL induced by ECT are specifically linked to the current or the seizure, and are not related to the type of psychopathology.

Ritanserin, a 5-HT2 receptor antagonist, does not modify ECT-induced prolactin release

The effect of pretreatment with ritanserin, a potent and selective serotonin-S2 (5-HT2) receptor antagonist, on the prolactin (PRL) response to electroconvulsive therapy (ECT) was studied in seven female patients suffering from major depressive disorder. They were given either ECT alone, or ECT after 10 or 20 mg ritanserin PO, and PRL was estimated in blood samples taken at times -5, 0, +5, +15, +30 and +60 min. The PRL responses after drug administration were not different from the responses after ECT alone. We conclude that, if serotonergic mechanisms are involved in the ECT-induced PRL increase, this neuroendocrine response seems to be rather a 5-HT1 than 5-HT2 receptor mediated event.

Alpha-2-adrenoreceptor binding as a possible vulnerability marker for affective disorders

The affinity (1/Kd) and density (Bmax) of alpha 2-adrenoreceptors in platelet membranes were studied in patients with major depressed illness (n = 10), affected first-degree relatives (n = 17), nonaffected first-degree relatives (n = 44) and controls (n = 31). The alpha 2 selective antagonist 3H-yohimbine was used as the radioligand. The mean Bmax values of affected subjects (probands and relatives) were significantly lower than those of controls. There was no difference in Kd values between the controls and affected subjects. There was a positive gradient of the mean Bmax values from the groups of probands to affected relatives, unaffected relatives and control subjects. A familial effect of Bmax values between members of the same families confirms a genetic control of alpha-receptor affinity. These results support the hypothesis that the density of alpha 2-adrenoreceptors, evaluated by 3H-yohimbine binding on human platelets, could be a potential vulnerability marker for affective disorder.