The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

Although endangerment towards others is a criterion for an involuntary admission in many countries, research on risk assessment of endangerment among involuntarily admitted individuals is limited. In this retrospective case-control study, we calculated scores for a German-translated version of the Violence Risk Screening-10 (V-RISK-10) and the Brøset Violence Checklist (BVC) in a sample of 111 people undergoing an involuntary admission in Reinickendorf, Berlin. Outcomes were violence, coercive measures, and readmission. In line with our hypotheses, the BVC demonstrated stronger predictive validities for short-term, and V-RISK-10 for long-term events. There was an incremental validity for both instruments for restraint 24 hours after admission and any violence until discharge. These findings support the evidence that structured risk assessment instruments may be useful for individuals undergoing an involuntary admission. Ethical considerations about screening procedures are discussed.

Large abdominal mechanoreceptive sense organs in small plant-dwelling insects

The Hemiptera, with approximately 98 000 species, is one of the largest insect orders. Most species feed by sucking sap from plant tissues and are thus often vectors for economically important phytopathogens. Well known within this group are the large cicadas (Cicadomorpha: Cicadoidea: Cicadidae) because they produce extremely loud airborne sounds. Less well known are their mostly tiny relatives, the leafhoppers, spittlebugs, treehoppers and planthoppers that communicate by silent vibrational signals. While the generation of these signals has been extensively investigated, the mechanisms of their perception are poorly understood. This study provides a complete description and three-dimensional reconstruction of a large and complex array of mechanoreceptors in the first abdominal segments of the Rhododendron leafhopper Graphocephala fennahi (Cicadomorpha: Membracoidea: Cicadellidae). Further, we identify homologous organs in the spittlebug Philaenus spumarius (Cicadomorpha: Cercopoidea: Aphrophoridae) and the planthopper Issus coleoptratus (Fulgoromorpha: Fulgoroidea: Issidae). Such large abdominal sensory arrays have not been found in any other insect orders studied so far. This indicates that these sense organs, together with the signal-producing tymbal organ, constitute a synapomorphy of the Tymbalia (Hemiptera excl. Sternorrhyncha). Our results contribute to the understanding of the evolution from substrate-borne to airborne communication in insects.

Neospora caninum DNA distribution in tissues of gerbils as experimental models of chronic neosporosis

ABSTRACT Neospora caninum is the main etiologic agent of neosporosis in domestic animals and its pathogenesis comprises two characteristic phases: acute and chronic. Rodents are used as experimental models to mimic acute and chronic bovine neosporosis. In this study, we inoculated a total of 27 female gerbils, with different doses of N. caninum tachyzoites aiming to induce chronic disease. DNA was extracted from different organs of each animal after spontaneous death or euthanasia. Encephalic tissues were submitted to a highly sensitive real time PCR aiming to detect chronically infected animals. All the other samples were submitted to standard PCR. A total of 11 gerbils died due to acute neosporosis, as confirmed by N. caninum DNA detection in organs. 5x103 tachyzoites/mL of N. caninum was the dosage of antigen that can induce chronic infection in gerbils. In the encephalon sections of some animals that showed clinical signs of persistent infection, we found 70% positive for the anterior encephalon section, suggesting this area as preferential for cyst formation. Therefore, we determined the doses of tachyzoites that cause acute or chronic infection and detection of positive tissues, preferably, systemic organs during acute and encephalon in chronic phases.

Toxoplasma gondii genotyping from free-range chickens (Gallus gallus domesticus) in a rural area of Rio Grande do Sul, Brazil

ABSTRACT Free-range chickens may ingest oocysts of T. gondii present in the environment and consequently harbor virulent strains of this parasite in different tissues, without any clinical signs. Isolation of T. gondii through bioassays on mice and cats from naturally infected chicken tissues has been described in several countries, demonstrating the importance of free-range chickens in the transmission of this parasite. The aim of this study was the genotypic characterization of T. gondii isolates obtained from naturally infected free-range chickens in a rural area of the state of Rio Grande do Sul, Brazil. Brain and heart tissue from 12 chickens seropositive for T. gondii were processed using peptic digestion technique for parasite isolation. From 12 samples subjected to mouse bioassay, nine isolates were obtained. RFLP-PCR genotypic characterization was performed using 11 genetic markers: SAG1, 5'-3'SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico. Genetic characterization of the isolates revealed the presence of five atypical genotypes according to ToxoDB (# 11, # 55, # 64, # 140 and # 163). Our results showed a wide genetic diversity of T. gondii in free-range chickens in this region.

Motor innervation pattern of labral muscles of Locusta migratoria

The current study investigates the motor innervation pattern of labral muscles in the adult locust and tries to interpret the results in the light of the hypothesis that the labrum phylogenetically developed by the fusion of paired appendages associated with the intercalary segment. Using Neurobiotin™ as a retrograde neuronal tracer, specific motor nerves or individual labral muscles were stained. Results show that the labral muscles receive innervation from tritocerebrum and suboesophageal ganglion. The axons of many motor neurons use three different pathways to cross the midline in the periphery to innervate ipsi- and contralateral muscles. Intracellular recordings from fibers of individual muscles and simultaneous recordings from motor neurons imply that the labral muscles lack inhibitory innervation. The location of motor neurons in both tritocerebrum and suboesophageal ganglion supports the notion that the labrum is innervated by the so-called intercalary segment. That many of the efferent axons cross the midline in the periphery might be explained by the hypothesis that the labrum derives from a fusion of appendages.

The differentiation potential of adipose tissue-derived mesenchymal stem cells into cell lineage related to male germ cells

ABSTRACT The adipose tissue is a reliable source of Mesenchymal stem cells (MSCs) showing a higher plasticity and transdifferentiation potential into multilineage cells. In the present study, adipose tissue-derived mesenchymal stem cells (AT-MSCs) were isolated from mice omentum and epididymis fat depots. The AT-MSCs were initially compared based on stem cell surface markers and on the mesodermal trilineage differentiation potential. Additionally, AT-MSCs, from both sources, were cultured with differentiation media containing retinoic acid (RA) and/or testicular cell-conditioned medium (TCC). The AT-MSCs expressed mesenchymal surface markers and differentiated into adipogenic, chondrogenic and osteogenic lineages. Only omentum-derived AT-MSCs expressed one important gene marker related to male germ cell lineages, after the differentiation treatment with RA. These findings reaffirm the importance of adipose tissue as a source of multipotent stromal-stem cells, as well as, MSCs source regarding differentiation purpose.

Coinfecções por Leishmania infantum, Neospora caninum e Toxoplasma gondii em cães necropsiados da região central do Rio Grande do Sul, Brasil

RESUMO O objetivo do presente trabalho foi determinar a presença de anticorpos para Leishmania infantum, Neospora caninum e Toxoplasma gondii, por meio da reação de imunofluorescência indireta (RIFI), em cães (n=78) provenientes da região central do Rio Grande do Sul, necropsiados no Hospital Veterinário da Universidade Federal de Santa Maria (UFSM), bem como avaliar os dados epidemiológicos, sazonais e anátomo-histopatológicos. Do total de animais avaliados, 67,9% (53/78) apresentaram soropositividade para ao menos um agente. A ocorrência de anticorpos para L. infantum, N. caninum e T. gondii foi de 33,3 (26/78), 37,1 (29/78) e 43,5% (34/78), respectivamente. Detectaram-se monoinfecções em 9,4% (5/53) para L. infantum, 18,8% (10/53) para N. caninum e 20,7% (11/53) para T. gondii. As coinfecções foram observadas em 27/53 (50,9%) dos animais. As infecções ocorreram independentemente de idade, sexo, procedência ou raça (P>0,05). Não se verificaram lesões anatomo-histopatológicas relacionadas aos agentes pesquisados, caracterizando-os como animais assintomáticos. Os resultados confirmaram a exposição de cães a esses protozoários na região central do RS e, em especial, demonstraram a circulação do agente causador da leishmaniose em uma área considerada indene para a enfermidade.

Adhesion enhancement of cribellate capture threads by epicuticular waxes of the insect prey sheds new light on spider web evolution

To survive, web-building spiders rely on their capture threads to restrain prey. Many species use special adhesives for this task, and again the majority of those species cover their threads with viscoelastic glue droplets. Cribellate spiders, by contrast, use a wool of nanofibres as adhesive. Previous studies hypothesized that prey is restrained by van der Waals' forces and entrapment in the nanofibres. A large discrepancy when comparing the adhesive force on artificial surfaces versus prey implied that the real mechanism was still elusive. We observed that insect prey's epicuticular waxes infiltrate the wool of nanofibres, probably induced by capillary forces. The fibre-reinforced composite thus formed led to an adhesion between prey and thread eight times stronger than that between thread and wax-free surfaces. Thus, cribellate spiders employ the originally protective coating of their insect prey as a fatal component of their adhesive and the insect promotes its own capture. We suggest an evolutionary arms race with prey changing the properties of their cuticular waxes to escape the cribellate capture threads that eventually favoured spider threads with viscous glue.

A new microfluidic device design for a defined positioning of neurons in vitro

A new triangle-shaped microfluidic channel system for defined cell trapping is presented. Different variants of the same basic geometry were produced to reveal the best fitting parameter combinations regarding efficiency and sensitivity. Variants with differences in the trap gap width and the inter-trap distance were analyzed in detail by Computational Fluid Dynamics simulations and in experiments with artificial beads of different sizes (30, 60, 80 μm). Simulation analysis of flow dynamics and pressure profiles revealed strongly reduced pressure conditions and balanced flow rates inside the microfluidic channels compared to commonly used systems with meandering channels. Quantitative experiments with beads showed very good trapping results in all channel types with slight variations due to geometrical differences. Highest efficiency in terms of fast trap filling and low particle loss was shown with channel types having a larger trap gap width (20 μm) and/or a larger inter-trap distance (400 μm). Here, experimental success was achieved in almost 85% to 100% of all cases. Particle loss appeared significantly more often with large beads than with small beads. A significantly reduced trapping efficiency of about 50% was determined by using narrow trap gaps and a small inter-trap distance in combination with large 80 μm beads. The combination of the same parameters with small and medium beads led to an only slight decrease in trapping efficiency (80%). All channel types were tested qualitatively with invertebrate neurons from the pond snail Lymnaea stagnalis. The systems were appropriate to trap those sensitive neurons and to keep their viability in the trapping area at the same time.

The plant hopperIssus coleoptratuscan detoxify phloem sap saponins including the degradation of the terpene core

Issus coleoptratus is a small plant hopper which mainly feeds on the phloem sap from ivy. Although all parts of ivy are poisonous as the plant contains saponins, especially hederasaponins, I.coleoptratus can cope with the poison. In contrast to other animals like the stick insect Carausius morosus which accumulates saponins in its body, I. coleoptratus can degrade and disintegrate not only the saponins but even the genines, i.e. the triterpene core of the substances. This is perhaps made possible by a specialised midgut and/or the salivary glands. When the glands and the gut are dissected and added to saponins in solution, the saponins, including the genines, are degraded ex vivo.

Summary: In contrast to other insects the plant hopper Issus coleoptratus does not accumulate toxic saponins from ivy. I. coleoptratus can degrade the saponines by its salivary glands and its gut as shown by HPLC-MS.

Was ist Betroffenen wichtig? Bestimmung patientennaher Therapiezieldimensionen in der Behandlung von bipolaren Störungen

Zusammenfassung. Patientenorientierung schließt die Berücksichtigung von Therapiezielpräferenzen ein. Shared decision making kann dazu beitragen, die Therapiezufriedenheit und -mitarbeit zu verbessern. Fragestellungen: 1) Bestimmung, der von Patienten priorisierten Therapieziele in der Behandlung bipolarer Störungen, 2) Extraktion der wichtigsten Therapiezieldimensionen, 3) Darstellung von Unterschieden in der Wichtigkeit abhängig von Geschlecht, Alter und Behandlungsstatus. Im Rahmen einer BMBF-geförderten Studie wurde die Wichtigkeit (1 = unwichtig bis 5 = sehr wichtig) von 73 Therapiezielen in der Behandlung bipolarer Störungen aus Betroffenensicht (N = 333) untersucht. Störungsbewältigung (R2 = 29 %), Lebensqualität (R2 = 9 %), Beteiligung am therapeutischen Geschehen (R2 = 7 %) und Nebenwirkungen von Medikamenten (R2 = 5 %) stellten die bedeutsamsten Zieldimensionen dar. Morbiditätsparameter (Symptome, Episoden) hatten dagegen einen geringeren Stellwert (R2 = 3,6 %). Die Wichtigkeitseinschätzungen variierten in Abhängigkeit von Geschlecht, Alter und Behandlungsstatus. In der Behandlung von bipolaren Störungen legen Patienten vor allem Wert auf die Bearbeitung störungsbezogener Probleme sowie die Verbesserung von Lebensqualität. Durch eine verstärkte Orientierung an Bedürfnissen von bipolar Betroffenen auf Seiten ihrer Behandler lassen sich Prozesse des shared decision making optimieren.

Neurons without dendrites?--A novel type of neurosecretory cell in locusts

Small-diameter nerves were found that are associated with the lateral peripheral nerves of the unfused abdominal ganglia of locusts. Such small nerves were observed in about 30% of all cases in Locusta migratoria, more than 60% in Schistocerca gregaria. Retrograde staining of these small nerves showed two somata in the posterior, lateral, and ventral region of an abdominal ganglion. These cells give rise to the small nerves that accompany the big lateral nerves and, on their surface, form putative neurohaemal release sites. Astonishingly the cells do not form any dendritic ramifications within the neuropile of the ganglia.

Agarose-Based Substrate Modification Technique for Chemical and Physical Guiding of Neurons In Vitro

A new low cost and highly reproducible technique is presented that provides patterned cell culture substrates. These allow for selective positioning of cells and a chemically and mechanically directed guiding of their extensions. The patterned substrates consist of structured agarose hydrogels molded from reusable silicon micro templates. These templates consist of pins arranged equidistantly in squares, connected by bars, which mold corresponding wells and channels in the nonadhesive agarose hydrogel. Subsequent slice production with a standard vibratome, comprising the described template pattern, completes substrate production. Invertebrate neurons of locusts and pond snails are used for this application as they offer the advantage over vertebrate cells as being very large and suitable for cultivation in low cell density. Their neurons adhere to and grow only on the adhesive areas not covered by the agarose. Agarose slices of 50 μm thickness placed on glass, polystyrene, or MEA surfaces position and immobilize the neurons in the wells, and the channels guide their neurite outgrowth toward neighboring wells. In addition to the application with invertebrate neurons, the technique may also provide the potential for the application of a wide range of cell types. Long-term objective is the achievement of isolated low-density neuronal networks on MEAs or different culture substrates for various network analysis applications.

Retinoic acid as a survival factor in neuronal development of the grasshopper, Locusta migratoria

Based on experience with cell cultures of adult insect neurons, we develop a serum-free culture system for embryonic locust neurons. Influences of trophic substances on survival and neurite outgrowth of developing neurons are investigated. For the first time, a positive trophic effect of 9-cis retinoic acid (9-cis RA) was shown in vitro on embryonic neurons of an insect. We observed longer cell survival of 50 % developmental stage neurons in cultures supplemented with 0.3 nM 9-cis RA. Furthermore, an influence on neuron morphology was revealed, as the addition of 9-cis RA to cell culture medium led to an increase in the number of neurites per cell. Although an RA receptor gene, LmRXR (Locusta migratoria retinoid X receptor), was expressed in the central nervous system throughout development, the influence of 9-cis RA on neuronal survival and outgrowth was restricted to 50 % stage embryonic cells.

A developmental study of serotonin-immunoreactive neurons in the embryonic brain of the marbled crayfish and the migratory locust: evidence for a homologous protocerebral group of neurons

It is well established that the brains of adult malacostracan crustaceans and winged insects display distinct homologies down to the level of single neuropils such as the central complex and the optic neuropils. We wanted to know if developing insect and crustacean brains also share similarities and therefore have explored how neurotransmitter systems arise during arthropod embryogenesis. Previously, Sintoni et al. (2007) had already reported a homology of an individually identified cluster of neurons in the embryonic crayfish and insect brain, the secondary head spot cells that express the Engrailed protein. In the present study, we have documented the ontogeny of the serotonergic system in embryonic brains of the Marbled Crayfish in comparison to Migratory Locust embryos using immunohistochemical methods combined with confocal laser-scan microscopy. In both species, we found a cluster of early emerging serotonin-immunoreactive neurons in the protocerebrum with neurites that cross to the contralateral brain hemisphere in a characteristic commissure suggesting a homology of this cell cluster. Our study is a first step towards a phylogenetic analysis of neurotransmitter system development and shows that, as for the ventral nerve cord, traits related to neurogenesis in the brain can provide valuable hints for resolving the much debated question of arthropod phylogeny.

Internal receptors in insect appendages project directly into a special brain neuropile

Background

The great majority of afferent neurons of insect legs project into their segmental ganglion. Intersegmental projections are rare and are only formed by sense organs associated with the basal joints of the legs. Such intersegmental projections never ascend as far as the brain and they form extensive ramifications within thoracic ganglia. A few afferents of chordotonal organs of the subcoxal joints ascend as far as the suboesophageal ganglion.

Results

We describe novel afferent neurons in distal segments of locust legs that project directly into the brain without forming ramifications in other ganglia. In the brain, the fibres terminate with characteristic terminals in a small neuropile previously named the superficial ventral inferior protocerebrum. The somata of these neurons are located in the tibiae and tarsi of all legs and they are located within branches of peripheral nerves, or closely associated with such branches. They are not associated with any accessory structures such as tendons or connective tissue strands as typical for insect internal mechanoreceptors such as chordotonal organs or stretch receptors. Morphologically they show great similarity to certain insect infrared receptors.

We could not observe projections into the superficial ventral inferior protocerebrum after staining mandibular or labial nerves, but we confirm previous studies that showed projections into the same brain neuropile after staining maxillary and antennal nerves, indicating that most likely similar neurons are present in these appendages also.

Conclusion

Because of their location deep within the lumen of appendages the function of these neurons as infrared receptors is unlikely. Their projection pattern and other morphological features indicate that the neurons convey information about an internal physiological parameter directly into a special brain neuropile. We discuss their possible function as thermoreceptors.

[S3 guidelines on diagnostics and therapy of bipolar disorders: development process and essential recommendations]

Bipolar disorders are severe psychiatric disorders with extensive individual and health economic consequences. Starting in 2007 the first German evidence and consensus based guideline for diagnostics and treatment of bipolar disorders was developed which holds the potential of increasing confidence of therapists, patients and relatives in the decision-making process and improving healthcare service experiences of patients and relatives. Apart from recommendations for diagnostics and treatment the guidelines provide those for trialogue action, knowledge transfer and self-help and for strategies for healthcare provision of this complex disorder. In the present article the methodology and essential recommendations are outlined and complemented in specific topics by corresponding articles in this special issue. Due to restrictions of the length of this presentation there is the need to refer to the comprehensive version of the guidelines at several points also regarding a detailed discussion of the limitations.

Sensory pits - Enigmatic sense organs of the nymphs of the planthopper Issus coleoptratus (Auchenorrhyncha, Fulgoromorpha)

The sensory pits of the nymphs of the planthopper Issus coleoptratus were investigated using light and electron microscopic techniques. Sensory pits consist of a bowl-shaped depression in the cuticle (25-70 μm in diameter) covered by a transparent cupola of presumably waxy material. Each pit is equipped with a long sensory hair that emerges from the inner wall of the pit and extends horizontally for about two thirds of the pit diameter. The cupola emerges from the rim of the pit opposite to the socket of this hair. Additional small sensory hairs extend into the base of the cupola. While the ultrastructure of these small hairs resembles that of other mechanoreceptive sensory hairs of insects, that of the long hairs shows several peculiarities. Sensory pits are dispersed over the frontal part of the head, the tergites of thoracic and abdominal segments. On the different parts of the exoskeleton, the orientation of long hairs within the pits varies in a systematic fashion with respect to the body axes. Size, location, and orientation of the pits show almost perfect bilateral symmetry. Their number increases with each moult. Comparative data show that the level of structural complexity of these sense organs varies considerably within this group of insects.

Neuroarchitecture of the arcuate body in the brain of the spider Cupiennius salei (Araneae, Chelicerata) revealed by allatostatin-, proctolin-, and CCAP-immunocytochemistry and its evolutionary implications

Here we describe the neuronal organization of the arcuate body in the brain of the wandering spider Cupiennius salei. The internal anatomy of this major brain center is analyzed in detail based on allatostatin-, proctolin-, and crustacean cardioactive peptide (CCAP)-immunohistochemistry. Prominent neuronal features are demonstrated in graphic reconstructions. The stainings revealed that the neuroarchitecture of the arcuate body is characterized by several distinct layers some of which comprise nerve terminals that are organized in columnar, palisade-like arrays. The anatomy of the spider's arcuate body exhibits similarities as well as differences when compared to the central complex in the protocerebrum of the Tetraconata. Arguments for and against a possible homology of the arcuate body of the Chelicerata and the central complex of the Tetraconata and their consequences for the understanding of arthropod brain evolution are discussed.

Binge eating disorder and menstrual cycle in unmedicated women with bipolar disorder

OBJECTIVE

Weight increase is a problem in women with bipolar disorder (BD). Furthermore, there is evidence that both binge eating disorder (BED) and menstrual cycle abnormalities occur more frequently in women with affective disorders than in the general population. We investigated whether there is a clinical link between the two disorders and menstrual cycle.

METHOD

Epidemiological and clinical variables associated with both BD and BED were assessed as well as menstrual cycle influence.

RESULTS

The prevalence of BED in the sample was 28.8%. Menstrual cycle significantly influenced BED in all participants in that BED became worse prior to menses. 80% of the participants noticed regular weight gain prior to menses.

DISCUSSION

BED is a common comorbidity in unmedicated subjects with BD, as is overweight. In women with BD menstrual cycle should be taken into consideration, as it can worsen the BD itself and associated comorbidities such as BED and overweight. Alteration in menstrual cycle-associated eating behavior should be routinely assessed in women with BD.

Low density cell culture of locust neurons in closed-channel microfluidic devices

Microfluidic channel systems were fabricated out of polydimethylsiloxane (PDMS) and used as culture vessels for primary culture of neurons from locust thoracic ganglia. In a biocompatibility study it was shown that cell adhesion and neuronal cell growth of locust neurons on uncoated PDMS was restricted. Coating with concanavalin A improved cell adhesion. In closed-channel microfluidic devices neurons were grown in static-bath culture conditions for more than 15 days. Cell densities of up to 20 cells/channel were not exceeded in low-density cultures but we also found optimal cell growth of single neurons inside individual channels. The first successful cultivation of insect neurons in closed-channel microfluidic devices provides a prerequisite for the development of low density neuronal networks on multi electrode arrays combined with microfluidic devices.

Actions of motor neurons and leg muscles in jumping by planthopper insects (hemiptera, issidae)

To understand the catapult mechanism that propels jumping in a planthopper insect, the innervation and action of key muscles were analyzed. The large trochanteral depressor muscle, M133b,c, is innervated by two motor neurons and by two dorsal unpaired median (DUM) neurons, all with axons in N3C. A smaller depressor muscle, M133a, is innervated by two neurons, one with a large-diameter cell body, a large, blind-ending dendrite, and a giant ovoid, axon measuring 50 microm by 30 microm in nerve N5A. The trochanteral levator muscles (M132) and (M131) are innervated by N4 and N3B, respectively. The actions of these muscles in a restrained jump were divisible into a three-phase pattern. First, both hind legs were moved into a cocked position by high-frequency bursts of spikes in the levator muscles lasting about 0.5 seconds. Second, and once both legs were cocked, M133b,c received a long continuous sequence of motor spikes, but the two levators spiked only sporadically. The spikes in the two motor neurons to M133b,c on one side were closely coupled to each other and to the spikes on the other side. If one hind leg was cocked then the spikes only occurred in motor neurons to that side. The final phase was the jump movement itself, which occurred when the depressor spikes ceased and which lasted 1 ms. Muscles 133b,c activated synchronously on both sides, are responsible for generating the power, and M133a and its giant neuron may play a role in triggering the release of a jump.

Emotional vulnerability and cognitive control in patients with bipolar disorder and their healthy siblings: a pilot study

Scheuch K, Bräunig P, Gauggel S, Kliesow K, Sarkar R, Krüger S. Emotional vulnerability and cognitive control in patients with bipolar disorder and their healthy siblings: a pilot study.

OBJECTIVE

There is evidence that, even in remission, patients with bipolar disorder (BD) have deficits in cognitive function and emotional regulation. Siblings of patients with BD are also reported to exhibit minor dysfunction in neuropsychological domains. In this study, we examined the interference of acute mood state with reaction time (RT) and response inhibition in euthymic patients with BD, in their healthy siblings and in healthy controls.

METHODS

A total of 34 patients with bipolar I disorder, 22 healthy siblings and 33 healthy controls performed a stop-signal paradigm after induction of a transient intense sadness and a relaxed mood state. The differences in RT and the response inhibition were compared between the groups.

RESULTS

Euthymic patients with BD displayed a higher emotional reactivity compared with their siblings and with controls. Compared with controls, patients with BD showed longer RTs in a relaxed mood state and a delay in response inhibition during emotional activation.

CONCLUSIONS

The present study provides evidence for the clinical observation that patients with BD have shorter RTs when in a state of emotional arousal rather than in a relaxed state. Inhibitory deficits in these patients may be because of a too strong emotional arousal. The results show that in patients with BD, relaxation and emotional arousal are inversely associated with performance in a neuropsychological task. This is in contrast to findings in healthy individuals suggesting a dysbalance in emotional regulation in these patients.

The Observer-Rated Scale for Mania (ORSM): development, psychometric properties and utility

BACKGROUND

The diagnosis of mania largely depends on the quality of information the physician is provided with. Often, the patient cannot give an accurate account of the symptom development and thus information from relatives and friends is required. No systematic rating instrument is available, however, to facilitate this.

OBJECTIVE

In this study, the psychometric properties of the 49-item Observer-Rated Scale for Mania (ORSM) are reported.

METHODS

The scale was used in 113 inpatients and the following psychometric aspects were assessed: reliability, test-retest reliability, construct validity (factor analysis, discriminant analysis, comparison of means), extreme-group validity, prognostic validity, sensitivity, specificity, positive and negative predictive values.

RESULTS

The ORSM proved highly valid and reliable. Factor analysis revealed three factors which were labelled euphoric mania, instable mania and psychotic mania.

CONCLUSION

The ORSM is a useful instrument to help non-professionals who are in regular contact with the patient diagnosed a manic/mixed episode. It thus complements existing rating scales for mania, which are either designed for professionals or are self-rating instruments.

Gender differences in psychotic bipolar mania

OBJECTIVE

This study examined gender differences in the prevalence and types of psychotic symptoms in bipolar mania.

METHODS

Participants were drawn from consecutive admissions to the psychiatric clinic in Chemnitz, Germany, in 2005. The diagnosis of bipolar disorder, manic episode was made within 24 hours of admission, and the severity of mania was assessed using the Young Mania Rating Scale (YMRS) and the German version of the Altman Self-Rating Mania Scale. Data collected for each patient included age at the onset of bipolar illness, number of previous episodes, social functioning between episodes, and duration of hospitalization for the index episode. Based on the Task Force for Methods and Documentation in Psychiatry system, psychotic symptoms were classified as hallucinations (visual, auditory, olfactory, tactile, acousma, somatic); delusions (paranoid, reference, guilt, grandeur, religious, erotomania, hypochondriac, poverty, jealousy); and ego disorder (thought control, thought broadcasting).

RESULTS

One hundred thirty-seven women and 109 men met the criteria for an acute manic episode, of whom 93 women and 62 men had psychotic symptoms. Compared with psychotic men, psychotic women had more delusions and hallucinations, both overall and per patient, and more delusions of reference and paranoid delusions. Psychotic women had more mixed states compared with psychotic men. Psychotic women differed from both psychotic men and nonpsychotic women on a number of clinical and social variables: they had higher YMRS scores and more previous episodes of depression despite an earlier onset of illness.

CONCLUSION

Women with bipolar mania exhibited a specific pattern of psychotic symptoms that appeared to be associated with greater severity of the acute episode, more mixed states, and a more severe course of illness.

Neuronal cell growth on iridium oxide

Iridium oxide is an attractive material for the development of novel multi electrode array (MEA) systems that provide electrodes for stimulation as well as recording single neurons. In this study the biocompatibility of pure iridium and different iridium oxides that differ characteristically in their surface roughness was investigated using two different biological test systems, insect and vertebrate neurons. Iridium oxide surfaces were coated with Concanavalin A and poly-(D)-lysine. In detailed investigations (R(a) value determination, contact angle measurement, marker enzyme assay) the surface characteristics of non-modified and coated iridium oxide films were analysed, demonstrating that the materials can be successfully coated. Furthermore, we show that locust neurons grow well on all substrates tested, while chicken neurons need coated surfaces for proper adhesion. Increasing the roughness of iridium oxide films, which in principle could improve cell adhesion, did not improve the neurocompatibility. These results show that in future applications iridium oxide films can be used with surface morphologies previously shown to be optimal for stimulation purposes (cauliflower-like surface structure).

Neurons controlling jumping in froghopper insects

The neurons innervating muscles that deliver the enormous power enabling froghopper insects to excel at jumping were revealed by backfilling the nerves from those muscles. The huge trochanteral depressor muscle (M133) of a hind leg consists of four parts. The two largest parts (M133b,c) occupy most of the metathorax and are innervated by the same two motor neurons that have small, laterally placed somata in the metathoracic ganglion and axons in nerve N3C(2). They are also supplied by three dorsal unpaired median (DUM) neurons with the largest diameter somata in the central nervous system. A small metathoracic part of the muscle (M133d) is supplied by two motor neurons with lateral somata and by common inhibitory motor neuron CI(1), all with axons in nerve N3C(3) The motor neuron with the larger soma has a thick primary neurite that projects across the midline of the ganglion so that its branches overlap those of its symmetrical counterpart,innervating the same muscle of the other hind leg. The fourth coxal part of the muscle (M133a) is innervated by two motor neurons (one with a ventral and the other with a dorsal and lateral soma), by CI(1), and by a DUM neuron with a small soma. All have axons in nerve N5A. The two trochanteral levator muscles of a hind leg are contained within the coxa and are separately innervated by nerves N3B and N4, respectively. The properties of the different motor neurons are discussed in the context of the neural patterns that generate jumping.

Risperidone long-acting injectable for maintenance therapy in bipolar disorder: An open-label pilot study

Objective. To investigate the maintained efficacy of antipsychotic therapy in stable patients with bipolar disorder transitioned directly to risperidone long-acting injectable (RLAI). Methods. Within a large multi-centre European trial (StoRMi), adults with bipolar I disorder (DSM-IV) stable on a medication regimen for ≥1 month, but requiring a change of antipsychotic therapy, received injections of RLAI 25mg i.m. (increased to 37.5 or 50 mg if necessary), every 14 days for 6 months. Results. Sixteen patients were included in this subgroup analysis. Reasons for changing to RLAI included non-compliance (eight patients), insufficient efficacy (four patients) and side effects (three patients), associated with previous therapy. Twelve patients completed the 6-month trial. The most common dosage at endpoint was 25mg (seven patients). Disease symptoms (CGI Disease Severity) were significantly reduced from baseline to endpoint (P=0.0225). Patient satisfaction with treatment increased from baseline to endpoint, with 36% of patients rating their treatment satisfaction as "very good" versus 0% at baseline. Mean total score of ESRS improved from baseline to endpoint. Conclusion. Patients with bipolar disorder showed maintained symptom control over a 6-month treatment period with RLAI. Controlled studies in this population are required.

Stability and course of neuropsychological deficits in manic and depressed bipolar patients compared to patients with Major Depression

BACKGROUND

Neuropsychological functioning varies across different subgroups of patients with affective disorders; yet there have only been a few studies pointing out distinctive neuropsychological profiles and following-up possible changes in this functioning. The aim of this study was to compare neuropsychological functioning across remitted manic or depressed patients with bipolar disorder compared to remitted patients with Major Depression and to explore the course of their cognitive functioning.

METHODS

30 patients with Major Depression, 17 manic bipolar patients, and 22 depressed bipolar patients were assessed for memory, attention, and executive functions using the Auditory Verbal Learning Test (AVLT), the Modified Card Sorting Test (MCST), the Attention Network Test (ANT), and Stop-Signal Task. Neuropsychological assessment was performed at discharge and seven weeks after discharge.

RESULTS

The three groups showed different neuropsychological performance at discharge. Regarding selective attention and speed of responding the manic bipolar patients displayed poorer performance than the other two groups. Furthermore, follow-up assessment revealed that although all patient groups demonstrated an overall improvement, some deficits (especially in executive functions) remain. Manic bipolar patients showed again the worst performance. Depressed bipolar patients, however, were not observed to show a poorer outcome than depressed unipolar patients.

CONCLUSIONS

This study provides further evidence for distinct neuropsychological functioning in patients with affective disorders depending on their state of illness. Furthermore, it supports the hypothesis that especially manic bipolar patients stay impaired in certain cognitive functions after remission. These findings may be of clinical relevance regarding treatment and prevention programs and emphasize the need of further research investigating stability and course of patients with mood disorders.

[Clinical standing of valproate treatment of bipolar disorders]

During recent years valproate has been established as a cornerstone for the drug-treatment of bipolar disorder. In Germany, valproate was licensed both for the treatment of acute mania and for maintenance treatment in summer 2005. At this occasion, this review summarises the scientific evidence and clinical experience of well-known experts with valproate-treatment. It was concluded that valproate will continue to be of high clinical significance despite the recent increase of treatment alternatives, both in monotherapy and combination treatment of acute mania, mixed states and maintenance treatment.

A simple fluorescent double staining method for distinguishing neuronal from non-neuronal cells in the insect central nervous system

Being able to discriminate between neurons and non-neuronal cells such as glia and tracheal cells has been a major problem in insect neuroscience, because glia-specific antisera are available for only a small number of species such as Drosophila melanogaster and Manduca sexta. Especially developmental or comparative studies often require an estimate of neuron numbers. Since neuronal and glial cell bodies are in many cases indiscernible in situ, a method to distinguish neurons from non-neuronal cells that works in any given species is wanting. Another application is cell culturing. Cultured cells usually change their outward shape dramatically after being isolated so that it is frequently impossible to tell neurons and glia apart. Here, we present a simple method that uses a commercially available antiserum directed against horseradish peroxidase, which specifically stains neurons but no other cell type in every insect species investigated. Counterstaining with DAPI, a fluorescent chromophore that binds to double-stranded DNA in the nuclei of all cells, yields the total number of cells in a given sample. Thus, double labeled cells can be identified as neurons, cells that carry only DAPI staining are non-neuronal.

Common and specific inhibitory motor neurons innervate the intersegmental muscles in the locust thorax

The inhibitory innervation of the intersegmental (body wall) muscles between the first and the second thoracic segment of the migratory locust, Locusta migratoria, was investigated using neuroanatomical, immunocytochemical and electrophysiological techniques. Three neurons located in the prothoracic ganglion show GABA-like immunoreactivity and project into the intersegmental nerve. Two are common inhibitors. One of those innervates the oblique intersegmental muscle M59 and two dorsal longitudinal muscles (M81 and M82). The second common inhibitor also innervates M59 and the ventral longitudinal muscle M60. The third neuron innervates M60 exclusively and, for that reason, has to be regarded as the first specific inhibitor ever observed in insect neuromuscular assemblies. According to their innervation pattern, we term these neurons CI(59/60), CI(59/81/82), and SI(60). CI(59/81/82) and CI(59/60) appear to be segmentally homologous to CI(a) and CI(b) neurons, respectively, in the other body segments.

Increased olfactory sensitivity in euthymic patients with bipolar disorder with event-related episodes compared with patients with bipolar disorder without such episodes

OBJECTIVE

Some patients with bipolar disorder experience mood episodes following emotional life events, whereas others do not. There is evidence that orbitofrontal hypoactivity may be related to this, because the orbitofrontal cortex is involved in the regulation of emotional and behavioural responses to external events. The close anatomical and functional connection between the orbitofrontal cortex and olfactory processing suggests that patients with bipolar disorder and heightened emotional reactivity may exhibit altered olfactory function compared with patients with bipolar disorder who do not exhibit this sensitivity.

METHODS

In this pilot study, olfactory function was assessed in patients with bipolar disorder and a history of event-triggered episodes (n = 7) and in patients with bipolar disorder without such a history (n = 9) at the Department of Psychiatry and the Taste and Smell Clinic of the University of Dresden, Germany. Each patient's bipolar disorder was in remission at study entry, and they were on monotherapy with mood stabilizers. Assessment included olfactory event-related potentials (ERP) and psychophysical tests for odour threshold, odour identification and olfactory quality discrimination.

RESULTS

Odour thresholds were lower in patients with bipolar disorder and event-triggered episodes compared with the other patient group. In addition, patients with event-triggered episodes exhibited shorter N1 peak latencies of the olfactory ERP.

CONCLUSIONS

Our findings indicate disinhibition of orbitofrontal areas involved in the processing of emotional events in a subset of patients with bipolar illness.

[Self-rating scales for manic episodes]

The article provides an overview of clinical self-rating scales for manic symptoms, aiming to promote its use in clinical practice. Of the four identified scales available in German language, the Manie-Selbstbeurteilungs-Skala MSS by Bräunig et al., which is a translation of the Self-Rating Manic Inventory SRMI by Shugar et al., is the best validated instrument both for diagnostic purposes and for measuring symptom severity during the course of illness. This overview is followed by a brief discussion of newer developments in the bipolar spectrum, temperament and hypomania research. In addition, options of using mania scales for measuring hypomania according to DSM-IV and/or ICD-10 criteria for bipolar disorders are suggested.

[Psychotherapy and psychoeducation for bipolar disorders -- manualized treatment programs]

The article provides an overview of published treatment manuals for psychotherapy in bipolar disorders and discusses content and structure of manualized programs. This is followed by a more detailed description of an elaborated psycho-educative program which have successfully been applied in individual as well as in group settings for the education of inpatients, outpatients and patients' relatives. Future research needs to further evaluate existing programs in terms of treatment efficacy.

[Official guidelines for the treatment of acute mania]

There are several national and international practice guidelines on the treatment of acute mania. Their purpose is to assess the available evidence of efficacy for medication used in the treatment of bipolar mania and to grade it according to the quality of studies available. The World Federation of Societies of Biological Psychiatry (WFSBP) has developed such guidelines in 2003. They categorize the scientific quality of the studies into four levels of evidence (A-D) and provide an algorithm based on the degree of severity of the acute manic episode.

[Quetiapine in the treatment of acute mania]

Quetiapine is an atypical antipsychotic that has shown efficacy in the treatment of positive and negative symptoms in schizophrenia without causing extrapyramidal symptoms (EPS). To date, there are two monotherapy and two combination therapy studies with a double blind, placebo-controlled design on the use of quetiapine in mania. Several open studies and case reports support the results of the controlled trials suggesting that quetiapine is effective in treating the broad spectrum of manic symptoms and is tolerated well.

Pharmakologische Therapie manisch-depressiver Mischzustände

OBJECTIVE

Mixed episodes comprise up to 40 % of acute bipolar admissions. They are difficult-to-treat, complex clinical pictures. This review provides an overview of the available literature on the pharmacotherapy of manic-depressive mixed states and suggests treatment options.

METHOD

Literature was identified by searches in Medline, Embase and the Cochrane Controlled Trials Register. Studies were considered relevant if they contained the keywords mixed mania, mixed state (s), mixed episode (s), treatment, therapy, study or trial.

RESULTS

Overall, there were very few double-blind, placebo-controlled studies specifically designed to treat manic-depressive mixed states. Rather, patients with mixed states comprised a subgroup of the examined patient cohorts. Nevertheless, the data show that acute mixed states do not respond favourably to lithium. Instead, valproate and olanzapine are drugs of first choice. Carbamazepine may play a role in the prevention of mixed states. Antidepressants should be avoided, because they may worsen intraepisodic mood lability. Lamotrigine may be useful in treating mixed states with predominantly depressive symptoms.

CONCLUSIONS

More treatment studies specifically designed to treat the complex clinical picture of mixed states are clearly needed. Current treatment recommendations for clinical practice based on the available literature can only target selected aspects of these episodes.

[Psychotherapy in bipolar disorders -- randomised controlled trials of treatment efficacy]

On the basis of a vulnerability-stress-model psycho-educative, cognitive-behavioural, family-oriented and interpersonal approaches of psychotherapy for bipolar disorders are described. This is followed by a review of randomised controlled trials investigating the treatment efficacy of psychotherapeutic interventions. These studies show positive results particularly for psychoeducation, cognitive-behavioural therapy and family-oriented therapy. Finally, it is discussed in which respects evidence for the successful implementation of psychotherapy is still missing and why it is so important to move towards manualized psychotherapeutic programs.

Long-acting risperidone in stable patients with schizoaffective disorder

Oral and long-acting risperidone has been shown to be effective for acute and maintenance treatment of patients with schizoaffective disorders. The present analysis investigated the efficacy and tolerability of direct transition from other antipsychotics to risperidone long-acting injectable in patients with schizoaffective disorder. Patients aged > or = 18 years with schizoaffective disorder (DSM-IV), who required a change of medication, received risperidone long-acting injectable 25 mg (increased to 37.5 or 50 mg, if necessary) every 2 weeks for 6 months. The analysis included 249 patients (47% male; mean age 43 years), of whom 74% completed the 6-month study. Mean scores for the total Positive and Negative Syndrome Scale (PANSS) and all three subscales were significantly reduced from baseline to week 4 (p < 0.001), with further improvements until treatment endpoint. Significant improvements from baseline to endpoint were seen in the mood symptom domains of anxiety/depression (10.4+/-4.1 vs 8.7+/-3.9) and uncontrolled hostility/excitement (7.6+/-3.6 vs 6.9+/-3.8). Mean Global Assessment of Function (GAF) score improved significantly from 59.4+/-15.6 at baseline to 66.4+/-17.7 (p < 0.001) at endpoint. Of 87 patients hospitalized at baseline, 67% were discharged at endpoint. Both quality of life (SF-36) and satisfaction with treatment were improved significantly at endpoint. Total ESRS scores fell progressively throughout the study, and the reduction was already statistically significant (p < 0.001) at 4 weeks. Small but statistically significant (p < 0.001) mean shifts of 1.8% were seen in body weight and Body Mass Index (BMI). Patients with schizoaffective disorder derived several benefits from a change to risperidone long-acting injectable, including reductions in psychiatric symptoms (particularly the mood symptom domains) and a reduction in the severity of drug-induced neurological movement disorders.