Liver complications in inflammatory bowel diseases

Diseases of the liver and the biliary tract are commonly observed in patients with inflammatory bowel diseases (IBD). Besides primary sclerosing cholangitis (PSC), drug-induced hepatotoxicity and non-alcoholic fatty liver disease (NAFLD) are the most frequent liver complications in IBD. PSC is a chronic inflammatory and commonly progressive disorder of unknown etiology associated with fibrosis and stricture development in the intrahepatic and extrahepatic biliary tree. Interestingly, this form of liver disease is mainly associated with ulcerative colitis. Development of PSC is highly relevant for IBD patients as cholestasis-associated problems increase over time resulting in biliary strictures, cholangitis, cholangiocarcinoma and importantly these patients also have a higher risk to develop colon cancer. Another major aspect regarding IBD and liver disease refers to drug-induced hepatotoxicity. Clinically, most relevant is liver toxicity caused by immunosuppressants such as azathioprine. Azathioprine and its derivate 6-mercaptopurine can cause a spectrum of liver injuries ranging from asymptomatic elevated liver enzymes to cholestasis and nodular regenerative hyperplasia. The third common IBD-associated liver disease is NAFLD, and first studies suggest that NAFLD might appear in IBD patients independent of classical risk factors such as obesity or insulin resistance. Overall, liver complications are observed in 10-20% of IBD patients, and therefore physicians have to be familiar with these complications to improve and to optimize patient care.

Neurotensin-like immunoreactivity in cerebrospinal fluid of patients with schizophrenia, depression, anorexia nervosa-bulimia, and premenstrual syndrome

Neurotensin (NT) concentrations in cerebrospinal fluid (CSF) were measured by a sensitive and specific radioimmunoassay in psychiatric patients and age- and sex-matched normal controls. No increase in CSF NT concentrations was observed after antipsychotic drug treatment. CSF NT concentrations were significantly lower in one group of schizophrenic subjects. NT concentrations were unaltered in patients with depression, anorexia/bulimia, or premenstrual syndrome, and no rostral-caudal gradient for NT in CSF was evident. NT concentrations were not related to age or sex, and probenecid treatment did not alter CSF NT concentrations. Finally CSF NT concentrations were unaltered in paranoid schizophrenic subjects. These findings confirm and extend previous studies of CSF NT that showed certain patients with schizophrenia, nonparanoid type, have reduced CSF concentrations of this tridecapeptide.

An MRI study of temporal lobe structures in men with bipolar disorder or schizophrenia

BACKGROUND

Hippocampal atrophy has been described in postmortem and magnetic resonance imaging studies of schizophrenia. The specificity of this finding to schizophrenia remains to be determined. The neuropathology of bipolar disorder is understudied, and temporal lobe structures have only recently been evaluated.

METHODS

Twenty-four bipolar, 20 schizophrenic, and 18 normal comparison subjects were evaluated using magnetic resonance brain imaging. Image data were acquired using a three-dimensional spoiled GRASS sequence, and brain images were reformatted in three planes. Temporal lobe structures including the amygdala, hippocampus, parahippocampus, and total temporal lobe were measured to obtain volumes for each structure in the three subject groups. Severity of symptoms in both patient groups was assessed at the time the magnetic resonance images were obtained.

RESULTS

Hippocampal volumes were significantly smaller in the schizophrenic group than in both bipolar and normal comparison subjects. Further, amygdala volumes were significantly larger in the bipolar group than in both schizophrenic and normal comparison subjects.

CONCLUSIONS

The results suggest differences in affected limbic structures in patients with schizophrenia and bipolar disorder. These specific neuroanatomic abnormalities may shed light on the underlying pathophysiology and presentation of the two disorders.

Lamotrigine toxicity secondary to sertraline

Blood level monitoring helps to determine the therapeutic and toxic ranges for anticonvulsants and antidepressants. We investigated initial drug-drug interactions between lamotrigine and sertraline. We report on case histories of two epileptic patients who were initially on lamotrigine and to whom sertraline was added to control psychiatric features. In case 1, a total daily dose of 25 mg sertraline, with nondetectable sertraline and desmethylsertraline blood levels, resulted in a doubling of the lamotrigine blood level with symptoms of toxicity. In case 2, a 25 mg reduction in the total daily dose of sertraline resulted in halving of the lamotrigine blood level even though the lamotrigine dosage was increased by 33%. This shows that sertraline has potent interactions with lamotrigine metabolism. The authors hypothesize that inhibition of glucuronidation is responsible. Clinicians are advised to observe for symptoms of toxicity and to do serial blood levels to monitor this interaction.

Dose-dependent valproic acid thrombocytopenia in bipolar disorder

The increased use of anticonvulsants in the treatment of bipolar disorders necessitates a greater appreciation of potential complications from these agents. The authors present a bipolar disorder patient with dose-dependent valproic acid thrombocytopenia and suggest treatment strategies.

Event-related potentials and item recognition in depressed, schizophrenic and alcoholic patients

Auditory event-related potentials (ERPs) to pure tones and performance on a measure of item recognition were compared in 20 controls, 14 alcoholics, 20 depressed and 21 schizophrenic patients. Compared with normal controls, P2 and N2 were delayed and of diminished amplitude in the psychopathological groups. Increased amplitude of P1 in alcoholics, diminished N1 in depressed patients, increased latencies of N1 in schizophrenics and N2 in alcoholics were pathology-specific. Unusual patterns of response in the item recognition test (elevated intercept and flattened slope) and its relationship with ERPs distinguished the diagnostic groups from the controls. Support for the preferential involvement of the left hemisphere in schizophrenia and of the right hemisphere in depression was found. Disinhibition of CNS activity in the response of alcoholics (increased P1 and delayed P3) was indicated. The findings suggested that discriminant analysis of auditory ERPs to simple, pure tones, in conjunction with psychometric data significantly differentiated pathologic groups from each other and from controls.

Orthostatic effect of imipramine and doxepin in depressed geriatric outpatients

Blood pressure measurements were collected from 36 depressed geriatric outpatients (ages 55 to 81 years) enrolled in a double-blind, placebo-controlled study of the efficacy of doxepin and imipramine. Mean systolic postural changes were 25.9 mm Hg for imipramine, significantly higher than the 10.5 mm Hg for doxepin, and 12.4 mm Hg for placebo. The orthostatic drop in the imipramine group was only weakly related to dose and did not correlate with amount of pretreatment orthostatic hypotension or with duration of treatment. The increased orthostatic hypotension occurred early in treatment and at low doses of imipramine. Accordingly, caution is advised in the use of imipramine for the elderly.

Dexamethasone suppression test and Axis I diagnoses of inpatients with DSM-III borderline personality disorder

To determine the relationship of Axis I diagnoses to the DSM-III diagnosis of borderline personality disorder, 100 consecutive admissions to an inpatient service were studied. Of the 27 patients labeled borderline, 14 were given an Axis I diagnosis of major depression (unipolar) compared with 8 of 73 nonborderlines; 73% (19 of 26) of all borderlines tested but only 46% (18 of 39) of nonborderlines had a positive DST (p less than .05). Few borderline patients received concomitant nonaffective diagnoses, and even fewer were given bipolar or schizoaffective diagnoses.

An experimental analysis of the interaction of chemotherapy and behavior therapy in anorexia nervosa

The interaction of imipramine and operant conditioning on weight gain in an anorexia nervosa patient was examined by a single-subject experiment consisting of a baseline and four treatment phases: phase 1--contingency management only; phase 2--contingency management plus imipramine; phase 3--contingency management plus imipramine placebo; phase 4--contingency management only. The results showed that the interaction of drug and behavior therapy had no significant effect on weight gain, but that imipramine may have contributed to a decrease in depression. Observations are made regarding weight changes related to passes and medication refusals.

Positron emission tomographic study of affective disorders: problems and strategies

Because anatomical studies of psychiatric disorders in humans have been largely unsuccessful, and because pharmacological interventions in patients with mental illness can be analyzed by means of biochemical assay techniques, positron emission tomography (PET) provides an exciting new means to study mental illness. Using fluorine-18-labeled fluorodeoxyglucose and PET to measure local cerebral glucose utilization, the investigators examined patients with affective disorders and normal age-matched controls. Patients with unipolar depression were studied in a drug-free baseline state following short-term administration of methylphenidate and in a euthymic state in long-term follow-up. Patients with bipolar disorders were studied in either the manic or depressed phases of illness and again in a euthymic state in long-term follow-up. Age-matched controls were studied both with and without methylphenidate administration. The results demonstrate that metabolic subgrouping of patients may be possible. Mood changes produced by pharmacological agents resulted in changes in the patterns of metabolism when compared with the baseline state. Problems associated with the use of PET to study mental illness fall into the categories of patient classification (diagnosis, state, trait, ambient conditions, and mental processes) and data analysis (anatomical and statistical). These problems, the limitations of the present techniques, and strategies for their improvement are discussed. Despite these difficulties, PET should prove to be a fruitful means of exploring the human biochemical abnormalities associated with mental illness.

Abnormal metabolite in alcoholic subjects

2,3-butanediol appears in the blood of some alcoholics following ethanol ingestion. Whether it be a genetic trait or a phenomenon of induction remains to be determined. It may be associated in some way with depression.

[11-Desoxycorticosterone * (DOC) during pregnancy and labor]

In this paper investigations into the increase in the concentration of DOC during the 8th and 40th week of pregnancy are described. It was found that the DOC values sub partu in the umbilical cord are higher than in the maternal blood and that a rapid decrease in the corticoid level occurs post partum both in the mother and in the infant. The fetoplacental unit is discussed as the possible site of synthesis of the steroid.

Treating geriatric depression: a 26-week interim analysis

Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive-behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.

The effects of sleep deprivation on average evoked responses in depressed patients and in normals

The effects of a single night of sleep deprivation on the amplitude and amplitude/stimulus intensity function of the visual evoked potential (EP) were studied in 16 patients with primary affective disorder and 20 normal controls. Visual EP amplitude and amplitude/intensity slopes tended to increase after sleep deprivation in the patient group, a direction found in other studies to be associated with a spontaneous mood improvement and changes with antidepressant medication. In contrast, normal volunteers who showed little or no mood elevation showed generally opposite EP effects. Taken together, the results suggest a similarity in the neurophysiological effect of sleep deprivation between patient and antidepressant medication in depressed patients.

[Determination of the protein binding capacity of corticosteroids from the serum (author's transl)]

This article describes a method which enables determination of the binding capacity of the corticosteroids from untreated serum with relatively little effort. The method is based on the principle of competitive protein binding. The binding capacity is given for cortisol and DOC and it is shown that progesterone enters into a bond with CBG.

[The behaviour of endocrinal parameters under prophylaxis of hyaline membrane disease with glucocorticoids (author's transl)]

Prevention of hyaline membrane disease with glucocorticoids produces suppression of the hypopituitary-adrenocortical axis of the mother as well as of the foetus. The extent of the suppression is significantly higher under medication with the 9 alpha-fluorinated preparations, betamethasone and dexamethasone, than under medication with 16-methyleneprednisolone. Increases in the concentration levels of the mineralocorticoid DOC are to be expected in 37% to 50% of the patients, depending on the administered corticoid. The percentage of increase is 150% under 16-methyleneprednisolone and 220% under betamethasone and dexamethasone.

Treatment of geriatric depression with trazodone, imipramine, and placebo: a double-blind study

Sixty unipolar depressed geriatric outpatients were subjects in a double-blind study of a new antidepressant, trazodone, versus imipramine and placebo. Over the four week study, patients in the two active medication groups improved significantly compared to placebo on both observer and self-ratings. Although imipramine and trazodone had similar therapeutic efficacy, trazodone was judged to have fewer side effects than imipramine, suggesting that trazodone may have particular clinical utility in the geriatric population which is especially vulnerable to cardiovascular and anticholinergic side effects.