Effect of a single-dose of olanzapine on sleep in healthy females and males

The effect of a single dose of 10 mg olanzapine on healthy volunteers of both sexes was examined using polysomnography and power spectral analysis. The structure and continuity of sleep were unaffected by olanzapine in both sexes. The increase in both actual sleep time and slow wave sleep in females correlated with the increase in theta power, while delta power was not significantly elevated, suggesting that theta power may be a sensitive indicator of changes in sleep. The changes in sleep had the same tendency in men, but they were not significant. The difference between the sexes could not be explained by differences in body mass index. Olanzapine affects sleep probably through 5-HT(2C) receptors. The receptor gene is located on the X-chromosome, inducing an allelic difference between the females and males. This difference may contribute to the different effects of olanzapine on sleep. Olanzapine seems to preserve the normal structure of sleep and increase the amount of slow-wave sleep, which might be of additional benefit in treatment of schizophrenia. The effective clinical dose may be lower for females than males.

Increased frequency of activated lymphocytes in the cerebrospinal fluid of patients with acute schizophrenia

We compared the cerebrospinal fluid (CSF) cytology of 30 acutely psychotic patients at the initial phase of their hospital treatment with that of 46 control individuals with no psychiatric disorder or central nervous system (CNS) disease. The cytological profile of May-Grünwald-Giemsa stained CSF cell slides of the patients was significantly different from that of the control population. The most striking finding was a significantly increased frequency of lymphoid cells showing morphological features of activation/stimulation and a decreased proportion of normal small lymphocytes. Many of the cells with aberrant morphology displayed structural details similar to those of the 'P cells' previously described in the blood of schizophrenic patients. The patients' CSF also contained elevated proportions of monocytes/macrophages, some of which were found in 'rosettes' with activated lymphocytes indicating an increased intercellular adhesion. Possible pathogenic mechanisms behind lymphocyte activation and macrophage dominance in the CSF of acutely ill psychotic patients are discussed.

Inverse correlation between hallucinations and serum prolactin in patients with non-affective psychoses

Serum prolactin (PRL) was correlated with clinical symptomatology in 17 drug-free patients suffering from non-affective psychoses. A clear-cut negative correlation was found between the Comprehensive Psychiatric Rating Scale (CPRS) items assessing hallucinations and serum PRL levels (r=-6.14, P=0.009). No correlation was observed between clinical measures (total CPRS score, schizophrenia subscale score or depression and anxiety subscale score) and serum PRL.

Risperidone versus clozapine in treatment-resistant schizophrenia: a randomized pilot study

1. The atypical antipsychotic risperidone may constitute an alternative to clozapine, the current treatment of choice for refractory schizophrenia. The objectives of this study were to evaluate the effectiveness of risperidone in comparison to clozapine in everyday practice and to assess the feasibility of a pragmatic trial procedure. 2. Patients were randomly assigned to open-label clozapine or risperidone treatment for 10 weeks and treatment outcomes were assessed blindly. Twenty-one patients were recruited and nineteen entered the randomized phase. 3. Five of 10 participants allocated to clozapine and one of nine risperidone participants dropped out before study completion. Five clozapine patients and six risperidone patients achieved clinical improvement, defined as a 20% decrease in the Positive and Negative Symptom Scale (PANSS) total score. No significant differences between the groups were detected in baseline or endpoint positive or negative symptoms, disease severity, or global or social functioning scores. Patients' opinion on the drugs did not differ between groups. 4. The findings of the intention-to-treat analysis of this study corroborates previous findings that risperidone may be equally effective as clozapine, and supports the feasibility and need of a multicenter randomized pragmatic trial with sufficient power to detect differences between treatments.

Positive treatment effect of estradiol in postpartum psychosis: a pilot study

BACKGROUND

Postpartum illnesses with psychiatric symptoms and serious adverse sequelae are highly prevalent during the childbearing years. Despite multiple medical contacts, these illnesses often remain unidentified and untreated. To study the association between estradiol and puerperal psychosis, we measured serum concentration of estradiol and performed an open-label trial of physiologic 17beta-estradiol in women with this disorder.

METHOD

Ten women with ICD-10 psychosis with postpartum onset consecutively recruited from a psychiatric duty unit were studied. Serum estradiol concentration was measured at baseline and weekly during sublingual 17beta-estradiol treatment for 6 weeks. The treatment effect was evaluated by a clinician-rated psychiatric symptom scale (the Brief Psychiatric Rating Scale [BPRS]).

RESULTS

The baseline serum estradiol levels (mean = 49.5 pmol/L; range, 13-90 pmol/L) were even lower than the threshold value of gonadal failure, and the patients exhibited high scores on the psychiatric symptom scale (mean BPRS total score = 78.3; range, 65-87). During the first week of 17beta-estradiol treatment, psychiatric symptoms diminished significantly (BPRS score decreased to a mean of 18.8, p < .001). Until the end of the second week of treatment, serum estradiol concentrations rose to near the values normally found during the follicular phase, and the patients became almost free of psychiatric symptoms.

CONCLUSION

The reversal of psychiatric symptoms in all patients by treating documented estradiol deficiency suggests that estradiol plays a role in the pathophysiology and may have a role in the treatment of this condition. There was a rebound of psychotic symptoms in the 1 patient who discontinued estradiol treatment. Given the small number of patients, this area deserves further study.

Current antipsychotic dose correlates to mononuclear cell counts in the cerebrospinal fluid of psychotic patients

Elevated cerebrospinal fluid (CSF) angiotensin I-converting enzyme (ACE) levels have been evidenced in patients with schizophrenia who have been treated with antipsychotics. In order to explore a possible mononuclear cell origin of CSF ACE, the authors determined CSF ACE and CSF mononuclear cell counts from 25 acutely psychotic patients, who had been drug-free for at least 4 months but started on conventional antipsychotic medication within a few days before sampling. No correlations were found between CSF to serum ACE ratio and CSF mononuclear cell counts. However, CSF total mononuclear cell count, CSF lymphocyte count, and CSF mononuclear phagocyte count evidenced significant positive correlations with current dose of antipsychotic medication expressed as chlorpromazine equivalents. The authors conclude that no indication of a relationship between mononuclear cells and CSF ACE activity was found. Surprisingly, a relationship between chlorpromazine dose and CSF mononuclear cell counts was found, which may indicate drug-related changes in cell-mediated immunity. This finding needs replication and further corroboration in well-designed studies.

Cerebrospinal fluid angiotensin-converting enzyme (ACE) correlates with length of illness in schizophrenia

The aim of the study was to evaluate a possible progression with time of cerebrospinal fluid (CSF) angiotensin-converting enzyme (ACE) levels in treated schizophrenia patients. CSF ACE was determined in duplicate by a sensitive inhibitor-binding assay (IBA) from morning CSF samples of 56 acute and chronic in-patients with schizophrenic psychoses diagnosed according to DSM-IV. CSF ACE correlated significantly with length of schizophrenic psychosis (r=0.39, p=0.003). There was also a positive significant correlation between CSF ACE and duration of current psychotic episode (r=0.39, p=0.003) as well as duration of current hospitalization (r=0.66, p<0.001). These significances were maintained even when patients who were not treated with antipsychotics at the time of sampling were excluded. The correlations also remained significant when controlling for current neuroleptic dose in chlorpromazine equivalents. Serum ACE did not correlate with any clinical variable. No significant correlations between serum or CSF ACE and age, diagnostic subgroup, gender, serum ACE, CSF to serum albumin ratios, or neuroleptic dose in chlorpromazine equivalents were detected. The elevation of CSF ACE seemed to be confined to a subgroup of chronic patients with few positive symptoms. Elevated CSF ACE may reflect an increased solubilization of ACE from cell membranes in the central nervous system or constitute an increased expression of the ACE gene in response to some stimuli. This may be a function of treatment or a result of the deteriorating schizophrenic process.

Accumulation of macrophages in the CSF of schizophrenic patients during acute psychotic episodes

OBJECTIVE

There have been numerous reports of organic or structural abnormalities in the central nervous system (CNS) of patients with schizophrenia. Given that pathological conditions in the CNS are frequently reflected in the cell profiles of CSF, the authors compared the cytology of CSF from schizophrenic patients with that from a reference population in order to find out trails of elementary pathogenetic events in this serious psychiatric disease.

METHOD

CSF samples from 35 patients with acute schizophrenia and 46 comparison subjects were prepared by Millipore filtration. The total and differential counts of CSF mononuclear cells were performed by light microscopy.

RESULTS

At the beginning of treatment, the proportion of mononuclear phagocytes/macrophages in the patients' CSF was significantly higher than that in the comparison subjects. During treatment with conventional neuroleptic medication, the cytology returned to normal in several patients.

CONCLUSIONS

The high proportion of macrophages in schizophrenia without a significantly higher total cell count may reflect neurodevelopmental disorder, a neurodegenerative process, or subtle CNS immunoactivation with mobilization of microglia.

Adjunctive nefazodone in neuroleptic-treated schizophrenic patients with predominantly negative symptoms: an open prospective pilot study

A combination of nefazodone with a conventional neuroleptic would lead to a serotonin (5-HT)2 and D2 receptor blockade resembling that of an atypical neuroleptic, with an additional increase of 5-HT (and noradrenaline) turnover. This may be of benefit in some cases of schizophrenia. In this study, eight patients with schizophrenia with predominantly negative and/or depressive symptoms underwent an open prospective 26-week trial with nefazodone, added to conventional neuroleptics. The total Positive and Negative Syndrome Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores (the last observations carried forward, LOCF) significantly (P < 0.05) decreased in these eight patients by a mean of 31% and 63%, respectively, mainly within the first 6 weeks. Positive symptoms, observed in three patients and panic attacks in two patients disappeared entirely. The doses of neuroleptics, stable during the first 6 weeks of the trial, subsequently were able to be decreased by 28%. Extrapyramidal symptoms noticeably improved during the phase of stable neuroleptic dose regimen. Of the three patients who discontinued the trial prematurely (after 14 weeks or more), only one evidenced a nefazodone-related adverse event. Adjunctive nefazodone may be a useful treatment option in this patient population, but additional studies are recommended.

Higher cerebrospinal fluid angiotensin-converting enzyme levels in neuroleptic-treated than in drug-free patients with schizophrenia

The aim of this study was to replicate our earlier finding of elevated angiotensin-converting enzyme (ACE) in cerebrospinal fluid (CSF) in schizophrenia and to elucidate the role of neuroleptic treatment in this phenomenon. Drug-free and medicated patients with acute schizophrenic psychoses, as well as healthy controls were recruited. Levels of ACE were measured in CSF and serum from 7 drug-free patients, 36 neuroleptic-treated patients, and 19 healthy control subjects. Although ACE levels in CSF did not differ between patients and controls, the drug-free patients showed significantly lower levels than the neuroleptic-treated patients. Serum ACE did not differ between groups. The elevation of CSF ACE may be more prominent in patients with deficit symptoms than in those with mainly psychotic symptoms. The possible enhancement of CSF ACE production or solubility by neuroleptic treatment is discussed. Elevated ACE levels in CSF may, together with other possible factors, cause polydipsia, stimulate secretion of arginine vasopressin, and even affect neuron growth and differentiation in schizophrenic psychoses.

No differences in phospholipase-A2 activity between acute psychiatric patients and controls

The phospholipase-A2 activity in plasma from 62 psychiatric patients admitted in an acute state to psychiatric hospital was determined by a fluorometric assay and compared to that of age- and sex-matched controls. Contrary to earlier findings, no significant differences were found between patients and controls.

A longitudinal study of cerebrospinal fluid angiotensin-converting enzyme in neuroleptic-treated schizophrenia

1. The aim of the study was to replicate our earlier finding of elevated cerebrospinal fluid (CSF) angiotensin-converting enzyme (ACE) in neuroleptic-treated schizophrenia and to elucidate the correlations between CSF ACE, neuroleptic treatment, and psychotic symptoms in a longitudinal study. 2. Levels of ACE were measured in CSF and serum from 9 acutely psychotic schizophrenic patients at two separate points of time; within a few days of admission and at follow-up after 3-4 weeks. CSF ACE was also determined from 9 healthy controls. 3. The schizophrenic patients showed non-significantly higher levels of CSF ACE than the controls. Although a significant clinical improvement was observed and the neuroleptic medication was reduced during the follow-up period, there were no significant differences in serum or CSF ACE between the two observation points in the schizophrenia group.

Elevated plasma vasopressin and normal cerebrospinal fluid angiotensin-converting enzyme in chronic pain disorder

The study was performed proceeding from the hypothesis that pain proneness in chronic pain disorder (CPD) is a result of alterations in central mechanisms regulating pain sensations. To elucidate the function of the central renin-angiotensin system, the levels of angiotensin-converting enzyme (ACE) and arginine vasopressin (AVP) in cerebrospinal fluid (CSF) and peripheral blood were measured in 15 CPD patients and 19 healthy controls. Plasma AVP levels (p = .01) as well as the serum osmolality (p = .01) were significantly higher in the CPD group. No significant differences in CSF ACE levels were found. AVP is a stress-related peptide, but central antinociceptive effects have also been reported. Elevated plasma AVP levels possibly may constitute a response to chronic stress.

Cerebrospinal fluid gamma-aminobutyric acid in patients with panic disorder

Cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels were measured in 11 patients with panic disorder (PD) prior to and following 7 months of treatment with alprazolam or imipramine and in six neurological control patients. Although a clear treatment response was observed in patients with PD, neither alprazolam nor imipramine significantly changed CSF GABA during the treatment period. A negative correlation was demonstrated between baseline CSF GABA and posttreatment overt psychopathology. Low pretreatment level of CSF GABA correlated significantly with poor therapeutic outcome, judged by the amount of anxiety and depression as well as by the frequency of panic attacks at the end of follow-up.

Abnormal distributions of T-lymphocyte subsets in the cerebrospinal fluid of patients with acute schizophrenia

We analysed the percentages of CD4+ and CD8+ T lymphocytes in the cerebrospinal fluid (CSF) from 31 acutely ill schizophrenic patients. The psychotic patients had in their CSF clearly altered proportions of CD4+ and/or CD8+ T cells. As compared to the distribution of T cell subsets in the CSF from non-psychotic controls, the schizophrenic patients displayed both abnormally high and abnormally low frequencies of CD4+ and/or CD8+ cells. Changes in the distribution of T cell subsets corresponding to those seen in the CSF were not observed in paired blood samples from schizophrenic patients.

The effect of fluoxetine on sleep: a longitudinal, double-blind polysomnographic study of healthy volunteers

Fluoxetine, a selective inhibitor of serotonin (5-HT) uptake, was compared with placebo in a randomized double-blind longitudinal trial in 12 healthy volunteers. Sleep polygraphic recordings were performed at home twice before and once after 6 days of medication. After 6 days fluoxetine significantly decreased the amount of rapid eye movement (REM) sleep. The sleep-onset latency and REM latency were increased, but there was no significant increase in the amount of awakenings during night. The relative proportion of stages 2 and 3 increased after fluoxetine administration, although there was no significant change with regard to total amount of slow-wave sleep. Fluoxetine did not induce prominent eye movements during non-rapid eye movement (NREM) sleep in this study. Results of the subjective assessment revealed tendencies of improved sleep and well-being in the fluoxetine group. It is concluded that a comparatively small dose of fluoxetine (20 mg/day) causes the same type of changes in REM sleep which are characteristic of most antidepressive drugs.

Psychosocial factors, female fertility and pregnancy: a prospective study--Part I: Fertility

The aim of the study was to determine prospectively whether psychosocial, personality-related or stress factors have influence on fertility. Initially 191 healthy nulliparas without a history of infertility who were planning to have children were studied gynecologically and by psychiatric examination. Life changes and changes in psychosocial stress were monitored throughout the study period of 6 months at regular intervals. The following factors turned out to be associated with higher than average fertility in the final follow-up sample of 180 women: looking younger than one's actual age, no fluctuation in body weight before pregnancy, low consumption of coffee, low score of psychosomatic symptoms, being the youngest sibling, low number of negative life changes, younger than spouse, having phobic traits, and customarily religious. There was no clearcut association between low fertility and deviations in personality factors.

Psychosocial factors, female fertility and pregnancy: a prospective study--Part II: Pregnancy

The aim of the study was to determine whether psychosocial factors have an influence on the progress and outcome of pregnancy and whether personality-related or stress factors are significant in this respect. One hundred and ninety-one nulliparas without a history of infertility were prospectively studied gynecologically and psychiatrically. Life changes and changes in stress factors were monitored throughout the study period and obstetric complications were registered. By the end of the study period 120 (63%) of the subjects had given birth, 38 (19%) had abortion, 22 (12%) did not conceive and the remaining 11 (6%) discontinued. Certain psychosocial factors (e.g. life changes, anxiety, subjectively estimated physically and mentally stressful work) were associated with complications of pregnancy. In the logistic regression analysis the psychosocial stress factors were more strongly associated with the outcome of pregnancy than the factors related to personality. Adjusting for the stress-buffering factors (personality, coping methods and social support) did not reduce the original association.

Plasma levels of interleukin-1 beta and interleukin-6 in schizophrenia, other psychoses, and affective disorders

Plasma levels of interleukin (IL)-1 beta and IL-6 were measured in 60 acutely hospitalized psychiatric patients and in 60 healthy controls by enzyme-linked immunosorbent assay (ELISA). Almost no IL-6 was detected in the plasma of the patients or controls. The mean level of IL-1 beta was found to be significantly higher in schizophrenic patients than in their corresponding controls (P = 0.03). The acute schizophrenics, but not the group of chronic schizophrenics, contributed to this increase. No correlation with age, duration of illness or overt psychopathology was found. The neuroleptic medication did not prove to have a significant effect on the plasma IL-1 beta levels. There was no difference between non-psychotic affective disorder patients (N = 17) and the controls.

Plasma and cerebrospinal fluid interleukin-1 beta and interleukin-6 in hospitalized schizophrenic patients

Interleukin (IL)-1 beta and IL-6 levels in plasma and cerebrospinal fluid (CSF) of 14 medicated schizophrenic patients and 9 controls were measured by enzyme-linked immunosorbent assay. Almost no detectable levels of IL-6 in plasma or CSF from patients or controls were found. With regard to mean plasma or CSF levels of IL-1 beta there were no statistically significant differences between the two groups investigated. The dose of neuroleptic medication the patients used did not correlate with the IL-1 beta plasma levels. For the whole series of subjects (n = 23) or for the schizophrenic patients (n = 14) no correlation between the plasma and CSF levels of IL-1 beta was found.

Is there a seasonal variation in the interferon-producing capacity of healthy subjects?

Induced production of interferon-alpha (IFN-alpha) and IFN-gamma was studied in 101 blood samples from 49 healthy subjects during 1 year. The results indicate a seasonal variation of the IFN-producing capacity, with a decrease in summertime, in Finland.

Elevated angiotensin-converting enzyme (kininase II) in the cerebrospinal fluid of neuroleptic-treated schizophrenic patients

Disturbances of water homeostasis have frequently been reported in schizophrenia. Water homeostasis is regulated by arginine vasopressin (AVP), the renin-angiotensin system and natriuretic hormones. The aim of this study was to determine the activity of the central renin-angiotensin system in schizophrenia by measuring levels of angiotensin-converting enzyme (ACE) in the cerebrospinal fluid (CSF) and blood in 14 in-patients with schizophrenia on neuroleptic medication and in 9 healthy volunteers. The levels of CSF ACE were significantly higher in the schizophrenia group. There were no correlations between CSF ACE and gender, age, age at first episode, duration of illness, term of hospitalization or neuroleptic dosage. No correlations between CSF ACE and serum ACE were found in either group. The authors suggest an activated central renin-angiotensin system in schizophrenia at least during antipsychotic drug treatment, which may cause 'psychogenic' polydipsia in some patients. ACE and the brain renin-angiotensin system may also play a role in the regulation of neuron growth and differentiation in schizophrenia.

Interferon-alpha as adjuvant treatment in chronic schizophrenia

The therapeutic use of interferon (IFN)-alpha administered as adjuvant medication in chronic schizophrenia was investigated. Natural leukocyte IFN-alpha was given to 9 long-term hospitalized chronic schizophrenic patients daily as subcutaneous injection of 3 million units 5 times a week. The trial followed a placebo-controlled double-blind crossover design. Each treatment period lasted for 8 weeks with a 2-week washout period in between. IFN-alpha did not prove to be beneficial for the total group of patients. Yet, 3 patients improved during the IFN-alpha drug period. The clinical improvement was seen as better social competence and less affective tension in the ward surroundings.

Moclobemide versus imipramine in depressed out-patients: a double-blind multi-centre study

One hundred and twenty seven patients with major depressive episode were included in a double-blind, four-week, prospective, randomized, multi-centre parallel-group trial comparing moclobemide and imipramine. The dose of moclobemide was 150-525 mg/day and that of imipramine 50-175 mg/day; the mean daily doses during the last week of treatment were 307 mg and 100 mg of moclobemide and imipramine, respectively. The decrease of the total scores of the Hamilton Depression Scale (HDRS) as well as the Overall Assessment of Efficacy by the Investigators showed significant amelioration of depression in both treatment groups (p < 0.001). No significant differences were found between the moclobemide and imipramine groups with regard to treatment outcome. The onset of the antidepressant activity was faster in the moclobemide group as measured by the Assessment of the Investigators. This difference was not observed when the therapeutic index figures calculated on the basis of the changes in the HDRS scores were scrutinized. Treatment-emergent side effects were somewhat more frequent during imipramine than during moclobemide treatment. Nevertheless, a total of only four patients discontinued the trial prematurely because of poor tolerability. Imipramine-treated patients reported more anticholinergic side effects, whereas tiredness and headache were observed more frequently in the moclobemide-treated patients. Restlessness, nervousness and sleep disturbances were noted with equal incidence in both patient groups.

Modified activity of the human auditory cortex during auditory hallucinations

Previous reports have shown abnormalities in brain metabolism and evoked responses of schizophrenic patients with hallucinations. The authors recorded electric and magnetic auditory responses during transitory auditory hallucinations in two patients. Small but replicable response delays occurred during hallucinations. The results suggest that the effect of hallucinations on auditory cortex activity is similar to the effect of real sounds.

Plasma concentrations of remoxipride and haloperidol in relation to prolactin and short-term therapeutic outcome in schizophrenic patients

Plasma concentrations of remoxipride and haloperidol as well as prolactin (PRL) were determined in 20 patients with acute symptoms of schizophrenia. Ten patients received remoxipride and ten patients haloperidol for a period of 6 weeks. A significant linear correlation was found between the plasma level of remoxipride and the dosage applied (P less than 0.02) as well as between the corresponding haloperidol dosage and plasma concentration (P less than 0.05). In both patient groups a significant reduction in psychopathology was observed during the trial period (P less than 0.001). In the haloperidol group this was associated with a clearcut elevation of plasma PRL, whereas in the remoxipride group after an initial rise for 4 weeks, the mean PRL level returned to baseline at the end of the study.

Alprazolam and oxazepam in the treatment of anxious out-patients with depressive symptoms: a double-blind multicenter study

In a four-week double-blind study comparing alprazolam with oxazepam, 62 outpatients suffering from anxiety with depressive symptoms were evaluated. The average daily doses of alprazolam and oxazepam were 1.48 mg and 44.4 mg, respectively. According to all rating scales applied, both alprazolam and oxazepam were effective in relieving anxiety associated with mild depression (p less than 0.01). Alprazolam proved somewhat more effective than oxazepam especially with regard to overall performance (p less than 0.05). Treatment-emergent adverse effects were few and mild for both compounds tested.

Prolactin response to submaximal stimulation by TRH in nonaffective psychoses

Nonaffective psychotic symptoms are heterogeneous and probably caused by mixed biopathology. A preliminary investigative tool to study pituitary dopamine activity, the prolactin response to submaximal stimulation by thyrotropin-releasing hormone (TRH) (mini-TRH test) was correlated in 20 subjects with nonaffective psychoses to positive psychotic symptoms as assessed by the Comprehensive Psychiatric Rating Scale psychosis subscale. A significant positive correlation was observed between the response and ratings of nonparanoid symptoms, especially nonparanoid delusions and disrupted thoughts. Because, in addition to pituitary dopamine activity, there is evidence to suggest that the response reflects extrapituitary dopamine activity as well, the results extend the evidence that nonparanoid acute productive psychotic symptoms may be associated with hypoactivity rather than with hyperactivity of brain dopaminergic systems.

Dynorphin A and substance P in the cerebrospinal fluid of schizophrenic patients

Radioimmunoassay procedures were used to assay levels of dynorphin A (DYN A) and substance P-like activity (SP) in cerebrospinal fluid (CSF) obtained from 10 schizophrenic patients before and after neuroleptic treatment, from 10 matched patients with other psychiatric disorders before and after treatment, and from 10 nonpsychiatric surgical controls. The highest mean concentration of CSF DYN A was found in the schizophrenic group on admission (significant vs. nonpsychiatric controls). The concentration remained almost unaltered after 4 weeks of zuclopenthixol treatment despite a highly significant decrease of overt psychopathology assessed by the Brief Psychiatric Rating Scale (BPRS). There was no significant difference between the mean CSF DYN A levels of the nonschizophrenic psychiatric patients and the surgical controls. When all psychiatric patients were pooled together, there was a significant correlation between the level of CSF DYN A and the BPRS total score. With regard to CSF SP levels, no statistically significant differences were observed within or between the groups studied. Neither was there a significant correlation between the concentration of CSF SP and overt psychopathology. Nevertheless, the mean CSF SP concentration of three patients with major depression was clearly higher than the corresponding mean concentration of the other patients in the nonschizophrenic group.

EEG and CT findings in patients with panic disorder

Fifty-four patients with panic disorder were investigated using extensive electroencephalographic (EEG) recordings and computerized tomography (CT). Fifteen (28%) of these patients had previously been treated for temporal lobe epilepsy or were considered to have another neurological disorder. EEG recordings showed increased slow-wave activity in 13 (24%) patients and CT scan revealed incidental abnormalities in 6 (20%) of the 30 patients investigated. Taking into account the limitations of the methods applied, the present results indicate that clear-cut epileptic EEG patterns only rarely occur in panic disorder: the vast majority of panic patients exhibit normal EEG and CT findings.

Cerebrospinal fluid monoamine metabolites and neuropeptides in patients with panic disorder

Concentrations of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), 3-methoxy-4-hydroxyphenylglycol (MHPG) as well as somatostatin (SRIF) and beta-endorphin (beta-END) were assayed in the cerebrospinal fluid (CSF) of 34 patients with panic disorder and of ten neurological controls. No aberrations of the monoaminergic or peptidergic variables measured were found in the nonpanic state of patients with panic disorder. A modest correlation (P = 0.04) between total anxiety scores and CSF MHPG was observed.

Production of interferon-alpha and gamma by leukocytes from patients with schizophrenia

Production of interferon (IFN)-alpha and -gamma by leukocytes from 34 patients with acute schizophrenia and 34 controls was measured before and after 5-6 weeks of antipsychotic treatment by using Sendai virus as IFN-alpha inducer and lentil lectin as inducer for IFN-gamma production. The schizophrenia series included 13 first admission patients (mean duration of illness 1.1 years) and 21 re-entry patients (mean duration of illness 10.1 years). Of the total series 23 were drug-free at the time of pretreatment sampling. In all subgroups the schizophrenic patients produced less IFNs than healthy controls although the differences reached statistical significance only in the total group of schizophrenic patients with regard to production of IFN-alpha. The antipsychotic drug treatment did not have an effect on IFN production. The techniques used, the influence of genetic factors, and eventual clinical implications are discussed.

Sulpiride and perphenazine in schizophrenia. A double-blind clinical trial

Seventeen patients with acute schizophrenia and 30 with chronic schizophrenia were included in a randomized, double-blind parallel-group trial comparing sulpiride and perphenazine. Patients were evaluated using the 16-item Brief Psychiatric Rating Scale (BPRS) prior to the onset of treatment and 1 and 2 weeks, and 1, 2, 3, and 4 months thereafter. In patients with acute schizophrenia, total BPRS scores declined significantly at the end of the trial compared with pretreatment values in sulpiride-treated patients but not in schizophrenics treated with perphenazine. Differences in response between the groups did not reach statistical significance, however. For patients suffering from chronic schizophrenia, a statistically significant decline was observed in total BPRS scores at 4 months compared with pretreatment scores in both sulpiride and perphenazine groups. There was no significant difference in the treatment response between the groups. Sulpiride appeared to be somewhat more effective than perphenazine for treatment of acute schizophrenia. Efficacy of both compounds was less marked in chronic forms of schizophrenia.

Long-term effects of alprazolam and imipramine on cerebrospinal fluid monoamine metabolites and neuropeptides in panic disorder

Cerebrospinal fluid (CSF) homovanillic acid, 5-hydroxyindoleacetic acid, 3-methoxy-4-hydroxyphenylglycol, and somatostatin and beta-endorphin levels were measured in 12 patients with panic disorder before and after 7 months of treatment with alprazolam or imipramine. The concentrations of CSF monoamine metabolites and neuropeptides were at baseline of the same order of magnitude in panic patients and controls. Neither alprazolam nor imipramine changed metabolite or neuropeptide levels in CSF despite clinical improvement in both treatment groups. According to present CSF data, the antipanic actions of alprazolam and imipramine do not involve the monoaminergic or peptidergic systems studied.

Interrelationship of hypochondriacal, paranoid, depressive, and suicidal symptoms in Chinese psychiatric patients

Data concerning 150 consecutive adult psychiatric patients treated by the authors in a general hospital psychiatric unit were analyzed. All patients with predominant hypochondriacal or paranoid symptoms were selected. The presence of depressed mood and suicidal ideas and their impact on prognosis were investigated. Finally, characteristics of patients with both hypochondriacal and paranoid symptoms were studied. We found that: (a) 79% of the patients with predominant hypochondriacal symptoms were depressed, but only 27% of these had suicidal ideas. These patients usually revealed a poor response to treatment. (b) Only 27% of the patients with paranoid symptoms only were depressed, but their suicidal risk was high. They usually had a good response to treatment. (c) Only 3% of the total sample exhibited both hypochondriacal and paranoid symptoms. They were all thought-disordered schizophrenics but had better prognosis than expected. The psychodynamic background of the results is discussed.

Viral antibodies and interferon in acute psychiatric disorders

In a prospective study of 54 patients with acute psychiatric disorders, interferon and antibodies in serum and CSF were measured to 19 microbes by the complement fixation (CF) test and to 7 viruses by enzyme immunoassay (EIA). The CF test revealed a fourfold or greater change (p less than .001) in serum antibody titers in 20 patients, and EIA showed a twofold or greater change in CSF titers in 7 patients. Pathological serum/CSF antibody ratio by EIA was observed in 8 patients. The results suggest that viral infections and inflammatory processes have significance in the etiopathogenesis of acute psychiatric disorders.

Relationship of migration to paranoid and somatoform symptoms in Chinese patients

Among 162 consecutive adult Chinese new psychiatric patients, the proportion of Chinese immigrants was not significantly higher, compared with the 1986 by-census results. However, the proportion of immigrants with predominant somatoform symptoms was significantly higher (p less than 0.02), and that of immigrants with predominant paranoid symptoms was almost significantly higher (p = 0.052) than the corresponding proportions of immigrants without these symptoms. Evidence was given suggesting that the increased proportion of paranoid immigrants was probably due to social selection, while the increased proportion of somatoform immigrants could be explained by the social causation theory.

Serum and cerebrospinal fluid antibodies to cytomegalovirus in schizophrenia

Antibodies to cytomegalovirus (CMV) were determined in the serum and cerebrospinal fluid (CSF) by complement-fixing (CF), enzyme immunoassay (EIA), and enhanced virus neutralization test (EVNT), in acute unmedicated schizophrenic patients and neurological controls. An elevated level of CF antibody was observed in three serum specimens from the schizophrenic patients and in one control specimen. No CF antibody was present in the CSF samples of the two patient groups tested. By EIA none of the serum or CSF specimens was positive for IgM antibody to CMV. By EVNT, 17% of the schizophrenic patients exhibited a CSF/serum ratio greater than 2 SD, whereas the corresponding figure for the control group was 4% (P greater than 0.05). The role of CMV in the etiopathogenesis of schizophrenia is discussed in the light of the present and previous negative findings.

Myelin basic protein antibodies in catatonic schizophrenia

Myelin basic protein (MBP) antibodies were determined by solid-phase radioimmunoassay in the serum and cerebrospinal fluid of 10 patients with catatonia, 10 patients with other forms of schizophrenia, and 10 psychiatrically healthy controls. The mean counts per minute (cpm) value of serum anti-MBP antibody of the catatonia group was significantly higher than that of the patients with other forms of schizophrenic psychoses (p less than .05). No significant differences were observed among the cpm values of the CSF specimens from the three patient groups. The hypothesis of a central virus-induced immunologic aberration in catatonic schizophrenia is discussed.

Serum and cerebrospinal fluid prolactin patterns during neuroleptic treatment in schizophrenic patients

Serum and CSF prolactin (PRL) concentrations were determined during eight weeks of fluphenazine medication in 28 patients with acute symptoms of schizophrenia. In both sexes a good correlation between the serum and CSF PRL values was found (r = 0.57, p less than 0.01). Throughout the entire study, first admission (FA) patients had significantly higher levels of serum and CSF PRL than the re-entry (RE) schizophrenics (0.05 greater than p less than 0.001). In addition, in FA patients, a gradual increase of the serum and CSF PRL concentrations was observed, whereas in the RE group an adaptive secretion pattern of PRL could be detected. In both patient groups, female patients exhibited significantly higher PRL serum and CSF levels than the male patients (0.05 greater than p less than 0.001). The tolerance phenomenon in the RE groups was more marked in the female than in the male patients. No correlation between clinical outcome and PRL response to fluphenazine treatment was observed. The prognostic significance of the differences in the PRL secretion pattern is discussed.

Altered white cell count, protein concentration and oligoclonal IgG bands in the cerebrospinal fluid of many patients with acute psychiatric disorders

In a prospective study, an abnormal white cell count and/or elevated protein concentration in the cerebrospinal fluid (CSF) was observed in 14/54 patients (26%) with acute psychiatric disorders, but in none of the 46 control subjects (p less than 0.001). In addition, electrophoretic analysis of immunoglobulin G (IgG) showed an oligoclonal pattern in the CSF of 22 psychiatric patients (41%). No such pattern could be detected in the control group (p less than 0.001). These findings reinforce the value of lumbar puncture and CSF analysis in acute psychiatric disorders.

Life stress and rheumatoid arthritis. A 15-year follow-up study

A 15-year follow-up study of 74 female patients with definite or classic rheumatoid arthritis (RA) was performed with special focus on the association between life stress and clinical course of the illness. Two categories of RA could be classified: a disease form less connected with genetic factors and more influenced by major psychodynamic conflict situations ('major conflict group' MCG) and a second form more associated with hereditary predisposition and less influenced by environmental psychosocial changes ('non-conflict group', NCG).

Elevation of substance P-like peptides in the CSF of psychiatric patients

Using a radioimmunoassay procedure substance P-like activity was measured in samples of human CSF obtained from 12 patients with major depressive disorder, 12 with schizophrenia, and 15 control cases diagnosed as psychiatrically normal. Levels were significantly higher in CSF of patients with depressive disorder as compared with schizophrenic patients or controls. Chemical characterization revealed that the measured activity was less basic than substance P itself and might be due to C-terminal fragments. A component reacting with an antiserum highly specific for the substance P[1-7]fragment was found in CSF of patients with depressive disorder. The results indicate that substance P-related peptides may be biological markers in psychoses, particularly in major depressive disorder.

Overt psychopathology in rheumatoid arthritis. A fifteen-year follow-up study

A 15-year follow-up study of 74 female patients (mean age 57.9 years) with definite or classic rheumatoid arthritis (RA) was performed, with special emphasis on overt psychopathology during the clinical course of the illness. Catamnestic investigation revealed that in 46% of the patients psychiatric disturbances necessitating treatment had appeared during the follow-up period. Generally, the psychiatric syndromes observed were of neurotic type not infrequently associated with depressive symptomatology. At the time of investigation 41% of the patients exhibited overt psychopathology, of whom the majority had depressive reactions (40%) or other forms of neurotic syndromes (18%). Only one patient was diagnosed as psychotic. In 5 instances distinct signs of chronic organic brain syndrome were noted. The importance of identifying clinical depression and of instituting adequate drug treatment and psychotherapy is emphasized.

Haloperidol, thioridazine and placebo in mentally subnormal patients-serum levels and clinical effects

A randomized cross-over trial was conducted in 30 restless mentally subnormal patients by increasing the dosage of haloperidol from 10 to 60 mg and that of thioridazine from 100 to 600 mg daily. The clinical effects of drug holidays on placebo and serum drug levels were also examined. There were more relative drug-responders than nonresponders or negative responders. Correlation between clinical response and drug serum levels was poor, probably owing to the heterogeneity of disorders treated. Mesoridazine and other metabolites had 5-6 times higher serum levels than the parent compound, and relatively high serum levels are achieved already with moderate doses. The observed differences between haloperidol and thioridazine treatment were surprisingly few. Serum cholesterol was higher (P less than 0.05) at the end of thioridazine than of the haloperidol administration.

Serum and CSF levels of haloperidol by radioimmunoassay and radioreceptor assay during high-dose therapy of resistant schizophrenic patients

Serum and cerebrospinal fluid (CSF) levels of haloperidol were measured in 12 chronic neuroleptic-nonresponsive schizophrenic patients after 1 month on 60 mg haloperidol daily and then again after 1 month on 120 mg haloperidol daily. Serum haloperidol and CSF haloperidol rose with increasing dose. Serum and CSF levels were significantly correlated. No clinical improvement was achieved despite the high serum and CSF drug levels.