Alteration of pain recognition in schizophrenia.

BACKGROUND: Schizophrenia patients display impaired recognition of their own emotions and those of others and deficits in several domains of empathy. The first-person experience of pain and observing others in pain normally trigger strong emotional mechanisms. We therefore hypothesized that schizophrenia patients would display impaired recognition and categorization of both their own pain and the pain of others. METHODS: We studied 29 patients (18 men/11 women; 36 ± 13 years old) with paranoid schizophrenia-spectrum disorder and 27 healthy volunteers (20 men/7 women; 31 ± 9 years old) matched for age, gender, IQ and socio-cultural level. We assessed symptom severity and theory of mind. The participants' ability to detect and categorize pain in others was assessed with the sensitivity to expressions of pain (STEP) test, which is based on facial expressions, and another dynamic test involving a series of video sequences showing various pain-inducing events. The ability of patients to evaluate their own pain was assessed with the situational pain questionnaire (SPQ), which includes a series of questions assessing how one would expect to feel in different imaginary situations. Empathic tendencies were assessed with the interpersonal reactivity index. RESULTS: Patients and controls differed significantly in STEP, pain video and SPQ scores. By contrast with control subjects, the patients' pain judgements were not correlated with their affective or cognitive empathic capacities. CONCLUSIONS: Schizophrenic patients have a deficit of the identification and categorization of pain both in themselves and in others.

[Humour and the theory of mind in schizophrenia: a review of the literature]. / Humour et théorie de l'esprit dans la schizophrénie, revue de la littérature.

Humour is a universal phenomenon, a daily fact holding positive aspects valued in society. The sense of humour is subjective, inherent in each and everyone and difficult to assess. We could qualify it as an indefinable sense set by an absence of norms. This intangible notion occupies a primordial social role of communication, confidence, shared by all with both therapeutic and physical benefit. Scientists started researching this theme in schizophrenic patients from 1950. Studies show a net deficit of humour capabilities between healthy subjects and patients. The hypothesis of a deficit of the theory of mind in the evaluation of humour in schizophrenics is currently the object of several experiments. Nowadays, cognitive functions are also taken into account in humour perception studies. However the little or few studies relevant to this subject are a definite obstacle to the understanding of this complex phenomenon.

[The placebo effect: general information and specificities in psychiatry (depression and schizophrenia)]. / L'effet placebo : généralités et spécificités en psychiatrie (dépression et schizophrénie).

INTRODUCTION: Placebos, consequences of their use, the placebo effect and the associated negative effects, the nocebo effect, have been widely studied. However, the lack of any consensus definition makes the interpretation and analysis of such findings difficult. LITERATURE FINDINGS: In this article, we will review existing definitions and factors affecting the placebo effect in medicine. We will then consider the possible mechanisms of action of the placebo effect, with a view to improving understanding of this issue. Finally, we will analyse data relating to placebos used in psychiatry and, more specifically, for schizophrenic patients. In an extensive review of the literature, we identified the various factors playing a role in the appearance of placebo effects in general medicine. As well as purely factual elements, such as the disorder, the sex of the subject and the treatment given, the placebo effect is strongly correlated with the quality of the relationship between the doctor and patient and with the capacity of the patient to communicate and establish a link. The attitude of the doctor, the temperament of the subject and the expectations and beliefs of each also contribute to the appearance and extent of a placebo effect. We then investigated placebo effects in psychiatry, particularly in depressed patients (the most widely studied condition) where studies have shown particular efficacy. We also addressed the use of placebos in schizophrenia: the placebo effect in patients with this disorder is essentially used as a tool for assessing new molecules to be released onto the market but the phenomenon itself has been little studied, if at all. Thus, it is of particular interest to consider in detail the use of placebos in schizophrenia, to try to gain a deeper understanding of the factors involved. This will allow potential specific effects associated with placebo use in this disorder to be established, improving the integration of placebos into therapy and to optimize the efficacy of treatment prescribed, taking into account mental state; indeed, the placebo effect is present in all treatments, whether involving a placebo or an active compound.

[Pain and schizophrenia: myth and reality]. / Douleur et schizophrénie: mythe et réalité.

INTRODUCTION: The International Association for the Study of Pain (IAPS), in 1986, defined pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Thus, the few studies on this phenomenon conducted on schizophrenic patients did not result in a firm consensus; certain studies showed that such patients seemed to have a higher threshold against pain (hypoalgesia) than healthy subjects, whilst other studies showed that the threshold is the same, but the absence of expressing the pain would be due to the pathology itself (non-expression of the pain, denial). Insensitivity to pain would be the consequence of a complex reaction between a biological sensorial abnormality and the psychopathology of schizophrenia itself (including the affective processes). Hence, various hypotheses referring to biological, psychological and sociological mechanisms have been proposed. BIOLOGICAL THEORIES: Various other hypotheses based on biological factors have been suggested. One of the interesting biologically-based hypotheses postulates that the insensitivity is due to a dysregulation of N-methyl-d-aspartate (NMDA). The biological factors are still not fully explored and would only explain in part the phenomenon of the apparent insensitivity to pain of individuals with schizophrenia. PSYCHOLOGICAL THEORIES: The thresholds of pain and a higher level of tolerance could be explained by an indifference to external stimuli and by inappropriate mental functions for these tests. The deficit is situated, therefore, both in the sensory discrimination of the stimulus (biological function) but also in the interpretation (cognitive and emotional functions). These different hypotheses (biological and psychological) might explain the insensitivity to pain of schizophrenic patients. PAIN AND SCHIZOPHRENIA: THE REALITY: Schizophrenic patients have a sensitivity to pain which is identical to that of healthy subjects. The apparent analgesia would be the result of a denial "attitude", a different manner of expressing pain in relation with the non-verbal communication difficulties, and not an alteration in the brain functions nor a biological anomaly. Diverse methodological biases arise from the studies of pain in patients with schizophrenia.

[Pell-Nicol, a medicinal toothpaste]. / Pell-Nicol, pasta de dinti medicinala.

A medicinal toothpaste based on an atomized extract obtained out of sulfurous mud of Nicolina Iassy (a natural organic-mineral complex) has been formulated and physico-chemically characterized. The optimal formula has been chosen corresponding to following parameters: aspect, colour, taste, smell; weight/tube (65 g +/- 5%); Dentine Abrasion Value (D. A. V.) = 30; pH = 6.95-7.42; foaming capability of foam, in minutes = 0.40-0.60; residue on the sieve (g% = 0.09); heavy metals content; abrasive substances; g% = 32-37 at least; sodium chloride g% = 0.30 at least; firmness time = 30 sec. Also it have been effectuated rheological measurements and dynamic viscosity. The medicinal toothpaste Pell-Nicole presents a plastic behaviour with thixotropic character, which confers a good stability in time, an adequate firmness and comparable properties with others marketed products. The therapeutical effects have been tested, such as the antimicrobial and anti-inflammatory actions. The medicinal dentifrice toothpaste Pell-Nicole is recommended for gum affections, superficial chronic inflammatory forms, deep paradontopathies, as well as for a proper dental hygiene.

[Antimicrobial activities of organic zinc compounds]. / Consideratii asupra activitatii antimicrobiene a unor compusi organici ai zincului.

Taking into account the competitive action of zinc towards other ion essential for pathogenic germs metabolism, the complex erythromycin-zinc, zinc salts of sulfamethoxydiazine, sulfanilamide, sulfacetimide, sulfathiazole as well as the Mannich basis of sulfamethoxydiazine were synthetized. The antimicrobial action towards gram-positive, gram-negative pathogens and fungi was tested by the classic diffusiometric method. An increased antimicrobial action for the Mannich basis of sulfamethoxydiazine and for the zinc salt of sulfamethoxydiazine, alone or in association with metronidazole--chemotherapeutic agent used in the infections with anaerobic organisms was found. A significant antimicrobial action was also found for the complex erythromycin-zinc and zinc salts of sulfacetimide and sulfathiazole.

[The physicochemical characterization and therapeutic evaluation of Cicatrol]. / Caracterizarea fizico-chimica si evaluarea terapeutica a produsului Cicatrol.

Cicatrol ointment with the formula: argentic sulphamethoxydiasine 1 g, bentonite hydrogel 12.5% for 100 g is manufactured at the Microproduction Laboratory of the Faculty of Pharmacy of Iasi. The one-year physicochemical determinations of the aspect, colour, homogeneity, pH, rheological behaviour and relative viscosity, content in argentic sulphamethoxydiasine as well as "in vitro" antimicrobial activity of Cicatrol showed a good stability and gel properties enabling an uniform and long-term contact with the wound. The clinical investigations carried out until now in patients with burns, varicose ulcers, trophic shank ulcers, superficial phlebitis with atonic ulcerations or wounds with multiple sites revealed its remarkable therapeutic value. As compared to other similar products, Cicatrol by its aseptic properties favours the scarring of any type of wound, a normal skin, without keloid scars being obtained, it also being well tolerated.

Radiocontrast-associated renal dysfunction: incidence and risk factors.

Contrast-induced nephropathy is a potentially serious untoward reaction to radiologic contrast media. The incidence of this nephropathy and the predisposing conditions are not well established, possibly because of methodologic differences between studies. We evaluated the incidence of contrast-induced nephropathy after femoral arteriography in 394 patients by using multiple definitions (different increases in serum creatinine or blood urea nitrogen levels at various times). When an increase in the level of serum creatinine of greater than 0.3 mg/dl and greater than 20% on day 1, 2, or 3 and on day 5, 6, or 7 was used to define the disorder, the incidence in our group of patients was 10% for nonazotemic patients vs 30% for azotemic patients (p less than .001); 2% for nondiabetic, nonazotemic patients vs 16% for diabetic, nonazotemic patients (p = .003); and 38% for patients who were both diabetic and azotemic vs 16% for diabetic, nonazotemic patients (p = .022). Baseline renal insufficiency and diabetes mellitus (especially when insulin dependent) were significant predisposing factors. The effects of dehydration and increased volume of contrast medium on the incidence of contrast-induced nephropathy were not clear; the age and sex of the patient were not important risk factors. The incidence of contrast-induced nephropathy depends on the definition used. Although contrast-induced nephropathy may develop in any patient, diabetes, renal insufficiency, and, possibly, dehydration and dose of contrast medium are risk factors.

Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media.

Nephropathy is an established untoward event associated with intravascular administration of conventional high-osmolality contrast media (HOM). It has not been shown previously that lower-osmolality contrast media (LOM) are less nephrotoxic in a clinical setting. We evaluate the ability to replace HOM with LOM (in lower-extremity angiography) to reduce the incidence of nephropathy. We use multiple definitions for contrast-induced nephropathy (six different magnitudes of rise of serum levels of creatinine or blood urea nitrogen in various periods). The incidences of nephrotoxic effects with LOM vs HOM in patients with presumed risk factors, including preexisting renal insufficiency and diabetes, are evaluated also. When all patients are considered, the incidence of contrast-induced nephropathy for LOM vs HOM (defined as an increase in serum creatinine level greater than 0.3 mg/dl and greater than 20% on day 1, 2, or 3 and on day 5, 6, or 7, is 7% vs 26% (p = .001). When only patients with preangiography azotemia are considered, the incidence of contrast-induced nephropathy for LOM vs HOM is 10% vs 41% (p = .017); for diabetic patients, regardless of preangiography creatinine level, the incidence is 10% vs 31% (p = .012). Although contrast-induced nephropathy may develop even in a patient with no risk factors who receives LOM, LOM is associated with a decreased incidence of this condition, to various degrees, depending on the presence of risk factors.