Elevated cerebrospinal fluid histidine in alcohol withdrawal.

Cerebrospinal fluid (CSF) histidine concentration was significantly elevated in seven patients early in the alcohol withdrawal syndrome (206.3 +/- 74.4 (SEM) nanomols/ml CSF). When these same patients were restudied an average of six days later when alcohol withdrawal was clinically resolved, their mean CSF histidine concentration continued to be significantly elevated (164.7 +/- 24.7) when compared to normal (12.0 +/- 0.5 nanomols/ml CSF). Other amino acids (aspartic acid, serine, alanine, methionine, leucine, tyrosine, phenylalanine, lysine and arginine) showed no definite changes from normal, and no change during the course of alcohol withdrawal. Possible reasons for these high concentrations and the extreme variability (especially early in alcohol withdrawal) are discussed.

Bipolar affective disorder. I. Comprehensive quantitative computed tomography.

Based on clinical similarities with schizophrenics and previous computed tomography (CT) studies that found distinct structural abnormalities in the brains of bipolar patients, we evaluated 26 DSM-III bipolar patients and 22 controls by CT, using quantitative measures of ventricular and sulcal size and of cerebral parenchymal density. Third ventricle size was increased, as was periventricular and cortical density. Comparison is made with results found in other psychotic conditions and the possible etiopathological significance discussed.

Bipolar affective disorder. II. EEG, neuropsychological, and clinical correlates of CT abnormality.

Since the clinical significance of CT abnormalities found in bipolar patients remains obscure, we studied 26 DSM-III bipolar patients who had specific CT abnormalities (third ventricle enlargement, and hyperdensity of the caudate, thalamus, anterior frontal white matter, and right temporal lobe) on numerous parameters such as EEG, the Halstead-Reitan Neuropsychological Battery, premorbid personality adjustment, family history of affective disorder, positive and negative symptoms, employment history, and response to lithium carbonate treatment. None of these measures could differentiate between the CT abnormal and CT normal subgroups. The implications of these findings are discussed.

Normal cerebral asymmetry in bipolar patients.

Reversal of normal cerebral asymmetry has been reported to be more frequent in children with higher cortical dysfunction and in schizophrenics, in whom it has clinical significance as well. As there are few studies of bipolar patients, we attempted to determine if significant reversal would be found in a clearly diagnosed sample of bipolar patients. As technical differences may account for varying results, we used two previously reported methods and a modified technique. Correlations of computed tomography (CT) findings with neuropsychological variables (Halstead Reitan Battery and WAIS subtests) were also studied. Bipolars and controls did not differ on any CT measure, nor were there meaningful correlations between asymmetry and neuropsychological variables. If if is confirmed that schizophrenics have increased reversed cerebral asymmetry but bipolars do not, it may point to an important difference, as all other CT abnormalities initially described in schizophrenics are now also noted in bipolar patients.

Relative utility of three indices of neuropsychological impairment in a young, chronic schizophrenic population.

The complete Halstead-Reitan Neuropsychological Test Battery and the Wechsler Adult Intelligence Scale were administered to 20 young, male, chronic schizophrenics. Three commonly used indices of neuropsychological impairment were calculated and compared. Although all three indices were similar in separating computerized axial tomography normal from abnormal patients, statistical significance was achieved only with the Halstead Impairment Index. Thus, the easier-to-obtain Halstead Impairment Index appears to be at least as good as, and possibly better than, the more-difficult-to-obtain indices of Percent of Ratings within the Impaired Range and the Average Impairment Rating. Reasons for these findings are discussed.

Cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol and norepinephrine levels in alcohol withdrawal. Correlations with clinical signs.

Cerebrospinal fluid (CSF) and plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) concentrations were significantly elevated in patients during the alcohol withdrawal syndrome. When CSF MHPG was corrected using a formula proposed to determine CSF MHPG levels of central origin, these values were still significantly elevated when compared with control values. The MHPG concentrations in CSF also showed significant positive correlations with heart rate, systolic and diastolic blood pressures, tremor, anorexia, and sweating. The results of this study indicate increased presynaptic release of norepinephrine during alcohol withdrawal.

Are schizophrenics with abnormal dexamethasone suppression test results a distinct subgroup?

Nonsuppression on the dexamethasone suppression test (DST) in schizophrenics has been reported by three independent groups. To elucidate the significance of this finding a schizophrenic cohort was tested on a wide range of parameters: computed tomography (CT), electroencephalography (EEG), the Halstead-Reitan Neuropsychological Battery (HRB), platelet monoamine oxidase activity (MAO), serum dopamine-beta-hydroxylase levels (DBH), premorbid personality adjustment, response to medication and family history of mental illness. Our results indicate that DST nonsuppressing and DST suppressing schizophrenics are no different on any of these measures, lending support to the notion that DST nonsuppression in schizophrenics is a random and changing event.

Brain and liver monoamine oxidase type A and type B activity in alcoholics and controls.

Monoamine oxidase activity in human postmortem brain and liver samples was measured in a group of patients with a prior history of alcoholism and compared to a control group with no prior history of alcoholism. Liver samples from patients with a prior history of alcoholism showed significantly lower monoamine oxidase activity with both phenylethylamine and serotonin as substrates. Postmortem brain samples, however, were not different in the two groups.

Adrenergic nervous system alteration and ethanol-induced narcosis in long-sleep and short-sleep mice.

Long-sleep (LS) and short-sleep (SS) mice were pretreated with either propranolol or phentolamine, followed by a hypnotic dose of ethanol. Pretreatment with propranolol, but not phentolamine, significantly reduced ethanol sleep time in LS mice. The SS mice were not affected. In a second study propranolol pretreatment was given subsequent to ethanol at various doses, different for each line, that produced similar sleep time durations in both lines. Under these conditions, propranolol decreased sleep time in both LS and SS mice. These data lend support to the idea that noradrenergic mechanisms play a role in the mediation of the hypnotic effects of ethanol.

Human brain: aldehyde dehydrogenase activity and isozyme distribution in different areas.

Three human post-mortem brains were dissected into seventeen areas and assayed for aldehyde dehydrogenase (EC 1.2.1.3) activity employing two assay systems: one at 68 microM and another at 13.6 mM propionaldehyde. The levels of activity with 68 microM propionaldehyde were significantly higher in cerebellum and putamen. The same brain areas were also examined by isoelectric focusing. By this procedure two distinct bands of aldehyde dehydrogenase activity (the cytoplasmic E1 and mitochondrial E2) could be readily visualized in cerebellum and putamen while other brain areas contained mainly the mitochondrial E2 isozyme.

Trace element levels in human alcoholic brain.

Copper, magnesium, zinc and manganese levels in the temporal cortex of human alcoholic and control brains were measured by atomic absorption spectrophotometry using both the flame and graphite furnace. All of the 21 alcoholics were male with a mean age of 54.1 years; the 19 male controls had a mean age of 60.2 years. The only statistically significant change in ion levels was an increase in manganese concentration (expressed both as microgram/g wet weight and ng/mg protein) in the alcoholic group when compared to the control group. Five of the alcoholics had malignancies, while 16 of the controls had systemic malignancies. Covariance analysis showed there was no effect of age on the level of manganese in the temporal cortex.

Electroconvulsive therapy in the 1980s.

Electroconvulsive therapy (ECT) has generated more controversy and strong feelings than any other psychiatric modality in use today. This review presents the facts upon which each reader can make a rational decision as to the advantages and disadvantages of ECT.

Mood-altering effects of disulfiram in alcoholics.

The effects of disulfiram on depression and anxiety were examined. In a 3-week double-blind study, 40 inpatients in al alcohol rehabilitation unit (ARU) were randomly assigned to receive placebo, 250 mg/day of disulfiram or 500 mg/day of disulfiram. During their first week in the ARU and prior to beginning medications, all subjects were administered the Zung self-rating depression scale, the Hamilton observer rating scale for depression, the Zung self-rating scale for anxiety and the Hamilton observer rating scale for anxiety. All subjects were rescored on these instruments at the end of their third week in the ARU. Three psychiatrists, blind to the medication condition, sequentially scored the Hamilton items. To evaluate intergroup differences at baseline as well as changes in scale scores during the 3 weeks, scale scores were subjected to analyses of variance. No statistically significant effect attributable to disulfiram was found but significant changes due to a time effect were noted.

Central brain morphology in chronic schizophrenic patients: a controlled CT study.

A comprehensive quantitative computed tomography (CT) study of the diencephalic region of 23 chronic schizophrenic patients and 23 normal controls was done. The third ventricle width, the Sylvian fissure widths, and the densities of the head of the caudate nucleus, thalamic nucleus, and medial temporal lobe were measured. In the schizophrenic patients, there was a significant increase in third ventricle and Sylvian fissure widths and a significantly greater density of both periventricular nuclei. The several explanations for this atypical association of atrophy with greater density are discussed.