Smell Function in Schizophrenia During Acute Psychosis and Correlation with Clinical Symptomatology and Length of Hospitalization.

BACKGROUND: While several studies have noted smell impairment in schizophrenia, it is unclear whether this impairment extends to acute psychosis and whether it is associated with more severe illness as expressed in extended hospitalization. OBJECTIVES: To evaluate the olfactory function of patients in an acute psychotic state and correlate it with clinical symptomatology and length of hospitalization. METHODS: Olfactory function was assessed in 20 patients with schizophrenia in their first week of hospital admission for acute psychosis compared with matched controls. Olfaction was evaluated via three stages: threshold, discrimination, and identification of different odors utilizing the Sniffin' Sticks test battery. RESULTS: Schizophrenia patients scored significantly lower on total smell score, discrimination, and identification abilities. A significant association was observed between hospitalization duration and total smell score and smell discrimination. No significant associations between smell and clinical symptomatology were observed. CONCLUSIONS: Study observations confirm impaired sense of smell in schizophrenia patients and suggest that smell impairment may be a potential marker of more serious illness as expressed in longer hospital stay.

Olfactory impairment in patients with the fibromyalgia syndrome and systemic sclerosis.

Patients with autoimmune diseases often present with olfactory impairment. The aim of the study was to assess the olfactory functions of female patients with fibromyalgia (FM) compared with patients with systemic sclerosis (SSc) and with healthy female controls. Olfactory functions were assessed in 24 patients with FM, 20 patients with SSc and 21 age-matched healthy controls. The sense of smell was evaluated using the Sniffin' Sticks test including the three stages of smell: threshold, discrimination, and identification (TDI) of the different odors. The severity of fibromyalgia was assessed using the fibromyalgia impact questionnaire (FIQ). The short form 36 (SF-36) questionnaire was also completed in order to seek a relationship between the patients perception of quality of life and the different aspects of the smell sense. Depression was evaluated in both FM and SSc patients utilizing the Beck depression inventory-II (BDI-II) questionnaire. Patients with FM had significantly lower TDI smell scores compared with both SSc patients and healthy controls (p < 0.005, One-Way ANOVA). Hyposmia (defined as TDI scores below 30) were observed in 14 of 24 (42 %) patients with FM compared to 3 of 20 (15 %) patients with SSc and 1 of the healthy controls (4.3 %) (p < 0.02). FM patients had significantly lower thresholds of smell compared to both healthy controls and patients with SSc (p < 0.001), whereas for patients with SSc only the ability to discriminate between odors was impaired (p < 0.006). We could not detect any statistical correlation between smell abilities and clinical manifestation of SSc or the FIQ and SF-36 scores among FM patients. However the correlation between depression, defined by the BDI-II score, and the sense of smell differed between patients with FM and patients with SSc. As only among SSc patients a lower sense of smell correlated with a higher BDI-II score (p = 0.02). Our findings suggest that there is a decrease in the sense of smell both in FM and SSc patients compared with healthy controls. However these impairments differ between patients group and might represent different mechanisms that affect the sense of smell.

Smell and autoimmunity: a comprehensive review.

The sense of smell is an ancient sensory modality vital for sampling and perceiving the chemical composition of surrounding environments. Olfaction involves a pathway of biochemical and electrophysiological processes, which allows the conversion of molecular information into sensations. Disturbances in the olfactory function have been investigated mainly in neurological/neurodegenerative disorders such as Alzheimer's and Parkinson's diseases; impaired sense of smell has been associated with depressed mood. Only recently, smell capability was tested in other diseases, particularly autoimmune diseases. Shoenfeld and colleagues opened this chapter showing that patients affected with systemic lupus erythematosus (SLE) have disturbances in their olfactory functions and revealed its association with neuropsychiatric manifestations of the disease. This evidence was confirmed in experimental models and replicated in other SLE populations. The connection between autoimmunity and the sense of smell was lately emphasized by studies on patients with Sjögren's syndrome and in patients with other autoimmune/immune-mediated diseases, such as polydermatomyositis, recurrent spontaneous abortion, and hereditary angioedema. Genetic susceptibility and hormonal and environmental factors may play a role in these conditions. Olfactory receptor gene clusters are located in proximity to key locus of susceptibility for autoimmune diseases such as the major histocompatibility complex, suggesting not only a physic linkage, but a functional association. Nonetheless, gender- and hormone-mediated effects are fundamental in the development of autoimmune diseases. The different connections between smell and autoimmunity, genes and hormones may suggest that this is another tessera of a mosaic which is waiting the answer of Oedipus.

Tricotillomania: pathopsychology theories and treatment possibilities.

The phenomenon of hair pulling has been recognized for centuries, yet the true prevalence of trichotillomania (TTM) is largely unknown and the topic has been sparsely studied. TTM is classified as an impulse-control disorder despite much debate about its etiology. In this review we summarize the different hypotheses, including impulse-control disorders, obsessive-compulsive disorders, behavioral problems and addiction, and the appropriate treatment methods. The combination of selective serotonin reuptake inhibitors and antipsychotic medications are shown to be most effective. Treatment with anti-addiction drugs seems relevant. Further research is needed to increase our knowledge regarding the etiology of TTM.

[Six-month follow-up study of drug treatment for cannabis addiction: comparison study of four drugs].

OBJECTIVES: Marijuana addiction is one of the most common forms of addiction worldwide. A variety of reasons for use exist, however, there are only a few tested treatments with frequent relapses. In this study, we examined the efficacy of four pharmacotherapy agents for the treatment of marijuana addiction: naltrexone, bupropion, escitalopram and bromazepam. MATERIALS AND METHODS: A total of 59 patients were randomly assigned into four groups. Each group received one of the pharmacological agents for 120 days. Four types of questionnaires were employed: The Hamilton Rating Scale for Depression--21 items, the Hamilton Rating Scale for Anxiety, the Global Assessment of Functioning and a Visual Analogue Scale for perceived need of the drug. In addition, random urine tests were performed to detect tetrahydrocannabinol [THC). RESULTS: Naltrexone proved to be the most efficacious of the four agents, with only four dropouts. Other agents proved less efficacious with six, seven and eights dropouts for bupropion, bromazepam and escitalopram, respectively. In addition, naltrexone was most efficacious in reducing anxiety and depression rates, and increasing functioning and perceived need for drug use. CONCLUSION: Out of four pharmacological agents, naltrexone proved to be most efficacious in treating marijuana addiction and related disorders. Further studies are needed to confirm our results.

Pathological gambling: an impulse control disorder? Measurement of impulsivity using neurocognitive tests.

Pathological gambling is classified in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) and in the ICD-10 (International Classification of Disease) as an impulse control disorder. The association between impulsivity and pathological gambling remains a matter of debate: some researchers find high levels of impulsivity within pathological gamblers, others report no difference compared to controls, and yet others even suggest that it is lower. In this review we examine the relationship between pathological gambling and impulsivity assessed by various neurocognitive tests. These tests--the Stroop task, the Stop Signal Task, the Matching Familiar Figures Task, the Iowa Gambling Task, the Wisconsin Card Sorting Test, the Tower of London test, and the Continuous Performance Test--demonstrated less impulsivity in gambling behavior. The differences in performance between pathological gamblers and healthy controls on the neurocognitive tasks could be due to addictive behavior features rather than impulsive behavior.

Anti-ribosomal-P antibodies in lupus patients and healthy controls: evaluation of three ELISA assays.

BACKGROUND: Anti-ribosomal-P antibodies have been associated with central nervous system manifestations of systemic lupus erythematosus. However, inconsistencies in their prevalence and clinical correlations have become an obstacle to their use as a diagnostic marker of the disease. This lack of consistency might stem from several factors, such as the lag period between clinical manifestations and the time blood was drawn; or the different methods used for antibodies detection. OBJECTIVES: To evaluate three different enzyme-linked immunosorbent assay tests for the detection of anti-Rib-P Abs in patients with SLE and in normal controls. METHODS: Sera from 50 SLE outpatients and 50 healthy subjects were tested with three ELISA kits: Kit-1, using synthetic peptide comprising the 22 C-terminal aminoacids; Kit-2, using native human ribosomal proteins (P0, P1, P2); and Kit-3, which is coated with affinity-purified human ribosomal proteins. ELISA studies were performed according to the manufacturers' instructions. RESULTS: The prevalence of anti-Rib-P Abs in SLE patients and controls was 30% vs. 0%, 17% vs. 21%, and 30% vs. 14% in kits 1-3 respectively. Anti-Rib-P Abs detected by Kit-1 correlated with the SLEDAI score (SLE Disease Activity Index). No correlation between prior CNS manifestations and anti-Rib-P Abs was observed. CONCLUSIONS: A significant difference was documented between the ELISA kits used for the detection of anti-Rib-P Abs. A correlation was found between these antibodies (evaluated by Kit-1) and concurrent SLEDAI scores, in contrast to the lack of correlation with previous CNS manifestations. This supports the notion of "active serology" that is evaluated at the same time manifestations are present, as well as the need for standardization of laboratory assays in the future which will enable a better assessment of anti-Rib-P Abs presence and clinical significance.

[Depressive disorders in elderly: treatment possibilities rather than pharmacotherapy].

Treatment of depression is one of the most challenging issues in adult populations. In adults, response rates to classic treatments are lower than expected. The effectiveness of different treatment strategies could be related to age, sex and physical conditions of the patients. The side-effect profile in adult population affects pharmacological interventions. The aim of this review is to present the non-pharmacological treatment strategies in the adult population. However, possible treatment strategies such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) were less frequently studied in this population. ECT was found to be the most effective treatment procedure for depression of adults. There were only a few double-blind sham (placebo) controlled studies with demonstrated effectiveness of TMS. DBS lacks double-blind studies of this invasive treatment method. ECT seems to be the gold standard for the treatment of resistant patients in this population but the side-effect profile of ECT in this sensitive population will be discussed. Double-blind sham controlled studies with larger samples are necessary to confirm preliminary results with TMS and DBS.

Mood disorders in elderly population: neurostimulative treatment possibilities.

Treatment of mood disorders is one of the most challenging territories in elderly. Effectiveness of different treatment strategies could be related to age, sex and physical conditions. The side effect profile in this population also affects pharmacological interventions. Our review includes the neurostimulative treatment strategies in elderly. However, possible treatment strategies such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS) and deep brain stimulation (DBS) were less studied in elderly. ECT was found to be an effective treatment procedure in mood disorders. Few double-blind sham controlled studies were conducted and demonstrated effectiveness of TMS. DBS has lack of double-blind studies. ECT seems to be the golden standard for the treatment resistant elderly patients, yet side effect profile of ECT in elderly will be discussed. Double -blind sham controlled studies with larger samples are necessary to confirm preliminary results with transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST) and VNS, DBS.

The sense of smell in systemic lupus erythematosus.

OBJECTIVE: To assess the olfactory functions in systemic lupus erythematosus (SLE) patients compared with age- and sex-matched healthy controls, and to examine the association between the sense of smell and disease activity and central nervous system (CNS) involvement. METHODS: Olfactory functions in 50 SLE patients and 50 age- and sex-matched controls were evaluated using the Sniffin' Sticks test, the 3 stages of which are threshold, discrimination, and identification (TDI) of different odors. TDI scores were analyzed according to SLE disease activity and CNS involvement. RESULTS: In both the SLE and control groups, smell deficit correlated with male sex and older age. A decrease in the sense of smell was observed in SLE patients (46%) and controls (25%) (P

The effect of melanism and vitamin D synthesis on the incidence of autoimmune disease.

Melanin has several physiological roles in maintaining health, but, notably, it affects the synthesis of vitamin D. Melanin is the primary determinant of the degree of skin pigmentation and protects the body from harmful ultraviolet radiation. Synthesis of 1,25-dihydroxyvitamin D(3) (1,25[OH](2)D(3)) in the skin, however, is dependent on ultraviolet B light. Highly pigmented skin, to the level found in people of African origin, abrogates almost all ultraviolet-induced 1,25(OH)(2)D(3) synthesis. Numerous animal models and clinical studies have underlined the essential role of vitamin D as a modulator of the different processes of the immune system. Evidence indicates that serum concentrations of 1,25(OH)(2)D(3) and the prevalence of autoimmune diseases in a certain population are associated with the latitude at which that population resides. This article explores the relationship between skin pigmentation, vitamin D and the prevalence of autoimmune disease.

To lock or not to lock patients'rooms: the key to autonomy?

Many patients with schizophrenia experience prominent negative symptoms. Functional impairment often results in patients who remain in their rooms for most of the day. It has thus become common practice in many psychiatric wards to lock patients' rooms during much of the morning and afternoon hours to encourage participation in ward activities and treatment modalities. Within the context of a quality control evaluation, two self-report surveys were conducted among patients (N=20) and staff members (N=9) in Beer Yaakov, Israel: the first survey was given when the rooms were locked at certain times, and the second survey was given after the rooms had been unlocked for one week. Patients and staff members expressed differing views both before and after the week-long open-door policy (patients enjoyed the policy, whereas many staff did not). Behavior during the period of the open-door policy varied among patients. The authors discuss the ethical grounds of locking doors and whether it is a best practice in keeping with rehabilitation interests.

Samson's suicide: psychopathology (Grossman) vs. heroism (Jabotinsky).

The biblical story of Samson may be understood at various levels and from different perspectives. Since the story of Samson in the Bible is sketchily drawn, the interpretations of the narrative are numerous. One version, according to David Grossman, a contemporary writer and liberal Israeli political activist, regards Samson critically, viewing him as a tormented individual who opts to end his life in order to end his suffering. Another version is that of Ze'ev Jabotinsky, a twentieth century author and nationalistic Jewish political activist, who regards Samson as a heroic figure exemplifying the ultimate Jewish hero who killed himself to help his people. While suicide is considered a tragic event, viewed as the outcome of an unstable state of mind from a psychopathological point of view, and a controversial issue in Judaism (as in other religions), there is value in examining how each of these authors explains the act. Since the personal and political opinions of the authors influenced their interpretations, the discussion will briefly expound on their biographies. A comparison between their two versions of the narrative will be made. A word of caution is introduced regarding the merits and demerits of artistic and creative analysis of the biblical narrative.

Effects of amino acid energy drinks leading to hospitalization in individuals with mental illness.

OBJECTIVE: The objective of this case report is to highlight the possible dangers in individuals with prior psychiatric illness of the use of amino acid and caffeine-containing drinks marketed as energy drinks to combat mental and physical fatigue. METHOD: We report on three patients with known psychiatric illness who demonstrated sequelae following use of these beverages with probable association with clinical deterioration leading to hospitalization. RESULTS: In all three cases, hospitalizations were associated with deterioration of mental state, manifested, amongst other symptoms, by hypervigilance, psychomotor unease and intensified affected responses. CONCLUSIONS: While a casual relationship between the use of these drinks and hospitalization cannot be definitively stated, the close temporal association between the two cannot be ignored. Use of these beverages by individuals with prior psychiatric illness should be with caution and the use of energy drinks may be relevant in the patients' evaluations.