Serum pseudocholinesterase in psychiatric patients.

Serum pseudocholinesterase activity was measured in 123 subjects: 16 agitated depressives, 12 retarded depressives, 7 acute schizophrenics, 14 residual schizophrenics, 16 healthy individuals, 45 surgical patients, and 13 first-degree relatives of 4 agitated depressive patients. The agitated depressive and acute schizophrenic patients had significantly higher pseudocholinesterase serum activity than their retarded inmates. As first-degree relatives of agitated depressive patients showed high levels similar to their ill relatives, a genetic component might play a crucial role. The level of pseudocholinesterase activity in serum of the surgical patients was significantly lower than that of all the psychiatric patients and the controls. The implications of this observation are still obscure.

Touch feel illusion in schizophrenic patients.

BACKGROUND: The rubber hand illusion is a tactile sensation referred to as an alien limb. The illusion has been explained by a spurious reconciliation of visual and tactile inputs reflecting functional connectivity in the brain and was used to explore alterations of functional connectivity in schizophrenia. METHODS: The rubber hand illusion was achieved when two paintbrushes simultaneously stroke the hand of the subject hidden from vision by a screen, as well as an artificial hand placed in view of the subject. The rubber hand illusion was assessed with a questionnaire affirming or denying the occurrence of the illusion. RESULTS: Schizophrenic subjects felt the illusion stronger and faster then did normal control subjects. Some rubber hand illusion effects correlated with positive symptoms of schizophrenia but not with negative symptoms. CONCLUSIONS: Altered functional integration of environmental inputs could constitute the basis for erroneous interpretations of reality, such as delusions and hallucinations.

Cytokine production in drug-free and neuroleptic-treated schizophrenic patients.

A line of evidence indicates changes of the immune system in schizophrenic patients. We investigated the production of cytokines by peripheral blood mononuclear cells (PBMCs) in drug-free and neuroleptic-treated schizophrenic patients compared to healthy, normal controls. A significant reduction in interleukin (IL)-2 production was detected in untreated schizophrenic patients (-59.6%; p < .05) as well as in IL-3-like activity (IL-3-LA) production (-27.4%; p < .05) in treated patients compared to controls. No alteration was observed in IL-1 beta production. It seems that schizophrenia is associated with diminished IL-2 production, while neuroleptic treatment interferes with the capacity of immunocompetent cells to synthesize and/or release Il-3-LA. The alteration in cytokine production did not correlate with either the severity of the disorder or the serum prolactin levels.

Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior.

OBJECTIVE: Knowledge about the frequency, severity, and risk factors of somatization (somatic manifestations of psychological distress) among immigrants is limited. The authors examined somatic distress in an immigrant population in Israel, explored its relationship with psychological distress symptoms and health-care-seeking behavior, and determined its correlation with the length of residence in Israel. METHOD: Two reliable and validated self-report questionnaires, the Brief Symptom Inventory and the Demographic Psychosocial Inventory, were administered in a cross-sectional community survey of 966 Jewish immigrants from the former Soviet Union who had arrived in Israel within the previous 30 months. RESULTS: The 6-month prevalence rate for somatization was 21.9% and for psychological distress, 55.3%. The current rate of co-occurrence of somatization and psychological distress was 20.4%. The most common physical complaints were heart or chest pain, feelings of weakness in different parts of the body, and nausea. Somatization was positively correlated with the intensity of psychological distress and with help-seeking behavior during the 6 months preceding the survey. Women reported significantly more somatic and other distress symptoms than men. Older and divorced or widowed individuals were more likely to meet the criteria for somatization. Within the first 30 months after resettlement, longer length of residence was associated with higher levels of somatization symptoms. CONCLUSIONS: Somatization is a prevalent problem among individuals in cross-cultural transition and is associated with psychological distress; demographic characteristics such as gender, age, marital status, and duration of immigration; self-reported health problems; and immigrants' help-seeking behavior.

Serum pseudocholinesterase in state anxiety.

Levels of serum pseudocholinesterase in 14 medical students before and after oral examinations in psychiatry were compared. Blood samples were collected 1 hour before and 2 to 4 weeks after the oral examinations. Serum pseudocholinesterase was significantly higher in state anxiety than in relaxation. The relation between state anxiety and high levels of this enzyme was established. No significant difference was observed in pseudocholinesterase levels between students with physiologic anxiety symptoms and those without.

Urinary amine metabolite excretion in a patient with adrenergic hyperactivity state: reaction to phenelzine withdrawal and combined treatment.

Urinary MHPG (3-methoxy-4-hydroxyphenylglycol) amounts increased threefold during a toxic delirious state in a 57-year-old bipolar patient 3 days after phenelzine treatment was stopped. This norepinephrine metabolite was not expected to rise as monoamine oxidase (MAO) was completely blocked. In addition, the delirious state appeared as a rebound phenomenon and not an acute toxic state during drug administration. It seems that phenelzine acts more through catecholamine release phenomenon than by inhibition of MAO.

The DST as a predictor of acute response to treatment with ECT, chlorimipramine, amitriptyline, and phenelzine.

Plasma cortisol levels of 41 patients suffering from major depressive episodes were measured at 4 p.m. and 10 p.m. one day after administration of 1 mg dexamethasone at 10 p.m. Comparison of cortisol results to clinical improvement measured by the Beck Depression Inventory before and after 5 weeks of treatment with either ECT, chlorimipramine, amitriptyline, or phenelzine showed no difference between nonsuppressors and suppressors in relation to clinical improvement. Clinical prediction of the outcome of acute response to these treatments using an initial DST does not seem feasible.

Serum cholesterol levels and suicidal tendencies in psychiatric inpatients.

BACKGROUND: Cholesterol has been generally associated with suicide and aggression. The aim of this study was to investigate the relationship between serum cholesterol levels and suicide in psychiatric inpatients. METHOD: Data on age, sex, serum cholesterol levels, absence or presence of suicidal ideations, absence or presence of past suicide attempts, ethnicity, weight, Hamilton Rating Scale for Depression scores, and physical illnesses were collected from 584 inpatient medical records. The patients were diagnosed by the authors according to the DSM-III-R criteria. Serum cholesterol levels were evaluated 24 to 48 hours after admission. The entire group and each diagnostic group were divided as follows: patients who had attempted suicide at least once, patients who expressed a suicidal wish or plan during hospitalization or the month before hospitalization, and patients who had neither made suicidal gestures nor expressed suicidal thoughts. Statistical evaluation was done using analysis of variance and chi-square test. RESULTS: Patients who had attempted suicide had significantly lower serum cholesterol than nonsuicidal patients (F = 4.68, df = 2, p < .01). Comparison on the basis of specific diagnoses revealed similar results in age- and sex-matched depressed patients (F = 4.02, df = 2, p < .01), but not in schizophrenic or bipolar patients. These results were not influenced by age, sex, ethnicity, weight, disease severity, or physical health. CONCLUSION: Our findings may imply that an association exists between cholesterol, suicide, and depression.

Comparison of sexual dysfunction in male schizophrenic patients maintained on treatment with classical antipsychotics versus clozapine.

BACKGROUND: Antipsychotic treatment is frequently associated with sexual dysfunction. The objective of the present study was to evaluate and compare sexual function and behavior in male schizophrenic patients who regularly take either classical neuroleptic drugs or the prototypical atypical antipsychotic agent, clozapine. METHOD: Participants included 60 schizophrenic male patients (DSM-IV criteria); 30 maintained on treatment with classical antipsychotics and 30 on treatment with clozapine. The patients were evaluated with a detailed 18-item sexual function questionnaire. RESULTS: Both groups reported sexual dysfunction, although scores were significantly higher, indicating better functioning, in the clozapine-treated group in the domains of orgasmic function (number of orgasms per month, p = .037; frequency of orgasm during sex, p = .046), enjoyment of sex (p = .013), and sexual satisfaction (p = .0004). Equivocal results were obtained for the desire parameters. CONCLUSION: Maintenance therapy with the atypical neuroleptic clozapine may be associated with a lesser degree of sexual dysfunction than the classical antipsychotics in male outpatients with chronic schizophrenia.

Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients.

BACKGROUND: Although treatment of severe mental disorders should strive to optimize quality of life (QOL) for the individual patient, little is known about variations in QOL domains and related psychopathologic and psychosocial factors in patients suffering from schizophrenia, schizoaffective disorder, and/or mood disorders. We hypothesized that QOL in severe mental disorder patients would have a more substantial relationship with psychosocial factors than with illness-associated factors. METHOD: A case-control, cross-sectional design was used to examine QOL of 210 inpatients who met DSM-IV criteria for a severe mental disorder and who were consecutively admitted to closed, open, and rehabilitation wards. Following psychiatric examination, 210 inpatients were assessed using standardized self-report measures of QOL, insight, medication side effects, psychological distress, self-esteem, self-efficacy, coping, expressed emotion, and social support. QOL ratings for patients and a matched control group (175 nonpatients) were compared. Regression and factor analyses were used to compare multidimensional variables between patients with schizophrenia and schizoaffective and mood disorders. RESULTS: In all QOL domains, patients were less satisfied than nonpatient controls. Patients with schizophrenia reported less satisfaction with social relationships and medication when compared with patients with schizoaffective and/or mood disorders. Regression analysis established differential clusters of predictors for each group of patients and for various domains of QOL. On the basis of the results of factor analysis, we propose a distress protection model to enhance life satisfaction for severe mental disorder patients. CONCLUSION: Psychosocial factors rather than psychopathologic symptoms affect subjective QOL of hospitalized patients with severe mental disorders. The findings enable better understanding of the combining effects of psychopathology and psychosocial factors on subjective life satisfaction and highlight targets for more effective intervention and rehabilitation.

Circadian rhythm of serotonin transport in human platelets.

The circadian rhythm of serotonin active transport in human platelets was investigated in ten healthy men, aged 27-35 years. Blood was collected at 08.00, 14.00, 20.00, 02.00 and 08.00 hours the next morning. Simultaneous evaluation of the mean platelet volume, platelet distribution width, platelet distribution skewness and platelet number in whole blood was performed. Km and Vmax for serotonin transport varied considerably among individuals over 24 h. However, the mean values and distribution of these kinetic parameters were reduced at 02.00 hours. All platelet size or number parameters were stable and normal over 24 h; therefore, the reduction in mean Km and Vmax values at 02.00 h is not related to morphological platelet differences but either to platelet intrinsic factors or plasmatic variables. Knowledge of the affinity and capacity of serotonin transport throughout the diurnal cycle is important for future comparisons with depressed patients as well as other hormonal rhythms in patients and healthy humans.

Serotonin uptake by blood platelets of acute schizophrenic patients.

Active uptake of serotonin by blood platelets of acute schizophrenic patients has been compared to that of a control group. Preliminary results presented in this article indicate that the uptake of the schizophrenic patients was about 40% lower than that of controls. Patients were followed over a period of 5 weeks with no significant change in uptake.

Phospholipid patterns of erythrocytes in schizophrenia: relationships to symptomatology.

The phospholipid composition of red blood cells (RBC) from 32 haloperidol-treated schizophrenic patients, classified according to the positive and negative syndrome scale (PANSS) as showing either predominantly positive or predominantly negative symptoms, was determined and compared with that of normal controls. While the levels of phosphatidylcholine and phosphatidylserine were similar in all three groups, sphingomyelin (SM) and phosphatidylethanolamine (PE) were, respectively, increased and decreased in RBCs of schizophrenic patients. In both patient groups, the SM/PE ratios correlated directly with the PANSS negative symptom scale scores and inversely with the positive symptom scale scores. However, the inverse changes in the contents of SM and PE were much more expressed in the negative group. It is suggested that a main source of that difference is a higher activity of the polyunsaturated acid-selective phospholipase A(2) in the negative syndrome patients than in the positive syndrome and control groups.

Maternal transmission disequilibrium of the glutamate receptor GRIK2 in schizophrenia.

Schizophrenia is characterized by thought disorders, hallucinations and delusions. Genetic studies have shown a high linkage at chromosome 6q16-21. Among the genes located in this region is the glutamate receptor ionotropic kainate 2 gene (GRIK2 or GLUR6), a functional candidate for susceptibility to schizophrenia. In this study, transmission of GRIK2 was evaluated in 356 schizophrenic patients from three different clinical centers. Whereas paternal transmission shows equilibrium, we observed maternal transmission disequilibrium of GRIK2 in the largest population (p=0.03), which was still significant when all populations were added (p=0.05). These results are similar to the maternal GRIK2 transmission disequilibrium previously reported for autism, and support the presence of a susceptibility gene for schizophrenia at 6q16.

Suicidal ideation and suicide attempts among immigrant adolescents from the former Soviet Union to Israel.

OBJECTIVE: A community survey was conducted to examine suicidal ideation and suicide attempts, behavior problems, psychological distress, social support, and adjustment difficulties in a sample of adolescents. METHOD: Four hundred six Russian-born Jewish immigrants to Israel, aged 11 to 18 years, were selected to match the age and sex distribution of the total immigrant adolescent population. Two indigenous samples of Jewish adolescents in Russia (n = 203) and in Israel (n = 104) were matched with immigrants for comparison. Parameters of interest were measured with self-administered questionnaires. RESULTS: The 6-month prevalence rate of suicidal ideation in the immigrant sample (10.9%) was significantly higher than that for Russian controls (3.5%) but not for Israeli natives (8.7%). There were few gender differences in suicidal ideation and suicide attempts. Older adolescents reported suicidal ideation 2 times more frequently than their younger counterparts. Suicide ideators scored significantly higher than nonideators on all scales of psychological distress and behavior problems. They rated higher sources of immigration difficulties concerning language, physical health, personality characteristics, and family problems but had less socioeconomic and intercultural problems of migration and lower social support from the family but not from other sources. CONCLUSIONS: Results clearly support the migration-convergence hypothesis of suicide risk among adolescents.

Mouse strains differ in their sensitivity to alprazolam effect in the staircase test.

The behavioral responses of five mouse strains (inbred: C57 and BALB/c; outbred: Swiss, ICR and HS/Ibg) to alprazolam was examined in the staircase test, an animal model sensitive to benzodiazepines (BZs). Alprazolam administration resulted in a dose-dependent suppression of rearing behavior, but to a different extent among the strains. By contrast, the number of stairs ascended was not suppressed by alprazolam at doses of 0.25 and 0.5 mg/kg, except in the C57 mice. The addition of flumazenil antagonized the alprazolam effect on rearing and climbing in all strains. There was a consistency within strains in sensitivity to alprazolam, with some strains being highly sensitive (C57 and HS) or less sensitive (Swiss, ICR and BALB/c) with regard to both rearing and climbing behaviors. Serum alprazolam levels did not differ significantly among the strains. This strain-dependent pattern of response to alprazolam seems to indicate a genetic component, rather than pharmacokinetic, in the behavior sensitivity to the BZ, with a spectrum of degree of responsivity among strains.

Parenteral abuse of diazepam: a case report.

A 26-year-old male was admitted to the emergency ward, presenting what seemed to be an acute dystonic crisis. The patient was found to be an oral and parenteral abuser of Valium (diazepam). He used to feign the dystonic syndrome in order to get an i.v. shot of the drug.

Elevated adhesiveness/aggregation of peripheral blood leukocytes in patients with major depression.

A simple slide test was used to determine the effects of major depression (MD) and heterocyclic antidepressants on leukocyte adhesiveness/aggregation (LAA) in the peripheral blood. Eighty subjects were categorized into four equal groups: untreated-MD patients, treated-MD patients, nondepressed patients treated with antidepressants and healthy controls. Significantly higher LAA values were observed both in untreated- and treated-MD patients, 13.8+/-1.7% and 13.5+/-1.9% respectively, compared to nondepressed-treated patients and healthy controls, 5.4+/-0.9% and 6.4+/-0.7% respectively (P < 0.0001). Increased LAA was associated with the depressive episode, was not affected by antidepressants and may potentially serve as a useful laboratory state marker for MD.

Effect of amantadine on sexual dysfunction in neuroleptic-treated male schizophrenic patients.

Twelve male schizophrenic outpatients treated with neuroleptics took part in an open-label drug study to assess the impact of co-administration of amantadine hydrochloride (100 mg daily for 6 weeks) on sexual function. Amantadine improved the patients' scores in three out of four areas of sexual function: desire (p < 0.02), erection (p < 0.05), and satisfaction from sexual performance (p < 0.05); there was no change in ejaculatory function. Amantadine may be effective for improving sexual function in male schizophrenic patients receiving neuroleptic medication.

Neuroendocrine response to trihexyphenidyl in depressed patients.

The effect of a single dose (10 mg P.O.) of trihexyphenidyl (THP) on plasma cortisol, growth hormone (GH), and immunoreactive beta-endorphin (ir-beta-EP) was studied in seven major depressed patients and seven controls. GH secretion was suppressed (34-41%) by THP in both groups. THP did not affect cortisol secretion in depressed patients and controls. An increase (18%; p less than 0.05) in plasma ir-beta-EP levels was detected in the healthy subjects only. The results of this study do not support the hypothesized altered responsiveness to anticholinergic provocation in major depression. The inhibitory activity of THP on GH secretion indicates the involvement of the cholinergic system in the regulation of GH release in humans.