Bruxism and oral parafunctional hyperactivity in social phobia outpatients.

Anxiety and selective serotonin reuptake inhibitors (SSRIs) are considered aggravating factors for bruxism. We examined the influence of anxiety, depression and SSRI on bruxism in social phobia (SP). Twenty-three drug naïve, 17 SSRI-treated SP patients and 33 healthy controls underwent a psychiatric assessment and completed Leibowitz Social Anxiety Scale and Beck Depression Inventory. Oral parafunctional activity (PF) was evaluated by TM-dental examination and by a questionnaire. Drug- naïve and SSRI-treated SP patients did not differ on demographic and clinical measures. Awake bruxism, 'JAW PLAY' and at least one PF were more prevalent in SP than in controls. Severity of SP predicted the presence of PF. SP, but not depression, was associated with higher risk of oral PF and awake bruxism. Chronic SSRI treatment of SP did not affect sleep and awake bruxism. Dental and anxiety screening may improve the prognosis psychiatric and dental patients. Effective treatment of SP may mitigate bruxism.

Urban daily life routines and human exposure to environmental discomfort.

This study suggests a shift in focus from studying environmental discomfort in urban strategic stations, from which average results for the city or specific results for selected sites are deduced, and from measuring environmental conditions in fixed monitoring stations to a study in which we monitor, with mobile portable sensors, the exposure of people to environmental sources of discomfort while performing their daily life activities. Significant variations in sense of discomfort were measured in this study, and almost half of this variability was found to be explained while four independent environmental variables were considered: air quality (concentrations of CO), noise level, climatic variables (thermal load), and social loads. The study conducted in the city of Tel Aviv, which suffers from hot, humid summers and cool winters, and noise levels that reach the average levels of 85 dB, and relatively lower levels of exposure to the other potential stressors. These levels of combined exposures result in moderate levels of discomfort for young, healthy people once they experience the more stressing environments in the city. It is shown also that noise from other people is the most salient source of discomfort in Tel Aviv. Levels of discomfort accumulate during the working hours, either due to the impact of social loads or noise, but the subjects showed good coping abilities that enabled them to recover in late afternoons. It seems that thermal load does not have immediate impact, but rather cumulative ones, mainly during transitional seasons when subjects are less adaptive to extreme changes in weather.

Obsessive-compulsive disorder: a disorder of pessimal (non-functional) motor behavior.

OBJECTIVE: To determine whether in addition to repetitiveness, the motor rituals of patients with obsessive-compulsive disorder (OCD) involve reduced functionality due to numerous and measurable acts that are irrelevant and unnecessary for task completion. METHOD: Comparing motor rituals of OCD patients with behavior of non-patient control individuals who were instructed to perform the same motor task. RESULTS: Obsessive-compulsive disorder behavior comprises abundant acts that were not performed by the controls. These acts seem unnecessary or even irrelevant for the task that the patients were performing, and therefore are termed 'non-functional'. Non-functional acts comprise some 60% of OCD motor behavior. Moreover, OCD behavior consists of short chains of functional acts bounded by long chains of non-functional acts. CONCLUSION: The abundance of irrelevant or unnecessary acts in OCD motor rituals represents reduced functionality in terms of task completion, typifying OCD rituals as pessimal behavior (antonym of optimal behavior).

Dynamic occupation assessment of executive function in adolescents with schizophrenia spectrum disorders: An initial report.

OBJECTIVE: This study presents an initial evaluation of the psychometric properties of the Dynamic Occupation Assessment of Executive Function (DOAEF), a new tool designed to assess adolescents' executive function (EF) in daily situations and offering two levels of mediation through the administration process. METHOD: In the preliminary study, we tested 22 healthy adolescents. In the advanced stage, the instrument was administered to 105 healthy adolescents and to another 92 adolescents diagnosed with schizophrenia spectrum disorders. Information regarding EF was assessed by the DOAEF and Wisconsin Card Sorting Computer Version Test (WCST-CV-64). RESULTS: Inter-rater, test-retest and internal consistency indices were found to be satisfactory. Correlation between the DOAEF and the WCST-CV-64 scores supports the DOAEF's convergent validity. Significant differences were found between the healthy participants and the adolescents diagnosed with schizophrenia spectrum disorders, thus supporting the DOAEF's criterion validity. CONCLUSION: The DOAEF may be useful in assessing the level of mediation, which patients need for the comprehension of daily situations in which EFs are required.

Is there sexual dimorphism in obsessive-compulsive disorder?

The present review addresses the question of sexual dimorphism in obsessive-compulsive disorder. It enumerates examples that could be interpreted to suggest the existence of such dimorphism from the fields of epidemiology, phenomenology, pharmacology, neuropsychology, neuroimaging and genetics. We conclude that data, at this point, are too scarce to warrant a firm conclusion. On the contrary it seems that there are enough indications in the literature that hint at the possibility of sexual dimorphism to stimulate further research in the field.

Event-related potentials in drug-naive schizophrenic patients.

Decreased amplitudes of late components of event-related potentials (ERPs) in schizophrenia were ascribed to either psychotic features or to neuroleptic treatment of the patients. To rule out the drug effect, ERPs to stroboscopic stimuli were recorded in drug-naive schizophrenics and control subjects during no-task and simple-task sessions. Patients had significantly lower amplitudes of the late ERP components during both sessions, thus confirming similar results with treated schizophrenics. On the other hand, drug-naive patients did not differ from controls in the task-related relative facilitation of late ERP components. These results differ from findings of minimal ERP facilitation to task in treated schizophrenics. This discrepancy is discussed in the context of the effects of neuroleptic treatment and task demands on ERPs.

First month of neuroleptic treatment in schizophrenia: only partial normalization of the late positive components of visual ERP.

In a previous study we recorded visual event-related potentials (ERP) in drug-naive schizophrenics during passive-attention and active-attention tasks. Patients, compared to normal controls, had much lower late positive components (LPC) in both sessions, but nearly normal LPC increase from passive to active task. The present sample consisted of drug-naive and drug-free patients who were tested before and during the first month of neuroleptic treatment. Neuroleptics initiated gradual amelioration of psychiatric symptoms expressed by reduced Brief Psychiatric Rating Scale (BPRS) scores. Schizophrenics compared to controls showed a session-related increase in LPC amplitude, but this process of LPC recovery was too minor to fully normalize the low LPC amplitudes in patients. Furthermore, the treatment either did not improve or even reduce the LPC reaction to the active-attention task. These findings indicate that normalization of low LPC in schizophrenia might require a long period of treatment, and that patients' reduced LPC reactivity to the task might be contributed, rather than treated, by neuroleptics.

Electroconvulsive therapy for persistent neuroleptic-induced akathisia and parkinsonism: a case report.

Neuroleptic-induced akathisia (NIA) and parkinsonism (NIP) continued for 3 months, despite two courses of anticholinergic treatments, a shift to low-potent neuroleptic (NL) and a NL-free period. The two adverse effects responded dramatically to electroconvulsive therapy (ECT) to reemerge 3 months after termination of ECT. The case supports the idea that ECT is effective for both NIA and NIP even when they are resistant.

Recurrence pattern of serum creatine phosphokinase levels in repeated acute psychosis.

BACKGROUND: Elevated serum creatine phosphokinase (CPK)MM level is frequently found in acute psychosis. Theories relate this CPKemia to psychomotor agitation and medication. We hypothesized that psychosis-related CPKemia observed in individual patients is relatively consistent. METHODS: Ninety psychotic patients were studied; 83% were schizophrenics (Brief Psychiatric Rating Scale scores > or = 40) whose serum CPKMM levels were recorded during two or more different acute psychoses. The serum CPKMM levels used were the maximal levels monitored during the beginning of each hospitalization. The last CPK measurement in a circumscribed period was defined as the index serum CPK level (IndCPK). The mean of all other individual maximal CPK measurements during other psychotic episodes was defined as the average CPK (AvgCPK). RESULTS: Multiple linear regression analysis showed a significant correlation of natural logarithm (Ln) of (IndCPK with Ln(AvgCPK), as well as with gender (coefficient = .65 and .63, p < .0001 and p < .01, respectively). There were significantly higher IndCPK levels among male patients than among female patients (p < or = .001). A relatively consistent individual pattern of serum CPKMM levels during repeated acute psychotic episodes was observed. CONCLUSIONS: Serum CPKMM levels and gender were found to be good predictors of maximal serum CPKMM levels during every repeated acute psychotic episode. High IndCPK levels are probably risk factors for neuroleptic malignant syndrome.

Cytokine production in obsessive-compulsive disorder.

Cytokine production was previously demonstrated to be reduced in untreated major affective patients. In addition, recovery from depression following clomipramine (CMI) treatment was accompanied by the restoration of interleukin-1 beta (IL-1 beta) and interleukin-3-like activity (IL-3-LA) to normal range. In the present study we assessed the in vitro production of IL-1 beta IL-2, and IL-3-LA by peripheral blood mononuclear cells (PBMC) in 11 nondepressed patients with obsessive compulsive disorder (OCD) before and after 8 weeks of CMI treatment. Results were compared with those of 11 healthy subjects. CMI treatment induced a significant improvement in OCD symptoms. No alteration was observed in cytokine production in OCD patients before treatment as compared to control subjects. Moreover, 8 weeks of drug treatment had no effect on cytokine production. In conclusion, OCD per se, as well as CMI treatment, have no effect on interleukin production as measured in this study.

T-cell subsets in acute psychotic schizophrenic patients.

Two-color flow cytometric analysis was performed on peripheral blood lymphocytes of 16 untreated schizophrenic patients during an acute psychotic attack and 16 healthy control subjects to evaluate differences in T-cell subpopulations. In schizophrenic patients, we observed decrease in CD4+ 2H4+ (suppressor-inducer) and CD8+ 2H4+ (suppressor-effector) T-cell subsets. The selective loss of 2H4+ cell markers both on helper and suppressor T cells was not correlated to the severity of the acute psychosis. Our results may indicate a mechanism of an immune disequilibrium in schizophrenic patients during an acute psychotic attack.

The hypouricemic effect of chlorprothixene.

The hypouricemic effect of chlorprothixene (Taractan), a major tranquilizer from the group of thioxanthenes, was evaluated in 30 psychiatric patients who took the drug as part of their regular treatment. Levels of serum uric acid, urea, and creatinine before, during, and after the treatment were measured, as well as creatinine clearance and uric acid clearance before and during the treatment. A uricosuric effect, resembling that of probenecid, was found that exerts itself in all the patients, regardless of age, sex, diagnosis, and associated drugs. The resulting hypouricemia starts as soon as 24 hours from the beginning of treatment, stabilizes within 10 days, and averages, at that time, 48% of the initial level. It is reversible within 10 days from the end of treatment.

The role of external heat load in triggering the neuroleptic malignant syndrome.

During a heat wave three patients developed neuroleptic malignant syndrome. The role of heat load in triggering this syndrome and possible mechanisms behind such a role are discussed. Data concerning the season of occurrence of neuroleptic malignant syndrome are reported.

Risk of malignant hyperthermia among patients with neuroleptic malignant syndrome and their families.

The occurrence of malignant hyperthermia in 20 patients who had had neuroleptic malignant syndrome and in their 108 first-degree relatives was retrospectively studied. The patients had experienced a total of 20 courses of ECT and 12 surgical operations in which drugs that can cause malignant hyperthermia were used, but no cases of malignant hyperthermia had occurred, and no cases had occurred in the 37 relatives who had undergone surgery or ECT. The authors conclude that patients who have had malignant neuroleptic syndrome are not at considerably greater risk than others for developing malignant hyperthermia during surgery or ECT; the clinical data suggest that the two disorders are not related.

High-affinity imipramine binding and serotonin uptake in platelets of eight adolescent and ten adult obsessive-compulsive patients.

The authors evaluated high-affinity [3H]imipramine binding and [3H]serotonin uptake to platelets in eight adolescent and 10 adult patients who met DSM-III criteria for obsessive-compulsive disorder in comparison with those of normal control subjects of similar ages. The maximal binding of [3H]imipramine was significantly lower in adults and adolescents with obsessive-compulsive disorder than in the control subjects. No differences between groups in the affinity of [3H]imipramine to its binding sites or in serotonin uptake kinetic measures were detected. The lower density of [3H]imipramine binding sites in platelet membrane in patients with obsessive-compulsive disorder might implicate involvement of the serotonergic system or might represent an adaptive response to a chronic disease.

Heat intolerance in patients with chronic schizophrenia maintained with antipsychotic drugs.

OBJECTIVE: Schizophrenia may be associated with hyperthermic syndromes such as febrile catatonia, neuroleptic malignant syndrome, and heatstroke. The authors hypothesized that an exercise-heat tolerance test would disclose abnormal thermoregulation in schizophrenic patients. METHOD: Seven male schizophrenic outpatients in remission maintained on depot antipsychotic treatment and eight healthy comparison subjects completed a heat tolerance test that consisted of two 50-minute bouts of walking a motor-driven treadmill at 40xC (relative humidity=40%). RESULTS: A significantly higher rise in rectal and skin temperatures was observed in the patient group. No differences in heart rate, blood pressure, or perspiration were detected. CONCLUSIONS: Schizophrenic patients maintained on antipsychotic drugs exhibit impaired heat tolerance. Possible explanations are a reduced ability to convey heat from the body's core to the periphery with or without excessive heat production. The hyperthermic response to the heat tolerance test may reflect a dysfunction associated with schizophrenia, a neuroleptic-induced side effect, or both.

Mortality from neuroleptic malignant syndrome.

The authors assess the mortality from the neuroleptic malignant syndrome (NMS) based on an exhaustive review of 202 published case reports, including a differential assessment of risk factors and protective factors. The results indicate a significant (p less than .05) decrease in mortality since 1984 (11.6% vs. 25% before 1984), which occurs independently of the therapeutic use of dopamine agonists and dantrolene. A significantly (p less than .001) lower rate of mortality from haloperidol-induced NMS (7%) and a high rate of mortality (38.5%) among patients with organic brain syndrome were also found. Myoglobinemia and renal failure are strong predictors of mortality, representing a mortality risk of approximately 50%. The authors discuss the implications of these findings.

Chlorprothixene-induced hypouricemia: a biologic indicator of drug compliance.

Chlorprothixene is a neuroleptic as well as a potent uricosuric drug that consistently lowers the levels of plasma uric acid (PUA). The usefulness of this relative hypouricemia as an indicator of compliance with treatment was evaluated in 17 outpatients treated from 120 to 600 days. Plasma uric acid values were substantially reduced in all patients with all doses within the therapeutic range. Low levels of PUA remained stable as long as the patients were treated and returned to normal within 7 days after treatment was terminated. The authors discuss the advantages and the limitations of PUA as an indicator of chlorprothixene treatment compliance.

Painful ejaculation associated with antidepressants in four patients.

BACKGROUND: Painful ejaculation associated with tricyclic antidepressants is rarely reported in the medical literature. METHOD: Painful ejaculation following the administration of imipramine and clomipramine is described in four patients. RESULTS: The phenomenon occurred in all patients during the first 3 weeks of treatment and disappeared within several days when the tricyclic dosage was reduced or the medication was withdrawn. CONCLUSION: Painful ejaculation was apparently evoked by tricyclic antidepressant administration. Clinicians should be aware of this underreported side effect.

Catatonic signs in severe obsessive compulsive disorder.

Two cases of prolonged catatonic states that were part of severe obsessive compulsive disorder (OCD) are described. The catatonic symptoms failed to respond to neuroleptics but were ameliorated by conventional OCD treatments; clomipramine was used in one case, and behavior therapy in the other. Inclusion of severe OCD in the differential diagnosis of catatonia is discussed.