Predictive factors of change in BMD at 1 and 2 years in women with anorexia nervosa: a study of 146 cases.

UNLABELLED: Bone mineral density (BMD; measured by DXA) changes were observed at all sites at 1 year in 146 patients with anorexia nervosa. Four independent factors accounted for the variation in BMD at the spine: duration of anorexia, bone-specific alkaline phosphatase (BAP), cross-linked carboxyterminal telopeptide region of type I collagen (ICTP), and triiodothyronine (T3). No change in BMD was observed from 1 to 2 years during follow-up. INTRODUCTION: The purpose of this study was to assess changes in BMD at 1 and 2 years in anorexia nervosa patients, and to explore the relationships between change in BMD and various clinical and biological parameters measured at the first visit. METHODS: BMD was measured in anorexia nervosa patients at inclusion, at 1-year follow-up (n = 146) and at 2-year follow-up (n = 89). RESULTS: Bone loss was observed at all sites at 1 year. When multivariate analyses were performed, four independent factors accounted for the variation in BMD at the spine: duration of anorexia nervosa, BAP, ICTP, and T3. At the total hip site, leptin level was the main factor accounting for the variation in BMD. Strong correlations were also observed between weight at 1 year and change in BMD at 2 years. At the 2-year follow-up, no significant change in BMD was observed at the spine or femoral neck. In patients who were no longer amenorrheic at 1 year, a significant improvement in BMD at 2 years was observed at the total hip (+1.2%, p = 0.02) and femoral neck (+3.7%, p = 0.02). Similarly, in patients with a body mass index >17 kg/m(2) at 1 year, an improvement in BMD at the total hip at 2 years was observed (+3%, p = 0.02) CONCLUSION: Bone loss in anorexia nervosa patients occurs at an early stage, and the factors influencing such are different at the spine and hip.

Anorexia nervosa, osteoporosis and circulating leptin: the missing link.

UNLABELLED: Methods: Leptin levels were measured in 103 consecutive women with anorexia nervosa. Results: Spine BMD and Z-score values were found to be significantly lower in the low tertile compared with the highest tertile. Duration of amenorrhea and leptin level accounted for 27% of the variance in lumbar spine BMD. INTRODUCTION: The purpose of this study was to assess leptin levels and other biological variables in a population of anorexia nervosa patients. METHODS: Leptin levels were measured consecutively in 103 women with anorexia nervosa (AN) with a mean age of 24.9 +/- 7.4 years. Osteodensitometry was also performed by dual energy X-ray absorptiometry (DXA). RESULTS: Spine bone mineral density (BMD) and Z-score values were found to be significantly lower in the low tertile compared with the highest tertile. Duration of amenorrhea and leptin level accounted for 27% of the variance in lumbar spine BMD. The mean leptin level was 3.9 +/- 4.6 ng/mL (normal values, 3.5-11 ng/mL). The distribution of leptin values was not a Gaussian distribution, and a log-transformed was therefore performed. A significant correlation was found between leptin level and spinal BMD (r = 0.3; p = 0.002); significant correlations were observed for both femoral neck and total hip BMDs. When leptin level values were divided into tertiles, spine BMD and Z-score values were found to be significantly lower in the lower tertile (p = 0.04 and p = 0.02) compared with the highest tertile. For femoral neck BMDs, the T-score was slightly lower between low and high tertile, but the difference was not statistically significant (p = 0.07). When multivariate analyses were performed, two independent factors which could possibly account for the variance in spinal BMDs were found. Duration of amenorrhea and leptin level accounted for 27% of the variance (p < 0.0001). CONCLUSION: The mechanisms underlying bone loss in AN patients remain unclear and complex, involving hypoestrogenia as well as nutritional factors such as insulin-like growth factor and leptin.

[Impact of interferon alpha immunotherapy on tryptophan metabolism in patients with chronic hepatitis C. Results of a pilot studies on ten patients]. / Impact du traitement par interféron alpha sur le métabolisme du tryptophane chez des patients porteurs d'hépatite C chronique Résultats de la phase d'étude pilote sur dix patients.

INTRODUCTION: The proinflammatory cytokine interferon (IFN) alpha is commonly used in the treatment of patients with hepatitis C but its administration is often responsible for neuropsychiatric side effects (low mood, fatigue, sleep-wake disorders, irritability and weight loss). Various mechanisms have been incriminated to explain the production of depression and anxiety symptoms, among which serotonergic hypothesis is supported by a growing body of evidence. The latter posits that IFN-alpha is responsible for central serotonin (5-HT) depletion by deviating its precursor, tryptophan (TRP), to a catabolic kynurenine (KYN) pathway through induction of indoleamine 2.3 dioxygenase (IDO). The aim of the study was to examine the time variation of 5-HT blood (serum and platelet) levels and serum KYN/TRP ratio along with instauration of IFN-alpha therapy and to correlate these biological variations with mood fluctuations. METHOD: Patients. Ten patients (mean [S.D.] age 45 years [12.7], range 29-63; three males, seven females) with chronic hepatitis C eligible to receive IFN-alpha (1.5microg/kg/week Viraferon, Schering-Plough, administered subcutaneously) were recruited from the Gastroenterology department of the University hospital of Lille, France. Patients with cirrhosis, HIV or hepatitis B or D co-infection, persistent intravenous addiction, corticoid therapy or any DSM-IV axis 1 psychiatric disorder (diagnosed with MINI interview) were excluded. Patients with chronic active hepatitis C were assessed at baseline and monthly during the first semester of IFN-alpha and ribavirine bi-therapy. Measurements. The Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Rating Scale for Anxiety (HAM-A) were used to assess depression and anxiety fluctuations. Serum and platelet serotonin levels were determined by HPLC with coulometric detection. Simultaneous quantification of TRP and KYN was determined by means of HPLC with fluorescence detection (TRP) or UV detection (KYN). Statistics. TRP, KYN concentrations and KYN/TRP ratio as well as MADRS and HAM-A measurements were performed at three time points (day 1, weeks 4 and 12) of IFN-alpha therapy. Analysis of variance used a linear model (with subject as the random factor) and correlation between measurements used an autoregressive model of order 1. For all probabilities, the level of significance was set at P<.05. RESULTS: Two patients were excluded before the first post-treatment assessment (results not shown). In the eight remaining patients, we observed significant increase of KYN/TRP ratio from baseline to early (week 4) and late (week 12) assessments (respectively, mean [S.D.] 5.57[5.24], 13.52[15.53] and 29.78[14.11], with P=.04). Similarly, significant increase in the MADRS (respectively 7.13[5.2], 12[6.9] and 16.6[8.6], with P=.03) and HAM-A (respectively 9.25[6.27], 15.1[6.95] and 18.7[6.27], with P=.02) mean scores were observed. Serum and platelet serotonin levels showed no significant variation with time. CONCLUSION: The results are consistent with the physiopathological hypothesis of an induction of IDO underlying depressive and anxiety symptoms related to IFN-alpha therapy in patients with chronic active hepatitis C. Nevertheless, this pilot study allows no firm conclusion since sample effective is weak and delay between IFN-alpha weekly injection and psychiatric and biological assessment was not controlled and thus may have biased our findings. However, these encouraging results advocate for further exploration of tryptophan metabolism for a better understanding of individual vulnerability to IFN-alpha-induced psychiatric adverse effects.

[Hepatitis C, interferon a and depression: main physiopathologic hypothesis]. / Hépatite C, Interféron alpha et dépression: principales hypothèses physiopathologiques.

UNLABELLED: Imputability of thymic disorders caused by IFNalpha during the chronic Hepatitis C treatment -- hepatitis C and depression -- the infection by the hepatitis C virus (HCV) is a major public health concern since it affects 1.2% in the French population. Eighty percent of those contaminated by HCV keep bearing the virus chronically although they remain asymptomatic during many years. HCV infection is associated with psychiatric symptoms like depression. Together with other factors (eg the severity of hepatic condition), depression may induce significant impairment in quality of life. Conversely, some psychiatric conditions may increase the risk of HCV infection. In drug-addicted subjects using intravenous route, HCV contamination rate ranges from 74 to 100%. Compared with general population, a higher HCV contamination rate has also been noticed in some other subgroups of subjects (patients with alcohol abuse or dependence, with alcohol-induced hepatic disease and psychiatric inpatients). However, no valid explanation to this phenomenon has been established. Interferon alpha and depression - Interferons are a variety of cytokines naturally produced by human tissues and have also been synthesized for therapeutic purposes (treatment of a variety of cancers and viral infections). Many psychobehavioural symptoms are observed under IFNalpha treatment. Among them, mood disorders are known to occur early after entry into treatment and to be within the reach of preventive measures. The reported frequency of depression during IFNalpha treatment ranges from 0 to 37%. This variation reflects either methodological biases (eg differences in psychiatric assessment) or the heterogeneity of the population of patients accepted in therapeutic protocols. Note that the adjunction of ribavirine to IFNalpha in therapeutic protocols has not brought any changes in the depression frequency. The causal relationship between IFNalpha administration and the occurrence of mood disorders has been tackled by various recent research works focusing on the importance of the immune system in the pathophysiology of depression. Miscellaneous pathophysiological hypotheses -- nature of the psychobehavioural symptomatology -- in addition to depressive symptoms, IFNalpha treatment also induces various cognitive impairments and disruptions in EEG patterns. These symptoms are consistent with a mild subcortical dementia. Data resulting from pharmacological trials in humans and in animals are controversial (eg IFNalpha-induced symptoms being alleviated by both immune and antidepressant therapies). However, the debate about the nature of the psychobehavioural disorders observed under IFNalpha treatment might be no longer relevant in the light of recent theories which regard depression as a maladaptive response to a particular form of stress, namely a deep and diffuse feeling of sickness ("malaise"). These theoretical views ascribe the production of depressive symptoms to a disruption in the immune function, mediated by the variety of cytokines. The therapeutic effects of anti-depressive drugs are thus attributed to their analgesic properties, reducing the "malaise" feeling underlying depressive symptoms. Necessity of a second messanger -- accordingly to current pathophysiological theories, depression results from disorders of various CNS functions, mainly limbic, monaminergic and neuroendocrinal systems. Though, exogenous IFNalpha does not cross the blood-brain barrier when unscathed and an intermediary mechanism is necessary. First to be addressed is the cytokines system itself since it is composed of numerous different molecules interacting in an infinite number of possible combinations. Some of these cytokines (eg some interleukins) both are activated by IFNalpha and can reach CNS; they are good candidates for the role of second messenger mediating the induction of psychobehavioural disorders. Second, keeping in mind that serotonin is a monoaminergic neurotransmitter classically involved in depression pathophysiology, other works have demonstrated that IFNalpha modulates the peripheral activity of indolamine-dioxygenase -- a regulating enzyme of serotonin metabolism -- possibly through lymphocyte T CD4 activation. Third, other authors have postulated an immune-induced vagal mechanism to explain depression caused by IFNalpha. Action of IFNalpha on the neuroendocrine and on neuromodulating functions: monoaminergic hypothesis -- cytokines could have an influence on the mood through their modulating role on the serotoninergic system. IFNalpha treatment is reported to produce: 1) a decrease in tryptophan availability for serotonin synthesis, 2) a decrease in the 5-HIAA level in the LCR, and 3) a modification of the central serotoninergic receptors. Moreover, selective inhibitors of serotonin transporters are effective to treat or prevent depression caused by IFNalpha. Many studies support the serotonin-transporter hypothesis: in vitro, both IFNalpha and interleukine 4 (IL-4) increases the expression of serotonin transporter gene, IFNalpha increases in the production of IL-4 by mononucleus cells (not found in vivo). Serotoninergic system can also be altered by a peripheral action of IFNalpha on trytophan catabolism by activating a concurrent pathway (known as "kynurenine pathway") to serotonin synthesis. Finally, serotonin-mediated vulnerability to the psychobehavioural effects of IFNalpha could be underlain by a polymorphism of serotonin transporter gene. Concerning the other monoaminergic systems, IFNalpha seems to have an amphetamine-like effect at its first administration, followed by a decrease in dopaminergic tone with chronic administration. Dopaminergic depletion, subsequent to psychostimulant abuse for instance, results in severe depressive syndromes. Interactions between IFNalpha and noradrenergic system have also been reported. Neuroendocrinian hypothesis -- when administered through central or peripheral way, IFNalpha simulates/inhibits the corticotrope axis and alters endorphin system as shown by the induction of analgesia, catatonia and behavioural slowdown that can be suppressed by opioid antagonists. IFNalpha neurotoxic effects are successfully treated by naltrexone. Lastly, IFNalpha is known to cause disorders in thyroid function that are likely to contribute to the production or aggravation of mood disorders. CONCLUSION: A better understanding of pathophysiologic mechanisms underlying psychiatric side-effects of IFNalpha is essential to extend access to treatment to some categories of patients that remain excluded from the protocols. A better management of those psychiatric side effects should help the clinician not to draw aside patients at risk, ie patients with depression, drug and alcohol addiction. Treating them in a pragmatic and careful way is a major issue, since this population represents a high percentage of the potential candidates for interferon therapy.

Simultaneous determination of tryptophan and kynurenine in serum by HPLC with UV and fluorescence detection.

Tryptophan metabolism is disturbed in mental depression, and the induction of indoleamine 2,3-dioxygenase increases kynurenine production. In order to determine this disturbance in patients with chronic hepatitis C and receiving interferon-based immunotherapy, a new and specific HPLC protocol was elaborated. For tryptophan, the assay was linear from 6.25 to 100 micromol L(-1), and the limits of detection (LOD) and quantitation (LOQ) for the method were 0.7 and 8.0 micromol L(-1). For kynurenine, the linearity of calibration was from 0.0625 to 6.25 micromol L(-1), with LOD and LOQ of 2 and 3 nmol L(-1). Reproducibility and repeatability were satisfactory. The method allowed study of human blood serum.

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.

The French experience--the pharmacist, general practitioner and patient perspective.

High-dose buprenorphine (Subutex(R)) has been available in France as a maintenance treatment since February 1996. Results from a twice yearly survey of pharmacists, general practitioners (GPs) and patients themselves in the use of Subutex(R) appeared to be representative of the general substitution therapy situation in France. Results from May 1997 were encouraging, with improved relationships between pharmacists and patients, and GPs and patients being reported in all three surveys. The most commonly prescribed dosage of buprenorphine (6-8 mg) was within the recommended range, although there was evidence that this was usually taken as several daily intakes by the majority of addicts. Although intravenous injection may occur in some cases, illicit resale was suspected only in a few cases. Treatment efficacy was high and retention at six months was good since patients had a positive opinion of their treatment and reported few adverse effects. Further improvement in the relationships between GPs and pharmacists is desirable to increase the success of the treatment programme.

Differences between general practitioner- and addiction centre-prescribed buprenorphine substitution therapy in France. Preliminary results.

The treatment of heroin addiction in France relies on either general practitioners (GP) or specialist Addiction Centres (ACs). In general, the GPs offer a more flexible approach regarding frequency of consultations, urine tests and dosing regimen while the AC approach is more structured. A cohort study was undertaken to compare the treatment strategies of buprenorphine therapy between these medical environments. To determine the efficacy of each treatment, a number of outcomes were measured including the Addiction Severity Index, retention rates at 90 and 180 days, the average dose prescribed, quality of life assessment, body weight and two self-reported measures: treatment perception and predictive total duration. A total of 69 patients were enrolled; 32 treated by GPs and 37 treated in ACs. Significant differences, including average age, addiction severity and employment status were apparent between each group. Nevertheless, significant improvements in the social and medical status were observed in all patients after 3 months, continuing after 6 months in both groups. Treatment retention was good in both groups with 65% of the total sample remaining after 180 days. The usually more flexible GP approach was more rigid in this study, resulting in an equally positive treatment outcome as seen in the ACs. The study highlights the effectiveness of buprenorphine in addicts with different social and medical backgrounds, regardless of the therapeutic approach.

Preliminary assessment of a 10-day rapid detoxification programme using high dosage buprenorphine.

The original French therapeutic strategy for the treatment of opioid addiction was a rapid detoxification occasionally accompanied by treatment for withdrawal symptoms. In 1995, substitution therapy using opioids was introduced with the aim of maintenance, utilising methadone and the partial agonist buprenorphine, introduced in 1996. As well as being a maintenance agent, buprenorphine has been prescribed for rapid detoxification due to its reduced tendency to cause any withdrawal effects and its ability to block the effects of other opioids. This trial was initiated to measure the efficacy of buprenorphine in rapid detoxification and to assess whether additional medication would be required. Participants in this open study had requested rapid detoxification and were referred to the addiction clinic as inpatients. Patients were assessed by the clinician and during counselling sessions, and an initial dose was agreed upon. This dose was then gradually decreased over ten days in a flexible dosing schedule, with concurrent toxicological urinalysis to ensure no illicit drug use. During the trial, 25% of patients transferred to a maintenance programme and 58% remained in the study. The large transfer of patients to maintenance programmes may indicate that many people requesting rapid detoxification are actually asking for a more generalised form of assistance. No opioid-positive urines were noted after the fourth day in any patients, and the study indicates that buprenorphine should prove to be a useful detoxification agent, particularly in less hardened addicts. Step-down buprenorphine detoxification minimises withdrawal symptoms and, therefore, reduces the need for concurrent medication.

Epidemiologic study of sleep quality and troubles in French secondary school adolescents.

BACKGROUND: The purpose of the study was to assess the prevalence and correlates of sleep problems in adolescents. METHODS: A total of 763 students chosen at random among the 15 secondary schools of a French département were given a self-report questionnaire. RESULTS: As much as 40.8% reported at least one of the five sleep disturbances we studied including difficulties falling asleep and staying asleep, a need for more sleep, early awakenings, and chronic sleeping pill intake. These sleep problems were highly related to various personal and family disorders. Discriminant analysis for categorical data pointed to a consistent but not significant descriptive profile accounting for sleep problems in these students. Suicide, weight concerns, and stimulant abuse were the most informative personal correlates as parts of this profile. CONCLUSION: These findings suggest that the complaint of poor sleep should be regarded with special care in adolescents as a possibly meaningful and sensitive sign of severe family or personal disruption.

[Evaluation of antibiotherapy in dental surgery]. / Evaluation de l'antibiothérapie en chirurgie dentaire.

OBJECTIVES: Debate on antibiotic prophylaxis in patients with infectious endocarditis has emphasized the need for reliable data on the effectiveness of antibiotic therapy in dentistry patients. METHODS: We randomly sampled 583 antibiotic prescriptions delivered by dentists working in out-patient clinics in the French department of Gironde in 1992. Two-hundred fifty-seven prescriptions were analyzed in detail after telephone contact with the prescribing practicians in coordination with infectiology experts from university hospitals. RESULTS: Antibiotic treatment was successful in 85.6% of the cases. The indication was justified in 74.1% and the dose was judged insufficient in 24% as was the administration rhythm in 37.8%. The duration of treatment was not in conformity with generally accepted prescription in 23.1% of the cases, usually being too short. According to the recommendations of the Consensus Conference on prophylaxis against infectious endocarditis held in Paris, March 27, 1992, antibiotic prophylaxy was not justified in 14.4% of the cases. In addition, the drug chosen in these cases was not in conformity with the recommendations in 43.2% and the duration in 100%. CONCLUSION: These findings emphasize that more adapted university and postgraduate training in antibiotic prescription both for prophylaxis and cure is needed in odontostomatology since a large number of antibiotics prescriptions are delivered by dentists.

[Children and alcohol. A study in the school milieu]. / Les enfants et l'alcool. A propos d'une enquête en milieu scolaire.

Epidemiologic studies have consistently found that use of alcohol is increasing among teenagers and that children who have their first drink before the age of ten years are at increased risk for alcohol use during adolescence. In this study, a questionnaire was completed by 351 children (185 boys and 166 girls) aged 7 to 11 years in eight different schools in the Lille area (northern France). Most respondents (70.8%) reported previous experience with alcoholic beverages. Regular use of alcohol was reported by 8.7% of respondents and at least one episode of acute over-drinking by 23.6%. Attitudes towards alcohol and reasons for alcohol use varied across age groups. Use of alcohol produced guilt in the youngest children but was viewed as normal in the older age groups. Although some awareness of alcohol-related hazards was found, misconceptions were common. Use of alcohol was related to age and awareness: among the younger children, the level of awareness was significantly higher in regular users than in non-users, whereas the opposite was true in the older respondents. A positive correlation was found between current alcohol use and the children's predictions of future use. These data highlight the value of epidemiologic surveys for developing strategies aimed at preventing alcohol use in youngsters.

Platelet serotonin levels in alcoholic patients: changes related to physiological and pathological factors.

This study investigated platelet serotonin (5-hydroxytryptamine; 5-HT) levels and the effects of different physiological and pathological factors in 108 alcoholic patients (alcohol abuse, n = 49; alcohol dependence, n = 59) and 32 healthy control subjects. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. In patients, platelet 5-HT levels during withdrawal from alcohol and after 2 weeks of abstinence were significantly lower than in control subjects. Among patients, this decrease was enhanced both in alcohol-dependent patients and in patients who were depressed during the withdrawal phase, whereas lifetime impulse control disorders (mostly found in alcohol abusers) were associated with comparatively high platelet 5-HT levels (i.e., close to control subjects' values). These results, which reflect the likely biphasic effect of alcohol ingestion upon 5-HT functioning, are consistent with the dimensional 5-HT hypothesis in psychiatric disorders.

The delayed sleep phase syndrome: clinical and investigative findings in 14 subjects.

Fourteen subjects are described in whom a clinical diagnosis of the delayed sleep phase syndrome was made. The condition is multi-factorial, dependent on lifestyle, mood and personality, as well as on familial factors but no single factor in isolation is sufficient to explain the delay in sleep timing. Refusal to attend school may be important in some instances but will not explain cases with delayed age of onset. In half the subjects the delay in sleep phase started in childhood or adolescence. The syndrome causes severe disruption to education, work and family life. Polysomnography, motor activity monitoring of rest-activity cycles, plasma melatonin profiles and urinary melatonin metabolite excretion are normal. Different patterns of sleep phase delay seen in the syndrome include stable, progressive, irregular and non-24 hour sleep-wake cycles. These patterns may result from different social and other Zeitgebers ("time-markers", for example sunrise, sunset) in the normal environment. Treatment by forced sleep-wake phase advance or with melatonin resulted in a partial sleep-phase advance but this was not maintained on stopping treatment.

Delayed sleep phase syndrome response to melatonin.

The actions of melatonin on the sleep-wake cycle were investigated by means of a randomised, double-blind, placebo-controlled trial in 8 subjects with a delayed sleep phase syndrome attending a sleep disorders clinic. In randomised order the subjects received placebo or melatonin 5 mg daily for 4 weeks with a 1 week washout period between the treatments. Drug or placebo was given at 2200 h, 5 h before the mean time of sleep onset determined by pretrial sleep logs. In all 8 subjects sleep onset time (mean advance 82 [range 19-124] min; p less than 0.01) and wake time (117 [10-187] min; p less than 0.01) were significantly earlier during melatonin treatment than during placebo. Mean total sleep time was slightly less on melatonin (8 h 12 min) than on placebo (8 h 46 min). Alertness acrophase calculated from the subjects' ratings of alertness made every 2 h while awake was unaltered. Melatonin may act as a phase-setter for sleep-wake cycles in subjects with a delayed sleep phase syndrome.

Platelet serotonin decrease in alcoholic patients.

This study investigated the platelet 5-HT levels and their changes according to different physiological and pathological factors in 30 young alcoholic patients (16 alcohol abusers and 14 alcohol-dependent subjects) and 26 healthy controls. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. The mean platelet 5-HT levels obtained in patients during withdrawal and after 2 weeks of abstinence were significantly lower than in controls. Presence of positive history of impulse control disorders (ICD) influenced the mean platelet 5-HT levels in patients. These preliminary results suggest that the platelet 5-HT level decrease observed in alcohol-dependent patients mostly free from ICD and in alcohol abusers mostly affected by ICD might result from comparable neurobiological mechanisms. However, the age of onset of alcohol dependence might depend on psychological functioning features.