31P-spectroscopy of frontal lobe in schizophrenia: alterations in phospholipid and high-energy phosphate metabolism.

Studies using 31P-magnetic resonance spectroscopy (MRS) reported on abnormalities in frontal lobe metabolism in schizophrenia. The most consistent findings were a reduction in the resonances of phosphomonoesters (PME) and/or increased phosphodiesters (PDE), which are, respectively, the precursors and the metabolites of membrane phospholipids, thus suggesting an accelerated phospholipid metabolism in the disease. Other studies reported increased high-energy phosphates (ATP-adenosine triphosphate and PCr-phosphocreatine) in schizophrenia, reflecting decreased use of energy in the frontal lobe. We investigated 53 schizophrenic patients (DSM-IV) and 35 healthy controls. Eighteen from these patients were drug nai;ve and the remaining 35 were drug-free for an average of 6 months. Phospholipid metabolism and high-energy phosphates were assessed in the left frontal lobe using 31P-MRS. Psychopathological evaluation was done with the Brief Psychiatric Rating Scale (BPRS) and the Negative Symptoms Rating Scale (NSRS). Neuropsychological evaluation was performed with the Wisconsin Card Sorting Test (WCST), Stroop Test and Wechsler Adult Intelligence Scale. Drug-nai;ve patients showed reduced PDE in the left frontal lobe compared to controls and to previously medicated patients (p<0.05). No differences among the three groups were found regarding the other spectroscopy parameters. In healthy controls, but not in schizophrenics, a negative (and probably physiological) correlation was found between PME and PDE (p<0.01). In schizophrenic patients, ATP was correlated with negative symptoms and with neuropsychological impairment (p<0.01). The lack of a correlation between PME and PDE, as well as the reduction of PDE in schizophrenia, suggest a disrupted phospholipid metabolism in the disease, albeit on a contrary direction of that reported in literature. The relationships of ATP with negative symptoms and neuropsychological deficit suggest an alteration of energetic demand in the frontal lobe of schizophrenic patients, which is in line with the hypofrontality hypothesis of the disease.

Serviço Integrado de Neurogeriatria. Ambulatório da Memória - Análise dos resultados iniciais / Neurogeriatric Integrated Service. Memory Clinic - description of the initial results

Demência é o declínio da capacidade intelectual e adequação social em grau suficiente para afetar as atividades de vida diária. A demência pode ter várias etiologias, sendo algumas reversíveis. O Ambulatório da Memória do Serviço Integrado de Neurogeriatria da Real e Benemérita Sociedade Portuguesa de Beneficência - Hospital São Joaquim - propõe um modelo de atendimento multidisciplinar para o diagnóstico e tratamento das síndromes demenciais, com os seguintes resultados preliminares: dos 104 pacientes, 10 (9,6 por cento) não apresentavam deterioração intelectual. Dos 94 demais, 27 (28,7 por cento) tinham afecções potencialmentereversíveis: 18 casos de doença psiquiátrica; dois de doenças metabólicas; três de intoxicações exógenas e 4 casos de hidrocefalia. Foram 67 casos (71,2 por cento) de perda cognitiva causada por lesão estrutural, dos quais 42 pacientes (62,5 por cento) tinham doença de Alzheimer, que, atualmente possui tratamento específico. A proposta de uma equipe multidisciplinar, bem estruturada, pode beneficiar estes pacientes e seus familiares

Impact of recombinant human growth hormone (RH-RG) treatment on psychiatric, neuropsychological and clinical profiles of GH deficient adults

Background: Untreated GH-deficient adults have a diversity of dysfunctions (e.g. reduced muscle strength, emotional instability during strress, depressive symptons) that may cause deletrious effects on quality of life, and may be positively influenced by recombinant human growth hormone (rh-GH) therapy. Aim: To evaluate the impact of a clinical intervention with rh-GH therapy on GH-deficient adults. Method: The physical, psychiatric and neuropsychological status of 9 GH-deficient adults was determined before and after the administration of rh-GH (0.250 IU/Kg/week) in a double blind placebo-controlled trial for six months. Patients then received rh-GH for a further period of 6 months and their status was re-evaluated. Results: Rh-GH was significant better than placebo at 6th month (p<0.05), producing increased serum Insulin like growth factor-I (IGF-1) levels, reduced body mas index (BMI) and body fat, increased lean body mass and water, reduced wains/hip ratio and increased energy expenditure. The rh-GH therapy was also significantly better than placebo on depressive features as measured by the Hamilton Depression Scale (17-itens) (p=0.0431) and the Beck Depression Inventory (p=0.0431). Neuropsychological evaluations showed significant improvements in measures of Attention: Digit Backward (p=0.035), Verbal Flency (FAS) (p=0.02) and Cognitive Efficiency (WAIS-R tests): Vocabulary (p=0.027), Picture Arrangements (p=0.017), and Comprehension (p=0.01) following rh-GH therapy. Conclusion: The clinical, psychiatric, and neuropsychological impairements of untreated GH-deficient adults can be decresed by rh-GH therapy.