Dysregulation of the hypothalamic-pituitary-adrenocortical system in panic disorder.

The responsiveness of the hypothalamic-pituitary-adrenocortical (HPA) system was investigated with the combined dexamethasone-corticotropin-releasing hormone (DEX-CRH) challenge test in 13 patients with "pure" panic disorder. After DEX pretreatment, this group of patients had higher CRH-induced adrenocorticotrophic hormone (ACTH) and cortisol levels than the control group, but lower than a reference group of depressed patients. The panic disorder patients were also in a middle position in the ratio of suppressors to nonsuppressors on the dexamethasone suppression test (DST) and in the ratio of normal to abnormal results on the DEX-CRH test. Our results using the combined DEX-CRH test, which is known to be much more sensitive than the original DST, support the hypothesis that HPA system functioning is altered in panic disorder patients and that this dysregulation is directly involved in the pathogenesis of the disorder.

Changes in late auditory evoked potentials induced by corticotropin-releasing hormone and corticotropin fragment 4-9 in male controls.

In order to investigate influences of corticotropin-releasing hormone (CRH) and corticotropin fragment (adrenocorticotropic hormone, ACTH, 4-9) on auditory perception processes, 10 subjects received either a placebo (sodium chloride 0.9%), CRH (100 micrograms) or ACTH 4-9 (Hoe 427, 300 micrograms) intravenously on different days. Late auditory evoked potentials (AEP) were computed and further analyzed using the brain electric source analysis method. As expected, CRH administration was followed by a rise in plasma cortisol and ACTH concentrations, whereas the injection of the ACTH 4-9 fragment did not alter plasma cortisol concentrations. In contrast to these different hormonal responses, both CRH and ACTH 4-9 modulated AEP in a similar manner, differing in quantity rather than in quality. The changes in AEP after the administration of ACTH 4-9 were most likely induced by a direct CNS action, whereas for the CRH effects, an indirect mechanism throughout the release of endogenous ACTH must be considered.

Changes in late auditory evoked potentials induced by growth hormone-releasing hormone (GHRH) but not somatostatin (SRIF) after peripheral administration in male controls.

To investigate possible influences of growth hormone-releasing hormone (GHRH) and somatostatin (SRIF) on auditory perceptional processes, 12 subjects received either placebo (sodium chloride 0.9%), GHRH (50 micrograms), or SRIF (100 micrograms) on different days. Late auditory evoked potentials (AEP) were computed and further analyzed by using the brain electric source analysis (BESA) method. Reduced late AEP latencies were observed following GHRH administration. In contrast, SRIF had no significant effects on the AEP. The changes in late auditory processing seen after administration of GHRH were most likely induced by a direct central nervous action.

Long-term habituation of brain evoked potential responses and pituitary-adrenal secretion with repeated (placebo) testing.

To study whether changes in late auditory evoked potentials (AEPs) and/or in stress-sensitive hormones of the hypothalamic-pituitary-adrenal (HPA) system take place between a first and a second placebo experiment and if so, whether these changes are possibly related to each other, we conducted two identical placebo sessions (2 ml 0.9% saline) and one cortisol session (50 mg) with 10 subjects on three different days. Plasma cortisol concentrations were significantly higher at the beginning of the first placebo experiment than the second, with a concordant decrease of plasma adrenocorticotropin hormone (ACTH) concentrations. In the AEP domain, a consistently lower P2 amplitude was observed in the first session. Since the change in late auditory processing could not be demonstrated after exogenous administration of cortisol, a direct mediation through an elevation of plasma cortisol concentrations or indirect mediation through a decrease of plasma ACTH concentrations seems unlikely. We rather propose that other stress-sensitive mechanisms, such as CCK, might account for the novelty-induced P2 amplitude lowering.

Pain perception in depression: relationships to symptomatology and naloxone-sensitive mechanisms.

A decrease in pain sensitivity during acute depression has been observed in several studies, apparently related to the severity of symptomatology. However, the question remains whether this relationship can be found only in heterogeneous groups of depressive patients or also in a single diagnostic group, such as major depression. In the present study, pain thresholds were assessed in 20 patients with major depression (DSM-III-R) and in 20 healthy controls. Two threshold methods with a differing impact of reaction time on the results were used. Contact heat was applied as a natural source of pain. With both methods the pain thresholds were significantly increased in the depressive patients. No relationship was found to the various symptoms of depression assessed by psychopathometric scales. In contrast to the pain thresholds, the thresholds of skin sensitivity for nonnoxious stimuli (warmth, cold, vibration) were only slightly increased. In subsamples (N = 10 in each group), naloxone (5 mg i.v.) and placebo were administered in a double-blind design. No systematic changes in pain thresholds occurred under either treatment. Our findings suggest that the decrease in skin sensitivity in major depression is specific to pain and not due to an increased reaction time. Moreover, the decrease appears to be related neither to a naloxone-sensitive mechanism nor to symptomatology.

Cholinergic REM sleep induction test in subjects at high risk for psychiatric disorders.

The influence of the cholinergic agonist RS 86 on electroencephalographic (EEG) sleep was investigated in 21 healthy members of families identified as being at high risk for psychiatric disorders and in 17 healthy control subjects without any personal or family history of a psychiatric illness. In comparison to the placebo night, the administration of RS 86 led to a shortening of rapid eye movement (REM) latency in both groups. This effect, however, was much more pronounced in the high-risk group, whereas in the control subjects the arousal system and the slow-wave sleep during the first nonREM period were more affected. These observations suggest that the cholinergic action on sleep regulating mechanisms has differing preferential targets in high-risk probands and in control subjects.

[Treatment of naevus flammeus lateralis by infrared contact coagulation]. / Die Behandlung des Naevus flammeus laterlis durch Infrarotkontaktkoagulation.

Twelve patients with port wine stains were treated with the infra-red contact coagulator. Good cosmetic results were achieved after nine treatments on the average. We obtained a distinct or nearly complete blanching of the port wine stains without conspicuous scar formation.

[Standardized recall antigen testing in patients with malignant melanoma, endogenous eczema patients and healthy humans]. / Standardisierte Recall-Antigentestung bei Patienten mit malignem Melanom, endogenen Ekzematikern und Gesunden.

By means of a new test kit (Multitest), intracutaneous tests have been performed on several groups of patients in order to evaluate the degree of cellular immunity. This test system affords the simultaneous application of seven quantitatively and qualitatively standardized antigens. In comparison to healthy people, patients suffering from malignant melanoma showed a slightly higher immunity reaction whereas patients with atopic dermatitis revealed a significantly lesser degree of reactivity to the recall-antigens. Chemotherapy with Dacarbazine did not change the amount of reactivity to the Multitest. This paper discusses the advantages of the new test kit as well as the difficulties of recall-antigen testing with regard to the evaluation of cellular immunity.