Oxidative stress in blood platelets from schizophrenic patients.

Oxidative stress in blood platelets is observed in various diseases, including neuropsychiatric disorders. The aim of our study was to evaluate oxidative stress in blood platelets from patients with schizophrenic disorders by measuring the activity of the platelet antioxidative enzyme, superoxide dismutase (SOD), concomitant with the level of thiobarbituric acid reactive species (TBARS). In blood platelets obtained from schizophrenic patients (with paranoid schizophrenia according to DSM-IV criteria) and from healthy volunteers the level of reactive oxygen species was also measured via chemiluminescence. In resting blood platelets from schizophrenic patients the chemiluminescence was higher than in platelets from control subjects (P < 0.05), but in thrombin-activated platelets an increase (about 53%) of chemiluminescence was observed, however this increase was lower than in thrombin-stimulated platelets from healthy subjects (101.5%). The results indicate that in platelets from schizophrenic patients generation of reactive oxygen species is enhanced. Moreover, we observed that SOD activity in blood platelets from schizophrenic patients was significantly lower than in control platelets and that a correlation exists between increased lipid peroxidation and inhibition of the activity of this antioxidative enzyme in schizophrenic platelets.

Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms.

UNLABELLED: The objective of the study was to find associations between obstetric complications (OCs) history and schizophrenia course and symptoms. We analysed the obstetric and psychiatric history of 50 DSM IV schizophrenic subjects who experienced their first schizophrenia episode in adolescence, and 30 healthy controls. Obstetrical data and Apgar scores were obtained from medical records and evaluated with the Lewis and Murray Scale. Based on patients' documentation [including longitudinal evaluation with Positive and Negative Syndrome Scale (PANSS)] the symptom profile and the course of schizophrenia were determined. RESULTS: we distinguished two major groups of patients: with prominent negative and prominent positive symptoms. Schizophrenics with prominent negative symptoms and a chronic schizophrenia course had significantly more definite OCs and lower Apgar scores than patients with prominent positive symptoms and controls. Subjects who had a positive OCs history were more than four times likely to develop schizophrenia in adolescence than those without such a history (OR=4.64; 95% CI=1.29-17.51) with the likelihood of developing schizophrenia with prominent negative symptoms especially high (OR=7.31; 95% CI=1.80-29.65). An Apgar score of between 0 and 3 after birth was associated with an increased risk for developing schizophrenia (OR=2.25; 95% CI=0.56-9.12), especially with prominent negative symptoms (OR=3.71; 95% CI=0.84-16.32). The findings support the hypothesis of a role of OCs in developing early-onset schizophrenia and suggest the associations of the OCs history with a specific symptoms profile (prominent negative symptoms) and a chronic course of schizophrenia.

Diurnal profile of melatonin secretion in the acute phase of major depression and in remission.

BACKGROUND: The aim of this study was to determine whether there are differences in the 24-hour melatonin secretion profile between patients with major depression (MD) before and after clomipramine treatment, and a control group, and also whether or not there exist statistically significant differences in the melatonin levels depending on the severity of depression. MATERIAL AND METHODS: 20 patients with MD and 14 healthy volunteers took part in the study. Before and after clomipramine treatment all the patients had an 8 ml blood sample collected 7 times, at fixed hours, for measurement of the melatonin level. The severity of depression was assessed (HAMDS, BDI, POMS) before and after treatment. RESULTS: The mean melatonin concentration at each of the chosen hours was higher in persons with MD than in the control, but the differences reached statistical significance only at certain night hours. In both groups the nocturnal rise in melatonin secretion began at 12 midnight, reaching its peak at 2 am, to reach low values by 8 am, similar to the values from the previous morning. After 8 weeks of clomipramine treatment, the melatonin concentrations at 12 midnight, 2 am, and 4 am were lowered, and were elevated at 8 am, 2 pm, and 8 pm. The difference was statistically significant only at 8 pm. Melatonin secretion during both night time hours and daytime hours is higher in individuals with MD than in healthy subjects, and remains elevated after 8 weeks of effective clomipramine treatment. Those patients whose state changed the least after 8 weeks of clomipramine treatment differed in a statistically significant way in terms of melatonin secretion level at 2 pm from those patients who improved the most. CONCLUSIONS: Some patients with MD have elevated melatonin concentration levels during daytime and nighttime hours, and this melatonin secretion pattern is independent of the severity of depression.

Diurnal profile of melatonin concentrations in patients with major depression: relationship to the clinical manifestation and antidepressant treatment.

OBJECTIVES: The aim of the study was to establish if there are differences in the 24-hour melatonin secretion profile between patients with major depression (before, and after treatment with clomipramine) compared to those in healthy subjects. Additionally, we determined if there are differences in melatonin concentrations, depending on the severity of depression, and the presence of 24-hour rhythm disturbances. MATERIAL AND METHODS: Twenty patients with major depression and 24-hour rhythm disturbances, and 14 healthy volunteers took part in the study. Before, and after treatment with clomipramine all subjects had blood samples collected at 08:00, 14:00, 20:00, 24:00, 02:00, 04:00, and 08:00 h, for estimation of melatonin concentrations. Before and after treatment, the severity of depression was evaluated using the following scales: the Hamilton Depression Rating Scale (HADRS), Beck Depression Inventory (BDI), and clinical observation, as well as presence, and if so, severity of 24-hour rhythm disturbances were assessed. RESULTS: In individuals with major depression with marked disturbances of their diurnal rhythms, melatonin secretion is also disturbed, shown by the higher melatonin concentrations at night as compared to those in healthy individuals. However, melatonin levels were independent of the severity or the clinical manifestation of depression. Moreover, no correlation between the disturbances in their diurnal rhythms (sleep-watchfulness, diurnal mood shifts) and disturbed melatonin pattern was observed. CONCLUSIONS: Melatonin nocturnal concentrations in patients with major depression were higher than those in healthy individuals. However, the melatonin concentration values do not differentiate the patients in terms of the severity of the depressive symptoms.

[Obsessive-compulsive disorders in adolescents with diagnosed schizophrenia]. / Zaburzenia obsesyjno-kompulsyjne u mlodocianych z rozpoznaniem schizofrenii.

The aim of the study was to assess the prevalence of OCD among 200 outpatients and inpatients (102 girls and 88 boys), 15-19 years old (mean age = 17.1 +/- 0.29) with schizophrenia (DSM-III-R, DSM-IV) and to determinate the time of onset of OCD: at least 6 months before schizophrenic symptoms, together with schizophrenic symptoms, while treatment with neuroleptics (name of drug, doses, duration of pharmacotherapy). Patients were examined with SCID-P for DSM-III-R and DSM-IV, version for patient, Y-BOCS and a specially prepared questionnaire for determining the age of onset, duration of OCD and a clinical picture of OCD. OCD was diagnosed in 13% adolescent patients with schizophrenia. Primary OCD--before schizophrenic symptoms was noted in 2.0% of patients, OCD together with schizophrenic symptoms in 4.5% of subjects, and while pharmacotherapy with various atypical neuroleptics: clozapine, risperidone, olanzapine in 6.0% of young patients. The most of assessed patients received clozapine (35 subjects), 24 subjects were treated with risperidone and 17 patients with olanzapine. It was determined that 14.3% of subjects used clozapine, 12.5% of subjects treated with risperidone and 5.9% treated with olanzapine presented OCD, where symptoms had appeared while in pharmacotherapy with these atypical neuroleptics. The differences were not statistically significant. OCD was not observed in these patients who had earlier treatment with classical neuroleptics (for example: haloperidol, perazine). It is possible that part of OCD in schizophrenic patients is induced by medication with new atypical neuroleptics, their influence on serotoninergic system, other, maybe the partial symptomatology of schizophrenia in a special subgroup of patients.

Therapeutic effects and tolerability of fluvoxamine treatment in adolescents with dysthymia.

OBJECTIVE: The aim of the study was to evaluate therapeutic effects and tolerability of fluvoxamine (150-200 mg daily) in 21 dysthymic adolescents. SUBJECTS: Twenty-one adolescents, attending psychiatric clinics, who met DSM-III-R criteria for dysthymia, without significant co-morbidity were the subjects. METHODS: Axis I and II diagnoses were made by using SCID-P and SCID II. Score A of >13 on HAMD-S at baseline was mandatory. The HAMD-S was completed after 4, 8, and 26 weeks. Adverse effects were recorded after 1, 2, 4, and 8, weeks. Tolerability was assessed by using CGI-T after 1, 2, and 4 weeks. Adverse effects caused three subjects to withdraw from the study. RESULTS: Good clinical response (decrease of HAMD-S score >50%) was observed after 4 weeks in 48% of patients; after 8 weeks in 56% of patients, and after 26 weeks in 44% patients. Relapse occurred in 34% of subjects. Fluvoxamine was well tolerated in 76.2% of the adolescents; poor toleration resulted in its discontinuation in 14.2% adolescents.

Levels of serum total cholesterol and LDL-cholesterol in patients with major depression in acute period and remission.

The aim of the study was to determine the level of total cholesterol and LDL-cholesterol in blood samples taken from 102 patients with recurrent major depression (according to DSM-IV). The analysis was performed during the acute period of major depression in 3 subgroups: with and without suicidal ideation (S+, S-), and after suicidal attempts (AS), and during remission of depressive symptoms. Putative correlations between the level of total cholesterol and severity of depressive symptoms and between total serum cholesterol and LDL-cholesterol and suicidal risk were evaluated. The patients did not suffer from any additional disorders, factors such as specific diet or pharmacotherapy, which could influence the levels of lipids, were absent. The subgroups were identified using clinical evaluation, medical records and Hamilton Depression Rating Scale--HAMD-S as well as a subscale of MMPI-DMS. Biochemical analyses were performed twice in all patients, in the acute period, before pharmacotherapy and after effective pharmacotherapy, in remission. The following parameters were evaluated: total serum cholesterol and LDL-cholesterol, T3, T4, TSH, ALT, AST, proteinogram. In all depressed patients with acute depression symptoms, low levels of total cholesterol and LDL-cholesterol were shown. The level of total cholesterol 160 mg/dl or less and the level of LDL-cholesterol 100 mg/dl or less were observed in persons with suicidal behavior only (S+ and AS). Low total cholesterol and LDL-cholesterol levels in persons in the acute period of major depression provided a useful parameter of suicide risk. A significant statistical correlation between the low level of total cholesterol and suicidal ideation was also found (r = 0.82, p < 0.05) as well as between the low level of serum total cholesterol and severity of depression, as evaluated by HAMD-S (r = 0.27, p < 0.05). During the remission of depressive symptoms, total cholesterol level and LDL-cholesterol increased significantly (p < 0.05) but a significant difference (p < 0.05) between subgroups (S-, S+, AS) were still observed. Low total cholesterol and LDL-cholesterol levels in remission in persons with the diagnosis of recurrent major depression may help to estimate the risk of suicidal behavior in the next depressive disorder. Possibly, low level of serum total cholesterol is a stable feature in some persons with recurrent major depression, probably dependent on their predisposition to autoaggression and presence of depressive disorder.

[The role of obstetric complications in the pathogenesis of schizophrenia]. / Rola komplikacji polozniczych w patogenezie schizofrenii.

The article is a review of research data on the occurrence of pregnancy and delivery complications in schizophrenic patients and their possible contribution to developing schizophrenia in adolescence or adulthood. Many studies revealed that subjects who have a positive obstetric complications history are at higher risk of developing schizophrenia. Obstetric complications, especially those resulting in asphyxia, are often mentioned as possible environmental factors that can disturb the brain developmental processes, which can be responsible for developing schizophrenia in the future. Obstetric complications can act as an environmental pathogenic factor in some cases of schizophrenia (for example not genetically conditioned ones). They can also constitute an additional factor that, acting together with other (for example genetic factors, results in schizophrenia phenotype). There are still inconsistent data and many methodological problems concerning obstetric complications studies. The problem requires further investigation with improved and unified methodological procedures applied.

[Clinical picture and duration of prodromal period of schizophrenia in adolescents]. / Obraz kliniczny i czas trwania objawów zwiastunowych schizofrenii u mlodziezy.

The aim of study was retrospective estimation of clinical picture and duration of prodromal period in 150 adolescents with the first episode of schizophrenia.

[CYP2D6 gene polymorphism in psychiatric patients resistant to standard pharmacotherapy]. / Polimorfizm genu CYP2D6 u pacjentów chorych psychicznie opornych na klasyczna farmakoterapie.

The debrisoquine polymorphism is a genetic variation in oxidative drug metabolism mediated by CYP2D6 gene, characterized by two phenotypes, the extensive metabolizer (EM) and poor metabolizer (PM). PM phenotype is inherited as autosomal recessive trait and occurs in 5-10% of Caucasian population. It is associated with the inefficient metabolism of over 30 drugs, including many psychotropic drugs. Clinical studies shown that PM are at higher risk than EM of adverse reactions to these drugs. We genotyped 22 psychiatric patients in whom standard pharmacotherapy had failed or drug adverse events occurred and in 14 patients in whom standard therapy was successful. CYP2D6 polymorphic alleles were identified using allele specific nested PCR reaction. The PM genotype was found in 4 of 22 (18%) patients resistant to standard pharmacotherapy and in none of 14 patients with improvement after standard therapy. Unsuccessful standard psychotropic drugs therapy in psychiatric patients may be associated with PM phenotype.

[Body dysmorphic disorder: clinical picture, diagnostic criteria, prevalence, course and treatment]. / Dysmorfofobia. Obraz kliniczny, kryteria rozpoznawania, rozpowszechnienie, przebieg i leczenie.

The article presents historical conceptions of dysmorphphobia and a review of recent references concerning aetiology, criteria for diagnosis of this disorder in new classifications of mental disorders (DSM-IV and ICD-10), course, and proposition of treatment. The author described characteristic personality traits of patients with dysmorphophobia and mental disorders, which are very often comorbid with this disorder (obsessive-compulsive disorder, phobia, delusional disorder-somatic type) and mental disorders in first-degree relatives of persons with dysmorphophobia.

[Results of long-term observation (3-11 years) of patients with dual diagnosis: body dysmorphic disorder and delusional disorder, somatic type]. / Wyniki dlugotrwalej (3-11 lat) obserwacji osób z podwójna diagnoza: dysmorfofobii i psychozy urojeniowej, typ somatyczny.

This work presents results of a retrospective and prospective research of 15 persons with a double diagnosis: body dysmorphic disorder, and delusional disorder, somatic type. It was established that these disorders starting in adolescence, occurred in persons who earlier had traits of avoidant and obsessive-compulsive personality or social phobia. In most subjects with dysmorphophobia there was comorbidity of dysthymia or major depression. An improvement in the state of these patients, most often after implementation of complex therapeutic measures: psychotherapy as well as pharmacotherapy with neuroleptic and SSRI's or clomipramine has to do with withdrawal of delusions, whereas the symptoms of body dysmorphic disorder usually last for years. In some patients delusional disorders had a tendency to reoccur or to be chronic, and lead to a considerable impairment of social functioning.

[Liaison between body dysmorphic disorder and eating disorders]. / Zwiazki miedzy dysmorfofobia i zaburzeniami odzywiania sie.

This study presents the cases of anorexia nervosa which began with a body dysmorphic disorder lasting for at least 6 months. In some subjects (25%) there was comorbidity of 3 mental disorders: anancastic personality or obsessive-compulsive disorder + dysmorphophobia + anorexia nervosa or dysmorphophobia + anorexia nervosa + depressive disorder (dysthymia or major depression). The author considers the conception that in some cases dysmorphophobia and anorexia nervosa are a spectre of obsessive-compulsive disorder or affective disorders in adolescents.

[Body image disturbance in anorexia nervosa]. / Zaburzenia obrazu wlasnego ciala w jadlowstrecie psychicznym.

30 girls aged 13-19, who met DSM-IV criteria for anorexia nervosa, and control group were investigated by using: 1. semistructured interview with subjects and their mothers about the pubertal status, history of marked overweight and the teasing about weight, the discrepancy between actual and ideal body weight, 2. a specially prepared questionnaire aimed to establish onset of body image disturbances, and the connection with above-mentioned symptoms and life events and lowered self-esteem, 3. Hamilton Anxiety Scale and 4. subscale from the Eating Disorders Inventory--Body Dissatisfaction Scale. Body image disturbances were characterized for anorectic persons with low global self-esteem and high level of anxiety, and developed during the change of the peer group or a change of the patient's position within the peer group.

[Opinions regarding the importance of body image disorders in the development and in the course of eating disorders]. / Poglady na temat znaczenia znieksztalconego obrazu ciala dla powstania i przebiegu zaburzen odzywiania.

The article presents a review of most important research results as well as opinions about the role and importance of body image disturbances in the development and the course of eating disorders. It also contains a review of definitions of body image, and techniques used in the evaluation of this type of disorders.

[Neurodevelopmental schizophrenia: the concept of developmental origins of certain forms of schizophrenia]. / Schizofrenia neurorozwojowa--koncepcja rozwojowego pochodzenia niektórych postaci schizofrenii.

This article presents the concept of neurodevelopmental schizophrenia and reviews the studies that contributed to its formulation. According to this concept some forms of schizophrenia (early onset, with predominating negative symptoms) are conditioned by distorted CNS development, probably in prenatal period. Such pathogenesis of certain forms of the disease is suggested by the following results of the studies on the CNS structure and function in schizophrenia: 1) structural abnormalities on in vivo brain imaging and postmortem studies 2) cytoarchitectural distortions in some brain regions, suggestive of disruption of cell migration during the CNS developmental processes 3) co-occurrence of the CNS congenital anomalies, minor physical anomalies and schizophrenia 4) neurological defects and psychosocial childhood dysfunction in individuals with adult onset schizophrenia. Genetical conditions, viral infections in prenatal period, obstetric complications or combination of the mentioned factors are considered as the factors disturbing the CNS developmental processes.

[Obsessive-compulsive disorder in girls with eating disorders]. / Zaburzenie obsesyjno-kompulsywne u dziewczat z zaburzeniami odzywiania.

30 girls aged 13-19 who met criteria DSM-IV for anorexia nervosa were investigated by using a semistructured diagnostic interview assessing general psychopathology as well as anorectic and bulimic behavior, The Yale-Brown Obsessive-Compulsive Scale. The Eating Disorder Inventory, The Anxiety Hamilton Scale, The Depression Hamilton Scale. The comparison group consisted of 30 healthy girls aged 13-19. 1/3 of the girls with anorexia nervosa met the DSM-IV criteria for OCD, 1/10 subjects had OCD and depressive disorder. The comorbidity of eating disorder and OCD or OCD and depressive disorder worsened the course of anorexia nervosa and prognosis.