Encephalic cycles during sleep and wakefulness in humans: a 24-hour pattern.

Twenty-four-hour polygraphic tracings from normal humans indicate that a pattern of alternating periods of the presence and absence of rapid eye movement, shown to exist for normal sleep, exist over all 24 hours of the daily period. This finding suggests that the so-called sleep-dream cycle of human sleep is not specific to sleep, but is a general activity pattern of the brain.

Suppression of sleep-related prolactin secretion and enhancement of sleep-related growth hormone secretion.

Methysergide, a clinically-used blocker of serotonin receptors, was administered to 10 normal young men at a dose of 2 mg every 6 h for 48 h. After drug treatment, serum levels of growth hormone during sleep were 41.9% higher than placebo values (less than 0.001). In contrast, drug treatment was associated with a 36.4% decrease in stimulated growth hormone secretion during insulin tolerance testing (P less than 0.01). These opposite effects of methysergide suggest that different mechanisms are responsible for sleep-related and insulin-induced growth hormone secretion. Accordingly, data obtained with pharmacologic stimuli may lead to erroneous inferences regarding physiologic growth hormone control mechanisms. Administration of methysergide profoundly suppressed sleep-related prolactin secretion; overall nocturnal mean prolactin fell by 70.3% from 4.30+/-0.19 to 1.28+/-0.06 ng/ml (P less than 0.0001). It appears that serotonin may be significant modulating neurotransmitter for the control of growth hormone secretion, limiting sleep-related release, and enhancing insulin-induced release. It seems likely from these data that the role of serotonin in the control of prolactin secretion is relatively more important, since serotonin receptor blockade dramatically reduced sleep-related prolactin secretion.

Somatization disorder and Briquet's syndrome. An assessment of their diagnostic concordance.

Somatization disorder (SD) as defined by DSM-III is a modification of criteria previously established to define Briquet's disorder (BD). We examined whether the less stringent SD criteria identify the same patient population as the more stringent BD criteria. All psychiatric female outpatients who reported having multiple unexplained physical problems prior to the age of 30 years were included in the study. Eighty-five (10.7%) of 794 patients fulfilled these screening criteria. Of the 85 patients, 41 had both SD and BD. Thirty-six patients did not have either disorder. The results indicate that the DSM-III criteria for SD are equally effective in identifying patients with BD but considerably less time-consuming and cumbersome to apply.

Serotonin inhibition and sleep.

Methysergide a clinically used blocker of serotonin receptors, was given for 48 hr to 11 normal adults, at a dose of 8 mg per 24 hr. Total REM sleep time was decreased, although total sleep time was unchanged. Stage 4 decreased and stage 3 increased, while total slow wave sleep remained constant. There was a tendency toward a decrease in the number of intact sleep cycles. The relationship of these data to published reports on p-chlorophenylalanine is discussed.

Plasma indolethylamine-n-methyltransferase activity and growth hormone level during sleep: a pilot study.

Polygraphic recordings and sequential growth hormone (GH) samplings were performed in eight healthy adult males. In the plasma samples from seven of the subjects, indolethylamine-N-methyltransferase (INMT) activity was also determined. Five of eight subjects showed significant fluctuation in plasma GH level, and six of seven subjects showed significant fluctuation in plasma INMT activity level. There were also significant positive correlations between plasma GH and INMT activity level during the second episode of NREM sleep stage 1 and during the third episode of NREM sleep stage 2. A significant negative correlation between plasma GH and INMT activity level during the seventh episode of sleep stage 2 and during the fifth episode of post sleep-onset wake was found. In view of a previous finding that INMT activity in the serum of psychiatric patients is positively correlated with severity of delusions, the observation that NREM sleep is associated with mental activity characterized by repetitive thoughts, and the result that GH level in plasma is increased in NREM sleep early at night, our present findings suggest the hypotheses that increased plasma INMT activity during sleep is indicative of both increased INMT activity in the central nervous system (CNS) and the activation or maintenance of NREM mental activity during sleep. Additional research will be needed in order to validate our observations and test these hypotheses.

A screening test for somatization disorder (hysteria).

For the diagnosis of somatization disorder, DSM-III requires the assessment of 37 specific symptoms, a time-consuming and cumbersome task. The authors describe a procedure by which the clinician can assess the presence of somatization disorder by screening for only seven symptoms, three of which must be present for a preliminary diagnosis of somatization disorder. The test was developed on female psychiatric outpatients (N = 85) who had multiple unexplained physical complaints beginning before the age of 30 years; it was validated on an independent sample (N = 47). The accuracy of this screening procedure is 80%-90%.

Is Briquet's syndrome a heterogeneous disorder?

A structured interview that identified 78 female psychiatric outpatients as having Briquet's syndrome also indicated that 77 of the 78 fulfilled inclusive diagnostic criteria for one or more other psychiatric syndromes. If, as this finding suggests, Briquet's syndrome represents a heterogeneous disorder, its various components should be evaluated and patient responses to treatments should be assessed. Until such studies are done, the general and psychiatric physician should be aware that the diagnosis of Briquet's syndrome does not rule out the possibility of other psychiatric illnesses that may be more amenable to treatment.

Cancer, emotions and mental illness: the present state of understanding.

The authors review recent and current literature on the relationship between psychological factors and cancer. They discuss the roles of predisposing personality patterns and emotional stress in the development, site, and course of cancer; the influence of awareness of terminal illness on the behavior of cancer patients; and the management of psychiatric symptoms in these patients.

Opioid effects on computer-derived sleep and EEG parameters in nondependent human addicts.

After one adaptation night, intramuscular doses of methadone (7.5, 15, 30 mg/70 kg), morphine (10 or 20 mg/70 kg), or placebo were given to seven male nondependent opiate addicts at weekly intervals in a randomized cross-over design. After three adaptation nights, heroin (3, 6, 12 mg/70 kg) was compared with morphine and placebo by means of a similar design in seven other subjects. Using electroencephalogram (EEG) bisector analysis, tape recordings of sleep were analyzed for two beta, three alpha, three theta, and two delta EEG patterns, as well as for detections of sleep spindles, K-complexes, eye movements, body movements, average electromyogram (EMG), and calculation of seven sleep-waking stages. All three opioids produce a dose-related arousal: they increase EMG and EEG measures of muscle activity, as well as body movements and EEG alpha, while decreasing EEG theta and spindling. These opioids also increase measures of waking state and decrease measures of spindle sleep and REM sleep. Although the 1974 version of the EEG bisector analysis is not exactly comparable to visual analysis, in this design it defined significant drug effects on sleep and EEG. Distinctive bisector analysis patterns are positively correlated with each sleep--waking stage.

Postcardiotomy confusion and sleep loss.

To examine the relationship between sleep loss and confusion after open-heart surgery, 27 consecutive patients were monitored 1 day preoperatively and 5 days postoperatively with the Folstein Mini-Mental State examination, a modified sleep latency test, and a sleep log. Confusion (low Mini-Mental State scores) peaked on postoperative Days 1 and 2 and correlated with insomnia (sleep time) during the following night but not during the preceding night. The results suggest that sleep loss is not the cause but, rather, a consequence of postcardiotomy confusion. Confusion, not insomnia, should be the focus of treatment.

Evaluation of sexual dysfunction.

Sixteen analogue scales were designed to measure drug- and illness-related changes in three dimensions of sexual function: interest, arousal, and performance. An orthogonal principal component factor analysis confirmed the three clinical factors. Retest reliability ranged between .80 and .94. Normals (N = 30) reported significantly better functioning than did psychiatric outpatients (N = 30).

Effect of buspirone on sexual dysfunction in patients with generalized anxiety disorder.

After 4 weeks' treatment with buspirone, sexual function was normalized in 8 of 10 patients with generalized anxiety disorder. Nine of the patients had reported decreased sexual function before treatment. Buspirone appears to offer a clinical advantage over existing anxiolytics, which are usually associated with impairment of sexual function.

The discriminate validity of the Psychiatric Diagnostic Interview.

The discriminate validity of the Psychiatric Diagnostic Interview (PDI), a criterion-referenced, structured diagnostic instrument, is discussed. Data presented indicate that the PDI has an acceptable level of discriminate ability, making it a useful screening tool for detecting a variety of well-defined psychiatric disorders.

Lithium and hypothyroidism.

There is general agreement that hypothyroidism is a possible consequence of lithium treatment but there is little agreement as to what the incidence of lithium related hypothyroidism is, or what clinical and laboratory tests could best be used to evaluate thyroid function. This study involved a survey of 70 clinicians, a chart review of 2,590 patients and a review of the pathophysiology of lithium-induced hypothyroidism. The major finding of this investigation is that lithium related thyroid dysfunction is not a common problem. Goiter during lithium therapy is 0.3%, clinical hypothyroidism is 1-2%, and TSH is the most specific laboratory test for evaluating thyroid function.

Prospective use of saliva lithium determinations to monitor lithium therapy.

A mathematical equation (y = 2.27x -0.45) relating saliva (y) to plasma (x) lithium concentrations was previously determined by one of the authors. A prospective study is reported here in which the correlation coefficient between the predicted and the observed plasma concentrations in a new group of 25 patients was r = 0.89 (p less than 0.001). The study demonstrates that saliva lithium determinations can be safely used to monitor lithium therapy.

Differential effect of amitriptyline and bupropion on primary and secondary depression: a pilot study.

In a prospective, controlled, double-blind study, 37 patients with major depressive disorder were subclassified into primary depression (N = 25) and secondary (N = 12) depression and treated with either amitriptyline (primary depressives N = 13, secondary depressives N = 6) or bupropion (primary depressives N = 12, secondary depressives N = 6). A differential response to the novel antidepressant bupropion was observed between the two diagnostic subgroups, but no differential response to amitriptyline was observed; patients with primary depression and secondary depression responded equally well to amitriptyline but not to bupropion. Our results provide pharmacological evidence supporting the usefulness of this subclassification of depression.

Refractory migraine headache controlled with alprazolam: case report.

A woman with major depressive disorder and refractory, incapacitating migraine headaches responded to alprazolam in a double-blind, placebo-controlled study. Migraine, but not depression, recurred following tapering of the drug, suggesting efficacy of alprazolam for control of refractory migraine.

Long-term efficacy and safety of bupropion.

Bupropion is a novel, structurally unique (single ring) compound, radically different from tricyclic antidepressants in its pharmacologic profile. In a random assignment, double-blind, long-term follow-up study of 60 depressed in- and outpatients (DSM-III criteria) in eight centers, the antidepressant actions of bupropion and amitriptyline were compared. Bupropion was as effective as amitriptyline in reducing depressive symptoms over a 6-month period, as measured by Hamilton depression and anxiety scales and Clinical Global Impression scores. Unlike amitriptyline, bupropion did not increase uric acid or cholesterol levels, and was not associated with weight gain. Bupropion was better tolerated than amitriptyline, the most commonly prescribed antidepressant.

Prevalence of additional psychiatric syndromes among male alcoholics.

The prevalence of psychiatric syndromes among 565 male alcoholic VA inpatients was examined using the structured Psychiatric Diagnostic Interview (PDI). Almost two-thirds fulfilled criteria for one or more additional psychiatric syndromes. Subjects positive only for alcoholism reported a significantly later onset of problem drinking and fewer first-degree relatives who abused alcohol than those positive for one or more additional syndromes. The most frequent additional syndromes were affective disorders and antisocial personality. The possible significance of subtyping alcoholics by the presence or absence of coexisting psychiatric syndromes is discussed.

Sleep and growth hormone secretion in alcoholics.

The effect of alcoholism on slow wave sleep (SWS) and SWS-related human growth hormone (HGH) secretion was investigated in 8 sober male alcoholics and 13 non-alcoholic controls. Sleep onset was temporally correlated with both elevated HGH levels and a high percentage of SWS in control subjects, with several specific qualifications related to age. By contrast, alcoholism was associated with a dissociation of sleep onset, SWS, and HGH elevation. The first noticeable HGH elevation in sober alcoholics often occurred several hours after sleep onset and in the absence of any SWS in the same time interval. Acute intoxication appeared to "normalize" the sleep onset-SWS linkage in alcoholics but did not influence the dissociation of HGH elevation from sleep onset and SWS.