Duration of lithium treatment and brain lithium concentration in patients with unipolar and schizoaffective disorder--a study with magnetic resonance spectroscopy.

Twenty psychiatric patients on lithium medication were examined with 7-Li-magnetic resonance spectroscopy of the brain. Patients on long-term lithium treatment (> 6 months) were compared with a short-term group who had been taking lithium for between 4 and 8 weeks. Patients met DSM-III-R criteria for either recurrent unipolar depressive disorder (DSM-III-R 296.3x) or schizoaffective disorder, depressive type (DSM-III-R 295.70). The brain:serum lithium ratio was 0.76 +/- 0.26; there was no significant difference between short-term and long-term treatment. In the group of long-term treatment patients there was a positive correlation between lithium dose per day and brain lithium concentration (R = .72, p < .01), and between lithium plasma concentration and brain lithium concentration (R = .65, p < .05). In the short-term group, however, there was no significant correlation for these parameters. No differences between unipolar and schizoaffective disorder were found.

Correlation between plasma clozapine concentration and heart rate variability in schizophrenic patients.

Forty schizophrenic patients treated with 50-600 mg/day of clozapine as monotherapy and 40 normal control subjects were tested for heart rate variability (HRV) which is mediated by the vagus nerve using acetylcholine as neurotransmitter. As compared to the control subjects, the patients showed essentially reduced HRV parameters which were negatively correlated with the plasma clozapine levels. Therefore, clozapine's anticholinergic effect is correlated to the plasma clozapine level when measured by the decrease of HRV. We suggest that HRV data might be useful as a predictor for plasma clozapine levels.

Initial lithium augmentation improves the antidepressant effects of standard TCA treatment in non-resistant depressed patients.

The hypothesis was tested that an initial lithium-tricyclic antidepressant (TCA) combination has a better antidepressant effect than standard TCA treatment in non-refractory depression at the beginning of an episode. Twenty bipolar melancholic type depressed inpatients under lithium-TCA treatment were compared with 20 patients with the same diagnosis and TCA-placebo treatment for 5 weeks under double-blind conditions. All patients were male. Initial lithium-TCA treatment reduced depressive symptoms significantly more than antidepressant treatment with TCA and placebo after 5 weeks, but not in weeks 1 or 2. It can be concluded that lithium augmentation of TCA treatment should be started even at the beginning of antidepressant TCA treatment to provide a better treatment response in those patients who will profit from long-term lithium prophylaxis, e.g. bipolar patients with melancholic type depression.

Left atrial myxoma presenting with synchronous carotid and femoral embolism.

Synchronous embolism of the right femoral and the left internal carotid arteries, occurring in a 39-year-old teacher upon physical effort, was found to be due to a left atrial myxoma. Clinical findings, electrocardiogram and chest radiographs had suggested myocarditis. The patient died of cerebral infarction. In cases of suspected myocarditis, left atrial myxoma has to be considered in the differential diagnosis. Histological examination is recommended of any material obtained by embolectomy.

Is diurnal variation of mood associated with parasympathetic activity?

18 patients with distinct improvement of mood in the evening and 18 patients without, both suffering from major depression and equally treated with tricyclic antidepressants (TCA), and an age- and sex-matched group of 18 normal control subjects underwent a standardized heart-rate (HR) analysis (HRA) in the morning (08:00) and 12 h later in the evening (20:00). The battery of cardiovascular reflex tests included the determination of HR variability (HRV) while resting and during deep breathing, and a spectral HRA. The depressed patients with diurnal variation of mood showed significantly decreased HR and significantly increased HRV parameters while resting and during deep respiration in the evening. On the contrary, patients without diurnal changes of mood just showed a significant HRV increase during deep respiration in the evening. No statistically significant changes of these parameters were detected in the healthy subjects. It is not known if the observed changes of HR parameters representing increment of parasympathetic tone are intrinsically related to the mood swings or if this rhythm just becomes visible under the circumstances of depression. Also, the impact of TCA treatment upon the results remains to be elucidated.

Are affective disorders associated with alterations of heart rate variability?

A standardized heart rate analysis was carried out in unmedicated patients with major depression, melancholic type (n = 16), panic disorder (n = 16), reactive depression with suicide attempts during the preceding 24 h (n = 16) and in 16 normal control subjects. The investigations included time- and frequency-derived measurements of heart rate variability. In the patients with reactive depression, no differences could be detected as compared with the control group. The patients with panic disorder showed a significantly increased low-frequency band of spectral analysis (P < 0.01) and a marginally significant increment of heart rate (P = 0.05), probably indicating predominance of sympathetic control of heart rate. In the patients with major depression, we found significantly lower values of heart's beat-to-beat intervals and of the high-frequency peak of spectral analysis than in the other groups (P < 0.025), indicating decreased parasympathetic activity.

Does bright-light therapy influence autonomic heart-rate parameters?

30 inpatients suffering from major depression (DSM-III-R), who did not fulfill the criteria of seasonal affective disorder (SAD), were treated with either doxepin or amitripytyline as monotherapy and supportively with bright light for 14 days. From days 15 to 19, bright light was replaced by dim light. 18 drug-free control subjects underwent an analogous sequence of bright- and dim-light applications. Phototherapy was applied between 06:00 and 07:30. Heart-rate (HR) analysis was performed in the patients and control subjects before and after the 5th session of bright and dim lights, respectively. 12 patients (40%) experienced improvement of mood during bright-light therapy (group I) while 18 (60%) did not (group II). Patients of group I, who reached significantly higher scores in the seasonal pattern assessment questionnaire than patients of group II, showed an increase of the coefficient of HR variation (HRV) during deep breathing as well as an increment of the high-frequency (HF) peak of spectral analysis exclusively after the bright-light sessions. Patients of group II did not show a significant alteration of these parameters, neither under the conditions of bright-light treatment nor under dim light. The control subjects experienced an increment of the HF power exclusively after bright light. The results suggest that a distinct subgroup of patients with non-SAD major depression shows a more pronounced light-associated increment of parasympathetically controlled cardiac functions than the other depressed patients and the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Identifying delirious states and autonomic cardiovascular dysfunction associated with amitriptyline treatment by standardized analysis of heart rate.

Ninety-one patients treated with amitriptyline and 60 normal control subjects underwent a standardized heart rate analysis in supine posture. Tests included the determination of time- and frequency-derived measurements of heart rate variability. The patients differed significantly from the control subjects in all parameters investigated. Two-thirds of the patients treated with a tricyclic antidepressant (TCA) reached values that met the criteria for cardiovascular autonomic neuropathy. Our results provide evidence that heart rate analysis might be a more sensitive tool in diagnosing amitriptyline-associated anticholinergic delirium than determination of TCA plasma levels. Further research is needed to elucidate what implications the TCA-associated alteration of autonomic cardiovascular function might have for patients.

[How are psychological processes, the neuroendocrine system and immune system integrated?]. / Wie sind psychische Prozesse, neuroendokrines System und Immunsystem integriert?

This short overview shows that there are bidirectional interactions between the central nervous system (CNS) and the immune system and deals with their anatomical and physiological correlates. Moreover, a number of immunological findings related to exogenous stress, depressive disorders and schizophrenias are discussed. An attempt is made to cautiously interpret the data presented and to demonstrate that the field of psychoneuroimmunology provides plenty of rewarding challenges for future research.

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression.

BACKGROUND: A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide. AIMS: To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state. METHOD: Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety. RESULTS: The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode. CONCLUSIONS: The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.

Changes in negative symptoms and EEG in schizophrenic patients after repetitive transcranial magnetic stimulation (rTMS): an open-label pilot study.

The effects of repetitive transcranial magnetic stimulation (rTMS) on schizophrenic negative symptoms (NS) and EEG topography were investigated in this pilot study. 10 patients with predominant NS were treated with 10 Hz rTMS over the left dorsolateral prefrontal cortex for 5 days. For NS ratings, the Scale for the Assessment of Negative Symptoms (SANS) was used. Both ratings and EEG recordings were obtained pre- and post-rTMS. Electrical activity changes were computed by Low Resolution Brain Electromagnetic Tomography. SANS showed an improvement after rTMS, from 49.0 (SD: 10.7) to 44.7 (SD: 11.8) (means). EEG frequency bands were changed fronto-temporally (right) and were mainly decreases in delta- and beta- and increases in alpha1-activity, as well as decreases in beta-activity in the temporal and parieto-occipital regions (left). Although we are aware of the limitations of this study, we assume a slight improvement in NS. The EEG findings refer to a possible neurophysiologic correlate of their improvement after rTMS.

[Paranoid hallucinatory psychoses as the first manifestation of HIV infection]. / Paranoid-halluzinatorische Psychose als Erstmanifestation einer HIV-Infektion.

All parts of the central nervous system may be involved in HIV infection, resulting in a variety of neuropsychiatric syndromes some of which resemble functional psychoses. Corresponding to the HIV-associated disease these syndromes differ in course and severity. A very common form is the AIDS-dementia complex, especially late in the course of disease. Up to now, however, a specific therapy is not available. A case of severe psychosis with paranoid delusions and hallucinations in a patient with otherwise asymptomatic HIV infection is reported. From her biography it was concluded that the infection occurred 10 years earlier. During therapy with azidothymidine, symptoms disappeared within 3 months, and more than one year after admission to our hospital the patient was still able to work. According to the course of the disease in this patient, reports from the literature and pathogenetic theories, an early therapy with antiviral agents is recommended in HIV-induced subacute encephalitis.

Blood lymphocyte subpopulations show characteristic changes during ACTH therapy in acute exacerbations of multiple sclerosis.

The percentages of the various lymphocyte subpopulations in blood samples of 22 patients suffering from acute bouts of multiple sclerosis (MS) were determined by E rosette formation and peroxidase staining techniques, respectively, before and during ACTH therapy. In accordance with earlier reports, most of the subjects showed a normal increase of their plasma cortisol concentrations in an ACTH quick test, which was routinely performed before the beginning of therapy. We observed a significant transitory decrease of the absolute and relative T-cell proportions with a minimum around the tenth day of treatment, accompanied by inverse changes of the null-cell numbers. The concentrations of total white blood cells, total lymphocytes, B-cells, and monocytes did not change significantly. Our results are consistent with data reported in the literature on follow-up studies of lymphocyte subpopulations in patients with myasthenia gravis undergoing treatment with ACTH and corticosteroids, respectively. Recent experimental findings indicate that T-helper cell activity can be regulated by a negative feedback control mechanism. In consideration of these reports, we discuss the significance of changes in the distribution of lymphocyte subpopulations for the therapeutic action of ACTH and corticosteroids in MS.

[Acquired immunologic deficiency syndrome (AIDS). I. Biologic principles]. / Das erworbene Immundefektsyndrom (AIDS). I. Biologische Grundlagen.

AIDS is a transmissible immunodeficiency syndrome which has first been observed less than a decade ago and since that time has spread in an epidemic manner. Usually it manifests itself by opportunistic infections and/or neoplasias. After courses of a few years, approximately 100% of cases have a lethal outcome. Sometimes, neuropsychiatric disturbances are the presenting symptoms and signs of AIDS. One of the first important observations was, that certain behavioural patterns such as homosexuality and intravenous drug abuse were apparently associated with a high risk for acquiring AIDS. The occurrence of AIDS in a number of haemophiliacs and recipients of blood transfusions suggested an important role of the haematogenous route of transmission. Not more than two years after the first clinical reports on AIDS a retrovirus was identified as the etiological agent. On the basis of different criteria this retrovirus can be classified as a slow virus. Subsequently, virological tests were developed which allowed an early diagnosis of this viral infection, even prior to the evolution of clinical symptoms. Immunological features of this new syndrome include disturbances of cellular as well as humoral immune functions. As we have no effective chemotherapy for AIDS and the successful development of a vaccine is delayed by a number of virological problems, it is of special importance to prevent transmission of the disease.