Association between toll-like receptor 4 expression and symptoms of major depressive disorder

BACKGROUND

In our previous study, toll-like receptor 4 (TLR4) mRNA expression level was associated with severity of major depressive disorder (MDD) evaluated with the 17-item Hamilton Depression Rating Scale (HAMD-17). However, there are few studies that have investigated the relationship between symptoms of MDD and changes in TLR4 expression. Therefore, the aim of the present study was to further analyze the association between subscales of HAMD-17 and TLR4.

METHODS

Fifty-one patients with MDD (15 male and 36 female) participated in this study. HAMD-17 was used to assess the symptoms of major depression. The mRNA expression levels of TLR4 were examined in parallel with a housekeeping gene, using real-time polymerase chain reaction. A stepwise linear regression forward model was used to evaluate the relationships between items of HAMD-17 and TLR4 expression.

RESULTS

Some sickness behavior-associated symptoms, including suicide, somatic symptoms of anxiety, or performance of work and activities, were not associated with TLR4 expression. However, psychological signs of anxiety and loss of weight in HAMD-17 can predict the expression level of TLR4.

CONCLUSION

Our results suggest a significant association between anxiety, body weight loss, and TLR4 mRNA levels in patients with MDD. Larger longitudinal studies combining both subjective and objective measures of depression are needed to clarify the link between TLR4 and symptoms of depression.

Association between toll-like receptors expression and major depressive disorder

Accumulating evidences suggest that Toll-like receptors (TLRs) were involved in the pathophysiology of major depressive disorder. TLR4 was thought to be associated with major depressive disorder in animal model, but the others were still unknown. In order to examine TLR1-9 mRNA expression levels in peripheral blood and their relationships with the psychopathology of major depressive disorder, 30 patients with major depressive disorder were compared with 29 healthy controls. The 17-item Hamilton Depression Rating Scale (HAMD-17) was used to assess the severity of major depression. The mRNA expression levels of TLRs were examined in parallel with a housekeeping gene using real-time polymerase chain reaction (RT-PCR). Analysis of covariance with age and body mass index adjustment revealed a significantly higher expression of TLR3, 4, 5 and 7 mRNA but lower expression of TLR1 and 6 in patients with major depressive disorder as compared with healthy controls. Multiple linear regression analysis revealed that TLR4 was an independent risk factor relating to severity of major depression. These findings suggest that TLRs, especially TLR4, may be involved in the psychopathology of major depression.

Nd:YLF laser at cryogenic temperature with orthogonally polarized simultaneous emission at 1047 nm and 1053 nm

A Nd:YLF laser at cryogenic temperature is demonstrated for the first time with orthogonally polarized simultaneous emission at 1047 nm and 1053 nm. By exploring the temperature dependence of the fluorescence and the absorption spectra from the Nd:YLF crystal, the feasibility of simultaneous emission at low temperature is achieved. Due to the local heating from the pump absorption, the optimal temperature with respect to the pump power for balancing output powers of simultaneous emission is thoroughly explored. At the optimal temperature of 138 K, the total output power of the simultaneous emission can reach 3.1 W at an incident pump power of 7.9 W, corresponding to the optical to optical slope efficiency up to 43%.

The acoustic radiation force impulse elastography evaluation of liver fibrosis in posttransplantation dysfunction of living donor liver transplantation

BACKGROUND

The acoustic radiation force impulse elastography (ARFI) is a new technology of elastography integrated into B-mode ultrasonography. It has been a reliable method to evaluate liver fibrosis of chronic liver disease in recent years, but less applied in the posttransplantation liver. The aim of the study was to evaluate liver fibrosis by the ARFI with correlation of pathological stages in living donor liver transplantation (LDLT).

MATERIALS AND METHODS

From August 2010 to August 2012, there were 57 LDLT patients with liver biopsy (LB) due to posttransplantation dysfunction; all patients also received posttransplantation ARFI liver stiffness measurement (LSM) after transplantation for liver fibrosis staging. The ARFI elastography was performed using a Siemens Acuson S2000 ultrasound system with 4V1 transducers (Acusion, Siemens Medical Systems Co. Ltd. Erlangen, Germany). The ARFI LSM value was presented by shear wave velocity (SWV, m/s). The fibrosis staging as F0 to F4 was in accordance with the Metavir scoring system.

RESULTS

A total of 57 patients had both posttransplantation LB and effective ARFI fibrosis staging for correlation. The ARFI LSM value increased with severity of liver fibrosis and had significant linear correlation with the results of histological fibrosis staging. The ARFI LSM sensitivities (Se), specificities (Sp), and cutoff values based on receiver-operator characteristic curve were F0: 0.75 m/s (Se: 93.8%, Sp: 4%), F1: 1.06 m/s (Se: 95.5%, Sp: 25.7%), F2: 1.81 m/s (Se: 50%, Sp: 83.6%) and F3: 2.33 m/s (Se: 100%, Sp: 92.9%). Predictive value of ARFI LSM reported a significant difference between early fibrosis stage (F0-F1) and advanced fibrosis stage (F ≧ 2) (P < .05).

CONCLUSION

In this study, ARFI demonstrated a strong linear correlation and severity of liver fibrosis with LB pathologic staging. ARFI can be an alternative and compensatory method for frequent LB in the posttransplantation liver.

Lower serum tropomyosin receptor kinase B levels in patients with schizophrenia

BACKGROUND

Brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) have previously been found to be reduced in the prefrontal cortex of patients with schizophrenia. In this study, we tried to investigate the protein levels of BDNF and TrkB from peripheral blood in the veins of individuals with schizophrenia and health controls.

METHODS

From January 2008 to November 2010, we recruited 40 schizophrenic patients and 56 healthy controls. Serum BDNF and total TrkB protein levels were detected with enzyme-linked immunosorbent assay (ELISA) kits. Outliners of BDNF and TrkB were excluded initially. Analysis of covariance (ANCOVA) with age adjustment was used for group mean differences of different groups.

RESULTS

After using the ANCOVA with age adjustment, the results of this work showed that BDNF presented no significant difference (F = 0.065, p = 0.800), but the serum TrkB protein level was significantly lower in schizophrenic patients than in healthy controls (F = 8.34, p = 0.005).

CONCLUSION

Our findings showed a lower TrkB protein level in serum from schizophrenia patients compared with healthy controls, indicating that the signaling transmission of BDNF/TrkB may be affected in peripheral blood from individuals with schizophrenia.

Effects of antipsychotics on the BDNF in schizophrenia

Brain-derived neurotropic factor (BDNF) is involved in the development of the brain, and likely influences the neuroplasticity in schizophrenia. BDNF is also believed to interact with other neurotransmitter systems implicated in schizophrenia, such as dopamine, glutamate, serotonin and GABA. Therefore, BDNF is a candidate gene for schizophrenia. In past decades, the blood (serum or plasma) BDNF protein levels and BDNF gene alleles and genotypes to the clinical features of schizophrenia, such as age of onset, clinical subtypes, symptom severity, and drug response, have been evaluated among different populations. However, the results are still inconsistent. Further, different drugs have been reported to have different effects on BDNF protein levels. A cross-sectional survey revealed that serum BDNF levels in chronic schizophrenic patients treated with clozapine exceeded those of patients treated with risperidone or with typical antipsychotics. In recent times, BDNF epigenetic studies have also been conducted in clinical studies of schizophrenia to address the question of why patients with the same gene genotype and alleles have different clinical presentations. In addition, the effects of different antipsychotic drugs on gene methylation and protein acetylation have also been reported. In conclusion, more data are needed regarding BDNF in the brain and in peripheral blood, including protein levels, single nucleotide polymorphisms, epigenetic regulation, and clinical data in order to understand the role of BDNF in schizophrenia.

2D-DIGE proteome analysis on the platelet proteins of patients with major depression

INTRODUCTION

Platelet activation is related to the psychopathology of major depression. We attempted to search and identify protein biomarkers from the platelets of patients with major depression. High resolution two-dimensional Differential Gel Electrophoresis (2D-DIGE), the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), Western blot, and bioinformatic tools were applied to examine the platelet proteins of 10 patients with major depression and 10 healthy controls.

RESULTS

The levels of 8 proteins were significantly different between the patients with major depression in the acute phase and healthy controls. The levels of protein disulfide-isomerase A3 (PDIA3) and F-actin-capping protein subunit beta (CAPZB) were higher in patients with major depression than in healthy controls. The levels of fibrinogen beta chain (FIBB), fibrinogen gamma chain (FIBG), retinoic acid receptor beta (RARB), glutathione peroxidase 1 (GPX1), SH3 domain-containing protein 19 (SH319), and T-complex protein 1 subunit beta (TCPB) were lower in patients with major depression than in healthy controls.

CONCLUSIONS

Platelet provided valuable information about the pathways and processes of inflammation/immunity, oxidative stress, and neurogenesis, related to major depression.

Bcl-2 associated with positive symptoms of schizophrenic patients in an acute phase

B cell lymphoma protein-2 (Bcl-2) may contribute to the pathophysiology of schizophrenia in the brain. The aim of this study was to investigate the serum levels of Bcl-2 in schizophrenic patients in an acute phase, and evaluate Bcl-2 level changes after antipsychotic treatment. We consecutively enrolled 41 schizophrenia patients in an acute phase; 28 were followed up with a 4-week antipsychotic treatment. Serum Bcl-2 levels were measured with assay kits. All patients were evaluated by examining the correlation between Bcl-2 levels and Positive and Negative Syndrome Scale (PANSS) scores, using Pearson correlation coefficients. In schizophrenic patients in an acute phase, positive PANSS subscores were significantly negatively correlated with Bcl-2 levels. In addition, we found Bcl-2 levels had a significantly negative correlation with PANSS total scores and positive subscores in male patients in an acute phase. Using the paired t-test, we found no significant changes in Bcl-2 levels in schizophrenia patients who had received the 4-week treatment with antipsychotic drugs (n=28). In conclusion, our results suggest that Bcl-2 might be an indicator of schizophrenia severity in the acute phase. In addition, Bcl-2 levels might be associated with positive symptoms in male patients with schizophrenia.

Rapid relief of catatonia in mood disorder by lorazepam and diazepam

BACKGROUND

Catatonia has risks of severe morbidity and mortality and needs early treatment. In this study, we investigated more patients to discuss the efficacy of this treatment in patients with major depressive disorder (MDD) or bipolar I disorder (BPI).

METHODS

During a period of 9 years, we identified 12 catatonic patients with mood disorder, with MDD (n = 10) and BPI (n = 2) in the emergency department, inpatient and outpatient units of a general hospital. The patients received intramuscular injection (IMI) of 2 mg lorazepam once or twice during the first 2 h. If intramuscular lorazepam failed, intravenous dripping (IVD) of 10 mg diazepam in 500 mL normal saline every 8 h for 1 day was prescribed.

RESULTS

Eight patients had full remission of catatonia after receiving one dose of 2 mg lorazepam IMI. Two patients needed two doses of 2 mg lorazepam IMI. Two patients with BPI recovered from catatonia using one dose of 10 mg diazepam IVD over 8 h after they failed to respond to two doses of 2 mg lorazepam IMI. The response rate to lorazepam IMI was 83.3%. All catatonic features remitted in 24 h with 100% response rate.

CONCLUSIONS

The lorazepam-diazepam treatment strategy is a safe and effective method to relieve catatonia in mood disorder within 1 day. Psychiatrist consultation is helpful for final diagnosis and rapid treatment of catatonia.

The Associations between Visual Attention and Facial Expression Identification in Patients with Schizophrenia

OBJECTIVE

Visual search is an important attention process that precedes the information processing. Visual search also mediates the relationship between cognition function (attention) and social cognition (such as facial expression identification). However, the association between visual attention and social cognition in patients with schizophrenia remains unknown. The purposes of this study were to examine the differences in visual search performance and facial expression identification between patients with schizophrenia and normal controls, and to explore the relationship between visual search performance and facial expression identification in patients with schizophrenia.

METHODS

Fourteen patients with schizophrenia (mean age=46.36±6.74) and 15 normal controls (mean age=40.87±9.33) participated this study. The visual search task, including feature search and conjunction search, and Japanese and Caucasian Facial Expression of Emotion were administered.

RESULTS

Patients with schizophrenia had worse visual search performance both in feature search and conjunction search than normal controls, as well as had worse facial expression identification, especially in surprised and sadness. In addition, there were negative associations between visual search performance and facial expression identification in patients with schizophrenia, especially in surprised and sadness. However, this phenomenon was not showed in normal controls.

CONCLUSION

Patients with schizophrenia who had visual search deficits had the impairment on facial expression identification. Increasing ability of visual search and facial expression identification may improve their social function and interpersonal relationship.

Lorazepam-diazepam protocol for catatonia in schizophrenia: a 21-case analysis

OBJECTIVES

Catatonia is a unique clinical phenomenon characterized by concurrent motor, emotional, vegetative and behavioral signs. Benzodiazepines (BZD) and electroconvulsive therapy (ECT) can rapidly relieve catatonic signs. The lorazepam-diazepam protocol presented here has been proven to relieve catatonia in schizophrenia within a day.

METHODS

From July 2002 to August 2011, schizophrenic patients requiring psychiatric intervention for catatonia in Kaohsiung Chang Gung Memorial Hospital were studied by medical chart review. The study used the Bush-Francis Catatonia Rating Scale (BFCRS). Patients receiving the lorazepam-diazepam protocol were identified.

RESULTS

The survey included 21 patients (eight males and 13 females) with a mean age of 30.3 ± 12.6 years. Mean duration of schizophrenia was 4.7 ± 5.6 years. Thirteen (61.9%) patients responded within 2 h, 18 (85.7%) responded within one day, and all became catatonia-free within a week. Mean BFCRS score was 9.9 ± 3.0 before treatment. Patients that responded with a single intramuscular lorazepam injection had mean BFCRS score of 8.9 ± 2.8, significantly lower than the mean score (11.6 ± 2.5) of the rest of the patients (p = 0.034).

CONCLUSIONS

The lorazepam-diazepam protocol can rapidly relieve retarded catatonia in schizophrenia. Most patients became catatonia-free within one day but some may require up to a week. ECT should be considered if the protocol fails.

Principle component analysis combined with matrix-assisted laser desorption ionization mass spectrometry for rapid diagnosing the sera of patients with major depression

BACKGROUND

Previously, we demonstrated that 6M HCl hydrolysis followed by matrix-assisted laser desorption/ionization (MALDI-TOF) mass spectrometry is a useful technique to detect potential protein biomarkers in the sera collected from major depression (MD) patients and from healthy controls.

METHODS

In this study, the effects of various organic acids in hydrolyzing proteins in serum were first examined. The organic matrixes commonly used in MALDI analysis were also examined for characterizing the hydrolyzed peptides. Finally, principle component analysis (PCA) was used to analyze the MALDI mass spectra of acid-hydrolyzed serum samples.

RESULTS

It was found that 20% TFA and sinapinic acid were the optimal reagents for hydrolysis and MALDI matrix. Samples collected from MD patients and healthy controls were readily classified through PCA analysis. A receiver operating characteristic (ROC) curve based on the ratio of the intensities of the two fragment ions (m/z 8606 and 9287) indicated by PCA plot was also constructed. The area under the curve was 0.845; the sensitivity and specificity were both 80%.

CONCLUSIONS

An analytical platform employing trifluoroacetic acid to hydrolyze serum proteins followed by MALDI-TOF/MS and PCA analysis was developed to rapidly differentiate the sera between MD patients and healthy controls.

Increased high-sensitivity C-reactive protein levels in Taiwanese schizophrenic patients

INTRODUCTION

Schizophrenia is associated with the activation of the immune/inflammatory system. C-reactive protein (CRP), a positive acute phase protein, may be associated with schizophrenia and antipsychotic treatment.

METHODS

The serum high-sensitivity CRP (hsCRP) levels of 36 schizophrenic patients undergoing clozapine, olanzapine or risperidone treatment and 36 sex-matched healthy subjects were collected. The difference in hsCRP levels between the schizophrenic and the control groups was estimated using ancova. anova was performed to examine the differences in the hsCRP levels between three antipsychotic groups (clozapine, olanzapine and risperidone).

RESULTS

ancova adjusted for age and body mass index (BMI) revealed a significant increase in the hsCRP levels in the schizophrenic group (1.4 mg/L, SD =1.5 mg/L) in comparison with the control group (0.9 mg/L, SD = 1.4 mg/L) (P = 0.013). anova revealed no statistical difference of age, BMI and hsCRP in three antipsychotic groups (P = 0.83, 0.90 and 0.71, respectively).

DISCUSSION

The elevation of CRP level is seen in chronic schizophrenia under antipsychotic treatment; however, studies with a larger sample size are required to confirm these results.

Mitochondrial DNA coding and control region variants as genetic risk factors for type 2 diabetes

Both the coding and control regions of mitochondrial DNA (mtDNA) play roles in the generation of diabetes; however, no studies have thoroughly reported on the combined diabetogenic effects of variants in the two regions. We determined the mitochondrial haplogroup and the mtDNA sequence of the control region in 859 subjects with diabetes and 1,151 normoglycemic control subjects. Full-length mtDNA sequences were conducted in 40 subjects harboring specific diabetes-related haplogroups. Multivariate logistic regression analysis with adjustment for age, sex, and BMI revealed that subjects harboring the mitochondrial haplogroup B4 have significant association with diabetes (DM) (odds ratio [OR], 1.54 [95% CI 1.18-2.02]; P < 0.001), whereas subjects harboring D4 have borderline resistance against DM generation (0.68 [0.49-0.94]; P = 0.02). Upon further study, we identified an mtDNA composite group susceptible to DM generation consisting of a 10398A allele at the coding region and a polycytosine variant at nucleotide pair 16184-16193 of the control region, as well as a resistant group consisting of C5178A, A10398G, and T152C variants. The OR for susceptible group is 1.31 (95% CI 1.04-1.67; P = 0.024) and for the resistant group is 0.48 (0.31-0.75; P = 0.001). Our study found that mtDNA variants in the coding and control regions can have combined effects influencing diabetes generation.

Survey of depression by Beck Depression Inventory in uremic patients undergoing hemodialysis and hemodiafiltration

High prevalence of depression has been reported in patients with end stage kidney disease and depression is associated with increased morbidity and mortality. We aimed to investigate the prevalence of depression in patients receiving standard hemodialysis (SHD) and hemodiafiltration (HDF) and compare the associated factors between these treatment modalities. The Beck Depression Inventory (BDI) was used to survey for major depressive symptoms. Demographic and biochemical data were reviewed and collected. Point prevalence of depression in HDF patients was significantly lower than SHD patients (23.9% vs. 43.1%, P < 0.05). The BDI score was also higher in SHD than HDF group (13.2 ± 11.6 vs. 8.7 ± 11.2, P < 0.05). SHD patients with major depressive symptoms had significantly lower levels of hemoglobin, albumin, creatinine, sodium and hand grip strength but had higher prevalence of diabetes and high sensitivity C-reactive protein (hs-CRP) levels. In HDF patients, phosphorus level was significantly lower in patients with major depressive symptoms. Logistic regression analysis revealed that hs-CRP, serum sodium and hand grip strength were significantly associated with major depressive symptoms in patients treated with SHD; while serum phosphorus was identified in HDF groups. We concluded that prevalence of depression was high in dialysis patients. Patients receiving HDF had a lower mean BDI score and a nearly 50% lower prevalence rate of major depressive symptoms than that of SHD. Factors associated with depression were different between two modalities.

Serum protein levels of brain-derived neurotrophic factor and tropomyosin-related kinase B in bipolar disorder: effects of mood stabilizers

AIM

In this study, we investigated serum protein levels of brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase B (TrkB) in patients with bipolar disorder.

METHODS

Over a 2-year period, 26 patients with bipolar I disorder (manic episode) and 56 healthy controls were recruited. The Young Mania Rating Scale scores of patients with bipolar mania were >26. Serum BDNF and TrkB protein levels were measured with ELISA kits.

RESULTS

Using ANCOVA with age adjustment, we found that there were no significant differences in serum BDNF protein levels between patients with bipolar mania and healthy controls (p = 0.582). In contrast, the serum TrkB protein level was significantly higher in bipolar mania patients than in healthy controls (p = 0.001), especially in women (p = 0.001). Of 26 patients with bipolar mania, 21 underwent a second measurement of serum BDNF and TrkB protein levels after a 4-week treatment with mood stabilizers. There were no significant changes in serum BDNF or TrkB protein levels.

CONCLUSION

These findings suggest that serum TrkB protein levels may play an important role in the psychopathology of bipolar mania. However, a larger sample size is needed to confirm these results.

Hemodynamics of portal venous stenosis before and after treatment in pediatric liver transplantation: evaluation with Doppler ultrasound

AIM

The aim of this study was to evaluate portal vein stenosis (PVS) in pediatric liver transplantation (PLT) using Doppler ultrasound (DUS) before and after interventional management for hemodynamic changes.

MATERIALS AND METHODS

From 2000 to 2010, we encountered 11 PVS cases among 180 PLT that were evaluated using DUS and computed tomography (CT) angiography (CTA); all underwent portal stenting. DUS was used to monitor portal hemodynamics. For the diagnosis of PVS, we investigated multiple parameters including stenotic size (SS), stenotic ratio (SR) (SR [%]=PRE-SS/PRE [PRE=stenotic size]), portal flow velocity ratio (VR) (VR=VS/PRE [PRE=velocity at prestenotic site; VS=peak velocity at stenotic site]), spleen size, and platelet count.

RESULTS

The incidence of PVS was 5.6% (11/180). The PV was 2.5 mm using DUS and 2.7 mm using CTA. The average SR was 65% fitting the criterion. Low prestenotic portal flow<12 cm/sec and high peak velocity in the stenotic segment (up to 147 cm/sec) were observed in 6 cases. The VR value was high at 7.5:1 and there was splenomegaly with thrombocytopenia. After portal vein stenting, hyperperfusion occurred might after reopening the stenosis: the flow increased to an average of 34 cm/sec and then flow decreased slowly to a stable level 2 weeks later. The size of the spleen decreased from 17 to 12 cm and the thrombocytopenia also improved with platelet counts increasing from 67×10(3) to 178×10(3)/μl at 2 months follow-up. The changes in portal flow, portal vein size, spleen size, and platelet count were significant (P<.05).

CONCLUSION

PVS is diagnosed using DUS by increased intrahepatic PV dilatation, peak flow at the stenotic site, discrepant VR. Early portal stenting showed a better prognosis. DUS is essential and effective for hemodynamic monitoring and management of PVS.

Effects of antipsychotics on the serum BDNF levels in schizophrenia

Brain-derived neurotrophic factor (BDNF) is active during a critical developmental period and likely influences the neuroplasticity of schizophrenia. This study longitudinally examined the effects of atypical antipsychotics on serum BDNF levels in schizophrenic patients. Specifically, this study measured serum BDNF levels in 53 patients with paranoid schizophrenia during a relapse and again 4 weeks following the administration of antipsychotic treatment (with risperidone in 32 cases, and clozapine in 21 cases). BDNF levels remained unchanged relative to study entry after 4 weeks of atypical antipsychotic treatment. However, serum BDNF was significantly increased in the subgroup receiving risperidone compared to that receiving clozapine, albeit only in the 15 male subjects and not in the 17 females. These results suggest that gender might significantly influence the antipsychotic treatment of schizophrenia from the perspective of BDNF. These findings may also indicate that the treatment with atypical antipsychotic agents differentially affects BDNF levels.

Increased interleukin-6 level in Taiwanese schizophrenic patients

BACKGROUND

Schizophrenia is accompanied by an activation of the immune/inflammatory system. In the present study, the relationships between serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1 levels and schizophrenia were explored in a group of Taiwanese inpatients. Furthermore, the serum IL-6, TNF-α, and TGF-β1 levels of patients with schizophrenia were compared before and after 1 month of antipsychotic treatment.

METHODS

The serum IL-6, TNF-α, and TGF-β1 levels of 34 acute stage schizophrenic patients and 30 healthy control subjects were collected. These levels were again collected in the 34 patients after 1 month of antipsychotic treatment. An analysis of covariance (ANCOVA) adjusted for gender was performed to examine the differences in cytokine levels between the schizophrenic patients and the control group. Repeated measures ANCOVA adjusted for gender was performed to examine the differences in cytokine levels of the schizophrenic patients before and after 1 month of treatment.

RESULTS

Using ANCOVA adjusted for gender, significantly increased IL-6 levels were found in schizophrenic patients compared with the control group (p = 0.02), but there were no significant differences in TNF-α and TGF-β1 levels (p = 0.06 and 0.91, respectively). After 1 month of medical treatment, there were no significant differences in IL-6 (p = 0.64), TNF-α (p = 0.48), and TGF-β1 (p = 0.23) levels in the schizophrenic patients, although IL-6 appeared to be normalizing.

CONCLUSION

An increase in the IL-6 level may play a role in the pathophysiology of schizophrenia. A larger sample size and a longer period of follow-up are needed to confirm this finding.

Association of serum levels of leptin, ghrelin, and adiponectin in schizophrenic patients and healthy controls

BACKGROUND

Leptin, ghrelin, and adiponectin play important roles in the regulation of body weight, food intake, and energy homeostasis, and have been suggested to be important biomarkers of metabolic syndrome. In this study, we tried to simultaneously investigate the serum levels of leptin, ghrelin, and adiponectin in schizophrenic patients and healthy controls.

METHODS

During a period of 2 years, we recruited 37 schizophrenic patients and 65 healthy controls. The levels of metabolic syndrome-related biomarkers including serum adiponectin, leptin, and ghrelin were measured with an enzyme-linked immunosorbent assay.

RESULTS

On applying analysis of covariance (ANCOVA) with age and body mass index adjustments, the leptin levels of schizophrenic patients (P = 0.038) were found to be higher than those of healthy controls. However, there were no significant differences in the serum levels of ghrelin or adiponectin between these two groups.

CONCLUSION

These results showed that serum leptin levels might be more sensitive than ghrelin or adiponectin levels between schizophrenic patients and healthy controls. However, studies with a large sample size are needed to confirm these results.

Changes in high-density lipoprotein and homeostasis model assessment of insulin resistance in medicated schizophrenic patients and healthy controls

BACKGROUND

This study intended to simultaneously investigate the relationships between high-density lipoprotein (HDL) and homeostasis model assessment of insulin resistance (HOMA-IR) in medicated schizophrenic patients vs healthy controls.

METHODS

During a 1-year period, we recruited 37 medicated schizophrenic patients and 30 healthy controls. Metabolic syndrome-related biomarkers including insulin and lipid profiles were enzymatically determined.

RESULTS

An analysis of covariance (ANCOVA) with BMI adjustment revealed that the patients had significantly lower HDL levels than the healthy controls (p = 0.017). ANCOVA with age adjustment revealed that the patients had significantly higher fasting insulin levels than the healthy controls (p = 0.034). In addition, in comparison with the healthy controls, the patients had higher mean serum levels of triglycerides, low-density lipoprotein, and total cholesterol as well as higher HOMA-IR values. However, there were no significant differences in any marker in the ANCOVA analysis after adjustment for age or BMI.

CONCLUSION

We found lower HDL and higher insulin levels in medicated schizophrenic patients than in healthy controls.

Severe neuroleptic malignant syndrome: successful treatment with high-dose lorazepam and diazepam: a case report

Neuroleptic malignant syndrome (NMS) is an idiosyncratic and potentially fatal adverse complication of antipsychotic medications and other dopamine-modulating agents. It is characterized by hyperthermia, muscle rigidity, autonomic dysfunction and alteration in mental status. Here, we report a patient with severe NMS who was successfully treated with highdose lorazepam and diazepam. A 61-year-old man with bipolar I disorder was admitted to the hospital because of manic episodes. Fever, muscle rigidity, tachycardia, diaphoresis, elevated blood pressure and delirium occurred following intramuscular injection of haloperidol and NMS was diagnosed. Supportive treatment included hydration, alkalinized fluids and correction of abnormal electrolytes without the use of dantrolene, dopaminergic agents or electroconvulsive therapy. The Francis-Yacoub NMS rating scale was employed for evaluation of clinical improvement, and scores were 55 on the first day and 0 at discharge. The patient was followed up for 6 months and was free of NMS. In conclusion, this is the first report of rapid relief of NMS with high-dose lorazepam and diazepam in a Taiwanese patient.

Higher serum tropomyosin-related kinase B protein level in major depression

Accumulating evidence suggests that the brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase B (TrkB) are molecules involved in the pathophysiology of major depressive disorder and response of antidepressants. To examine both BDNF and TrkB protein levels and their relationship with psychopathology in patients with major depressive disorder, 55 physically healthy patients with major depressive disorder were compared with 53 healthy controls. The severity of major depression was assessed by the 17-item Hamilton Depression Rating Scale (HDRS). Serum BDNF and TrkB protein levels were measured with Enzyme-linked immunosorbent assay (ELISA) kits. After using the analysis of covariance (ANCOVA) with age adjustment, the results of this work showed that BDNF presented no significant difference (F((1,107))=0.149, p=0.701) but the TrkB protein level was significantly higher in depressive patients than in healthy controls (F((1,107))=4.043, p=0.047). These findings suggest that the serum TrkB protein level may play an important role in the psychopathology of major depression.

Serum thiobarbituric acid-reactive substances and free thiol levels in schizophrenia patients: effects of antipsychotic drugs

This study investigated the levels of serum thiobarbituric acid-reactive substances (TBARS) and free thiols in schizophrenia patients and healthy control subjects, and evaluated the effects of antipsychotic drugs. During a 2-year period, 77 schizophrenia patients and 110 healthy control subjects were recruited. Psychiatric diagnoses of schizophrenia were made according to DSM-IV criteria. Serum TBARS and free thiol levels were measured using the standard procedure in the laboratory room. Using analysis of covariance with body mass index adjustment, we found that schizophrenia patients had significantly lower serum levels of free thiols than the controls. Fifty-five patients were followed up and their serum TBARS and free thiol levels were measured at the end of the 4-week treatment with antipsychotic drugs. We found that there were significantly decreased changes in free thiol levels, but not in TBARS levels. Furthermore, patients taking risperidone had significantly decreased changes in free thiol levels. Additionally, the responders showed significantly decreased changes in free thiol levels, but not in TBARS levels. In conclusion, these analytical results suggested that serum free thiols might play an important role in the psychopathology of schizophrenia and could be used as markers for determining the treatment response in schizophrenia.

Chronic administration of cyclosporine A changes expression of BDNF and TrkB in rat hippocampus and midbrain

Neurotrophins, including the brain-derived neurotrophic factor (BDNF), are essential for regulating neuronal differentiation in developing brains. BDNF and its receptor tyrosine kinase receptor B (TrkB) are involved in neuronal signaling, survival and plasticity. Cyclosporine A (CsA) is a potent immunosuppressive agent which prevents allograft rejection in organ transplantation and various immunological diseases. We investigated whether chronic administration of CsA decreases BDNF gene expression in rats, and the influence of CsA on mRNA levels of TrkB receptors was also examined. For 30 days of CsA (10 mg/kg/day) administration, the expression of BDNF and TrkB mRNA was significantly decreased in the hippocampus and midbrain, but there was no significant difference in the cortex. CsA (0, 1, 5 10, 15 ug/ml) down-regulated BDNF and TrkB gene expression through cultured SH-SY5Y cells, as did all-trans retinoic acid (ATRA), and there was no effect on cell viability. These experimental results indicate that suppression of the BDNF and TrkB mRNA, protein level of BDNF expression in the hippocampus and midbrain may be related to altered behavior observed following chronic administration of CsA. A common mechanism of adverse effects of CsA induced depressive symptoms may involve neurotoxicity mediated by down-regulation of brain BDNF and TrkB.

Intramuscular lorazepam in catatonia in patients with acute renal failure: a report of two cases

Cases of catatonia in patients with renal failure have been rarely reported. In this report, we describe two renal-insufficient patients with catatonia who had a good response to intramuscular lorazepam whereby the catatonic symptoms were relieved. Case 1 involved a patient with end-stage renal disease and severe pneumonia related respiratory failure. He responded well to intramuscular lorazepam (total dose, 4 mg) whereby the catatonia was elieved. Case 2 involved a patient with alcoholic liver cirrhosis and rhabdomyolysis-related acute renal failure. He showed great improvement with intramuscular lorazepam (2 mg) whereby the catatonia was subsequently relieved. This report demonstrates that intramuscular lorazepam is safe, effective and rapid in relieving catatonia associated with renal function impairment. Neither of the patients had a recurrence of catatonia during a period of 6- months follow-up. In conclusion, intramuscular lorazepam may play an important role in the treatment of catatonia associated with renal insufficiency.

Acid hydrolysis followed by matrix-assisted laser desorption/ionization mass spectrometry for the rapid diagnosis of serum protein biomarkers in patients with major depression

We have developed a technique combining acid hydrolysis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for the rapid study of the changes in the levels of positive and negative acute phase protein biomarkers in the sera of patients suffering from major depression. The serum proteins were first precipitated using an organic solvent; after separation, they were subjected to hydrochloric acid hydrolysis (6 M HCl) for 10 min. The resulting peptides were characterized using MALDI-TOF MS. Short-term treatment of the serum proteins with HCl efficiently removed interference from the abundant protein - albumin - and produced abundant peptide ion signals in the range of m/z 4000-10 000. This approach allowed us to rapidly detect the peptide ions originating from transferrin (a common negative acute phase protein) and fibrinogen (a common positive acute phase protein). The average ratios and (standard deviations) of the ion signals derived from transferrin/fibrinogen were 3.58 (+/-1.93) for the healthy control subjects and 1.02 (+/-0.52) for the patients suffering from major depression. The differences in transferrin/fibrinogen ratios between healthy controls and patients suggest that major depression will induce internal inflammation and cause either an increase in the level of fibrinogen or a decrease in the level of transferrin.

Serum brain-derived neurotrophic factor levels in patients with major depression: effects of antidepressants

This study tried to investigate the relationships between serum brain-derived neurotrophic factor (BDNF) protein levels and major depressive patients and discuss the effects of antidepressants on the serum BDNF protein levels. A total of 218 participants, including 111 patients with major depression (91 women) and 107 healthy controls (65 women), were recruited in this study. Serum BDNF protein levels were measured using an ELISA kit. Psychiatric diagnoses were made according to DSM-IV criteria. Severity of major depression was assessed by the 17-item Hamilton Depression Rating Scale. Using analysis of covariance with age adjustment, there were significantly low serum BDNF protein levels in depressive patients than healthy controls in women (F=7.530, p=0.007), but not in men. Additionally, changes in serum BDNF protein levels were significantly increased in 79 patients taking antidepressants during a period of 4 weeks (t=2.116, p=0.038), especially in 61 women (t=2.542, p=0.014). Age-adjusted ANCOVA revealed no significant differences in serum BDNF protein levels between 58 responders and 21 non-responders (F=0.008, P=0.928). In responders, there were significantly increased changes in serum BDNF protein levels in 44 women (t=2.501, p=0.016), but not in 14 men (t=-0.767, p=0.457). These analytical results suggest that low serum BDNF may play an important role in depressive women and antidepressant treatment significantly increase serum BDNF. However, further studies of larger populations are necessary to confirm these results and further elucidate the effects of different classes of antidepressants on serum BDNF protein levels.

Associations between brain-derived neurotrophic factor G196A gene polymorphism and clinical phenotypes in schizophrenia patients

BACKGROUND

Brain-derived neurotrophic factor (BDNF) had been chosen as a candidate gene for schizophrenia. This study investigated the relationships between BDNF G196A gene polymorphism and clinical phenotypes in schizophrenia patients in the Taiwanese population.

METHODS

During a one year period, 132 schizophrenic patients and 103 healthy controls were recruited. Psychiatric diagnoses were made according to DSM-IV criteria. Genotyping of the G196A polymorphism of BDNF was performed by polymerase chain reaction amplification and restriction fragment length polymorphism.

RESULTS

The data showed that the BDNF G196A genotypes and their allele distributions did not differ between patients with schizophrenia and healthy controls. No significant differences were noted in the BDNF G196A genotypes and allele distribution between schizophrenia patients with and without a family tendency for schizophrenia or between those with an age of onset before or after 25 years old. However, there was a significant difference in BDNF G196A genotype distribution between schizophrenia patients with and without a suicide history.

CONCLUSIONS

These analytical results suggest that BDNF G196A gene polymorphism is associated with a susceptibility to a suicide history in schizophrenia patients in the Taiwanese population. Further study with a larger number of samples is needed to prove these findings.

Low serum albumin and high ferritin levels in chronic hemodialysis patients with major depression

We investigated the relationships between serum albumin and ferritin levels in chronic hemodialysis patients with or without major depression. During a 1-year period, a total of 107 chronic hemodialysis patients were recruited. The diagnosis of major depression in patients was made by one psychiatrist. The data showed that patients with major depression (n=15) had significantly lower albumin and higher ferritin levels than patients without major depression (n=92). Chronic hemodialysis patients with major depression might have a more severe inflammation reaction and greater oxidative damage than patients without major depression.

T-helper 1/T-helper 2 cytokine imbalance and clinical phenotypes of acute-phase major depression

Several studies have discussed the relationships between T-helper 1 (Th1) or Th2 cytokines and major depression. The aim of the present study was to investigate the relationships between Th1/Th2 cytokine balance and clinical phenotypes of acute-phase major depression. A total of 82 subjects including 42 patients with major depressive disorder and 40 healthy controls were recruited. Serum cytokine levels of interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and IL-10 were examined. Using ancova with age and body mass index (BMI) adjustments, there were no significant differences in serum IL-1beta, TNF-alpha, and IL-10 levels between patients with major depressive disorder and healthy controls. However, using ANCOVA with BMI adjustment only, the results showed that patients with major depressive disorder had significantly higher TNF-alpha levels than control subjects. In addition, using ANCOVA with age and BMI adjustments, significantly higher serum IL-1beta level and IL-1beta/IL-10 ratio were noted in patients with melancholic features than patients with non-melancholic features. However, there were no significant differences in serum IL-1beta, TNF-alpha and IL-10 levels between patients with and without suicide attempt. In conclusion, serum TNF-alpha, IL-1beta level and IL-1beta/IL-10 ratio might play an important role in the psychopathology of acute-phase major depressive disorder.

Serum brain-derived neurotrophic factor levels in patients with major depression: effects of antidepressants

This study tried to investigate the relationships between serum brain-derived neurotrophic factor (BDNF) protein levels and major depressive patients and discuss the effects of antidepressants on the serum BDNF protein levels. A total of 218 participants, including 111 patients with major depression (91 women) and 107 healthy controls (65 women), were recruited in this study. Serum BDNF protein levels were measured using an ELISA kit. Psychiatric diagnoses were made according to DSM-IV criteria. Severity of major depression was assessed by the 17-item Hamilton Depression Rating Scale. Using analysis of covariance with age adjustment, there were significantly low serum BDNF protein levels in depressive patients than healthy controls in women (F=7.530, p=0.007), but not in men. Additionally, changes in serum BDNF protein levels were significantly increased in 79 patients taking antidepressants during a period of 4 weeks (t=2.116, p=0.038), especially in 61 women (t=2.542, p=0.014). Age-adjusted ANCOVA revealed no significant differences in serum BDNF protein levels between 58 responders and 21 non-responders (F=0.008, P=0.928). In responders, there were significantly increased changes in serum BDNF protein levels in 44 women (t=2.501, p=0.016), but not in 14 men (t=-0.767, p=0.457). These analytical results suggest that low serum BDNF may play an important role in depressive women and antidepressant treatment significantly increase serum BDNF. However, further studies of larger populations are necessary to confirm these results and further elucidate the effects of different classes of antidepressants on serum BDNF protein levels.

High-sensitivity C-reactive protein levels in patients with major depressive disorder and bipolar mania

The serum high-sensitivity C-reactive protein (hsCRP) levels in patients with major depressive disorder and bipolar I disorder in acute phases were investigated. During a 1-year period, a total of 67 participants including 23 patients with major depressive disorder, 13 patients with bipolar I disorder (manic episode) and 31 healthy controls were recruited in this study. The diagnoses of mental disorders in participants were made by one psychiatrist according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Both patient groups with major depression and bipolar disorder had higher mean serum hsCRP levels than the healthy control group. Using analysis of covariance with age adjustment, patients with bipolar I disorders still had significantly higher hsCRP levels than healthy controls (P=0.043). However, patients with major depression did not have significantly higher hsCRP levels than healthy controls (P=0.172). These results suggest that patients with bipolar I disorder might have a more severe inflammation reaction than patients without major depression. However, larger samples and adequate statistical methods are needed to prove these results.

Correlations between weight changes and lipid profile changes in schizophrenic patients after antipsychotics therapy

BACKGROUND

In our previous study, we had identified strong associations between dyslipidemia and acute-phase schizophrenia during the 3-week study period. In this study, we further investigated the correlations between weight changes and lipid changes during this short period in Taiwan.

METHODS

During a 1-year period, the data of age, body mass index, antipsychotic drugs and fasting blood samples for serum lipid profiles were collected at baseline and endpoint of 3 weeks. The antipsychotic drugs used include haloperidol, loxapine, sulpiride, olanzapine, risperidone, and clozapine.

RESULTS

A total of 97 schizophrenia patients were enrolled in this study. The authors found that most antipsychotic drugs showed increased weight changes in Taiwanese patients. Using linear regression, the authors also found that the weight changes in patients taking clozapine had significantly negative correlation with HDL changes during the 3-week study period. However, no significant correlations between weight changes and lipid changes were noted in patients using other antipsychotic drugs.

CONCLUSIONS

The results of this study showed that most antipsychotic drugs showed increased weight changes and schizophrenia patients using clozapine might have negative correlations between weight changes and HDL changes during a very short period. However, due to the limitation of the sample size, larger samples are needed to prove the results after controlling confounding factors.

Liver graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in living donor liver transplantation

Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-to-recipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-to-recipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p = 0.001) and RPVF (p = 0.014). Graft hyperperfusion (RPVF flow > 250 mL/min/100 g graft) was seen in eight recipients. If the GRSSR was < 0.6, 5 of 11 cases were found to have graft hyperperfusion (p = 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p = 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of < 0.6.

Benzodiazepines in catatonia associated with systemic lupus erythematosus

Neuropsychiatric disturbances are found in 50-70% of systemic lupus erythematosus (SLE) patients. However, there are rare cases of catatonia being described in SLE. Some studies have shown the effectiveness of high-dose steroid, plasma exchange and electroconvulsive therapy (ECT) in lupus catatonia. Herein are described two SLE patients with catatonia who had good response to i.v. diazepam (i.e. relief of catatonia symptoms). Patient 1, with mild cortical atrophy, had great improvement in catatonia symptoms on i.v. diazepam 150 mg during a period of 5 days. Patient 2, without cortical atrophy, had quick response to i.v. diazepam 10-20 mg. Both patients had no recurrence during 6-month follow up. In conclusion, benzodiazepines may play an important role in the treatment of catatonia associated with SLE if patients refuse ECT treatment.

Lymphocyte subsets and viral load in male AIDS patients with major depression: naturalistic study

This study investigated the relationships between lymphocyte subsets and viral load in AIDS patients with and without major depression. During a 7-year period, a total of 60 male hospitalized AIDS patients were recruited in this study. The diagnosis of major depression in patients was made by the same psychiatrist according to the 4th edition of the Diagnostic and Statistical Manual for Mental Disorders criteria. All patients had data for CD4, CD8 and CD4/CD8, and only 42 patients had viral load data. Of 60 AIDS patients, 32 patients had received highly active antiretroviral therapy and received subsequent assessment of lymphocyte cell counts 1 month later. Using ancova with age adjustment, the authors found that patients with major depression (n = 22) had significantly lower CD8 cell counts than patients without major depression (n = 38). However, CD4 cell counts and CD4/CD8 ratios were not significantly different between these two groups. In addition, there was no significant difference in viral load between patients with major depression (n = 16) and patients without major depression (n = 26). Of 32 patients received highly active antiretroviral therapy, 14 patients with an antidepressant (e.g. fluoxetine 20 mg/day) had significantly decreased CD4 and not CD8 cell counts and significantly reduced CD4/CD8 ratios during a period of 1 month. In conclusion, these results suggest that AIDS patients with major depression had significantly lower CD8 cell counts and might have a more severe inflammation/immunity reaction than patients without major depression.

Clozapine for blepharospasm, obsessive-compulsive symptoms, and psychotic symptoms in a patient of old brain infarction

Blepharospasm, psychotic symptoms, and obsessive-compulsive symptoms can result from brain infarction. However, a presentation of these 3 symptoms simultaneously is rare. This report describes a 65-year-old woman who had old brain infarction and presented with these 3 symptoms for 2 years. The patient recovered after receiving a regimen of clozapine 125 mg/d for 3 months. No recurrences of symptoms were noted during a 6-month follow-up. This is the first case report demonstrating that clozapine is effective for a patient with blepharospasm, obsessive-compulsive symptoms, and psychotic symptoms presenting simultaneously. This report also reminds physicians of the possible organic causes of unusual presentations in elderly patients.

Associations between serum brain-derived neurotrophic factor levels and clinical phenotypes in schizophrenia patients

This study investigated serum brain-derived neurotrophic factor (BDNF) protein levels in schizophrenia patients and healthy control subjects and schizophrenia patients with various clinical phenotypes. During a 1-year period, 126 schizophrenic patients and 96 healthy control subjects were recruited. Serum BDNF protein levels were measured using an ELISA Kit. Psychiatric diagnoses were made according to DSM-IV criteria. One-way analysis of variance (ANOVA) showed no significant differences in serum BDNF protein levels between schizophrenia and healthy normals. Additionally, no significant differences existed in BDNF levels between schizophrenia patients for the following variables: with/without a suicide attempt; antipsychotic drug use, family tendency and disease onset before and after 25 years old. However, patients with catatonic schizophrenia had lower serum BDNF protein levels than patients with paranoid or residual schizophrenia. These analytical results suggested that BDNF might play an important role in the clinical subtypes of schizophrenia, but it needed further investigation in future.

Lorazepam and diazepam rapidly relieve catatonic features in major depression

We have proved that a modified strategy (ie, lorazepam intramuscular injection [IMI] or diazepam intravenous drip [IVD] if lorazepam IMI fails) can rapidly relieve catatonic features in patients with schizophrenia. During a period of 3 years, we identified 7 major depressive patients with catatonic features in the emergency unit of a general hospital. The patients were treated with lorazepam IMI (dose, 2 mg/mL.per ampule) once or twice during the first 2 hours. If lorazepam IMI failed, diazepam IVD (dose, 10 mg/2 mL.per ampule) in 500 mL normal saline every 8 hours for 1 day would be administered. The total complete remission rate to lorazepam IMI within 2 hours was 6 (85.7%) per 7 patients, and the total complete remission rate to benzodiazepines (lorazepam IMI and diazepam IVD) within 1 day was 7 (100%) of all 7 patients. These results highly suggest that this modified strategy can also rapidly relieve catatonic features in major depression within 1 day and attain a high complete remission rate, even without electroconvulsive therapy.

Association of serum lipid profiles with depressive and anxiety disorders in menopausal women

BACKGROUND

Several studies have investigated the relationships of lipid levels with depressive and anxiety disorders, and their results revealed an association between low cholesterol and higher levels of depressive symptoms in young, middle-aged, and postpartum women. However, few studies have explored this relationship in menopausal women. Hence, in this study of menopausal Taiwanese women, we attempted to determine the correlation of depressive and anxiety disorders with serum lipid profiles.

METHODS

This was a cross-sectional study covering a 2-year period. Sixty-nine menopausal women who visited the gynecologic outpatient department of our hospital were enrolled. Psychiatric diagnoses were made using the semi-structured clinical interview for the Diagnostic and Statistical Manual (DSM-IV) criteria. Blood samples for serum lipid profiles were simultaneously collected. Data were analyzed using analysis of co-variance (ANCOVA) adjusted for age and body mass index (BMI).

RESULTS

Total cholesterol (TC) and low-density lipoprotein (LDL) were higher in postmenopausal women than in perimenopausal women, but this was not true for triglyceride (TG), high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), the TC/HDL ratio, or the LDL/HDL ratio. However, when peri- and postmenopausal women were categorized into normal controls and those having anxiety disorders and depressive disorders, no significant differences were found in lipid concentrations of TG, TC, HDL, VLDL, LDL, TC/HDL, or LDL/HDL among the 3 groups.

CONCLUSIONS

Although these results do not suggest that serum lipid profiles can be used as biological markers to distinguish depressive or anxiety disorders in menopausal women, larger samples are required to prove such results in the future.

Clozapine in schizophrenia patients with recurrent catatonia: report of two cases

Prolonged catatonia can be a source of extremely serious morbidity and mortality. Lorazepam is effective in rapidly relieving most cases of catatonia. Reports have also shown that second-generation antipsychotic drugs are also efficacious in relieving catatonia. This report describes two schizophrenia patients who demonstrated recurrent catatonic features mutism and stupor. Both patients were treated with lorazepam, diazepam or electroconvulsive therapy (ECT). Patient 1 responded well and rapidly to lorazepam each time catatonia happened; but catatonia recurred once a year under treatment with many antipsychotic drugs. Patient 2 had catatonia features associated with discontinuing or decreasing clozapine. With each recurrent episode, the duration of catatonia increased, requiring an increased dosage of benzodiazepine. The patient's response to lorazepam and ECT gradually decreased, until the patient had almost no response to lorazepam, diazepam or ECT. Both patients had no recurrence during a period of 2-year follow up with continuous clozapine therapy.

Serum lipid profiles and schizophrenia: effects of conventional or atypical antipsychotic drugs in Taiwan

This study investigated the relationships between serum lipid profiles and schizophrenia and the effects of conventional or atypical antipsychotic drugs on serum lipid profiles. During a 1-year period, fasting blood samples for serum lipid profiles were collected from 126 schizophrenic patients and 59 healthy control subjects. The serum lipid profiles were detected by enzymatic determination. Patients were assessed for disease severity at baseline and endpoint at 3 weeks using the Positive and Negative Syndrome Scale. At baseline, patients with acute-phase schizophrenia had lower high-density lipoprotein (HDL) levels, higher low-density lipoprotein (LDL) levels, and higher ratios of total cholesterol/high-density lipoprotein (TC/HDL) and LDL/HDL than healthy control subjects. At endpoint, after a 3-week treatment with antipsychotics, the blood samples of the 97 schizophrenic patients were assessed again. Responders to antipsychotic treatment (n = 68) but not nonresponders (n = 29) had significantly increased TC, triglyceride (TG), and very low-density lipoprotein (VLDL) levels and decreased ratio of LDL/HDL. Experimental findings also showed significantly increased TC, TG, HDL, and VLDL levels and decreased ratio of LDL/HDL in responders taking atypical antipsychotic drugs (n = 32), but not in patients treated with conventional antipsychotic drugs (n = 36). In conclusion, this study identified strong associations between dyslipidemia and acute-phase schizophrenia and dyslipidemia and responders taking atypical antipsychotics; both associations would increase the risk of developing diabetes and coronary heart disease.

Benefits of fatty fish on dementia risk are stronger for those withoutAPOEε4

OBJECTIVE

To compare associations of lean fish vs fatty fish (tuna or other fish) intake with dementia, Alzheimer disease (AD), and vascular dementia (VaD) and in relation to APOE epsilon4 status in the Cardiovascular Health Cognition Study (CHCS).

METHODS

Fish intake was assessed by food frequency questionnaires. Incident dementia, AD, and VaD were determined through a series of cognitive tests, physician's assessment, and committee consensus. We used Cox proportional hazards regression to calculate hazard ratios of dementia, AD, and VaD with lean fried fish, fatty fish, or total fish intake, which were then stratified by the presence of APOE epsilon4.

RESULTS

Although consumption of lean fried fish had no protective effect, consumption of fatty fish more than twice per week was associated with a reduction in risk of dementia by 28% (95% CI: 0.51 to 1.02), and AD by 41% (95% CI: 0.36 to 0.95) in comparison to those who ate fish less than once per month. Stratification by APOE epsilon4 showed this effect to be selective to those without the epsilon4 allele. Adjustment by education and income attenuated the effect.

CONCLUSION

In the Cardiovascular Health Cognition Study, consumption of fatty fish was associated with a reduced risk of dementia and Alzheimer disease for those without the APOE epsilon4 allele.