Alcoholics' deficits in the decoding of emotional facial expression

The present study investigated emotional facial expression decoding in alcoholics. Twenty-five alcoholic patients at the end of the detoxification process were compared with 25 volunteers matched for age, sex, and education. They were presented with facial expressions of neutral, mild, moderate, or strong emotional intensity. Results indicate that alcoholics overestimate the intensity of emotional expressions and make more errors in their decoding with a special bias for anger and contempt. Moreover, this decoding deficit is not perceived by the alcoholic patients. A general model is proposed that links visuospatial deficits, abnormal processing of social information, interpersonal stress, and alcohol abuse.

Does sleep EEG data distinguish between UP, BPI or BPII major depressions? An age and gender controlled study

Clinical characteristics and sleep EEG data of 14 unipolar (UPR), 14 bipolar I (BPI) and 14 bipolar II (BPII) patients, matched for age and gender, were investigated during a major depressive episode. We observed a remarkable similarity in the clinical characteristics of the three samples and, concerning sleep EEG data, a trend to a higher percentage of awakening among BPI patients. Pairwise comparisons of the three subgroups showed that only the Newcastle rating scale score reached significant difference between BPI and UPR groups. We observed trends regarding the difference of awakening both between BPI and BPII groups and between BPI and UPR groups, difference of percentage of REM sleep between BPI and BPII groups and difference of Sleep Period Time between BPII and UPR groups. We also observed that the distribution of REM latencies in the BPI subgroup was different from the two others.

Alcoholism and emotional reactivity: more heterogeneous film-induced emotional response in newly detoxified alcoholics compared to controls--a preliminary study

Alcoholics are thought to be characterized by irregular emotional responses, having trouble reaching an optimal level of emotional arousal. They therefore may use alcohol to restore emotional homeostasis. This study investigated whether recently detoxified alcoholics show different emotional responses as compared to controls. Film excerpts were used to induce emotions in 14 newly detoxified alcoholics (9 men, 5 women) and matched controls in a standardized laboratory setting. Subjective emotional (questionnaires) and physiological measures were employed. Depression and cognitive deterioration were controlled. Based on subjective ratings, alcoholics displayed greater variability of emotion; they displayed also fewer or no physiological arousal changes. Subjective emotional responses were exceedingly high or low. These differences were not accounted for by depression or cognitive deterioration. We hypothesize that alcohol could be used to restore an optimal level of emotional arousal. This homeostatic function of alcohol is yet to be clearly assessed.

Divergent responses to fluoxetine from two compulsive, food-related conditions: bulimia nervosa and compulsive water drinking

BACKGROUND

The association of compulsive water drinking with bulimia nervosa is rarely encountered. Nevertheless similar behavior patterns could involve a common pathophysiological mechanism.

METHODS

A case report with the association of those two disorders is described. Treatment with fluoxetine was introduced to alleviate the compulsive aspects of those disorders.

RESULTS

Fluoxetine had a positive effect on bulimia nervosa but none on compulsive water drinking.

CONCLUSIONS

The different response to pharmacologic treatment could mean that bulimia nervosa and compulsive water drinking are based on different physiological mechanisms.

Efficacy and safety of acamprosate in the treatment of detoxified alcohol-dependent patients. A 90-day placebo-controlled dose-finding study

BACKGROUND

Acamprosate is a newly registered drug that appears to reduce alcohol-drinking in both animal models and clinical conditions.

METHOD

In order to assess the efficacy and safety of the drug in the treatment of detoxified alcoholics, we performed a 90-day double-blind trial comparing two dosages of acamprosate (1332 mg/day and 1998 mg/day).

RESULTS

For all efficacy parameters, acamprosate appeared to be significantly superior to placebo, with a trend towards a better effect at the higher dosage. Furthermore, acamprosate appeared to be extremely safe.

CONCLUSION

This study confirms that acamprosate could be an interesting adjuvant for maintaining abstinence in detoxified alcoholics.

Sleep in detoxified alcoholics: impairment of most standard sleep parameters and increased risk for sleep apnea, but not for myoclonias--a controlled study

OBJECTIVE

To assess recently alcohol-abstinent chronic alcoholic patients for selected parameters indicative of sleep quality.

METHOD

Patients (n = 24, 14 male), abstinent 3-6 weeks, and healthy controls (n = 20) were admitted to a clinical sleep unit. Measurements included sleep respiratory events and periodic limb movements, using strict methodology.

RESULTS

Clear signs of sleep deterioration and a high prevalence of apneic/hypopneic episodes were observed. Apneas were found at the same frequency for men and women; this has not been described before. No periodic limb movement was found.

CONCLUSIONS

Considering the high degree of morbidity and mortality observed in sleep apneic syndrome, systematic screening for sleep apneas is recommended for alcoholics seeking help.

[Rational use of antidepressants in general medicine]

Depression is a common cause of morbidity and is frequently recurrent. Therefore, treatment must be oriented more and more to the prevention of relapses in addition to the cure of depressive episodes. Long-term administration of antidepressant drugs becomes thus the rule and, as a consequence, general practitioners are increasingly concerned by the prescription of such medications. The choice of an antidepressant is mostly oriented by the side-effects profile of the pharmacological class of the compound. Fortunately, more recent drugs like SSRIs (selective serotonin reuptake inhibitors) and reversible MAOIs (monoamine inhibitors) have a very higher security index than tricyclics and classical MAOIs.

Fluparoxan in male erectile disorder: a case report

During a protocol study for the efficacy of fluparoxan (a noradrenergic α(2)-antagonist) in depression, a positive effect on male erectile impotence has been observed in one case, with no important secondary effects. This result confirms the involvement of α(2)-antagonists in the handling of male impotence. The action on the erectile disorder appeared slightly before the antidepressive effect (2-3 weeks) and lasted for 6 weeks after the discontinuation of treatment, suggesting that the effects on impotence were not a mere reflection of the antidepressive action.

[Pharmacological approach to the treatment of drinking problems]

Many pharmacological agents have been proposed for the treatment of drinking problems. However, there are many pitfalls in the assessment of the clinical interest of those drugs. In this paper, we propose a new classification of drugs of interest for treating alcohol abuse and related problems. We also review the major clinical studies about those pharmacological agents and discuss some peculiar aspects of those trials think to be important to develop better strategies for the evaluation of pharmacotherapy of alcoholism.

[Cognitive-behavioral approach to alcoholism: preliminary report of the realization of a therapeutic group]

The heterogeneity of alcoholic patients has lead alcohologists to find specific treatments for them. The cognitive-behavioural approach enables recognition of the cognitive and communicational distortions disclosed by these patients. This approach attempts to correct these distortions by training social skills. In accordance with this orientation, we have organised a therapeutic group for alcoholic patients. We have estimated how much patients appreciate this approach and how they expect it to change their drinking behaviour. Thirty-five alcohol-dependent patients have agreed to take part in three groups during their stay in hospital for detoxification. Each session deals with one of the following themes: "reproach & refusal", "request & emotions" and "relapse". The rating is assessed through a self-administered questionnaire. The appreciation of the method is very good for all measured parameters, and 76% of the patients consider it can help them.

[Fetal alcohol syndrome]

Ethanol teratogenicity manifests itself in the form of the foetal alcohol syndrome (FAS). This syndrome is characterised by growth delay, impairment of the central nervous system, and various facial dysmorphisms. We report the case of a 19 month-old boy affected by FAS. In addition to the three common features of FAS, this patient disclosed organic (digestive and cardiac) malformations and cellular chemotaxis deficiency. We have reviewed the literature to provide an update on the clinical signs of FAS. The abnormalities provoked by foetal exposure to ethanol can be very varied, none of them being specific.

[Fetal alcoholism syndrome: apropos of a case]

Fetal alcoholic syndrome (F.A.S.) is a well-recognized entity for over 20 years; it associates mental retardation, delayed growth and anomalies of the cranium in children born from alcoholic mothers. The syndrome has been described primarily in young children. By contrast, its evolution is not well known. We report the case of a 15-year old youngster, who exhibited the characteristic features of F.A.S. We also review the data related to the clinical and pathophysiologic aspects of the syndrome.

Yohimbine can induce ethanol tolerance in an in vitro preparation of rat locus coeruleus

Noradrenergic neurons have been implicated in the development of ethanol dependence and tolerance. Moreover, the development of an hyposensitivity of alpha 2 adrenoceptors has been postulated during long-term exposition to ethanol. In order to test the putative role of alpha 2 receptors in ethanol intoxication, we have studied the interaction between ethanol and yohimbine, an alpha 2 antagonist, on the spontaneous firing rate of rat locus coeruleus (LC) in an in vitro slice model. The spikes from single neurons were recorded by glass microelectrodes. Ethanol at 100 mM, a concentration that parallels the behavioral effects in the human and in the animals, inhibits the firing activity of some LC cells. This inhibition was quickly reversed after stopping the ethanol perfusion and was observed for each further administration. However, if yohimbine (20 microM) was simultaneously perfused, the ethanol-induced inhibition was rapidly antagonized. This effect is reversible after long time washout of yohimbine. This suggests that alpha 2 adrenoceptors could be implicated in the inhibitory effect of ethanol on LC noradrenergic neurons and perhaps in the development of tolerance. However, other hypotheses are discussed, because yohimbine can also antagonize other types of receptors.

Acute amphetamine-induced subsensitivity of A10 dopamine autoreceptors in vitro

Extracellular recordings were obtained from spontaneously active, presumed dopamine (DA) neurons of the ventral tegmental area (VTA) of the rat in a slice preparation. Bath-applied (+)-amphetamine (AMPH) (1-30 microM) induced a concentration-dependent decrease in the firing rate of these neurons, which tended to saturate with the highest concentrations used (n = 11). This inhibitory effect was dependent on the activation of D2 receptors since it was reversed by the D2 antagonist sulpiride (n = 8). However, the most striking effect of AMPH was the induction of a prominent subsensitivity of DA autoreceptors: whereas in 18 out of 20 control neurons, the D2 agonist BHT 920 (100 nM) produced a rapid and complete inhibition of the firing, this was observed in none out of 11 neurons 10 min after the end of the application of AMPH (1-30 microM) (P less than 0.001). In these cells, the mean percent inhibition produced by BHT 920 was only 47 +/- 8%. This subsensitivity remained unchanged after 20 min and declined after one hour. This effect was specific, since the sensitivity of GABAB receptors to baclofen (500 nM-1 microM) was not modified by the application of AMPH (n = 12). These results suggest that AMPH-induced DA autoreceptor subsensitivity can be produced acutely and may be the first step in a cascade of events leading to behavioral sensitization to this compound.

[Alarming chest pains in the young adult. Apropos of a case]

Presentation of an observation of alarming thoracic pain, during a panic attack. Actualization of this psycho-somatic pathology concerning the epidemiologic, etiopathogenic and therapeutic aspects as well as its cardiovascular repercussion.

[Organic morbidity of a hospitalized psychiatric population]

In order to determine organic morbidity in psychiatry, 140 psychiatric inpatients (aged between 20 and 49) were examined. After various investigations (physical, biological, chest film, EEG, ECG), it was concluded that 52% of the patients suffer from at least one physical disease, and 23% suffer from more than one. The most frequent diseases are digestive (hepatic), respiratory and cardiovascular. The relationship between opiate addiction and stomatological, urogenital and dermatological diseases, and between alcoholism and liver diseases seems clear. It would appear that a medical approach adapted to psychiatric patients is necessary in order better to diagnose these physical diseases, and to reduce psychiatric overmorbidity, which might lead to a decrease in psychiatric excess mortality.

Electrophysiological effects of ethanol on monoaminergic neurons: an in vivo and in vitro study

Monoaminergic neurons have been shown to play a role in both the intoxicating and chronic effects of ethanol. We present here the results of a study about the acute effects of ethanol on serotonergic raphe nucleus, noradrenergic locus coeruleus, and dopaminergic ventral tegmental area. These nuclei were investigated electrophysiologically by recording the spontaneous firing rate of single neurons using glass microelectrodes, both in vivo in chloral hydrate anesthetized rats and in vitro in brain slices. Ethanol was perfused intravenously at a rate ranging from 0.2 mg/kg/min to 0.2 g/kg/min in vivo, and at concentrations between 10(-8) M and 1 M in vitro. We observed that each monoaminergic nucleus had its own pattern of responses to acute ethanol perfusion, and that high and low concentrations have different actions, suggesting a biphasic effect. For example, in slices, ethanol concentrations higher than 10 mM induce an excitation in most raphe and ventral tegmental area neurons, and an inhibition of firing in locus coeruleus neurons. The results were comparable in the in vivo model, but much more heterogenous. We conclude that the effect of ethanol on the monoaminergic neurons is specific of the type of neuron, and that a biphasic effect is commonly found.

Evidence for the presence of N-methyl-D-aspartate receptors in the ventral tegmental area of the rat: an electrophysiological in vitro study

Extracellular recordings were obtained from spontaneously active, presumed dopaminergic neurons of the ventral tegmental area (VTA) of the rat in a slice preparation. Bath-applied N-methyl-D-aspartate (NMDA) (1-20 microM) activated all neurons tested (n = 36). This effect was clearly concentration-dependent (n = 14), quickly reversible and reproducible. No bursting type of discharge was observed during NMDA infusion. The NMDA receptor blocker DL-2-amino-5-phosphonovaleric acid (50 microM) reversibly antagonized the increase in cell firing produced with 10 microM NMDA by 83.5 +/- 3% (mean +/- S.E.M.) (n = 8, P less than 0.05). Lowering the Mg2+ concentration of the perfusion fluid to one-third of its normal value significantly enhanced the excitatory effect of 5 microM NMDA (n = 7, P less than 0.05), but not of 500 nM carbachol (n = 6). Finally, NMDA did not modify the sensitivity of dopaminergic autoreceptors of VTA neurons (n = 8), when compared to controls (n = 10). These observations strongly support the presence of specific NMDA receptors in the VTA.

Galanin decreases the activity of locus coeruleus neurons in vitro

A brain slice preparation was used to examine the effects of galanin on the spontaneous firing rate of locus coeruleus noradrenergic neurons. Galanin (10(-9)-10(-7) M), added to the bath, inhibited the firing of 14 out of 19 neurons in a concentration-dependent manner. The observed effect was quite variable, ranging from 20 to 100% at 10(-7) M. Experiments performed in low-Ca2+, high-Mg2+ medium also showed a significant inhibition by galanin (10(-7) M) in three out of five neurons, which suggests that the peptide acts directly.

Somatosensory conduction in vitamin B12 deficiency

We tested the hypothesis that the somatosensory central conduction time (CCT) can reveal central nervous system involvement in vitamin B12-deficient patients when this cannot be established on clinical grounds alone. Three patients with pernicious anemia and without clinical signs of upper motor neuron lesion had a striking increase of CCT. This increase was shown to be reversible in 1 patient who improved over 3 years of treatment. Detailed analysis of the CCT showed that the decrease of conduction velocity occurred in the posterior columns, whereas the conduction was normal at the thalamo-cortical level. We conclude that CCT is a useful parameter to localize and quantify central nervous system disease in vitamin B12 deficiency.

Processing of proenkephalin is tissue-specific

Most neuropeptides are synthesized as large precursor proteins. These precursors undergo a maturation process involving several proteolytic events that generate the biologically active peptides. The enzymatic mechanisms underlying this processing are still largely unknown. The processing of the precursor protein proenkephalin was studied in two different bovine tissues, the hypothalamus and adrenal medulla. The high molecular weight enkephalin-containing peptides that accumulate in these two tissues were found to be different, indicating the existence of two processing pathways for this neuropeptide precursor.

The enkephalinergic neuron: implications of a polyenkephalin precursor

The study of the biochemical and physiological functions of the enkephalinergic cell has greatly extended our understanding of peptidergic cells in general. In the adrenal gland, the major part of the proenkephalin-derived peptides is present as intermediates in the processing of the precursor. These peptides are contained within the adrenergic chromaffin granules, from which they are released in response to stimulation of the cell. The nature of the products released depends on the nature of the stimulus, but it appears that mature granules containing completely processed peptides are preferentially released under physiological conditions. In the brain, the presence and release of the heptapeptide that comprises the carboxyl terminus of adrenal proenkephalin suggest that similar mechanisms are operating centrally. The identity of brain and adrenal proenkephalin is further supported by the purification from brain of a large fragment of the proenkephalin molecule, synenkephalin , and the occurrence in brain of this and the other proenkephalin-derived peptides in a molar ratio close to that found in the sequence of the adrenal precursor. The processing of proenkephalin in brain appears to follow the classical models first proposed for peptide hormones (Steiner et al. 1980), which may thus be generalized to include peptide neurotransmitters/neuroregulators. In addition, the results presented in this paper indicate that enkephalins may be cotransmitters in at least two diverse systems. Enkephalins and catecholamines are colocalized in the adrenergic granules of the adrenal gland. In the brain, enkephalins and oxytocin are colocalized in the magnocellular neurons of the hypothalamo-neurohypophyseal oxytocinergic pathway. In both of these systems, the enkephalins are present in a molar concentration that is less than 1% of the concentration of the principal messenger. Such colocalization , coupled with the numerous active peptides that may arise from proenkephalin, suggests many elegant but complex schemes of neurotransmitter interactions. For example, release of enkephalins in the neurohypophysis may regulate oxytocin release through an action on autoreceptors of the oxytocinergic terminal. In the adrenal the coreleased enkephalins may act by regulating presynaptically the cholinergic output of the splanchnic nerve. However, further studies are needed to define clearly the physiological roles of such cotransmission . From the abundance of proenkephalin-derived peptides in the basal ganglia, it appears that enkephalins may represent the principal transmitter in some central neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

HLA antigens in affective disorders and schizophrenia

The distribution of HLA antigen frequencies has been studied in patients with affective disorders. There were no significant differences between bipolar patients, unipolar patients, or controls. Preliminary data on HLA antigen distribution in schizophrenic patients are reported. Our negative results in affective disorders are discussed in relation to HLA studies reported from other laboratories, with special reference to some potential methodological problems.

Cholecystokinins in the central nervous system and neurohypophysis

Research on digestive peptides in brain started in 1975 with the discovery of peptides of the gastrin-cholecystokinin family in the brain of various vertebrates. Cholecystokinin octapeptide is largely distributed in the brain and neurohypophysis and its mapping has recently been reported by various authors. An up to data table summarizing CCK mapping is included. Cholecystokinin coexists with dopamine in some mesencephalic neurones and with oxytocin in some hypothalamic neurones. CCK immunoreactive fibers have been detected in the anterior commissura and in the corpus callosum especially after its surgical sectioning. CCK immunoreactive cell bodies are present in the nucleus septum lateralis, the nucleus of the bed of the stria terminalis and the nucleus preopticus medialis especially after direct colchicine injection into the cerebral hemispheres. Cholecystokinin is of importance in structures related to various physiological functions such as motricity, sensory mechanisms, endocrine and limbic systems. Consequently it should be interesting to study cholecystokinins in neurological disorders and in psychiatric conditions.

Lithium accumulation in erythrocytes of manic-depressive patients: an in vivo twin study

Genetic factors play an important role in drug metabolism and drug response. In order to investigate genetic variables in lithium prophylaxis and lithium distribution across the erythrocyte in manic-depression, we have examined forty-two pairs of twins monozygotic (n = 25) and dizygotic (n = 17) with manic-depression. Concordant twins as a group show better lithium prophylaxis than do discordant twins. These results are consistent with previously published family studies of affective illness suggesting a positive relationship between genetic background and success of lithium prophylaxis. Lithium distribution across the red blood cell (RBC) was assessed by estimating lithium RBC/plasma ratios. The lithium ratio's intrapair differences in both groups of twins were minimal with a high heritability index suggesting that genetic factors play a role in lithium ion distribution. A high linear correlation was found between lithium ratio and plasma lithium and there was no difference in lithium ratios according to sex, affective state and response to lithium. The distribution of lithium ratios was homogenous in the lithium responders' population but this was not the case in the non-responders, suggesting biological heterogeneity of lithium distribution in lithium failures. The implications of these results are discussed as they relate to the genetic determinates of lithium prophylaxis in manic-depressive illness. These results indicate that lithium ratios are of limited value in lithium maintenance therapy. Our lithium kinetic data, however, are consistent with the concept of a lithium extrusion mechanism from red blood cells.