Prognostic factors determining response to antidepressant drugs in psychiatric out-patients and general practice

The outcome of antidepressant drug treatment was measured in 200 patients, 145 seen in psychiatric out-patient clinics and 55 in general practice, after 4 weeks of therapy. The results of the 200 patients taken together suggested that prognosis was largely determined by factors dependent on the natural history of the disorder and that clinical symptoms were unimportant, but when the results for patients in each drug group were analysed separately symptoms were more important than natural history factors. We conclude that clinical symptoms are only important predictors of response to antidepressant drugs when the patients studied are homogeneous with regard to natural history factors, particularly duration of illness.

An extrapyramidal syndrome after lithium therapy

Two patients developed an extrapyramidal syndrome after therapy with lithium carbonate. Although the clinical features of this syndrome were indistinguishable from those of drug-induced parkinsonism, it was made worse by the anti-parkinsonian drug, orphenadrine. These findings were reproduced later under laboratory conditions when extrapyramidal symptoms and physiological tremor were recorded before and after challenge doses of orphenadrine. This unwanted effect of lithium carbonate may be explained by selective blockade of dopamine receptors.

Awareness of cardiac function in anxious, phobic and hypochondriacal patients

Awareness of pulse rate was tested in 60 psychiatric out-patients with anxiety, phobic or hypochondriacal neuroses by asking them to record how fast their hearts were beating during exposure to short film sequences. Correlations between subjective and objective heart rate (ECG) were significantly higher in anxious and hypochondriacal patients than in phobic ones. The results suggest that somatic symptoms in hypochondriacal and anxiety neurosis reflect increased awareness of bodily function.

Responses of chronic agoraphobics to subliminal and supraliminal phobic motion pictures

Fifteen agoraphobics took part in a study to investigate their responses to repeated presentations of a phobic motion pciture. Five patients were shown the film supraliminally, five were shown it subliminally, and the remaining five formed a control group. Subjective feelings were assessed with visual analogue scales, and three physiological measures, heart rate, skin conductance, and respiratory rate, were recorded. An earlier report showed that both subliminal and supraliminal presentation produced significant improvements in phobic fear and avoidance, and the present results show that the subliminal group found the procedure much less stressful than the supraliminal group. The physiological changes during treatment showed no consistent pattern and appeared to be independent of clinical response. The results show that repeated exposure to subliminal phobic motion pictures is not anxiety provoking to agoraphobic patients and so may be appropriate therapy for those unable to tolerate other forms of treatment.

Finger tremor and extrapyramidal side effects of neuroleptic drugs

Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequently was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.

Inhibition of elastolysis by proteinase inhibitors from chick plasma and aorta

Chick plasma contains inhibitor(s) against trypsin and elastase which also appear to retard the degradation of tropoelastin by arterial tissue extracts. Chick aorta extracts also contain similar inhibitors against elastase and trypsin. Both levels of the plasma inhibitor(s) and inhibitor(s) extracted from thoracic aorta increase during early stages of growth and maturation. There is a three- to four-fold increase in the levels of the inhibitor(s) in chick plasma and aorta between one to four weeks after hatching. Of particular interest are the observations that the presence of the inhibitor(s) retards the conversion of soluble elastin (tropoelastin) to smaller elastin peptides. Subsequently, it is speculated that in addition to other vital roles, such proteinase inhibitors may also act in regulating elastogenesis and elastin fiber formation.

Treatment of agoraphobia by subliminal and supraliminal exposure to phobic cine film

Three groups of 5 chronically agoraphobic patients were treated by repeated exposure to cine film at weekly intervals for six weeks. A supraliminal group saw an agoraphobic film specially made for the study illustrating a range of phobic situations. A subliminal group viewed the same film at a level of illumination below the threshold of awareness. A control group saw a blank screen with no filmed material for the same length of time. The films were screened five times at each treatment and were alternated with neutral film shown under normal viewing conditions. Ratings of phobic and other symptoms were made by a separate assessor who was unaware of the patient's treatment. The supraliminal and subliminal groups improved significantly more than the control group with regard to phobic fears, avoidance, and overall assessment.

Effects of subliminal and supraliminal stress on symptoms of anxiety

Two experiments were carried out with volunteer subjects to test whether the subliminal viewing of emotive material induced anxiety and its associated bodily symptoms. In one experiment 24 subjects looked at anxiety-inducing words presented singly through a tachistoscope under supraliminal or subliminal conditions, and in the other study 50 subjects looked at a neutral and an emotive movie film under similar conditions. Subliminality was insured in the first experiment by reducing the duration of exposure and in the second by reducing the level of illumination. The results showed that ratings of anxiety were significantly increased under subliminal emotive conditions, and reduced following subliminal neutral exposure. Correlations between psychic and somatic symptoms of anxiety were significantly higher under supraliminal conditions compared with subliminal ones. The possible role of subliminal stimulation in investigating the psychic and somatic components of anxiety is discussed.

Arterial elastin synthesis in the young chick

In the growing chick a marked stimulation in soluble and mature arterial elastin synthesis occurs 2 and 5 weeks after hatching. Measurement of [3H]valine and [3H]proline incorporation into arterial soluble protein during this period indicated that most of the label is found in a 70 000 dalton protein subunit. The labeled soluble subunit had the characteristics of native soluble elastin or tropoelastin. During the period in which the greatest percentage increase in mature elastin occurs, the highest specific activities of soluble [3H]valine-labeled protein were observed. These changes were striking and suggest a developmental period for the growing chick in which factors related to elastin metabolism may be more easily studied.

Treponemal antigen in immunopathogenesis of syphilitic glomerulonephritis

A patient with syphilitic glomerulonephritis had a renal biopsy and was treated for secondary syphilis. Light, electron, and immunofluorescence microscopic studies revealed an acute proliferative glomerulonephritis with subepithelial, intramembranous, and subendothelial immune complex deposits containing IgG, IgA, IgM, C4, and C3. Similar local deposits containing predominantly IgM were noted in areas of mesangial proliferation. Indirect fluorescent antibody studies employing rabbit treponemal antibody and sheep antirabbit globulin conjugate revealed the presence of treponemal antigen in the glomerular deposits. This finding provides strong evidence for the immunopathogenesis of the glomerular lesion as well as a causal link with Treponema pallidum.