Abnormalities of fine motor control in schizophrenia

Response time and fine motor control during a classification task were examined in schizophrenics and nonschizophrenics. The task involved decisions about either the sensory characteristics of auditory and visual stimuli or the referential meanings of spoken words and viewed pictures. Nonschizophrenics responded more quickly and exhibited a smoother and faster motor response on all tasks. Response time and motor control were influenced by stimulus modality and the complexity of the classification task in both groups. In the analysis of motor control, the schizophrenics differed from the nonschizophrenics in exhibiting a pattern suggestive of a specific difficulty with decisions involving referential meaning. The observed motor control dysfunction in schizophrenics is a psychomotor deficit similar to previously reported abnormalities in smooth pursuit eye movement. Further, the interaction of group and task variables in the motor response suggests that decisions about the abstract referential meaning of words and pictures produce greater cognitive loads in schizophrenics than in nonschizophrenics.

Descriptive, biological, and theoretical aspects of borderline personality disorder

Although the diagnosis of borderline personality disorder has reasonable interrater and test-retest reliability, its discriminative validity is poor. The authors review studies indicating that the patient group subsumed by the borderline category actually includes those with various affective, organic, and schizotypal disorders. They speculate that borderline personality disorder represents a broad range of affective disorders resulting in part from childhood object loss, which may impair the reinforcement mechanisms necessary for the development of competent object relations.

Chronic stress and major depression

Six-month and lifetime rates of DSM-III major depressive disorder (MDD) and characteristics of the disorder were compared in mothers of children with disabilities (chronic stress sample, n = 310) and in a geographically based probability sample (controls, n = 357). The presence of DSM-III MDD was ascertained by the National Institute of Mental Health Diagnostic Interview Schedule. Although mothers in the chronic stress sample had significantly more depressive symptoms, rates of MDD were not significantly different in the two samples. The women with MDD in the chronic stress sample reported a lower age of onset and more episodes in lifetime than diagnostically comparable controls, but the two samples did not differ in symptomatology of worst episode. The data do not support an etiologic role for chronic stress in MDD, nor do they support the hypothesis that chronic stress is associated with a unique symptom profile or more severe episodes. They suggest a role for chronic stress in precipitating episodes, although the evidence on this point must be interpreted with caution.

An improved enzymatic synthesis of labeled gibberellin A12-aldehyde and gibberellin A12

The biochemical synthesis of labeled gibberellin A12-7-aldehyde (GA12ald) and and gibberellin A12 (GA12) from labeled R,S-mevalonic acid (MVA) using cell-free extracts from pumpkin (Cucurbita maxima) endosperm has been improved over the previously reported procedure. Three major improvements were developing a one-step HPLC procedure to isolate GA12ald and GA12 in radiochemically pure form; adjusting the pH of the reaction mix to pH 6.9 which increased the GA12ald/GA12 ratio over that at pH 7.8 by ca. 18-fold while reducing the combined yield of these two compounds by less than 17%; and developing a technique that permitted sampling of the fruits without interrupting growth; this doubled the fraction of extracts with "high activity." Conversion of MVA into GA12ald or GA12 displayed Michaelis-Menten kinetics with half-maximal synthesis at 0.4 mM MVA. Four-hour incubations afforded the highest yields from 0.25 mM MVA. Up to 15 and 7% of the MVA was incorporated into GA12ald and GA12, respectively. About one-quarter of the extracts incorporated at least 10% of the 0.25 mM MVA into GA12ald. One pumpkin fruit can provide sufficient endosperm to synthesize ca. 0.6 mumol of GA12ald.

Refining DSM-III criteria in Major Depression. An assessment of the descriptive validity of criterion symptoms

In this study we estimate the power of DSM-III Major Depression (MDD) symptoms to discriminate MDD from (1) Generalized Anxiety Disorder (GAD) and (2) no disorder. The NIMH-DIS was administered to 319 women exposed to chronic stress (all were mothers of disabled children). Two methods were used: (1) conditional probabilities, and (2) multiple regression analysis. Symptoms had greater utility in discriminating MDD from no disorder than from GAD. 'Gained weight' and 'thinking about death' had the least efficacy in either discrimination. 'Hypersomnia' and 'insomnia' contributed to the discrimination from no disorder, whereas 'fatigue' and 'sex disinterest' discriminated MDD from GAD. 'Guilt', 'trouble concentrating', 'lost appetite' and 'wanted to die' were important in both comparisons. Despite recent emphasis on observable behaviors and physiologic measures, guilt, a subjectively experienced inner state, was the most important symptom in MDD.

Combat-related flashbacks in posttraumatic stress disorder: phenomenology and similarity to panic attacks

Combat veterans (N = 25) with posttraumatic stress disorder had flashbacks related to their combat stressors, which included major losses and exposure to danger. Certain affects, loud noises, fatigue, and personal stress tended to precipitate flashback episodes. Flashbacks began a year or more after exposure to combat in 50% of patients; 56% of patients experienced daily flashbacks. Flashback phenomenology met DSM-III criteria for panic attacks. The similarity of flashbacks to panic attacks suggests treatment trials with monoamine oxidase inhibitors or imipramine for these selected symptoms.

Measuring thought disorder with clinical rating scales in schizophrenic and nonschizophrenic patients

The distinction between disorders of thought structure and disorders of thought content in a diagnostically heterogeneous psychiatric population was empirically tested using factor analysis applied to the item scores on two common clinical rating scales, the Brief Psychiatric Rating Scale and Andreasen's Thought, Language, and Communication Scale. The factor structure supported the separation of disordered thinking into disorders of thought content and disorders of thought structure or communication. Additionally, our results indicate that both aspects of disordered thinking are present in schizophrenic and manic patients; neither is specifically characteristic of schizophrenia. Indeed, disordered thought structure appears to be more common or worse in the manic patient than in the schizophrenic patient.

DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria

The diagnoses of generalized anxiety disorder (GAD) according to DSM-III and according to revised criteria (requiring 6 months' duration and 6 symptoms) were determined by the use of the National Institute of Mental Health Diagnostic Interview Schedule in a probability sample of 357 women. The DSM-III GAD lifetime rate of 45% was reduced by a factor of five when the revised definition was applied. The reduction was due chiefly to the longer duration criterion. Requiring a higher number of symptoms did not raise the threshold for the diagnosis, since 74% of persons with a period of 1 month or more of generalized anxiety reported six symptoms. Although chronicity was associated with more pervasive symptomatology, the excess in symptoms appears to be due to the very high prevalence of major depression (73%) among the newly defined (i.e., chronic) GAD positives.

The nosologic status of borderline personality: clinical and polysomnographic study

The REM latencies of 24 nonschizotypal borderline outpatients--who were not in the midst of a major depressive episode--were in the range of those of 30 patients with primary major depression but were significantly shorter than those of 16 patients with nonborderline personality disorders and 14 nonpsychiatric controls. Also, more of the borderline subjects had lifetime diagnoses of affective disorder, such as dysthymic, cyclothymic, and bipolar II disorder, and of a spectrum of anxiety and somatization disorders. The authors conclude that contemporary operational criteria for borderline disorder identify a wide net of temperamental disorders with strong affective coloring rather than a unitary nosologic entity.

Borderline: an adjective in search of a noun

Outpatients diagnosed as borderline (N = 100) were prospectively followed for 6-36 months and examined from phenomenologic developmental, and family history perspectives. At index evaluation, 66 met criteria for recurrent depressive, dysthymic, cyclothymic, or bipolar II disorders, and 16 for those of schizotypal personality. Other subgroups included sociopathic, somatization, panic-agoraphobic, attention deficit, epileptic, and identify disorders. Compared with nonborderline personality controls, borderlines had a significantly elevated risk for major affective but not for schizophrenic breakdowns during follow-up. Prominent substance abuse history, tempestuous biographies, and unstable early home environment were common to all diagnostic subgroups. In family history, borderlines were most like bipolar controls, and differed significantly from schizophrenic, unipolar, and personality controls. It is concluded that, despite considerable overlap with subaffective disorders, the current adjectival use of this rubric does not identify a specific psychopathologic syndrome.

Case report of neuroleptic malignant syndrome associated with withdrawal from amantadine

Withdrawal of dopamine agonists may precipitate or exacerbate neuroleptic malignant syndrome. This case report of neuroleptic malignant syndrome following withdrawal of neuroleptics and amantadine suggests that dopamine agonists should not be discontinued in hyperpyrexic patients at risk for this syndrome.

Endorphins and pain

Endorphinergic neurons certainly play a role in the brain's processing of painful stimuli. Endorphins act to alter pain appreciation at many levels within the central nervous system including spinal cord, midbrain, thalamus, and cortex. The activity of this pain-suppressing system may play a role in individual differences in the experience of pain. Endorphinergic mechanisms play a major role in analgesia associated with stress and acupuncture, and perhaps mediate placebo-induced analgesia. Chronic pain influences endorphinergic function perhaps depleting endorphinergic neurons of their neurotransmitters. Endorphin function and pain sensibility are prominently affected in affective illness and schizophrenia. It may be that endorphinergic neurons play a fundamental role in selective attention--a kind of sensory filtering of information flow--in somatosensory and other sensory modalities.

Pain enhances naloxone-induced hyperalgesia in humans as assessed by somatosensory evoked potentials

The effect of 8 mg IV naloxone on pain appreciation was studied with electric shocks administered to the left forearm of 20 normal volunteers. Pain sensitivity was assessed with a psychophysical task and with evoked potentials (EP) to the pain stimuli which were found sensitive to opiate agonists and antagonists in previous experiments. Naloxone-induced hyperalgesia before and after 20 min of intermittent shock was assessed in a 3-day placebo crossover experiment designed to provide control comparisons of time effects. EP amplitude enhancement with naloxone was significantly greater following 20 min of shocks than preceding them, while pain judgments were not significantly affected. Thus, naloxone increases pain sensitivity, especially after prolonged pain stimulation. This finding is consistent with endorphin mediation of stress-induced analgesia and raises the question of whether this type of response decrement over time is related to the phenomena of habituation.

Naloxone in chronic schizophrenic patients: neuroendocrine and behavioral effects

Naloxone produced improvement in abnormal thought content in medicated chronic schizophrenic patients, but not in drug-free patients. In contrast, drowsiness and increases in plasma prolactin concentrations were seen only in drug-free schizophrenic patients. Although growth hormone concentrations increased in drug-free and medicated schizophrenic patients, the time course was different in the two groups. Neuroleptics appear to alter naloxone's clinical and neuroendocrine effects in chronic schizophrenic patients.

Behavioral and biological effects of acute beta-endorphin injection in schizophrenic and depressed patients

In this double-blind study, beta-endorphin, 4-15 mg, was administered intravenously to 6 schizophrenic and 4 depressed patients. There were neither significant differences in behavioral ratings between beta-endorphin and placebo for the overall group nor for either the schizophrenic or depressed subgroup. Clinical worsening and improvement were observed in individual schizophrenic patients. There was no evidence of late-appearing therapeutic effects in 4 schizophrenic patients rated for 5 consecutive days after placebo and drug infusions. In 1 patient 10 mg of beta-endorphin produced neuroendocrine effects comparable to those produced by 5 mg of intravenously administered methadone; in 2 other patients it produced large increases in circulating opioid activity as determined by radioreceptor assay. These biological data support the notion that parenterally administered beta-endorphin exerts significant opiate-like activity in vivo.

Naloxone effects on beta-endorphin, cortisol, prolactin, growth hormone, HVA and MHPG in plasma of normal volunteers

8 mg of naloxone were administered IV to 14 normal volunteers in a placebo-controlled, double-blind experiment. Plasma levels of beta-endorphin, cortisol, prolactin, growth hormone, HVA and MHPG were determined before and 45 min after administration. Naloxone elicited significant increases in cortisol and MHPG but did not change plasma levels of the other compounds. In an additional experiment on two subjects, 20 mg of naloxone caused elevations of beta-endorphin as well as of cortisol. This parallel increase indicates that the linkage between the secretion of beta-endorphin and ACTH/cortisol may be dose-dependent. The increase in MHPG is in agreement with the hypothesized association of noradrenergic hyperactivity and opiate withdrawal.