The effect of pergolide and MDL 72974 on rat brain CuZn superoxide dismutase

It has previously been shown that both the dopamine receptor agonist, pergolide, and the monoamine oxidase inhibitor, (-)-deprenyl, can cause induction of CuZn superoxide dismutase in the rat striatum. We have now confirmed this effect of pergolide (0.04 mg/kg i.p.) as being localised to the striatum, but not the cerebellum, and shown it to take 3 weeks to develop. Furthermore, we have found that MDL 72974, a more specific monoamine oxidase inhibitor than (-)-deprenyl, failed to bring about such an induction either at a low selective monoamine oxidase B inhibitory dose, or at a higher non-selective dose.

Phenylpyruvic acid may be a direct precursor of mandelic acid without intermediate transamination of phenylalanine

A series of compounds related to phenylalanine was administered to rats. Output of mandelic acid, a major but unexplained metabolite in phenylketonuria, was increased after the administration of phenylethanolamine or phenylpyruvic acid, whereas phenylethylamine or phenylalanine increased its excretion only marginally. Phenylacetic acid, previously suggested as a possible precursor in man, was almost without effect. It seems likely that mandelic acid can be formed from phenylpyruvic acid directly, without intermediate transamination to phenylalanine.

The tyramine test is not a marker for postnatal depression: early postpartum euphoria may be

Abnormally low tyramine test values are known to be markers for vulnerability to unipolar, but not bipolar, endogenous depression. In the present study, 37 women with recent postnatal depression (25 major, 12 minor) and 22 puerperal controls with no depressive disorder, all assessed by Schedule for Affective Disorder and Schizophrenia (SADS-L) interview, together with 17 other controls, underwent the test. No significant differences in tyramine sulfate output were demonstrated between the different groups. Those subjects with endogenous features according to Newcastle score (n = 7) or Research Diagnostic Criteria (RDC) (n = 6) also had normal output. Thus, the tyramine test does not appear to be a useful marker for vulnerability to postnatal depression. Over half the subjects recalled that their postnatal depression had started in the first 2 weeks postpartum. Of the total of 62 postpartum subjects interviewed with the SADS-L, ten recalled a period of euphoria in the first postpartum week, which met RDC for hypomania and eight of them went on to become depressed postnatally. An additional patient from the total group was hospitalized with mania.

Critical components of obstetric management of chemically dependent women

Providing prenatal care to chemically dependent women presents multiple dilemmas and challenges to clinicians. It is a complex task and one that is incongruent with the usual perceptions of the obstetric experience. However, it must be viewed as an opportunity to bring these alienated women into the health care system. Pregnancy represents a period in most women's lives when they recognize the need for and are receptive to caring and responsive intervention. By optimizing the prenatal experience of chemically dependent women, maternal-fetal outcomes will be improved and the groundwork laid for the ongoing therapeutic services that are needed to maintain the health and well-being of the mother and child.

Migraine and depression: biological aspects

There is a considerable overlap in migraine and depression incidence, and both conditions may be associated with low levels of 5-hydroxytryptamine (5-HT). During a migraine attack there is evidence for low levels of platelet 5-HT and possibly also low Vmax for 5-HT uptake; both these findings are also associated with the depressed state. Both conditions can be treated by tricyclic and monoamine oxidase inhibiting antidepressants. However, there are also clear differences: migraine attacks are brief and self limiting. Part of the migraine cascade occurs outside the blood brain barrier, presumably involving blood vessels and, unlike depression, migraine attacks can be ameliorated by drugs which only act peripherally. In addition, migraine patients, especially males, often have permanently low levels of platelet monoamine oxidase activity, whereas patients with unipolar depression tend to have raised levels of this marker. This low enzyme activity may reflect part of the vulnerability to migraine, often associated in the prodromal phase with agitation or hyperactivity. Migraine may form part of a family of brief recurrent self-limiting disorders, which involve disturbances of both mood and monoamines; during the headache phase of the attack, the links with depression are most apparent.

Platelet monoamine oxidase B activity in Parkinson's disease: a re-evaluation

An increase in platelet monoamine oxidase (MAO) B activity in drug-free parkinsonians (n = 6) compared with healthy controls (n = 10) has been confirmed using both phenylethylamine (PEA) and dopamine as substrates, reaching statistical significance in the case of PEA oxidising activity (p < 0.05). Thus, certain reports of raised platelet MAO B activity towards PEA but decreased activity towards dopamine in parkinsonians, raising the possibility of the existence of an abnormal form of MAO B in this condition, cannot be supported.

Increase of brain endogenous monoamine oxidase inhibitory activity (tribulin) in experimental audiogenic seizures in rats: evidence for a monoamine oxidase A inhibiting component of tribulin

Brain tribulin activity in rats with an inherited predisposition to audiogenic epilepsy was studied after seizures of different intensity were induced by an electric bell. Weak seizures (from 0 to 2 arbitrary units) did not produce any changes in endogenous inhibitory activity towards either monoamine oxidase (MAO) A or B. Moderate seizures were characterized by increases in both MAO A and MAO B inhibitory activity (up to 1.9-fold). Complete tonic epileptiform seizures with total areflexia (4 arbitrary units) induced further augmentation (up to 2.5-fold) of MAO A but not of MAO B inhibitory activity. This dissociation between the two inhibitory activities points to the existence of a separate MAO A-inhibiting component of brain tribulin which is different from isatin.

Is the tyramine test for depressive illness useful in elderly patients?

There were no significant differences in tyramine sulphate excretion following tyramine ingestion between elderly depressed, demented or control patient groups, in contrast with younger subjects where this test is a trait marker for unipolar endogenous depression. There are inherent problems in urine collection studies in the elderly and the results may have been influenced by the medication that elderly patients have to take for other disorders. This study suggests that the tyramine test is unlikely to be of clinical usefulness in the over 65 age group.

Inhibitory potency of some isatin analogues on human monoamine oxidase A and B

Isatin is an endogenous compound which acts as a selective inhibitor of monoamine oxidase (MAO) B. In this study a range of isatin analogues were tested for their in vitro inhibition of human MAO A and B. Most of the analogues were less potent than isatin. Hydroxylation of the aromatic ring changed the inhibitory potency in favour of MAO A, with 5-hydroxyisatin being a potent and selective MAO A inhibitor (IC50 8 microM). Isatinic acid, which is formed reversibly from isatin at alkaline pH, showed no inhibition.

Links between early post-partum mood and post-natal depression

The Edinburgh Postnatal Depression Scale (EPDS) was used to rate 217 patients at five days and six weeks post-partum. There was a highly significant positive correlation between the two scores, together with similar symptom profiles. Of the 25 women who suffered post-natal depression (6-week EPDS score greater than or equal to 13), 17 had similar symptoms in the first week post-partum (5-day EPDS score greater than or equal to 10). Low birth weight of the baby, delivery by Caesarean section, a delivery much more difficult than expected, and bottle feeding were all significantly associated with a high EPDS score in the first week post-partum. Bottle feeding and delivery by Caesarean section were the only factors associated with depression at the sixth week. A recollection of low mood after a previous birth was also associated with post-natal depression after the current birth. This, together with an EPDS score of 13 or more at five days post-partum, increased the risk of post-natal depression at six weeks 85-fold.

Pergolide can induce soluble superoxide dismutase in rat striata

Pergolide, a dopamine receptor agonist, given daily i.p. for three weeks at 0.04 mg/kg and 0.4 mg/kg, significantly induced soluble (Cu-Zn) superoxide dismutase in the rat striatum, while having no effect on the mitochondrial (Mn) form of the enzyme. Such induction, which can also be effected by (-)-deprenyl, may help to protect against nigrostriatal degeneration.

Abnormal platelet 5-hydroxytryptamine uptake and imipramine binding in postnatal dysphoria

Platelet 14C-5-hydroxytryptamine (14C-5-HT) uptake, 3H-imipramine binding and monoamine oxidase (MAO) activity were measured in women 5 days postpartum and compared with depression scores (Edinburgh Postnatal Depression Scale) at that time and 6 weeks later. Mean Km of 14C-5-HT uptake was significantly reduced in the group showing dysphoria at 5 days (p less than 0.01). Mean Kd of 3H-imipramine binding was significantly increased in the group who later went on to become depressed at 6 weeks postpartum (p less than 0.03). Vmax for 14C-5-HT uptake, Bmax for 3H-imipramine binding and MAO activity did not differ between depressed and non-depressed patients on either occasion. Although the observed changes manifested in a system known to be disturbed in other forms of depression, they were in affinity rather than Bmax or Vmax. Even though probably not of direct physiological significance, such results, if confirmed, together with other pointers in the literature, suggest biochemical abnormalities specific to the puerperal period.

Training experience and views of recently appointed consultants in geriatric medicine

A postal survey of 71 recently appointed consultant geriatricians was undertaken in spring 1991. Several respondents were concerned about the adequacy of training in domiciliary visiting and continuing care, and about the time allocated for research and study. A high proportion felt they had been poorly prepared for the administrative and organisational components of their consultant post, and 75% of respondents advocated training in managerial skills for senior registrars. These findings are relevant to the planning of future training for senior registrars in geriatric medicine.

Amiodarone dosage in older patients with atrial fibrillation: an open, multi-centre study

An open, multi-centre study was carried out to assess the effectiveness and tolerability of amiodarone at a lower dose than routinely used in the clinical and symptomatic treatment of older patients with atrial fibrillation who were resistant to other therapy or in whom other therapy was either poorly tolerated or contraindicated. Suitable patients for dose adjustment were selected from a dosing survey population of those aged 60 years or over who were currently receiving amiodarone at a dosage of 200 mg or more daily. Periodic 100 mg dose reductions were made at 6-weekly intervals until there were signs of exacerbation or recurrence of the arrhythmia or until a daily dose of 100 mg was reached. Evaluation of the results from 167 patients showed that 156 (94%) were stabilized on a final dose of 100 mg daily and the remaining 11 (6%) on 200 mg daily. The majority of these patients were either in sinus rhythm or atrial fibrillation with a ventricular rate less than 100 beats per min. Twenty-one patients reported 22 adverse events. The majority of adverse events were not considered serious by the investigators, while approximately half were considered as 'probably unrelated' to amiodarone treatment. Six deaths were recorded during the treatment period but none was linked to amiodarone or 'probably related' to dose reduction.

Effect of aromatic amino acids, pentylenetetrazole and yohimbine on isatin and tribulin activity in rat brain

The effects of i.p. injection of 3 aromatic amino acids and two anxiogenic agents on rat brain isatin concentration and tribulin (endogenous monoamine oxidase inhibitor) activity were investigated. Isatin levels were significantly increased by pentylenetetrazole, confirming the link with 'anxiety', but were unaffected by the other compounds. In contrast, tribulin activity was significantly increased by phenylalanine and tryptophan as well as by both pentylenetetrazole and yohimbine. Whilst these findings shed no light on the mode of synthesis of isatin, they clearly demonstrate the existence of rat brain monoamine oxidase inhibitory activity that is different from it.

Senior registrar training in geriatric medicine 1977-1990

Higher medical training in geriatric medicine was assessed in 1977, 1983 and 1990 by a questionnaire distributed to members of the British Geriatrics Society Senior Registrar Group. Comparisons over this 14 year span show consistent concern about training programmes, particularly in relation to research, health service management and psychiatry of the elderly.

Anticholinergic antiparkinsonian drugs in psychiatry

In this article the treatment of drug-induced extrapyramidal disorders is briefly reviewed. Anticholinergic antiparkinsonian drugs are discussed with emphasis on the extent of their usage; the potential for abuse, causing confusion, and impairing cognition; and their effect on neuroleptic drug levels and on tardive dyskinesia. Practical guidance for their use is included.

Urinary but not brain isatin levels are reduced in germ-free rats

Germ-free rats excreted considerably smaller amounts of the monoamine oxidase-inhibiting compound isatin than the substantially larger output by conventional animals of the same strain, although concentrations in brain and other tissues were similar in the two groups. Thus, isatin is likely to be elaborated both endogenously in rat tissues and "exogenously" by flora inhabiting the lumen of the alimentary tract.

Kinetics of platelet 5-hydroxytryptamine uptake in headache patients

Platelet 5-hydroxytryptamine (5-HT) uptake was measured in asymptomatic headache patients attending a specialist migraine clinic, and in hospital staff who did not suffer from regular or severe headache. Current levels of anxiety and depression were assessed in all subjects using the Hospital Anxiety and Depression (HAD) scale and their possible influence on the uptake kinetics taken into account during the analysis of results. The Michaelis-Menten constant (Km) was significantly raised in common migraine and tension headache compared with controls (p less than 0.001 and p less than 0.01, respectively), but not in classical migraine or cluster headache. The increase remained significant after adjusting for differences in age, sex, presence of anxiety or depression (HAD sub-scale score greater than or equal to 8), drug intake during the week before testing, time elapsed since last attack and time of assay (am or pm). No differences were observed between patients and controls in the maximal rate of uptake (Vmax) or platelet count, and previous reports of a reduction in Vmax in patients experiencing attack within 5 days prior to testing could not be confirmed. The cause and significance of an increased Km are not clear, but plasma factors acting as competitive inhibitors for the uptake site or an alteration in the configuration of the uptake site are possible explanations. If confirmed, the shared biochemical abnormality may suggest that common migraine and tension headache have a common pathogenesis.

Chocolate is a migraine-provoking agent

Patients with migraine who believed that chocolate could provoke their attacks were challenged with either chocolate or a closely matching placebo. In a double-blind parallel group study, chocolate ingestion was followed by a typical migraine episode in 5 out of 12 patients, while none of the 8 patients challenged with placebo had an attack (p = 0.051). The median time to the onset of the attack was 22 h. This brief study provides some objective evidence that chocolate is able to provoke a migraine attack in certain patients who believe themselves sensitive to it.

Augmentation of rat brain endogenous monoamine oxidase inhibitory activity (tribulin) by electroconvulsive shock

The effects of acute and subacute supramaximal and submaximal electroshock-induced convulsions on rat brain tribulin activity were investigated. Both supramaximal and submaximal shocks induced a marked increase, as measured 30 min after the onset of convulsions, with a significantly greater effect from the former. The effects were no longer present 24 h after stimulus. Repeated electroshock for 5 and 10 days showed that submaximal stimuli produced little change, whereas supramaximal shock brought about a significant increase in tribulin activity, the effect being greater with 10-day exposure. The results are not inconsistent with the clinical observation that a single electroconvulsive therapy (ECT) shock has little clinical usefulness but that repeated shocks, spread over several days, result in therapeutic benefit due, perhaps, to an increase in brain concentrations of tribulin, an endogenous monoamine oxidase inhibitor.

(-)-Deprenyl can induce soluble superoxide dismutase in rat striata

(-)-Deprenyl (0.25 or 2 mg/kg) or saline was injected daily into male Wistar rats for 3 weeks. The striata were dissected out and soluble and particulate superoxide dismutase activity measured. (-)-Deprenyl at 2 mg/kg induced a significant increase in the soluble but not the particulate form of the enzyme. The possibility that this action contributes to the ability of (-)-deprenyl to retard nigral degeneration in man and prolong life in rats is discussed.