Investigations of cytokine production in whole blood cultures of paranoid and residual schizophrenic patients

In an attempt to define potential immunological dysfunctions in schizophrenia, we determined the production of interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma), and soluble IL-2 receptor (sIL-2R) in a whole-blood assay after stimulation with phytohemagglutinin (PHA) as well as the serum concentrations of sIL-2R. Because CD4+CD45RO+T cells are the main producers of IFN-gamma, we determined the percentage of these cells, as well as of panT, CD4+T, and CD8+T cells, by flow cytometry. A whole-blood count was performed in addition. Two groups of patients were examined, paranoid-type and residual-type schizophrenics. The numbers of both monocytes and neutrophils, but not of lymphocytes, were increased significantly in the schizophrenic sample. The IFN-gamma production of the schizophrenics as a whole group, and of the paranoid patients, was reduced significantly in comparison with the control group (p < or = 0.05). The residual patients produced less IFN-gamma than the controls, but more than the paranoid patients. The latter differences did not reach statistical significance. The production of IL-4, which physiologically antagonizes the production of IFN-gamma, was not significantly higher in the patient group. No changes in the lymphocyte subpopulations were observed. The production of IL-2 showed a trend toward reduction in paranoid patients, but not in residual schizophrenics. The serum sIL-2R levels were elevated slightly in schizophrenics when compared with controls. In order to rule out a possible effect of cortisol on cytokine production, 20 schizophrenics were compared with 20 age- and gender-matched controls. However, neither elevated cortisol levels were detected in the schizophrenic sample, nor significant intercorrelations between cortisol levels and cytokine production, or levels of sIL-2R, respectively. In summary, our data reinforce the possibility of immune dysfunction in schizophrenia and point to the possible relevance of disease subgroups in this respect.

Positron emission tomography and plasma biochemistry findings in schizophrenic patients before and after electroconvulsive therapy

The clinical effects of electroconvulsive therapy (ECT) on the morbidity of paranoid schizophrenic patients were assessed by positron emission tomography (PET) and plasma biochemistry studies before and after ECT. The present study included five patients whose average age was 41.4 years. The average duration of illness was 23.0 years. To avoid any effect of changes in drugs on PET, no changes were made in the medication of any of the five patients during the study period. ECT improved the clinical symptoms in every patient. Regional cerebral blood flow (rCBF) on PET in both temporal lobes and the left cerebellum was higher in paranoid schizophrenia before ECT than in normal subjects, and rCBF after ECT in both frontal lobes, the right temporal lobe and the right putamen was lower than before ECT as mental symptoms improved. These findings suggest high cerebral blood flow volume in paranoid schizophrenia. Plasma biochemistry studies revealed a lower level of 3-methoxy-4-hydroxyphenylglycol (MHPG) after ECT than before ECT, but a higher level of prolactin existed.

Haloperidol: therapeutic window in schizophrenia

Twenty-two schizophrenic inpatients were treated for 3 weeks with three randomly fixed oral doses of haloperidol (10, 20, or 30 mg). Analysis of the results by a nonlinear regression model revealed a curvilinear relationship between haloperidol levels in plasma and clinical response, as assessed on the Brief Psychiatric Rating Scale (pseudo-R2 = 0.85, F = 17.7, p < 0.001, correlation between coefficients ranged from 0.99 to -0.52). This curve defines roughly three drug level ranges (low, < 5.5 ng/ml; optimal, 5.5 to 14.4 ng/ml; and high or toxic, > 14.4 ng/ml), which are significant for clinical practice. Patients with high levels improve to a lesser extent or even worsen in negative symptoms, showing a nonstatistically significant trend to present more extrapyramidal symptoms. Our data thus support the existence of a therapeutic window for haloperidol. Schizophrenic patients with acute exacerbation and drug levels in this range would have a greater probability of global clinical improvement.

Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders

In the present study, we measured cytosolic lymphocyte glucocorticoid receptor and 24-hour urinary cortisol excretion in patients with major depressive disorder, bipolar mania, posttraumatic stress disorder, panic disorder, and schizophrenia. Patients with major depression had the smallest, and posttraumatic stress disordered patients the largest, mean number of glucocorticoid receptors per cell compared to patients in the other groups. Bipolar manic and panic patients did not differ from each other in regard to the number of lymphocyte glucocorticoid receptors. Bipolar manic and panic patients did have significantly more glucocorticoid receptors/cell than schizophrenic patients. The mean 24-hour urinary cortisol excretion was significantly higher in patients with major depression and bipolar mania than in those in the other diagnostic groups. Lymphocyte glucocorticoid receptor number and cortisol excretion tended to be inversely related, when the entire sample was considered as a whole, but this effect did not reach statistical significance. It is concluded that lymphocyte glucocorticoid receptors may be modulated by multiple influences, not just ambient cortisol levels. These preliminary data suggest that the assessment of lymphocyte glucocorticoid receptor number in tandem with cortisol levels may provide a more meaningful estimate of hypothalamic-pituitary-adrenal axis activity than is achieved using cortisol alone.

[Comparative research on some clinical and psychopharmacological parameters of reactive paranoid psychoses]

10 patients suffering from reactive psychoses were treated in a standardized manner with pernazine. The dynamic of the clinical picture as well as the behaviour of prolactin levels and the activity of DBH in blood plasma were assessed.

Depressed nocturnal plasma melatonin levels in drug-free paranoid schizophrenics

The 24-h profiles of plasma melatonin and cortisol were evaluated in 7 drug-free male paranoid schizophrenics and in 7 healthy subjects matched to the patients for age, sex, body weight, height and season of testing. Blood samples were obtained at 20.00, 22.00, 24.00, 01.00, 02.00, 06.00, 08.00 and 12.00 h. Light was turned off from 21.00 to 07.00 h. Compared with that of the normal controls, the circadian rhythm of plasma melatonin was absent in paranoid schizophrenics (F7.84 = 7.30, p less than 0.0001; two-way ANOVA with repeated measures) whereas the 24-h profile of plasma cortisol was preserved, although at a slightly higher level (F1.12 = 26.810, p less than 0.0002). The melatonin/cortisol ratio was significantly higher in healthy subjects than in the schizophrenic patients. A functional relationship between disturbances in the melatonin rhythm especially and schizophrenia may be proposed, although the significance of this relationship remains to be elucidated.

[3H]dopamine uptake by platelet storage granules in schizophrenia

[3H]Dopamine (DA) uptake by platelet storage granules was determined in 26 schizophrenic male patients, paranoid type (14 acute stage; 12 in remission) and 20 age-matched, normal controls. Maximum velocity (Vmax) of DA uptake was significantly higher in acute patients, than patients in remission or controls (p less than 0.05). The apparent Michaelis constant (Km) of DA uptake in acute patients was also significantly different from chronic patients (p less than 0.05). Preincubation with reserpine (10(-4), 10(-5) M) produced a substantial diminution of DA uptake, while haloperidol (10(-4), 10(-5) M) did not affect the assay. Considering that a DA dysequilibrium in schizophrenia may be expressed not only in the brain, but also in the periphery and that an increased amount of DA accumulated in the vesicles, implies that an increased quantity of catecholamine is available for release, our findings suggest additional evidence for the role of DA overactivity in the pathophysiology of this disorder.

[Assays of arylsulfatase activity in psychotic patients. Review of the literature and results of a study of 22 patients]

After a clinical and biological description of arylsulfatase A and metachromatic leucodystrophy, we present the results of a study of leucocyte arylsulfatase A in a population of 22 adult psychotic inpatients. The patients, clinically defined, filled the criteria of DSM III of schizophrenic disorders. All of them were treated by neuroleptics. None of these 22 patients showed a level of arylsulfatase A different from the range of 27 healthy adult controls. These results differ from those of most precedent studies of arylsulfatase A in "psychiatric populations". Some explanations of this difference are suggested. The concept of "purely psychiatric" form of adult metachromatic leucodystrophy is discussed.

Multidimensional hormonal discrimination of paranoid schizophrenic from bipolar manic patients

The search for biological markers of psychiatric disorders has traditionally involved univariate approaches, usually focusing upon one measure at a time, and to date has been primarily directed towards the assessment of depressive rather than psychotic illnesses. The present study explores a multidimensional psychoendocrine strategy, using a profile of five hormones, including cortisol, epinephrine, norepinephrine, testosterone, and free thyroxine, and is directed at the differentiation of two major psychotic illnesses, bipolar manic disorder and paranoid schizophrenia. When the levels of these hormones were assessed at admission and biweekly during hospitalization, the mean values for all five hormones were found to differ markedly between the two diagnostic groups. There was, however, always a zone of overlap in levels between the two groups when each of the five hormones were viewed individually, so that at best only about 70% of patients were correctly separated by diagnostic group using any single hormone alone. By contrast, multivariate approaches combining mean values of three or more hormones, using either stepwise discriminant analysis or multidimensional scaling, yielded 95% correct classification of the two diagnostic groups. Similar but not quite as great accuracy of classification was achieved with only the initial hormone sample obtained at the time of hospital admission. These preliminary findings provide encouragement for further exploration of multidimensional hormonal strategies in the search for useful biological criteria to assist in the diagnosis of psychiatric disorders.

Phenylacetic acid in CSF and serum in Indian schizophrenic patients

1. It has been proposed that an increase in the concentration of the neuromodulator phenylethylamine at the post-synaptic dopamine receptor may be involved in the etiology of schizophrenia. If this increase is the case, a reduction in the CSF and/or serum concentrations of phenylacetic acid, its major metabolite, might be anticipated. 2. The authors have found in hospitalized Indian schizophrenic patients ingesting antipsychotic drugs, that the paranoid subgroup did indeed exhibit lower levels of unconjugated, conjugated and total phenylacetic acid in both serum and CSF.

Neuroleptic actions on the thyroid axis: different effects of clozapine and haloperidol

Twenty-six in-patients treated for schizophrenia, were divided in two groups. The first group received haloperidol, 20-40 mg p.d., and the second, clozapine, 150-250 mg p.d. TRH-TSH test was performed by injecting 0.2 mg TRH. Four drug-free schizophrenic patients gave normal TSH response to TRH, as well as the group of patients treated with haloperidol. Contrary to that, the clozapine-treated group showed a blunted TSH response. The results obtained are discussed in terms of the different pharmacological profiles of haloperidol and clozapine, especially regarding their dopaminergic actions, alpha-adrenergic and serotonergic control upon thyroid axis.

[Correlation of the results of neurotensin therapy and plasma levels in paranoid schizophrenia]

The subjects were 21 paranoid schizophrenic patients (10 women, 11 men). The average duration of illness was 4.5 years. The severity of psychopathological symptoms was evaluated using BPRS-LA before and on 7 and 21 day of trifluoperazine therapy (60 mg per os). Simultaneously plasma neurotensin (NT) level was determined by radioimmunologic method. In 11 patients a considerable improvement was obtained, in 7 cases there were only a minimal changes, in remaining 2 a worsening of symptoms was observed. The plasma neurotensin changes were of minimal value and did not correspond to clinical symptoms and diagnosis.

[Comparative studies of various clinical and psychopharmacological parameters of schizoaffective psychosis and paranoid schizophrenia]

Two groups of male patients were investigated: 19 subjects with diagnosis of paranoid schizophrenia and 13 with schizoaffective psychosis (8 with both depressive and paranoid symptoms, 5 with manic and paranoid). All patients were treated with perazine in this same manner. During the consecutive stages of therapy the following parameters were examined and compared: clinical symptoms, DBH activity, plasma prolactin concentration and the simple reaction time task to auditory and visual stimuli. The noticeable changes, similarities and differences were described.

Amino acid patterns in schizophrenia: some new findings

Blood concentrations of various amino acids were measured in schizophrenic patients and control subjects. Significantly higher blood concentrations of glycine, glutamate, and serine were found in the schizophrenic patients. Glycine was abnormally elevated in subjects with paranoid or undifferentiated schizophrenia, but not in disorganized patients. Since glutamate, glycine, and serine play a complex role in the regulation of N-methyl-D-aspartate (NMDA) receptors, which are important in the control of normal cognitive processes, we hypothesized that the elevated levels of these amino acids might disrupt the normal functioning of NMDA receptors and might be involved in the pathophysiology of schizophrenia.

Serum thyroxine levels in schizophrenic and affective disorder diagnostic subgroups

Serum free thyroxine (FT4) and total thyroxine (TT4) levels were measured at 2-week intervals during the course of hospitalization in 29 male inpatients in the following four diagnostic groups: paranoid schizophrenia (PS); undifferentiated schizophrenia; bipolar I disorder, manic; and major depressive disorder, endogenous type. The most striking finding was a difference in the direction of both TT4 and FT4 change during clinical recovery in the PS group compared with the other three groups. Analysis of the delta values, representing the change between admission and discharge values, revealed significant differences between the mean rise in the PS group vs. the mean decreases in the other three groups for both TT4 (p less than .0003) and FT4 (p less than .003). For TT4, 75% of the PS group showed a rise during recovery in contrast to 4% of the remaining groups; for FT4, 50% of the PS group showed a rise compared with 14% of the other groups. A significant difference was also observed between the FT4 levels of bipolar I, manic vs. PS patients at the time of hospital admission, which may have potential usefulness in the differential diagnosis of these two disorders. This study emphasizes the importance of exploring more fully the psychiatric significance of thyroxine levels within the endocrinological normal range and of doing longitudinal assessments of thyroxine and symptom changes during clinical recovery in psychiatric disorders.

Plasma 3-methoxy-4-hydroxyphenylglycol changes associated with clinical state and schizophrenic subtype

In a study of 14 drug-free schizophrenic patients and 22 healthy control subjects, the plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) level appeared to be altered by changes in clinical state. Repeated sampling in schizophrenic patients showed that plasma MHPG values were elevated in high-psychosis phases in comparison with metabolite levels at times of lower psychosis. There was a nonsignificant trend toward higher MHPG levels in paranoid schizophrenic patients in comparison with patients who had undifferentiated schizophrenia. Paranoid schizophrenic patients had significantly elevated plasma MHPG levels in comparison with previously studied healthy controls. These findings suggested that alterations in the plasma MHPG level may reflect psychosis-related changes in norepinephrine function in schizophrenia.

Effects of 4 weeks treatment with chlorpromazine and/or trihexyphenidyl on the pituitary-gonadal axis in male paranoid schizophrenics

Serum prolactin (PRL), luteinizing hormone (LH) and testosterone (T) levels were estimated in a group of 30 male paranoid schizophrenics before and after 4 weeks treatment with chlorpromazine and/or trihexyphenidyl, and in a group of 14 healthy male individuals. After treatment with chlorpromazine (100 mg t.i.d., p.o.), 10 patients presented a significant increase in serum PRL values and a significant decrease in serum T values. A significant increase in serum PRL values was also found in 10 patients who were treated with chlorpromazine (100 mg t.i.d., p.o.) plus trihexyphenidyl (5 mg t.i.d., p.o.). No significant difference in any of the investigated endocrine parameters was detected in 10 patients after 4 weeks administration of trihexyphenidyl (5 mg t.i.d., p.o.). Following chlorpromazine treatment with or without concomitant administration of trihexyphenidyl, 20 patients showed a significant increase in serum PRL levels and a significant decrease in serum LH and T levels.