Serum thiobarbituric acid-reactive substances and free thiol levels in schizophrenia patients: effects of antipsychotic drugs

This study investigated the levels of serum thiobarbituric acid-reactive substances (TBARS) and free thiols in schizophrenia patients and healthy control subjects, and evaluated the effects of antipsychotic drugs. During a 2-year period, 77 schizophrenia patients and 110 healthy control subjects were recruited. Psychiatric diagnoses of schizophrenia were made according to DSM-IV criteria. Serum TBARS and free thiol levels were measured using the standard procedure in the laboratory room. Using analysis of covariance with body mass index adjustment, we found that schizophrenia patients had significantly lower serum levels of free thiols than the controls. Fifty-five patients were followed up and their serum TBARS and free thiol levels were measured at the end of the 4-week treatment with antipsychotic drugs. We found that there were significantly decreased changes in free thiol levels, but not in TBARS levels. Furthermore, patients taking risperidone had significantly decreased changes in free thiol levels. Additionally, the responders showed significantly decreased changes in free thiol levels, but not in TBARS levels. In conclusion, these analytical results suggested that serum free thiols might play an important role in the psychopathology of schizophrenia and could be used as markers for determining the treatment response in schizophrenia.

Chronic administration of cyclosporine A changes expression of BDNF and TrkB in rat hippocampus and midbrain

Neurotrophins, including the brain-derived neurotrophic factor (BDNF), are essential for regulating neuronal differentiation in developing brains. BDNF and its receptor tyrosine kinase receptor B (TrkB) are involved in neuronal signaling, survival and plasticity. Cyclosporine A (CsA) is a potent immunosuppressive agent which prevents allograft rejection in organ transplantation and various immunological diseases. We investigated whether chronic administration of CsA decreases BDNF gene expression in rats, and the influence of CsA on mRNA levels of TrkB receptors was also examined. For 30 days of CsA (10 mg/kg/day) administration, the expression of BDNF and TrkB mRNA was significantly decreased in the hippocampus and midbrain, but there was no significant difference in the cortex. CsA (0, 1, 5 10, 15 ug/ml) down-regulated BDNF and TrkB gene expression through cultured SH-SY5Y cells, as did all-trans retinoic acid (ATRA), and there was no effect on cell viability. These experimental results indicate that suppression of the BDNF and TrkB mRNA, protein level of BDNF expression in the hippocampus and midbrain may be related to altered behavior observed following chronic administration of CsA. A common mechanism of adverse effects of CsA induced depressive symptoms may involve neurotoxicity mediated by down-regulation of brain BDNF and TrkB.

Intramuscular lorazepam in catatonia in patients with acute renal failure: a report of two cases

Cases of catatonia in patients with renal failure have been rarely reported. In this report, we describe two renal-insufficient patients with catatonia who had a good response to intramuscular lorazepam whereby the catatonic symptoms were relieved. Case 1 involved a patient with end-stage renal disease and severe pneumonia related respiratory failure. He responded well to intramuscular lorazepam (total dose, 4 mg) whereby the catatonia was elieved. Case 2 involved a patient with alcoholic liver cirrhosis and rhabdomyolysis-related acute renal failure. He showed great improvement with intramuscular lorazepam (2 mg) whereby the catatonia was subsequently relieved. This report demonstrates that intramuscular lorazepam is safe, effective and rapid in relieving catatonia associated with renal function impairment. Neither of the patients had a recurrence of catatonia during a period of 6- months follow-up. In conclusion, intramuscular lorazepam may play an important role in the treatment of catatonia associated with renal insufficiency.

Acid hydrolysis followed by matrix-assisted laser desorption/ionization mass spectrometry for the rapid diagnosis of serum protein biomarkers in patients with major depression

We have developed a technique combining acid hydrolysis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for the rapid study of the changes in the levels of positive and negative acute phase protein biomarkers in the sera of patients suffering from major depression. The serum proteins were first precipitated using an organic solvent; after separation, they were subjected to hydrochloric acid hydrolysis (6 M HCl) for 10 min. The resulting peptides were characterized using MALDI-TOF MS. Short-term treatment of the serum proteins with HCl efficiently removed interference from the abundant protein - albumin - and produced abundant peptide ion signals in the range of m/z 4000-10 000. This approach allowed us to rapidly detect the peptide ions originating from transferrin (a common negative acute phase protein) and fibrinogen (a common positive acute phase protein). The average ratios and (standard deviations) of the ion signals derived from transferrin/fibrinogen were 3.58 (+/-1.93) for the healthy control subjects and 1.02 (+/-0.52) for the patients suffering from major depression. The differences in transferrin/fibrinogen ratios between healthy controls and patients suggest that major depression will induce internal inflammation and cause either an increase in the level of fibrinogen or a decrease in the level of transferrin.

Serum brain-derived neurotrophic factor levels in patients with major depression: effects of antidepressants

This study tried to investigate the relationships between serum brain-derived neurotrophic factor (BDNF) protein levels and major depressive patients and discuss the effects of antidepressants on the serum BDNF protein levels. A total of 218 participants, including 111 patients with major depression (91 women) and 107 healthy controls (65 women), were recruited in this study. Serum BDNF protein levels were measured using an ELISA kit. Psychiatric diagnoses were made according to DSM-IV criteria. Severity of major depression was assessed by the 17-item Hamilton Depression Rating Scale. Using analysis of covariance with age adjustment, there were significantly low serum BDNF protein levels in depressive patients than healthy controls in women (F=7.530, p=0.007), but not in men. Additionally, changes in serum BDNF protein levels were significantly increased in 79 patients taking antidepressants during a period of 4 weeks (t=2.116, p=0.038), especially in 61 women (t=2.542, p=0.014). Age-adjusted ANCOVA revealed no significant differences in serum BDNF protein levels between 58 responders and 21 non-responders (F=0.008, P=0.928). In responders, there were significantly increased changes in serum BDNF protein levels in 44 women (t=2.501, p=0.016), but not in 14 men (t=-0.767, p=0.457). These analytical results suggest that low serum BDNF may play an important role in depressive women and antidepressant treatment significantly increase serum BDNF. However, further studies of larger populations are necessary to confirm these results and further elucidate the effects of different classes of antidepressants on serum BDNF protein levels.

Associations between brain-derived neurotrophic factor G196A gene polymorphism and clinical phenotypes in schizophrenia patients

BACKGROUND

Brain-derived neurotrophic factor (BDNF) had been chosen as a candidate gene for schizophrenia. This study investigated the relationships between BDNF G196A gene polymorphism and clinical phenotypes in schizophrenia patients in the Taiwanese population.

METHODS

During a one year period, 132 schizophrenic patients and 103 healthy controls were recruited. Psychiatric diagnoses were made according to DSM-IV criteria. Genotyping of the G196A polymorphism of BDNF was performed by polymerase chain reaction amplification and restriction fragment length polymorphism.

RESULTS

The data showed that the BDNF G196A genotypes and their allele distributions did not differ between patients with schizophrenia and healthy controls. No significant differences were noted in the BDNF G196A genotypes and allele distribution between schizophrenia patients with and without a family tendency for schizophrenia or between those with an age of onset before or after 25 years old. However, there was a significant difference in BDNF G196A genotype distribution between schizophrenia patients with and without a suicide history.

CONCLUSIONS

These analytical results suggest that BDNF G196A gene polymorphism is associated with a susceptibility to a suicide history in schizophrenia patients in the Taiwanese population. Further study with a larger number of samples is needed to prove these findings.

Low serum albumin and high ferritin levels in chronic hemodialysis patients with major depression

We investigated the relationships between serum albumin and ferritin levels in chronic hemodialysis patients with or without major depression. During a 1-year period, a total of 107 chronic hemodialysis patients were recruited. The diagnosis of major depression in patients was made by one psychiatrist. The data showed that patients with major depression (n=15) had significantly lower albumin and higher ferritin levels than patients without major depression (n=92). Chronic hemodialysis patients with major depression might have a more severe inflammation reaction and greater oxidative damage than patients without major depression.

T-helper 1/T-helper 2 cytokine imbalance and clinical phenotypes of acute-phase major depression

Several studies have discussed the relationships between T-helper 1 (Th1) or Th2 cytokines and major depression. The aim of the present study was to investigate the relationships between Th1/Th2 cytokine balance and clinical phenotypes of acute-phase major depression. A total of 82 subjects including 42 patients with major depressive disorder and 40 healthy controls were recruited. Serum cytokine levels of interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and IL-10 were examined. Using ancova with age and body mass index (BMI) adjustments, there were no significant differences in serum IL-1beta, TNF-alpha, and IL-10 levels between patients with major depressive disorder and healthy controls. However, using ANCOVA with BMI adjustment only, the results showed that patients with major depressive disorder had significantly higher TNF-alpha levels than control subjects. In addition, using ANCOVA with age and BMI adjustments, significantly higher serum IL-1beta level and IL-1beta/IL-10 ratio were noted in patients with melancholic features than patients with non-melancholic features. However, there were no significant differences in serum IL-1beta, TNF-alpha and IL-10 levels between patients with and without suicide attempt. In conclusion, serum TNF-alpha, IL-1beta level and IL-1beta/IL-10 ratio might play an important role in the psychopathology of acute-phase major depressive disorder.

Serum brain-derived neurotrophic factor levels in patients with major depression: effects of antidepressants

This study tried to investigate the relationships between serum brain-derived neurotrophic factor (BDNF) protein levels and major depressive patients and discuss the effects of antidepressants on the serum BDNF protein levels. A total of 218 participants, including 111 patients with major depression (91 women) and 107 healthy controls (65 women), were recruited in this study. Serum BDNF protein levels were measured using an ELISA kit. Psychiatric diagnoses were made according to DSM-IV criteria. Severity of major depression was assessed by the 17-item Hamilton Depression Rating Scale. Using analysis of covariance with age adjustment, there were significantly low serum BDNF protein levels in depressive patients than healthy controls in women (F=7.530, p=0.007), but not in men. Additionally, changes in serum BDNF protein levels were significantly increased in 79 patients taking antidepressants during a period of 4 weeks (t=2.116, p=0.038), especially in 61 women (t=2.542, p=0.014). Age-adjusted ANCOVA revealed no significant differences in serum BDNF protein levels between 58 responders and 21 non-responders (F=0.008, P=0.928). In responders, there were significantly increased changes in serum BDNF protein levels in 44 women (t=2.501, p=0.016), but not in 14 men (t=-0.767, p=0.457). These analytical results suggest that low serum BDNF may play an important role in depressive women and antidepressant treatment significantly increase serum BDNF. However, further studies of larger populations are necessary to confirm these results and further elucidate the effects of different classes of antidepressants on serum BDNF protein levels.

High-sensitivity C-reactive protein levels in patients with major depressive disorder and bipolar mania

The serum high-sensitivity C-reactive protein (hsCRP) levels in patients with major depressive disorder and bipolar I disorder in acute phases were investigated. During a 1-year period, a total of 67 participants including 23 patients with major depressive disorder, 13 patients with bipolar I disorder (manic episode) and 31 healthy controls were recruited in this study. The diagnoses of mental disorders in participants were made by one psychiatrist according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Both patient groups with major depression and bipolar disorder had higher mean serum hsCRP levels than the healthy control group. Using analysis of covariance with age adjustment, patients with bipolar I disorders still had significantly higher hsCRP levels than healthy controls (P=0.043). However, patients with major depression did not have significantly higher hsCRP levels than healthy controls (P=0.172). These results suggest that patients with bipolar I disorder might have a more severe inflammation reaction than patients without major depression. However, larger samples and adequate statistical methods are needed to prove these results.

Correlations between weight changes and lipid profile changes in schizophrenic patients after antipsychotics therapy

BACKGROUND

In our previous study, we had identified strong associations between dyslipidemia and acute-phase schizophrenia during the 3-week study period. In this study, we further investigated the correlations between weight changes and lipid changes during this short period in Taiwan.

METHODS

During a 1-year period, the data of age, body mass index, antipsychotic drugs and fasting blood samples for serum lipid profiles were collected at baseline and endpoint of 3 weeks. The antipsychotic drugs used include haloperidol, loxapine, sulpiride, olanzapine, risperidone, and clozapine.

RESULTS

A total of 97 schizophrenia patients were enrolled in this study. The authors found that most antipsychotic drugs showed increased weight changes in Taiwanese patients. Using linear regression, the authors also found that the weight changes in patients taking clozapine had significantly negative correlation with HDL changes during the 3-week study period. However, no significant correlations between weight changes and lipid changes were noted in patients using other antipsychotic drugs.

CONCLUSIONS

The results of this study showed that most antipsychotic drugs showed increased weight changes and schizophrenia patients using clozapine might have negative correlations between weight changes and HDL changes during a very short period. However, due to the limitation of the sample size, larger samples are needed to prove the results after controlling confounding factors.

Liver graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in living donor liver transplantation

Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-to-recipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-to-recipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p = 0.001) and RPVF (p = 0.014). Graft hyperperfusion (RPVF flow > 250 mL/min/100 g graft) was seen in eight recipients. If the GRSSR was < 0.6, 5 of 11 cases were found to have graft hyperperfusion (p = 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p = 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of < 0.6.

Benzodiazepines in catatonia associated with systemic lupus erythematosus

Neuropsychiatric disturbances are found in 50-70% of systemic lupus erythematosus (SLE) patients. However, there are rare cases of catatonia being described in SLE. Some studies have shown the effectiveness of high-dose steroid, plasma exchange and electroconvulsive therapy (ECT) in lupus catatonia. Herein are described two SLE patients with catatonia who had good response to i.v. diazepam (i.e. relief of catatonia symptoms). Patient 1, with mild cortical atrophy, had great improvement in catatonia symptoms on i.v. diazepam 150 mg during a period of 5 days. Patient 2, without cortical atrophy, had quick response to i.v. diazepam 10-20 mg. Both patients had no recurrence during 6-month follow up. In conclusion, benzodiazepines may play an important role in the treatment of catatonia associated with SLE if patients refuse ECT treatment.

Lymphocyte subsets and viral load in male AIDS patients with major depression: naturalistic study

This study investigated the relationships between lymphocyte subsets and viral load in AIDS patients with and without major depression. During a 7-year period, a total of 60 male hospitalized AIDS patients were recruited in this study. The diagnosis of major depression in patients was made by the same psychiatrist according to the 4th edition of the Diagnostic and Statistical Manual for Mental Disorders criteria. All patients had data for CD4, CD8 and CD4/CD8, and only 42 patients had viral load data. Of 60 AIDS patients, 32 patients had received highly active antiretroviral therapy and received subsequent assessment of lymphocyte cell counts 1 month later. Using ancova with age adjustment, the authors found that patients with major depression (n = 22) had significantly lower CD8 cell counts than patients without major depression (n = 38). However, CD4 cell counts and CD4/CD8 ratios were not significantly different between these two groups. In addition, there was no significant difference in viral load between patients with major depression (n = 16) and patients without major depression (n = 26). Of 32 patients received highly active antiretroviral therapy, 14 patients with an antidepressant (e.g. fluoxetine 20 mg/day) had significantly decreased CD4 and not CD8 cell counts and significantly reduced CD4/CD8 ratios during a period of 1 month. In conclusion, these results suggest that AIDS patients with major depression had significantly lower CD8 cell counts and might have a more severe inflammation/immunity reaction than patients without major depression.

Clozapine for blepharospasm, obsessive-compulsive symptoms, and psychotic symptoms in a patient of old brain infarction

Blepharospasm, psychotic symptoms, and obsessive-compulsive symptoms can result from brain infarction. However, a presentation of these 3 symptoms simultaneously is rare. This report describes a 65-year-old woman who had old brain infarction and presented with these 3 symptoms for 2 years. The patient recovered after receiving a regimen of clozapine 125 mg/d for 3 months. No recurrences of symptoms were noted during a 6-month follow-up. This is the first case report demonstrating that clozapine is effective for a patient with blepharospasm, obsessive-compulsive symptoms, and psychotic symptoms presenting simultaneously. This report also reminds physicians of the possible organic causes of unusual presentations in elderly patients.

Associations between serum brain-derived neurotrophic factor levels and clinical phenotypes in schizophrenia patients

This study investigated serum brain-derived neurotrophic factor (BDNF) protein levels in schizophrenia patients and healthy control subjects and schizophrenia patients with various clinical phenotypes. During a 1-year period, 126 schizophrenic patients and 96 healthy control subjects were recruited. Serum BDNF protein levels were measured using an ELISA Kit. Psychiatric diagnoses were made according to DSM-IV criteria. One-way analysis of variance (ANOVA) showed no significant differences in serum BDNF protein levels between schizophrenia and healthy normals. Additionally, no significant differences existed in BDNF levels between schizophrenia patients for the following variables: with/without a suicide attempt; antipsychotic drug use, family tendency and disease onset before and after 25 years old. However, patients with catatonic schizophrenia had lower serum BDNF protein levels than patients with paranoid or residual schizophrenia. These analytical results suggested that BDNF might play an important role in the clinical subtypes of schizophrenia, but it needed further investigation in future.

Lorazepam and diazepam rapidly relieve catatonic features in major depression

We have proved that a modified strategy (ie, lorazepam intramuscular injection [IMI] or diazepam intravenous drip [IVD] if lorazepam IMI fails) can rapidly relieve catatonic features in patients with schizophrenia. During a period of 3 years, we identified 7 major depressive patients with catatonic features in the emergency unit of a general hospital. The patients were treated with lorazepam IMI (dose, 2 mg/mL.per ampule) once or twice during the first 2 hours. If lorazepam IMI failed, diazepam IVD (dose, 10 mg/2 mL.per ampule) in 500 mL normal saline every 8 hours for 1 day would be administered. The total complete remission rate to lorazepam IMI within 2 hours was 6 (85.7%) per 7 patients, and the total complete remission rate to benzodiazepines (lorazepam IMI and diazepam IVD) within 1 day was 7 (100%) of all 7 patients. These results highly suggest that this modified strategy can also rapidly relieve catatonic features in major depression within 1 day and attain a high complete remission rate, even without electroconvulsive therapy.

Association of serum lipid profiles with depressive and anxiety disorders in menopausal women

BACKGROUND

Several studies have investigated the relationships of lipid levels with depressive and anxiety disorders, and their results revealed an association between low cholesterol and higher levels of depressive symptoms in young, middle-aged, and postpartum women. However, few studies have explored this relationship in menopausal women. Hence, in this study of menopausal Taiwanese women, we attempted to determine the correlation of depressive and anxiety disorders with serum lipid profiles.

METHODS

This was a cross-sectional study covering a 2-year period. Sixty-nine menopausal women who visited the gynecologic outpatient department of our hospital were enrolled. Psychiatric diagnoses were made using the semi-structured clinical interview for the Diagnostic and Statistical Manual (DSM-IV) criteria. Blood samples for serum lipid profiles were simultaneously collected. Data were analyzed using analysis of co-variance (ANCOVA) adjusted for age and body mass index (BMI).

RESULTS

Total cholesterol (TC) and low-density lipoprotein (LDL) were higher in postmenopausal women than in perimenopausal women, but this was not true for triglyceride (TG), high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), the TC/HDL ratio, or the LDL/HDL ratio. However, when peri- and postmenopausal women were categorized into normal controls and those having anxiety disorders and depressive disorders, no significant differences were found in lipid concentrations of TG, TC, HDL, VLDL, LDL, TC/HDL, or LDL/HDL among the 3 groups.

CONCLUSIONS

Although these results do not suggest that serum lipid profiles can be used as biological markers to distinguish depressive or anxiety disorders in menopausal women, larger samples are required to prove such results in the future.

Clozapine in schizophrenia patients with recurrent catatonia: report of two cases

Prolonged catatonia can be a source of extremely serious morbidity and mortality. Lorazepam is effective in rapidly relieving most cases of catatonia. Reports have also shown that second-generation antipsychotic drugs are also efficacious in relieving catatonia. This report describes two schizophrenia patients who demonstrated recurrent catatonic features mutism and stupor. Both patients were treated with lorazepam, diazepam or electroconvulsive therapy (ECT). Patient 1 responded well and rapidly to lorazepam each time catatonia happened; but catatonia recurred once a year under treatment with many antipsychotic drugs. Patient 2 had catatonia features associated with discontinuing or decreasing clozapine. With each recurrent episode, the duration of catatonia increased, requiring an increased dosage of benzodiazepine. The patient's response to lorazepam and ECT gradually decreased, until the patient had almost no response to lorazepam, diazepam or ECT. Both patients had no recurrence during a period of 2-year follow up with continuous clozapine therapy.

Serum lipid profiles and schizophrenia: effects of conventional or atypical antipsychotic drugs in Taiwan

This study investigated the relationships between serum lipid profiles and schizophrenia and the effects of conventional or atypical antipsychotic drugs on serum lipid profiles. During a 1-year period, fasting blood samples for serum lipid profiles were collected from 126 schizophrenic patients and 59 healthy control subjects. The serum lipid profiles were detected by enzymatic determination. Patients were assessed for disease severity at baseline and endpoint at 3 weeks using the Positive and Negative Syndrome Scale. At baseline, patients with acute-phase schizophrenia had lower high-density lipoprotein (HDL) levels, higher low-density lipoprotein (LDL) levels, and higher ratios of total cholesterol/high-density lipoprotein (TC/HDL) and LDL/HDL than healthy control subjects. At endpoint, after a 3-week treatment with antipsychotics, the blood samples of the 97 schizophrenic patients were assessed again. Responders to antipsychotic treatment (n = 68) but not nonresponders (n = 29) had significantly increased TC, triglyceride (TG), and very low-density lipoprotein (VLDL) levels and decreased ratio of LDL/HDL. Experimental findings also showed significantly increased TC, TG, HDL, and VLDL levels and decreased ratio of LDL/HDL in responders taking atypical antipsychotic drugs (n = 32), but not in patients treated with conventional antipsychotic drugs (n = 36). In conclusion, this study identified strong associations between dyslipidemia and acute-phase schizophrenia and dyslipidemia and responders taking atypical antipsychotics; both associations would increase the risk of developing diabetes and coronary heart disease.

Benefits of fatty fish on dementia risk are stronger for those withoutAPOEε4

OBJECTIVE

To compare associations of lean fish vs fatty fish (tuna or other fish) intake with dementia, Alzheimer disease (AD), and vascular dementia (VaD) and in relation to APOE epsilon4 status in the Cardiovascular Health Cognition Study (CHCS).

METHODS

Fish intake was assessed by food frequency questionnaires. Incident dementia, AD, and VaD were determined through a series of cognitive tests, physician's assessment, and committee consensus. We used Cox proportional hazards regression to calculate hazard ratios of dementia, AD, and VaD with lean fried fish, fatty fish, or total fish intake, which were then stratified by the presence of APOE epsilon4.

RESULTS

Although consumption of lean fried fish had no protective effect, consumption of fatty fish more than twice per week was associated with a reduction in risk of dementia by 28% (95% CI: 0.51 to 1.02), and AD by 41% (95% CI: 0.36 to 0.95) in comparison to those who ate fish less than once per month. Stratification by APOE epsilon4 showed this effect to be selective to those without the epsilon4 allele. Adjustment by education and income attenuated the effect.

CONCLUSION

In the Cardiovascular Health Cognition Study, consumption of fatty fish was associated with a reduced risk of dementia and Alzheimer disease for those without the APOE epsilon4 allele.