Fluphenazine treatment reduces CSF somatostatin in patients with schizophrenia: correlations with CSF HVA

CSF somatostatin and homovanillic acid (HVA) were measured in 14 schizophrenic patients while they were drug-free and during chronic fluphenazine treatment. CSF somatostatin was significantly reduced and CSF HVA was significantly elevated (p less than 0.002) during fluphenazine treatment. There was a trend toward correlation between CSF somatostatin and CSF HVA in the 14 schizophrenic patients when drug-free (r = 0.49, p less than 0.07) and fluphenazine-treated (r = 0.47, p less than 0.08). When examined in a larger group (n = 46) of drug-free schizophrenics, this relationship was highly significant (r = 0.59, p less than 0.001). These clinical data are consistent with preclinical evidence indicating a functional interaction between CNS somatostatin and dopamine systems.

Microvascular angina and panic disorder

Recent cardiac studies have suggested that patients with chest pain and angiographically normal coronaries have "microvascular angina" (MVA). In contrast, prior psychiatric studies have shown that some of these patients have panic disorder (PD). We compared the clinical and psychologic characteristics of fifteen patients with MVA and fifteen patients with panic disorder (PD), and examined response to lactate infusion in a subgroup of MVA patients. Although 40 percent of MVA patients met criteria for PD and had chest pain following lactate infusion, there were psychologic and symptomatic differences between the MVA and PD groups. These results reflect either co-morbidity of MVA and PD in some patients or two types of MVA, one of primary cardiac origin and one a centrally mediated epiphenomenon of the increased autonomic arousal seen in PD.

Characteristics of cerebrospinal fluid neuropeptides relevant to clinical research

Studies of human cerebrospinal fluid (CSF) peptides were conducted in an attempt to broaden the utility of CSF peptide determinations in psychiatric research. Healthy volunteers had two lumbar punctures, at least 3 weeks apart, to assess reproducibility within subjects. CSF levels of eight peptides were reliably reproducible, indicating that longitudinal studies of these CSF neuropeptides are feasible. Levels of 10 peptides were determined in four sequential 8 ml aliquots of CSF. CSF rostrocaudal gradients were not found for any of these 10 peptides. Neuropeptide Y (NPY), growth hormone releasing factor (GHRF), and corticotropin releasing factor (CRF) were measured in CSF from twins and brothers. CSF NPY levels were heritable, while CRF and GHRF levels were influenced more by environment. CSF levels of CRF, beta-lipotropin, vasoactive intestinal peptide, adrenocorticotropic hormone, and somatostatin were highly correlated with one another, suggesting that a common factor is responsible for a significant proportion of the observed variance in their CSF levels. These results suggest that CSF peptide measurements may have a broad range of applicability to clinical psychiatric research.

Menstrual cycle phase-related changes in appetite in patients with premenstrual syndrome and in control subjects

Menstrual cycle phase-dependent changes in appetite in women with premenstrual syndrome has not thus far been systematically demonstrated. In this study of 21 patients with premenstrual syndrome and 13 control subjects, there were significant increases in appetite in both groups, with a greater effect of menstrual cycle phase on appetite in the patients. Further, the premenstrual increase in appetite was highly correlated with self-ratings of mood (particularly depression) in the patients only. The authors discuss these findings with respect to endocrine influences on appetite regulation and potential implications for investigation of atypical depression.

Salivary cortisol: a practical method for evaluation of adrenal function

Salivary cortisol represents a simple, noninvasive, stress-free measure that can greatly facilitate the longitudinal study of hypothalamic-pituitary-adrenal axis activity in patients with psychiatric disorders. By means of a slight modification of a commercially available radioimmunoassay kit, we studied the stability of salivary cortisol under different conditions, as well as the relationship between plasma and salivary cortisol under basal circadian conditions and following stimulation (CRH) and suppression (dexamethasone). We observed that salivary cortisol was quite stable at room temperature without centrifugation and that salivary and plasma cortisol values were highly correlated. Additionally, we observed a close correspondence in circadian and ultradian fluctuations in salivary and plasma cortisol. The salivary cortisol response to ovine and human CRH was similar to that observed with plasma cortisol, but was greater in magnitude. Finally, employing a plasma criterion as the standard, salivary measures identified 48% of the nonsuppressed Dexamethasone Suppression Tests (DSTs) and 97% of the suppressed DSTs.

Somatostatin in neuropsychiatric disorders

1. Somatostatin is a peptide that is widely and discretely distributed throughout the central nervous system. 2. Its relevance to neuropsychiatric disorders is suggested both by the existence of disease-related alterations in somatostatin content in brain and cerebrospinal fluid as well as by the manifold neuroregulatory capabilities of somatostatin and related peptides. 3. This article will summarize the central nervous system effects of somatostatin, identify those neuropsychiatric disorders that are characterized by changes in somatostatin, and review the evidence for and potential significance of decreases in cerebrospinal fluid somatostatin in depression.

Changes in plasma hormones across the menstrual cycle in patients with menstrually related mood disorder and in control subjects

A variety of hypotheses have been proposed to explain the premenstrual syndromes. These hypotheses serve as rationales for an equally diverse range of proposed treatments. To investigate these hypotheses, we obtained multiple blood samples across the menstrual cycle in women with well-characterized menstrually related mood disorder and in control subjects. No diagnosis-related differences were observed in the levels or patterns of secretion of progesterone, estradiol, follicle-stimulating hormone, luteinizing hormone, testosterone-estradiol-binding globulin, dehydroepiandrosterone sulfate, dihydrotestosterone, prolactin, or cortisol. Our data suggest that premenstrual syndrome does not represent a simple hormonal deficiency and that the cited rationales for several of the proposed treatments are of questionable merit.

Alternate-day corticosteroid treatment, mood and plasma HVA in patients with systemic lupus erythematosus

Corticosteroid therapy may produce alterations in mood. Furthermore, several monoamines, including dopamine, have been implicated in the regulation of mood. We, therefore, examined the relationship between alterations in mood and plasma homovanillic acid (HVA) levels in patients on alternate-day corticosteroid treatment. Although several patients had substantial alterations in mood, there was no significant difference in plasma HVA levels between the on- and off-medication day. Furthermore alterations in depression and anxiety levels were not related to plasma HVA levels. The implications of these findings are discussed.

Mood effects of alternate-day corticosteroid therapy in patients with systemic lupus erythematosus

Mood and cognition were assessed on consecutive days in 18 female patients with systemic lupus erythematosus on alternate-day corticosteroid therapy. No overall differences in mood and cognition were observed between the on- and off-medication days. However, 10 patients showed marked worsening or improvement of either depression or anxiety on their off-medication day. Two weeks of prospective behavioral ratings confirmed the observed mood changes in several patients. The clinical and theoretical implications of these findings are discussed.

Neuropsychiatric consequences of AIDS

As part of a study in progress, neuropsychological tests have been administered to 13 patients with clinical acquired immunodeficiency syndrome, 9 human immunodeficiency virus-seropositive patients, 4 seropositive patients with chronic active hepatitis, 5 seronegative patients with chronic active hepatitis, and 6 healthy controls. Consistent with findings in earlier patient and control groups, the acquired immunodeficiency syndrome patients had substantially lower scores on a variety of cognitive tests. Although the acquired immunodeficiency syndrome group is not education-matched at present, the results are nonetheless consistent with impairments of language function and timed, self-paced performance. Test results obtained may reflect focal and global cognitive impairment as well as motivational decrements in patients with the acquired immunodeficiency syndrome relative to seropositive patients or controls.

Prednisone decreases CSF somatostatin in healthy humans: implications for neuropsychiatric illness

Several neuropsychiatric illnesses, including depression and Alzheimer's disease, are reported to be characterized by hypercortisolemia and by reduced levels of cerebrospinal fluid somatostatin-like immunoreactivity (CSF-SLI). To investigate a possible causal linkage between these abnormalities we administered prednisone, 80 mg orally per day for 5 days, to 9 healthy volunteers. We observed significant prednisone-induced reductions in CSF-SLI. Moreover, the magnitude of these reductions was inversely related to the magnitude of prednisone-induced reductions in plasma ACTH levels, suggesting a functional interaction between circulating corticosteroids, central somatostatin and pituitary ACTH release.

CSF somatostatin in patients with Alzheimer's disease, older depressed patients, and age-matched control subjects

Somatostatin-like immunoreactivity was measured in the CSF of 12 patients with Alzheimer's disease, 15 age-matched control subjects, and 20 older depressed subjects. Patients with dementia or depression were found to have lower CSF somatostatin concentrations than control subjects despite markedly different clinical presentations. Severity of depression was clearly different in all three groups but showed no significant correlation with CSF concentration of somatostatin. There was a significant positive correlation between CSF somatostatin-like immunoreactivity and cognitive functioning in all 47 subjects, but this association was not statistically significant within individual diagnostic groups. These data raise interesting questions about possible biological links between Alzheimer's disease and depression in older patients.

Differential time course of antidepressant effects after sleep deprivation, ECT, and carbamazepine: clinical and theoretical implications

The pattern and time course of antidepressant response to different treatment modalities provide important clinical information and hints about underlying neurobiological mechanisms. Depressed patients who responded to 1 night's sleep deprivation (11 of 33 patients) showed maximal improvement on day 1 and deterioration in mood thereafter. In contrast, slower onset and more sustained effects were observed following carbamazepine (12 of 37) or electroconvulsive therapy (ECT) (8 of 8). Nearly maximal improvement required about 2 weeks for ECT and 3 weeks for carbamazepine. Possible differential or common biological mechanisms with differential times of action are implied by these data, which are of importance to the neuroscientist attempting to uncover neural substrates of antidepressant response and the clinician attempting to find rapid onset, yet sustained antidepressant treatments.

The neuropsychiatric effects of treatment with interleukin-2 and lymphokine-activated killer cells

STUDY OBJECTIVE

To study the neuropsychiatric manifestations of therapy with interleukin-2 and lymphokine-activated killer cells.

DESIGN

Longitudinal survey of consecutive patients who were given the treatment. Each patient was initially interviewed within 5 days before treatment, and a personal and family psychiatric history was obtained during this first session. Cognitive tests and mood self-rating instruments were administered at the beginning and end of interleukin-2 and lymphokine-activated killer cell treatments, before discharge, and at a follow-up visit 2 to 4 weeks after discharge.

SETTING

National Cancer Institute inpatient units at the National Institutes of Health.

PATIENTS OR OTHER PARTICIPANTS

Sequential samples of 44 patients with metastatic cancer (age range, 28 to 69 years) who were treated systemically with recombinant interleukin-2 combined with autologous lymphokine-activated killer cells between 30 December 1985 and 31 March 1986.

MEASUREMENTS AND MAIN RESULTS

Of the 44 patients studied, 15 developed severe behavioral changes that necessitated acute intervention, and 22 patients had severe cognitive changes (all 22 became disoriented and many also had psychometric evidence of cognitive deterioration). The neuropsychiatric side effects were dose and time related, appearing more frequently at the higher dose and almost uniformly at the end of each treatment phase. All 39 patients who were seen at follow-up had a return to their baseline cognitive scores. None of the factors investigated was found to be predictive of the development of neuropsychiatric toxicity.

CONCLUSIONS

The development of clinically significant neuropsychiatric changes during the administration of interleukin-2 and lymphokine-activated killer cells was common and may be treatment limiting. A marked latency in the appearance of neuropsychiatric changes after treatment onset was noted in almost all patients. Every patient studied recovered from the neuropsychiatric side effects.

Lack of effect of chronic carbamazepine on brain somatostatin in the rat

We investigated the effects of chronic carbamazepine treatment in rats on brain somatostatin. Following 12 days of carbamazepine treatment, no changes in somatostatin levels were found in any of the brain areas examined which included: amygdala, hippocampus, caudate-putamen, median eminence, arcuate nucleus, nucleus accumbens, nucleus interstitialis of the stria terminalis, nucleus periventricularis, parietal cortex, and occipital cortex. Thus, carbamazepine in low doses does not affect basal levels of brain somatostatin in the rat, in contrast to the previous reports of decreased somatostatin in the cerebrospinal fluid of affectively ill patients.

Reduced anxiety and depression in cystic acne patients after successful treatment with oral isotretinoin

We evaluated the psychiatric morbidity and mood characteristics of a group (n = 72) of patients with cystic acne before and after treatment with one of three dosage schedules of isotretinoin. Although no excess psychiatric morbidity was observed, substantial evidence of psychologic distress was noted before treatment. Significant reductions in anxiety were observed on several measures of anxiety after treatment, with mitigation of anxiety and depression most robust in those patients with the greatest dermatologic improvement with isotretinoin.

Mood disorders and the menstrual cycle

Since the premenstrual syndromes characteristically present with mood, cognitive and behavioral disturbances, a special relationship between psychiatric disorders and the premenstrual syndromes has been postulated. With a series of questions we attempted to clarify the nature of the relationship between the menstrual cycle and mood and behavior, and we specifically addressed the similarities and differences between the premenstrual syndromes and formal psychiatric disorders. The premenstrual syndromes may serve as a biobehavioral model for the investigation of the biologic contributors to mood state regulation.

TSH and prolactin responses to TRH in patients with premenstrual syndrome

The thyroid-stimulating hormone (TSH) and prolactin responses to thyrotropin-releasing hormone (TRH), administered during the follicular and luteal phases of the menstrual cycle, were examined in 14 women with prospectively confirmed premenstrual syndrome and in nine control subjects. There were no differences in basal or maximum increase in TSH or prolactin values between menstrual cycle phases in patients or in control subjects or between patients and control subjects in either phase. However, there was significantly greater variability in TSH response to TRH among symptomatic patients (seven of 10 patients: three with blunted and four with augmented response) than among control subjects (none of nine patients).

Conditioning and sensitisation in the longitudinal course of affective illness

Few biological theories of manic-depressive illness have focused on the longitudinal course of affective dysfunction and the mechanisms underlying its often recurrent and progressive course. The authors discuss two models for the development of progressive behavioural dysfunction--behavioural sensitisation and electrophysiological kindling--as they provide clues to important clinical and biological variables relevant to sensitisation in affective illness. The role of environmental context and conditioning in mediating behavioural and biochemical aspects of this sensitisation is emphasised. The sensitisation models provide a conceptual approach to previously inexplicable clinical phenomena in the longitudinal course of affective illness and may provide a bridge between psychoanalytic/psychosocial and neurobiological formulations of manic-depressive illness.

Depression and carcinoma of the pancreas

A systematic psychiatric evaluation of 21 subjects with intraabdominal malignancy (pancreatic or gastric carcinoma) was performed. Depression was frequently associated with and often the presenting symptom complex of patients with carcinoma of the pancreas. This finding was not observed in patients with gastric carcinoma. Clinical and theoretical implications of these findings are discussed.

Cerebral ventricular size and cognitive impairment in depression

Twenty-one patients with major affective disorder were given the Halstead-Reitan Category Test and had CT brain scans performed in order to measure ventricular-brain ratio (VBR). A significant correlation between ventricular size and cognitive impairment was found. Possible pathophysiological mechanisms that might explain this relationship are discussed.