Well-being and the menopausal transition

This paper examines the relationship between well-being, age, menopausal status, hormone levels and hot flashes. Data from the first 4 years of longitudinal observation from the Melbourne Women's Midlife Health project was utilized. This study involved a population-based sample of 405 women interviewed annually. Blood was taken during the follicular phase (if still menstruating) for estradiol, sex hormone binding globulin, follicle stimulating hormone and testosterone. A validated well-being scale was used. Positive affect increased with age while negative affect decreased with age but only in the postmenopausal category. Positive affect was significantly lower in the 2 years postmenopausal group but this effect of menopausal status did not remain when hot flashes were included in the analysis. Negative affect was highest in the 1-2 years postmenopausal group. Although hot flashes adversely affected negative moods, a significant effect of menopausal status remained. No direct association between any of the hormone levels and positive or negative affect scores was evident. In conclusion, this study found that well-being was decreased in the first 2 years after the first menstrual period but began to improve spontaneously after this time.

Use of hormone replacement therapy by Melbourne women

Hormone replacement therapy (HRT) is used for relief of symptoms related to the menopause and for the prevention of postmenopausal osteoporosis and cardiovascular disease. Patterns of use of HRT are thought to be changing rapidly, but little is known about who is using the therapy, for what purpose or for what period of time. Telephone interviews were conducted in May 1991 with a randomly selected sample of 2001 Australian-born women aged 45 to 55 years living in Melbourne, as part of the Melbourne Women's Midlife Health Project. Questions related to use of HRT, health status, use of health services, sexual functioning, attitudes to menopause and aging, and sociodemographic characteristics. Twenty-one per cent of the sample were using HRT. Use was more prevalent among women 50 years and over (28 per cent) than those under 50 (15 per cent). Seventeen per cent of nonhysterectomised women, 31 per cent of hysterectomised women and 49 per cent of women who had undergone hysterectomy and bilateral oophorectomy were current users. Almost 60 per cent had been using the therapy for two years or less, and 34 per cent for one year or less. Just over half reported control of hot flushes as a benefit, and 10 per cent mentioned prevention of bone loss as a benefit. Logistic regression analysis identified differences between users and nonusers in experience of hot flushes, health status, use of preventive and treatment services, sexual functioning, wellbeing, attitudes to menopause and aging, and sociodemographic characteristics. These differences may relate to risk of later cardiovascular disease.

Schizophrenia, narcolepsy, and HLA-DR15, DQ6

A strong association between HLA-DR2, DQ1 and narcolepsy-cataplexy has been known since 1986. In 1990 a subdivision (HLA-DR15, DQ6) was shown to be equally associated. Narcolepsy symptoms include rapid eye movement (REM)-sleep intrusion hallucinations during the day. Some narcoleptics may be so hallucinated that they become delusional and receive a diagnosis of schizophrenia. Fifty-six inpatient schizophrenics and 56 normal controls were compared to see if there was an excess of the narcolepsy-associated antigens (NAA) among schizophrenics. Patients had frequency of the NAA 3.89 times higher than controls. After a subset was studied by night (n = 9) and day (n = 7) polysomnography, two patients were found to be true narcoleptics. Their psychosis improved with treatment for narcolepsy. When NAA(+) and NAA(-) schizophrenics were compared, the NAA(+) subgroup had significantly higher Brief Psychiatric Rating Scale (BPRS) scores and more hospitalizations. There were no effects attributable only to gender or race. We conclude that narcolepsy can simulate schizophrenia in some cases, and that even in nonnarcoleptic patients, the HLA-DR15,DQ6 antigens mark a group of severe schizophrenics that merits further study.

Gamma delta T-cell lines isolated from intestinal epithelium respond to a B-cell lymphoma

gamma delta T-cell hybrid clones were obtained from intestinal intraepithelial lymphocytes (i-IEL) by fusion with the BW5147 thymoma line. Four clones which expressed different V gamma/V delta genes were selected for further study. All of the gamma delta clones secreted interleukin-2 (IL-2) in the presence of the BALB/c-derived B-lymphoma line, A20. No alpha beta T-cell hybrid clones derived from spleen or i-IEL responded to A20. We obtained several pieces of evidence which strongly suggest that these responses are mediated by the gamma delta T-cell receptor (TcR). Class II major histocompatibility complex (MHC), FcR and surface Ig expressed on A20 are not involved in the response. Native i-IEL derived from BALB/c selectively survive in culture in the presence of A20 cells. The ligand may be a superantigen-like molecule because all our gamma delta T-cell clones responded to A20 in spite of their different combinations of V gamma/V delta gene segments.

Age disorientation in Kraepelinian schizophrenia: frequency and clinical correlates

Many schizophrenic patients exhibit significant neuropsychological impairment, and age disorientation is considered to be one of the more extreme manifestations. To evaluate clinical correlates of age disorientation with reference to the course of schizophrenic illness, we compared 39 deteriorated chronic Kraepelinian schizophrenic patients and 39 nondeteriorated schizophrenic patients early in the course of illness. Age disorientation was observed in 36% of patients in the Kraepelinian group, but in no patient in the non-Kraepelinian group. In the Kraepelinian group, age disorientation was unrelated to positive/negative symptoms or illness duration. Our data suggest that age disorientation may be a function of aging in schizophrenia, but is not merely a function of chronicity.