Transmission disequilibrium studies in children and adolescents with obsessive-compulsive disorders pertaining to polymorphisms of genes of the serotonergic pathway

Pharmacological and challenge study data showed an involvement of the serotonergic system in the development of obsessive-compulsive disorder (OCD). We studied transmission disequilibrium of polymorphisms in three candidate genes of the serotonergic pathway in 64 trios comprising patients with early onset OCD and both of their parents. Polymorphisms of the following genes were studied: tryptophan hydroxylase 1 (rs1800532), serotonin transporter (polymorphism in the promoter region; 5-HTTLPR) and the serotonin 1 B receptor (rs6296). This is, to our knowledge, one of the first family based association studies pertaining to children and adolescents with OCD. We did not detect transmission disequilibrium of the investigated polymorphisms in OCD. Hence, these polymorphisms do not play a major role in the genetic predisposition to early onset OCD.

Effects of secretin on extracellular amino acid concentrations in rat hippocampus

In 1998, Horvath et al. (1998) observed a marked improvement in speech, eye contact, and attention in autistic children five weeks after treatment with secretin, which ocurred in the course of an endoscopic investigation. Since autism is hypothesized to be a hypoglutamatergic disorder we investigated the in vivo effects of secretin on extracellular amino acids in the rat brain. Studies were carried out on freely moving rats with microdialysis probes in the hippocampus. Amino acids were examined using tandem mass spectroscopy and HPLC/fluorometric detection. Following secretin injection (8.7 microg/kg i.p.), considerable increases in microdialysate glutamate and gamma-aminobutyric acid (GABA) levels were observed; other amino acids were not affected. The observed increased microdialysate concentrations of glutamate and GABA following secretin application may explain the results of the Horvath study.

Lebensqualität bei psychisch kranken Kindern und Jugendlichen

Zusammenfassung: Fragestellung: Das neu entwickelte krankheitsunspezifische Instrument zur Messung der Lebensqualität von Kindern und Jugendlichen (ILK, Mattejat et al., 1998 ) sollte hinsichtlich seiner Differenzierungsfähigkeit zwischen ambulanten und stationären psychiatrischen Stichproben überprüft werden. Methodik: 626 kinder- und jugendpsychiatrische Patienten aus regional unterschiedlichen Kliniken und Praxen wurde der ILK-Bogen vorgelegt. Die so gewonnenen Daten werden deskriptiv dargestellt und mit Hilfe logistischer Regressionen genauer analysiert. Ergebnisse: Während eine rein deskriptive Betrachtung zeigt, dass stationär behandelte Kinder und Jugendliche durchweg alle Lebensbereiche als belastender erleben, relativiert sich dieses Ergebnis durch die Regressionsanalyse. Hier zeigt sich, dass die deskriptiv gefundenen Unterschiede zwischen stationären und ambulanten Patienten teilweise auf Alters- und/oder Geschlechtseffekte zurückzuführen sind; in einigen Lebensbereichen jedoch erweisen sich die Unterschiede zwischen der ambulanten und stationären Stichprobe unter Berücksichtigung von Alter und Geschlecht als Kovariaten als durchaus substantiell. Schlussfolgerungen: Das ILK ist als effizientes ökonomisches Verfahren in der Lage, Lebensqualität in Abhängigkeit von dem Schweregrad psychiatrischer Störungen zu erfassen; darüber hinaus ist es sensitiv für Alters- und Geschlechtseffekte. Indem das ILK Bereiche mit verminderter Lebensqualität schnell und sicher identifiziert, bietet es Ansatzpunkte für Indikationsstellung, Therapieplanung und erste therapeutische Interventionen.

5-HT2A promoter polymorphism -1438G/A in children and adolescents with obsessive-compulsive disorders

Positive association between obsessive compulsive disorder (OCD) and the A-allele of the 5-HT(2A)-receptor promoter polymorphism -1438G/A has recently been reported in adults. We performed an association analysis of this polymorphism in 55 children and adolescents with OCD and in 223 controls consisting of unrelated students. We detected statistically significant differences in genotype (P < 0.05) and allele frequencies (P < 0.05) between individuals with OCD and controls. In this, to our knowledge, first association study based on children and adolescents with OCD, we confirm an association of the A-allele of the 5-HT2A receptor gene with OCD.

Degradation of phytate in the gut of pigs--pathway of gastro-intestinal inositol phosphate hydrolysis and enzymes involved

The present study gives an overview on the whole mechanism of phytate degradation in the gut and the enzymes involved. Based on the similarity of the human and pigs gut, the study was carried out in pigs as model for humans. To differentiate between intrinsic feed phytases and endogenous phytases hydrolysing phytate in the gut, two diets, one high (control diet) and the other one very low in intrinsic feed phytases (phytase inactivated diet) were applied. In the chyme of stomach, small intestine and colon inositol phosphate isomers and activities of phytases and alkaline phosphatases were determined. In parallel total tract phytate degradation and apparent phosphorus digestibility were assessed. In the stomach chyme of pigs fed the control diet, comparable high phytase activity and strong phytate degradation were observed. The predominant phytate hydrolysis products were inositol phosphates, typically formed by plant phytases. For the phytase inactivated diet, comparable very low phytase activity and almost no phytate degradation in the stomach were determined. In the small intestine and colon, high activity of alkaline phosphatases and low activity of phytases were observed, irrespective of the diet fed. In the colon, stronger phytate degradation for the phytase inactivated diet than for the control diet was detected. Phytate degradation throughout the whole gut was nearly complete and very similar for both diets while the apparent availability of total phosphorus was significantly higher for the pigs fed the control diet than the phytase inactivated diet. The pathway of inositol phosphate hydrolysis in the gut has been elucidated.

Psychotische Störungen und Drogenmissbrauch bei Jugendlichen

Zusammenfassung: Fragestellung: Der Zusammenhang zwischen Drogenabusus und psychotischen Symptomen wird anhand einer klinischen Inanspruchnahmepopulation der Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Philipps-Universität Marburg evaluiert. Methodik: Es wurden alle Patienten mit einem komorbiden Drogenabusus unter Verwendung einer Kinder- und Jugendlichen Version des IRAOS (Instrument of the retrospective assessment of the onset of schizophrenia, Häfner et al., 1990) in die Evaluation eingeschlossen. Patienten mit einer drogeninduzierten Psychose (n = 8) wurden im Vergleich zu schizophren erkrankten Patienten mit komorbidem Substanzabusus (n = 19) und zu Patienten mit anderen psychiatrischen Erkrankungen und Substanzabusus (n = 30) untersucht. Ergebnisse: Diese drei Gruppen unterschieden sich signifikant anhand der Belastung mit prämorbiden Symptomen und anhand der Charakteristika des Erkrankungsbeginns. Schlussfolgerungen: Anhand des IRAOS ergibt sich, dass sich schizophren erkrankte Patienten mit komorbidem Substanzabusus von Patienten mit einer drogeninduzierten Psychose anhand des Verlaufs der initialen Psychopathologie und prämorbiden Auffälligkeiten unterscheiden lassen.

[Psychotic disorders and drug abuse in adolescents]

OBJECTIVES

The relation between substance abuse and symptoms of psychosis as well as related disorders was evaluated among patients at the Hospital for Child and Adolescent Psychiatry and Psychotherapy of the University of Marburg.

METHODS

Using a child and adolescent version of the IRAOS (Instrument of the Retrospective Assessment of the Onset of Schizophrenia, Häfner et al., 1990), all patients with a co-morbid substance abuse were assessed. Patients with a drug-induced psychosis (n = 8) were compared to psychotic patients with co-morbid substance abuse and to patients with other psychiatric disorders and substance abuse (n = 30).

RESULTS

These three groups could be significantly distinguished on the basis of pre-morbid symptoms and pre-morbid functioning.

CONCLUSIONS

The IRAOS shows some evidence that psychotic patients with co-morbid substance abuse can be distinguished from patients with a drug-induced psychosis according to the course of the initial psychopathology and pre-morbid functioning.

Antioxidant activity of DL omega-phenyl-amino acid octyl esters with anti-inflammatory activity. Correlation of the structure with lipophilicity

The antioxidant activities (in vitro) and the lipophilicity (as RM values) of 12 DL-omega-phenyl-amino acid octyl esters with anti-inflammatory/analgesic activities were studied. The tested compounds were found to interact with 1,1-diphenyl-2-picrylhydrazyl stable free radical (DPPH), whereas most of them were essentially inactive in other tests. DL-2-Amino-4-(4-aminophenyl)butyric acid octyl ester was found to be the most active. The anti-inflammatory activity does not seem to be connected with O2-. or HO. scavenging activity at least under the experimental conditions applied. However, the interaction with DPPH was found to be correlated with their anti-inflammatory activity. Between the lipophilicity and the anti-inflammatory activity only a poor relationship exists. For a subgroup of the derivatives of the phenyl glycine octyl ester (1-8) a significant correlation was found between the RM values and the calculated clog P lipophilicity.

The correlation of serum hyaluronan of liver donors with posttransplant liver function

Primary organ non-function occurs in 2-17% of patients after liver transplantation (LTX). Liver function tests focus on hepatocytes, underestimating the importance of non-parenchymal cells such as endothelium. Liver endothelium metabolises hyaluronan (HA). The function of endothelium can be estimated by measuring the concentration of HA in serum. We evaluated two organ donor groups, the first with HA levels below 200 microg/l and the second with HA levels above 200 microg/l. Both groups degraded more than 60% of HA during the first 6 h after reperfusion. Determination of hyaluronic acid in patients after LTX gives valuable information about the functional state of liver endothelium. It does not necessarily parallel the release of transaminases. In this study, there was no correlation between the levels of HA in the donor and posttransplant liver function. High HA in organ donors are most likely a consequence of different degrees of trauma and a higher release of HA into the circulation rather than impaired endothelial function.

Atypical neuroleptics in child and adolescent psychiatry

Atypical neuroleptics have enriched our treatment programmes, especially in childhood and adolescent schizophrenia. This article reviews the use of atypical neuroleptics in children and adolescents with schizophrenic disorder. It considers the receptor binding profile and pharmacological properties, indications, side effects, clinical applications and trials of atypical neuroleptics in comparison to the classical neuroleptic haloperidol in adolescent schizophrenia. Special emphasis is placed on the most common atypical neuroleptics clozapine, olanzapine and risperidone since most studies are carried out with these compounds, especially with clozapine. More clinically controlled trials have to be conducted since only one was performed so far. The place of the atypical neuroleptics is discussed and further studies are necessary in order to differentiate the indications tested so far and to find out if the spectrum of indications can be broadened.

Unilateral congenital oculomotor nerve palsy, optic nerve hypoplasia and pituitary malformation: a preliminary report

A newborn male presented with complete external third nerve palsy of his right eye immediately at birth. Pediatric examination and MRI of the skull revealed no abnormalities. At the age of six weeks, strabismus surgery was performed to facilitate amblyopia treatment. The muscles appeared small and fibrotic. At the age of ten weeks, a brow suspension of the upper lid and a second strabismus surgery were performed. The amblyopia treatment and patching, applied for half of the waking hours over a period of six weeks, were unsuccessful. At the age of six months, a relative pallor of the right optic nerve head became evident. At the age of three years, at a new examination because of growth deficiency, a second MRI revealed defects involving the pituitary region. We concluded that extraocular muscle abnormality or oculomotor nerve palsy was present together with optic nerve dysplasia and pituitary gland malformation.

Management of schizophrenia in children and adolescents. The role of clozapine

Clozapine is a dibenzodiazepine derivative with established antipsychotic efficacy in adult patients with schizophrenic psychoses. There are more than 15 studies that have also demonstrated the antipsychotic efficacy of clozapine in childhood and adolescent schizophrenia. The main advantages of clozapine treatment in this age group in comparison with typical antipsychotics are: (i) high antipsychotic efficacy during an acute schizophrenic episode; (ii) better improvement in chronic cases with a high load of negative symptoms; and (iii) markedly fewer extrapyramidal adverse effects and, therefore, fairly good tolerability. However, because of its possible adverse effects on the haemopoetic system (granulocytopenia, agranulocytosis), clozapine should not be used as first-line antipsychotic medication. Other adverse effects are related to the cardiovascular system (hypotonia, tachycardia or arrhythmia), the central nervous system (epileptic seizures, fever) and liver function (transient increases in levels of hepatic transaminases). Two other frequent adverse effects are hypersalivation and body-weight gain, which may present a particular problem in adolescents and young adults. Careful monitoring of haematological parameters and other adverse effects are preconditions for a successful treatment programme.

Cognitive functions and psychopathological symptoms in early-onset schizophrenia

Type and extent of objectively tested cognitive impairments (attention, verbal fluency, nonverbal reasoning) and their association with self-ratings (Paranoia Depression Scale; Frankfurt Complaint Questionnaire) and clinical assessments (Brief Psychiatric Rating Scale, Scales for the Assessment of Positive Symptoms and Negative Symptoms) of psychopathological symptoms were studied in a sample of 74 adolescents primarily suffering from chronic schizophrenia (DSM-III-R; mean duration of illness = 3.4 years), including 15 patients with a very early onset (< 14 years). Special consideration was given to the differentiation between positive and negative symptoms. In cross-sectional analyses, the schizophrenic adolescents were remarkably impaired in both cognitive functions (attention, reasoning) and psychopathological measures (BPRS, SANS, SAPS). However, factor analysis yielded orthogonal factors for cognitive and psychopathological parameters, and canonical correlation analyses did not find a significant correlation between these two areas. As the degree of objectively measured cognitive impairment in chronic schizophrenic adolescents cannot be predicted by the severity of individual psychopathological symptoms, a multidimensional evaluation of the symptomatology seems to be appropriate. Moreover, premorbid disturbances (motor and/or language developmental disorders) and onset characteristics (age, pattern, subdiagnosis), and their relationship to cognitive impairments were investigated. Premorbid disturbances were confirmed as risk factors for the subsequent occurrence of cognitive impairments.

[Atypical neuroleptics in child- and adolescent psychiatry]

Atypical neuroleptic drugs have enriched our treatment programs, especially in childhood and adolescent schizophrenia. Reviewed here is the use of atypical neuroleptics in children and adolescents with a schizophrenic disorder. The receptor binding profile and pharmacological properties, indications, side effects, clinical application, and trials of atypical neuroleptic drugs are compared to the classical neuroleptic drug haloperidol in the treatment of adolescent schizophrenia. Special attention is paid to the most common atypical neuroleptics clozapine, olanzapine and risperidone since most studies are carried out with these compounds, most often with clozapine. More clinically controlled trials have to be conducted since only one has been performed to date. The place of atypical neuroleptic drugs is discussed and further studies are necessary in order to differentiate, and eventually broaden the spectrum of the indications tested thus far.

Endothelin-1 plasma levels are not elevated in patients with obstructive sleep apnoea

Endothelin-1 (ET-1), a potent vasoconstrictor, is released mainly by vascular endothelial cells under the influence of hypoxia and other stimuli. ET-1 is related to endothelial dysfunction, as well as arterial and pulmonary hypertension, all of which are thought to be associated with obstructive sleep apnoea (OSA). This study evaluated venous plasma concentrations of ET-1 and noradrenaline and 24-h systemic blood pressure in 29 patients with OSA (age=56.9+/-1.6 yrs; body mass index=29.5+/-0.7 kg x m2 (mean+/-SEM)). Blood samples were taken in the morning, evening and during sleep. In the same way, the patients were assessed during a night of continuous positive airway pressure (CPAP) and after 13.9+/-1.4 months while still on CPAP. ET-1 levels were compared to those of control subjects, who were selected from in- and outpatients and were matched to patients for age, sex, presence of arterial hypertension and coronary artery disease. ET-1 plasma levels were not elevated in the patients compared to the controls (41.6+/-2.2 and 44.9+/-1.3 pg x mL(-1), respectively, p=0.20). The ET-1 concentration did not change significantly, neither during sleep nor in the first night on CPAP therapy, nor under long-term treatment with CPAP. ET-1 neither correlated to the severity of OSA nor to that of systemic hypertension. The results suggest that endothelin-1 does not play a crucial role in the pathophysiology of obstructive sleep apnoea.

Atypische Neuroleptika in der Kinder- und Jugendpsychiatrie

Zusammenfassung: Atypische Neuroleptika haben unsere Therapiemöglichkeiten in der Kinder- und Jugendpsychiatrie verbessert. Dieser Artikel faßt die Anwendung der atypischen Neuroleptika bei Kindern und Jugendlichen mit schizophrenen Psychosen zusammen. Es werden das Rezeptor-Bindungsprofil, pharmakologische Eigenschaften, Indikationen, Nebenwirkungen, klinische Anwendungen und Studien der atypischen Neuroleptika, im Vergleich zu dem klassischen Neuroleptikum Haloperidol, berücksichtigt. Besondere Betonung wurde auf die am häufigsten verwendeten atypischen Neuroleptika Clozapin, Olanzapin und Risperidon gelegt, da weltweit die meisten Studien mit diesen Medikamenten durchgeführt worden sind. Der Stellenwert der atypischen Neuroleptika wird diskutiert und es werden weitere Studien gefordert, um die Indikationen zu differenzieren, und um zu sehen, ob das Indikationsspektrum erweitert werden kann.