Pain and personality in duodenal ulcer: a preliminary report

Personality factors measured by the Cattell's 16 Personality Factor Questionnaire were assessed for 78 duodenal ulcer patients with moderate to severe pain and in 30 duodenal ulcer patients with mild or no pain. The two groups were comparable for relevant sociodemographic variables. Patients with moderate to severe pain were significantly more tender-minded, kindly, and tended to be more introspective and glum than those reporting mild or no pain. However, the reported differences are small; adjustment of the p values to avoid Type I errors makes these differences no longer statistically significant. These results must be considered preliminary; further studies are necessary to understand the topic better.

Pain symptoms in an adolescent Italian population

We have assessed the incidence of four types of self-reported pain symptoms (headache, pain in heart or chest, pain in lower back and muscle soreness) in a randomised sample of 1413 persons from a population of 93481 students aged 14-16 years in the Veneto region of Italy. In males, 26% reported moderate and 1.2% severe pain distress. In female, 35% and 3.7% reported moderate and severe pain respectively. Pain symptoms were positively correlated with anxiety and depressive symptoms and were more frequent in females.

Evidence for an inhibitory effect exerted by yeast NMN adenylyltransferase on poly(ADP-ribose) polymerase activity

We have previously reported for the first time the purification to homogeneity of the enzyme NMN adenylyltransferase (EC 2.7.7.1) from yeast and its major molecular and catalytic properties. The homogeneous enzyme was found to be a glycoprotein containing 2% carbohydrate and 1 mol of adenine residue and 2 mol of phosphate covalently bound per mole of protein. Such a stoichiometry, apparently consistent with that of ADP-ribose, prompted us to further investigate the possibility that NMN adenylyltransferase could be subjected to poly(ADP-ribosylation) in vitro in a reconstituted system. Poly(ADP-ribose) polymerase was purified to homogeneity from bull testis by means of a rapid procedure involving two batchwise steps on DNA-agarose and Reactive Blue 2 cross-linked agarose and a column affinity chromatography step on 3-aminobenzamide-Sepharose; the optimal conditions for the poly(ADP-ribosylation) of exogenous substrates were determined. When pure NMN adenylyltransferase was incubated in the presence of the homogeneous poly(ADP-ribose) polymerase, a marked inhibition of the polymerase was observed, both in the presence and in the absence of histones, while the activity of NMN adenylyltransferase was not affected. The inhibition could not be prevented by increasing the concentrations of either DNA or NAD. Mg2+ did not affect the activity or the inhibition. The significance of such a phenomenon is at present unknown, but it may be of biological relevance in view of the close topological and metabolic relationship between the two enzymes.

A double-blind comparison of mianserin and maprotiline in depressed medically ill elderly people

A double-blind, randomized 4-week mianserin vs maprotiline trial was conducted in 48 depressed geriatric medical inpatients. The drug dosages were up to 90 mg of mianserin and up to 150 mg of maprotiline per day. Efficacy was measured by the Geriatric Depression Scale, the Hopkins Symptom Check List depression subscale and the Clinical Global Impression Scale. The overall dropout figure was 27% of the sample. Side effects were relatively similar in the two treatment groups and suggested a safety profile somewhat better than that of the first-generation antidepressants. Mianserin showed some advantages in efficacy over maprotiline, particularly by the 4th week of the trial, but the overall figures of treatment responders were rather small (Geriatric Depression Scale: mianserin 48%, maprotiline 30%). Clinical trials vs placebo are needed to clarify the role of antidepressant pharmacotherapy in depressed geriatric medical inpatients.

Panic attacks and major depression after discontinuation of long-term diazepam abuse

A case is described of a patient with a history of several years of diazepam abuse (in the last 24 months at dosages of 120 mg/d). A tapering schedule was carried out during a 12-day stay in the hospital in which the diazepam dosage was reduced by a fixed quantity every day, corresponding to about ten percent of the initial dosage. Five days after discharge from the hospital the patient experienced panic attacks, for the first time, which continued until 13 days after discharge. By the 40th day, the patient was experiencing a major depressive episode, which improved after administration of clomipramine therapy. We suggest that a relatively quick withdrawal schedule (ten percent per day) is probably inadequate in preventing withdrawal reactions to long-acting benzodiazepines taken in high doses for an extended period of time.

A spectrophotometric method for the assay of pyrimidine 5'-nucleotidase in human erythrocytes

A new spectrophotometric assay for human erythrocyte pyrimidine 5'-nucleotidase using a continuous spectrophotometric method is described. The activity is detected by measuring uracil, which is produced by a coupled assay including cytidine deaminase and uridine nucleosidase. The results obtained with the continuous spectrophotometric method have been confirmed by high pressure liquid chromatography (HPLC) analysis. This procedure, not based upon inorganic phosphate formation and avoiding the use of radioactive material, offers significant advantages with respect to commonly adopted assays.

A double-blind, placebo-controlled study of alpidem, a novel anxiolytic of imidazopyridine structure, in chronically anxious patients

In this double-blind study alpidem, a new imidazopyridine anxiolytic drug, was compared with placebo to assess its efficacy and safety in severely anxious patients at the fixed dose of 150 mg/day (50 mg t.i.d.) for 3 weeks. Fifty-nine patients with a score of at least 18 on the Hamilton Rating Scale for Anxiety (HRSA) entered the trial after a 3- to 7-day placebo run-in period. Symptom improvement was evaluated with the HRSA, the State and Trait Anxiety Inventory (STAI-1 and STAI-2), a Visual Analogue Scale (VAS) and the Clinical Global Impression (CGI). Alpidem was more effective than placebo in improving mean HRSA (total score and factorial scores for somatic and psychic anxiety), STAI-1 and STAI-2 and VAS scores. The efficacy index of the CGI was better for alpidem than for placebo. Side effects were negligible in both groups. Alpidem appears to be a new interesting anxiolytic drug devoid of significant sedative effects on mental functions.

[Double-blind versus placebo comparison of single dose alpidem (50 mg or 75 mg) in a model of situational anxiety]

Alpidem (Ananxyl) is a new imidazopyridine anxiolytic. Two studies of single doses of alpidem (50 or 75 mg) versus placebo, involving 104 patients each, showed alpidem at these two doses to be effective in a human model for situational anxiety, which is the psychological state of patients awaiting cardiovascular examination or surgery. Clinical assessment showed no significant difference in safety between alpidem 50 mg and placebo. Conversely, at the dose of 75 mg, there was a higher incidence of drowsiness with alpidem than with placebo.

[Psychological factors associated with chronic pain]

Current knowledge of the complex relationship between chronic pain and its several psychological aspects is reviewed. After a word of caution concerning the selection biases frequently present in the samples described in the literature, the authors examine the relationships between pain and personality, pain and psychopathology and lastly pain and environment (stress). While chronic pain and depression share some neurochemical abnormalities suggesting new lines of research, much remains to be done to improve the clinical characterization of pain and notably its prognostic aspects.

The role of life events in the myasthenia gravis outcome: a one-year longitudinal study

We examined 51 patients suffering from myasthenia gravis (MG) and studied the relevance of stressful life events in relation to the course of the disease. Life events were assessed by means of the Paykel's Interview for Recent Life Events. The stage severity of MG was assessed by means of the Osserman and Genkins scale, twice per patient, at one year intervals. Simultaneously, life events were assessed for the 12 months preceding each of the 2 assessments of MG. Over the 2 MG evaluations 16 patients improved, 6 worsened and in 29 no change took place. Using life events data collected at the first interview, and applying a prospective design, no difference was found between patients who improved and those who remained unchanged or worsened. Life events reported at the second interview, as having occurred during the inter-assessment year, and collected according to a retrospective design, were significantly fewer in improvers than in non-improvers.

Fengabine, a new GABAmimetic agent in the treatment of depressive disorders: an overview of six double-blind studies versus tricyclics

Fengabine is a new GABAmimetic compound active in animal models predictive of antidepressant activity. The present overview reports the results of 6 double-blind trials versus tricyclics (TCAs) (3 in outpatients and 3 in inpatients). Overall, 398 adult patients (149 males and 249 females) were treated; 194 with fengabine and 204 with TCAs (98 clomipramine, 63 amitriptyline and 43 imipramine). 284 suffered from major depression (MD) (including major depressive disorder and bipolar disorder, depressed; DSM III) and 114 from minor depression (MiD) including dysthymic disorder, atypical depression and adjustment disorder with depressive mood (DSM III). Dosage ranged from 600 to 2,400 mg/day for fengabine and 50 to 200 mg/day for TCAs. Efficacy was evaluated with the HAM-D scale. 311 subjects (154 fengabine and 157 TCAs) ended the 4-week treatment period. Considering the whole sample and mean IAM-D scores, no significant differences emerged between the 2 treatment groups at any of the assessment periods. Because of a significant treatment x type of depression interaction, MD and MiD were analysed separately, and a different trend appeared in the 2 subgroups with TCAs behaving slightly better than fengabine in MD and fengabine performing slightly better than TCAs in MiD. Using the physician's clinical improvement, 74% of patients under fengabine and 72% of those under TCAs were rated as improved or much improved. Side effects, particularly of the anticholinergic type were significantly more frequent in the TCAs group. Gamma-GT were more frequently altered in the fengabine group (30.4 vs. 10.5%); this increase was interpreted as a consequence of enzymatic induction. Lastly, more patients taking fengabine exhibited an increase in cholesterol values.

DST in chronic pain patients not suffering from major depression

The relationship between chronic pain and depression is complex, and nonorganic chronic pain has been hypothesised (at least in some cases) as the expression of an underlying affective disturbance. Postdexamethasone cortisol nonsuppression was assessed in two groups of patients with chronic organic (n = 43) and nonorganic (n = 20) pain, none of them suffering from a major depressive disorder. Non-suppression occurred in 16.3% of the organic group and 20% of the nonorganic one. No difference emerged between the two groups for mean postdexamethasone cortisol values. The DST test results did not suggest the existence of a close relationship between chronic pain and major depressive disorder; however, a wider relationship between chronic pain and affective disturbances, at least in a subgroup of patients, cannot be ruled out.

A comparative study of some properties of cytidine deaminase from Escherichia coli and chicken liver

The molecular and kinetic properties of cytidine deaminase from E. coli and chicken liver show several interesting differences and similarities: 1. Both enzymes possess an oligomeric structure, and linear kinetics. 2. The chicken liver enzyme is strictly dependent on the presence of reducing agents and presents a microheterogeneity in the pure preparation. 3. Both enzymes display identical specificity and share a rapid-equilibrium random Uni-Bi mechanism of catalysis. 4. The chicken liver enzyme is inhibited competitively by dTTP, CMP and dCMP.

Longitudinal evaluation of psychological distress in medical geriatric in-patients

A longitudinal evaluation of the degree and type of psychological distress was carried out in 50 geriatric medical in-patients, using the Symptom Distress Checklist. They were tested within three days of admission, after 12-15 days of hospital stay, and 20-30 days after discharge. The first two evaluations showed significantly higher distress than the third for almost all the subscales. Scores indicating a significant depressive distress decreased from 70 per cent (first evaluation) and 76 per cent (second evaluation) to 34 per cent at the third one. The number of patients with significant distress for the other SCL-90 subscales was, at the third evaluation, rather low. Our data hence seem to show that the phenomenon of psychological distress in the hospital setting is transitory, and mainly arises from the factors of 'disease' and 'hospitalization'. However, in the case of some particular aspects of psychological distress, such as depression, whilst most patients overcome it, one out of three still presents a significant degree of suffering after returning home.

Personality factors in chronic gastric and duodenal ulcers: a controlled study

The personality profiles, as evaluated with Cattell's 16 personality factors test (16 PF), were compared in 25 subjects with gastric ulcer, 25 with duodenal ulcer and 25 healthy controls. Subjects were matched for sex, age, education, geographical area of living and duration of illness (only for patients). The profiles of the gastric and duodenal ulcer patients were substantially similar and characterized by greater anxiety, dependence, introversion, low ego strength and greater adaptability as compared to the controls. Patients with gastric ulcer, however, seemed to be slightly more disturbed than those with duodenal ulcer.

Results of dexamethasone suppression test in early Alzheimer dementia

The frequency of an abnormal response to the Dexamethasone Suppression Test (DST) was examined in 24 non-depressed patients in the early stages of Alzheimer dementia. Results were compared with those obtained in 51 geriatric medical inpatients: 15 with major depression, 18 with dysthymic disorder and 18 normal controls. As an abnormal lack of suppression was found in 9 demented patients, in 9 with major depression, 1 with dysthymic disorder and in 2 the normal controls, it appears that DST alone is not useful in distinguishing dementia, even in its early stages, from major depression. In our experience abnormal DST results in demented patients were unrelated to mood.

[Type A personality and risk of post-infarction coronary events]

The purpose of this study was to verify the prevalence of Coronary-prone Behaviour Pattern in a group of eighty-eight patients recovering from their first episode of myocardial infarction. These patients were followed for a period of 4 years to verify the eventual appearance of coronary events, after their first myocardial infarction, with high Coronary-prone Behaviour Pattern levels. The results showed that the number of subjects who died from recurrent myocardial infarction was nearly twice as high in type B, non coronary-prone subjects, as in type A subjects. The Authors hypothesize that specific ways of coping with stressful events adopted by type A subjects may constitute a protection factor as regards the risk of death from recurrent myocardial infarction.

An integrated approach to the assessment of family adjustment to acute lymphocytic leukemia in children

This study evaluated psychological distress, social support and adjustment to the disease of 69 parents of 35 children suffering from acute lymphocytic leukemia. The study dealt with the initial phase of the disease. The following rating scales were used: the Symptom Distress Checklist-90, the Social Support Questionnaire and the Family Adjustment Scale. Psychological distress of the mothers was negatively correlated with their and their child's adjustment to the disease. A similar trend was found for fathers but the correlations reached statistical significance only for fathers' adjustment. Social support as evaluated by the 2 parents was positively correlated with their and their child's adjustment to the disease experience.

Clinical correlates of ECT-resistant depression in the elderly

Clinical findings in a group of 11 patients who failed to respond to at least one course of antidepressant (usually tricylic) treatment and at least seven bilateral electroconvulsive treatments (ECTs) were compared with the findings in a group of 19 patients with similar sociodemographic characteristics who were responsive to ECT. The major correlates of ECT nonresponse were onset of physical illness during the index episode, fewer life events preceding the onset of the index episode, and a higher frequency of preceding depressive episodes of longer duration in the nonresponder group.

Locus of control, life events and treatment outcome in alcohol dependent patients

We investigated the relationship of locus of control and life events to outcome of treatment at 6 months in 67 patients with alcohol dependence. Outcome was less favourable in patients with pre-treatment scores indicating external locus of control than in those with internal locus of control. Furthermore, patients with relapse in the follow-up period experienced more independent life events with moderate to severe objective negative impact than those with more favourable outcome. These results suggest that locus of control may be of clinical use in formulating treatment and prognosis, and that the occurrence of life events may influence outcome. The results are discussed in relation to strategies for treatment and prevention of relapse.