Impact on adherence and sustained virological response of psychiatric side effects during peginterferon and ribavirin therapy for chronic hepatitis C

BACKGROUND

The psychiatric side effects of interferon, often responsible for dose reduction or treatment discontinuation, represent a major limitation in the treatment of chronic hepatitis C (CHC).

AIM

To prospectively assess the impact on adherence and sustained virological response (SVR) of the occurrence of psychiatric side effects during peginterferon and ribavirin therapy for CHC.

METHODS

Ninety-eight consecutive treatment-naïve CHC patients receiving a standard course of peginterferon plus ribavirin were systematically screened for psychiatric side effects, using DSM-IV, at baseline and both during and after treatment.

RESULTS

Psychiatric side effects occurred in 38 patients (39%), mostly within the first 12 weeks (87%), and always consisted of mood disorders. Overall, 68% of patients achieved an SVR (71% of patients with mood disorders and 68% of those without; P = N.S.). Peginterferon and ribavirin dose reductions did not differ between patients with mood disorders and those without (46% vs. 37%, respectively; P = N.S. and 13% vs. 22%, respectively; P = N.S.). Anti-viral therapy had to be discontinued in four patients (nonresponse: two, hyperthyroidism: one, psychiatric event: one).

CONCLUSION

Early detection and appropriate management of psychiatric side effects during peginterferon and ribavirin therapy for CHC allow optimizing adherence and virological efficacy.

Genome-wide scan for genes involved in bipolar affective disorder in 70 European families ascertained through a bipolar type I early-onset proband: supportive evidence for linkage at 3p14

Preliminary studies suggested that age at onset (AAO) may help to define homogeneous bipolar affective disorder (BPAD) subtypes. This candidate symptom approach might be useful to identify vulnerability genes. Thus, the probability of detecting major disease-causing genes might be increased by focusing on families with early-onset BPAD type I probands. This study was conducted as part of the European Collaborative Study of Early Onset BPAD (France, Germany, Ireland, Scotland, Switzerland, England, Slovenia). We performed a genome-wide search with 384 microsatellite markers using non-parametric linkage analysis in 87 sib-pairs ascertained through an early-onset BPAD type I proband (AAO of 21 years or below). Non-parametric multipoint analysis suggested eight regions of linkage with P-values<0.01 (2p21, 2q14.3, 3p14, 5q33, 7q36, 10q23, 16q23 and 20p12). The 3p14 region showed the most significant linkage (genome-wide P-value estimated over 10 000 simulated replicates of 0.015 [0.01-0.02]). After genome-wide search analysis, we performed additional linkage analyses with increased marker density using markers in four regions suggestive for linkage and having an information contents lower than 75% (3p14, 10q23, 16q23 and 20p12). For these regions, the information content improved by about 10%. In chromosome 3, the non-parametric linkage score increased from 3.51 to 3.83. This study is the first to use early-onset bipolar type I probands in an attempt to increase sample homogeneity. These preliminary findings require confirmation in independent panels of families.

Multiplicité des syndromes associant symptômes dépressifs et maniaques: nécessité d’une approche dimensionnelle

The heterogeneity of mood states in bipolar disorders leads to some confusion in diagnostic and therapeutic strategies. Apart from the classical syndromes characterizing euphoric mania and melancholic depression, recent literature has pointed to alternative mood states associating both manic and depressive symptoms. This resulted in the definition of various syndromes including mixed states, dysphoric mania, agitated depression and more recently the depressive mixed state. This consequently raises the question of the best therapeutic strategies. As the boundaries between the various states associating both depressive and manic symptoms have yet to be clarified, there is a need to further discuss whether dimensional rather than categorical approaches could help to further refine their definitions and define the best therapeutic strategies. As stated by Kraepelin, mood episodes in manic-depressive illness were defined according to three dimensions: mood, cognitive processes, and motor and motivational drive. Cognitive and motor processes were regarded as quantitative items whose alterations may correspond to either an increase or a decrease. The current definitions are far from this dimensional approach. Thus, the current diagnostic criteria make it difficult to define mixed states. Such poorly convincing diagnostic criteria may account for the description of many other states exhibiting both manic and depressive symptoms. A dimensional approach could be useful to define mood states in bipolar disorders. These dimensions should progressive, from inhibition to excitation. Because tonality affects is not a dimension, the emotional reactivity (hyper-reactivity versus hypo-reactivity) represents an additional dimension that would help characterize these states better.

Decreased brain tryptophan availability as a partial determinant of post-partum blues

BACKGROUND

The post-partum blues is a transient mood alteration affecting most women a few days after delivery. Its stereotypic pattern of symptoms and time course, peaking on post-partum day 3-5, is suggestive of biological determinants superimposed on psycho-social factors. This study was designed to evaluate the possible role of the serotonin system during this period through assessment of brain tryptophan availability.

METHODS

Blood samples from 50 women were collected just before (D0) and 3 days after (D3) delivery. Based on plasma concentration of tryptophan, amino acids competing with tryptophan for transport across the blood-brain barrier and on their respective affinities for this transporter, a brain tryptophan availability index (BTAI) was calculated and its variation correlated with the intensity of post-partum blues evaluated through the Kennerley and Gath score at D3.

RESULTS

The BTAI showed a -15% decrease between D0 and D3 (p < 0.01, paired t-test). This decrease was not supported by a drop in plasma tryptophan since its level rather increased (+19%). There was no evidence for change in placental indoleamine-2,3-dioxygenase activity since the variation in plasma l-kynurenine (+12%) paralleled the change in tryptophan level. The decreased BTAI appeared the consequence of a dramatic increase in plasma levels of most amino acids, particularly the competitor aminoacids leucine, isoleucine, valine and tyrosine, during the early post-partum. This decrease in brain tryptophan availability was concomitant to the post-partum blues, whose intensity significantly correlated with the amplitude of BTAI variation (Pearson's coefficient -0.283, p < 0.05).

CONCLUSION

This study suggests that generalized, large amplitude metabolic and/or nutritional changes occurring in the early post-partum result in a transient decrease in brain tryptophan availability, partly accounting for the mood alteration referred to as the post-partum blues, a model for the triggering of puerperal mood disorder in vulnerable women.

Le baby blues : caractérisation clinique et influence de variables psycho-sociales

BACKGROUND

Within days following birth, most women are showing signs of mood changes, commonly named baby blues. Due to the frequency of this condition, baby blues is considered as a physiological state probably associated to biological modifications. Some studies have shown an existing link between the intensity of the baby blues and post-partum mood disorder. Therefore, it seems important to report and explore in more details the clinical background related the condition. The aim of this study was to demonstrate the possibility of a link between the intensity of the baby blues and some specific factors like maternal self-esteem, maternal childcare stress and social background, and also to define the symptoms of the baby blues from core dimensions in mood disorders.

METHOD

Mothers were recruited few hours before giving birth in a teaching hospital. At the third day following birth, an appointment was made to obtain the necessary information (past medical history and social history) and history of previous mood disorders. The mood was evaluated from the scale of the intensity of baby blues from Kennerly and Gath (1989). Moreover, evaluations at day 3 and week 6 post birth of self-esteem in relation to motherhood (Maternal self-report Inventory from Shea and Tronick, 1988), stress in relation with the care of the baby (Childcare Stress Inventory from Cutrona, 1983) and the social support (Social Support scale from Bruchon-Schweitzer, 1998) were undertaken.

RESULTS

95 women were included in the final sample. The intensity of the baby blues was explained by the type of pregnancy (p=0.002), a low maternal self-esteem (p=0.025), high levels of stress in relation to the care of the baby (p=0.074). The basic clinical characteristic of the baby blues seems to be due to an increase in the emotional reaction with a sharp feelings, leading to a lability rather than an affect sad tonality.

CONCLUSION

The baby blues seems to be a physiological process whereby the intensity is influenced by psychological factors. Consequently the diminution of self-esteem with motherhood and the increase of stress in relation to the care of the baby appeared to be significant factors in the intensity of the baby blues. Moreover, the clinical characteristics found in this study implies that the baby blues is more related to hypomania rather than to depression syndrome. This non-pathological state could be the first stage leading to a puerperal psychosis in predisposed women, which is mainly characterized by manic symptoms.

Observation et étude expérimentale de mycobactéries atypiques en aquariums d'eau douce et d'eau de mer

L'eau des aquariums est source de Mycobactéries atypiques qui peuvent être pathogènes pour l'homme et les poissons.

Une étude a été réalisée à l'aquarium du Musée de Zoologie de Nancy. La recherche de Mycobactéries a été effectuée dans 40 aquariums équipés de lampes germicides à UV : 11 bassins étaient alimentés en eau douce et 29 en eau de mer. Deux aquariums non équipés de système de désinfection ont également été analysés, les propriétaires de ces derniers ayant présenté un granulome cutané à M. marinum. L'action des UV sur M. marinum en suspension dans l'eau a été testée expérimentalement dans des bassins d'eau douce peuplés de Cichlidés.

Pour chaque aquarium, un échantillon de 250 ml a été prélevé. Les cultures après décontamination au lauryl sulfate de soude ont été réalisées sur milieu de Loewenstein.

Les résultats indiquent que, quel que soit l'aquarium, la présence de mycobactéries est constante. L'isolement des mycobactéries peut être gêné par la présence d'une flore bactérienne ou fongique importante (≥ 103 U.F.C./ml).

Les espèces les plus fréquemment isolées sont M. gordonae et M. fortuitum ; M. kansasii et M. marinum ont rarement été isolées (6140 aquariums). Différents facteurs peuvent intervenir sur la sélection des espèces. La salinité de l'eau limite le développement de certaines espèces, alors qu'elle permet la croissance de M. fortuitum. Dans notre étude, la température de l'eau n'a pas été un facteur sélectif. L'utilisation de lampes UV limite le nombre de Mycobactéries. Dans les bassins expérimentaux, les radiations UV se sont révélées très actives sur M. marinum en présence ou en l'absence de poissons. A l'inverse de M. gordonae, M. fortuitum est rarement isolée en présence d'UV. Un nombre important de poissons par aquarium augmente la flore bactérienne et mycobactérienne.

La prévention des infections à Mycobactéries atypiques chez l'homme comme chez les poissons devrait pouvoir être assurée par des mesures d'hygiène élémentaire.

Intérêt de l’analyse du tempérament chez les sujets bipolaires

Temperaments in bipolar subjects, as observed by Kraepelin and later re-dynamized and operationalized by Akiskal, have given rise to various studies, which results are hereby synthesized. In the light of these studies, the evaluation of temperaments allows to define subgroups of bipolar subjects, in order to sharpen diagnosis and therefore be able to propose more accurate treatment. A depressive temperament is linked to more frequent thymic relapses, on a depressive slope and it is associated with more frequent comorbid anxiety disorder and with an increased suicidal risk. A hyperthymic temperament is linked to manic relapses and is more likely to switch mood when patients were treated with antidepressants. A thymic episode that appears in a temperament of the opposite polarity will result in a mixed episode. Temperament evaluation is also helpful in choosing drug treatments. Practical clinical benefits can be gained from the study and analysis of those temperaments. As a further development, it could be useful to characterize euthymic period by a dimensional approach.

Structure and Deformations of Pd−Ni Core−Shell Nanoparticles

Homogeneous collections of Pd-Ni core-shell nanoparticles have been prepared by decomposition of metal-organic compounds and studied by several electron microscopy techniques: transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), high-resolution transmission electron microscopy (HRTEM), energy-filtered microscopy (EFTEM), and by X-ray photoelectron spectroscopy (XPS). The physical and chemical properties of the Pd shell are supposed to depend on its electronic properties, which are influenced by the presence of the Ni core and by the deformation in the Pd lattice. Here, the interfacial structure of Pd/Ni and the lattice deformations in the core and the shell are studied in detail. The catalytic properties of the pure metal and the bimetallic particles, toward CO oxidation, have been investigated.

Antidepressant-induced mania, rapid cycling and the serotonin transporter gene polymorphism

The genes involved in the serotonin system are major candidates in association studies on affective disorders and responses to antidepressants. We studied a functional polymorphism of the serotonin transporter (5-HTT) gene (a 44 bp insertion/deletion in the 5-HTT-linked polymorphic region (5-HTTLPR)) and lifetime history of antidepressant-induced mania (AIM) in a population of 305 patients with bipolar affective disorder. AIM was defined using a broad definition and a restrictive definition. No association was found between the "s" allele of the 5-HTTLPR and AIM for either definition. However, we found an association between the 5-HTTLPR and lifetime history of rapid cycling in a subsample of patients (for allele and genotype distributions: exact probability, p=0.0009 and chi(2)=9.4; df=1; p=0.002, respectively). These results may help to explain the conflicting association results obtained with the 5-HTT gene polymorphism, in particular with AIM. Indeed, the precise phenotype associated with the 5-HTT gene is unclear. The association between the "s" allele and rapid cycling may provide further evidence for an association between the 5-HTTLPR "s" allele and a pattern of affective instability.

Toxicity, bioaccumulation and tissue partitioning of dieldrin by the shrimp, Macrobrachium faustinum de Sassure, in fresh and brackish waters of Jamaica

The 2-week no observed effect (NOEC) and lowest observed effect (LOEC) concentrations of dieldrin were determined for Macrobrachium faustinum de Sassure in fresh and brackish waters. LOEC1,10,50,95 values in fresh water were 0.001, 0.003, 0.011 and 0.058 microg l(-1), respectively, and in brackish water, 0.00006, 0.00027, 0.00165, and 0.0172 microg l(-1), respectively. The 96-hr LC10, LC50 and LC95 values were 0.029, 0.123 and 0.771 microg l(-1), respectively. It is proposed that NOEC and LOEC be redefined to take into account the percentage of individuals affected, the severity of symptoms and the recovery of poisoned individuals. Two new terms are proposed--Median Observable Effect Concentration (MOEC) for pronounced toxic symptoms in most individuals but mortality in <50%, and Pronounced Observed Effect Concentration (POEC), which inflicts mortality in >50% individuals. Bioaccumulation of dieldrin by M. faustinum from surrounding fresh and brackish waters were rapid and fairly uniform for the first 48 h when the bioconcentration equilibrium (14.4 +/- 0.42 ng g(-1) at 0.001 microg l(-1) and 42.5 +/- 1.72 ng g(-1) at 0.01 phi g l(-1)) was achieved. Relative partitioning of residues (ng g(-1) wet wt.), after 24h exposure to 0.001 microg l(-1) of dieldrin in fresh water, in the different tissues was hepatopancreas > gonads > gills > large claws > muscle and exoskeleton. Shrimp which had accumulated 10.5 +/- 0.52 ng g(-1) dieldrin in fresh and brackish water, eliminated only about 52% of the residues after eight days in uncontaminated water.

[Pseudohypoparathyroidism or hypoparathyroidism? A misleading clinical presentation]

We report the case of a 27-year old woman who presented hypocalcemia and hyperphosphoremia during her first pregnancy. Her phenotype was in favor of Albright's hereditary osteodystrophy: short stature, obesity, round face, brachymetacarpy and mental retardation. However, the diagnosis of pseudohypopara thyroidism type Ia was ruled out due to low PTH level (10 pg/ml). The patient's 22q11 microdeletion was suspected and identified because of the association of severe neonatal hypocalcemia, abnormal face and renal malformation in her children. Deletion 22q11 leads to various syndromes, including Di George syndrome, also referred to as CATCH 22 syndrome (Cardiac defect (C), Abnormal face (A), Thymic hypoplasia (T), Cleft palate (C) and Hypocalcemia (H)). Retrospectively, the patient presented with symptoms suggestive of CATCH 22: abnormal face, hypernasal voice suggestive of velopharyngeal insufficiency, mental retardation, recurrent otitis in childhood. It is also noteworthy that there was an idiopathic thrombocytopenic purpura. In conclusion, while the phenotype was suggestive of Albright's hereditary osteodystrophy, the constatation of a low PTH level would cast doubt on this diagnosis. Furthermore, the 22q11 microdeletion should be searched by FISH (Fluorescence In Situ Hybridization) in all patients with hypopara thyroidism of unknown origin, even in the absence of cardiac malformations. Finally, it seems that patients with CATCH 22 would be predisposed to auto-immune disease as a result of thymic dysfunction.

New 8-hydroxyquinoline and catecholate iron chelators: influence of their partition coefficient on their biological activity

Four new hexadendate chelators, three hydroxyquinoline-based, Csox, O-Trensox, Cox750, and one catecholate-based CacCam-which have comparable skeletal structures and pFe, but widely different partition coefficients, (Kpart), 0.01, 0.02, 1 and 3.2 respectively, have been tested for their iron chelating efficacy in vitro by two methods. First, by their ability to remove iron from ferritin in solution or second, to remove iron from iron-loaded hepatocytes in vitro. Our objective was to ascertain the importance of Kpart and pFe, on the biological efficiency of the molecule. Previous studies proposed that an ideal value of Kpart of 1 should give maximum biological activity. Mobilization of iron by Csox and CacCAM from ferritin was similar and furthermore more efficient than desferrioxamine B. In the iron-loaded hepatocyte cultures, the three hydroxyquinoline chelators, although showing diversity in terms of lipophilicity, appeared to be very similar in their capacity to chelate iron. CacCAM, the unique catecholate, was the most efficient of the molecules tested, as well as being the least toxic in the cellular model despite having the lowest value of pFe. In conclusion, the use of the partition coefficient and pFe, as tools for predicting biological activity of iron chelators should be not generalized. Further studies are required in order to understand the influence of the structure on the biological activity of the molecule.

Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences

OBJECTIVES

many studies have reported a high degree of comorbidity between mood disorders, among which are bipolar disorders, and borderline personality disorder and some studies have suggested that these disorders are co-transmitted in families. However, few studies have compared personality traits between these disorders to determine whether there is a dimensional overlap between the two diagnoses. The aim of this study was to compare impulsivity, affective lability and intensity in patients with borderline personality and bipolar II disorder and in subjects with neither of these diagnoses.

METHODS

patients with borderline personality but without bipolar disorder (n=29), patients with bipolar II disorder without borderline personality but with other personality disorders (n=14), patients with both borderline personality and bipolar II disorder (n=12), and patients with neither borderline personality nor bipolar disorder but other personality disorders (OPD; n=93) were assessed using the Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), the Buss-Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Scale (BIS-7B).

RESULTS

borderline personality patients had significantly higher ALS total scores (P<0.05) and bipolar II patients tended to have higher ALS scores than patients with OPD (P<0.06). On one of the ALS subscales, the borderline patients displayed significant higher affective lability between euthymia and anger (P<0.002), whereas patients with bipolar II disorder displayed affective lability between euthymia and depression (P<0.04), or elation (P<0.01) or between depression and elation (P<0.01). A significant interaction between borderline personality and bipolar II disorder was observed for lability between anxiety and depression (P<0.01) with the ALS. High scores for impulsiveness (BISTOT, P<0.001) and hostility (BDHI, P<0.05) were obtained for borderline personality patients only and no significant interactions between diagnoses were observed. Only borderline personality patients tended to have higher affective intensity (AIM, P<0.07).

CONCLUSIONS

borderline personality disorder and bipolar II disorder appear to involve affective lability, which may account for the efficacy of mood stabilizers treatments in both disorders. However, our results suggest that borderline personality disorder cannot be viewed as an attenuated group of affective disorders.