The lessons of platelet monoamine oxidase

Psychiatrie et épidémiologie

L’épidémiologie psychiatrique s’est beaucoup développée depuis trente ans. Après avoir rappelé les définitions et méthodes fondamentales en épidémiologie, nous décrivons des progrès accomplis en épidémiologie psychiatrique. Parmi eux, la définition des cas, les techniques d’identification des cas, et la recherche de facteurs de risque sont présentés ici. Pour les illustrer, certaines connaissances actuelles sur les facteurs de risque dans la schizophrénie et la dépression sont brièvement décrits. Ensuite, les travaux en psychiatrie de l’enfant sont brièvement présentés en insistant sur quelques difficultés spécifiques à la recherche en pédopsychiatrie. Finalement, après avoir fait le point de la situation française, quelques opinions communes qui freinent l’essor de la recherche épidémiologique sont passées en revue. Les conclusions soulignent la possibilité et la nécessité de développer cette approche multi-disciplinaire en psychiatrie.

Dopamine and serotonin metabolism in response to chronic administration of fluvoxamine and haloperidol combined treatment

Treating primary 'negative symptoms' of schizophrenia with a combination of a typical antipsychotic and a selective serotonin reuptake inhibitor, is more effective than with antipsychotic alone and is similar to the effect of the atypical antipsychotic, clozapine. The mechanism of this treatment combination is unknown and may involve changes in dopaminergic and serotonin systems. We studied dopamine and serotonin metabolism in different rat brain areas at 1.5 and 24 h after the last dosage of chronic treatment (30 days), with haloperidol plus fluvoxamine, each drug alone, and clozapine. Haloperidol-fluvoxamine combination, haloperidol, and clozapine treatments increased striatal and frontal cortex dopamine turnover and reduced striatal tyrosine hydroxylase activity at 1.5 h. At 24 h both dopamine turnover and tyrosine hydroxylase activity were reduced. Thus, in chronically treated animals, release of striatal dopamine increases following a drug pulse and returns to baseline by 24 h. Serotonin and 5-hydroxyindoleacetic acid concentrations were decreased at 1.5 h in haloperidol-fluvoxamine and clozapine groups and returned to normal levels by 24 h. A limited behavioral assessment showed that treatment with haloperidol plus fluvoxamine reduced motor activity compared to haloperidol, and increased sniffing compared to haloperidol, fluvoxamine and clozapine. These findings indicate that combining antipsychotic with SSRI results in specific changes in dopaminergic and serotonergic systems and in behavior. The possibility that these may be relevant to the mechanism underlying the clinical effectiveness of augmentation treatment warrant further study.

Inhibition of monoamine oxidases by haloperidol and its metabolites: pharmacological implications for the chemotherapy of schizophrenia

The effect of haloperidol and its metabolites on human platelet monoamine oxidase B (MAO-B) and human placenta monoamine oxidase A (MAO-A) in vitro has been investigated. We found that 4-(4-chlorophenyl)-1-[4-(4-fluorophenyl)-4-oxobutyl]-pyridinium (HP+), 4-(4-chlorophenyl)-1-[4-(4-fluorophenyl)-4-oxobutyl]-1,2,3,6- tetrahydropyridine (HTP) and 4-chlorophenyl-1,2,3,6-tetrahydropyridine (CPTP) are potent inhibitors of MAO. HP+ appeared to be a reversible, uncompetitive and selective MAO-B inhibitor with a Ki of 0.83 microM. HTP was found to be an irreversible, uncompetitive and selective MAO-B inhibitor (Ki of 1.84 microM). CPTP inhibits both MAO-A and MAO-B. Some other haloperidol metabolites, i.e. 4-(4-chlorophenyl)-4-hydroxypyridine (CPHP), 4-(4-chlorophenyl)-1-[4-(4-fluorophenyl)-4-oxobutyl]-1,2,3,6- tetrahydropyridine N-oxide (HTPNO) and reduced haloperidol (RHAL), do not inhibit MAO to any appreciable degree at concentrations up to 100 microM. The results suggest that haloperidol metabolites may contribute to the reduction of platelet MAO-B activity in schizophrenic patients undergoing neuroleptic chemotherapy. An examination of the literature reveals that schizophrenic patients with low platelet MAO activity exhibit a strong association with the use of haloperidol. Other possible pharmacological implications of the inhibition of MAO activity are discussed.

A kinetic analysis of platelet monoamine oxidase activity in patients with panic attacks

A kinetic analysis of platelet monoamine oxidase (MAO) was performed in 22 patients with panic disorder and 14 normal controls, using tyramine as a substrate. Patients and controls did not differ significantly for either Km or Vmax, when same sex contrasts were carried out. The results do not support some studies that have shown elevated MAO activity in patients with panic attacks. The reasons for the discrepancies between previous studies and the present one are explored.

Enzyme activity and behavior in hyperactive children grown up

Thirty-one men, originally seen as children for problems with overactivity, distractibility, and impulsiveness, were reevaluated at ages 21-23 years. Subjects were interviewed and tested and provided a blood sample for analyses of dopamine-beta-hydroxylase (DBH), monoamine oxidase (MAO), and catechol-O-methyl-transferase (COMT). A series of Pearson correlations between the biological variables and psychological measures revealed that MAO levels were negatively associated with measures of drug involvement, cigarette use, fire-setting, and sensation seeking; DBH levels were positively associated with measures of sensation-seeking; and COMT levels were negatively associated with a measure of hostility and positively correlated with a measure of impulsiveness.

Physiological and psychological factors as predictors of alcoholism risk

This chapter synthesizes data accruing since January 1984 from studies of populations at elevated risk for the future development of alcoholism. These recent data demonstrate the continued potential importance of the decreased intensity of reaction to ethanol in sons of alcoholics, a conclusion bolstered by replications of the less intense postethanol subjective ratings by the higher-risk group, as well as their demonstration of less intense changes in several hormones following drinking. Additional studies also indicate a possible importance of neuropsychological test deficits in higher-risk boys studied in their preteen or early-teen years; information continues to support the importance of the aldehyde dehydrogenase isoenzyme pattern for the alcoholism risk among Orientals, but little consistent information has yet identified other enzyme activity levels or personality profiles as factors significantly different for higher-risk and lower-risk populations. Although studies of populations at high risk for the future development of alcoholism are relatively new, the findings to date have been interesting and could lead to important future developments in prevention and treatment of this prevalent disorder.

Platelet monoamine oxidase activity and schizophrenia--a myth that refuses to die?

Platelet monoamine oxidase (MAO) activity was determined using kynuramine as a substrate in a group of schizophrenic patients (n = 107), a group of healthy individuals (n = 100), and a group of psychiatric patients who were neither schizophrenics nor alcoholics (n = 110). No significant difference emerged between the schizophrenics and the other two groups, while a significant reduction in platelet MAO activity in a group of alcoholics (n = 60) was confirmed. Breaking down the schizophrenic group according to course of illness, phenomenology (paranoid-hallucinatory or not) and drug use did not lead to a significant deviation in platelet MAO activity in any of these subgroups. It can also be demonstrated from the literature that the results reached by most research teams question the usefulness of platelet MAO activity as a genetic marker for psychiatric illness.

Selective decreases in MAO-B activity in post-mortem brains from schizophrenic patients with type II syndrome

The activities of the A and B forms of the enzyme monoamine oxidase (MAO, E.C. 1.4.3.4) have been assessed with the substrates 5-hydroxytryptamine and benzylamine respectively in seven areas of the brains of 39 patients with schizophrenia and 44 control subjects. Whereas previous studies have found the enzyme unchanged in brain in schizophrenia, in this study there was a modest but significant decrease in the activity of MAO-B in frontal and temporal cortices and in amygdala. This decrease could not be accounted for by neuroleptic medication, age, sex or post-mortem variables. In a series of 22 patients who had been assessed in life, the reduction in MAO-B activity was found to be associated specifically with the presence of negative symptoms (flattening of affect and paucity of speech). The findings are therefore consistent with other evidence for structural and neurochemical change in the temporal lobe that have been associated with the type II (defect state) syndrome of schizophrenia. The change in enzyme activity is unlikely to be related to a change in monoamine metabolism but may reflect a disturbance in glial function. The change in MAO-B activity in brain in this study is confined to particular areas of brain and a subgroup of patients; it is thought to be entirely unrelated to earlier reports of reductions of enzyme activity in platelets, which are probably attributable to prolonged neuroleptic medication.

Platelet monoamine oxidase: low activity in cigarette smokers

Platelet monoamine oxidase (MAO) activity and plasma thiocyanate concentration (an index of smoking behavior) were measured in 109 normal male and female volunteers. MAO activity was significantly lower and plasma thiocyanate concentration significantly higher in smoking volunteers than in nonsmoking volunteers. A significant negative correlation between MAO activity and thiocyanate concentration was observed in female smokers (rs = 0.43, n = 36) but not for male smokers (rs = 0.02, n = 31). In nine smokers who gave up smoking, mean (+/- SD) platelet MAO activity increased significantly (17.5 +/- 4.1 nmole/mg/hour to 24.6 +/- 4.2 nmole/mg/hour). At the same time, mean (+/- SD) plasma thiocyanate concentrations decreased significantly (144 +/- 41 microM to 50 +/- 12 microM). These data suggest that smoking directly or indirectly reduced platelet MAO activity.

Platelet serotonin levels in panic disorder

Platelet serotonin levels were examined in 18 patients with panic disorder and compared to platelet serotonin levels of eight healthy controls. There was no statistically significant difference in the platelet serotonin levels between the two groups.