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Kim J, Yang C, Joo HJ, Park RW, Kim GE, Kim D, Choi J, Lee JH, Kim E, Park SC, Kim K, Kim IB. Risks of complicated acute appendicitis in patients with psychiatric disorders. BMC Psychiatry 2022; 22:763. [PMID: 36471298 PMCID: PMC9721022 DOI: 10.1186/s12888-022-04428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Acute appendicitis often presents with vague abdominal pain, which fosters diagnostic challenges to clinicians regarding early detection and proper intervention. This is even more problematic with individuals with severe psychiatric disorders who have reduced sensitivity to pain due to long-term or excessive medication use or disturbed bodily sensation perceptions. This study aimed to determine whether psychiatric disorder, psychotropic prescription, and treatment compliance increase the risks of complicated acute appendicitis. METHODS The diagnosis records of acute appendicitis from four university hospitals in Korea were investigated from 2002 to 2020. A total of 47,500 acute appendicitis-affected participants were divided into groups with complicated and uncomplicated appendicitis to determine whether any of the groups had more cases of psychiatric disorder diagnoses. Further, the ratio of complicated compared to uncomplicated appendicitis in the mentally ill group was calculated regarding psychotropic dose, prescription duration, and treatment compliance. RESULTS After adjusting for age and sex, presence of psychotic disorder (odds ratio [OR]: 1.951; 95% confidence interval [CI]: 1.218-3.125), and bipolar disorder (OR: 2.323; 95% CI: 1.194-4.520) was associated with a higher risk of having complicated appendicitis compared with absence of psychiatric disorders. Patients who are taking high-daily-dose antipsychotics, regardless of prescription duration, show high complicated appendicitis risks; High-dose antipsychotics for < 1 year (OR: 1.896, 95% CI: 1.077-3.338), high-dose antipsychotics for 1-5 years (OR: 1.930, 95% CI: 1.144-3.256). Poor psychiatric outpatient compliance was associated with a high risk of complicated appendicitis (OR: 1.664, 95% CI: 1.014-2.732). CONCLUSIONS This study revealed a close relationship in the possibility of complicated appendicitis in patients with severe psychiatric disorders, including psychotic and bipolar disorders. The effect on complicated appendicitis was more remarkable by the psychiatric disease entity itself than by psychotropic prescription patterns. Good treatment compliance and regular visit may reduce the morbidity of complicated appendicitis in patients with psychiatric disorders.
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Affiliation(s)
- Junmo Kim
- grid.31501.360000 0004 0470 5905Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Chaeyoung Yang
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.411986.30000 0004 4671 5423Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Hyung Joon Joo
- grid.411134.20000 0004 0474 0479Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Rae Woong Park
- grid.251916.80000 0004 0532 3933Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ga Eun Kim
- grid.411076.5Department of Psychiatry, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Daeho Kim
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joonho Choi
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jun Ho Lee
- grid.49606.3d0000 0001 1364 9317Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Seon-Cheol Park
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Il Bin Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea. .,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Kim DJ, Mirmina J, Narine S, Wachtel J, Carbajal JM, Fox H, Cáceda R. Altered physical pain processing in different psychiatric conditions. Neurosci Biobehav Rev 2021; 133:104510. [PMID: 34952034 DOI: 10.1016/j.neubiorev.2021.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 01/07/2023]
Abstract
Several reports indicate either increased or decreased pain sensitivity associated with psychiatric disorders. Chronic pain is highly prevalent in many of these conditions. We reviewed the literature regarding experimental pain sensitivity in patients with major depression, bipolar disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and schizophrenia. Electronic searches were performed to identify studies comparing experimental pain in patients with these conditions and controls. Across 31 depression studies, reduced pain threshold was noted except for ischemic stimuli, where increased pain tolerance and elevated sensitivity to ischemic pain was observed. A more pervasive pattern of low pain sensitivity was found across 20 schizophrenia studies. The majority of PTSD studies (n = 20) showed no significant differences compared with controls. The limited number of bipolar disorder (n = 4) and anxiety (n = 9) studies precluded identification of clear trends. Wide data variability was observed. Awareness of psychiatric patients' pain perception abnormalities is needed for active screening and addressing physical comorbidities, in order to enhance quality of life, life expectancy and mental health.
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Affiliation(s)
- Diane J Kim
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Julianne Mirmina
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Serah Narine
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Jonathan Wachtel
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Jessica M Carbajal
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Helen Fox
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, New York, USA.
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3
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Zhou L, Bi Y, Liang M, Kong Y, Tu Y, Zhang X, Song Y, Du X, Tan S, Hu L. A modality-specific dysfunction of pain processing in schizophrenia. Hum Brain Mapp 2020; 41:1738-1753. [PMID: 31868305 PMCID: PMC7267942 DOI: 10.1002/hbm.24906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Clinical observations showed that schizophrenia (SCZ) patients reported little or no pain under various conditions that are commonly associated with intense painful sensations, leading to a higher risk of morbidity and mortality. However, this phenomenon has received little attention and its underlying neural mechanisms remain unclear. Here, we conducted two experiments combining psychophysics, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) techniques to investigate neural mechanisms of pain insensitivity in SCZ patients. Specifically, we adopted a stimulus-response paradigm with brief stimuli of different sensory modalities (i.e., nociceptive, non-nociceptive somatosensory, and auditory) to test whether pain insensitivity in SCZ patients is supra-modal or modality-specific, and used EEG and fMRI techniques to clarify its neural mechanisms. We observed that perceived intensities to nociceptive stimuli were significantly smaller in SCZ patients than healthy controls, whereas perceived intensities to non-nociceptive somatosensory and auditory stimuli were not significantly different. The behavioral results were confirmed by stimulus-evoked brain responses sampled by EEG and fMRI techniques, thus verifying the modality-specific nature of the modulation of nociceptive information processing in SCZ patients. Additionally, significant group differences were observed in the spectral power of alpha oscillations in prestimulus EEG and the seed-based functional connectivity in resting-state fMRI (seeds: the thalamus and periaqueductal gray that are key nodes in ascending and descending pain pathways respectively), suggesting a possible contribution of cortical-subcortical dysfunction to the phenomenon. Overall, our study provides insight into the neural mechanisms of pain insensitivity in SCZ and highlights a need for systematic assessments of their pain-related diseases.
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Affiliation(s)
- Lili Zhou
- CAS Key Laboratory of Mental HealthInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Yanzhi Bi
- CAS Key Laboratory of Mental HealthInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Meng Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional ImagingTianjin Medical UniversityTianjinChina
| | - Yazhuo Kong
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- CAS Key Laboratory of Behavioural ScienceInstitute of Psychology, Chinese Academy of SciencesBeijingChina
| | - Yiheng Tu
- Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolCharlestownMassachusetts
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental HealthInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Yanying Song
- Psychiatry Research CentreBeijing Huilonguan HospitalBeijingChina
| | - Xia Du
- Psychiatry Research CentreBeijing Huilonguan HospitalBeijingChina
| | - Shuping Tan
- Psychiatry Research CentreBeijing Huilonguan HospitalBeijingChina
| | - Li Hu
- CAS Key Laboratory of Mental HealthInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Department of Pain ManagementThe State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Reyad AA, Girgis E, Ayoub A, Mishriky R. Bruxism and psychotropic medications. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ayman Antoun Reyad
- Dr Antoun Reyad is a Senior Lecturer in Pharmacology, School of PharmacyUniversity of Wolverhampton
| | - Eriny Girgis
- Dr Girgis is a Dental Officer, Community Dental Service, City of Coventry Health Centre, Coventry and Warwickshire Partnership NHS Trust
| | - Amin Ayoub
- Dr Ayoub is an Associate Professor of DentistryNew York University New York
| | - Raafat Mishriky
- Dr Mishriky is Consultant Psychiatrist, Birmingham and Solihull Mental Health NHS Foundation Trust
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5
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Owen-Smith A, Stewart C, Sesay MM, Strasser SM, Yarborough BJ, Ahmedani B, Miller-Matero LR, Waring SC, Haller IV, Waitzfelder BE, Sterling SA, Campbell CI, Hechter RC, Zeber JE, Copeland LA, Scherrer JF, Rossom R, Simon G. Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. BMC Psychiatry 2020; 20:40. [PMID: 32005200 PMCID: PMC6995196 DOI: 10.1186/s12888-020-2456-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. METHODS Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N = 65,750), BD (N = 38,117) or schizophrenia or schizoaffective disorder (N = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. RESULTS Multivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85-1.95) or BD (OR = 1.71; 95% CI = 1.66-1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82-0.90). Having a MDD (OR = 2.59; 95% CI = 2.44-2.75) or BD (OR = 2.12; 95% CI = 1.97-2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. CONCLUSIONS Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.
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Affiliation(s)
- Ashli Owen-Smith
- Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA, 30303, USA. .,Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA.
| | - Christine Stewart
- 0000 0004 0615 7519grid.488833.cHealth Research Institute, Kaiser Permanente Washington, Seattle, USA
| | - Musu M. Sesay
- 0000 0000 9957 7758grid.280062.eCenter for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA
| | - Sheryl M. Strasser
- 0000 0004 1936 7400grid.256304.6Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA 30303 USA
| | - Bobbi Jo Yarborough
- 0000 0000 9957 7758grid.280062.eCenter for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Brian Ahmedani
- 0000 0000 8523 7701grid.239864.2Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA ,0000 0000 8523 7701grid.239864.2Depart Behavioral Health Services, Henry Ford Health System, Detroit, USA
| | - Lisa R. Miller-Matero
- 0000 0000 8523 7701grid.239864.2Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA ,0000 0000 8523 7701grid.239864.2Depart Behavioral Health Services, Henry Ford Health System, Detroit, USA
| | - Stephen C. Waring
- 0000 0004 0449 6525grid.428919.fEssentia Institute of Rural Health, Duluth, USA
| | - Irina V. Haller
- 0000 0004 0449 6525grid.428919.fEssentia Institute of Rural Health, Duluth, USA
| | - Beth E. Waitzfelder
- 0000 0000 9957 7758grid.280062.eCenter for Health Research, Kaiser Permanente Hawaii, Honolulu, USA
| | - Stacy A. Sterling
- 0000 0000 9957 7758grid.280062.eDivision of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Cynthia I. Campbell
- 0000 0000 9957 7758grid.280062.eDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Rulin C. Hechter
- 0000 0000 9957 7758grid.280062.eDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - John E. Zeber
- 0000 0001 2184 9220grid.266683.fSchool of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | | | - Jeffrey F. Scherrer
- 0000 0004 1936 9342grid.262962.bDepartment of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Rebecca Rossom
- 0000 0004 0461 4886grid.280625.bHealth Partners Institute, Minneapolis, USA
| | - Greg Simon
- 0000 0004 0615 7519grid.488833.cHealth Research Institute, Kaiser Permanente Washington, Seattle, USA
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6
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Banki L, Büki A, Horvath G, Kekesi G, Kis G, Somogyvári F, Jancsó G, Vécsei L, Varga E, Tuboly G. Distinct changes in chronic pain sensitivity and oxytocin receptor expression in a new rat model (Wisket) of schizophrenia. Neurosci Lett 2020; 714:134561. [DOI: 10.1016/j.neulet.2019.134561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022]
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7
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Yamamotová A, Hrabák P, Hříbek P, Rokyta R. Do multiple body modifications alter pain threshold? Physiol Res 2018; 66:S493-S500. [PMID: 29355376 DOI: 10.33549/physiolres.933804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In recent years, epidemiological data has shown an increasing number of young people who deliberately self-injure. There have also been parallel increases in the number of people with tattoos and those who voluntarily undergo painful procedures associated with piercing, scarification, and tattooing. People with self-injury behaviors often say that they do not feel the pain. However, there is no information regarding pain perception in those that visit tattoo parlors and piercing studios compared to those who don't. The aim of this study was to compare nociceptive sensitivity in four groups of subjects (n=105, mean age 26 years, 48 women and 57 men) with different motivations to experience pain (i.e., with and without multiple body modifications) in two different situations; (1) in controlled, emotionally neutral conditions, and (2) at a "Hell Party" (HP), an event organized by a piercing and tattoo parlor, with a main event featuring a public demonstration of painful techniques (burn scars, hanging on hooks, etc.). Pain thresholds of the fingers of the hand were measured using a thermal stimulator and mechanical algometer. In HP participants, information about alcohol intake, self-harming behavior, and psychiatric history were used in the analysis as intervening variables. Individuals with body modifications as well as without body modifications had higher thermal pain thresholds at Hell Party, compared to thresholds measured at control neutral conditions. No such differences were found relative to mechanical pain thresholds. Increased pain threshold in all HP participants, irrespectively of body modification, cannot be simply explained by a decrease in the sensory component of pain; instead, we found that the environment significantly influenced the cognitive and affective component of pain.
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Affiliation(s)
- A Yamamotová
- Department of Normal, Pathological and Clinical Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Sakson-Obada O. Pain perception in people diagnosed with schizophrenia: where we are and where we are going. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1344294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- O. Sakson-Obada
- Department of Psychology of Personality, Institute of Psychology, Adam Mickiewicz University, Poznan, Poland
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9
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Riquin É, Hubault P, Baize N, Lhuillier JP, Duverger P. Particularités de l’accompagnement en soins palliatifs d’un patient atteint de schizophrénie en secteur psychiatrique. ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Signs of bruxism and temporomandibular disorders among patients with bipolar disorder. BALKAN JOURNAL OF DENTAL MEDICINE 2017. [DOI: 10.1515/bjdm-2017-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Aim: There is an abundance of data regarding temporomandibular disorders (TMD) and bruxism specific to patients with bipolar disorder (BD). This study aimed to investigate the prevalence of TMD signs in subjects with and without BD. Material and Methods: The case group included 242 adult patients (103 men and 139 women) with BD and the control group included 187 subjects without BD (89 men and 98 women). The case and control groups were compared for the presence of bruxism and the signs of TMD including muscle and temporomandibular joint (TMJ) tenderness to palpation, limitation of maximum mouth opening, and TMJ sounds. Results: The frequency of at least one sign of TMD was significantly higher in patients with BD (191 ⁄242, 78.9%) than the control group (95 ⁄187, 50.8%) (p<0.001). Statistically significant differences were found between the case and control groups in terms of joint pain on palpation (p<0.05), masseter muscle pain on palpation (p<0.01), joint clicks (p<0.001) and limited mouth opening (p<0.001). Bruxism was significantly higher in patients with BD (49.6%) than the control group (19.8%) (p<0.001). Conclusions: Patients with BD appear to be more prone to having TMD signs and bruxism compared to the control group, but this comorbidity should be better understood by further studies.
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Sakson-Obada O, Chudzikiewicz P, Pankowski D, Jarema M. Body Image and Body Experience Disturbances in Schizophrenia: an Attempt to Introduce the Concept of Body Self as a Conceptual Framework. CURRENT PSYCHOLOGY 2016; 37:390-400. [PMID: 29563762 PMCID: PMC5845076 DOI: 10.1007/s12144-016-9526-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disturbances in body experience are described as key schizophrenia symptoms and early disease predictors. In case studies, different disorders relating to body experience are presented, but only a few empirical studies have aimed to distinguish the characteristics of body experience in schizophrenia, and these have been selected arbitrarily and without reference to cohesive theoretical model. To integrate this fragmentary approach, we propose a body self (BS) model, composed of: functions; representations (e.g., body image); and sense of body identity. The aim of the study was to determine whether the BS differentiates schizophrenic patients from healthy controls, and to investigate the relations between aspects of BS and a history of illness and clinical characteristics. The Body Self Questionnaire and the Positive and Negative Syndrome Scale were administered to 63 schizophrenic patients and 63 healthy subjects. The difference was found in the functions of the body-self (perceiving, interpreting, and regulating body experience), in the sense of body identity, and in one of three aspects of body image explored (e.g., acceptance of biological sex). Disturbances in BS were related to positive symptoms and to the number of hospitalizations for other diseases. Together, the results demonstrate that schizophrenia is more body experience than body image disorder, since the negative emotional attitude towards the body and acceptance of fitness were not distinctive for schizophrenia. The link between the disturbances in BS and the number of nonpsychiatric hospitalizations suggests that misinterpretation of body experiences in schizophrenia can promote a search for medical attention.
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Affiliation(s)
- Olga Sakson-Obada
- Institute of Psychology, Adam Mickiewicz University, 89 Szamarzewskiego Street, 60-568 Poznan, PL Poland
| | - Paulina Chudzikiewicz
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
| | - Daniel Pankowski
- Faculty of Psychology, University of Warsaw, Stawki 5/7 Street, 00-183 Warsaw, PL Poland
| | - Marek Jarema
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
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Alelú-Paz R, Carmona FJ, Sanchez-Mut JV, Cariaga-Martínez A, González-Corpas A, Ashour N, Orea MJ, Escanilla A, Monje A, Guerrero Márquez C, Saiz-Ruiz J, Esteller M, Ropero S. Epigenetics in Schizophrenia: A Pilot Study of Global DNA Methylation in Different Brain Regions Associated with Higher Cognitive Functions. Front Psychol 2016; 7:1496. [PMID: 27746755 PMCID: PMC5044511 DOI: 10.3389/fpsyg.2016.01496] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/20/2016] [Indexed: 12/29/2022] Open
Abstract
Attempts to discover genes that are involved in the pathogenesis of major psychiatric disorders have been frustrating and often fruitless. Concern is building about the need to understand the complex ways in which nature and nurture interact to produce mental illness. We analyze the epigenome in several brain regions from schizophrenic patients with severe cognitive impairment using high-resolution (450K) DNA methylation array. We identified 139 differentially methylated CpG sites included in known and novel candidate genes sequences as well as in and intergenic sequences which functions remain unknown. We found that altered DNA methylation is not restricted to a particular region, but includes others such as CpG shelves and gene bodies, indicating the presence of different DNA methylation signatures depending on the brain area analyzed. Our findings suggest that epimutations are not relatables between different tissues or even between tissues' regions, highlighting the need to adequately study brain samples to obtain reliable data concerning the epigenetics of schizophrenia.
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Affiliation(s)
- Raúl Alelú-Paz
- Biochemistry and Molecular Biology Unit, Department of Systems Biology, School of Medicine, University of AlcaláMadrid, Spain; Laboratory for Neuroscience of Mental Disorders Elena Pessino, Department of Medicine and Medical Specialties, School of Medicine, University of AlcaláMadrid, Spain; Department of Psychiatry, CIBERSAM, IRYCIS, Hospital Ramón y CajalMadrid, Spain
| | - Francisco J Carmona
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat Barcelona, Spain
| | - José V Sanchez-Mut
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat Barcelona, Spain
| | - Ariel Cariaga-Martínez
- Laboratory for Neuroscience of Mental Disorders Elena Pessino, Department of Medicine and Medical Specialties, School of Medicine, University of Alcalá Madrid, Spain
| | - Ana González-Corpas
- Biochemistry and Molecular Biology Unit, Department of Systems Biology, School of Medicine, University of Alcalá Madrid, Spain
| | - Nadia Ashour
- Biochemistry and Molecular Biology Unit, Department of Systems Biology, School of Medicine, University of Alcalá Madrid, Spain
| | - Maria J Orea
- Biochemistry and Molecular Biology Unit, Department of Systems Biology, School of Medicine, University of Alcalá Madrid, Spain
| | - Ana Escanilla
- Neurological Brain Bank, Parc Sanitari Sant Joan de Déu Barcelona, Spain
| | - Alfonso Monje
- Neurological Brain Bank, Parc Sanitari Sant Joan de Déu Barcelona, Spain
| | | | - Jerónimo Saiz-Ruiz
- Department of Psychiatry, CIBERSAM, IRYCIS, Hospital Ramón y Cajal Madrid, Spain
| | - Manel Esteller
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, L'Hospitalet de LlobregatBarcelona, Spain; Institució Catalana de Recerca i Estudis AvançatsBarcelona, Spain; Department of Physiological Sciences II, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Santiago Ropero
- Biochemistry and Molecular Biology Unit, Department of Systems Biology, School of Medicine, University of Alcalá Madrid, Spain
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Marrag I, Anes I, Hajji K, Essid N, Nasr M. [Bilateral concomitant oedipism: Two case reports]. Encephale 2016; 43:195-196. [PMID: 27349583 DOI: 10.1016/j.encep.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/15/2015] [Indexed: 10/21/2022]
Affiliation(s)
- I Marrag
- Service de psychiatrie, EPS Tahar Sfar, 5111 Mahdia, Tunisie.
| | - I Anes
- Service de psychiatrie, EPS Tahar Sfar, 5111 Mahdia, Tunisie
| | - K Hajji
- Service de psychiatrie, EPS Tahar Sfar, 5111 Mahdia, Tunisie
| | - N Essid
- Service de psychiatrie, EPS Tahar Sfar, 5111 Mahdia, Tunisie
| | - M Nasr
- Service de psychiatrie, EPS Tahar Sfar, 5111 Mahdia, Tunisie
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15
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Urban-Kowalczyk M, Pigońska J, Śmigielski J. Pain perception in schizophrenia: influence of neuropeptides, cognitive disorders, and negative symptoms. Neuropsychiatr Dis Treat 2015; 11:2023-31. [PMID: 26273205 PMCID: PMC4532169 DOI: 10.2147/ndt.s87666] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The causes and nature of insensitivity to pain in schizophrenia remain unknown. The role of endorphins and the association of cognitive dysfunction and negative symptoms are postulated. METHODS In this study, 43 patients with schizophrenia, five first-degree relatives, and 34 healthy controls were examined. Participants' plasma concentrations of substance P, β-endorphin, and calcitonin gene-related peptide (CGRP) were assessed. In patients, the Trail-Making Test, the Color Reading Interference Test (Stroop test), and the Positive and Negative Syndrome Scale Negative Syndrome subscale (PANSS N) test were performed. We also evaluated pain threshold using nociceptive reflex (RTIII) testing. RESULTS The mean β-endorphin concentration was about 20% higher in patients than in healthy controls (P<0.05). CGRP concentrations were significantly higher in patients than in controls (5.34 ng/mL versus 4.16 ng/mL; P<0.01). Subjects treated with antipsychotic polytherapy had higher concentrations of CGRP than did patients treated with second-generation antipsychotic monotherapy (5.92 ng/mL versus 5.02 ng/mL; P<0.05). There were no correlations between any biochemical parameters and Trail-Making Test, Stroop test, and PANSS N scores. There were no differences in RTIII among study groups. Strong negative correlation (P<0.001) was found between PANSS N scores and subjective pain threshold on the right lower limb. CONCLUSION The insensitivity to pain in schizophrenia is a complex phenomenon that is probably not related to changes in nociceptive pathways. Increase in β-endorphin level may be related to this issue, but it is uncertain if such concentration ensures analgesic effect. It is unknown if patients with schizophrenia in fact experience less pain. Cognitive impairment and excess negative symptoms may strongly influence the patient's expression of pain.
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Affiliation(s)
| | - Justyna Pigońska
- Department of Neurology and Movement Disorders, Medical University of Łódź, Łódź, Poland
| | - Janusz Śmigielski
- Department of Geriatrics, Healthy Ageing Research Centre (HARC), Medical University of Łódź, Łódź, Poland
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Newson PN, van den Buuse M, Martin S, Lynch-Frame A, Chahl LA. Effects of neonatal treatment with the TRPV1 agonist, capsaicin, on adult rat brain and behaviour. Behav Brain Res 2014; 272:55-65. [PMID: 24975423 DOI: 10.1016/j.bbr.2014.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 12/28/2022]
Abstract
Treatment of neonatal rats with the transient receptor potential vanilloid 1 (TRPV1) channel agonist, capsaicin, produces life-long loss of sensory neurons expressing TRPV1 channels. Previously it was shown that rats treated on day 2 of life with capsaicin had behavioural hyperactivity in a novel environment at 5-7 weeks of age and brain changes reminiscent of those found in subjects with schizophrenia. The objective of the present study was to investigate brain and behavioural responses of adult rats treated as neonates with capsaicin. It was found that the brain changes found at 5-7 weeks in rats treated as neonates with capsaicin persisted into adulthood (12 weeks) but were less in older rats (16-18 weeks). Increased prepulse inhibition (PPI) of acoustic startle was found in these rats at 8 and 12 weeks of age rather than the deficit commonly found in animal models of schizophrenia. Subjects with schizophrenia also have reduced flare responses to niacin and methylnicotinate proposed to be mediated by prostaglandin D2 (PGD2). Flare responses are accompanied by cutaneous plasma extravasation. It was found that the cutaneous plasma extravasation responses to methylnicotinate and PGD2 were reduced in capsaicin-treated rats. In conclusion, several neuroanatomical changes observed in capsaicin-treated rats, as well as the reduced cutaneous plasma extravasation responses, indicate that the role of TRPV1 channels in schizophrenia is worthy of investigation.
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Affiliation(s)
- Penny N Newson
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW 2308, Australia; Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
| | - Maarten van den Buuse
- Mental Health Research Institute, Parkville, Victoria 3052, Australia; School of Psychological Science, La Trobe University, Melbourne, Australia
| | - Sally Martin
- Mental Health Research Institute, Parkville, Victoria 3052, Australia
| | - Ann Lynch-Frame
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW 2308, Australia; Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
| | - Loris A Chahl
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW 2308, Australia; Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.
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Tiemann L, Heitmann H, Schulz E, Baumkötter J, Ploner M. Dopamine precursor depletion influences pain affect rather than pain sensation. PLoS One 2014; 9:e96167. [PMID: 24760082 PMCID: PMC3997524 DOI: 10.1371/journal.pone.0096167] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/03/2014] [Indexed: 01/15/2023] Open
Abstract
Pain is a multidimensional experience, which includes sensory, cognitive, and affective aspects. Converging lines of evidence indicate that dopaminergic neurotransmission plays an important role in human pain perception. However, the precise effects of dopamine on different aspects of pain perception remain to be elucidated. To address this question, we experimentally decreased dopaminergic neurotransmission in 22 healthy human subjects using Acute Phenylalanine and Tyrosine Depletion (APTD). During APTD and a control condition we applied brief painful laser stimuli to the hand, assessed different aspects of pain perception, and recorded electroencephalographic responses. APTD-induced decreases of cerebral dopaminergic activity did not influence sensory aspects of pain perception. In contrast, APTD yielded increases of pain unpleasantness. The increases of unpleasantness ratings positively correlated with effectiveness of APTD. Our finding of an influence of dopaminergic neurotransmission on affective but not sensory aspects of phasic pain suggests that analgesic effects of dopamine might be mediated by indirect effects on pain affect rather than by direct effects on ascending nociceptive signals. These findings contribute to our understanding of the complex relationship between dopamine and pain perception, which may play a role in various clinical pain states.
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Affiliation(s)
- Laura Tiemann
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
- * E-mail:
| | - Henrik Heitmann
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Jochen Baumkötter
- Department of Pediatrics, Technische Universität München, Munich, Germany
| | - Markus Ploner
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
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Engels G, Francke AL, van Meijel B, Douma JG, de Kam H, Wesselink W, Houtjes W, Scherder EJA. Clinical pain in schizophrenia: a systematic review. THE JOURNAL OF PAIN 2013; 15:457-67. [PMID: 24365324 DOI: 10.1016/j.jpain.2013.11.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/29/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Studies about clinical pain in schizophrenia are rare. Conclusions on pain sensitivity in people with schizophrenia are primarily based on experimental pain studies. This review attempts to assess clinical pain, that is, everyday pain without experimental manipulation, in people with schizophrenia. PubMed, PsycINFO, Embase.com, and Cochrane were searched with terms related to schizophrenia and pain. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Fourteen studies were included. Persons with schizophrenia appear to have a diminished prevalence of pain, as well as a lower intensity of pain when compared to persons with other psychiatric diseases. When compared to healthy controls, both prevalence and intensity of pain appear to be diminished for persons with schizophrenia. However, it was found that this effect only applies to pain with an apparent medical cause, such as headache after lumbar puncture. For less severe situations, prevalence and intensity of pain appears to be comparable between people with schizophrenia and controls. Possible underlying mechanisms are discussed. Knowledge about pain in schizophrenia is important for adequate pain treatment in clinical practice. PERSPECTIVE This review presents a valuable insight into clinical pain in people with schizophrenia.
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Affiliation(s)
- Gwenda Engels
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands.
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (NIVEL) and EMGO+ VU Medical Center, The Netherlands
| | - Berno van Meijel
- Department of Health, Sports and Welfare, Cluster Nursing, Inholland University of Applied Sciences and Parnassia Psychiatric Institute, The Netherlands
| | - Johanna G Douma
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands
| | - Heidi de Kam
- GGz Centraal, Center for Mental Healthcare, The Netherlands
| | | | - Wim Houtjes
- GGZ-VS School for Masters of Advanced Nursing Practice, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands
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Horiguchi N, Ago Y, Asada K, Kita Y, Hiramatsu N, Takuma K, Matsuda T. Involvement of spinal 5-HT1A receptors in isolation rearing-induced hypoalgesia in mice. Psychopharmacology (Berl) 2013; 227:251-61. [PMID: 23274507 DOI: 10.1007/s00213-012-2959-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE Isolation rearing in rodents causes not only abnormal behaviors which resemble the clinical symptoms of schizophrenia but also hypoalgesia in thermal nociception models. However, the mechanism of the hypoalgesia is not known. OBJECTIVES The present study investigated the effect of isolation rearing on acute pain and the descending pain inhibitory pathways in mice. RESULTS Rearing in isolation for 6 weeks from post-weaning reduced pain sensitivity in the hot plate test and acetic acid-induced writhing test. Isolation rearing also reduced the intraplantar capsaicin-induced licking behavior. Capsaicin increased c-Fos expression, a neuronal activity marker, in the spinal cord and primary somatosensory cortex both in group- and isolation-reared mice, but this effect did not differ between groups. On the other hand, c-Fos expression in the anterior cingulate cortex, periaqueductal gray matter, and rostral ventromedial medulla, but not in the spinal cord or somatosensory cortex, was enhanced by isolation rearing. Systemic administration of WAY100635 (serotonin (5-HT)1A receptor antagonist), but not of ketanserin (5-HT2 receptor antagonist), prazosin (α1-adrenoceptor antagonist), or yohimbine (α2-adrenoceptor antagonist), attenuated isolation rearing-induced hypoalgesia in capsaicin-induced licking behavior. Attenuation of isolation rearing-induced hypoalgesia was also observed following the intrathecal injection of WAY100635. Naloxone, an opioid receptor antagonist, did not affect the hypoalgesia in isolation-reared mice. CONCLUSIONS These findings suggest that isolation rearing causes hypoalgesia in mouse models of acute pain and imply that the spinal 5-HT1A receptor activation probably through descending serotonergic inhibitory pathway is involved in isolation rearing-induced hypoalgesia.
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Affiliation(s)
- Naotaka Horiguchi
- Laboratory of Medicinal Pharmacology, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamada-oka, Suita, 565-0871, Osaka, Japan
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Wojakiewicz A, Januel D, Braha S, Prkachin K, Danziger N, Bouhassira D. Alteration of pain recognition in schizophrenia. Eur J Pain 2013; 17:1385-92. [PMID: 23529960 DOI: 10.1002/j.1532-2149.2013.00310.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Schizophrenia patients display impaired recognition of their own emotions and those of others and deficits in several domains of empathy. The first-person experience of pain and observing others in pain normally trigger strong emotional mechanisms. We therefore hypothesized that schizophrenia patients would display impaired recognition and categorization of both their own pain and the pain of others. METHODS We studied 29 patients (18 men/11 women; 36 ± 13 years old) with paranoid schizophrenia-spectrum disorder and 27 healthy volunteers (20 men/7 women; 31 ± 9 years old) matched for age, gender, IQ and socio-cultural level. We assessed symptom severity and theory of mind. The participants' ability to detect and categorize pain in others was assessed with the sensitivity to expressions of pain (STEP) test, which is based on facial expressions, and another dynamic test involving a series of video sequences showing various pain-inducing events. The ability of patients to evaluate their own pain was assessed with the situational pain questionnaire (SPQ), which includes a series of questions assessing how one would expect to feel in different imaginary situations. Empathic tendencies were assessed with the interpersonal reactivity index. RESULTS Patients and controls differed significantly in STEP, pain video and SPQ scores. By contrast with control subjects, the patients' pain judgements were not correlated with their affective or cognitive empathic capacities. CONCLUSIONS Schizophrenic patients have a deficit of the identification and categorization of pain both in themselves and in others.
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Affiliation(s)
- A Wojakiewicz
- Unité de Recherche Clinique, Neuilly sur Marne, France
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21
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Laux-Biehlmann A, Mouheiche J, Vérièpe J, Goumon Y. Endogenous morphine and its metabolites in mammals: History, synthesis, localization and perspectives. Neuroscience 2013; 233:95-117. [DOI: 10.1016/j.neuroscience.2012.12.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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22
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La perception et l’évaluation de la douleur chez le schizophrène. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Lévesque M, Potvin S, Marchand S, Stip E, Grignon S, Pierre L, Lipp O, Goffaux P. Pain Perception in Schizophrenia: Evidence of a Specific Pain Response Profile. PAIN MEDICINE 2012; 13:1571-9. [DOI: 10.1111/j.1526-4637.2012.01505.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Sandner G, Meyer L, Angst MJ, Guignard B, Guiberteau T, Mensah-Nyagan AG. Neonatal ventral hippocampal lesions modify pain perception and evoked potentials in rats. Behav Brain Res 2012; 234:167-74. [DOI: 10.1016/j.bbr.2012.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/20/2012] [Accepted: 06/22/2012] [Indexed: 01/27/2023]
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25
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Boettger MK, Grossmann D, Bär KJ. Increased cold and heat pain thresholds influence the thermal grill illusion in schizophrenia. Eur J Pain 2012; 17:200-9. [PMID: 22865795 DOI: 10.1002/j.1532-2149.2012.00188.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with schizophrenia show decreased sensitivity towards clinical and experimental painful conditions. To date, the exact underlying mechanisms are not completely understood. One method to examine central integrative processes of pain perception is the thermal grill illusion (TGI), in which interlacing cold and warm bars create the illusion of a painful sensation. METHODS In 18 unmedicated patients with acute paranoid schizophrenia, cold and heat pain thresholds (CPT/HPT) as well as the perception of the TGI were examined and compared to 18 matched controls. In addition, symptom scales were obtained in order to relate pain perception to psychopathology. RESULTS CPT and HPT were significantly increased in patients compared to controls. In the range of TGI stimuli that were perceived painful by controls, patients did not indicate painful sensations, instead the stimulus response curve of TGI pain perception was shifted towards higher stimulus intensities, i.e., greater temperature differentials between cold and warm bars. This increase was comparable to that seen in CPT and HPT. There was no association with psychopathology for any pain parameter. CONCLUSIONS CPT and HPT, as well as temperature differentials for the perception of the TGI were increased in patients with schizophrenia as compared to controls. Similar to visual illusions, in which reduced contrast sensitivity has been shown to alter the perception of illusions, the discriminatory somatosensory deficit, which is reflected in higher CPT and HPT as well as the previously reported increased warmth perception thresholds, might account for the attenuation of TGI in patients.
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Affiliation(s)
- M K Boettger
- Institute of Physiology I, Teichgraben 8, University Hospital, Jena, Germany
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Jarcho JM, Mayer EA, Jiang ZK, Feier NA, London ED. Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. Pain 2012; 153:744-754. [PMID: 22386471 DOI: 10.1016/j.pain.2012.01.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/29/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022]
Abstract
Converging preclinical, and human epidemiological, neuroimaging, and genetic evidence suggests a central role for dopamine neurotransmission in modulating pain perception and analgesia. Dysregulation in dopamine signaling may modulate the experience of pain both directly, by enhancing or diminishing the propagation of nociceptive signals, and indirectly, by influencing affective and cognitive processes, which affect the expectation, experience, and interpretation of nociceptive signals. Hypersensitivity to pain and high rates of comorbid chronic pain are common in disorders linked with deficits in dopamine system function, including disorders of mood and affect, substance abuse, and Parkinson disease. Hyposensitivity to pain, however, is common in patients with schizophrenia, which has been linked with excessive dopamine neurotransmission. Although patients are typically affected most by the primary symptoms of their disorders, alterations in pain perception may further increase the burden of their illness, compromising their quality of life. The present review focuses on this relationship, and discusses clinical and potential therapeutic implications for both patients with dopamine-related disorders and those with chronic pain syndromes.
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Affiliation(s)
- Johanna M Jarcho
- National Institute of Mental Health, Bethesda, MD, USA Department of Medicine, Oppenheimer Family Center for Neurobiology of Stress, University of California, Los Angeles, CA, USA Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA Brain Research Institute, University of California, Los Angeles, CA, USA
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Retamero C, Paglia C. When patients do not hurt: silent acute abdomen in a patient with schizophrenia. Gen Hosp Psychiatry 2012; 34:210.e9-11. [PMID: 22154657 DOI: 10.1016/j.genhosppsych.2011.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/07/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022]
Abstract
The phenomenon of pain insensitivity in schizophrenia and other psychotic disorders has been described since the early 20th century. Medical conditions often present atypically in the seriously mentally ill patient. Emergency physicians, primary care practitioners, surgeons and psychiatrists must maintain a high index of suspicion for acute abdomen in seriously mentally ill patients who may exhibit a diminished or absent perception of pain. The authors present a case of an atypical presentation of acute abdomen in a patient with schizophrenia.
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Affiliation(s)
- Carolina Retamero
- Department of Psychiatry and Behavioral Science, Temple University School of Medicine, Philadelphia, PA, USA.
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Abstract
OBJECTIVE Whether schizophrenic patients are hypoalgesic or feel pain in the same manner as unaffected individuals can affect the primary care of schizophrenic patients, which often involves an assessment of pain severity made by a medical provider. This study was developed to explore the pain sensitivity of schizophrenics under conditions similar to those of a medical examination that included investigating for sites of pain. METHODS We developed 2 experimental models of pain induction using either pressure or ischemia and used them with 35 schizophrenic patients and 35 controls to record: (1) the stimulus intensity required to induce moderate pain; and (2) the pain intensity induced by a predetermined level of pressure. Clinical data were also collected for the schizophrenic group. RESULTS Schizophrenic patients needed less pressure (P=0.006) and a shorter duration of ischemia (P<0.001) than controls to record moderate pain, and they felt more pain from a fixed pressure stimulus (P<0.001). Pain histories for the previous 6 months and the heart rate variations that occurred during the tests did not differ between the groups. Pain responses were unrelated to the clinical characteristics of the schizophrenic patients, although hallucination production correlated with the pain felt during the fixed pressure test. DISCUSSION Under these conditions, schizophrenic patients were hypersensitive to pain induction compared with normal individuals. The hypoalgesia typically associated with schizophrenic patients may correspond to fewer than normal reports of pain, rather than to impaired sensations of pain. This should be taken into account during routine medical practice.
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de la Fuente-Sandoval C, Favila R, Gómez-Martín D, León-Ortiz P, Graff-Guerrero A. Neural response to experimental heat pain in stable patients with schizophrenia. J Psychiatr Res 2012; 46:128-34. [PMID: 21955439 DOI: 10.1016/j.jpsychires.2011.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/01/2011] [Accepted: 09/09/2011] [Indexed: 10/17/2022]
Abstract
Diminished pain sensitivity in schizophrenia has been reported in clinical studies. While the role of antipsychotic medications as a cause of the decrease in pain perception has been questioned, little is known about neural pain processing in treated schizophrenia patients. The aim of this pilot study was to examine the blood oxygen level-dependent (BOLD) changes induced by an experimental pain tolerance (endure) hot stimuli vs. non-painful stimuli in clinically stable patients with schizophrenia and in healthy controls. Twelve patients with schizophrenia, treated with risperidone and considered clinically stable, and 13 gender- and age-matched healthy controls were studied using painful and non-painful thermal stimuli in a periodic block design. BOLD changes were assessed using high field, 3 T functional Magnetic Resonance Imaging (fMRI). Pain tolerance in stable patients was not statistically different than healthy controls. Interestingly, patients showed higher activation in the primary somatosensory cortex (S1) and superior prefrontal cortex, and less activation in the posterior cingulate cortex and brainstem than controls. Our pilot study indicates that pain tolerance is similar in clinically stable patients and controls, although the neural processing of pain is not normalized with antipsychotic treatment.
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Canetta SE, Luca E, Pertot E, Role LW, Talmage DA. Type III Nrg1 back signaling enhances functional TRPV1 along sensory axons contributing to basal and inflammatory thermal pain sensation. PLoS One 2011; 6:e25108. [PMID: 21949864 PMCID: PMC3176819 DOI: 10.1371/journal.pone.0025108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/24/2011] [Indexed: 12/15/2022] Open
Abstract
Type III Nrg1, a member of the Nrg1 family of signaling proteins, is expressed in sensory neurons, where it can signal in a bi-directional manner via interactions with the ErbB family of receptor tyrosine kinases (ErbB RTKs). Type III Nrg1 signaling as a receptor (Type III Nrg1 back signaling) can acutely activate phosphatidylinositol-3-kinase (PtdIns3K) signaling, as well as regulate levels of α7* nicotinic acetylcholine receptors, along sensory axons. Transient receptor potential vanilloid 1 (TRPV1) is a cation-permeable ion channel found in primary sensory neurons that is necessary for the detection of thermal pain and for the development of thermal hypersensitivity to pain under inflammatory conditions. Cell surface expression of TRPV1 can be enhanced by activation of PtdIns3K, making it a potential target for regulation by Type III Nrg1. We now show that Type III Nrg1 signaling in sensory neurons affects functional axonal TRPV1 in a PtdIns3K-dependent manner. Furthermore, mice heterozygous for Type III Nrg1 have specific deficits in their ability to respond to noxious thermal stimuli and to develop capsaicin-induced thermal hypersensitivity to pain. Cumulatively, these results implicate Type III Nrg1 as a novel regulator of TRPV1 and a molecular mediator of nociceptive function.
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Affiliation(s)
- Sarah E. Canetta
- Department of Neurobiology and Behavior, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Edlira Luca
- Integrated Department, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Elyse Pertot
- Department of Biological Science, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Lorna W. Role
- Department of Neurobiology and Behavior, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - David A. Talmage
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Department of Pharmacological Science, State University of New York at Stony Brook, Stony Brook, New York, United States of America
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Boyette-Davis J, Fuchs PN. Chronic administration of phencyclidine produces decreased sensitivity to mechanical stimulation in the absence of altered affective behavior: Implications for pain processing in schizophrenia. Neurosci Lett 2011; 498:153-7. [DOI: 10.1016/j.neulet.2011.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/29/2011] [Accepted: 05/02/2011] [Indexed: 11/16/2022]
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Arnaiz A, Zumárraga M, Díez-Altuna I, Uriarte JJ, Moro J, Pérez-Ansorena MA. Oral health and the symptoms of schizophrenia. Psychiatry Res 2011; 188:24-8. [PMID: 21055830 DOI: 10.1016/j.psychres.2010.09.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 09/10/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
The objectives of this study were to evaluate the oral health of a group of schizophrenic outpatients and a control group without psychiatric illness. The study also aimed to assess the influence of positive and negative symptomatology on oral health among outpatients with schizophrenia. The DMF-T Index (sum of decayed, missing and filled teeth) and the Community Periodontal Index of Treatment Needs (CPITN) were assessed in both groups. We evaluated the psychopathological state of the patient group using the Positive and Negative Syndrome Scale (PANSS). The schizophrenic patients had higher scores than the control group with respect to decayed teeth (4.39 vs. 0.72), missing teeth (5.66 vs. 1.50), the DMF-T index (13.51 vs. 7.8) and CPITN (2.32 vs. 1.04); and lower scores for filled teeth (3.53 vs. 5.54). The PANSS negative subscale score correlated positively with the oral health variables studied, whereas the PANSS positive subscale score correlated negatively and exclusively with the number of missing teeth. Age and smoking status affected oral health in both groups, but even when the influence of these factors was considered, the oral health of the patients was poorer than that of the control group.
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Affiliation(s)
- Ainara Arnaiz
- Servicio de Rehabilitación, Hospital de Zamudio, Osakidetza, Zamudio, Vizcaya, Spain.
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TRP Channels and Psychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 704:987-1009. [DOI: 10.1007/978-94-007-0265-3_51] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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de la Fuente-Sandoval C, Favila R, Gómez-Martin D, Pellicer F, Graff-Guerrero A. Functional magnetic resonance imaging response to experimental pain in drug-free patients with schizophrenia. Psychiatry Res 2010; 183:99-104. [PMID: 20609569 DOI: 10.1016/j.pscychresns.2010.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 02/06/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
Clinical evidence suggests that there is decreased pain sensitivity in schizophrenia; however, the neurobiological mechanism of this decrease remains unknown. Using functional magnetic resonance imaging, we examined the blood oxygen level-dependent (BOLD) changes induced by experimental pain-tolerance (endure) hot stimuli vs. non-painful stimuli during an acute psychotic episode in 12 drug-free patients with schizophrenia and in 13 gender- and age-matched healthy controls. The analyses revealed that patients showed a greater BOLD response at S1 compared with controls but a reduced BOLD response in the posterior cingulate cortex (PCC), insula, and brainstem during pain-tolerance stimuli. Pain-tolerance temperature was higher in patients than in healthy controls. BOLD response in the insula positively correlated with unpleasantness and temperature in controls, but this effect was not observed in patients. S1 BOLD response positively correlated with unpleasantness in patients but not in controls. These initial results confirm that unmedicated patients with schizophrenia have a higher pain tolerance than controls, decreased activation in pain affective-cognitive processing regions (insula, PCC, brainstem), and an over-activation of the primary sensory-discriminative pain processing region (S1). These pilot results are the first to explore the mechanism driving altered pain sensitivity in schizophrenia.
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Abstract
Historically, drug research targeted to pain treatment has focused on trying to prevent the propagation of action potentials in the periphery from reaching the brain rather than pinpointing the molecular basis underlying the initial detection of the nociceptive stimulus: the receptor itself. This has now changed, given that many receptors of nociceptive stimuli have been identified and/or cloned. Transient Receptor Potential (TRP) channels have been implicated in several physiological processes such as mechanical, chemical and thermal stimuli detection. Ten years after the cloning of TRPV1, compelling data has been gathered on the role of this channel in inflammatory and neuropathic states. TRPV1 activation in nociceptive neurons, where it is normally expressed, triggers the release of neuropeptides and transmitters resulting in the generation of action potentials that will be sent to higher CNS areas where they will often be perceived as pain. Its activation also will evoke the peripheral release of pro-inflammatory compounds that may sensitize other neurons to physical, thermal or chemical stimuli. For these reasons as well as because its continuous activation causes analgesia, TRPV1 has become a viable drug target for clinical use in the management of pain. This review will provide a general picture of the physiological and pathophysiological roles of the TRPV1 channel and of its structural, pharmacological and biophysical properties. Finally, it will provide the reader with an overall view of the status of the discovery of potential therapeutic agents for the management of chronic and neuropathic pain.
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Affiliation(s)
- Andrés Jara-Oseguera
- Departamento de Biofísica, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico
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Autié A, Montreuil M, Moulier V, Braha S, Wojakiewicz A, Januel D. Douleur et schizophrénie : mythe et réalité. Encephale 2009; 35:297-303. [DOI: 10.1016/j.encep.2008.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 04/11/2008] [Indexed: 11/25/2022]
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Potvin S, Grignon S, Marchand S. Human evidence of a supra-spinal modulating role of dopamine on pain perception. Synapse 2009; 63:390-402. [DOI: 10.1002/syn.20616] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Becker A, Grecksch G, Zernig G, Ladstaetter E, Hiemke C, Schmitt U. Haloperidol and risperidone have specific effects on altered pain sensitivity in the ketamine model of schizophrenia. Psychopharmacology (Berl) 2009; 202:579-87. [PMID: 18810393 DOI: 10.1007/s00213-008-1336-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 09/03/2008] [Indexed: 01/27/2023]
Abstract
RATIONALE The ketamine (ket) model reflects features of schizophrenia as well as secondary symptoms such as altered pain sensitivity. OBJECTIVES In the present study, we investigated the effect of subchronic oral treatment with haloperidol (hal, 0.075 mg/kg) and risperidone (ris, 0.2 mg/kg) on altered pain perception and locomotor activity in this model. RESULTS In reaction to 5 mg/kg morphine, ket pretreated animals showed a diminished analgesic response. Hal had no analgesic effect per se, but the compound normalised the analgesic reaction to morphine in the ket pretreated animals. The effect of ris was complex. First, there was no analgesic effect per se, and control animals showed a dose-dependent increase in the analgesic index after morphine injection. In the ket group treated with ris, the analgesic response to 5 mg/kg morphine was attenuated and in response to 10 mg/kg analgesia was comparable with that measured in controls. The reduced analgesic effect was not due to pharmacokinetic differences in morphine metabolism. After administration via drinking water in saline-injected control animals, the hal blood serum concentration was 2.6 +/- 0.45 ng/ml. In ket-injected animals, the mean serum concentration of hal amounted to 1.2 +/- 0.44 ng/ml. In the experiment using ris, animals in the control group had higher ris serum concentrations compared with ket-injected animals. In control animals, morphine dose dependently decreased locomotor activity. This effect was significantly stronger in the ket pretreated groups. CONCLUSIONS Hal and ris had different effects on altered pain sensitivity. It was hypothesised that these results are connected with alterations in dopamine D2 and mu opioid receptor binding.
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Affiliation(s)
- Axel Becker
- Faculty of Medicine, Institute of Pharmacology and Toxicology, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
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Are Patients With Schizophrenia Insensitive to Pain? A Reconsideration of the Question. Clin J Pain 2009; 25:244-52. [DOI: 10.1097/ajp.0b013e318192be97] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Potvin S, Stip E, Tempier A, Pampoulova T, Bentaleb LA, Lalonde P, Lipp O, Goffaux P, Marchand S. Pain perception in schizophrenia: no changes in diffuse noxious inhibitory controls (DNIC) but a lack of pain sensitization. J Psychiatr Res 2008; 42:1010-6. [PMID: 18093615 DOI: 10.1016/j.jpsychires.2007.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 10/31/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pain is a dynamic phenomenon resulting from the activity of both excitatory (e.g. sensitization) and inhibitory endogenous modulation systems. Preliminary experimental studies have shown diminished pain sensitivity in schizophrenia patients. The objective of the study was to investigate the role of excitatory and inhibitory systems on pain perception in schizophrenia. METHODS Participants were 23 patients with a schizophrenia-spectrum disorder (DSM-IV criteria) and 29 healthy volunteers, who did not differ in age, sex or ethnicity. Excitatory and inhibitory systems were elicited using a temporal summation test (Peltier thermode) administered before and after activation of the diffuse noxious inhibitory control (DNIC) by means of a cold-pressor test. RESULTS Time was a significant predictor of pain scores in controls, but not in patients. That is, pain ratings increased during the tonic thermal stimulation among controls but not in schizophrenia patients. When correlation coefficients (between time and pain ratings) for patients and controls were compared, the correlation coefficient emerged as significantly weaker in the schizophrenia group (Z=12.04; p=0.0001), suggesting a lack of sensitization in schizophrenia. DNIC was similar in magnitude in both patients and controls. CONCLUSIONS Diminished pain sensitivity in schizophrenia may be related to abnormal excitatory mechanisms, but not to DNIC. More studies are needed to better characterize the neurophysiological and neurochemical mechanisms involved in the lack of sensitization in schizophrenia.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche Fernand-Seguin, University of Montreal, Montreal, Canada
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Hypoalgesia in schizophrenia is independent of antipsychotic drugs: a systematic quantitative review of experimental studies. Pain 2007; 138:70-78. [PMID: 18160219 DOI: 10.1016/j.pain.2007.11.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 10/31/2007] [Accepted: 11/13/2007] [Indexed: 11/22/2022]
Abstract
Diminished sensitivity to pain in schizophrenia has been reported since the early works of Bleuler [Bleuler E. Textbook of psychiatry (trans. Brill HA, 1951). New York: Dover Publications; 1911] and Kraepelin [Kraepelin E. Dementia praecox and paraphrenia. Edinburgh, Scotland: E and S Livingstone; 1919]. Over the last decade, experimental studies have measured pain perception in schizophrenia and produced mixed results. This meta-analysis sought to determine if the scientific literature confirms the hypothesized hypoalgesia in schizophrenia. The search was performed with computerised literature databases. A study was retained in the meta-analysis if: (i) it comprised a group of schizophrenia patients, compared to a control group of healthy volunteers; and (ii) pain was measured via experimental procedures (e.g. thermal, electrical, or mechanical stimuli). Using Comprehensive Meta-Analysis-2, effect size estimates of the differences in pain scores (all pain scores derived from all pain tests) between schizophrenia patients and healthy volunteers were calculated. Eleven studies were included in the meta-analysis. For the composite analysis, a positive, moderate, and significant effect size estimate emerged (N=497; Hedges's g=0.437; p=0.005), suggesting that patients with schizophrenia show a diminished response to experimentally-induced pain. Secondary analyses showed that: (i) drug-free patients also have hypoalgesic responses; and that (ii) sensory thresholds are increased in schizophrenia patients. This meta-analysis substantiates the hypothesis of a diminished pain response in schizophrenia. The study also suggests that hypoalgesia in schizophrenia cannot be solely explained by the effects of antipsychotic drugs, and that it may not be a pain-specific blunted response. Further studies are warranted to determine the clinical and biological correlates, and the social and health consequences, of hypoalgesia in schizophrenia.
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Atik L, Konuk N, Akay O, Ozturk D, Erdogan A. Pain perception in patients with bipolar disorder and schizophrenia. Acta Neuropsychiatr 2007; 19:284-90. [PMID: 26952940 DOI: 10.1111/j.1601-5215.2007.00193.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pain perception is reported to be altered in patients with depression and schizophrenia. However, few studies have investigated the pain perception in patients with bipolar disorders. We therefore aimed to compare pain sensitivity between patients with bipolar disorder, schizophrenia and controls. METHODS Study groups consisted of 30 patients with bipolar disorder, and control groups consisted of 27 patients with schizophrenia and 59 healthy subjects. Pain perception was assessed with cold pressor test (CPT) by exposure to ice-water. RESULTS Patients with schizophrenia had significantly higher pain thresholds (PTh) than patients with bipolar disorder. There were no differences between the PTh of patients with schizophrenia and healthy control subjects. However, patients with bipolar disorder had significantly lower pain tolerance (PT) in the CPT than patients with schizophrenia and corresponding healthy control subjects. CONCLUSIONS The higher PTh in the schizophrenia group compared with the bipolar group found in this study supports further investigation of a potential difference in the pain perception between patients with schizophrenia and bipolar disorder. Theoretical implications of these findings and possible relevant behavioural and neurochemical mechanisms are discussed.
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Affiliation(s)
- Levent Atik
- 1Zon guldak Karaelmas University, Faculty of Medicine, Department of Psychiatry, Zonguldak, Turkey
| | - Numan Konuk
- 1Zon guldak Karaelmas University, Faculty of Medicine, Department of Psychiatry, Zonguldak, Turkey
| | - Omer Akay
- 1Zon guldak Karaelmas University, Faculty of Medicine, Department of Psychiatry, Zonguldak, Turkey
| | - Devrim Ozturk
- 1Zon guldak Karaelmas University, Faculty of Medicine, Department of Psychiatry, Zonguldak, Turkey
| | - Ayten Erdogan
- 1Zon guldak Karaelmas University, Faculty of Medicine, Department of Psychiatry, Zonguldak, Turkey
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Abstract
Dissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. The authors tested whether experimentally induced increases in state dissociation would cause an analgesic response. Participants (N = 120) were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on pre- and postchanges in subjective pain and immersion time in response to a standard cold pressor test. Unexpectedly, the dissociation induction led to small, but significant increases in subjective pain and did not lead to greater immersion time. An exploratory analysis revealed that increases in absorption and derealization significantly predicted increased subjective pain and increased immersion time, respectively.
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Affiliation(s)
- Jonathan D Horowitz
- Laboratory for Study of Anxiety Disorders, University of Texas at Austin, Austin, TX 78712-0187, USA
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Abstract
Molecular biology investigates the genetic causes of many diseases. Currently, molecular biology in pain research lags behind the investigations of the molecular basis of mental disorders. A significant challenge in pain genetic research is the fact that pain involves emotional factors. Tools available for pain measurements and interindividual comparisons have been imperfect. Another problem relates to research ethics. Unlike animal studies, there is very limited ability to evoke experimental pain in a group of humans with precisely defined age, sex, medication, and pain experience. Nevertheless, pain investigations at the gene level have commenced. Recent progress in molecular biology has enabled gene expression modulation in animal models using "knockout," "oligo-antisense," and viral vector techniques. These methods enable investigation, at molecular level, as to which of the approximately 30,000 genes of the human genome might be involved in pain mediation, which of these are polymorphic, and which polymorphisms are responsible for interindividual differences in pain perception. Recently, the genetic bases of familial hemiplegic migraine and congenital insensitivity to pain with anhidrosis have been shown. In the last 6 years, genetic pain research has focused on potential gene therapy for patients with chronic pain. Results of these studies are encouraging and potentially applicable to clinical practice in the near future.
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Affiliation(s)
- Omar Serý
- Laboratory of Neurobiology and Molecular Psychiatry, Department of Comparative Animal Physiology and General Zoology, Masaryk University, Faculty of Science, Brno, Czech Republic.
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Chahl LA. TRP's: links to schizophrenia? Biochim Biophys Acta Mol Basis Dis 2007; 1772:968-77. [PMID: 17587552 DOI: 10.1016/j.bbadis.2007.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 05/15/2007] [Accepted: 05/15/2007] [Indexed: 01/22/2023]
Abstract
Schizophrenia is a chronic psychiatric disorder the cause of which is unknown. It is considered to be a neurodevelopmental disorder that results from an interaction of genetic and environmental factors. Direct evidence for links between schizophrenia and TRP channels is lacking. However, several aspects of the pathophysiology of the disorder point to a possible involvement of TRP channels. In this review evidence for links between TRP channels and schizophrenia with respect to neurodevelopment, dopaminergic and cannabinoid systems, thermoregulation, and sensory processes, is discussed. Investigation of these links holds the prospect of a new understanding of schizophrenia with resultant therapeutic advances.
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Affiliation(s)
- Loris A Chahl
- Centre for Mental Health Studies and Schizophrenia Research Institute, James Fletcher Hospital, University of Newcastle, New South Wales, 2308 Australia.
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Winocur E, Hermesh H, Littner D, Shiloh R, Peleg L, Eli I. Signs of bruxism and temporomandibular disorders among psychiatric patients. ACTA ACUST UNITED AC 2007; 103:60-3. [PMID: 17178495 DOI: 10.1016/j.tripleo.2006.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 03/04/2006] [Accepted: 03/20/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the prevalence of bruxism and signs of temporomandibular disorders (TMDs) among psychiatric patients compared with a healthy population and to assess the effect of psychiatric medications on the parameters studied. STUDY DESIGN Subjects included 77 psychiatric patients under treatment at 2 psychiatric hospitals in Israel and 50 healthy individuals (control). One experienced calibrated examiner performed the clinical examination (presence of bruxism and signs of TMD). RESULTS Abnormal attrition was evident in 46.8% of the psychiatric patients compared with 20% in the controls (P < .005). Significant differences between groups were apparent for mean muscle sensitivity to palpation, joint sensitivity to palpation, and range of mouth opening. There were no differences between groups in the prevalence of joint clicks and no association between time of receiving treatment with dopamine antagonists (or any other psychotropic drugs) and TMD signs and symptoms. CONCLUSION The higher prevalence of bruxism and signs of TMD in psychiatric patients is a major clinical comorbidity. Whether it is a manifestation of the abnormal central nervous system of psychiatric patients or neuroleptic-induced phenomenon deserves further attention. The exact factors that affect the pain experience in these patients should be evaluated as well.
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Affiliation(s)
- Ephraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Becker A, Grecksch G, Schröder H. Pain sensitivity is altered in animals after subchronic ketamine treatment. Psychopharmacology (Berl) 2006; 189:237-47. [PMID: 17016710 DOI: 10.1007/s00213-006-0557-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 08/08/2006] [Indexed: 12/20/2022]
Abstract
RATIONALE Clinical observations have shown that pain sensitivity is altered in some schizophrenic patients. OBJECTIVES To study alterations in pain sensitivity, the ketamine model in schizophrenia research was employed. MATERIALS AND METHODS Rats were subchronically injected with the dissociative anaesthetic ketamine (Ket, ten injections of 30 mg/kg, one injection per day over a period of 10 days). Two weeks after treatment completion, the animals' pain sensitivity was assayed in the hot plate test and they were subjected to electrical stimulation of the tail root. In addition, the effect of morphine was studied. RESULTS In group-housed animals, there was no difference between Ket-injected animals and control rats as measured in both nociceptive tests. In singly housed Ket-injected rats, pain threshold was increased in the electrical stimulation test. This suggests that stress due to single housing might be essential for modifications of pain sensitivity. Moreover, the antinociceptive effect of morphine was modified after single housing. Interestingly, the effect of morphine on locomotor activity was similar in both groups. In group-housed rats, mu receptor binding was unchanged in the frontal cortex, whereas Ket-injected animals had decreased levels in the hippocampus. In singly housed animals, mu receptor binding in Ket-injected rats increased in the frontal cortex and decreased in the hippocampus. (35)S-GTPgamma-S binding increased in the frontal cortex in both singly housed groups, but remained unchanged in the hippocampus. CONCLUSIONS The data suggest that the ketamine model might be useful for studying altered pain sensitivity in schizophrenia. Moreover, the data suggest that modifications in mu opioid receptor binding contribute to this phenomenon.
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Affiliation(s)
- Axel Becker
- Faculty of Medicine, Institute of Pharmacology and Toxicology, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany.
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Klossika I, Flor H, Kamping S, Bleichhardt G, Trautmann N, Treede RD, Bohus M, Schmahl C. Emotional modulation of pain: A clinical perspective. Pain 2006; 124:264-268. [PMID: 16934927 DOI: 10.1016/j.pain.2006.08.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 08/07/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Iris Klossika
- Department of Psychosomatic Medicine and Psychotherapy, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany Department of Cognitive and Clinical Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany Department of Clinical Psychology, Johannes-Gutenberg-University, Mainz, Germany Institute of Physiology und Pathophysiology, Johannes-Gutenberg-University, Mainz, Germany
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Too much or too little pain: The dichotomy of pain sensitivity in psychotic versus other psychiatric disorders. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/bf02629336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bär KJ, Boettger S, Wagner G, Wilsdorf C, Gerhard UJ, Boettger MK, Blanz B, Sauer H. Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45:1068-1076. [PMID: 16926614 DOI: 10.1097/01.chi.0000227876.19909.48] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. METHOD Heat pain perception was assessed in 15 female adolescent AN patients and matched controls. Results were correlated with autonomic and endocrine parameters (free triiodothyronine, free cortisol). Autonomic function was studied using heart rate variability and pupillary light reflex assessment. To investigate the influence of therapy on these parameters, data were obtained at three different time points. RESULTS Heat pain thresholds were significantly increased in the acute state and decreased after weight had been regained for 6 months. Similarly, an increased parasympathetic tone was present in the acute state only. The relative amplitude of the pupillary light reflex showed a positive correlation to pain thresholds over time and predicted disease progression. In addition, the authors found a negative correlation between increased pain thresholds and low free cortisol. CONCLUSION Increased pain thresholds are associated with increased parasympathetic tone and a hypothyroid state in AN. This may either indicate common central mechanisms or suggest a causative interaction.
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Affiliation(s)
- Karl-Jürgen Bär
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany.
| | - Silke Boettger
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Gerd Wagner
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Christine Wilsdorf
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Uwe Jens Gerhard
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Michael K Boettger
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Bernhard Blanz
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
| | - Heinrich Sauer
- Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany
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