Diagnostic relevance of sleep complaints in anxiety and mood disorders

Clinical assessments of sleep and subjective state upon waking were performed in normal controls and patients with generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, primary dysthymia and major depression. Subjects were selected according to DSM-III-R criteria. As compared to normal controls, patients with generalised anxiety, dysthymia and major depression exhibit pervasive and intense complaints of insomnia, and no clear distinctions can be drawn among these groups. Patients with panic disorder do not differ from normal controls, whereas obsessive compulsive patients present limited sleep symptoms. These findings suggest that subjective sleep variables are relevant for the diagnostic discrimination of panic and obsessive-compulsive disorders.

Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in adult patients

Autoimmune hemolytic anemia (AIHA) after allogeneic hematopoietic stem cell transplantation (HSCT) is still not well characterized. The aim of this study was to analyze the incidence and risk factors for the development of AIHA, as well as its prognosis and response to treatment in a series of patients undergoing allogeneic HSCT at a single institution. Between 1996 and 2004, 272 adult patients with a variety of malignant hematopoietic disorders underwent allogeneic HSCT. Direct antiglobulin testing was performed in routine pretransfusion compatibility testing or after clinical suspicion of AIHA. Twelve patients developed AIHA after HSCT at a median time of 147 days (range, 41-170). The 3-year cumulative incidence of AIHA was 4.44%. Eight cold antibodies and four warm antibodies were detected. Multivariate analysis shows that HSCT from unrelated donors (P=0.02) and the development of chronic extensive graft-versus-host disease (GVHD) (P=0.0004) were the only independent factors associated with AIHA. Two patients are still alive. AIHA was never the primary cause of death but added morbidity in patients with other concomitant complications. Patients undergoing HSCT from unrelated donors and those who develop chronic extensive GVHD are especially predisposed for this complication.

Role of methylene blue-treated or fresh-frozen plasma in the response to plasma exchange in patients with thrombotic thrombocytopenic purpura

Twenty patients with thrombotic thrombocytopenic purpura (TTP) underwent plasma exchange using either standard fresh-frozen plasma (Group A, n = 13) or methylene blue-treated plasma (Group B, n = 7). Both groups presented similar characteristics except that bilirubin values were higher in Group A (P < 0.05). The complete remission rate was higher in Group A than B (69% versus 57%). The mean number of procedures was higher in Group B (21 +/- 7 versus 11 +/- 3, P < 0.01) and the mean duration of hospitalization was also longer (37 +/- 12 d versus 22 +/- 11 d; P < 0.01). Our study shows that the use of methylene blue-treated fresh-frozen plasma to treat TTP is associated with a higher number of plasma exchanges and greater transfusion requirements without improving clinical results.

[Anticipation and quality of life in depression: 2 cognitive concepts?]

This study purports to investigate the relation between negative predictions and quality of life occurring in dysthymia and non-melancholic depression according DSM-IV, in the absence of any personality disorders. The relation between anticipation and quality of life (QoL) is also examined. The results suggest that both anticipatory cognitions and the QoL discriminate the two depressive entities and may have some nosological prediction potential. It is curious to observe the similar behaviour of the two concepts, anticipation and QoL, when implemented with the chosen scales. Moreover, their strong mutual correlation suggests a conceptual proximity or even a concurrent criteria validity. In conclusion, the possibility that both concepts belong to a cognitive sphere should not be ruled out.

Development of non-ABO RBC alloantibodies in patients undergoing allogeneic HPC transplantation. Is ABO incompatibility a predisposing factor?

BACKGROUND

Data from the appearance of RBC antibodies other than ABO in patients undergoing HPC transplantation are limited.

STUDY DESIGN AND METHODS

The incidence and specificity of non-ABO RBC alloantibodies are described in a series of 217 patients undergoing allogeneic HPC transplantation because of various hematologic malignancies.

RESULTS

Eight patients (3.7%) developed 10 antibodies after transplant. None of these patients had previously been immunized. Seven patients had one RBC antibody and one patient had three RBC antibodies. Antibody specificity were anti-Jk(b) (2 patients), -Kell (2), -M (2), -Le(b) (1), and -D (1). Finally, two patients had a panagglutinin. The mean time between transplant and antibody detection was 23 days (range, 16-672). The source of the HPCs, the conditioning regimen administered, and the type of GVHD prophylaxis administered did not influence the rate of antibody formation. On multivariate analysis, ABO blood group incompatibility (p = 0.005) and patient's age (p = 0.02) were the only two variables significantly associated with the development of RBC alloantibodies.

CONCLUSION

Patients undergoing allogeneic HPC transplantation are at risk of developing RBC-specific antibodies despite the immunosuppressive therapy administered. Antibody formation was more frequently observed in ABO-mismatched cases, which suggests a potential role of this incompatibility in facilitating antibody production.

Response to plasma exchange and steroids as combined therapy for patients with thrombotic thrombocytopenic purpura

We describe our experience in the management of 11 consecutive patients with thrombotic thrombocytopenic purpura (TTP) treated with a combined therapy of plasma exchange (PE) and steroids. Nine patients (82%) achieved complete remission (CR) after a median of 6 rounds of PE (range 2-22). There were 3 early relapses managed in the same way as the initial episode. One patient relapsed 23 months after diagnosis achieving CR with standard therapy; another patient suffered several relapses, and splenectomy was performed after the last one. Three patients died, 2 of them with resistant disease 9 and 38 days after diagnosis, and the remaining one died due to AIDS-related complications while he was in CR. Eight patients are alive in CR with a median follow-up of 38 months (range 8-74). The combination of PE and steroids is a well-tolerated and effective treatment of TTP, but improvements in therapy are needed to manage refractory patients.

[The concept of dysthymia. Its clinical usefulness and nosological status]

Dysthymia is currently conceived as an independent diagnostic category in the area of mood disorders, but the concept is controversial, both from a theoretical and clinical point of view. This article reviews the concept of dysthymia as well as its history. The clinical usefulness and validity are examined, taking into special consideration the influential classificatory notions of DSM-IV.

Severe hemolytic anemia due to multiple red cell alloantibodies after an ABO-incompatible allogeneic bone marrow transplant

BACKGROUND

A patient who received an ABO-incompatible allogeneic bone marrow transplant experienced three episodes of immune hemolytic anemia due to multiple red cell (RBC) alloantibodies.

CASE REPORT

A 41-year-old man with chronic myeloid leukemia received an ABO-incompatible bone marrow graft from his HLA-identical brother. Selective removal of RBCs from donor marrow before transfusion was performed by centrifugation using a continuous-flow blood cell separator. The patient was given group O Rh-positive RBCs and group A Rh-positive platelets. Prophylaxis for graft-versus-host disease consisted of cyclosporine and methotrexate. The patient experienced three hemolytic episodes, on Days 21, 35, and 160 which were due to different RBC alloantibodies (anti-K, anti-Jk(b), anti-M, IgG anti-A) produced by host lymphocytes surviving the conditioning regimen.

RESULTS

The patient was group O, Jk(b-), and the marrow donor was group A, Jk(b+). After the first hemolytic episode (Day 21), immunohematologic studies showed group O RBCs and a positive direct antiglobulin test (IgG+, C3d+). Antibody screening test and eluate studies detected anti-M, anti-Jk(b), and anti-K. During the second hemolytic episode (Day 35), the patient's blood group showed a mixed population of group A and group O RBCs. The direct antiglobulin test was positive (IgG+, C3d+). Anti-M, anti-Jk(b), and IgG anti-A were detected in the serum. Eluates made from the recipient's RBCs showed the same specificity as serum antibodies. During the third hemolytic episode (Day 160), a mixture of group O and group A RBCs was still present, the direct antiglobulin test was positive (IgG+, C3d-), and anti-Jk(b) and IgG anti-A were observed in the serum and in an eluate made from the patient's RBCs.

CONCLUSION

This is the first reported case of severe immune hemolytic anemia due to multiple RBC alloantibodies after an allogeneic bone marrow transplant. The time of appearance and the specificity of the antibodies strongly suggest that they were produced by residual recipient lymphoid cells.

[The applications of sleep studies in psychiatry]

In the last two decades considerable progress has been made in defining sleep changes in mental disorders, as well as in studying the relationship between sleep and psychiatric treatments. The pathophysiological significance of those changes has also been investigated, with some theoretical models of mental disorders indicating a direct role of sleep. In psychiatric research, sleep studies have contributed to the clarification of a variety of issues in relation to taxonomy, aetiology, pathogenesis and treatment. Furthermore, clinical and EEG aspects of sleep have proven useful for practical diagnostic and treatment purposes. This article aims to provide a systematic and critical review of current applications of sleep studies in psychiatry, both in research and clinical fields.

[Immunohematologic study and transfusion approach to patients with public antibodies]

OBJECTIVES

To analyze the different immunohematologic studies required to identify anti-red cell antibodies directed against high incidence antigens and comment the best tranfusion management.

PATIENTS AND METHODS

Five patients with suspected anti-red cell alloantibodies directed against high frequency antigens are reported. After a positive antibody screening test (AST), an agglutination test with a commercial panel of 24 red cells was performed. Red cells were treated with proteolytic enzymes and AET to try to identify the circulating antibody. However, it was necessary to send the samples to reference laboratories for definitive identification. In order to evaluate the haemolytic potential of the antibody serum samples were treated with DTT and immunoglobulin subtype was studied with the capillary agglutination test. Finally, we analyze the half life of Cr51 labelled red cells. To obtain compatible blood for transfusion, autologous transfusion and cross-match with blood from direct relatives were performed.

RESULTS

AST was positive in every case. A decrease in the agglutination test was observed after ficin treatment in two patients, and an increase in the remaining. The treatment of red cells with ZZAP and AET resulted in a decrease of agglutination in three cases and an increase in the remaining two. Specificity of the antibodies was as follows: anti-Cellano (two cases), anti-Ku (one case) and anti-Yta (two cases). Anti-Kell antibodies were IgG1 and anti-Cartwright antibodies were IgG4. One patient was transfused with autologous blood alone, another patient received compatible blood from direct relatives. A third patient was transfused both with autologous and allogeneic compatible blood. The fourth patient did not need red cell transfusion and, finally the last patient had to be transfused with incompatible blood but no postransfusion haemolysis was observed.

CONCLUSIONS

In patients with anti-red cell antibodies against high-frequency antigens, red blood cells treatment with proteolytic enzymes (ZZAP, ficin) and AET are useful techniques to approach to their identification. Beside this, the study of type and subtype of Ig are necessary to know the haemolytic activity of the antibody. Regarding the transfusional management, autologous transfusion, crossmatch with blood from direct relatives and cryopreservation of compatible blood are the most adequate attitudes to cover future needs.

Effects of trazodone on insomnia and anxiety in depressed patients: a clinical and sleep EEG study

Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week single-blind study design. Nine patients with DSM-N major depression were selected. Trazodone (50-250 mg) was given following a 2-week placebo run-in period. Both sleep and psychiatric evaluations were performed at different time points. Early and persistent sleep-inducing effects were detected, including the improvement of objective insomnia features and increased amounts of slow wave sleep. However, no significant changes of REM sleep measures were found. The sleep EEG changes seem to be related to the clinical improvement of both anxiety and insomnia, but there is no apparent relationship with the antidepressant action, which occurs at a later stage of the treatment. Trazodone may be useful in depressed patients, either as a hypnotic-like agent or as an effective antidepressant drug with beneficial effects on sleep.

The sleep of non-depressed patients with panic disorder: a comparison with normal controls

All-night sleep EEG recordings were performed in non-depressed patients with panic disorder, agoraphobia, and a group of age- and sex-matched normal controls. Patients were selected according to DSM-IV and all subjects were studied under drug-free conditions. In addition to sleep continuity disturbances, patients with panic disorder have a reduced percentage of slow wave sleep, mainly due to diminished amounts of stage 4. REM sleep characteristics are identical in the two groups. When depressive co-morbidity and non-specific causes of insomnia are excluded, the sleep EEG of panic patients seems to be characterized by modest changes in sleep continuity and sleep architecture. These findings favour the existence of a neurophysiological frontier between anxiety disorders and depressive illness.

[Immunohematologic study in 112 patients with myelodysplastic syndromes: 10-year analysis]

PURPOSE

To describe the immunohematological response after multiple red blood cells transfusions in 112 patients with myelodysplastic syndromes (MDS).

PATIENTS AND METHODS

From 1982 to 1992 every patient with MDS entered the study. Immunohematological studies consisted of an antibody screening test (AST) and a direct antiglobulin test (DAT) at diagnosis and after every four transfused units of red blood cell concentrates.

RESULTS

Twenty-three out of 112 patients (20.5%) presented a positive AST and/or DAT during the study period. Eleven out of the 23 patients (9.8%) developed a positive DAT, six of them with red cell alloantibodies associated. In the remaining 12 patients (10.7%) the immune response observed was the development of red cell alloantibodies without a positive DAT. No patient presented with positive AST or DAT at diagnosis and no differences were observed in the pattern of immunohematological response and the FAB subtype.

CONCLUSION

Patients with MDS have disordered immune systems with a high prevalence of autoantibodies against red cells. However, the incidence of red cell alloimmunization is similar to that observed in other multitransfused populations. Finally, despite the high immunization rate, the absence of any hemolytical reaction make the AST and DAT a safe and effective method of pretransfusion testing in this heavily transfused population.

[Sleep, depression and antidepressive treatments (2)]

Sleep research in depressive disorders has advanced considerably in the last two decades. In this review we highlight the different facets of this research, including neurophysiological descriptions of sleep disturbances in depression and data regarding the effects of antidepressant treatments on sleep. The available information is discussed taking into consideration a possible pathogenic role of certain sleep changes in depression, as assumed by several theoretical models. The scope of these models and their explanatory power are briefly analysed. Some comments are made on conceptual and methodological problems in the field of sleep research in psychiatric disorders.

[Sleep, depression, and antidepressive treatments (1)]

Sleep research in depressive disorders has advanced considerably in the last two decades. In this review we highlight the different facets of this research, including neurophysiological descriptions of sleep disturbances in depression and data regarding the effects of antidepressant treatments on sleep. The available information is discussed taking into consideration a possible pathogenic role of certain sleep changes in depression, as assumed by several theoretical models. The scope of these models and their explanatory power are briefly analysed. Some comments are made on conceptual and methodological problems in the field of sleep research in psychiatric disorders.

EEG sleep characteristics in dysthymia and major depressive disorder

All night EEG sleep recordings were compared in patients with dysthymia and major depressive disorder. Subjects were selected according to DSM-IV and underwent 2 weeks of treatment with placebo before the sleep evaluations. All patients with major depressive disorder were classified as nonmelancholic and belonged to the recurrent subtype, without full interepisode recovery. Patients with major depressive disorder have a shorter duration of total sleep time, a longer sleep latency and a lower sleep efficiency. However, similar sleep architecture and REM sleep characteristics were found in the two groups. These EEG sleep data seem to favor the existence of a biological overlap between the two forms of nonmelancholic unipolar depression. The validity of dysthymia is still unclear and therefore the nosological implications of our observations are discussed.

Sleep phasic events in dysthymic patients: a comparative study with normal controls

Among psychiatric entities, dysthymic patients provide a good model for studies on minor disturbances in sleep organization because they present borderline abnormalities in their night sleep that concern mainly slow wave sleep. A study on sleep phasic events was performed to evaluate abnormalities in sleep microstructure. Therefore, for all subjects--normal controls and dysthymic patients--the following phasic activities were scored: K-complexes, vertex sharp transients, posterior occipital transients, delta paroxysms, theta bursts, microarousals, and awakenings. Furthermore, other sleep EEG patterns, such as REM with spindles, and intermediate stages, were assessed. The following results were obtained: 1) dysthymic patients have less K-complexes and vertex sharp transients, with lower densities of these events; 2) they have a reduced number of microarousals, with an increased rate of awakenings; 3) patients present a higher incidence of other events such as theta bursts, POSTs, REM with spindles, and intermediate stages. These results suggest that the analysis of phasic events is useful for the discrimination between normal and pathologic sleep, even when there are only minor differences in terms of macrostructure.

[Transfusion policy toward a patient with an anti-Cartwright antibody (anti-Yta)]

We have observed one patient with hepatic cirrhosis showing on her antibody screening an anti-Yta. We studied the 51 Cr-labelled erythrocyte survival using either Yt (a+) and autologous blood red cells. She was transfused two Yt (a+) red blood cell concentrates without any adverse reaction.

[Research in psychogeriatrics. Various theoretical and methodologic aspects]

The rapid increase in individuals aged 65 years old and more in the general population has directed attention to geriatrics, a medical specialty concerned with the study, prevention and treatment of pathological conditions in the aged. Among these conditions, frequent psychiatric disturbances occur and therefore it is widely recognized the increasing role of psychogeriatrics. A comprehensive review of theoretical and methodological issues related with research in psychogeriatrics is presented. In a short introduction, the state of the art in some main areas is analyzed. It is pointed out that controversial and unsolved problems still influence the ongoing research in this field. The use of different theoretical models is discussed, taking into consideration their specific scope and drawbacks. Psychopathological phenomena in the elderly are under the influence of a variety of etiologic and pathogenic factors and the conclusion arises that an adequate conceptual framework can be provided by systemic and multifactorial models. However, in order to preserve their explicatory power, they require valid and reliable definitions of all variables involved--not only independent and dependent variables, but also mediating variables--as well as clear hypothesis on their relationships. Different approaches for the fulfillment of these requirements are discussed.

[The use of cryopreserved homografts in reconstructing the right ventricular outflow tract in congenital cardiopathies]

In recent years the use of cryopreserved allograft valves has become very popular. Homograft valves have been used for aortic valve replacement and for reconstruction of the outflow tract of the right ventricle for more than 30 years with very good results. Recently the method of cryopreservation has made possible the creation of valve banks. The use of this cryopreserved valves has obtained very good short and medium term results. We present our experience with the use of cryopreserved allograft valves in the reconstruction of the right ventricular outflow tract in the treatment of complex cardiac malformations. We have operated 15 children. Six were diagnosed of different types of transpositions of the great arteries with ventricular septal defect and pulmonary atresia or stenosis. There were 2 deaths not related to the use of the allograft valves. Nine other patients were diagnosed of different types of complex cardiac malformations. One patient with a univentricular heart and pulmonary stenosis and a neonate presenting with a truncus arteriosus communis died after the operation; again the deaths were not related to the use of the homograft conduits. Our technique of cryopreservation consists in the procurement of aortic and pulmonary valves from multiorgan donor patients. The valves are sterilized in antibiotics for 48 hours. Then the process of freezing is began with a period of progressive cooling down to -40 degrees C and second phase of storage in liquid nitrogen to a temperature of -178 degrees C. The short and medium term results are very satisfactory. We have not seen late important complications.

[Culture of cells forming granulomonocytic colonies in bone marrow (GM-CFU) in myelodysplastic syndromes and their relation to hematological findings and FAB subtype]

The results of "in vitro" culture of granulomonocytic precursor cells (CFU-GM) of the bone marrow from 44 patients were analysed in the present work. The correlation with the patient's haematological characteristics, their FAB subtypes (i.e., 6 cases of refractory anaemia (RA), 11 of acquired sideroblastic anaemia (ASA), 15 cases of refractory anaemia with excess blasts (RAEB), 5 cases of RAEB in transformation (RAEBT) and 7 cases of chronic myelomonocytic leukaemia (CMML), and the survival were examined as well. The technique used for cell culture was that of Pike and Robinson, following the classification proposed by Florensa for estimating the growth patterns. Anomalies of the myeloid clonal proliferation were found in 81% of the cases. There was direct correlation between the number of aggregates and the polymorphonuclear cell count, whereas the highest number of blast cells coincided with increased number of clusters in cultures. CNNL showed the highest aggregate counts. The B growth pattern (both colony and aggregate growth) was most frequently seen in CMML; pattern C2 (decreased colonies with increased aggregate count) appeared in RAEB, RAEBT and CMML, and pattern C3 (decrease of both colony and aggregate counts) was found only in RA and ASA. None of the culture findings appreciably associated with the survival.

[Sleep disturbances in patients with generalized anxiety: a clinical and EEG sleep study]

All night EEG sleep recordings and clinical evaluations of sleep were performed in order to compare patients with generalized anxiety and normal controls. Patients were selected according to DSM III-R criteria and went through a two weeks phase treatment with placebo before the sleep evaluation. As compared to normals, anxious patients showed a fragmented and superficial sleep with no changes of REM sleep features. Further to disturbances of sleep continuity and duration, they had a higher percentage of wake and stage 2, as well as a reduction of slow wave sleep (SWS) mainly due to a diminished percentage of stage 4. Several EEG sleep measures--related both with the amounts of SWS and sleep duration and continuity--are significantly correlated with symptoms severity. The pathogenic significance of sleep disturbances in generalized anxiety is discussed.

[Harvesting of mononuclear cells from peripheral blood in malignant hemopathies]

After demonstrating through animal models that progenitor cells with haemopoietic regenerative capability are present in peripheral blood, such precursor cells were also found in the mononucleated cell (MNC) fraction of human peripheral blood. It was shown that such cells increase in the recuperative period following chemotherapy. A number of studies have demonstrated that autologous infusion of such MNC achieved by cytapheresis may lead to a quick restoration of haemopoiesis. The initial results of peripheral blood MNC achievement in 18 patients with different malignancies of the blood are presented in this paper. Ninety-one cytapheresis sessions were carried out, 88 with a Fenwall CS-3000 continuous-flow machine, and the remaining three with a Haemonetics V-50 discontinuous-flow cell separator. The number of sessions per patient ranged from three to six and the harvested MNC count was 19.3 x 10(9)/L, the percentage of recovery being 56.4%. Some studies are currently in course aimed to analyse the MNC subpopulations in order to measure the progenitor-cell fraction and to establish the viability of such cells for further transplants. Since only five patients have recently been transplanted, all successfully, no definite conclusions can be drawn presently in this connection.

Absence of central effects with levocabastine eye drops

Twelve healthy volunteers were randomly allocated to receiving in a double-blind cross-over fashion levocabastine eye drops (0.5 mg/ml solution) and placebo. They were advised to instill 2 drops per eye, four times daily. Each treatment was administered for a period of 1 week. Before and after each treatment period psychomotor function was assessed using Critical Flicker Fusion Test and the Choice Reaction Time Test. At the same time intervals a subjective evaluation of sedation was given using a Visual Analogue of Sedation. Both objective and subjective measurements showed that no significant treatment effects could be detected. It is concluded that repeated instillations of levocabastine eye drops are devoid of any sedative side effects.

The sleep of dysthymic patients: a comparison with normal controls

All-night electroencephalographic (EEG) sleep recordings were compared in dysthymic patients and normal controls. Patients were selected according to DSM-III and underwent 2 weeks of treatment with placebo before the sleep evaluation, which also included self-assessments of sleep quality. As compared with normals, dysthymic patients demonstrated fragmented and superficial sleep with no changes in rapid eye movement (REM) sleep. In addition to sleep continuity disturbances, dysthymics had a higher percentage of stage 1 and a reduction of slow wave sleep (SWS), mainly due to a diminished percentage of stage 4. Other differences were related to a higher incidence of some EEG events, and it is suggested that the analysis of sleep microstructure is a useful approach to study sleep physiology in psychiatric patients. The classification of minor forms of depression is a controversial issue and therefore the nosological implications of our findings are discussed.

[Transfusion management of a patient with multiple anti-erythrocyte antibodies (anti-c + anti-K + anti-Fyb + anti-Jkb) subjected to a valvular reoperation using extracorporeal circulation]

A woman with multiple anti-red cell antibodies (anti-c, anti-K, anti-Jkb, anti-Fyb) due to previous transfusions was admitted to the hospital for valvular replacement. To ensure enough transfusional supply, a high number of packed red cell units was typed and screened prior to previous operation. Haemorrhagic complications developing during surgery led to transfusion of 32 blood units, 20 of them compatible. Besides this, measures directed to prevent complications derived from haemolytic disease were instituted. These included intravenous fluids and diuretics to maintain circulatory integrity and improve renal cortical blood flow. High-dose gammaglobulin was also administered in an attempt to decrease extravascular haemolysis. Despite therapy, severe adult distress respiratory syndrome caused patient's death nine days after surgery. We remark the need of storing frozen blood of low-frequency phenotypes in blood banks to face significant transfusional problems, providing sufficient numbers of antibody-compatible blood.

Clinical and EEG sleep changes in primary dysthymia and generalized anxiety: a comparison with normal controls

All night EEG sleep recordings and clinical assessments of sleep quality were performed in normal controls, patients with generalized anxiety disorder and primary dysthymia. Patients were selected according to DSM-III R. Changes of sleep architecture, namely a reduction of slow wave sleep, are similar in generalized anxiety and dysthymia. Also the two groups do not exhibit the REM sleep disturbances usually observed in affective illness. Duration and continuity measures are unchanged in dysthymics, but anxious patients show some features of insomnia. The analysis of subjective aspects of sleep showed no relevant differences between the two groups of patients. Using a conventional set of EEG sleep parameters, primary dysthymia seems closer to anxiety disorders than to affective illness. However, the reduction of slow wave sleep in dysthymics and anxious patients may have different pathogenic meanings and the analysis of nonconventional sleep parameters may prove useful in this regard.

Effects of ritanserin on sleep disturbances of dysthymic patients

Ritanserin, a selective and potent serotonin-2 antagonist, is effective in the treatment of a variety of syndromes related to anxiety and depression, including dysthymic disorder. In animals and healthy volunteers, ritanserin specifically increases slow-wave sleep and the hypothesis arises that this effect on sleep may contribute to its therapeutic properties. Therefore, we studied the effects of ritanserin on sleep in a group of dysthymic patients (DSM-III). Polygraphic recording as well as subjective evaluations of the quality of sleep were performed before and at the end of a 4-week period of double-blind medication with either ritanserin (10 mg o.d. in the morning) or placebo. At baseline, patients showed at fragmented and superficial sleep, with low amounts of slow wave sleep. Ritanserin significantly increased Slow Wave Sleep and changed the frequency and distribution of some stage transitions during the night. No other sleep parameters were modified by ritanserin treatment.

Effects of lithium on dopamine behavioural supersensitivity induced by rapid eye movement sleep deprivation

The effects of lithium on the potentiation of d-amphetamine-induced hyperlocomotion were evaluated in rapid eye movement (REM) sleep deprived rats. Under control conditions, pretreatment with lithium during 7 days did not modify the hyperlocomotion produced by d-amphetamine. REM sleep deprivation induced a pronounced potentiation of the locomotor response to d-amphetamine. In a stress control group this potentiation also occurred, but to a lesser degree than in the REM sleep deprived group. Lithium pretreatment prevented the increased response to d-amphetamine in both REM sleep deprived and stress control animals. The effects of lithium in REM sleep deprived rats are in accordance with reports that lithium is able to prevent the development of dopamine receptor supersensitivity. However, it cannot be excluded that in both REM sleep deprived and stress control groups the increased response to d-amphetamine is related to noradrenergic changes and/or noradrenergic-dopaminergic interactions. REM sleep deprivation seems to be an interesting model to study the underlying mechanisms of manic-depressive illness.

Mimicking anti-S simulating a delayed transfusion reaction

An autoantibody mimicking anti-S specificity is described in an S-s+ patient. The antibody was detected 2 weeks after transfusion. The direct antiglobulin test (DAT) was positive and the antibody was thought to be an alloantibody formed after the transfusion. Eighteen months later, the DAT was still positive and anti-S could be eluted from the patient's red blood cells in spite of the fact that these were S-s+. The autoantibody was characterized as mimicking anti-S specificity by in vitro absorption studies. It was present during the 3 years in which the patient was observed without causing hemolitic anemia.