[Environmental crisis and mental health]

Global warming threatens the survival of humanity and is the greatest challenge of our generation. While the consequences for physical health are well documented, the impact on mental health, while considerable, was too little studied. This unprecedented crisis is putting a strain on our health care systems and is mostly affecting vulnerable and precarious populations. There is an urgent need to rethink and improve our way of life, our work habits and the resilience of our health care system.

[Deep brain stimulation as a treatment for severe multidrug-resistant obsessive compulsive disorder]

Obsessive compulsive disorder (OCD) is a common and disabling psychiatric condition. About 10 % of patients are considered to be severely affected and refractory to the usual treatments, combining antidepressants and psychotherapy. Deep brain stimulation (DBS) is a promising treatment, reserved for specialized university centers. It is based on the implantation of electrodes aimed at modulating dysfunctional cortico-striato-thalamo-cortical circuits. After studying the different targets to be used, it is now proposed to rethink DBS in terms of networks. The improvement of pathophysiological knowledge of OCD and the development of functional neuroimaging techniques should allow the design of individualized treatment protocols.

[Obesity and eating disorders]

Obesity is a chronic disease that is difficult to manage and is often punctuated by treatment failure. Screening for eating disorders, the prevalence of which is high in overweight patients, is essential in order to minimize the risk of relapse and the «yoyo» phenomenon. As the reason for consulting obese subjects is rare to be eating disorders from the outset, it is necessary to assess this behaviour from the first consultations, in order to propose a specific therapeutic approach aimed at stable weight loss in the long term.

[Catatonia, complicated withdrawal from benzodiazepines]

The article describes a clinical case of catatonic syndrome. We describe the manifestations of the syndrome, its diagnostic criteria and associated scales. The modalities of the challenge test, constituting a diagnostic test, and first line treatment are detailed. Clinical and paraclinical investigations are proposed to determine the etiology. The benzodiazepine withdrawal as an etiology of catatonic syndrome is detailed.

[Innovative therapeutic approaches in psychiatry : neuromodulation. For whom, why and how ?]

Recent technological advances have seen the resumption or the advent of new approaches in the field of psychiatry such as electroconvulsive therapy, repeated transcranial magnetic stimulation, transcranial direct current electrical stimulation or even deep brain stimulation. These new approaches offer a window into the understanding of the neurobiological mechanisms linked to mental illnesses. This review summarizes current knowledges in the field and the future directions for the treatment of depression or obsessive-compulsive disorder.

[Benefits and risks associated to lithium use in psychiatry]

The goal of the article was to provide some clinical recommendations for a secure use of lithium. We described the mechanism of action of lithium, that acts as a mood stabilizer but also has anti-suicidal and neuroprotective effects. We also described the toxics effects of lithium and the toxicological tools that help to prevent and to treat those effects. We concluded that lithium remains a first choice for the treatment of bipolar disorders.

[Conversion disorder : functional neuroimaging and neurobiological mechanisms]

Conversion disorder is a psychiatric disorder often encountered in neurology services. This condition without organic lesions was and still is sometimes referred as an imaginary illness or feigning. However, the absence of organic lesions does not exclude the possibility of cerebral dysfunction. The etiologic mechanisms underlying this disorder remain uncertain even today.The advent of cognitive and functional imaging opens up a field of exploration for psychiatry in understanding the neurobiological mechanisms underlying mental disorders and especially the conversion disorder. This article reports several neuroimaging studies of conversion disorder and attempts to generate hypotheses about neurobiological mechanisms.

[ELECTRONIC LOGBOOK: LEARNING TOOL AND TEACHING AID FOR THE EVALUATION OF LEARNING ACTIVITIES]

A LogBook is a learning tool and teaching aid I where clinical settings lived during training courses are provided. A LogBook is basically a journal which evidences learning and skills. LogBook provides a means for monitoring student learning, both for the student and for the instructor. It provides a feedback loop for the evaluation of learning activities. This LogBook has been developed for the student's training in psychiatry but it may be extended to all medical disciplines. The authors have developed an electronic logbook to support learning and assessment. In the context of Europe, it has become necessary to set up a LogBook of uniform learning outcomes to assist medical students.

[50 Hz electric and magnetic fields and health: which message to the public?]

Scientific data of effects of 50 Hz electric and magnetic fields on health are inconclusive. This uncertainty raises numerous questions. In this paper, significant key concepts are described to better understand the potential effects of electric and magnetic fields on health. Everyday life exposure values are included, as well as courses of action to be taken in front of a patient asking questions on health effects of 50 Hz electric and magnetic fields.

[Depression as a common complication of systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is an inflammatory disease with multiple and disabling consequences, including the psychological status. The prevalence of major depressive episodes among patients suffering from SLE is significantly higher than in healthy people, or people suffering from other inflammatory diseases. While it is obvious that its chronic disease status with a frequently pejorative ending, as well as the number of treatments it requires, are contributing factors, it is likely that due to its pathogenic mechanisms, SLE causes direct injury to the brain, leading to a depressive symptomatology. Numerous hypotheses are under consideration. We shall review them all, recall a few epidemiologic features, add histology and medical imaging contributions and discuss the importance of setting up a fitting therapy for such patients.

[Depression and type 2 diabetes: etiopathogenic analysis of a frequent comorbidity]

Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.

Additional intranasal oxytocin to escitalopram improves depressive symptoms in resistant depression: an open trial

The aim of this open trial was to assess the antidepressant/anxiolytic effects of oxytocin used as an adjunct to antidepressant in treatment-resistant depression. Fourteen patients, who have not responded to 40mg of escitalopram, received intranasal synthetic oxytocin during 4 weeks, in association with antidepressant. This is the first open trial study suggesting OT in association with escitalopram significantly reduced scores on Hamilton Depression Rating Scale.

[Clinical study of the month: depressive pseudo-dementia]

We report the case of a man aged 62 suffering from a known type I bipolar disorder and referred by his attending psychiatrist because of a state of spatiotemporal disorientation, confusion and prostration evoking significant neurologic impairment. The interest of this case report is in the use of the 18-FDG PET-Scanner, which is increasingly widespread in clinical psychiatry, to support the differential diagnosis between a psycho-organic pathology like dementia or a functional psychiatric pathology like depressive pseudo-dementia (also named melancholic dementia), in which some patterns of dysfunction can now be identified by functional imaging.

[The acute management of agitation]

Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.

[Antipsychotics in depression]

Depression is a major public health problem. In the treatment of depression, the main objectives must be complete remission and prevention of recurrence. However, the objective of remission remains difficult in clinical practice. Several pharmacological strategies exist to handle treatment resistant depression and achieve remission. Among these options, addition of an atypical antipsychotic has become a popular choice. Second generation antipsychotics have been investigated in clinical trials in treatment resistant depression and in bipolar depression. Scientific data are available particularly for aripiprazole and quetiapine XR.

[Affective dependency]

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could <imprint>> on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

[Cocaine addiction]

Cocaine is the second most commonly used illicit drug after cannabis in the general population. Cocaine is a powerful stimulating agent of the central nervous system and a highly addictogenic drug. Somatic and psychiatric consequences of cocaine addiction are major and clinically relevant. The increasing consumption of cocaine and the importance of its consequences justify an update of our knowledge about cocaine addiction.

[Psychiatric complications and addictions]

Psychiatric complications are clearly associated with substance abuse. Psychopathological symptoms appear during intoxication or in patients suffering from substance-induced psychiatric disorders. However, the assessment of the psychiatric symptomatology is particularly challenging in patients who express clear difficulties to accept that the disorder is favoured by substance abuse. Psychotic reactions, major depression and anxiety disorders are the main psychiatric issues observed in addict patients.

[How to cope with the bad reputation of depression]

Today, the term depression has lost its meaning. Recent scientific data suggests a change in our classifications of mental disorders. Depression is frequently used to refer to "normal" sadness, anxiety disorders, personality disorders or adjustment disorders... Moreover, in our society, this diagnosis remains badly accepted. It is really time to be aware of the deterioration of the image of psychiatry, and particularly the bad image of depression and its treatment with antidepressants. This paper is a reflexion inviting general practicioners and psychiatrists to progressively avoid the term depression and rather use the diagnosis of unipolar mood disorder, a broader concept, more adapted to new scientific data, less stigmatizing, and closer to the evolution of our society.

[Clinical and therapeutical approach of depression in old age]

Despite recent clinical and scientific developments in the psychogeriatric field, depression in old age remains an underdiagnosed and undertreated disorder. However, depressive symptoms are frequent in older people and the impact on patients, their family and the society is very important. Depression is also frequently associated with somatic illnesses, with alcoholism, anxiety and a significant risk of suicide. In this context, a systematic screening of depression and an adequate treatment are a priority.

[Role of psychosocial stress in complex diseases]

Complex diseases are chronic diseases where the interrelations between genetic predisposition and environmental factors play an essential role in the arisen and the maintenance of the pathology. Upon psychological stress, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system are activated resulting in release of glucocorticoids and catecholamines. Chronic stress may induce complex diseases where alterations of nervous, endocrine and immune systems are involved. Thus, chronic stress is more likely to induce a range of effects, depending on the capacity of the subject to cope with stress. CRH ("Corticotropin Releasing Hormone") is a key factor in the stress-immunity relationship. In this article, we propose an overview of the interrelations between central nervous, endocrine and immune systems and implications for health and diseases. The objective for the clinician is to propose therapeutic strategies targeting changes in human behaviour to cope with a potentially stressful environment.

[Bipolar disorder: a multifactorial disease]

Bipolar disorder is a multifactorial disease with a strong genetic component. However, environmental factors also play a role in the onset of the disease and in manic and depressive recurrence. The onset of the disorder is the consequence of a complex interaction between genetic and environmental factors. This gene-environment interaction is well illustrated by the influence of childhood trauma on the clinical expression of the disease in terms of age of onset, comorbidity and suicide. The complexity and heterogeneity of bipolar disorder require the identification of homogenous sub-groups with the use of biomarkers that could help reduce the etiological heterogeneity and better target the therapeutical options.

[Antidepressants of the future: role of the glutamatergic system]

Despite the availability of several antidepressants, the treatment of major depression is far from being satisfactory. With conventional antidepressants, more than 30 to 45% of the patient will not respond or present only partial remission. In the prospect of a better treatment of depression, research tends to develop original molecules, more effective, with a faster onset of action and a better tolerability. The new targets of antidepressive pharmacotherapy are beyond the membrane receptor. The future in the treatment of depression requires a better understanding of cellular and molecular mechanisms involved in the pathophysiology of depression and biochemical mechanisms explaining the antidepressive effect. In this context, the glutamatergic system plays a role in the pathophysiology of depression. Agents modulating glutamatergic activity could act as antidepressants.

[Tricyclic antidepressants and monoamine oxidase inhibitors - do they still have a role in the treatment of depression?]

Today, tricyclic antidepressants and MonoAmine Oxidase Inhibitors are prescribed less frequently compared to Selective Serotonin Reuptake Inhibitors (SSRIs) or selective serotonin and noradrenalin reuptake inhibitors. These new medications are associated with a better safety profile. The new generation of psychiatrists is not really comfortable with these old medications. However, their use is still justified in some cases of treatment resistance, in the treatment of some anxious disorders, and in the management of chronic pain. But, their prescription requires a good knowledge of the potential complications.

[Recovering from depression: a matter of objective and determination]

Depression is a major public health problem. According to the World Health Organization (OMS), depression is currently the second cause of disability in developping countries. Depression is also one of the most frequent mental illnesses. In the treatment of depression, the main objective is to achieve complete remission and to prevent recurrence. Unfortunately, in clinical practice, this aim is particularly difficult to reach. Indeed, in clinical trials and in naturalistic studies, remission levels are rather low. Fortunately, different therapeutic strategies are available that increase chances to achieve remission. Therapeutic options such as switching, augmentation and combination are very effective. Some strategies are considered as more effective than others, but the choice is generally based on the experience of the clinician. Indeed, scientific data remain limited in the field of treatment resistant depression. Besides pharmacology, psychotherapy and cerebral stimulation techniques could be interesting alternatives.

[Antidepressants in bipolar disorder: beware of risks!]

The value of antidepressants in bipolar disorder is the subject of significant controversy. The prescription of antidepressants remains frequent in clinical practice despite international guidelines recommending serious carefulness in their use. Caution should be exerted before the initiation of a treatment for an episode of major depression in a bipolar patient. The prescription of antidepressants might be envisaged in case of therapeutic failure with a thymostabilizing agent, and always in association with a preventive therapy.

[Neurobiology and pharmacotherapy of obsessive-compulsive disorder]

Obsessive-compulsive disorder belongs to anxiety disorders, with a prevalence of 2,5% in the general population. The pathogeny of the disorder includes a probable genetic component but of moderate importance. Neuroimaging studies showed a hyperactivity of the prefrontal cortex and the caudate nucleus which appears to reflect abnormalities in cerebral circuits. The pharmacological treatment of obsessive-compulsive disorder comprises in first line selective serotonin reuptake blocker antidepressants. Clomipramine (Anafranil), often considered as more effective represents a second choice due to its side-effects. The treatment generally requires high doses of antidepressants administered over a prolonged period. Several augmentation strategies have been proposed for resistant patients. Very recently, brain neurostimulation techniques using implanted electrodes have demonstrated their interest in case of failure of other treatment strategies.

[Neurohypophyseal neuropeptides and unipolar depression: which future?]

Vasopressin (AVP) and oxytocin (OT) are two chemically similar neurohypophyseal neuropeptides which could be involved in mood disorders. Those two sister neuropeptides might be considered as ago-antagonist hormones. They act as neuromodulators of the stress response. AVP is known as an ACTH stimulating factor synergistic to CRH while OT could act as an antagonist of AVP on ACTH secretion. AVP seems to play an important role in the pathophysiology of major depression. Evidence suggests a role for OT as an endogenous antidepressant/anxiolytic hormone. OT release is also an important aspect of the pharmacological action of SSRIs. In addition, their receptors are of growing interest for psychiatric research. A selective AVP V1b receptor, SSR1419415, has been characterized and is endowed with anxiolytic- an and antidepressant-like properties. This paper proposes an overview of neurohypophyseal hormones in major depression.

[Dopamine and depression: the forgotten neurotransmitter]

Several lines of evidence suggest a major role for dopamine in the pathophysiology of depression. In particular, affective disorders tend to be associated with a decrease in dopaminergic function. Moreover, some data show that antidepressants increase the activity of dopaminergic synapses at the mesolimbic level. In fact, the mesocorticolimbic dopaminergic system appears to be an extremely interesting target for the study of the pathophysiology of depression and for the development of antidepressive strategies. Recent developments of molecular biology and new imaging techniques provide interesting perspectives that could bring a better comprehension of the real implication of dopamine in depression.

[Discontinuation syndrome associated with antidepressants]

Sometimes, the discontinuation of antidepressant therapy is associated with both physical and psychological symptoms. These symptoms are parts of the discontinuation syndrome and are very different from relapse or recurrence. The discontinuation syndrome appears within 1 week and lasts about 3 weeks after discontinuation of the antidepressant. In the vast majority of cases, the symptomatology is self-limiting. Sometimes, in the presence of a severe syndrome, reintroduction of the antidepressant induces a rapid resolution of the symptoms. In fact, the discontinuation of the antidepressant should be progressive.

Plasma oxytocin levels and anxiety in patients with major depression

Cerebrospinal fluid and plasmatic levels of oxytocin (OT) have been found to change in mood disorders. In post-mortem studies, the numbers of OT-expressing neurons in the paraventricular nucleus have been reported to be increased. Moreover, OT is considered as an endogenous antistress hormone. It has also revealed antidepressive effects. OT may contribute to the dysregulation of the HPA system in major depression. The aim of the study was to assess a possible relationship between anxiety and plasma oxytocin (OT) levels in depressive patients. Severity of depression was estimated with the Hamilton Depression Rating Scale and anxiety by using the Spielberger State-Anxiety Inventory. Results showed a significant negative correlation between oxytocin and the scored symptoms depression (r=-0.58, p=0.003) and anxiety (r=-0.61, p=0.005).

AVP- and OT-neurophysins response to apomorphine and clonidine in major depression

A number of studies have reported abnormalities of neurohypophyseal secretions in major depressive disorder. The purpose of the present study was to test the influence of apomorphine and clonidine injections on plasma vasopressin (AVP)-neurophysins and oxytocin(OT)-neurophysins levels, as direct index of posterior pituitary activation in major depression. Apomorphine and clonidine tests were carried out in 25 medication-free depressive patients and 25 age and gender-matched healthy controls. Blood for neurophysins analysis was drawn by venipuncture at t0, t + 20, t + 40, t + 60 and t + 120. Baseline AVP-neurophysins concentrations were significantly lower in depressives (0.12 +/- 0.14 ng/ml) than in healthy subjects (0.24 +/- 2.15 ng/ml) (p < 0.04). The response to apomorphine test revealed a significant reduced response at 20 (p = 0.01), 40 (p = 0.007) and 60 (p = 0.02) and 120 (p = 0.02)min. Following clonidine test, post hoc tests also revealed a significant decrease at 0 (p = 0.04), 20 (p = 0.01), 40 (p = 0.007) and 60 (p = 0.02) and 120 (p = 0.006)min. Concerning OT-neurophysins, no significant differences were found between depressed and controls in response to clonidine or apomorphine injections. Following clonidine and apomorphine, major depressives exhibited a significantly lower peak GH response than controls. The study supports partially the hypothesis of a reduced vasopressinergic activity in depression. Moreover, we did not find any influence of acute apomorphine or clonidine injections on vasopressin-neurophysin or oxytocin-neurophysin in depressive patients.

[Panic attack]

Panic attacks can occur unexpectedly and in almost any situation. The present article discusses the main features of anxiety states, the approach, the management and the practice guidelines for the treatment of panic disorder.

[Early hormonal exposure and behavior effects in congenital adrenal hyperplasia: a case report]

Congenital adrenal hyperplasia is a recessive autosomal transmission endocrine pathology that exposes people who suffer from it to an abnormally high concentration of adrenal androgens during the prenatal and early postnatal periods. This disease induces female's virilism of variable degree. The case of a 29 year-old patient, who suffers from this affection and also presents a psychiatric disorder, raises questions about the possible consequences of an early exposure to androgens on the adult behaviour.

Mismatch negativity is not correlated with neuroendocrine indicators of catecholaminergic activity in healthy subjects

The identification of the brain structures and neurotransmitters responsible for the generation and/or modulation of the mismatch negativity (MMN) may contribute to a clearer understanding of its functional significance, and may have clinical implications. In this context, some findings suggest that the scalp-recorded MMN reflects activity from multiple neuronal ensembles within or in the immediate vicinity of the primary auditory cortex and with possible contribution from the frontal cortex. However, few data are available concerning the influence of neurotransmitter systems on the MMN. In this study, the relationship between both noradrenergic and dopaminergic systems and the MMN were investigated in 34 healthy volunteers. Noradrenergic and dopaminergic activities were assessed with the apomorphine and clonidine challenge tests. The results showed no significant relationship between either growth hormone (GH) responses to apomorphine or clonidine and the MMN amplitude or latency. Therefore, this study does not demonstrate the implication of dopaminergic and noradrenergic activities as assessed by GH response to apomorphine and clonidine for the generation and/or the modulation of the MMN. However, given the complexity of the central neurotransmitter systems, these results cannot be considered as definitive evidence against a relationship between dopaminergic and noradrenergic activity and the MMN.

5-HT1A dysfunction in borderline personality disorder

BACKGROUND

A number of challenge studies have reported abnormalities of serotonergic function in borderline personality disorder (BPD). There are, however, problems with the pharmacological probes used in these studies since fenfluramine and m-CPP are not only serotonergic agents but also induce release of catecholamines, particularly dopamine. Therefore, we tested whether subjects with BPD showed a blunted prolactin (PRL) response to flesinoxan, a highly potent and selective 5-HT1A agonist.

METHODS

Flesinoxan challenge test was carried out in 20 BPD in-patients and 20 healthy controls matched for gender but not for age. Since 16 BPD in-patients exhibited major depressive co-morbidity, a group of 20 depressed in-patients matched for gender but not for age was also included.

RESULTS

BPD in-patients exhibited blunted PRL responses as compared to controls, whereas depressed in-patients did not differ from controls. Moreover, PRL responses were lower among BPD in-patients than among depressed in-patients. Among the BPD in-patients, PRL responses to flesinoxan were lower in patients with past history of suicide attempts (N = 8) than in those with a negative history.

CONCLUSIONS

The results show major involvement of serotonergic function in BPD and are consistent with previous studies linking lower serotonergic activity with impulsivity. More particularly, our data suggest that BPD is characterized by lower 5-HT1A receptor sensitivity. Moreover, the data support the involvement of 5-HT1A activity in suicidal behaviour. However, this conclusion is limited because other hormonal responses such as ACTH and cortisol were not assessed, and because BPD was assessed by a self-report questionnaire and not a structured clinical interview.

[Anxiety disorders and organic pathology: a differential diagnosis difficulty]

The diagnostic criteria for panic disorder include symptoms commonly experienced by patients with organic diseases. We report a case of coronary artery spasm in a patient with chest pain, exhibiting atypical characteristics, and accompanied by symptoms of nervousness. The approach and the management of anxiety disorders are discussed.

[Role of the neurohypophysis in psychological stress]

Effects of different psychological stimuli on oxytocin (OT) and vasopressin (AVP) secretion are reviewed in animals and in humans. The secretion of neuropituitary hormones is also discussed in various psychiatric diseases such an anorexia nervosa, bipolar disorder, schizophrenia and obsessive-compulsive disorder. AVP and OT are secreted into the hypophyseal portal circulation by neurons which project from the paraventricular nucleus to the external zone of the median eminence. AVP and OT-containing neurons in the suprachiasmatic and paraventricular nuclei project to limbic areas, including the hippocampus, the subiculum, the ventral nucleus of the amygdala and the nucleus of the diagonal band. Specific AVP receptors which are pharmacologically different from the pressor and antidiuretic AVP receptors have been found in the anterior pituitary. OT receptors have been identified in a variety of forebrain sites. The neurohypophyseal secretion is regulated by the cholinergic muscarinic, histaminergic and beta-adrenergic systems. Stress alters the secretion of one or more of the hypothalamic factors which interact at the pituitary to increase the secretion of ACTH. AVP and OT have been shown to modulate the effect of Corticotropin-Releasing Factor (CRF) on ACTH secretion and appear to play a key role in mediating the ACTH response to stress. Although AVP is a relatively weak secretagogue for ACTH, it markedly potentiates the activity of CRF both in vitro and in vivo. The role of OT is more complex. In vitro, OT stimulates ACTH release at high doses whereas in human it inhibits ACTH secretion at low doses. The type of stressor appear to determine the relative importance of these secretatogues in ACTH response. Several recent studies indicate that psychological stressors display a similar degree of variety of secretagogue release patterns as was found earlier for physical stressors. A bewildering array of technique produces a bewildering array of conclusions. In rats, OT may be an important secretagogue during a novel stimulus, whereas the role for AVP is less clear. Indeed two studies out of ten suggest a stimulating role for AVP. In response to frustration and submission, OT and AVP are secreted. Regarding social isolation, results are difficult to interpret and the role of AVP could be species-dependent. In contrast plasma OT levels do not change. After restraint, ACTH release is primarily mediated by the active increase of OT and AVP does not appear to play a role. When restraint is associated with moderate levels of physical components and during immobilisation, all two secretagogs are involved in the ACTH response. With fear, ACTH response appears to be driven by OT. In humans, one study indicates that high emotionality women increase plasma OT in response to uncontrollable noise. Various neuroendocrine dysregulations have been observed in psychiatric disease. Either an increase or a decrease of the hypothalamic-pituitary-adrenal (HPA) function have been described in several illnesses. Effects of OT appear to be reciprocal to the effects of AVP. OT has been called the "amnestic" neuropeptide due to its capacity to attenuate memory consolidation and retrieval. AVP exhibits a central activating action on mood, memory and selective attention. Underweight patients with anorexia nervosa have abnormally high levels of centrally directed AVP and reduced OT levels. These modifications could enhance the retention of cognitive distortions of aversive consequences of eating. Patients with bipolar disorder show a biphasic secretion of AVP. Depressive episodes are associated with decreased vasopressinergic activity whereas manic episodes involve an increased release. AVP might be responsible for an increased catecholamine activity. In addition, lithium could act as an antagonist to AVP. In schizophrenic patients, studies using the apomorphine stimulation suggest increased oxytoninergic and decreased vasopressinergic functions. These findings are consistent with the beneficial role of AVP on schizophrenic symptoms noted in several trials. The increased OT could be responsible for "positive" symptomatology such as delusions and hallucinations. Obsessive compulsive disorder (OCD) includes a range of cognitive and behavioral disturbances that could be influenced by OT. In animals, several studies have emphasized the role of AVP in promoting repetitive grooming behaviors and maintaining conditioned response to aversive stimuli. In OCD patients, one study have reported that AVP/OT ratio was negatively correlated with symptom severity. However, an independent report found similar AVP concentrations in OC patients without a personal or family history of tic disorder and in normal subjects. Whether these modifications are only a consequence of the central disturbances or whether those peptides could participate in the pathogenesis of these affections remains to be elucidated.

Inv(12)(q15q24): a nonrandom change associated with myelodysplasia?

A patient with refractory anemia and a paracentric inversion of chromosome 12, inv(12)(q15q24), is described. This is the second reported case with this chromosome anomaly, suggesting that this rearrangement is a rare but nonrandom change associated with myelodysplastic syndromes.