From pre- to post-big bang: an (almost) self-dual cosmological history

We present a short introduction to a non-standard cosmological scenario motivated by the duality symmetries of string theory, in which the big bang singularity is replaced with a 'big bounce' at high but finite curvature. The bouncing epoch is prepared by a long (possibly infinitely extended) phase of cosmic evolution, starting from an initial state asymptotically approaching the string perturbative vacuum. This article is part of the theme issue 'The future of mathematical cosmology, Volume 2'.

Do stochastic inhomogeneities affect dark-energy precision measurements?

The effect of a stochastic background of cosmological perturbations on the luminosity-redshift relation is computed to second order through a recently proposed covariant and gauge-invariant light-cone averaging procedure. The resulting expressions are free from both ultraviolet and infrared divergences, implying that such perturbations cannot mimic a sizable fraction of dark energy. Different averages are estimated and depend on the particular function of the luminosity distance being averaged. The energy flux being minimally affected by perturbations at large z is proposed as the best choice for precision estimates of dark-energy parameters. Nonetheless, its irreducible (stochastic) variance induces statistical errors on Ω(Λ)(z) typically lying in the few-percent range.

Seasonal concordance of recurrence in mood disorder patients

The aim of the present study is to evaluate the seasonal pattern of recurrences and the concordance among first episode (index episode) versus the subsequent recurrences in a sample of 210 patients affected by mood disorders, referred to the Mood Disorder Unit of San Raffaele Hospital. The most depressive recurrences are in spring for unipolar subjects and in fall for bipolars. Manic episodes are more frequent in summer. Patients presented a high concordance rate between the first and the second episode, female patients were more concordant than male subjects, and patients with low cycle of illness (one episode every six or more years) were the most concordant ones.

Ethical questions in the treatment of subjects with dementia. Part I. Respecting autonomy: awareness, competence and behavioural disorders

The document deals with some ethical issues raised by the treatment of demented people. In particular the conceptual and empirical aspects of the assessment of awareness and competence of these patients are analysed, as well as the dilemmas related to the treatment of behavioral disorders.

Four-year follow-up study of sertraline and fluvoxamine in long-term treatment of unipolar subjects with high recurrence rate

We prolonged from 24 to 48 months a follow-up study of unipolar subjects with high recurrence rate treated with fluvoxamine (N=25) and sertraline (N=22). During the two-year additional period a significant risk of recurrences was observed during the third year of follow-up, without differences in the two long-term therapy groups. During the fourth year no patients showed new episodes of illness.

Early onset of lithium prophylaxis as a predictor of good long-term outcome

The recurrence rates during lithium preventive treatment were investigated in a sample of 270 Mood Disorder subjects subdivided according to their onset time for lithium prophylaxis as very early (within 5 years from the onset of illness), early (6-10 years), late (11-20 years) and very late (more than 21 years). 131 subjects of the sample followed for 4 years prolonged the observation for a further period of 8 years. Results indicated that beginning lithium therapy within the first ten years of illness predicts better preventive outcomes than beginning prophylaxis later, both in major depression, recurrent and bipolar patients.

Two-year maintenance treatment with citalopram, 20 mg, in unipolar subjects with high recurrence rate

BACKGROUND

The efficacy of citalopram, 20 to 60 mg/day, in relapse prevention in major depression was demonstrated in 6-month placebo-controlled studies. The authors tested the efficacy of citalopram, 40 mg/day, in relapse prevention over a 4-month period and citalopram, 20 mg/day, in recurrence prevention over a 24-month period.

METHOD

Fifty inpatients with recurrent major depressive disorder (DSM-IV criteria) who had had at least one depressive episode during the 18 months preceding the index episode were openly treated with citalopram, 40 mg/day. Thirty-six subjects had a stable response to citalopram and remained in the continuation treatment with citalopram, 40 mg/day, for 4 months as outpatients. At the time of recovery, 32 patients gave their written informed consent before entering the 24-month maintenance period with citalopram, 20 mg/day. They were evaluated monthly by trained psychiatrists on the basis of the 21-item Hamilton Rating Scale for Depression. Every 3 months, patients were given the Sheehan Disability Scale, a self-rating instrument, to assess their psychosocial adjustment.

RESULTS

No relapse was observed in the 4-month continuation period. Sixteen (50%) of 32 patients who entered the 24-month maintenance period had a new recurrence. Patients with recurrence showed a persistent moderate disability on Sheehan Disability Scale score, while no further differences were highlighted in clinical and demographic characteristics between patients with and without recurrence.

CONCLUSION

In agreement with previous findings, these data suggest that a full dose of antidepressant is strongly recommended in prophylactic therapy of patients with recurrent major depression. Moreover, it appears that psychosocial impairment may increase the risk of recurrence, thus conditioning a poor outcome.

Clinical and demographic features of psychotic and nonpsychotic depression

The present study evaluated clinical and demographic features of subjects with delusional versus nondelusional major depressive disorder. Two hundred eighty-eight subjects with mood disorder (bipolar disorder, n = 94; major depressive disorder, n = 194) were included in the study. No differences were observed for gender, polarity of mood disorder, age of onset, duration of index episode, number of episodes, number of previous hospital admissions, frequency of illness episodes, and number of suicide attempts. On the other hand, delusional subjects showed a higher rate of cluster A personality disorder and a lower level of education. We also detected a larger number of cluster B personality disorders among nondelusionals. Our data suggest that subjects with delusional mood disorder do not differ substantially from nondelusionals in terms of the clinical and demographic variables considered in this study except for personality disorders.

Tryptophan hydroxylase gene and response to lithium prophylaxis in mood disorders

Lithium is an effective prophylactic agent in mood disorders but not all patients with mood disorders respond to lithium therapy; it is therefore necessary to identify responders prior to treatment. Clinical predictors account for about half of the variance and it is probable that genetic factors play a substantial role. The aim of this study was to investigate the possible association between the tryptophan hydroxylase (TPH) gene and prophylactic efficacy of lithium in mood disorders. One hundred and eight subjects affected by bipolar (n = 90) and major depressive (n = 18) disorder were followed prospectively for an average of 50.4 months and were typed for their TPH variant using polymerase chain reaction techniques. TPH variants were marginally associated with lithium outcome (F = 3.16; d.f.=2,105; P = 0.046). Subjects with the TPH*A/A variant showed a trend toward a worse response compared to both TPH*A/C and TPH*C/C variants. Consideration of possible stratification effects such as gender, polarity or age at onset did not influence the observed association. TPH variants may be a possible factor influencing the prophylactic efficacy of lithium in mood disorders.

Symptomatologic analysis of psychotic and non-psychotic depression

BACKGROUND

The aim of the present study is to evaluate the symptomatologic presentation of delusional compared to non-delusional major depressive episodes.

METHODS

Two hundred and eighty-eight subjects suffering from mood disorder (144 bipolar, 133 unipolar) were assessed at admission by the Hamilton Depression Rating Scale (HAMD-21).

RESULTS

Depressive symptomatology was more severe in the delusional sample, even after the exclusion of the items directly involved with delusional symptoms (P = 0.00002).

CONCLUSIONS

Our data support the hypothesis of delusional depression as a more severe form of mood disorder.

Faster onset of action of fluvoxamine in combination with pindolol in the treatment of delusional depression: a controlled study

This double-blind, controlled study was undertaken to investigate whether the addition of pindolol could improve the therapeutic response to fluvoxamine of depressed patients with psychotic features. After a 1-week placebo run-in period, 72 patients received fluvoxamine 300 mg/day in combination with placebo or pindolol 7.5 mg/day. At study completion, 28 (80%) of 35 patients treated with fluvoxamine plus placebo and 29 (80.5%) of 36 patients treated with fluvoxamine plus pindolol were categorized as responders (reduction of their score on the 21-item Hamilton Rating Scale for Depression to 8 or less and on the Dimension for the Delusional Experience Rating Scale to 0). In the third and fourth weeks, the response rates were significantly superior in the fluvoxamine plus pindolol group (p = 0.0001, p = 0.023, respectively). Treatment response seemed to be unrelated to the demographic and the clinical characteristics recorded. No significant difference was found comparing plasma levels of fluvoxamine between groups, thus excluding a pharmacokinetic interaction. Other than mild nausea and sedation in a few patients, treatments were well tolerated. No medically significant adverse events occurred. Depressed patients with psychotic features who were administered pindolol experienced a more rapid improvement during fluvoxamine treatment. Thus, the combination of fluvoxamine with pindolol may be a useful pharmacologic strategy in the treatment of this disorder. A rapid clinical response in such patients is of relevance in clinical practice as well as in economic fields, given the direct and indirect costs of depression.

Mode of inheritance in mood disorder families according to fluvoxamine response

Mood disorders are known to cluster within families, but the mode of transmission remains largely unknown. The purpose of our analysis was to determine whether selection of a sample that was homogeneous in its response to an antidepressant provided stronger evidence for a single major locus. Complex segregation analysis was applied to a sample of 171 Italian families of bipolar and unipolar probands that were responsive to the antidepressant fluvoxamine. We used regressive logistic analyses to determine the best fit from among environmental, arbitrary Mendelian, dominant, recessive and additive models. For the 171 affective families with probands that were responsive to the antidepressant fluvoxamine, a Mendelian model of inheritance was rejected. When considering 68 families of bipolar probands, the best fit was obtained for a Mendelian dominant model of transmission. The identification of a Mendelian mode of transmission in bipolar subjects who were selected according to their response to fluvoxamine supports the use of a pharmacological criterion as a tool for identifying true genetic disorders.

Familial concordance of fluvoxamine response as a tool for differentiating mood disorder pedigrees

Concordance to antidepressant response in members of the same family is a common observation in clinical practice. However, few published data support this view; moreover families with affected members responder to the same antidepressant have been poorly studied. We have analyzed 45 pairs consisting of one mood disorder fluvoxamine double-responder proband and one first-degree relative with known outcome to fluvoxamine treatment. Among 45 pairs 30 (67%) were concordant for good response to fluvoxamine. In family pedigrees of concordant pairs we found a significantly higher distribution of bipolar forms in secondary cases than in families of non concordant pairs (14.9% vs 3.9% P = 0.039) suggesting that concordance to antidepressant therapy could select families with higher genetic loading.

Mechanical ventilation in chronic respiratory insufficiency: report on an Italian nationwide survey. The Italian Telethon Committee and the AIPO Study Group on Pulmonary Rehabilitation and Intensive Care

Respiratory home care is an important aspect of rehabilitation programmes designed for patients needing long-term mechanical ventilation. Many differences have emerged between countries in the long-term care of these patients, depending on the different ways of supplying material, managing patients and providing equipment. The results of analysis of the data obtained in a preliminary survey carried out in 1995-1996 among 115 Italian centres operating in the field of home mechanical ventilation are presented. A questionnaire (all closed-circuit items) consisting of two sections (the first epidemiological, and the second methodological and economic) was sent to all centres. Fifty-seven out of 115 (50%) centres responded to the questionnaire, with a prevalence of responses from the north of Italy (37 centres). The responding centres had been working in this field for a mean period of 6 +/- 3 yrs, and a total of 1,842 patients were surveyed. The analysis focuses on the prevalence of treated diseases, methods of mechanical ventilation, regulation of prescription, evaluations carried out during follow-up, supply of equipment, costs and reimbursement, and relations with volunteer associations. A more thorough approach to all the problems emerging from this Italian survey regarding candidates for home mechanical ventilation is warranted. A more detailed comparative analysis of indications, management and costs vis-à-vis other countries should contribute towards achieving maximum uniformity of standards throughout Europe.

Dose-response efficacy of paroxetine in preventing depressive recurrences: a randomized, double-blind study

BACKGROUND

The authors evaluated and compared the efficacy of 20 mg versus 40 mg of paroxetine in a randomized, double-blind, parallel-group study during a maintenance period of 28 months.

METHOD

Ninety-nine inpatients with recurrent, unipolar depression (DSM-IV criteria) who had at least 1 depressive episode during the 18 months preceding the index episode were openly treated with paroxetine 40 mg/day. Seventy-two subjects had a stable response (Hamilton Rating Scale for Depression score < 8) to paroxetine treatment and remained in the continuation treatment as outpatients for 4 months. At the time of recovery, 68 patients were randomly assigned to 1 of the 2 maintenance treatment groups: paroxetine 20 mg or paroxetine 40 mg daily.

RESULTS

Sixty-seven patients completed the 28-month follow-up period. Seventeen (51.5%) of 33 patients in the 20-mg paroxetine regimen had a single recurrence compared with 8 (23.5%) of 34 subjects in the 40-mg dose regimen (chi2 = 5.56, p = .018).

CONCLUSION

These data suggest that a full dose of paroxetine is recommended in unipolar patients who are at high risk for recurrent depressive episodes.

How long should pindolol be associated with paroxetine to improve the antidepressant response?

A double-blind study was undertaken to investigate the period of treatment with the beta-adrenoreceptor/5-hydroxytryptamine 1A (5-HT1A) antagonist pindolol required to enhance the antidepressant effects of paroxetine. After 1 week of a placebo run-in period, 63 untreated major depressive inpatients were randomly assigned to three different groups. Group 1 received paroxetine (20 mg/day) plus placebo (4 weeks). Group 2 received paroxetine (20 mg/day) plus pindolol (7.5 mg/day) for 1 week and placebo for 3 weeks. Group 3 received both active treatments for the entire duration of the study (4 weeks). Clinical response was defined as a reduction of the score in the Hamilton Rating Scale for Depression (HAM-D) to 8 or below. Also, to preliminarily examine whether beta-adrenoreceptor blockade was involved in the action of pindolol, another group of 10 inpatients was treated in an open-label manner with paroxetine (20 mg/day) plus 50 mg/day of the beta-adrenergic antagonist metoprolol, devoid of significant affinity for 5-HT1A receptors. At endpoint, the incidence of treatment-emergent side effects did not significantly differ among the three groups. After 1 and 2 weeks of treatment, the two groups treated with paroxetine plus pindolol displayed a significantly greater response rate than the group treated with paroxetine plus placebo. At study completion, only the patients treated with pindolol for the entire period showed a significantly greater response rate (p = 0.05). HAM-D score were also significantly lower at endpoint in patients treated with the combination for 4 weeks (p = 0.00003). The group of patients treated with paroxetine and metoprolol exhibited a side-effect profile comparable to that of paroxetine alone. Response rates were also comparable. These findings support the efficacy of pindolol, but not of metoprolol, in accelerating the antidepressant effect of paroxetine and suggest that the administration of pindolol for the entire period of the acute treatment may increase the efficacy of paroxetine.

Long-term treatment of psychotic (delusional) depression with fluvoxamine: an open pilot study

The aim of this open pilot study was to evaluate the efficacy of fluvoxamine in the continuation as well as in the maintenance therapy of delusional depression. Thirty patients with recurrent, unipolar depression (DSM-IV criteria) were selected who had at least one depressive episode during the 18 months preceding the delusional depressive index episode and were treated with fluvoxamine 300 mg/day. Twenty-five of them had a sustained response to this short-term treatment and agreed to enter into the 30-month follow up study. All participants completed the follow up period. No relapse was observed during the 6 months of continuation therapy. During the further 24 months of maintenance therapy, 80% of the patients remained well, whereas 20% (five out of 25) had a single recurrence. Based on these observations, fluvoxamine might be a promising drug for long-term therapy of delusional depression. Further controlled studies are required to confirm this finding.

A double-blind study of long-term treatment with sertraline or fluvoxamine for prevention of highly recurrent unipolar depression

BACKGROUND

We evaluated and compared the efficacy and safety of sertraline and fluvoxamine in a randomized, double-blind, parallel-group study during a follow-up of 24 months.

METHOD

Sixty-four patients with recurrent, unipolar depression (DSM-IV criteria) who had at least one depressive episode during the 18 months preceding the index episode were accepted into the trial. Patients were randomly assigned to one of the two long-term treatment groups and evaluated monthly by trained psychiatrists, blinded to treatment option, on the basis of the Hamilton Rating Scale for Depression.

RESULTS

All patients completed the 24-month follow-up period. Sertraline and fluvoxamine showed an equal efficacy in preventing new recurrences. In fact, there was no significant difference in survival rates between the two medication groups: 7 sertraline-treated patients (21.9%) and 6 fluvoxamine-treated patients (18.7%) had a single new recurrence (z = 0.14; p = .88). Moreover, recurrence observed during maintenance therapies was less severe and/or of shorter duration than index episodes.

CONCLUSION

Long-term treatment with sertraline or fluvoxamine has been shown to be effective for prevention of highly recurrent unipolar depression. The high tolerability of these compounds, together with their prophylactic effectiveness, has an important role in improving the quality of life of these patients.

Double-blind controlled trial of sertraline versus paroxetine in the treatment of delusional depression

OBJECTIVE

In this study the authors evaluated the efficacy and the tolerability of sertraline and paroxetine in the treatment of delusional depression.

METHOD

Under double-blind conditions, 46 hospitalized patients who met the DSM-III-R criteria for major depression with psychotic features were treated with sertraline or paroxetine for 6 weeks.

RESULTS

The response rates were 75% and 46% for sertraline and paroxetine, respectively. The dropout rate was substantial (41%) in the paroxetine group and was attributable to side effects.

CONCLUSIONS

Selective serotonin reuptake inhibitors administered alone are useful in the treatment of delusional depression.

Fluvoxamine and lithium in long-term treatment of unipolar subjects with high recurrence rate

We prolonged from 24 to 36 months a follow-up study of unipolar subjects with a high probability of recurrence treated with fluvoxamine (n = 32) or lithium (n = 32). During the extra observation period, two patients developed mania and were excluded from the study. There were no further recurrences in either the lithium or the fluvoxamine group. In our sample, previous prescriptions of tricyclics seem to predict a worse prognosis.

Fluvoxamine alone in the treatment of delusional depression

OBJECTIVE

The aim of this study was to evaluate the efficacy of fluvoxamine in the treatment of delusional depression.

METHOD

Fifty-nine inpatients who met the DSM-III-R criteria for major depression with psychotic features were treated with fluvoxamine for 6 weeks. Patients were assessed at baseline and weekly thereafter with the Hamilton Depression Rating Scale and the Dimensions of Delusional Experience rating scale.

RESULTS

Of the 57 subjects completed the trial, 84.2% (N=48) recovered. The index episodes of the patients who did not respond to fluvoxamine were of significantly longer duration than those of the responders.

CONCLUSIONS

Fluvoxamine has a response rate similar to that of the currently most efficacious treatments for delusional depression, including antidepressants plus antipsychotics and ECT.

Abnormalities of cAMP-dependent endogenous phosphorylation in platelets from patients with bipolar disorder

OBJECTIVE

The aim of the study was to assess cAMP-dependent endogenous phosphorylation in platelets from euthymic bipolar patients.

METHOD

Platelets from 10 drug-free euthymic patients with bipolar disorder were compared with those from 10 age- and sex-matched healthy subjects. Basal and cAMP-stimulated protein phosphorylation was examined in each group.

RESULTS

Endogenous phosphorylation in both the healthy volunteers and the bipolar patients was significantly stimulated by cAMP; the major polypeptides had apparent molecular weights of 38 and 22 kDa. The cAMP-stimulated 32P incorporation differed between the bipolar patients and the comparison subjects only in the 22-kDa band.

CONCLUSIONS

These data suggest a possible role of cAMP-dependent protein phosphorylation in the pathophysiology of bipolar disorder.

35% CO2 challenge in panic and mood disorders

20 patients with Panic Disorder (PD), 19 patients with Mood Disorder (MD) and 20 healthy controls inhaled one vital capacity of 35% CO2-65% O2 gas mixture and of compressed air in a double-blind, random, cross-over design. Only PD patients showed a strong reaction to 35% CO2 while MD patients and controls did not react significantly. These results support the specificity of the 35% CO2 challenge in PD patients and suggest that PD and MD are separate disorders.

A 24-month follow-up study of unipolar subjects: a comparison between lithium and fluvoxamine

The authors compared rates of new episodes in a sample of 64 unipolar subjects treated with fluvoxamine (n = 32) and lithium (n = 32) during a follow-up period of 24 months. Unipolar patients on lithium treatment had a worse outcome with a higher frequency of new recurrences compared with of new recurrences compared with patients on fluvoxamine during the course of preventive treatment.

Inter and intra-individual variability of sperm morphology after selection with three different techniques: layering, swimup from pellet and percoll

Sperm morphology has been suggested to be one of the most reliable factor in predicting male fertility potential both in spontaneous cycles and in assisted reproduction. In this work the morphology of spermatozoa selected with three different techniques (layering, swimup from pellet and mini-percoll) has been assessed and compared in 20 infertile patients. All the techniques allowed the recovery of sperm populations of a better quality than in basal samples, with a higher percentage of normal forms (p < 0.001). No significant differences were observed among the three different techniques in selecting sperm populations. The scatter diagrams comparing pairwise differences between the methods against their means regard the percentage of normal forms selected show a great (over 20%) inter and intra-individual variability. These data demonstrate that the three techniques select different percentages of normal spermatozoa, even in the same patient. Since it is crucial to obtain the highest number of morphologically normal and motile spermatozoa and each technique may provide different results in a given patient, we suggest that at least two techniques of sperm selection be performed before assisted reproduction procedures. This combined testing could also be relevant in the prognostic evaluation of the infertile male, since it explores the different characteristics of sperm function.

A study of relapses in subjects with mood disorder on lithium treatment

In a sample of 213 mood disorder subjects on long-term lithium treatment, we analyzed the recurrence indices of relapses during the prophylactic treatment period. The differences found in the recurrence rates were due to the current age and age of onset, duration of illness and polarity of the probands. The patients with personality disorders showed the worst relapse indices and could represent a group of mood disorder subjects with a bad outcome of lithium treatment.

The influence of muscular lengthening on cramps

Muscle cramps induced by voluntary contraction and by electrical stimulation of the peripheral nerve were studied electrophysiologically in 10 healthy subjects. The aim was to verify that cramps can be evoked by electrical stimulation of peripheral nerve and to clarify the physiological mechanism responsible by analyzing the effect of muscular stretching on cramps. Our results showed: (1) Cramps can be induced even after peripheral nerve block by electrical stimulation distal to the block. (2) No cramps were recorded during or following maximal voluntary contraction without muscular shortening, while 7 of 10 subjects showed a true cramp following maximal effort with shortening of the muscle. (3) Muscle stretching caused a sudden interruption of cramps induced by either voluntary contraction or electrical stimulation of the peripheral nerve, even after the induction of nerve block. (4) The lengthening state of the muscle can strongly influence the possibility of evoking cramps by electrical stimulation of nerve. Our study verifies the experimental model proposed by Lambert in 1969, emphasizing the relevance of frequency of stimulation and confirming the hypothesis that cramps are of peripheral origin. The effects of muscle stretch and lengthening on cramp interruption and development also have a peripheral mechanism.

A comparison between delusional and non-delusional depressives

Delusional depressive episodes may represent more sever degrees of depressive manifestations or a distinct subtype of depressive illness. To test these two alternative hypotheses, characteristics on demographic, clinical and symptomatic variables, presence of personality disorders and familial loading were compared in 57 delusional and 57 non-delusional depressive patients. The delusional group did not differ on symptomatological intensity degree, clinical and familial loading characteristics. They did differ on higher distribution of Cluster 1 personality disorders. In the delusional sample the presence of mood incongruent psychotic features and hallucinations were evaluated as possible indicators of different subtypes of delusional depression.

The nature of depression in borderline depressed patients

The symptomatology of 15 borderline (BDL) depressed and 45 non-BDL depressed consecutive inpatients was assessed using the Hamilton depression scale (HAM-D) and the 90-item Symptoms Checklist (SCL-90) self-rating questionnaire. No significant differences were found in the total scorings of the two instruments in the two groups of patients. However, while non-BDL depressive rated significantly higher in items related to melancholic forms of depression, BDL depressives showed less specific symptoms, and the persistence, or possibly the magnification, of their maladaptive personologic structure. Two discriminant analyses, performed on the ratings at the HAM-D and SCL-90 of the two groups of patients, suggested that although the total degree of severity may be the same, the depressive episodes of BDL patients are qualitatively different from those of patients with less maladaptive personologic traits.

Perspectives in clinical psychopharmacology of amitriptyline and fluvoxamine. A double-blind study in depressed inpatients

The efficacy of fluvoxamine was compared to that of amitriptyline in a double-blind 6-week fixed-dose trial of 56 inpatients with major depressive episode. The two drugs were comparable in their antidepressant efficacy. We tested the percentage of improvement in Hamilton-D scores during the first and the second weeks of treatment as predictors of efficacy for the last week. Improvement rates during the second week significantly predicted the outcome. We also investigated whether or not some symptomatological characteristics would permit prior prediction of the outcome with amitriptyline or fluvoxamine, dividing our sample into responders and nonresponders to the two drugs. The four groups showed differences in their symptomatological profiles.

Morbidity risk for mood disorders in the families of borderline patients

We analyzed the familial morbidity risk for mood disorders (MR) and the presence of a family history of alcoholism in a group of 58 patients with DSM-III borderline personality disorder (PD). The MR in the families of borderline subjects was not significantly different from that found in a control group of affective patients with other cluster II PD, or without PD. The MR in the families of borderline subjects who had never developed an affective episode was not significantly different from that found in the families of borderline PD with a history of mood disorders. Borderline subjects with mood disorders had higher rates of alcoholism in their families, mainly among parents. Our results support the hypothesis that borderline PD, even in absence of the codiagnosis of a mood disorder in the subject, may be a predictor of higher familial liability to mood disorders, although it may be more informative for the familial clustering of specific subgroups than for mood disorders as a whole.

Psychiatric disorders in the families of schizotypal subjects

In a study of the families of 21 schizotypal patients, we found an increased morbidity risk for schizophrenia compared with that in the families of 21 nonschizotypal patients and 42 controls. The Axis I diagnoses did not influence the distribution of the morbidity risk in the families of the schizotypal patients. If the schizotypal subjects also had other personality disorders, the morbidity risk for schizophrenia among their relatives was lower, although not significantly.

Personality features related to generalized anxiety disorder

Forty-six patients with generalized anxiety disorder (GAD) without any other coexisting axis I diagnoses were compared with 50 control subjects for assessment on axis II. No specific personality disorder (PD) was found to be significantly associated with chronic anxiety, although the majority of anxious patients showed significantly more maladaptative traits than controls. Discriminant analysis selected a list of items able to provide a correct classification rate of 91% based on personality features selected in canonical function. Factor analysis indicated that personality characteristics of expectation of damage were more closely related to GAD in our sample.

Occupational contact dermatitis in 2 dental technicians

2 dental technicians, both with chronic hand eczema, reported worsening from the use of 2 products containing methyl methacrylate, employed in manufacturing acrylic prostheses. Patch tests in both patients gave positive reactions to methyl methacrylate, ethylene glycol dimethacrylate and products employed in manufacturing acrylic prostheses (2% and 5% pet.). On the basis of results subsequently obtained from patch tests carried out with pieces of glove interposed between the skin and the allergens (methyl methacrylate and products employed), we advised our patients still to use latex gloves during work. Follow-up after 1 year showed complete regression of the dermatitis in 1 case and considerable improvement in the other.

Far-field and cortical somatosensory evoked potentials in motor neuron disease

We examined median somatosensory evoked potentials (SEPs) in 26 patients with sporadic motor neuron disease (MND). SEPs were recorded with multiple scalp derivations, using both the midfront and the earlobe as references for each subject. Central conduction time (CCT) was abnormal in three patients, but only when using the midfront reference. Moreover, an exclusive alteration of the early prerolandic potentials (absent or delayed P20 and/or P22) was noted using the earlobe reference in amyotrophic lateral sclerosis and in progressive bulbar palsy (54% and 50% of patients, respectively) but not in progressive muscular atrophy. These findings correlated with clinical evidence of upper motor neuron signs and with the severity of the disease. In agreement with recent views regarding the sources of the early anterior cortical responses, neuronal loss in the motor cortex may be considered as affecting the generator sites of these potentials.