Platelet serotonin, plasma cortisol, and dexamethasone suppression test in schizophrenic patients

BACKGROUND

Serotonin (5-HT) regulates hypothalamic-pituitary-adrenal (HPA) axis activity. Abnormal response to the dexamethasone suppression test (DST) and altered platelet 5-HT concentration have been shown in some schizophrenic patients.

METHODS

Platelet 5-HT and plasma cortisol concentrations were determined simultaneously in 86 male schizophrenic patients before and after DST. Basal plasma cortisol and platelet 5-HT levels were also determined in 69 healthy male persons.

RESULTS

Schizophrenic patients had higher plasma cortisol and platelet 5-HT concentrations than healthy persons. An abnormal escape from dexamethasone suppression was observed in 50% of patients. In these patients predexamethasone cortisol and platelet 5-HT concentrations were higher than in patients with normal DST.

CONCLUSIONS

This study demonstrates that schizophrenic patients have the HPA axis dysregulation that could be connected with a disturbance in the 5-HT system.

Platelet 5-HT concentrations and suicidal behaviour in recurrent major depression

Platelet 5-HT concentrations were determined in 84 male and 82 female psychotic and non-psychotic depressed inpatients with various degrees of suicidal behaviour, and in 175 healthy controls. Psychotic patients had higher platelet 5-HT concentrations than non-psychotic depressed patients and healthy controls. A sex difference, i.e., lower platelet 5-HT concentrations in females was found in healthy controls, depressed patients, non-psychotic patients and non-suicidal depressed patients. A negative relationship was shown between platelet 5-HT concentrations and suicidal behaviour. The lowest platelet 5-HT concentrations were associated with the most pronounced suicidal behaviour (with suicidal attempts and with the acts of suicide). The results suggest that the differences in platelet 5-HT concentrations found in depressed patients might be used as a biological marker for suicidal behaviour.

Platelet serotonin in subtypes of schizophrenia and unipolar depression

In subtypes of schizophrenia and unipolar depression, both increased and decreased levels of platelet serotonin were found. Hyperserotonemia was usually observed in patients with psychotic features (i.e., in paranoid schizophrenia and psychotic depression). Hyposerotonemia, although less common than hyperserotonemia, was present in nonparanoid schizophrenia and nonpsychotic depression (i.e., in patients without psychotic symptoms). A sex difference in platelet monoamine oxidase activity was observed among healthy subjects, but not among schizophrenic patients. The activity of platelet monoamine oxidase in paranoid and nonparanoid schizophrenic patients did not differ from that in healthy subjects. The findings in this study suggest that biological differences between subtypes of unipolar depression or schizophrenia might depend upon the presence of psychotic symptoms.

Olanzapine in the treatment-resistant, combat-related PTSD--a series of case reports

OBJECTIVE

Nightmares and insomnia in combat-related post-traumatic stress disorder (PTSD) might be resistant to treatment with selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines.

METHOD

We describe five case reports of patients suffering from long-lasting and intractable nightmares and insomnia. They were given different psychotropic agents in past few years, with no improvement in their sleep disturbance. Olanzapine was added to the current treatment regimen.

RESULTS

Both nightmares and insomnia improved rapidly after olanzapine institution in all of five patients. No adverse events of olanzapine were reported.

CONCLUSION

Olanzapine augmentation might be useful in alleviating treatment-resistant nightmares and insomnia in patients with combat-related PTSD.

Effect of antidepressant treatment on platelet 5-HT content and relation to therapeutic outcome in unipolar depressive patients

Platelet 5-HT levels and scores on the 17-item Hamilton Rating Scale for Depression (HRS) were studied in patients with unipolar depression before and after antidepressant treatment. Before treatment there were no differences in platelet 5-HT values or in HRS scores between patients who showed a good and a poor therapeutic response. Repeated administration of 5-HT uptake inhibitors (amitriptyline, clovoxamine, fluvoxamine) for 28 days markedly decreased platelet 5-HT levels. Chronic treatment with trazodone or maprotiline (weak inhibitors of platelet 5-HT uptake) produced no changes in platelet 5-HT levels. No significant correlation was observed between platelet 5-HT concentrations and the HRS scores before or during treatment. The findings suggest that the changes in platelet 5-HT levels after antidepressant treatment are mainly due to the effects of antidepressants on the 5-HT uptake system.

Seasonal influence on platelet 5-HT levels in patients with recurrent major depression and schizophrenia

The influence of seasons on platelet serotonin (5-HT) concentration was determined in 88 unipolar depressed and 117 schizophrenic male inpatients, and 90 normal male controls. Platelet 5-HT concentrations showed moderate, but insignificant intragroup seasonal variations in healthy controls and in the groups of depressed (psychotic and nonpsychotic) and schizophrenic (positive and negative) patients. In spring, platelet 5-HT concentrations were higher in schizophrenic patients than in normal controls or in depressed patients, while in other seasons platelet 5-HT concentrations were not significantly different between the groups. Higher platelet 5-HT concentrations were detected in psychotic when compared to nonpsychotic depressed patients in summer, fall, and winter. Increased platelet 5-HT concentrations observed in schizophrenic patients with positive symptoms clearly separated these patients from patients with negative schizophrenia, especially in spring, summer, and fall. Our results indicate the necessity to match patients with regard to the season of the sampling, and to divide depressed and schizophrenic patients into subtypes.

Analysis of the tyrosine hydroxylase and dopamine D4 receptor genes in a Croatian sample of bipolar I and unipolar patients

We selected 83 patients with bipolar disorder type I or unipolar recurrent major depression and 71 healthy controls for genetic analysis of the tyrosine hydroxylase and the dopamine D4 receptor gene. No significant association was found between bipolar disorder type I and unipolar recurrent major depression and the polymorphisms located near these genes. Therefore, the hypothesis that the tyrosine hydroxylase and the dopamine D4 receptor genes may be involved in the etiology of bipolar disorder and unipolar recurrent major depression is not supported in our study.

Hypothalamic-pituitary-adrenal axis function and platelet serotonin concentrations in depressed patients

Plasma cortisol and platelet serotonin (5-hydroxytryptamine, 5-HT) concentrations were determined in 39 male psychotic and 39 male non-psychotic depressed inpatients, and in 69 male healthy control subjects. Psychotic or non-psychotic depressed patients had higher predexamethasone plasma cortisol levels than found in the control group. After the dexamethasone suppression test (DST), psychotic and non-psychotic depressed patients were subdivided into suppressors and non-suppressors. Psychotic and non-psychotic patients had significantly different platelet 5-HT concentrations among themselves and compared with the control group. However, there was no significant correlation between plasma cortisol levels and platelet 5-HT concentrations. Dexamethasone administration did not affect platelet 5-HT concentrations within subtypes of depressed patients. Abnormal cortisol suppression after the DST occurred more frequently in psychotic than in non-psychotic patients. Platelet 5-HT and plasma cortisol concentrations were decreased in patients with pronounced suicidal behaviour. Our results suggest that plasma cortisol and platelet 5-HT concentrations might serve as independent biological markers for different subtypes of depression.

Positive association between the GABRA5 gene and unipolar recurrent major depression

The gamma-aminobutyric acid (GABA) neurotransmitter system has been implicated in the pathogenesis of mood disorders. To test this hypothesis we carried out an association study between a dinucleotide repeat polymorphism in the GABAA receptor alpha 5 subunit gene and bipolar and unipolar mood disorders. Our results suggest a possible involvement of this gene in unipolar but not in bipolar disorder.

Time course of schizophrenia and platelet 5-HT level

The concentration of platelet serotonin (5-HT) and the simultaneous uptake of 5-HT into platelets have been investigated in schizophrenic patients with (A) intermittent time course of illness (complete remission), (B) chronic time course (partial remission and residual symptoms), and (C) intermittent-chronic time course (good remission at the beginning of illness with gradual progression to chronic stage). An increased platelet 5-HT concentration (i.e., hyperserotoninemia) of unknown etiology was observed, especially in the group with chronic time course of disease as compared to the normal controls. At the same time, kinetic constants Km and Vmax of 5-HT uptake into platelets were unchanged in all patients. Neuroleptic treatment did not produce any significant change either in platelet 5-HT level or in the uptake of 5-HT. These results provide further support for the possible 5-HT dysfunction in schizophrenia.

Platelet 5-HT levels and hypothalamic-pituitary-adrenal axis activity in schizophrenic patients with positive and negative symptoms

Hypothalamic-pituitary-adrenal (HPA) axis activity and platelet 5-HT concentrations were determined before dexamethasone suppression test (DST) in 80 male schizophrenic patients with predominantly positive or negative symptoms. Significant differences in platelet 5-HT and no differences in baseline plasma cortisol concentrations among schizophrenic suppressors and nonsuppressors were found. A similar rate of nonsuppression (56% positive and 53% negative schizophrenic patients) was detected. Platelet 5-HT, but not plasma cortisol concentrations, could be used to differentiate positive and negative symptoms of schizophrenia.

Sex differences, season of birth and platelet 5-HT levels in schizophrenic patients

Similar occurrence of schizophrenia was observed in men and women independent of their season of birth. Platelet 5-HT concentration was determined in 116 healthy control subjects (61 male and 55 female) and 152 patients with schizophrenia (96 male and 56 female). Platelet 5-HT concentration was significantly higher in male than in female healthy persons and schizophrenic patients. Male and female healthy subjects born in different seasons had similar platelet 5-HT concentrations, whereas schizophrenic patients with different birth-seasons had significantly different platelet 5-HT concentrations. The highest platelet 5-HT levels were observed in both male and female schizophrenic patients born in winter when compared to matched healthy controls. Male schizophrenic patients born in winter had higher platelet 5-HT levels than schizophrenic men born in spring and summer. Female schizophrenic patients born in winter had higher platelet 5-HT than schizophrenic women born in all other seasons. These results indicated sex differences in platelet 5-HT levels in healthy persons and schizophrenic patients. The relationship between season of the birth and platelet 5-HT concentration observed only in schizophrenic patients added further support to the presumption that schizophrenia is connected with a disturbance in the central serotoninergic system.

Validation of a patient satisfaction questionnaire in primary health care

BACKGROUND

Improvement in patient satisfaction with healthcare services can be evaluated by satisfaction questionnaires of high construct validity.

OBJECTIVES

To establish the dimensions and construct validity of a 20-item patient satisfaction questionnaire to assess satisfaction with general practice services.

SUBJECTS

In total, 1314 adult patients of both genders, who were users of healthcare services at the General Medicine Department of Health Centre Valjevo in Serbia for two consecutive years, were included in the study.

METHODS

Multidimensional scaling (MDS) was employed to identify similarities and dissimilarities among items comprising the satisfaction questionnaire. Patient satisfaction dimensions were estimated by principal component analysis for categorical data (CATAPCA).

RESULTS

The MDS model configuration derived two dimensions: (1) patient satisfaction with the timeliness of healthcare service provision; and (2) patient centredness related to doctors' and nurses' commitment towards their health. In the CATAPCA model, two dimensions of patient satisfaction were found: the first dimension patient satisfaction with medical staff and the second dimension was indicative of contextual patient dissatisfaction.

CONCLUSIONS

This study shows that the applied patient satisfaction questionnaire has high validity and reliability. It also has high sensitivity for longitudinal measurements, as well as good discriminatory power in measuring the different levels of patient satisfaction.

Platelet 5-HT and plasma cortisol concentrations after dexamethasone suppression test in patients with different time course of schizophrenia

Platelet 5-HT and plasma cortisol concentrations were determined in 59 schizophrenic patients with different time course of illness before and after dexamethasone suppression test (DST). An abnormal DST (nonsuppression) was observed in 51% of patients. In these patients basal cortisol and platelet 5-HT concentrations were higher than in patients with normal DST. After DST, plasma cortisol levels were higher in nonsuppressors with intermittent and intermittent-chronic time course, whereas platelet 5-HT concentrations were increased in nonsuppressors with intermittent-chronic time course. The results suggest that schizophrenic patients have dysregulated hypothalamic-pituitary-adrenal axis as shown by a high rate of DST nonsuppression, and that nonsuppressors showed hypercortisolemia and hyperserotonemia independent of the time course of schizophrenia. No significant association between DST and time course of the illness was found.

Platelet serotonin concentration in dialysis patients with somatic symptoms of depression

Platelet serotonin (5-HT) concentration was measured in 65 male and 45 female chronic renal patients on hemodialysis (HD) with different somatic symptoms of depression (crying spells, irritability, sleep disturbance, fatigability, loss of appetite, weight loss, somatic preoccupation and loss of libido), to find out the relationship between the severity of symptoms and platelet 5-HT concentration. Male and female patients had significantly lower platelet 5-HT concentration than 62 male and 38 female healthy subjects. Gender-differences in platelet 5-HT values observed in healthy subjects were not found in patients. Platelet 5-HT concentration differed in the groups of patients with the different scores of particular somatic symptoms (loss of appetite and loss of libido), but was similar in patients with other somatic symptoms. There was no relationship between platelet 5-HT concentration and the severity of somatic symptoms, or between platelet 5-HT concentration and age of the patients. Gender-related differences in the occurrence of somatic symptoms were detected in patients with the different degrees of weight loss, somatic preoccupation and loss of libido. Our results suggest that platelet 5-HT concentration could not be used as a biological marker for the severity of somatic symptoms in chronic renal patients on HD.

Analysis of the Financing of Russian Health Care over the Past 100 Years

The evolution of epidemiological burden in Imperial Russia and, consecutively, the Union of Soviet Socialist Republics (USSR), took place mostly over the duration of the past century [...].

Effect of age on platelet 5-HT concentrations in healthy controls, depressed and schizophrenic patients

The influence of age on platelet 5-HT concentrations was investigated in 85 male unipolar depressed inpatients, 113 male schizophrenic inpatients and 81 normal male controls. The correlation coefficients between platelet 5-HT concentrations and age within groups were very low and nonsignificant. Our results suggest that higher platelet 5-HT content, observed in schizophrenic patients, could not be ascribed to the influence of age.

Genetic differentiation of Liparus glabrirostris (Curculionidae: Molytinae) populations from the fragmented habitats of the Alps and Carpathian Mountains

Populations of Liparus glabrirostris (Curculionidae: Molytinae), a weevil inhabiting higher altitudes of Central Europe, were sampled from 24 localities in the Alps and Carpathian Mountains, and the geographical structuring of genetic variation was analyzed. Comparison of the concatenated mitochondrial cytochrome oxidase subunit I and subunit II sequences revealed consistent genetic divergence between the populations of L. glabrirostris from different mountain ranges. In phylogenetic analysis using maximum parsimony and median-joining networks, concatenated mitochondrial haplotypes from the Alps and Carpathians clustered as separate lineages, with high bootstrap support. Substantial genetic distances determined between the separated groups ranged from 2.6 to 3.0%, with divergence estimated to have initiated approximately 0.85-0.98 million years ago. The nuclear elongation factor 1α gene was additionally amplified and haplotype analysis showed very low evolutionary divergence (0.2%), with separate clustering as well. The observed divergence suggests that the populations have been isolated for a long time, as a consequence of environmental changes resulting in varying fragmentation of habitats in the Alps and Carpathians, interrupting genetic exchange events and altering the genetic structure of L. glabrirostris populations. On the other hand, comparison of morphological characteristics showed no differences to confirm genetically well differentiated groups of populations. A polymerase chain reaction and restriction fragment length polymorphism-based method was therefore developed to discriminate between the Alpine and Carpathian lineages.

First Report of Alder Yellows Phytoplasma Associated with Common Alder (Alnus glutinosa) in the Republic of Macedonia

Alder yellows phytoplasma (AldYp) is classified as a member of the 16SrV-group of phytoplasmas and is closely related to Flavescence dorée (FD), a quarantined pathogen of economic importance affecting vineyards across Europe. AldYp is associated with common (Alnus glutinosa) and grey alder (A. incana), and has been reported in France, Italy, Germany, Austria, Switzerland, the Baltic region, Serbia, and Montenegro (1,2,4). For Macedonian vineyards, so far, neither infection of grapevine with 16SrV-group of phytoplasmas nor the presence of the main FD phytoplasma vector, Scaphoideus titanus, has been recorded. However, the presence of FD-related phytoplasma was detected in wild Clematis vitalba. In September and October 2013, leaves with petioles from A. glutinosa exhibiting leaf discoloration and yellowing were collected from two sites (41°23'43″ N, 22°54' E and 41°23' N, 22°53' E) in southeast Macedonia near the village of Smolare (Strumica district). Eight samples were collected from each site. Leaves of six asymptomatic alder seedlings collected from the same sites served as a control. Nucleic acids were extracted from fresh leaf midribs and petioles using a DNeasy Plant Mini Kit (Qiagen, Hilden, Germany). Initial phytoplasma identification was carried out by nested PCR assay of the 16S rRNA gene, using universal primers P1/P7 and R16F2n/R16R2 followed by RFLP with MseI endonuclease (Fermentas, Vilnius, Lithuania), as previously reported (4). Characterization of detected phytoplasmas was performed by amplifying two genetic loci specific for the members of the 16SrV group phytoplasmas; the ribosomal protein gene operon (rp) using primers rp(V)F1/rpR1 and rp(V)F1A/rp(V)R1A (3), and the non-ribosomal metionine aminopeptidase (map) gene using primer set FD9f5/MAPr1 and FD9f6/MAPr2 (1). The PCR amplicons were sequenced and deposited in NCBI GenBank database under the accession numbers KJ605448 to 52 (map) and KJ605453 to 57 (rp). The obtained sequences were compared with reference sequences of the 16SrV-group phytoplasmas (1,3) using the neighbor-joining method in MEGA5 (5). The presence of phytoplasma was detected in 14 of 16 symptomatic alder samples, while all control plants tested negative. The MseI restriction profiles were identical among all 14 samples and with the reference strains of the 16SrV group phytoplasmas (EY1 - 16SrV-A, FD-C - 16SrV-C, and FD-D - 16SrV-D). The rp-based phylogeny enabled identification of four diverse phytoplasma strains among the AldYp strains from Macedonia. Three strains clustered within the rpV-E subgroup while one belonged to rpV-L subgroup. Phylogenetic analysis of the more variable genetic locus, map, showed the presence of five diverse phytoplasma strains. Four strains belonged to the map-FD2 (FD-D, FD92) cluster, while one grouped within the map-FD1 (FD70) cluster. To our knowledge, this is the first report of 16SrV phytoplasma group occurrence on alder in Macedonia. The significant similarity between AldYp strains and FD sensu stricto indicate the risk of pathogen exchange between the wild ecosystem and the grapevine (1). Alder trees naturally infected with the FDp-related strains could therefore represent a serious risk for FD outbreak in Macedonian vineyards if local S. titanus populations developed. References: (1) G. Arnaud et al. Appl. Environ. Microbiol. 73:4001, 2007. (2) T. Cvrković et al. Plant Pathol. 57:773, 2008. (3) M. Martini et al. Int. J. Syst. Evol. Microbiol. 57:2037, 2007. (4) S. Radonjić et al. Plant Dis. 97:686, 2013. (5) K. Tamura et al. Mol. Biol. Evol. 28:2731, 2011.

Postcardiotomy assisted circulation with roller pump-early and late results

The incidence of postcardiotomy myocardial failure (PMF) requiring mechanical circulatory support beyond IABP is reported to be 0.2% to 1.2%. From Dec. 1989 through Dec. 1995, 18 patients (0.3% of the total pump cases) were supported with roller pump type of LVAD. Assisted flow ranged from 3.5 up to 5 L/min with average support time of 35.5 hours. Six (33.3%) patients (pts) died while on LVAD. The causes of additional seven deaths (pts weaned of LVAD) were: myocardial failure (4), stroke (2) and intractable bleeding during removal of the LVAD (1). Overall, five patients (27.8 %) were successfully discharged from the hospital. Two out of five long-term survivors died later, 6 months and 4 years postoperatively, both of cardiac causes. The actuarial survival rate of long-term survivors was 60% at 7 years, all of them being in NYHA functional class II. These results have proved efficiency of roller pump driven LVAD for short-term circulatory support in pts with PMF. Results are comparable to so far published data on postcardiotomy support with the same, as well as other types of more versatile and costly devices.

Predictors of job satisfaction in public hospitals in Belgrade, Serbia: a cross-sectional study

Background

Growing evidence has suggested that job satisfaction in the health-care system can affect productivity, the quality of service, and patient safety. Knowledge regarding job satisfaction of health workers and its determinants is valuable to health-care managers for decision making in the field of personnel policy. This study was aimed to assess job satisfaction among health workers in public hospitals in Belgrade, Serbia and identify its associated factors.

Methods

This was a cross-sectional study, carried out within 24 hours, in December 2018, as a part of a national survey, which is conducted annually in all health care institutions in Serbia. Data were collected by self-administered structured questionnaire, which was distributed to all health workers who were at work at the time of the survey (11,588 health workers in 26 public hospitals in Belgrade). The completed questionnaires were returned by 9,203 health workers, which constituted the response rate of 79.4%. Multivariable logistic regression was applied to identify factors significantly and independently associated with a higher level of job satisfaction.

Results

Overall, 31.4% of the respondents were satisfied with their job. Age less than 35 years [AOR = 1.40; 95% CI (1.18-1.67)], no work stress [AOR = 2.66; 95% CI (1.94-3.65)], satisfaction with time for accomplishment of tasks [AOR = 1.92; 95% CI (1.64-2.26)], satisfaction with recognition and value of health workers’ engagement [AOR = 1.79; 95% CI (1.51-2.13)], and satisfaction with leadership style and work organization [AOR = 1.90; 95% CI (1.60-2.26)] were identified as determinants with highest influence at job satisfaction.

Conclusions

Less than third of health workers in Belgrade’s hospitals were satisfied with their job, while satisfaction with various aspects of the job, age, and work stress, were identified as predictors. The results of this study could be useful in proposing strategies to improve job satisfaction of health workers.

Key messages

The job satisfaction of health workers in Belgrade’s hospitals is low. Health-care managers should pay attention to create an environment that promotes job satisfaction and reduces work stress.