Identification of interrelationship immune reactivity with social adaptation types of schizophrenic patients.

We examined 38 schizophrenic patients (F20.00, F20.01, F20.02). The scale SASS (Bosc M. et al., 1997) was used to estimate the social adaptation of schizophrenic patients. The immunological examination included the definition of phenotypes of surface receptors of immunocompetent cells, immunoglobulins, circulating immune complexes and phagocytosis levels. The research was carried out in two points: first - at admission, second - in 6 weeks of treatment.

Three adaptation types have been revealed: normal type of social adaptation (15 patients, 39,47%), difficult social adaptation (18 persons), disadaptation (5 patients). By week 6 of treatment number of patients with normal social adaptation has heightened by 1,4 times (21 patients, 55,26%), improvement of indices of social adaptation was observed in 10 patients, type of social adaptation did not change in 28 patients. At admission T-immunodeficiency (CD2+, CD3+, CD16+-lymphocytes decrease), increase CD8+, HLADR+, CD20+- lymphocytes, IgM and phagocytosis decrease were diagnosed among schizophrenic patients. During therapy, features of psychoneuroimmunomodulation were as follows: the normal type of social adaptation is relatively favorable in the immunological context. Patients with low level of social adaptation were characterized by clinical-immunological resistance toward therapy with deepening of T-cellular immune deficiency. Improvement of indices of social adaptation was accompanied by positive dynamic of immunological parameters.

Thus, social differences between groups have been confirmed by data according to immune reactivity.

Different proposals of the staging model in bipolar disorder (BD) have been launched suggesting a progression from prodromal to more severe and refractory presentations. Biochemical variations in BD are receiving attention as they may help to understand the neurobiological correlates of the disorder and its neuroprogression.

Study pro-inflammatory factors, such as interleukins along the progression of the disorder.

To investigate a) the role of interleukin-6 (IL-6) in the model of staging and b) to detect clinical predictors of variations in IL-6 levels.

This is a case-control study matched for age and gender. Patients required the diagnosis confirmation by SCID, being in euthymia (HDRS, YMRS scores ≤ 7 in last month), and were classified in Kapczinski et al. clinical stages. At the end, 109 patients and 25 controls were eligible for the study. Serum IL-6 levels were determined by ELISA.

Seventy-six (69.7%) patients were female and the mean age was 44.2 (SD= 12.9) years. A significant increase in IL- 6 was found in patients compared to controls (t=2.33, p=0.02) and among the four groups of patients (F=2.85, p=0.04). Results from linear regression analysis revealed that number of episodes per year, age at first episode, and age were significantly associated with IL-6 (β=0.025, CI: 0.005-0.044, p=0.012; β=-0.016, CI:(-0.031)-(-0.001),p=0.033; β=0.042, CI:0.027-0.058, p=0.0001, respectively).

Interleukin-6 may be a useful biomarker in the model of staging in bipolar disorder and could be related to the number of episode per year and early onset of the disorder.

Discontinuation of anti-psychotic drugs in schizophrenia patients is a major concern, since it results in relapse and re-hospitalizations. Non-adherence is strongly associated with negative subjective response to antipsychotics which is composed of the subjective experience of negative drug effects and attitude towards the treatment.

To assess subjective experience towards specific drug-related adverse effects which leads to a generally negative subjective attitude towards antipsychotics.

Attitude and experience were measured in schizophrenia inpatients (n=84) on eight subscales: weight gain, sedation, sexual anhedonia, extra-pyramidal syndrome, affective flattening, excessive sleep, diminished sociability and metabolic syndrome. DAI-30 was used to measure attitude towards drugs, and PANSS to assess psychopathology.

Weak correlation was found between subjective experience and attitude on most of the sub-scales. The only strong, albeit inverse, correlation between experience and attitude that was found was with regard to affective flattening, experienced by 37% of the sample, and it also predicted negative drug attitude as measured by the DAI-30, RR: 1.87 (95% CI: 1.06-3.3, df=1, x2=4.525, p< 0.05).

Drug-related affective flattening should be evaluated routinely, since experiencing it may predict negative attitude towards drugs, potentially leading to poor compliance and relapse.

Mild Cognitive Impairment (MCI) is a transitional stage from normal aging to dementia. The objective of this study was to determine whether a source retrieval ERP is an effective neural marker for differentiating MCI from normal older adults while their behavioral performances were matched which may have implications for identifying seniors at risk for cognitive decline.

A source memory task was conducted on 16 aMCI and15 healthy older adults. Event-Related Potentials (ERPs) were recorded during retrieval phase. Memory performances were matched between the two groups by manipulating the number of items presented for each study session.

The behavioral results showed that both source memory and item memory performances were perfectly matched between aMCI group under easy condition and healthy elderly group under hard condition. While under such case, the ERP results showed remarkable differences between the two groups. First, the right-lateralized positive-going old-new effects significantly decreased for aMCI group compared to control group, especially on the parietal sites. Second, the negative leftlateralized old new effect extended to the posterior sites of right hemisphere only in aMCI group but not in control group.

The results showed that source retrieval ERP is an effective neural marker for differentiating MCI from normal older adults even when they have matched task performances. The results also suggested that MCI brain may involve more regions to compensate their reduced efficiency of dedicated circuits so that they could behave like normal older adults.

Atrial natriuretic peptide (ANP) is well known as a regulator of fluid and electrolyte homeostasis. However, studies suggest that ANP also plays an important role in the neurobiology of anxiety. Recent evidence suggests that ANP may be involved in the pathophysiology of addictive behavior. The present study aims to elucidate the effects of ANP on alcoholdependent patients’ anxiety, perceived stress and craving during alcohol withdrawal.

A sample of 59 alcohol-dependent inpatients was included in the analysis. A blood sample was taken at day 14 of detoxification in order to assess the concentration of ANP in plasma. In parallel, we assessed patients’ alcohol craving, using the Obsessive Compulsive Drinking Scale (OCDS), as well as their symptoms of anxiety (State-Trait Anxiety Inventory; STAI). Patients’ stress levels were assessed using the Perceived Stress Scale (PSS).

We found a significant negative association between patients’ ANP plasma concentrations and their anxiety, craving for alcohol, and perceived stress. Regression analyses suggest that ANP is a significant predictor both for patients’ perceived stress and for the severity of their anxiety during early abstinence. Additionally, we were able to show the association of patients’ ANP plasma levels and craving to be mediated by their perceived stress.

Our results suggest that the association of patients’ ANP plasma levels and craving is mediated by their perceived stress. For this reason, intranasal application of ANP may prove to be a new avenue for the treatment of alcohol dependence in patients exhibiting high levels of perceived stress.

Depression in women is supported by specific psychoendocrine factors. Neuroprotection is reduced in conditions of exposure to psychostress by increase of endogenous cortisol due to excessive HPA activity associated with somatic risks. Decrease of neuroprotection after hypercortisolemia due to excessive HPA activity is associated with somatic obvious risks that may cause an increase in social malfunction of women with depression.

Retrospective-prospective study on a sample of 206 female patients, with positive history for depressive disorder, hospitalized in the Mental Health Center (MHC) of Craiova, monitored between January, 1st 2012 and June, 31st 2012. At these patients we evaluated depression evolution, somatic comorbidities, cognitive impairment and psychosocial stress.

Somatic comorbidities (obesity and cardiovascular disease, 41 patients - 19.9%, obesity and diabetes and metabolic syndrome, 36 patients - 17.5%, hysterectomy, 35 patients - 17.5%) occurred during maintenance therapy emphasizes evolutionary risk of depressive disorder in women and cognitive impairment, especially in peri- and postmenopausal period (68.6%). Appeared in a large number of cases of the syndrome MCI (Mild Cognitive Impairment) (29 patients - 14.1%) and 4 cases of Alzheimer's disease also increase the predictive value of perimenopausal depression and psychostress conditions (13.1%).

Vulnerability to depression is correlated with peri- and postmenopausal ovarian steroid imbalance favoring the disruption of brain neurotransmission. Excess of serotonin activating substance therapy may promote the emergence of hypodopaminergy with risk of increased somatic and cognitive deficiency. Hypodopaminergy conduced to an increased glutamatergic activity, with significant decreases in neuroprotection and neurodegenerative risk.

Alcohol hangover is the most commonly experienced next day consequence of heavy drinking. The symptoms experienced during this post-intoxication state develop when blood alcohol concentration (BAC) returns to zero. The feeling of general misery can persist up to 24 h and can significantly affect planned activities and cognitive functioning.

To examine the effects of alcohol hangover on driving performance.

In N=47 healthy volunteers, driving performance was tested the morning following heavy drinking (alcohol hangover) and on a control day (no alcohol). Subjects performed a standardized 100-km highway driving test in the STISIM driving simulator. Primary outcome measure was the Standard Deviation of Lateral Position (SDLP), i.e. the weaving of the car. In addition, self-reported driving quality and driving style measures were scored.

Driving performance was significantly worse during alcohol hangover (ΔSDLP = +1.85 cm; p=0.005). Driving impairment during alcohol hangover was supported by subjective measures. During alcohol hangover, driving quality was rated as significantly worse (p=0.0001), less safe, less considerate, less predictable, and less responsible (p=0.001). Subject reported being significantly more tensed during hangover and more effort was needed to perform the driving test (p=0.001).

Driving is significantly impaired during alcohol hangover. The magnitude of driving impairment is higher than that observed after administering alcohol to achieve a BAC of 0.05% (ΔSDLP = +1.7 cm), i.e. the legal limit for driving in many countries.

It has been suggested that mixing alcohol with energy drinks (AMED) and other caffeinated beverages may alter the awareness of intoxication. The proposed reduction in subjective intoxication, also called “the masking effect”, may have serious consequences by increasing the likelihood of engaging in potentially dangerous activities such as driving while intoxicated.

The aim of this meta-analysis was to determine if mixing alcohol with caffeinated beverages alters subjective intoxication.

A literature search was conducted (August 21st, 2012) to collect all studies measuring subjective intoxication after administration of AMED, or other caffeinated alcoholic drinks compared to alcohol only. To this extent, PubMed and Embase were searched using the key words “alcohol”, “caffeine”, “energy drinks” and “intoxication”. The studies were critically reviewed and, where possible, included in a meta-analysis in order to determine whether masking exists after mixing alcohol with caffeinated beverages.

Twelve studies were identified of which 8 could be used for the meta-analysis. When including higher caffeine doses (4 mg/kg) the meta-analysis revealed no significant masking effect (p= 0.477). Similarly, when including lower caffeine doses (2 mg/kg) no significant masking effect was found (p=0 .434). Despite the large range of caffeine content (46 - 383 mg) and alcohol levels (0.03% - 0.12% BAC) investigated, caffeine had no effect on the correct judgment of subjective intoxication.

Mixing alcohol with energy drink or other caffeinated beverages does not alter subjective intoxication.

We previously demonstrated that the difference between 23.00h and 08.00h TSH response to TRH tests on the same day (ΔΔTSH test) is reduced in about 75% of drug-free depressed inpatients. This study sought to determine whether this chronobiological index, at baseline and after 2 weeks of treatment, could predict antidepressant response.

The ΔΔTSH test was performed in 50 drug-free DSM-IV euthyroid major depressed inpatients and 50 hospitalized controls. After 2 weeks of antidepressant treatment the ΔΔTSH test was repeated in all inpatients. Antidepressant response was evaluated after 6 weeks of treatment.

At baseline, ΔΔTSH values were significantly lower in patients compared to controls (p< 0.000001): 38 patients showed reduced values (i.e. ΔΔTSH ≤ 2.5 mIU/L; sensitivity, 76%; specificity, 98%). After two weeks of treatment, 20 patients showed ΔΔTSH normalization (among them 18 were subsequent remitters), while 18 patients did not normalize their ΔΔTSH (among them 15 were non remitters) (p < 0.00001). Among the 12 patients who had normal ΔΔTSH values at baseline, 8 out 9 who had still normal values after 2 weeks of treatment were remitters, while the 3 with worsening thyroid axis function (i.e. reduced ΔΔTSH value after 2 weeks of treatment) were non-remitters (p< 0.02).

Our results suggest that after 2 weeks of antidepressant treatment: 1) an abnormal ΔΔTSH test could predict non-remission, and 2) ΔΔTSH normalization is associated with subsequent remission. Thus, chronobiological restoration of the thyroid axis activity precedes clinical improvement and may predict the therapeutic outcome in major depression.

The serotonergic system modulates brain functions that are considered to underlie affective states, emotion and cognition. Several lines of evidence point towards a strong lateralization of these mental processes, indicating similar asymmetries in associated neurotransmitter systems.

To investigate a potential brain asymmetry of the serotonin transporter (SERT) distribution using Positron Emission Tomography (PET).

As brain asymmetries differ between sexes, we aimed to compare serotonin transporter asymmetry between females, males and male-to-female transsexuals whose brains are considered to be partly feminized.

36 subjects aged 19-54 years (9 female controls, 13 male controls and 14 male-to-female transsexuals) were measured with PET and [11C]DASB. Whole-brain voxel-wise SERT binding potential (BPND) maps were computed using a tracer-specific symmetric template. Statistics comprised repeated measures ANOVA with group as the between subjects factor, voxel-wise SERT asymmetry as repeated factor and group*asymmetry as interaction term.

SERT binding in all groups showed both strong left and rightward asymmetries in several cortical and subcortical structures including temporal and frontal cortices, anterior cingulate, hippocampus, caudate and thalamus (p< 0.05 FDRcorrected). Further, male controls showed a rightward asymmetry in the midcingulate cortex (p>0.05 FDR-corrected) which was absent in females and male-to-female transsexuals.

Our data support the notion of a lateralized serotonergic system, which is in line with previous findings of asymmetric serotonin-1A receptor distributions, extracellular serotonin concentrations, serotonin turnover and uptake. The absence of serotonin transporter asymmetry in the midcingulate in male-to-female transsexuals may be attributed to an absence of brain masculinization in this region.

Suicide is one of the leading causes of premature death among people with psychotic disorders. However, little is known about treating suicide in delusional disorder.

To investigate effectiveness of PPLAI in delusional disorder (DD) patients.

To compare effectiveness of PPLAI vs,other atypical antipsychotics (OAA) in psychopathology and suicidality.

Prospective observational study including 45 DD outpatients (DSM-IV-RT) attended at the Department of Psychiatry (Hospital Clinic- BCN) from 2008 to 2012 and followed up for 6 months. Demographic and clinical variables were recorded. Hamilton Rating Scale for Depression-17 (HRSD-17), PANSS for psychopathology, Personal and Social Performance Scale (PSP) and Columbia Suicide Severity Rating Scale (C-SSRS) were assessed at baseline and after 6 months. The sample was divided into four groups according to which treatment they received: oral risperidone, Risperidone Long Acting Injection (RLAI), OAA and PPLAI. For comparisons, Kruskal-Wallis and Chi-square tests were used.

Eighty-two per cent were women. Mean age (SD) at onset: 46.9(11.8) years. 6 patients received oral risperidone, 23 OAA, 7 RLAI and 9 were treated with PPLAI. No statistically significant differences were found regarding demographic features, motives leading for consultation, depressive comorbidity and antidepressant prescription. After 6 months, patients treated with PPLAI presented lower frequency of ideation (0% vs.11.1%;p=0.027) and suicidal behaviour (0% vs.2.2%;p=NS). The group receiving PPILD presented a significant increase in functionality (PSP) (p=0.046) and an improvement in PANSS negative subscale scores (p=0.017).

Patients receiving PPLAI showed a decrease in suicidality, an improvement in psychotic symptoms and functionality.

Drug abuse during pregnancy is a growing problem in all developed countries of the world. Maternal drug abuse affects the developing system and its long-term effects can persist till adulthood so it can decreases the rate of their maturation. Since endogenous opioid induced analgesia, and morphine can interact with it, Thus the present study was designed to determine whether the exposure to the morphine during gestation permanently alter pain response.

To determine the effects of prenatal morphine exposure on pain response.

12 Pregnant rats were divided to morphine and control groups. Morphine was administrated (S.C) to female rats twice a day (08 h and 20 h) on gestational days 11-18, (5 mg/kg morphine for 3 days and 10 mg/kg for 5 days). Analgesic response of pups (P90, n=6) were tested by formaline test.

The results of our experiment demonstrated that prenatal morphine exposure rats exhibited significantly lower pain thersholds.

Prenatal morphine exposure impair pain sensitivity.

Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT.

There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS.

Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway.

All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers.

We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments.

This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.

Women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of relapse postpartum. Although lithium prophylaxis has demonstrated efficacy in reducing postpartum relapse, the timing of prophylaxis remains controversial given the balance of risks and benefits for the mother and fetus. The authors compared lithium use during pregnancy compared to its initiation postpartum in women at high risk for postpartum psychosis.

Between 2003 and 2010, 70 pregnant women at high risk for postpartum psychosis were referred to the authors'psychiatric outpatient clinic. Women who were initially medication-free were advised to start lithium prophylaxis immediately postpartum. Women already taking maintenance lithium during pregnancy were advised to continue treatment.

All women with a history of psychosis limited to the postpartum period (n=29) remained stable throughout pregnancy despite being medication-free. Of the women with bipolar disorder (n=41) 24.4% relapsed during pregnancy, despite prophylaxis use by the majority throughout pregnancy. The postpartum relapse rate was highest in women with bipolar disorder who experienced mood episodes during pregnancy (60.0%). In contrast, none of the 20 women with postpartum psychosis using postpartum prophylaxis relapsed, compared to 44.4% of postpartum psychosis patients who declined prophylaxis.

The authors recommend initiating prophylactic treatment immediately postpartum in women with a history of psychosis limited to the postpartum period, to avoid in utero fetal exposure to prophylactic medication. Patients with bipolar disorder require continuous prophylaxis throughout pregnancy and the postpartum period to reduce peripartum relapse risk.

Relatively little is known on longitudinal effects of antipsychotic medication on brain morphometry in schizophrenia after the illness onset. There are inconsistent findings on medication effects on brain structures.

We will study the effect of antipsychotic medication on brain volumes in schizophrenia.

The aim of the current study was to systematically review previous literature on longitudinal MRI studies of antipsychotic effects on brain morphometric changes in schizophrenia and related psychoses.

Studies were systematically collected using four different databases. A study was included if subjects were scanned twice, the average scanning interval was at least two years and antipsychotic medication data was used to predict morphometric changes. The studies focused on several different brain areas; we categorized these into eleven larger areas.

In total 22 studies fulfilled our inclusion criteria. The main finding of our study was that most of the reported correlations were statistically non-significant. The significant associations between antipsychotic use and brain changes were reported from various areas. In the studies with significant findings, use of antipsychotics more often associated with decrease than increase of brain volumes, even in the very few studies taking into account illness severity.

Antipsychotic medication should be adjusted to lowest possible dose for reducing psychotic symptoms and prescribed with caution especially to people not suffering from psychosis. More studies in different kind of patient populations are needed to clarify the possible adverse effect antipsychotic medication may have on brain structure.

Attention bias (AB) is a biased information processing towards threat among competing stimuli occurred in early stage of sensory input. Substantial evidence indicates that AB is involved in the development and maintenance of anxiety and depressive disorders. However, little is known about the relationships between AB and individual differences of endocrine and neuropsychological functions.

Thirty healthy participants without major physical illness or axis I/II mental disorders as evaluated with the Mini-International Neuropsychiatric Interview, were enrolled. Participants completed a dot-probe task, the Temperament and Character Inventory (TCI), the Beck Depression Inventory-II (BDI-II), the Interpersonal Sensitivity Measure, and the Trail Making Test (TMT). Salivary cortisol levels were measured at three time points per day for consecutive 2 days: immediately and 30 min after awaking in the morning and before sleep at night. Correlation analyses were performed between AB and psychological measures, cortisol levels, and attention measures.

As predicted, AB significantly correlated with BDI-II and Harm avoidance sub-dimension of the TCI. Above all, when those variables that were significantly correlated with AB were included in a step-wise multivariate regression analysis, higher cortisol level at night remained the most influential predictor for AB.

Our results suggest that AB is significantly influenced not only by anxious personality traits and depressive symptoms but also by individual differences of attention function and stress hormonal levels. Particularly, AB modification approach might have a beneficial effect on anxiety in individuals who have high cortisol levels.

This audit is of particular interest to the Royal College of Psychiatrists ECT accreditations service and our local ECT department at the Warneford hospital.

ECT has the drawback of affecting memory to different extents. This audit looks at the effect of ECT on the cognitive function of the recipients.

A random sample of patients (who had received ECT in the last 2 years) was selected.

We looked at the following domains:

1. 1. Were the 3 forms returned to the ECT department.

2. 2. Was there any short or long term memory impairment.

3. 3. Problems with reading, speaking and concentration.

4. 4. Impairment of learned skills.

The majority of the respondents didn’t have major memory problems in remembering planned events, visits and appointments or in finding the right words when spoken.They didn’t believe that ECT worsened their long term memory.The majority advised that their overall memory is good.

The overall memory was retained in most respondents and it seems that ECT didn’t have a major impact on the long term memory, reading, speaking and learned skills.

Further research into more detailed cognitive functions and their changes after ECT will be conducted at a later stage next year.

Research indicates a higher risk of somatic problems and cardiovascular and respiratory mortality among patients with non-affective psychotic disorders (NAPD). Data on health care (HC) utilization of this group have revealed ambivalent results pointing at a higher appeal to somatic HC and possible under-consumption.

This study focuses on somatic HC utilization in the Netherlands among patients with NAPD, unipolar depression, anxiety or bipolar disorder, compared to matched controls without psychiatric diagnosis.

To study possible under-consumption associated with NAPD and its correlates.

The HC utilization of 2,392 cases with NAPD registered in the Psychiatric Case Register Middle Netherlands (PCRMN) and above mentioned comparison groups was analyzed by using linked data on prescribed medication, general practitioner (GP) consults and treatment by specialists from insurance company Agis.

The costs for somatic HC among NAPD patients was on average €1621 per year, marginally higher compared to matched controls (€1441, p=0.079). Among patients with depression and anxiety, much greater differences with their matched controls were found (p< 0.05). The percentage of NAPD patients who received somatic treatment by a specialist was lower than that of controls (OR=0.89, P< 0.05), especially at higher age (>60) and longer duration since diagnosis (>5 years) (OR=0.60, P< 0.05). In particular, treatment by a specialist was lower for cardiovascular disorders (OR=0.61) and diabetes (OR=0.37, P< 0.05).

In view of the higher somatic death risk, our data suggest HC under-consumption, which is increasing with a longer illness duration and older age.