Treatment of refractory rapid cycling bipolar disorder with risperidone

BACKGROUND: There is evidence for a hypercoagulable state in inflammatory bowel disease (IBD), and small vessel thrombosis has been identified in the bowel of patients with Crohn's disease, suggesting thrombosis as a possible etiologic factor. Activated protein C (APC) resistance is the most common inherited disorder leading to thrombosis and accounts for 30% to 40% of episodes of idiopathic venous thrombosis. METHODS: The prevalence of APC resistance was studied in 23 patients with IBD (17 with Crohn's disease, 6 with ulcerative colitis) and in 11 control subjects with recurrent abdominal pain or celiac disease, using an APC resistance screening method. RESULTS: One patient with Crohn's disease had a positive screen result, two patients (one with Crohn's, one with ulcerative colitis) had borderline results, and results in all of the control subjects were normal. One patient with Crohn's disease had a history of a thromboembolic event but had a normal screen result. CONCLUSIONS: Activated protein C resistance does not seem to play a major role in the etiology of the hypercoagulable state in inflammatory bowel disease.     

Validity of rapid cycling as a course specifier for bipolar disorder

OBJECTIVE: This study's aim was to test the validity of rapid cycling, defined by criteria consistent with those proposed in the DSM-IV draft, as a course specifier for bipolar disorder. METHOD: The study was conducted at a university center for affective disorders on patients fulfilling Research Diagnostic Criteria for bipolar disorder. Thirty-seven rapid-cycling patients, i.e., patients with at least four affective episodes during the previous year, were compared with 74 nonrapid-cycling patients on several demographic and clinical variables. All patients were then followed up prospectively for 2-5 years by monthly personal interviews. RESULTS: The rapid-cycling group was significantly older and had a significantly longer illness duration than the nonrapid-cycling group but did not have a significantly higher percentage of women or frequency of current hypothyroidism. During each year of follow-up, the mean number of affective episodes and the percentage of patients with at least four affective episodes were significantly higher among rapid-cycling patients. Rapid-cycling patients with a pole-switching pattern during the year preceding intake were significantly more likely than other rapid-cycling patients to have at least four affective episodes during each of the first 4 years of follow-up. CONCLUSIONS: These findings support the practical usefulness of rapid cycling as a course modifier for bipolar disorder, since it identifies a patient subgroup with a high recurrence rate. The predictive value of the modifier may be enhanced by the requirement of a pole-switching pattern. Since no external (i.e., unrelated to course) validator was found, the idea that rapid cycling represents one extreme of a continuum of episode frequency in bipolar disorder remains viable.     

Agreement between face-to-face and telephone-administered mood ratings in patients with rapid cycling bipolar disorder

BACKGROUND AND PURPOSE: Clinical trials have demonstrated that high dose radiation therapy and daily cisplatin (CDDP) could increase local control and survival in carcinoma from various sites. The present phase I-II study has combined high dose radiation therapy and daily CDDP at escalating dosages. METHODS: From August 1994 to December 1995, 23 patients with non-resectable carcinoma of the pancreas were enrolled in a phase I-II multicentric, pilot study to test the toxicity and the effectiveness of high dose radiotherapy and daily cisplatin (CDDP) at escalating dosages. A dose of 6 mg/sqm/day of CDDP was selected for the phase II step since no grade IV toxicity occurred in any patient in the phase I step. RESULTS: Toxicity was considered fairly acceptable. At the time of analysis, the 23 patients who entered the study had clear evidence of evolutive disease either locally or distantly in the liver. It is suggested that high dose radiotherapy (60 Gy continuously) and daily CDDP have little effect on local control of the tumor and survival, and only a moderate effect on pain. CONCLUSIONS: In unresectable, apparently non-metastatic cancers of the pancreas, there is an urgent need for new agents or new combinations of agents to be tested.     

Outcome of lithium prophylaxis: a prospective follow-up of affective disorder patients assigned to high and low serum lithium levels

Recently, the availability of 5-hydroxytryptamine-3 antagonists has provided better protection from chemotherapy-induced emesis. These drugs, in combination with dexamethasone, are more expensive but more cost-effective than the alternative antiemetic regimens in the prevention of acute emesis induced by high single dose and low and repeated doses of cisplatin and, probably, of acute emesis induced by moderately emetogenic chemotherapy. In the prevention of emesis induced by oral cyclophosphamide-methotrexate-fluorouracil and in the prevention of delayed emesis induced by cisplatin and moderately emetogenic chemotherapy, the most cost-effective choices are represented, respectively, by a combination of intravenous dexamethasone on day 1 and 8 plus 14-day oral metoclopramide (a combination of oral dexamethasone plus metoclopramide and oral dexamethasone alone). In all cases, the 5-hydroxytryptamine-3 antagonists should be used only in patients in whom the most cost-effective antiemetic regimens either fail or are not tolerated.     

Treatment of seasonal affective disorder with a high-output negative ionizer

A retrospective analysis was performed to explain the decreasing incidence of postoperative arthrofibrosis of the knee in 191 consecutive patients who had anterior cruciate ligament reconstruction using the central third patellar tendon from 1987 through 1991. Follow-up data were available on 188 patients (98%). Age, sex, time interval from injury, preoperative motion, and concomitant meniscal repair or partial meniscectomy were evaluated for their significance as risk factors. Twenty-two of 188 patients (12%) developed arthrofibrosis; the incidence was lower when the acute anterior cruciate ligament reconstruction was delayed at least 3 weeks from the injury, and when preoperative extension was 10 degrees or better. Age, sex, preoperative flexion, and need for concomitant meniscal surgery were not risk factors. The postoperative motion protocol evolved during the study period. Group 1 patients were braced in 45 degrees of flexion for 1 week before passive extension was allowed. In Group 2, motion was started after 48 hours. Group 3 patients were braced in full extension, with motion starting with 24 hours. With these changes, the incidence dropped from 23% to 3%. Decreases in the incidence of arthrofibrosis with modifications in operative technique and postoperative analgesia were not statistically significant.     

A viro-psycho-immunological disease-model of a subtype affective disorder

Borna Disease Virus (BDV) infections are widespread in animal species. This neurotropic, negative and single-stranded enveloped RNA virus spreads via axonal and transsynaptic pathways quite specifically into olfactoric and limbic structures. The symptoms in BDV-infected animals range from unapparent or subtle clinical manifestations to fatal neurological disorders. The severe and fulminant course of the infection, which is often accompanied by neurobehavioral and "emotional" disturbances, occurs sporadically and, at least in experimentally infected animals (rats), is thought to be mediated by immunopathology. Increases in serum-BDV antibodies have also been detected in neuropsychiatric patients. In addition, viral antigen and viral RNA have been observed in acutely ill major depressive patients, leading to the conclusion that BDV was causally related to psychiatric disorders, in particular to affective disorders. A number of studies have meanwhile furnished evidence of abnormal immune functions in mentally ill patients. In addition, stress has been shown to decrease immune responses to viral infections. On the basis of these findings it is hypothesized that human BDV infection represents a co-factor in the development or course of psychiatric diseases. Stress may cause immunosuppression and thus induce activation of persisting BDV in the limbic system, resulting in an inflammatory reaction of these structures. These neuropathological changes might influence the serotonergic or dopaminergic neurotransmitter systems. In addition, a specific affinity of BDV structural elements for aspartate and glutamate receptors in the hippocampal formation might directly induce an imbalance of these transmitter system interactions, causing affective and behavioral disturbances. The possible interactions between stress-induced immunosuppression, BDV infection and affective disorders in humans, and the theoretical and clinical aspects of this concept are discussed.     

Labial herpes in patients with affective disorders receiving long-term lithium carbonate

Lithium carbonate has been administered to 69 patients (45 women and 24 men) for 1-17 years as affective disorders prevention. Its effect on the recurrence and clinical course of labial herpes infection has been analysed both prior to and after the administration of lithium carbonate. Labial herpes has been diagnosed in 28 patients before lithium prophylaxis. The drug significantly decreased virus infection recurrence incidence in this group. No labial herpes recurrence has been noted in 13 patients after the treatment. Lithium efficiency has not been dependent on patients' age, duration of therapy, and lithium levels in both blood serum and erythrocytes. These results suggest, that lithium salts may be effective in certain herpes simplex infections at doses used for prevention affective disorders.     

Primary affective disorder: Thought disorder in depression.

To investigate the occurrence of 1 type of thought disorder in depression, here defined as impairment in abstractive performance, 65 hospitalized depressed patients and 49 normal controls were compared on the Category Test (CT). 36 patients had been diagnosed as bipolar and 29 as unipolar. Analysis of covariance indicated that the depressed groups had significantly more errors than the control group on the CT, suggesting that severely depressed patients show the type of thought disorder defined in this study. No significant differences were found, however, between the CT scores of the unipolar and bipolar groups. The possibility that some features of the depressed state can be described as cerebral dysfunction is discussed. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Misdiagnosis of bipolar affective disorder as personality disorder

Patients with longstanding recurrent behavioural disturbance, unstable interpersonal relationships and periodic affective symptoms are often diagnosed as having a cluster B personality disturbance using DSM-III-R criteria. Two women are described who were diagnosed as having a personality disorder on several admissions to hospital, but in whom closer inquiry revealed evidence of bipolar affective disorder. Since treatment with lithium and adjunctive mood-stabilizing drugs neither patient has required further admissions to hospital within the past five years.     

Clinical significance of sodium-dependent lithium transport in affective psychoses

The steady state red blood cell/plasma lithium (Li) ratios were determined simultaneously with the in vitro rates of sodium-dependent Li transport of erythrocytes during prophylactic Li therapy in 30 unipolar, 52 bipolar forms of manic-depressive patients and in 58 nonmanic-depressive psychiatric patients as a control group. A reciprocal correlation was found between the Li ratios and the values of Na-dependent Li transport. These transport rates were in positive correlation with the steady state Li contents of red blood cells and that of the plasma. Significant differences were revealed between the different nosologic subgroups in the respect of in vitro rates of Na-dependent Li countertransport. Results are discussed in the light of clinical and pharmacogenetic aspects.     

Antisaccade performance in patients with schizophrenia and affective disorder.

The authors examined psychotic patients with schizophrenia, major depression, and bipolar disorder; "normal" participants; and 1st-degree relatives of patients with schizophrenia on an antisaccade task in which participants were instructed to move their eyes in the opposite direction of a target that moved unpredictably and abruptly either to the left or right of central fixation. Patients with schizophrenia were found to make significantly more errors than their relatives, and the latter made more errors than the controls. The poor performance of the relatives could not be attributed to their having a psychiatric disorder. Comparison of the 3 patient groups indicated that antisaccade deficits were more pronounced in schizophrenia and bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral factors in seasonal affective disorder.

To longitudinally examine cognitive-behavioral correlates of seasonal affective disorder (SAD), the authors assessed women with a history of SAD and nondepressed, matched controls across fall, winter, and summer. SAD history participants reported more automatic negative thoughts throughout the year than controls and demonstrated a progression from decreased activity enjoyment during fall to reduced activity frequency during winter. Ruminative response style, measured in fall, predicted symptom severity during the winter. Across assessments, SAD history women endorsed greater depressive affect in response to low light intensity stimuli than to bright or ambiguous intensity stimuli, but less depressed mood to bright light stimuli than controls. These results suggest that the cognitive-behavioral factors related to nonseasonal depression may play a role in SAD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid tryptophan depletion in drug-free depressed patients with seasonal affective disorder

The authors of a large number of Norwegian detective stories, particularly from the first part of this century, are occupied with neurologists and neurobiological problems. A survey of this literature shows. One Norwegian neurologist has written four detective stories. Not one single neurologist can be found as a detective hero. On the other hand there are numerous examples of the neurologist as a criminal or even a murderer. Neurological symptoms and signs (mostly functional pareses and epileptic fits) are used to construct the plot in other novels. The most striking finding is a detective story where the criminal is a neurobiologist, the plot is based on neurobiology and the author discusses neurological phenomena throughout the entire book.     

Cyclothymia in the adolescent offspring of parents with bipolar affective disorder.

Explored the prevalence and types of psychopathology exhibited by the adolescent and young adult offspring (n?=?37, aged 15–21 yrs) of 24 patients (mean age 48.4 yrs) with bipolar affective disorder and by the age-matched offspring (n?=?22) of 14 patients (mean age 46.7 yrs) with nonaffective psychiatric disorders. It was hypothesized that the offspring of bipolar Ss would be characterized by an increased rate of cyclothymia. Offspring received structured diagnostic interviews conducted by interviewers unaware of parental diagnosis. Anonymous diagnoses were derived based on Research Diagnostic Criteria. It was found that the offspring of bipolar Ss exhibited significantly higher rates of affective disorder in general and cyclothymia in particular than the offspring of the nonaffective controls, a finding concordant with the proposed hypothesis. The offspring groups did not differ on rates of nonaffective disorders. Results support a continuum model of bipolar disorder in which cyclothymia is viewed as a mild form of full syndromal bipolar illness. (84 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysthymia in the offspring of parents with primary unipolar affective disorder.

This study examined whether there is a familial relation between primary early-onset dysthymia and major affective disorder. In addition, it explored the prevalence of other forms of psychopathology and social impairment in the adolescent and young adult offspring of patients with primary unipolar affective disorder. Subjects included 47 offspring of patients with primary unipolar depression, 33 offspring of patients with chronic orthopedic and rheumatological conditions, and 38 offspring of randomly selected community controls with no personal or family history of psychiatric disorder. All offspring received structured diagnostic interviews. Diagnoses were derived blind to parental group by using multiple sets of diagnostic criteria. The offspring of unipolar patients exhibited significantly higher rates of affective disorder, major depression, and dysthymia than did the offspring of medical and normal controls. The groups did not differ on rates of nonaffective disorders. Parental characteristics associated with dysthymia in offspring included chronic depression, age of onset of major depression, number of hospitalizations, and multiple family members with major affective illness. These results support the view that at least some forms of early-onset dysthymia are variants of major affective illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive automatic cognition in major affective disorder.

This article reports 2 studies assessing the clinical validity of the Positive Automatic Thoughts Questionnaire (ATQ–P). In the 1st study, clinically depressed inpatients showed reliably lower ATQ–P scores than a nondepressed control group. In the 2nd study, the specificity of the ATQ–P to emotional distress was evaluated by examining responses in a chronic pain sample. Results indicated that depressed but not nondepressed pain patients had significantly lower scores on the ATQ–P than health control Ss. On the basis of these data, the ATQ–P appears to be an appropriate measure for assessing positive cognition in psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental sex effects in bipolar affective disorder pedigrees

Measurements of transepithelial electrical resistance (TEER), the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide) test and monitoring of poly(ethylene glycol) (PEG) transport have been used to study the effects of the non-ionic surfactants Solulan C24 and Solulan 16, either free in solution or as an integral part of niosome bi-layers, on intestinal epithelial cells from man (Caco-2 cell monolayers). The effects on epithelial integrity and on the transport of the hydrophilic drug metformin depend on the concentration of the surfactants. At concentrations above 1% the effect on TEER of the surfactant in niosomal form and free in solution were equivalent whereas cell viability was preserved to a higher concentration of Solulans when the Solulans were present in the niosomal form. It was concluded that the toxic effect of niosomes arises from free surfactant present in the niosome suspension.