30 research outputs found
Serum Leptin Levels in Treatment-Naive Patients with Clinically Isolated Syndrome or Relapsing-Remitting Multiple Sclerosis
Several studies have investigated leptin levels in patients with multiple sclerosis (MS) with somewhat conflicting results. They have all focused on patients with established relapsing-remitting (RR) MS but have not specifically looked at patients with clinically isolated syndrome (CIS) suggestive of MS, in the early stages of disease. In this study, serum leptin levels were measured in 89 treatment-naïve patients with CIS (53 patients) or RRMS (36 patients) and 73 controls searching for differences between the groups and for associations with several disease parameters. The expected significant sexual dimorphism in leptin levels (higher levels in females) was observed in both MS patients and controls. Increased leptin levels were found in female patients with RRMS compared to female controls (P=.003) and female CIS patients (P=.001). Female CIS patients had comparable levels to controls. Leptin levels correlated positively to disease duration, but not to EDSS, in female patients with RRMS. The results of the present study do not indicate involvement of leptin in the early stages of MS. Normal leptin levels in patients with CIS suggest that leptin does not have a pathogenic role. The ratio leptin/BMI increases during disease course in female MS patients in a time-dependent and disability-independent manner
On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales
Objective. Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment. Methods. 164 consecutive female middle-aged inpatients, diagnosed as A-MDD () or NA-MDD () by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis. Results. We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD. Conclusion. Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients
Lack of specific association between panicogenic properties of caffeine and HPA-axis activation. A placebo-controlled study of caffeine challenge in patients with panic disorder
A subgroup of patients with Panic Disorder (PD) exhibits increased
sensitivity to caffeine administration. However, the association between
caffeine-induced panic attacks and post-caffeine hypothalamic pituitary
adrenal (HPA)-axis activation in PD patients remains unclear. In a
randomized, double-blind, cross-over experiment, 19 PD patients
underwent a 400-mg caffeine-challenge and a placebo-challenge, both
administered in the form of instant coffee. Plasma levels of
adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone
sulfate (DHEAS) were assessed at both baseline and post-challenge. No
patient panicked after placebo-challenge, while nine patients (47.3%)
panicked after caffeine-challenge. Placebo administration did not result
in any significant change in hormones’ plasma levels. Overall, sample’s
patients demonstrated significant increases in ACTH, cortisol, and DHEAS
plasma levels after caffeine administration. However, post-caffeine
panickers and non-panickers did not differ with respect to the magnitude
of the increases. Our results indicate that in PD patients,
caffeine-induced panic attacks are not specifically associated with
HPA-axis activation, as this is reflected in post-caffeine increases in
ACTH, cortisol and DHEAS plasma levels, suggesting that caffeine-induced
panic attacks in PD patients are not specifically mediated by the
biological processes underlying fear or stress. More generally, our
results add to the evidence that HPA-axis activation is not a specific
characteristic of panic. (C) 2015 Elsevier Ireland Ltd. All rights
reserved
Testosterone and dehydroepiandrosterone sulfate in female anxious and non-anxious major depression
Objectives. Major Depression with severe anxiety has been proposed as a
distinct clinical variant of Major Depressive Disorder (MDD). This
proposal invites the investigation of the differential biological
correlates of the anxious versus non-anxious MDD. One such research area
might be their possible differential associations with androgens.
Methods. Plasma total testosterone and dehydroepiandrosterone were
assessed in adequately matched female inpatients with anxious MDD,
non-anxious MDD and normal controls. Results. Androgen levels were
significantly lower in both patient groups compared to those of
controls. Moreover, they were significantly lower in anxious MDD
patients compared to those of their non-anxious MDD counterparts. The
limitations of this study were cross-sectional design of the study, the
small sample size of the study sample and the outpatient status of the
control group. In addition, free testosterone levels were not measured.
Conclusions. Our findings indicate that female major depression is
associated with lower androgen levels, a deficiency aggravated by the
severity of their concomitant anxiety
Apathy associated with antidepressant drugs:: A systematic review
Objectives: Administration of antidepressant drugs-principally selective serotonin reuptake inhibitors (SSRIs)-may induce clinically significant 'apathy' which can affect treatment outcomes adversely. We aimed to review all relevant previous reports. Methods: We performed a PUBMED-search of English-language studies, combining terms concerning psychopathology (e.g. apathy) and classes of antidepressants (e.g. SSRI). Results: According to certain inclusion (e.g. use of DSM/ICD diagnostic criteria) and exclusion (e.g. presence of a clinical condition that may induce apathy) criteria, 50 articles were eligible for review. Together, they suggest that administration of antidepressants-usually SSRIs-can induce an apathy syndrome or emotional blunting, i.e. a decrease in emotional responsiveness to circumstances which would have triggered intense mood reactions prior to pharmacotherapy. The reported prevalence of antidepressant-induced apathy ranges between 5.8%-50%, and for SSRIs ranges between 20%-92%. Antidepressant-induced apathy emerges independently of diagnosis, age, and treatment outcome, and appears dose-dependent and reversible. The main treatment strategy is dose reduction, though some data suggest the usefulness of treatment with olanzapine, bupropion, agomelatine or amisulpride, or the methylphenidate-modafinil-olanzapine combination. Conclusion: Antidepressant-induced apathy needs careful clinical attention. Further systematic research is needed to investigate the prevalence, course, etiology, and treatment of this important clinical condition
Plasma total cholesterol in psychiatric patients after a suicide attempt and in follow-up
Background: Low plasma total cholesterol (TC) levels have been found in
subjects after a suicide attempt in most studies. Other studies question
these results because of possible influences on TC of somatic effects
due to the attempt (drugs, somatic trauma, hospitalization), or
nutritional habits and physical activity before attempt, especially in
patients with depression.
Methods: To address this issue, TC levels were estimated in 51 subjects
on admission to psychiatric clinic after a suicide attempt, as well as
later in follow-up when patients were back in their normal activities.
Patients were evaluated for suicide intent (SIS), aggression, and
severity of depression (BDI).
Results: A small (7% in the mean) but statistically significant
increase in plasma cholesterol levels was observed in samples taken in
follow-up compared to samples after attempt. However, TC levels of
patients were significantly lower than controls in both assessments.
There were no differences in TC between violent and non-violent
attempters, either after attempt or in follow-up. In the subgroup of
patients with major affective disorder, TC levels were lower compared to
age-matched controls in both assessments, although patients showed
significant reductions in BDI score in follow-up. In this subgroup, TC
levels after attempt correlated negatively to SIS score.
Conclusions: TC levels in psychiatric patients after a suicide attempt
are lower than healthy controls and remain low in follow-up,
independently from the severity of psychopathology. The results support
the role of plasma total cholesterol as a biological risk factor in
suicidal behavior, especially in affective patients. (c) 2012 Elsevier
B.V. All rights reserved
Neurochemical and neuroendocrine correlates of overactive bladder at first demyelinating episode
AimsBladder dysfunction is frequent during the course of multiple
sclerosis (MS), observed in up to 75% of patients. Urinary
symptomatology can be a feature of the first episode of MS in a minority
of cases, and most often shows characteristics of an overactive bladder
(OAB), with voiding symptoms seen less frequently, often in combination
with OAB. The neural control of micturition is complex, involving
systems located in the brain, spinal cord, and periphery, and
implicating central noradrenergic, serotonergic, and dopaminergic
activities. Urinary disorders are also linked to anxiety and depression,
conditions connected to hypothalamus-pituitary-adrenal axis activity. In
this study we aimed to investigate neurochemical and neuroendocrine
correlates of bladder dysfunction in early MS.
MethodsWe included 101 patients at first demyelinating episode
suggestive of MS that were drug-free at assessment. We evaluated the
presence of urinary symptomatology and estimated CSF levels of the main
metabolites of noradrenaline, serotonin, and dopamine, as well CSF-ACTH
and serum cortisol.
ResultsIn total, 15 patients (15%) reported urinary dysfunction
suggestive of OAB. Four of these had coexistent voiding symptomatology.
The serotonin metabolite 5-HIAA was significantly reduced (P=0.017) in
patients with OAB syndrome, while there were no differences in the
metabolites of noradrenaline (MHPG) and of dopamine (HVA). Additionally,
significantly lower serum cortisol (P=0.009) and borderline lower
CSF-ACTH (P=0.08) were found in patients with OAB.
ConclusionsMS patients with OAB syndrome at the first demyelinating
episode show reductions in central serotonergic activity and stress
hormones. Whether the same changes persist at later disease stages
remains to be investigated. Neurourol. Urodynam. 35:955-958, 2016. (c)
2015 Wiley Periodicals, Inc
Plasma testosterone and dehydroepiandrosterone sulfate in male and female patients with dysthymic disorder
Background: Depressive symptomatology has been connected with an
activation of the hypothalamus-pituitary-adrenal axis and, in several
studies, with reduced androgen levels, while administration of
androgens, usually in older subjects, may have positive effects on mood,
both in males and females. Regarding dysthymic disorder (DD), low serum
testosterone levels have been reported in older males, while information
on younger male or on female patients is lacking.
Methods: We assessed the serum levels of testosterone (T),
dehydroepiandrosterone sulfate (DHEAS) and cortisol in male and female
patients with DD, and compared them to the levels of sex and age matched
controls. Eighteen male and 43 female patients in the age range of 22 to
71 years were studied and diagnosed according to the Scheduled
Diagnostic Interview for DSM-IV axis I disorders (SCID). Depressive
symptomatology was assessed using the Hamilton Depression Rating Scale.
Subgroups with subjects below or over 50 years of age were also built
and compared.
Results: Serum T levels were lower than controls mainly in the subjects
aged below 50 years, in both genders. More pronounced were reductions in
DHEAS levels both in male and female patients, while cortisol levels
were normal or reduced. T levels were positively correlated to both
DHEAS and cortisol. The negative correlations of DHEAS and T to age were
significant for all groups and subgroups, except in the group of male
patients. Four male patients (22%) had T levels below 2.0 ng/ml.
Conclusions: Male and female patients with DD aged below 50 years show
reduced gonadal and adrenal androgen levels, and normal to low cortisol
levels. These neuroendocrine characteristics differentiate DD from
depression, and place this diagnostic group closer to posttraumatic
stress disorder. (c) 2006 Elsevier B.V. All rights reserved
Gonadal axis hormones in psychiatric male patients after a suicide attempt
Epidemiological and clinical studies support the view that aggressive
acts like suicidal and violent behaviors share a common substrate.
Certain aspects of violence in males have been related to high
testosterone levels, but the relation of testosterone to attempted
suicide has not been studied until now. We estimated plasma levels of
testosterone (T), LH, and FSH in 80 male subjects after a suicide
attempt and in whom a psychiatric assessment was done during their
hospitalization. Suicide intent was evaluated in 72 subjects. A group of
56 healthy males in the same age range served as control. As a group,
attempters showed significantly lower T levels, marginally higher LH,
and normal FSH compared to controls. The attempters who used violent
methods (26 subjects) had T levels even lower than the non-violent (drug
overdose) subgroup. Comparisons of T levels of subgroups according to
the (main) drug ingested (analgesics, benzodiazepines, antidepressants,
neuroleptics, or other drugs) did not reveal any significant drug
effect. In relation to diagnosis, the lowest T levels were found in the
subgroup with schizophrenia (29 subjects). The T levels of this subgroup
were also significantly lower compared to those of a group of 31 male
schizophrenic patients, hospitalized and treated with neuroleptics. If
the influence of post-attempt stress and medical condition on plasma T
could be ruled out, low plasma T may prove to be a biological predictor
of attempt, at least in male schizophrenic patients. Nevertheless, the
findings differentiate suicidal behavior from other aggressive/violent
behaviors and do not support the notion that suicidal and aggressive
behaviors are manifestations of the same impulse