Disturbances of serine and glycine metabolism as a cause of episodic acute polymorphous psychoses

Psychiatrists are frequently confronted with psychoses that are difficult to classify. Many forms of these atypical psychoses have been described in European literature. They often have an acute onset and a tendency towards complete remission, albeit with an episodic course. Rich, multiform symptomatology is noted sometimes in addition to altered states of consciousness. In patients with a grossly impaired consciousness the psychiatrist has also to consider whether such a psychosis is due to organic factors or is functional (I). Even when morphologically demonstrable organic factors are excluded, the possibility of a reaction of the brain to subtle toxic factors disturbing the normal physico-chemical equilibrium without causing cellular damage has to be taken into account. An intermittent production of such toxins in the brain or the liver has been an attractive concept for many researchers to understand and account for the endogenous functional psychoses (2). In this thesis an attempt is made to provide clinical evidence for the endogenous synthesis of toxic factors which are causally related to some types of the atypical psychoses. The findings have led to a new classification of the group of poorly defined and previously unclassifiable psychoses

Changes in serine metabolism by a serum factor present in a group of episodic psychotic patients

__Abstract__ Addition of serum, obtained from patients suffering from an acute psychosis characterized by dysperceptions, to the culture media of fibroblasts altered the amino acid metabolism in these cells. After subculturing of fibroblasts in the presence of serum obtained from these patients, the concentrations of both serine and methionine were decreased in the medium as well as in the fibroblasts. Moreover, the concentration of taurine in the fibroblasts was increased. The specific activities of serine hydroxymethyltransferase and cystathionine β-synthase were also measured in the fibroblasts. It was found that both enzyme activities were significantly higher after subculturing with patients' serum as compared with serum obtained from healthy controls. It is concluded that a factor, present in the serum of these acute psychotic patients, is responsible for the observed changes in serine, taurine, and methionine concentrations in the fibroblasts as well as for the increased enzyme activities mentioned

Eicosanoid and amino acid metabolism in transient acute psychoses with psychedelic symptoms

It has been hypothesized that a disturbance of glutathione (GSH) metabolism might be a common factor in many psychiatric disorders. The aim of the present study was to test this hypothesis in transient acute psychotic patients with distorted perceptions. Since the metabolism of GSH is related to that of thromboxane B 2 (TXB 2), prostaglandin E (PGE) and some amino acids, we determined these substances in the plasma of 15 patients and 17 normal controls. Plasma concentrations of TXB 2 were significantly higher and concentrations of serine and tryptophan were significantly lower in patients than in controls. Large variation was observed in plasma PGE levels in patients, although mean values did not differ significantly from controls. These results are consistent with the hypothesis that the metabolism of GSH is impaired in transient psychotic states

Device-related complications in the subcutaneous and transvenous ICD: a secondary analysis of the PRAETORIAN trial.

BACKGROUND: The subcutaneous ICD (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. The PRAETORIAN trial demonstrated that the S-ICD is non-inferior to the TV-ICD with regard to the combined primary endpoint of inappropriate shocks and complications. This prespecified secondary analysis evaluates all complications in the PRAETORIAN trial. METHODS: The PRAETORIAN trial is an international, multicenter, randomised trial in which 849 patients with an indication for ICD therapy were randomised to receive an SICD (N = 426) or TV-ICD (N = 423) and followed for a median of 49 months. Endpoints were device-related complications, lead-related complications, systemic infections and the need for invasive interventions. RESULTS: Thirty-six device-related complications occurred in 31 patients in the S-ICD group of which bleedings were the most frequent. In the TV-ICD group 49 complications occurred in 44 patients of which lead-dysfunction was most frequent (HR 0.69; P =0.11). In both groups half of all complications were within 30 days after implantation. Lead-related complications and systemic infections occurred significantly less in the S-ICD group compared to the TV-ICD group (P <0.001, P =0.03 respectively). Significantly more complications required invasive interventions in the TV-ICD group compared to the S-ICD group (8.3% vs. 4.3%, HR 0.59; P =0.047). CONCLUSIONS: This secondary analysis shows that, lead-related complications and systemic infections are more prevalent in the TV-ICD group compared to the S-ICD group. In addition, complications in the TV-ICD group were more severe as they required significantly more invasive interventions. This data contributes to shared decision making in clinical practice