Management commentary

It is perhaps prudent to preface any discussion about this diagnostic category by standing back and looking at diagnoses more broadly. In no other branch of medicine does pathophysiology linearly track phenomenology, yet we are limited to phenomenological-based diagnostic boundaries. Biomarkers have shown scant respect for the most commonly used diagnostic categories, and treatments too have minimal diagnostic specificity. The only clear caveat perhaps is lithium, whose profile of efficacy is in the domain of classical bipolar disorder and the cyclical recurrent mood disorders. For the rest, we need to acknowledge that we are parsing the clouds on an overcast day. The counterpoint is that we need to make major clinical and treatment decisions on the basis of a very incomplete evidence base, drawing on the basis of experience, interpretation and bias simultaneously from the bipolar and unipolar literature, without a clear pathophysiological foundation

Molecular hydrogen: an overview of its neurobiological effects and therapeutic potential for bipolar disorder and schizophrenia

Hydrogen gas is a bioactive molecule that has a diversity of effects, including anti-apoptotic, anti-inflammatory and anti-oxidative properties; these overlap with the process of neuroprogression in major psychiatric disorders. Specifically, both bipolar disorder and schizophrenia are associated with increased oxidative and inflammatory stress. Moreover, lithium which is commonly administered for treating bipolar disorder has effects on oxidative stress and apoptotic pathways, as do valproate and some atypical antipsychotics for treating schizophrenia. Molecular hydrogen has been studied pre-clinically in animal models for the treatment of some medical conditions including hypoxia and neurodegenerative disorders, and there are intriguing clinical findings in neurological disorders including Parkinson’s disease. Therefore, it is hypothesized that administration of hydrogen molecule may have potential as a novel therapy for bipolar disorder, schizophrenia, and other concurrent disorders characterized by oxidative, inflammatory and apoptotic dysregulation

The many roads to mitochondrial dysfunction in neuroimmune and neuropsychiatric disorders

BACKGROUND: Mitochondrial dysfunction and defects in oxidative metabolism are a characteristic feature of many chronic illnesses not currently classified as mitochondrial diseases. Examples of such illnesses include bipolar disorder, multiple sclerosis, Parkinson\u27s disease, schizophrenia, depression, autism, and chronic fatigue syndrome. DISCUSSION: While the majority of patients with multiple sclerosis appear to have widespread mitochondrial dysfunction and impaired ATP production, the findings in patients diagnosed with Parkinson\u27s disease, autism, depression, bipolar disorder schizophrenia and chronic fatigue syndrome are less consistent, likely reflecting the fact that these diagnoses do not represent a disease with a unitary pathogenesis and pathophysiology. However, investigations have revealed the presence of chronic oxidative stress to be an almost invariant finding in study cohorts of patients afforded each diagnosis. This state is characterized by elevated reactive oxygen and nitrogen species and/or reduced levels of glutathione, and goes hand in hand with chronic systemic inflammation with elevated levels of pro-inflammatory cytokines. SUMMARY: This paper details mechanisms by which elevated levels of reactive oxygen and nitrogen species together with elevated pro-inflammatory cytokines could conspire to pave a major road to the development of mitochondrial dysfunction and impaired oxidative metabolism seen in many patients diagnosed with these disorders

Medical error

South African Psychiatry Review - May 200

Reproductive hormones as psychotropic agents?

The female preponderance in unipolar mood and anxiety disorders is well documented, with a double to triple lifetime prevalence compared to males. Much of this increased vulnerability is in the childbearing years. Hormones are a tempting explanation, although other biochemical factors such as cytokines may also be important. Psychosocial factors are clearly involved, including role issues.South African Psychiatry Review - May 200

The effect of geomagnetic storms on suicide

Objectives: To correlate geomagnetic storm activity with suicide rates. Design: A retrospective analysis over a 13 year period, Janaury 1980 to December 1992.Setting: Hermanus Magnetic Observatory (data on geomagnetic storm activity), South African Central Statistical Services (data on suicide rates). Subjects: Nil. Outcome measures: Geomagnetic storm activity and suicide rates.Results: A significant correlation (r= 0,6964 ; p< 0,01) was found between the mean total of suicides and the mean average of storm activity during the same period. This correlation was true of both male (r= 0,6301 ; p< 0,025) and female (r= 0,7544 ; p< 0,005) suicides.Conclusions: Geomagnetic storm activity is correlated with suicide, and confirms previous research suggesting an impact of ambient magnetic field activity on behaviour.S Afr Psychiatry Rev 2003;6:24-2