CSF noradrenaline and schizophrenia.
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Adolescent↗
Biomedical subjects
M Maj
Publications and source records attributed to M Maj.
Clinical and neuropsychological correlates of cerebral ventricular enlargement in schizophrenia.
A comprehensive assessment of computed tomography (CT) with respect to clinical, historical and neuropsychological variables has been carried out in a sample of DSM III schizophrenics fairly heterogeneous with respect to duration and severity of illness and in a normal control group matched for sex, age and educational level. The mean value of ventricular brain ratio (VBR) was significantly higher in schizophrenics than controls. Seven patients (21.2%) who had VBRs exceeding 2 SD of the control mean showed a significantly longer duration of illness than the other schizophrenics with significantly higher scores on the subscales alogia, effective flattening and attentional impairment of SANS, on the scales self-care and behaviour in crises and emergencies of DAS, on the scales rhythm, tactile, visual, reading, arithmetic, memory and left hemisphere of LNNB, and on the subtests arithmetic, digit span, digit symbol and block design of WAIS. These results confirm earlier reports of an enlargement of lateral cerebral ventricles in a subset of schizophrenics, and its association with a higher degree of cognitive and neuropsychological impairment, social maladjustment and defectual symptomatology. Moreover, they suggest that the neuropathological process likely to underlie the increase of cerebral ventricular size progresses during the course of the illness rather than predating its onset.
Adolescent↗
Factors associated with response to lithium prophylaxis in DSM III major depression and bipolar disorder.
The relationship of some clinical, personality and biological variables to the outcome of lithium prophylaxis was investigated in two patient samples fulfilling, respectively, the DSM III definitions of "major depression, recurrent" and "bipolar disorder". In major depressives, the presence of psychomotor retardation and melancholia during the index episode was associated with a favorable response to treatment, whereas the presence of mood-incongruent psychotic features during the same episode, a high score on the "anxiety" and "phobic" subscales of the Middlesex Hospital Questionnaire and a high score on the "neuroticism" subscale of the Eysenck Personality Questionnaire were related to a poor response. These findings are discussed in the light of the heterogeneity of DSM III major depression and of the reported common occurrence of an "anxiety-phobic" personality profile in unipolar depressives. In bipolar patients, a family history of bipolar affective illness and a high lithium ratio were associated with a good response to treatment, and the presence of the HLA-A3 antigen with an unfavorable response. These findings seem to support a role of pharmacogenetic factors in conditioning response to lithium prophylaxis.
Adult↗
Perceived parental rearing behaviour in unipolar and bipolar depressed patients. A verification study in an Italian sample.
Two groups of former depressed Italian patients comprising 54 bipolars and 52 unipolars completed the Italian version of the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing behaviour. As in a previous study of Swedish depressives, three factors, "rejection", "emotional warmth", and "over-protection", have been taken into account. The results obtained in the patient group have been compared with those obtained in Italian healthy controls. Depressed patients rated both parents significantly lower than the controls on the factor "emotional warmth". The present results cross-validate those obtained previously in the Swedish depressives and strengthen, together with other findings in the literature, the assumption that the lack of emotional warmth in the parents' rearing practices might be a crucial variable in the pathogenesis of depressive illnesses.
Attitude↗
Cross-national study of perceived parental rearing behaviour in healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden: pattern and level comparisons.
Samples of healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden completed the EMBU, a Swedish questionnaire aimed at assessing the experience of parental rearing practices. For the purpose of comparison three factors - "emotional warmth", "rejection" and "overprotection" - obtained in a previous factor analytic study, have been used. The most pronounced differences occurred between the Dutch and the Swedish sample on the one hand, and the Italian and Australian sample on the other, with the Danish sample in between. Differences in perceived parental rearing should be considered when comparing personality characteristics and/or psychopathological conditions in subjects from different countries.
Adult↗
An approach to the diagnosis and classification of schizoaffective disorders for research purposes.
A classification of schizoaffective disorders for research purposes is presented. Two main categories are preliminarily singled out: 1) that characterized by the consecutive appearance of an affective and a schizophrenic syndrome (type I), 2) that marked by the concurrent appearance of a full schizophrenic and a full affective syndrome (type II). Within type I, two subtypes are distinguished: 1) that beginning as a typical schizophrenic disorder and shifting later on into a recurrent affective syndrome (affective subtype), 2) that beginning as an affective disorder and showing in its further course a progressive schizophrenic development towards deterioration (schizophrenic subtype). For type II, a multiaxial classification is proposed. Axis 1 should be used to describe the cross-sectional symptomatology, axis 2 to define the course, and axis 3 to note the presence of associated factors. On axis 1, schizoaffective disorder type II can be divided into a manic and a depressive subtype. Operational diagnostic criteria for each are provided. On axis 2, an affective (recurrent) and a schizophrenic (continuous with exacerbations) subtype can be distinguished.
Cross-Sectional Studies↗
Clinical course and outcome of schizoaffective disorders. A three-year follow-up study.
Four samples of patients (fulfilling at the index episode, respectively, Research Diagnostic Criteria for schizoaffective disorder manic type, schizoaffective disorder depressed type, manic disorder and major depressive disorder) were followed up for 3 years. At the end of the follow-up period, no significant difference with respect to the mean scores on the Disability Assessment Schedule (DAS) and on the Strauss-Carpenter Outcome Scale was observed between schizomanics and manics (although the global outcome was slightly poorer in the former group). In contrast, significant differences between schizodepressives and depressives were found both on some DAS subscales (the schizodepressives were more socially withdrawn, had less social contacts and poorer work performance) and on the Strauss-Carpenter Outcome Scale (the mean total score and the mean scores on the items "social contacts" and "employment" were significantly lower in schizodepressives). The most frequent pattern of course in patients diagnosed cross-sectionally as schizomanic was a bipolar one. Some patients had only recurrent schizomanic episodes and others more an alternance of schizomanic and schizophrenic episodes. In patients diagnosed cross-sectionally as schizodepressives, the most frequent pattern of course was that characterized by recurrent schizodepressive episodes. In some patients an alternance of schizodepressive and depressive or schizodepressive and schizophrenic episodes was observed. These data confirm that patients diagnosed cross-sectionally as schizoaffective represent a very heterogeneous group when they are studied longitudinally, and support the usefulness of a "multiaxial" approach to the classification of schizoaffective disorders, taking into account both cross-sectional symptomatology and clinical course.
Adult↗
Relationship between CSF noradrenaline levels, C-EEG indicators of activation and psychosis ratings in drug-free schizophrenic patients.
A significant increase of cerebrospinal fluid (CSF) noradrenaline (NA) levels, probably reflecting a rise of central noradrenergic activity, has been observed in a sample of acute schizophrenic patients as compared with a population of subjects without personal or family history of major psychoses. CSF NA levels have been found to be significantly correlated with computerized EEG (C-EEG) indicators of arousal (negative correlation with alpha relative activity and positive correlation with alpha barycentric frequency and beta relative activity in frontal and central leads). No significant relationship has emerged between CSF NA concentration and psychosis ratings on CPRS as well as platelet MAO activity. These findings seems to confirm the link between central noradrenergic hyperactivity and the condition of enhanced arousal of the schizophrenic patient, although the role of this condition in the pathophysiology of schizophrenia (primary phenomenon or non-specific consequence of the stress related to the illness?) remains to be elucidated.
Adolescent↗
Brief history of Italian psychiatric legislation from 1904 to the 1978 Reform Act.
A brief survey is given of the evolution of Italian psychiatric legislation. The following acts are examined: the 1904 law, stating that people affected by mental derangement must be kept in custody and treated in mental hospitals when they are dangerous to themselves or to others or create public scandal; the 1909 regulations, in which various aspects of mental hospital organization are dealt with; the 1968 law, sanctioning the institution of voluntary admission; the 1978 Reform Act. It is emphasized that the 1978 Italian mental health law is the only one, in the Western industrialized world, in which: 1) patient's dangerousness is not used as a criterion for commitment, and compulsory admission is restricted to therapeutic emergency cases; 2) it is established that compulsory admission of psychiatric patients must be implemented in general hospitals; 3) prolonged hospitalizations are discouraged, by stating that compulsory treatment should last as a rule seven days; 4) it is sanctioned the abolishment of mental hospitals. Moreover, stress is laid on the law's attention to community-based facilities, described as the places in which preventive, therapeutic and rehabilitative interventions relevant to mental diseases should be implemented as a rule.
History, 20th Century↗
Application of the Psychiatric Reform Act in the city of Naples. A survey of requests for compulsory admission to the special unit at the University Psychiatric Department I.
One of the most patent inconsistencies in the application of the 1978 Psychiatric Reform Act in many areas of Southern Italy has resulted from the irrational choice, by regional governments, of the general hospitals in which Psychiatric Special Units had to be implemented, and from the inappropriate determination of territorial boundaries defining the competence of such Units. Thus, in the city of Naples, it was decided, in June 1978, to set up Psychiatric Special Units only in the two University Psychiatric Departments and in the Psychiatric Emergency Ward at S. Gennaro Hospital. These Units, equipped with an overall number of 39 beds, were put in charge with the whole province of Naples (about three millions inhabitants). Quite arbitrarily, it was established that University Departments had to admit patients coming from the city of Naples and S. Gennaro Hospital those residing in the rest of the province. By an equally arbitrary choice, female patients from the city of Naples were entrusted to the University Department I and male patients to the Psychiatric Department II. In the following years, from 1979 to 1983, some additional Units were set up in general hospitals of the Naples province. Nonetheless, available beds have not exceeded the overall number of 69, and the catchment areas of the three pre-existing Special Units have not been modified. The chaotic situation engendered by this incongruous application of the Reform Act is outlined, by means of an analysis of the requests for compulsory admission addressed to the Special Unit at the Psychiatric Department I of Naples University during the periods June 16, 1978-December 31, 1979 and June 16, 1982-December 31, 1983.
Commitment of Persons with Psychiatric Disorders↗
Patients admitted for compulsory treatment to selected psychiatric units in Italy and in Sweden.
Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatment to either an Italian or a Swedish psychiatric unit in selected areas of the two countries have participated in an exploratory study aimed at assessing the main characteristics of compulsory admitted patients, and in particular, the immediate reason for admission. The two series proved to be quite similar as concerns most sociodemographic variables, and as concerns clinical diagnosis and severity of the morbid condition at admission as measured by means of a rating scale. More Swedish than Italian patients lived alone when admitted to hospital, and for more of them the request for admission was made by other people than relatives, and a larger proportion of them was accompanied to the hospital by medical or social welfare personnel. In both series the largest proportion had a low educational level and belonged to the lower social groups. The same proportion in the two series had previous admissions. The most common reason for admission was "odd or improper behaviour" for the Swedish patients, and "feared or manifest dangerousness" for the Italian patients. The Italian patients remained at hospital on average half the time than the Swedish patients.
Adolescent↗
24-hour plasma levels of prolactin, cortisol, growth hormone and catecholamines in schizophrenic patients.
The 24-hour pattern of prolactin, cortisol and growth hormone (GH) secretion, and the diurnal variations of plasma catecholamine levels, were tested in a sample of DSM III schizophrenics and in a control population of patients hospitalized in the same ward and diagnosed as suffering from neurotic disorders. All subjects were acclimated to the ward and kept free from any drug for at least 2 weeks. No difference between schizophrenics and controls was observed with respect to the 24-hour profile of plasma prolactin and cortisol levels. The nocturnal peak of GH secretion was absent in 10 out of the 23 schizophrenics. These patients did not differ from the other schizophrenics with respect to the mean scores on any item of the Comprehensive Psychopathological Rating Scale. The mean plasma noradrenaline levels were significantly higher in schizophrenics than in controls during the wake period, but not during the sleep hours. A consistent decrease of the amine levels during the sleep period was observed in both groups. Since the nocturnal surge of plasma GH concentration has been associated with slow-wave sleep, which has been reported to be reduced in schizophrenic patients, the possibility is considered that this abnormality of sleep pattern can explain the alteration of GH release in schizophrenics. On the other hand, findings concerning plasma noradrenaline are interpreted as an indication that the state of increased autonomic arousal of schizophrenic patients is closely linked to daytime social interaction.
Adolescent↗
Response to lithium prophylaxis in schizoaffective psychoses.
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Adult↗
Platelet monoamine oxidase activity in schizophrenia: relationship to family history of the illness and neuroleptic treatment.
Platelet monoamine oxidase (MAO) activity was determined in a large population of drug-free and haloperidol-treated schizophrenic patients and healthy controls and, in a second study, in a sample of schizophrenics after a wash-out period and at different times during treatment with haloperidol. Enzyme activity was significantly decreased in both acute and chronic haloperidol-treated schizophrenics, but not in drug-free schizophrenics, compared with normal controls. No significant difference was observed between drug-free schizophrenics with a family history of the illness and those without such history, and between healthy relatives of schizophrenic patients and normal controls without a family history of schizophrenia. MAO activity was significantly reduced after 14 and 21 days of haloperidol treatment, and such reduction did not correlate with response to treatment. These data strongly support the idea that neuroleptic intake may, at least in part, explain low MAO values repeatedly reported in schizophrenics.
Adolescent↗
Effectiveness of lithium prophylaxis in schizoaffective psychoses: application of a polydiagnostic approach.
The effectiveness of lithium prophylaxis has been tested in a group of patients fulfilling the relatively broad ICD-9 definition of schizophrenic psychosis, schizoaffective type, and in each of the subgroups resulting from the application to the same patients of four different sets of diagnostic criteria for schizoaffective or cycloid psychoses. Moreover, a comparison has been made, within the whole patient population, between responders and non-responders to treatment, with respect to some clinical and biological variables. The mean number of morbid episodes and the mean total morbidity have been found significantly reduced during the treatment period, as compared with a control period of the same length, in the whole patient population as well as in subjects meeting RDC and Kendell's criteria for schizoaffective disorder (with special regard to schizomanics) and Perris's criteria for cycloid psychoses. No significant difference between the two periods has been observed in patients diagnosed as schizoaffectives according to Welner et al. Clinical/historical variables (with special regard to those concerning the course of the illness and the family history of major psychoses) have been found the most reliable predictors of response, whereas biological variables did not discriminate between responders and nonresponders to prophylaxis.
Adult↗
Prediction of affective psychoses response to lithium prophylaxis. The role of socio-demographic, clinical, psychological and biological variables.
A set of socio-demographic, clinical, psychological and biological variables was examined in 100 patients diagnosed according to Perris as bipolar affective psychotics or unipolar depressive psychotics, maintained on prophylactic lithium for 2 years and divided into responders and non-responders to this treatment on the basis of strict criteria. The results confirmed the potential role of four indices as predictors of response to prophylaxis: a positive family history of bipolar affective illness and a high red blood cell/plasma lithium ratio (positive predictors) and the presence of the HLA-A3 antigen and a high score on the Neuroticism Scale of the Eysenck Personality Questionnaire (negative predictors). A stepwise discriminant analysis showed that neuroticism score, lithium ratio and HLA-A3 antigen, taken together, correctly classified 74.6% of responders and 68.3% of non-responders. It is hypothesized that these variables as a group may be of practical value in predicting response to lithium prophylaxis, and that pharmacogenetic and, perhaps, personality factors may be involved in treatment failures.
Adolescent↗
Evolution of the American concept of schizoaffective psychosis.
A brief survey is given of the evolution of the concept of schizoaffective psychosis in the United States. The following phases are singled out: a first, 'prehistorical', one including description of 'mixed' psychotic syndromes regarded as subtypes of manic-depressive psychosis; a second, which covers the subsequent 30 years, in which the concept of schizoaffective psychosis is gradually included under the heading of schizophrenia, in accordance with the broad Bleulerian concept of this illness prevailing in those years; a third one, in which, under the influence of a number of factors, schizoaffective psychosis is shifted from the schizophrenic to the affective area, and even good-prognosis schizophrenia and DSM III schizophreniform disorder (a syndrome characterized by the same clinical picture of schizophrenia, but which lasts less than 6 months) are regarded as variants of affective illness. It is emphasized that the history of the evolution of the American concept of schizoaffective psychosis is, indeed, the history of the vicissitudes of the American conceptions of schizophrenia and manic-depressive psychosis.
Bipolar Disorder↗
Plasma cortisol, catecholamine and cyclic AMP levels, response to dexamethasone suppression test and platelet MAO activity in manic-depressive patients. A longitudinal study.
Plasma cortisol, catecholamine and cyclic AMP levels, response to dexamethasone suppression test and platelet MAO activity have been determined in 15 patients suffering from bipolar affective psychosis, each examined during a depressive, a manic and an euthymic phase, and in 15 sex- and age-matched normal controls. Mean basal and post-dexamethasone cortisol levels have been found to be enhanced in patients during depression, but not during mania or free intervals. Non-suppression of cortisol secretion after dexamethasone has been observed in 46.7% of patients while in a state of depression, but in none of them during mania or euthymia. Mean plasma noradrenaline and adrenaline levels, which are thought to be the most reliable biochemical indices of emotional arousal, have been found to be increased in patients during mania, but not during depression. No significant difference has been observed between patients during any phase of their illness and controls with regard to mean plasma cyclic AMP levels and platelet MAO activity. These results confirm the state-dependent overactivity of HPA axis in endogenous depression, and suggest that it should not be regarded as a correlate of emotional hyperarousal. Moreover, they do not support the postulated role of plasma cyclic AMP as a state variable and of platelet MAO activity as a trait variable for manic-depressive illness.
Adult↗