Neuroactive substances in cerebrospinal fluid. Normal and pathological regulatory mechanisms.
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Biomedical subjects
Publications and source records attributed to W Berrettini.
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Cerebrospinal fluid concentrations of the neurotransmitter metabolites 5-hydroxyindoleacetic acid (5HIAA), homovanillic acid (HVA), 3,4-dihydroxyphenylacetic acid (DOPAC) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were compared in two groups of healthy volunteer subjects. One group (outpatient) was composed of 27 subjects who were transported to the outpatient clinic on the day of the lumbar puncture (LP). The other group (inpatient) was composed of 10 subjects who were admitted to the NIMH Research Ward on the evening prior to the LP. After statistical adjustment for age, height, sex and season in which LP was performed the inpatient group had significantly higher concentrations of both 5HIAA and HVA (P less than 0.005 and P less than 0.05, respectively) than the outpatient group. The difference in DOPAC concentration approached significance (P = 0.056), but there was no difference in MHPG concentration between the groups. This result indicates the need for strict control of environment in studies of CSF monoamines and their metabolites.
Acute and prophylactic effects of carbamazepine are documented in a double-blind clinical trial in a 55-year-old treatment-refractory, lithium-non-responsive, manic-depressive patient. Double-blind crossover to two other anticonvulsants was also achieved; the patient showed no evidence of response to phenytoin or valproic acid. The clinical and theoretical issues raised by the selective response to carbamazepine in this patient are discussed.
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Twenty-nine out of 195 bipolar/episodic schizoaffective patients were judged to be rapid-cyclers (15%). Twenty-five of the 29 were female (86%). The age-corrected morbid risk for major affective disorder was 23.5% in 179 relatives of rapid-cyclers and 31.0% in 189 relatives of matched non-rapid cyclers (chi 2 = 2.6, NS). The prevalence of rapid-cycling itself was also not different in the two groups of relatives. Rapid-cycling thus appears to arise from factors which are separable from the genetic vulnerability to bipolar illness and which do not lead to aggregation within families.
Depression and bipolar illness are the major affective disorders. Various genetic studies indicate the existence of inherited susceptibility factors. Recent linkage studies indicate that loci on chromosomes 18, 21, and X contribute to genetic susceptibility of bipolar illness.