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Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse.

OBJECTIVE: The objective of our study was to evaluate the psychological consequences of real-world AAS use in athletes abusing such agents, in comparison with a placebo and control group of comparable athletes, while correlating the severity of abuse with the side effects observed. The hypothesis tested by the study was that the use of AAS induces a wide range of psychological side effects whose impact and emergence is dependent upon the severity of the abuse. DESIGN: The study includes a substantial group of AAS abusing athletes and two more groups demographically similar to the first, one composed of athletes not using any substance and a placebo group. All athletes were stratified according to the severity of AAS abuse. Psychometric instruments were applied to all athletes in specific time intervals, dependent to the AAS abusers' regimens, providing us with a final psychological profile that was to be compared to the pre-study profile. All results were comparable (within and between groups) for statistically significant differences and correlated to the severity of the abuse. Homogeneity of all groups was safeguarded by random doping controls, monitoring of drug levels and analysis of all self obtained drugs by method of liquid chromatography/mass spectrometry. All athletes were provided with a common exercise and dietary regime, so common training and nutritional conditions were achieved. METHODS: We studied a cohort of 320 body-building, amateur and recreational athletes, of whom 160 were active users of AAS (group C), 80 users administering placebo drugs (group B) and 80 not abusing any substance (Group A). Group C athletes were stratified according to AAS abuse parameters, thus providing us with three subgroups of "light, medium and heavy abuse". Athletes of groups A and B were included in a "no abuse" subgroup. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 13 months. Statistical analysis was performed by using the Mann-Whitney/Wilcoxon two-sample non-parametric test (Kruskal-Wallis test for two groups) for data that were not normally distributed and Linear regression analysis was used to ascertain the correlation between severity of use and escalation of side effects. RESULTS: The study showed a statistically significant increase in all psychometric subscales recorded in group C, and no statistically significant difference in group C and A. There was a significant increase in the scorings of group C for all subscales of SCL-90 and HDHQ. Correlation of abuse severity and side effects showed that there was a statistical significant increase in Delta values of all SCL-90 and HDHQ subscales that escalated from light abuse to medium and heavy abuse/consumption patterns. CONCLUSIONS: The results of the study suggest that the wide range of psychiatric side effects induced by the use of AAS is correlated to the severity of abuse and the force of these side effects intensifies as the abuse escalates.

Adult↗

Cytokines production in chronic schizophrenia patients with or without paranoid behaviour.

1. Several immunological abnormalities have been found in schizophrenia but their significance still remains largely unknown. In this study the authors analyzed mitogen-stimulated interleukin (IL)-2, Interferon gamma (IFN)-gamma and IL-10 (type 2 cytokine) production in a sample of 37 chronic schizophrenic patients as compared with a sample of 40 age and sex-matched controls with the aim to evaluate whether patients belonging to different diagnostic subtypes (i.e. paranoid patients vs non paranoid patients) could be immunologically different from each other. 2. The findings indicate that paranoid patients produce less IL-10 than the others and thus, from an immunological viewpoint, they are more similar to healthy controls. 3. Furthermore, neuroleptic medications were observed to differently affect IL-2 production; this preliminary finding might stimulate further studies aiming to get a link between different drug profile of action both in terms of clinical and receptorial profile and different immunological effects.

Adult↗

A theoretical reappraisal of mixed states: dysphoria as a third dimension.

Mixed states are heterogeneous clinical entities difficult to define precisely. The stringent actual DSM IV criteria are unsatisfactory for current clinical use. Many frequently encountered mixed patients benefit without an accurate diagnosis from biological therapeutic interventions such as the introduction of mood stabilizers. We propose a brief review of the definition and characteristics of mixed states and propose a new approach to the typology of mixed states. Based on recent literature data, we add to the depressive and manic syndrome the concept of dysphoria as a third dimension. Integrating this three dimensional approach with recent factor analysis, we describe in addition to the DSM IV mixed state (type I) two new subtypes of mixed states (type IIM and IID). This new typology can give the clinician a more accurate understanding of the complex and polymorphous reality of mixed states and help him make more specific therapeutic interventions. These subtypes of mixed states will need validation through prospective clinical studies. Biological differences, differential outcome over time, and differential response to treatment will be important validation criteria.

Affect↗

[Exogenous psychosis induced by cobalamin-deficiency].

The case of a 69 years old female patient is reported, who developed paranoid behaviour due to cobalamin-deficiency without megaloblastosis based on a chronic gastric atrophy. The psychosis showed complete remission after vitamin B 12 supplementation. The discussion leads to the question, whether or not chronic use of tricyclic antidepressants may be one cause of atrophic gastritis. Furthermore, differentialdiagnostic reflections consider the role of cobalamine and folate in the synthesis of monoamine neurotransmitters in the brain.

Aged↗

Assessment of anxiety, depression, and suspiciousness in the home care setting.

Home care nurses who are not trained as psychiatric nurses can meet the challenge of caring for clients with anxiety, depression, or suspiciousness. The home care setting provides more opportunity for prolonged periodic nurse-client interaction in the client's usual surroundings. Home care nurses have a further advantage over acute care nurses in that they tend to have a more developed concept of cultural and environmental influence. Assessing psychosocial issues requires nontangible tools, the most crucial of which is the ability to listen--to listen with ears and heart. Although test instruments may be useful, most assessment involves interview and observation. Drawing on these special opportunities and skills, the home care nurse can objectively collect and evaluate data to determine the presence of anxiety, depression, or suspiciousness in preparation for appropriately intervening.

Anxiety↗

Paranoid/belligerence and neuroleptic dosage in newly admitted schizophrenic patients.

The aim of this study was to determine if the severity of paranoid/belligerence was a major determinant of neuroleptic dosage in newly admitted patients with acute or exacerbated schizophrenia. Two clinical psychiatrists, who had no clinical responsibility for drug treatment and were blind to neuroleptic dosage regimens, jointly interviewed 155 patients who were cooperative enough to be carefully interviewed with the Structured Clinical Interview for the DSM-III-R, Positive and Negative Syndrome Scale (PANSS) Edition. The large majority of the patients were receiving moderate dosages of neuroleptics (mean peak dosage: 500 mg/day of chlorpromazine equivalents). There was a positive correlation between the score on the PANSS paranoid/belligerence cluster and the daily dosage of neuroleptic treatment. Splitting the sample by gender, the correlations remained highly significant. In a multivariate analysis controlling for the effects of other clinical variables, paranoid/belligerence and gender emerged as significant predictors of neuroleptic dosage. Clinicians prescribed lower doses of neuroleptics for female patients and higher doses for patients with higher ratings on the PANSS paranoid/belligerence cluster. These findings suggest that clinicians' strategy of increasing neuroleptic dosage at the manifestation of hostility is not limited to assaultive or uncooperative schizophrenic patients who are on very high dosages of neuroleptics.

Adolescent↗

Cynicism and paranoid alienation in the Cook and Medley HO Scale.

Factor analysis of responses from 1002 men and women were used to define two subscales of the Cook and Medley Hostility Scale. Both the Cynicism and the Paranoid Alienation subscale described attitudes of mistrust and alienation, and both were correlated with MMPI factors measuring aspects of psychopathology. It was suggested that measures of the broader domain of Agreeableness-Antagonism be examined as possible predictors of CHD.

Coronary Disease↗

Characterizing paranoia in the DSM-III borderline personality disorder.

The relationship between paranoia and the borderline personality disorder continues to be the subject of debate. This study compares the extent and intensity of paranoia in 29 subjects fulfilling DSM-III criteria for borderline personality disorder. The control group consists of 22 subjects with dysthymic disorder. Paranoia was both more prevalent and severe in borderline patients. Results are discussed in light of previous descriptive and research literature.

Adolescent↗

Delusional theme, sex and age.

In a retrospective study of 865 delusional syndromes, connections were investigated between delusional themes and the sex of patients, and the ages in which these themes extensively occurred. According to previous reports, the results of this investigation indicated that differences exist between the ages of manifestation regarding the themes of hypochondria, persecution, love and jealously. Furthermore, differences could be observed between males and females in relation to the frequency of choice of particular themes, as well as the age of occurrence. Based on psychological studies concerned with the content's dependence on motives we conclude that the age distribution of delusional themes corresponds to the main existential concerns in different life periods.

Adolescent↗

Paranoid delusions and cognitive impairment suggesting Fahr's disease.

The authors present the case of a 60-year-old woman with elaborate paranoid delusions and cognitive impairment found during a workup for atypical chest pain. Clinical evaluation revealed mild dementia, and radiography showed basal ganglia calcification consistent with Fahr's disease. She was treated with risperidone and transferred to a psychiatric inpatient unit for definitive care. Psychiatrists should consider Fahr's disease as a differential diagnosis in the evaluation of psychosis and cognitive impairment when neuroimaging reveals calcification of the basal ganglia.

Basal Ganglia↗

Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity.

OBJECTIVE: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. METHOD: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. RESULTS: Of the 57 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. CONCLUSIONS: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.

Adult↗