Neuropsychobiology
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Comparative Study
Endocrine response to surgical stress and postoperative confusion in depressed patients with alcohol abuse.
Both alcohol drinking and depression are risk factors for postoperative confusion and are associated with alteration of pituitary-adrenal function. We investigated the incidence of postoperative confusion, plasma cortisol and ACTH response to surgical stress in depressed patients with alcohol abuse. We studied sixty depressed patients with and without alcohol abuse who underwent abdominal surgery. ⋯ In depressed patients with alcohol abuse, plasma cortisol concentrations (34.9 +/- 7.1, 33.2 +/- 5.8 and 33.4 +/- 5.5 microg dl(-1)) 60 min after the end of surgery, the next day and third day after surgery in postoperatively confused depressed patients were significantly higher than those (26.4 +/- 6.3, 25.4 +/- 5.0 and 25.2 +/- 4.9 microg dl(-1)) of nonconfused depressed patients. In conclusion, the incidence of postoperative confusion was significantly higher in depressed patients with alcohol abuse than in depressed patients without alcohol abuse. Increased plasma cortisol concentrations after surgery were associated with postoperative confusion in depressed patients with alcohol abuse.
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Clinical Trial
Low-dose pramipexole in the management of restless legs syndrome. An open label trial.
Dopaminergic agents are considered the treatment of choice for restless legs syndrome (RLS); levodopa is the only substance licensed for this disorder in some European countries. However, in a substantial proportion of patients symptoms are not adequately controlled for a whole night due to the short half-life of levodopa or because symptom augmentation may develop. To further investigate the impact of pramipexole on the management of RLS we performed a short-term open label trial with pramipexole in 17 patients who were being insufficiently treated with levodopa or for whom pramipexole was primarily being considered because of the severity of the RLS symptoms. ⋯ All patients who had developed a worsening of RLS symptoms under levodopa recovered from daytime symptoms after their medication was switched to pramipexole. Since pramipexole was well tolerated, an ideal dosage to control RLS symptoms could be reached rapidly. Pramipexole has proven a suitable alternative in patients with moderate to severe RLS, particularly when their therapy has to be switched to a dopamine agonist.
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Comparative Study
Cytochrome P-450 2D6*10 C188T polymorphism is associated with antipsychotic-induced persistent tardive dyskinesia in Chinese schizophrenic patients.
Typical antipsychotic treatment had been postulated to be a risk factor for the susceptibility to tardive dyskinesia (TD). The cytochrome P-450 debrisoquine/sparteine hydroxylase (CYP2D6) metabolizes a majority of antipsychotics and exhibits various phenotypes on enzymatic activities from poor metabolizers to ultrarapid metabolizers. The various phenotypes are encoded by polymorphic genetic variants on the CYP2D6 gene. ⋯ This positive finding was only observed in male patients (p = 0.001), but not in females. Our findings also support the correlation between AIMS scores and C188T polymorphism within the TD group after adjusting for confounding effects with the multiple regression analysis (p = 0.033). We concluded that the CYP2D6*10 C188T polymorphism may be associated with the susceptibility to the occurrence of TD induced by typical antipsychotics, especially in male patients, and may also be correlated with AIMS scores in TD patients.
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The relationships between pretreatment EEG parameters and seizure duration in electroconvulsive therapy (ECT) were studied in order to provide information useful for the prediction of ECT-induced seizures. ⋯ Interhemispheric coherence may reflect, in a quantitative manner, cortico-cortical transmission via commissural pathways required for the generation of a generalized seizure through right unilateral stimulation. It may represent a useful parameter with respect to seizure threshold with potential therapeutic implications for ECT.
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Comparative Study
Pain thresholds as a putative functional test for cerebral laterality in major depressive disorder and panic disorder.
Both major depressive disorder (MDD) and panic disorder (PD) exhibit an illness-related functional cerebral laterality with a frontal right/left asymmetry. Using experimental pain lateralization as a putative indicator of functional cerebral laterality, we assessed body side differences in pressure, cold and heat pain thresholds in patients with MDD and PD as well as in healthy control subjects (HC). To control for an attentional bias in perception, reaction times for selective attention were also measured for both visual fields. ⋯ Body side asymmetry of pain perception was only found for pressure pain targeting mainly deep tissue (muscle) nociception. This asymmetry, however, cannot be regarded as an indicator of a pathological functional cerebral laterality in MDD and PD.