Suicide attempts in depressive disorders and the hypothalamic pituitary adrenal axis. Is it a tool for suicide prediction?

A non-fatal suicide attempt is the strongest known clinical predictor of eventual suicide. Approximately 15-20% of depressed patients commit suicide despite maintenance therapy with antidepressant medication. The aim of the present study was to evaluate the role of the hypothalamic pituitary adrenal [HPA] axis in cases of attempted suicide through hormonal assay and adrenal ultrasonography in an attempt to provide a useful tool to predict suicide and perhaps prevent suicidal behavior in patients with major depressive disorders. Thirty patients with major depression who recently attempted suicide were included. The seriousness of the suicide attempt was assessed according to the Suicide Intent Scale [SIS] which ranged from 25 to 29 in the depressive patients indicating a high suicidal intent. The number of male patients exceeded the number of female patients and the mean age of the patients was 34.4 +/- 5.86 years. The methods used in suicide included; drug overdose, cut wrist, jumping off balcony and gas inhalation. Drug overdose accounted for the majority of the cases [76.66%]. The plasma adrenocorticotrophic hormone [ACTH] levels in the patients' studied group were significantly lower than those of the control group while the plasma cortisol level was significantly higher than the control group. Patients also showed a significantly lower cholesterol plasma level than controls. Regarding adrenal ultras onography results, the adrenal gland size in depressives was significantly larger than the adrenal gland size of their matched controls, where 17 of the patients had an enlarged adrenal gland. It is concluded that there is a relation between stress, depression and the HP A axis. The results in this study may help clinicians identify suicide vulnerable individuals. The findings may also help in the postmortem identification of suicide victims, during autopsy, through nonpathological adrenal enlargement

Histological study of the effect of haloperidol on the corpus striatum of Albino rats and the possible neuro-protective role of vitamin E

Halperidol [HP] is a high potency antipsychotic drug used in treatment of schizophrenia. One of its major side effects is Tardive Dyskinesia [TDD] which is a syndrome of irreversible involuntary movements in tongue, face, arms and legs. Different mechanisms were proposed to explain the pathphysiology of TD and to suggest the proper treatment of this iatrogenic effect caused by HP. The most accepted theory could be histological alterations in the striatum caused by an oxidative stress mechanism and hence the trial of vitamin E [being an antioxidant] as a protective agent against HP-induced TD. The study was performed to investigate the effect of HP on the corpus striatum of rat and the possible neuroprotective role of vitamin E. The present study was carried out on forty adult male albino rats which were divided into four groups; the control group, vitamin E group received only vitamin E orally in a dose of 100 mg/kg/day for 4 consecutive weeks, the HP group received HP in a dose of 40 mg/kg/day for 4 consecutive weeks and the HP and vitamin E group received 100 mg/kg vitamin E in conjunction with HP for the same period. Clinical observation for VCMs [analogue of TD] was made during the period of experiment. At the end of four weeks, animals were sacrificed and brain specimens were prepare for histological study of the basal ganglia by light microscopy using H and E. and DOPA reaction. There were different histological alternations in neurons of the striatum in the HP-treated group, which were in the form of distortion, cellular infiltration,, shrinkage and hypereosinophilia of the cytoplasm. Other neurons showed cytoplasmic vacuolations, Co-administrations of vitamin E, reduced the HP-induced striatal neuronal changes, thus, vitamin E could be of value as a neuroprotective agent against HP-induced striatal changes in humans

PTSD, does it really exist in Alexandria out-patient clinic?

Posttraumatic stress disorder [PTSD] was observed to be clinically under diagnosed in the psychiatric outpatient clinic in Alexandria University Main Hospital. Because of the significant implications of PTSD on the sufferers and the whole community, so the aim of this work was to estimate the actual one-month rate of PTSD and to identify the causes of under diagnosis. All patients attended the clinic during one month were assessed by using a list of traumas [Kessler 's et al 1995] and DSM-IV PTSD criteria. Demographic characteristics, trauma and other clinical correlates of PTSD diagnosis were also examined. Out of 570 patients, 11.2% had PTSD; two-thirds of them had partial syndrome. Only 20% of the cases presented with PTSD manifestations. Ninety-four percent experienced one traumatic event and witnessing was the most common reported trauma. The majority [97%] had acute onset and the main duration of illness was more than 10 years. PTSD was strongly associated with other psychiatric disorders with major depression being the commonest comorbid disorder [20% of cases]. The rate of PTSD in the out-patient clinic in Alexandria University is relatively high. Patients' failure to acknowledge the traumatic experience, the presentation of PTSD patients with other psychiatric or somatic manifestations, the high rate of partial syndrome rather than full syndrome and the high comorbidity rate might be the possible factors behind the under diagnosis of PTSD