Negative correlation between serum S100B and leptin levels in schizophrenic patients during treatment with clozapine and risperidone: preliminary evidence

Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocyte-specific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source. In this study we evaluated the relationship between S100B and leptin in schizophrenic patients under treatment with clozapine and risperidone. This study included 19 patients meeting the DSM-IV-TR criteria for schizophrenia, having body mass index [BMI] of 16- 25 kg/m[2] and suffering schizophrenia for more than 3 years and from this study. Twenty five healthy controls were group matched for age and gender whose BMI was 16-25 kg/m[2]. Serum S100B and leptin levels and positive and negative symptom scale [PANSS] were assessed at admission and after six weeks. During the study, S100B showed a strong and negative correlation with leptin [r = -0.5, P = 0.01]. Also, there were negative correlation between serum S100B level and PANSS negative subscale after 6 weeks of treatment [r = -0.048, P = 0.8]. Positive correlation between leptin level and PANSS suggested a potential role for leptin which can mediate the link between antipsychotic induced weight gain and therapeutic response in schizophrenia

Depression after myocardial infarction

Depression after myocardial infarction [MI] is a common and debilitating condition that could increase mortality and morbidity in these patients. Depression in MI patients is three times more prevalent than general population and women are more susceptible to this event. Psychosomatic condition of MI patients could worsen with co morbidity of depression and therefore poor quality of life, inappropriate self-care behaviors and increased risk of recurrence and poor outcome. In addition lack of social support could expose them to more severe disease. Diagnosis of depression in MI patients is difficult because there are many overlap in symptoms of depression and cardiovascular disease. Therefore routine depression screening and management in MI patients should become one of the mainstays of their care. Medical and non medical management of depression in MI patients may improve their outcome, although it seems that combination therapy is associated with better response

Toll like receptor-4 896a/g gene variation, a risk factor for migraine headaches

The pathogenesis of migraine involves immune-mediated mechanisms in the vascular endothelium. Toll like receptor 4 [TLR-4] is a signaling receptor of innate immunity which plays a role in various neuropathologies related to neuron inflammation. This case/control study is aimed to investigate whether TLR- 4 896A/G variation is related to migraine headaches in an Iranian population. A total of 170 migraine patients [130 females, mean age 33.24 +/- 11 years] and 170 age, sex, and ethnicity matched healthy controls [118 females, mean age of 31 +/- 10 years] were recruited. Genotyping was carried out using the tetra primer amplification refractory mutation system [ARMS]-PCR. The frequency of G allele was higher in migraine patients than the controls [15% vs. 4.7%; p<0.0001]. Interestingly, the distribution of heterozygous 896A/G genotype statistically differed between migraineurs and controls [25.3% vs. 8.2%, p=0.00002, OR 3.87, 95% CI; 2.02-7.4]. Multivariate logistic regression analysis indicated that G allele in affected female migraineurs is an independent factor associated with increased risk of migraine [OR 3.2, 95% CI 1.23-8.24, p=0.01]. Our results showed TLR-4 polymorphism as a genetic risk factor for migraine. However, further studies in different populations are required to elucidate the precise role of TLR-4 896A/G mutation in susceptibility to migraine.

Congenital diaphragmatic hernia following usage of lithium carbonate; is lithium a teratogen?

Lithium is used mainly for the treatment of Bipolar Disorder [BD]. Case reports and several retrospective studies have demonstrated possible teratogenicity, but the data in different studies is inconclusive. The risk for cardiovascular malformations, particularly Ebstein's anomaly and other congenital abnormalities have been reported. A 25-year-old gravida 1, para 1 woman at 38 weeks of gestation was admitted for an elective caesarean section. She had a history of BP for which she was treated with lithium 600mg q12h in the first trimester of pregnancy. There was no familial history of birth defects, any antenatal infection or exposure to any other medications, alcohol, smoking, or X-rays. A baby boy [3500g] was born. After 2 to 3 hours respiratory distress clinical picture and chest radiograph suggested diagnosis of congenital diaphragmatic hernia. Repair of his diaphragm was preformed and patient discharged after 12 days. Lithium probably produces a defect in normal development of the diaphragm and may pose specific risk for an anomaly known as congenital diaphragmatic hernia [CDH]

[Study on the simultaneity of the substance abuse with psychiatric disorder in referred outpatients to psychiatry clinic of zare hospital for period of one year]

One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse. In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis, slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis. Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital. In this descriptive research study, 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D.S.M. IV interview. The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used. The results obtained, showed that 79.1% were men, 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance - withdrawal and 95.2% for psychiatry problems. And also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow: 60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia, 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the variables such as sex, residential areas, occupation, education, marital status, history of cigarette smoking and age of commence ment of smoking with substance dependency [p<0.05]. Considering the high prevalence of Substance usage by the patients referred to psychiatric clinics, the Concurrency of substance usage and psychiatry problems are important in history taking and treatment of the patients. On the other hand to have a high success Coefficient, a simultaneous psychiatric diagnosis for the patients referred for withdrawal, should be kept in mind

Comparative study of clozapine, electroconvulsive therapy [ECT], and the combination of ECT with clozapine in treatment-resistant schizophrenic patients

Despite the discovery of new antipsychotic drugs, a number of schizophrenic patients show no response to such drugs and are considered treatment-resistant. In such cases, clozapine and occasionally ECT or a combination of drugs are used, though they are not very effective. In recent years, the combination of clozapine and ECT for treatment-resistant schizophrenic patients has been suggested; the results of preliminary studies have been hopeful. The aim of this study was to compare the results of treatment with clozapine alone, ECT alone, and the combination of clozapine with ECT in treatment-resistant schizophrenia. Eighteen treatment-resistant schizophrenic patients were assigned to three equal groups: one group was given clozapine; one group was treated with ECT; and one group was treated with the combination of clozapine and ECT. The treatment response was evaluated using the PANSS criteria, and the data were analyzed with ANOVA. Combination therapy was superior to single modality therapy. The reduction of PANSS scores was 46% in the clozapine group, 40% in the ECT groups, and 71% in the combination group; the difference between the combination group and the other groups was statistically significant [p<0.05]. Patients had a quick response to combination treatment, which resulted in a higher cure rate of positive and negative symptoms and improved the patients' general performance. There were no significant adverse effects with combination treatment. Combination treatment with clozapine and ECT was safe and effective in treatment-resistant schizophrenic patients. It should be considered for the treatment of treatment-resistant schizophrenic patients