Differential expression of interferon-induced genes and other tissue-based biomarkers in acute graft-versus-host disease vs. lupus erythematosus in skin.

BACKGROUND: In both acute graft-versus-host disease (GVHD) and lupus erythematosus (LE), the patient's own tissues are subjected to immunological assault via complex mechanisms influenced by interferon (IFN) and other cytokines. Although not typically confused clinically, these entities have overlapping histopathological findings in the skin. AIM: To assess whether GVHD can be differentiated from LE using molecular methods on skin specimens. METHODS: We developed a quantitative reverse transcription PCR assay based on previously identified tissue-based biomarkers of cutaneous GVHD, and compared gene expression in GVHD with that in LE. RESULTS: Both entities showed robust expression of IFN-induced genes and of genes encoding proteins involved in antigen presentation, cell signalling and tissue repair. Levels of gene expression differed significantly in GVHD compared with LE, particularly those of IFN-induced genes such as MX1, OAS3, TAP1 and STAT3 (P < 0.01). Three logistic regression models could differentiate the two entities with a high degree of certainty (receiver operating characteristic area under the curve of 1.0). CONCLUSION: The study demonstrates the feasibility of distinguishing between microscopically similar inflammatory dermatoses using tissue-based molecular techniques.

Trichotillomania: symptom or syndrome? A need for revision.

A 40-year-old religious Hindu male presented with his fourth episode of mania along with repetitive plucking of hair. This unusual behaviour was explained by him as a way to 'attain divinity by discarding the impure demoniac hair'. He had not shown this symptom in the previous episodes. With treatment of the mood disorder the hair plucking also disappeared. Hair removal has an important religious-cultural meaning in eastern India. Possible implication of the symptom is discussed. A case is made for reporting hair plucking as a symptom rather than a syndrome and it may at times represent a culture-specific symptom.

Multifocal leucoencephalopathy presenting as antidepressant induced mania.

A male patient presented with tricyclic induced hypomania after treatment for chronic depression. On follow up the patient deteriorated towards dementia with multifocal leucoencephalopathy. The possible role of brain lesions in the causation of affective syndromes and the neurobiological hypothesis of bipolar syndromes are discussed. The authors propose that chronic depression should be thoroughly investigated for a probable Axis III diagnosis.

Transient release reflexes in catonic schizophrenia.

This case report describes the presence of grasp reflex and palmomental reflex as a state dependant phenomenon in a 23 year old patient with catatonic schizophrenia. A transitory disturbance of frontal lobe function is proposed as the probable mechanism. The need to study the release reflexes as an effort to delineate a neurological "sub group" of schizophrenia is suggested.

"Incomplete koro"- a forerunner for mood disorder: two case reports.

Koro was initially reported as a culture-bound psychiatric syndrome confined to South-east Asian cultures. Later on, isolated cases of Koro have been reported from non-Chinese cultures also. Incomplete Koro syndrome or a 'Koro-like state' is usually grafted on to a primary psychiatric disorder. The association of Koro with depression is rare and this paper reports two cases of mood disorder presenting with Koro symptoms. Recurrence of Koro symptoms in the depressive phase and its disappearance during the period of mania has not been reported. The initial anxiety associated with Koro might result into major depression. It is proposed that a Koro-like state may be a non-specific epiphenomenon that vanishes with recovery of depression.

Prospective study of neuroleptic-induced dystonia in mania and schizophrenia.

OBJECTIVE: The authors' goal was to conduct a prospective study comparing the rate of occurrence of neuroleptic-induced dystonia in a group of consecutively admitted manic and schizophrenic patients receiving typical inpatient treatment from several clinicians. METHOD: All patients met the following criteria: 1) male sex, 2) age between 17 and 45 years, 3) definite diagnosis of mania or schizophrenia according to Research Diagnostic Criteria, 4) no exposure to neuroleptics during the past month, 5) absence of past or family history of a neurodegenerative disorder with extrapyramidal symptoms. All treatment decisions were left to the treating clinicians. Fifty patients with mania and 33 with schizophrenia were included in the study. Most of these patients received high-potency neuroleptics, but the specific neuroleptic used varied in the two groups. RESULTS: Twelve (24%) of the patients with mania and five (15%) of the patients with schizophrenia developed acute dystonia. Manic patients received significantly higher peak doses of neuroleptics during the risk period for dystonia. Stepwise multiple regression analysis revealed that the peak neuroleptic dose and age were most strongly related to the occurrence of dystonia. CONCLUSIONS: This prospective study failed to support the retrospective finding of another study that acute dystonia occurred more often in manic patients than in patients with nonparanoid schizophrenia. The authors conclude that there is a need for carefully controlled prospective studies with larger groups of patients.