Higher brain blood flow at amygdala and lower frontal cortex blood flow in PTSD patients with comorbid cocaine and alcohol abuse compared with normals.

Posttraumatic stress disorder (PTSD) patients with histories of cocaine and alcohol abuse (CA-PTSD) were compared with normal volunteers. Positron emission tomography (PET) scans with 15O-butanol were used to compare regional cerebral blood flow (rCBF) between the groups during rest and during an auditory continuous performance task (ACPT). CA-PTSD patients had significantly higher rCBF in right amygdala and left parahippocampal gyrus than normals during the ACPT. Normals had higher rCBF at frontal cortex during the resting scan and during the ACPT. The role of the amygdala in attention and fear conditioning suggests that increased amygdala rCBF may be related to clinical features of PTSD. Cocaine use may be associated with increased amygdala rCBF in PTSD patients. Amygdala and frontal cortex attention system components may be reciprocally related and their relative contributions to processing of neutral stimuli perturbed in CA-PTSD.

PET measurement of neuroreceptor occupancy by typical and atypical neuroleptics.

UNLABELLED: The goal of this study was to use PET and 11C-N-methylspiperone (11C-NMSP) to measure the difference in relative occupancy of serotonin (5-hydroxytryptamine-2 or 5-HT2A) and dopamine-2 (D2) neuroreceptors in subjects being treated with typical or atypical antipsychotic drugs. METHODS: We used PET and single-dose 11C-NMSP to measure receptor indices and relative receptor occupancy of 5-HT2A receptors in frontal cortex and D2 receptors in basal ganglia in five subjects who were neuroleptic free, five subjects who were being treated with typical antipsychotic drugs and five subjects who were being treated with clozapine, an atypical antipsychotic drug. RESULTS: Among the three groups, there were significant differences in 5-HT2A indices, D2 indices and the ratio of 5-HT2A to D2 indices. With no overlap, the 5-HT2A index separated all subjects who received clozapine and the D2 index separated the remaining two groups. CONCLUSION: Typical antipsychotic and atypical antipsychotic subjects do have differing patterns of 5-HT2A and D2 relative receptor occupancy when measured with a single PET scan, single 11C-NMSP radiotracer dose and no separately injected "cold" pharmaceutical.

Attention and regional cerebral blood flow in posttraumatic stress disorder patients with substance abuse histories.

Performance on an attentional task was assessed in posttraumatic stress disorder patients with substance abuse histories (PTSD-SA). Positron emission tomography (PET) was used to measure concurrent regional cerebral blood flow (rCBF). Eight male PTSD-SA patients and eight normal subjects each received three serial PET scans with 15O-labeled water under the following conditions: (1) resting, (2) auditory continuous performance task (ACPT1), and (3) repeat auditory task (ACPT2). PTSD-SA patients made more errors of commission on the ACPT than normal subjects. Examination of right frontal and parietal cortex ACPT task substrates revealed decreased parietal blood flow in PTSD-SA, which may represent a pathophysiology for poor attentional task performance in PTSD-SA. Attentional problems may underlie other symptomatology in PTSD.

Positron-emission tomography and personality disorders.

This study used positron-emission tomography to examine cerebral metabolic rates of glucose (CMRG) in 17 patients with DSM III-R diagnoses of personality disorder. Within the group of 17 personality disorder patients, there was a significant inverse correlation between a life history of aggressive impulse difficulties and regional CMRG in the frontal cortex of the transaxial plane approximately 40 mm above the canthomeatal line (CML) (r = -.56, p = 0.17). Diagnostic groups included antisocial (n = 6), borderline (n = 6), dependent (n = 2), and narcissistic (n = 3). Regional CMRG in the six antisocial patients and in the six borderline patients was compared to a control group of 43 subjects using an analysis of covariance with age and sex as covariates. In the borderline personality disorder group, there was a significant decrease in frontal cortex metabolism in the transaxial plane approximately 81 mm above the CML and a significant increase in the transaxial plane approximately 53 mm above the CML (F[1,45] = 8.65, p = .005; and F[1,45] = 7.68, p = .008, respectively.

Cerebral glucose metabolism in patients with summer seasonal affective disorder.

Positron emission tomography scans of nine patients diagnosed with summer seasonal affective disorder (SSAD) were compared with scans of 45 normal control subjects to investigate differences in brain glucose metabolism. All subjects performed an auditory discrimination task beginning several minutes before injection of F-18-deoxyglucose and continuing for 30 minutes after injection. Regional glucose metabolic rates were extracted from 60 rectangular regions of interest measured in five planes selected as atlas matches from 28 total slices. Statistically significant differences between patients with SSAD and normal control subjects were found in cerebral glucose metabolic rate and also in normalized regional glucose metabolic rates in the orbital frontal cortex and in the left inferior parietal lobule.

Axillary iodine-131 accumulation due to perspiration.

A case of spurious axillary uptake of I-131 proven to be caused by perspiration is presented. False-positive localizations of radioiodine, both pathologic and physiologic, are reviewed to avoid confusion of these entities with functioning thyroid carcinoma metastases.

Mood-altering effects of disulfiram in alcoholics.

The effects of disulfiram on depression and anxiety were examined. In a 3-week double-blind study, 40 inpatients in al alcohol rehabilitation unit (ARU) were randomly assigned to receive placebo, 250 mg/day of disulfiram or 500 mg/day of disulfiram. During their first week in the ARU and prior to beginning medications, all subjects were administered the Zung self-rating depression scale, the Hamilton observer rating scale for depression, the Zung self-rating scale for anxiety and the Hamilton observer rating scale for anxiety. All subjects were rescored on these instruments at the end of their third week in the ARU. Three psychiatrists, blind to the medication condition, sequentially scored the Hamilton items. To evaluate intergroup differences at baseline as well as changes in scale scores during the 3 weeks, scale scores were subjected to analyses of variance. No statistically significant effect attributable to disulfiram was found but significant changes due to a time effect were noted.

Same-sex rape of nonincarcerated men.

Psychiatric evaluations of nonincarcerated adult male victims of same-sex rape have been reported infrequently in the literature. In their work with a population of military men, the authors reviewed the psychiatric evaluations of 13 such victims, ages 18 to 31, over a 2-year period. Most of the men reported mood disturbances (e.g., fear, depression, anger), somatic disturbances (e.g., in sleep, appetite, digestion), and difficulties in peer relationships following the assault, and almost half of these victims reported that they had experienced subsequent sexual problems.

Aggression, suicide, and serotonin: relationships to CSF amine metabolites.

In an earlier, separate study, the authors found that human aggression and suicide (a specific aggression-related behavior) were associated with lower levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite. That study focused on subjects with personality disorders without affective illness. In the present study they examine the life history of aggression and history of suicidal behavior in 12 subjects with borderline personality disorders without major affective disorder. Histories of aggressive behaviors and of suicide attempts were significantly associated with each other, and each was significantly associated with lower 5-HIAA levels. Altered serotonin metabolism may be a highly significant contributing factor to these behaviors in whatever diagnostic group they occur.

Aggression in humans correlates with cerebrospinal fluid amine metabolites.

Cerebrospinal fluid of the major central metabolites of serotonin (5HT), norepinephrine (NE), and dopamine (DA)--5-hydroxyindoleacetic acid (5HIAA), 3-methoxy-4-hydroxy=phenylglycol (MHPG), and homovanillic acid (HVA), respectively--were studied in a group of 26 age-similar military men with no history of major psychiatric illness, but with various personality disorders and difficulties adjusting to military life. Independently scored history of aggressive behavior showed a significant negative correlation with 5HIAA (r = -0.78) and a significant positive correlation with MHPG (r = 0.64).

Hepatotoxicity in disulfiram-treated patients.

Thirty-five alcoholics receiving disulfiram for 3 weeks showed no dose-related hepatotoxicity compared with controls, but 9 did exhibit non-dose-related subclinical hepatotoxicity.

Effects of disulfiram and pyridoxine on serum cholesterol.

Disulfiram, 500 mg/day, raised serum cholesterol levels in alcoholic persons from a mean of 193 +/- 16.4 mg/dl to 227.2 +/- 17.2 mg/dl after 3 weeks and 264 +/- 40 mg/dl after 6 weeks. This increase was not seen in a group taking pyridoxine 50 mg/day in addition to disulfiram 500 mg/day. In contrast to the disulfiram and disulfiram-pyridoxine treatment groups, control groups receiving pyridoxine alone, or no drug, had a 33 mg/dl reduction in serum cholesterol during the first 3 weeks of abstinence, a finding consistent with other evidence showing a rapid decrease in serum lipids on abstinence from alcohol. Patients taking disulfiram 250 mg/day, with or without pyridoxine, did not have this expected decrease in serum cholesterol. Since increased serum cholesterol is one of the risk factors in a coronary heart disease, chronic disulfirm therapy may increase the incidence of arteriosclerotic cardiovascular disease, as has been the case with chronic exposure to carbon disulfide, a principal metabolite of disulfiram.