Brain activation induced by psychological stress in patients with schizophrenia.

Environmental influences are critical for the expression of genes putatively related to the behavioral and cognitive phenotypes of schizophrenia. Among such factors, psychosocial stress has been proposed to play a major role in the expression of symptoms. However, it is unsettled how stress interacts with pathophysiological pathways to produce the disease. We studied 21 patients with schizophrenia and 21 healthy controls aged 18 to 50years with 3T-fMRI, in which a period of 6min of resting state acquisition was followed by a block design, with three blocks of 1-min control-task, 1-min stress-task and 1-min rest after-task. Self-report of stress and PANSS were measured. Limbic structures were activated in schizophrenia patients by simple tasks and remained active during, and shortly after stress. In controls, stress-related brain activation was more time-focused, and restricted to the stressful task itself. Negative symptom severity was inversely related to activation of anterior cingulum and orbitofrontal cortex. Results might represent the neurobiological aspect of hyper-reactivity to normal stressful situations previously described in schizophrenia, thus providing evidence on the involvement of limbic areas in the response to stress in schizophrenia. Patients present a pattern of persistent limbic activation probably contributing to hypervigilance and subsequent psychotic thought distortions.

The use of metaphors by the "ambulatory inpatients" of the managed care era.

An important effect of managed care is keeping partially decompensated patients out of the hospital, for this is the single most decisive factor in cutting the costs of psychiatric services. It is proposed that discharging sicker patients from inpatient units and denying admission to poorly compensated patients poses new challenges to their outpatient therapists. This calls for new, refined psychotherapeutic skills, especially around the development of a therapeutic alliance. Patient communications in the form of metaphors may help the clinician understand the patient's conflicts while avoiding excessive anxiety that might accompany more direct communications. Recognizing the meaning of the metaphor and working with it can keep the patient from regressing and assist in the formation of a therapeutic alliance. This statement is examined in a number of clinical examples. The similarities and differences between metaphors and dreams, symptoms, and the transference are discussed.

Insuficiencia autonómica en un caso de feocromocitoma con hipotensión postural / Pheochromocytome with autonomic failure and orthostatic hypotension

En un caso de feocromocitoma con crisis de hipertensión e hipotensión postural, el análisis espectral de la variabilidad de la frecuencia cardíaca indicó que en decúbito supino la actividad simpática y vagal estaba disminuída, con falta de incremento en la actividad simpática durante la bipedestación. Luego de la extirpación del tumor se observó un aumento marcado en la actividad simpática y vagal en reposo y una respuesta normal ante la bipedestación. La insuficiencia autonómica global, causal en parte de la hipotensión postural, podría deberse a inhibición de la liberación de noradrenalina y acetilcolina en las terminaciones nerviosas, resultante de la estimulación de los receptores alfa-adrenérgicos por las concentraciones elevadas de catecolaminas y de neuropéptido Y segregadas por el tumor (AU)

Insuficiencia autonómica en un caso de feocromocitoma con hipotensión postural / Pheochromocytome with autonomic failure and orthostatic hypotension

En un caso de feocromocitoma con crisis de hipertensión e hipotensión postural, el análisis espectral de la variabilidad de la frecuencia cardíaca indicó que en decúbito supino la actividad simpática y vagal estaba disminuída, con falta de incremento en la actividad simpática durante la bipedestación. Luego de la extirpación del tumor se observó un aumento marcado en la actividad simpática y vagal en reposo y una respuesta normal ante la bipedestación. La insuficiencia autonómica global, causal en parte de la hipotensión postural, podría deberse a inhibición de la liberación de noradrenalina y acetilcolina en las terminaciones nerviosas, resultante de la estimulación de los receptores alfa-adrenérgicos por las concentraciones elevadas de catecolaminas y de neuropéptido Y segregadas por el tumor

Electrodermal response in nonglabrous skin of freely moving rats: mediation by the sympathetic nervous system and evaluation in an animal model of depression.

Electrodermal responses in the facial region of freely moving rats were recorded bilaterally. After a nociceptive stimulus (ammonia vapor exposure), the response (a transient negative potential followed by a longer-lasting positive potential) attained a similar amplitude on both sides. Surgical sympathetic denervation of facial skin by ipsilateral superior cervical ganglionectomy (SCGx) significantly decreased the electrodermal response. When an inferior cervical ganglionectomy was performed in addition to SCGx, a further decrease in electrodermal response was observed. Pretreatment of unilaterally SCGx rats with atropine blunted the electrical response in the control side to levels similar to those found in the SCGx side. Treatment with phenoxybenzamine or propranolol was ineffective. Skin potential responses were measured in adult rats administered with clomipramine from the 8th to the 21st day of life and exhibiting a long-lasting syndrome resembling human depression. Clomipramine-injected rats developed larger skin potential responses to sound stimulation than controls while responses to ammonia vapor were similar in both groups, as well as the habituation rate after repetitive exposure to ammonia vapor. The results indicate that some of the altered electrodermal responses found in depressed patients are detectable in the clomipramine animal model of endogenous depression.

Correlation between serum and urinary calcium levels and psychopathology in patients with affective disorders. Short communication.

To examine whether serum and urinary calcium levels were related to the psychopathology index (i.e. average score in clinically relevant scales of Minnesota Multiphasic Personality Inventory), 24 women aged 35.6 +/- 2.5 years and 20 men aged 34.3 +/- 2.1 years, suffering from affective disorders, were studied. A non-parametric bivariate correlation analysis revealed a negative correlation between PI and serum calcium (r = -0.256, p < 0.01), while urinary calcium levels correlated positively with PI (r = 0.236, p < 0.02). A positive correlation occurred between serum and urinary calcium (r = 0.968, p < 0.0001). When the data were analyzed by categorical classification of patients with normal or abnormal PI scores, serum calcium levels were smaller, and urinary calcium levels higher, in patients with abnormal PI (p < 0.01). The results support to the concept that alterations of calcium homeostasis occur in psychopathology.

Cardiovascular tests of autonomic function and sympathetic skin responses in patients with major depression.

To assess the function of the autonomic nervous system in major depression, a series of cardiovascular tests, together with the recording of sympathetic skin response, were performed in 18 depressed patients (melancholic type, DSM-III-R criteria) and in 18 healthy control subjects. Depressed patients showed significantly poorer performance in Valsalva's, deep breathing, and lying to standing manoeuvres than controls, indicating an impairment of parasympathetic function. Depressed patients developed a significantly larger sympathetic skin response than controls during the lying to standing and hand grip manoeuvres, whereas cardiovascular sympathetic performance (as assessed by the responses to hand grip, cold, mental arithmetic, explosive sound, or hyperventilation) was similar in both groups. The results are compatible with the view that a diminished parasympathetic reactivity, and presumably an increased sympathetic reactivity, occur in patients with major depression.

Correlation between skin potential response and psychopathology in patients with affective disorders.

The correlation between the degree of psychopathology (assessed by the Minnesota Multiphasic Personality Inventory, MMPI) and sympathetic function (assessed by the skin potential response to somatosensory stimuli) was evaluated in 209 patients with affective disorders. A number of skin potential parameters (skin potential levels, negative fluctuations of first derivative of skin potential, negative areas in phase plane analysis, differences between last and initial average potentials and between the last average potential for the preceding stimulus and initial average potentials for a given stimulus) were correlated with the psychopathology index, calculated as the average of clinically relevant MMPI scales. Categorical classification of patients having or not having abnormally high psychopathology index scores also supported the differences in skin potential response between both groups of patients. The results further indicate the existence of a correlation between severity of mood disorders and increased sympathetic reactivity.

Time-dependent anesthetic and anticonvulsant activities of alphaxalone in Syrian hamsters.

To assess whether the anesthetic and anticonvulsant activities of alphaxalone display diurnal variability, groups of Syrian hamsters were studied at 4 h-intervals during a 24 h-cycle. The administration of alphaxalone (5 mg/kg) brought about a greater anesthetic activity (loss of righting reflex) at the middle of the photophase. When assessed in hamsters injected with 3-mercaptopropionic acid, alphaxalone displayed maximal anticonvulsant activity at the 4th of darkness. Evaluation of the time needed for first convulsive response indicated that alphaxalone did not show time-dependent effects, while in control hamsters seizure threshold was low during daylight and attained maximal values at night, showing a peak in seizure threshold at light-dark transition.

Some neurovegetative correlates of Minnesota Multiphasic Personality Inventory (MMPI)

In 57 patients with psicovegetative disorders and abnormal MMPI, abnormality in MMPI scales indicating hypochondriasis, hysteria, gender deviant, paranoia, psychastenia, schizophrenia, hypomania or introversion was accompanied by increased plasma catecholamine levels and/or responses to hypoglycemia or by an increased cardiovascular reactivity. A high depression scale was associated with lower plasma catecholamine levels. Blunted plasma growth hormone responses to hypoglycemia were found in abnormal hypomania scale, and augmented responses of plasma cortisol in abnormal hysteria or schizophrenia scales. Paranoia and hypomania traits correlated with absence of morning-evening differences in blood cortisol levels. Electrodermal responses compatible with increased sympathetic activity correlated with high hysteria, gender, paranoia, schizophrenia or hypomania MMPI scales. This study indicates that most psychopathological traits in MMPI are accompanied by humoral and/or electrophysiological signs of abnormality of the autonomic nervous system.

Some neurovegetative correlates of Minnesota Multiphasic Personality Inventory (MMPI)

In 57 patients with psicovegetative disorders and abnormal MMPI, abnormality in MMPI scales indicating hypochondriasis, hysteria, gender deviant, paranoia, psychastenia, schizophrenia, hypomania or introversion was accompanied by increased plasma catecholamine levels and/or responses to hypoglycemia or by an increased cardiovascular reactivity. A high depression scale was associated with lower plasma catecholamine levels. Blunted plasma growth hormone responses to hypoglycemia were found in abnormal hypomania scale, and augmented responses of plasma cortisol in abnormal hysteria or schizophrenia scales. Paranoia and hypomania traits correlated with absence of morning-evening differences in blood cortisol levels. Electrodermal responses compatible with increased sympathetic activity correlated with high hysteria, gender, paranoia, schizophrenia or hypomania MMPI scales. This study indicates that most psychopathological traits in MMPI are accompanied by humoral and/or electrophysiological signs of abnormality of the autonomic nervous system.

Some neurovegetative correlates of Minnesota Multiphasic Personality Inventory (MMPI)

In 57 patients with psicovegetative disorders and abnormal MMPI, abnormality in MMPI scales indicating hypochondriasis, hysteria, gender deviant, paranoia, psychastenia, schizophrenia, hypomania or introversion was accompanied by increased plasma catecholamine levels and/or responses to hypoglycemia or by an increased cardiovascular reactivity. A high depression scale was associated with lower plasma catecholamine levels. Blunted plasma growth hormone responses to hypoglycemia were found in abnormal hypomania scale, and augmented responses of plasma cortisol in abnormal hysteria or schizophrenia scales. Paranoia and hypomania traits correlated with absence of morning-evening differences in blood cortisol levels. Electrodermal responses compatible with increased sympathetic activity correlated with high hysteria, gender, paranoia, schizophrenia or hypomania MMPI scales. This study indicates that most psychopathological traits in MMPI are accompanied by humoral and/or electrophysiological signs of abnormality of the autonomic nervous system.