Serum and cerebrospinal fluid prolactin patterns during neuroleptic treatment in schizophrenic patients.

Serum and CSF prolactin (PRL) concentrations were determined during eight weeks of fluphenazine medication in 28 patients with acute symptoms of schizophrenia. In both sexes a good correlation between the serum and CSF PRL values was found (r = 0.57, p less than 0.01). Throughout the entire study, first admission (FA) patients had significantly higher levels of serum and CSF PRL than the re-entry (RE) schizophrenics (0.05 greater than p less than 0.001). In addition, in FA patients, a gradual increase of the serum and CSF PRL concentrations was observed, whereas in the RE group an adaptive secretion pattern of PRL could be detected. In both patient groups, female patients exhibited significantly higher PRL serum and CSF levels than the male patients (0.05 greater than p less than 0.001). The tolerance phenomenon in the RE groups was more marked in the female than in the male patients. No correlation between clinical outcome and PRL response to fluphenazine treatment was observed. The prognostic significance of the differences in the PRL secretion pattern is discussed.

Prolactin levels in cerebrospinal fluid of patients with chronic schizophrenia.

Baseline concentrations of prolactin (PRL) was determined in the CSF of 28 lobotomized and 28 non-lobotomized patients with chronic schizophrenia. The mean PRL level of the female patients was significantly higher than that of the male patients (p < 0.001). In addition, non-lobotomized patients had significantly higher concentrations of CSF PRL than patients of the lobotomized group (p < 0.05). On the other hand, patients belonging to the latter group exhibited significantly more central as well as cortical brain atrophy than the patients on whom no psychosurgery had been performed (0.05 > p < 0.001). The significance of cerebrospinal PRL as an index of central dopamine metabolism is discussed.

Low prolactin levels in cerebrospinal fluid: an after effect of lobotomy in chronic schizophrenia.

In order to elucidate the interplay of prolactin and dopamine in schizophrenia, base-line levels of prolactin were assayed in the cerebrospinal fluid (CSF) of chronic schizophrenic patients with or without lobotomy. Cental and cortical atrophy and significantly lowered CSF prolactin levels were found in lobotomized patients in comparison to equally neuroleptic-treated non-lobotomized patients. The mean CSF prolactin level in the female patients was significantly higher than in the male patients. This study did not support the 'dopamine hypothesis' of schizophrenia, since CSF prolactin levels did not correlate with schizophrenic symptoms. The brain atrophy blocked completely the expected elevation of CSF prolactin levels induced by neuroleptics.

Cerebrospinal fluid endorphins in schizophrenia.

Opioid-receptor-active material, endorphins, has been measured in cerebrospinal fluid samples obtained from schizophrenics. A chromatographic procedure isolated the Fraction I endorphin which was quantitated in a receptorassay. At least two cerebrospinal fluid samples were obtained from each patient, at Day 0 with no medication and at Days 30 and 60 after medication with fluphenazine under standardized conditions. Three series of patients were included: acute schizophrenics (= 11); re-entry schizophrenics (n = 7) who have previously been treated with neuroleptics but were readmitted to hospital usually as a consequence of stopped medication, and chronic schizophrenics (n = 9) who had been without neuroleptics for at least 2 weeks prior to Day 0. At Day 0, 6/9 acute cases, 4/6 of re-entry and 2/9 chronic cases had endorphin levels above the range of healthy volunteers. The levels in chronic cases were significantly lower than those in acute cases. Treatment with neuroleptics significantly lowered the endorphin levels in acute cases. These results confirm and extend previous observations.

Münchausen syndrome: a review and two case reports.

In the light of the pertinent literature, 2 illustrative cases of the Münchausen syndrome are presented. In both patients there had been dynamically significant losses in the oedipal age leading to an intense feeling of being rejected. Both patients also exhibited problems of dependence, perfectionistic attitudes toward the self, and fear of social failure. In addition, characteristics typical of alexithymia could be noted. As a dynamical interpretation it is proposed that in these patients basic helplessness and inadequacy of expressing feelings have been channelled into multiform psychosomatic symptoms. The latter in turn have caused continuous seeking for acceptable somatic etiology and treatment of the symptoms. Thus, gradually, the clinical picture of the Münchausen syndrome has developed.

Monoamine metabolite levels in cerebrospinal fluid and brain atrophy in lobotomized schizophrenic patients.

Baseline concentrations of homovanillic acid (HVA), 5-hydroxyindole acetic acid (5-HIAA) and MHPG in the cerebrospinal fluid (CSF) were determined in 67 lobotomized and 30 non-lobotomized patients with chronic schizophrenia. In addition, in 69 of these patients the degree of brain atrophy was assessed by a pneumoencephalographic (PEG) technique. There were no significant differences in the concentrations of the monoamine metabolites in the CSF between the two patient groups studied despite the fact that the group of lobotomized schizophrenics had significantly more central and cortical brain atrophy than the group of nonlobotomized schizophrenic patients. The amine metabolite levels were also unrelated to the subtype of schizophrenia, duration of illness, or degree of mental incapacitation.

Tricyclic antidepressants in the treatment of depressions. A double-blind clinical comparison of clomipramine (Anafranil) and amitriptyline.

The clinical efficacy of oral clomipramine and amitriptyline treatment (50--125 mg/day) was compared over a period of 2 months in 72 depressive patients visiting a psychiatric out-patient clinic. Both drugs were equally effective as measured by the Hamilton Rating Scale for Depression. According to a nurse's independent evaluation of 13 items the two drugs were equipotent in relieving depressive symptoms and no statistically significant differences between the treatment groups were found in the global evaluation by the investigator and the patient. A trend in favour of clomipramine was, however, seen in several parameters. The declines in the Hamilton Rating Scale scores and the nurse's evaluation scores were highly significant during the first 2 weeks of treatment (P less than 0.001) in both groups and the scores continued to decrease during the 2nd month of the study. The most common unwanted effects were dryness of the mouth and fatigue. The frequency of side effects was 51% in the clomipramine group and 43% in the amitriptyline group. The side effects were generally mild and transient and called for discontinuation of treatment in only one case in each group.

The effect of social class on psychiatric psychological evaluations in patients with pulmonary tuberculosis.

The present study is a methodological examination in which the social and psychic background factors of 100 tuberculous patients, aged 20 to 45 years, were explored using psychiatric interview and psychological tests (MMPI, Rorschach, and Wartegg). The purpose of the study was to analyse the effect of social background factors on the psychiatric and psychological examination. With the help of correlation coefficients and three-factor factor analysis, the variable indicating the social class of the subject could be proved to correlate significantly to the projective test variables (Rorschach, Wartegg). No such correlation between the social group variable and those obtained in the psychiatric interview or the MMPI test could be demonstrated. On the basis of the projective tests, subjects in the lower social classes were considered more disturbed. It can be supposed that the background factors characteristic of lower social classes would contribute to the unfamiliar test situation, causing reactions disturbing the test performance. This suggests that the mentioned tests should be used with caution in the evaluation of personality disturbances.