ABSTRACT
This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. The "trauma" group comprised 19 patients (76%) and the "no-trauma" group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P<0.001) and a higher median score of dissociation (P<0.001). Patients without trauma had more frequent "frustration situations" as a factor triggering PNES and subsequent sick leaves as perpetuating factors (P=0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.
Subject(s)
Conversion Disorder/etiology , Epilepsy/etiology , Psychophysiologic Disorders/etiology , Psychophysiologic Disorders/psychology , Wounds and Injuries/complications , Adult , Conversion Disorder/complications , Electroencephalography , Epilepsy/complications , Epilepsy/epidemiology , Epilepsy/psychology , Female , Humans , Male , Mental Disorders/epidemiology , Middle Aged , Prospective Studies , Psychiatric Status Rating Scales , Psychophysiologic Disorders/complications , Statistics, Nonparametric , Surveys and Questionnaires , Wounds and Injuries/psychology , Young AdultABSTRACT
DNA sequence variations within the 22q11 DiGeorge chromosomal region are likely to confer susceptibility to psychotic disorders. In a previous report, we identified several heterozygous alterations, including a complete deletion, of the proline dehydrogenase (PRODH) gene, which were associated with moderate hyperprolinemia in a subset of DSM III schizophrenic patients. Our objective was (i) to determine whether hyperprolinemia is associated with increased susceptibility for any of three psychiatric conditions (schizophrenia, schizoaffective disorder and bipolar disorder) and (ii) to establish a correlation between hyperprolinemia and PRODH genotypes. We have conducted a case-control study including 114 control subjects, 188 patients with schizophrenia, 63 with schizoaffective disorder and 69 with bipolar disorder. We report that, taking into account a confounding effect due to valproate treatment, hyperprolinemia is a risk factor for DSM IIIR schizoaffective disorder (P=0.02, Odds ratio=4.6, 95% confidence interval 1.3-16.3). We did not detect 22q11 interstitial deletions associated with the DiGeorge syndrome among the 320 patients of our sample and we found no association between common PRODH polymorphisms and any of the psychotic disorders. In contrast, we found that five rare PRODH alterations (including a complete PRODH deletion and four missense substitutions) were associated with hyperprolinemia. In several cases, two variations were present simultaneously, either in cis or trans in the same subject. A total of 11 from 30 hyperprolinemic subjects bore at least one genetic variation associated with hyperprolinemia. This study demonstrates that moderate hyperprolinemia is an intermediate phenotype associated with certain forms of psychosis.
Subject(s)
Bipolar Disorder/blood , Proline Oxidase/genetics , Proline/blood , Schizophrenia/blood , Adult , Analysis of Variance , Antimanic Agents/pharmacology , Antimanic Agents/therapeutic use , Bipolar Disorder/drug therapy , Bipolar Disorder/enzymology , Bipolar Disorder/genetics , Case-Control Studies , Chromosomes, Human, Pair 22/genetics , Female , Gene Deletion , Genetic Predisposition to Disease/genetics , Humans , Male , Phenotype , Proline/drug effects , Proline Oxidase/drug effects , Psychotic Disorders/blood , Psychotic Disorders/drug therapy , Psychotic Disorders/enzymology , Psychotic Disorders/genetics , Reference Values , Risk Factors , Schizophrenia/drug therapy , Schizophrenia/enzymology , Schizophrenia/genetics , Sex Factors , Statistics, Nonparametric , Valproic Acid/pharmacology , Valproic Acid/therapeutic useABSTRACT
In a double blind controlled study, rTMS results in a similar antidepressant effect to sham in combination with paroxetine. Both groups had the same delay in scale's scores improvement. rTMS seems not to be efficient as an add-on treatment to pharmacological medication in non-resistant major depression.