Homocysteine, cortisol, diabetes mellitus, and psychopathology.

OBJECTIVE: This study investigates the association of homocysteine and cortisol with psychological factors in type 2 diabetic patients. METHOD: Homocysteine, cortisol, and psychological variables were analyzed from 131 diabetic patients. Psychological factors were assessed with the Eysenck Personality Questionnaire (EPQ), Hostility and Direction of Hostility Questionnaire (HDHQ), the Symptom Checklist 90-R (SCL 90-R), the Zung Self-Rating Depression Scale (ZDRS), and the Maudsley O-C Inventory Questionnaire (MOCI). Blood samples were taken by measuring homocysteine and cortisol in both subgroups during the initial phase of the study (T0). One year later (T1), the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments and with an identical blood analysis. RESULTS: The relation of psychoticism and homocysteine is positive among controlled diabetic patients (P value = 0.006 < 0.05) and negative among uncontrolled ones (P value = 0.137). Higher values of cortisol correspond to lower scores on extraversion subscale (r(p) = -0.223, P value = 0.010). Controlled diabetic patients showed a statistically significant negative relationship between homocysteine and the act-out hostility subscale (r(sp) = -0.247, P = 0.023). There is a statistically significant relationship between homocysteine and somatization (r(sp) = -0.220, P = 0.043). CONCLUSIONS: These findings support the notion that homocysteine and cortisol are related to trait and state psychological factors in patients with diabetes mellitus type 2.

Oxytocin and diabetes mellitus: a strong biochemical relation. Review.

Oxytocin (OXT) is a neurohypophysial hormone which is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. OXT is currently attracting considerable attention because it has been discovered that it regulates various functions of behavior especially in the context of social interactions. OXT is a key component in bone formation, glycemia, male sexuality, cardiac differentiation and pregnancy and thus it is important to be further explored. The authors review various aspects of gestational diabetes, including definition, screening, diagnostic procedures, complications, clinical evaluation, indications of delivery and neonatal aspects. Not only the relation among diabetes mellitus, oxytocin and neurophysiology concerning erectile dysfunction, but also the role of OXT in the activity of arginine and vasopressin is investigated. It is imperative to develop technological and experimental methods that will be able to reveal the oxytocin and its potential.

Oxytocin and psychological factors affecting type 2 diabetes mellitus.

BACKGROUND: The aim of this study was to investigate the association of oxytocin with trait and state psychological factors in type 2 diabetic patients. METHODS: OXT and psychological variables were analyzed from 86 controlled diabetic patients (glycosylated haemoglobin A1c (HbA1c) < 7%) from 45 uncontrolled diabetic patients (HbA1c ≥ 7). Psychological characteristics were assessed with the Eysenck Personality Questionnaire (EPQ), while state psychological characteristics were measured with the Symptom Checklist 90-R (SCL 90-R). Blood samples were taken for measuring oxytocin in both subgroups during the initial phase of the study. One year later, the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments. RESULTS: During the first evaluation of the uncontrolled diabetic patients, a statistically significant positive relationship between the levels of OXT and psychoticism in EPQ rating scale (P < 0.013) was observed. For controlled diabetic patients, a statistically significant negative relationship between oxytocin and somatization (P < 0.030), as well as obsessive-compulsive scores (P < 0.047) in SCL-90 rating scale, was observed. During the second assessment, the values of OXT decreased when the patients managed to control their metabolic profile. CONCLUSIONS: The OXT is in association with psychoticism, somatization, and obsessionality may be implicated in T2DM.

Aggressive behaviour in schizophrenic patients after abrupt treatment discontinuation.

OBJECTIVE: This retrospective study examined the demographic, clinical and pharmacological factors associated with aggressive behaviour after abrupt discontinuation of medication in schizophrenic patients. METHOD: The study reports on a survey of 402 schizophrenic patients, who had abruptly discontinued their medication and had been involuntarily hospitalized to Psychiatric Hospital of Attika. The survey utilized the Discontinuation-Emergent Signs and Symptoms Checklist (DESS) to assess the signs and symptoms that patients exhibited (Rosenbaum et al., Biol Psychiatry 1998;44:77), as well the Aggression Scale (Delgado-Escueta et al., New England J Med 1981;305:711) to estimate the aggressive behaviour. Demographic and clinical variables as well as variables related to pharmacological treatment have been also investigated. RESULTS: Analyses revealed that the presence of aggressive behaviour after abrupt drug discontinuation was associated positively with previous history of aggression, male gender , abrupt discontinuation of anticholinergics, delusions, nervousness or anxiety, elevated mood, irritability and negatively with negative symptoms. These predictors can correctly classify 76.3% of patients with aggressive behaviour and 64.0% of patients without aggressive behaviour. CONCLUSION: These findings suggest that abrupt discontinuation of medication in schizophrenic patients may lead to aggressive behaviour, being connected at least in the acute phase with particular demographic, clinical and pharmacological parameters.

Maternity blues in Athens, Greece: a study during the first 3 days after delivery.

BACKGROUND: Although maternity blues have been studied in many countries worldwide the factors that influence the occurrence of this clinical entity are not well understood. The purpose of this study was to investigate the prevalence, time course and symptomatology of maternity blues in a Greek urban environment as well as the relation of maternity blues with certain clinical and sociodemographic factors. METHOD: A study of a sample of 402 women that were recruited during the first day after delivery. Each woman completed the Kennerley's Blues Questionnaire on a daily basis for the first 3 days of puerpartum. Clinical and sociodemographic data were obtained through questionnaires and personal interview. RESULTS: 179 (44.5%) women experienced severe maternity blues during the first 3 days after delivery. Delivery by caesarian section (P=0.006), stressful events during pregnancy (P=0.02), depressive feelings the last month prior to delivery (P=0.002), anxiety on the day of delivery (P=0.001) and hypochondriasis (P=0.001) were the factors that were found to relate significantly to maternity blues. CONCLUSION: The women's emotional condition prior and after delivery, delivery via caesarotomy, as well as fears concerning somatic health had strong impact on the occurrence of maternity blues.

Oral transmucosal abuse of transdermal fentanyl.

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

Design and implementation of an SVM-based computer classification system for discriminating depressive patients from healthy controls using the P600 component of ERP signals.

A computer-based classification system has been designed capable of distinguishing patients with depression from normal controls by event-related potential (ERP) signals using the P600 component. Clinical material comprised 25 patients with depression and an equal number of gender and aged-matched healthy controls. All subjects were evaluated by a computerized version of the digit span Wechsler test. EEG activity was recorded and digitized from 15 scalp electrodes (leads). Seventeen features related to the shape of the waveform were generated and were employed in the design of an optimum support vector machine (SVM) classifier at each lead. The outcomes of those SVM classifiers were selected by a majority-vote engine (MVE), which assigned each subject to either the normal or depressive classes. MVE classification accuracy was 94% when using all leads and 92% or 82% when using only the right or left scalp leads, respectively. These findings support the hypothesis that depression is associated with dysfunction of right hemisphere mechanisms mediating the processing of information that assigns a specific response to a specific stimulus, as those mechanisms are reflected by the P600 component of ERPs. Our method may aid the further understanding of the neurophysiology underlying depression, due to its potentiality to integrate theories of depression and psychophysiology.

Working memory deficits in multiple sclerosis: a controlled study with auditory P600 correlates.

BACKGROUND: Recently, the P600 component of event related potentials, a waveform that is conceived to be generated and/or modulated by basal ganglia and cingulate area has been considered an index of the completion of any synchronised operation after target detection, having much in common with working memory operation. Moreover, dysfunction of these brain structures as well as working memory deficits have been implicated in the pathophysiology of multiple sclerosis. The aim of this study was to investigate the patterns of P600 elicited during a working memory test in multiple sclerosis patients compared with healthy controls. METHODS: Twenty two definite, chronic progressive multiple sclerosis patients, with recent exacerbation of their illness, and 20 normal subjects matched for age, sex, and educational level, were studied with a computerised version of the digit span test of Wechsler batteries. Auditory P600 were measured during the anticipatory period of this test. RESULTS: The patient group, as compared with healthy controls, showed significantly reduced latencies of P600 at left frontal areas and reduced P600 amplitudes at left temporoparietal region. Moreover, memory performance of patients was significantly more impaired when compared with healthy controls. CONCLUSIONS: These findings may indicate that multiple sclerosis is associated with abnormal features of the completion of synchronised operation after target detection, as they are reflected by P600 amplitudes and latencies. Dysfunction of this mechanism may contribute to the identification of basic cognitive processes that could account for the cognitive deficits in multiple sclerosis.

Psychophysiological correlates in male to female transsexuals studied with a P300 investigation.

BACKGROUND: Transsexualism is thought to be related to cortical processes reflecting a complex mosaic of biological, psychological and social/cultural information. Since the P300 component of event-related potentials is considered as an index of attentional processes, the present study focuses on auditory P300 elicited during a short memory test in male to female (MF) transsexuals, compared with that in healthy controls. METHOD: The P300 component was evaluated during the anticipatory period of a short memory test in 13 MF transsexuals who had a gender reassignment operation, at least 3 years previously (mean time 17-6 years, range 3-31 years) and 26 healthy subjects (11 males and 15 females) matched for age and educational level. RESULTS: MF transsexuals exhibited significant reduction of P300 amplitude in the left frontal and temporoparietal areas in comparison to the control group. Furthermore, the group of transsexuals showed a significant delay of P300 latency in comparison to the controls, at the central frontal region. CONCLUSIONS: These findings point to significant psychophysiological alterations of distributed cortical circuits in MF transsexuals. These alterations may be critically related to the biological substrate of MF transsexualism.

Glossodynia: personality characteristics and psychopathology.

BACKGROUND: Glossodynia or burning mouth syndrome has been suggested to be a multifunctional disorder. Etiologic factors that have been reported include hematologic or vitamin deficiencies, denture factors, the climacteric, infections or endocrinological disorders. On the other hand psychological factors, such as anxiety, depression and phobias have been reported to play a significant role at the beginning of this nosological entity. It seems therefore that there are two main categories of glossodynia, one with a detectable organic etiology and another with a psychologic origin. The purpose of this study was to provide further information concerning the personality characteristics and the incidence of psychopathology in patients suffering from glossodynia without an organic etiology. METHODS: Twenty-five patients suffering from glossodynia and 25 control subjects, matched for sex and age, participated in the study. Patients and controls were assessed concerning their psychosomatic morbidity. Both groups were given psychometric instruments (SRSD, STAI, EPQ, HDHQ, SSPS) for the assessment of personality characteristics and psychopathological symptoms. RESULTS: Patients were significantly differentiated from controls with respect to all factors of HDHQ; they exhibited more hostility, either introverted or extroverted, than control subjects. The patients also had significantly higher values in the N (neuroticism) and the L (lie) factors of the EPQ. Concerning the other psychometric measurements there were no significant differences. Patients also had significantly higher rates of psychosomatic morbidity than controls. CONCLUSIONS: Our findings indicate that hostility-especially introverted hostility-neuroticism and possibly depression are important components of the psychological profile of patients suffering from glossodynia.

Clinical significance of the electrodermal habituation rate in anxiety disorders.

The electrodermal response habituation rate (EDR-HR) is examined in relation to clinical, personality and electrodermal measures in patients with generalized anxiety, phobic, obsessive-compulsive, dysthymic and conversion disorders by means of a stepwise regression analysis procedure. The results in the entire sample suggest that EDR-HR depends on the phasic component (amplitude and spontaneous activity) of the electrodermal response as well as on state anxiety, extraversion and depersonalization. When tested separately, most of the diagnostic groups demonstrated main trends similar to those found in total patients. A noteworthy correspondence between the importance of the contribution of certain clinical symptoms to the EDR-HR variance and some long-standing views of psychopathology was also found during the separate analysis of the groups. Although these findings question the diagnostic specificity of EDR-HR, the importance of this index as an objective measure of change following a therapeutic intervention as well as its potential usefulness in high-risk studies of anxiety disorders is put forward.

Electrodermal activity in low and high alexithymia neurotic patients.

This study explores the relations between alexithymia and level of arousal in patients suffering from anxiety states. Among 105 patients investigated, two groups were finally identified by means of the Schalling-Sifneos Personality Scale; a group of patients with 'low' and a group with 'high' alexithymia. These groups underwent a psychophysiological assessment concerning electrodermal activity measures recorded during resting and stimulation periods. The results suggested that high alexithymia patients demonstrated significantly higher levels of electrodermal arousal and slower recovery time in novel situations as compared with low alexithymia patients. These findings support the view that an exacerbated degree of arousal may be an important factor with respect to the development of alexithymia, even in a nonpsychosomatic population.

Synchrony of subjective and psychophysiological responses in involutional depression.

The synchronous changes of subjective and autonomic responses to neutral and "stress' stimulation in patients with involutional depression and normal subjects were investigated. The stimuli employed were individually determined during a pretest interview and consisted of neutral, emotionally loaded and "mental task' testing periods of equal duration presented at random. GSR, heart rate and finger plethysmography measures were taken during administration of these stimuli, while the subjective anxiety experienced during the same periods of stimulation was rated by the subjects on a five-point scale. The results suggest that measures of synchrony between subjective and autonomic response systems may differentiate (1) patients from controls and (2) certain types of emotional stimuli from others in patients. Implications for further research regarding the qualitative differentiation of the arousal associated with emotional stimuli are discussed.

Epidemic faintness: a psychophysiological investigation.

A psychophysiological assessment was carried out in 16 telephone operators, who fainted during an epidemic, and in 16 control subjects. Heart rate, skin conductance level, number of spontaneous fluctuations and pulse volume were measured at rest and during periods of auditory and visual stimulation. All subjects completed rating scales on anxiety, depression, anxiety experienced during experimental procedure and personality inventories. Analysis of data support the notion that the fainting episodes represent a form of transitory anxiety attacks in response to environmental stress and are not related either to hysteria or to anxiety state.

The post-traumatic syndrome. Some considerations related to psychiatric prevention.

Certain aetiological factors related to prognosis of the post-traumatic syndrome are presented. The organic vs. psychological controversy and the principal risk factors, namely the pre-traumatic personality, psychological state, social and occupational influences and the compensation issue are discussed in relation to management and prevention.

Relations of obsessional traits to anxiety in patients with ulcerative colitis.

The obsessional personality traits and the "state" and "trait" anxiety, measured by means of self-rating inventories, were correlated in a group of patients with ulcerative colitis and a group of anxiety neurotics. The results suggest that patients with ulcerative colitis demonstrate strong positive trends, contrary to neurotics who show negative or very weak correlations, during the active period of their illness. These findings are discussed and some hypotheses concerning the different association of anxiety to obsessionality between the two groups are presented.

Mood changes and flooding outcome in obsessive-compulsive patients. Report of a 2-year follow-up.

Twenty-five chronic obsessive-compulsive patients treated with flooding were investiaged retrospectively after 2 years by an independent assessor for the presence of depressive mood fluctuations during their life histories using a five-point rating scale. Patients themselves also completed rating scales for obsessional phenomena during the pre-, post-treatment, and follow-up assessment. Fifteen patients were characterized as not having exhibited mood changes and 10 as having such changes. Patients without changes responded promptly to flooding treatment and showed further improvement during follow-up. Patients with mood changes, although responding well to initially delivered flooding sessions, showed significant relapse at follow-up.

Peptic ulcer in childhood. Psychological factors.

Thirty children (20 girls and 10 boys, aged 6-16 years) with primary peptic ulcers, matched in paris for age, sex and socio-economic standard to a group of 30 ulcer-free controls, were submitted to a structured psychiatric interview, a structured 'present psychiatric state' examination and to personality and intelligence tests. With one exception all patients suffered from duodenal ulcer; 3 male patients had personalities with psychopathic elements, 7 patients had nicknames, 5 suffered from psychiatric disorders, 3 had attempted suicide in the past, and 3 had had homosexual experiences. These parameters were negative in all controls. The patients had lower mean IQ, worse scholastic adaptation, more anxious and overprotective parents, higher frequency of faddiness in food and lower frequency of nail-biting than the controls. Psychotraumatic events had preceded the onset of ulcer symptomatology in 11 cases. The findings are discussed and the contribution of psychological factors in the pathogenesis of childhood peptic ulcer is stressed.