[28-year-old patient with iron deficiency anemia]. / 28-jährige Patientin mit Eisenmangelanämie.

We report the case of a 28-years-old woman with Turner's syndrome and iron deficiency anaemia. The faecal occult blood test was intermittently positive whereas earlier upper and lower endoscopy revealed no source of bleeding. Capsule endoscopy showed multiple vascular malformations on the jejunum and ileum. Our case report emphasizes the importance of capsule endoscopy in the localising occult bleedings in the small bowel. We discuss the different diagnostic modalities and possible treatments.

[Attitude of medical students to psychiatry. A study with the German translated, expanded version of the ATP-30]. / Einstellungen von Studierenden der Medizin zur Psychiatrie. Eine Untersuchung mit einer in das Deutsche übersetzten, erweiterten Version des ATP-30.

Medical students' attitudes toward psychiatry are very important for the future care of psychiatric patients and the recruitment of qualified graduates. We examined the attitudes of 105 German medical students toward psychiatry using a German translation of the ATP-30, a reliable, self-administered questionnaire. In spite of a marked interest in psychiatry, most students thought it improbable that they would become psychiatrists. Attitudes toward psychiatry were generally positive (ATP-30 score: 104.6 +/- 13.4, where 90 represents middle, or neither positive nor negative) but showed clear differences in some aspects. Attitudes toward psychotherapy were markedly positive, while those toward psychiatric therapy in general or the scientific basis of psychiatry were less positive. We could find no influence of sex on the ATP score, whereas students having previous experience with psychiatry showed more positive attitudes towards it.

Circadian rhythm of vital signs, norepinephrine, epinephrine, thyroid hormones, and cortisol in schizophrenia.

Changes in the circadian rhythmicity in vital signs, catecholamines, thyroid hormones, and cortisol have been observed in psychiatric disorders, most notably in depression. With respect to schizophrenia, the literature is scanty. We report here on the circadian parameter estimates of the vital signs, epinephrine, norepinephrine, triiodothyronine, thyroxine, thyroid stimulating hormone, and cortisol in the blood of 34 healthy subjects, 89 drug-free schizophrenic patients, and 25 neuroleptic-treated schizophrenic patients. The analyses are based on the cosine model to fit the experimental data. The circadian profiles of heart rate, blood pressure, and oral temperature are similar among schizophrenic patients and healthy subjects. Neuroleptic-treated patients have significantly higher MESORs (the daily mean) of serum norepinephrine and epinephrine than healthy subjects. The TSH MESOR is significantly lower in schizophrenic patients; the MESOR of triiodothyronine also shows a tendency to be nonsignificantly lower in schizophrenic patients compared with control subjects. The circadian serum thyroxine and cortisol profiles are similar in the three groups. The data show that the circadian profiles of vital signs in drug-free chronic schizophrenic patients who are not chronically hospitalized are similar to those of healthy subjects and that the increase in serum catecholamines and the apparent lowering in some thyroid indices might induce a down-regulation in the noradrenergic receptor system that could contribute to the pathophysiology of schizophrenia.

Circadian rhythm of tryptophan, serotonin, melatonin, and pituitary hormones in schizophrenia.

Circadian rhythm abnormalities have been described mostly with respect to manic-depressive illness; little information is available concerning circadian rhythms and schizophrenia or their influence on neuroleptic drugs. We showed previously that the MESOR of dopamine is higher in schizophrenic patients than in healthy subjects and that women who are drug-free schizophrenic have lower prolactin MESORs and lower amplitudes than healthy women. We now report the data of a cosinor analysis of tryptophan, serotonin, melatonin, and pituitary hormones in the blood of 34 healthy subjects, 90 drug-free schizophrenics, and 25 neuroleptic-treated schizophrenic patients. This data indicated a significant phase advance of serum tryptophan, prolactin, and melatonin concentrations, a trend toward a phase advance in serotonin. Thyroid stimulating hormone (TSH), and growth hormone concentrations, and decreases in the TSH MESORs among patients compared to healthy subjects. These results suggest that circadian changes, such as phase advances and alterations in MESOR, are not only present in depression but also in schizophrenia. Although neuroleptic treatment raised the prolactin MESOR and amplitude, it did not elicit any change in circadian rhythmicity among the other parameters.

Hyperdopaminergia in schizophreniform psychosis: a chronobiological study.

Circadian rhythm abnormalities have been described in various psychiatric disorders, but they have not received much attention in studies of schizophrenia and schizophreniform psychosis. The present study used the cosine model to determine the circadian patterns of amino acids, dopamine, and prolactin concentrations, which were analyzed over a 24-hour period in serum of healthy subjects, drug-free schizophrenic patients, and neuroleptic-treated schizophrenic patients. The mesor (the daily mean) of phenylalanine was lower in drug-free schizophrenic women than in healthy women. The mesors of the ratio of phenylalanine or tyrosine to competing amino acids were similar in healthy subjects and patients. The ratio of phenylalanine/competing amino acids showed a phase advance (i.e., earlier onset of the time of highest concentration) in drug-free patients compared with healthy subjects. Schizophrenic patients displayed a higher dopamine mesor than healthy subjects. Female drug-free schizophrenic patients had lower prolactin mesors and lower amplitudes (i.e., half of the total predictable change in rhythm) than healthy women. Compared with healthy subjects, schizophrenic patients showed a phase advance of circadian prolactin concentrations. Neuroleptics raised the prolactin mesor and amplitudes but did not elicit any phase change in amino acids, dopamine, or prolactin. These data confirm the indirect pharmacologic evidence of increased dopaminergic activity in schizophrenic patients that relates to dopamine's precursors and to the neuroendocrine regulation of prolactin.

Blood serotonin, serum melatonin and light therapy in healthy subjects and in patients with nonseasonal depression.

The 24-h rhythms of blood serotonin and serum melatonin were determined in 39 unmediated inpatients with nonseasonal affective disorder and in 14 healthy men and women after 7 days of morning bright-light (2500 lx) or dim-light (50 lx) treatment. Bright-light treatment led to a more than 50% decrease in the Hamilton Rating Scale for Depression (HRSD) score in 4/19 patients and dim light in 1/17 patients. After light treatment the mesor (the daily mean estimated by cosinor analysis) of patients' and subjects' melatonin levels did not change significantly, nor was there a correlation between phase change and decrease in HRSD score. We observed after bright- and dim-light treatment a consistent increase in blood serotonin in patients and healthy subjects, which differed significantly between healthy subjects and patients. These findings suggest the involvement of serotonergic mechanisms following light therapy.

Serum amino acid profiles and dopamine in schizophrenic patients and healthy subjects: Window to the brain?

Altered dopamine turnover has been postulated as underlying cause for schizophrenia. This is partially inferred from pharmacological studies and from changes in serum dopamine and dopamine metabolite levels. It is not clear whether the serum amino acid precursors' availability and neurotransmitter-mediated hormonal release could be indicative of the neurotransmitter turnover. We speculate in this context that the profile of serum amino acids and neurotransmitters reflects differences of neurotransmitter activity in the central nervous system and may be considered in a broad sense "window to the brain".We analyzed basal serum amino acids (including monoamine precursors), and monoamines in schizophrenic patients after a drug holiday of 3 or more days, and in healthy subjects.Asparagine, phenylalanine, and cystine were higher and tyrosine, tryptophan, and the ratio of tryptophan to competing amino acids lower in schizophrenic patients than in healthy subjects (P < 0.05). Dopamine was increased in schizophrenic patients compared to healthy subjects.We speculate that these results sustain the notion for dopamine overactivity in schizophrenia, which might be caused by altered amino acid precursor availability.

Serum amino acids, central monoamines, and hormones in drug-naive, drug-free, and neuroleptic-treated schizophrenic patients and healthy subjects.

Basal serum amino acids (including central monoamine precursors), central monoamines, and hormones were studied in schizophrenic patients (drug-naive; n = 20; drug-withdrawn for 3 or more days, n = 67; neuroleptic-treated, n = 23) and healthy subjects (n = 90) to answer the following questions: (1) Do neuroleptic-withdrawn and neuroleptic-naive patients differ on these serum measures? (2) What are the effects of neuroleptic treatment on these measures? (3) On which variables do drug-free and neuroleptic-treated patients differ? Because serum amino acid, central monoamine, and hormone levels were similar in drug-naive and drug-withdrawn patients, data from these groups ("drug-free") were combined and compared to those of healthy subjects and neuroleptic-treated patients. Asparagine, citrulline, phenylalanine, and cysteine were higher, while tyrosine, tryptophan, and the ratio of tryptophan to competing amino acids were significantly lower in drug-free schizophrenic patients than in healthy subjects. Dopamine was increased, and melatonin and thyroid hormones were decreased in drug-free schizophrenic patients compared to healthy subjects. Norepinephrine, epinephrine, and prolactin were higher in neuroleptic-treated men compared to drug-free male patients or healthy men. These results are consistent with the hypothesis of dopaminergic overactivity in schizophrenia, which might be caused by altered amino acid precursor availability and could be related to the decrease in melatonin and reduction in thyroid hormone levels.

The influence of phototherapy on serotonin and melatonin in non-seasonal depression.

Circadian profiles of melatonin in serum and serotonin in blood were assessed before and after 7 days of artificial light treatment in 30 patients with non-seasonal depression and 12 healthy subjects. Patients and volunteers were allocated at random to either dim (50 lux) or bright light (2,500 lux) for 2 hours daily. The study has not been completed yet. Preliminary findings are presented here. Light treatment modifies marginally the circadian melatonin profiles of depressed patients and healthy subjects; however, it augments blood serotonin throughout the day. This increase is seen in all patients and healthy subjects after bright as well as dim light. These results suggest that the influence of light is more pronounced on serotonin than melatonin metabolism.