Sleep deprivation in depression stabilizing antidepressant effects by repetitive transcranial magnetic stimulation.

Partial sleep deprivation (PSD) has a profound and rapid effect on depressed mood. However, the transient antidepressant effect of PSD - most patients relapse after one night of recovery sleep - is limiting the clinical use of this method. Using a controlled, balanced parallel design we studied, whether repetitive transcranial magnetic stimulation (rTMS) applied in the morning after PSD is able to prevent this relapse. 20 PSD responders were randomly assigned to receive either active or sham stimulation during the following 4 days after PSD. Active stimulation prolonged significantly (p < 0.001) the antidepressant effect of PSD up to 4 days. This finding indicates that rTMS is an efficacious method to prevent relapse after PSD.

[Enucleation as a form of self-aggression--2 case reports and review of the literature]. / Enukleation als eine Form der Autoaggression--zwei Kasuistiken und Literaturübersicht.

BACKGROUND: Autoenucleation is the worst form of self-mutilation of the eye. Patients affected are mostly those with psychosis and delusions, but such acts can also happen under the influence of drugs, alcohol, solvents and seldom with organic illnesses. Often, these patients are known to be autoaggressive and suicidal. PATIENTS: We present two psychiatric patients who autoenucleated one eye and injured the other. A 41-year-old patient with known organic epilepsy based on a temporal-lobe-hemangioma and psychosis with delusions autoenucleated his right eye and lacerated the conjunctiva of the other, following imperative voices. A 50-year-old female suffered from a long-standing paranoid schizophrenia and religious delusions, and autoaggressive acts with resulting amaurosis of the right eye and several suicidal attempts had preceded the autoenucleation of the left eye. DISCUSSION: After the completion of the autoaggressive act the patients experience relief, but often the autoaggresive or suicidal impulses persist or recur. A close cooperation between ophthalmologists and psychiatrist in these patients is imperative.

Detection of polymorphic triplet repeats in the genomes of patients suffering from bipolar affective disorder.

Evidence for the operation of expanded trinucleotide repeats in the pathogenesis of bipolar affected disorder has recently been found at the molecular genetic level. For the screening of these repeat motifs in genomes of patients with bipolar affective disorder, we established a modified PCR-based fingerprinting technique, called triplet repeat enhanced arbitrarily primed PCR (TREAP-PCR). Using this approach, 40 patients suffering from bipolar affective disorder (ICD10: F31) and 15 healthy controls were investigated. Interindividual polymorphisms generated by TREAP-PCR seemed to depend on the type of triplet. Using CCG triplet primers, polymorphisms could be observed more often in the genomes of patients compared with controls, whereas no significant differences could be found using primers of the CAG or AAT type. These data might indicate the existence of subgroups of manic-depressive patients based on molecular genetic differences.

[Hypothermia caused by neuroleptics. 2 case reports and review of the literature]. / Hypothermie durch Neuroleptika. Zwei kasuistische Darstellungen und Literaturübersicht.

The present paper discusses appearance and course of neuroleptic induced hypothermia of a 36 years old woman suffering from periodic catatonia and a 38 years old seriously mentally handicapped man. Analysis of clinical studies and pharmacological tests with animals about body temperature changes caused by neuroleptics yields that these may lead to hypothermia as well as hyperthermia, depending on individual disposition and dose, which is mainly a result of their effect through dopaminergic neurons of the hypothalamus, which controls thermoregulation, and of their influence on vasomotoric mechanisms of vessels of the skin. Though hyperthermic changes are more hazardous and occur more frequently hypothermia by neuroleptic agents is clinically relevant as shown by the summarizing presentation of previously released case reports: hypothermia is found at neuroleptic medicated healthy volunteers and at psychiatric patients with or without physical illness, at which hypothyreosis and impair of the brain seem to represent special risks.