Cerebral atrophy and plasma cortisol levels in alcoholics after short or a long period of abstinence.

Basal cortisol levels were significantly lower in 4 week abstinent alcoholics (n = 11; group A) than in normal controls (n = 9; group C), whereas no significant difference was found between alcoholics abstinent greater than 1 year (n = 9; group B) and controls. In all groups, dexamethasone induced a similar decrease in circulating cortisol concentrations. Computed tomographic examinations showed a significantly higher ventricular-brain ratio VBR) and wider 3rd ventricle width in group A than in group B; no significant differences were observed between groups B and C. In contrast, the number of cerebral sulci was similar in all groups. A negative relationship was found between neuroradiological findings and basal cortisol values in group A, but not in groups B and C. The neuropsychological tests showed worse scores in group A than in the other groups. These findings show subcortical damages and reduced cortisol levels in alcoholics after 4 weeks of abstinence. These alterations appear to be at least in part reversible after a long period of abstinence.

TRH test in alcoholics: relationship of the endocrine results with neuroradiological and neuropsychological findings.

Neuroradiological, neuropsychological and neuroendocrine parameters were evaluated in 20 non-depressed alcoholic men after 4 weeks (N = 11) or after at least 1 year (N = 9) of abstinence from alcohol and in normal men (N = 9). With regard to normal controls, 4-week abstinent alcoholics showed larger lateral and third ventricles, without modification in the number of cerebral sulci, and altered scores of tests evaluating subcortical and frontal function. Furthermore, in these patients the TSH (thyroid stimulating hormone) and PRL (prolactin) responses to thyrotropin releasing hormone were higher than in controls, suggesting a reduced hypothalamic control of TSH and PRL secretion. Taken together, these findings suggest the presence of a frontal-subcortical disorder in alcoholics. Patients who had been abstinent from alcohol for at least 1 year were not distinguishable from controls for neuroradiological, neuropsychological and neuroendocrine findings, suggesting that the alcohol-related brain alterations are reversible after a long period of abstinence.

Reduction of GH response to the GABA-B agonist baclofen in patients with major depression.

In order to establish whether alterations in the GABAergic control of GH secretion occur in male patients with major depression, the GH response to the GABAergic-B agonist baclofen (10 mg PO at 0830h) or to placebo was tested in 9 depressed men and in 10 age- and weight-matched male normal controls. The basal concentrations of GH were significantly lower in the depressed patients (0.87 +/- 0.69 ng/ml) than in the normal controls (1.57 +/- 0.33 ng/ml) (p = 0.011) and were not modified by the administration of placebo. The administration of baclofen induced a striking, significant increase in GH concentrations in the normal controls (mean peak at 90 min = 6.4 +/- 1.5 ng/ml). In contrast, a slight, nonsignificant GH increase occurred in the depressed patients after baclofen (mean peak at 90 min = 1.57 +/- 1.45 ng/ml). The GH response was significantly lower in the depressed than in the control subjects (p less than 0.001). These data indicate the presence of reduced GABAergic control of GH secretion in male depressed patients.

Prevalence of migraine and muscle tension headache in depressive disorders.

This study was undertaken in order to evaluate the prevalence of headache and its subtypes (migraine, muscle tension headache, cluster and psychogenic headache) in a population of 160 depressed patients. Headache was present in 83 subjects (51.9%); 36 (22.5%) were affected by migraine, 39 (24.4%) by muscle tension headache, six (3.7%) by psychogenic headache and two (1.2%) by cluster headache. No significant differences in the prevalence of migraine and muscle tension headache were observed among patients with major depression, bipolar depressive disorder and dysthymic disorder. These data speak against a specific correlation among subtypes of headache and depressive disorders.

Dopaminergic control of TSH secretion in endogenous depression.

To evaluate whether the inhibitory control exerted by endogenous dopamine on thyroid-stimulating hormone (TSH) secretion is altered in patients with major depressive disorder, 11 depressed patients and 9 normal controls were tested with the dopaminergic receptor antagonist domperidone (10 or 20 mg i.v.). The administration of domperidone induced a significant increase in circulating TSH levels in the normal controls, but not in the depressed patients. These data excluded the possibility that the dopaminergic inhibition of TSH secretion is enhanced in depression. To establish whether domperidone failure was due to a reduced dopaminergic tone, domperidone was administered before stimulation of TSH secretion with thyrotropin-releasing hormone (TRH) (200 micrograms i.v.). The TSH response to TRH was significantly lower in the depressed than in the control subjects, regardless of domperidone priming. However, in both groups domperidone enhanced the TRH-induced TSH release by 50%. These data suggest that the dopaminergic control of TSH secretion is not altered in patients with endogenous depression and that a reduced capacity of the pituitary to secrete TSH might be responsible for the reduced TSH responsiveness to TRH and domperidone.

EMG-biofeedback training in fibromyalgia syndrome.

Fifteen patients with fibromyalgia syndrome were given EMG-BFB (biofeedback) training sessions because of persistent aches after one year of monthly courses of NSAID. A long-lasting clinical benefit was observed in 56%. The improvement was found in those without overt psychopathological disturbances. In fact, a subgroup of clinically depressed patients responded poorly. Our findings were confirmed in a controlled study. Six patients were allocated into "true EMG-BFB" and 6 into "false EMG-BFB" treatment in a blinded fashion. The rheumatological assessment revealed a significant improvement in most of the variables only in the "true EMG-BFB" group.

Involvement of a dopaminergic mechanism in the response of growth hormone to thyrotropin releasing hormone in patients with major depression.

In an attempt to establish whether, in patients with major depression, dopaminergic receptors are involved in the release of growth hormone (GH) induced by thyrotropin releasing hormone (TRH), eleven subjects were tested with TRH (200 micrograms in an i.v. bolus) with or without concomitant treatment with domperidone (10 mg in an i.v. bolus 10 min before TRH), an antidopaminergic agent which does not readily cross the blood-brain barrier. In 7 out of the 11 patients, TRH strikingly increased GH levels (responders) (the mean peak level was 9 times higher than basal value), whereas it was without effect in the remaining 4 patients (non-responders). When the responders were treated with domperidone before TRH injection, TRH-induced GH increase was still present, but it was significantly lower (the mean peak level was 5.3 times higher than basal value) than in the TRH test (p less than 0.02). These data suggest that the paradoxical response of GH or TRH in patients with major depression involves a dopaminergic mechanism active at sites situated outside the blood-brain barrier.

[Analysis of a case series of 1,500 suicide attempts in Parma (1971-1983)]. / Analisi di una casistica di 1.500 tentativi di suicidio a Parma (1971-1983).

The authors analyse data from a case series of 1500 attempted suicides, gathered by the University of Parma, Institute of Psychiatry. The attempted suicides were studied according to sex, age, class, place where the subject was born and where the attempt took place, marital status, family background, level of education, financial position, occupation, as well as the method of the attempted suicide and the mental condition of the patient when under observation. The main points to emerge were the similarities between these data and those of the literature, as well as the psychological features and social background of these patients. Our study also confirms the results of a previous research on 500 attempted suicides, here included: the obtained out of the last 1.000 cases confirms those out of previous 500.

[Analysis of the effect of lithium salts on cognitive functions]. / Analisi dell'influenza dei sali di litio su alcune funzioni cognitive.

In this work the authors studied the effects of lithium on memory and reaction times in 7 manic-depressive patients receiving long-term therapy. The results suggest lithium treatment does not change these intellectual functions to any significant extent, comparing the trials of the experimental sessions during the therapy and after two weeks off lithium. Our data mostly agree with the studies of other Authors who used similar experimental methods.

Cerebral hemispheric lateralization of cognitive deficits due to alcoholism.

Twenty chronic alcoholics and a group of matched control subjects were tested on verbal and visuospatial memory tasks in order to test directly the hypothesis that alcoholism disturbs cognitive functions subserved by the right hemisphere more than those subserved by the left hemisphere. The results provide some support for the hypothesis and indicate that information may be lost by pooling together test results from alcoholics which come from a mixture of verbal and nonverbal tasks.

[Problems in differential diagnosis between early presenile dementia and depression in elderly persons (author's transl)]. / Problemi ed insufficienze nella diagnosi delle demenze e delle depressioni nell'anziano.

The difficulties in correct differential diagnosis between depression and early pre-senile dementia syndromes are pointed-out by the AA. They underline that, on the ground of literature reports and clinical experience, the instrumental methods (electroencephalography, cerebral blood flow examination, pneumoencephalography, evoked cerebral responses, etc...) appear of little use in differential diagnosis, if separately considered. A particular attention is called on psychometric tests, in order to worn the non-specialist against any too over-simplified and mechanistic acceptance of test results.

[Repeated attempted suicides: a clinical study (author's transl)]. / Tentativi di suicidio recidivanti. Analisi di una casistica.

In this work we have again examined a sample of 500 attempted suicides which took place in Parma between September 1971 and January 1976. We have made a distinction between the various types--those who tried only once and those who repeated their attempts, and have also taken into consideration other factors--sex, marital status, family background, level of education, financial position, as well as the method of the attempted suicide and the mental condition of the patient when under observation. The main points to emerge were: a) there was a much higher rate of mental illness among the patients who had repeated their attempts, (66,6%), in comparison to those who had tried only once (19,5%). b) while there was already a high proprotion of females who made one attempt (74%), the rate rose even higher so with those who repeated their attempts (88,8%).

[Electroencephalographic changes during lithium salt therapy: correlation with the erythrocyte lithium content]. / Modificazioni elettroencefalografiche in corso di terapia con sali di litio: correlazione con il contenuto intraeritrocitario di litio.

18 subjects, affected by manic-depressive psychosis, have been studied during lithium therapy, in order to control EEG. changes in relation to erythrocyte lithium concentration. According to data obtained, significant relation subsistes between EEG. changes and erythrocyte lithium concentration.

[Tardive dyskinesia. Synthetic-critical review and case contribution]. / La discinesia tardiva. Rassegna sintetico-critica e contributo casistico

The clinical features, etiology and treatment of tardive dyskinesia, a neurological syndrome observed during or after withdrawal of long term neuroleptic therapy, are discussed in reference to the literature records and to the contributions drawn out from 16 new cases.