More than words: The association of childhood emotional abuse and suicidal behavior.

BACKGROUND: All types of abuse and neglect have been associated with suicide attempts. However, the association between the level of each type of childhood trauma and suicidal behavior severity (including the progression from ideation to attempts), adjusting for their co-occurrence, is not yet clear. METHODS: We used a cross-sectional web-based survey collected from the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) to investigate the isolated effects of each type of childhood trauma on suicidal behavior severity. The sample consisted of 71,429 self-selected volunteers assessed with the Childhood Trauma Questionnaire (CTQ) and the following key question: "Have you ever thought about or attempted to kill yourself?" (Suicidal Behavior Questionnaire, SBQ-17). RESULTS: After adjusting for demographic variables, and childhood trauma subtypes, severe emotional abuse (EA) was associated with suicidal ideation and attempts, mainly for serious suicide attempts (OR, 22.71; 95% CI, 2.32-222.05). We found associations of smaller magnitude for severe emotional neglect (EN) with serious suicide attempts, and for severe physical neglect (PN) and sexual abuse (SA) with attempts without really meaning to die. No meaningful trend for physical abuse (PA) was found. Using as reference group ideators, EA was associated with serious suicide attempts, with a peak at the 95th percentile (OR, 4.39; 95% CI, 2.04-9.41). We found associations of smaller magnitude for PN and SA, and no meaningful trend for EN and PA. CONCLUSIONS: Suicidal behavior was strongly associated with emotional abuse in childhood, even when compared with ideators, suggesting that it is a relevant factor for the progression from ideation to attempts.

Emotional and affective temperament in 23 professional areas.

BACKGROUND: Preliminary data has shown temperament differences in workers of a few professions, particularly in artists. METHODS: 3805 subjects (75.5% female, mean 32.4+/-9.8 years) of 23 broad professional areas answered a web-survey with the Combined Emotional and Affective Temperament Scale (CEATS). RESULTS: Educational level was correlated with drive and control, was lower in depressives and apathetics and higher in euthymics and hyperthymics. Fear was lower in administration and communications and higher in computing and office workers. Drive was lower in those unemployed and at home and higher in fitness and administration. Control was lower in arts and higher in teaching and health caring. Anger was lower in subjects in the areas of teaching and health caring and higher in human studies and unemployed. For affective temperament scores: depressive was lower in fitness and higher in human studies; anxious and apathetic scores were lower in fitness and higher in unemployed subjects; cyclothymic was lower in health caring and higher in unemployed; euthymic score was lower in human studies and higher in fitness; irritable was lower in religion and higher in unemployed; labile was lower in health caring and higher in unemployed; disinhibited was lower in engineering and higher in communications and arts; hyperthymic was lower in human studies and high in fitness. LIMITATION: Convenience sample by the internet and most subjects assessed the instruments through a psychoeducational website for bipolar spectrum disorders, which may have biased the absolute scores of emotional temperaments. CONCLUSIONS: Professional areas and educational level are associated with distinct emotional and affective profiles.

Association of serum uric acid levels with emotional and affective temperaments.

BACKGROUND: Temperament relates to emotions and the prevailing mood or affective temperament. Uric acid (UA) is the end-product of purine metabolism and has been associated with psychological features such as high energy/drive, positive affect, achievement, good performance, higher social status and leadership. METHODS: 129 subjects (44 males, 85 females) completed with the Combined Emotional and Affective Temperaments Scale, serum UA levels and a general health questionnaire. RESULTS: In the whole sample, serum UA levels were significantly correlated with disinhibition (r=0.36, p<0.001) and drive (r=0.25, p<0.01), but not with control, anger or any of the affective temperament scores. Among males, we found correlations at trend level (p>0.05 and <0.07) for control (r=0.27), irritable (r=0.29) and hyperthymic (r=0.27) affective temperaments. Among females, a significant correlation was found only with disinhibition (r=0.34, p=0.001). The top tertile of males (serum UA>6.0 mg/ml, n=16) had significantly higher drive (29.9+/-5.9x26.0+/-3.6, p=0.01) and higher control at trend level (21.2+/-3.1x19.3+/-2.9, p=0.054) than other males. Among women, the top tertile (serum UA>4.0 mg/ml, n=29) showed higher disinhibition scores (20.7+/-4.9x17.9+/-3.6, p<0.01) and more frequent choices of hyperthymic (8/26x6/59, p=0.023) and irritable temperaments (7/26x5/59, p=0.031) than the rest of the sample. Controlling for daily intake of meat and grains, which could lead to higher UA levels, did not change these results. LIMITATIONS: Small sample size for males. CONCLUSIONS: Externalized traits of temperament are associated with higher serum UA levels both in men and women.

Anti-nociceptive properties of the xanthine oxidase inhibitor allopurinol in mice: role of A1 adenosine receptors.

BACKGROUND AND PURPOSE: Allopurinol is a potent inhibitor of the enzyme xanthine oxidase, used primarily in the treatment of hyperuricemia and gout. It is well known that purines exert multiple effects on pain transmission. We hypothesized that the inhibition of xanthine oxidase by allopurinol, thereby reducing purine degradation, could be a valid strategy to enhance purinergic activity. The aim of this study was to investigate the anti-nociceptive profile of allopurinol on chemical and thermal pain models in mice. EXPERIMENTAL APPROACH: Mice received an intraperitoneal (i.p.) injection of vehicle (Tween 10%) or allopurinol (10-400 mg kg(-1)). Anti-nociceptive effects were measured with intraplantar capsaicin, intraplantar glutamate, tail-flick or hot-plate tests. KEY RESULTS: Allopurinol presented dose-dependent anti-nociceptive effects in all models. The opioid antagonist naloxone did not affect these anti-nociceptive effects. The non-selective adenosine-receptor antagonist caffeine and the selective A(1) adenosine-receptor antagonist, DPCPX, but not the selective A(2A) adenosine-receptor antagonist, SCH58261, completely prevented allopurinol-induced anti-nociception. No obvious motor deficits were produced by allopurinol, at doses up to 200 mg kg(-1). Allopurinol also caused an increase in cerebrospinal fluid levels of purines, including the nucleosides adenosine and guanosine, and decreased cerebrospinal fluid concentration of uric acid. CONCLUSIONS AND IMPLICATIONS: Allopurinol-induced anti-nociception may be related to adenosine accumulation. Allopurinol is an old and extensively used compound and seems to be well tolerated with no obvious central nervous system toxic effects at high doses. This drug may be useful to treat pain syndromes in humans.

Increased serum adenosine deaminase activity in schizophrenic receiving antipsychotic treatment.

Adenosine is an important modulator of the nervous system that has been implicated in the pathophysiology of schizophrenia. We studied peripheral adenosine metabolism by determining the activity of serum adenosine deaminase, which converts adenosine into inosine, and 5'-nucleotidase, which converts AMP into adenosine, in 26 DSM-IV male schizophrenic patients under antipsychotic monotherapy and 26 healthy volunteers balanced for age and race. Schizophrenic patients treated either with typical antipsychotics or clozapine showed increased serum adenosine deaminase activity compared to controls (controls=18.96+/-4.61 U/l; typical=25.09+/-10.98 U/l; clozapine=30.32+/-10.83 U/l; p<0.05, ANOVA) and 5'-nucleotidase activity was also increased in patients on clozapine. After adjusting for confounding factors, adenosine deaminase, but not 5'-nucleotidase, alterations remained significant particularly in the clozapine group. This result suggests that either altered adenosine metabolism is present in schizophrenic patients or is influenced by treatment with antipsychotics, particularly clozapine.

Effect of subchronic caffeine treatment on MK-801-induced changes in locomotion, cognition and ataxia in mice.

N-Methyl-D-aspartate (NMDA) receptor antagonists cause hyperlocomotion and cognitive deficits in rodents, and caffeine-tolerant mice show diminished locomotor response to NMDA receptor antagonists. The aim of this study was to evaluate the effect of subchronic caffeine treatment on MK-801-induced hyperlocomotion, ataxia and cognitive deficits, as well as amphetamine-induced hyperlocomotion in mice. Mice were treated subchronically with caffeine (0, 0.1, 0.3 and 1 mg/ml and 1, 3 and 7 days) and evaluated for locomotor activity, working memory (delayed alternation test), long-term memory (inhibitory avoidance task) and ataxia. Hyperlocomotion induced by MK-801 (0.25 mg/kg i.p.) was diminished after 3 days and almost abolished after 7 days of caffeine treatment at the 1 mg/ml dose, and this effect was also dose-dependent. Ataxia induced by 0.5 mg/kg MK-801 was not affected by caffeine treatment, but a short-lived hyperlocomotor effect was observed. Performance deficit in the inhibitory avoidance task induced by MK-801 (0.01 mg/kg) was prevented in mice treated with caffeine for 7 days at 1 mg/ml, and perseverative errors in the T-maze by MK-801 (0.4 mg/kg) were attenuated. The locomotor effect of amphetamine (5 mg/kg) was unaffected by subchronic caffeine treatment. The findings that hyperlocomotion and cognitive effects induced by MK-801 can be specifically influenced by reduced adenosinergic activity agree with a model of adenosine hypofunction in schizophrenia, since NMDA receptor antagonists are pharmacological models for this disorder.

Purinergic dysfunction in mania: an integrative model.

The purinergic system, which includes the anticonvulsant and antikindling neuromodulator adenosine and the neurotransmitter ATP, modulates second messenger systems, neurotransmitters, energy metabolism and different behaviors, such as sleep, motor activity, cognition, memory, aggressive behavior and social interaction. At the same time, mania is characterized by similar behavioral changes and a molecular basis to explain the pathological activation observed during manic episodes has been also associated with second messenger systems dysfunction and kindling. This hypothesis put forward an integrative model of neuronal communication, associating a reduced adenosinergic activity, mostly at A1 receptors, with the complex network of changes on neurotransmitters pathways related to manic behavior.

Elevated serum S100B protein in drug-free bipolar patients during first manic episode: a pilot study.

S100B protein is a calcium-binding protein mostly derived from glial cells, which exerts trophic or toxic effects on neural cells depending on its concentration. Since serum S100B levels has been tested as a potential marker in neuropsychiatric disorders, and structural abnormalities on glial cells have been recently associated with bipolar disorder patients, we conducted this preliminary study to examine if S100B serum levels are altered during first manic episode. We quantitated S100B in serum of 40 subjects (20 unmedicated patients during manic episode and 20 healthy matched controls). The mean+/-S.D. values for S100B for bipolar subjects were 0.065+/-0.068 microg/l and 0.018+/-0.029 microg/l for healthy controls. Increased levels of S100B in bipolar mania was statistically significant (Wilcoxon signed ranks test, Z=-2.45, P=0.01). These preliminary findings suggest that mania may increase the levels of S100B in serum of bipolar disorder patients, which could be related to adaptative neural mechanisms in bipolar mania.

Catalepsy and hypolocomotion induced by a nitric oxide donor: attenuation by theophylline.

Nitric oxide (NO) promotes adenosine release in the striatum and hippocampus. Behavioral effects of the nitric oxide donor sodium nitroprusside were studied in mice and included an examination of spontaneous locomotion and catalepsy, which are behaviors modulated by adenosine. Sodium nitroprusside caused a dose-dependent (2, 4 and 6 mg/kg) decrease in locomotor activity and catalepsy at the dose of 6 mg/kg. These effects were substantially attenuated by pretreatment with the non-selective adenosine receptors antagonist theophylline (10 and 30 mg/kg). Moreover, combined treatment with theophylline (30 mg/kg) and sodium nitroprusside (6 mg/kg) induced limbic seizures in 23% of animals. The pretreatment with the selective adenosine A(1) receptor antagonist 8-cyclopentyl-1, 3-dimethylxanthine (CPT) (1.2 mg/kg) caused no effect on the spontaneous or sodium nitroprusside-induced behavior. These data suggest that these behavioral effects of sodium nitroprusside are at least partially mediated by adenosine in the striatum and hippocampus, probably via adenosine A(2A) receptors.

Effect of orally administered guanosine on seizures and death induced by glutamatergic agents.

Intraperitoneal guanosine has been shown to prevent quinolinic acid-induced seizures in mice. In this study, we investigated the effect of orally administered guanosine on seizures induced by the glutamate agonists quinolinic acid and kainate, and the endogenous glutamate releaser alpha-dendrotoxin. Guanosine (7.5 mg/kg, per os), administered 75 min in advance, prevented 70% of seizures induced by i.c.v. quinolinic acid, being as efficient as the NMDA channel blocker MK-801 administered intraperitoneally. Guanosine was ineffective against kainate-induced seizures, but significantly reversed the potentiation of seizures and death caused by the concomitant injection of MK-801. Guanosine also significantly prevented seizures and death induced by i.c.v. alpha-dendrotoxin, whereas MK-801 and phenobarbital only prevented death. Altogether, our findings underscore the therapeutic potential of oral administration of guanosine for treating diseases involving glutamatergic excitotoxicity, including epilepsy.

Chronic treatment with clozapine, but not haloperidol, increases striatal ecto-5'-nucleotidase activity in rats.

In the search for differential mechanisms underlying clozapine's superior antipsychotic efficacy, the purinergic system has been considered, since an antagonist of the adenosine receptor A(2A) was shown to block clozapine acute effects on c-fos expression in rat striatum. Further investigating the interaction of clozapine with the purinergic system, we studied the effects of chronic treatment (28 days, intraperitoneal) with clozapine (25 mg/kg) and haloperidol (1.5 mg/kg) on the activity of ectonucleotidases in the striatum and hippocampus of rats. Clozapine selectively increased striatal 5'-nucleotidase activity (22%) compared to control and haloperidol groups. In vitro, neither drug affected enzyme activities. These results reinforce the differential effects of clozapine compared to haloperidol on the purinergic system.

Allopurinol augmentation for poorly responsive schizophrenia.

Adenosine has been proposed to contribute to the pathophysiology of schizoprenia and as a target for therapeutic intervention. In the lack of direct adenosine agonists, allopurinol may indirectly elevate adenosine levels by inhibiting degradation of purines. We report two cases of poorly responsive schizophrenic patients who improved considerably with add-on allopurinol 300 mg/day. Their clear clinical improvement warrant further investigation of allopurinol, as well as other purinergic strategies, for the treatment of schizophrenia.

Increased serum S100B protein in schizophrenia: a study in medication-free patients.

S100B protein, a calcium binding protein produced and released by glial cells, has been used as a sensitive marker of brain damage. Previous studies have found alterations in peripheral S100B levels in schizophrenic patients on medication. We compared serum S100B levels of 20 medication-free DSM-IV schizophrenic patients and 20 age-gender matched healthy controls. Schizophrenic patients presented higher serum S100B levels (mean 0.120 ng/ml+/-S.D. 0.140) compared to controls (mean 0.066 ng/ml+/-S.D. 0.067; P=0.014) and there was a negative correlation with illness duration (r=-0.496, P=0.031). The results of this study indicate that serum S100B levels may be a state marker of a limited neurodegenerative process, particularly in the early course of schizophrenia or, at least, in a subgroup of schizophrenic patients.

Activation of glutamate uptake by guanosine in primary astrocyte cultures.

Guanine-based purines have been shown to modulate the effects of glutamate, which is essential for brain function and mediates excitotoxicity. In the search for a mechanism involving the interaction between purine nucleoside guanosine and glutamate, we found that guanosine dose-dependently, significantly (63%) and potently (EC50 =2.47 microM) enhanced glutamate uptake in cultured astrocytes. This effect was not inhibited by the blocker of nucleoside transporter dipyridamole nor by the adenosine antagonist theophylline, suggesting an extracellular site of action without the involvement of adenosine receptors. These results indicate a regulatory role of guanosine on extracellular levels of glutamate, possibly contributing for protecting neural cells against glutamate-induced excitotoxicity.