Zaleplon increases nocturnal melatonin secretion in humans.

Insomnia is the most common sleep condition. Many hypnotics decrease nocturnal melatonin secretion. The aim of this research consists of studying the effect of the hypnotic drug zaleplon on melatonin secretion. Twelve non-smoker drug-free healthy male subjects participated in the study. All participants were normal sleepers and aged 33.2 +/- 11.7 years. They orally took 10 mg of zaleplon at 22:00 h in a double-blind, randomized, cross-over design. The study was carried out during two consecutive days in a week-end. Blood samples were extracted at 22:00, 23:00, 24:00, 01:00, 02:00 and 12:00 h. Melatonin was measured by an ELISA assay. All the subjects had a circadian rhythm of melatonin secretion. Zaleplon compared to placebo increased significantly the melatonin levels at 23:00, 24:00 and 01:00 h. No differences in melatonin levels between placebo and zaleplon were found at 12:00, 22:00 and 02:00 h. Zaleplon compared to placebo increased by 46% the Area Under the Curve of melatonin secretion. The present study indicates that zaleplon increases nocturnal melatonin secretion without increasing daytime melatonin levels. We suggest that when clinicians prescribe a hypnotic, the effect on melatonin levels should be another parameter to be taken into account.

Síndrome de Burnout / The burnout syndrome

El síndrome de burnout es una forma de estrés laboral crónico que puede afectar casi a cualquier profesión. Descrito en 1974 por Freudenberger, durante la última década está alcanzando su verdadera dimensión, condicionada, entre otras cosas, por la evolución tecnológica y constituyéndose en la actualidad en una verdadera epidemia que origina importantes pérdidas, tanto a nivel humano como económico. Con esta revisión se pretende conjugar diversas visiones sobre el origen, diagnóstico y posibles terapéuticas a aplicar en los individuos afectados por dicho cuadro, habida cuenta de los beneficios que implica una intervención precoz (AU)

The burnout syndrome is a type of labour stress that may affect almost every profession. It was described in 1974 by Freudenberger but its real dimension is being achieved in the last decade, reaching an epidemic magnitude that causes important human and economic losses. With this review we want to combine different views about the origin, diagnostic and possible therapies to apply on subjects suffering from the consequences of the syndrome, because early interventions are beneficial (AU)

Proteínas de fase aguda como marcadores biológicos de la psicopatología negativa en la esquizofrenia paranoide / Acute phase proteins as biological markers of negative psychopathology in paranoid schizophrenia

Introducción. La respuesta inflamatoria aguda es uno de los elementos fisiopatológicos que se pueden alterar en la psicosis esquizofrénica. El objetivo de este trabajo consiste en estudiar las relaciones existentes entre psicopatología y proteínas de fase aguda (PFA) en la esquizofrenia paranoide. Método. Se estudiaron 15 pacientes diagnosticados de esquizofrenia paranoide según el DSM-IV. A todos los sujetos se les administró la versión española de la Escala de síndromes Positivo y Negativo (PANSS) para cuantificar la psicopatología. Como PFA se midieron los niveles de ceruloplasmina y las fracciones 3 y 4 del complemento. Resultados. Cinco de los siete ítems de la subescala negativa de la PANSS se correlacionaron de manera positiva y significativa con las PFA. Dos ítems de la escala de psicopatología general, Atención deficiente y Evitación social activa, se correlacionaron positiva y significativamente con las PFA. Ningún ítem de la subescala positiva se correlacionó significativamente con los niveles sanguíneos de las PFA. Conclusiones. La cuantificación de los niveles plasmáticos de ceruloplasmina y las fracciones 3 y 4 del complemento puede consideralos como marcadores periféricos de la psicopatología negativa en la esquizofrenia paranoide aguda

Introduction. Acute inflammatory response is one of the pathophysiological elements involved in the etiology of schizophrenia. This paper aims to study the relationship between Acute Phase Proteins (APPs) and psychopathology in paranoid schizophrenia. Method. Fifteen physically healthy inpatients meeting DSM-IV criteria for paranoid schizophrenia took part in the study. The Spanish version of the Positive and Negative Syndrome Scale (PANSS) was used in order to rate psychopathology. Ceruloplasmin, Complement's fraction 3 (C3) and fraction 4 (C4) levels were measured as APPs. Results. Five out of seven items of the PANSS negative subscale showed a positive correlation with the APPs at a significant level. Poor Attention and Active Social Avoidance, two items of the general psychopathology subscale, correlated significantly with the APPs. No single item of the positive subscale correlated with the APPs. Conclusions. Ceruloplasmin, C3 and C4 blood levels are useful peripheral biological markers of negative acute paranoid schizophrenic symptoms

Acute phase proteins as biological markers of negative psychopathology in paranoid schizophrenia.

INTRODUCTION: Acute inflammatory response is one of the pathophysiological elements involved in the etiology of schizophrenia. This paper aims to study the relationship between Acute Phase Proteins (APPs) and psychopathology in paranoid schizophrenia. METHOD: Fifteen physically healthy inpatients meeting DSM-IV criteria for paranoid schizophrenia took part in the study. The Spanish version of the Positive and Negative Syndrome Scale (PANSS) was used in order to rate psychopathology. Ceruloplasmin, Complement's fraction 3 (C3) and fraction 4 (C4) levels were measured as APPs. RESULTS: Five out of seven items of the PANSS negative subscale showed a positive correlation with the APPs at a significant level. Poor Attention and Active Social Avoidance, two items of the general psychopathology subscale, correlated significantly with the APPs. No single item of the positive subscale correlated with the APPs. CONCLUSIONS: Ceruloplasmin, C3 and C4 blood levels are useful peripheral biological markers of negative acute paranoid schizophrenic symptoms.

Seasonality of psychopathology and circannual melatonin rhythm.

The association of seasonal changes in health and disease has been known for centuries. The prevalence of psychopathological symptoms with seasonal fluctuations and the use of melatonin as a biological marker of circadian and circannual rhythms is well documented. The aim of this work was to study the variability of melatonin secretion between summer and winter in our geographical area (28 degrees N, 16 degrees W) and relate the changes to the level of psychopathology. Ten drug-free, nonsmoker, healthy subjects were studied in summer (August) and winter (December). Blood samples for melatonin assays were collected every hour at night for 5 hr, from 22:00 to 02:00 hr, and next day at noon. Melatonin was assayed by an ELISA technique. Psychopathology was evaluated by means of the 28-item version of the General Health Questionnaire (GHQ-28). All subjects had a circadian rhythm of melatonin secretion in summer and winter. There was a seasonal rhythm with melatonin levels being significantly higher at night in winter than in summer. Melatonin levels at 22:00, 23:00, 24:00 and 01:00 hr and mean melatonin area under the curve (AUC) were significantly higher in winter than in summer. Melatonin AUC increased 80% in winter compared with summer. The GHQ-28 somatic and anxiety subscales and the total GHQ-28 score were significantly higher in winter than summer. Psychopathology scores were significantly and negatively correlated with melatonin production in summer and winter. Our data strongly suggest that melatonin production and psychopathology levels present seasonal fluctuations and these variations should be taken into account when conducting research in this field.

[Safety in melatonin use]. / Seguridad en el uso de la melatonina.

INTRODUCTION: The interest on melatonin (MLT) as a psychiatric treatment has increased a lot in the last decade. This is mainly due to MLT safety and its lack of serious adverse reactions. The aim of this paper consists of reviewing the adverse effects to MLT consumption in humans. METHOD: A 35-year (1966-2000) bibliographic search using the Medline database was carried out. The intersection of the key word melatonin with the group of words adverse effects or side effects or adverse reactions or toxicity was the strategy of the search. RESULTS: 307 articles were elicited and 9 were related to MLT adverse effects. The range of MLT dose involved in the adverse reactions oscillated between 1 mg and 36 mg. The adverse reactions were: one patient with autoimmune hepatitis, one case of confusion due to MLT overdose, one case of optic neuropathy, four subjects with fragmented sleep, one psychotic episode, one case of nistagmus, four cases of seizures, one case of headache and two cases of skin eruptions. CONCLUSIONS: Attention should be paid on the necessity of enquiring about the drugs that patients are taking, because this product is not harmless for health.

[Efficiency of melatonin in the treatment of insomnia]. / Eficacia de la melatonina en el tratamiento del insomnio.

UNLABELLED: The aim of this research consists of studying whether melatonin (MLT) may be considered as an alternative for the treatment of insomnia. METHODS: A 33-year period (1966-1998) of computerised search using Medline database was performed. Melatonin, pineal gland and insomnia were used as key words. RESULTS: 93 articles were elicited; 85 were excluded because they were reviews (44) or were not directly related to the research topic (41). 111 insomniac patients were treated with MLT in 8 articles. 60% of the patients reported an improvement of sleep quality. Objective sleep measures also improved; there was a decrease in the sleep latency time and the number of awakenings (62% and 50% of patients respectively) after MLT treatment. CONCLUSIONS: Melatonin may have a promising future for the treatment of insomnia. The lack of standardised criteria for diagnosing sleep disorders and the lack of structured psychiatric interviews for ruling out psychiatric pathology are clear obstacles in generalizing these results.

Risperidone and clozapine combination for the treatment of refractory schizophrenia.

Clozapine is the most widely used antipsychotic drug for the treatment of refractory schizophrenia. Here we report the case of two residual schizophrenic patients refractory to conventional antipsychotics who showed a poor response to atypical antipsychotics. The combination of risperidone and clozapine produced a noticeable improvement in the patients' clinical status and a shortening of the treatment response latency.