Mobilized peripheral blood grafts include more than hematopoietic stem cells: the immunological perspective.

Although stem cell mobilization has been performed for more than 20 years, little is known about the effects of mobilizing agents on apheresis composition and the impact of graft cell subsets on patients' outcome. With the increasing use of plerixafor and the inclusion of poor mobilizers in autologous transplant procedures, new parameters other than CD34(+) stem cell dose are emerging; plerixafor seems to mobilize more primitive CD34(+)/CD38(-) stem cells compared with G-CSF, but their correlation with stable hematopoietic engraftment is still obscure. Immune recovery is as crucial as hematopoietic reconstitution, and higher T and natural killer cells infused within the graft have been correlated with better outcome in autologous transplant; recent studies showed increased mobilization of immune effectors with plerixafor compared with G-CSF, but further data are needed to clarify the clinical impact of these findings. In the allogeneic setting, much evidence suggests that mobilized T-cell alloreactivity is tempered by G-CSF, probably with the mediation of dendritic cells, even though no clear correlation with GVL and GVHD has been found. Plerixafor is not approved in healthy donors yet; early data suggest it might mobilize a GVHD protective balance of immune effectors, but further studies are needed to define its role in allogeneic transplant.

Percept-genetic codings of defense in chronic schizophrenia.

Hitherto available studies on the percept-genetic defensive organization of Schizophrenia have not distinguished between acute and chronic stages of the disorder. The present research with the Defense Mechanism Test included 30 chronic inpatients with several years of hospitalization and with acceptable perceptual thresholds. Compared with 30 sex- and age-matched nonschizophrenic psychiatric control patients, schizophrenics resorted significantly more often to (a) regression, (b) disappearance of the peripheral figure, (c) introjection (wrong sex attribution to the hero), and (d) significantly less often to the most mature variants of repression. In a further comparison of a subgroup of 16 women schizophrenic patients and a matched group of melancholic inpatients, the findings on regression, introjection, and repression were replicated.

Diabetes mellitus in schizophrenic patients.

Studies conducted in the United States and Japan indicate that diabetes mellitus is more common among schizophrenic patients than among the general population. The prevalence of known diabetes was examined in 95 schizophrenic patients aged 45 to 74 years admitted to a long-term care facility in Italy. The overall prevalence of diabetes was 15.8% (95% confidence interval, 12.1% to 19.5%), and increased from 0% in those younger than 50 years, through 12.9% in the 50- to 59-year age group, and to 18.9% in the 60- to 69-year age group, and then decreased to 16.7% in those aged 70 to 74 years. These rates are considerably higher than those reported from population surveys in Italy, and indicate that a higher prevalence of diabetes in schizophrenic patients may be a universal phenomenon. The clinical picture indicated that in all cases this was the common variant of type II (non-insulin-dependent) diabetes mellitus. Diabetes was more common in patients not receiving neuroleptics than in those who were receiving such treatment. There was no association between diabetes and the use of anticholinergic drugs.

Adjunctive trazodone in the treatment of negative symptoms of schizophrenia.

OBJECTIVE: The study examined whether adjunctive treatment with trazodone would reduce negative symptomatology in patients with chronic, residual schizophrenia. METHODS: Patients selected for the study had an established clinical diagnosis of chronic schizophrenia with stable symptomatology, an absence of florid psychotic symptons, a stable regimen of neuroleptic medication, and an absence of depressive disorder. Active psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) score on the thinking disturbance factor. Negative symptoms were assessed using the BPRS withdrawal retardation factor as well as the affective flattening and alogia subscales from the Scale for Assessment of Negative Symptoms. Forty-nine patients were randomly assigned to either trazodone or placebo in a six-week double-blind trial. RESULTS: Forty-seven patients, 23 men and 24 women with an average age of 60 years, completed the six-week trial. Twenty-six of the patients received trazodone. Adjunctive treatment with trazodone significantly reduced the severity ratings on two of three measures of negative symptoms and did not significantly increase the severity of positive symptoms; however, the magnitude of the therapeutic effect was modest. The scores for negative symptoms were reduced by approximately 10 to 15 percent, and only three of the 26 actively treated patients showed moderate clinical improvement. CONCLUSIONS: Trazodone, used in conjunction with neuroleptics, mildly reduces the severity of negative symptoms in residual schizophrenia and does not exacerbate florid psychosis. The potential benefits of adjunctive trazodone therapy may outweigh the risk of worsening psychosis.