Biomedical subjects
Publications and source records attributed to G Molnar.
Of 15 unmedicated chronic schizophrenic patients with acute exacerbations and 15 healthy controls given the dexamethasone suppression test (DST), 11 patients and two controls were nonsuppressors. The results add to the evidence that the DST has limited value in psychiatric diagnosis.
It was observed that in the course of allergic encephalomyelitis (EAE) in chickens. Isoprinosine reduced the production of the specific IgA and IgM antibodies against encephalic antigen. Its influence on IgG production was slight. It was also found that isoprinosine reduced the antitrypsine activity in EAE. Its effect upon the level of antibodies and biochemical indices of inflammation was particularly pronounced on days 28-35 after immunization, i.e. at the time of the most intensive microscopic inflammatory changes in the brain. Histological analysis revealed an inhibition of plasmatic cells reproduction in the spleens of chickens receiving isoprinosine. No effect of the drug on the GvH reaction in chickens was found.
Computer assistance and a descriptive focus contributed to the cost-effectiveness and physician acceptance of a psychopharmacology study of problems physicians encountered on acute care units regarding antipsychotic (AP) drugs. The charts of 100 patients on AP drugs were reviewed after discharge from the psychiatry unit of Erie County Medical Center, a 600-bed teaching hospital in Buffalo. A computer program identified the exceptions to standards, which were then reviewed to discover idiosyncratic or inefficient prescribing practices.
Elopements from psychiatric units are a frequent but usually low-grade risk. However, they are sometimes followed by harmful consequences, for which the psychiatrist and the hospital may be held liable. We describe management methods developed to reduce such liability. These include a structured observation system and procedures to return elopers to the hospital or to refer them for community-based treatment. Data on 105 elopers and 360 controls were gathered and analyzed. Acceptance of some risk of elopement is inevitable on wards that follow the principle of treatment in the "least restrictive alternative."
The metyrapone test was applied to groups of patients suffering from major depressive illness with melancholia, mania or schizophrenia, before and after treatment. There were interesting individual correlations between post-metyrapone cortexolone values, cortexolone/cortisol ratios and clinical improvement in depressives. Two patients who had exhibited abnormal metyrapone responses displayed a normalization of post-metyrapone cortexolone values upon clinical improvement, whereas the opposite trend was observed in a patient who did not improve and in another who became manic. These preliminary results may indicate that abnormal metyrapone responses in depression are state dependent.
The metyrapone test was applied to patients suffering from major depressive illness with melancholia, from mania, and from schizophrenia. Hypoactivity of the HPA axis as assessed by the test appears to occur infrequently in affective disorders and schizophrenia. High normal or exaggerated responses to metyrapone, as observed in Cushing's disease, appear to be correlated to DST non-suppression in melancholia.
The metyrapone (Metopiron) test (MT), a useful and reliable procedure for assessing hypothalamic-pituitary-adrenal (HPA) axis function, was applied to manic patients and healthy subjects. Three out of 11 patients had high normal responses to metyrapone, as observed in patients with Cushing's disease. One patient exhibited a subnormal response to metyrapone, as occurs in patients with adrenal insufficiency. No such abnormalities were detected in 11 matched healthy control subjects. These preliminary results suggest that the HPA axis activity patterns in mania may be more complex than previously reported.
Health attitudes and psychological distress were investigated in 50 patients attending a lithium clinic and in 50 normal controls. Patients receiving lithium treatment did not report more worry about illness, hypochondriacal attitudes, concern about pain, disease phobia and bodily preoccupations than normals, even though they took fewer precautions about their health and exhibited more self-rated psychological distress. Since most of the psychiatric patients were found to display more fears about illness and death than controls in other studies, this preliminary report may suggest that normal health attitudes are associated with lithium compliance in affective illness.
The lithium loading dose method developed by Cooper and associates resulted in achievement of therapeutic concentrations in 29 of 30 psychiatric inpatients. Fewer lithium determinations were required than in 30 other inpatients treated with the traditional trial-and-error technique.
Experimental allergic encephalomyelitis (EAE) was induced in chickens by injecting human myelin basic protein (MBP) in Freund's complete adjuvant (CFA). Antibodies of IgM, IgA and IgG class to MBP were measured by enzyme-linked immunosorbent assay (ELISA). The ability of the blood from the experimental chickens to induce graft-versus-host (GvH) reaction was tested in chick embryos. Serum concentrations of sialic acid and antitrypsin were monitored. Substantial inflammatory infiltrations were found in various parts of the central nervous system of the animals injected with MBP, but not in the controls receiving plain CFA. Enlargement of the white pulp and plasmocytosis were found in the spleens of the EAE animals. In the course of the disease, anti-MBP IgM and IgA antibody levels strongly increased, while IgG antibodies remained unchanged. The GvH caused by the blood from EAE animals did not differ from that of control birds. The EAE group showed significantly higher antitrypsin concentration than the controls. The increase in sialic acid concentration was of equal magnitude in the EAE animals and in the CFA controls.
Data on 225 adult arsonists arrested in a metropolitan county over a four-year period were systematically gathered. In each case 83 variables related to the arsonist and the arson were examined. The presence or absence of a partner in crime clearly differentiated two groups of arsonists . Partner and solo arsonists are characterized by a different level of social functioning and a different burden of mental impairment and criminal history. By focusing on the partner variable, it also becomes clear that the characteristics of the offense are related to those of the offender.
Maprotiline is a tetracyclic antidepressant which appears to have accounted for a relatively large proportion of the seizures associated with antidepressant use. The literature proposes two mechanisms of seizure induction: interaction with other medications and concomitant medical conditions lowering the seizure threshold. Observations during a study of maprotiline blood levels suggest that elevated serum concentrations achieved with therapeutic doses may also be linked to the seizure-induction mechanism. Monitoring of maprotiline blood levels may help to identify patients at risk.
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Cerebrospinal fluid 5-hydroxyindoleacetic acid (5HIAA), homovanillic acid (HVA), and tryptophan in both CSF and plasma were measured in a carefully selected group of 33 depressed women. Strict and explicit inclusion and exclusion criteria were used, and CSF was taken under controlled circumstances. Seventeen operationally defined and uniformly rate psychiatric symptoms as well as global depression severity and 12 clinical background variables were correlated with the four biochemical parameters, using multivariate regression analysis based on Spearman's rank correlation coefficient according to the nature of the data. Global depression severity did not correlated with any of the biochemical variables; there were, however, significant correlations between CSF 5HIAA and anxiety, insomnia, and suicide on the one hand, and between CSF HVA and motor symptoms and paranoidity on the other hand. Background variables showed only a few--and much weaker--correlations. It was concluded that central monoamine metabolism does affect some particular psychiatric symptoms but is not parallel with the complex clinical construct of the depressive disease. Further studies using isolated psychopathological symptoms instead of nosological categories are suggested in clinical neurochemistry.
5-Hydroxyindoleacetic acid, homovanillic acid, and tryptophan were measured in the lumbar cerebrospinal fluid of 33 female patients with severe hospitalized depression. Total plasma tryptophan was also determined in blood samples taken simultaneously at the time of lumbar puncture. Twelve clinical parameters were recorded using operational definitions for variables not measurable in physical units, and were compared in patient subgroups containing individuals with the highest and the lowest metabolite levels. Only age proved to be significantly higher in patients with low CSF 5-HIAA, and body height showed the same tendency. The lack of other significant differences indicates that there are no close relations between these clinical parameters and the biochemical variables except the two mentioned above.
The group of 33 severely depressed female patients was divided into 3 equally large subgroups, separately according to their CSF 5-HIAA, HVA, tryptophan and total plasma tryptophan, and the severity of 17 operationally defined psychopathological symptoms was compared between the subgroups containing the highest and lowest biochemical values. Nonparametric statistical testing yielded significant results on several symptoms, when the subgroups were formed from CSF 5-HIAA and HVA. There was only one significant symptom difference between subgroups separated by CSF tryptophan and a few other differences by plasma tryptophan level. The results indicate that lumbar CSF metabolites correlate more with certain individual symptoms than with the global severity of depression.
Cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5HIAA), homovanillic acid (HVA) and tryptophan (TRY) were measured in 14 male alcohol-dependent patients with delirium tremens. Lumbar punctures were performed immediately after admission following a standardized psychiatric examination and symptom rating in a drug-free state. Results were compared with a control group consisting of 32 neurological patients with only peripheral disorders, excluding spinal processes and abnormal routine CSF findings. All three substances were significantly increased in delirium tremens; 5HIAA showed the most marked and TRY the least pronounced increase. The statistical correction for age, height and body weight did not decrease but somewhat increased the differences. Duration of alcohol abuse did not account for the observed metabolic changes; severity of delirium tremens, however, correlated significantly with the 5HIAA and to a lesser degree with the HVA level. The further analysis revealed a differential relationship of the amine metabolite concentrations to some prominent symptoms: agitation was significantly dependent only on the HVA level while disorientation and hallucination seemed to be determined mostly by the serotonin metabolite 5HIAA in the CSF. TRY concentration proved to be unrelated to either global severity or any of these symptoms.