Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our system...Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy(ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques.展开更多
Background: An association between apolipoprotein E (apoE) gene polymorphism and temperament has been found in the Young Finns cohort. Motor activity in childhood and mental vitality, sociability and positive emotiona...Background: An association between apolipoprotein E (apoE) gene polymorphism and temperament has been found in the Young Finns cohort. Motor activity in childhood and mental vitality, sociability and positive emotionality in adolescence were associated with apoE. Two research groups have attempted to replicate these findings but no associations have been found. Purpose: The purpose of the present study was to confirm the original findings with new and more reliable genotyping from a larger sample derived from the same Young Finns Study as the original finding.Methods: The study included 2808 participants aged 3 - 18 years in 1980. The same methods in assessing temperament were used as in the original study. Temperament was operationalized as motor activity, cooperativeness, negative emotionality, mental vitality, sociability and positive emotionality. Temperament was assessed by participants’ mothers in 1980 and 1983 and self-rated in 1983 by adolescent participants. Results: Motor activity was not associated with apoE polymerphisms. All other previous results were replicated. Adolescents’ positive emotionality, mental vitality and sociability were associated with apoE. Conclusions: The results indicated that there is an association between temperament and apoE. The previous absence of association between temperament and apoE in the replication studies may be due to the fact that researchers used different dimensions of temperament and thus probably studied different phenomena. Cultural differences in personality assessment might also explain the contradictory findings.展开更多
Objective: To investigate whether stimulated monocyte cytokine release and its inhibition by glucocorticoids differs between men and women. Design: In vitro m onocyte interleukin 6 (IL-6) and tumour necrosis factor α...Objective: To investigate whether stimulated monocyte cytokine release and its inhibition by glucocorticoids differs between men and women. Design: In vitro m onocyte interleukin 6 (IL-6) and tumour necrosis factor α(TNFα) release after lipopolysaccharide stimulation were assessed with and without co-incubation with increasing doses of dexamethasone and hyd rocortisone separately. Glucocorticoid sensitivity was defined as the amount of a particular glucocorticoid required to inhibit lipopolysaccharide stimulated mo nocyte cytokine release by 50%. The established cardiovascular risk factors of age, body mass index, number of cigarettes smoked daily, low density cholesterol to high density cholesterol ratio, systolic and diastolic blood pressure, and h aemoglobin A1c were used as covariates. Setting: Aircraft manufacturing plant in southern Germany. Patients: 269 middle aged male and 36 middle aged female empl oyees. Results: Release of monocyte IL-6 and TNFα(each p=0.001) was higher in samples from men than in those from women. Inhibition of lipopolysaccharide stim ulated IL-6 and TNFαrelease by either glucocorticoid was less pronounced in sa mples from men than in those from women (IL-6: dexamethasone p=0.033, hydrocort isone p=0.029; TNFα: dexamethasone p< 0.001, hydrocortisone p=0.089). Conclusio ns: The finding suggests that proinflammatory activity of circulating monocytes is higher in men than in women independent of cardiovascular risk factors, there by providing one explanation for the relatively greater coronary risk in men.展开更多
Recent research on autoimmune disorders suggests additional links between systemic and central nervous system(CNS)pathophysiology,among which the identification of antibody-induced limbic encephalitis provided the str...Recent research on autoimmune disorders suggests additional links between systemic and central nervous system(CNS)pathophysiology,among which the identification of antibody-induced limbic encephalitis provided the strongest evidence for the potential involvement of autoimmunity in the pathogenesis of severe mood and psychotic symptoms.In these illnesses,psychiatric symptoms predominate in the initial phase of the disorder in up to 70%of the cases,and they often lead patients to early psychiatric evaluation.For this reason,it is very important to increase the limited knowledge among psychiatrists about these autoimmune neuropsychiatric diseases,which can mimic psychiatric syndromes,in particular,those typically presented in severe mood disorders and schizophrenia.On the other hand,similarities in clinical presentation suggest that neuroinflammation and systemic immune dysregulation may play a role in the pathophysiology of severe mood and psychotic disorders.A complex interaction between periphery and immune cells of the CNS may result in cellular damage through mechanisms involving excitotoxicity,oxidative stress,and mitochondrial dysfunction.These pathways are possibly shared between comorbid medical disorders and severe mood and psychotic disorders and may reflect common underlying vulnerability.展开更多
文摘Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy(ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques.
基金The Academy of Finland projects 258578 (M. H.) 258711 (L. K.-J.)+19 种基金 126925 (O. T. R.) 121584 (O. T. R.) 124282 (O. T. R.) 129378 (O. T. R) 117797 (O. T. R.) 41071 (O. T. R.) 129398 (T. L.) 117941 (T. L.) grants from the Emil Aaltonen Foundation (M. H., O. T. R., T. L.) the Ella & Georg Ehrnrooth Foundation (M. H.) the Signe & Ane Gyllenberg Foundation (M. H., L. K.-J.) the Research Funds of the University of Helsinki (M. H.) the Finnish Cultural Foundation (P. M., O. T. R.) the Alfred Kordelin Foundation (P. M.) the Social Insurance Institution of Finland (O. T. R.) Kuopio, Tam- pere and Turku University Hospital Medical Funds (O. T. R.), the Juho Vainio Foundation (O. T. R.), the Paavo Nurmi Foundation (O. T. R.) the Finnish Foundation of Cardiovascular Research (O. T. R., T. L.) the Sigrid Ju- selius Foundation (O. T. R.) the Tampere Tuberculosis Foundation (T. L.) the Competitive Research Funding of Tampere University Hospital (T. L.)
文摘Background: An association between apolipoprotein E (apoE) gene polymorphism and temperament has been found in the Young Finns cohort. Motor activity in childhood and mental vitality, sociability and positive emotionality in adolescence were associated with apoE. Two research groups have attempted to replicate these findings but no associations have been found. Purpose: The purpose of the present study was to confirm the original findings with new and more reliable genotyping from a larger sample derived from the same Young Finns Study as the original finding.Methods: The study included 2808 participants aged 3 - 18 years in 1980. The same methods in assessing temperament were used as in the original study. Temperament was operationalized as motor activity, cooperativeness, negative emotionality, mental vitality, sociability and positive emotionality. Temperament was assessed by participants’ mothers in 1980 and 1983 and self-rated in 1983 by adolescent participants. Results: Motor activity was not associated with apoE polymerphisms. All other previous results were replicated. Adolescents’ positive emotionality, mental vitality and sociability were associated with apoE. Conclusions: The results indicated that there is an association between temperament and apoE. The previous absence of association between temperament and apoE in the replication studies may be due to the fact that researchers used different dimensions of temperament and thus probably studied different phenomena. Cultural differences in personality assessment might also explain the contradictory findings.
文摘Objective: To investigate whether stimulated monocyte cytokine release and its inhibition by glucocorticoids differs between men and women. Design: In vitro m onocyte interleukin 6 (IL-6) and tumour necrosis factor α(TNFα) release after lipopolysaccharide stimulation were assessed with and without co-incubation with increasing doses of dexamethasone and hyd rocortisone separately. Glucocorticoid sensitivity was defined as the amount of a particular glucocorticoid required to inhibit lipopolysaccharide stimulated mo nocyte cytokine release by 50%. The established cardiovascular risk factors of age, body mass index, number of cigarettes smoked daily, low density cholesterol to high density cholesterol ratio, systolic and diastolic blood pressure, and h aemoglobin A1c were used as covariates. Setting: Aircraft manufacturing plant in southern Germany. Patients: 269 middle aged male and 36 middle aged female empl oyees. Results: Release of monocyte IL-6 and TNFα(each p=0.001) was higher in samples from men than in those from women. Inhibition of lipopolysaccharide stim ulated IL-6 and TNFαrelease by either glucocorticoid was less pronounced in sa mples from men than in those from women (IL-6: dexamethasone p=0.033, hydrocort isone p=0.029; TNFα: dexamethasone p< 0.001, hydrocortisone p=0.089). Conclusio ns: The finding suggests that proinflammatory activity of circulating monocytes is higher in men than in women independent of cardiovascular risk factors, there by providing one explanation for the relatively greater coronary risk in men.
文摘Recent research on autoimmune disorders suggests additional links between systemic and central nervous system(CNS)pathophysiology,among which the identification of antibody-induced limbic encephalitis provided the strongest evidence for the potential involvement of autoimmunity in the pathogenesis of severe mood and psychotic symptoms.In these illnesses,psychiatric symptoms predominate in the initial phase of the disorder in up to 70%of the cases,and they often lead patients to early psychiatric evaluation.For this reason,it is very important to increase the limited knowledge among psychiatrists about these autoimmune neuropsychiatric diseases,which can mimic psychiatric syndromes,in particular,those typically presented in severe mood disorders and schizophrenia.On the other hand,similarities in clinical presentation suggest that neuroinflammation and systemic immune dysregulation may play a role in the pathophysiology of severe mood and psychotic disorders.A complex interaction between periphery and immune cells of the CNS may result in cellular damage through mechanisms involving excitotoxicity,oxidative stress,and mitochondrial dysfunction.These pathways are possibly shared between comorbid medical disorders and severe mood and psychotic disorders and may reflect common underlying vulnerability.
