BACKGROUND: The American College of Rheumatology has defined 19 neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE) involving the central, peripheral, and autonomic nervous systems. Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in up to 95% of pediatric patients with SLE. OBJECTIVE: The authors describe a 15-year-old African American young woman with a family history positive for bipolar I disorder and schizophrenia, who presented with symptoms consistent with an affective disorder. METHOD: The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic work-up, which revealed cerebral vasculitis. RESULTS: NPSLE was diagnosed and, after treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy. CONCLUSION: Given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent patient may indeed be the initial manifestations of SLE, as opposed to a primary affective disorder.
Neuropsychiatric Systemic Lupus Erythematosus Presenting as Bipolar I Disorder With Catatonic Features
понедельник, 26 октября 2009 г.
четверг, 22 октября 2009 г.
повышенное количество маркеров воспаления при шизофрении и бар
Sigrun Hope, from the University of Oslo, and colleagues therefore measured plasma soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin (IL)-1 receptor antagonist (IL-1Ra), IL-6, high-sensitivity C reactive protein (hs-CRP), soluble CD40L ligand (sCD40L), and von Willebrand factor (vWF) levels in 125 bipolar disorder patients, 186 schizophrenia patients, and 244 healthy controls.
The findings, published in the journal Bipolar Disorders, indicate the combined patient groups had significantly higher plasma levels of sTNF-R1 and vWF compared with healthy controls, at increases of 17% and 27%, respectively. While hs-CRP levels were significantly increased in patients versus controls, at an average of 0.95 ng/ml versus 0.80 ng/ml, there were no significant differences for the other inflammatory markers.
The team also found that unmedicated bipolar disorder and schizophrenia patients had significantly increased levels of sTNF-R1 and vWF compared with controls, at1.09 versus 0.91 ng/ml and 101 versus 77%, respectively. There were no significant differences between bipolar disorder and schizophrenia patients, regardless of medication status.
The findings were unaffected by controlling for age, gender, ethnicity, liver function, kidney function, cardiovascular disorder, diabetes, and alcohol intake, as well as for hs-CRP levels.
Inflammatory markers increased in bipolar disorder and schizophrenia
The findings, published in the journal Bipolar Disorders, indicate the combined patient groups had significantly higher plasma levels of sTNF-R1 and vWF compared with healthy controls, at increases of 17% and 27%, respectively. While hs-CRP levels were significantly increased in patients versus controls, at an average of 0.95 ng/ml versus 0.80 ng/ml, there were no significant differences for the other inflammatory markers.
The team also found that unmedicated bipolar disorder and schizophrenia patients had significantly increased levels of sTNF-R1 and vWF compared with controls, at1.09 versus 0.91 ng/ml and 101 versus 77%, respectively. There were no significant differences between bipolar disorder and schizophrenia patients, regardless of medication status.
The findings were unaffected by controlling for age, gender, ethnicity, liver function, kidney function, cardiovascular disorder, diabetes, and alcohol intake, as well as for hs-CRP levels.
Inflammatory markers increased in bipolar disorder and schizophrenia
понедельник, 19 октября 2009 г.
Средиземноморская диета снижает риск возникновения депрессии
Dr. Martinez-Gonzalez said the risk for depression was substantially lower in participants with higher adherence to the MDP and that depression rates were about 30% lower in those with the highest consumption of fruit, nuts, legumes, and monounsaturated vs saturated fats.
"The important thing regarding fish is that a very low consumption of fish (lowest quintile) was in fact a risk factor when it was compared with the 3 upper categories of fish consumption (merged together)," he added.
The researchers were trying to determine why the lifetime prevalence of mental disorders is lower in Mediterranean than Northern European countries. One possible factor is diet, as previous research has suggested that the monounsaturated fatty acids in olive oil — used abundantly in the Mediterranean diet — may be associated with a lower risk for severe depressive symptoms.
The study included 10,094 healthy Spanish participants who reported their dietary intake on a food frequency questionnaire. After a median follow-up of 4.4 years, there were 480 new cases of depression. Individuals who followed the Mediterranean diet most closely had a greater than 30% reduction in the risk for depression than whose who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle.
The strength of the inverse association between the [MDP] and depression surprised the investigators. "The new question for us is that if these results will be reproduced in a primary prevention trial," Dr. Martinez-Gonzalez said. "Another new question is whether the MDP is longitudinally associated with increased serum levels of BDNF," or brain-derived neurotrophic factor — a peptide critical for axonal growth, neuronal survival, and synaptic plasticity.
According to the authors, "An emerging concept in neuroscience is that perturbations in the health of cerebral endothelium (such as some loss of the neuroprotection afforded by BDNF) may mediate progressive neuronal dysfunction." Depression is associated with low BDNF in some patients.
Mediterranean Diet Cut Depression Risk by 30%
"The important thing regarding fish is that a very low consumption of fish (lowest quintile) was in fact a risk factor when it was compared with the 3 upper categories of fish consumption (merged together)," he added.
The researchers were trying to determine why the lifetime prevalence of mental disorders is lower in Mediterranean than Northern European countries. One possible factor is diet, as previous research has suggested that the monounsaturated fatty acids in olive oil — used abundantly in the Mediterranean diet — may be associated with a lower risk for severe depressive symptoms.
The study included 10,094 healthy Spanish participants who reported their dietary intake on a food frequency questionnaire. After a median follow-up of 4.4 years, there were 480 new cases of depression. Individuals who followed the Mediterranean diet most closely had a greater than 30% reduction in the risk for depression than whose who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle.
The strength of the inverse association between the [MDP] and depression surprised the investigators. "The new question for us is that if these results will be reproduced in a primary prevention trial," Dr. Martinez-Gonzalez said. "Another new question is whether the MDP is longitudinally associated with increased serum levels of BDNF," or brain-derived neurotrophic factor — a peptide critical for axonal growth, neuronal survival, and synaptic plasticity.
According to the authors, "An emerging concept in neuroscience is that perturbations in the health of cerebral endothelium (such as some loss of the neuroprotection afforded by BDNF) may mediate progressive neuronal dysfunction." Depression is associated with low BDNF in some patients.
Mediterranean Diet Cut Depression Risk by 30%
пятница, 16 октября 2009 г.
депрессия и фолиевая кислота
Instead, the men were referring to medical foods - more specifically, a new product called Deplin, a medical food that includes L-methylfolate, the only active form of folate that can cross the blood brain barrier and help with the synthesis of the neurotransmitters associated with mood and, consequently, mood disorders such as depression: serotonin, dopamine, and norepinephrine.
Research shows that people with depression and low folate levels are less likely to respond to treatments such as antidepressants and less likely to achieve remission.
Treating Depression and Folate Deficiency With Medical Foods
Research shows that people with depression and low folate levels are less likely to respond to treatments such as antidepressants and less likely to achieve remission.
Treating Depression and Folate Deficiency With Medical Foods
отравление бергамотом
A 44-year-old man presented in May, 2001, with muscle cramps. He had no medical history of note, but volunteered the fact that he had been drinking up to 4 L of black tea per day over the past 25 years. His preferred brand was GoldTeefix (Tekanne, Salzburg, Austria). Since this type of tea had given him occasional gastric pain, he changed to Earl Grey (Twinings & Company, London, UK), which he thought would be less harmful to his stomach. 1 week after the change, he noticed repeated muscle cramps for some seconds in his right foot. The longer he drank Earl Grey tea, the more intense the muscle cramps became. After 3 weeks, they also occurred in the left foot...
Earl Grey tea is composed of black tea and the essence of bergamot oil, an extract from the rind of bergamot orange (Citrus aurantium ssp bergamia), which has a pleasant, refreshing scent. Bergamot oil contains bergapten (5-methoxypsoralen), bergamottin (5-geranyloxypsoralen), and citropten (5,7-dimethoxycoumarin), which can be found in grapefruit juice, celery, parsnips, and Seville orange juice. Bergamot oil is a well-known UVA-induced photosensitiser with a strong phototoxic effect, and is used therapeutically in psoriasis, vitiligo, mycosis fungoides, and cutaneous lymphoma. Because of this side-effect, bergamot oil has been widely banned as an ingredient in cosmetics and tanning products. Bergamot oil also has a hepatotoxic effect and may cause contact-allergy. The adverse effects of bergamot oil in this patient are explained by the effect of bergapten as a largely selective axolemmal potassium channel blocker, reducing potassium permeability at the nodes of Ranvier in a time-dependent manner. This may lead to hyperexcitability of the axonal membrane and phasic alterations of potassium currents, causing fasciculations and muscle cramps.
Tea intoxication
Earl Grey tea is composed of black tea and the essence of bergamot oil, an extract from the rind of bergamot orange (Citrus aurantium ssp bergamia), which has a pleasant, refreshing scent. Bergamot oil contains bergapten (5-methoxypsoralen), bergamottin (5-geranyloxypsoralen), and citropten (5,7-dimethoxycoumarin), which can be found in grapefruit juice, celery, parsnips, and Seville orange juice. Bergamot oil is a well-known UVA-induced photosensitiser with a strong phototoxic effect, and is used therapeutically in psoriasis, vitiligo, mycosis fungoides, and cutaneous lymphoma. Because of this side-effect, bergamot oil has been widely banned as an ingredient in cosmetics and tanning products. Bergamot oil also has a hepatotoxic effect and may cause contact-allergy. The adverse effects of bergamot oil in this patient are explained by the effect of bergapten as a largely selective axolemmal potassium channel blocker, reducing potassium permeability at the nodes of Ranvier in a time-dependent manner. This may lead to hyperexcitability of the axonal membrane and phasic alterations of potassium currents, causing fasciculations and muscle cramps.
Tea intoxication
среда, 14 октября 2009 г.
вторник, 13 октября 2009 г.
Илоперидон
QT Prolongation: In an open-label QTc study in patients with schizophrenia or schizoaffective disorder (N=160), Fanapt was associated with QTc prolongation of 9 msec at an iloperidone dose of 12 mg twice daily. This affect was augmented by the presence of CYP450, 2D6 or 3A4 metabolic inhibition. The use of Fanapt should be avoided in combination with other drugs that are known to prolong QTc. Caution is warranted when prescribing Fanapt with drugs that inhibit Fanapt metabolism.
Weight Gain: Based on the pooled data from the four placebo-controlled, 4- or 6-week, fixed- or flexible-dose studies, the proportions of patients having a weight gain of greater than or equal to 7% body weight was 12% for Fanapt 10-16 mg/day, 18% for Fanapt 20-24 mg/day, and 13% for Fanapt (combined doses) versus 4% for placebo.
Orthostatic Hypotension and Syncope: Fanapt can induce orthostatic hypotension and syncope. Fanapt should be used with caution in patients with known cardiovascular disease, cerebrovascular disease, or conditions that predispose the patient to hypotension.
Leukopenia, Neutropenia, and Agranulocytosis: In clinical trial and postmarketing experience, events of leukopenia/neutropenia have been reported temporally related to antipsychotic agents. Agranulocytosis (including fatal cases) have been reported. Patients with a pre-existing low white blood cell count (WBC) or a history of leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue Fanapt at the first sign of a decline in WBC in the absence of other causative factors.
Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, Fanapt elevates prolactin levels. Galactorrhea, amenorrhea, gynecomastia and impotence have been reported in patients receiving prolactin-elevating compounds.
Novartis Enters Into Agreement for Exclusive US and Canadian Rights to Fanapt(TM), an FDA-Approved Oral Therapy for Schizophrenia
Weight Gain: Based on the pooled data from the four placebo-controlled, 4- or 6-week, fixed- or flexible-dose studies, the proportions of patients having a weight gain of greater than or equal to 7% body weight was 12% for Fanapt 10-16 mg/day, 18% for Fanapt 20-24 mg/day, and 13% for Fanapt (combined doses) versus 4% for placebo.
Orthostatic Hypotension and Syncope: Fanapt can induce orthostatic hypotension and syncope. Fanapt should be used with caution in patients with known cardiovascular disease, cerebrovascular disease, or conditions that predispose the patient to hypotension.
Leukopenia, Neutropenia, and Agranulocytosis: In clinical trial and postmarketing experience, events of leukopenia/neutropenia have been reported temporally related to antipsychotic agents. Agranulocytosis (including fatal cases) have been reported. Patients with a pre-existing low white blood cell count (WBC) or a history of leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue Fanapt at the first sign of a decline in WBC in the absence of other causative factors.
Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, Fanapt elevates prolactin levels. Galactorrhea, amenorrhea, gynecomastia and impotence have been reported in patients receiving prolactin-elevating compounds.
Novartis Enters Into Agreement for Exclusive US and Canadian Rights to Fanapt(TM), an FDA-Approved Oral Therapy for Schizophrenia
понедельник, 12 октября 2009 г.
Кортизол и память
В Лейденском университете защищена диссертация на тему ''Ускользающее из памяти'' (ориг. на англ. ''Fading memories''). Автор работы - M.Tollenaar (ф-т социальных наук). Исследование посвящено непосредственным и долговременным эффектам гормонов стресса на способность вспомнить что-либо. Исследовательница изучала прежде всего гормоны стресс: кортизол и (нор)адреналин. Диссертация показывает, что стресс или добавление кортизола приводят к ухудшению памяти. Эти эффекты лучше всего просматривались при попытке воспроизведения заученных слов, но практически не затрагивали личные воспоминания. Если под воздействием только стресса люди затруднялись припомнить менее эмоциональные слова, то при добавлении кортизола они уже хуже справлялись с задачей припоминания нейтральных слов. Самым важной новой находкой является то, что острый стресс в сочетании с некоторой дозой кортизола производит также долговременный эффект в части воспоминания нейтральных и эмоциональных слов. Автор не обнаружила воздействия стресса и кортизола на эмоциональные переживания воспоминаний. Исследовательница планирует в будущем исследовать эффекты гормонов стресса на автобиографические воспоминания. Это позволит лучше понять применение кортизола и пропранолола в клинической практике.
МНИИП
МНИИП
воскресенье, 11 октября 2009 г.
Нейролептики при деменции
После рекомендации воздерживаться от употребления атипичных нейролептиков из-за повышенного риска инсультов, Trifiro отметил убедительный рост количества назначений классических антипсихотиков. Но эти препараты несут такой же высокий (зависимый от дозы) риск инсульта, что и атипичные антипсихотики, по сравнению с пациентами, которые не принимали никаких психотропных препаратов. В некоторых подгруппах классических нейролептиков риск намного выше, в частности, 5,8 для фенотиазинов и 3,6 для бутирофенонов (например, галоперидола). Trifiro призывает максимально ограничить использование обоих классов лекарств. ''Употреблять их только при необходимости, в самых низких дозах и в течение максимально короткого времени''. Trifiro не отмечает при использовании классических антипсихотиков повышенного риска (в т.ч. фатальной) пневмонии, по сравнению с атипичными антипсихотиками. Вместе с тем, он ожидал повышенных рисков в связи с действием на экстрапирамидную систему, что вызывает акинезию и впоследствии может вызвать аспирационную пневмонию. Но, как оказалось, летальные случаи от воспаления легких чаще встречались при использовании атипичных антипсихотиков. Вероятность пневмонии возрастает в связи с аффинитетом антипсихотиков к гистаминергическим рецепторам Н1. Именно поэтому у фенотиазинов самый высокий сравнительный риск 4,3 – по сравнению с пациентами, которые не принимают психотропных препаратов. Trifiro объясняет это тем, что гистаминовые рецепторы участвую в седации, а седация может создавать проблемы с глотанием и впоследствии аспирационную пневмонию.
МНИИП
МНИИП
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