The treatment of negative symptoms: a clinical and methodological study.

The primary objective of this study was to evaluate the efficacy, safety and tolerability of remoxipride (controlled release) versus haloperidol in patients with negative symptoms. The study comprised a multicentre, randomised, double-blind, parallel-group clinical trial. Two hundred and five patients were randomised to either remoxipride or haloperidol.

Impasse or pseudo-impasse in the psychotherapy of an inhibited writer.

This paper describes the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy, during which there occurred two significant impasse enactments. At first sight, each resembled a classical impasse. On further review of the case, the interactions took on a different texture that we have described as a pseudo-impasse in the course of the therapy.

Neuroanatomic correlates of CCK-4-induced panic attacks in healthy humans: a comparison of two time points.

Background: Several functional imaging studies have demonstrated increases of brain activity in the temporofrontal, cingulate, and claustrum regions during a pharmacologically induced panic attack when scanning was done at a single point in time. However, no study has evaluated changes in brain activity at two time points during a panic attack. We hypothesized that in response to a single bolus injection of the panicogen cholecystokinin-4 (CCK-4) in healthy volunteers, changes in regional cerebral blood flow (rCBF) might be different if scanning were done at two different time points.

Influence of acute tryptophan depletion on mood and immune measures in healthy males.

Depressive illness has been associated with variations of several aspects of immune functioning, as well as alterations of cytokine production in stimulated lymphocytes. In the present investigation we sought to determine whether pharmacologically-induced reductions of mood in healthy, male subjects would be associated with alterations in the levels of circulating IL-1 beta or IL-6 or to in vitro lymphocyte proliferation in response to T cell mitogens, PHA and Con A. Lowering tryptophan levels by means of a tryptophan-deficient amino acid mixture, which reduced plasma tryptophan and serotonin (5-HT) levels, produced a lowering of mood in a subset of male subjects (that had no personal or family history of depression) relative to subjects that received a balanced amino acid mixture.

Paraphrenia redefined.

Background: Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis," "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category.

Event-related potentials in schizophrenic patients during a degraded stimulus version of the visual continuous performance task.

Previous studies of the auditory P300 event-related potential (ERP) have reported smaller amplitudes in chronic schizophrenics but similar consistencies have not been observed with visual P300s. This study examined P300s in symptomatically stable, medicated, chronic schizophrenics (n = 14) and normal controls (n = 14) performing a visual continuous performance task utilizing degraded stimuli to burden encoding processes. Performance analysis found slower response times, fewer target detections and more false alarms in patients than in controls.

Event-related potential correlates of primed and unprimed words in children co-morbid for disruptive behaviour disorders and academic delay.

Children with disruptive behaviour disorders and academic delay (DD-AD) were compared to children with disruptive behaviour disorders only (DD) and normal control children with no psychiatric disturbance or academic delay (NO) with respect to scalp-recorded event-related electrical potentials (ERPs) elicited by semantically primed and unprimed words. Primed words were preceded by spoken words having a related meaning, while unprimed words were preceded by nonassociated spoken words. For normal controls, the unprimed words elicited greater N400 amplitudes at frontal-central recording sites than primed words.

Evidence supporting the independent inheritance of primary affective disorders and primary alcoholism in the families of bipolar patients.

Background: This study explored the nature of the association between bipolar disorder and alcoholism.

Methods: The authors studied 814 first-degree relatives of 121 bipolar patients, divided on the basis of response to lithium prophylaxis. Logistic regression analysis was used to analyze the contribution of demographic, familial and clinical variables to the risk of primary alcoholism in the relatives.

Behavioral, cardiovascular, and neuroendocrine profiles following CCK-4 challenge in healthy volunteers: a comparison of panickers and nonpanickers.

Healthy subjects who panic following systemic cholecystokinin-tetrapeptide (CCK-4) challenge typically exhibit a symptom profile reminiscent of that evident among panic patients. However, the biological concomitants of CCK-4-induced panic in healthy subjects remain obscure. Accordingly, we evaluated the behavioral, cardiovascular, and neuroendocrine effects of CCK-4 in panickers and nonpanickers.

The cholinergic basis of the smoking-induced EEG activation profile.

Acute quantitative electroencephalographic effects of cigarette smoking were examined in 15 smokers within a repeated-measures design which assessed changes in power-spectral estimates following acute pre-treatment with placebo, a dose (20 mg) of mecamylamine, a dose (0.6 mg) of scopolamine and a combined dose of mecamylamine and scopolamine. Compared to sham smoking, the smoking of a single cigarette following placebo pre-treatment reduced absolute and relative power in slow (delta, theta) frequency bands, increased absolute and relative power in alpha and beta frequency bands and accelerated mean frequency.

Decrease in short-term memory function induced by CCK-4 in healthy volunteers.

The purpose of this study was to assess the effects of continuous intravenous infusion of the central cholecystokinin (CCK) receptor agonist, CCK-4, on short-term memory and psychomotor performance in healthy volunteers in a double-blind, placebo-controlled, parallel group study. Compared to placebo, CCK-4 (0.5 mg/h) significantly impaired performance on free-recall and recognition of words in the middle of the CCK-4 infusion, but did not affect psychomotor acuity.

A Canadian multicenter study of three fixed doses of controlled-release ipsapirone in outpatients with moderate to severe major depression.

Ipsapirone, an azapirone with 5-hydroxytryptamine (5-HT1A) partial agonist activity, has been shown in preliminary studies to be effective in the treatment of major depressive disorder. This 8-week, randomized, double-blind study compared the efficacy, safety, and tolerability of three fixed doses of controlled-release ipsapirone (10-, 30-, and 50-mg dose once daily) with placebo in 410 patients with moderate to severe major depression (Hamilton Rating Scale for Depression [HAM-D] score > or = 20). The 10-mg ipsapirone treatment arm was discontinued early in the study.

Diminished serotonin-mediated prolactin responses in nondepressed stroke patients compared with healthy normal subjects.

Background And Purpose: The purpose of this study was to use hormonal responsiveness to d-fenfluramine (d-FEN) challenge as a measure of central serotonin (5-HT) function in a comparative evaluation of serotonergic abnormalities between stroke patients and healthy elderly normal subjects to test the hypothesis that stroke may be associated with diminished serotonergic functioning.

Methods: Eight nondepressed medically stable stroke patients and 12 healthy volunteers completed a single-blind, placebo-controlled, fixed-order, crossover design challenge test with 30 mg of oral d-FEN. Baseline prolactin (PRL) and cortisol (CORT) and hormonal responses to d-FEN and placebo were measured at hourly intervals over a 4-hour period.

Has the effectiveness of lithium changed? Impact of the variety of lithium's effects.

Lithium treatment, initially considered specific for bipolar disorder, has since been shown to provide additional benefits in affective and other disorders. This variety of benefits should be taken into account when interpreting recently reported lower efficacy during lithium prophylaxis, as well as early relapses and loss of efficacy after lithium discontinuation. There are particularly striking parallels between these recent reports and earlier observations of "antipsychotic" lithium effects.

Risperidone for the treatment of behavioral disturbances in dementia: a case series.

The authors describe a series of 22 patients with dementia and behavioral disturbances, including agitation, aggression, delusions, and hallucinations, who were treated with risperidone. Risperidone, in low doses, was well tolerated; 50% of patients experienced significant improvement, although 50% experienced some extrapyramidal symptoms.

Mixed Anxiety and Depression : Diagnosis and Treatment Options.

Symptoms of anxiety and depression often appear together in patients, either as 2 discrete disorders, such as major depressive disorder and panic disorder, or as a combination of symptoms not meeting criteria for specific disorders. The social, economic, occupational and medical costs of such comorbid anxiety and depression can be enormous, affecting both the individual and society.The clinician must be creative when treating patients with mixed anxiety and depressive symptoms; psychopharmacological treatment can involve the use of a variety of mono- and polytherapies.

Psychiatric symptoms and syndromes among adolescent children of parents with lithium-responsive or lithium-nonresponsive bipolar disorder.

Objective: The purpose of this pilot study was to describe the initial course of psychiatric illness in the adolescent children of parents with bipolar disorder who were divided into two groups on the basis of their response to long-term lithium monotherapy.

Method: Proband parents met Research Diagnostic Criteria for bipolar illness and predetermined criteria for a clear response or nonresponse to lithium prophylaxis. All adolescent offspring were interviewed by a blinded interviewer using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and final diagnosis was made by blinded consensus.

Aging, smoking and EEG coherence: a preliminary study.

Although the cigarette smoking habit is prevalent in young, middle aged and elderly adults, it is yet unknown whether a long term smoking history alters the aging brain and/or whether the aging brain demonstrates an altered sensitivity to acute smoking. Inter- and intrahemispheric EEG coherence was compared in 20 young (18-39 years) adults (10 smokers, 10 nonsmokers) and 20 elderly (64-81 years) adults (10 smokers, 10 nonsmokers). The acute effects of sham inhaling on a nonlighted cigarette and cigarette smoking on EEG coherence was also compared in young and elderly adult smokers.

Relaxation-induced EEG alterations in panic disorder patients.

Based on previous reports of relaxation-induced panic attacks in panic disorder patients, quantitative electroencephalographic (EEG) profiles and subjective anxiety ratings were assessed in panic disorder patients and normal controls listening to neutral and relaxation audiotapes. Regardless of tape condition, patients exhibited a greater frequency and severity of panic-related symptoms. Relaxation failed to alter panic-related symptom ratings or anxiety ratings in patients and controls.

Moclobemide versus fluoxetine in the treatment of major depressive disorder in adults.

The objective of the present study was to compare the safety and efficacy of moclobemide versus fluoxetine in adult patients with major depressive disorder. The design of the study was a multicenter, double-blind, comparative, and randomized trial. A 1- to 2-week single-blind placebo washout phase was followed by 6 weeks of double-blind treatment with moclobemide or fluoxetine.

A comparison of placebo response with major depressive disorder in patients recruited through newspaper advertising versus consultation referrals.

Recent evidence indicates few differences between patients recruited through advertising and by consultation referral, and there is some suggestion that those recruited through advertising are more representative of the target community population. However little has been reported on differences in placebo response and compliance in these two patient groups. We conducted a retrospective chart review of 49 patients with major depressive disorder (MDD), recruited through advertising or consultation, randomized to placebo in five clinical trials.

Case study: withdrawal syndrome in adolescent chronic cannabis users.

Cannabis use is common among adolescents and has recently been increasing, especially among young teenagers. Whether the reduction of cannabis in chronic heavy users results in a clinically significant withdrawal syndrome is controversial. This article presents three case vignettes supporting the view that chronic cannabis use by adolescents may result in a clinically significant withdrawal syndrome and that the associated physiological symptoms directly contribute to the persistent use of the substance.