Urinary excretion of metabolites of norepinephrine in Tourette’s syndrome

Urinary excretion of the norepinephrine metabolites 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) and normetanephrine (NME) was measured in Tourette’s Syndrome (TS) patients and in control subjects matched for age and education. The 24-h excretion (expressed per gram of creatinine) of total MHPG and of free and total (free + conjugated) NME was significantly lower in TS patients than in the normal subjects.     

Urinary norepinephrine excretion in panic and phobic disorders

Summary Morning urinary norepinephrine (NE) was assessed in 36 patients suffering from panic and phobic disorders according to DSM III. Urinary NE excretion was significantly higher in this group than in a normal control one. Phobic patients excreted lower levels of NE than panic ones. No significant association was found between urinary NE levels and anxiety scores according to Zung's Anxiety Status Inventory or Wittenborn Psychiatric Rating Scale. The NE increase is interpreted as reflecting a sympathetic nervous system hyperactivity in anxiety. A concomitant effect upon NE metabolism of benzodiazepine withdrawal cannot be discarded since the group of patients previously medicated showed the highest NE excretion.     

High correlations of norepinephrine, dopamine, and epinephrine and their major metabolite excretion rates

We have previously reported high correlations between norepinephrine and its metabolite outputs in depressed patients. In this article, we expand this finding to healthy volunteers and alcoholic patients. Furthermore, we find similar high correlations between urinary outputs of dopamine, norepinephrine, and their major metabolites. The same is true, to a lesser degree, for epinephrine and metanephrine outputs. There are implications of these findings for psychobiological research on the monoamine systems.     

The pattern of urinary catecholamines and their metabolites in Duchenne myopathy,in relation to disease evolution

Summary In this report we have tried to determine whether or not catecholamines are involved in the progressive muscular dystrophy. Catecholamines and their metabolites were studied in urines of children with Duchenne disease or other forms of myopathy (limb-girdle and facio-scapulo humeral myopathies). Catecholamine deaminated metabolites were normal in either form of myopathy; in contrast, Duchenne patients, contrarily to other children, eliminated excessive amounts of most amines (catecholamines and methoxylated amines) in relation to age and degree of disease evolution.Our results indicate that catecholamines are not the primary factors involved in the pathogenesis of Duchenne myopathy, but are rather secondary to some disease effects. It is suggested that the high excretion of catecholamines and their methoxylated amine metabolites observed in severely affected Duchenne boys might be related to thermoregulatory processes or/and to alterations in some enzymatic systems.     

Urinary free and conjugated catecholamines and metabolites in autistic children

Urinary catecholamines (DA, NE, E) and their main metabolites (HVA, DOPAC, MHPG) were analyzed both as free and conjugates in eight children diagnosed as autistic according to DSM-III criteria and eight normal children. Significant differences appeared for the urinary excretion of both DA and NE and their respective metabolites: Autistic children showed low DA, high HVA, high NE, low MHPG urinary levels. These results are consistent with previous findings on altered catecholamine metabolism in autistic children. They suggest that autistic behaviour might be related to an abnormal functional imbalance among monoamines either at a molecular level or at a system level. Furthermore, they emphasize the special interest of urinary assays in pediatric research.This work was supported by CNRS (ER 196 and ERA-N 697, Biology and Neuropsychiatry), INSERM ATP 78-97, Social Security, 1982–1983, and Fondation Langlois. We thank Mrs. Barre, Mrs. Lardeux, Mrs. Lehn, and Miss Renon for their technical work.     

Plasma catecholamines and their metabolites in obsessive-compulsive disorder

Plasma catecholamines and their metabolites were sampled in 13 medication-free patients with obsessive-compulsive disorder (OCD) and 29 normal controls. In addition to severe OCD symptoms, the patients had significantly higher anxiety, tension, and resting pulse rates than the controls. Nonetheless, mean plasma concentrations of norepinephrine (NE) and epinephrine (E), the catecholamine metabolites 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA), and the stress-related hormone cortisol did not differ between OCD patients and normal controls. When the patients and control populations were combined and average plasma NE and E levels calculated over 35 min, subjects with a higher mean NE output (greater than 1.1 pm/ml) had higher Profile of Mood States depression scores than subjects with a low NE output (less than 1.1 pm/ml). Altogether, these results indicate that elevated plasma catecholamine measures are not likely to be associated with the pathophysiology of OCD.     

Urinary catecholamines and cortisol in parasuicide.

A relationship of urinary catecholamines and of urinary free cortisol with violent suicide attempts has been reported. We have reexamined this issue in patients within 24 hours of hospital admission. Suicide attempters had significantly higher norepinephrine (NE: mean +/- SD = 58.3 +/- 27.0 micrograms/24 hours; n = 27) than did control patients with suicidal ideation (mean +/- SD = 37.1 +/- 21.3; n = 10). Among suicide attempters, those who used physical means had the highest NE levels (mean +/- SD = 69.7 +/- 21.3) and those who took overdoses of antidepressants (mean +/- SD = 51.9 +/- 17.3; n = 6), benzodiazepines (mean +/- SD = 65.1 +/- 29.7; n = 5), or miscellaneous drugs (mean +/- SD = 59.1 +/- 36.5; n = 11) had lower NE values. In contrast to NE, urinary dopamine (mean +/- SD = 402.6 +/- 392 micrograms/24 hours, epinephrine (EPI: mean +/- SD = 14.3 +/- 4.0 micrograms/24 hours), the NE/EPI ratio (mean +/- SD = 8.3 +/- 0.9), urinary free cortisol (mean +/- SD = 157.9 +/- 11.5 micrograms/24 hours) and serum cortisol (mean +/- SD = 35.0 +/- 13.1 nM/l) did not differ between groups. There were no group differences in age (mean +/- SD = 36.3 +/- 16.5 years), Beck Depression Inventory score (mean +/- SD = 26.3 +/- 12.9), Beck Hopelessness Scale score (mean +/- SD = 10.0 +/- 5.6), Beck Scale for Suicidal Ideation score (mean +/- SD = 13.6 +/- 9.3), or Hamilton Rating Scale for Depression score (mean +/- SD = 19.5 +/- 9.8). In the four parasuicide groups, there was no difference in suicide intent (mean +/- SD = 13.3 +/- 7.9). These findings indicate that there is increased NE output shortly after suicide attempts. Previous reports of a low NE/EPI ratio in suicidal patients may reflect adaptive changes rather than the acute state of the patient at the time of the attempt.     

Metabolism and excretion of the neuroleptic drug perazine in healthy volunteers

The renal and faecal excretion of a single dose of 75 mg 35S-labelled perazine was investigated. The time course of the total radioactivity in plasma could not be adjusted satisfactorily to a Bateman function, whereas the renal excretion of radioactivity corresponded to an open two-compartment model. The marked interindividual variation of the metabolic profile, and of plasma half-lives reported in patients was not observed in normal volunteers. Thus, it is suggested that such interindividual variance is related to the special conditions in psychiatric patients such as individual pretreatment strategies.     

Toward a biochemical classification of depressive disorders. X. Urinary catecholamines, their metabolites, and D-type scores in subgroups of depressive disorders

Data on 24-hour urinary levels of catecholamines and metabolites were determined in 114 depressed patients. For each patient, a D-type score was calculated, using a discriminant function equation that was previously derived using data from an independent group of depressed patients. Of all measures, D-type scores provided the highest sensitivity and specificity for separating bipolar/schizoaffective-depressed patients from all remaining patients or from those patients with unipolar nonendogenous depressions. Using Research Diagnostic Criteria (RDC), bipolar I patients demonstrated significantly lower D-type scores than did all other RDC depressive subtypes, including bipolar II disorders. Similar findings were observed using the Clinical Inventory for the Diagnosis and Classification of Affective Disorders (CIDCAD) system: bipolar/schizoaffective patients demonstrated significantly lower D-type scores than all remaining subtypes, including diagnostically unclassifiable, probable bipolar patients (a category somewhat akin to RDC bipolar II disorder). Data pointed to the heterogeneity of bipolar disorders. Catecholamine and metabolite data in this study were compared with recent studies of others.     

Nociceptive-specific blink reflex and glyceryl trinitrate infusion in healthy volunteers

Glyceryl trinitrate (GTN) is known to induce early headache in healthy humans after intravenous infusion. Moreover, in animal models subcutaneous administration produces an increase in Fos expression in brainstem areas that are involved in trigeminal pain processing. In a double-blind crossover study, we tested the blink reflex before, during and immediately after GTN and placebo intravenous infusion in eight healthy volunteers using a new stimulation electrode that preferentially activates A-delta nociceptive afferent fibres. The initial hypothesis that GTN could induce an increase in the magnitude of the nociceptive blink reflex R2 component by stimulating activity of trigeminal nucleus caudalis wide dynamic range interneurones was not confirmed. Although mild headache was induced in six subjects, there was no significant change between the R2 area under the curve before and after drug vs. placebo.     

Misattribution of self-generated speech in relation to hallucinatory proneness and delusional ideation in healthy volunteers

When patients with hallucinations and delusions encounter their own distorted speech they tend to mistakenly attribute it to someone else. This external misattribution of self-generated material is thought to be associated with 'positive' psychotic symptoms. The aim of the present study was to examine this process in relation to the predisposition to hallucination-like experiences and unusual beliefs in a healthy population. Fifty-seven volunteers completed assessments of hallucination proneness and delusional ideation and performed a source-monitoring task. Participants listened to a series of pre-recorded words for which the source (self/non-self) and acoustic quality (undistorted/distorted) of the speech were varied across trials. Participants indicated whether the words were spoken in their own or another person's voice via a button press. Misattribution errors were greatest when participants made source judgements about their own distorted speech (p < 0.01) and were positively correlated with delusional ideation scores, particularly the level of conviction with which delusional ideas were held (p = 0.03), and there was a trend for a positive correlation with hallucination proneness scores. There was a negative correlation between unsure responses and delusional ideation when participants were processing their own distorted speech (p = -0.03). The misattribution of self-generated speech occurs in healthy individuals with high levels of psychotic-like experiences. This suggests that the same cognitive impairments may underlie psychotic phenomena in healthy individuals as in patients with psychotic disorders, consistent with a continuum model of psychosis.     

6-Hydroxydopamine lesions of dopaminergic A10 neurons. Long-term effects on the urinary excretion of free and conjugated catecholamines and their metabolites in the rat

Free and conjugated catecholamines (dopamine, noradrenaline, adrenaline) and their methoxylated and/or deaminated metabolites were studied in rat urine after the bilateral destruction of the A10 dopaminergic cell group. Two months after the lesion, dopamine (DA) loss reached 91% in the nucleus accumbens, and was greater than 80% in olfactory tubercles, lateral septum and frontal cortex. At the same time urinary conjugated dihydroxyphenylacetic acid (DOPAC) was decreased by 45% whilst homovanillic acid (HVA) was increased only in its sulfated form (+62%). In contrast, no changes were observed in the free and conjugated forms of urinary DA, 3-methoxytyramine noradrenaline, normetanephrine, adrenaline, vanylmandelic acid, 3-methoxy-4-hydroxyphenylglycol and in the free forms of DOPAC and HVA.The present report confirms and extends our previous findings on the relationships between central dopaminergic activity and urinary deaminated metabolites of DA in the rat. It emphasizes the interest of urinary assays which could provide in vivo information on CNS functions.     

Cerebroventricular size and cerebrospinal fluid monoamine metabolites in schizophrenic patients and healthy volunteers

Computed tomography (CT) measures and cerebrospinal fluid (CSF) levels of the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5-HIAA) were determined in 43 healthy volunteers and in 26 patients with an acute psychosis of the schizophrenic type. There were no differences in the mean CSF levels of monoamine metabolites between the two groups. However, the patients had significantly wider lateral and third ventricles as compared to the volunteers. In the volunteers there were no significant correlations between ventricular sizes and monoamine metabolite levels, whereas in the patients a significant negative correlation was obtained between the size of the lateral ventricles and the levels of HVA and 5-HIAA in the CSF. These results may indicate that the enlargements of the brain ventricles found in a subgroup of schizophrenic patients may be associated with deficiencies in central monoamine transmission mechanisms.     

Characteristics of norepinephrine and clonidine displacement of [3H]yohimbine binding to platelet alpha2-adrenoreceptors in healthy volunteers.

Clonidine's estimates of platelet alpha2-adrenoreceptor (alpha2AR) density are substantially lower than yohimbine's. This discrepancy could have contributed to inconsistent results from studies on the role of alpha2AR in depression. Furthermore, few studies have investigated the relative distribution of alpha2AR between the high- and low-affinity states or their Gi protein coupling. [3H]yohimbine saturable binding to platelet alpha2AR, its displacement by norepinephrine and clonidine, and the effects of Gpp(NH)p on agonist displacement curves were investigated in 11 healthy volunteers. Clonidine estimates of alpha2AR density were close to norepinephrine estimates, and both were strongly correlated. Clonidine's K(L)/K(H) ratio was lower than norepinephrine's, consistent with its partial agonist nature. Norepinephrine and clonidine displacement curves revealed two affinity states. Gpp(NH)p induced a significant rightward shift to a single low-affinity state. When used in combination with a specific antagonist, clonidine's estimates of alpha2AR density were similar to those of norepinephrine's, and both were higher than previously reported, when clonidine was used alone. Re-evaluation of previous studies on alpha2AR in depression using clonidine is needed. The combined use of antagonist-saturation and agonist-displacement experiments to examine possible dysregulation in alpha2AR coupling to Gi protein in psychiatric disorders is recommended.     

Influence of ondansetron on gastric sensorimotor responses to short duodenal acid infusion in healthy volunteers

Background Duodenal acid infusion induces gastric relaxation and sensitization to distension in healthy volunteers. The acid‐sensitive mechanism is still unknown. We hypothesized that 5HT₃‐blockade can inhibit the acid‐induced duodenogastric sensorimotor reflex in healthy volunteers. Methods Fourteen healthy volunteers were included in a randomized, double‐blind placebo‐controlled cross‐over trial. An infusion tube with attached pH‐electrode was positioned in the duodenum and a barostat balloon was located in the gastric fundus. Proximal gastric volume and sensitivity to distension were assessed before and during duodenal acid infusion and after pretreatment with intravenous (i.v.) ondansetron (a 5HT₃‐receptor antagonist, 8 mg) or saline. An overall perception score (0–6) and an assessment of nine dyspeptic symptoms by visual analogue scales (VAS) were obtained. Results are given as mean ± SEM. Key Results Ondansetron had no effect on duodenal pH and on the acid‐induced increase of proximal gastric volume (increase of 80 ± 20 vs 83 ± 15 mL after ondansetron and placebo; effect of acid <0.001, between treatments ns). After ondansetron, the overall perception score during duodenal acidification and gastric distension was significantly decreased compared with placebo (P = 0.01). There was no effect of ondansetron on the individual dyspeptic symptoms. Conclusions & Inferences Ondansetron decreased gastric sensitivity during duodenal acid infusion and gastric distension. 5HT₃‐receptors are involved in acid‐induced duodenogastric sensitization, but not in the duodenogastric inhibitory motor reflex.     

Plasma concentrations of phensuximide, methsuximide, and their metabolites in relation to clinical efficacy.

The clinical efficacy of phensuximide and methsuximide was studied in relation to plasma concentrations of these compounds and their desmethyl metabolites. Single- and chronic-dose studies of each drug were carried out in five patients with intractable seizures. Patients were evaluated before and during treatment by 6-hour simultaneous video and telemetered electroencephalographic recordings to characterize the seizure type and by daily determinations of plasma antiepileptic drug concentrations. Phensuximide had a mean half-life of 7.8 hours and accumulated to an average fasting level of only 5.7 micrograms per milliliter. Desmethylphensuximide averaged only 1.7 micrograms per milliliter with a similar half-life. Methsuximide had an even shorter half-life, averaging 1.4 hours, but its desmethyl metabolite had a mean half-life of 38 hours and therefore accumulated to levels in excess of 40 micrograms per milliliter. The addition of phensuximide to their regimens benefited none of the patients, but two had an excellent response to methsuximide. The failure of phensuximide and its desmethyl metabolite to accumulate to reasonable levels is the likely explanation for the relatively weak antiepileptic effect of phensuximide as compared with methsuximide.