Hypothermic, ACTH, and cortisol responses to ipsapirone in patients with mania and healthy controls.

BACKGROUND: The selective 5-HT1A receptor agonist ipsapirone causes dose-dependent decrease in body temperature and increase in adrenocorticotropic hormone (ACTH) and cortisol release in humans. These responses are attenuated by 5-HT1A receptor antagonists, suggesting that hypothermia, ACTH and cortisol release induced by ipsapirone are indeed mediated by 5-HT1A receptors and that these responses provide a valid index of 5-HT1A receptor function in humans. METHODS: To examine the 5-HT1A receptor sensitivity in patients with mania, we studied six manic patients and six age and sex matched healthy controls. After obtaining a blood sample for baseline hormone levels and measuring body temperature, a single dose of 0.3 mg/kg of ipsapirone was given orally to all the subjects and further bloods and temperature reading were obtained every 30 minutes for 3 hours. RESULTS: We found that ACTH and cortisol responses to ipsapirone were significantly increased in mania when compared to healthy controls, but there was no significant difference in hypothermic response to ipsapirone between the two groups. LIMITATIONS: A lack of placebo control, heterogeneity of patients, and a small sample size are the limitations. CONCLUSIONS: Our findings suggest that manic patients may have enhanced postsynaptic 5-HT1A receptor sensitivity, but presynaptic 5-HT1A receptors are unaltered in this condition. Further placebo-controlled studies with a larger number of manic patients are needed to verify this.     

Role of lipids, lipoproteins and lipid peroxidation in thrombocytopenia in patients with vivax malaria

Possible roles of oxidative and metabolic changes of lipids in the development of thrombocytopenia in patients with vivax malaria were investigated. Serum total cholesterol, HDL and LDL cholesterols, triglycerides, lipid peroxidation level and platelet counts were determined in 60 patients with vivax malaria and compared with 50 healthy individuals. Inter-relationships of parameters were investigated. In patients, serum total cholesterol, HDL and LDL cholesterol concentrations and platelet counts were lower, and serum triglycerides and plasma lipid peroxidation concentrations were higher than those of control subjects. Significant relationships were found among serum lipid parameters, plasma lipid peroxidation and thrombocyte counts. Decrease in total cholesterol, HDL and LDL cholesterols and platelet counts may be related or secondary to oxidative stress. In the treatment of thrombocytopenia required in the some cases of malaria, the supplementation of antioxidative vitamins may be considered.     

Subtypes of manic episodes according to ICD-10-prediction of time to remission and risk of relapse

BACKGROUND: The long-term predictive ability of the ICD-10 subtypes of hypomania, mania without psychosis and mania with psychosis has not been investigated. METHODS: All patients who got a diagnosis of a single hypomanic episode, single manic episode without psychosis or single manic episode with psychosis in a period from 1994 to 1999 at the first discharge ever in Denmark were identified. The time to discharge from first admission and the risk of relapse leading to readmission were compared for the three groups of patients. RESULTS: Totally, 41 patients with a hypomanic episode, 149 patients with a manic episode without psychotic symptoms and 202 patients with a manic episode with psychotic symptoms at first discharge ever were identified. Patients with mania and psychotic symptoms were admitted longer than patients with mania without psychosis, and patients with mania without psychosis were admitted longer than patients with hypomania. No differences were found in the risk of relapse leading to readmission between the three groups of patients. LIMITATIONS: The results apply to hospitalised patients only. CONCLUSIONS: The ICD-10 subclassification of manic episodes does only partially predict long-term outcome.     

Changes in platelet 5-hydroxytryptamine uptake in mania

[3H]5-Hydroxytryptamine (5HT) platelet uptake was examined in a small group of hospitalised drug-free manic patients and in a larger group of drug-treated manic and schizophrenic patients compared to controls. 5HT platelet uptake was significantly higher in the manic group at the beginning of the illness episode than in either schizophrenics or controls. No difference was found in the uptake rates between the schizophrenics and controls. At discharge, manic patients had 5HT uptake values similar to control subjects. Manic patients with no previous history of either mania or depression had highly significant increases in 5HT platelet uptake compared to either schizophrenics, controls or manic patients with a previous history of manic-depression. No correlation was found between the initial increased 5HT uptake rate in the manic patient and the severity or duration of the illness episode, the length of hospitalisation or the gender of the patient.     

The significance of psychotic features in manic episodes: a report from the NIMH collaborative study

BACKGROUND: Psychotic features in the context of major depressive syndromes have correlates in symptom severity, acute treatment response and long-term prognosis. Little is known as to whether psychotic features have similar importance when they occur within manic syndromes. METHODS: These data derive from a multi-center, long-term follow-up of patients with major affective disorder. Raters conducted follow-up interviews at 6-month intervals for the first 5 years and annually thereafter. A sub-set of probands participated in a family study in which all available, adult, first-degree relatives were interviewed as well. RESULTS: Of 139 who entered the study in an episode of mania, 90 patients had psychotic features. Symptom severity ratings at intake were more severe for this group. Though time to first recovery and time to first relapse did not distinguish the groups, psychotic features were associated with a greater number of weeks ill during follow-up and the strength of this association was similar to that seen for psychotic features within depressed patients described in an earlier publication. Patients with psychotic mania at intake did not differ significantly from those with nonpsychotic mania by response to acute lithium treatment, suicidal behavior during follow-up, or risks for affective disorder among first-degree relatives. Psychotic features within manic syndromes were not associated with high psychosis ratings during follow-up. In contrast, when psychotic features accompanied depressive syndromes, they strongly predicted the number of weeks with psychosis during follow-up, particularly among individuals whose episodes at intake were less acute. CONCLUSIONS: As with major depressive syndromes, psychotic features in mania are associated with greater symptom severity and higher morbidity in the long-term. Psychotic features are much less predictive of future psychosis when they occur within a manic syndrome than when they occur within a depressive syndrome.     

Low-density lipoproteins isolated from the blood of patients with coronary heart disease induce the accumulation of lipids in human aortic cells

Smooth muscle cells cultured from the intima of unaffected human aorta accumulate lipids during incubation with the blood serum of patients with coronary heart disease (CHD). Blood sera of most healthy subjects fail to induce the deposition of lipids in cultured cells. Very-low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins of two subclasses (HDL2 and HDL3) were isolated from the blood of healthy subjects and CHD patients. LDL from the blood of healthy individuals did not raise intracellular lipid levels within 24 hr of cultivation (the maximal concentration used, 1000 micrograms/ml). During the same incubation period, LDL obtained from the blood of CHD patients (200 to 1000 micrograms/ml) caused a 2- to 5-fold rise in cholesteryl esters as well as a 1.5- to 3-fold rise in free cholesterol and triglycerides, whereas intracellular phospholipid levels remained unchanged. There was a direct correlation (r = 0.95) between cholesterol accumulation in the cells incubated with whole sera of CHD patients and cholesterol level in the cells incubated with LDL isolated from these sera. In one of the three cases, the ability to raise the intracellular level of cholesteryl esters was demonstrated by VLDL (500 micrograms/ml) derived from CHD patients' blood. HDL2 and HDL3 did not affect lipid levels in smooth muscle cells cultured from unaffected intima. HDL3 from the blood of CHD patients and healthy subjects (50 to 250 micrograms/ml) reduced cholesteryl ester levels in cells cultured from atherosclerotic plaques 1.5- to 2-fold. HDL2 also decreased the content of cholesteryl esters in plaque cells, though less effectively than HDL3. The data obtained suggest that circulating LDL and, possibly, VLDL in the blood of CHD patients are capable of inducing the accumulation of fat in vascular wall cells.     

Changes in platelet monoamine oxidase activity, cholesterol levels and hyperactive behaviour in adolescents over a period of three years

Platelet monoamine oxidase (MAO) activity is a peripheral marker of central serotonergic activity, and has been associated with aggressive, impulsive and hyperactive behaviour, alcohol and drug abuse. Central serotonergic activity has also been associated with plasma cholesterol levels. In the present longitudinal investigation in adolescents (n = 320) changes in platelet MAO activity and in plasma cholesterol levels over three years were measured, and their possible association with changes in aggressive and hyperactive behaviour, smoking, alcohol and drug use was studied. The measures were taken at age 15 and 18 years. Psychological data were obtained from teachers by using the Hyperactivity Scale [B. af Klinteberg, Studies on Sex-related Psychological and Biological Indicators of Psychosocial Vulnerability: A Developmental Perspective, University of Stockholm, Department of Psychology, 1988]. The results of the study show that in most of the tested individuals, platelet MAO activity is a relatively stable measure, however, there was a significant number of subjects with a noticeable change in MAO activity. In subjects with decreased platelet MAO activity, total and HDL cholesterol levels were significantly increased. Also, changes in HDL cholesterol and in platelet MAO activity were inversely associated with changes in the score of Concentration Difficulties. The changes in platelet MAO activity and cholesterol level were not associated with alcohol and drug use among the subjects. This longitudinal analysis provides preliminary evidence that changes in platelet MAO activity and cholesterol, which may reflect changes in central serotonergic activity are associated with attention deficit in adolescents.     

Targets for preventing epilepsy following cortical injury

Insomnia is a common sleep disorder frequently occurring in chronic alcoholic patients. Neurobiological basis of insomnia, as well as of alcoholism, is associated with disrupted functions of the main neurotransmitter systems, including the serotonin (5-hydroxytryptamine, 5-HT) system. Blood platelets are considered a limited peripheral model for the central 5-HT neurons, since both platelets and central 5-HT synaptosomes have similar dynamics of 5-HT. Platelet 5-HT concentration and platelet monoamine oxidase type B (MAO-B) are assumed to represent biomarkers for particular symptoms and behaviors in psychiatric disorders. The hypothesis of this study was that platelet 5-HT concentration and platelet MAO-B activity will be altered in chronic alcoholic patients with insomnia compared to comparable values in patients without insomnia. The study included 498 subjects: 395 male and 103 female medication-free patients with alcohol dependence and 502 healthy control subjects: 325 men and 177 women. The effects of early, middle and late insomnia (evaluated using the Hamilton Depression Rating Scale), as well as sex, age and smoking on platelet 5-HT concentration and platelet MAO-B activity were evaluated using one-way ANOVA and multiple regression analysis by the stepwise method. Platelet 5-HT concentration, but not platelet MAO-B activity, was significantly reduced in alcoholic patients with insomnia compared to patients without insomnia. Multiple regression analysis revealed that platelet 5-HT concentration was affected by middle insomnia, smoking and sex, while platelet MAO activity was affected only by sex and age. The present and previous data suggest that platelet 5-HT concentration might be used, after controlling for sex and smoking, as a biomarker for insomnia in alcoholism, PTSD and in rotating shift workers.     

Neuroleptic effects on platelet aggregation: a study in normal volunteers and schizophrenics

Platelet-rich plasma from healthy controls was pre-treated with neuroleptics of the phenothiazine, butyrophenone or benzamide variety before aggregation with one of the following agonist agents: ADP, adrenaline, 5-HT, collagen, platelet activating factor or ristocetin. All compounds effective as antipsychotics, except sulpiride, depressed aggregation. Unmedicated schizophrenics showed aggregation responses indistinguishable from healthy controls. However, within days of treatment with either trifluoroperazine or haloperidol responses became abnormal in acutely psychotic patients. Increased responses to 5-HT and depressed responses to platelet activating factor were detected. After 4 weeks of treatment responses tended to return to normal. Aggregation responses were normal in those patients on long-term depot neuroleptics.     

Effects of symptomatic severity on elevation of plasma soluble interleukin-2 receptor in bipolar mania

BACKGROUND: Circulating soluble interleukin-2 receptors (sIL-2Rs) and soluble interleukin-6 receptors (sIL-6Rs) are stable immune measures. Elevated plasma sIL-2R levels are present in patients with schizophrenia, major depression, and bipolar mania, but not with minor psychiatric disorders. The increased plasma sIL-2R levels are state-dependent in bipolar mania. However, altered production of plasma sIL-6R and the effects of clinical characteristics on plasma sIL-6R and sIL-2R levels in bipolar disorder remains uncertain. METHODS: Plasma sIL-2R and sIL-6R levels were measured in 31 Taiwanese bipolar manic (DSM-IV) patients with Young Mania Rating Scale (YMRS) scores of > or =26 as well as during the subsequent remission (YMRS< or =12), and equal numbers of age- and gender-matched healthy controls. The relationships of clinical variables such as age, age of onset, smoking, medication status, coexisting psychotic features, number of prior episodes, duration of illness, presence of depression before or following the manic episode, and manic severity to plasma sIL-2R and sIL-6R levels in acute mania along with remission were examined. RESULTS: Plasma sIL-2R but not sIL-6R levels were significantly higher in acute mania than in subsequent remission (P<0.05) and controls (P<0.0005). In acute mania, the plasma sIL-2R levels were significantly correlated to YMRS scores (r=0.34, P<0.05). The remaining clinical variables had no effect on plasma sIL-2R and sIL-6R levels in acute mania or remission. There was a significantly positive relationship between the reduction of plasma sIL-2R levels from the acute to follow-up measurements (DeltasIL-2R) and symptomatic improvement of acute mania (DeltaYMRS) (r=0.61, P<0.001). Limitations: Our sample included medicated and unmedicated patients in acute mania. The psychotropic medication may have divergent effects on the plasma sIL-2R levels in acute mania and subsequent remission. CONCLUSIONS: Elevation of plasma sIL-2R but not sIL-6R levels in bipolar mania supports the idea that the immunomodulatory mechanism may vary in different psychotic disorders. In contrast to being a trait marker in schizophrenia and depressive disorder, plasma sIL-2R levels may be considered a biological indicator of manic severity in a group of bipolar affective patients.     

Cytokine profiles in bipolar affective disorder: focus on acutely ill patients

BACKGROUND: The role of the immune system in mood disorders is predominately supported by studies in unipolar major depression. However activation of the immune system has also been demonstrated in bipolar mania. Our study examines pro-inflammatory and anti-inflammatory cytokines in both phases of bipolar affective disorder (BPAD). METHODS: Plasma concentrations of IL-6, IL-8, IL-10, TNF-alpha and sIL-6R were measured with enzyme linked immunosorbent assays (ELISA) in patients with BPAD who were depressed, or manic and in healthy controls. RESULTS: Bipolar depression had significantly higher production of the pro-inflammatory cytokines, IL-8 (p < 0.001) and TNF-alpha (p < 0.05) compared to healthy subjects. The manic group also had increased production of IL-8 (p < 0.05) and TNF-alpha (p < 0.001) as compared to healthy subjects. Anti-inflammatory cytokine levels did not differ across the 3 groups. LIMITATIONS: A small sample size was studied. All patients remained on medication for this study. CONCLUSIONS: BPAD is associated with increased production of pro-inflammatory cytokines both in the manic and in the depressed phase as compared to healthy subjects. This is the first study, which examined both mania and bipolar depression.     

Platelet serotonin in combat related posttraumatic stress disorder with psychotic symptoms

BACKGROUND: Combat-related posttraumatic stress disorder (PTSD) is severe form of PTSD, frequently associated with psychotic symptoms. Platelet serotonin (5-hydroxytryptamine, 5-HT) was used as a peripheral 5-HT marker to identify particular symptoms in PTSD. METHODS: Platelet 5-HT was determined fluorimetrically in 67 war veterans with combat related PTSD, 36 combat exposed veterans who did not develop PTSD, 35 veterans with PTSD complicated with psychotic features. PTSD diagnosis of current and chronic PTSD, and clinical symptoms of PTSD and psychoses were assessed according to DSM-IV criteria, using the Clinician Administrated PTSD Scale, and Positive and Negative Syndrome Scale (PANSS). RESULTS: Platelet 5-HT concentration was significantly higher in veterans with psychotic PTSD than in veterans with non-psychotic PTSD, veterans without PTSD, or in control subjects. Platelet 5-HT was significantly positively correlated with the positive symptoms in PANSS subscale, and with the symptoms of delusions within PANSS positive subscale. LIMITATIONS: The results were obtained on peripheral 5-HT marker, i.e. platelet 5-HT concentration. CONCLUSIONS: Since the delusions are the core psychotic symptoms occurring in our psychotic PTSD patients, the result of the increased platelet 5-HT concentration, associated with delusions, indicate that platelet 5-HT might be used as a trait marker of psychotic symptoms in PTSD, but not as a state marker for PTSD.     

Effect of lithium carbonate on serotonin uptake in blood platelets of patients with affective disorders

Lithium carbonate treatment for 2-3 weeks produced a significant decrease in the maximum velocity (Vmax) of serotonin (5-HT) uptake, a measure of the number of 5-HT uptake sites in blood platelets from bipolar patients. The decrease was more pronounced in bipolar manic patients than bipolar depressed patients. There was no significant affect on the affinity for 5-HT (Km) of the uptake sites in the platelets of manic or depressed bipolar patients although Km did decrease (indicating increased affinity) in the majority of subjects from both groups of patients. However, lithium treatment of at least 1 year duration was associated with significant increases in Vmax without affecting Km. Lithium in vitro, at concentrations up to 1 mM, had no effect on the Km or Vmax of 5-HT uptake in blood platelets of normal controls. The possible mechanisms of the inhibitory and stimulatory effect of lithium carbonate treatment on platelet 5-HT uptake are discussed.     

Gene dose effect of the APOE-epsilon4 allele on plasma HDL cholesterol level in patients with Alzheimer's disease.

It has been reported that decreased serum high density lipoprotein (HDL) cholesterol level is related with severity of Alzheimer's disease (AD). Here, 82 patients with AD and 40 non-demented individuals were examined to determine how the APOE-epsilon4 allele modifies plasma cholesterol fractions. In adjusting for age, sex and plasma albumin level, plasma HDL cholesterol level was inversely correlated with the APOE-epsilon4 dose only in the patients (P = 0.0048), while plasma low density lipoprotein (LDL) cholesterol level tended to be correlated with the APOE-epsilon4 dose in both groups, although this was not significant. The ratio of LDL to HDL cholesterol in the patients showed a similar correlation with the APOE-epsilon4 dose to that in the controls, and this correlation was evident (P = 0.0069) after putting all subjects into one group. However, neither HDL nor LDL cholesterol levels showed significant differences between the groups. These results indicated that the APOE-epsilon4 dose affects the composition of plasma cholesterol, and suggested that the genetic effect on plasma lipid metabolism could be distinctive in patients with AD.     

Increased sensitivity to error during decision-making in bipolar disorder patients with acute mania

BACKGROUND: Decision-making is a complex and important function for daily life that can be assessed quantitatively using a simple two-choice prediction task. Bipolar disorder (BD) patients are thought to show altered responsivity to positive and negative feedback. In this study we examined whether BD patients with psychotic mania show altered patterns of decision-making as a function of the frequency of incorrect predictions or error rate. METHODS: Fourteen adult DSM-IV-diagnosed BD patients with psychotic mania and 14 normal comparison subjects (NC) were tested with a two-choice prediction task using three error rate conditions (20%, 50%, or 80%). RESULTS: BD patients showed an increased sensitivity to error rate changes and switched more frequently at high error rates than NC subjects. In comparison, there were no differences between BD and NC subjects on the degree to which the response or stimulus during a previous trial predicts the current response. CONCLUSIONS: Decision-making in BD patients with psychotic mania appears to be highly sensitive to high error rates. Moreover, the patterns of responses appear distinct from what has been previously observed in acutely and chronically ill schizophrenia patients. The results of this study are informative as to the effects of errors on decision-making strategies in psychotic BD manic patients.     

Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy

BACKGROUND: Although the construct of depression has been subjected to numerous factor analytic studies and phenomenological subtypes of clinical relevance have been delineated, this is not the case for mania. The few available studies have reported at least two factors, which consist of euphoric versus dysphoric-hostile subtypes. Our objective was to replicate and further enrich this literature. METHODS: In the EPIMAN French National Study we systematically evaluated 104 DSM-IV hospitalized manic patients in four university centers in different regions of France. Psychiatrists completed the Beigel-Murphy Manic State Rating Scale (MSRS), as well as the HAM-D(17), affective temperament scales, and the GAF Axis V from DSM-IV. Categorization of patients into pure versus dysphoric mania was made on the basis of clinical diagnosis, independent from psychometric measures. RESULTS: On principal component analysis of the MSRS, three factors explained the largest variance: a global manic (23.3% variance), paranoid-hostile (14.8% variance), and psychotic (9.1% variance). After varimax rotation, we obtained seven independent factors: F1 Disinhibition-instability, F2 Paranoia-hostility, F3 Deficit, F4 Grandiosity-psychosis, F5 Elation-euphoria, F6 Depression, and F7 (Hyper)sexuality. We could not demonstrate significant correlations between the individual factors and impaired functioning on GAF. However, depressive and, to some extent, cyclothymic temperaments correlated with F6 Depression. Finally, intergroup comparisons between pure versus dysphoric mania diagnosed clinically showed high levels of F3 Deficit and F5 Elation in the pure, and of F6 Depression in dysphoric, mania; F2 Paranoia-hostility did not discriminate these two clinical forms of mania. LIMITATIONS: Although the present analyses on the Beigel-Murphy represent the largest sample studied to date, they are still underpowered and do not guarantee a stable factorial structure. Our findings are cross-sectional and require prospective validation. CONCLUSIONS: Our data suggest that 'dysphoria' as used in the literature to qualify mania is insufficiently precise, and is best further specified as 'depressive' versus 'irritable.' Moreover, our data extend the rich multidimensional phenomenology of mania beyond the existing literature: we submit that disinhibition-instability (a core 'activation' component) can, on the one hand, be associated with distinct emotional presentations (euphoric, depressive, or irritable-hostile), as well as psychotic and deficit symptomatology on the other.     

Platelet serotonin and plasma tryptophan decreases in endogenous depression. Clinical, therapeutic, and biological correlations.

Platelet serotonin (5-HT) and plasma tryptophan (free and total) levels were measured in 25 unmedicated depressed patients and in 25 age- and sex-matched healthy controls. The same parameters were determined in the patients after 3 weeks and 2 months of imipramine treatment. Comparisons between patients and control values showed a significant decrease in total plasma tryptophan and platelet 5-HT in unmedicated patients. During treatment, the clinical condition of the patients improved, while plasma tryptophan and platelet 5-HT values normalized after 3 weeks and 2 months, respectively. Clinical status, plasma tryptophan, platelet 5-HT, as well as other biological parameters determined concurrently in the patients, such as platelet monoamine oxidase (MAO), 5-HT uptake, and imipramine binding were compared in search of significant correlations: neither the individual values of any of them nor the magnitude of their changes at any given stage or interval of the study, respectively, were found significantly correlated. These results suggest that a series of 5-HT-related biological parameters are altered in endogenous depression and tend to normalize with imipramine treatment leading to clinical recovery. Within individuals, those parameters are not correlated, suggesting that both the effect of the drug and clinical improvement affect them separately.     

Platelet 5-HT and plasma MHPG levels in patients with bipolar I and bipolar II depressions and normal controls.

BACKGROUND: It has been suggested that platelet serotonin (5-HT) content may reflect aspects of the presynaptic reuptake of 5-HT, while plasma 3-methoxy-4-hydroxy-phenylglycol (MHPG) levels may provide an index of central noradrenergic function. METHODS: In order to determine if there is a biological distinction in 5-HT or noradrenergic function within bipolar I and bipolar II depressions, we measured levels of platelet 5-HT and plasma MHPG in 12 patients with bipolar I depression, 12 patients with bipolar II depression, and 20 normal healthy controls. All subjects were medication free for at least 4 weeks prior to the study. RESULTS: There was a trend towards higher platelet 5-HT in bipolar I or II depressions when compared to normal controls, whereas there was no difference in platelet 5-HT levels between bipolar I and II depressed patients. When bipolar I and II patients were pooled, there was a significant increase in platelet 5-HT levels in bipolar depressives compared to normal controls, and there was a trend towards a weak positive correlation between platelet 5-HT and 21-item HAMD scores in the patient group. In contrast, there was no difference in plasma MHPG levels between the three groups. LIMITATIONS: This study was limited to a small sample size, single point sampling and did not match seasons. CONCLUSIONS: Our findings did not provide supportive evidence for a distinctive 5-HT or noradrenergic function within bipolar I and bipolar II depressions. However, the finding of increased platelet 5-HT levels in bipolar depressed patients compared to normal controls is consistent with the results of previous studies, and may suggest an increase in presynaptic 5-HT reuptake, presumably resulting from diminished synaptic 5-HT availability in this condition.     

Mismatch between self-reported quality of life and functional assessment in acute mania: a matter of unawareness of illness?

BACKGROUND: Studies addressing self-reported quality of life (QoL) in acute mania are scarce and inconsistent. While it has been suggested that there is some disagreement between objective measures and subjective QoL as reported by acutely manic patients, this issue has not been systematically studied. This study aims to investigate the self-reported QoL in manic, depressed, and euthymic BD subjects, as compared to matched healthy controls. METHODS: One-hundred and twenty type-I bipolar patients (40 manic, 40 depressed, and 40 euthymic) and 40 matched controls were studied. Self-reported QoL was assessed using the World Health Organization's Quality of Life Instrument-Short Version (WHOQOL-BREF). Objective functioning was assessed using the Global Assessment of Functioning (GAF), and depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale-17 items (HDRS) and the Young Mania Rating Scale (YMRS), respectively. RESULTS: Manic patients presented the lowest GAF measures but reported same overall QoL as euthymic patients and controls, and better QoL than depressed patients. Within the manic subgroup, there was a significant inverse correlation between psychological QoL and GAF scores (r=-0.54; p=0.001). LIMITATIONS: The cross-sectional design and the lack of control for potential comorbid conditions are the major limitations of the present study. CONCLUSIONS: Our findings suggest that this mismatch between objective and subjective measures during acute mania may be associated with a lack of insight or awareness of their own illness.     

Abnormal low density lipoproteins in children with familial hypercholesterolemia — Effet of polyanion exchange resins

Summary In 20 children and adolescents with familial Type IIa hyperlipoproteinemia, serum lipids and lipoproteins were examined before and during treatment with polyanion exchange resins. The composition of LDL was compared to that of healthy siblings. The patients were given Colestyramine (0.6 g/kg body weight) and Colestipol (0.5 g/kg body weight) in a cross-over study for 8 weeks each, after they had been under dietary treatment for at least 12 months. In 6 children, drug treatment had to be stopped due to side-effects. The most common complaints were gastrointestinal discomfort and constipation.Cholesterol, triglycerides and phopholipids were measured in whole serum and cholesterol, triglycerides and Apolipoprotein-B in isolated lipoprotein fractions after ultracentrifugation. Apo-B was determined by radial immunodiffusion.The Apo-B: cholesterol ratio in whole serum and in the LDL fraction was identical in the patients and in the controls. The LDL triglyceride: Apo-B ratio, however, was about 50% lower in the patients. This abnormal LDL composition was not altered by therapy with polyanion exchange resins. HDL cholesterol levels were significantly lower in the patients than in healthy children, and remained low during therapy.The decrease of total and LDL cholesterol (25%) and Apo-B (20%) was similar under both Colestipol and Colestyramine. Triglycerides and phospholipids showed no significant changes in therapy.These studies were supported by grants of the Schweizerische Nationalfonds and the Deutsche Forschungsgemeinschaft (Sonderforschungsbereich 90, Cardiovasculäres System)