The neuroendocrine approach to psychiatric disorders: A critical appraisal

Summary Tremendous efforts have been made to exploit the strategy of measuring the secretion of hormones into the plasma by the pituitary as a window to the brain and therefore as an insight into potential neurotransmitter receptor lesions in patients with psychiatric disorders. This contribution focuses upon the advantages and drawbacks of the neuroendocrine approach, caution and objectiveness necessary for the critical evaluation and interpretations of the data. Factors related to the neurobiology of the medial basal hypothalamus and its peculiar features, the information that can be derived from the administration of a specific neuroregulatory hormone or a neuroactive compound and evaluation of the evoked hormone release, the multiple constraints related to the drug itself and/or the physiology or coexisting pathology of the psychiatric patient under examination, are thoroughly discussed.     

精神科自动出院患者前瞻性调查分析

目的:探讨影响精神科住院患者自动出院的原因和有关因素.方法:对843例住院患者进行问卷调查,分析患者自动出院的原因及其影响因素.结果:自动出院者239例,Logistic回归分析显示:病区模式、性别、年龄、家属文化程度、费用负担、求医途径及患者家庭收入是患者自动出院的影响因素.经济困难是导致自动出院的最主要原因.结论:加强精神疾病知识的宣传教育,减轻疾病负担,是降低精神疾病未治率和提高治疗有效率的积极措施.     

1002例服刑人员精神障碍鉴定资料分析

目的 了解服刑罪犯中精神障碍的鉴定情况.方法 整理2003年～2007年的精神医学鉴定资料1002例.结果 发现此类患者受教育程度低,男性罪犯多见,暴力型罪犯为主,青壮年比例最高,慢性起病多见.鉴定构成比依次为精神分裂症及精神病性障碍385例,占38.4%;情感性精神障碍137例,占13.7%;癔症90例,占9.0%;人格障碍84例,占8.3%;应激相关障碍61例,占6.1%;精神发育迟滞60例,占6.0%;颅脑损伤所致精神障碍48例,占4.8%.无精神病63例,占6.3%.其它74例,占7.4%.送鉴原因依次为:言行异常(53.4%),包括自语、傻笑、呆滞、冲动行为;不服从管教、违反监规(50.3%),包括违反劳动、学习纪律、不听从管理和教育;人际交往差(40.2%),平时很少与人交往,不参加群体活动.结论 与一般司法鉴定相比,精神分裂症、精神发育迟滞比例较低,情感性精神障碍、应激相关障碍、人格障碍的比例较多,同时无精神病的结论比例明显较低.此类特殊人群的患者除了普通精神病人的表现外,还具有对象的特殊性和复杂性,要求鉴定人员具有较强的执法意识、严谨的工作作风和扎实的专业技能.     

Modeling neurodevelopmental and psychiatric diseases with human iPSCs

Neurodevelopmental and psychiatric disorders, including autism spectrum disorder and schizophrenia, are complex and heterogeneous disorders that affect a large portion of the world's population. While the causes are still poorly understood, currently available treatments are limited; the development of rational therapeutics based on an understanding of the etiology and pathogenesis of the disease is imperative. The breakthrough technology of deriving induced pluripotent stem cells (iPSCs), reprogrammed from somatic cells of healthy subjects or patients, offers an unprecedented opportunity to recapitulate both normal and pathological development of human tissue, thereby opening up a new avenue for disease modeling and drug development in a more genetically tractable and disease‐relevant system. Here, I review the recent progress in the use of human iPSCs for modeling neurodevelopmental and psychiatric disorders and developing novel therapeutic strategies, and discuss challenges in this rapidly moving field. © 2017 Wiley Periodicals, Inc.     

Viral infection and psychiatric disorders.

A psychiatric population of 94 inpatients and 12 outpatients was investigated on referral to a psychiatric unit in a general hospital for serum antibody titres to several viruses by a complement fixation technique. Of the total population studied, only eight were considered to have antibody titres of possible significance. This result would appear to indicate that viral infection does not play a major part in the causation or precipitation of psychiatric disorders.     

血管生成相关基因在脑动-静脉畸形不同部位差异表达的初步研究

目的:应用功能分类基因芯片研究脑动-静脉畸形(BAVM)不同结构部位的血管生成相关基因表达。方法:6例BAVM,分别在“供血动脉”、“引流静脉”、“畸形团血管”和“周边脑组织”4个不同部位取材,进行血管新生芯片杂交。以“周边脑组织”为自身对照,计算“畸形团血管”、“供血动脉”和“引流静脉”与之的比值。随意选取8个基因进行逆转录-聚合酶链反应(RT-PCR)验证。结果:经过分析和比较,共筛选出44个明显异常的基因,包括了生长因子和受体相关基因18个(含4个下调基因),黏附分子相关基因6个,基质蛋白相关基因6个,转录因子基因5个,细胞因子和趋化因子基因9个(含1个下调基因)。RT-PCR结果与之基本一致。结论:为BAVM的机制研究开辟了许多新的切入点。     

Dynamics of global gene expression changes during brain metastasis formation

As methods of cancer diagnosis and treatment improve, interest in metastatic brain tumors continues to increase. In the present study, we attempted to characterize genetically the dynamic changes occurring during brain metastasis formation by DNA microarray, and attempted to compare these findings with histological observations. Lewis lung carcinoma cells were injected into C57BL/6Ncrj mice carotid arteries. The mice were sacrificed at days 1–9 after injection. We performed histological observation and genome‐wide expression profiling using a DNA microarray. In histological observation, tumor cells were observed in capillary vessels at day 1 after injection. At day 3, the tumor cells had begun to proliferate. At day 6, the metastatic foci showed “perivascular proliferations”. Next, we performed a pairwise comparison of gene expression microarray data from day 1 to day 9 after injection. The first major change occurred between Phase Two and Phase Three. When hierarchical clustering was performed between different samples using the 867 genes, they could be classified into identical clusters for days 1 and 2, identical clusters for day 3 to day 5, and identical clusters for day 6 to day 9. For time course analysis, we extracted 623 genes by the pairwise comparison. By using the quality threshold (QT) nonhierarchical clustering method, we identified 37 expression patterns. These patterns can be separated into eight clusters by using the k‐means method. The microarray results reported here strongly suggest that a large number of genes exhibit a spike pattern, which is tantamount to phase‐specific expression.     

Gender differences in the associations between past-year gambling problems and psychiatric disorders

Background Psychiatric disorders frequently co-occur with pathological gambling. The extent to which co-occurence extends to subsyndromal levels of gambling or differs between women and men is incompletely understood. Aim To examine whether the association between psychiatric disorders and past-year gambling problems is stronger in women than men. Methods Data from the national epidemiological survey of alcoholism and related disorders (NESARC) (n = 43,093) were analyzed. Results Increasing severity of past-year gambling problems was associated with increasing odds of most past-year Axis I and lifetime Axis II disorders, regardless of gender. Associations between gambling problems and major depression, dysthymia, panic disorder, and nicotine dependence were statistically stronger in women than in men. Conclusions A severity-related association exists between past-year gambling problems and psychiatric disorders. The stronger associations in women suggest that gambling research, prevention and treatment efforts consider gender differences.     

Prognosis of postpartum psychiatric disorders in a Turkish sample

Objective

The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course.

Methods

The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis.

Results

Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up.

Conclusion

These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.     

Regional differences in psychiatric disorders in Chile

Background Psychiatric epidemiological surveys in developing countries are rare and are frequently conducted in regions that are not necessarily representative of the entire country. In addition, in large countries with dispersed populations national rates may have low value for estimating the need for mental health services and programs. Methods The Chile Psychiatric Prevalence Study using the Composite International Diagnostic Interview was conducted in four distinct regions of the country on a stratified random sample of 2,978 people. Lifetime and 12-month prevalence and service utilization rates were estimated. Results Significant differences in the rates of major depressive disorder, substance abuse disorders, non-affective psychosis, and service utilization were found across the regions. The differential prevalence rates could not be accounted by socio-demographic differences between sites. Conclusions Regional differences across countries may exist that have both implications for prevalence rates and service utilization. Planning mental health services for population centers that span wide geographical areas based on studies conducted in a single region may be misleading, and may result in areas with high need being underserved.     

SNPs on chips: the hidden genetic code in expression arrays.

Gene expression microarray analysis in postmortem brains is one of the fastest growing fields of psychiatric research. Here we show that common polymorphisms (SNPs) present on probe sets can masquerade as significant "gene expression" differences. After first observing this artifact in the Catechol-O-methyl transferase (COMT) gene, we replicate the finding in two additional genes predicted to show this artifact. Many Affymetrix chips contain thousands of SNPs that are both common and in the central probe region affecting hybridization, and thus have the potential to confound expression analysis.     

Transcription profiling reveals mitochondrial,ubiquitin and signaling systems abnormalities in postmortem brains from subjects with a history of alcohol abuse or dependence

Alcohol abuse is a common human disorder with high rate of comorbidity with other psychiatric disorders. To identify candidate mechanisms for alcohol abuse, the expression of 12,626 genes was measured in postmortem temporal cortex from 11 subjects with a history of alcohol abuse or dependence, with or without other psychiatric diagnoses and compared pairwise with the expression in 11 nonalcoholic subjects matched for the other psychiatric diagnoses and demographics. Genes were defined to have altered expression in alcohol abuse if: 1) the gene showed decreased expression in at least 10 of 11 subjects with alcohol abuse, or showed increased expression in at least 10 of 11 subjects with this diagnosis compared to matched non-abusers (P < 0.007, chi(2)test); or 2) the difference in the mean abuser/non-abuser ratio for the gene from value of 1.0 was significant at P < 0.05 (one sample t-test). In subjects with a history of alcohol abuse or dependence, 163 genes were changed significantly. The most abundant and consistent changes were in gene families encoding mitochondrial proteins, the ubiquitin system, and signal transduction. These alterations indicate disturbances in energy metabolism and multiple signaling mechanisms in the temporal cortex of subjects with a history of alcohol abuse or dependence. We hypothesize that these mechanisms may be related to alcohol abuse traits or long-term effects of alcohol.     

Health care utilization in children and adolescents with psychiatric disorders

Objective

Mental illness is increasing among young people and likewise the request for health care services. At the same time, somatic comorbidity is common in children and adolescents with psychiatric disorders. There is a lack of studies on health care use in children and adolescents, and the hypothesis was that children and adolescents with psychiatric disorders use more primary-, and specialized somatic health care compared to children without psychiatric disorders.

Methods

In this retrospective population-based register study, all individuals aged 3–17 years living in Västra Götaland region in Sweden in 2017 were included (n = 298,877). Linear and Poisson regression were used to compare health care use during 2016–2018 between children with and without psychiatric diagnoses, controlling for age and gender. The results were reported as unstandardised beta coefficient (ß) and adjusted prevalence ratio (aPR) respectively.

Results

Having a psychiatric diagnosis was associated with more primary care visits (ß 2.35, 95% CI 2.30–2.40). This applied to most diagnoses investigated. Girls had more primary care visits than boys. Likewise, individuals with psychiatric diagnoses had more specialized somatic outpatient care (ß 1.70, 95% CI 1.67–1.73), both planned and unplanned (ß 1.23, 95% CI 1.21–1.25; ß 0.18, 95% CI 0.17–0.19). Somatic inpatient care was more common in those having a psychiatric diagnosis (aPR 1.65, 95% CI 1.58–1.72), with the diagnoses of psychosis and substance use exerting the greatest risk.

Conclusions

Psychiatric diagnoses were associated with increased primary-, somatic outpatient- as well as somatic inpatient care. Increased awareness of comorbidity and easy access to relevant health care could be beneficial for patients and caregivers. The results call for a review of current health care systems with distinct division between medical disciplines and levels of health care.     

Hospital vs. outreach treatment of patients with mental retardation and psychiatric disorders: a controlled study

The aim of this study was to investigate the effectiveness of specialized hospital treatment vs. outreach treatment of patients with mental retardation and serious mental illness. A total of 50 patients were randomly assigned to either the hospital treatment (n=25) or the outreach treatment group (n=25). The outcome measures included psychiatric symptoms, family burden, costs and hospital admissions. At most observation points (up to 28 weeks) and at all endpoints the two groups were equivalent with regard to psychiatric symptoms. The burden on carers did not increase significantly during the outreach treatment. Treatment costs were lower for the outreach treatment. Of the 25 patients who received outreach treatment, four had to be admitted to the specialized hospital. Aggressive behaviour, social competence and number of previous psychiatric hospitalizations were found to be predictors of treatment outcome. It is concluded that outreach treatment represents an effective and efficient alternative to hospital treatment for patients with mental retardation and psychiatric disorders.