Therapeutic efficacy of bilateral prefrontal slow repetitive transcranial magnetic stimulation in depressed patients with Parkinson's disease: an open study.

Recent studies have suggested that both high- and low-frequency repetitive transcranial magnetic stimulation (rTMS) have antidepressant effects in patients with major depression. We conducted an open study to assess the effects of slow rTMS on mood changes in patients with depression associated with Parkinson's disease (PD). Ten depressed patients with PD (four with major depression and six with dysthymia) received daily sessions of rTMS (frequency, 0.5 Hz; pulse duration, 0.1 msec; field intensity, 10% above the motor threshold) over both prefrontal regions (a total of 100 stimuli per prefrontal region daily) over 10 consecutive days. This treatment resulted in a moderate but significant decrease in scores of the Hamilton Depression Rating Scale (33-37%) and the Beck Depression Inventory (24-34%), which persisted 20 days after finishing the stimulation. In parallel, we observed mild improvement (18-20%) of motor symptoms. No significant adverse effects were reported. These preliminary results suggest the therapeutic potential of daily prefrontal low-frequency rTMS (0.5 Hz) in depression associated with PD.     

Galactose-1-phosphate uridyl transferase gene mutations in women with premature ovarian failure

We determined the frequency of galactose-1-phosphate uridyl transferase gene mutations: Q188R, K285N, and the Duarte allelle in 86 patients with idiopathic premature ovarian failure (POF) and 95 controls. No association of the mutations with POF was found.     

The preoperative assessment of patients with valvular heart disease as a comorbidity

In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different de-Spending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. In this paper we have outlined the criteria for evaluating the severity of valvular disease, given that the risk in surgery is proportional to the degree of valvular disease. Also, given that the risk in surgery is also directly proportional to the type and extent of non cardiac surgery, it will be presented recommendations for intraoperative monitoring, with the purpose of evaluating patient's hemodynamic state, as well as recommendations for perioperative treatment of hypotension, tachycardia, and other hemodynamic disturbances. In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.     

Isocratic RP-HPLC method for rutin determination in solid oral dosage forms

A rapid and sensitive assay for quantitative determination of rutin in oral dosage forms based on isocratic reversed phase high performance liquid chromatography (RP-HPLC) was developed and validated. Using a C(18) reverse-phase analytical column, the following conditions were chosen as optimal: mobile phase methanol-water 1:1 (v/v), pH 2.8 (adjusted with phosphoric acid), flow rate=1 mL min(-1) and temperature T=40.0 degrees C. Linearity was observed in the concentration range 8-120 microg mL(-1) with a correlation coefficient of 0.99982 and the limit of detection (LOD)=2.6 microg mL(-1), and limit of quantification (LOQ)=8.0 microg mL(-1). Intra- and inter-day precision were within acceptable limits. Robustness test indicated that the mobile phase composition and pH influence mainly the separation. The proposed method allowed direct determination of rutin in pharmaceutical dosage forms in the presence of excipients, but is not suitable for preparations where compounds structurally/chemically related to rutin may be present.     

Oxidative stress in response to xenobiotics in the blue mussel Mytilus edulis L.: evidence for variation along a natural salinity gradient of the Baltic Sea

Blue mussels (Mytilus edulis L.) collected at three sampling sites in each of three geographical regions (South, Middle, North) along the permanent longitudinal South-North salinity gradient of the Baltic Sea, were exposed for 10 days to copper (35ppb) or 95 octane petrol (0.3 per thousand). During the experiment, they were maintained at the respective sampling site salinity. Scope for growth (SFG) was determined, and biochemical stress markers (protein carbonyl groups, disulfide bond formation, and glutathione transferase (GST), and catalase (CAT) activities) were investigated in gill tissue upon termination of the experiment. Treatment and regional effects for SFG and protein carbonyl groups were all significant for petrol. The largest increase in protein carbonyl groups was observed in the North. Mussels from the southern, more saline ( approximately 7 per thousand) region had the highest SFG, and displayed the largest SFG decrease in response to treatment, indicating that they had the most energy available for allocation to stress response. They also displayed the least increase in the level of protein carbonyl groups. Mussels from the Northern, less saline ( approximately 5%) region had the highest degree of protein carbonyl groups in response to both treatments, and lowest average SFG. Silver stained diagonal gels for samples from one sampling site in South and North, respectively, demonstrated differences in disulfide bond profiles for both stress treatments. There was also a regional difference in the number of protein disulfides observed on diagonal gels. The most diverse protein disulfide response was found in South. No treatment related effects on GST and CAT activities were observed. We suggest that both SFG and protein carbonyl groups show that geographical difference in stress susceptibility, previously established between the North and the Baltic Seas, also apply on a regional scale within the Baltic Sea, along the salinity gradient.     

The pituitary-adrenal axis of fetal rats after maternal dexamethasone treatment

Elevated glucocorticoid level in the gravid female circulation affects number of endocrine functions in fetuses and offspring. In this research female rats were injected with dexamethasone (Dx) in three consecutive daily doses of 1.0, 0.5, 0.5 mg/kg body weight, starting from day 16 of pregnancy. The influence of this treatment on the pituitary adrenocorticotrophic (ACTH) cells and adrenal glands of 19-day-old fetuses was examined immunocytochemically and by morphometric analysis. Moreover, the proliferative activity of adrenocortical cells was estimated after application of the mitotic inhibitor Oncovine. Administration of Dx to pregnant rats induced a decline of fetal ACTH cell immunopositivity and significant decreases of ACTH cell volume (23%, p<0.05), volume density (41%, p<0.05), and its number per unit area (17%, p<0.05) in comparison to the control 19-day-old fetuses. Reduced proliferative activity of adrenocortical cells (31%; p<0.05) in zona glomerulosa, as well as the volume of this zone were detected. The volume and number of fetal adrenocortical cells in the inner zone and chromoblasts were not significantly reduced after Dx treatment of pregnant rats. These results show that maternal Dx administration in the period when the fetal hypothalamo-pituitary-adrenal (PA) axis begins its function inhibited the PA axis. Reduced ACTH cell function and mitotic activity led to suppression of adrenocortical cell multiplication in zona glomerulosa, the region of the adrenal cortex where most proliferating cells were found in control 19-day-old fetuses. Thus, increased glucocorticoid levels during late pregnancy caused developmental modifications involving the fetal PA axis, which could be the basis of the altered endocrine responsiveness in adult life.     

Long-term dynamic-oriented group psychotherapy of posttraumatic stress disorder in war veterans: prospective study of five-year treatment

Aim

To assess the effectiveness of the long-term group psychotherapy in the treatment of posttraumatic stress disorder (PTSD) in war veterans on the basis of clinical picture of PTSD, associated neurotic symptoms, and adopted models of psychological defense mechanisms.

Methods

Prospective cohort study involved 59 war veterans who participated in dynamic-oriented supportive group psychotherapy for five years. The groups met once a week for 90 minutes. Forty-two veterans finished the program. The Clinician-Administered PTSD Scale structured interview was used to assess the intensity of PTSD. Crown-Crisp Index was used to evaluate other neurotic symptoms, and Life Style Questionnaire was used to assess the defense mechanisms. The assessments were done at the beginning of psychotherapy, after the second, and after the fifth year of treatment. Comorbid diagnoses, hospitalizations, and outpatient clinic treatments were also recorded.

Results

Long-term group psychotherapy reduced the intensity of PTSD symptoms in our patients (the difference between Clinician-Administered PTSD Scale score at the beginning and the end of treatment, F = 9.103, P = 0.001). Other neurotic symptoms and the characteristic profile of defense mechanisms did not change significantly during the course of treatment. Predominant defense mechanisms were projection (M = 82.0 ± 14.4) and displacement (M = 69.0 ± 16.8). None of the symptoms or defense mechanisms present at the beginning of the treatment changed significantly after two or five years of treatment. The number of diagnosed major depressive episodes, which increased after the second year of psychotherapy, decreased by the end of treatment.

Conclusion

Psychotherapy can reduce the intensity of PTSD symptoms, but the changes in the personality of veterans with PTSD are deeply rooted. Traumatic experiences lead to the formation of rigid defense mechanisms, which cannot be significantly changed by long-term group psychotherapy.A traumatic experience greatly changes the perception of inner and outer world in a patient with posttraumatic stress disorder (PTSD) (1). Feelings of deep isolation, alienation, helplessness, and distrust, together with interpersonal problems and socially dysfunctional behavior, are the main psychological components of PTSD (1). Group psychotherapy, therefore, has the central role in the integrated psychiatric treatment of patients with PTSD (2).Since 1980, when the term “posttraumatic stress disorder” was introduced in psychiatric nomenclature, numerous studies have been conducted to establish the most appropriate psychotherapeutic methods for treating this disorder (3). Although recent guidelines recommend cognitive-behavioral approach, it seems that this type of therapy cannot be successfully applied in all war veterans, especially not in those with chronic PTSD (2-5). Deeply rooted changes in personality, which disturb biological, psychological, and social equilibrium, require long-term therapy. The corrective emotional experience and the feeling of security in a therapeutic group setting strengthen the healthy parts of the self, and neutralize and reintegrate the destructive ones (6). Dynamic-oriented group therapy is commonly used because the number of patients who need psychological help is relatively high, the availability of group therapists is limited, and the range of indications for this type of therapy is broad (2).After the 1991-1995 war in Croatia, the number of war veterans asking for psychiatric help has been increasing. In the first encounters with these patients, psychiatrists prescribed psychopharmaceuticals more often than short psychotherapeutic interventions. However, they soon realized that PTSD symptoms were recurring after an initial improvement and that the disorder had a strong and lasting impact on the patients'' professional, social, and family life. It was obvious that initially applied treatment methods could not successfully meet veterans’ needs for continuous and accessible mental health care. A more comprehensive and effective psychotherapeutic approach had to be adopted (6,7).Our aim was to assess the effectiveness of long-term group psychotherapy in the treatment of war veterans with PTSD by evaluating the clinical picture of PTSD, associated neurotic symptoms, and adopted models of psychological defense mechanisms after two and five years of treatment.     

Evaluation of examination stress based on the changes of sinus arrhythmia parameters

AIM: The aim of this study was to assess changes during the pre-examination, examination and postexamination period investigation in the sinus arrhythmia parameters. EXAMINEES AND METHODS: Twelve female subjects, first year students of Psychology, matched by age and previous experience in taking exams, participated in the study. The state of anxiety, high activation and exam apprehension were assessed. The R-R cardiac intervals were continuously recorded by an eight-channel polygraph (Powerlab). The measurements were made four times in the pre-examination period (days-20, -10, -1 and immediately before the exam), and on two occasions after the exam (days 1 and 10 days of the exam). The recording of R-R intervals also began five minutes before the exam and continued during the exam and five minutes after the exam. RESULTS AND DISCUSSION: The level of anxiety, exam apprehension and high activation changed in a similar way, showing almost linear increase with the approaching of the exam. The changes of R-R interval parameters showed that stress was highest during the exam. The measurements and analysis of results showed a decrease of stress in the postexamination period.