Capillaria hepatica parasitism

Capillaria hepatica is rarely encountered in humans, with fewer than 30 documented cases. The clinico-pathological features of capillaria hepatica infection, diagnosed on liver biopsy of a 6-year-old child are discussed. Pathologically, it is characterised by prominent granulomatous lesions in the liver surrounding the eggs, which on cursory examination may be confused withSchistosoma mansoni.     

Hypomanic switching caused by the psychological effects brought on by a change in environment due to hospital admission: two cases of bipolar II patients who showed a hypomanic switch

Hypomanic episodes in two cases involving depressed patients (bipolar II) were observed after admission to an open psychiatric ward. The patients had not exhibited any prior (hypo)manic episodes during outpatient treatment. Thus, manic switching was thought to have been caused by the psychological effects brought on by the change in environment due to hospital admission. Hospital admission was believed to have been an unloading from their stressful lives, given that the affective state of both patients prior to admission was characterized by depression resulting from work-related stress. The close relationship between the patients and the predominantly female nursing staff may have triggered a psychological regression in both patients. These factors appear to have led to the hypomanic switching.     

Serotonin in mania and in the mechanism of action of mood stabilizers: a review of clinical studies

Objectives: Serotonin (5-hydroxytryptamine, 5-HT) was implicated in the pathophysiology of manic-depressive illness as early as 1958. Although extensive evidence has accumulated since then to support 5-HT's role in depression, relatively fewer studies examined its role in mania. The purpose of this paper was to review and summarize the current state of knowledge on the role of 5-HT in mania and its treatment.

Methods: We systemically reviewed clinical studies of 1) 5-HT function in mania and 2) 5-HT in the mechanism of action of mood stabilizers, including lithium and anticonvulsants.

Results: Review showed that cerebrospinal fluid, postmortem, platelet, neuroendocrine challenge, and tryptophan depletion studies provided some evidence to support the hypothesis that a 5-HT deficit is involved in mania and that enhancement of 5-HT neurotransmission exerts a mood-stabilizing effect.

Conclusions: There is some evidence from clinical studies for the contribution of 5-HT in mania and in the mechanism of action of mood stabilizers. However, it is very likely that other neurotransmitters also play important roles. Future directions for research include 1) in vivo study of 5-HT receptor subtypes using positron emission tomography, 2) investigation of the interaction between 5-HT and other neurotransmitter systems, and 3) determination of the relationships between diagnostic subtypes of mania and 5-HT function and other neurotransmitter systems.     

The impact of lithium prophylaxis on the course of bipolar disorder: a review of the research evidence

A critical review is provided of the available research evidence concerning the efficacy and effectiveness of lithium prophylaxis in bipolar disorder. It is emphasized that, in spite of the limitations of available placebo-controlled trials and naturalistic studies, lithium is the only drug whose prophylactic activity in bipolar disorder is convincingly proved, and remains the first-choice medication in the long-term treatment of bipolar patients. The impact of lithium prophylaxis is likely to be less significant on atypical and comorbid cases of bipolar disorder than in typical manic–depressive illness, but the superiority of other medications over lithium in the long-term treatment of those cases is at present not convincingly proved by research. Currently available research evidence does not seem to support the idea that lithium exerts its prophylactic effect on relapses but not on recurrences of bipolar disorder. Clinicians should be aware of the fact that the drop-out rate in bipolar patients receiving long-term lithium prophylaxis is high even if treatment surveillance is accurate, and that complete suppression of recurrences is a relatively rare outcome of prophylaxis.     

Relationship of childhood physical and sexual abuse to adult bipolar disorder

Objectives: To characterize whether adult depressives with either bipolar or unipolar disorder differ in the prevalence of childhood sexual or physical abuse.

Method: The investigators reviewed data from patients who were evaluated over a 2-year period by a semi-structured clinical interview. In total, 333 cases with a bipolar or unipolar diagnosis were included in the present study.

Results: A childhood history of abuse, in particular sexual abuse, was significantly more frequent in bipolar subjects compared with unipolar subjects. Consistent with previous studies, women reported higher rates of sexual abuse than men, although no interaction by diagnosis was shown. Sexual abuse incidence in male samples was markedly dissimilar, with male bipolar subjects demonstrating a significantly increased rate of sexual abuse and combined sexual and physical abuse compared with unipolar male subjects.

Conclusion: The increased incidence of sexual abuse in women supports growing evidence of gender differences in sexual abuse among adult depressives. In contrast to literature reports, the finding that male bipolar patients have significantly increased rates of sexual abuse histories suggests differences in psychiatric depressive subgroups. This result may reflect the particular characteristics of our cohort (treatment resistant, privately insured, and educated). Further work will aid in characterizing sexual abuse prevalence in other male bipolar samples.     

米氮平与西酞普兰治疗双相抑郁的对照研究

目的:评价米氮平与西酞普兰治疗双相抑郁的疗效及安全性.方法:将符合中国精神障碍分类与诊断标准第3版双相抑郁诊断标准的64例患者随机分为两组,予米氮平(32例)及西酞普兰(32例)分别合并碳酸锂治疗,疗程为12周.采用汉密尔顿抑郁量表(HAMD)、躁狂量表(BRMS)、临床疗效总评量表(CGI)评定疗效,以治疗中出现的症状量表(TESS)评定不良反应.结果:治疗12周后,两组患者HAMD、CGI评分均显著减少(P＜0.05或P＜0.01),BRMS、TESS评分均无明显增加.两组间比较HAMD、CGI、BRMS、TESS评分差异无显著性(P＞0.05).结论:米氮平与西酞普兰治疗双相抑郁均有较好的疗效,不良反应较少,无诱发躁狂病例.     

NMNAT1缺失对小鼠视网膜双极细胞和无长突细胞的影响

目的　探索烟酰胺单核苷酸腺苷转移酶1（NMNAT1）缺失对视网膜神经元细胞结构及功能的损伤作用。方法　利用NMNAT1^fl/fl小鼠与Six3启动子下表达Cre重组酶的转基因（Six3-Cre）小鼠杂交,获得NMNAT1条件基因敲除小鼠及其同窝对照小鼠,实时荧光定量PCR和Western blot进行检测。在基因敲除小鼠出生后第0、4、10、30天（P0、P4、P10、P30）取材,制作冰冻切片,分别进行HE染色测量视网膜厚度,免疫荧光染色鉴定受损细胞类型以及检测恢复蛋白和视紫质表达水平。结果　与同窝对照小鼠相比,基因敲除小鼠在P0时视网膜并没有明显的形态差异,视网膜厚度比较差异无统计学意义（P>0.05）;到P4时基因敲除小鼠表现出视网膜内层和外层中的分层破坏和大规模细胞死亡,基因敲除小鼠P4时距视神经500 μm、1000 μm、1250 μm的视网膜厚度均明显低于同窝对照小鼠（均为P<0.05）,而距视神经1750 μm的视网膜厚度尚未受影响（P>0.05）;基因敲除小鼠P10时距视神经500 μm、1000 μm、1250 μm、1750 μm的视网膜厚度均低于同窝对照小鼠（均为P<0.05）。基因敲除小鼠全部视网膜内外层的退化在 P30 时几乎完成。此外,与同窝对照小鼠相比,P4时基因敲除小鼠视网膜神经节细胞、双极细胞和无长突细胞的数量差异均没有统计学意义（均为P>0.05）,P10时视网膜神经节细胞没有显著差异（P>0.05）,基因敲除小鼠双极细胞、无长突细胞分别减少了约75%、51%（均为P<0.05）。与同窝对照小鼠相比,基因敲除小鼠在P4时视网膜几乎不表达恢复蛋白和视紫质（均为P<0.05）。结论　NMNAT1缺失主要导致视网膜双极细胞和无长突细胞损害以及恢复蛋白和视紫质缺失。     

Treatment-refractory bipolar disorder: classification to aid in clinical management

Bipolar disorder is an illness with complex symptomatology that encompasses severe symptoms of mood and thought disorder and can limit the cognitive range of human brain functioning. The Diagnostic and Statistical Manual, 4th edition and International Classification of Mental Disorder recommend subgroups of bipolar disorder based on symptoms, illness severity, and frequency of episodes. Pharmacological agents commonly used in the management of bipolar disorder include lithium; anticonvulsants, such as valproate, carbamazepine and lamotrigine; and recent years have witnessed increasing use of atypical antipsychotics. There are several intra- and inter-class differences in these compounds, especially relating to polarity of mood episode under consideration. Monotherapy trials have focused on efficacy of the compounds; few have explored combination therapy, especially in patients failing to respond or inadequately responding to one agent. Clinicians have frequently prescribed two or more compounds to stabilize moods. Monotherapy treatment of bipolar manic episode with various compounds including atypical antipsychotics, mood stabilizers such as lithium, valproic acid and carbamazepine yielded response rates of 50%. However, combination therapy of atypical antipsychotics with valproic acid or lithium offered an additional 20% improvement in the response rates. The article will review published data on augmentation studies, comment on case reports published in treatment-refractory bipolar disorder, and propose a new classification guideline for staging treatment-refractory bipolar disorder.     

Multiple Invagination Patterns and Synaptic Efficacy in Primate and Mouse Rod Synaptic Terminals

PurposeOptical retina images are scaled based on eye size, which results in a linear scale ratio of 10:1 for human versus mouse and 7:1 for macaque monkey versus mouse. We examined how this scale difference correlates with the structural configuration of synaptic wiring in the rod spherule (RS) between macaque and mouse retinas compared with human data.MethodsRod bipolar cell (BC) dendrites and horizontal cell (HC) axonal processes, which invaginate the RS to form synaptic ribbon-associated triads, were examined by serial section transmission electron microscopy.ResultsThe number of rod BC invaginating dendrites ranged 1∼4 in the macaque RS but only 1∼2 in the mouse. Approximately 40% of those dendrites bifurcated into two central elements in the macaque, but 3% of those dendrites did in the mouse. Both factors gave rise to 10 invagination patterns of BC and HC neurites in the macaque RS but only two in the mouse. Five morphological parameters: the lengths of arciform densities and ribbons, the area of the BC–RS contact, and the surface areas of BC and HC invaginating neurites, were all independent of the invagination patterns in the macaque RS. However, those parameters were significantly greater in the macaque than in the mouse by ratios of 1.5∼1.8.ConclusionsThe primate RS provides a more expansive BC–RS interface associated with the longer arciform density and more branched invaginating neurites of BCs and HCs than the mouse RS. The resulting greater synaptic contact area may contribute to more efficient signal transfer.