ResumenLos autores investigaron las variables de la historia y clínicas de 159 pacientes internos afectados por trastornos del estado de ánimo para identificar variables que pudieran diferenciar formas psicóticas de no psicóticas. Los resultados mostraron que el 32% de los pacientes tenían síntomas psicóticos. Aunque no se detectaron diferencias significativas con respecto a la gravedad de la depresión, los pacientes con depresión psicótica eran más jóvenes y tenían una edad de comienzo inferior, así como una duración más breve del episodio. Estos rasgos indican que la depresión puede expresarse con o sin síntomas psicóticos, según el diferente substrato individual y, quizá, biológico. Tomados juntos, nuestros resultados parecen indicar que la depresión psicótica no se debería considerar una entidad clínica separada, sino un subtipo de los trastornos del estado de ánimo.

The authors investigated the historical and clinical variables of 159 inpatients affected by mood disorders in order to identify variables which might differentiate psychotic from non-psychotic forms. The results showed that 32% of the patients had psychotic symptoms. Although no significant difference was detected with regard to the severity of depression, psychotic depressives were younger and had a lower age at onset, as well as a shorter episode length. These features suggest that depression may express itself with or without psychotic symptoms, according to the different individual and, perhaps, biological substrate. Taken together, our findings seem to indicate that psychotic depression should not be considered a separate clinical entity, but a subtype of mood disorders.

ResumenUna mujer de 38 años, que sufría trastorno esquizoafectivo desde hacía 17 años aproximadamente, mejoró de forma significativa con la asociación de clozapina (CZP) y nimodipino.

A thirty-eight year old woman, suffering from schizoaffective disorder for approximately 17 years, improved significantly with the association of clozapine (CPZ) and nimodipine.

1. The authors investigated the possible antimanic properties of a Calcium channel blocker, Verapamil, in 15 in-patients admitted consecutively to the female psychiatric ward at Pisa University for a manic episode. 2. The results showed that most of the patients presented a global improvement of the manic symptoms and, in some cases, even a complete clinical remission. 3. Although it was necessary to add chlorpromazine for the severe conditions of several patients, verapamil appeared to speed the positive outcome and to lead to a faster resolution of the symptoms. In addition, the association of verapamil and chlorpromazine did not produce any relevant side-effect. These preliminary findings thus indicate that verapamil by itself does not seem to be sufficient in the treatment of a severe affective episode, but it may constitute an alternative to lithium salts in association with neuroleptics.

We examined clinical features in 877 in- und outpatients affected by depression who were enrolled in psychopharmacological trials, subdivided according to Hollingshead's method into five social classes. The results showed that social class correlated significantly with the subtypes of mood disorders, with bipolar disorder being more frequent amongst the upper than the lower social classes. Furthermore, as already reported in other countries, social class appeared to influence the psychopathological pattern of depressive symptoms: somatization and anxiety were more frequent amongst the lower social classes, while psychic and cognitive symptoms were more common amongst the upper classes.

We studied the effect of lithium (L), carbamazepine (CBZ), valproic acid (VA), verapamil (VP) and nifedipine (NF) on the specific binding of H-3-imipramine (H-3-IMI) to platelet membranes, as compared with clomipramine (CLO). The results showed that VP, NF and CLO exerted a concentration-dependent inhibition on the IM] binding; CLO had the most potent inhibitory effect. No effect was observed with L. CBZ or VA. These results suggest that while VP and NF interact with the 5-HT transporter complex, L, CBZ and VA do not. Therefore, their effective (or suggested) mood-stabilizing effects are likely to be related to different mechanisms.

The recent discovery of peripheral markers of central neurotransmitter systems has broadened the scope of biological research in psychiatry. Human platelets resemble presynaptic serotoninergic neurons and permit us to investigate the involvement of the serotonin system in the pathophysiology of mood disorders. In particular, platelets show an active uptake of serotonin and the related 3H-imipramine (3H-IMI), similar to cerebral binding sites. We evaluated 3H-IMI binding in a group of 30 bipolar patients as compared with healthy controls. In 20 patients, platelet 14C-5HT uptake was also measured. The results showed no difference in IMI binding parameters between bipolar patients and healthy controls. However, the patients showed a lower Vmax of 14C-5HT uptake than the controls. These findings suggest that bipolarity influences one of the main components of the 5HT transporter complex in platelets.

The 5HT transporter complex in platelets is similar to that in the brain and thus widely used in biological psychiatry as a peripheral marker of the 5HT system. Our study aim was to measure 14C-5HT uptake parameters (Vmax and Km) in platelets from 12 patients affected by bipolar disorder, as compared with 12 healthy controls. The uptake assay was performed according to the method of Arora and Meltzer (1981). The results showed that the Vmax was significantly lower in bipolar patients than in healthy controls, with no modification of the Km. These preliminary data would indicate therefore that the mechanism of 5HT transport is altered in platelets of bipolar patients.

"Variations in Platelets 3h-Imipramine Binding During Two Different Periods of the Year." Chronobiology International, 6(4), pp. 303–304

This study examined compliance with lithium and carbamazepine regimens from the perspective of the illness and its characteristics. Patients were more likely to stay in treatment when prophylaxis was begun following a depressive episode and in the presence of congruent psychotic experiences. The reverse was true for grandiose and manic patients and those with somatic preoccupations.

Thirty-one female inpatient depressives underwent a systematic open trial with rubidium chloride, 180 to 720 mg/day. By week 2, at least two-thirds had improved significantly (p less than 0.01) as measured by standard rating instruments such as the Brief Psychiatric Rating Scale and the Hamilton Depression Scale. Regression analysis suggested that the retarded endogenous pattern was most predictive of positive response. Treatment-emergent symptomatology, such as diarrhea, polyuria, and excitement, was generally mild and rarely necessitated interruption of the trial. The authors conclude that this salt has shown sufficient clinical promise to warrant more extensive trials under double-blind conditions.

The rubidium and lithium ions are known to have opposite effects on a wide range of biochemical and behavioral parameters in experimental animals. Based on the proven effectiveness of lithium as an antimanic agent, several trials have been conducted with rubidium in the acute treatment of the depressive phase of bipolar illness. The results to date are promising. However, the 30‐ to 60‐day biologic half‐life of rubidium has mandated careful studies of potential toxicity before engaging in long‐term administration of this ion to depressive subjects. One area of potential concern is the possibility of renal toxicity, which could be expressed as unexpectedly increased retention of rubidium. The data in this paper show that after 15 days of rubidium administration, there are no changes beyond the normal range in a variety of kidney function tests, including in four enzymes which are specific markers of tubule cell function.

The comparative usefulness of carbamazepine and lithium carbonate in the acute and prophylactic management of DSM-III diagnosed major affective, schizoaffective, or schizophreniform psychoses was investigated in a 3-year, prospective double-blind randomized trial with 83 in- and outpatients. The incidence of side effects was similar in both treatment groups, and side effects generally responded well to dosage reduction. Both drugs were effective in two thirds of the patients and appeared about equal in most outcome measures, except for a significantly higher dropout rate for patients with mood-incongruent psychotic features who were assigned to the lithium group. Both drugs appeared more effective in preventing excited rather than depressive symptoms.