Epilepsy and religious delusions

166S

Poster session m

DIOL. PSYCHIATRY 1997;42:15-2975

studied. The diagnostic were done by DSM IV and were excluded patients with substance abuse, neurological or organic diseases. Auto-agresslve behavior was correlated to encephalographlc trace of brain, and all cases showed disorders in the basal line. 50% of patients presented irritative spikes at the confluence temporo-parieto-occlpltal region with high Influence in the temporal lobe: 70% of these patients presented Irritative spikes with pathological values, and the remaining ones (30%) showed Irritation at specific localization delimited by the trace. The other 50% presented IrregUlar and unspecific disorders on base line with moderate to severe disorganization. In conclusion, there Is an Important correlation between auto-aggressive behavior with Indicator of Irritability (specially at temporal lobe) In the Brain Mapping.

165-121

Changes of visual evoked potentials In Initial stages of treatment with antidepressants

V. Novotny, E. Koliba§, V. Koi'inkov4. Psychiatric University Clinic, Mickiewiczova 13, 81369 Bratislava, Slovakia In a group of psychiatric patients with major depression, changes In the visual evoked potentials (YEP) and some cognitive parameters were studied. Methods: We examined 19 patients treated with Imipramine and 14 patients treated with citalopram. Changes In the latency and amplitude of late components of YEP were correlated with changes In HAMD, SARS and memory tests. The changes were evaluated on treatment- day 0 and 7. Results: At 7th day we observed in both treatment groups reduction of mean total HAMD score and slight Increase of cognitive performance. In• crease of total SARS score was statistically significant, but no anticholinergic side effects In cltalopram treated patients were registered. The evaluation of YEP has showed Increase in P 300 latency and decrease In P 300 amplitude. Some correlations between yEP and clinical parameters were statistically significant In the Imipramine group, but not significant In the cltalopram group. Conclusion: Antidepressants with anticholinergic properties (e.g. imipramine) have negative effect on cognitive functions. In this respect SSAI antidepressants (e.g. citalopram) are more favourauble.

165-131

Association of GABAA receptor subunit genes with childhood absence epilepsy Feucht 2 ,

FOreder 1 ,

G0l3ler 2 ,

J. Scharfetter', M. K. Fuchs', T. R. N. Cvetkovlc', E. Plchlbauer 3, W. Sleghart 3, S. Kasper 1, H.N. Aschauer 1• 1 University Hospital for Psychiatry. Dep. of Gen. Psychiatry, Vienna, Austria, 2 University Hospital for Neuropsychiatry of Childhood and AdoiescsflC8, Vienna, Austria, 3 University Hospital for Psychiatry, Dep. of Biochem. Psychiatry. Vienna, Austria Introduction: In the etiology of primary generalized epilepsies a genetic factor seems to be of Importance. GABA Is the major Inhibitory neurotrans• mitter In the brain and activation of GABAA receptors triggers anticonvulsive effects. This makes GABAA receptor genes Interesting targets for genetic association studies. Methods: Patients with childhood absence epilepsy and their parents were examined, 8 GABAA receptor subunit genes (alpha 1-6, beta 1 and 3) were genotyped from blood samples, using PCR. Genetic association was tested by haplotype relative risk statistics, calculating Fishers exact test. ReSUlts: Statistlcal analysis displayed association with GABAA-receptor• beta3 (P • 0.008) and -alpha1 (p. 0.023). Conclusions: These results further promote the Interest In GABAA re• ceptors In epilepsy genetics. Associated genes could either be the site of disease related mutations or be In vicinity of such sites. The possibility of genetic heterogeneity 01 the nosological entity ·chlldhood absence epilepsy" should be considered.

165-141

Panic disorder versus epilepsy

P. Kukumberg. M. Kuchar. Department of Neurology. Derer's Hospital, Bratislava, Slovak Republic Panic disorder requires a multidisciplinary approach because It represents a fascinating model of sudden paroxysmal excess of activity in the brain as a whole, Involving both psychiatric and neurological aspects. There Is a common complex of resembling features In epilepsy and panic disorder. This Idea originates in Gordon's neuroanatomical hypothesis and Klein's suffocation alarm theory. The reticular formation of the brain stem, the limbic

apparatus and the cortex are involved In the pathophysiology of panic altac*. anticipatory anxiety and agoraphobia. The following symptoms and signs of epileptic seizures (especially temporal) and panic attacks were bn2 to be comparable: spontaneous daily and noctumal occurrence, duratior\ features of Interparoxysmal period, common Items of paroxysm (deperson. allzation, derealization, autonomic hyperarousal), provoking factors. kirding phenomenon, EEG findings, MRI abnormalities of limbic structures. WId antiepiletic drug response.

165-151

Epilepsy, post-Ictal psychosis and use of vlgabatrin: Inducing affective disorder? A case-report

U.M.H. Klumpers, J.A.P. Van Parys. Delta Psychiatric Hospital, Poortupat The Netherlands, Instituut voor Epilepsiebestrijding. Heemstede, The Netherlands Background: Post-ictal psychosis In epilepsy consists of a short psychotic episode with affective symptomatology following a complex partial seiZlQ (CPS) or a secondary generaliZed tonic-elonlc seizure (SGTe), after. ked Interval. Features may include grandiosity, sexual Indiscretions and A1f1Qious delusions, often In the setting of an elevated mood. V1gabatrin (Sabri!). an antl-eplleptic drug and GABA-agonist may induce psychoses and affective disorders. For the latter, typical onset follows an Increase in dosage and is accompanied by a full seizure remission. Case-report: We report upon a 31 year old right handed male P8tient of normal Intelligence with localisation-related epilepsy (left temporal lobe). Since adolescence, patient Is suffering dysthymic complaints. Since 199o a stable medication regime consists of oxcarbazepine 1500 mg (OXe), primidone 500 mg and vlgabatrin 2000 mg (VGB) per day. Starting spMg 1995, a flattening of affect is noticed by his environment From August 1995 upto April 1996 patient experiences 5 post-Ictal psychoses with extensive hypomanic symptomatology. After withdrawal of VGB and Increasing dosage of OXC (mood-stabilizer I), seizures and affective symptomatology abated No negative symptoms exist. Conclusion: In this patient recurrent post-ietaJ psychoses may point 10 • cycling bipolar affective illness, Induced by use of VGB.

165-161

Epilepsy and religious delusions

M. Raja. A. Azzoni. Servizio Pslchiatrlco dl Dlagnosl e Curs. 0spedaJe Santo Spirito In Sassla, Rome, Italy Although religious delusions have been regular1y associated With epilepsy throughout the history of neuropsychiatry, surprisingly, there is no systematic study In unselected populations aimed at comparing the rate of of religious delusions in psychiatric patients with or without epilepsy. In a series of 313 unselected cases (271 patients) admitted to a P6YChiatric: intensive care unit (PICU), we found 63 cases (54 patients) With religious delusion. In comparison with patients without religious delusion, they ........ significantly older, had started their first neuroleptic treatment more ~ before, had suffered less acute psycho-social stressors and had PI'8Sented • worse global functioning during the last year before the present examination. Furthermore. they received significantly higher SAPS, BPRS total and 8PRS psychotic cluster scores and were treated with a higher mean number d different neuroleptlcs during current hospitalization. Three (5.8%) out 0( 52 patients with religious delusions and two (1.0%) of 206 patients ~ religious delusions were epileptic (Fisher exact test; p • 0.057). all of the epileptics with religious delusions were admitted more than one time and accounted for 8 (12.7%) of the 63 admitted cases with religious delusions. Among the patients without religious delusions. the epileptics were admitted only one time and accounted for the 1% of the cases.. (Fisher exact test; p • 0.0002). Neither religious delusion nor epilepsy were associated to any psychiatric diagnostic group.

HoweYer.

165-171

EEG and behavioral changes following repetitive transcranlal magnetic stimulation In kindled rabbit

H. Okamura, H. Sakamoto, W. Dol. H. Fukuzako, H. Morioka, M. Takiga Department of Neuropsychiatry, Faculty of Medicine. Kagoshima U~ Kagoshlma, Japan Repetitive transcranial magnetic stimulation (rTMS) has recently been ported to have potential usefulness for neurological examination and . . chiatric treatment. However, the safety of rTMS in patients With epiiepy~

Poster session

m

not been detennined yet. We Investigated the effects of rTMS on EEGs and

behaviorS of amygdaloid kindled rabbits to clarify this Issue. Methods: As an epileptic model, we used amygdaloid kindled rabbits by rn~s to .the f~ntal area of them, using a stimulus Intensity of 80% of the maximum Induction voltage (132 V), • stlrnulus duration of 5 sec, a stimulus frequency 0110 Hz and 30 Hz, and thel'I monitored their behaviors and EEGs recorded from electrodes placed In the bilateral amygdalas, frontal lobes and occipital lobes. Results: rTMS did not provoke paroxysmal activity at first, but repeated stJrooIat1ons gradually caused spikes and slow waves In amygdala and they spread to the cortex. However, thirty sessions of rTMS failed to evoke an atterdischaT9 9 and convulsive seizures In all rabbits. However, the thresholds d atterdischarge and convulsive seizure were found to be lowered when ele<;trIcaJ stimulation was applied to the rabbit's amygdala after thirty sessions

eIeCtI1ClII stimulations and applied dally

drTMS,

. f T S Conclusion: These results suggest that a few ses.slons o. r M a~e not likely to evoke clinical seizures, and that rTMS potentially activates epileptic Iod with Increasing number of rTMS.

[65.18]

Does repetitive transcranlal magnetic stimulation Induce eplleptogenesls In rabbit brain?

Y. Saka/TlOto H. Okamura, W. Dol, S. Muroya, H. Fukuzako, M. Takigawa.

Dept NeuroPsychiatry. Fac Med, Kagoshima University. Kagoshlma, Japan rpose of the present study Is to evaluate the s.afety of repe~itlve ~ial magnetic stimulation (rTMS) when it Is applied to the patients

The

Wllh neurologic and psychiatric disorders. Methods" For recording depth EEGs, bipolar electrodes were Implanted e:twoniCaIly into the bilateral amygdalas of Japanese white rabbits. Epidural EEG electrodes were also Implanted over the frontal and occipital areas. The Cadwell rapid-rate magnetic stimulator was used lor the stimulation. All rabbitS received a rTMS of 5 seconds once a day at a power level equal to 80% of the maximum Induction voltage (132 V). The stimulus Irequency was 10 Hz and 30 Hz. We observed time course of the EEGs and behaviors. A!tBt the 30 rTMSs, we loaded low grade electrical stimulation that does not nduc8 atter-discharge on EEGs at the amygdala. ResultS: After 20-25 sessions 01 rTMS, spikes appeared sporadically at the amygdala, and IrregUlar slow waves were observed at the cortex. HowevEII: no seizure was provoked by the rTMS. The first, low grade eledficaJ' stimulation on the amygdala evoked the after-discharge at the amygdala. spread Into cortical areas, and convulsive seizures occurred. Conclusion: Our results suggest that rTMS is less likely to Induce kindling phel'lOI1lBnon than local electrical stimulation, however, rTMS may reduce f\r8ShOld of convulsion.

[6S.1 ~

Status epllepticus and psychiatric conditions

Hadfield L.I<. Gamett, C.A. Fortner-Burton, R.J. Delorenzo. Medical ~ vl/g,nlaNlrglnla Commonwealth University. Richmond, Virginia

oJ

BIOL. PSYCffiATRY 1997:42:18-2975

1678

I benzodiazepine receptors mRNA expression In

165-20 Effect of carbamazeplne on peripheral human Iymphocy1es

A.M. Beonl, E. Calza, L. Santarelli, P. Ferrero " P. Rocca, B. Bergamasco 1 l. Ravlzza Department of Neuroscience, University of Turin, Italy. Department of Psychiatric, University of Turin, Italy. 1 Neurologic Clinic, University of Turin, Italy Although carbamazepine (CZ) has proven effective In the treatment of both neurological and psychiatric disorders Its mechanism of action remains unclear. This study was aimed to examine the effect 01 CZ on the expres· slon of peripheral benzodlazeplne receptors (pBR) mRNA In cultures of humsn peripheral blood mononuclear cells (PBMC). The relative content of mRNA encoding pBR in PBMC was determined by reverse-transcriptase polymerase chain reaction, using ll-actJn as Intemal standard. A significant Increase 01 pBR mRNA was observed by the exposure of PBMC to CZ (low J.LM) lor 72 hours in comparison with untreated cells. A further pBR binding, defined by sH-PK 11195 binding with the Intact PBMC, showed an approximately 30% higher value of PBR density In CZ treated cells compared with controls, without alteration In the apparent affinity value. These results indicate that CZ possesses the activity to Increase the expression 01 pBR In human lymphocytes. These findings may provide novel Insights Into the mechanisms underlying one or more clinical effects 01 CZ, which may contribute to similar alteration In pBR density preViously observed by us and other groups in lymphocytes and platelets of epileptic patients under chronic CZ therapy.

[65=illlnteractlon between adenosine and angiotensin II In pentylenetetrazol kindling seizures In mice V.P. Georglev, J.D. Tchekalarova. Inst. Phys/ol., Bulg. Acad. Sci., 1113 Sofia, Bulgaria The objective 01 the present study was the evaluation 01 the effects of agents acting on adenosine A, receptor, alone and In combination with ATII and sarmesin (S) - an ATII analogue, on PTZ kindling In mice. The results (after i.c.v. administration of drugs) showed that ATII (0 05 j.Lg), S (0.5, 1.5 j.Lg), 2-chloroadenosine (2-ClAdo) adenosine agonist (1.5, 10 j.Lg), as well as cyclopentyladenoslne (CPA) adenosine A, agonist (0.1 J.Lg), decreased the Intensity of seizures. In combination with ATII, S (1 j.Lg) Induced strong decrease 01 seizure Intensity whereas with 8pSPT - a specific adenosine A, receptor antagonist (100 j.Lg) the decreasing effect of S was abolished. Pretreatment 01 8pSPT antagonized the effect of 2-CIAdo (1 j.Lg). Combination of Ineffective dose of 2-CIAdo (0.5 J.Lg» with Ineffective dose of ATII (0.05 j.Lg) lead to pronounced decrease of seizure Intensity. Similar tendency was found In combination of CPA (0.1 j.Lg) with ATII (0.05 j.Lg). Taken together the results might suggest Interaction between ATII and adenosine A, receptors In regulation of seizure Intensily In PTZ kindling. Acknowledgement: This study was supported by EC through the Copeml• cus programme, contract N CIPA CT 94-0239 and by Grant L·526 from the NF "Selent. Res', Bulg. Min. Educ. Sci Technol.

23298. USA e series of patients with status epilepticus (SE) (defined as con·

In our

~re actJvlty, or Intennittent selzu.res wi.thout aW~kening, lasting

IinuOUIutes or more), we encountered some Intriguing pSYChiatric problems; 30 mtn strikingly at least three patients with undetected, non-convulsive,

1) Most raphic seizures developed delusional symptoms leading to psychi·

~p1talization. The psychotic symptoms did not clear under neuroleptic ~ bUt only after the proper diagnosis of SE was made and an· IIconVIJ\sant therapy was Instituted. This Is a little known consequence of is of vital Importance to biological psychiatry. 2) On the other Sf whlCh patients with a bona fide diagnosis of depression developed SE hand. .1WOelectroconvulsive therapy (ECn. One suffered. from cardiac an:est toI\OWIng ther did not. 3) In a fairly large subset of patients, psychological bI.C the: arious types and Intensities exacerbated episodes of SE and 4) streII ~ e was a still larger group of alcoholics and drug abusers with SE. FnaJly, r cerbated particularly by alcohol withdrawal but also by drug use. SE was e~ some patients, SE resulted from head injuries sustained while Moreover'j II enoe of alcohol and drugs. All of these conditions point to the =:~rtance 01 SE In the practJce of psychiatry.

165-221 Increased size of axospinous synapses In postmortem prefrontal cortex of schizophrenics with predominantly positive symptoms N.A. Uranova, D.O. Orlovskaya, a.v. Vikhreva, D.V. Denisov. Mental Health Research Center, Moscow, Russia Synaptic plasticity is supposed to be Involved In pathophysiology of schizophrenia. Electron microscopic morphometric blind study of synaptic components 01 axosplnous synapses was perfonned In the prelrontal cortex (area 10, layer VI) in 10 cases 01 paranoid schizophrenia with predominantly positive symptoms compared to 20 nonnal matched controls. Mop-Vldeoplan Image analyzer (Kontron) and Kontron stereologlcal program were used lor the study. A signillcant increase In volume density of postsynaptic spines as weil as a significant Increase In area and width of postsynaptic density have been found in schlzophrenl~ compared to controls (p < 0.05). There were no effects of age, sex, postmortem Interval, neuroleptic treatment on the pa• rameters measured. The modillcations 01 synaptic size were similar to those described In long-term potentiation model of memory. The data obtained suggest that the potentiation of synaptic transmission might participate in mediation 01 positive symptoms In schizophrenics. Supported by a grant of the Stanley Foundation.