- Email: [email protected]
Osteopenia in anorexia nervosa (AN): Markers of bone turnover show increased resorption and decreased formation
S302
RF16 Other topics
over, phenylalanine correlated with failing memory. The CSF level of tryptophan was negatively correlated with reduced sexual interest. There was a negative correlation between inner tension and the CSF concentration of CCK-4. Due to the small number of patients, our results must be interpreted with caution. However, our findings are in keeping with the existence of relationships between depressive symptoms and neurotransmitter concentrations in CSF. Further studies could contribute to a greater understanding of the complicated mechanisms involved. References (11 Win&w, A. (1993): Thyroid axis and depressive disorders. In: Mann, J.J., Kupfer, D.J. (eds.), Biology of depressive disorders, Part A. Plenum Press, New York, PP 155-170. [2] Gold, M.S., Pottash, A.L.C., Extein, 1. (1981): Hypothyroidism and depression. JAMA 245 (19): 1919-1922.
lp.6.0251
Osteopenia in anorexia nervosa (AN): Markers of bone turnover show increased resorption and decreased formation
C. Lennkh, U. Bailer, A. Strnad, C. Nagy, S. Wiesnagrotzki, M. de Zwaan, S. Kasper. Department of General Psychiaq, University Hospital of Psychiatry Vienna, Austria Purpose: Osteopenia is a well recognized medical complication of AN. As AN primarily affects adolescent females at a developmentally critical period of bone formation this failure to obtain bone mass during adolescence may lead to increased spine and stress fractures. The mechanism of this bone loss is not fully understood and there is uncertainty about its management. New markers of bone turnover have been developed. C-terminal type 1 propeptide (PICP) is a measure of bone formation and urinary pyridinolines such as Deoxypyridinoline (DPYRX) and serum carboxyterminal crosslinked telopeptide (ICTP) are markers of bone resorption. The aim of this study was to examine these bone markers in patients with AN. Methods: Twenty female AN patients meeting DSM-IV criteria for AN with a mean body mass index (BMI) of 15.7 kg/m2, mean age of 22.5 years, and a mean duration of illness of 3.6 years were included in the study. The results were compared to those of twelve healthy volunteers with no history of eating disorders and a BMI range of 20-25 kg/m2. Bone density of AN patients was measured by dual energy x-ray absorptiometry (DEXA) on lumbar, spine, femoral neck, and whole body. All values were transformed to t-scores, and compared to standardized, age-matched values. Results: The markers of bone resorption were significantly higher in AN than in healthy controls (Mann Whitney U-test: ICTP p = 0.04, DPYRX p = 0.033). Bone formation, measured by PICP was not significantly decreased. The results of DEXA showed t-scores of 83% compared to standardized values. There was a significant correlation between lumbar as well as femoral bone mass reductions and the duration of illness (p = 0.059, and p = 0.001 respectively). We also found a significant correlation with minimal body weight (p = 0.033). Conclusions: AN appears to be associated with increased bone resorption and decreased bone formation. This pattern differs from osteopenia in menopausal women and should therefore lead to the development of specific therapeutic strategies in AN associated osteopenia. Hormone replacement therapy as well as calcium and vitamine D-supplementation are so far discussed controversially. Long-term treatment studies are warranted. lp.6.0261
Early short-term amitriptiline administration prevention of postherpetic neuralgia
for
F. Ser', S. Milovanovic’, M. Lazovic’ , M. Veljkovic’ ‘City Department for Skin and Venereal Diseases: 21nstityte for Psychiatry, Belgrade Herpes Zoster presents rather frequent clinical entity in everyday dermatologic practice. Postherpetic neuralgia poses itself a great therapeutic
problem as a rather frequent complication but sometimes difficult to control especially in the elderly. Various therapeutic regimens are recommended. Authors present a study of 34 patients with Herpes Zoster. Early in the course of the disease they were treated with amitriptiline orally. Routine topical treatment was administered simultaneously. Initially 50 mg of amitriptiline was administered at bedtime as a single dose. In a first few days improvement of sleep, as well as control of pruruitus was obtained. Painful sensations dye to Herpes Zoster were mild. After a 10 days period adjustment of the dosage was made according to clinical response. Usually maintenance dose was only 25 mg daily and was continued for approximately three months. Only two patients developed postherpetic neuralgia and were treated with 75 mg amitriptiline daily for approximately three months. Authors believe that initial experience with low-dosage amitriptiline early in the course of disease gives encouraging results and is worth-trying in high risk patients.
lp.6.0271
Psychopathological implications in course of spinal cord injuries and their phannacologlcal treatment
H. Piatkowska. Medical Academy, Clinic of Rehabilitation
- Warsaw,
Poland Our neuropsychiatric study presents the image of psychopathological
complications in subject after spinal cord injuries submitted to treatment in the Clinic of Rehabilitation. This problem is very difficult and important in the course of therapeutic proceedings, of farther rehabilitation and adaptation to disability with state of different limitations. 1. Acute period The injury of spinal cord is connected in somatic sphere with an acute aggression on the organism. Clinical consequences of this acute aggression are: 1. Acute interruption of interceptive impulses 2. Acute disorders of mechanism of central regulation 3. Disorders of blood circulation and of respiratory functions 4. Disorders of basic physiological functions, endocrine and metabolic changes 5. Loss of motor activities, immobilization 6. Neurological consequences: paretic syndromes: para- or tetraparesis or para- or tetraparaplegia - dependently of the level of injury. Particularly these somatic disorders are strong after cervical injury. In the acute period appear the following psychopathological symptoms: ?? Insomnia . Disorders of perception . Disorders of consciousness ?? Psychotic reactions These complications are connected with organic ground of somatic factors. Their course and evolution is very different and demands an appropriate treatment. II. Subacute period In this period the somatic state of patients improve. The new situation of immobilization and dependance, persistent disorders in self perception, body image and self image activate the different reactions. The psychological factors play a significant role in development of affective disorders: mood disorders, lack of initiative and motivation, hippodepressive or depressive states, suicidal toughts. The course of these psychopathological syndroms is very individual, the affective disorders by rehabilitation and pharmacological treatment (3-cyclic antidepressants, maprotyline) may retrait. The subacute period is very important in the process of further adaptation. III. Chronic period This stage involves the different psychological reactions and may reveal the psychopathological complications in the process of adaptation to the disability. The psychological reactions consist in self defence reactions are: Agression Rejection
RF16 Other topics
over, phenylalanine correlated with failing memory. The CSF level of tryptophan was negatively correlated with reduced sexual interest. There was a negative correlation between inner tension and the CSF concentration of CCK-4. Due to the small number of patients, our results must be interpreted with caution. However, our findings are in keeping with the existence of relationships between depressive symptoms and neurotransmitter concentrations in CSF. Further studies could contribute to a greater understanding of the complicated mechanisms involved. References (11 Win&w, A. (1993): Thyroid axis and depressive disorders. In: Mann, J.J., Kupfer, D.J. (eds.), Biology of depressive disorders, Part A. Plenum Press, New York, PP 155-170. [2] Gold, M.S., Pottash, A.L.C., Extein, 1. (1981): Hypothyroidism and depression. JAMA 245 (19): 1919-1922.
lp.6.0251
Osteopenia in anorexia nervosa (AN): Markers of bone turnover show increased resorption and decreased formation
C. Lennkh, U. Bailer, A. Strnad, C. Nagy, S. Wiesnagrotzki, M. de Zwaan, S. Kasper. Department of General Psychiaq, University Hospital of Psychiatry Vienna, Austria Purpose: Osteopenia is a well recognized medical complication of AN. As AN primarily affects adolescent females at a developmentally critical period of bone formation this failure to obtain bone mass during adolescence may lead to increased spine and stress fractures. The mechanism of this bone loss is not fully understood and there is uncertainty about its management. New markers of bone turnover have been developed. C-terminal type 1 propeptide (PICP) is a measure of bone formation and urinary pyridinolines such as Deoxypyridinoline (DPYRX) and serum carboxyterminal crosslinked telopeptide (ICTP) are markers of bone resorption. The aim of this study was to examine these bone markers in patients with AN. Methods: Twenty female AN patients meeting DSM-IV criteria for AN with a mean body mass index (BMI) of 15.7 kg/m2, mean age of 22.5 years, and a mean duration of illness of 3.6 years were included in the study. The results were compared to those of twelve healthy volunteers with no history of eating disorders and a BMI range of 20-25 kg/m2. Bone density of AN patients was measured by dual energy x-ray absorptiometry (DEXA) on lumbar, spine, femoral neck, and whole body. All values were transformed to t-scores, and compared to standardized, age-matched values. Results: The markers of bone resorption were significantly higher in AN than in healthy controls (Mann Whitney U-test: ICTP p = 0.04, DPYRX p = 0.033). Bone formation, measured by PICP was not significantly decreased. The results of DEXA showed t-scores of 83% compared to standardized values. There was a significant correlation between lumbar as well as femoral bone mass reductions and the duration of illness (p = 0.059, and p = 0.001 respectively). We also found a significant correlation with minimal body weight (p = 0.033). Conclusions: AN appears to be associated with increased bone resorption and decreased bone formation. This pattern differs from osteopenia in menopausal women and should therefore lead to the development of specific therapeutic strategies in AN associated osteopenia. Hormone replacement therapy as well as calcium and vitamine D-supplementation are so far discussed controversially. Long-term treatment studies are warranted. lp.6.0261
Early short-term amitriptiline administration prevention of postherpetic neuralgia
for
F. Ser', S. Milovanovic’, M. Lazovic’ , M. Veljkovic’ ‘City Department for Skin and Venereal Diseases: 21nstityte for Psychiatry, Belgrade Herpes Zoster presents rather frequent clinical entity in everyday dermatologic practice. Postherpetic neuralgia poses itself a great therapeutic
problem as a rather frequent complication but sometimes difficult to control especially in the elderly. Various therapeutic regimens are recommended. Authors present a study of 34 patients with Herpes Zoster. Early in the course of the disease they were treated with amitriptiline orally. Routine topical treatment was administered simultaneously. Initially 50 mg of amitriptiline was administered at bedtime as a single dose. In a first few days improvement of sleep, as well as control of pruruitus was obtained. Painful sensations dye to Herpes Zoster were mild. After a 10 days period adjustment of the dosage was made according to clinical response. Usually maintenance dose was only 25 mg daily and was continued for approximately three months. Only two patients developed postherpetic neuralgia and were treated with 75 mg amitriptiline daily for approximately three months. Authors believe that initial experience with low-dosage amitriptiline early in the course of disease gives encouraging results and is worth-trying in high risk patients.
lp.6.0271
Psychopathological implications in course of spinal cord injuries and their phannacologlcal treatment
H. Piatkowska. Medical Academy, Clinic of Rehabilitation
- Warsaw,
Poland Our neuropsychiatric study presents the image of psychopathological
complications in subject after spinal cord injuries submitted to treatment in the Clinic of Rehabilitation. This problem is very difficult and important in the course of therapeutic proceedings, of farther rehabilitation and adaptation to disability with state of different limitations. 1. Acute period The injury of spinal cord is connected in somatic sphere with an acute aggression on the organism. Clinical consequences of this acute aggression are: 1. Acute interruption of interceptive impulses 2. Acute disorders of mechanism of central regulation 3. Disorders of blood circulation and of respiratory functions 4. Disorders of basic physiological functions, endocrine and metabolic changes 5. Loss of motor activities, immobilization 6. Neurological consequences: paretic syndromes: para- or tetraparesis or para- or tetraparaplegia - dependently of the level of injury. Particularly these somatic disorders are strong after cervical injury. In the acute period appear the following psychopathological symptoms: ?? Insomnia . Disorders of perception . Disorders of consciousness ?? Psychotic reactions These complications are connected with organic ground of somatic factors. Their course and evolution is very different and demands an appropriate treatment. II. Subacute period In this period the somatic state of patients improve. The new situation of immobilization and dependance, persistent disorders in self perception, body image and self image activate the different reactions. The psychological factors play a significant role in development of affective disorders: mood disorders, lack of initiative and motivation, hippodepressive or depressive states, suicidal toughts. The course of these psychopathological syndroms is very individual, the affective disorders by rehabilitation and pharmacological treatment (3-cyclic antidepressants, maprotyline) may retrait. The subacute period is very important in the process of further adaptation. III. Chronic period This stage involves the different psychological reactions and may reveal the psychopathological complications in the process of adaptation to the disability. The psychological reactions consist in self defence reactions are: Agression Rejection