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Both neurodegenerative and neurodevelopmental abnormalities have been suggested to be part of the etiopathology of severe mental illness (SMI). Neuron-specific enolase (NSE), mainly located in the neuronal cytoplasm, may indicate the process as it is upregulated after neuronal injury while a switch from non-neuronal enolase to NSE occurs during neuronal maturation.
Methods
We included 1132 adult patients with SMI [schizophrenia (SZ) or bipolar spectrum disorders], 903 adult healthy controls (HC), 32 adolescent patients with SMI and 67 adolescent HC. Plasma NSE concentrations were measured by enzyme immunoassay. For 842 adults and 85 adolescents, we used total grey matter volume (TGMV) based on T1-weighted magnetic resonance images processed in FreeSurfer v6.0. We explored NSE case-control differences in adults and adolescents separately. To investigate whether putative case-control differences in NSE were TGMV-dependent we controlled for TGMV.
Results
We found significantly lower NSE concentrations in both adult (p < 0.001) and adolescent patients with SMI (p = 0.007) compared to HC. The results remained significant after controlling for TGMV. Among adults, both patients with SZ spectrum (p < 0.001) and bipolar spectrum disorders (p = 0.005) had lower NSE than HC. In both patient subgroups, lower NSE levels were associated with increased symptom severity. Among adults (p < 0.001) and adolescents (p = 0.040), females had lower NSE concentrations than males.
Conclusion
We found lower NSE concentrations in adult and adolescent patients with SMI compared to HC. The results suggest the lack of progressive neuronal injury, and may reflect abnormal neuronal maturation. This provides further support of a neurodevelopmental rather than a neurodegenerative mechanism in SMI.
There is still limited systematic research on the effectiveness of psychotropic drugs used in liaison psychiatry settings. All drugs available in clinical psychiatry for the treatment of psychiatric disorders can be used in liaison settings. However, before choosing a specific drug, liaison psychiatrists must address additional important issues beyond those related to the indication for a psychotropic drug. Most psychotropic drugs used today are aimed at g-protein coupled receptors such as serotonergic (5HT). The availability of psychotropic drugs varies to some extent between countries within the European Union. This chapter discusses the most frequently used drugs. Depressive disorders accompanying physical illness should be treated to improve quality of life and treatment adherence. The main indications in liaison psychiatry settings are behavioural disorders caused by organic brain dysfunction including temporal lobe epilepsy, acute mania, pain disorders and prophylactic treatment of bipolar disorders.
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