The aim of this paper is to present the state of the art concerning the role of metabotropic glutamate receptors (mGluRs) in the CNS physiology and pathology. In the first part of this work a classification of mGluRs and their distribution in the CNS are outlined. The influence of mGluRs on the regulation of calcium and potassium channels as well as interaction of these receptors with other neurotransmitter systems are discussed. The second part of the article presents mGluRs involvement in CNS pathology and a potential role of the ligands of these receptors in the treatment of pain, epilepsy, neurodegenerative diseases, anxiety, depression and drug addictions
The paper presents mechanisms underlying such neurodegenerative processes as accumulation of protein aggregates, excitotoxicity, oxidative stress, metabolic compromise, apoptosis, and necrosis. The authors describe the multistage process of apoptosis, the PTPC channel role in the mitochondrial membrane, and the role of caspases in the mechanism of apoptosis. Attention is drawn to the role of dopamine in neurodegenerative processes. In the second part of the article therapeutic implications of the above-described mechanisms are discussed. In this respect of special importance may be not only the antagonization of excitotoxicity processes (where especially the NMDA glutaminergic receptor is involved), but also antioxidative therapy, as well as the use of neurotrophic factors and immunosuppressants. The new strategy is to inhibit apoptosis and protein aggregates accumulation.
Dementia associated with human immunodeficiency virus (HIV dementia) has been reported in HIV-infected patients. HIV-retrovirus plays an important role in the pathogenesis of the syndrome. A number of indirect factors generated by infected macrophages may contribute to the pathogenesis of HIV dementia. Inflammatory cytokines and mediators damage neuronal cells, with a subsequent loss of cognitive functions. Also Gp120, an HIV surface antigen, and Vpr protein can cause neuronal death via apoptosis. Activation of NMDA receptor s is the final common pathway both in HIV dementia and in other neurodegenerative processes. Antiretroviral therapy protects against neuropsychological deficits and clinical manifestation of dementia.
Multiple system atrophy (MSA), especially in the form with a predomination of parkinsonic symptoms, in its early stage is difficult to diagnose, often being misdiagnosed as Parkinson's disease, while the correct diagnosis is found not earlier than in a postmortem verification. Clinical differences as well as various additional tests helpful in arriving sooner at the correct differential diagnosis of MSA are discussed, which may be of importance in clinical practice.
Stomatodynia or the burning mouth syndrome (BMS) is defined as a burning sensation in oral mucosa in patients with no clinically recognizable changes in this area. Three groups of etiological factors are distinguished in the literature: local, systemic, and psychogenic. Depressive disorders, anxiety, or mixed depressive-anxiety syndromes are the most frequent BMS concomitants. It is not clear whether BMS symptoms are a somatic expression of anxiety or depression, or whether the latter result from experiencing the troublesome BMS symptoms chronically.
In both reported cases serotoninergic-type side effects were seen after phototherapy implementation in patients receiving fluoxetine or sertraline. On stopping phototherapy the symptoms completely disappeared. In the authors' opinion the symptoms were probably associated with a specific interaction of the treatment methods used (enhancing the serotonin effect). To our knowledge this is the first ever report concerning such an effect.
The paper presents the state-of-the-art knowledge about schizophrenia with the onset after the age of 40. The standpoint is discussed of an international group of experts summarizing findings of research on "late" schizophrenia. Moreover, a case is reported of a female patient who at the age of 41 developed symptoms meeting the ICD-10 criteria for schizophrenia.
A form for submitting psychiatric court expertise in accordance with relevant legal regulations is proposed to satisfy the needs of court experts producing such a document. (Ed.)