1. Consultation-Liaison Psychiatry, Psychosomatics, and Psychotherapy
An integrating study on psychopathology and brain energy metabolism by Gerd Krüger MD PhD
Consultation-Liaison Psychiatry, Psychosomatics, and Psychotherapy
In the DSM5 disorders sign “personality and mood changes, abulia, depression, and emotional lability” as common symptoms in this category. emotionally labile (asthenic), and mild cognitive disorders (F )”were not corresponding with DSM- IV-TR. It is obvious that the classical concept of psychopathology was broader than that one in DSM eds, and even at present in DSM 5. Biomarkers as MRI and/or CT results are established, but other biomarkers, reflecting neuroscientic advances, were not currently discernible in the DSM5 . Probably, we need a “robust grasp of PSYCHOPATHOLOGY , over and beyond the constraints of ICD1O/11? and DSM5 on the one side and “BIOMARKERs” as NEUROENERGETICS on the other to compare them wit each other.
AMDP System 2017, 1st ed translated in now in English from the9th ed. The comparative analysis of the AMDP rated psychopathology was only possible of having reduced the mass of data by PRINCIPAL COMPONENT, DISCRIMINANT FUNCTION, and CLUSTER ANALYSIS to correlate them with those of CEREBRAL BLOOD FLOW and METABOLISM.
PSYCHOPATHOLOY: Four different clusters provided to be the maximum of the of AMDP rated variables which could usefully interpret SYMPTOM-SIGN CLUSTERS: FLTR
1st:Depression(42);2nd:Delusional(8);3rd:Behavioral- and Personality Disorders (52);4th:Dementia (45).
All organic brain syndromes are ,by definition, caused by DYSFUNCTION on CELLULAR LEVEL and METABOLISM in BRAIN whether the syndrome is caused by toxin, Inflammation, tumor, vascular or degenerative disease. Can we imagine that psychiatric diseases did not involve the brain? We cannot. Therefore we should not ignore the ambiguity of the adjective `organic´ in this context.
Seven patients could not be clustered, but representing individuell cases Two female patients showed histrionic psychopathology which was a prime example with masked and hidden brain dysfunction showing a rare clinical picture of encephalapathy by Bi. After having been crossed the blood/ brain barrier, like other heavy metals, Bi binds with thiol groups of enzymes, i.e. Pyruvatdehydrogenase (PDH) at the bridge between the GLYCOLYSIS and the KREBS (TCA) cycle. There is metabolic trafficking between astrocytes and neuron. Lactate, the major end product of glycolysis, is released astrocytes and taken up by neurons where it can enter the TCA cycle.
In the DSM5 cognitive disorders as “personality and mood changes, abulia, depression, and emotional lability” and common symptoms as emotionally labile (asthenic), and mild cognitive disorders (F )”were not corresponding with DSM- IV-TR. It is obvious that the classical concept of psychopathology was broader than that one in DSM eds, and even at present in DSM 5. Biomarkers as MRI and/or CT results are established, but other biomarkers, reflecting neuroscientic advances, were not currently discernible in the DSM5 . Probably, we need a “robust grasp of PSYCHOPATHOLOGY , over and beyond the constraints of ICD1O/11? and DSM5” on the one side and “BIOMARKERs” as NEUROENERGETICS on the other to compare them wit each other.
AMDP System 2017, 1st ed translated in now in English from the 9th ed. The comparative analysis of the AMDP rated psychopathology was only possible of having reduced the mass of data by PRINCIPAL COMPONENT, DISCRIMINANT FUNCTION,and CLUSTER ANALYSIS to correlate them with those of CEREBRAL BLOOD FLOW(CBF) and METABOLISM(CMR).
PSYCHOPATHOLOY: Four different clusters provided to be the maximum of the of AMDP rated variables which could usefully interpret SYMPTOM-SIGN CLUSTERS (FLTR) as syndromes (p=0.0000):
1st:Depression(42);2nd:Delusional(8);3rd:Behavioral- and Personality Disorders (52);4th:Dementia (45).
All organic brain syndromes are ,by definition, caused by DYSFUNCTION on CELLULAR LEVEL and METABOLISM in BRAIN whether the syndrome is caused by toxin, Inflammation, tumor, vascular or degenerative disease, and by stress. Can we imagine that psychiatric diseases did not involve the brain? We cannot. Therefore we should not ignore the ambiguity of the adjective `organic´ in this context.
Eight patients could not be clustered representing individuell cases. There are two female patients showing ´histrionic` psychopathology which was a prime example with MASKED and HIDDEN BRAIN DYSFUNCTION inert a rare clinical picture of ENCEPHALOPATHY by Bi.
Pyruvatdehydrogenase Complex (PDHC) at the bridge between the GLYCOLYSIS and the KREBS (TCA) cycle: There is metabolic trafficking between astrocytes and neurons. Lactate, the major end product of glycolysis, is released at astrocytes and taken up by neurons where it can enter the TCA cycle.
BRAIN ENERGY METABOLISM: LACTATE AS NEUROENERGETICS, ASTROCYTE-NEURON lactate shuttle (ANLS), ASTROCYTE- MICROGLIA lactate shuttle (AMLS) in terms of NEUROPATHOLOGICAL CONDITIONS FOCUSING on LACTATE and its SHUTTLES by MICROGLIA in NEURONAL ALLOSTASIS as well as STRESS beyond HOMEOSTASIS. MASON S: Is the ANLS hypothesis the new paradigm for homeostatic NEUROENERGETICS ? LIPIDOMICS and METABOLOMICS.
2017:11;43
Frequent or chronic challenges produce dysregulation of several physiological systems by triggering chemical mediators of adaption that operate in a nonlinear network: cumulative “wear and tear“, allostatic overload that results in the development of stress related disease.
(P=0.001)
Sample: N:155-8=147,mean age: 54 years, SEM:1.25 in
Reevaluated regarding the results of lactate in brain since the 90s.
The nearly demented (N=45) and those with personality and behavioral changes (N=52), correlated with increased percent changes compared with normal of AV–differences of lactate lac/glucose index, in contrary to the depressives (N=42) with about half of normal decreased levels of these metabolites; the delusional patients (N=8) were not so much decreased.
Arterial and internal jugular venous blood, taken at the time of CBF measurements, was analysed for glucose, lactate, and oxygen. This enabled the utilization or production of each substance to be calculated. For example, the utilization of O2/min (CMRO2)= arterivenous difference in O2 x CBF.
Bi in significant amounts in both patients cerebral venous blood.
The Lancet, Sep 4,1976,
Bi crossed the blood- brain- barrier (BBB) and
binds with thiol (SH) groups of PDHC like other heavy metals.
Bi: 160µg/ml >>>>> 0 µg/ml µg/ml >>>>> µg/ml
The most striking dsturbance was the high cerebral metabolic rate of lactate which returned to minimal values after she had stopped using the skin cream.
Patient 1 using the cream at admission also had 3 µg/ml of Bi in her CSF.
After 3 weeks without using the cream, no Bi was detectable in blood and CSF.
The interconversion of lactate and pyruvate occurs via Lactatehydrogenase, with increased lactate typically being associated with ANAEOROBIC RESPIRATION, i.e. the PASTEUR effect.
But the low, especially subnormal levels of O2/ glucose in both cases not opened the door to, at that time, the WARBURG effect with AEROBIC GLYCOLYSIS.
In patient 2 the levels of all values besides hypernormal lactate showed the chronic disturbance of oxidative metabolism with reduced utilisation of glucose and subnormal O2-values. This patient heard about her cousin´s (patient1) admission and stopped using the cream. Look on the symptoms: starting to have headaches, difficulty with concentration and memory,and dizziness.
“A neurological opinion that she was neurotic. When seen at the hospital she still had headaches. Her memory was impaired and there was evidence of a mild dementia with normal CSF and EEG examinations“.
Raichle ME: Phil.Trans.R.Soc.B.370:
AEROBIC GLYCOLYSIS (glycolytic index)/
REVERSE WARBURG EFFECT (FLTR).