This issue of Psychiatric Annals will focus on recent advances in psychiatry in the areas of sleep, endocrinology, pharmacology, neurology and visual brain imaging. There is a growing body of evidence suggesting that biological alterations associated with psychiatric illness may serve as possible markers of mental disease. The potential markers may be either traitdependent (present in both well and ill phases of the illness) or statedependent (present only in the ill phase). This issue will review several of the potential candidates for biological markers which have been proposed to help in the diagnosis and treatment of psychiatric illness.
Briefly, one area of study has been sleep alterations in psychiatric patients as compared to controls. In a review, Dr. Gillin reports both transient and persistent sleep abnormalities in patients with major affective disorders.
A second area of research and one that has recently received much attention is that of neuroendocrinology. Dr. Targum reviews neuroendocrine challenge studies in psychiatric patients. He suggests that the challenge studies, namely, dexamethasone suppression tests or thyroid releasing hormone tests, can be used to discriminate mania from schizophrenia. In combination with clinical exams, and assessment of family history, neuroendocrine tests may be extremely useful in helping with the diagnosis of a first break patient with an uncertain psychiatric history.
An alternative method for identifying biological markers may be possible through the analysis of neuronal changes in response to psychotropic drugs. Drs. Haugerand Paul review receptor alterations in response to antidepressants and antipsychotics and suggest that changes in receptor sensitivity in animals may correlate with clinical changes observed in man. They note that some depressed patients are more responsive to drugs which differentially alter drug binding sites in the brain.
Dr. Rickler describes certain neurological illnesses which might present as psychiatric disease and emphasizes the need for the use of improved diagnostic procedures in psychiatric patients.
The recent introduction of visual imaging techniques has provided scientists with a number of possible markers of brain function. Drs. Weinberger and Wyatt review CAT scan evidence suggesting alterations in ventricular size in the brains of schizophrenics. Drs. Bunney and Buchsbaum describe four additional visual imaging techniques used to measure brain function. Briefly, cerebral blood flow techniques offer the advantages of studying circulatoryrelated metabolic events, EEG studies allow for the studies of patterns of responses associated with behavioral parameters, NMR techniques provide a means to study cell energy metabolism and may eventually replace CAT scanning, and finally, PET scan studies are capable of producing three-dimensional maps of regional cerebral metabolism. Thus far, visual imaging studies, although preliminary, have provided evidence that alterations in brain function may be a marker for psychiatric illness.