The mitogen induced lymphocyte responses were measured in 33 depressed patients categorized according to the DSM-III into minor (300.40, 309.00), simple major (296.X2) and major depression with melancholia and/or psychotic features (296.X3, 296.X4). Three distinct mitogens were used, i.e. phytohemaglutinin (PHA), pokeweed mitogen (PWM) and concanavalin A (CON A). We found that major depressives with associated features showed significantly lower mitogen induced lymphocyte responses to PHA and PWM as compared to all other depressed patients. The severity of illness was significantly inversely related to the lymphocyte responses to PHA. Cortisol nonsuppressors exhibited significantly lower PHA and PWM induced lymphocyte responses as compared with suppressors. There were significant and negative correlations between the postdexamethasone Cortisol values and the PHA and PWM stimulated lymphocyte responses.

In this case report of a patient with carcinoid carcinoma we discuss the normal metabolism of tryptophan, one of the essential amino acids.

We also examined the changes of this metabolism due to the metastasis of the carcinoid carcinoma and its psychiatric complications based on a central tryptophan deficiency.

A less frequent complication of the changes in the tryptophan metabolism due to carcinoidosis is the disease pellagra. This disease is always accompanied with psychiatric symptoms. It plays an important role in the development of the transmethylation hypothesis of schizophrenia.

The present review summarizes the prevalence, clinical phenomena, and pathogenesis of sleep and wake disorders in shift workers. Insomnia and hyper-somnolence occur in more than 50% of shift workers, mainly in association with the night shift. Circadian rhythm disruption is the major determinant of these disorders. Furthermore they are frequently associated with psycho-social problems and somatic diseases. In more than 20% of the shift workers problems are so pronounced, that they fail to adapt to the rotating schedules. This is defined as ‘shift maladaptation syndrome’.

The present review deals with preventive and treatment strategies for sleep and wake disorders, and the other problems of shift workers. Management must take into account the direction, speed and other parameters of the rotation schedule. Good sleep-wake hygiene may alleviate the problems. Further, additional napping may compensate – at least partially – for sleep deprivation and fatigue. Hypnotics must be avoided as much as possible. Finally, new techniques for manipulation of circadian rhythms are discussed: light, melatonin and benzodiazepines.