Publisher Summary This chapter provides an overview of the morphology of central monoamine neurons and the function of central monoamine neurons. The Nigro–Neostriatal neurons perform both the motor and mental functions. Their degeneration causes hypokinesia and rigidity while overstimulation of neostriatal dopamine (DA) receptors causes stereotyped behavior. The tubro-infundibular DA neurons probably act by way of inhibiting the release of luteinizing hormone releasing factor (LHRF) from the median eminence. The central noradrenaline (NA) neurons perform various functions, such as function in wakefulness, emotion, behavior, neuroendocrine function, and function in reflex activity. The central 5-hydroxytryptamine (5-HT) neurons contribute to the function in mood, wakefulness, thought process, behavior, neuroendocrine function, and function in reflex activity. The NA neurons probably are essential for conditioned processes as are the DA neurons while a destruction of the 5-HT neurons results in insomnia. Increased NA receptor activity results in aggression. The descending bulbospinal 5-HT neurons participate in the control of autonomic and somatic reflex activity, especially in the lumbosacral part.

Morphological and Functional Aspects of Central Monoamine Neurons

Although recent data suggest that pimozide has effects at other neurotransmitter receptor sites, it is one of the more specific neuroleptics in its effects on dopamine receptors We report that in manic patients pimozide produces substantial clinical improvement with a magnitude and time course similar to that observed with the more routinely used phenothiazines chlorpromazine and thioridazine Pimozide did not significantly increase probenecid-induced accumulations of the dopamine metabolite homovanillic acid (HVA) compared to pretreatment values Higher HVA values were observed in manic than in nonmanic patients, however These clinical and biochemical data add to a growing body of indirect evidence that a dopaminergic alteration may be associated with some components of the manic syndrome

Dopamine and mania: Behavioral and biochemical effects of the dopamine receptor blocker pimozide

SYNOPSIS



Nineteen male patients aged 26 to 67 years have been treated with lithium sulphate in the form of slow release tablets (Lithionit(r) Durules(r)) to prevent attacks of cluster headache. Treatment was given to a serum concentration between 0.7 and 1.2 mmolI. Eight of the patients had chronic symptoms and in all of them the treatment resulted in immediate partial remission of their headaches. The average headache index improved within 2 weeks by 85.3 per cent (75–100%). Three patients were treated for between 18 and 36 months. In one of them the treatment was still effective after 2 years, while the other two appeared in due course to become tolerant to the effects of the drug. Both of them, however, had long periods of remission after interruption of treatment, which may indicate that lithium alters the natural course of the disease in chronic cases.



In 7 patients with periodic symptoms lithium had only a slight or no effect on the headaches. In four other cases lithium was given for, on average, 19.7 months (6-31), principally owing to psychiatric symptoms. This long-term prophylactic treatment resulted in an almost complete suppression of cluster periods. Two of these patients tried to discontinue the drug after one year. This produced extremely severe rebound headaches after 3 weeks.



It is concluded that lithium is efficacious in chronic cluster headache. Lithium has only slight effects in acute periods of cluster headache but may prevent them in some patients when the drug is given in a free interval between two periods. In view of its potential serious side-effects, lithium should be given with caution to strictly selected patients.



The mechanisms of actions of lithium are discussed.

Mogens Schou

Papers

The effect of prolonged lithium administration on cerebral monoamine neurons in the rat.