Amino Acids

, Volume 12, Issue 2, pp 107–117 | Cite as

Amino acid studies in transient acute polymorphic psychosis

  • D. Fekkes
  • L. Pepplinkhuizen
Review Article


Data are reviewed on the amino acid metabolism in patients suffering from transient acute polymorphic psychoses according to ICD-10. The psychotic episodes of many of these patients are characterized by distorted sensory perceptions and intense emotional states; plasma amino acid analysis revealed a disturbed serine-glycine metabolism.

In remitted patients oral loading with serine induced the characteristic dysperceptions and psychedelic symptoms. Plasma concentrations of serine and methionine were decreased, and the concentration of taurine was increased. Fibroblast experiments suggest that the activities of the serine metabolizing enzymes serine hydroxymethyltransferase and cystathionineβ-synthase are increased in these patients.

The determination of plasma amino acid concentrations proved to be useful in discriminating these patients. The prevalence of this transient psychosis in a psychiatric in-patient population ranged between 1.4 and 3.6%.


Amino acids Serine TSM-ratio Acute polymorphic psychosis 


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  1. Brimblecombe RW, Pinder RM (1975) Hallucinogenic agents. Wright Scientechnica, BristolGoogle Scholar
  2. Bruinvels J, Pepplinkhuizen L (1984) Impaired glycine-serine conversion and increased plasma taurine levels in episodic psychotic patients with psychedelic symptoms. J Psychiatr Res 18: 307–318PubMedGoogle Scholar
  3. Bruinvels J, Pepplinkhuizen L (1985) Disturbances in serine-glycine metabolism in relation to acute psychoses with psychedelic symptoms. In: Beckmann H, Riederer P (eds) Pathochemical markers in major psychoses. Springer, Berlin Heidelberg New York Tokyo, pp 59–73Google Scholar
  4. Bruinvels J, Pepplinkhuizen L, Van Tuijl HR, Moleman P, Blom W (1980) Role of serine, glycine, and the tetrahydrofolic acid cycle in schizoaffective psychosis. A hypothesis relating porphyrin biosynthesis and transmethylation. In: Usdin E, Sourkes TL, Youdim MBH (eds) Enzymes and neurotransmitters in mental disease. John Wiley, Chicester, pp 139–154Google Scholar
  5. Bruinvels J, Pepplinkhuizen L, Fekkes D (1988) Derangement of one-carbon metabolism in episodic schizoaffective psychoses. Pharmacopsychiatry 21: 28–32PubMedGoogle Scholar
  6. DSM III-R (1987) Diagnostic and statistical manual of mental disorders, 3rd edn. Am Psychiatric Association, Washington DCGoogle Scholar
  7. Fekkes D, Bruinvels J (1986) Serine and folate metabolism in fibroblasts from episodic psychotic patients with psychedelic symptoms. Biol Psychiatry 21: 951–959PubMedGoogle Scholar
  8. Fekkes D, Pepplinkhuizen L, Bruinvels J (1991) Changes in serine metabolism by a serum factor present in a group of episodic psychotic patients. Biol Psychiatry 30: 966–972PubMedGoogle Scholar
  9. Fekkes D, Pepplinkhuizen L, Verheij R, Bruinvels J (1994) Abnormal plasma levels of serine, methionine, and taurine in transient acute polymorphic psychosis. Psychiatry Res 51: 11–18PubMedGoogle Scholar
  10. ICD-10 (1992) Classification of mental and behavioural disorders. World Health Organization, GenevaGoogle Scholar
  11. Leonhard K (1979) The cycloid psychoses. In: Robbins E (ed) The classification of endogenous psychoses, 5th edn. Irvington Publishers Inc., New York, pp 99–139Google Scholar
  12. Magnan V (1893) Leçons Cliniques, 2nd edn. Bataille éd., ParisGoogle Scholar
  13. Meller E, Rosengarten H, Friedhoff AJ, Stebbins RD, Silber R (1975) 5-Methyltetrahydrofolic acid is not a methyl donor for biogenic amines: enzymatic formation of formaldehyde. Science 187: 171–173PubMedGoogle Scholar
  14. Mitsuda H (1965) The concept of “Atypical Psychoses” from the aspect of clinical genetics. Acta Psychiat Scand 41: 372–377PubMedGoogle Scholar
  15. Osmond H, Smythies J (1952) Schizophrenia: a new approach. J Ment Sci 98: 309–315PubMedGoogle Scholar
  16. Pearson AG, Turner AJ (1975) Folate-dependent-1-carbon transfer to biogenic amines mediated by methylenetetrahydrofolic acid reductase. Nature 258: 173–174PubMedGoogle Scholar
  17. Pepplinkhuizen L (1983) Disturbances of serine and glycine metabolism as a cause of episodic acute polymorphous psychoses. Thesis, Erasmus University RotterdamGoogle Scholar
  18. Pepplinkhuizen L (1988) Ritanserin in the treatment of therapy resistent psychoses: 13 pilot case reports. Janssen Res Rep 15: 109–113Google Scholar
  19. Pepplinkhuizen L, Bruinvels J, Blom W, Moleman P (1980) Schizophrenia-like psychosis caused by a metabolic disorder. Lancet i: 454–456Google Scholar
  20. Perris C (1974) A study of cycloid psychoses. Acta Psychiat Scand [Suppl] 253Google Scholar
  21. Rijn-van den Meijdenberg JCC, Fekkes D, Wilson JHP, Pepplinkhuizen L, Verhoeven WMA, Jansen HML, Ederveen AB (1994) Acute intermittent porphyria and disturbances in amino acid metabolism in a psychiatric in-patient population. Eur Psychiatry 9: 249–253Google Scholar
  22. Schröder P (1920) Degeneratives Irresein und Degenerationspsychosen. Z Gesamte Neurologie Psychiatrie 60: 119–126Google Scholar
  23. Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria. Rationale and reliability. Arch Gen Psychiatry 35: 773–782PubMedGoogle Scholar
  24. Wunderink AL, Pepplinkhuizen L, Bruinvels J (1986) Nutrition and psychoses. Progr Brain Res 65: 49–57Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • D. Fekkes
    • 1
    • 2
  • L. Pepplinkhuizen
    • 1
    • 2
  1. 1.Section Pathophysiology of BehaviourMedical Faculty, Erasmus University RotterdamDR RotterdamThe Netherlands
  2. 2.Department of PsychiatryUniversity Hospital DijkzigtRotterdamThe Netherlands

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