Fluoxetine-induced akathisia does not reappear after switch to paroxetine.
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Akathisia, Drug-Induced↗
Biomedical subjects
A Baumgartner
Publications and source records attributed to A Baumgartner.
The hypothalamic-pituitary-thyroid axis in patients maintained on lithium prophylaxis for years: high triiodothyronine serum concentrations are correlated to the prophylactic efficacy.
Serum concentrations of thyrotropine (TSH), thyroxine (T4), free T4 (fT4), triiodothyronine (T3) and reverse T3 (rT3) were measured 4 x during a 12-month period in 28 patients with major depressive disorder maintained on lithium prophylaxis for 4-23 years (mean = 11.8). The course of illness was carefully monitored and documented for all patients throughout a 3.5-year period. All hormones were also measured in 41 healthy controls matched for age and gender. Patients on lithium had normal serum concentrations of TSH, T4, fT4 and T3 only the levels of rT3 were elevated. The efficacy of the lithium prophylaxis was significantly correlated to the serum concentrations of T3, i.e., the higher the patients' serum levels of T3, the shorter was the overall duration of recurrences of depression within the 3.5-year period. We conclude that: (1) thyrotropine and the thyroid hormones, which are often abnormal during the first weeks or months of lithium treatment, returned to normal when lithium prophylaxis was maintained for years; (2) a possible explanation for the higher T3-serum concentrations in responders might be that lithium interacts with thyroid hormone metabolism in the CNS, leading to enhanced T3 concentrations in the tissue and to a secondary increase in the serum concentrations of T3.
Adult↗
Hypothalamic-pituitary-gonadal axis, prolactin, and cortisol in alcoholics during withdrawal and after three weeks of abstinence: comparison with healthy control subjects.
Serum concentrations of luteinizing hormone, follicle-stimulating hormone, testosterone, androstenedione, estradiol, sex hormone-binding globulin, cortisol, and prolactin were measured in 12 male chronic alcoholics once during withdrawal and once after 21 days of abstinence. The results were compared with those of 14 healthy volunteers. During withdrawal, luteinizing hormone, estradiol, and cortisol levels were significantly enhanced. Estradiol and cortisol concentrations fell significantly during abstinence, whereas luteinizing hormone concentrations remained elevated. The results may be interpreted as follows: the well-known inhibitory effect of alcohol on the biosynthesis of testosterone may have led to a compensatory increase in luteinizing hormone secretion, so that normal serum concentrations of testosterone were maintained. On the other hand, peripheral conversion from androstenedione to estradiol via aromatase pathways seemed to be enhanced in chronic alcoholics, at least during withdrawal. Whether this marked increase in estradiol concentrations is implicated in different clinical and psychological symptoms seen in chronic alcoholics remains to be investigated.
Adult↗
The effects of desipramine on thyroid hormone concentrations in rat brain.
The effects of the antidepressant desipramine on the tissue concentrations of thyroxine and triiodothyronine in 9 different regions of the brain and also in the pituitary and liver were investigated in male rats. The investigations were carried out at three different times of the light/dark cycle: 5 a.m., 1 p.m. and 11 p.m. After fourteen days' treatment with 20 mg/kg/day desipramine by gavage the concentrations of triiodothyronine in the frontal and parieto-occipital cortex were significantly higher than in the saline-treated controls, those in the hippocampus lower and those in the 6 remaining brain regions the same. In 8 areas of the brain the concentrations of thyroxine were lower in the desipramine-treated rats and the tissue ratios of triiodothyronine to thyroxine were enhanced in 6 regions. These effects are most likely the result of the action of desipramine on the activity of the isoenzyme 5'II deiodinase. This enzyme catalyzes the deiodination of thyroxine to triiodothyronine in rat brain and its activity has recently been reported to be enhanced by desipramine. The observed effects were dose-dependent and also strongly dependent upon the time within the 24 h light/dark cycle at which the hormone concentrations were measured. No effects of desipramine were seen in the pituitary or liver after 14 days' treatment, or in various areas of the central nervous system 24 h after administration. In view of the psychotropic properties of thyroid hormones, it seems possible that the observed increases in triiodothyronine concentrations, particularly in cortical areas, are involved in the mechanisms of action of desipramine.
Administration, Oral↗
Intensified antihypertensive therapy is associated with improved survival in type 1 diabetic patients with nephropathy.
OBJECTIVE: To determine the prognosis of treated hypertensive type 1 (insulin-dependent) diabetic patients with overt nephropathy. DESIGN: A controlled, prospective, parallel, 5-year follow-up trial. SETTING: The tertiary care centre of the Heinrich Heine University Hospital in Dusseldorf, Germany. PATIENTS AND INTERVENTIONS: A sequential sample of 91 hypertensive patients with overt diabetic nephropathy participated in a diabetes treatment programme. Thereafter 45 patients received intensified antihypertensive therapy including blood pressure self-monitoring and self-adjustment of antihypertensive drug treatment with the goal of permanent normalization of blood pressure values below 140/90 mmHg. The remaining 46 patients were administered routine antihypertensive therapy and formed the control group. At baseline both groups were comparable in age, sex, metabolic control and renal function. The groups differed at baseline in their duration of diabetes and blood pressure values, which were higher in the intensified antihypertensive therapy group. OUTCOME MEASURES: Total mortality and the need for renal replacement therapy. MAIN RESULTS: Blood pressure control was significantly improved in patients who were subjected to intensified antihypertensive therapy, whereas it deteriorated in the group of patients who received routine antihypertensive therapy. At follow-up, primary end points of the study occurred in five (11%) patients of the intensified therapy group and in 19 (41%) patients of the routine therapy group. According to life table analysis, intensified antihypertensive therapy was associated with less frequent primary end points (P = 0.0058) and longer survival (P = 0.01). The differences between the groups remained significant after adjustment for covariates in the proportional hazards model. CONCLUSION: Participation in a treatment programme aimed at intensification of antihypertensive therapy is associated with a reduction of mortality in hypertensive type 1 diabetic patients with overt nephropathy.
Adult↗
Effects of lithium on thyroid hormone metabolism in rat frontal cortex.
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Animals↗
Interferometric measurement of corneal thickness with micrometer precision.
The recently developed partial coherence laser Doppler interferometry technique was improved to measure central and peripheral corneal thickness with high precision. Corneal thickness profiles were measured on 18 eyes of health, volunteer subjects. All of these eyes were measurable at angles (between visual axis and measuring direction) ranging from 20 degrees nasal to 25 degrees temporal. At larger angles (up to 35 degrees) only part of the eyes was measurable. The thickness profiles of the 18 corneas have a nearly perfectly parabolic shape within the measured region. The precision (standard deviation) was 1.6 microns for central measurements and decreased somewhat to about 3.5 microns at measuring angles in the range of 25 to 30 degrees. No significant interobserver variability was found on 14 eyes measured by three different observers. This study indicates that the new technique is likely to be superior to currently used ultrasound and conventional optical pachymetry techniques, especially for refractive procedures.
Cornea↗
Effects of chronic desipramine treatment on thyroid hormone concentrations in rat brain: dependency on drug dose and brain area.
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Animals↗
Subchronic administration of fluoxetine to rats affects triiodothyronine production and deiodination in regions of the cortex and in the limbic forebrain.
The effects of subchronic administration of the antidepressant fluoxetine (15 mg/kg i.p., 14 days) on thyroid hormone metabolism were investigated in 11 regions of the CNS and three peripheral tissues in the rat. Fluoxetine significantly enhanced the activity of the 5'II-deiodinase isoenzyme (5'D-II), which catalyzes the deiodination of the inactive prohormone thyroxine (T4) to the active compound triiodothyronine (T3) in areas of the cortex, the limbic forebrain and the striatum. The activity of the 5D-III deiodinase isoenzyme (5D-III), which catalyzes the further deiodination of T3 to the inactive metabolite 3,3'-T2, was inhibited in the first two of these areas. The areas affected were roughly the same as those with the highest density of 5-HT2 receptors in rat brain. Theoretically, the enhancement 5'D-II activity, together with a concomitant decrease in 5D-III activity, should lead to a rise in T3 concentrations. Whether or not these effects are involved in the as yet unknown mechanism of action of this antidepressant compound is discussed.
Animals↗
Carbamazepine affects triiodothyronine production and metabolization in rat hippocampus.
The effects of subchronic administration of carbamazepine on thyroid hormone metabolism were investigated in the hippocampus in adult male rats at two different measuring times (4 a.m. and 8 p.m.). Carbamazepine enhanced the activity of 5'II-deiodinase, which catalyzes the deiodination of the prohormone T4 to the active compound T3, at 8 p.m., but not at 4 a.m. The activity of 5III-deiodinase, which catalyzes the further deiodination of the active hormone T3 to its metabolite 3,3'T2, was inhibited at 4 a.m. but not at 8 p.m. These effects of carbamazepine on intracellular thyroid hormone metabolism in the hippocampus should theoretically lead to a rise in T3 production. It remains to be investigated whether they are somehow involved in the as yet unknown mechanisms underlying the anticonvulsant/mood-stabilizing effects of carbamazepine.
Animals↗
Psychological and endocrine abnormalities in refugees from East Germany: Part I. Prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity.
The influence of prolonged psychological stress on hormonal secretion was investigated in 84 East Germany refugees suffering from psychiatric disorders within 6 weeks of their arrival in West Berlin shortly before or after the fall of the Berlin Wall. Before leaving the German Democratic Republic, these patients had already experienced prolonged stress, which continued after migration. In most cases, the diagnosis was anxious-depressive syndrome with vegetative complaints and symptoms of increased arousal. Their formal DSM-III-R diagnoses (American Psychiatric Association, 1987) included adjustment disorders, depressive disorders, and anxiety disorders (the latter including posttraumatic stress disorder). Serum levels of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine, free thyroxine, triiodothyronine, and reverse triiodothyronine) were measured and compared with those of 20 healthy control subjects. TSH and all thyroid hormone concentrations were significantly reduced in the patient group. Fifty-two of the patients (62%) were in the hypothyroid range but did not show any clinical signs of hypothyroidism. These disturbances in hormonal secretion were not correlated to any psychiatric diagnosis or to the severity of acute or chronic stress. The marked abnormalities in the hypothalamic-pituitary-thyroid axis seen in these refugees differ from those reported in depression and would seem to reflect severe chronic stress rather than specific psychiatric disorders. The underlying neurochemical mechanisms remain to be investigated.
Adjustment Disorders↗
Psychological and endocrine abnormalities in refugees from East Germany: Part II. Serum levels of cortisol, prolactin, luteinizing hormone, follicle stimulating hormone, and testosterone.
We investigated afternoon serum levels of cortisol, prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone in a group of 84 refugees who had fled from East to West Germany and suffered from psychiatric disorders within 6 weeks of their arrival in West Berlin. The mean hormone levels were compared with those of healthy control subjects. Cortisol levels were lower and LH levels were higher in the patients than in the control subjects, but only at trend levels of significance. No differences were found between the prolactin, FSH, or testosterone concentrations of the two groups. The patients with major depressive disorder (MDD) had a significantly higher mean cortisol level than the mean levels in the subgroups in whom posttraumatic stress disorder, dysthymia, and adjustment disorder were diagnosed. It can be concluded that the hypothalamic-pituitary-adrenal axis may "adapt" during severe long-term psychological stress and that long-term stress may be only one of the neurochemical mechanisms underlying the hypercortisolemia in patients with MDD.
Depressive Disorder↗
Treatment of intractable non-rapid cycling bipolar affective disorder with high-dose thyroxine: an open clinical trial.
Six patients with very severe forms of non-rapid cycling bipolar affective illness whose symptoms had previously been refractory to all current antidepressant and/or prophylactic medications were treated with supraphysiological doses of thyroxine (250 to 500 micrograms/day) as an adjuvant to their previous medications. The mean follow-up period was 27.8 +/- 12.8 months (range 12 to 46). The mean number of relapses during the follow-up period of each patient declined from 5.3 +/- 3.1 to 0.8 +/- 0.8 and the mean duration of hospitalization from 10.0 +/- 5.6 to 0.8 +/- 1.2 months as compared to the same length of time for each patient before the start of treatment with high-dose thyroxine (T4). Three of the patients had no further relapses at all. Thus, for these patients, who had previously been severely ill and therapy-resistant, high-dose T4 administration proved to have excellent effects on the course of the illness. However, in five of these patients the effect of the T4 was strong enough only when it was administered in combination with a prophylactic and antidepressant and/or neuroleptic drug, of which in some cases high doses were also needed. The side effects were negligible. Mechanisms that may possibly underlie the beneficial effects of high-dose T4 in bipolar affective disorder are discussed.
Adult↗
[Comparison of astigmatism due to ambulatory cataract surgery with 3 different techniques].
We show that there was little difference in the average astigmatism induced in three surgical groups (Extracapsular (EC), Phacoemulsification with and without scleral tunnelization) at the last control. An examination of a second group of patients shows a significant reduction in the time necessary for recovering at least 80% of the final visual function and a significant shortening of the time elapsed before the prescription of the glasses in the group of patients operated on using phaco with tunnellization. Just as there is a significant relationship between the post-operative cyclinder and postoperative phase 1, there is also a reduction in, and early and lasting stabilisation of, the cyclinder induced by surgery using small incisions. We show that the technique of vectorial calculation brings into play discontinuous trigonometric functions that require great prudence when interpreting statistics of cylinders induced by surgery.
Ambulatory Surgical Procedures↗
Hypothalamic-pituitary-thyroid (HPT) axis in chronic alcoholism. I. HPT axis in chronic alcoholics during withdrawal and after 3 weeks of abstinence.
Thyroxine (T4), free T4 (fT4), triiodothyronine (T3), free T3 (fT3), reverse T3 (rT3), thyrotropin (TSH), thyroxine binding globulin (TBG), and T3 uptake were measured in 14 chronic alcoholics during withdrawal and after 21 days of abstinence. Results were compared with those of 16 healthy volunteers. During withdrawal, the fT4 and fT3 concentrations were subnormal, whereas the respective protein-bound fractions were normal. T4, T3, and TBG increased during the abstinence period, T3 and TBG being significantly higher than in normals at the second measuring time. T3 uptake values fell, but remained well within the normal range at both measuring times. During abstinence, the fT3 levels remained significantly lower than in healthy subjects. rT3 concentrations decreased, but not significantly. The TSH values were normal throughout. These results showed numerous abnormalities in the hypothalamic-pituitary-thyroid axis in alcoholics, the reasons for which are as yet unclear. The following possible interpretations are suggested: 1. The abnormally low serum fT3 and fT4 levels during withdrawal might reflect an increase in tissue uptake. 2. The increases in T4--and partly those in T3--during abstinence seem to reflect increased binding by TBG, the level of which rose markedly for reasons as yet unknown. 3. If increases in TBG during abstinence are taken into account, the decreases in rT3 concentrations may reach the level of statistical significance. These falls in rT3 concentrations may reflect an increase in rT3 metabolization (deiodination) in various tissues, including the CNS, leading to a reduction in serum rT3 bioavailability. 4. Factors such as liver disease, protein caloric malnutrition, and "psychological stress" do not fully explain all these abnormalities. A direct effect of ethanol on intracellular thyroid hormone metabolism and/or function seems conceivable.
Adult↗
Hypothalamic-pituitary-thyroid axis in chronic alcoholism. II. Deiodinase activities and thyroid hormone concentrations in brain and peripheral tissues of rats chronically exposed to ethanol.
Thyroxine (T4), triiodothyronine (T3) concentrations, and the activities of the three deiodinase isoenzymes were measured in different brain regions and peripheral tissues of rats. According to an animal model of alcohol addiction, "behaviorally" dependent rats having lost control over their intake of ethanol were compared with alcohol-naive controls and ethanol-experienced, but "controlled" consumers. The two kinds of alcohol-experienced rats were investigated either 24 hr or 3 months after ethanol withdrawal. The results of these four groups were compared with those of an ethanol-naive control group. During withdrawal, the activities of type II 5'-deiodinase (which catalyzes deiodination of T4 and T3 in the CNS) in both the "behaviorally dependent" rats and the "controlled drinkers" were significantly lower than in the alcohol-naive controls in the frontal cortex, parieto-occipital cortex, hippocampus, and striatum, but not in the cerebellum or pituitary. Probably as a result, the tissue concentrations of T4 were higher in areas of the CNS in the groups exposed to alcohol. However, the T3 concentrations were normal. No relevant differences were seen between the activities of type III 5-deiodinase (which catalyzes the further deiodination of T3) observed in these groups. After 3 months of abstinence, the type II 5'-deiodinase activities had almost returned to normal in both "controlled drinkers" and "behaviorally dependent" animals, whereas type III 5-deiodinase activity was inhibited, possibly to maintain physiological concentrations of T3 during abstinence. Indeed, the tissue levels of T3 were normal in the areas of the CNS, and the T4 levels were still elevated. However, the liver concentrations of T3 and T4 were significantly lower in the "behaviourally dependent" animals than in the "controlled" drinkers after 3 months of abstinence, whereas no differences were found between the T4 and T3 concentrations in the areas of the CNS investigated in the two groups exposed to ethanol. These results suggest that chronic administration of ethanol affects intracellular thyroid hormone metabolism in both rat CNS and liver in the highly complex manner. No direct evidence of ethanol-induced enhancement of tissue uptake or concentrations was obtained. However, taking into account the numerous similarities between the clinical picture of hyperthyroidism and the symptomatology of alcoholism, it may be hypothesized that ethanol may directly influence any step in the as yet unknown biochemical cascade of thyroid hormone function.
Alcoholism↗
Risk factors for Campylobacter enteritis in Switzerland.
From February to December 1991, 167 sporadic cases of Campylobacter enteritis in Switzerland and 282 controls were enrolled in a case-control study using self-administered questionnaires. In the multivariate matched analysis, travel abroad was identified as the most important risk factor for an infection with Campylobacter (adjusted odds ratio [OR] = 21.2, 95% confidence interval [CI]7.6-56.2). Having foreign citizenship also increased the risk (OR = 6.7, 95% CI 1.3-34.5). Among food items consumed within five days before onset of illness, consumption of poultry liver was shown to be a risk factor (OR = 5.7, 95% CI 1.4-22.8), while the consumption of curd or cottage cheese lowered the risk (OR = 0.5, 95% CI 0.3-0.9). The unmatched analysis confirmed travel abroad and the consumption of poultry liver as risk factors and the consumption of curd or cottage cheese as being protective, and, in addition, identified the consumption of poultry as a risk factor (OR = 2.0, 95% CI 1.1-3.3). The study showed the feasibility of using self-administered questionnaires for this type of analysis. The method is logistically simple and reduces the cost of case-control studies.
Adolescent↗
The influence of desipramine on thyroid hormone metabolism in rat brain.
The effect of the antidepressant desipramine (DMI) on the activities of the three iodothyronine deiodinase isoenzymes involved in the central metabolism of thyroid hormones were investigated in 11 brain regions and 3 peripheral tissues in the rat. The investigations were carried out at three different times during the light/dark cycle: 5 A.M., 1 P.M. and 11 P.M. Interest is focused on changes in the two enzymes that catalyze: i) the 5'deiodination of T4 to the biologically active T3, i.e., type II 5'deiodinase (5'D-II), and ii) the 5 (or inner-ring) deiodination of T3 to the biologically inactive 3,3'T2, i.e., type III 5 deiodinase (5D-III). Fourteen days' treatment with 20 mg/kg DMI, but not with 5 mg/kg DMI, induced significant increases in 5'D-II in eight different areas of the CNS. The regions affected were identical to those that receive noradrenergic input from the locus coeruleus. Even control animals showed a circadian rhythm of 5'D-II activity in some brain regions, and the effects of DMI also depended on the time of death within the 24-hr rhythm. 5D-III was not affected. Serum T4 were lower after administration of DMI, most probably because of enhanced tissue uptake of T4. This is in line with the corresponding finding in depressed patients, indicating that similar changes in both central and peripheral thyroid hormone metabolism may occur after antidepressant pharmacotherapy in both humans and rats. These data support the hypothesis that interactions with the CNS metabolism of the thyroid hormones may be involved in the mechanisms of action of DMI.
Animals↗