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Biomedical subjects

A J Rush

Publications and source records attributed to A J Rush.

At least 163 records · Page 9Linked to original sources
PubMed1994

Melancholic symptom features and DSM-IV.

OBJECTIVE: The purpose of this article is to provide an overview of existing systems for the diagnosis of the endogenous (melancholic) subtype of major depression. METHOD: The authors review the critical empirical research examining this subtype and discuss its implications for DSM-IV. They examine the relationship of endogenous/melancholic symptoms to other clinical features, treatment response, selected laboratory tests, consistency across episodes, family history, and particular courses of illness. RESULTS: Melancholic symptom features are predictive of a positive response to ECT and to tricyclic antidepressants in the severely ill. Key features include psychomotor retardation, unreactive mood, pervasive anhedonia, and distinct quality of mood. Melancholic features are associated with shorter REM latency and/or nonsuppression of cortisol during the dexamethasone suppression test. Depressive episodes that are not melancholic may take on melancholic features with repetition and passage of time in some individuals. Once melancholic features are present, it is unclear whether they repeat across subsequent episodes. Melancholic features are not uniquely associated with a positive family history of depression per se, but they may be especially associated with a family history of severe depression. CONCLUSIONS: The available evidence suggests some clinical utility and some (albeit not entirely consistent) validity for the concept of melancholic features. Consequently, DSM-IV will retain the designation "with melancholic features," return to the shorter DSM-III feature listing, and broaden the designation by requiring either unreactive mood or pervasive anhedonia but not both. Further research on this subgroup is indicated.

Depressive Disorder↗
PubMed1993

Clinical practice guidelines. Good news, bad news, or no news?

Clinical practice guidelines for primary care providers that address the detection, diagnosis, and treatment of depression may have an impact on psychiatric practice as well as on general medical education and the research agenda. This commentary highlights the conceptual and scientific issues that surrounded the development of these guidelines and speculates on their potential practical impact, particularly on psychiatry.

Depressive Disorder↗
PubMed1993

Prospective assessment of electroencephalographic sleep in remitted major depression.

We studied 29 patients with major depression before treatment and then followed these patients prospectively with monthly electroencephalographic (EEG) sleep assessments after successful treatment. Most EEG sleep measures demonstrated no change from the episode throughout a prolonged period of clinical remission. When there was evidence of a change in EEG sleep measures, the effect was modest and due to only a small subset of patients. These findings contribute to the accumulating evidence that selected EEG sleep measures appear to be trait-like and may be useful in identifying individuals at risk for major depression.

Adult↗
PubMed1993

Tridimensional Personality Questionnaire and serotonin in bulimia nervosa.

To determine the relationship between Tridimensional Personality Questionnaire (TPQ) scales and bulimia nervosa, TPQ scores of 27 bulimic women, age range 21-59, were compared with values for an age-matched sample of 128 normal control women drawn from the national norming sample by Przybeck. Scores for Novelty Seeking and Harm Avoidance were significantly higher, while scores for Reward Dependence were significantly lower for the bulimic women. A stepwise regression model of severity of purging on TPQ selected Novelty Seeking and a composite depression score, with Novelty Seeking being the stronger of the two predictors. Whole blood serotonin levels did not relate to TPQ scores or to purging frequency.

Adult↗
PubMed1993

Digital period analysis of EEG in depression: periodicity, coherence, and interhemispheric relationships during sleep.

1. Interhemispheric EEG differences were compared between 12 symptomatic depressed outpatients, 12 asymptomatic patients and 12 normal controls during two consecutive nights in the Sleep Study Unit. 2. EEG was quantified using digital period analysis (DPA), a time-domain analysis of successive polarity changes (zero-cross) and instances of zero slope (first derivative), yielding percent-time in each frequency band. 3. The degree of hemispheric asymmetry (L-R) was computed for delta, beta and theta percentages from REM, Stage 2 and Slow-Wave (SW) sleep. 4. Normals showed small asymmetries throughout sleep with largest differences in SW, with no consistent relationship between right and left activity and sleep stage. 5. Both depressed groups showed largest asymmetries in REM sleep, with significantly more beta, theta and delta in the right hemisphere consistently. None of the 24 depressed patients showed greater left hemisphere activity throughout sleep.

Adult↗
PubMed1993

Regional cerebral blood flow alterations in unipolar depression.

Forty-seven symptomatic inpatients and outpatients with major depression (13 nonendogenous, 23 endogenous, and 11 psychotic by Research Diagnostic Criteria) were compared with 138 normal control subjects. Absolute regional cerebral blood flow (rCBF, ml/minute/100 g) was measured with 133Xe single photon emission computed tomography. Flow ratios (region of interest/global flow) and residual scores (the difference between patient flow ratios and expected normal flow ratios, as derived from the control population) were also computed. Results revealed significant age x region x depression subtype interactions for absolute, ratio, and residual flow data. Consequently, a test of group means (or analysis of covariance) could not be used to examine between-group differences. Multiple regression analyses were employed to study the effects of age on rCBF. This analysis revealed that different, though sometimes overlapping, regions exhibited different age effects on rCBF in different depressive subtypes. Thus, diagnostic-subtype-dependent age effects on rCBF precluded comparisons of mean values within or across regions for subject groups, but distinguished between symptomatic depressed patients and control subjects and among patient groups. Possible causes of such effects include variations in duration of illness or medication history or sensitization phenomena.

Adolescent↗
PubMed1993

Low plasma GABA is a trait-like marker for bipolar illness.

Plasma gamma-aminobutyric acid (pGABA) is an index of brain GABA activity and a peripheral marker of mood disorder. Previous research has indicated that pGABA is abnormally low in approximately 40% of patients symptomatic with primary unipolar depression. We have now measured pGABA in a series of patients with bipolar disorder. Blood samples for GABA determinations were collected soon after admission to hospital or clinic while patients were symptomatic. In both manic and depressed phase bipolar patients, mean levels of pGABA were significantly lower than in healthy control subjects. The distribution of pGABA in bipolar patients, whether manic or depressed, was similar to that in symptomatic unipolar depression, with 30% to 40% having pGABA levels lower than the control range. These data indicate that low pGABA is not specific to the depressed state, as it is also found in the manic phase of bipolar disorder. Low pGABA may represent a shared biologic correlate between bipolar and unipolar illness.

Adult↗
PubMed1993

Dexamethasone suppression test and onset of poststroke depression in patients with ischemic infarction.

BACKGROUND: Studies documenting abnormal results in the 1.0-mg dexamethasone suppression test (DST) and the prevalence of depression in stroke patients are usually accomplished between 1 and 6 months poststroke. One study, however, reported that 27% of patients met DSM-III criteria for major depression and 20% for minor depression 1 to 3 weeks poststroke even though previous research has indicated that the prevalence of poststroke depression was greatest at approximately 6 months. Therefore, we decided to assess DST abnormalities and depression within the first month of stroke. METHOD: Twelve patients with single, computed tomography (CT)-verified, ischemic infarctions were administered the DST at 1 and 3 weeks poststroke. Each patient also received a complete psychiatric evaluation, including a special clinical interview and the 17-item Hamilton Rating Scale for Depression (HAM-D). 3 to 4 weeks poststroke. RESULTS: DST results were abnormal in 75% of the patients at 1 week poststroke and 50% of the patients at 3 weeks poststroke. Those patients whose HAM-D scores revealed more depressive symptoms at 3 to 4 weeks were more likely to evidence abnormal DST results (cortisol nonsuppression). None of the patients, however, met either DSM-III or modified criteria for clinical depression at 3 to 4 weeks. CONCLUSION: Poststroke depression appears to have a delayed clinical onset. Abnormal DST results at 3 weeks poststroke may serve as a potential marker for those patients at risk for developing poststroke depression.

Aged↗
PubMed1992

Low plasma gamma-aminobutyric acid levels in male patients with depression.

Plasma levels of gamma-aminobutyric acid (GABA) were significantly lower in males with primary unipolar major depressive disorder than in healthy controls. Although the difference in means between control and symptomatic depressed patient groups was small, the distribution of plasma GABA in the depressed patients was markedly different from controls. Forty percent of depressed patients had plasma GABA levels below those of controls. Plasma GABA levels correlated positively with duration of illness, and negatively with age at onset of the mood disorder and the total Endogenomorphic Symptom Score on the Hamilton Rating Scale. Plasma GABA levels may be a biochemical marker of vulnerability to depression, as opposed to a consequence of the illness. A low GABA condition in depression fits and complements the prevailing biogenic amine hypotheses of depression.

Adult↗
PubMed1992

Digital period analysis of sleep EEG in depression.

The period-analyzed sleep electroencephalogram (EEG) was compared in a group of 9 depressed outpatients and 9 age-matched normal controls. Both groups showed rhythms in beta, delta, and theta activity with an approximately 90-min period. The phase and coherence between fast and slow frequency EEG measures, however, differed significantly in the two groups. Beta and delta rhythms were less coherent in the depressed outpatient sample. The control group showed higher coherence and a strong coupling of beta and delta activity. These preliminary data suggest that depression may be associated with some degree of ultradian rhythm disturbances though periodicity is unaffected.

Activity Cycles↗
PubMed1992

Comparison of the delta EEG in the first and second non-REM periods in depressed adults and normal controls.

The distribution of period-analyzed delta activity in the first and second non-rapid eye movement (NREM) periods was compared in nine symptomatic depressed outpatients and nine normal controls. The groups did not differ in ratios of delta zero-cross or delta power in the first to the second NREM periods. Further, neither group showed a systematic change in delta count or delta power across the first two NREM periods. Our findings suggest that ratios of delta activity in the first two NREM periods may not systematically differentiate depressed adults from normal subjects.

Adult↗
PubMed1991

Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence.

In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Depressive Disorder↗
PubMed1991

Does learned resourcefulness predict response to cognitive therapy in depressed outpatients?

Thirty-seven unipolar, nonpsychotic, outpatients with major depression were treated with cognitive therapy in an ongoing study designed to identify which depressions respond to cognitive therapy. Pretreatment levels of learned resourcefulness, assessed by Rosenbaum's (1980) Self Control Schedule (SCS), were used to predict response to cognitive therapy (according to the 17-item Hamilton Rating Scale for Depression and the 21-item Beck Depression Inventory). Pretreatment SCS scores did not predict response to cognitive therapy according to either measure.

Adaptation, Psychological↗