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Biomedical subjects

A L Pottash

Publications and source records attributed to A L Pottash.

At least 37 records · Page 2Linked to original sources
PubMed1983

The dexamethasone suppression and thyrotropin-releasing hormone tests in depressed borderline patients.

Borderline patients can be both a diagnostic and a therapeutic enigma. We investigated a group of 24 depressed women with borderline personality disorder or strong borderline features by DSM III criteria for the presence of either an abnormal dexamethasone suppression test (DST) or a blunted TSH response to TRH, abnormalities which have been reported in major depression. Thirteen of the 24 borderlines failed to suppress on the DST, compared with one of 14 normal women (p less than 0.01). Nine of the 24 borderlines had a blunted TSH response to TRH, compared with one of 11 normal women. Neuroendocrine abnormalities were found in a total of 75% of the borderline women, independent of whether or not they met DSM III criteria for major depressive disorder. The results of this study support the notion that many borderline patients with depression have a genuine affective component to their illness, perhaps biologically similar to major depression in non-borderlines.

Adolescent↗
PubMed1982

Using the protirelin test to distinguish mania from schizophrenia.

To explore the possible utility of the protirelin test in differentiating manic and schizophrenic patients, we gave a test dose of protirelin to 30 consecutive euthyroid inpatients who met Research Diagnostic Criteria for mania, 30 who met criteria for schizophrenia, undifferentiated subtype, and 20 normal volunteer controls. The mean maximal thyroid-stimulating hormone (TSH) response (delta TSH) to protirelin in the manic patients was lower than in the schizophrenic patients and in the controls. This mean difference was not attributable to differences in age, sex, baseline thyroid functioning, cortisol levels, or medication, but there was a considerable overlap of values in the patient groups. However, with a delta TSH less than or equal to 7.0 I microunits/mL to identify manic patients in the overall group, the sensitivity of the protirelin test was 60% and the specificity was 84%.

Adult↗
PubMed1982

Thyroid-stimulating hormone response to thyrotropin-releasing hormone in unipolar depression before and after clinical improvement.

Fourteen patients with unipolar depression who had a blunted thyroid-stimulating hormone (TSH) response to infusion of 500 micrograms of thyrotropin-releasing hormone (TRH) and who showed marked clinical improvement after pharmacotherapy and/or electroconvulsive therapy had the TRH test repeated after improvement. The mean (+/- SD) maximal TSH response to TRH (delta TSH) increased significantly from 4.0 +/- 1.9 to 9.1 3.5 micro IU/ml. The number of patients with delta TSH less than 7.0 micro IU/ml increased significantly from 0 to 9 of 14 after improvement. Eleven of the patients were followed for 5 to 19 months, and none showed clear relapse. The results suggest that the blunted TSH response to TRH has features of both a state marker for active unipolar depression and a trait marker for vulnerability to this illness, and support the suggestion that the TRH test may be useful in diagnosis and treatment planning.

Depressive Disorder↗
PubMed1982

"Symptomless" autoimmune thyroiditis in depression.

The magnitude of the thyroid-stimulating hormone (TSH) response induced by thyrotropin-releasing hormone (TRH) helps identify patients whose thyroid is failing. Many of these patients have been found to have Hashimoto's thyroiditis, symptomless autoimmune thyroiditis (SAT), and subclinical hypothyroidism. While patients with SAT are clinically euthyroid, what might be "symptomless" for the endocrinologist might be a syndrome presenting with psychiatric symptoms to the psychiatrist. As a preliminary test of this hypothesis, we tested 100 consecutive admissions to a psychiatric hospital who complained of depression or lack of energy. Fifteen (15%) of 100 patients were identified from the baseline thyroxin (T4), triiodothyronine (T3) resin uptake (RU), T3 radioimmunoassay (T3RIA), TSH, and TRH test who met criteria for either subclinical, mild, or overt hypothyroidism. Of these 15 patients, 9 (60%) had positive thyroid microsomal antibodies with titers of greater than or equal to 1:10. Our data suggest that SAT is not symptomless and may be an important diagnosis to consider in the evaluation of depressed, anergic, or atypical patients.

Depressive Disorder↗
PubMed1982

The future of private psychiatric hospitals.

In the near future the programs, the staff, and the physical plant of private psychiatric hospitals will become increasingly specialized. Development of neuropsychiatric evaluation units and greater liaison between the psychiatric hospital and the clinical laboratory have already begun. Improved standards of patient care and opportunities for research should attract to the private hospital more psychiatrists who are academically oriented. The authors predict a decrease in inpatient acute-care alcoholism treatment and shorter hospital stays for adolescents and those who were formerly considered long-term patients. The private hospital will need to increase its contacts with industry and health maintenance organizations. The authors also predict that ownership will become more centralized in hospital chains, similar to the pattern in general hospitals. The believe the major risk to the private hospital lies in abrupt changes in insurance coverage and regulatory interference.

Cost Control↗
PubMed1982

Clinical correlates of the TRH infusion test in primary depression.

Relationships between clinical measures, diagnosis and neuroendocrine findings were examined in a group of 25 primary depressives maintained drug free on a Neuropsychiatric Evaluation Unit. The TSH response to TRH infusion curves for unipolar and bipolar depressives were significantly different. Agitated patients but not psychomotor retarded patients demonstrated a blunted TSH response curve. No relationships were noted for cortisol hypersecretion and/or loss of diurnality and either diagnosis or psychomotor activity levels in depression. Biochemical and diagnostic implications of these findings are discussed.

Adult↗
PubMed1982

Does subclinical hypothyroidism predispose to tricyclic-induced rapid mood cycles?

A 24-year-old woman with a unipolar depression had an augmented thyroid-stimulating hormone response to thyrotropin-releasing hormone (TRH), suggesting subclinical hypothyroidism. Desipramine produced rapid cycling between depression and hypomania. After discontinuation of the desipramine she was successfully treated with lithium and thyroid hormone replacement. We discuss the possible role of hypothyroidism in the etiology of tricyclic-induced rapid mood cycling, and suggest that the TRH test may help identify depressed patients predisposed to rapid mood cycling on tricyclics. The possibility that such patients respond to lithium and/or thyroid hormone replacement needs to be further investigated.

Adult↗
PubMed1982

Neuroendocrine abnormalities in affective disorders.

The authors review neuroendocrine abnormalities in depression, and present data on the thyrotropin-releasing hormone (TRH) test in unipolar depression. Sixty of 105 patients who met Research Diagnostic Criteria for major unipolar depression had a blunted thyroid-stimulating hormone (TSH) response to TRH as defined as by delta TSH less than 7.0 micro IU/ml. Only 4 of 40 patients with non-major depression and 0 of 20 normal controls had a blunted TSH response to TRH by this criteria. Of 50 unipolar patients administered both the TRH test and the dexamethasone suppression test (DST), 34% were identified by the TRH test only, 20% by the DST only, 30% by either test, and 15 by neither test. The TRH test and DST seem to be complementary in the neuroendocrine evaluation of the patient with possible unipolar depression. The TRH test along with other neuroendocrine tests may be of help to the clinician in the diagnosis of depression and in treatment planning.

Adult↗
PubMed1982

Clonidine: inpatient studies from 1978 to 1981.

We have studied and reviewed data reported by others, which support a norepinephrine (NE) hyperactivity hypothesis for opiate withdrawal. Other hypotheses explained parts of the opiate withdrawal syndrome but the NE hypothesis had the potential to explain most of the clinical manifestations of abrupt opiate discontinuation in addicted persons. Clonidine's ability to almost completely reverse the opiate withdrawal syndrome in acute withdrawal studies supported the NE hypothesis and suggested a new use of clonidine. Lofexidine's efficacy was additional support for the NE hypothesis. Clonidine is an effective emergency treatment for acute opiate withdrawal and in the detoxification of methadone, heroin, and other opiate addictions. Clonidine reverses the cognitive, affective, and physiological signs and symptoms and continues to suppress their re-emergence when given for 10-14 days in a detoxification protocol. NE hyperactivity in withdrawal may result from endorphin system dysfunction at the level of the locus coeruleus (LC), the mismatch between needed NE, opiate and other inhibition at the LC in the person addicted to high doses of powerful exogenous opiate LC inhibitors and available endogenous inhibitory substances or other mechanisms.

Animals↗
PubMed1981

Hypothyroidism and depression. Evidence from complete thyroid function evaluation.

To evaluate the relationship between hypothyroidism and depression, thyroid function was evaluated in 250 consecutive patients referred to a psychiatric hospital for treatment of depression or anergia. Twenty of the 250 patients had some degree of hypothyroidism. Two patients (less than 1%) were identified with grade 1 (overt); nine patients (3.6%), grade 2 (mild); and ten patients (4%), grade 3 (subclinical) hypothyroidism. These results suggest that a significant proportion of patients with depression and anergia may have early hypothyroidism, the cases of about half of which are detected only by thyrotropin-releasing hormone (TRH) testing. Because hypothyroidism can produce signs and symptoms of depression and can coexist as a second illness in depressed patients, patients with early hypothyroidism may be candidates for thyroid replacement therapy. Clinical examination and measurement of triiodothyronine resin uptake thyroxine and baseline thyroid-stimulating hormone (TSH) levels, and TSH response to TRH are necessary to identify candidates for thyroid replacement among cases diagnosed by descriptive criteria as having either major or minor depression, particularly those that are atypical or treatment resistant.

Adolescent↗