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Biomedical subjects

A M Ghadirian

Publications and source records attributed to A M Ghadirian.

At least 19 recordsLinked to original sources
PubMed2000

Depressive relapse following acute tryptophan depletion in patients with major depressive disorder.

Acute tryptophan depletion (ATD) lowers serotonin synthesis and elicits depressive symptoms in some, though not all, remitted patients with major depressive disorder (MDD). In the present study, eight medication-free remitted patients with MDD, seasonal pattern, were tested twice, once following the ingestion of a tryptophan-containing mixture, once following ATD. ATD significantly increased Hamilton depression scores (p < 0.001). Four of the patients had a family history of psychiatric disorders: substance abuse (n = 4), mood disorders (n = 3) or Cluster B personality disorders (n = 3). The mood-lowering response to ATD was significantly greater in those patients with, than without, affected relatives (p < 0.001). These preliminary findings (1) support the hypothesis that depressed states are related to disturbed serotonin neurotransmission and (2) suggest that depressive symptoms following ATD might identify a subgroup of patients at high genetic risk for disorders associated with affective lability and dysregulated impulse-control, conditions thought to be related to low serotonin neurotransmission.

Adult↗
PubMed1999

Vitamin B12 and folate levels and lithium administration in patients with affective disorders.

BACKGROUND: It is unclear whether there is a relationship between lithium administration and vitamin B12 metabolism. METHODS: We compared serum B12, serum folate, and red blood cell folate concentrations in patients receiving and not receiving lithium at two Mood Disorders Clinics. As the two centers differed in vitamin assay methods, data were first analyzed separately and then combined. To rule out an in vitro effect of lithium on the assays, we also added varying amounts of lithium to lithium-free blood samples and measured vitamin concentrations. RESULTS: Mean serum B12 concentrations were approximately 20% lower in the lithium than in the nonlithium group at each center. This difference was statistically significant for each center and on combination (two-tailed p = .017, .021, and .0009). The parametric effect size for each center and the combined weighted mean effect size were moderate in magnitude (.605, .523, and .565). There was a nonsignificant trend toward an increased prevalence of assay-defined B12 deficiency in the lithium group at one center only, with no cases in either group at the other center and a nonsignificant combined relative risk. CONCLUSIONS: Our data may represent a lithium-associated decrease in serum B12 concentration. The clinical significance of these findings is not yet clear.

Adult↗
PubMed1998

Efficacy of light versus tryptophan therapy in seasonal affective disorder.

BACKGROUND: Although light therapy has become the accepted treatment for patients suffering from seasonal affective disorder (SAD, winter depression), almost 40% of these patients do not respond, and require an alternative treatment. METHODS: The therapeutic effects of light versus tryptophan on SAD were studied in a repeated measures design in 13 SAD patients (11 women, 2 men). Light therapy for 2 weeks or tryptophan for 4 weeks was given, separated by a one week washout period. All were assessed with the modified Hamilton Depression Rating scale (SIGH-SAD) at the beginning and end of each treatment. RESULTS: Four (31%) of the patients did not respond to either therapy. Four tryptophan-resistant patients responded to light therapy, while one light therapy-resistant patient responded to tryptophan. Relapse occurred rapidly after stopping light therapy but not after stopping tryptophan therapy. CONCLUSIONS: There were significant therapeutic effects of both light (p = 0.012) and tryptophan (p = 0.014) on SAD, which were not significantly different from each other. There may be a time difference between the residual pharmacokinetic effects after stopping therapy. LIMITATIONS: The groups studied were small. This was an open study. CLINICAL RELEVANCE: Tryptophan was equally effective to light therapy in treating SAD, but relapse after withdrawal of tryptophan probably occurs more slowly.

Adult↗
PubMed1998

Neuroendocrine responses to inhibitors of steroid biosynthesis in patients with major depression resistant to antidepressant therapy.

OBJECTIVE: Patients with major depression frequently have high cortisol levels and resistance to dexamethasone. We sought to determine to what extent major depression might be influenced by inhibitors of steroid biosynthesis and to study the endocrine changes produced. METHOD: After drug washout, 20 treatment-resistant patients with major depression were given aminoglutethimide, metyrapone, and/or ketoconazole, along with a small dose of cortisol for 8 weeks. Hamilton Depression Rating Scale (HDRS) ratings, 8:00 AM cortisol dehydroepiandrosterone sulfate (DHAS), adrenocorticotropin (ACTH), and testosterone levels were followed weekly or oftener. A dexamethasone suppression test (DST) was conducted before and after treatment. RESULTS: Seventeen patients (85%) completed the course of treatment, and a significant mean drop (P < or = 0.0001) of 50% in the HDRS score occurred by 7 weeks of treatment. Cortisol levels fluctuated widely and were often still high after the patient had improved clinically. Dehydroepiandrosterone sulfate levels fell more uniformly and were found to be a useful indicator of compliance and, to some extent, efficacy with aminoglutethimide and ketoconazole therapy. The correlation between DHAS and HDRS (r = 0.94) was significant (P = 0.02). Testosterone levels in men fell with ketoconazole but returned promptly to normal at the end of treatment. Adrenocorticotropin levels were normal or elevated, depending on the assay used, and rose (P = 0.07; n = 13) in most subject during therapy. Of the 6 responders who had nonsuppressor DSTs before starting therapy, 5 had reverted to normal 1 to 2 weeks following cessation of therapy (P = 0.0006). CONCLUSIONS: Abnormal metabolism of adrenocortical steroids may perpetuate depression, and alterations of synthesis or metabolism of these steroids may lead to a remission.

Adult↗
PubMed1997

The effect of tryptophan depletion on mood in medication-free, former patients with major affective disorder.

Acute tryptophan depletion (ATD) induces transient clinical relapse in medicated patients with major affective disorder. Our objective was to determine whether this effect persists once patients are euthymic and off antidepressants. Thus, we examined the effects of ATD in fully remitted, medication-free, former patients with major depression (n = 14). ATD had no significant effect on mood. These results suggest that the previous report that ATD substantially lowers mood in pharmacologically treated patients reflects a reversal of mechanisms involved in the therapeutic effects of antidepressants. Alternatively, ATD might induce clinical relapse only in subgroups that have yet to be identified.

Adult↗
PubMed1996

Familial eating concerns and psychopathological traits: causal implications of transgenerational effects.

OBJECTIVE: This study extends an earlier investigation on the link between familial traits and eating disorders (EDs), and examines the extent to which selected eating attitudes and psychopathological traits are (a) familial in nature and (b) specific to anorexia- and bulimia-spectrum disorders. METHODS: We measured various ED-relevant dimensions (eating and body image attitudes) and psychopathological traits (e.g., affective instability, narcissism, compulsivity, restricted expression) in the mothers, fathers, and sisters of probands displaying an ED (n = 88), another psychiatric disturbance (n = 42), or neither disturbance (n = 59). Total sample, including relatives, was 553. RESULTS: A principal components analysis (PCA), used to reduce variables and to characterize main sources of variation, yielded three interpretable factors: eating concerns and symptoms (grouping all eating-related dimensions), dramatic-erratic traits (grouping affective instability, narcissism, and conceptually related dimensions), and obsessive-compulsive traits (grouping compulsivity and restricted expression). Correlations among subjects' factor scores (derived from the PCA) showed two types of transgenerational effects: correspondences between daughters' and parents' psychopathological traits, and between daughters' and mothers' eating concerns. Despite these, relatives of ED probands were not discriminable on any factor score from relatives of controls. DISCUSSION: These results imply that transgenerational effects exist on eating attitudes and psychopathological traits, but do not uniquely identify families in which clinical ED syndromes occur.

Adolescent↗
PubMed1996

A cross-sectional study of parkinsonism and tardive dyskinesia in lithium-treated affective disordered patients.

BACKGROUND: The purpose of this study was to investigate the prevalence of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) in affective disordered patients treated with lithium and to study the association of these symptoms with medication and other factors. METHODS: This cross-sectional study was carried out in all consenting outpatients attending an affective disorders clinic in a psychiatric hospital. The study sample consisted of 130 stable outpatients: 110 with bipolar disorder, 18 with unipolar (major) depression, and 2 with atypical affective disorder. At the time of evaluation, 110 patients were receiving lithium, 37 in combination with antidepressants and 19 with neuroleptics, and 40 had a history of neuroleptic treatment during the previous 6 months. The patients were assessed with the Extrapyramidal Symptom Rating Scale (ESRS) for parkinsonism, akathisia, dystonia, and TD. The prevalence of these symptoms was calculated for all patients and by current lithium and neuroleptic intake. Multiple linear regression analysis was used to investigate the relationship between the ESRS subscale scores and gender, age, diagnosis, and medication type. RESULTS: The prevalence of tremor was 20.8%; hypokinetic parkinsonism, 7.7%; akathisia, 4.6%; dystonia, 3.8%; and TD, 9.2%. Tremor was associated with lithium and neuroleptic intake; hypokinesia was associated with neuroleptic treatment and age; and TD was associated with neuroleptic, lithium, and tricyclic intake and age. Seven of 51 patients taking lithium but without a history of neuroleptic treatment during the previous 6 months presented symptoms of TD. CONCLUSION: The combination of lithium and neuroleptics was associated with a high prevalence of EPS. The presence of TD in lithium-treated patients not treated with neuroleptics for at least 6 months is consistent with the hypothesis that lithium may exacerbate the vulnerability of affective disordered patients to dyskinesias.

Adult↗
PubMed1995

The psychotropic effects of inhibitors of steroid biosynthesis in depressed patients refractory to treatment.

Twenty patients, diagnosed as suffering from treatment-resistant major depression, were treated with one or more drugs that decrease corticosteroid biosynthesis. Nine were psychotic, 11 nonpsychotic. Seventeen completed the treatment (8 psychotic, 9 nonpsychotic); 13 responded (5 psychotic, 8 nonpsychotic; 11 responded completely (i.e., a drop in the Hamilton Depression Scale of at least 50%, to < or = 15), and 2 responded partially. The mean age of the responders (45.2 +/- 12.6 years) did not differ significantly from that of the nonresponders (48.7 +/- 12/3). Data were analyzed in the following categories; (1) the presence or absence of psychosis, (2) response or nonresponse to treatment, and (3) the drug(s) used (aminoglutethimide, ketoconazole, or a combination of either of these with metyrapone). The patients improved over time on the Hamilton Depression Scale independent of the medication used. Responders demonstrated improvement in mood, insomnia, anxiety, diurnal variation, paranoia and obsessive compulsiveness. Nonpsychotics responded better than psychotics.

Adrenal Cortex Hormones↗
PubMed1995

Controlled study of eating concerns and psychopathological traits in relatives of eating-disordered probands: do familial traits exist?

To examine the extent to which first-degree relatives of eating-disordered (ED) probands endorse maladaptive eating attitudes and personality/affective traits, we compared self-reported eating concerns (Restraint, Emotional Eating, Body Dissatisfaction, and maladaptive eating attitudes) and psychopathological traits (Affective Instability, Anxiousness, Compulsivity, and Narcissism) across groups of restricter (n = 19), binger (n = 56), psychiatric control (PC, n = 38), normal dieter (ND, n = 29), and nondieter control (NC, n = 28) probands, and then across participating nuclear family members. Results among probands were as anticipated: ED probands showed expected elevations in both areas, and predicted restricter/binger differences were obtained. However, corresponding differences were not obtained on measures of mothers', fathers', or siblings' eating concerns and traits. Our findings corroborate the notion that EDs represent a convergence of eating, affective, and personality disturbances, but not that such a clustering of features exists as a familial trait. We discuss normal trait and attitudinal variations observed in ED probands' relatives in light of findings showing EDs and other psychiatric syndromes to aggregate within families.

Adolescent↗
PubMed1995

Prevalence and symptoms at onset of bipolar illness among adolescent inpatients.

The records of 236 adolescents (116 males and 120 females) admitted to an inpatient psychiatric unit over an eight-year period were retrospectively reviewed to determine the characteristics of patients with a discharge diagnosis of bipolar disorder. Forty-two patients had a diagnosis of an affective disorder, including 18 patients (nine males and nine females) with bipolar disorder. Mean age at onset of illness for patients with bipolar disorder was 15.7 years, and their onset of illness was likely to have been associated with psychotic symptoms. On admission, they were more likely to show symptoms of mania than of depression.

Adolescent↗
PubMed1993

A longitudinal CNV study of the evolution and treatment of bipolar illness.

In a longitudinal CNV study of bipolar illness we followed the evolution of this illness in six bipolar patients by recording their CNV and mood changes as well as their psychopharmacological treatment for a period of 8 months. The longitudinal CNV recordings of these patients did not show changes corresponding to their mood variations. The most salient result emerging from this study was the consistency in the patterns of the records in different patients in spite of variations in their clinical state and medications. We believe that these electrophysiological parameters cannot be used as markers of the mental state in bipolar patients nor do they reflect specific drug effect. These findings are congruent with available data which do not support a linear relationship between a complex psychological process such as manic depressive illness and a single physical dimension of brain activity. Further studies are warranted for a deeper understanding of this phenomenon.

Adult↗
PubMed1993

Possible use of glucocorticoid receptor antagonists in the treatment of major depression: preliminary results using RU 486.

The rationale for the use of anti-glucocorticoids in the treatment of major depression has been reviewed. Four patients with chronic severe depression who were resistant to conventional therapies were given RU 486 (200 mg/day) for periods up to eight weeks. Substantial levels of RU 486 were achieved within the first few days, and the levels fell gradually over the week after the treatment was discontinued. In three cases, treatment was stopped before the eight weeks were completed: in one case because of the appearance of a rash, in the others because of side-effects, which, in retrospect, were likely unrelated to the drug. The mean scores on the Hamilton Rating Scale for Depression of three patients decreased. Levels of adrenocorticotrophin, dehydroepiandrosterone and cortisol rose during treatment. These preliminary results suggest that glucocorticoid antagonists may be effective in the treatment of major depression and merit further exploration.

Adrenocorticotropic Hormone↗
PubMed1992

Lithium treatment and memory assessment: methodology.

Clinical observations have suggested that lithium may exert adverse effects on memory. The difficulty in achieving empirical consensus regarding this issue has reflected several methodological problems: diversity of research designs, heterogeneous samples, lack of control groups and the possible confounding of memory test scores by variables such as depression, other acute psychopathologies, organicity, treatment duration, and age. The diversity of memory tests in terms of the complexity and modality of the stimuli as well as the types of memory assessed (immediate, short- and long-term, logical, visuo-practic) has further complicated the comparison of results across studies. Furthermore, the administration of test batteries has been limited by patients' fatigue and the severity of their illness, and by the time required to complete testing. Hence, the use of test norms may be restricted. Suggestions are made for the selection of appropriate memory tests, patients sampling and data analysis. The authors discuss the difficulties inherent in blind studies and in matched-group designs examining the effects of lithium on memory. Conclusions point to the advantages of prospective within-subject designs with repeated testing in which patients serve as their own controls.

Analysis of Variance↗
PubMed1992

Lithium, benzodiazepines, and sexual function in bipolar patients.

OBJECTIVE: Lithium and benzodiazepines are widely used in the treatment of bipolar patients. Yet studies of the effect of these drugs on sexual function are scarce. This study surveyed sexual function in bipolar patients treated with lithium, either alone or in combination with other drugs. METHOD: Sexual function was assessed by self-rating scale in 104 outpatients (45 men and 59 women) with a DSM-III diagnosis of bipolar disorder who were attending an affective disorders clinic. All patients were under treatment with lithium, either alone (35%) or in combination with benzodiazepines (49%), tricyclic antidepressants (17%), neuroleptics (17%), tryptophan (10%), or carbamazepine (1%). The patients were in a stable and euthyroid state at the time of the assessment. Serum lithium and plasma prolactin concentrations were measured at the same time. RESULTS: Multiple regression analysis revealed an association between concomitant benzodiazepine administration and sexual dysfunction scores. Difficulties in sexual functioning were significantly more common in patients treated with a combination of lithium and benzodiazepines (49%) than in those treated with either lithium alone (14%) or lithium in combination with other drugs (17%). No relationship was found between serum lithium or plasma prolactin levels and sexual dysfunction scores. CONCLUSIONS: Lithium, when given alone, did not appear to have a major effect on sexual function, whereas its combination with benzodiazepines was associated with sexual dysfunction in about half of the patients. More attention should be given to drug-induced sexual dysfunction, since its presence can have important consequences for clinical management and compliance.

Adult↗
PubMed1991

Substance misuse among native and rural high school students in Quebec.

A questionnaire exploring the smoking habits, past and current use of alcoholic beverages, cannabis, and other illicit drugs was distributed among Francophone and Native high school students in a rural area of Quebec. The lifetime prevalence figures indicated that use of illicit drugs was significantly higher among Native students. This held true particularly for stimulants and inhalants (p less than .001). Figures for the 1-year prevalence indicated that use of stimulants in Native students remained still significantly higher (p less than .01). However, consumption of alcoholic beverages was more important in Francophone students (p less than .05). A gender difference was observed in Native students, females reporting an earlier involvement with most substances under study. This tendency decreased with age. The implications of this study for the prevention of alcohol and substance abuse among rural and Native youths are discussed.

Adolescent↗
PubMed1991

A Baha'i perspective on drug abuse prevention.

The present article provides a description of some of the principles that are considered by Baha'i communities in developing programmes for the prevention of drug abuse that target the individual, the family and society. The individual is helped to develop a sense of purpose, a feeling of self-esteem and respect for others, a state of maturity making it possible for him or her to evaluate circumstances objectively and to postpone immediate gratification for a future goal, a feeling of responsibility, and spiritual orientation, which can help the individual to develop positive attitudes towards himself or herself and the environment. Parents are encouraged to promote love and unity, as well as a drug-free lifestyle, so that children are provided with healthy models. The family experience is also intended to help children to cope with stress and other problems of daily life. By means of education, society at large is encouraged to adopt positive attitudes towards health and to promote activities that lead to the elimination of isolation.

Adaptation, Psychological↗
PubMed1991

Response to steroid suppression in major depression resistant to antidepressant therapy.

Because of the similarities in the psychiatric symptoms of Cushing's syndrome and those of major depression, and because the former generally remits when the hyperadrenalism is alleviated, an open clinical trial of the effect of steroid suppression in major depression was undertaken. Ten patients satisfying the DSM-III-R criteria for major depression, and classified as treatment-resistant, were included. Eight patients completed the study, which consisted of discontinuation of other psychotropic drugs and 2 months' treatment with one or more steroid suppressive agent (aminoglutethimide, ketoconazole and/or metyrapone). Six were classified as responders, and two as partial responders. In six, the improvement has been sustained for longer than 5 months after withdrawing the drugs. Side effects were mild to moderate. These results provide some evidence that steroids are involved in the maintenance of major depression, and that their suppression may lead to a readjustment of the hypothalamic-pituitary-adrenal axis with remission of the depression.

Adult↗