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Biomedical subjects

B J Carroll

Publications and source records attributed to B J Carroll.

At least 145 records · Page 8Linked to original sources
PubMed1982

The dexamethasone suppression test in prepubertal depressed children.

The authors evaluated 18 dysphoric children aged 6--12 years by structured clinical assessments and an overnight dexamethasone suppression test (DST) administered on an outpatient basis. Nine children met diagnostic criteria for major depressive disorder, and 8 of the 9 also met the Research Diagnostic Criteria for endogenous depression. Of the 9 depressed children, 5 had abnormal DST results; 8 of the 9 nondepressed children had normal test results. The results suggest that endogenous depression in childhood is not a rare condition and that it is clinically and neuroendocrinologically similar to the adult disorder. The DST may be useful as a diagnostic aid with depressed children.

Child↗
PubMed1982

The dexamethasone suppression test for melancholia.

Melancholia is thought by many investigators to have a biological basis, and biological research, particularly on abnormalities of the neuroendocrine system and of the sleep electroencephalogram, is now beginning to yield results which can help in the differential diagnosis of depressive illness. This review will focus on the most widely studied neuroendocrine disturbance: disinhibition of the hypothalamus-pituitary-adrenal cortex (HPA) system as revealed by the dexamethasone suppression test (DST).

Bipolar Disorder↗
PubMed1982

Separation of subtypes of depression using discriminant analysis. I. Separation of unipolar endogenous depression from non-endogenous depression.

We derived a discriminant function based on clinical features to classify patients with endogenous depression ('melancholia') and non-endogenous ('neurotic') depression. The difference between the groups was not one of overall severity of illness alone. Bipolar melancholic patients were classified less well than were unipolars, supporting previous findings of clinical differences between these groups. The discriminant function (DF) was reduced to a discriminant index (DI) which classified a separate group of unipolar melancholic and non-endogenous patients with comparable accuracy. Approximately 80 per cent of all cases received a definite classification by the DI. The agreement between the 105 definite DI classifications and the clinical diagnoses was 90 per cent when results from the derivation and validation groups were combined. The DI classification was then validated against an objective biological marker, the dexamethasone suppression test (DST). The diagnostic discriminant index predicted the DST result with the same accuracy as the clinical diagnoses. The discriminant index can serve as an operational definition of the patients diagnosed as endogenous or nonendogenous unipolar depression in future studies by ourselves and other groups of investigators.

Adult↗
PubMed1982

EEG studies of sleep in the diagnosis of depression.

Psychiatric diagnoses have traditionally been made on the basis of clinical criteria, including current phenomenology and historical information. This traditional procedure presents several problems, including standardization of data gathering and interpretation. Biological criteria have been shown to be useful aids to diagnosis, but the same problems of standardization must be overcome. We present here the derivation of discriminant functions (DFs) using sleep EEG data to separate depressed from normal subjects. More important, we have cross-validated these DFs in a separate group of patients, using them to separate endogenous (ED) from nonendogenous depressed (ND) patients. ADF using the sleep variables REM latency and REM density can make this discrimination with sensitivity = 0.61 and specificity = 0.93. We also present our preliminary findings in support of the earlier conclusion that the sleep of unipolar ED patients is more disturbed than that of bipolar ED patients.

Adult↗
PubMed1981

A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.

Four hundred thirty-eight subjects underwent an overnight dexamethasone suppression test (DST) to standardize the test for the diagnosis of melancholia (endogenous depression). Abnormal plasma cortisol concentrations within 24 hours after dexamethasone administration occurred almost exclusively in melancholic patients. The best plasma cortisol criterion concentration, above which a DST result may be considered abnormal, was 5 microgram/dL. The optimal dose of dexamethasone was 1 rather than 2 mg. Two blood samples obtained at 4 and 11 PM after dexamethasone administration detected 98% of the abnormal test results. This version of the DST identified melancholic patients with a sensitivity of 67% and a specificity of 96%. Baseline nocturnal plasma cortisol concentrations were not useful. Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms. Extensive evidence validates this practical test for the diagnosis of melancholia.

Adolescent↗
PubMed1981

Acute and chronic stress effects on open field activity in the rat: implications for a model of depression.

The initial activity of a rat placed in novel surroundings (i.e., open field activity) has been taken as an indicator of its emotional state. We have investigated the effects of immediately antecedent stress upon open field activity in comparison with basal (i.e., unstressed) activity, and additionally, the effects of a history of chronic stress upon the above behavioral patterns. Acute exposure to a non-traumatic, non-debilitating stress (noise and light) consistently increased activity in comparison with basal activity. A history of chronic stress on the other hand reduced basal activity from control levels, and eliminated the activation response to acute stress. This lack of acute activation may bear some resemblance to depression on several grounds. Behaviorally it represents a "refractory loss of interest." Also, chronically stressed rats showed endocrine changes similar to those seen in human depressives. Finally, antidepressant treatment with the monoamine oxidase inhibitor pargyline restored the ability of chronically stressed rats to respond actively to stress.

Acute Disease↗
PubMed1981

Dexamethasone suppression test and selection of antidepressant medications.

Endogenous depressives with abnormal dexamethasone suppression tests (DSTs) respond better to somatic antidepressant treatments than those with normal DSTs. Whether the DST also aids in the selection of specific antidepressants has not been determined. A pilot report suggested that patients with abnormal DSTs might be noradrenaline-deficient and respond preferentially to imipramine or desipramine, whereas those with normal DSTs might be serotonin-deficient and respond best to amitriptyline or clomipramine. Attempting to replicate this observation, we studied 26 patients diagnosed with Research Diagnostic Criteria as major depressive disorder, endogenous subtype, and with DSM-III as having melancholia. All were drug-free during baseline evaluation. All had abnormal DST results, with post-dexamethasone plasma cortisol levels exceeding 5 microgram/dl. We treated subjects with either imipramine or amitriptyline and compared clinical response with weekly Hamilton Depression Rating Scales, completed by raters blind to both DST results and the research question. Thereapeutic plasma levels were documented. We found no significant differences in treatment response between the subgroups. Twenty of the 26 subjects did well. The imipramine-treatment group failed to have either earlier response or better final outcome. These data fail to replicate suggestions that DST results assist in the selection of either imipramine or amitriptyline.

Amitriptyline↗
PubMed1981

Monitoring lithium dose levels: estimation of lithium in blood and other body fluids.

The theoretical basis and practical application of the analytical procedures used to quantitate lithium in biological fluids, i.e., flame emission and atomic absorption, are described in their most simple form in nontechnical language. The clinical relevance of the erythrocyte to plasma ratio, saliva, urine, and spinal fluid lithium measures is discussed. Other topics include acute treatment plasma lithium levels and maintenance treatment plasma levels, pitfalls in sample collection, availability of micro (finger prick) procedures, and laboratory accuracy and evaluation.

Blood Specimen Collection↗
PubMed1981

Comparison of brainstem and adrenal circadian patterns of epinephrine synthesis.

The enzyme which converts to norepinephrine to epinephrine, phenylethanolamine N-methyltransferase (PNMT), is found in brain as well as in the adrenal medulla. PNMT activity is subject to regulation by glucocorticoids, hormones which have a diurnal rhythm. We asked (1) whether a diurnal fluctuation exists in adrenal and brain PNMT activity and (2) what relationship this fluctuation might have to the diurnal rhythm in circulating glucocorticoids. Rats were sacrificed at 4-hour intervals over a 24-hour period. The PNMT activity in the adrenals and brainstems of these animals was determined by radioenzymatic assay, and the plasma levels of corticosterone were measured by competitive protein binding. No significant temporal variation was found in adrenal PNMT activity. Brainstem PNMT activity, however, showed a distinct diurnal fluctuation in activity, with a nadir at 7 a.m. and a peak at 3 p.m. The rise in brainstems PNMT clearly preceded by several hours the circadian rise in plasma corticosterone. We conclude that the circadian rhythm in circulating corticosterone does not drive the diurnal variation in brain PNMT activity. In unstressed animals, injection of exogenous corticosterone failed to elevate brainstem PNMT activity, whereas injection of specific inhibitors of PNMT activity significantly elevated plasma corticosterone levels. These data raise the possibility that the converse is true: changes in epinephrine synthesis may modulate the diurnal rhythm in pituitary-adrenal activity.

Adrenal Glands↗
PubMed1981

Psychomotor function in affective disorders: an overview of new monitoring techniques.

Clinicians and researchers lack accuracy in assessing psychomotor functions of patients. Several objective monitoring techniques have recently been proposed with the goal of compiling accurate determinations. These include electromyographic determinations of facial expressions of emotion, measurement of speech phonation and pause times, and use of movement-activated recording monitors to quantify motility. Objective psychomotor assessments may improve classification, longitudinal monitoring, treatment selection, and prediction of outcome for patients with depression and mania.

Bipolar Disorder↗
PubMed1981

The Carroll rating scale for depression. I. Development, reliability and validation.

The Carroll rating scales (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scales (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.

Adult↗