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Biomedical subjects

Bruce G Pollock

Publications and source records attributed to Bruce G Pollock.

81 records · Page 5Linked to original sources
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Executive functioning, illness course, and relapse/recurrence in continuation and maintenance treatment of late-life depression: is there a relationship?

OBJECTIVE: The authors tested the hypothesis that impaired executive functioning leads to high rates of relapse and recurrence in late-life depression. METHODS: They analyzed data from subjects participating in two independent intervention trials. Study I included 53 elderly depressed patients who participated in an open trial comparing the efficacy of paroxetine and nortriptyline and recurrence prevention over 18 months. Study II focused on 146 elderly depressed patients who received open treatment with paroxetine in a relapse-prevention study over 4 months of continuation treatment. They examined the effect of cognitive functioning, in general, and executive functioning, in particular, on time-to-relapse/recurrence, using baseline and post-treatment measures of neuropsychological functioning. RESULTS: The associations between cognitive measures and both probability of, and time-to-relapse/recurrence were small and statistically nonsignificant. CONCLUSION: Data failed to support the hypothesis that cognitive impairment, in general, or executive dysfunction, in particular, predicts relapse or recurrence of major depression in late life. Authors recommend future testing of the hypothesis with detailed, comprehensive measures over longer periods of observation during maintenance trials.

Age of Onset↗
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Plasma levels of citalopram in depressed patients with hepatitis C.

Hepatitis C affects an estimated 4 million Americans and 100 million people worldwide. Rates of depression are higher than that seen in the general population. Antidepressant therapy is often initiated at lower doses in patients with liver disease because of concerns about impaired metabolism and clearance. This study assessed plasma levels of citalopram in 15 subjects with hepatitis C and major depression during an 8-week trial. The mean citalopram dose at study completion was 26.67 mg/day. Mean plasma levels of citalopram, compared with levels previously reported, were lower than expected (at 10 mg/day [N = 1]: 21 ng/ml [N = 1]; at 20 mg/day [N = 8]: mean = 42.25 ng/ml, SD = 18.38; at 30 mg/day [N = 1]: 54 ng/ml; at 40 mg/day [N = 5]: mean = 76.2 ng/ml, SD = 35.86). There was a tendency for lower plasma levels to be found in those subjects receiving interferon, although a statistically significant difference was not observed. Citalopram was well tolerated. The results of this study suggest that patients with major depression and hepatitis C, but without evidence of severe liver disease, may be able to tolerate usual recommended doses of citalopram, thus avoiding the potential for undertreatment of the depression.

Adult↗
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Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients.

Tricyclic antidepressants (TCAs) have previously been found to be related to an increased incidence of falls in elderly persons. Recent pharmacoepidemiologic and nursing home studies have suggested that the risk of falls and fractures in elderly patients receiving selective serotonin reuptake inhibitors (SSRIs) is not different from that of patients receiving TCAs. The authors therefore evaluated postural sway in an older population of depressed patients randomly assigned to treatment with either nortriptyline or paroxetine and did not find any change in postural sway after 6 weeks' treatment with either antidepressant. Further studies with other SSRIs are needed.

Aged↗
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Glucose metabolic response to total sleep deprivation, recovery sleep, and acute antidepressant treatment as functional neuroanatomic correlates of treatment outcome in geriatric depression.

OBJECTIVE: The variable speed and durability of response to antidepressant medications in geriatric depression is a significant clinical problem. The authors evaluated changes in cerebral glucose metabolism measured with positron emission tomography (PET) during a clinical trial designed to accelerate medication response by the use of one night of total sleep deprivation (TSD), and they asked whether changes would correlate with treatment outcome after 12 weeks of antidepressant treatment. METHODS: Twelve elderly, unipolar depressed patients underwent serial PET studies at baseline, post-TSD, post-recovery sleep (after an initial paroxetine dose), and after 2 weeks of paroxetine treatment. RESULTS: Decreased regional glucose metabolism after TSD, recovery sleep, and 2 weeks of treatment was associated with clinical improvement at 12 weeks. The right cingulate gyrus area was consistently correlated with clinical improvement across treatment conditions. CONCLUSION: These data indicate that the early metabolic alterations in the right cingulate gyrus and the persistence of these adaptive changes are associated with improvement in depressive symptoms.

Aged↗
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Response speed and rate of remission in primary and specialty care of elderly patients with depression.

OBJECTIVE: Depression treatment in primary care elderly patients has been inadequate, resulting in low rates of response and remission. The authors compared treatment remission rates and time-to-remission of elderly subjects enrolled in two ongoing depression treatment studies, one in primary care practices ("PROSPECT") and the other in an academic tertiary mental health care center ("MTLD-2"), in order to assess the value of standardizing and intensifying depression treatment in primary care elderly patients. METHODS: Authors compared remission rates and time to criterion endpoints via survival analysis. The 126 PROSPECT subjects (mean age 71) included primary care patients with either current episodes of major depression or minor depression. The 129 MTLD-2 subjects (mean age 77) had single or recurrent unipolar major depression. PROSPECT subjects received a variety of open treatments, including the drug citalopram and/or interpersonal psychotherapy (IPT). Both patient and provider preferences influenced treatment selected. MTLD-2 subjects received more structured, open paroxetine treatment and IPT. RESULTS: The remission rates of PROSPECT and MTLD-2 were 86.5% and 88.4%, respectively. Median time-to-remission in PROSPECT was significantly longer than in MTLD-2 (12 weeks versus 8.7 weeks). Limiting the survival analysis to subjects with major depression produced faster attainment of remission criteria. CONCLUSION: Notwithstanding these differences in speed and rate of symptom resolution, good treatment can work well in geriatric depression in the primary care sector.

Aged↗
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Evaluating the consistency of pharmacotherapy exposure by use of state-of-the-art techniques.

OBJECTIVE: The authors examine the usefulness of population pharmacokinetics coupled with electronic compliance monitoring in evaluating consistency of exposure to pharmacotherapy. Adherence to pharmacotherapy can have a significant impact on drug response, especially in the treatment of schizophrenia and depression. Previous studies evaluating antipsychotics identified schizophrenic individuals with poor pharmacotherapy adherence as having a higher risk of rehospitalization. Other investigators have shown a relationship between pattern of taking selective serotonin-reuptake inhibitors (SSRIs) and probability of a positive outcome. Therefore, it is important to measure adherence patterns in clinical trials evaluating these treatments and to incorporate this information into the research findings. METHODS: Two multisite trials with atypical antipsychotics and antidepressants were simulated to evaluate, by use of population pharmacokinetic methods, the impact of electronic monitoring on measuring consistency of exposure to pharmacotherapy. One of the trials is ongoing and evaluates exposure to atypical antipsychotics, and the other is a proposed trial that examines exposure to an SSRI. RESULTS: Erratic exposure patterns were detected with population pharmacokinetic techniques in the absence of Electronic Medication Event Monitoring (MEMS) data. In our simulations, the use of electronic monitoring improved the identification of atypical exposure by population pharmacokinetics both for the atypical antipsychotics and SSRIs. CONCLUSION: Our simulations demonstrate the potential usefulness of the combination of population pharmacokinetics with electronic monitoring as a robust method for accurately and precisely capturing both magnitude and consistency of pharmacotherapy exposure.

Antidepressive Agents, Second-Generation↗
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Verification of scale sub-domains in elderly patients with dementia: a confirmatory factor-analytic approach.

OBJECTIVE: Use of cognitive, psychiatric and behavioral domains to assess the effectiveness of a pharmacological or behavioral intervention in the treatment of neurodegenerative disorders (e.g., Alzheimer disease) aids the identification of specific types of impairment or distress in behavioral status and quality-of-life issues in this population. With confirmatory approaches to subscale development readily available, we can obtain a more precise understanding of the sub-components of a scale, potentially providing the basis for selecting behavioral and/or quality-of-life outcome measures that may be more sensitive to the effects of pharmacological or behavioral interventions. METHODS: The authors illustrate the use of a confirmatory factor-analytic approach to verify scale sub-domains of the Neurobehavioral Rating Scale (NBRS) in elderly patients with dementia. With data collected from two groups of patients being treated for significant psychiatric and behavioral symptoms, authors investigated the relationships among scale items in order to test several competing models, including a general one-factor model, a first-order multifactor model, and a second-order factor model. RESULTS: The first-order model, with seven factors, provided the best fit to the correlations among items in the NBRS, indicating the multidimensionality of problematic behaviors and symptoms exhibited by dementia patients. CONCLUSION: Authors advocate the use of a confirmatory factor-analytic approach to verify scale sub-domains in other, more widely used rating scales for patients with dementia.

Aged↗
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Acute and chronic effects of citalopram on cerebral glucose metabolism in geriatric depression.

OBJECTIVE: In vivo studies of serotonin function have been limited by the lack of safe and selective pharmacologic agents and availability of suitable radiotracers. In the present study, the authors evaluated the cerebral metabolic effects of acute and continued administration of the selective serotonin reuptake inhibitor citalopram in patients with geriatric depression as a potential marker of serotonin dysfunction. METHODS: Six patients with geriatric depression and five comparison subjects underwent two resting positron emission tomography (PET) studies, performed after administration of a placebo infusion (Day 1) and a citalopram infusion (40 mg, Day 2). The patients were re-scanned after 8 weeks of treatment with the oral medication. RESULTS: The elderly comparison subjects demonstrated greater right-hemisphere cortical decreases than the patients. The depressed patients demonstrated greater left-hemisphere cortical decreases than comparison subjects. The depressed patients demonstrated greater increases in the right putamen and left occipital cortex. After 8 weeks of citalopram treatment, regional decreases and increases in metabolism were observed. CONCLUSION: These findings suggest regional deficits and also compensatory responses in the acute metabolic response to citalopram in the patients. These preliminary results suggest that the cerebral metabolic response to citalopram may be a useful marker of the pathophysiology of serotonin function in geriatric depression.

Aged↗