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Biomedical subjects

D B Menkes

Publications and source records attributed to D B Menkes.

At least 19 recordsLinked to original sources
PubMed2000

Long-term assessment of psychological well-being in a randomized placebo-controlled trial of cholesterol reduction with pravastatin. The LIPID Study Investigators.

BACKGROUND: There is controversial evidence that a low serum cholesterol level is associated with an increased risk of depression, suicide, and violence. The aim of this study was to identify or exclude any small or infrequent adverse effect of long-term reduction of serum cholesterol with pravastatin sodium on psychological well-being. METHODS: The study population consisted of 1130 respondents from a representative sample of 1222 patients with stable coronary artery disease participating in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Subjects were randomized in a double-blind manner to treatment with pravastatin sodium, 40 mg/d (n = 559), or placebo (n = 571) for at least 4 years. Psychological well-being was assessed with a standard self-administered questionnaire at baseline and after 6 months, 1 year, 2 years, and 4 years. The questionnaire assessed anxiety and depression, anger, impulsiveness, alcohol consumption, and adverse life events. RESULTS: Serum cholesterol levels decreased by an average of 1.3 mmol/L (50 mg/dL) with pravastatin therapy and did not change with placebo. During follow-up there was no significant difference by treatment group in measures of anxiety and depression, anger expression, or impulsiveness (95% confidence interval excluded differences of >0.2 SD) and no difference in the proportion of subjects with excessive alcohol consumption or adverse life events (odds ratio, 1.0; 95% confidence interval, 0.8-1.2). There was no evidence of a treatment effect for persons whose baseline serum cholesterol level was in the lowest 10% (<4.6 mmol/L [178 mg/dL]) or whose scores for anxiety and depression, anger, or impulsiveness were in the highest 10% at baseline. There was no association between change in the serum cholesterol level and measures of anxiety and depression, anger, or impulsiveness during follow-up. CONCLUSION: Long-term reduction of serum cholesterol with pravastatin has no adverse effect on psychological well-being.

Adult↗
PubMed2000

Interferons, serotonin and neurotoxicity.

BACKGROUND: Interferons are a class of cytokines profoundly affecting immune function. Several interferons are now synthesized and used clinically, notably for viral diseases and cancer. In addition to their desired immune effects, interferons cause a number of toxicities, including prominent effects on the nervous system. METHODS: This literature review focused on the incidence of depression associated with interferon treatment. Possible neurochemical mechanisms and remedial strategies were also considered. RESULTS: Interferon treatment, particularly with the alpha subtype, is unquestionably linked with depression, but the strength of association is uncertain because of erratic ascertainment and pretreatment co-morbidity. A likely pathogenic mechanism has been described, involving interferon suppression of serotonin synthesis. Controlled treatment trials of interferon-induced depression are not yet available. CONCLUSIONS: Neurotoxicity substantially limits the use of interferons. At least some of the risk of depression appears to derive from their anti-serotonergic effects, consistent with the large body of evidence pointing to a general link between serotonin and affective illness. Vigilant detection and aggressive treatment of depression is necessary to optimize interferon treatment of many patients.

Antineoplastic Agents↗
PubMed2000

Subtyping depression by clinical features: the Australasian database.

OBJECTIVE: To distinguish psychotic, melancholic and a residual non-melancholic class on the basis of clinical features alone. Previous studies at our Mood Disorders Unit (MDU) favour a hierarchical model, with the classes able to be distinguished by two specific clinical features, but any such intramural study risks rater bias and requires external replication. METHOD: This replication study involved 27 Australasian psychiatrist raters, thus extending the sample and raters beyond the MDU facility. They collected clinical feature data using a standardized assessment with precoded rating options. A psychotic depression (PD) class was derived by respecting DSM-IV decision rules while a cluster analysis distinguished melancholic (MEL) and non-melancholic classes. RESULTS: The MELs were distinguished virtually entirely by the presence of significant psychomotor disturbance (PMD), as rated by the observationally based CORE measure, with over-representation on only three of an extensive set of 'endogeneity symptoms'. CONCLUSION: In comparison to PMD, endogeneity symptoms appear to be poor indicators of 'melancholic' type, confounding typology with severity. Results again support the hierarchical model.

Adult↗
PubMed1998

Exporting hazards to developing countries.

The health of people in developing countries is threatened by the importation of hazardous products, wastes and industrial processes from the developed world. Combating this menace is a facet of environmental protection and management of the planet's resources.

Commerce↗
PubMed1997

Too easily lead? Health effects of gasoline additives.

Octane-enhancing constituents of gasoline pose a number of health hazards. This paper considers the relative risks of metallic (lead, manganese), aromatic (e.g., benzene), and oxygenated additives in both industrialized and developing countries. Technological advances, particularly in industrialized countries, have allowed the progressive removal of lead from gasoline and the increased control of exhaust emissions. The developing world, by contrast, has relatively lax environmental standards and faces serious public health problems from vehicle exhaust and the rapid increase in automobile use. Financial obstacles to the modernization of refineries and vehicle fleets compound this problem and the developing world continues to import large quantities of lead additives and other hazardous materials. Progress in decreasing environmental health problems depends both on the adoption of international public health standards as well as efforts to decrease dependence on the private automobile for urban transport.

Air Pollutants↗
PubMed1996

Distribution of blood lead levels in a birth cohort of New Zealanders at age 21.

Little is known about lead exposure in the general population of young adults. In this study, whole blood lead concentration (PbB) was determined in a sample of the Dunedin Multidisciplinary Health and Development Study, a well-documented birth cohort of New Zealanders aged 21 years in 1993-1994. PbB in those who consented to venipuncture at 21 years of age (n = 779; 411 males, 368 females) was compared to PbB for the same cohort at age 11 years. The PbB at age 21 ranged from 0.4 to 56 micrograms/dl with a geometric mean of 4.5 micrograms/dl (95% CI, 4.3-4.7 micrograms/dl). Only three individuals had a PbB above 30 micrograms/dl. Males had significantly higher PbB than females (geometric mean 6.0 vs. 3.2 micrograms/dl; p < 0.0001). The PbB at age 21 was 53% lower than in the same individuals at age 11 (geometric mean 4.8 vs. 10.2 micrograms/dl; p < 0.001; n = 480) and the correlation between corresponding values was weak (r = 0.19; p < 0.001). PbB at age 21 showed significant associations with high risk occupational activities, recreational exposure, domicile close to a main road, smoking, and male sex. Blood lead concentrations continue to fall in New Zealand, but occupational and recreational activities remain a significant source of lead exposure.

Adult↗
PubMed1995

Moclobemide in chronic neuropathic pain: preliminary case reports.

OBJECTIVE: This trial aimed to study moclobemide, a reversible, Type-A selective monoamine oxidase inhibitor, in patients with chronic neuropathic pain. DESIGN: Pain clinic patients suitable for antidepressant therapy were treated for 2 months in an open label, uncontrolled trial with moclobemide 150-600 mg/day. OUTCOME MEASURES: Visual analog scores of pain and affective symptoms, a side-effect checklist, and clinical global impressions of efficacy and tolerability. RESULTS: The trial was terminated after assessment of seven patients; partial analgesic activity was discernible only in one, and beneficial mood effects notable in two others. Significant adverse effects, particularly insomnia and GI disturbance, were reported by the majority of patients. CONCLUSION: Moclobemide appears to have limited efficacy in the treatment of neuropathic pain.

Adult↗
PubMed1995

Premenstrual syndrome: a double-blind controlled trial of desipramine and methylscopolamine.

The aim of this study was to compare the effect of the selective noradrenergic reuptake inhibitor desipramine and methylscopolamine bromide, a parasympatholytic agent, on late luteal phase dysphoric disorder (LLPDD), or premenstrual syndrome (PMS), as defined in DSM-III-R. Fourteen patients with PMS were assessed both retrospectively and prospectively during premenstrual cycles. All met the DSM-III-R criteria for LLPDD. They received 3 months treatment each with both desipramine and methylscopolamine in random order using a double-blind cross-over design. PMS symptomatology was significantly reduced after treatment with desipramine and methylscopolamine bromide compared with baseline, but there was no significant difference between them in efficacy. There is evidence from this study that both anticholinergic and noradrenergic pathways may be involved in the genesis of PMS.

Adolescent↗
PubMed1994

Early intervention for alcohol misuse: encouraging doctors to take action.

AIMS: An early intervention programme was introduced to improve the detection and management of problem drinkers admitted to acute orthopaedic wards at Dunedin hospital. METHOD: Intervention included brief staff education and the integration of an alcohol screen into the general patient assessment form used by junior doctors. Two hundred sets of patient records were examined, half before, and half after the introduction of these changes. Information was collected on the adequacy of alcohol history taking, whether alcohol misuse was identified, and how misuse was addressed. RESULTS: The proportion of patients with an adequate, quantitative alcohol history recorded increased from 37% to 84%. Although the detection of hazardous drinking increased only slightly, the proportion of cases where some form of action was taken increased from 14% to 71%. The majority of cases referred for follow up in the latter period were younger, nondependent problem drinkers. The programme was initially successful, but over time practices tended to revert when active encouragement was withdrawn. CONCLUSIONS: Our findings, consistent with those obtained overseas, indicate a striking plasticity of hospital junior doctor practice. Improvements in the detection and management of alcohol misuse are possible, but appear to require dedicated input and coaching. When such input is withdrawn, reversion can be disappointingly rapid. We suggest that if improved practices are to be sustained, preventive approaches need to be given greater emphasis in medical school curricula, and promoted by both senior medical staff and hospital management.

Accidental Falls↗