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D G Spiker

Publications and source records attributed to D G Spiker.

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

Electroencephalographic sleep, aging, and psychopathology: new data and state of the art.

Dysregulation of sleep-wake function is an important problem in both normal aging and in the two most common neuropsychiatric disorders of old age, depression and primary degenerative dementia. Since considerable overlap of symptoms in depression and dementing disorders (e.g., sleep disturbance, dysphoria, and cognitive impairment) often results in patients with a "mixed" syndrome, the development of specific, objective indicators as diagnostic markers, using electroencephalographic sleep patterns, was undertaken. Patients with dementia showed significantly less sleep continuity disturbance than patients with depression, less rapid eye movement activity, a different temporal distribution of REM density, and a longer REM latency. A discriminant function analysis using three variables (REM latency, REM density, and scaled sleep maintenance) correctly identified eight of nine depressives and six of nine dementing patients (78%) (k = 0.56, p = 0.008). These differences in REM sleep timing and density may be related to several factors: (i) defects in acetylcholine production in dementia; (ii) cholinergic mechanisms of REM sleep; and (iii) increased cholinergic induction of REM sleep in depression. The data suggest the utility of EEG sleep measures in the differential diagnosis of dementia and depression in the elderly.

Age Factors↗
PubMed1982

Application of automated REM analysis in depression.

Application of automated rapid-eye-movement (REM) analysis can characterize individual REM periods in depressed patients. Average REM count for the individual REM periods generally demonstrated considerable decreases in the second half of the REM period and differentiated patients who subsequently did not respond well to tricyclic antidepressants. These findings suggest that, even as late as six hours into a night of sleep, significant differences among depressed patients are present, based on treatment responder groups. Furthermore, a reevaluation of the previous emphasis on REM abnormalities in the first hour or two of the night may be indicated.

Adult↗
PubMed1982

Assortative mating among in-patients with primary affective disorder.

Assortative mating among 56 married in-patients with primary affective disorders and their spouses was studied by determining the prevalence of psychiatric illness among the spouses by means of direct interviews and standardized diagnostic criteria. A high degree of assortative mating among both male and female patients was observed for total psychiatric illness, broad spectrum affective illness and major depression. A significantly higher prevalence of psychiatric and affective illness was found among the first-degree relatives of the ill spouses when compared with the first-degree relatives of the well spouses. There was a high degree of diagnostic concordance between the patients and spouses for both affective illness and alcoholism, with a higher degree of assortative mating among bipolar patients than among unipolar patients. The finding in this study of an increased prevalence of psychiatric disorder in the first-degree relatives of the ill spouses would support the hypothesis that there is a tendency for individuals with a predisposition to psychiatric illness to marry, rather than the existence of a marital interaction which causes an increased concordance for psychiatric illness.

Adolescent↗
PubMed1982

EEG sleep and tricyclic blood levels: acute and chronic administration in depression.

An understanding of the effects of antidepressants on sleep can be aided by determinations of tricyclic plasma levels in relationship to sleep. Previous studies have been established that steady state plasma levels of amitriptyline relate to certain aspects of rapid eye movement (REM) sleep. The present investigations attempt to replicate the REM sleep/tricyclic plasma level relationships in a larger group of psychiatric hospitalized patients for depression and to study whether such relationships persist in a group of ambulatory patients studied longitudinally for 1 to 2 years. In an acute treatment study of 38 patients, REM sleep percent and average REM activity demonstrated a significant relationship with plasma levels, even when controlled for age and severity. The sleep-plasma level relationships seem more prominent with amitriptyline levels than with nortriptyline plasma levels. In a long term comparison of plasma levels, tricyclic plasma levels showed a significant correlation with REM latency, REM percent and average REM activity. Thus, it appears that changes in REM sleep such as REM suppression correlate significantly with tricyclic plasma levels both on a short (4 weeks) and long term basis (1 to 2 years). The implications of these findings are discussed.

Adult↗
PubMed1982

Prevalence of sleep apnea and nocturnal myoclonus in major affective disorders: clinical and polysomnographic findings.

We performed screening polysomnography on 86 inpatients with affective disorders and found that 13 (15.1 per cent) had sleep apnea and one had nocturnal myoclonus. The apnea tended to be extremely mild, with an average of 27.8 episodes per patient and with a mean duration of 15.0 seconds. No clinically significant cardiac arrhythmia accompanied the apnea. The apnea was predominantly obstructive or mixed, not central. Only four patients (4.7 per cent) had apnea indices greater than five, and even here the total apnea was considered mild. Much of the apnea (68.3 per cent) occurred during rapid eye movement sleep. While there was no association of apnea with gender or with type of sleep-wake complaint, a significant relationship with age emerged. On the basis of these data, we suggest that routine polysomnographic screening for sleep apnea and nocturnal myoclonus in affective disorders is not indicated. On occasion, however, both an affective disorder and a sleep-apnea syndrome co-exist in the same patient. In such cases, the sleep-wake complaint is usually very prominent and/or long-standing in relation to other psychopathology and requires appropriate polysomnographic evaluation.

Adult↗
PubMed1982

Nortriptyline and EEG sleep in depressed patients.

The effect of nortriptyline was assessed on the EEG sleep of 20 inpatients with major depressive syndrome. While 25 mg of nortriptyline had an immediate effect on REM sleep variables, relatively little influence on sleep continuity measures was noted. Subsequent administration of 75 and 100 mg of nortriptyline produced continued REM sleep suppression over several weeks. In summary, nortriptyline altered EEG sleep in a pattern similar to that of amitriptyline. REM latency and REM sleep time were consistently reduced by drug administration, while REM activity was only transiently altered as with amitriptyline. The comparison with amitriptyline showed, for the most part, similar influences on REM sleep without the sedative effects of amitriptyline.

Adult↗
PubMed1981

REM sleep, naps, and depression.

Continued interest in rapid eye movement (REM) sleep abnormalities in depression stimulated comparative studies on daytime naps versus nighttime sleep. In a group of 15 depressed patients, REM latencies in morning and afternoon naps were similar to the shortened REM onset at night. Although REM latency did not vary across the three times, the propensity for REM sleep appeared to be greater in the morning nap than in the afternoon nap and the early portion of nocturnal sleep. Finally, the data suggest that responders to tricyclic treatment tend to be poor sleepers during daytime naps.

Adult↗
PubMed1981

Sleep and treatment prediction in endogenous depression.

The prediction of clinical response in depression has been based primarily on clinical symptoms and history. Recently, psychobiologic measures have been used to increase the accuracy of clinical prediction. In 34 drug-free patients with primary endogenous depression treated with amitriptyline, the application of EEG-monitored sleep criteria alone was more significant than clinical status alone in the prediction of clinical response. Prolonged REM latency and reduced difficulty in sleep onset following the administration of amitriptyline were the main sleep variables contributing to this prediction equation. These data suggest a strong relationship between clinical outcome and psychobiologic profile in patients with endogenous depression after a "pharmacologic probe" with a tricyclic antidepressant.

Adult↗
PubMed1981

Refractory depression: prediction of non-response by clinical indicators.

The prediction of non-response in a well-defined group of 76 inpatients with a major depressive syndrome was made on the basis of clinical data. While agitation, anxiety, presence of delusions and bipolarity were significant factors, previously considered predictors (e.g. endogenous subtype, duration of present episode, number of previous episodes) did not contribute to the successful discrimination of response in this group at three levels: Clear-cut response, partial response and non-response. Since this investigation has carefully controlled for drug withdrawal and washout phases, medical complications and antidepressant drug compliance, the results of earlier studies may need to be reevaluated.

Adult↗
PubMed1981

Neuropsychological assessment and EEG sleep in affective disorders.

The neuropsychological test performance of 76 hospitalized, depressed patients meeting RDC for the presence of affective disorder was assessed as part of a protocol involving amitryptyline (n = 53) or placebo (n = 23). Tests included the Trail-making Test (TMT), the Benton Visual Retention Test, and the Shipley-Hartford Scale. Clinical ratings and data concerning the characteristics of EEG sleep were also obtained. Analysis of data collected after a drug-free period of 2 weeks and again at the end of the protocol yielded the following conclusions. Base-line performance was inferior to norms for these tests, but for the TMT, scores were not as poor as that expected for brain-damaged patients. Poor performance was often associated with older age, the presence of psychotic features, and prolonged sleep latencies. Baseline Hamilton Rating Scale (HRS) was predicted best by TMT part B. However, this association was not as strong as that between HRS and poor sleep efficiency. Treatment with drug or placebo had little differential effect upon test performance over the course of the protocol. It is suggested that further research should utilize tests which have specificity in localizing cerebral lesions, so that any focal deficits in brain function in depression might be identified.

Adult↗
PubMed1980

EEG sleep and affective psychosis.

EEG sleep changes in delusional depression have been reported previously but no attempt has been made to examine sleep profiles among specific delusional subtypes. In 29 psychotically depressed patients, those patients with delusions of guilt or sin demonstrated both increased sleep discontinuity and decreased REM sleep, especially during the first REM period, while patients with somatic delusions showed increased REM activity, especially in the first REM period. The implications of these findings are discussed.

Affective Disorders, Psychotic↗
PubMed1980

MHPG excretion in depression.

3-Methoxy-4-hydroxyphenylethyleneglycol (MHPG) was measured in 24-hour urine collections obtained from 44 drug-free patients hospitalized for a major depressive disorder, MHPG was significantly lower in a group of three biopolar 1 patients than in a group of unipolar patients. The excretion of MHPG did not significantly differ among patients classified as psychoatic, agitated, or retarded subtypes of depression as compared to patients not assigned to these subtypes.

Adult↗
PubMed1980

MHPG excretion and EEG sleep in primary depression.

Measures of daily urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion and electroencephalographic (EEG) sleep data were examined in 30 patients hospitalized for depression. This sample (mean age = 35 years) comprised 17 females and 13 males, all of whom were drug-free for 2 weeks and met Research Diagnostic Criteria for primary depressive disorder. Data analyses were conducted on the entire group, as well as the male, female, unipolar, and recurrent subgroups. No significant relationships were observed between total MHPG excretion and rapid eye movement (REM) or non-REM sleep variables. In particular, the absence of an interrelatedness of MHPG and REM sleep fails to confirm earlier findings in a smaller patient sample. These results, therefore, raise new questions about the proposed role of central noradrenergic activity in the mediation of REM sleep in depression.

Adult↗