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Biomedical subjects

D L Dunner

Publications and source records attributed to D L Dunner.

At least 73 records · Page 4Linked to original sources
PubMed1988

Mitral valve prolapse and the anxiety disorders.

Confusing and contradictory results have emerged from studies of the relationship between anxiety disorders and mitral valve prolapse (MVP), a commonly occurring heart defect that has been associated with chest pain, palpitations, tachycardia, and arrhythmias. Patients with anxiety disorders, particularly panic attacks, appear to have an increased prevalence of MVP compared with control groups or the general population, although most individuals with MVP are asymptomatic. MVP does not appear to distinguish a subgroup of patients with panic disorder on the basis of vulnerability to panic attacks, symptom presentation, biological abnormalities, or treatment response. The authors review some current hypotheses about causal relationships between anxiety disorders and MVP, describe methods of diagnosing MVP and their shortcomings, and identify possible medical complications of MVP and ways to treat or prevent them.

Adult↗
PubMed1987

Biological markers in panic states: lactate-induced panic and mitral valve prolapse.

Anxious patients, and more specifically, patients experiencing panic attacks, are thought to have a significant biological component to their illness. This study looks at two promising biological markers associated with this patient population-mitral valve prolapse and lactate-induced panic. We present our findings, which further characterize clinical and biological aspects of these two markers.

Adolescent↗
PubMed1987

Lactate infusions in major depression without panic attacks.

Sodium lactate infusion provokes panic attacks in panic disorder patients but not in normal controls. We have previously shown that patients who develop panic disorder during a major depressive episode are similar to panic disorder patients in their rate of panic attacks with lactate. In the present pilot study, nine patients with major depression without panic attacks underwent lactate infusions. These patients differed significantly from panic disorder patients but not from controls in their response to lactate. This argues for the specificity of lactate sensitivity for the phenomenon of panic attacks and gives further evidence for biological differences between panic and depression.

Adolescent↗
PubMed1987

Lactate infusions: the role of baseline anxiety.

Sodium lactate infusions provoke panic symptoms in patients with panic attacks at a greater rate than in normal controls. The effect of the baseline, preinfusion state on subsequent response to lactate is the subject of debate. Baseline symptoms, anxiety levels, and autonomic arousal and subsequent response to lactate were examined in 44 panic patients and 10 normal controls. Patients who had a typical panic attack with lactate had higher baseline symptom ratings, but these did not fully account for differences in response to lactate. Although baseline measures are not the sole determinant of response to lactate infusion, they may be one factor influencing how readily a patient reaches the threshold for a panic attack.

Adult↗
PubMed1987

Mitral valve abnormalities and catecholamine activity in anxious patients.

We studied 38 anxiety disorder patients, 19 of whom had evidence of mitral valve abnormalities by two-dimensional echocardiography. The presence or absence of mitral valve abnormalities was not related to 3-methoxy-4-hydroxyphenylglycol/creatinine excretion, platelet and plasma monoamine oxidase-type activity, or autonomic arousal as measured by blood pressure and resting heart rate. These findings fail to support the hypothesis that mitral valve abnormalities identify a specific subpopulation of anxious patients with differences in catecholamine function.

Adult↗
PubMed1987

Clinical characteristics and response to sodium lactate of patients with infrequent panic attacks.

Nine patients with panic attacks too infrequent to meet DSM-III criteria for panic disorder were compared to 20 panic disorder patients with respect to clinical characteristics and response to sodium lactate infusion. The two groups showed similar clinical characteristics and response to lactate. The authors conclude that patients with infrequent panic attacks are clinically and biologically similar to those with panic disorder and discuss implications for the diagnosis of panic states.

Adolescent↗
PubMed1987

Panic disorder precipitated by exposure to organic solvents in the work place.

The authors describe three cases of idiosyncratic response to occupational solvent exposure, with symptoms characteristic of panic disorder (DSM-III). The specific treatment and prognostic implications of this panic-like reaction to solvents are discussed. Sodium lactate infusion is proposed as an objective test to aid in the diagnosis.

Adult↗
PubMed1987

A case of nonneuroleptic malignant syndrome.

Neuroleptic malignant syndrome is a diagnosis that has been reported with increasing frequency in recent years. We report the case of a patient who was not treated with a neuroleptic but in whom a syndrome identical to neuroleptic malignant syndrome developed. The case highlights the overuse of and the confusion about the diagnosis of the syndrome.

Adult↗
PubMed1986

Lactate-induced panic in primary affective disorder.

Intravenous sodium lactate was given to seven patients with primary depression and secondary panic attacks and 26 patients with panic disorder or agoraphobia with panic attacks. The two groups had similar rates of panic response. These results challenge the diagnostic specificity of lactate-induced panic.

Adult↗
PubMed1986

Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study.

Forty-eight patients currently experiencing panic attacks were randomly assigned to double-blind treatment with alprazolam, diazepam, or placebo. Efficacy was assessed using the Hamilton Rating Scale for Anxiety and a panic attack frequency rating scale. Results indicate that the two active treatments appeared equally effective in reducing both the frequency of panic attacks and the severity of generalized anxiety when compared with placebo. Overall, these data support the use of benzodiazepines in the treatment of panic disorder.

Adult↗
PubMed1986

Early placebo response in anxious and depressed patients.

Specific subgroups of anxiety disorder patients (N = 130) and depression patients (N = 105), defined according to DSM-III criteria, were given 1 week of placebo treatment as part of ongoing clinical drug trials. Placebo responses and dropout rates were assessed at the end of the placebo trial period. The results indicate a comparable dropout rate between depression and anxiety disorder groups due to positive placebo response, negative placebo response, and "nonsymptomatic" reasons. In addition, male anxiety disorder patients dropped out at a significantly higher rate than male depression patients.

Adolescent↗
PubMed1985

The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder, or primary affective disorder.

The authors administered the dexamethasone suppression test (DST) to outpatients, who were free from psychoactive drugs for at least 10 days before the test, with primary affective disorder (N = 60), generalized anxiety disorder (N = 26), panic disorder (N = 22), and agoraphobia with panic attacks (N = 13). With a cortisol value of 5 micrograms/dl considered nonsuppression, there were no significant differences in dexamethasone nonsuppression rates among the diagnostic groups. Scores on the Hamilton Rating Scale for Depression and a melancholia subscale were significantly higher in the depressed group than in the anxiety disorder group. The findings raise questions concerning the specificity of the DST for primary affective disorder in relationship to anxiety disorders.

Adult↗
PubMed1984

Self and other directed violence on a closed acute-care ward.

Violence to self and to others on a locked, acute-care unit is reported for a three-year period. Drug abuse correlated strongly with both types of violence. Self-violence appeared to be a more predictable event due to its diagnostic specificity, history of prior violence and timing of the episodes. Assaults occurred more randomly demonstrating only a mild association with schizophrenia, but not with other psychotic disorders.

Acute Disease↗
PubMed1984

Search for biological/genetic markers in a long-term epidemiological and morbid risk study of affective disorders.

A long-term epidemiological genetic study was conducted in which all new patients were evaluated prospectively at the Foundation for Depression and Manic Depression and two Lithium/Affective Disorders clinics at the Columbia-Presbyterian Medical Center between the years of 1972 and 1978. All patients met Feighner, RDC and DSM III criteria for Major Depressive Disorder after initial clinical screening interviews and were further subtyped using the Fieve-Dunner 7-point criteria. All 604 probands and 90% of 2711 first-degree relatives were interviewed blindly by diagnosticians trained in the use of the SADS structured interview. Cumulative morbid risk in parents, siblings and children of 490 bipolar probands was 15.6 +/- 3% and 14.0 +/- 1.7% in the first-degree relatives of 114 unipolar probands. A number of biological and genetic marker studies were simultaneously performed on samples of the overall population. The enzymes catechol O-methyltransferase and dopamine beta-hydroxylase, and the dexamethasone suppression test (SDT) did not show any biological marker value for outpatients even though both enzymes were determined to have hereditability. The HLA system, monoamine oxidase and acetylcholinesterase segregated differently from normal controls in samples of the patient population. The positive association findings with monoamine oxidase and the HLA system conflicted with the positive findings of other investigators, leaving doubtful their biological marker value. Red cell acetylcholinesterase was found to be significantly lower in affective disorder patients than in controls. This positive association finding was recently replicated by Mathews et al. (1982) but needs further confirmation. Using 28 blood group markers, a prior association study between the trait defining susceptibility to affective disorder and the genetic marker was positive for haptoglobin GC, and properdinfactor B, confirming earlier findings. Using the sib-pair method on the remaining 25 blood groups revealed that none other than peptidase A showed significant linkage with affective disorder since one significant finding is expected by chance. We conclude from the overall morbid risk data and segregation analyses that bipolar manic-depressive illness is a spectrum disease inherited through a multifactorial mode of genetic transmission (which is not synonymous with polygenetic inheritance) with possible genetic heterogeneity and find no evidence for X-linkage. Additional studies with acetylcholinesterase, haptoglobin, GC, and properdin-factor B are needed to confirm their positive biological/genetic marker value suggested by our long-term epidemiological study.

Acetylcholinesterase↗
PubMed1984

Acute viral encephalitis complicating a first manic episode.

The diagnosis of viral encephalitis in a patient with acute mania was difficult because of symptom overlap and inconclusive laboratory evaluations. Final differentiation was made clinically. Despite the generally assumed usefulness of diagnostic tests for encephalitis, only the electroencephalogram showed consistent sensitivity in this patient and in similar previously reported cases. Diagnosis was further complicated by the potential side effects of neuroleptic medications, which may mimic infection through extrapyramidal symptoms, fever, or altered blood counts. In addition, legitimate physical complaints were discounted as a result of the patient's psychiatric status.

Acute Disease↗
PubMed1984

A study of primary affective disorder in the People's Republic of China.

Symptoms, course, and familial factors relating to depression were ascertained for 40 Chinese patients who had histories of primary affective disorder. In general, the symptoms, course, and familial factors among these patients were similar to findings in equivalent U.S. populations. A high degree of diagnostic interrater reliability was demonstrated in this cross-cultural study. Depression ratings of this population and euthymic controls showed a high correlation between the Carroll rating scale (a self-rating) and the 17-item Hamilton depression scale. Many of the currently depressed Chinese showed nonsuppression of serum cortisol after dexamethasone administration. This study suggests that effective disorder (particularly bipolar affective disorder) in China is similar to that seen in the U.S.

Adult↗