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Biomedical subjects

D S Robinson

Publications and source records attributed to D S Robinson.

At least 127 records · Page 7Linked to original sources
PubMed1990

Symptom comorbidity in anxiety and depressive disorders.

The ability of the Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, and 50 items from the self-rated Hopkins Symptom Checklist to discriminate generalized anxiety disorder from major depressive disorder was examined for over 3,000 patients entering studies in three drug development projects at Bristol-Myers Squibb Company. Discriminant analysis models using stepwise procedures were developed for each scale separately, combining both Hamilton scales, and combining all three scales. The statistical model using both Hamilton scales produced the best discrimination. Items from the Hopkins Symptom Checklist scale did not improve the ability to discriminate patients by diagnosis correctly. The generalizability was tested by applying the discriminant models to new data sets or subsets of the data sets used in the model-building process. Correct classification rates for differentiating the two disorders ranged from 87-99% for the final model.

Adult↗
PubMed1990

Clinical effects of the 5-HT1A partial agonists in depression: a composite analysis of buspirone in the treatment of depression.

The azapirone class of anxiolytic drugs is being evaluated for clinical use in the treatment of depression. Buspirone, a serotonin (5-hydroxytryptamine, 5-HT) partial agonist active at the 5-HT1A receptor subtype, was evaluated in the treatment of depression in a series of five placebo-controlled, parallel group studies involving 382 patients with DSM-III major depression and significant associated anxiety symptoms (both Hamilton depression [HAM-D] and Hamilton anxiety [HAM-A] scales greater than or equal to 18). Buspirone therapy was initiated at 15 mg/day with individual dose titration to a maximum of 90 mg/day and resulted in marked improvement in both depressive and anxiety symptoms. Analyses of the composite data base from the five studies show significant (p less than 0.05) improvement in mean HAM-D, HAM-A, and Clinical Global Impression-Global Improvement scale ratings for buspirone-treated compared with placebo-treated patients. Of particular interest was significant improvement in cardinal depression symptoms, e.g., depressed mood, guilt, work and interest, anergia, and diurnal variation of mood. Subset analyses revealed that patients with melancholic-type major depression and patients with more severe symptoms (judged by higher initial HAM-D or HAM-A total scores) responded better to buspirone than did patients who were less ill. The buspirone dose most frequently associated with clinically significant improvement was 40 mg/day. Gepirone, an analogue of buspirone with highly selective binding affinity for the 5-HT1A receptor subtype, also shows promise of antidepressant efficacy in preliminary controlled clinical trials. These data suggest that azapirones, which as partial agonists modulate 5-HT1A receptor function, have clinically important antidepressant properties.

Adolescent↗
PubMed1990

Gepirone in the treatment of major depression.

Gepirone is a serotonin (5-hydroxytryptamine, 5-HT) type1A receptor agonist and a pharmacologic analogue of buspirone. Two double-blind, placebo-controlled studies show the efficacy of gepirone in the treatment of major depression. Study 1 demonstrates gepirone's superiority over placebo in an 8-week acute treatment of patients with major depression, including the melancholic subtype. Gepirone's antidepressant dose range is tentatively established at 5-30 mg/day. Study 2 reveals the benefit of gepirone compared with placebo in 4-week continuation therapy of patients with major depression who initially responded to 6 weeks of open therapy with gepirone. Analysis of Hamilton Rating Scale for Depression item scores show gepirone especially improves scores on items of core depression.

Adult↗
PubMed1990

Placebo-controlled dose-ranging trial designs in phase II development of nefazodone.

Nefazodone is a selective 5-HT2 receptor antagonist. Nefazodone has a pharmacologic profile similar to trazodone and other phenylpiperazine antidepressants, but distinct from nonselective first-generation agents and other selectively acting second-generation agents. Results of a multicenter, double-blind, fixed-dose trial indicate nefazodone is effective in improving depressive symptoms of outpatients with major depressive disorder treated with daily doses of 100 mg to 200 mg. A comparison of the fixed-dose trial design with an alternative design permitting dose titration within fixed ranges is presented. The relative merits of each design for establishing therapeutic dose ranges are discussed.

Depressive Disorder↗
PubMed1989

Primary localized breast cancer. Treatment options and informed choices.

As understanding of the natural history of breast cancer has increased, radical mastectomy has given way to a preference for breast-sparing surgery and greater reliance on radiation therapy and chemotherapy. Probably the most important factor for selection of treatment is consultation with a multidisciplinary team skilled in the various procedures and techniques that might be efficacious. The key to successful management is selection of an appropriate course of treatment with which the patient feels comfortable.

Breast Neoplasms↗
PubMed1989

Serotonergic anxiolytics and treatment of depression.

The serotonin 5-hydroxytryptamine-1A (5-HT1A) receptor agonists buspirone and gepirone have effects on serotonergic systems, including presynaptic and postsynaptic receptors, that predict both anxiolytic and antidepressant activity. Chronic administration of both drugs produces a down-regulation of 5-HT2 receptors, a finding common to most antidepressant drugs irrespective of mechanism of action. In addition, gepirone induces a full-blown serotonin syndrome in rodents and is active in the behavioral despair test mediated by an action on serotonergic neurons. Buspirone is active in this paradigm when injected directly into the serotonergic dorsal raphe nucleus. The therapeutic effects of both buspirone and gepirone have been assessed in placebo-controlled studies of patients with major depression. Findings in these studies support antidepressant efficacy in addition to anxiolysis. In double-blind studies of patients with major depression treated for 8 weeks, each drug was found to be superior to placebo in improvement in Hamilton Depression and Anxiety total scores as well as individual depressive symptoms. These clinical findings are consistent with preclinical pharmacology suggesting that 5-HT1A partial agonists may possess intrinsic antidepressant activity.

Adult↗
PubMed1988

Enhanced inactivation of bacterial lipases and proteinases in whole milk by a modified ultra high temperature treatment.

Cultures of Pseudomonas spp. strains P10, P12 and P15 grown in whole milk which contained approximately 1 x 10(8) viable bacteria ml-1 demonstrated near linear increases in the concentration of short-chain free fatty acids and trichloroacetic acid soluble free amino groups at 20 degrees C, following either ultra high temperature (UHT) treatment (140 degrees C for 5 s) or dual heat treatments (140 degrees C followed by either 57, 60 or 65 degrees C). The dual heat treatments reduced the rates of lipolysis and proteolysis compared to the UHT treatment by up to 25-fold. The dual heat treatment utilizing 60 degrees C for 5 min also effectively limited both lipase and proteinase activities in raw milk culture samples which had contained either 6 x 10(6), 5 x 10(7) or 1 x 10(8) viable bacteria ml-1. In this system enzyme activities were reduced by up to 10-fold following dual heat treatment compared to UHT treatment alone.

Animals↗
PubMed1988

Effects of age and nutritional status on surgical outcomes in head and neck cancer.

Older and younger malnourished and well-nourished head and neck cancer patients scheduled for surgery were studied. More of the young (75%) compared with the old (58%) underwent curative surgery, and only the old with lower clinical states of cancer were selected. When data on those undergoing surgery were analyzed in regard to older and younger malnourished and well-nourished men, the malnourished old had the poorest surgical outcomes of any group, with significantly more complications and morbidity rates. The well-nourished old had outcomes that did not differ from younger patients. On further examination, 60% of the young malnourished and only 20% of the old malnourished received preoperative enteral or parenteral nutritional support. Findings suggest that more attention to the needs of the older malnourished patients could improve surgical outcomes.

Adult↗
PubMed1988

Morphology and immunology of circulating cells in leukaemic phase of follicular lymphoma.

Ten patients with follicular lymphoma presented with a high white cell count (45-220 x 10(9)/l) which resembled chronic lymphocytic leukaemia (CCL): all had pronounced splenomegaly and, except one, generalised lymphadenopathy. The blood lymphocytes were small with scanty cytoplasm, densely condensed nuclear chromatin, and deep clefts originating in sharp angles from the nuclear surface. CLL cells are larger, have more cytoplasm, a different pattern of chromatin condensation, and may have shallow nuclear indentations or foldings rather than clefts. The circulating follicular lymphoma cells had moderate to strong membrane immunoglobulins (SmIg), low mouse (M)-rosettes, strong reactivity with the monoclonal antibody FMC7, and occasional expression of the CD5-antigen; at least one third of cells in each case were positive with anti-cALLa (J5,CD10). Half the cases were referred as B-CLL but none had the typical B-CLL immunophenotype: weak SmIg, M-rosettes of greater than 50%, CD5 positive, FMC7 and J5 negative. The diagnosis of follicular lymphoma was confirmed by lymph node biopsy in seven of the 10 cases. The overall response to treatment was poor and five patients died within three years of diagnosis. This aggressive form of follicular lymphoma needs to be distinguished from B-CLL as different management is required.

Adult↗
PubMed1988

The influence of panic attacks on response to phenelzine and amitriptyline in depressed outpatients.

A total of 169 depressed outpatients completed a 6-week double-blind study designed to compare the relative efficacy of a tricyclic antidepressant (amitriptyline) with a monoamine oxidase inhibitor (phenelzine). Various "target" symptoms reported to predict preferential response to monoamine oxidase inhibitors were assessed. The major finding within the whole patient sample, based on results from serial self-report and interviewer-rated scales, was that phenelzine-treated patients showed greater improvements in anxiety symptoms than did patients treated with amitriptyline. Because of the heterogeneity of the sample, patients were classified into homogeneous subgroups of clinical interest. Data analyses of these subgroups detected important drug treatment differences not discernible by analysis of data from the overall sample. Panic attacks and corresponding anxiety symptoms were reported by about one third of the patients, more often by patients with major depression than with minor depression. Patients who reported "spells of terror or panic" responded preferentially to phenelzine on several measures, particularly on items measuring anxiety. Results suggest that phenelzine may be a preferred drug for treating depressed patients with panic attacks.

Adolescent↗