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Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 217 records · Page 12Linked to original sources
PubMed1996

Treatment outcome in recurrent major depression: a post hoc comparison of elderly ("young old") and midlife patients.

OBJECTIVE: The authors compared response rates, the temporal course of response to acute treatment, and relapse rates during continuation treatment of elderly and midlife patients with recurrent major depression. METHOD: They analyzed results from two separate controlled studies of maintenance therapies for recurrent major depression, in which 148 elderly patients (mean age = 67.9 years) and 214 midlife patients (mean age = 38.5 years) were treated in open acute and continuation therapy with a combination of interpersonal psychotherapy and a tricyclic antidepressant (nortriptyline for the elderly, imipramine for the midlife patients). In an intent-to-treat analysis, remission rates during acute treatment and relapse rates during continuation treatment were examined. Random regression analysis of weekly Hamilton depression scale ratings was used to compare the temporal course of response. RESULTS: During acute-phase therapy, 78.4% (N = 116) of the elderly patients and 69.6% (N = 149) of the midlife patients had remissions. The midlife patients had a faster reduction of Hamilton depression ratings. Following stabilization, 15.5% of the elderly patients and 6.7% of the midlife patients relapsed. Ultimately, 66.2% of the late-life patients and 57.0% of the midlife patients recovered fully. CONCLUSIONS: Older patients appear to benefit as much as, but perhaps more slowly then, midlife patients from treatment of major depression. Continuation treatment should be vigorous and closely monitored, given the apparently higher relapse rates among the elderly. These conclusions should be viewed as preliminary because of the post hoc nature of the analysis reported here.

Adult↗
PubMed1996

Changes in perceived health status of depressed elderly patients treated until remission.

OBJECTIVE: The authors predicted that depressed elderly patients who responded to treatment would rate their baseline health more positively than nonresponders, that responders would again rate their health more positively once they were in remission, and that lower baseline self-ratings of health would predict lack of response to protocol treatment. METHOD: The Perception of Illness Scale was administered to 61 depressed elderly patients at baseline and again upon completion of the acute phase of a depression treatment protocol. A logistic regression was performed to ascertain whether Perception of Illness Scale scores predicted response to protocol treatment. RESULTS: Baseline Perception of Illness Scale scores were poorer among the nonresponders, accurately predicted response or lack of response in 75% of the subjects, and showed before-to after-treatment improvement among the responders. CONCLUSIONS: Patients who initially rated their health as fair to poor were less likely to recover from depression in a standardized treatment protocol. Self-ratings of health improved with resolution of depression.

Age Factors↗
PubMed1996

High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression.

OBJECTIVE: The authors documented outcomes of elderly depressed patients requiring adjunctive medication during acute-phase pharmacotherapy because of slow or partial response to nortriptyline. Twenty-eight patients (17.7%) received inpatient care at some point during acute-phase treatment. METHOD: Rates of response, relapse, and sustained remission were examined in 158 elderly patients with recurrent major depression, grouped by whether they received brief treatment with adjunctive medication (lithium, perphenazine, or paroxetine) (N = 39) or did not (N = 119). RESULTS: The group receiving adjunctive medication had a lower rate of response to acute therapy (64.1% versus 83.2%), a higher relapse rate during continuation therapy (52.0% versus 6.1%), and a lower rate of sustained remission (recovery) (48.7% versus 76.5%) than did the group without augmentation. CONCLUSIONS: Elderly depressed patients requiring augmented pharmacotherapy to achieve remission may need continuation of adjunctive medication to remain well and to avoid early relapse. Alternatively, factors that lead to augmentation in the first place (e.g., heightened anxiety) may also increase the risk of relapse.

Age Factors↗
PubMed1996

Transitioning to the breast at six weeks: use of a nipple shield.

After forceful help with breastfeeding on the first day after birth, a baby began to refuse to latch onto the breast. The mother received help maintaining her milk supply and advice on feeding methods and use of a nipple shield from a lactation consultant after leaving the hospital and was eventually able to breastfeed with the help of a nipple shield. Important aspects of this case were the treatment in the hospital, which included forcing the baby to the breast and using a tube-feeding device with artificial baby milk. Also critical was this mother's commitment to breastfeeding and the long-term support she received.

Bottle Feeding↗
PubMed1996

New psychosocial treatments for the outpatient management of bipolar disorder.

The psychosocial treatment of bipolar disorder has the potential to augment the efficacy of outpatient pharmacotherapy if it succeeds in enhancing the protective effects of the social and familial environment and the patient's adherence to drug regimes. We describe two manual-based psychotherapies under evaluation in controlled clinical trials: a family-focused psychoeducational treatment and an individual, interpersonally-oriented psychotherapy. Both target recently ill patients and are delivered in combination with standard pharmacotherapies on an outpatient basis. Results from the ongoing clinical trials suggest high patient retention rates for both models over the first year of treatment. Future research should focus on the appropriate sequencing of pharmacologic and psychosocial treatments, and the conditions under which psychosocial treatment will be most effective.

Adult↗
PubMed1995

Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss.

Certain symptoms of grief have been shown (a) to be distinct from bereavement-related depression and anxiety, and (b) to predict long-term functional impairments. We termed these symptoms of "complicated grief" and developed the Inventory of Complicated Grief (ICG) to assess them. Data were derived from 97 conjugally bereaved elders who completed the ICG, along with other self-report scales measuring grief, depression, and background characteristics. Exploratory factor analyses indicated that the ICG measured a single underlying construct of complicated grief. High internal consistency and test-retest reliabilities were evidence of the ICG's reliability. The ICG total score's association with severity of depressive symptoms and a general measure of grief suggested a valid, yet distinct, assessment of emotional distress. Respondents with ICG scores > 25 were significantly more impaired in social, general, mental, and physical health functioning and in bodily pain than those with ICG scores < or = 25. Thus, the ICG, a scale with demonstrated internal consistency, and convergent and criterion validity, provides an easily administered assessment for symptoms of complicated grief.

Adjustment Disorders↗
PubMed1995

Electroencephalographic sleep profiles in single-episode and recurrent unipolar forms of major depression: I. Comparison during acute depressive states.

The current study was conducted to examine if recurrent depression is associated with more severe disturbances of all-night EEG sleep profiles than single-episode depressions. Unmedicated sex- and age-matched groups of 22 single-episode (SE) and 44 recurrent unipolar (RU) outpatients with DSM-III-R/SADS/RDC major depression underwent 2 consecutive nights of EEG sleep recording. Multivariate analyses of covariance (MANCOVAs) and/or analyses of covariance (ANCOVAs) were performed on six sets of sleep measures. Recurrent unipolar depression was associated with significantly increased phasic REM sleep, as well as increased REM counts on the second night of study. Recurrent depression also was associated with significantly poorer sleep efficiency, although the groups did not show consistent differences in sleep architecture or slow-wave sleep. Our findings generally support the hypothesis that recurrent depression is associated with a more severe neurophysiologic substrate than phenotypically similar SE cases. Results are, for the most part, compatible with Post's (1992) model of illness progression, particularly with respect to greater disturbances of state-dependent sleep abnormalities in the RU cases. Longitudinal studies are needed to confirm the evolution of such changes prospectively.

Acute Disease↗
PubMed1995

HLA-DR expression on arachnoid cells. A role in the fibrotic inflammation surrounding nerve roots in spondylotic cervical myelopathy.

STUDY DESIGN: Human arachnoid cells were examined immunohistochemically for expression of HLA-DR or Fc receptors. OBJECTIVE: To assess the ability of arachnoid cells to express HLA-DR and act as antigen presenting cells. SUMMARY OF BACKGROUND DATA: An intradural inflammatory reaction surrounds the cervical nerve roots and radicular vessels in patients with spondylotic cervical myeloradiculopathy. Active arachnoid proliferation and fibrosis in this reaction suggest these cells are actively involved in this inflammatory process. An inflammatory response is initiated by an antigen presenting cell. Evidence suggests that arachnoid cells may be antigen presenting cells, like macrophages, because they can phagocytize foreign tissue and have immunoglobulin G and complement receptors. METHODS: Spinal arachnoid obtained from patients undergoing spinal surgery for intramedullary processes was grown in culture. The arachnoid cells were characterized and examined immunohistochemically for the expression of HLA-DR and Fc receptors. RESULTS: HLA-DR was expressed in vivo and in vitro by arachnoid cells. The macrophage Fc receptor was not expressed in vivo nor in vitro by arachnoid cells. CONCLUSION: Finding in vivo and in vitro HLA-DR expression on arachnoid cells adds further support to the concept that arachnoid cells have the potential to serve as antigen presenting cells. The absence of Fc receptors, although necessary for macrophages, does not negate antigen presenting function because other types of cells-e.g., endothelium-can present antigen without displaying Fc receptors. These experiments provide new evidence that arachnoid cells may initiate or sustain the intradural inflammatory reaction found in cervical myeloradiculopathy.

Antigen-Presenting Cells↗
PubMed1995

Does recruitment method make a difference? Effects on protocol retention and treatment outcome in elderly depressed patients.

The specific aim of this study was to contrast effects of recruitment method (solicited, referred) on demographic, psychosocial, medical, and treatment outcome measures in an ongoing clinical trial of maintenance therapies in late-life depression. Data from 125 elderly patients (56 solicited via media campaign, 69 clinically referred) with recurrent, unipolar major depression were available for analysis. Several statistical contrast procedures, including group t tests, chi 2 tests, survival analysis, and logistic regression, were used to assess differences in patient profiles related to method of recruitment. Referred patients included a higher proportion of African Americans and had a lower level of education, fewer economic resources, and higher chronic medical burden. Solicited patients had been in the index episode longer than the referred patients at the time of protocol entry and were 3.4 times more likely to have experienced a "provoking agent" (severe life event or chronic difficulty) during the 6 months that preceded the onset of depressive symptoms. In contrast to these demographic and illness history differences, there were no differences in treatment response rates or time to response related to recruitment method. Solicited patients had an overall treatment response rate of 71% versus 62% in the referred group. Median time to response was 14.3 weeks in the solicited group and 13.6 weeks in the referred group. These results suggest that the inclusion of solicited patients in geriatric depression clinical trials does not bias short-term treatment outcome.

Adjustment Disorders↗
PubMed1995

Cost utility analysis of maintenance treatment for recurrent depression.

This paper presents a cost-utility analysis of three maintenance treatments for recurrent depression: interpersonal therapy (IPT-M), imipramine drug therapy (Drug), and a combination of the two. We base our analysis on the results of the University of Pittsburgh's Controlled Clinical Trial of Maintenance Therapies for Recurrent Depression. We construct a Markovian state-transition model to incorporate clinical effectiveness into cost and quality-of-life impacts; we assign empirical values to the parameters of this model; and we then use Monte Carlo analysis to compare the relative cost effectiveness of the different maintenance treatments. For the patients who met the eligibility standards for the study, Drug maintenance treatment is cost-effective in the strongest sense of the term compared to either a placebo group or IPT-M: it both improves expected lifetime health (measured in quality-adjusted life years, or QALYs) and reduces direct medical costs. This is true even when relatively severe side effects of the drug are considered. Compared to the placebo group, IPT-M and the combination of IPT-M and Drug each improve expected lifetime health, although in neither case are expected direct medical costs reduced. Still, the cost of the resulting health improvements, under $5000/QALY, are very reasonable. A similar conclusion holds comparing Drug and IPT-M to IPT-M alone. All of the above conclusions are quite robust to sensitivity analyses.

Adult↗
PubMed1995

Late-migrating neuroepithelial cells from the spinal cord differentiate into sensory ganglion cells and melanocytes.

During embryonic development, neural crest cells give rise to many structures in peripheral tissues. Other neural tube cells are thought to contribute only to structures within the CNS. In contrast to this idea, we report a second wave of migration of cells away from the spinal cord occurring after the emigration of crest cells is complete. Neuroepithelial cells from spinal cords in E5 chicken embryos migrate into the periphery and differentiate into neurons and satellite cells within sensory ganglia and into melanocytes in skin and feathers. These results show that some cell types previously considered to be the descendants exclusively of neural crest cells are also derived from neuroepithelial cells in the spinal cord.

Animals↗
PubMed1995

Maintenance therapies for late-life recurrent major depression: research and review circa 1995.

Major depression in the elderly is often a relapsing, chronic illness with high risk for chronic invalidism, poor treatment compliance, and suicide. In most cases, maintenance treatment to prevent recurrence and to enhance the quality of life is thought to be indicated. We review recent data from our ongoing studies that support both the efficacy and the safety of pharmacotherapeutic and psychotherapeutic maintenance treatments. However, the challenges of conducting maintenance therapy research (particularly with a placebo control) with the elderly are many, involving such areas as recruitment, retention, compliance, choice of outcome measures, and informed consent. We discuss each of these challenges and our responses to them. Finally, we suggest that maintenance therapy trials should be extended in several directions: (a) long-term treatment of bipolar and delusional subtypes in the elderly, as well as depression associated with progressive neurodegenerative disorders such as Alzheimer's dementia; (b) assessment of the benefits and risks of long-term therapy with other than tricyclic and monoamine oxidase inhibitor antidepressant agents, such as selective serotonin reuptake inhibitors; and (c) development of models of long-term course, including the interaction of treatments with medical and psychosocial variables that can have a profound impact on illness onset and offset. These issues are illustrated with a discussion of a new protocol designed to test the acute and maintenance efficacy of antidepressant therapy for depressed patients with Alzheimer's disease.

Alzheimer Disease↗
PubMed1995

Cortical basic fibroblast factor expression after head injury: preliminary results.

Growth factors are important for normal development and maturation of the CNS. Recently, interest has centred on the role of these factors in response to the CNS injury. Basic Fibroblast Growth Factor (bFGF) stimulates mitogenesis of neuroectodermal tissues, potentially promoting neuronal survival and astrocytic growth suggesting a possible role following injury. We have studied expression of bFGF in male Sprague-Dawley rats subjected to a fluid percussion head injury of 4 atmospheres. Sham operated controls and injured animals were perfused 48 h after injury. 50 micron frozen sections of fixed tissue were immunohistochemically analysed for bFGF expression using the avidin-biotin complex technique with antibodies to bFGF. In the cortex, bFGF expression on astrocytes was enhanced in the injured hemisphere as compared with the contralateral uninjured hemisphere or controls (914 vs. 334 cells/mm2). bFGF expression in the hippocampal (CA2) neurons was the same for both normal and injured rats. The finding of enhanced bFGF in the cortex is consistent with the pathologic astrocytic responses found 48 h after injury and may correlate with later gliosis. These results suggest further study of bFGF, its temporal expression and relationship to other growth factors is warranted.

Animals↗
PubMed1995

Injuries resulting from bicycle collisions.

OBJECTIVE: To review all bicycle crash-related injuries reported to the Oregon Injury Registry for 1989 to compare patterns of injury and other features in adults vs children and adolescents. METHODS: A retrospective descriptive study was conducted using data from the Oregon Injury Registry. For 1989, this registry included all injury-related deaths and approximately 75% of hospital admissions of 24 hours or more for injury in the State of Oregon. Deaths, helmet use, neurologic injuries, and concurrent ethanol use were evaluated for all patients and for the two age groups. RESULTS: There were 311 bicycle-related injured patients in the registry for 1989; 122 (40%) were adults (age > or = 21 years) and 189 (60%) were children/adolescents (age < 21 years). Approximately 69% of both age groups were male. All of the 15 deaths involved male patients and most deaths [10/15 (67%)] involved injured adults. Bicycle vs motor vehicle collisions accounted for 14 (93%) deaths and 106 (34%) of all registry entries. While only 19 (15%) of the injured adults had elevated blood alcohol levels, half the adults who died had been intoxicated. Helmet use was rare with only 12 (4%) of all the injured riders known to have been helmeted; no rider who died was known to have been helmeted. Neurologic injuries were common. In children, 27 (14%) had sustained skull fractures, 36 (19%) intracranial injuries, and one (0.5%) a spinal injury. In adults, 13 (10%) had sustained skull fractures, 32 (26%) intracranial injuries, and three (2%) spinal injuries. CONCLUSIONS: Although children account for 60% of the serious bicycle injuries in Oregon, adults account for 67% of the deaths. Helmet use is rare, brain injuries are frequent, and alcohol use appears to be a contributing factor in cycling deaths among adults. Public education efforts should be directed to both adult and pediatric populations, emphasizing safe cycling practices and helmet use.

Accidents, Traffic↗