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Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 289 records · Page 16Linked to original sources
PubMed1992

Life stress and treatment course of recurrent depression: 1. Response during index episode.

Research on treatment course and outcome in depression is mixed with respect to the implications of life stress. Several concerns are addressed in a prospective study of 91 individuals treated for recurrent depression. Specific forms of stress occurring before treatment entry predicted a poor clinical response both after 16 weeks and after a more extended intervention period. Specific forms of stress occurring during the 1st 6 weeks of treatment also predicted poor response after 16 weeks and after the extended intervention period. Severe stress occurring early in treatment predicted a longer time to attain relief for treatment responders. Concepts underlying the idea that stress-related disorders have a better clinical outcome are discussed, and it is proposed that life stress has different implications for individuals with and without recurrent depression.

Adjustment Disorders↗
PubMed1992

Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report.

OBJECTIVE: The authors examined the rate of response to the combination of nortriptyline and interpersonal psychotherapy for acute and continuation treatment of elderly patients with recurrent major depression. METHOD: The subjects were 73 elderly patients, 61 of whom completed treatment. Nortriptyline steady-state blood levels were maintained at 80-120 ng/ml, and interpersonal psychotherapy was administered weekly for 9.1 weeks (medium) of acute therapy and was decreased from biweekly to triweekly during 16 weeks of continuation therapy. During acute treatment nonresponding patients also received brief adjunctive pharmacotherapy with lithium or perphenazine. RESULTS: Of the 61 subjects given adequate trials of nortriptyline and interpersonal psychotherapy, 48 (78.7%) achieved full remission (Hamilton depression rating of 10 or lower over 16 weeks of continuation therapy), 10 patients (16.4%) did not respond (Hamilton rating never below 15), and three achieved only partial remission (Hamilton rating of 11-14). Early versus late onset was not associated with a difference in response rate. During the placebo-controlled, double-blind transition to maintenance therapy, 19 (76.0%) of the 25 patients randomly assigned to placebo maintenance conditions showed continued recovery and six relapsed. None of the 24 patients assigned to nortriptyline conditions relapsed. CONCLUSIONS: Use of nortriptyline plus interpersonal psychotherapy for 9.1 weeks (median) of acute and 16 weeks of continuation therapy appears to be associated with good response and relatively low attrition but about a 25% chance of relapse during double-blind discontinuation of nortriptyline. These data require confirmation in a controlled clinical trial of acute and continuation therapy.

Age Factors↗
PubMed1992

Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

BACKGROUND: Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. METHODS: Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). RESULTS: The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). CONCLUSION: If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.

Adult↗
PubMed1992

Relationship of pharmacologic compliance to long-term prophylaxis in recurrent depression.

This report examines the relationship of long-term medication compliance (as measured by stability of level/dose ratios and total blood level averages) to prophylaxis in recurrent unipolar patients. Of the 53 patients assigned to active imipramine conditions in a long-term maintenance treatment protocol, 42 were evaluated as clearly compliant, 8 were clearly noncompliant, and 3 were not classifiable. We examined a number of demographic and clinical variables in an attempt to find possible predictors of compliance. No differences were observed between compliant and noncompliant patients with respect to sex, age at screening, age at the onset of their recurrent unipolar illness, duration of the index episode, number of previous episodes, bipolar II vs. recurrent unipolar subtype, endogenous vs. nonendogenous subtype, or baseline severity of depression as assessed by the Hamilton Rating Scale for Depression. However, medication compliance was found to be significantly associated with effective prophylaxis. There was a significantly larger proportion (6 of 12) of noncompliant patients among those experiencing a recurrence in one of the two active medication conditions than among those who remained well for 3 years (2 of 28). The value associated with this difference was p = .04. We conclude that effective prophylaxis is strongly related to stability of medication blood levels which fall within the therapeutic range.

Adult↗
PubMed1992

Results of nocturnal penile tumescence studies are abnormal in sexually functional diabetic men.

Nocturnal penile tumescence (NPT) studies are commonly used in the assessment of sexual dysfunction in diabetic men. While much of the evidence in favor of its use has come from the observation of markedly abnormal NPT in impotent diabetic men, little research has focused on the quality of nocturnal erections in sexually functional diabetics. Ten diabetic men who reported normal daytime sexual function were studied with 4 nights of polysomnography, including NPT assessment. They had significantly diminished NPT profiles when compared with that of an age-matched, nondiabetic, healthy control group. Without controlling for the effect of diabetes on NPT, between 70% and 90% of sexually functional diabetics had NPT profiles in a range that would be classified as indicative of organic sexual dysfunction for a man presenting for evaluation of sexual dysfunction. The finding of NPT abnormalities in a diabetic man should not be taken as evidence for irreversible sexual dysfunction. Rather, the condition of diabetes appears to result in NPT abnormalities, regardless of the adequacy of daytime sexual function.

Adult↗
PubMed1992

Treatment of imipramine-resistant recurrent depression, III: Efficacy of monoamine oxidase inhibitors.

BACKGROUND: The effectiveness of monoamine oxidase inhibitors (MAOIs) in tricyclic resistant depression has received surprisingly little systematic study. METHOD: Patients who failed to respond to sustained, adequate treatment with the tricyclic imipramine (mean maximum dosage = 260 mg/day) and interpersonal psychotherapy were withdrawn from imipramine and treated in a standardized, but open-label 6-week trial with either phenelzine (N = 4; 60 mg/day) or tranylcypromine (N = 36; mean = 38.5 mg/day) and continued interpersonal psychotherapy. RESULTS: Forty of 42 patients (95%) completed the trial, of whom 23 (58%) responded to treatment. Highly significant improvement was documented on measures of depression, reversed neurovegetative symptoms, and somatic symptoms. Response was significantly correlated with severity of depression (pre-MAOI score on the Hamilton Rating Scale for Depression), severity of a composite score of anergic and reversed neurovegetative features, and low levels of improvement during initial imipramine/interpersonal psychotherapy. Of patients who met criteria for proposed subforms of anergic or atypical depression, 67% (18/27) responded (p less than .05); 77% (17/22) of patients who scored above the mean on the composite measure of anergic and reversed neurovegetative features responded (p less than .01). CONCLUSION: These findings provide strong evidence of the utility of MAOIs in tricyclic-resistant depression, especially in patients with features such as fatigue, volitional inhibition, motoric retardation, hypersomnia, and/or weight gain.

Adult↗
PubMed1991

Predictors of physician's smoking cessation advice.

OBJECTIVES: To determine the percentage of smokers reporting that a physician had ever advised them to smoke less or to stop smoking, and the effect of time, demographics, medical history, and cigarette dependence on the likelihood that respondents would state that a physician had ever advised them to stop smoking. DESIGN AND SETTING: Data were collected from the Stanford Five-City Project, a communitywide health education intervention program. The two treatment and three control cities were located in northern and central California. As there was no significant difference between treatment and control cities regarding cessation advice, data were pooled for these analyses. PARTICIPANTS: There were five cross-sectional, population-based Five-City Project surveys (conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990); these surveys randomly sampled households and included all residents aged 12 to 74 years. MAIN OUTCOME MEASURES: Improved smoking advice rates over time in all towns was an a priori hypothesis. RESULTS: Of the 2710 current smokers, 48.8% stated that their physicians had ever advised them to smoke less or stop smoking. Respondents were more likely to have been so advised if they smoked more cigarettes per day, were surveyed later in the decade, had more office visits in the last year, or were older. In 1979-1980, 44.1% of smokers stated that they had ever been advised to smoke less or to quit by a physician, vs 49.8% of smokers in 1989-1990 (P less than .07). Only 3.6% of 1672 ex-smokers stated that their physicians had helped them to quit. CONCLUSION: These findings suggest that physicians still need to increase smoking cessation counseling to all patients, particularly adolescents and other young smokers, minorities, and those without cigarette-related disease.

Adolescent↗
PubMed1991

EEG sleep profiles and recurrent depression.

Earlier investigations have suggested that electroencephalographic (EEG) sleep may be altered as a function of the duration of an episode of depression. We compared the EEG sleep profiles in a group of recurrent depressives who had been depressed for less than 6 weeks with their sleep profiles as measured during their previous episode of depression. Findings in this sample of 32 patients point to the presence of specific rapid eye movement (REM) sleep abnormalities as being more pronounced earlier in the course of a depressive episode. Changes in REM latency and REM activity were also reflected in reductions in EEG spectral power in almost all bandwidths during the first REM period of the recurrent episode. These results are not easily explainable on the basis of traditional measures of clinical severity or the number of episodes.

Adult↗
PubMed1991

Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence.

In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Depressive Disorder↗
PubMed1991

Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression. Contributing factors.

In earlier reports, we demonstrated that in patients with recurrent unipolar depression, survival time without a new episode of major depression following discontinuation of medication was significantly and positively related to continued interpersonal psychotherapy (IPT). To determine whether the prophylactic benefit of monthly sessions of IPT was a function of specific features of the intervention, we examined the contribution of the quality of IPT sessions to the length of the well interval in this 3-year maintenance trial. Therapy sessions were rated on specificity and purity of interpersonal interventions. Analysis of these ratings indicated that psychotherapy that was more specifically interpersonal was associated with significantly increased survival time. Patients whose therapy sessions were rated above the median on specificity of IPT had a median survival time of almost 2 years, while those below the median had a median survival time of less than 5 months. We concluded that when patient and therapist are able to maintain a high level of interpersonal focus, monthly sessions of IPT have substantial prophylactic benefit.

Adult↗
PubMed1991

Weight change in depression: influence of "disinhibition" is mediated by body mass and other variables.

The direction of weight change (gain or loss) in depression has recently been found to be a stable characteristic of patients across depressive episodes. A search for determinants of the direction of weight change revealed two candidates: the body mass index (BMI) (weight in kilograms/height in meters squared) and a psychological variable, "disinhibition" of dietary restraint. The present study, of 68 patients with a history of recurrent depression, found a significant correlation between BMI and weight change; in other words, heavier persons were more likely to gain weight if depressed. There was also a correlation between "disinhibition" and weight change. "Disinhibition" correlated with BMI and, when controlled for BMI, age and sex, the correlation between "disinhibition" and weight change fell to insignificance. We conclude that BMI along with age and sex mediated the correlation between "disinhibition" and weight change.

Appetite↗
PubMed1991

The balance of positive and negative affects in major depression: a further test of the States of Mind model.

The States of Mind (SOM) model provided a framework for assessing the balance between self-reported positive and negative affects in a sample of 39 outpatients with major depression and 43 healthy control subjects. The SOM model proposes that healthy functioning is characterized by an optimal balance of positive (P) and negative (N) cognitions or affects (P/(P + N) approximately 0.63), and that psychopathology is marked by deviations from the optimal balance. Research thus far has focused on the functional significance of cognitive rather than affective balance. Within this framework, we hypothesized that patients in untreated episodes of major depression would balance their positive and negative affects at the same level where depressed patients in other studies have balanced their positive and negative cognitions--namely, at P/(P + N) approximately 0.37. Points and confidence interval (CI) estimation procedures yielded results (mean = 0.35, 95% CI = 0.30 - 0.40) consistent with this hypothesis in a sample of 39 depressed male outpatients. Correlational analysis indicated that affect balance is inversely related to symptom severity as measured by self-report (Beck) and clinician-rating (Hamilton) scales.

Adult↗
PubMed1991

The Social Rhythm Metric (SRM): measuring daily social rhythms over 12 weeks.

A "Social Rhythm Metric" (SRM) of daily rhythmic behavior (developed previously) was given to 20 treated depressives (in remission) and 15 day-working control subjects for a continuous 12-week period. Long-term use of the SRM appeared feasible with no evidence of a deterioration in scores over the 12 weeks. Comparisons were made between intersubject and intrasubject variability, as well as a study of overall trends in SRM during the 12 weeks. Two further measures from the instrument--the Activity Level Index (ALI) and Other Person Involvement--were developed and shown to be useful adjuncts to the SRM. Although no simple differences in absolute SRM score emerged between patients and controls, there were significant differences in intersubject vs. intrasubject variability between the two groups. The patients showed more intrasubject variability and required more weeks of sampling to achieve a stable "trait" measure. Patients' social rhythms also appeared to be more "other person" prompted than those of controls.

Adult↗
PubMed1991

P0 is an early marker of the Schwann cell lineage in chickens.

We have generated a monoclonal antibody, termed 1E8, that is specific for myelinating and nonmyelinating Schwann cells in mature chickens. 1E8 first stains cells at the edge of the neural crest; later, cells located between the neural tube and somites and in the sclerotome are immunopositive. Double labeling with HNK-1 indicates that these 1E8-positive cells represent a subset of neural crest cells in the ventral migratory pathways. 1E8-positive cells are later associated with the dorsal and ventral roots and with extending nerve trunks. In Western blots, 1E8 reacts with proteins comigrating with P0. Immunodepletion experiments establish that all P0 molecules carry the 1E8 determinant. The developmental distribution of P0, as determined by 1E8 immunoreactivity, differs from that reported for P0 in mammals and suggests that, in chicken, P0 is an early marker for the Schwann cell lineage.

Animals↗
PubMed1991

Planning stereotactic surgery using the graphic prescription and explicit prescription MRI programs.

A method is described for planning stereotactic approaches to central nervous system lesions utilizing specialized programs contained within the GE sigma Magnetic Resonance Imaging scanner software. The graphic prescription program creates oblique scans relative to a localizer scan made in any standard orthogonal plane and the explicit prescription program creates slices perpendicular to any two chosen points. Using these programs to advantage, one can create an oblique coronal scan that contains the entry point, the approach tract and the target plus a series of cross sectional oblique scans perpendicular to and progressing along the approach track to the target. These scans can then be employed to modify a proposed approach so as to avoid blood vessels and other vital structures.

Brain↗