Biomedical subjects
Publications and source records attributed to F Petty.
Depression is the most common psychiatric complication of severe medical illness, and it occurs in about 20% of cases. Diagnosis of depression in patients with serious medical illness requires modified criteria. Treatment also must be adjusted for patients with such dual diagnoses.
To stimulate peripheral gamma-aminobutyric acid (GABA) receptors, GABA, which does not cross the blood-brain barrier, was administered to dogs with vagally innervated gastric fistulas at intravenous doses of 0, 0.66, 2, 6, 18, and 54 micrograms.kg-1.min-1. Mean gastric acid output increased from zero basally to 3.0 +/- 1.4 mmol/h during infusion of 54 micrograms.kg-1.min-1 GABA. Plasma somatostatin-like immunoreactivity decreased significantly below basal levels during infusion of 54 micrograms.kg-1.min-1 GABA (P less than 0.05). To stimulate central nervous system GABA receptors as well as peripheral GABA receptors, progabide, a GABA-receptor agonist, which readily crosses the blood-brain barrier, was injected intravenously. Mean acid output was 3.5 +/- 1.3 mmol/h after 20 mg/kg progabide and 0.6 +/- 0.5 mmol/h after its vehicle (P less than 0.05). Basal serum gastrin concentration increased significantly after progabide injection. Acid output during insulin-induced hypoglycemia was inhibited 59% by 30 mg/kg intravenous progabide. Progabide infusion also diminished or abolished circulating gastrin, somatostatin, and pancreatic polypeptide responses during insulin-induced hypoglycemia (P less than 0.05). Further studies were performed in dogs with a gastric fistula and a vagally denervated Heidenhain pouch to confirm that GABA-receptor stimulation affects acid secretion via peripheral pathways. Intravenous injection of baclofen (0.5 mg/kg), a GABAB-receptor agonist, increased acid secretion significantly from the gastric fistula and the Heidenhain pouch. These studies suggest that GABA may play a role in regulating gastric acid secretion and gastrointestinal and pancreatic endocrine function by both central and peripheral mechanisms.
Two hundred and sixty men entering an inpatient program for alcohol and drug treatment were interviewed and tested for cognitive disturbances and hepatic function. When the treatment group was separated by the presence or absence of antisocial personality disorder, the antisocial group was distinguished by several factors. Antisocial alcoholics were more likely to have an early onset of alcoholism and to be involved with other illicit drugs, and showed evidence of more problems with control of their drinking. They reported more alcohol-related problems as defined in DSM-III. Despite histories of a more severe form of alcoholism, the antisocials were no more likely to develop alcohol dependence or show signs of cognitive or hepatic toxicity.
Plasma levels of gamma-aminobutyric acid (GABA) appear to be altered in affective disorders and alcoholism. Plasma levels of GABA were not affected by menstrual cycle, exercise, gender, gut flora, nor by cholinergic stimulation by bethanechol. An obvious peripheral source for plasma GABA could not be demonstrated.
Alcoholic liver cirrhosis is a leading cause of morbidity and mortality in alcohol dependence. A common precursor to cirrhosis is alcoholic hepatotoxicity evident clinically by elevated serum liver enzymes. In this study 50 male patients with significant (greater than two times upper limits of normal) elevation of liver enzymes attending a veterans inpatient alcohol treatment center were matched by age and time since last drink to 50 male veterans without elevated liver enzymes. Patients with elevated liver enzymes were found to be more likely to be daily drinkers, less likely to indulge in binge drinking patterns or have alcoholic blackouts, and showed a trend towards a less severe pattern of alcoholism. Significant gamma glutamyl transferase (GGT) elevations were found in patients consuming an average of 7 beers/day for 5 years, and significant aspartate aminotransferase (AST) elevations were found in patients consuming a threshold of 12 beers/day for 10 years. These findings are consistent with current research suggesting alcoholic cirrhosis is a result of a threshold exposure to alcohol in alcoholics with an additional environmental or genetic risk factor.
Male alcoholics (N = 260) presenting for inpatient treatment were given a structured psychiatric interview that included questions about previous motor vehicle accidents while intoxicated. The histories of 57 patients who reported personal injury accidents were compared with those of 131 patients who did not report accidents. Patients reporting accidents were more severely ill and had an earlier onset of heavy drinking. Also, more patients with accidents belonged to a subgroup of alcoholics with antisocial personality. The identification of high-risk alcoholics may contribute to motor vehicle accident prevention.
Depression is the most frequent psychiatric complication of serious medical illness, occurring in up to 20 per cent of cases. Criteria for its diagnosis and guidelines for its treatment are presented.
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Acute injection of glutamate into frontal neocortex of naive rats produced a subsequent deficit in escape performance behavior that was similar to that produced by exposure to uncontrollable shock. The behavioral deficit was dose-related. The behavioral deficit was similar in time-course to that produced by 15 min (but not 40 min) of exposure to learned helplessness induction. Unlike learned helplessness produced by exposure to inescapable shock, the behavioral deficit produced by intracortical glutamate injection was not prevented by chronic intraperitoneal administration of imipramine.
Ethanol intoxication has been noted to cause marked changes in brain and CSF levels of gamma-aminobutyric acid (GABA). Using plasma GABA levels to assess brain GABA activity, the authors found that 85 chronic alcoholics had significantly lower levels than control subjects.
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In order to assess the possible loci of action of neuroleptics in blocking the acquisition of a one-way conditioned avoidance response, microinjections of three neuroleptics and seven putative neurotransmitters were made into several brain regions and their effects on this behavior were assessed. When injected into the amygdala, the ED50 values for haloperidol (0.128 nmol), chlorpromazine (1.04 nmol) and thioridazine (1.41 nmol) were appropriate in relation to their clinical potency. Injections of neurotransmitters were without effect except in a few cases. Most significantly, the intra-amygdaloid administration of glutamate diethyl ester (an antagonist at quisqualate-type receptors) produced a blockade of avoidance acquisition which, as in the case of the neuroleptics, was not diminished by pretreatment with atropine. Following intraperitoneal injection of chlorpromazine, a statistically-significant blockade of avoidance acquisition and of glutamate, released from slices of amygdala, was obtained at doses of 2 mg/kg or more. With haloperidol, comparable behavioral effects and release of glutamate were found at doses of 0.05 mg/kg or more. The depression of release of glutamate from amygdaloid slices could be attributed to glutamate derived from glutamine. These data suggest a possible role for glutamatergic transmission in the effects of neuroleptics.
Specific binding of [3H]imipramine decreased in frontal neocortex from rats demonstrating learned helplessness, an animal model of depression. The decrease was in maximal binding but not in affinity for the receptor site. No change in [3H]imipramine binding was found in septum or hippocampus. The receptor changes found in frontal neocortex parallel behavioral and neurochemical changes produced by learned helplessness in this region. These changes are also similar to those found in the frontal neocortex from suicides and in platelets of patients with depression.
In two separate studies, we have obtained plasma levels of GABA in 134 psychiatric patients and 22 normal controls. Patients with a unipolar affective disorder had levels significantly lower than control (n = 58) as did patients with alcoholism (n = 10). Patients with a bipolar affective disorder had levels significantly higher than control when manic (n = 28) and also when euthymic on lithium prophylaxis (n = 17), but levels in the control range when depressed (n = 4). Patients with schizophrenia demonstrated a high degree of variability in their levels of plasma GABA but were not statistically different from control (n = 36). Patients with unipolar depression who received a dexamethasone suppression test had no correlation between nonsuppression of cortisol secretion and plasma levels of GABA. Diagnostic and research implication of plasma GABA in psychiatric illness are discussed.
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Chlorpromazine injected into the amygdala, septum, or caudate delayed the acquisition of a one-way active avoidance response. Injections into nine other brain areas were inactive. Following a standard dose of chlorpromazine at its ED50 for delaying avoidance acquisition, tissue levels of chlorpromazine from those animals displaying reduced acquisition were significantly higher in the caudate and amygdala than from animals not demonstrating a drug effect.
In the behavioral reversal of learned helplessness in the rat by imipramine, a strong correlation is found between "cure" of helplessness and drug level in anterior neocortex, the locus of drug action in this model of depression. This suggests that the delayed onset of therapeutic action of antidepressant drugs is due to the time required to achieve adequate drug levels at the site of their action.
The learned helplessness model of depression was tested for its responsiveness to several types of antidepressant therapies, and to a number of psychoactive drugs which are not effective in treating depression in humans. Chronic administration of tricyclic antidepressants (imipramine, desipramine, amitryptyline, nortryptyline, or doxepin), atypical antidepressants (iprindole or mianserin), monoamine oxidase inhibitors (iproniazid or pargyline), or electroconvulsive shock was effective in reversing learned helplessness. Chronic treatment with anxiolytics (diazepam, lorazepam, or chlordiazepoxide), neuroleptics (chlorpromazine or haloperidol) stimulants (amphetamine or caffeine), or depressants (phenobarbital or ethanol) was not. Thus, this model provides a reasonable degree of specificity toward therapies which are successful in humans.