Reproducibility of the dexamethasone suppression test in depression.
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Adult↗
Biomedical subjects
G Charles
Publications and source records attributed to G Charles.
Plasma and urinary cortisol levels after dexamethasone in affective disorders.
The validity of the dexamethasone suppression test was evaluated for the differential diagnosis of primary and secondary depressions. Forty hospitalized psychiatric patients (14 primary depressed, 15 secondary depressed and 11 non-depressed controls) were studied. The Research Diagnostic Criteria of Spitzer et al. (1978) were used to classify these patients. Eight out of the 14 primary depressed patients had an abnormally high plasma cortisol at 4 p.m. after dexamethasone. Only 2 out of the 15 secondary depressed patients and none of the 11 controls had an abnormal response to dexamethasone. Based on these results, the dexamethasone suppression test has a sensitivity of 57%, a specificity of 87% and a predictive value of 80%. The determination of urinary free cortisol excretion does not improve the performance of the test.
Adult↗
Absence of anemia in maintenance hemodialysis.
Anemia is usual in untreated uremia. Persistent anemia is thought to be universal in uremic patients treated by maintenance hemodialysis (MH). A retrospective chart analysis of 549 patients on (MH) at five facilities in Brooklyn, found that eleven (2%) of these patients had a hematocrit (Hct) in the normal range (40%). To distinguish this subset of patients from the majority of MH, we compared both groups for: (1) etiology of the renal disease, (2) presence of residual renal function, (3) dialysis prescription, (4) decreased arterial O2 saturation, (5) greater use of vitamins or anabolic steroids, (6) absence of parathyroid disease. The relatively high hematocrit was not explained by any factor evaluated in this small subset of MH patients.
Adult↗
A problem-oriented approach to medical information systems: an application in a primary care group practice.
A relatively simple computer-based information system developed for a primary care group practice at the San Francisco Veterans Administration Hospital contributes to the management of the practice, to improvement of medical care for patients within the group, and to research studies on resource utilization in the management of chronic diseases and the evaluation of care of chronically ill patients. Preliminary results from the use of the information system are encouraging and demonstrate that much may be achieved by information systems that do not attempt to computerize the entire medical record.
California↗
A physician extender training program based on clinical algorithms.
The ability of physician extenders to provide patient care in a variety of settings has been reported widely. Less attention has been paid to training programs, especially those of short duration, for physician extenders. A three-month training program for physician extenders at a large teaching hospital was based on teaching the skills needed to run 39 clinical algorithms. The course content and the methods used to test the students during the three months may prove of value to those preparing similar programs.
California↗
[A rare case of cavernous haemangioma of the bladder (author's transl)].
The authors report a case of haemangioma of the bladder treated by partial cystectomy in a young man aged 17 years and review the world literature. Less than 70 cases have been published up to the present time. In 30 per cent of cases, the presence of signs of vascular dysplasia of the limbs is also noted.
Adolescent↗
Physician's assistants and clinical algorithms in health care delivery. A case study.
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California↗
Assessment of medical care.
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Quality of Health Care↗
Discharging cortical lesions produced by freezing. The effect of anticonvulsants on sodium-potassium-activated ATPase, sodium, and potassim in cortex.
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Adenosine Triphosphatases↗
Age and gender effects on the diagnostic power of the DST.
Among 365 major and 158 minor depressive inpatients, the dexamethasone suppression test (DST) yielded an overall diagnostic sensitivity of 50%, a specificity of 85%, and a confidence level of 88%. Age was significantly correlated with the post-dexamethasone cortisol levels in the whole sample (r = 0.11; P less than 0.01); however, this low relationship disappeared when all subgroups defined by gender or diagnostic were considered. Gender did not appear to influence DST results; however, among the patients between 30 and 39 years, the diagnostic performance of the DST was significantly lower among female as compared to male patients, suggesting possible interferences with endocrine variables.
Adult↗
[P 300 slow potential. Clinical interest in 3 mental diseases and neurobiology: a review].
P300 is a late component of evoked potential which meet special relevance to the study of cognitive processes. P300 indexes categorization processes and the context updating of memory. Its latency reflects the stimulus evaluation time, and P300 amplitude is related to some psychological variables such as expectancy, attention and stimulus significance. In this review, clinical correlation between P300 components and mental diseases are reported, especially dementia, schizophrenia and depression. Delayed P300 latency has been found in Alzheimer disease and in other forms of dementia. Reduced P300 amplitude as well as altered topography has been reported in schizophrenia. In depression, reduced P300 amplitude has been related with longer reaction time. Unfortunately, the diagnosis utility of P300 seems limited. The authors also propose an overview of the actual knowledge on neurobiological findings in the generation of the P300 wave. Anatomical data point out the importance of the limbic system, more specifically, of the hippocampus and the locus coeruleus, in generating and modulating P300 wave. Data from the literature on the psychopharmacological modifications induced by cholinergic, catecholaminergic and other agents, are reviewed. Although the dopaminergic and noradrenergic systems are of some importance, these data emphasise the importance of the cholinergic system for the generation and modulation of P300 amplitude and latency. The value and interpretation of these neurobiological and clinical findings are discussed.
Adolescent↗
Suicide prevention and intervention with young people in foster care in Canada.
Given the history of turmoil in their lives, foster children and young people coming into care are particularly at risk of suicide. Whether a crisis is successfully prevented, or treated and transcended, depends upon the ability of foster parents and agency staff members to understand the nature of the situation and to work together in dealing with it.
Adolescent↗
[Assessment of the clinical activity of fluoxetin (Prozac) according of the "Stars of Liège" model].
Ten psychiatrists have independently rated the clinical profile of fluoxetin (Prozac) at the daily dose of 20 mg according to a "Stars of Liège" model comprising three parameters of therapeutic activity (antidepressant, psychostimulant and anxiolytic) and three parameters of side-effects (anticholinergic, sedative and hypotensive). Each parameter, graduated from 0 to 5 (no, very weak, weak, moderate, potent, very potent effect) was rated by each investigator according to his personal experience with at least 10 patients. Mean ratings given to fluoxetine show a moderate antidepressant effect, equal to amitriptyline (Rédomex, Tryptizol 75 mg/d, clomipramine (Anafranil 75 mg/d and nialamide (Niamide 100 mg/d, weak psychostimulating and anxiolytic effects, a very weak sedative effect and a lack of anticholinergic and hypotensive effects. Digestive side-effects of moderate intensity were also noted as well as a very weak anorexia. The important variability between investigators in the rating of the clinical profile of fluoxetine suggests that more experience is needed in order to define better its physiognomy.
Anti-Anxiety Agents↗
[Stimulation of somatotropin hormone by piribedil, a dopaminergic agonist, in endogenous depression. Preliminary study].
Piribedil, a dopaminergic agonist, was administered intravenously (0.5 mg over 10 minutes) to two unipolar endogenous depressed. The two patients, a 38-year-old man and a 60-year-old woman, were matched for age and sex with two volunteers without any mental illness. Effects of piribedil on plasma levels of growth hormone and on blood pressure were studied. The two volunteers evaluated their "feelings" of anxiety and of physical comfort using visual analogue scales. The experimentation was repeated in a double blind fashion with a placebo. Piribedil induced an elevation of GH in the normal man but not in the depressed man. In contrast, no increase was noted in women. No elevation of GH was observed after placebo. Importance of factors such as depression, sexual steroid environment and influence of stress are discussed.
Adult↗
[The clinical use of carbamazepine. Review of the literature and personal results].
Clinical use of carbamazepine is reviewed from the literature. Antidepressive, antimanic and prophylactic uses in bipolar and unipolar disorders are explained through six tables. The authors also arise clinical results observed in personality disorders. Prophylactic and antimanic activities are widely commented. Based on this review of the literature, although clinical efficacy in depression is more debated. Carbamazepine uses in personality disorders and schizoaffective patients seem to be promising. Moreover, the authors reported 25 clinical observations and attempt to draw some conclusions for the clinical use of carbamazepine.
Adolescent↗
[Depression and anxiety].
Anxiety and depression are the two most common syndromes in the practice of psychiatry. The authors look at the differences and similarities on a clinical, etiopathological, therapeutic and neurobiological point of view. Clinicians need to differentiate anxiety with depressive mood from anxious depression. This review tries to focus on this dilemma.
Anxiety Disorders↗
[The Newcastle Index for the diagnosis of endogenous depression. Comparison with the Research Diagnostic Criteria for major depression].
The Newcastle index comprises 10 items (with a positive or negative score) the sum of which enables us to separate endogenous and neurotic depressive patients. We applied this index to a sample of 41 depressive inpatients who met Research Diagnostic Criteria (RDC) for major depression. According to Newcastle index, 20 patients were considered to be endogenous and 21 to be neurotic. There was no significant difference between the two groups with regard to sex distribution and mean age. The distribution of scores suggested a trend toward bimodality. Endogenous depressives exhibited higher severity level than neurotic depressives, as shown by the total score on the Hamilton depression scale as well as the scores on various items related to depressive mood, guilt, decreased activity, psychomotor disturbances, genital symptoms, helplessness, hopelessness, and worthlessness. This higher severity level was confirmed by the higher frequency of two symptomatic criteria of major depression among endogenous depressives as compared to neurotic depressives: psychomotor and memory disturbances. Moreover, endogenous depressives defined by Newcastle index were more frequently of primary, endogenous, agitated and simple RDC subtypes whereas neurotic depressives were more frequently of secondary and situational RDC subtypes. Therefore, the results of this preliminary study suggest that the Newcastle index may enable us to define two subtypes of depressive patients characterized by different symptomatic severity levels.
Adult↗