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Biomedical subjects

H M van Praag

Publications and source records attributed to H M van Praag.

At least 37 records · Page 2Linked to original sources
PubMed1998

The diagnosis of depression in disorder.

OBJECTIVE: My purpose is to critically evaluate psychiatry's current approach to the diagnosis of depression. METHODS: I have closely examined trends in diagnosing depression, especially since DSM-III, and have considered alternative options. RESULTS/CONCLUSIONS: Psychiatric taxonomy is currently based on invalid nosological premises that have worked as a strait jacket for conceptual progress and related biological and psychopharmacological research. A fresh approach that replaces nosological analysis with the concepts of functionalisation and verticalisation is essential.

Biological Psychiatry↗
PubMed1997

Over the mainstream: diagnostic requirements for biological psychiatric research.

Progress in biological psychiatry is contingent on progress in neurobiology and on research into proper characterisation and assessment of abnormal behavior. Advances in neurobiology are rapid and steady; diagnostic research does not keep pace. On the contrary, the diagnostic approach seems solidified, as today's basic premises are uncritically accepted. The diagnostic requirements for meaningful biological psychiatric research are discussed and contrasted with present-day diagnostic practices. Serious reflection on the state of psychiatric diagnosing is urgently needed.

Biological Psychiatry↗
PubMed1997

[Treatment of refractory primary depression].

Refractory depressions are depressions that respond insufficiently to treatment with the standard antidepressants, given long enough and in adequate dosage. If tricyclic antidepressants or selective serotonin reuptake inhibitors are insufficiently efficacious, an augmentation strategy may be applied. Drugs with a reinforcing effect on antidepressant medication are lithium and possibly liothyronine (triiodothyronine). If the results are nil or insufficient, administration of MAO inhibitors may be resorted to. Finally, electroconvulsive treatment may be administered to patients with a vital depression. If in depression there are indications of personality disorders and/or stressful life situations, treatment should comprise not only antidepressants but also psychological intervention and psychosocial measures.

Antidepressive Agents, Tricyclic↗
PubMed1997

Measurement of aggression in psychiatric patients.

This article analyzes, describes, and characterizes the methods used for measuring aggression in studies on psychiatric patients. The authors reviewed all studies published between 1985 and 1994 in seven major psychiatric journals and found 103 studies on adult aggression and 43 on childhood and adolescent aggression. Almost half (44.7%) of the adult studies and 23.3% of the child and adolescent studies did not use any structured instrument; the remainder used a total of 52 different instruments, indicating that the methodology in this area is not well established. The methods used for measuring aggression were mainly of three types: observational measures; self-report questionnaires; and structured chart reviews. Each of these tools is described herein, with special focus on reliability and validity. Overall the reliability of the various scales is high, but the empirical validity is rather poor. In choosing a suitable method for measuring aggression, researchers should take into account the direction of investigation (e.g. state vs. trait aggression, dynamic or biological aspects of aggression) and the target population. Practical suggestions in this regard are offered.

Adolescent↗
PubMed1997

[Depression following a first heart infarct; similarities with and differences from 'ordinary' depression].

OBJECTIVE: To determine frequency and clinical features of major depressive disorder according to DSM IV criteria in patients following a first myocardial infarction. DESIGN: Questionnaire. SETTING: Departments of Cardiology and Psychiatry, University Hospital Maastricht, the Netherlands. METHOD: Depression was assessed using the Zung 'Self-rating depression scale' (Zung-SDS) and the 'Symptom checklist' (SCL)-90 in 228 patients who filled the questionnaires out themselves (response: 60-70%), 1, 3, 6 en 12 months after their first heart attack. When the score on one or both lists was above threshold, the patient was invited for a clinical interview with a psychiatrist. RESULTS: One month post infarction 10% were diagnosed with a major depressive episode, a percentage which increased to 34% one year post infarction. The clinical features of the depression in these patients were the same as in a matched sample of depressed psychiatric inpatients without a cardiac history, except that hostility was significantly increased in the post-infarction patients. There was no mortality. CONCLUSION: Depressive disorder is a frequent comorbid disease after a first myocardial infarction.

Depression↗
PubMed1996

Faulty cortisol/serotonin interplay. Psychopathological and biological characterisation of a new, hypothetical depression subtype (SeCA depression)

The hypothesis is proposed of a new subtype of depression named: stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression (SeCA depression). Biologically, these patients are characterized by impaired 5-HT synthesis and reduced 5-HT1A receptor sensitivity. Under normal conditions these functions proceed marginally; in times of stress they easily fail, due to sustained overproduction of cortisol. Psychopathologically this depression type shows the following characteristics: anxiety and aggression, not mood lowering, heralding a depressive episode; the personality structure shows 'character neurotic' impairments and tolerance for (certain) traumatic life events is low. As specific therapeutic agents selective 5-HT1A agonists and cortisol or CRH antagonists are proposed. Prophylactically, maintenance treatment with 5-HT1A agonists seems indicated as well as psychological interventions to increase the stressor threshold.

Aggression↗
PubMed1996

Selective serotonin reuptake inhibitors (SSRIs) in the treatment of elderly depressed patients: a qualitative analysis of the literature on their efficacy and side-effects.

A qualitative analysis of studies on the efficacy and side-effects of selective serotonin reuptake inhibitors (SSRIs) for the treatment of elderly people with depression is presented. Only placebo-controlled or comparison studies of SSRI versus other antidepressants were included. The description and methodological quality of the analysed studies were important criteria in the outcome of the analysis. Quality was assessed by means of a blinded review approach. After excluding duplicate publications, 16 studies were analysed, of which six turned out to be of good quality. The results indicated that at the end of the treatment periods (4-8 weeks) all antidepressants were equally effective. Side-effects occurred less frequently with SSRIs than with tricyclics (TCAs), and different side-effect profiles were found. Significantly fewer SSRI-treated patients than TCA-treated patients dropped out both overall and due to side-effects.

1-Naphthylamine↗
PubMed1996

Comorbidity (psycho) analysed.

Many psychiatric patients seem to suffer from a multitude of psychiatric disorders. The term 'comorbidity' was introduced to characterise that situation. This term, however, is multi-interpretable and thus conceals more than it clarifies. Five interpretations of the concept of comorbidity are discussed, in conjunction with the consequences their validity would have for psychiatric research, in particular for the biological branch. If the term comorbidity continues to be used without further qualification, it will slow down the process of conceptualization of novel research strategies in experimental psychiatry, which is so urgently needed.

Causality↗
PubMed1995

The role of serotonin in schizophrenia.

The hypothesis that the LSD psychosis and by inference schizophrenic psychoses are related to dysfunctions in central serotonergic systems, formulated by Woolley and Shaw in the early 1950s was the first testable theory of modern biological psychiatry. Initially, it did not get the scientific attention it deserved. First, because LSD fell into disrepute and was to all intents and purposes banned from human experimentation. Secondly, the antipsychotics were discovered in the same period, and it became clear that these compounds block dopaminergic transmission and hence for many years thereafter the dopaminergic system occupied center stage in biological schizophrenia research. Presently, interest in the relation between serotonin and schizophrenia has been revived, due to the development of serotonin-blocking agents that appear to exert therapeutic effects in schizophrenia. In this paper the evidence for and against a link between serotonergic defects and schizophrenia psychopathology is critically discussed. The conclusion to be reached is threefold. (1) Interruption of certain serotonergic circuits represents an antipsychotic principle. (2) Tentative evidence suggests the involvement of serotonergic dysfunctions in the pathogenesis of schizophrenic psychoses. (3) It is not yet known whether serotonergic lesions contribute directly to the occurrence of schizophrenic psychopathology or via alterations in the dopaminergic system.

Blood Platelets↗
PubMed1995

The neuroendocrine challenge paradigm in headache research.

The neuroendocrine challenge paradigm provides a "window" on central neurotransmitter function in vivo. This strategy is based on the premise that the sensitivity of certain central receptors can be inferred from the magnitude of the hormonal response to specific pharmacologic probes. For example, the serotonin (5HT) receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin and induces migraine-like headaches. We have previously reported that the headache and cortisol responses to m-CPP are highly correlated, which may implicate a disturbance in central serotonergic neurotransmission in the pathogenesis of migraine. As pharmacologic probes with greater specificity for 5HT receptor subtypes become available, we may be able to elucidate these mechanisms with greater precision. The neuroendocrine challenge methodology is also applicable to the study of other neurotransmitter systems and other headache disorders.

Headache↗
PubMed1995

Cerebrospinal fluid 5-hydroxyindolacetic acid and aggression: a critical reappraisal of the clinical data.

Over the past 15 years several clinical studies have been published dealing with the hypothesis that disturbances in central serotonergic functioning could be related to outward directed aggression and impulsivity. Close reading of the 22 relevant reports, however, raises doubt about the unequivocality of the results across diagnostic boundaries and in comparison with normal controls. Only eight of the studies are methodologically acceptable and seem to support the hypothesis. Taking all data together, it is concluded that some relationship exists between decreased serotonin metabolism, as reflected by lowered cerebrospinal fluid 5-hydroxyindolacetic acid, and certain aspects of aggressive behavior in a subgroup of young, male, personality-disordered subjects with seriously deviant behavior.

Behavior↗
PubMed1995

Treatment of depression in Parkinson's disease: a meta-analysis.

Despite a 40% prevalence of depression in idiopathic Parkinson's disease (PD), an extensive literature search found only 12 controlled studies of treatment efficacy. A meta-analysis of these was performed in pursuit of guidelines for pharmacological treatment. Articles were scored on a scale from 0 to 100 on a specially adapted list of methodological criteria. Only 4 articles scored more than 50 points, and these generally did not use depression rating scales. Thus, there are virtually no empirical data on the treatment of depression in PD. Further studies are urgently needed, both for the sake of patient care and to gain a better understanding of the pathophysiological mechanisms underlying depression in PD and the interrelation between depression and cognitive decline.

Alzheimer Disease↗
PubMed1995

Parental loss and family violence as correlates of suicide and violence risk.

Seventy-nine psychiatric inpatients were administered a battery of psychometric instruments that obtained information about early parental loss, exposure to family violence, and behavioral problems in themselves and in their first-degree relatives. These variables were correlated with suicide and violence risk measures. Suicide risk significantly correlated with all family variables whereas violence risk correlated with behavioral problems both in oneself and in one's first-degree relatives. Moreover, suicidal and/or violent patients had experienced maternal loss significantly more frequently than the nonsuicidal/nonviolent patients. In the suicidal/violent group, age of patient at death of parents was significantly lower than in the nonsuicidal/nonviolent group. Finally, family violence was significantly correlated with behavioral problems in self and in first-degree relatives. Findings are interpreted according to the authors' theoretical model of aggression regulation.

Adolescent↗
PubMed1994

Negative symptoms in schizophrenia: considerations for clinical trials. Working group on negative symptoms in schizophrenia.

There is little agreement about the methodology of clinical trials of antipsychotic drugs in patients with negative symptoms. A literature review revealed wide variation in experimental design, rating scales and study duration. This reflects differing views as to the definition and response to treatment of negative symptoms. Some degree of standardization would improve comparability of studies and aid the development of new compounds. Patients included in such studies should have displayed negative symptoms for at least 6 months. Depressive symptoms, positive schizophrenic symptoms and extrapyramidal signs may all influence or be confused with negative symptoms and may respond to treatment; they should be at a low level at baseline and should be measured during the study period. Studies should last at least 8 weeks. Several scales are available for measuring negative symptoms and are reviewed; a global impression score should be used additionally.

Clinical Trials as Topic↗
PubMed1994

Effects of alprazolam on increases in hormonal and anxiety levels induced by meta-chlorophenylpiperazine.

The effects of alprazolam, a triazolobenzodiazepine, on hormonal and behavioral responses induced by meta-chlorophenylpiperazine (MCPP), a serotonin receptor agonist, were investigated in 10 healthy men. Alprazolam (0.5 mg) or placebo was given 1 hour before MCPP (0.5 mg/kg) or placebo. Cortisol, prolactin, and growth hormone (GH) release, MCPP and alprazolam plasma levels, anxiety level, and panic symptoms were measured over 210 minutes. MCPP was found to increase cortisol, prolactin, GH, and anxiety levels. Alprazolam decreased cortisol and GH levels but had no effect on prolactin. When used in combination with MCPP, alprazolam blunted MCPP-induced cortisol and GH release, and it blocked the anxiogenic effects of MCPP.

Adult↗
PubMed1994

Homicidal behaviors among psychiatric outpatients.

OBJECTIVE: Most studies of violent behavior among psychiatric patients focus on inpatients or patients recently discharged from psychiatric units. To explore violent behavior among patients living in the community, the authors examined the prevalence of homicidal behaviors in a general psychiatric outpatient population. METHODS: During an intake evaluation, 517 outpatients completed several self-report instruments that included a detailed survey of past and current homicidal behaviors covering homicidal ideation, plans, and attempts. Demographic and clinical characteristics of patients with and without a history of homicidal behaviors were compared. RESULTS: Twenty-two patients (4 percent) reported a past homicide attempt. Patients who reported homicide attempts could be distinguished from patients with no homicidal behaviors by the presence of other aggressive behavior such as suicidal ideation and suicide attempts by themselves and their family members and by elevated current measures of interpersonal sensitivity, hostility, and paranoid ideation. CONCLUSIONS: The rate of homicide attempts in the general outpatient population studied was considerably lower than the reported rates of assault among inpatients. The relationship between past and current episodes of aggressive behavior reinforces the importance of including a careful assessment of past history of violent behaviors as part of the routine psychiatric evaluation.

Adolescent↗