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Biomedical subjects

I Extein

Publications and source records attributed to I Extein.

At least 37 records · Page 2Linked to original sources
PubMed1982

Antimanic, antidepressant, and antipanic effects of opiates: clinical, neuroanatomical, and biochemical evidence.

These clinical data may offer some support for the hypothesis that opiates have antidepressant, antimanic, and antipanic effects. This hypothesis should be studied directly by double-blind studies of the effects of exogenous and synthetic endogenous opioid peptides in patients with major depressive illness, panic and anxiety states, schizophrenia, and schizo-affective illness. These clinical data support our studies in nonhuman primates and man which suggest a common LC or NE hyperactivity may underly both drug withdrawal and spontaneous panic states. Whether endorphin deficiency or derangements account for the postulated NE hyperactivity needs additional study and we will discuss our preliminary work later. Failure of endorphins to terminate bursts in LC firing rate and NE release may be responsible for both of these types of panic states. In addicts, this mechanism could exist prior to opiate use, or abuse of potent exogenous endorphinomentic compound may cause an endorphin-abnormality. Both of these possibilities would be compensated by continuous opiate maintenance. Methadone maintenance is a complicated psychiatric, psychological, and social phenomenon. Further studies are necessary to evaluate the role of opiate maintenance in treating or suppressing the emergence of underlying psychopathology. Previous psychiatric hospitalization or treatment for a schizophrenic or affective illness may contraindicate absolutely the use of clonidine or other rapid detoxification methods. These data suggest the possibility of substituting a nonaddicting psychotropic medication for opiates in some patients who are self-medicators. The clinical data support other data suggesting the potential antipsychotic, antidepressant, and antianxiety/antipanic effects of the endogenous opioids, endorphins, and exogenous opioids, endorphins, and exogenous opiates. These and other data suggest potential utility for opioid agonists and endorphin testing in psychiatric treatment and diagnosis.

Adult↗
PubMed1982

The future of private psychiatric hospitals.

In the near future the programs, the staff, and the physical plant of private psychiatric hospitals will become increasingly specialized. Development of neuropsychiatric evaluation units and greater liaison between the psychiatric hospital and the clinical laboratory have already begun. Improved standards of patient care and opportunities for research should attract to the private hospital more psychiatrists who are academically oriented. The authors predict a decrease in inpatient acute-care alcoholism treatment and shorter hospital stays for adolescents and those who were formerly considered long-term patients. The private hospital will need to increase its contacts with industry and health maintenance organizations. The authors also predict that ownership will become more centralized in hospital chains, similar to the pattern in general hospitals. The believe the major risk to the private hospital lies in abrupt changes in insurance coverage and regulatory interference.

Cost Control↗
PubMed1982

Clinical correlates of the TRH infusion test in primary depression.

Relationships between clinical measures, diagnosis and neuroendocrine findings were examined in a group of 25 primary depressives maintained drug free on a Neuropsychiatric Evaluation Unit. The TSH response to TRH infusion curves for unipolar and bipolar depressives were significantly different. Agitated patients but not psychomotor retarded patients demonstrated a blunted TSH response curve. No relationships were noted for cortisol hypersecretion and/or loss of diurnality and either diagnosis or psychomotor activity levels in depression. Biochemical and diagnostic implications of these findings are discussed.

Adult↗
PubMed1982

Does subclinical hypothyroidism predispose to tricyclic-induced rapid mood cycles?

A 24-year-old woman with a unipolar depression had an augmented thyroid-stimulating hormone response to thyrotropin-releasing hormone (TRH), suggesting subclinical hypothyroidism. Desipramine produced rapid cycling between depression and hypomania. After discontinuation of the desipramine she was successfully treated with lithium and thyroid hormone replacement. We discuss the possible role of hypothyroidism in the etiology of tricyclic-induced rapid mood cycling, and suggest that the TRH test may help identify depressed patients predisposed to rapid mood cycling on tricyclics. The possibility that such patients respond to lithium and/or thyroid hormone replacement needs to be further investigated.

Adult↗
PubMed1982

Neuroendocrine abnormalities in affective disorders.

The authors review neuroendocrine abnormalities in depression, and present data on the thyrotropin-releasing hormone (TRH) test in unipolar depression. Sixty of 105 patients who met Research Diagnostic Criteria for major unipolar depression had a blunted thyroid-stimulating hormone (TSH) response to TRH as defined as by delta TSH less than 7.0 micro IU/ml. Only 4 of 40 patients with non-major depression and 0 of 20 normal controls had a blunted TSH response to TRH by this criteria. Of 50 unipolar patients administered both the TRH test and the dexamethasone suppression test (DST), 34% were identified by the TRH test only, 20% by the DST only, 30% by either test, and 15 by neither test. The TRH test and DST seem to be complementary in the neuroendocrine evaluation of the patient with possible unipolar depression. The TRH test along with other neuroendocrine tests may be of help to the clinician in the diagnosis of depression and in treatment planning.

Adult↗
PubMed1982

Clonidine: inpatient studies from 1978 to 1981.

We have studied and reviewed data reported by others, which support a norepinephrine (NE) hyperactivity hypothesis for opiate withdrawal. Other hypotheses explained parts of the opiate withdrawal syndrome but the NE hypothesis had the potential to explain most of the clinical manifestations of abrupt opiate discontinuation in addicted persons. Clonidine's ability to almost completely reverse the opiate withdrawal syndrome in acute withdrawal studies supported the NE hypothesis and suggested a new use of clonidine. Lofexidine's efficacy was additional support for the NE hypothesis. Clonidine is an effective emergency treatment for acute opiate withdrawal and in the detoxification of methadone, heroin, and other opiate addictions. Clonidine reverses the cognitive, affective, and physiological signs and symptoms and continues to suppress their re-emergence when given for 10-14 days in a detoxification protocol. NE hyperactivity in withdrawal may result from endorphin system dysfunction at the level of the locus coeruleus (LC), the mismatch between needed NE, opiate and other inhibition at the LC in the person addicted to high doses of powerful exogenous opiate LC inhibitors and available endogenous inhibitory substances or other mechanisms.

Animals↗
PubMed1981

Hypothyroidism and depression. Evidence from complete thyroid function evaluation.

To evaluate the relationship between hypothyroidism and depression, thyroid function was evaluated in 250 consecutive patients referred to a psychiatric hospital for treatment of depression or anergia. Twenty of the 250 patients had some degree of hypothyroidism. Two patients (less than 1%) were identified with grade 1 (overt); nine patients (3.6%), grade 2 (mild); and ten patients (4%), grade 3 (subclinical) hypothyroidism. These results suggest that a significant proportion of patients with depression and anergia may have early hypothyroidism, the cases of about half of which are detected only by thyrotropin-releasing hormone (TRH) testing. Because hypothyroidism can produce signs and symptoms of depression and can coexist as a second illness in depressed patients, patients with early hypothyroidism may be candidates for thyroid replacement therapy. Clinical examination and measurement of triiodothyronine resin uptake thyroxine and baseline thyroid-stimulating hormone (TSH) levels, and TSH response to TRH are necessary to identify candidates for thyroid replacement among cases diagnosed by descriptive criteria as having either major or minor depression, particularly those that are atypical or treatment resistant.

Adolescent↗
PubMed1981

Relationship of thyrotropin-releasing hormone test and dexamethasone suppression test abnormalities in unipolar depression.

The thyrotropin-releasing hormone (TRH) test and the dexamethasone suppression test (DST) were administered to 50 inpatients with unipolar depression. Of the patients tested, 64% had a blunted thyroid-stimulating hormone (TSH) response to TRH and 50% failed to suppress on the DST. There was no significant association between these two abnormalities by chi-square test. This lack of association suggests that the blunted TSH response to TRH is not an artifact of hypothalamic-pituitary-adrenal hyperactivation. The TRH test and the DST complemented each other as biological markers for active unipolar depression: 30% of the patients were identified by both tests, 34% by the TRH test only, 20% by the DST only, and 16% by neither test. The two tests may be useful in developing a nosology for major unipolar depression that is based on both descriptive and neurobiological information.

Adult↗
PubMed1981

The thyrotropin-releasing hormone test in the diagnosis of unipolar depression.

The establishment of criteria for a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) may prove useful in distinguishing patients with major unipolar depression from patients with nonmajor depressions and controls. To this end, we administered the TRH test to a group of depressed, euthyroid inpatients diagnosed by Research Diagnostic Criteria and 20 normal volunteer controls. The mean maximal TSH response (delta TSH) to infusion of 500 micrograms of TRH of 7.3 +/- SD 4.6 microIU/ml in the 105 patients with major depressive disorder, primary unipolar subtype was significantly lower than that of 13.4 +/- SD 4.4 in the 20 controls and 10.9 +/- SD 4.4 in the 40 patients with nonmajor depressions. The differences were not explainable by differences in baseline thyroid function, age, or sex. When a delta TSH less than or equal to 7.0 microIU/ml was used as a diagnostic test for unipolar depression, the sensitivity of the TRH test was 56%, the specificity 93%, and the predictive value 91%. These results suggest that the TRH test may be useful in confirming the diagnosis of major unipolar depression and hence identifying patients likely to respond to antidepressant medications or electroconvulsive therapy.

Adult↗
PubMed1981

Evidence for an endorphin dysfunction in methadone addicts: lack of ACTH response to naloxone.

Chronic exogenous opiate administration might be responsible for the acute and protracted abstinence syndrome by producing a prolonged decrease in the availability of endogenous opioids (endorphins). However, the hypothesis that potent exogenous opiates may have anti-endorphin effects has been difficult to test. We have been investigating this hypothesis with neuroendocrine test paradigms which have provided preliminary evidence of anti-endorphin effects for chronic methadone. Naloxone-induced ACTH response data from chronic methadone addicts offers preliminary support for the hypothesis that chronic exogenous opiate administration has anti-endorphin effects. The subjects were 7 male methadone addicts who had been addicted to greater than or equal to 40 mg of methadone and 7 male healthy opiate-naive volunteers. Naloxone failed to produce a significant increase in ACTH in methadone addicts while opiate-naive normal volunteers demonstrated a significant naloxone-induced release of ACTH. Five of the seven methadone addicts ahd no demonstrable ACTH response to naloxone. These impaired naloxone response data reported here for recently detoxified addicts suggest that chronic methadone administration comprises the functional integrity of the endorphin system. Prolonged abstinence, post-detoxification depression and other affective symptoms which contribute to relapse may result from a prolonged endorphin derangement.

Adrenocorticotropic Hormone↗
PubMed1981

Specific norepinephrine and serotonin uptake inhibitors in man: a crossover study with pharmacokinetic, biochemical, neuroendocrine and behavioral parameters.

Eight depressed patients with major affective illness were treated with both zimelidine, a selective serotonin-uptake inhibitor, and with desipramine, a selective norepinephrine uptake inhibitor, following a double-blind crossover design. At steady-state the active metabolite of zimelidine, norzimelidine, predominated in the CSF by a factor of 7 to 1 over parent drug. As predicted, even high concentrations of norzimelidine were not associated with decreased 3-methoxy-4-hydroxy-phenylglycol (MHPG) in the CSF. In the same individuals, desipramine concentrations were highly correlated with decreases of MHPG in the CSF. Despite specific effects on monoamine neurotransmitter systems which have been implicated in the control of neuroendocrine secretion, neither drug had consistent effects on plasma cortisol, luteinizing hormone, growth hormone or prolactin. Both drugs had a marked and unexpected common effect on the 24-hour rest-activity cycle. The excess activity during the normal rest period (0--700 hr.) which has been noted in severely depressed individuals was significantly reduced by both the serotonergic zimelidine and the noradrenergic desipramine. These findings suggest that effects on the rest-activity pattern may be a common pathway for antidepressant effect.

Adolescent↗