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Biomedical subjects

J C Nelson

Publications and source records attributed to J C Nelson.

At least 163 records · Page 9Linked to original sources
PubMed1987

Treating depressions of bereavement with antidepressants. A pilot study.

Seven of 10 bereaved, depressed spouses had moderate to marked improvement of depressive symptoms during a 4-week open trial of tricyclic antidepressants. Several considerations suggested that this was a response in large part to the pharmacologic intervention and not simply to a therapeutic relationship. The application of antidepressants to treatment of the persistent major depressive syndromes observed late in the course of bereavement should be studied in systematic, controlled studies with larger samples. This is an important clinical issue given the high risk of prolonged depressive syndromes in acutely bereaved spouses.

Adult↗
PubMed1986

Reliability and validity of the symptoms of major depressive illness.

In two consecutive studies, we examined the interrater reliability and then the concurrent validity of interview ratings for individual symptoms of major depressive illness. The concurrent validity of symptoms was determined by assessing the degree to which symptoms observed or reported during an interview were observed in daily behavior. Results indicated that most signs and symptoms of major depression and melancholia can be reliably rated by clinicians during a semistructured interview. Ratings of observable symptoms (signs) assessed during the interview were valid indicators of dysfunction observed in daily behavior. Several but not all ratings based on patient report of symptoms were at variance with observation. These discordant patient-reported symptoms may have value as subjective reports but were not accurate descriptions of observed dysfunction.

Adolescent↗
PubMed1986

Lithium augmentation in psychotic depression refractory to combined drug treatment.

In this retrospective study the authors determined the efficacy of lithium added to a combined antipsychotic-antidepressant drug regimen in 21 psychotically depressed patients who had been refractory to combined drug treatment. Response to lithium was then compared with response rates of 15 patients to ECT, the established treatment for nonresponsive delusional depression. Lithium was effective in eight of nine patients with bipolar depression but in only three of 12 patients with unipolar depression; ECT was effective in nine of 15 patients with unipolar depression. Lithium augmentation appeared to be a realistic treatment alternative for refractory bipolar patients but was disappointing in unipolar patients.

Antipsychotic Agents↗
PubMed1986

Neuroleptic dose and desipramine concentrations during combined treatment of unipolar delusional depression.

The relationship of response to neuroleptic dose and desipramine plasma concentration was examined in 31 patients with unipolar delusional depression. The patients received either perphenazine or haloperidol for 1-2 weeks, after which desipramine, 2.5 mg/kg of body weight per day, was added. Neuroleptic dose varied among patients but was constant within individuals. Global response was rated retrospectively on the basis of outcome during the fourth week of combined drug treatment. Responders had higher plasma desipramine concentrations and had received higher neuroleptic doses than nonresponders had. The effective threshold level for desipramine was similar to that previously described for nonpsychotic melancholic patients, suggesting a similar mode of action for the drug in the two disorders.

Administration, Oral↗
PubMed1985

Reactivity of IgE and IgG serum levels to chymopapain after chemonucleolysis.

Patients suffering from herniated lumbar intervertebral disks can currently be treated by chemonucleolysis. This procedure involves reducing the nucleus pulposus by injecting chymopapain into the affected intervertebral disk. A small percentage of the patients who undergo this treatment experience an immediate hypersensitivity reaction. In this study the IgE and IgG specific for sensitivity to chymopapain of 21 patients receiving chymopapain (Discase for injection) was monitored over a 6-month period after injection. This study demonstrates that serum levels of IgE and IgG to chymopapain increase after chemonucleolysis.

Antigen-Antibody Reactions↗
PubMed1985

Ruminative thinking. A distinctive sign of melancholia.

We propose that ruminative thinking, the tendency to dwell on the same thought or theme, is useful for distinguishing melancholic from nonmelancholic major depression. We demonstrate that the symptom can be rated reliably and that interview ratings are concordant with ward observation of the symptom. The frequency of ruminative thinking, rated retrospectively in a prior study, was 60% in 75 patients having autonomous depression while only 18% of 48 nonautonomous patients were so affected. In this study, we found that ruminative thinking, prospectively rated in 71 patients with unipolar major depression, was present in 53% of patients with DSM-III melancholia but only 11% of the nonmelancholic patients. The presence of ruminative thinking appears to be useful for making the diagnosis of melancholia and its definition may facilitate study of the psychobiology of this disorder.

Delusions↗
PubMed1985

Elevated plasma homovanillic acid in depressed females with melancholia and psychosis.

Plasma free homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were measured before drug treatment in 29 patients diagnosed as having major depression with melancholia and in 18 control subjects. Plasma HVA was significantly elevated in the total group of female melancholic patients when compared with female controls or male melancholics. Most female patients with psychotic melancholia had elevated HVA levels. These differences were not found in male patients. No significant differences were found for plasma MHPG.

Adult↗
PubMed1985

The effect of serum dilution on free thyroxine (T4) concentration in the low T4 syndrome of nonthyroidal illness.

Progressive dilution of normal sera causes little change in free T4 concentrations. Similar dilution of sera containing drug inhibitors of T4 binding to serum proteins causes a progressive fall in free T4. The low T4 syndrome of nonthyroidal illness is thought to be associated with a circulating inhibitor(s) of T4 binding. It would be expected, therefore, that dilution of sera from the low T4 syndrome might also result in a fall in free T4 concentrations. We compared the effect of progressive serum dilution on free T4 concentrations in low T4 syndrome sera to those in normal, hyperthyroid, pregnancy, TBG-deficient and salicylate-containing sera. A tracer dialysis method proved inappropriate for studying dilution effects. Using a new dialysate RIA method to measure free T4, we found a progressive fall in free T4 concentrations in sera from patients with the low T4 syndrome similar to that in serum containing salicylate, but not to that in normal sera. The magnitude of the fall varied widely among individual patients. Free T4 methods which use a diluted serum sample will underestimate free T4 concentrations in the low T4 syndrome.

Adult↗
PubMed1985

Desipramine plasma levels and response in elderly melancholic patients.

The relationship of response and plasma desipramine concentrations was examined in elderly depressed patients to determine whether they were more sensitive to the antidepressant effects of the drug and whether they would respond at lower plasma concentrations than younger patients. Twenty-five inpatients over the age of 60, who met criteria for major depression with melancholia, were unipolar, were not delusional, were without active medical illness or definite brain disease, and were still depressed after 1 week of hospitalization off psychotropic drugs, were treated with desipramine (2.5 mg/kg) for 3 weeks. Of the 18 patients completing the drug trial, six responded and 12 did not. Desipramine levels of responders (median, 126 ng/ml) were higher than those of nonresponders (median, 81 ng/ml; Mann-Whitney test, p less than 0.05). The threshold for response was the same as the threshold (115 ng/ml) observed in 31 nondelusional melancholic patients under the age of 60 treated in a similar manner with desipramine. Among elderly patients with levels above 115 ng/ml, four of five responded, and below this level, two of 13 responded (Fisher's exact test, p less than 0.025). Five patients not responding to the initial 3-week trial responded when desipramine was increased and the plasma level rose above 115 ng/ml. The data indicate that elderly melancholic patients to not respond to lower desipramine plasma concentrations and that therapeutic levels are similar to those for younger melancholic patients. The doses of desipramine needed to reach these levels were also similar to those required in younger patients.

Adult↗
PubMed1985

Concurrent depression and dementia: implications for diagnosis and treatment.

The need to distinguish between depression and dementia is well recognized and has been much discussed, but the coexistence of the two illnesses has received less attention. Three cases are presented which corroborate previous reports of the coexistence of dementia and depression but also raise other issues. It is suggested that this diagnosis should not be viewed as an "either/or" decision, but that each diagnosis should be considered independently. The cases illustrate that the type of depression present may vary and that an accurate assessment of dementia may be possible only after depressive symptoms have abated. Other issues encountered in this clinical situation are discussed.

Aged↗
PubMed1985

Changes in fibrinolytic activity during the course of a single hemodialysis session.

Cardiopulmonary bypass, a form of extracorporeal circulation, markedly increases blood fibrinolytic activity. Accordingly, we measured the effect of hemodialysis, another form of extracorporeal circulation, on fibrinolytic activity in 13 patients with end stage renal disease during and after a single hemodialysis session. Total fibrinolytic activity on fibrin plates, which reflects plasminogen activator levels, was below normal prior to dialysis, rose well above normal at one hour, and then dropped gradually so that just prior to the end of a dialysis session it was still significantly elevated. Within 30 minutes of the end of dialysis, fibrinolytic activity fell rapidly, approaching predialysis levels. In contrast, 5 patients studied before and 3 hours into a peritoneal dialysis session showed no change in their subnormal levels of plasminogen activator. Plasminogen and alpha-2 antiplasmin levels did not change significantly during the course of hemodialysis. Thus, hemodialysis, but not peritoneal dialysis, transiently increases fibrinolytic activity without consuming plasminogen, a pattern consistent with the release of tissue type plasminogen activator.

Adult↗
PubMed1984

Subjective complaints during desipramine treatment. Relative importance of plasma drug concentrations and the severity of depression.

Subjective complaints, including those traditionally considered tricyclic antidepressant side effects, were studied in 43 depressed inpatients during a three-week trial of desipramine hydrochloride. Multiple regression analysis was employed to examine the independent relationship of pretreatment symptoms, concurrent depression, and plasma drug concentrations to subjective complaints reported during treatment. As a group, subjective complaints were positively associated with pretreatment symptoms and the concurrent severity of depression, but not with plasma desipramine concentration. Of the 23 individual complaints studied, three increased during treatment and nine improved. Only two complaints, tremors and light-headedness, were significantly associated with plasma drug concentration. The data indicate that during initial treatment of severe depression with desipramine, subjective complaints are more likely to be symptoms of depression than side effects of the drug and that plasma desipramine determinations would not be useful for predicting or avoiding these complaints. The best management of most symptoms studied was adequate treatment of the depression.

Attitude to Health↗
PubMed1984

Drug-responsive symptoms in melancholia.

Depressive symptoms present in 43 patients with unipolar nondelusional melancholia were studied to determine which symptoms were the best measures of response to desipramine hydrochloride. An extended Hamilton Depression Scale was used to identify symptoms that were present frequently. We then determined which symptoms improved in direct relation to achievement of therapeutic plasma desipramine concentrations, using multiple regression analysis to account for pretreatment symptom severity. In ten symptoms, improvement was significantly associated with desipramine treatment. These ten symptoms seem to be the best measure of drug response during tricyclic antidepressant treatment in patients with nondelusional melancholia.

Delusions↗
PubMed1984

Procainamide-induced agranulocytosis with reversible myeloid sensitivity.

A 56-year-old man developed procainamide-induced agranulocytosis. Bone marrow aspiration showed the absence of myeloid elements beyond the promyelocyte stage. Procainamide at therapeutic concentrations in vitro depressed bone marrow granulocyte-macrophage colonies (CFUc) while CFUc growth was normal in the absence of drug. Following the patient's recovery, CFUc growth was no longer suppressed by procainamide in vitro. The observations in this patient showing reversible sensitivity to drug contrast with those on other patients with drug-induced agranulocytosis that show persistent marrow injury or drug sensitivity despite clinical recovery.

Agranulocytosis↗
PubMed1984

Family history in delusional depression.

Family psychiatric history was compared in the 472 first-degree relatives of 31 delusional and 35 nondelusional inpatients who met DSM III criteria for major depression with melancholia. Morbid risks for psychiatric illness or for psychiatric treatment variables did not differ between the two groups. Specifically, rates of affective and psychotic illnesses in families did not distinguish delusional from nondelusional probands. The findings do not support the hypothesis of a genetic relationship of nonaffective psychosis to delusional depression.

Adult↗
PubMed1984

The clinical utility of family history for the diagnosis of melancholia.

History of psychiatric illness in 982 first degree relatives of 155 inpatients with major depression was examined to determine its clinical value for distinguishing melancholic from nonmelancholic major depressions. A positive family history of unipolar depression was not more common in the melancholic patients, although relatives of melancholic probands were more likely to have received electroconvulsive therapy or experienced nonaffective psychosis. Whereas the morbid risk estimate for unipolar depression was higher in the relatives of nonmelancholic probands, this appeared to be related to the manner in which morbid risk was calculated. Two methodological problems, variability in the risk periods of depressive subtypes, and the reliability of subtyping depressed family members, are discussed with respect to their implications for future family studies.

Adult↗