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Biomedical subjects

J Prudic

Publications and source records attributed to J Prudic.

50 records · Page 3Linked to original sources
PubMed1991

Electroconvulsive therapy in the treatment-resistant patient.

In medication-resistant patients with major depressive disorder, the response rate with bilateral electroconvulsive therapy (ECT) drops to 50% from the expected range of 80% to 90%. Relapse rates following ECT are high in medication-resistant depressed patients and are clustered in the first 4 months following clinical response. Medication resistance during the index episode predicts a high rate of relapse, whereas those patients who have not received an adequate medication trial prior to ECT are less likely to relapse. If a patient who fails an antidepressant trial then responds to a course of ECT, alternative pharmacologic strategies or maintenance ECT should be considered to decrease the likelihood of relapse. Patients who do not respond to a traditional course of bilateral ECT may respond subsequently to longer courses of bilateral ECT at markedly suprathreshold stimulus intensity, or may respond to a different class of antidepressant medication from that which they failed previously.

Antidepressive Agents↗
PubMed1990

Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest.

We measured regional cerebral blood flow with the xenon 133 inhalation technique in 41 patients with major depressive disorder and 40 matched, normal controls during an eyes-closed, resting condition. The depressed group had a marked reduction in global cortical blood flow. To examine topographic abnormalities, traditional multivariate analyses were applied, as well as a new scaled subprofile model developed to identify abnormal functional neural networks in clinical samples. Both approaches indicated that the depressed sample had an abnormality in topographic distribution of blood flow, in addition to the global deficit. The scaled subprofile model identified the topographic abnormality as being due to flow reduction in the depressed patients in selective frontal, central, superior temporal, and anterior parietal regions. This pattern may reflect dysfunction in the parallel distributed cortical network involving frontal and temporoparietal polymodal association areas. The extent of this topographic abnormality, as revealed by the scaled subprofile model, was associated with both patient age and severity of depressive symptoms.

Adult↗
PubMed1990

Medication resistance and clinical response to electroconvulsive therapy.

We examined the extent to which medication resistance during an episode of major depression was related to short-term clinical response to bilateral electroconvulsive therapy (ECT). Strength of pharmacological treatment trials was rated in 53 patients who met Research Diagnostic Criteria for major depressive disorder and were subsequently treated with ECT. Patients who had failed to respond to adequate pre-ECT pharmacotherapy were substantially less likely to respond to ECT than patients who had not received adequate pharmacological trials before ECT. Therefore, medication resistance had predictive value with respect to the therapeutic effects of ECT. The clinical and theoretical implications of this finding are discussed.

Aged↗
PubMed1990

The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression.

After clinical response to electroconvulsive therapy (ECT), 58 patients with major depressive disorder were followed for 1 year or until relapse. The rate of relapse was substantially higher in patients who had failed adequate antidepressant medication trials prior to ECT than in patients not determined to be medication resistant. Adequacy of post-ECT pharmacotherapy was only marginally related to likelihood of relapse. The subgroup of patients who appeared to benefit from adequate post-ECT pharmacotherapy were those who did not receive an adequate medication trial prior to ECT. The findings call into question the common practice of administering as continuation pharmacotherapy following ECT the same class of medications that patients had failed with during the acute episode prior to ECT. The findings also indicate that resistance to antidepressant medication is a strong predictor of relapse following response to ECT.

Aged↗
PubMed1988

The development of mania and organic euphoria during ECT.

Mania that develops in depressed patients who are undergoing ECT is relatively uncommon and may occur more frequently in bipolar patients. The authors' review of three cases illustrates the importance of the clinician distinguishing mania from organic euphoric states that can also develop during ECT. Severity of cognitive impairment and the presence of silly or inappropriate laughter are useful in making this distinction. Capacity to clinically evaluate the persistence of depressive symptoms should determine whether ECT can continue when an organic euphoric state develops.

Adult↗
PubMed1987

Acute effects of ECT on cardiovascular functioning: relations to patient and treatment variables.

In 34 patients with primary, major depressive disorder, randomly assigned to bilateral or right unilateral ECT, heart rate (HR) and blood pressure (BP) were assessed prior and following seizure induction at every treatment. In contrast to prior reports, no cumulative pattern was observed in HR or BP changes as a function of treatment number. Generally, treatment variables, including ECT modality (bilateral vs. unilateral), anesthetic agent (methohexital vs. pentothal), and prior subconvulsive stimulation in a session, had no effects on the magnitude of peak postictal increases in HR or BP. The peak changes were also unrelated to the history of cardiac illness, remission of depressive symptomatology, patient seizure threshold and patient seizure duration. Pre-treatment HR was strongly predictive of peak postictal change in both HR and BP, while pretreatment BP was not. Patients with high pre-ECT HR had smaller peak postictal HR and BP increases. The findings suggested that low dosage, titrated ECT has HR and BP effects similar to traditional high dosage techniques, and that pre-treatment HR is the best predictor of these effects.

Blood Pressure↗
PubMed1985

The dexamethasone suppression test in depressive, non-depressive and schizoaffective psychosis.

The authors examined the 24-h plasma cortisol response to dexamethasone in 19 patients with co-existing depressive and psychotic features and in 12 non-depressed patients with only psychotic features. The rate and degree of abnormal dexamethasone suppression was greatest in patients who met RDC criteria for primary depressive disorder. Patients who met criteria for schizoaffective--mainly schizophrenic--depressed and other psychotic disorders did not differ from each other in their response to dexamethasone. These data suggest that the DST may have utility in the diagnostic evaluation of some patients with depressive and psychotic features.

Adult↗
PubMed1984

Effect of hospital admission on DST results.

The authors examined the dexamethasone suppression test (DST) responses of 41 patients with primary major depressive disorder and 40 patients with other psychiatric disorders who were tested within 2-6 days of hospital admission. Significantly more patients with primary depression who were tested on day 2 demonstrated abnormal cortisol suppression than those who were tested on days 3, 4, or 3-6 and than patients with other psychiatric disorders regardless of test day. These results suggest that patients with primary depression may be sensitive to psychophysiologic stresses associated with hospital admission and that the utility of the DST may require further evaluation vis-à-vis the day of DST administration.

Adult↗
PubMed1984

Guidelines for treatment of psychosis during pregnancy.

Treatment of the acutely psychotic pregnant woman presents therapeutic problems for the psychiatrist and the inpatient unit. Controlled studies of the comparative efficacy of therapeutic modalities during pregnancy are lacking, and the literature on the morphological and behavioral teratogenicity of somatic treatments does not lead to definitive conclusions about their safety in pregnancy. The authors review studies in those areas, focusing on the use of psychotropic drugs. Guidelines for treating psychotic pregnant patients in the last six months of pregnancy and the immediate postpartum period are outlined.

Abnormalities, Drug-Induced↗
PubMed1984

Clinical utilization of the dexamethasone suppression test.

To explore the procedural nature and clinical impact of the dexamethasone suppression test (DST) in psychiatric hospital practice, case records of 115 consecutive psychiatric inpatients who had undergone overnight DSTs were examined. It was found that clinicians often fail to perform the test according to previously established guidelines and that the results obtained rarely affect clinical psychiatric management in a positive manner.

Antidepressive Agents↗
PubMedDate not supplied

Relative response of endogenous and non-endogenous symptoms to electroconvulsive therapy.

A sample of patients with endogenous depression (RDC), who had only a partial response to electroconvulsive therapy (ECT), was identified from a larger group of patients participating in a study of the affective and cognitive effects of low-dose titrated ECT. Using symptom scores on the Hamilton Rating Scale for Depression, subscales were constructed to reflect Klein's formulation of endogenomorphic depression, the RDC for endogenous subtype, and the DSM-III criteria for melancholia. Regardless of the subscale used, no evidence was obtained that endogenous symptoms were more responsive to ECT than non-endogenous symptoms.

Adult↗