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Biomedical subjects

K D Wagner

Publications and source records attributed to K D Wagner.

At least 37 records · Page 2Linked to original sources
PubMed1999

The Texas Children's Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder.

OBJECTIVES: To develop consensus guidelines for medication treatment algorithms for childhood major depressive disorder (MDD) based on scientific evidence and clinical opinion when science is lacking. The ultimate goal of this approach is to synthesize research and clinical experience for the practitioner and to increase the uniformity of preferred treatment for childhood MDD. A final goal is to develop an approach that can be tested as to whether it improves clinical outcomes for children and adolescents with MDD. METHOD: A consensus conference was held. Participants included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review and use clinical evidence to recommend specific pharmacological approaches for treatment of MDD in children and adolescents. After a series of presentations of current research evidence and panel discussion, the consensus panel met, agreed on assumptions, and drafted the algorithms. The process initially addressed strategies of treatment and then tactics to implement the strategies. RESULTS: Consensually agreed-upon algorithms for major depressions (with and without psychosis) and comorbid attention deficit disorders were developed. Treatment strategies emphasized the use of selective serotonin reuptake inhibitors. The algorithm consists of systematic strategies for treatment interventions and recommended tactics for implementation of the strategies, including medication augmentation and medication combinations. Participants recommended prospective evaluation of the algorithms in various public sector settings, and many volunteered as sites for such an evaluation. CONCLUSIONS: Using scientific and clinical experience, consensus-derived algorithms for children and adolescents with MDD can be developed.

Adolescent↗
PubMed1999

Preliminary examination of sex differences in depressive symptoms among adolescent psychiatric inpatients: the role of anxious symptoms and generalized negative affect.

Assessed the emerging view that generalized negative affect and anxious symptoms are important in understanding sex differences in depressive symptoms. Sixty-three adolescent psychiatric inpatients (32 boys, 31 girls), ages 12 to 16 (M = 13.87, SD = 1.36), completed measures of positive and negative affect and anxious and depressive symptoms. Results demonstrated, as predicted, that depressive and anxious symptoms were more highly associated in adolescent girls than boys. Furthermore, girls with depressive symptoms were more likely to have comorbid anxious symptoms than boys with depressive symptoms. Sex differences were not found for adolescents with specific depressive symptoms and specific anxious symptoms (i.e., the absence of comorbidity). Our findings supported the possibility that sex differences in pure forms of depression are overestimated and that comorbid internalizing conditions may be more prevalent in adolescent girls than boys.

Adolescent↗
PubMed1999

Mechanically induced potentials in fibroblasts from human right atrium.

It has been shown that cardiac fibroblasts of the human heart are electrically non-excitable and mechanosensitive. The resting membrane potential of these cells is -15.9+/-2.1 mV and the membrane resistance is 4.1+/-0.1 G[Omega]. Rhythmic contractions of the myocardium associated with stretch of the surrounding tissue produce reversible changes in the membrane potential of cardiac fibroblasts. These mechanically induced potentials (MIPs) follow the rhythm of myocardial contractions. Simultaneous recording of the action potential of cardiomyocytes and MIPs of cardiac fibroblasts demonstrates a delay of 40.0+/-0.4 ms after the action potential before the appearance of the MIP. Contraction produces a MIP which is more positive or more negative than the reversal potential - the membrane potential due to current injection at which the MIP reverses its direction. Regardless of the initial orientation of the MIP, intracellular polarization increases the amplitude towards the reversal potential if the background MIP had depolarized the membrane or away from the reversal potential if the initial background MIP had hyperpolarized the membrane. Artificial intracellular polarization changed the amplitude but not the frequency of the MIP. The pool of electrically non-excitable mechanosensitive cells, which change their electrical activity during contraction and relaxation of the heart, may play a role in the mechano-electrical feedback mechanism which has to be taken into account in the normal function of the heart as well as in pathological processes.

Aged↗
PubMed1998

Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial.

CONTEXT: The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults. OBJECTIVE: To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder. DESIGN: Randomized, double-blind, placebo-controlled trial. PATIENTS: One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents). SETTING: Twelve US academic and community clinics with experience conducting randomized controlled trials. INTERVENTION: Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo. MAIN OUTCOME MEASURES: The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales. RESULTS: In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements. CONCLUSION: Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.

Adolescent↗
PubMed1998

Electrophysiological properties of mechanosensitive atrial fibroblasts from chronic infarcted rat heart.

Electrically non-excitable but mechanosensitive right-atrial fibroblasts are thought to be involved in the chronotropic response of the heart to stretch. After myocardial infarction, altered chronotropic response may be due to the remodeling process which also involves the right atrium. Remodeling is associated with the development of hypertrophy of cardiomyocytes and proliferation of fibroblasts. Electrical properties of atrial mechanosensitive fibroblasts from chronic infarcted hearts and their possible role for altered chronotropic response has not, to our knowledge, been studied until now. Thus, resting membrane potential as well as mechanically induced potential of fibroblasts, action potential (AP) of cardiomyocytes, spontaneous frequency and mechanical activity of preparations from the sinus node region were studied 10 weeks after myocardial infarction induced by ligation of the left coronary artery in rats. The prolongation of AP repolarization (increases in APD50 and APD90) correlated closely to the infarct size (IS) and the degree of hypertrophy, respectively. Along with increasing IS, membrane potentials of fibroblasts were shifted to more negative values, with a peak of frequency distribution at -15 mV (control and very small IS), at -35 mV (intermediate IS), and -55 mV (large IS), and spontaneous electrical activity was decreased. Membrane resistance of fibroblasts also correlated to IS and was eight-fold greater at large IS than in control. We hypothesize that, in the infarcted heart, increased membrane potential and membrane resistance of fibroblasts may alter electrical activity of neighbouring myocytes in the sinus-venosus region via intercellular electrical coupling.

Animals↗
PubMed1998

Decreased susceptibility of contractile function to hypoxia/reoxygenation in chronic infarcted rat hearts.

Cardiac hypertrophy is associated with modifications in Ca2+ transport processes, enzymes of energy metabolism and antioxidant capacity. It is unknown whether these changes occur in infarct-induced hypertrophy with regard to an altered susceptibility to ischemia/reperfusion injury. We examined changes in sarcoplasmic reticulum (SR) Ca2+ transport, creatine kinase (CK) system, and the antioxidant enzymes glutathionperoxidase (GSH-Px) and superoxide dismutase (SOD) in rats 6 weeks after infarction due to coronary ligation (MI). Phenotypic modifications v sham operation (SHAM) were related to the contractile response of hypertrophied papillary muscle to hypoxia/reoxygenation for 30 min each. Under aerobic conditions we observed in MI v SHAM: decreases in isometric contraction and relaxation rate, a reduced Vmax-equivalent of sarcomeric shortening, a faster twitch-to-twitch decay of post-rest potentiation (PRC) which correlated closely to the decrease in SR Ca2+ uptake (-25%), a decrease in CK activity (-20%), reduced CK-MI and CK-MM, increased CK-MB and CK-BB, and enhanced activities of SOD (40%) and GSH-Px (50%). During hypoxia, an initial increase in peak force (PF) was followed by a slower PF decline in MI v SHAM. Reoxygenation caused a recovery of PF to approximately 30% in both groups; rates of contraction and relaxation recovered better in MI. In SHAM but not MI, twitch-to-twitch decay of PRC was accelerated after reoxygenation v aerobic control. The results suggest that adaptive changes in SR Ca2+ handling, CK isoenzymes and antioxidant enzymes may contribute to higher resistance against reduced oxygen supply and reoxygenation in hypertrophy due to MI.

Animals↗
PubMed1998

Attributional style and depression in pregnant teenagers.

OBJECTIVE: Study 1 evaluated whether pregnancy is a stressful life event for teenagers and is associated with depression for teenagers with a pessimistic attributional style but not for those with an optimistic attributional style. Study 2 replicated unexpected findings from study 1. Study 3 evaluated whether pregnant teenagers with a pessimistic attributional style will be more depressed after childbirth than optimistic pregnant teenagers. METHOD: In study 1, 122 pregnant and 96 nonpregnant teenagers completed questionnaires assessing depression and attributional style. In study 2, 43 pregnant teenagers and 49 nonpregnant teenagers completed the same questionnaires. In study 3, subjects from studies 1 and 2 were contacted by mail and asked to complete the same questionnaires; 63 (38%) did so. RESULTS: In studies 1 and 2, pregnant teenagers with a pessimistic attributional style were less depressed than those with an optimistic attributional style and the nonpregnant group. In study 3, pessimistic teenagers experienced a higher level of depression than nonpessimistic adolescents following childbirth. CONCLUSIONS: Pregnancy may serve to protect pessimistic teenagers from experiencing depression. The subsequent demands of motherhood may remove any protection from depression afforded by the pregnancy. The experience of depression being relieved by another pregnancy may be a previously unidentified risk factor for repeated pregnancies in teenagers.

Adolescent↗
PubMed1998

HIV/AIDS education survey for mental health professionals.

A total of 6804 mental health professionals, e.g., licensed and certified psychologists, licensed professional counselors, in Arkansas, Louisiana, New Mexico, Oklahoma, and Texas were mailed a questionnaire regarding HIV/AIDS topics professionals might recommend for educational programs. Participants were asked to rate how strongly they would recommend each topic. The return rate was 31% (2121). The percentage of participants who did not recommend the topics was low (0.7%-10.9%). Most topics were either recommended (6.5%-50.2%) or strongly recommended (29.0%-92.8%). Topics with ratings of 80% of participants endorsing the strongly recommended rating included psychological crises associated with learning one is HIV positive, psychosocial issues, and counseling dying clients regarding grief, loss, and legal issues. The results are discussed in terms of continuing to develop educational programs targeting mental health professionals.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Contractile function of papillary muscle from rats with different infarct size after beta-adrenergic blockade and ACE-inhibition.

We tested whether ACE-inhibition with ramipril (A), beta-adrenergic blockade with metoprolol (beta) or combined treatment (beta A) for 6 weeks after inducing myocardial infarction in rats by left coronary artery ligation modifies contractile function of hypertrophied papillary muscle from left ventricles with different infarct size (IS) compared to a placebo group (P). At IS<40% of left ventricle, contraction and relaxation were less impaired than at IS>40% compared to sham operated rats (SO). Isometrically developed peak force and calcium sensitivity of myofilaments, measured in skinned fibres, were significantly higher in beta. Treatment with ramipril or metoprolol improved contraction rate and force development, respectively, mainly at IS<40%, but deteriorated relaxation rate. ACE-inhibition and beta-adrenergic blockade had no significant improving effect on the relaxation rate and further characteristics of the contractile function at IS>40%, although combined treatment reduced the infarct size and ramipril treatment suppressed the development of hypertrophy. Post-extrastimulatory potentiation was increased in beta and beta A at IS>40%. Post-rest potentiations were influenced hardly at IS<40% and were significantly smaller in A at IS>40%. The twitch-to-twitch decay of the potentiations was faster at IS>40%. Increase in the degree of post-extrastimulatory potentiation, steeper twitch-dependent decay of the potentiations and loss of rest-dependent potentiation at IS>40% indicate relatively increased trans-sarcolemmal Ca2+ transports via Ca2+ channels and Na+/Ca2+ exchange, partly modified by ramipril and metoprolol. The results demonstrate that ACE-inhibition and beta-adrenergic blockade induce a dissociation between trophic effects and phenotypic effects on contractile function after chronic infarction.

Adrenergic beta-Antagonists↗
PubMed1996

Parental, child-centered attributions and outcome: a meta-analytic review with conceptual and methodological implications.

Eight empirical studies which bear on the relation between parents' "child-centered" attributions for children's problems and parental satisfaction or child adjustment were meta-analyzed. The parental attributional dimensions of stability and globality garnered the most support as correlates of parental satisfaction and/or children's adjustment; the dimensions of intent, selfish motivation, and blame received initial support and warrant further study. Important methodological and conceptual issues were identified and improvements are suggested. The need for prospective designs aimed at determining the causal relation, if any, between parental attributions and outcome, thorough assessment of attributions and the events which impinge upon them, detailed measurement of symptom and satisfaction variables, a wider array of child diagnoses, and establishment of parental diagnoses, are emphasized.

Adolescent↗
PubMed1996

Prevalence and correlates of psychopathology in pregnant adolescents.

PURPOSE: To investigate the prevalence and correlates of psychopathology, as measured by the Youth Self-Report Scale, in pregnant adolescents so that interventions during pregnancy may be tailored to treat the psychopathology and thereby improve maternal and child outcomes. METHODS: Scores on seven psychologic syndromes (withdrawn, delinquent, aggressive behaviors; anxiety/depression; and social, thought, and attention problems) were compared for groups of pregnant adolescents (n = 185), never pregnant teenagers (n = 126), and previously published normative samples of clinically referred (n = 518) and nonreferred (n = 518) female adolescents using chi-square, Student's t-tests, analysis of covariance, or multiple logistic regression. Correlates of psychopathology were identified for the pregnant sample using odds ratios and 95% confidence limits. RESULTS: Pregnant adolescents exhibited less serious or lower rates of psychopathology than groups against which they were compared. Correlates of psychopathology included substance use during pregnancy, prior assault, maternal childbirth before age 18 years, ethnicity, > or = 3 sexual partners, and absence of a relationship with the baby's father. CONCLUSIONS: Although the prevalence of psychopathology was lower among pregnant patients, those who exhibit psychopathology are likely to engage in risky health behaviors that contribute to poor perinatal outcome.

Adolescent↗
PubMed1996

Major depression and anxiety disorders associated with Norplant.

BACKGROUND: Norplant is a relatively new long-acting subdermal implant system that is used widely for contraception. In a recent report, Wagner and Berenson described two cases of Norplant-associated major depression and panic disorder. These were the first reports of severe psychiatric disorders linked to the use of Norplant. METHOD: Five cases are described of women who developed major depression, two of whom also developed obsessive-compulsive disorder and one of whom also developed agoraphobia, while using the Norplant system. RESULTS: These women who had no prior psychiatric history developed major depression within 1 to 3 months after Norplant insertion. The depression worsened over time and in all cases resolved within 1 to 2 months after Norplant removal. There was no recurrence of depression after 7 to 8 months in four cases available for follow-up. In addition to major depression, obsessive-compulsive disorder developed in two women and symptoms of agoraphobia developed in one woman during Norplant treatment, which resolved after Norplant removal. CONCLUSION: These cases provide further support for the association between Norplant and major depression, as well as a broad spectrum of anxiety disorders. It is important to design prospective studies to carefully examine the incidence of major depression and anxiety disorders in women who use Norplant. Risk factors for these disorders require further clarification.

Adult↗
PubMed1994

Medical liability claims and lawsuits filed against the University of Texas System involving adult psychiatric patients.

A survey was conducted to investigate medical liability claims filed against the University of Texas System (the U.T. System), physicians, and/or institutions concerning care of adult psychiatric patients. There were 34 such claims filed between 1978 and 1991 that had closed by December 1991. In many of these cases, medical record documentation was determined to be inadequate. Of the 34 claims filed, only seven were settled on behalf of U.T. personnel or U.T. institutions. Of these seven settlements, the mean monetary amount paid per case on behalf of U.T. System and non-U.T. System parties was $98,678.57. The two categories with the largest number of claims were 1) cases involving suicides, and 2) cases involving adverse reactions to medication. The largest award was $350,000, paid on behalf of U.T. physicians, a private physician, and non-U.T. institutions for alleged negligent failure to diagnose Cushing's disease. Of this amount, only $150,000 was paid on behalf of U.T. physicians. Risk management strategies should be implemented to address areas of liability in psychiatry residency programs.

Adult↗
PubMed1994

Norplant-associated major depression and panic disorder.

BACKGROUND: Norplant is a long-acting subdermal implant system that is widely used for contraception. The implant releases a continuous dose of levonorgestrel, a synthetic progestin. Although oral contraceptives are associated with depression and panic disorder, no cases have been reported of psychiatric disorders secondary to the use of Norplant. METHOD: Two women, aged 18 and 29 years, are described who developed major depression and panic disorder while using the Norplant system. RESULTS: These women who had no prior psychiatric history developed major depression and panic disorder 1 to 2 months after insertion of Norplant system capsules. The symptoms worsened over the course of a year. Following removal of Norplant, the symptoms of depression and anxiety resolved within 1 month. CONCLUSION: The progesterone content of oral contraceptives has been linked to major depression and panic disorder. Since Norplant is a progestin-only preparation, it is likely that some women will develop these disorders. These cases illustrate the importance of careful follow-up for adolescents and adults who select Norplant for contraception. Patients should be informed about the possible occurrence of psychiatric disorders. When evaluating new onset of depression and panic disorder in adolescent and adult women, it is important to inquire about Norplant insertion.

Adolescent↗
PubMed1993

Malpractice litigation against child and adolescent psychiatry residency programs, 1981-1991.

A national survey was conducted to investigate malpractice litigation at United States child and adolescent psychiatry residency programs between 1981 and 1991. Fourteen percent of the directors of child and adolescent psychiatry reported at least one malpractice claim during this period. The highest percentage of lawsuits reported was in the northeast. Suicide and sexual abuse of latency age patients by other patients accounted for the most litigation. The mean monetary award was $167,000, and the largest award was $500,000 for discharge of a patient who killed his mother. There has been an increase in malpractice litigation during the past 10 years. Risk management strategies should be implemented to address areas of liability in child and adolescent psychiatry training programs.

Adolescent↗
PubMed1993

Fluoxetine treatment of trichotillomania and depression in a prepubertal child.

The case of a ten-year-old boy with a two-year history of trichotillomania and depression is presented. Imipramine was unsuccessful in treating trichotillomania and showed limited success in alleviating depression. Treatment with low-dosage fluoxetine (10 mg daily) led to marked improvement of both trichotillomania and depression.

Behavior Therapy↗