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Biomedical subjects

L A Tupler

Publications and source records attributed to L A Tupler.

35 records · Page 2Linked to original sources
PubMed1996

A 2-year follow-up of social phobia. Status after a brief medication trial.

Although social phobia is thought to be a chronic disorder, little is known about its long-term course in patients who engage in brief treatment studies. We, therefore, conducted a follow-up study of social phobics who had participated in a brief, placebo-controlled treatment trial of clonazepam. Of the original 75 subjects, 56 were assessed through telephone interview and self-report questionnaires that evaluated current social phobia symptoms. Information was also gathered about treatment received in the 2-year interval since the initial pharmacotherapy trial. The group as a whole showed maintenance of the gains acquired during initial treatment. On a number of symptom scales, subjects initially treated with clonazepam exhibited significantly less severe scores compared with placebo subjects. This study provides evidence of long-term benefit for social phobics when treated with a brief medication trial.

Adult↗
PubMed1995

Alcohol pharmacodynamics in young-elderly adults contrasted with young and middle-aged subjects.

Effects of aging on ethyl alcohol (EtOH) pharmacodynamics were examined over progressive dosing schedules (0.4, 0.6, 0.8, 1.0 g/kg) in groups of young (25.0 +/- 2.9 years), middle-aged (41.1 +/- 6.6 years), and young-elderly adults (60.9 +/- 2.6 years) using three computerized cognitive-neuromotor tasks: digit-symbol substitution (DSS), keypad reaction time (KRT), and subcritical tracking (SCT). Hysteresis curves of performance impairment (adjusted for pre-drug baseline) as a function of blood alcohol concentration (BAC) were examined for time-course effects, and regression analyses were performed to assess the contribution of age beyond that accounted for by BAC. Results reflected differences in the patterning but not magnitude of impairment for elderly subjects, with earlier decrements and more rapid acute tolerance observed for DSS, in conjunction with less pharmacodynamic sensitivity for SCT. Regression analyses furthermore indicated that age and impairment were negatively related, arguing against synergistic intoxication effects as a function of aging. Analyses specifically comparing performance at baseline versus legally intoxicating BACs (> 1.0 mg/ml) likewise reflected a lack of interactive effects involving the elderly. Elderly subjects nevertheless exhibited significantly lower baseline performance for DSS and KRT than young subjects and achieved higher BACs with equivalent doses. These latter findings support the exercise of caution by elderly individuals consuming EtOH prior to engaging in neuromotor pursuits such as driving.

Adult↗
PubMed1995

Reliability of the Rey-Osterrieth Complex Figure in use with memory-impaired patients.

Rater reliability was evaluated for the system most widely used to assess copy and recall of the Rey Complex Figure: the Osterrieth (1944) 18-item scoring system. The study sample consisted of 95 subjects (49 males, 46 females), most of whom were elderly individuals (M = 59.83, SD = 15.21 years) suffering from memory impairment. Four raters rated copy and delayed-recall protocols, and three raters re-rated the protocols after an interval of 3 months. Results revealed excellent inter- and intra-rater reliability coefficients (.85-.97) for total scores. However, reliabilities for the 18 individual items ranged from poor (.14) to excellent (.96). Differences in both reliability and level of subject performance were observed as a function of item and conditions of copy versus recall. It is concluded that the Osterrieth scoring system supports excellent reliability in use with memory-impaired patients using total scores. Nevertheless, individual-item reliability would benefit from enhancement, for example, via amplified delineation of relevant decision criteria.

Adult↗
PubMed1995

Clinical and phenomenological comparisons of late-onset and early-onset depression.

OBJECTIVE: The authors examined the relationship between age at onset of first depressive episode and clinical features in elderly depressed patients. METHOD: They used data on age at onset and clinical features in 246 elderly depressed patients treated at the National Institute of Mental Health Clinical Research Center for the Study of Depression in Later Life, located at Duke University. RESULTS: Two variables--loss of interest and number of depressive episodes--were related to age at onset in all analyses. CONCLUSIONS: This study confirms the hypothesis that apathy is more prominent in late-onset than in early-onset depression.

Activities of Daily Living↗
PubMed1994

Emergency department patterns in psychiatric visits during the holiday season.

STUDY OBJECTIVE: To determine the prevalence of psychopathology during the holiday season and which subpopulations are at greatest risk for holiday decompensation. DESIGN: A retrospective analysis of emergency department records. SETTING: ED of a university-affiliated hospital located in a mixed urban-agricultural catchment area in North Carolina. PARTICIPANTS: Eight thousand seven hundred fifty-six patient visits to the ED, with subsequent triage for psychiatric evaluation, for a 6-year period (1987 to 1993), were analyzed. RESULTS: We observed seasonal patterns in visits, with a general decrease in visits preceding holidays followed by an increase afterward. Substance abusers, men, and black patients were more likely to visit the ED than expected, particularly during the weeks surrounding Christmas. CONCLUSION: These results support the existence of a "Christmas effect" on ED visitations by patients with psychiatric symptoms. Understanding of these patterns may help emergency physicians predict the seasonal variation of such patient visits and apply preventive measures accordingly.

Emergency Service, Hospital↗
PubMed1994

Treatment of social phobia with benzodiazepines.

Although social phobia is a common and highly treatable anxiety disorder, the majority of social phobics do not receive treatment. Without intervention, it is unlikely that patients will attain significant relief from the symptoms and disability associated with the disease. The authors review the results of studies concerning the use of high-potency benzodiazepines in the treatment of social phobia. These studies, which include open trials as well as a double-blind, placebo-controlled evaluation of clonazepam, have demonstrated clinical efficacy and suggest a therapeutic role for this drug class in the treatment of social phobia. Developmental work with the Davidson Brief Social Phobia Scale is described, along with predictors of treatment outcome for clonazepam and placebo and relapse data upon discontinuation of both treatments. Finally, the authors discuss general issues concerning the relapse of patients upon drug discontinuation, the long-term use of benzodiazepines, and other important issues concerning the use of these agents for the treatment of social phobia.

Alprazolam↗
PubMed1993

The Neurobehavioral Cognitive Status Examination: psychometric properties in use with psychiatric inpatients.

The present investigation sought to enhance clinical utility of the Neurobehavioral Cognitive Status Examination (NCSE; Northern California Neurobehavioral Group, Inc.) by providing reference scores for an inpatient psychiatric sample and assessing construct validity. A total of 866 patients (aged 15-92 years) received an NCSE 2 to 4 days after admission. Examination of means, standard deviations, z scores, and percent who passed each screening item revealed consistently poorer performance for psychiatric patients relative to the original normative sample. Pearson product-moment correlations between age and each NCSE subtest similarly yielded significant negative correlations, particularly on tests predicted to be differentially sensitive to aging. Intercorrelations between subtests, however, failed to yield expected patterns of performance. We conclude that the NCSE provides a moderately valid screening instrument for cognitive impairment.

Adolescent↗
PubMed1993

Neuroanatomical substrates of depression in the elderly.

The etiology of depression in the elderly is poorly understood. In this study, magnetic resonance imaging was used to evaluate the role of subcortical structures in the pathophysiology of depression in the elderly. Elderly depressed patients were found to have smaller caudate nuclei, smaller putaminal complexes and in increased frequency of subcortical hyperintensities compared with normal, healthy controls. These findings were more pronounced in patients with late-onset depression. Based on these findings, the authors discuss the role of the basal ganglia in the pathophysiology of depression in the elderly.

Age Factors↗
PubMed1993

Hypercortisolemia and hippocampal changes in depression.

Hypercortisolemia is a frequently observed abnormality in patients with major depression. It has been hypothesized that the hippocampus, as a major feedback site for glucocorticoids, is involved in the pathophysiology of hypercortisolemia. Some have in fact posited that the hippocampus is marked by diminished size in depressed patients with hypercortisolemia. We tested this hypothesis by examining the relationship between hippocampal volume, assessed with magnetic resonance imaging, and hypercortisolemia using the dexamethasone suppression test (DST) in a group of 19 depressed patients. No differences in hippocampal volume were observed between patients and control subjects (n = 30). Within the patient group, DST suppressors did not differ from DST nonsuppressors in hippocampal volume. However, a relationship between hippocampal volume and 11 p.m. cortisol concentration was observed after covariance adjustment for age and sex. Furthermore, significant negative correlations were observed between hippocampal volume and both age of depressive onset and number of hospitalizations. The results of this study therefore provide limited support for the hypothesis regarding an essential role of the hippocampus in the neuroendocrine elevation of glucocorticoids in depression.

Adult↗
PubMed1992

Neuropsychological importance of subcortical white matter hyperintensity.

Subcortical hyperintensity on magnetic resonance imaging is a common incidental finding in healthy elderly subjects. The relationship of such changes to cognitive functioning remains unclear, however, because only a small number of studies have examined this issue with conflicting results. We therefore assessed 66 healthy adult volunteers (mean [+/- SD] age, 61.8 +/- 15.8 years) with magnetic resonance imaging scans rated for subcortical hyperintensity, and with two neuropsychological instruments selected a priori on the basis of previous reports in the literature. Findings were highly significant for both the Benton Facial Recognition Test and the Wechsler Adult Intelligence Scale-Revised Digit Symbol. However, in both cases, the majority of variance was accounted for by age and educational level. Effects of subcortical hyperintensity were not significant. We conclude that subcortical hyperintensity in healthy adults does not relate to cognitive functioning, at least with these two instruments.

Aged↗
PubMed1988

On the independence of physical and nominal codes: a correlational analysis.

In studies of college students, normal children at three grades, and learning-disabled children, physical and nominal matching procedures were highly correlated, (range .72-.96). In each instance, expected time differences favoring physical matches were replicated. Comparable results were found with both tachistoscopic and paper-and-pencil methods. In two studies where relevant data were available, correlations were not significantly attenuated when the effects of motor speed were partialled out. The results challenge the premise that nominal and physical matching measures are empirically independent, invalidate their application as measures of independent types of information processing, and help explain inconsistent findings in hemispheric specialization research.

Adolescent↗
PubMedDate not supplied

A family study of chronic post-traumatic stress disorder following rape trauma.

There is evidence that familial factors serve as determinants of risk for post-traumatic stress disorder (PTSD), especially familial anxiety. This study investigates the relationship between chronic PTSD and family psychiatric morbidity. The sample was drawn from 81 female rape survivors with or without lifetime PTSD, 31 major depressive disorder controls, 20 anxiety disorder controls and 39 healthy controls. First-degree family members were directly interviewed (n = 285) and diagnoses assigned of major depressive, anxiety and alcohol or substance use disorder. Information was also available by family history for 639 relatives. In the directly interviewed sample, no consistently increased morbidity risk was observed for anxiety, PTSD, or alcohol/substance abuse in the rape survivor groups, but there was an increase in depression relative to the anxiety in healthy control groups. When comorbid depression in rape survivor probands was taken into account post hoc, an increased risk for depression was noted in family members of PTSD probands with depression, but not in relatives of PTSD probands without lifetime depression. Among rape survivor probands with non-comorbid PTSD, rates by history of familial anxiety and depression were negligible. In a logistic regression analysis, individual vulnerability to depression served as an independent predictor of chronic PTSD, along with specific trauma-related variables. In the family history group, results were consistent with those obtained from the directly interviewed group. Our findings clearly support the view that PTSD following rape is associated with familial vulnerability to major depression, which may thus serve as a risk factor for developing PTSD. The exact nature of this predisposition calls for further inquiry and there is a need to expand this study to include other PTSD populations. PTSD may on occasion represent a form of depression which is induced and/or modified neurobiologically and phenomenologically by extreme stress. Our findings may be a reflection of the sample composition, the current conceptualization of PTSD, or be related to study limitations.

Adolescent↗