The dexamethasone suppression test in repeated hospitalizations.
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Adult↗
Biomedical subjects
L Grunhaus
Publications and source records attributed to L Grunhaus.
Depressive pseudodementia: a suggested diagnostic profile.
Severe cognitive and memory impairments often occur during episodes of depression, making it difficult to differentiate true dementia from depressive pseudodementia. The dexamethasone suppression test (DST) and the computerized tomography of the brain (CT scan) may aid in this problem. Eleven patients were assessed with the Hamilton Depression Rating Scale (HDRS), a Dementia Scale (DS), the overnight DST, and CT scans. Clinicians and raters were blind to DST results. All patients initially had high DS scores. These changed in most patients following antidepressant treatments. This study suggests a profile for the diagnosis of pseudodementia. Patients with cognitive impairment, dysphoric mood, abnormal response to the DST, and normal CT scan tend to have depressive pseudodementia. Patients with the first three features but with an abnormal CT scan likely have depression and structural brain pathology. Both groups respond to antidepressant treatments, although the latter continued to have some cognitive dysfunction during euthymia. A third group, the "true" dementia patients, may have abnormal CT scans and a normal DST response but larger samples are needed for confirmation.
Aged↗
Mitral valve prolapse and panic attacks.
Patients complaining of recurrent spontaneous panic attacks (RSPA) are frequently seen in emergency rooms and psychiatric outpatient services. The symptomatology of RSPA suggests some underlying cardiac pathology. Recent publications in the psychiatric literature have reported a high incidence of mitral valve prolapse (MVP) in patients complaining of RSPA. In our study we report a 39% incidence of MVP in a psychiatric population with RSPA. The importance of this finding is yet to be determined.
Adult↗
Treatment of spontaneous panic attacks with chlomipramine.
Recurrent spontaneous panic attacks are psychophysiological symptoms present in panic disorder and agoraphobia with panic attacks. Effective pharmacological treatment for panic attacks is essential to any treatment plan for these conditions. The authors administered chlomipramine to 20 patients who had panic disorder or agoraphobia with panic attacks, and after 8 weeks of treatment 75% of the patients with each diagnosis were asymptomatic. These results support the claim that chlomipramine is highly effective in preventing recurrence of panic attacks.
Adult↗
Panic attacks. A review of treatments and pathogenesis.
In the psychiatric literature, panic attacks have been considered as part of the clinical manifestations of anxiety neurosis, agoraphobia, functional cardiovascular disturbances, and the phobic depersonalization syndrome. Even though recurrent spontaneous panic attacks are described in these entities, the importance ascribed to them has been minor one. Therefore, panic attacks are poorly understood from a psycho-physio pathological point of view. In the past years, new trends in the nosology of psychiatric disorders have grouped the recurrent spontaneous panic attacks under the heading "panic disorder and agoraphobia with panic attacks." In this view, we present the results of the controlled pharmacological trials on patients complaining of panic attacks. Some relationships between panic attacks, panic disorder, and agoraphobia are discussed.
Adrenergic beta-Antagonists↗
Twenty-four-hour rhythm of prolactin depressive patients.
Twenty-four-hour rhythms of serum prolactin (PRL) levels were studied in seven depressive patients. Blood was collected through an indwelling catheter and the PRL level was determined by homologous double antibody radioimmunoassay. Findings showed a different pattern of secretion of prolactin among depressives as compared to the normal 24-hour rhythm of the hormone. A statistically significant elevation of PRL levels during the evening, several hours before sleep, was found. Morning PRL levels were slightly higher and the average increase of PRL level from one determination to the consecutive one was higher among the depressives. It is assumed that there may be a connection between the diurnal rhythmicity of mood, characteristic of vital depression, and the different 24-hour rhythmicity of PRL level.
Adjustment Disorders↗
Neuroleptic malignant syndrome due to depot fluphenazine.
The parenteral long-acting phenothiazines are drugs frequently used in the treatment of hospitalized and ambulatory psychiatric patients. The usual side effects of these drugs are familiar to psychiatrists. However, the "Neuroleptic malignant syndrome" reported in this paper can give rise to considerable diagnostic difficulty. The clinical characteristics and differential diagnosis of this syndrome are described with a care report. The need for prompt initiation of adequate therapy is stressed.
Adult↗
Genetic control of human plasma creatine phosphokinase activity.
Plasma creatine phosphokinase (CPK) activity was determined in 14 monozygotic (MZ) and 14 dizygotic (DZ) twin pairs. The heritability indexes calculated for plasma CPK activity indicated support for the hypothesis that plasma CPK activity is under some genetic control. This finding is discussed in relation to various diseases in which plasma CPK activity is increased.
Creatine Kinase↗
Lithium inhibition of adrenaline-stimulated adenylate cyclase in humans.
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Adenylyl Cyclases↗
A twin study of human red blood cell catechol-o-methyl transferase.
Significant sibling-sibling and within-family correlations of human red blood cell catechol-o-methyl transferase activity have suggested a high degree of genetic control over levels of activity of this catecholamine-related enzyme. However, family studies do not disentangle genetic from environmental similarities as causative of within-family correlations. We therefore undertook a human twin study using the monozygotic-dizygotic comparison method. Twelve pairs of monozygotic twins had an intraclass correlation of 90 in red blood cell catechol-o-methyl transferase activity, and seven pairs of dizygotic twins had an intraclass correlations of 37. Heritability of the enzyme activity was estimated by different methods as between 68-100 per cent.
Adolescent↗
Relapse and recurrence following a course of ECT: reasons for concern and strategies for further investigation.
Patients treated with electroconvulsive therapy (ECT) have a more severe illness. This severity is evidenced in the clinical profile of the illness, in the course of the illness, in the resistance to pharmacotherapy, and in the high relapse and recurrence rates after the course of ECT. In this article the authors explore some of the issues, particularly those of biological correlates of severe mood disorders and the continuation of treatment after ECT, which may be factors in this increased severity. The authors propose avenues for the investigation and treatment of severe mood disorders treated with ECT.
Antidepressive Agents↗
Self-reported diurnal mood changes, early morning awakening and the dexamethasone suppression test in endogenous depression.
Several authors have suggested that Dexamethasone Suppression Test (DST) non-suppression is related to circadian alternations of hypothalamic-pituitary-adrenal function. Two clinical manifestations of altered circadian rhythms in depressed patients are early morning awakening and diurnal variation in mood. To observe whether these clinical symptom patterns were associated with an increased frequency of abnormal DSTs, we examined post-DST plasma cortisol concentrations and matched clinical ratings of early morning awakening and diurnal variation in mood in 49 patients with major depressive disorder, endogenous subtype. We found no significant association between these clinical and laboratory variables.
Adult↗
Serial dexamethasone suppression tests in depressed patients treated only with electroconvulsive therapy.
Several systematic studies have evaluated serial dexamethasone suppression tests (DST) in patients with major depression who were treated with antidepressant medications. DST changes were noted to parallel clinical improvement in most recovering patients. If serial DSTs are a valid state-related correlate of depressive pathophysiology, all types of effective antidepressant treatment should result in DST 'normalization'. However, no treatment modalities other than antidepressant medications have been studied serially with systematic assessments. To test whether serial DSTs reflect clinical progress in depressives treated solely with electroconvulsive therapy (ECT), we studied weekly DSTs and Hamilton Rating Scales for Depression (HRSD) in 22 drug-free depressed patients. We observed progressive DST 'normalization' in most patients and moderately high correlations between weekly DST and HRSD values throughout treatment. Most patients receiving ECT became DST suppressors. In most patients the DST appeared to reflect the severity of depressive pathophysiology, perhaps providing serial feedback to clinicians monitoring the progress of treatment with ECT.
Depressive Disorder↗
Alexithymia and suicidality in panic disorder.
To evaluate the prevalence of suicidal behavior in patients with panic disorder (PD) and to study the role of alexithymia (AL), an affect component, as a predictor of suicidal behavior in PD, we compared 42 patients with PD with or without agoraphobia with 24 healthy controls with regards to depression, AL and suicide risk. Only 5% of the PD patients reported previous suicide attempts. A higher frequency of positive AL (score > 73) was found among the PD patients (39% v 4% among the controls). PD patients had a higher suicide risk and AL as compared to controls, but only the increased suicide risk reached statistical significance. AL subjects had higher suicide risk scores as compared to non-AL subjects. Significant correlations were found between the AL score and suicide risk, although the most significant correlation was, as expected, between the depression level and the suicide risk. A low rate of previous suicide attempts was found in the PD group, perhaps reflecting the low comorbidity in our sample. We suggest that AL may have a role in the causation of suicidal behavior in PD patients, although further studies should re-examine this issue with larger samples.
Adult↗
Cognitive behavioral group therapy in panic disorder patients: the efficacy of CBGT versus drug treatment.
The aim of our study was to evaluate the effectiveness of Cognitive Behavioral Group Therapy (CBGT) in the treatment of Panic Disorder (PD) and to compare the treatment outcome of CBGT versus Paroxetine pharmacotherapy. Fifty seven patients referred to our anxiety disorder clinic for the treatment of PD were randomly allocated to receive either CBGT or Paroxetine. Follow up was done by a masked rater after four and twelve weeks of treatment in order to compare the efficacy of CBGT versus Paroxetine. CBGT and Paroxetine were both effective in the short-term treatment of PD. Assessments at weeks four and twelve of treatment showed no statistically significant differences between the two groups in terms of treatment outcome. Treatment with CBGT alone for the acute phase of PD appears to be equally efficacious to treatment with Paroxetine alone. Our study shows that CBGT produced beneficial results, for it was associated with a reduction in the number and frequency of panic attacks and with an improved feeling of well-being.
Adult↗
Effects of yohimbine on cerebral blood flow, symptoms, and physiological functions in humans.
OBJECTIVE: Increases in adrenergic activity are associated with stress, anxiety, and other psychiatric, neurological, and medical disorders. To improve understanding of normal CNS adrenergic function, CBF responses to adrenergic stimulation were determined. METHODS: Using PET, the CBF changes after intravenous yohimbine, an alpha2-adrenoreceptor antagonist that produces adrenergic activation, were compared with placebo in nine healthy humans. Heart rate, blood pressure, Paco2, plasma catecholamines, and symptom responses were also determined. RESULTS: Among nonscan variables, yohimbine produced significant symptom increases (including a panic attack in one subject), a decrease in Paco2 due to hyperventilation, increases in systolic and diastolic blood pressure, and a trend toward a significant norepinephrine increase. Among scan results, yohimbine produced a significant decrease in whole-brain absolute CBF; regional decreases were greatest in cortical areas. Medial frontal cortex, thalamus, insular cortex, and cerebellum showed significant increases after normalization to whole brain. Medial frontal CBF change was correlated with increases in anxiety. A panic attack produced an increase instead of a decrease in whole-brain CBF. Factors potentially contributing to the observed CBF changes were critically reviewed. Specific regional increases were most likely due in large part to activation produced by adrenergically induced anxiety and visceral symptoms. CONCLUSIONS: This study supports the relationship of anxiety and interoceptive processes with medial frontal, insular, and thalamic activation and provides a baseline for comparison of normal yohimbine-induced CNS adrenergic activation, adrenergically-based symptoms, and other markers of adrenergic function to stress, emotion, and the adrenergic pathophysiologies of various CNS-related disorders.
Adrenergic alpha-Antagonists↗