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Biomedical subjects

L L Altshuler

Publications and source records attributed to L L Altshuler.

At least 73 records · Page 4Linked to original sources
PubMed1994

Rapid resolution of first episodes of mania: sleep related?

BACKGROUND: While sleep deprivation has been observed to precipitate mania, the relationship between sleep and resolution of mania is less well understood. We observed a rapid reversal of manic symptoms in several patients hospitalized for mania who slept many hours on Night 1 of hospitalization. We therefore undertook to study this relationship more systematically. METHOD: Charts for all patients admitted with a diagnosis of bipolar disorder, manic within a 2-year period were retrospectively reviewed. Patients were assigned to a group called "rapid responders" if improvement in symptoms, as described in progress notes, was moderate by Day 2 of hospitalization. Patients were "nonrapid responders" if improvement in symptoms was minimal or mild by Day 2. Sleep records, medications, and demographic data were obtained by researchers blind to the patients' response status on Day 2 of hospitalization. RESULTS: Compared with the 27 patients who did not have a rapid response, the 7 rapid responders were significantly more likely to (1) be in a first manic episode, (2) have a stressor associated with the onset of mania, (3) sleep more hours the first night of hospitalization, and (4) spend fewer days in the hospital. CONCLUSION: The possibility is raised that sleep restoration might induce a rapid antimanic response in patients experiencing their first episode of mania. The clinical implications of a rapid reversal of mania--including a reduction in number of hospital days--are discussed.

Adult↗
PubMed1994

Course of psychiatric disorders in pregnancy. Dilemmas in pharmacologic management.

Although it is generally believed that pregnancy is a time of emotional well-being, many women develop or have a recurrence of psychiatric illness during this time. The risks associated with leaving a woman untreated during pregnancy are potentially substantial and must be weighed against the risks of exposing the fetus to the potentially teratogenic medications. Large prospective and retrospective studies suggest a relative safety of use of tricyclic antidepressants during pregnancy. Data available for neuroleptics, lithium, benzodiazepines, and the anticonvulsants valproic acid and carbamazepine, although mixed, point to increased risks of congenital malformations in the children of mothers exposed to these agents in the first trimester of pregnancy. Very little is known about the behavioral abnormalities in offspring of mothers exposed to these agents. Animal studies suggest changes in brain receptor number and function in the offspring of mothers on a variety of psychotropic drugs studied to date. The few human studies do not suggest long term effects, but given the very limited data, no definitive conclusions can be drawn. Large epidemiologic follow-up studies of children exposed to medication in utero may help clarify questions relating to behavioral changes and thus help guide clinical decisions.

Abnormalities, Drug-Induced↗
PubMed1990

Depression, anxiety, and temporal lobe epilepsy. Laterality of focus and symptoms.

The association between anxiety, depression, and lateralization of an epileptogenic focus was explored in 18 adult patients with a left temporal lobe focus, 21 with a right focus, 20 with bilateral temporal foci, and 16 individuals with absence seizures. No significant difference in the level of anxiety was found among the groups. However, patients with left-sided temporal lobe epilepsy scored significantly higher than other groups on self-ratings for depression. This could not be accounted for by factors such as duration of epilepsy, employment status, education, age at seizure onset, or medication status. The left temporal lobe epilepsy group had a nonsignificantly larger number of males and left-handed subjects. The possible interactions between gender, handedness, seizure focus, and vulnerability to depression are described.

Adult↗
PubMed1990

The hippocampus and parahippocampus in schizophrenia, suicide, and control brains.

Recent postmortem studies in schizophrenia have shown abnormalities in medial temporal lobe structures, including the hippocampus and parahippocampus. We tried to replicate previous studies and to explore the specificity of this finding to schizophrenia. The anterior hippocampus and parahippocampal cortex were evaluated for area and shape in postmortem tissue from 12 schizophrenic, 17 nonschizophrenic suicide, and 10 nonpsychiatric control brains. No significant differences were found in hippocampal area, but the parahippocampal cortex was significantly smaller in the schizophrenic group than in the control group. When parahippocampi from right and left sides were analyzed separately, both the suicide and schizophrenic groups had smaller parahippocampi on the right side than did the controls [corrected]. The suicide group exhibited greater parahippocampal areas in the left than in the right tissue samples within the group, while such a difference did not exist in the schizophrenic or control groups. This study demonstrated changes in temporal lobe structures in both schizophrenic and nonschizophrenic suicide groups.

Adult↗
PubMed1990

Carbamazepine prophylaxis in refractory affective disorders: a focus on long-term follow-up.

Twenty-four patients with refractory affective disorders who were taking carbamazepine were followed in an open-label fashion for an average of 4 years. Carbamazepine, usually in combination with lithium and other previously ineffective medications, reduced the number and severity of manic and depressive episodes. An overall illness index of morbidity (duration x severity) decreased 72% in the first year and 66% in the second year of carbamazepine treatment. One-half of the patients (N = 11) who were followed for more than 2 years showed a pattern of continued improvement (stable); the other half showed loss of prophylaxis (escape). Those showing the escape pattern had a more rapidly deteriorating course of illness in the 4 years before the study than those showing the stable improvement. Clinical and mechanistic implications of these findings are discussed, including the phenomenon of contingent tolerance as a possible explanation for the emergence of loss of efficacy in a subgroup of patients.

Adult↗
PubMed1990

Treatment of rapid cycling bipolar illness.

Rapid cycling patients (greater than or equal to 4 episodes/year) often show inadequate response to lithium carbonate and are vulnerable to antidepressant-induced switches or cycle acceleration. Treatment with the anticonvulsant carbamazepine is now an accepted adjunct or alternative, and a series of uncontrolled studies also suggest the utility of valproate in this patient population. Clonazepam, suppressive doses of thyroid, calcium channel blockers, and other innovative treatments appear promising and deserve careful clinical investigation.

Bipolar Disorder↗
PubMed1989

Lymphocyte function in major depression.

Immunologic function as measured by lymphocyte response to phytohemagglutinin (PHA) mitogen was evaluated in 8 psychiatric inpatients. All were less than 45 years of age and had a DSM-III diagnosis of major depression. When patient's immunologic responses were compared with healthy age- and sex-matched controls, a significant increase in PHA mitogen stimulation was observed in the depressed group. Further, a significantly greater variance in PHA response was observed in the patients compared with controls. The literature on depression and immunity is reviewed and the clinical implications of our findings are discussed.

Adult↗
PubMed1989

Temporal lobe measurement in primary affective disorder by magnetic resonance imaging.

Magnetic resonance imaging brain scans were performed on 17 patients with primary affective disorder and 21 normal subjects. A coronal slice through the temporal lobes at the level of the pons and interpeduncular cistern was selected in each subject, and specific temporal lobe structures and the cerebral area were measured. Ratios between structures of the same hemisphere were calculated. The ratio of the temporal lobe to cerebral area was smaller in patients than controls both on the left (p less than .02) and on the right (p less than .03). The data suggest that patients with primary affective disorder may have a relative decrease in the size of the temporal lobe compared with normal controls.

Adult↗
PubMed1988

Who seeks mental health care in China? Diagnoses of Chinese outpatients according to DSM-III criteria and the Chinese classification system.

The authors gave DSM-III diagnoses to 116 Chinese psychiatric outpatients in Shanghai and compared them with the diagnoses of the same patients made by a Chinese psychiatrist according to Chinese criteria. Affective disorders were the most common DSM-III diagnoses, accounting for 26.7% of the sample. A full range of psychopathology, including schizophrenia, organic mental disorders, adjustment disorders, anxiety disorders, and paranoid disorders, was seen. Some consistent differences in diagnosis by Chinese and Western standards, especially in the area of major depression, were found. The authors discuss the implications for interpreting psychiatric studies from China and for future cross-cultural research comparing U.S. and Chinese diagnoses.

Adult↗
PubMed1987

Hippocampal pyramidal cell orientation in schizophrenia. A controlled neurohistologic study of the Yakovlev collection.

The finding of marked disorganization of the hippocampal pyramidal cell layer in the brains of schizophrenic patients has recently been reported. The present study was undertaken to determine whether similar abnormalities could be found in the brains of a population of schizophrenic patients, most of whom were never exposed to neuroleptics. Though statistical analysis of 2808 pyramidal cells failed to reveal significantly greater disorganization in a group of seven alleged schizophrenic brains than in brains of age-matched, nonpsychotic controls, the data suggest a relationship between the degree of pyramidal cell disarray and the severity of behavioral impairment due to psychosis. The implications and pitfalls in interpreting these findings are discussed.

Adult↗
PubMed1987

Effect of interrupted sleep patterns and partial sleep deprivation on DST and mood in psychiatric house officers.

To gain further insight into clinical associations seen in depression, the authors investigated the effect of interrupted night-time sleep on the HPA axis and mood in 20 psychiatric house officers taking overnight call. Specific interest was in whether multiple awakenings could induce a positive DST. No statistically significant association emerged between number of nocturnal awakenings, number of hours of sleep deprivation or temporal occurrence of sleep deprivation and cortisol, DST or mood. The results suggest that cortisol and DST changes are not likely to be causally linked to, or epiphenomenon of disrupted sleep. The implications of these findings for major depression are discussed.

Adult↗
PubMed1986

Prolongation of the antidepressant response to partial sleep deprivation by lithium.

Depressed patients given a loading dose of lithium on the first of 2 successive days of partial sleep deprivation (PSD), and kept at maintenance levels thereafter, showed significantly greater prolongation of the antidepressant effects of PSD than patients treated with PSD and placebo, even though the acute elevation in mood derived from PSD was as great on placebo as on lithium. Depression was assessed 3 days after PSD with an augmented version of the Hamilton Rating Scale for Depression. Patients on lithium alone, without PSD, did not have the acute elevation in mood seen in the two PSD groups and had significantly less improvement in depression than those who received PSD with lithium.

Adult↗