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Biomedical subjects

L L Altshuler

Publications and source records attributed to L L Altshuler.

79 records · Page 5Linked to original sources
PubMed1986

Mutism: review, differential diagnosis, and report of 22 cases.

Mutism is a common manifestation of both psychiatric and neurologic illness. Psychiatric disturbances associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurologic disorders producing mutism involve the basal ganglia, frontal lobes, or limbic system structures. In psychiatric and neurologic conditions, mutism is often associated with other signs of catatonia. The authors review the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes. Methods to discriminate among the many causes of mutism in the clinical setting are discussed, and 22 new cases of mutism are reported to emphasize the wide differential diagnosis.

Adolescent↗
PubMedDate not supplied

Hormonal changes in the postpartum and implications for postpartum depression.

The months following childbirth are a time of heightened vulnerability to depressive mood changes. Because of the abrupt and dramatic changes occurring in hormone levels after delivery, many studies have examined the role of hormonal factors in postpartum depression. The authors review the literature on potential hormonal etiologies in postpartum depression, in particular for progesterone, estrogen, prolactin, cortisol, oxytocin, thyroid, and vasopressin. While evidence for an etiologic role is lacking for most hormones, changes in certain hormonal axes may contribute to depressive mood changes in some women following childbirth.

Depression, Postpartum↗
PubMedDate not supplied

Pharmacological management of premenstrual disorder.

Over the last decade there has been increasing recognition of premenstrual disorders, and numerous treatments have been tried for symptom relief. A literature search using Medline was conducted to locate all articles written in English and including the terms "premenstrual treatment," "premenstrual syndrome," "late luteal phase dysphoric disorder," or "menstruation and mood" over the last 30 years. Although more than 300 articles were retrieved, only one-third of them described double-blind studies and just 41 of the double-blind studies involved prospective diagnosed patients. The definition of the disorder varied across studies, as did research design and outcome measures. Many studies did not assess for Axis I comorbidity, which may have a significant impact on drug response. We attempted to do a metaanalysis of the existing double-blind, prospectively diagnosed studies, broken down by drug class and symptom reduction. However, we could not make statistical comparisons within or across drug groups to assess efficacy of treatment for specific symptoms due to differences in outcome-assessment measures across studies. Several promising pharmacological strategies exist to treat the patient with premenstrual dysphoric disorder. We review double-blind studies for each class of drugs, highlight some open studies, and present guidelines. Additional double-blind studies with prospectively diagnosed patients are needed. Standardization of definition, design, and outcome measures used in this field is important to enable direct comparison across studies of different treatment strategies.

Clinical Protocols↗
PubMedDate not supplied

Course of psychiatric disorders across the menstrual cycle.

Women of reproductive age with psychiatric disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest an exacerbation of symptoms during the premenstrual and menstrual phases. The usefulness of such reports is limited, however, by the lack of prospective assessments and the small number of patients involved. Additionally, many reports do not specify whether the exacerbations reflect an intensification of the underlying psychiatric disorder or a new onset of symptoms that occur only during certain phases of the menstrual cycle. Because symptomatic intensification has been reported for illnesses including schizophrenia, bipolar disorder, depression, anxiety disorders, bulimia nervosa, and substance abuse, the data bring attention to the importance of assessing the relationship between a female patient's symptomatic exacerbation and the menstrual-cycle phase in which it occurs. We present a review of the literature on the course of psychiatric symptoms across the menstrual cycle and discuss the potential effects of estrogen and progesterone on these symptoms.

Female↗
PubMedDate not supplied

Depressive symptoms in the perimenopause: prevalence, assessment, and guidelines for treatment.

This review describes the biological changes occurring in perimenopause and analyzes epidemiological studies that shed light on the relationship between perimenopause and mood. The role of estrogen as a treatment for depressive symptoms is also examined. We found that a positive association may exist between depressive symptoms and the perimenopause, and that a prior history of depression may be associated with such symptoms. In most of the studies reviewed, the use of estrogen in replacement doses appears to improve depressive symptoms in perimenopausal patients who do not have major depression. We suggest an approach to the treatment of middle-aged women presenting with such symptoms. No careful study of the incidence of DSM-IV major depression associated with perimenopause has been done, and the efficacy of estrogen as a primary or adjunctive treatment for the disorder during perimenopause is unclear.

Adult↗
PubMedDate not supplied

Relationship between prior course of illness and neuroanatomic structures in bipolar disorder: a preliminary study.

OBJECTIVE: In this preliminary study, we examined the relationships between prior course and severity of illness and size of the hippocampus, temporal lobes, and third and lateral ventricles in patients with bipolar disorder. BACKGROUND: The few studies that have investigated relationships between course of illness measures and neuroanatomic structures in patients with bipolar disorder found divergent results. METHOD: Twenty-six outpatients, who met Diagnostic and Statistical Manual, Third Edition - Revised (DSM-III-R) criteria for bipolar disorder, received a magnetic resonance imaging (MRI) scan, from which volumes of the temporal lobes, hippocampi, third ventricle, and areas of the lateral ventricles were calculated. Prior course of illness variables were determined using the NIMH Life-Chart Method and were correlated to the volumetric measures of neuroanatomic structures using multiple regression analyses. RESULTS: A longer duration of illness was paradoxically associated with a larger left temporal lobe volume whether patients with a history of substance abuse were removed from the analyses. CONCLUSIONS: Additional studies are needed to both replicate and further examine the association of prior course of illness and larger hippocampal and ventricular volumes in bipolar disorder.

Adult↗