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Biomedical subjects

M Fava

Publications and source records attributed to M Fava.

At least 109 records · Page 6Linked to original sources
PubMed1996

Traditional and alternative research designs and methods in clinical pediatric psychopharmacology.

OBJECTIVE: To review both traditional and alternative research designs and methods in pediatric psychopharmacology. METHOD: Study designs used in clinical trials in psychiatry were selected for review with the special considerations of pediatric psychopharmacological trials in mind. Where possible, a reference to a specific published trial in pediatric psychopharmacology was provided for each design. RESULTS: It appears that pediatric psychopharmacology trials require a relatively greater flexibility in design to avoid significant study biases. Alternative research designs may be preferable to the traditional approaches, particularly when the use of the latter may raise important issues of feasibility. CONCLUSIONS: Evolution of a clinical research hypothesis to a study protocol in pediatric psychopharmacology is a manageable task if one keeps in mind essential elements such as selection of study design, population, sample size, treatment duration, and efficacy assessments.

Adolescent↗
PubMed1996

Cynicism, hostility, and suicidal ideation in depressed outpatients.

Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.

Adult↗
PubMed1996

Patterns of personality disorder comorbidity in early-onset versus late-onset major depression.

OBJECTIVE: This study tested the hypothesis that in a population of adult outpatients with major depression, those with an early onset of depression would have a greater prevalence of personality disorders than those with a late onset of depression. METHOD: The 404 subjects were patients participating in depression treatment studies at the Massachusetts General Hospital. They were administered the Structured Clinical Interview for DSM-III-R-Patient Version to assess the current presence of major depression and the age at onset of the initial depressive episode. The subjects were then divided into two groups: those with early onset (before 18 years of age) and those with late onset (at age 18 or later). The prevalence of personality disorders was determined through use of the physician-rated Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the patient-rated Personality Diagnostic Questionnaire-Revised (PDQ-R). RESULTS: The patients with early onset of major depression had a significantly higher prevalence of avoidant, histrionic, narcissistic, and borderline personality disorders according to the SCID-II. The PDQ-R scores indicated that avoidant, dependent, passive-aggressive, histrionic, narcissistic, borderline, and antisocial personality disorders were significantly more prevalent among the patients with early onset of major depression. CONCLUSIONS: Overall, the results are consistent with the view that early-onset depressive illness is distinguished from late-onset major depression by more frequent association with persistent disturbances in behaviors and attitudes.

Adolescent↗
PubMed1996

Fluoxetine treatment of anger attacks: a replication study.

"Anger attacks" are outbursts of anger which are accompanied by intense autonomic arousal and are clearly inappropriate to the situation in which they occur. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 164 consecutive patients (78 men and 86 women; mean age, 40.5 +/- 11.0 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. These patients were treated openly with fluoxetine, 20 mg/day for 8 weeks, and the prevalence of anger attacks was assessed before and after treatment. At baseline, 64 (39%) (26 men and 38 women) of these patients reported having anger attacks according to our criteria. Forty-one (64%) of the 64 depressed patients with anger attacks at baseline did not report anger attacks following fluoxetine treatment, while 7 (7%) of the 100 patients who did not have anger attacks at baseline reported these attacks following treatment, with this difference being statistically significant (chi 2 = 22.7, p < .0005).

Adolescent↗
PubMed1996

[Pulmonary thromboendarterectomy: a case of surgical treatment of chronic pulmonary thromboembolism under circulatory arrest with deep hypothermia].

Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 year old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on April 27, 1995. After the operation the patient had an immediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities.

Adult↗
PubMed1996

[Percutaneous transluminal angioplasty (PTA) and intravascular stents in the treatment of central and peripheral venous stenoses of arteriovenous fistulae for chronic hemodialysis].

BACKGROUND: The maintenance of permeable vascular accesses in chronic hemodialysis patients is a major challenge. AIM: To report our experience in the percutaneous treatment of venous stenoses of arteriovenous fistulae for hemodialysis. PATIENTS AND METHODS: We studied retrospectively 48 patients with arteriovenous fistulae stenoses, that were followed during 24 months. When the fistulography disclosed an stenosis, a percutaneous transluminal angioplasty was performed. If indicated, an intravascular stent was installed or thrombolysis was done. These procedures were repeated as needed. RESULTS: Twenty four patients had a peripheral vein stenosis, 20 had subclavian vein stenosis and 4 had both veins compromised. All were dilated with percutaneous transluminal angioplasty. Five stents were installed in the subclavian vein and five in peripheral veins. Two patients required thrombolysis. The procedure was successful in 96% of peripheral lesions and 92% of central lesions. There was regression of superior limb edema in 16 of 20 patients. Five patients had an hematoma in the puncture site. Twelve months later, 61% of treated peripheral and 42% of subclavian treated veins remained patent. CONCLUSIONS: The use of percutaneous transluminal angioplasty and intravascular stents, maintains long term arteriovenous fistulae permeability and has similar results to surgical procedures.

Adult↗
PubMed1995

Social adjustment does not predict depressive relapse during continuation fluoxetine therapy.

The purpose of this study was to assess the relationship between social adjustment and the risk of depressive relapse during continuation antidepressant treatment. The Social Adjustment Scale-Self Report Version (SAS-SR) was used to assess a broad range of social functioning before and after acute treatment in 41 outpatients with unipolar depression who responded to fluoxetine and then continued on this antidepressant. No differences were detected between those who relapsed and those who stayed well with regard to pre- and posttreatment SAS-SR total or subscale scores. These data suggest that social functioning does not affect the risk of relapse while depressed patients are taking fluoxetine continuation treatment.

Adult↗
PubMed1995

Anger attacks in eating disorders.

As central nervous system serotonergic dysregulation has been postulated to exist in both eating and aggression disorders, we hypothesized that anger attacks would be more common among patients with eating disorders than among control subjects. In addition, we wanted to examine possible relationships between the presence of anger attacks and the type or severity of the eating disorder. Subjects were 39 normal female volunteers and 132 female outpatients with anorexia nervosa, bulimia nervosa, or both. Forty-one (31%) of the patients met criteria for anger attacks compared with four (10%) of the control subjects. Bulimic patients reported the highest prevalence of anger attacks to be associated with greater severity of illness. In addition, patients with eating disorders who have anger attacks had significantly more depressive symptoms than patients without these attacks. Central serotonergic function is involved in such diverse processes as feeding behavior, mood regulation, and anger and aggression. The higher prevalence of anger attacks among patients than among control subjects may reflect central hyposerotonergic function, found in previous studies to be present in both eating disorders and pathologic aggression. Supporting this interpretation is the finding that the prevalence of anger attacks increased, although nonsignificantly, with the severity of bulimia, which has previously been shown to be inversely correlated with central serotonergic activity.

Adolescent↗
PubMed1995

Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine.

A possible method of reducing the delay in antidepressant response is to use S-adenosyl-L-methionine (SAMe), a naturally occurring compound that appears to have a rapid onset of effect in the treatment of depression. In this open, multicenter study, 195 patients were given 400 mg of SAMe, administered parenterally, for 15 days. Depressive symptoms remitted after both 7 and 15 days of treatment with SAMe, and no serious adverse events were reported. Further studies with a double-blind design are needed to confirm this preliminary indication that SAMe is a relatively safe and fast-acting antidepressant.

Adolescent↗
PubMed1995

Gender differences in hostility among depressed and medical outpatients.

We assessed possible gender differences in state and trait hostility in a large sample of depressed outpatients and in a group of medical outpatients. We administered the Cook and Medley Hostility Scale, measuring trait hostility and aggressiveness, and the Symptom Questionnaire, including a state measure of irritability and hostility, to 218 depressed outpatients and 51 medical outpatients. There was a statistically significant positive correlation between severity of depression and our state measure of hostility, and a weak, although statistically significant, relationship between severity of depression and total score of our trait measure of hostility. Among depressed outpatients, trait hostility was greater in men than in women, while no significant gender difference was observed in state hostility. Among medical outpatients, the state hostility scale scores were significantly higher in men than in women. These gender differences in both groups remained significant even after adjusting for severity of depression. Thus, it appears that men with depression tend to have higher scores than women on state and trait measures of hostility, suggesting that men may be at greater risk than women of developing patterns of pathologic aggression and hostile behavior.

Adult↗
PubMed1995

The Mini-Mental State Examination among adult outpatients with major depressive disorder.

One hundred forty-eight patients, ages 18-65, with major depression were administered the Mini-Mental State Examination (MMSE) prior to 8 weeks of treatment with fluoxetine; 75 of these patients were readministered the MMSE following treatment. MMSE scores were not related to pretreatment severity of depression or to reported concentration problems and were not predictive of antidepressant response. Non- and partial responders had lower posttreatment MMSE scores than responders, men had lower posttreatment scores than women, and subjects over 50 had lower pretreatment scores than younger subjects, although in all cases, the magnitude of the differences was small and unlikely to be clinically important. Our results suggest that while the MMSE has been shown to be useful among geriatric and other depressed inpatients, it is not a sensitive indicator of depression severity, concentration problems, or likelihood of treatment response among otherwise healthy adults with major depression in an outpatient setting.

Adolescent↗
PubMed1995

Early nonresponse to fluoxetine as a predictor of poor 8-week outcome.

OBJECTIVE: The purpose of this study was to quantify the proportion of patients who show no response to a fixed dose of fluoxetine after 2, 4, and 6 weeks of treatment and then respond by week 8. METHOD: In an open trial, 143 outpatients who met DSM-III-R criteria for major depressive disorder were treated with a regimen of fluoxetine, 20 mg/day. The authors analyzed the proportion of patients who had less than a 20% decrease from baseline in their scores on the Hamilton Rating Scale for Depression after 2, 4, and 6 weeks and who went on to have a 50% or greater reduction by week 8. A last-observation-carried-forward strategy was used to calculate conditional probabilities of 8-week response. Kaplan-Meier survival analysis was used to estimate probabilities of response at week 8 given degrees of response at week 2. RESULTS: Eighty-two subjects (57.3%) who started the trial responded by week 8. Of those subjects who showed no improvement at weeks 2, 4, and 6, the proportions of responders at week 8 were 36.4%, 18.9%, and 6.5%, respectively. The Kaplan-Meier estimate of 8-week response given nonresponse at week 2 was 0.45. CONCLUSIONS: The proportion of patients with no response to antidepressant treatment by 4 or 6 weeks who responded by week 8 was substantially less than that for subjects who had at least a partial response. Nonresponse as early as week 2 predicted 8-week outcome.

Adult↗
PubMed1995

Gender differences in personality disorders.

OBJECTIVE: The aim of this study was to assess gender differences in personality disorders. Since heterogeneity of axis I diagnoses could introduce variability in the assessment of axis II diagnoses, the authors studied a group of patients with a primary diagnosis of major depression. METHOD: A total of 316 patients were evaluated with the Personality Diagnostic Questionnaire--Revised, a self-rating measure, or the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), a clinician-rated instrument, or both. Axis II disorders were assessed with the Personality Diagnostic Questionnaire--Revised for 288 patients with major depression. The SCID-II was administered to 117 subjects, with an additional 95 subjects receiving the SCID-II for cluster B diagnoses only. RESULTS: The mean 17-item Hamilton Depression Rating Scale scores for 108 men (mean age = 39.28 years) and 208 women (mean age = 39.11) were 19.0 (SD = 3.8) and 19.6 (SD = 6.9), respectively. Men were significantly more likely than women to meet criteria for narcissistic, antisocial, and obsessive-compulsive personality disorders as measured by the Personality Diagnostic Questionnaire--Revised and for narcissistic and obsessive-compulsive personality disorders as measured by the SCID-II. CONCLUSIONS: These findings are consistent with those of previous studies showing a greater prevalence of antisocial and narcissistic personality disorders in men. In contrast with other investigations, however, neither the Personality Diagnostic Questionnaire--Revised nor the SCID-II revealed a higher prevalence of any personality disorder in women.

Adult↗
PubMed1995

Patterns of improvement in depressive symptoms with fluoxetine treatment.

By definition, patients who respond to antidepressant treatment show significant improvements in most, if not all, of their depressive symptoms. We assessed the patterns of change in depressed outpatients treated openly with fluoxetine 20 mg/day for 8 weeks. We studied 62 depressed outpatients with major depressive disorder who showed full response following fluoxetine treatment. Analysis of the data revealed that the symptoms that tended to improve relatively early during treatment were suicidal ideation, excessive guilt, and lack of appetite. Our tentative conclusion from this pilot study was that symptom improvement tends to occur in both cognitive and neurovegetative areas early in treatment as well as later.

Adolescent↗
PubMed1995

Hypothyroidism and hyperthyroidism in major depression revisited.

BACKGROUND: The aim of our study was to evaluate the prevalence of thyroid abnormalities among depressed outpatients and to examine the response to treatment of those subjects with relatively low or high thyroid hormone levels. METHOD: Outpatients (N = 200) 18 to 65 years of age who met DSM-III-R criteria for major depression were screened for the presence of thyroid abnormalities using a number of thyroid indices. Of these patients, 166 were then treated openly with the antidepressant fluoxetine for 12 weeks. We assessed whether patients with relatively low or high thyroid hormone levels had a different response to treatment compared with other patients. The 17-item Hamilton Rating Scale for Depression (HAM-D-17) was administered during the study to assess changes in depressive symptoms. Thyroid function was assessed by measuring T3, T4, free T4 index (FT4I), T3 uptake (T3U), and serum thyroid-stimulating hormone (TSH) levels. RESULTS: No clinical cases of hyperthyroidism or hypothyroidism were detected. Of the patients examined, 5 (2.6%) had slightly elevated TSH levels (range, 4.7-8.2); none of these had T4 or FT4I levels below the normal range. Subnormal levels of T4 or FT4I were found in 1 subject (0.5%). T3 and T3U levels were below the normal range in a larger number of patients (7.6% and 15.0% respectively), but only 1 of these patients had elevated TSH levels. None of the patients had levels of TSH below the normal range, and only 3 subjects (1.5%) had T4 levels above the normal range. No relationship was found between response rate (assessed as either change in HAM-D-17 score or as remission of depressive symptoms with a HAM-D-17 score < or = 7 for 3 consecutive weeks) and each of the thyroid tests, even after adjusting for baseline severity of depression. CONCLUSION: In depressed outpatients, it appears that hypothyroidism and hyperthyroidism are extremely uncommon and that the presence of subtle thyroid function abnormalities does not have an impact on treatment outcome.

Adolescent↗
PubMed1995

Relapse in patients on long-term fluoxetine treatment: response to increased fluoxetine dose.

BACKGROUND: Although several studies have examined the long-term efficacy of antidepressants, relatively little attention has been paid to the management of relapses or recurrences during continued antidepressant treatment. This study examined whether depressed patients who had recovered and then relapsed on fluoxetine 20 mg/day would benefit from an increase in fluoxetine dose. METHOD: Eighteen patients who relapsed on fluoxetine 20 mg/day during long-term treatment with fluoxetine as part of a placebo-controlled study had their fluoxetine dose raised to 40 mg/day and were followed for at least 1 month (mean time = 4.7 months). RESULTS: Twelve (67%) were full responders, 3 (17%) partial responders, and 3 (17%) dropped out because of side effects (e.g., insomnia and agitation). Of those patients who had either full or partial response (N = 15; 83%), 3 complete responders had a recurrence on 40 mg/day after a mean of 5.8 months and 1 partial responder had a recurrence 11 months later. Overall, 11 (61%) of 18 patients maintained their response during their follow-up while taking the higher dose of fluoxetine. CONCLUSION: An increase in dose of fluoxetine to 40 mg/day appears to be an effective strategy in the treatment of relapse among depressed patients who had initially responded to fluoxetine 20 mg/day.

Adult↗