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Biomedical subjects

M Fava

Publications and source records attributed to M Fava.

At least 145 records · Page 8Linked to original sources
PubMed1993

[Renal scintigraphy with captopril in the evaluation of renovascular hypertension].

The administration of an angiotensin-converting enzyme (ACE) inhibitor transitorily reduces the GFR in a kidney with renal artery stenosis, effect that can be ascertained with scintigraphic studies using ACE inhibitors. We evaluated the clinical usefulness of captopril renography (CR) in the diagnosis of renovascular hypertension (RVH) in 51 hypertensive patients in which this diagnosis was suspected. All subjects underwent angiography and RVH was diagnosed when renal artery stenosis exceeded 60%, there was lateralization of renal vein renin or there was a concordant clinical outcome. Renography was performed 15 minutes after Lasix administration, using Tc-99m DTPA, before and 60 minutes after the oral administration of 50 mg of captopril. The scintigraphic criteria for a positive test were a decreased split renal function, a delayed peak uptake, a decreased excretion of DTPA and a prolonged transit time. In three of 28 patients in whom angiography discarded RVH, CR was positive. In the 23 patients with confirmed RVH, CR was positive in 10 of 12 with unilateral stenosis, in 3 of 8 with bilateral stenosis and 1 of 3 with stenosis in a transplanted kidney. The overall sensitivity and specificity of the test for RVH was 60.9% and 89.2% respectively. There were no changes in blood pressure or adverse effects after captopril administration. We conclude that CR in RVH is useful to select patients for further studies (angiography) and to perform a functional interpretation of angiographic alterations.

Adolescent↗
PubMed1993

Drug interactions in psychopharmacology.

The importance of psychotropic drug interactions has become increasingly evident in recent years. Although drug interactions may lead to therapeutic benefits, they also may result in diminished efficacy of drug therapy or may cause toxic or life-threatening reactions. To avoid these unwanted effects, it is important for the clinician to be aware of the basic principles that govern drug interactions.

Drug Interactions↗
PubMed1992

Psychological, behavioral and biochemical risk factors for coronary artery disease among American and Italian male corporate managers.

Differences in psychological, behavioral and biochemical risk factors for coronary artery disease (CAD) among male corporate managers of 2 countries (United States and Italy), with very different age-specific rates of mortality for CAD were evaluated. In all, 129 American (mean age 43 +/- 7 years) and 80 Italian (mean age 45 +/- 7 years) managers volunteered to participate in this study. Each subject was administered several questionnaires assessing various psychological and behavioral risk factors for CAD, and all 129 Americans and 55 of 80 Italians had their blood drawn between 8:00 and 9:30 AM after overnight fasting for the measurement of plasma levels of dehydroepiandrosterone-sulfate (DHEA-S), total cholesterol, triglycerides, and apolipoproteins A-I and B. Italian managers reported significantly more cynicism and hostility, and less enjoyment in leisure activities than did American ones. Furthermore, 40 Italian (51%) and only 18 American (14%) managers were smokers (this difference being statistically significant). Although no significant differences were found in factors positively related with CAD (cholesterol, triglycerides and apolipoprotein B), there were clear differences in parameters inversely correlated with the incidence of CAD. Italian managers had significantly lower levels of plasma DHEA-S and apolipoprotein A-I than did American ones. In conclusion, this study found that Italian managers had a significantly more unhealthy psychological and behavioral profile than did American ones, and had lower levels of those biochemical parameters (apolipoprotein A-I and DHEA-S) thought to have a protective role against development of CAD.

Administrative Personnel↗
PubMed1992

High-dose fluoxetine in the treatment of depressed patients not responsive to a standard dose of fluoxetine.

In a four-week, open label study of major depression, 15 patients who had failed to respond to a trial of fluoxetine 20 mg/day of 8-12 weeks duration were then treated with fluoxetine 40 mg/day for one week and then, if tolerated, with either 60 or 80 mg/day. The mean HAM-D-17 and CGIS scores of these 15 patients decreased significantly at the end of 4 weeks on a higher dosage of fluoxetine (60 or 80 mg/day) with respect to the beginning of the four-week study. No significant side-effects were noted.

Adolescent↗
PubMed1992

The thyrotropin response to thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients.

We evaluated the predictive value of the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) in 32 depressed outpatients completing a double-blind placebo-controlled trial of s-adenosyl-l-methionine (SAMe), which failed to show any significant difference between SAMe and placebo. Treatment response was defined as the change in Hamilton Rating Scale for Depression (HRSD-24) score between baseline and the end of the six-week trial. Subjects with TSH response outside the normal range (7-25 uU/ml) had a significantly greater response than patients with a normal response. There was also a significant correlation between absolute deviations from the mean TSH response (16 uU/ml) and changes in HRSD-24 scores.

Adolescent↗
PubMed1992

Accumulation of fluoxetine and norfluoxetine in human brain during therapeutic administration.

In vivo 19fluorine nuclear magnetic resonance spectroscopy was used to measure the brain concentration of fluoxetine and norfluoxetine in five patients with obsessive-compulsive disorder and three with major depression. The mean brain:plasma ratio of the parent drug plus the metabolite was significantly elevated to 2.6 (SD = 1.0) (95% confidence interval = 1.9-3.3). This accumulation may have implications for understanding both the therapeutic and the toxic effects of fluoxetine.

Adult↗
PubMed1992

[Computed tomography guided fine needle aspiration biopsies].

Computed tomography (CT) allows the performance of fine needle aspiration biopsies in situations in which ultrasound or conventional X rays do not correctly visualize the lesion or the needle tract. One hundred four patients with a clinical suspicion of neoplasia were subjected to CT guided percutaneous aspiration biopsies in a lapse of 6 years. The most frequently biopsied organs were the lung (39.5%), liver and gallbladder (20.2%) and pancreas (15.4%). Forty nine percent of procedures were performed in the thorax and 51% in the abdomen. Of 51 patients with suspicion of thoracic cancer, there was only one false negative and no false positive results, with an overall accuracy of 98%. For abdominal procedures, there were no false positive results, although there were 6 false negative results, specially for pancreatic or retroperitoneal lesions. Overall accuracy for abdominal procedures was 88%. It is concluded that CT guided fine needle biopsy is a safe and accurate method for the diagnosis of thoracic and abdominal lesions.

Abdominal Neoplasms↗
PubMed1991

Perceptual asymmetry, plasma cortisol, and response to treatment in depressed outpatients.

Perceptual asymmetries as indicated by dichotic listening tasks have been associated with both subtype of depression and response to antidepressant treatment. To examine the association between this relatively new measure and more traditional measures of hypothalamic-pituitary-adrenal axis (HPA) activation in depression, we assessed perceptual asymmetry and basal plasma cortisol in a sample of depressed outpatients undergoing a double-blind, placebo-controlled medication trial. Each measure was examined for its ability to predict response to treatment. Perceptual asymmetry was significantly associated with plasma cortisol levels, and was also a significant predictor of treatment response. The association between plasma cortisol and treatment response did not reach significance. Our findings are limited by relatively small sample sizes but encourage further examination of perceptual asymmetry measures as predictors of treatment response and in relation to HPA activation in depression.

Adult↗
PubMed1991

Psychological and behavioral benefits of a stress/type A behavior reduction program for healthy middle-aged army officers.

Twenty army officers who participated in a stress/type A behavior reduction program and a comparison group of 17 officer nonparticipants volunteered to undergo a battery of psychological and behavioral tests before and after the program. Following the program, participants displayed a significantly greater reduction in average daily caloric intake and levels of perceived stress, anxiety, hostility, depression, psychological distress, and type A behavior as compared to the officers who did not participate in it. Given the fact that most of these psychological and behavioral factors have been found in previous studies to be related to an increased risk for coronary artery disease, it seems that the changes reported by the participants in the program are potentially healthful.

Adaptation, Psychological↗
PubMed1991

Sexual disinhibition during treatment with a benzodiazepine: a case report.

We are reporting a case of a woman with a history of drug abuse, alcohol abuse, and sexual promiscuity as a teenager who later on in life had become very religious, sober and sexually abstinent. A few years later, she began having anxiety and panic attacks, typically when in physical proximity to men and sought treatment. The patient became clearly sexually disinhibited while treated with clonazepam, a high potency anti-anxiety benzodiazepine, and her "inappropriate" sexual behavior ceased when the medication was discontinued. Given her history, it is likely that the medication weakened the already fragile defenses by the removal of the "warning signals" represented by her panic attacks. The result was a more direct expression of her sexual drive in the form of strip tease dancing and sexual promiscuity. This case suggests the importance of carefully examining the history of a patient's capacity for regulating sexual drive before prescribing an anti-anxiety drug.

Anxiety Disorders↗
PubMed1991

Anger attacks in depressed outpatients and their response to fluoxetine.

"Anger attacks" are spells of anger that are inappropriate to the situation and have physical features resembling panic attacks. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 79 consecutive patients (25 men and 54 women, mean age 38.8 +/- 10.3 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. Of these 79 depressed patients, 34 (13 men and 21 women) reported having anger attacks according to our criteria. The prevalence of anger attacks in a group of 31 younger depressed patients (48%) was significantly higher (p = .048) than that of 29 normal controls (21%) of similar age. Of the 79 depressed patients, 19 (7 men, 12 women) were treated openly with fluoxetine at 20 mg/day for at least 8 weeks. At pretreatment, 9 patients (47%) had reported anger attacks, only 3 (16%) continued to report them after treatment, and the difference was statistically significant (p less than .05).

Adult↗
PubMed1991

[Adverse reactions to intravascular contrast media].

Adverse reactions to intravascular contrast media are infrequent in radiological practice and rarely pose a life threatening risk. Contraindication to contrast injection should be evaluated and prophylactic measures taken, if available, in patients with risk factors for adverse reactions. Details of pathogenesis, frequency and management of adverse reactions for different contrast media are discussed.

Adolescent↗
PubMed1991

Suicidality and fluoxetine: is there a relationship?

A recent report of six depressed patients who developed intense, violent suicidal preoccupation after 2 to 7 weeks of fluoxetine treatment prompted the authors to survey 27 psychiatrists who treated 1017 depressed outpatient with antidepressants during 1989: 3.5% (8/231) of those treated with fluoxetine alone, 6.5% (4/62) of those treated with fluoxetine and tricyclics, 1.3% (5/385) of those treated with tricyclics alone or with lithium, and 3.0% (3/101) of those treated with other antidepressants became suicidal only after treatment with these antidepressants was initiated. None of these patients, however, reported intense suicidal thoughts of the degree described in the previously reported six cases. The difference in incidence of suicidal ideation occurring only after initiation of treatment was not significant between patients treated with fluoxetine alone and those receiving the other antidepressant treatments.

Ambulatory Care↗
PubMed1990

Neuroendocrine effects of S-adenosyl-L-methionine, a novel putative antidepressant.

S-adenosyl-L-methionine (SAMe), a putative antidepressant, is a naturally occurring substance whose mechanism of action is still a matter of speculation. It has been recently postulated that SAMe may increase the dopaminergic tone in depressed patients. Since dopamine inhibits both thyrotropin (TSH) and prolactin secretion, we investigated the effects of treatment with SAMe on the TSH and prolactin response to thyrotropin-releasing-hormone (TRH) stimulation in 7 depressed outpatient women (mean age: 46.1 +/- 7.2 years) and 10 depressed outpatient men (mean age: 38.0 +/- 10.0 years) participating in a six-week open study of oral SAMe in the treatment of major depression. At the end of the study, there was a significant reduction after treatment with SAMe in the response of both prolactin and TSH to TRH stimulation in the group of depressed men compared to pre-treatment values. On the other hand, in the group of depressed women, the posttreatment prolactin response to TRH did not appear to change when compared to pre-treatment and the TSH response to TRH challenge tended even to augment slightly after treatment with SAMe. Our results, at least in depressed men, seem to support the hypothesis of a stimulating effect of SAMe on the dopaminergic system.

Administration, Oral↗
PubMed1990

The antidepressant potential of oral S-adenosyl-l-methionine.

S-adenosyl-l-methionine (SAMe), a naturally occurring brain metabolite, has previously been found to be effective and tolerated well in parenteral form as a treatment of major depression. To explore the antidepressant potential of oral SAMe, we conducted an open trial in 20 outpatients with major depression, including those with (n = 9) and without (n = 11) prior history of antidepressant nonresponse. The group as a whole significantly improved with oral SAMe: 7 of 11 non-treatment-resistant and 2 of 9 treatment-resistant patients experienced full antidepressant response. Side effects were mild and transient.

Administration, Oral↗
PubMed1990

"Anger attacks": possible variants of panic and major depressive disorders.

The authors report a series of illustrative cases in which patients presented with sudden "spells" of anger with physical features that resembled panic attacks but lacked the affects of fear and anxiety. These spells or "attacks" of anger were experienced as uncharacteristic and were inappropriate to the situations in which they occurred. Since treatment of these attacks with antidepressants produced in each case marked improvements in behavior, the authors also formulate some hypotheses as to the nature of these episodes.

Adult↗