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Biomedical subjects

O Lingjaerde

Publications and source records attributed to O Lingjaerde.

At least 19 recordsLinked to original sources

Thyroid function in seasonal affective disorder.

Morning serum levels of triiodothyronine (T3), free thyroxine (F-T4) and thyroid-stimulating hormone (TSH) were measured in Winter-Seasonal Affective Disorder patients in nondepressed state in summer and before and after light treatment in winter. Practically all patients had hormone levels well within the reference ranges. T3 and F-T4, but not TSH, were significantly higher in winter than in summer; this is considered a normal phenomenon. There was no significant correlation between hormone levels and severity of winter depression. Light treatment did not alter serum hormone levels.

Adult

A double-blind comparison of moclobemide and doxepin in depressed general practice patients.

A total of 56 patients attending a general practitioner for treatment of depression, most of whom met the criteria for major depression, were included in this double-blind, parallel group, 6-week study, in which the selective MAO-A inhibitor moclobemide (MOC; maximum dose 600 mg) was compared with the tricyclic antidepressant doxepin (DOX; maximum dose 250 mg). Thirty patients on MOC and 23 on DOX were assessed after treatment for at least 1 week and are included in the response evaluation. Improvement was assessed primarily with the Montgomery-Asberg Depression Rating Scale (MADRS). There were only 4 drop-outs in the MOC group and three in the DOX group after 1 week. Overall improvement measures showed a nonsignificant difference in favor of DOX. Two factors were found to have prognostic significance: (1) previous or present panic attacks (10 patients in the MOC group and--by chance--only one in the DOX group) were associated with significantly lower improvement within the MOC group. Since we had no a priori hypothesis about this effect, it could be a chance finding. (2) Improvement was negatively correlated with age; this was statistically significant in the total group as well as in the MOC group, with a nonsignificant trend in the same direction in the DOX group. Side effects differed little between the two groups; only dryness of mouth appeared with markedly higher frequency in the DOX group.

Antidepressive Agents

Personality disorders in patients with winter depression.

Sixty-six patients satisfying the criteria for seasonal affective disorder (SAD) winter depression type (n = 57) or subsyndromal SAD (n = 9), were interviewed in a nondepressed state with the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). Twenty-three percent of the patients in the SAD sample met DSM-III-R criteria for one or more categorical diagnosis of personality disorder (PD). Disorders in cluster C occurred in 18% of the sample, while 12% had cluster B PDs and 5% a cluster A disorder. The relative number of positive criteria, as a dimensional measure of PD, were higher for all cluster C disorders than for any PD in the other clusters. Our data indicate that the pattern of personality disorders in patients with winter SAD are similar to that previously reported for outpatients with non-SAD major depression. We explored the relationship between lifetime severity and clinical manifestation of SAD and dimensional measures of PD with multiple regression analyses. No significant association was found. This is in accordance with the hypothesis that the two disorders are distinct conditions with independent causes.

Adult

New perspectives on biological treatment of schizophrenia.

Recent research seems to indicate that many schizophrenics suffer from a defective brain development, which is reflected by basic disturbances in cognitive, information-processing, volitional and emotional functions. Positive symptoms like hallucinations and delusions may be secondary to the more basic disturbances. Varying degrees of defective brain development places a ceiling on the functional improvement that can be obtained in this illness. However, whereas positive symptoms usually respond best to neuroleptics, even negative symptoms can be improved, for instance by clozapine. To obtain such improvement, it seems necessary, in addition to blocking dopamine D2 receptors, to influence other receptor systems, as for instance serotonergic 5HT-2 and possibly dopaminergic D1 and/or D4 receptors. Stimulation of glutamatergic NMDA receptors also seems to be a promising possibility.

Antipsychotic Agents

Risperidone versus perphenazine in the treatment of chronic schizophrenic patients with acute exacerbations.

Risperidone (RIS), a new neuroleptic with 5-HT2- and dopamine D2 receptor-blocking properties, was compared with perphenazine (PER) in a double-blind, multicentre, parallel-group study in 107 chronic schizophrenics with acute exacerbation. RIS 5-15 mg or PER 16-48 mg daily was given for 8 weeks. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression. Seventy-eight patients completed the trial; there was an equal number of dropouts on both drugs. The mean daily dose at endpoint was 8.5 mg RIS and 28 mg PER. The reduction in total PANSS score to endpoint did not differ significantly, although there was a tendency in favour of RIS. The number of patients with predominantly negative symptoms who showed at least 20% reduction in total PANSS score was significantly larger in the RIS group. Furthermore, the number of patients showing at least 20% reduction in Brief Psychiatric Rating Scale (BPRS) score (BPRS being a subscale of PANSS) was significantly larger in the RIS group. The hostility cluster of BPRS improved more on RIS than on PER in the endpoint analysis. The overall prevalence of side effects was fairly similar in the two groups.

Acute Disease

[Drug therapy of depression in general practice].

The authors advocate use of the Montgomery-Asberg Depression Rating Scale in general practice as a screening instrument for depression. A score of 20 and above for more than two weeks indicates a need for treatment with antidepressant drugs. The treatment should continue with full dosage for at least two months after the patient has been cured. In order to maintain the patient's quality of life, reduce risk of drug-related toxicity and improve compliance, we recommend alfa-2-receptor blocker, a selective 5HT-re-uptake inhibitor or a selective monoamino-oxidase A inhibitor as the first drug choice for treatment of depression by general practitioners. Monitoring serum levels of the drug may be helpful, especially in persons who do not respond to treatment.

Antidepressive Agents

Benzodiazepines in the treatment of schizophrenia: an updated survey.

Reports on the effects of benzodiazepines in schizophrenia have appeared since the early 1960s. Conclusions drawn from these studies, most of which have been uncontrolled, have ranged from worse than placebo to better than neuroleptics. A critical appraisal of the literature seems to warrant the following main conclusions. Benzodiazepines alone, in conventional doses, have no convincing antipsychotic effect in schizophrenia, although they may reduce anxiety, tension and insomnia. However, very high doses of diazepam, and possibly other benzodiazepines, may have a symptomatic antipsychotic effect, especially in paranoid-hallucinatory schizophrenics, also when given alone. Benzodiazepines, in conventional doses, can enhance the antipsychotic effect of neuroleptics in schizophrenics who have not responded satisfactorily to neuroleptics alone. This effect may be most conspicuous against hallucinations, but improvement may also be obtained from delusions, thought disturbances, some negative symptoms, anxiety and tension. Some benzodiazepines may be more effective than others in schizophrenia, but this has been insufficiently elucidated.

Anti-Anxiety Agents

[Schizophrenic patients and the emotional climate in the family. Causes, consequences and treatment of intensely expressed emotions of close relatives].

In recent years it has been shown that the course of schizophrenia is influenced by the attitudes and behaviour of the close relatives with whom the schizophrenic person lives. In particular, there is greater risk of relapse if family members show a high degree of criticism, hostility, or emotional over-involvement in relation to the schizophrenic; these attitudes have been described as high expressed emotion (High EE) and are usually assessed by means of the Camberwell family interview. However, as discussed in this paper, there are still many unsettled questions regarding content, validity, causes, effects, and treatment of High EE.

Attitude to Health

Prevalence of reported sleeplessness in northern Norway in relation to sex, age and season.

As part of a comprehensive population health survey in the municipality of Tromsø, north of the Arctic Circle, men between 20 and 54 years and women between 20 and 49 years were presented a questionnaire containing questions about sleeplessness and its possible association with season. Of the 14,667 respondents, 41.7% of the women and 29.9% of the men said they were sometimes bothered by insomnia. Insomnia not associated with any special time of the year was reported by 16.9% of women and 16.2% of men; insomnia in the "dark period" (midwinter insomnia) was reported by 17.6% of women and 9.0% of men; insomnia in the midnight-sun period or in spring or autumn was much less common. Difficulty falling asleep was the most common type of insomnia, especially in winter and summer. Overall, the frequency of insomnia increased with increasing age, but with some notable differences with regard to type (initial insomnia showed little relation to age, whereas middle and late insomnia increased markedly with age) and seasonal type (insomnia in the midnight-sun period decreased with age, whereas the other seasonal types increased with age).

Adult

Attention deficit disorders: a study of peptide-containing urinary complexes.

In several behavioral disorders, we have observed that abnormal amounts of peptides and protein-associated peptide complexes are excreted in the urine. The gel filtration patterns of these excreted substances have some specificity for the different disorders. The urinary excretion of peptide-containing complexes was studied in 91 boys and 13 girls (mean age 9.4 years, range 1-23) with the clinical diagnosis of attention deficit disorder (ADD), with or without hyperactivity. The gel filtration of urine precipitate showed patterns in all patients that were different from those seen in 36 normal controls. Sixty-four patients had increased benzoic acid-glycoprotein-peptide complexes in the late peaks. The symptoms of all these patients fit the criteria for diagnosis of attention deficit disorder with hyperactivity (ADDH). Thirty-five patients showed reduced amounts of uric acid complexes in the late peaks. Clinically, this group, with the exception of three patients, fit the criteria for diagnosis of attention deficit disorder without hyperactivity. Five patients showed reduced amounts of all urinary complexes; four of these were hyperactive. Moderate exercise in control children did not change the urinary pattern. One urinary peptide fraction from hyperactive patients, purified to homogeneity, increased the uptake of 14C[5-HT] in platelets. Strict clinical, neuropsychological, and psychophysiological selection of the patients reduced the heterogeneity of the patterns. Although more studies are needed, the findings seem promising for the possibility of developing biochemical tests that may be helpful diagnostically.

Adolescent

The uptake, storage, and efflux of serotonin in platelets from migraine patients.

A recently developed method for analysing 5-hydroxytryptamine (5-HT) efflux from platelets preloaded with a small amount of 14C-5-HT enables the assessment of the relative size of the granular and the cytoplasmatic pools of 5-HT within the platelets and of the rate of spontaneous efflux from these two compartments. This method, together with conventional assessment of the 5-HT uptake measures Km and Vmax, was applied in this study, comparing platelets from 14 patients with common migraine and 10 patients with classic migraine with platelets from 25 healthy controls. All patients were unmedicated and in an attack-free period. Neither the total patient group nor either of the two subgroups differed significantly from the control group on any measure of 5-HT uptake or efflux. However, two differences approached the conventional significance level: the relative size of the granular compartment (Compartment III) was larger for classic than for common migraine, and the efflux rate from Compartment III was shorter for classic migraine than for the healthy controls (P approximately 0.10 in both cases). Further studies are required to show whether these differences are real and, if so, whether they have any relevance for the pathogenesis of migraine attacks.

Adolescent

Effects of the benzodiazepine receptor ligands midazolam, Ro 15-1788, and Ro 5-4864, alone and in combinations, on platelet serotonin uptake.

The benzodiazepine (BZ) agonist midazolam, the BZ antagonist Ro 15-1788, and the peripheral BZ binding site ligand Ro 5-4864 have been assessed, separately and in combinations, as to their effect on the active uptake of serotonin (5HT) in human blood platelets in vitro, in an artificial, protein-free medium. Midazolam had a moderate noncompetitive (or mixed competitive/noncompetitive) inhibitory effect on the uptake. This effect was not influenced by Ro 15-1788, which in itself had only a very weak inhibitory effect. Ro 4-5864 showed in several independent experiments (but not always) a biphasic inhibitory effect, with a moderate but significant inhibition in the concentration range of about 10(-8) to 10(-6) M, and a stronger, noncompetitive inhibitory effect above 10(-6) M. When Ro 5-4864 was tested in the presence of a fixed concentration of midazolam (4 X 10(-6) M), the inhibitory effect of the former was markedly reduced (at higher concentrations), eliminated (at intermediate concentrations), or even reversed into a relative stimulatory effect (at low concentrations). Thus, low concentrations of Ro 5-4864 reduced the inhibitory effect of midazolam. A possible explanation of this interaction is that low concentrations of Ro 5-4864 have both an inhibitory and a stimulatory effect on platelet 5HT uptake (often seen to vary in relative strength between experiments), and that the stimulatory component is unmasked in the presence of a drug that already has an inhibitory effect, probably mediated by the same site.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzodiazepines