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Biomedical subjects

R A Remick

Publications and source records attributed to R A Remick.

At least 55 records · Page 3Linked to original sources
PubMed1989

Evening urine cortisol excretion and DST results in depression and anorexia nervosa.

Cortisol determination in a single one-hour urine sample collected between 2200 h and 2300 h has been shown to identify accurately patients with Cushing's disease. To examine the usefulness of this procedure for identifying psychiatric patients with a pituitary-adrenal disturbance, we studied 17 drug-free depressed patients, 6 euthymic anorectic patients and 10 healthy volunteers. We found that there was good agreement between DST results and evening urine cortisol excretion in this sample (when cortisol levels were expressed as ng of cortisol per mg of creatinine), and that adopting as a criterion a urine cortisol value two standard deviations above the mean cortisol value of the controls predicts 74% of the dexamethasone suppression test (DST) results. We would like to suggest that this measure deserves further study as a potentially useful and simple alternative to the DST for identifying psychiatric patients with a pituitary-adrenal disturbance.

Adolescent↗
PubMed1989

Reduction of post-ECT memory complaints through brief, partial restricted environmental stimulation (REST).

1. A previous paper (Suedfeld, et al. 1987) reported on preliminary results of placing patients into a room with substantially reduced environmental stimulation (REST) immediately after recovery from ECT. 2. Comparing two depressed patients who had undergone this experience with three who had instead returned to their own hospital room (Ward), Suedfeld et al. (1987) found that the former registered much fewer complaints concerning memory loss related to ECT administration than the latter. 3. The current report extends this finding to a total of 19 patients, of whom 13 completed four testing sessions. Once again, objective tests of memory showed no significant change as a function of ECT. Both groups of patients complained of substantial memory disruption after the first ECT. By the one-week follow-up, such complaints were minimal among REST patients but showed only a slight decline among the Ward group. This was the only significant intergroup difference.

Adult↗
PubMed1989

Common side effects associated with monoamine oxidase inhibitors.

There is relatively little documentation on the common side effects associated with monoamine oxidase inhibitors (MAOI) and their frequency of occurrence. A retrospective chart review of patient records in a Mood Disorders Service was completed. Side effects of patients receiving phenelzine (N = 42) and tranylcypromine (N = 19) were rated as mild (resulting in no change in treatment), moderate (some modification in treatment plan necessary), and severe (definite change in treatment plan or drug discontinuation due to MAOI side effect). A total of 35 reports of side effects were noted in 15 of 19 tranylcypromine patients (1.84 per patients) and a total of 125 side effect reports were noted in 39 of 42 phenelzine patients (2.98 per patient). Only two severe tranylcypromine side effects occurred (resulting in drug cessation for one of these patients - hypotension), while 9 severe reactions occurred with phenelzine, resulting in drug discontinuation in 6 of these patients. The side effects for tranylcypromine and the number of reports were insomnia (N = 10), sedation (N = 8), hypotension (N = 5), sexual dysfunction (N = 3), hypomania (N = 3), weight gain/edema (N = 2), hypertensive episode (N = 2), and myoclonic jerking (N = 2). The number of reports of phenelzine side effects were insomnia (N = 26), hypomania/mania (N = 27; most common reason for drug cessation - 4), hypotension (N = 16; three cases considered severe), weight gain/edema (N = 15), sedation (N = 15), sexual dysfunction (N = 13), hypertensive episode (N = 6), and myoclonic jerking (N = 7).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Effect of morphine on cortisol and prolactin secretion in anorexia nervosa and depression.

Endogenous opioid peptides are involved in feeding regulation, and alterations in opioidergic regulation have been implicated in the pathophysiology of eating disorders. To investigate further this hypothesis, we conducted a placebo-controlled study of the effect of the opiate alkaloid morphine on cortisol and prolactin secretion in six patients with anorexia nervosa and six age-matched healthy volunteers, and compared the results with those obtained in nine depressed patients. Basal cortisol but not basal prolactin levels were elevated in patients with anorexia nervosa and patients with depression. Following the administration of morphine plasma concentrations of cortisol levels declined progressively and at a similar rate in all three groups. The prolactin response to morphine was attenuated significantly in patients with depression. Neither the cortisol and prolactin response to morphine in the anorectic patients nor the cortisol response in the depressed patients we observed in this study suggests altered opiate receptor sensitivity. However, the decreased prolactin response to morphine in depressed patients remains compatible with this hypothesis.

Adolescent↗
PubMed1989

Treatment resistant depression.

Despite major research efforts in mood disorders, careful scientific studies and evaluations of "treatment resistant depression" (TRD) are limited. Treatment resistant depression often encompasses several conflicting definitions and concepts: (1) the distinction between 'absolute' TRD and 'relative' TRD is seldom made; (2) the combination of a dysthymic disorder and a major depression ("double depression") can lead to diagnostic confusion when one disorder improves while the similar symptoms of the other persist; and (3) the literature becomes confused when ineffective prophylaxis and ineffective acute treatment are not separated. The research at our Center continues to suggest that the primary problem in this area remains 'relative' TRD. In a recent study of 114 patients referred to our Mood Disorders Service with a diagnosis of TRD, 59 of 98 (60.2%) had complete depressive symptom remission with appropriate treatment interventions. Further, the majority of these 59 successful treatment interventions were the 'bread and butter' treatments available to all physicians; 9 (15.3%) patients responded to an adequate trial of a tricyclic, 12 (20.3%) to a monoamine oxidase inhibitor, and 17 (28.8%) to a course of electroconvulsive therapy.

Antidepressive Agents↗
PubMed1988

Anticholinergic side effects of tricyclic antidepressants and their management.

Side effects associated with tricyclic antidepressant (TCA) therapy often leads to premature drug discontinuation. The most common side effects associated with TCA's are those related to the anticholinergic activity of these medicines. The peripheral anticholinergic complaints of dry mouth, constipation, ocular side effects and urinary hesitancy are described and specific clinical guidelines for their effective management are provided.

Antidepressive Agents, Tricyclic↗
PubMed1988

The lateralization of atypical facial pain.

Various theories have been proposed to explain the reported predominance of left-sided symptoms in patients with conversion disorders, psychogenic symptoms, and chronic pain. In a population of 110 patients with atypical facial pain (AFP), there were no significant differences in the side of pain or lateralization of pain between psychiatric and non-psychiatric patients. A non-significant trend to left-sided pain in psychiatric patients was found if only those patients with lateralized pain were examined. The significance of these results to etiological theories of chronic pain lateralization is discussed.

Conversion Disorder↗
PubMed1988

A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients.

Fifty-two adult depressed outpatients fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. Twenty-nine patients completed the seven week (one week placebo followed by six weeks of active drug) study. The mean daily dose of alprazolam and desipramine at study termination was 3.34 mg and 192 mg respectively. Based on psychometric ratings of depression (Hamilton Scale) and severity of illness (Clinical Global Impressions) there was no significant difference between alprazolam and desipramine at the end of six weeks of active drug treatment. Both medications were well tolerated with drowsiness being the most common side effect of alprazolam, and insomnia, dry mouth, and constipation, the complaints most associated with desipramine.

Adult↗
PubMed1988

Treatment resistant depression: a clinical perspective.

One hundred and fourteen patients with a diagnosis of "treatment resistant depression" (TRD) were assessed and treated at a Mood Disorders Clinic. Diagnostically, 52 (45.6%) subjects met criteria for bipolar disorder, 49 (42.9%) for recurrent depression, and 13 (11.4%) patients did not fulfill diagnostic criteria for affective disorder which explained their treatment resistance. With appropriate, individualized treatment, 59 of 98 (60.2%) patients had complete symptom remission based on clinical and psychometric ratings (initial Ham-D 26.7, final Ham-D 5.9). Eighteen of 98 patients had partial remission (final Ham-D 15.9) with vigorous pharmacological interventions, and 8 subjects exhibited "absolute" TRD (final Ham-D 23.4). The results suggest the value of specialized mood disorder services. The partial and absolute TRD's were more likely to be older, received more Axis II diagnoses, and had previous histories of drug or alcohol abuse.

Adult↗
PubMed1988

Weight gain with antidepressants and lithium.

Undesired weight gain is a common complaint of patients receiving pharmacological treatment for major affective disorders. It has been found to jeopardize patient compliance and may pose additional health hazards. A review of the literature on weight gain associated with tricyclic antidepressants, monoamine oxidase inhibitors, and lithium was carried out with the aim of deriving practical management strategies. Tricyclic antidepressants were found to stimulate appetite, carbohydrate craving, and a dose-dependent continuous weight gain of 0.57 to 1.37 kg per month of treatment. Proposed mechanisms include noradrenergic or antihistaminic inhibition of satiety and decreased metabolic rate. Novel serotonergic and dopaminergic antidepressants were found to be anorectic. Monoamine oxidase inhibitors may stimulate appetite and potentiate insulin-induced hypoglycemia. Lithium maintenance therapy stimulates weight gains of over 10 kg in 20% of patients. Documented mechanisms include insulin-like actions on carbohydrate and fat metabolism, polydipsia, and sodium retention. Recommendations regarding choice of antidepressant drug as well as dietary and behavioral strategies to prevent excessive weight gain are presented. Potential adjunctive drug approaches to severe weight gain are reviewed.

Antidepressive Agents↗
PubMed1987

Memory effects of restricted environmental stimulation therapy (REST) and possible applications to ECT.

Restricted environmental stimulation (REST) has been shown to facilitate learning and memory in both human and animal experimental subjects. This paper reports early data from a test of the usefulness of REST in reducing post-ECT amnesia in depressive patients. Two such patients were placed in a quiet, dimly illuminated room for 2-4 hrs. after recovering from each ECT administration in a series of treatments; three others, following standard practice, were returned to their normal hospital rooms. Measures of memory (verbal, numerical, nonverbal, life event, and self-rating) were given prior to the first ECT treatment; after the first post-recovery session; after the last post-recovery session; and one week after the last ECT administration. The major difference found was that the REST group showed an improvement in self-rated memory functioning from the first to the last ECT administration that was 15 times as great as that reported by the control group. This finding is interesting because of the major role played by self-reported memory disturbances in the scientific, clinical, and popular evaluation of ECT. The sample size is being increased, as it must be for any reliable conclusions to be drawn from this study.

Amnesia↗
PubMed1987

Blood pressure effects of monoamine oxidase inhibitors--the highs and lows.

Clinical guidelines for the management of the most common side effects associated with monoamine oxidase inhibitors (postural hypotension and hypertensive episodes) are offered. When non-pharmacological interventions fail to alleviate MAOI induced postural hypotension, the use of volume expanders (salt tablets or fludrocortisone) may be effective alternatives to drug discontinuation. Phentolamine and chlorpromazine are traditional drug treatments for MAOI hypertensive emergencies. The newer drug treatments evolved in the last decade for treating hypertensive emergencies is not reflected in the psychiatric or emergency medicine literature on treating MAOI induced hypertensive states. Nifedipine, diazoxide, or sodium nitroprusside appear to be more rational choices for this problem.

Adrenergic alpha-Antagonists↗
PubMed1986

Tardive dyskinesia: an unrecognized cause of orofacial pain.

Tardive dyskinesia has not previously been discussed in the dental literature. It is a drug-induced movement disorder commonly involving the perioral and masticatory muscles. It can sometimes be a cause of orofacial pain. Two brief cases reports are provided as examples. Clinical features of tardive dyskinesia are presented to assist the dental practitioner in recognizing the syndrome. Suggestions for management are included.

Dyskinesia, Drug-Induced↗