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Biomedical subjects

R F Ulrich

Publications and source records attributed to R F Ulrich.

At least 37 records · Page 2Linked to original sources
PubMed1989

Interpreting the structure of diagnosis in initial evaluations: primary, auxiliary and rule out patterns.

The study evaluates DSM III as a natural taxonomy, a system of categories devised for identifying complex objects represented as clinical conditions. Adults seeking initial evaluations constitute the study's population. An individual's clinical condition is examined in terms of a diagnostic format consisting of primary, auxiliary and rule out positions in Axis I and presence and number of diagnoses in Axis II. Each clinical condition thus differs with respect to complexity and diagnostic formats of such conditions are analyzed quantitatively. Differences between the sexes and the races with respect to number of Axis I and Axis II diagnoses are presented. The frequency of use of a diagnostic category is analyzed with respect to position on Axis I, and Axis II, and ratings of the perceived salience and efficacy of treatment plans of the disorders referenced by the category. The number of symptoms in conditions that differ with respect to level of complexity (i.e., number of diagnoses) are compared. An attempt is made to understand how Axis I and Axis II of the DSM III system are used by clinicians and also how they operate as devices to codify clinical information under conditions of relative uncertainty.

Adult↗
PubMed1988

Dose of fluphenazine, familial expressed emotion, and outcome in schizophrenia. Results of a two-year controlled study.

Issues regarding the side effects of antipsychotic medication and the possible contribution of the environment to dose requirements led to a two-year controlled dosage study of maintenance antipsychotic medication and familial environment among recently discharged schizophrenic patients. Seventy stable patients, living in high- or low-expressed emotion (EE) households, were randomized, double blind, to receive a standard dose of fluphenazine decanoate (average, 25 mg every two weeks) or a minimal dose representing 20% of the dose prescribed (average, 3.8 mg every two weeks). No differences in relapse were observed among dose, EE, or dose and EE. Patients in the minimal dose/high-EE condition experienced more minor but aborted episodes in year 2. Side effects were fewer on the minimal dose after one year, and low-EE patients were better adjusted than high-EE patients. Over time, minimal-dose recipients were significantly more improved in their instrumental and interpersonal role performance than were standard-dose recipients.

Adult↗
PubMed1988

Changes in EEG mean frequency associated with anxiety and with amphetamine challenge in BPD.

Recent authors have hypothesized that cerebral dysfunction, as reflected in an abnormal EEG, may play an important role in the behavioral symptoms of patients with borderline personality disorder (BPD). Spectral analysis and amphetamine challenge testing are two promising methods for probing the clinical symptomatology of this disorder. In this study, we evaluated the relationship between clinical symptoms and computerized EEG spectral analysis in BPD patients both before and after amphetamine challenge. We found that mean frequency values on spectral analysis consistently correlated with anxiety levels in our patients, but did not correlate with a wide variety of other important symptoms, such as depression or transient psychosis. This result, coupled with our previous negative findings concerning EEG abnormalities in patients with BPD, casts doubt on the etiological relationship of cerebral dysrhythmias to the behavioral pathology of this disorder, but raises interesting questions concerning the relationship of anxiety and mean frequency.

Adult↗
PubMed1988

Diagnostic efficacy of computerized spectral versus visual EEG analysis in elderly normal, demented and depressed subjects.

Computerized spectral and visual EEG analyses were performed in 35 patients with Alzheimer's disease (AD) and compared to 23 patients with major depression and to 61 healthy elderly controls. In particular, we were interested in the diagnostic efficacy of these two techniques in the identification of cases of AD with only mild cognitive impairment (as measured by the Folstein Mini-Mental State score). For the computer analyzed data, in differentiating AD patients from controls, the spectral pooled parasagittal mean frequency was used. In comparing AD patients to depressed subjects, a combined parasagittal delta and theta spectral score was employed. Visual analysis criteria were based on the severity of generalized EEG abnormalities (with or without focal features). We found that spectral analysis afforded only modest advantages over visual EEG analysis in differentiating AD patients from elderly controls as well as from those with major depression. Since the degree of spectral and visual EEG abnormalities correlated with the severity of dementia, both tests more often correctly classified those AD patients with lower Folstein scores. Also, both tests identified primarily the same patients. We did not find the computer to be more sensitive than the eye in the identification of AD patients with mild impairment. However, computerized spectral data was derived from only 4 channels, while 16 channels and a longer recording time were used for visual analysis. In addition, some areas which have been reported to show EEG abnormalities in AD were not included in the computerized data.

Aged↗
PubMed1986

Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo.

In symptomatic patients with borderline disorder, we conducted a double-blind, placebo-controlled trial of haloperidol and amitriptyline hydrochloride to test the differential efficacy of medication against the affective and schizotypal symptoms that characterize the disorder. Sixty-one patients, diagnosed by the Diagnostic Interview for Borderline of Gunderson et al, completed randomized trials of haloperidol (n = 21), amitriptyline (n = 20), and placebo (n = 20). Medications were given in dose ranges of 4 to 16 mg for haloperidol (mean, 7.24 mg) and 100 to 175 mg for amitriptyline hydrochloride (mean, 147.62 mg) for five-week periods, with weekly self-rated and observer-rated measures of mood, schizotypal symptoms, and global functioning. Haloperidol was superior to both amitriptyline and placebo on a composite measure of overall symptom severity, with no difference between amitriptyline and placebo. Haloperidol produced significant improvement on a broad spectrum of symptom patterns, including depression, anxiety, hostility, paranoid ideation, and psychoticism. In contrast, amitriptyline was minimally effective, with small gains limited to some areas of depressive content. The magnitude of change tended to be modest and was more apparent in self-rated than observer-rated measures.

Adolescent↗
PubMed1986

Electroencephalographic sleep in psychotic depression. A valid subtype?

Electroencephalographic (EEG) sleep patterns were examined in 27 psychotic and 79 nonpsychotic subjects with major depression to evaluate the validity of the psychotic-nonpsychotic subtype dichotomy. Sleep in psychotic depression was characterized by increased wakefulness, decreased rapid eye movement (REM) sleep percentage, and decreased REM activity even after controlling for clinical differences in age, severity, and agitation. Psychotic depressive subjects also were more likely to have extremely short sleep-onset REM latencies. In psychotic depression EEG sleep varied as a function of total illness duration. Patients with recent-onset syndromes had profiles characterized by marked initial insomnia, increased stage 1 sleep percentage, and long REM latency; patients with illnesses of longer duration had extremely short REM latencies. Demonstration of selected EEG sleep variables discriminating between psychotic and nonpsychotic depression further supports psychotic depression as a distinct subtype of major affective disorder.

Adult↗
PubMed1986

Comparison of automated REM and slow-wave sleep analysis in young and middle-aged depressed subjects.

A comparison of electroencephalographic sleep measures between young and middle-aged groups of depressed inpatients was conducted with specific interest in the application of automated measures of REM and delta wave sleep. Aside from the expected differences in sleep continuity, increased Stage 1 percent, decreased Stage 2 percent, and decreased REM latency in the middle-aged depressives as compared to the younger depressives, distinct findings from automated analyses were noted in the distribution of REM and delta sleep throughout the night. Although the younger depressed patients showed increased numbers of delta waves, the middle-aged depressives showed greater average REM count. Such changes were more pronounced in the first third of the night. Finally, in the middle-aged depressives, little statistical relationship between manual measures of slow-wave sleep and automated measures of delta sleep was found.

Adult↗
PubMed1986

Computerized EEG spectral analysis in elderly normal, demented and depressed subjects.

Computerized spectral analysis of the EEG was performed in 35 patients with Alzheimer's disease and compared to patients with major depression (23) and healthy elderly controls (61). Compared to controls, demented patients had a significant increase in the theta and alpha 1 bandwidths as well as an increased theta-beta difference. The parasagittal mean frequency, beta 1 and beta 2 activity were significantly decreased. Depressed patients differed from demented patients, particularly at the lower end of the spectrum, having significantly less delta and theta activity. Like the demented group, depressed patients also had a decreased parasagittal mean frequency, beta 1 and beta 2 when compared to controls. In demented patients, there was a high correlation between several spectral parameters (parasagittal mean frequency, delta and theta activity, and the theta-beta difference) and the Folstein score, EEG measures used for discriminant analysis were more accurate in identifying demented patients who had lower Folstein scores.

Aged↗
PubMed1986

Aspects of short REM latency in affective states: a revisit.

Electroencephalographic (EEG) sleep changes in affective disorders have been characterized by sleep continuity, slow wave sleep, and rapid eye movement (REM) abnormalities. The most commonly cited feature, however, has been shortened REM latency. Because the diagnostic and prognostic significance of shortened REM latency has been debated, this issue was reexamined in a group of 186 psychotic and nonpsychotic depressed inpatients and outpatients. The analyses suggest an increased frequency of sleep onset REM periods in psychotic depression and in elderly depressed patients (psychotic or nonpsychotic).

Adolescent↗
PubMed1985

Electroencephalographic sleep of younger depressives. Comparison with normals.

The electroencephalographic sleep of younger depressives (aged 20 to 44 years) was compared with that of an age-matched group of normals. The patients demonstrated many of the typical sleep changes reported for older depressed populations: shortened rapid-eye-movement (REM) latency; REM sleep activity alterations, with a shift to the early portion of the night (first REM period); reduced delta sleep; and sleep efficiency reductions marked by sleep-onset difficulties. The traditional scoring procedures were supplemented by automated REM and delta-sleep analyses that provided more precise delineation of these differences between patients and normals, particularly the distributions of REM activity and delta-wave patterning.

Adult↗
PubMed1984

Iron mydriasis.

Explore the source record for details and available documents.

Adolescent↗
PubMed1984

Patterning of NREM sleep periods in normals: an observation revisited.

Both the visual examination of all-night sleep recordings in both normals and patients, generated by a delta wave analyzer, and spectral analysis have suggested that delta wave sleep often appear to rise gradually during a NREM period and then to cease abruptly. Such observations by minute-by-minute computer plots of delta wave activity have strengthened the notion of a REM generator and/or a delta sleep generator in the central nervous system. We now report observations on a sample of 23 normal subjects under the age of 45 in which we investigated the 'rise and fall' of delta sleep activity during successive NREM periods. For these 23 normal subjects, significantly greater maximal decreases throughout the night were noted in each of these 4 NREM periods as compared to the maximal increases. Furthermore, these findings have implications for the understanding of the physiology of sleep and particularly the on- and off-generator of REM and NREM sleep.

Adult↗
PubMed1984

Application of automated REM and slow wave sleep analysis: I. Normal and depressed subjects.

Computerized analysis of rapid eye movement (REM) and delta electroencephalographic (EEG) sleep patterns in normal and depressed subjects offers opportunities to examine sleep more precisely than previously possible. In the present study, automated REM analyses demonstrated good reliability with traditional manual procedures in both normal and depressed subjects. However, automated delta analyses correlated well with traditional scoring in normal subjects, but not in depressed patients. These findings suggest the use of automated delta techniques similar to those employed in this report or spectral analytic techniques in the following types of studies: specificity of delta sleep in various psychiatric syndromes, changes in delta sleep produced by the administration of psychotropic agents, relationships between delta sleep and sleep-related neuro-endocrine patterns, and, finally, relationships between delta sleep patterns and other biological rhythms such as activity and temperature.

Adult↗
PubMed1984

Application of automated REM and slow wave sleep analysis: II. Testing the assumptions of the two-process model of sleep regulation in normal and depressed subjects.

Abnormalities in a two-process model of sleep regulation (a sleep-dependent process, termed Process S, and a sleep-independent circadian process, termed Process C) have been proposed to account for sleep abnormalities in depressive states. The major tenets of the two-process model of sleep regulation as applied to depression are: the level of process S, as reflected by the electroencephalographic (EEG) slow-wave activity, corresponds to the sleep-dependent facet of sleep propensity; the pathognomonic changes of sleep in depressives are a consequence of a deficiency in the build-up of process S. The application of automated rapid eye movement (REM) and delta wave analyses in normal subjects and younger depressed patients supports the model to some extent: The time spent asleep is positively correlated with total delta waves (normals and depressives) and average delta waves (depressives); delta sleep is lower in depressives than in normals; the average delta wave count is significantly reduced in younger depressives over the total night and in non-REM period 1. The model also postulates that measures of phasic REM activity are inversely related to process S, suggesting that process S can be regarded as exerting an inhibitory influence on phasic REM activity.

Adult↗
PubMed1984

All-night spectral analysis of the sleep EEG in untreated depressives and normal controls.

Sleep was recorded in nine drug-free depressive patients and nine age- and sex-matched normal control subjects. All-night spectral analysis of the sleep electroencephalogram (EEG) showed a significantly reduced power density in the 0.25-2.50 Hz band in the depressive group. Power density values integrated over the entire frequency range (0.25-25.0 Hz) exhibited for both groups a decreasing trend over the first three non-REM/REM sleep cycles. In each cycle depressives had lower values than controls. The results are consistent with hypothesis that the build-up of a sleep-dependent process is deficient in the sleep regulation of depressive patients.

Adult↗
PubMed1982

EEG sleep, depression, and aging.

To date little attention has been paid to the possible age-dependent relationships of EEG sleep measures in depression or to the implications of such relationships for diagnostic sensitivity and specificity. In a study of 108 patients with major depressive disorders (67 inpatients, 41 outpatients), age was shown to be a very powerful determinant of electroencephalographic (EEG) sleep patterns. Thus, among other sleep variables, sleep efficiency, delta sleep percent, and REM latency all showed significant linear declines with increasing age. Similar trends were seen in both inpatients and outpatients. Some variables were without age trends (age-stable), including sleep latency, REM sleep percent, and REM activity. These findings confirm those of an earlier report from our laboratory [45] and suggest that age-corrected sleep variables can be developed for clinical diagnostic application. Thus, using normative data from Gillin et al. [19] for comparison, a sensitivity level of 65% for age-corrected REM latency was demonstrated, together with a specificity of 95% and a diagnostic confidence of 92%. Data from a pilot study comparing EEG sleep measures in depression and dementia are also presented; these data suggest the potential utility of EEG sleep measures in the differential diagnosis of these two disorders, especially in patients with mixed symptoms. Additional areas for further research are reviewed with enumeration of specific testable hypotheses.

Adult↗
PubMed1981

Diagnostic interview for borderline patients. A replication study.

The borderline diagnosis is widely used despite a lack of systematic research on its reliability and validity. The recent development of a structured interview incorporating diagnostic criteria for borderline disorders in a replicable format represents a necessary, but not sufficient, methodological step in testing the validity of the borderline concept. To our knowledge, this is the first replication of Gunderson's Diagnostic Interview for Borderlines in a clinical setting and population quite different from the original. Clinically defined borderline patients were compared with control groups of schizophrenic and nondelusional unipolar depressed patients. Of 29 scored statements on the diagnostic interview, borderlines differed significantly from schizophrenics on 19, from depressives on 16, and from both on 19. Stepwise discriminant-function analyses of borderline vs each comparison group gave substantial support to the reliability of the interview and the diagnostic criteria.

Adult↗