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Biomedical subjects

R H Howland

Publications and source records attributed to R H Howland.

At least 37 records · Page 2Linked to original sources
PubMed1995

The treatment of persons with dual diagnoses in a rural community.

Persons with dual diagnoses of psychiatric illness and substance abuse represent a large subpopulation within the mental health system, but mental health service delivery systems typically do not adequately address their special needs. The literature on dual diagnoses is marked by the paucity of information on such persons in rural settings. This paper describes the characteristics of a rural community mental health system, which illustrate the difficulties in treating persons with dual diagnoses in rural communities. These problems include a fragmented system of services, centralized services in a large geographic area, overly restrictive regulations, conceptual differences in treatment approaches, confidentiality and stigma in a rural culture, and the academic and professional isolation of mental health workers, leading to high turnover and a shortage of staff having sufficient training and experience to work with persons with dual diagnoses. Some recommendations to address these problems and to improve the delivery of services to persons with dual diagnoses are suggested.

Community Mental Health Services↗
PubMed1993

A comprehensive review of cyclothymic disorder.

Chronic affective disorders have generated much interest during the past decade due to increasing recognition of their clinical importance and because of controversy about their appropriate classification and treatment. The purpose of this paper was to review cyclothymic disorder. This review will include historical concepts, clinical phenomenology, family history, biological studies, and treatment of cyclothymia. In addition, the relationship of cyclothymia to other psychiatric disorders, such as bipolar, dysthymic, and personality disorders, is examined. The results suggest that some forms of cyclothymia are strongly associated with bipolar disorder, but that the condition is clinically heterogeneous. The problems of existing research in this area and future directions for research are also discussed.

Bipolar Disorder↗
PubMed1993

Chronic depression.

OBJECTIVE: Chronic depression has not been appreciated or studied as well as episodic mood disorders or other chronic psychiatric disorders. This review provides an overview of the clinical features, biology, and treatment of chronic depression and suggests additional areas for research. METHODS: The English-language literature was searched using MEDLINE. Additional references were selected from the bibliographies of recent publications. Studies of chronic nonbipolar depressed patients were selected; chronicity was defined as the persistence of depressive symptoms for at least two years or as a diagnosis of DSM-III or DSM-III-R dysthymia, "double depression," or chronic major depression. RESULTS AND CONCLUSIONS: Reported prevalence rates of chronic depression range from 3 to 5 percent in community samples and from 9 to 31 percent in clinical samples. Compared with patients with major depression, those with chronic depression have increased neurotic personality traits, adverse life events, health care utilization, and comorbid psychiatric and medical conditions, especially thyroid dysfunction. Biological and family studies support the relationship of chronic depression to the major mood disorders. Chronicity is also associated with inadequate treatment with anti-depressant drugs. Serotonergic or monoamine oxidase inhibitors may be more effective in treating chronic depression than tricyclic antidepressants. Psychosocial therapies need further study but may be especially useful in combination with drug treatment. Future research should investigate the clinical and biological correlates of subtypes of chronic depression, the response of the subtypes to different antidepressants, and the relative efficacy of combined antidepressant-psychosocial treatment.

Antidepressive Agents↗
PubMed1993

Bipolar disorder associated with primary generalised epilepsy.

A patient with bipolar disorder and primary generalised epilepsy, and a family history of psychiatric illness and epilepsy, is described. The episodic psychiatric symptoms were temporally correlated with epileptic discharges and absence seizures observed during repeated EEGs.

Adult↗
PubMed1993

General health, health care utilization, and medical comorbidity in dysthymia.

OBJECTIVE: This article reviews the literature on the general health, health care utilization, prevalence, medical comorbidity, and treatment of dysthymia in medical settings. METHOD: The literature was searched by using MEDLINE and by reviewing the bibliographies of recent publications. Studies were selected that included health data on patients with dysthymia or chronic depression according to DSM-III, DSM-III-R, ICD-9, or RDC criteria, or patients who were described as having persistent depressive symptoms. RESULTS: This review shows that dysthymic patients are at increased risk for poor general health and frequently use medical services. Compared to the general population, dysthymia is more prevalent in primary care and among patients with various medical and neurological conditions, sleep disorders, chronic fatigue, hypothyroidism, and somatoform disorders. Pharmacotherapy is effective, but has not been well studied. Non-tricyclic antidepressants might be especially useful. Psychotherapy studies are virtually non-existent. CONCLUSIONS: Although dysthymia is considered a minor depressive condition, these findings show that it is a significant public health problem, comparable to major depression. Recent efforts to improve the recognition and treatment of major depression in medical settings, therefore, should be extended to include the entire spectrum of depressive disorders. Future studies should investigate the type and pattern of medical comorbidity and health care utilization, different antidepressant and psychosocial therapies, and the clinical and biological correlates of treatment response in different chronic depressive subtypes in medical settings and compare them to major depressive and subsyndromal depressive conditions.

Antidepressive Agents, Tricyclic↗
PubMed1993

Thyroid dysfunction in refractory depression: implications for pathophysiology and treatment.

BACKGROUND: Many studies of thyroid augmentation in refractory depression are methodologically weak, have had mixed results, and often do not include biological measures of hormonal effects. In this paper, recent clinical and preclinical research on thyroid dysfunction in refractory depression is reviewed. METHOD: A search of MEDLINE for articles published from 1970 to the present was conducted, in addition to a search of the bibliographies of published papers in this area. The clinical studies chosen for review included those in which the patient population was identified as having refractory depression and where a specific measure of thyroid function was used, such as thyroid indices, thyroid-releasing hormone stimulation, or basal metabolic rate. Animal studies of depression using the learned helplessness experimental paradigm were also reviewed and included if they examined the factors involved in antidepressant treatment response. RESULTS: Fifty-two percent of patients with refractory depression in six clinical studies evidenced subclinical hypothyroidism (range, 29%-100%), which can be contrasted with a prevalence of approximately 8% to 17% in unselected populations of depressed patients. Four studies investigating an animal model of refractory depression strongly implicate a pathophysiologic role for hypothyroidism, perhaps mediated by altered beta-adrenergic function. CONCLUSION: These findings indicate that hypothyroidism is significantly associated with refractory depression, suggesting that this characterizes one biological subtype of refractory depression. Failure to rigorously investigate the effects of thyroid augmentation, including measures of thyroid and beta-adrenergic function, may partly explain the ambiguous results from many treatment studies, and future research should incorporate these measures in the study of refractory depression.

Animals↗
PubMed1992

Fluoxetine treatment of depression in mentally retarded adults.

Six depressed mentally retarded adults were treated with fluoxetine in an open trial. Five patients significantly improved, and one patient partially improved, after treatment with fluoxetine. Their mean Hamilton Depression Rating Scale score was significantly reduced after treatment. These results suggest that fluoxetine is a safe and effective treatment for depression in mental retardation. Some potential advantages of using fluoxetine in this clinical population are discussed. Additional controlled research studies are needed to confirm these findings.

Adult↗
PubMed1991

Biological studies of dysthymia.

Dysthymic disorder (DD) is a chronic subsyndromal depressive condition that has generated increasing interest since its formal introduction into the psychiatric nomenclature in 1980. Although DD was included among the affective disorders in DSM-III, this classification was controversial. Some clinical and family studies support an association between DD and major depression disorder (MDD), but there has been little additional research firmly establishing the diagnostic validity of DD or clarifying its relation to MDD and to personality disorders. In this article, the literature on the biology of DD is reviewed. Studies of rapid eye movement (REM) latency, electrodermal activity, and the thyroid axis show similarities between DD and MDD, but the findings are mixed. Other investigations, including the Dexamethasone Suppression Test (DST), catecholamines, and several other electroencephalogram (EEG) sleep variables, show more consistent differences between DD and MDD. These findings suggest that DD manifests primarily trait characteristics of depression, thus differentiating it from the state characteristics of MDD. The methodological problems and implications of these studies, and suggestions for future research, are discussed.

Arousal↗
PubMed1991

Pharmacotherapy of dysthymia: a review.

The clinical significance of chronic mild depression (dysthymia) is well recognized, but has not been the focus of extensive research. In particular, basic research on the phenomenology and treatment of these conditions is limited. Clinical lore suggests that psychotherapy, rather than pharmacotherapy, is the treatment of choice. This is based more on a theoretical understanding of chronic depression as a personality disorder rather than on actual treatment studies. This paper reviews the literature on the pharmacotherapy of dysthymia. The results provide substantial evidence for the efficacy of antidepressants in dysthymia, although the treatment response is less than that typically found in major depression. Furthermore, the findings suggest the possibility that monoamine oxidase inhibitors (MAOIs) may be superior to tricyclic antidepressants (TCAs) in the treatment of dysthymia, although this needs to be more rigorously evaluated. Some of the methodological problems with these studies are discussed. Additional areas of research, including the clinical and biological indicators of drug response, the use of non-TCA, nonMAOI drugs, the effects of pharmacological intervention on the development and maintenance of chronicity, and the comparison of and interaction between pharmacotherapy and psychotherapy are identified and suggested for future study.

Antidepressive Agents↗
PubMedDate not supplied

Schizophrenia and amyotrophic lateral sclerosis.

Schizophrenia and amyotrophic lateral sclerosis (ALS) are central nervous system (CNS) disorders of unknown etiology. The association of these two disorders has been infrequently reported in the literature, but is not a rare occurrence. Various neuromuscular abnormalities involving the alpha-motor neuron have been described in some patients with schizophrenia. This report reviews the literature on schizophrenia, psychosis, and ALS and describes two additional cases of schizophrenia associated with ALS. The possibility that the neuromuscular dysfunction in schizophrenia may predispose to ALS and provide an explanation for the association of these two disorders is discussed. Additional research data are needed to test this hypothesis.

Adult↗