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Biomedical subjects

R J Kavoussi

Publications and source records attributed to R J Kavoussi.

32 records · Page 2Linked to original sources
PubMed1996

Hormonal responses to d- and d,l-fenfluramine in healthy human subjects.

Two different doses of d-fenfluramine HCl and d,l-fenfluramine HCl (0.5 mg/kg and 1.0 mg/kg) were administered to 11 healthy male volunteers to compare the neuroendocrine responses to these two forms of fenfluramine in human subjects. Prolactin (PRL) responses to d- and d,l-fenfluramine were significantly greater than those to placebo and were equivalent at both dose levels. Adrenocortiatrophic-releasing hormone (ACTH) and cortisol (CORT) responses to d-fenfluramine at both dose levels were also significantly greater than those to placebo. In contrast, the higher dose of d,l-fenfluramine was associated only with a significant CORT response in comparison to placebo. PRL responses to d-fenfluramine were higher than the PRL response to d,l-fenfluramine at either dose level. The PRL response to d-fenfluramine at 0.5 mg/kg was very highly correlated with the PRL responses to d,l-fenfluramine at 1.0 mg/kg (r = 0.97, n = 10). Homovanillic acid (HVA) were not altered by either d, or d,l-fenfluramine at either dose in a subsample of subjects (n = 4). ACTH/CORT responses to d- and d,l-fenfluramine were modestly intercorrelated. These data suggest that the PRL response evoked by d-fenfluramine is quantitatively very similar to that evoked by d,l-fenfluramine.

Adrenocorticotropic Hormone↗
PubMed1995

Physiological responses to d-fenfluramine and ipsapirone challenge correlate with indices of aggression in males with personality disorder.

Hormonal responses to challenge with the 5-HT2A/2C probe d-fenfluramine and hormonal and thermal responses to challenge with the 5-HT1A probe ipsapirone were correlated with self-report and historical assessments of aggression in a pilot sample of eight male personality-disordered individuals. Prolactin responses to d-fenfluramine and cortisol responses to ipsapirone challenge were inversely correlated with self-reported assaultiveness. Thermal responses to ipsapirone were inversely correlated with a historical assessment of aggression. Since none of these physiological indices of 5-HT system function were intercorrelated, it is possible that simultaneous assessment of these 5-HT indices may yield a more comprehensive assessment of the relationship between central 5-HT system function and aggressive behavior in humans.

Adult↗
PubMed1994

Neuropsychopharmacologic challenge in biological psychiatry.

Psychopharmacologic challenge procedures offer many useful features for biological psychiatry research. First, challenge procedures acutely stimulate neurotransmitter and (or) hormonal systems in the brain and offer the chance to assess the function, and (or) reserve, of the brain neurotransmitter/hormone system of relevance. Second, these paradigms often offer functional information about specific areas of the brain (e.g., limbic-hypothalamus). Regardless of these advantages, the power of these procedures is limited to the specificity of the agent and of the functional anatomy of the "circuit" that leads to the outcome measure, which, in turn, is linked to the stimulation by the acute pharmacologic challenge. We describe here the development of the psychopharmacologic challenge methodology and the strengths and weaknesses of this approach. Finally, the application of this paradigm in the study of various neuropsychiatric disorders will be reviewed and critiqued.

Affective Disorders, Psychotic↗
PubMed1994

An open trial of sertraline in personality disordered patients with impulsive aggression.

BACKGROUND: Biological studies suggest that an abnormality in CNS serotonergic functioning underlies the impulsive, aggressive, and self-destructive behaviors of personality disordered patients. Preliminary data suggest that these behaviors may respond preferentially to agents with serotonergic-enhancing properties. This study evaluated the effectiveness of sertraline, a serotonin selective reuptake inhibitor, as a treatment for irritability and aggression in personality disordered patients. METHOD: Eleven patients meeting DSM-III-R criteria for at least one personality disorder were treated with sertraline in an open clinical trial with a flexible dosing schedule. Behavioral ratings for impulsive aggressive behavior and irritability were made at baseline and at Weeks 2, 4, and 8 using a semistructured interview--the Overt Aggression Scale. RESULTS: Nine of 11 patients completed at least 4 weeks of treatment, and 7 patients completed an 8-week trial. Significant changes from baseline on both irritability and overt aggression were noted by the end of 4 weeks, and improvement continued to occur through Week 8. CONCLUSION: This study suggests that sertraline is an effective treatment for impulsive aggressive behavior in personality disordered patients. It supports the hypothesis that different symptom constellations/personality traits have different underlying biological substrates that may respond differentially to pharmacologic agents with specific modes of action. Controlled studies are needed to evaluate the effectiveness of sertraline and other seronergic agents in the treatment of various dimensions of personality psychopathology.

1-Naphthylamine↗
PubMed1993

The TRH-stimulation test in DSM-III personality disorder.

The authors examined thyrotropin-releasing hormone (TRH) stimulation testing in the neuroendocrine evaluation of DSM-III major depressive disorder in 26 consecutive medication-free, medically healthy patients meeting a primary DSM-III diagnosis of axis II personality disorder. Thyroid-stimulating hormone (TSH) responses to TRH challenge were not significantly different between patients with or without major depression at time of study, or between patients with or without a life history of major affective disorder. Further, TSH responses to TRH among 11 healthy male nonpsychiatric controls were not significantly different from those in patients with personality disorders. Comparison of those patients with blunted TSH responses (< 7.0 microU/ml) versus those without blunted response (< or = 7.0 microU/ml) also did not reveal a significant difference. In addition, the TSH response to TRH did not correlate with dimensional assessments of state or trait depression, anxiety, or with past history of suicide attempt or alcohol abuse. These data suggest that TRH stimulation testing has limited utility in the evaluation of major depression or other relevant affective states/traits in personality-disordered patients. Affective symptoms in personality-disordered patients do not seem to be associated with dysregulation of the hypothalamic-pituitary-thyroid axis.

Adult↗
PubMed1993

The amphetamine challenge test correlates with affective lability in healthy volunteers.

The personality dimension of mood lability may be reflected in the mood response to the amphetamine challenge test. To test this hypothesis, the investigators acutely administered oral dextroamphetamine or placebo in a double-blind fashion to 11 normal control subjects who were free of any psychiatric disorders. Increased scores on interview and self-report measures of mood change during the challenge test, particularly increases in depression and anxiety, positively correlated with scores on the Affective Lability Scale, a measure of the lifetime personality trait of mood lability. These findings suggest that a dysphoric response to amphetamine is a marker for affective lability and that it may be useful to study this trait in patients with personality disorders.

Adult↗
PubMed1991

Plasma homovanillic acid in schizotypal personality disorder.

Schizotypal patients were found to have a significantly higher mean plasma HVA concentration than normal comparison subjects. Furthermore, plasma HVA concentration positively correlated with "psychotic-like" schizotypal symptoms. These results implicate dopaminergic mechanisms modulating the psychotic-like symptoms of schizotypal personality disorder.

Dopamine↗
PubMed1991

Biological and pharmacological aspects of borderline personality disorder.

Biological and psychopharmacological research focusing on patients with a DSM-III-R diagnosis of borderline personality disorder suggests that the disorder may encompass three clusters of symptoms--affective instability, transient psychotic phenomena, and impulsive aggressive behavior--that have different underlying biological substrates that respond to different classes of pharmacological agents. Affective instability, which may be related to abnormalities in the brain's adrenergic and cholinergic systems, appears to respond to agents such as lithium and carbamazepine that are effective in treating major affective disorders. Abnormalities in central dopaminergic systems may underlie transient psychotic symptoms. This relationship is consistent with reports of beneficial effects of low-dose neuroleptics in treating some borderline patients. Abnormalities in central nervous system serotonergic functioning appear to underlie impulsive aggressive behaviors. These behaviors may respond to serotonergic agents such as fluoxetine.

Borderline Personality Disorder↗
PubMed1990

Structured interviews for borderline personality disorder.

The authors compared three instruments used to diagnose borderline personality disorder--the Diagnostic Interview for Borderline Patients (DIB), the Schedule for Interviewing Borderlines, and the Structured Interview for DSM-III Personality Disorders--in 56 patients with personality disorders. A borderline diagnosis was made according to the DIB in 30%, the Structured Interview for DSM-III Personality Disorders in 48%, and the Schedule for Interviewing Borderlines in 55% of the patients. Diagnostic agreement was only 52%, which has implications for the generalizability of results of validation studies of the borderline diagnosis. Improvement in diagnostic agreement requires modification of current criteria sets and/or the use of dimensional models.

Adolescent↗
PubMedDate not supplied

Overlap between borderline and schizotypal personality disorders.

Borderline personality was split into two diagnostic categories in DSM-III: borderline personality disorder (BPD) and schizotypal personality disorder (SPD). There remains a great deal of diagnostic overlap between these two categories despite modifications in DSM-III-R. This report discusses four possible hypotheses for this overlap: (1) an independent, random association; (2) artifactual overlap due to imperfections in the criteria sets; (3) a synergistic association of the two personality disorders; and (4) a manifestation of dimensional psychopathology. Empirical evidence for each of the first three hypotheses is weak and contradictory. Recent biologic and treatment studies appear to most strongly support the use of dimensional models of "borderline" and "schizotypal" personality traits.

Borderline Personality Disorder↗
PubMedDate not supplied

Intermittent explosive disorder-revised: development, reliability, and validity of research criteria.

The study of human aggression has been hindered by the lack of reliable and valid diagnostic categories that specifically identify individuals with clinically significant displays of impulsive aggressive behavior. DSM intermittent explosive disorder (IED) ostensibly identifies one such group of individuals. In its current form, IED suffers from significant theoretical and psychometric shortcomings that limit its use in clinical or research settings. This study was designed to develop a revised criteria set for IED and present initial evidence supporting its reliability and validity in a well characterized group of personality disordered subjects. Accordingly, research criteria for IED-Revised (IED-R) were developed. Clinical, phenomenologic, and diagnostic data from 188 personality disordered individuals were reviewed. IED-R diagnoses were assigned using a best-estimate process. The reliability and construct validity of IED-R were examined. IED-R diagnoses had high interrater reliability (kappa = .92). Subjects meeting IED-R criteria had higher scores on dimensional measures of aggression and impulsivity, and had lower global functioning scores than non-IED-R subjects, even when related variables were controlled. IED-R criteria were more sensitive than DSM-IV IED criteria in identifying subjects with significant impulsive-aggressive behavior by a factor of four. We conclude that in personality disordered subjects, IED-R criteria can be reliably applied and appear to have sufficient validity to warrant further evaluation in field trials and in phenomenologic, epidemiologic, biologic, and treatment-outcome research.

Adult↗