Search PubMed⌕ Search

Biomedical subjects

R W Cowdry

Publications and source records attributed to R W Cowdry.

At least 37 records · Page 2Linked to original sources
PubMed1987

Dysphoria associated with methylphenidate infusion in borderline personality disorder.

Two patients with borderline personality disorder experienced dramatic dysphoric episodes after acute administration of intravenous methylphenidate in a double-blind manner. These dysphoric episodes were similar to those which occurred spontaneously under conditions of psychological stress. Case histories and the behavioral and cardiovascular effects of the infusions are described. The pharmacology of methylphenidate is discussed in order to elucidate possible mechanisms mediating the observed responses to this drug.

Adult↗
PubMed1987

Psychopharmacology of borderline personality disorder: a review.

Borderline personality disorder poses a significant treatment challenge to the clinician. The frequent presence of comorbid disorders and the occurrence of a wide array of possible target symptoms complicate clinical assessment. Limited data from controlled clinical trials suggest that neuroleptics, monoamine oxidase inhibitors, and the anticonvulsant carbamazepine produce statistically and clinically significant short-term symptom reduction and may be useful components of the treatment approach to borderline personality disorder. Further research is needed to identify subgroups of patients with borderline personality disorder who are particularly responsive to a given medication and to explore the possibility that specific symptom complexes (such as suspiciousness, anhedonia, affective lability, or behavioral dyscontrol) are preferentially responsive to specific agents.

Antipsychotic Agents↗
PubMed1986

Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder.

In a double-blind crossover trial, carbamazepine, an anticonvulsant with primary effects on subcortical limbic structures, decreased the severity of behavioral dyscontrol in 11 women with borderline personality disorder significantly more than placebo. The authors emphasize the preliminary nature of their findings and discuss alternative hypotheses regarding mechanisms by which carbamazepine might influence behavioral dyscontrol.

Adult↗
PubMed1986

Development of melancholia during carbamazepine treatment in borderline personality disorder.

Carbamazepine, an anticonvulsant, has shown efficacy in the treatment of a wide range of psychiatric disorders, including classical affective disorders. Because patients with borderline personality disorder show prominent affective symptomatology on the one hand and symptoms suggestive of an epileptoid disorder on the other, carbamazepine was included in a multidrug, placebo-controlled, double-blind study. During carbamazepine treatment, three of 17 (18%) patients developed melancholia, which remitted on discontinuation of carbamazepine. While carbamazepine may prove to be an effective medication for some patients with borderline personality disorder, careful attention to change in depressive symptoms is suggested.

Adult↗
PubMed1985

Selective antidepressants and cerebrospinal fluid. Lack of specificity on norepinephrine and serotonin metabolites.

Cerebrospinal fluid concentrations of the norepinephrine metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), and the dopamine metabolite, homovanillic acid, were measured in depressed patients before and after treatment with three putatively specific antidepressants. The expected specificity of action on these three neurotransmitter metabolites was not observed. Desipramine hydrochloride, a norepinephrine uptake inhibitor, reduced 5-HIAA as well as MHPG concentrations; zimeldine hydrochloride, a serotonin uptake inhibitor, reduced MHPG as well as 5-HIAA concentrations; and clorgyline, a selective monoamine oxidase type A inhibitor, which might be predicted to most affect 5-HIAA, dramatically reduced MHPG, moderately reduced homovanillic acid, and only modestly reduced 5-HIAA concentrations.

Adolescent↗
PubMed1985

Alprazolam-induced dyscontrol in borderline personality disorder.

The authors report a significant increase in dyscontrol in patients with borderline personality disorder who were taking alprazolam during a double-blind, placebo-controlled crossover study. They suggest that caution be used in prescribing alprazolam to patients with similar histories.

Adult↗
PubMed1985

Suicidal and parasuicidal behavior in borderline personality disorder.

One of the most perplexing and dangerous aspects of borderline personality disorder is the wide array of suicidal and parasuicidal behaviors. Close phenomenologic evaluation of these behaviors reveals that they can be differentiated into various subcategories. Approaching these behaviors with a biologic perspective may prove helpful in elucidating the underlying etiologies and therapeutic approaches.

Adolescent↗
PubMed1983

Thyroid abnormalities associated with rapid-cycling bipolar illness.

Bipolar patients taking lithium carbonate were classified as rapid-cycling or non-rapid-cycling based on whether they had ever experienced four or more affective episodes in a 12-month period. Overt hypothyroidism was found in 12 (50.7%) of the 24 rapid-cycling patients and in none of the 19 non-rapid-cycling patients. Elevated thyroid-stimulating hormone levels were present in 92% of the rapid-cycling group v 32% of the non-rapid-cycling group. Abnormalities of the hypothalamic-pituitary-thyroid axis, some of which may become apparent only during treatment with lithium carbonate, appear to interact with a predisposition to bipolar illness to produce rapid-cycling. These overt and covert abnormalities may help explain the reported efficacy of thyroid in treating "periodic catatonia" and rapid-cycling.

Bipolar Disorder↗
PubMed1983

Cerebrospinal fluid probenecid studies: a reinterpretation.

Probenecid is used to block the transport of acid monoamine metabolites from cerebrospinal fluid (CSF), on the assumption that the resultant rise in CSF concentrations of the metabolites will reflect presynaptic "turnover" of the parent monoamine. However, CSF levels of probenecid correlate with CSF levels of the metabolite, suggesting that the blockade is incomplete at the probenecid levels obtained in human studies. This article reviews the literature on CSF probenecid-metabolite correlations and presents data demonstrating variations in the correlations across diagnostic groups. These cross-diagnostic variations may be due to group differences in membrane transport characteristics and and confound attempts to "correct for" CSF probenecid concentrations in studies of monoamine turnover.

Biological Transport↗
PubMed1982

Using the protirelin test to distinguish mania from schizophrenia.

To explore the possible utility of the protirelin test in differentiating manic and schizophrenic patients, we gave a test dose of protirelin to 30 consecutive euthyroid inpatients who met Research Diagnostic Criteria for mania, 30 who met criteria for schizophrenia, undifferentiated subtype, and 20 normal volunteer controls. The mean maximal thyroid-stimulating hormone (TSH) response (delta TSH) to protirelin in the manic patients was lower than in the schizophrenic patients and in the controls. This mean difference was not attributable to differences in age, sex, baseline thyroid functioning, cortisol levels, or medication, but there was a considerable overlap of values in the patient groups. However, with a delta TSH less than or equal to 7.0 I microunits/mL to identify manic patients in the overall group, the sensitivity of the protirelin test was 60% and the specificity was 84%.

Adult↗
PubMed1982

Zimelidine and norzimelidine protein binding measured by equilibrium dialysis and cerebrospinal fluid.

Steady-state concentrations of a new antidepressant, zimelidine (ZIM), and its active metabolite, norzimelidine (NZIM), were measured in plasma and cerebrospinal fluid (CSF) in eight depressed patients. Free drug, as calculated from the ratio of CSF to plasma concentration, of ZIM was 8.4 +/- 1.8% and of NZIM was 18.3 +/- 2.8%. Equilibrium dialysis (ED) of plasma from the same patients on placebo yielded free fractions of 8.6 +/- 2.2% and 28.1 +/- 3.4% for the two compounds. alpha 1-Acid glycoprotein (alpha a-AG) was also measured in the same samples. Variation in free drug using either method was not great, but did modestly correlate with alpha 1-AG concentration in six of the eight patients in whom simultaneous placebo measures were available. Our results indicate that measurements in plasma or of free drug dependent on ED lead to erroneous conclusions regarding the proportion of free NZIM to ZIM. Considering the different potencies of the parent compound and active metabolite, this is an unusual problem.

Adolescent↗
PubMed1980

Monoamine metabolites in cerebrospinal fluid of depressive subgroups.

Lumbar punctures were performed on 69 patients who met Research Diagnostic Criteria (RDC) for major affective disorder, while they were drug-free and depressed. None of the patients met RDC for alcoholism. Cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) were measured by fluorometry and 3-methoxy-4-hydroxyphenylglycol (MHPG) by gas chromatography. Family histories were ascertained by systematic interviews of patients and their relatives, and diagnoses were made by family history diagnostic criteria (Andreasen et al., 1977). Depressed patients with alcoholism in a first degree relative had significantly lower levels of 5-HIAA and MHPG than patients without a family history of alcoholism (p < 0.05). No difference in HVA levels was found. The metabolite differences remained significant when the influence of sex ratio was considered. These results are in agreement with previous work linking alcoholism to abnormal serotonin metabolism. They provide further biochemical evidence of distinct genetic subtypes of affective disorder along lines suggested by Winokur (1979a, 1979b), and illustrate the usefulness of the family history method in defining patient subgroups.

Adult↗
PubMed1979

Tricyclic-induced mania and MHPG excretion.

In order to evaluate the presumed involvement of altered noradrenergic receptor sensitivity in the switch process from depression into mania, we explored the relationship between pretreatment 3-methoxy-4-hydroxy-phenylglycol (MHPG) and tricyclic-induced mania or hypomania in bipolar depressed patients. Within the group of patients developing mania or hypomania on tricyclics, there was a strong positive correlation between pretreatment 24-hour urinary MHPG and the latency of onset of the episode. This finding is consistent with both the reported differences in MHPG excretion between unipolar and bipolar patients and the postulated noradrenergic involvement in the switch process.

Affective Disorders, Psychotic↗